ABSTRACT
OBJECTIVE: To examine whether patient flow factors in the ED such as prolonged length of stay are associated with hand hygiene (HH) compliance. METHODS: We conducted a retrospective study at an urban district hospital utilising available data from January 2018 to December 2021. Compliance to the World Health Organization five moments of HH expressed as percentage of total moments observed were collated every 2 months. Patient flow measures including proportion of patients referred or discharged within 4 h (LOS4), proportion of patients with ED length of stay >24 h (LOS24) and total number of patient presentations, were obtained for each 2-month periods. The association between these patient flow measures and HH compliance was examined using Pearson's correlation (P < 0.05). RESULTS: The results showed a moderate and significant association between rates of HH compliance and LOS24 (r = -0.48, P = 0.025). That is, lower proportion of patients with ED length of stay >24 h was associated with improved HH compliance. There was no significant correlation between HH compliance and LOS4 (r = 0.38, P = 0.085) or total number of ED presentations (r = -0.30, P = 0.17). CONCLUSIONS: The findings show that prolonged ED length of stay may explain, at least partly, lower rates of HH compliance. Improvements in ED HH compliance should also include strategies that enhance patient flow.
Subject(s)
Cross Infection , Hand Hygiene , Humans , Hand Hygiene/methods , Retrospective Studies , Length of Stay , Emergency Service, Hospital , Guideline Adherence , Health PersonnelABSTRACT
Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is an autosomal recessive disease due to mutations in the AIRE (AutoImmune REgulator) gene. The role of pituitary autoimmunity in APECED is not known. We determined the prevalence of pituitary autoantibodies in a cohort of 67 Finnish patients with APECED from 217 serum samples collected over 26 years by one investigator. Overall, autoantibodies to the 49 kDa cytosolic autoantigen, human pituitary enolase were detected in 39 of the 67 patients (58%). On their first sample, 25 patients had autoantibodies compared to 5 of 68 controls (chi-square, 1df=17.11, p< 0.001; OR=7.32), but subsequently 14 patients seroconverted between 10 and 53 years of age. Once seropositive, all but two of the patients maintained their positive autoantibody status, even over many years. In the current study all but 7 of the 19 patients known to have high titre anti-candidal enolase antibodies had developed autoantibodies directed against human pituitary enolase. Other pituitary autoantibody reactivities were detected against cytosolic proteins of molecular weights 40-, 45-, 60- and 105 kDa in 15%, 16%, 12% and 3% of patients respectively. Autoantibodies to pituitary enolase are markers of neuroendocrine autoimmunity but seem not to be associated with clinical hypopituitarism in APECED patients.
Subject(s)
Autoantibodies/immunology , Autoantigens/immunology , Phosphopyruvate Hydratase/immunology , Pituitary Gland/immunology , Polyendocrinopathies, Autoimmune/immunology , Adolescent , Adult , Antigens, Fungal/immunology , Autoantibodies/biosynthesis , Autoantibodies/blood , Candida albicans/enzymology , Candida albicans/immunology , Child , Child, Preschool , Cohort Studies , Cross Reactions , Cytosol/immunology , Female , Follow-Up Studies , Fungal Proteins/immunology , Humans , Male , Middle Aged , Molecular Weight , Organ Specificity , Pituitary Gland/enzymology , Polyendocrinopathies, Autoimmune/genetics , Species Specificity , Transcription Factors/genetics , AIRE ProteinABSTRACT
Lymphocytic hypophysitis is part of the spectrum of organ-specific autoimmune diseases, and although its histopathology is well documented, its pathogenesis is unclear. Serum autoantibodies directed against a 49-kDa cytosolic protein are detected by immunoblotting in 70% of patients with biopsy-proven lymphocytic hypophysitis. Here we report the purification and identification of this first target autoantigen in lymphocytic hypophysitis. The autoantigen has a molecular mass of 49 kDa, a cytosolic localization, and a ubiquitous tissue distribution. The 49-kDa protein was purified from monkey brain and human placental cytosol. Limited amino acid sequencing after proteolytic digestion of the human placental protein showed identity with alpha-enolase. The identification was confirmed using sera from patients with pituitary autoimmunity, which strongly reacted with recombinant human alpha-enolase and yeast enolase, but not with rabbit muscle beta- enolase. This indicates that the immunoreactive epitopes are largely conserved from yeast to human, but are not present in beta-enolase. alpha-Enolase autoantibodies are not specific to pituitary autoimmune disease and have been reported in other autoimmune diseases. However, this study is the first to indicate a role for alpha-enolase as an autoantigen in lymphocytic hypophysitis.
