Surgical team member's application of personal protective equipment: an observational study.

Background: Personal protective equipment (PPE) is a term used to refer to clothing or equipment that creates a barrier to protect an individual from work-place hazards, thereby protecting the worker against work-related injuries and illnesses. This study was aimed at determining the compliance of application of personal protective equipment against the standards. Methods: One hundred surgical personnel were included in this study from 21 March 2023 to 23 April 2023. Data were collected through direct observation. The standards were directly changed into question forms with two integral checking components, "Yes", and "No". Data were entered and analyzed by statistical package of social sciences (SPSS) version 25. Result: A total of 100 surgical personnel involved in surgical procedures were assessed for how they applied PPE. Majority of healthcare workers, 61.2%, were compliant with the communicable disease control standard on the application of PPE. The highest compliance rate was observed for the put-on gloves over the gown, while the lowest compliance rate was observed for wearing eye protection. Conclusion and recommendation: The practice of PPE usage by surgical personnel was suboptimal. Healthcare facilities can better protect their staff and patients from the spread of infections and other hazards through PPE use protocols. Donning and doffing must always be methodical and supervised by another staff member, especially during surgical emergencies. PPE should be used in accordance with infection prevention and control guidelines and the level of risk involved in the specific procedure.

Prevalence and associated factors of postoperative orthostatic intolerance at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2022: cross sectional study.

BACKGROUND: Postoperative orthostatic intolerance is an inability to maintain an upright position because of symptoms of cerebral hypoperfusion. It is a common problem in the early postoperative period and hinders early mobilization, however, there is limited information about factors associated with it. Thus, the main aim of this study was to determine the prevalence and identify factors associated with postoperative orthostatic intolerance. METHOD: Hospital based cross-sectional study was conducted from April 08 to July 20, 2022, at University of Gondar comprehensive Specialized Hospital. A semi-structured questionnaire containing sociodemographic variables and perioperative factors related to anesthesia and surgery was used for data collection. The presence of postoperative orthostatic intolerance during the first ambulation was evaluated with a standardized symptom checklist which contains symptoms of orthostatic intolerance. Binary logistic regression analysis was performed to assess factors associated with postoperative orthostatic intolerance. In multivariable regression, variables with P-value < 0.05 were considered statistically significant. RESULT: A total of 420 patients were included in this study with a response rate of 99.06%. Postoperative orthostatic intolerance was experienced in 254 (60.5%) participants. Being female (AOR = 2.27; 95% CI = 1.06-4.86), low BMI (AOR = 0.79; 95% CI = 0.71-0.95), ASA II and above (AOR = 3.34; 95% CI = 1.34-8.28), low diastolic blood pressure (AOR = 0.82; 95% CI = 0.88-0.99), general anesthesia (AOR = 3.26, 95% CI = 1.31-8.12), high intraoperative blood lose (AOR = 0.93, 95% CI = 0.88-0.99), high postoperative fluid intake (AOR = 2.09, 95% CI = 1.23-3.55), pain before ambulation (AOR = 1.99, 95% CI = 1.28-3.11) and pain during ambulation (AOR = 1.82, 95% CI = 1.23-2.69) were the significant factors associated with orthostatic intolerance. CONCLUSION: Our study revealed that postoperative orthostatic intolerance was experienced in nearly two-thirds of participants. During the time of ambulation, assessing patients for the presence of orthostatic intolerance is necessary to reduce the adverse effects of postoperative OI. In addition, maintaining preoperative normotension, reducing intraoperative blood loss and optimizing postoperative pain control is recommended to reduce the risk of postoperative orthostatic intolerance.

Evidence-based airway management protocol for a critical ill patient in medical intensive care unit: Systematic review.

Background: Airway management outside the theatre is performed either to resuscitate a physiologically unstable critically ill patients or to secure an emergency airway in the absence of essential equipments. It is a life saving procedure for critically ill and injured patients. Delaying in securing airway or awaking the patient is not an option in case of difficult airway in intensive care unit. Therefore, developing and implementation of an evidence-based airway management protocol is important. Objective: This review was conducted to develop a clear airway management protocol for a critical ill patient in medical intensive care unit. Methods: After formulating the key questions, scope, and eligibility criteria for the evidences to be included, a comprehensive search strategy of electronic sources was conducted. The literatures were searched using advanced searching methods from data bases and websites to get evidences on airway management of a critical ill patient. Duplication of literatures was avoided by endnote. Screening of literatures was conducted based on the level of significance with proper appraisal. This review was carried out in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 statement. Results: A total of 626 articles were identified from data bases and websites using an electronic search. Of these articles, 95 were removed for duplication and 305 studies were excluded after reviewing their titles and abstracts. At the screening stage, 79 articles were retrieved and evaluated for the eligibility. Finally, 40 studies related to airway management of a critical ill patient in medical ICU were included in this systematic review. Conclusion: A critical ill patient needs oxygenation and ventilation support. A focused and rapid assessment, with special attention of the airway and hemodynamic status of the critical ill patient is paramount. An appropriate airway management option should be employed to resuscitate or to control an emergency airway of a critical ill patent. This could be non invasive ventilation or invasive airway intervention.

Patients' knowledge and perception of anesthesia and the anesthetists: Cross-sectional study.

Background: Anesthesiology was misconceived as a behind the screen specialty. Despite significant advancements in its scope, anesthesia remains have a poor public image, clients are not even aware of an anesthetist as a medically qualified health professional, particularly in underdeveloped countries. There has been very little study done on the public's awareness of anesthesia in Ethiopia. This study was conducted to assess the level of patients' knowledge and perception of anesthesia and the anesthetists. Methods: Institution-based, cross-sectional study was conducted from January to May 2021, at the University of Gondar comprehensive specialized hospital, Ethiopia. Consenting participants were asked to answer a standard questionnaire in a personal interview to assess their knowledge about anesthesia and the anesthetist. Descriptive statistic was used to explain the study participants with study variables and to describe their perception about anesthesia and anesthetists. Binary logistic regression analysis was performed to identify the association between the level of knowledge and independent variables. The strength of the association between the independent variables and the level of knowledge was presented by an adjusted odds ratio and 95% Confidence Interval. Results: A total of 307 study participants were included in this study with a response rate of 100%. Of these 113 (36.8) were males and 194 (63.2) were females. Two hundred twenty (71.7%) study participants answered less than half of the questions correctly and had a poor level of knowledge the rest 87 (28.3%) had a good level of knowledge and the mean knowledge score was1.72 ± 0.45. Previous anesthesia exposure (p value = 0.001) and occupation (p value = 0.022) of participants had statistically significant association with the level of knowledge. Conclusion: and recommendation: We have found that patients had very limited (poor) knowledge and perception regarding anesthesia and the role of anesthetists. Anesthetists should do a complete pre-anesthetic assessment which helps them to achieve good patient recognition.

Assessment of post-operative nausea and vomiting prophylaxis usage for cesarean section, 2021: A cross sectional study.

Background: Post-operative nausea and vomiting (PONV) are common and distressing to patients. This common anesthetic and surgical side effect has been reported to increase patient dissatisfaction and can be more distressing to patients than post-operative pain. It has multi-factorial causes: patient, anesthesia and surgery related risk factors have been identified. Prevention of PONV is important since it has psychological and physical effects, and it can also cause severe complications. Objective: To determine the level of practice of PONV prophylaxis usage for caesarean section. Methods: This clinical perspective study was conducted at all pregnant mothers scheduled for caesarean section under anesthesia from March 1 to March 30, 2021 consecutively. The standards were directly changed into question forms with two integral checking components, "Yes", and "No". Data were entered and analyzed by statistical package of social sciences (SPSS) version 20. Results: A total of 100 parturients scheduled for caesarean section were included with a response rate of 100%. Based on the standards, Anti-emetic treatment to patients with post-operative nausea and vomiting (PONV), adherence of anesthetists to local evidence based guideline for PONV prevention and more importantly no prophylactic administration to patients at low risk for PONV were implemented with a percentage of 17%,47%, and 14% respectively. Conclusions: and recommendations: There was a significant performance gap in the clinical practice of prevention of post-operative nausea and vomiting. We strongly suggest that adherence to a Protocol to reduce baseline risk and the adoption of a multimodal approach will highly likely ensure success in the management of PONV. The usage of appropriate anti-emetic prophylaxis to the right patient is necessary to have a good outcome after surgery and anesthesia.

Prevalence and Factors Associated with Back Pain among Patients Undergoing Spinal Anesthesia at the University of Gondar Comprehensive and Specialized Hospital, North West Ethiopia: An Institutional Based Cross-Sectional Study.

BACKGROUND: Back pain is often reported as a common complaint after surgery. Many studies showed that the prevalence of back pain after spinal anesthesia is high and its magnitude is considerable in developing countries. It is highly related to reduced quality of life, loss of work productivity, burden of health care costs, and satisfaction regarding health care service; therefore, measures should be taken to reduce or prevented postspinal back. The aim of this cross-sectional study was to assess the prevalence and factors associated with back pain among patients undergoing spinal anesthesia at the University of Gondar Comprehensive and Specialized Hospital, Northwest Ethiopia. Methodology. An institutional based cross-sectional study was conducted from March to May 2020. A total of 215 participants were enrolled in this study. A convenience sampling technique was used to get the study participants. Both univariable and multivariable logistic regression were used to identify factors associated with postspinal back pain. Variables with a p value less than <0.2 in the bivariable analysis were fitted into the multivariable analysis. In the multivariable analysis, a variable with a p value of <0.05 was considered statistically significant. RESULTS: The overall prevalence of postspinal back pain was 40.5% (95% CI: 34.0, 47.4). Being overweight (AOR = 3.8; 95% CI: 1.47, 9.96) and obese (AOR = 4.9; 95% CI: 1.19, 20.4), using big spinal needles (AOR = 5.9; 95% CI: 1.04, 33.4), two attempts of lumbar puncture (AOR = 5.5; 95% CI: 1.74, 17.59), more than three attempts of lumbar puncture (AOR = 4.9; 95% CI: 1.63, 15.2), and the number of bone contacts during spinal anesthesia procedure (AOR = 3.1; 95% CI: 1.14, 8.45) were positively associated with postspinal back pain. Conclusion and Recommendation. The overall incidence of back pain is high. Body mass index, size of spinal needle, number of attempts, and number of bone contacts are significantly associated with the incidence of back pain following spinal anesthesia. Thus, it is better to minimize the number of lumbar puncture attempts and bone contacts during spinal anesthesia to reduce postspinal back pain. In addition, using smaller size spinal needle is a good choice.

Magnitude and Factors Associated with Preoperative Anxiety Among Pediatric Patients: Cross-Sectional Study.

BACKGROUND: Anesthesia and surgery are common sources of anxiety and stressful experiences in children. This unpleasant sensation depends on several factors. This study aimed to determine the magnitude of preoperative anxiety and associated factors in pediatrics patients at the University of Gondar Comprehensive Specialized Hospital North West Ethiopia 2020. METHODS: An institutional-based cross-sectional observational study was conducted from March to September 2020 at the University of Gondar Comprehensive Specialized Hospital. After obtaining ethical approval from the institutional review board. All consecutive ASA physical status I & II boys and girls with the age of 2-12 years scheduled for a variety of elective (general, urologic, ENT, ophthalmic and other surgical) operations were included. The level of anxiety was measured using the Modified Yale Preoperative Anxiety Scale short form (m-YPAS-SF) observational tool. Parental anxiety was assessed using Spielberger's short version of state-trait anxiety. Binary logistic regression analysis was performed to identify the association between preoperative children's anxiety and independent variables. The strength of the association was present by adjusted odds ratios. RESULTS: The magnitude of preoperative anxiety in children in the operation room was 75.44% (95% confidence interval (CI): 68.36, 81.34). Age (AOR: 3.83; 95% CI: 1.58, 9.30), previous surgery and anesthesia (AOR: 6.73, 95% CI: 1.25, 36.19), outpatient surgery (AOR: 5.16, 95% CI: 1.32, 20.23) and parental anxiety (AOR: 3.26, 95% CI: 1.30, 20.23) were significantly associated with preoperative children anxiety. CONCLUSION: The magnitude of preoperative anxiety in pediatric patients was considerably high in our setup. Younger age, previous surgery and anesthesia, outpatient surgical setting, and parental anxiety were the independent risk factors for preoperative anxiety. Therefore, the operating staff should assess the child's anxiety and should consider appropriate anxiety reduction methods during the preoperative visit of pediatric patients and their families.

Knowledge and Attitude of Ethiopian Oncology Nurses About Cancer Pain Management: National Survey.

BACKGROUND: Cancer is becoming a leading cause of death worldwide. Pain is a common and devastating symptom of cancer patients that can significantly affect the patient's quality of life. Optimal cancer pain control requires adequate knowledge and positive attitudes of nurses. Little is known about the knowledge and attitudes of oncology nurses towards cancer pain management in Ethiopia. The current study aimed to assess the knowledge and attitude of nurses and determinants of cancer pain management in all oncology centers in Ethiopia. METHODS: A nationwide cross-sectional survey was conducted on 138 nurses in all oncology centers in Ethiopia. Self-completed survey questionnaires were distributed using the 'Knowledge and Attitudes Survey Regarding Pain (KASRP)' tool. Both bivariable and multivariable logistic regression analyses were used. Both crude odds ratio and adjusted odds ratio with the corresponding 95% CI were calculated to show the strength of association. Variables with a p-value of <0.05 were considered as statistically significant. RESULTS: Only 7.2% (95% CI: 2.9, 11.6) of oncology nurses had good knowledge and attitude about cancer pain management. Among 41 items, the mean number of correctly answered questions was 20.4 (SD = 5.13). Nurses who had a master's degree in nursing were positively associated with good knowledge and attitude about cancer pain management. CONCLUSION: In this nationwide study, the overall knowledge and attitude level of oncology nurses towards cancer pain management were poor. Nurses who had a master's degree in nursing were significantly associated with good knowledge and attitude towards cancer pain management. Regular training and revision of the contents of pain management education in the academic curriculum of nursing education are recommended.

Factors associated with knowledge and attitude towards adult cardiopulmonary resuscitation among healthcare professionals at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: an institutional-based cross-sectional study.

OBJECTIVE: This study was conducted to assess the factors associated with knowledge and attitude towards adult cardiopulmonary resuscitation (CPR) among health professionals at the University of Gondar Hospital, Northwest Ethiopia. STUDY DESIGN: An institutional-based cross-sectional study was conducted from 15 February to 15 March 2018. Both bivariable and multivariable logistic regression analyses were used to identify factors associated with knowledge and attitude level of health professionals towards CPR. Variables with a p value less than <0.2 in the bivariable analysis were fitted into the multivariable analysis. In the multivariable analysis, variables with a p value <0.05 were considered statistically significant. SETTING: University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. PARTICIPANTS: A total of 406 health professionals (physicians, nurses, anaesthetists, health officers and midwives) were included. RESULTS: Among the study participants, 25.1% (95% CI 21.2 to 29.3) had good knowledge and 60.8% (95% CI 55.9 to 65.5) had good attitude towards adult CPR. Work experience (adjusted OR (AOR): 5.02, 95% CI 1.25 to 20.20), number of work settings (AOR: 6.52, 95% CI 2.76 to 15.41), taking CPR training (AOR: 2.76, 95% CI 1.40 to 5.42), exposure to cardiac arrest case (AOR: 2.16, 95% CI 1.14 to 4.07) and reading CPR guidelines (AOR: 5.57, 95% CI 2.76 to 11.20) were positively associated with good knowledge. Similarly, taking CPR training (AOR: 1.74, 95% CI 1.42 to 1.53) and reading CPR guidelines (AOR: 2.74, 95% CI 1.55 to 4.85) were positively associated with good attitude. CONCLUSIONS: The level of knowledge and attitude of health professionals towards adult CPR was suboptimal. Health professionals who were taking CPR training and reading CPR guidelines had good knowledge and attitude towards CPR. In addition, work experience, number of work settings and exposure to cardiac arrest case had a positive association with CPR knowledge. Thus, providing regular CPR training and work setting rotations is highly crucial.

Review of evidences for management of rapid sequence spinal anesthesia for category one cesarean section, in resource limiting setting.

BACKGROUND: Globally obstetric anesthesia is being done under spinal and epidural than general anesthesia (GA) for most caesarean sections (CSs). This is because GA is associated with failed endotracheal intubation and aspiration of gastric contents. Eventhough general anesthesia is the fastest method for anesthetizing a category 1 cesarean section, it is associated with increased maternal mortality and morbidity. Spinal anesthesia is the preferred regional technique for cesarean section but failure sometimes occurs. To minimize the time factor of spinal anesthesia as well as to avoid the side effects of general anesthesia 'rapid sequence spinal '(RSS) has developed as a novel approach in cases of category one cesarean sections. METHODS: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Search engines like PubMed through HINARI, Cochrane database and Google Scholars were used to find high-level evidences that help to draw appropriate conclusions. DISCUSSION: Neuraxial anesthetic techniques have several advantages which include low risk of aspiration and failed intubation, avoidance of central nervous system (CNS) and respiratory depressant drugs, the ability to maintain a wakeful state of mother enjoying the experience of delivery of baby and also lower incidence of blood loss. 'Rapid sequence spinal' described to minimize anesthetic time. This consists of a no-touch spinal technique, consideration of omission of the spinal opioid, limiting spinal attempts, allowing the start of surgery before full establishment of the spinal block, and being prepared for conversion to general anesthesia if there are delays or problems. To do rapid sequence spinal anesthesia safely and timely, cooperative work is mandatory with good team relation for those simultaneous and necessary tasks. CONCLUSION: The choice of anesthetic in Cesarean section has long been recognized as one of prime importance, because there are two lives to safeguard instead of one. A balance must be struck between the anesthetic dictated by the general condition of the mother and that suited to the needs of the fetal respiratory system.