Nurses compliance to hand hygiene practice and knowledge at Klang Valley hospital.

BACKGROUND AND AIMS: Hand hygiene is the most important measure in the prevention of healthcare-associated infections (HCAI). Adherence to hand hygiene protocols in hospital by nurses enables in prevention and control the HCAI. The main aim of the present study was to assess nurses' compliance to hand hygiene practice and knowledge in a hospital. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted in the intensive care units of a hospital in Kuala Lumpur. A total of 84 registered nurses from the intensive care were recruited for this study. A self-administered questionnaire was deployed to measure knowledge and compliance about hand hygiene. RESULTS: The findings showed the total mean and standard deviation of knowledge (60.65±4.213) and compliance (84.65±7.024) to be high among the respondents. There were no significant differences with the knowledge and compliance to hand hygiene with respondents' age groups with a p value >0.05. However, there were significant differences between respondents' years of service with the knowledge and compliance with p values <0.05. The results showed significant differences between respondents' with post basic course with compliance to hand hygiene with a p value <0.05 actual p value added (p = 0.001). There were no significant differences between the respondents' post basic course with knowledge to hand hygiene with p values >0.05 actual p value added (p=0.072). CONCLUSION: Nurses compliance to hand hygiene practice and knowledge was good. Nurses' years of service have great implications on compliance to hand hygiene practice. The study opines that constant reinforcement and motivation are required by the hospital infection control team to impart hand hygiene practice.

A study of knowledge and attitudes of registered nurses towards pain management in an urban hospital.

BACKGROUND AND AIMS: Nurses play a pivotal role in pain management. Unrelieved pain significantly interferes with patient's quality of life and is of great concern to nurses. The aim of this study was to determine the knowledge level and attitudes of nurses related to pain management. MATERIALS AND METHODS: This descriptive study was conducted in an urban hospital. A total of 84 registered nurses were recruited using a modified version of questionnaire of Knowledge and Attitudes Survey Regarding Pain. RESULTS: The findings showed that respondents possessed good knowledge (99.12±14.810) and attitude (66.00 ±10.415) towards pain management. Fifty five respondents (66%) responded as positive to cultural beliefs affecting their pain management and 65 respondents (77%) viewed that their personal experiences had influenced their practice in pain management. Another 45 respondents (54%) reported they have attended pain course. There was no significant difference in pain management between respondents' year of service, cultural belief and personal experiences (p=>0.05). In terms of knowledge towards to pain management, respondents' age groups of more than 40 years were noted to possess better knowledge (p=0.046), unmarried respondents (p=0.018), and attended pain course (p=0.001) were significant. Attitude towards to pain management was not significant (p≤0.05). CONCLUSION: Nurses' knowledge and attitudes scores were impressive but there is room for further improvement to pain management. Continuing education organized by the hospital had significant impact on the nurses. However, this education course has to be reinforced from time to time in order to improve patients' pain experiences.

Perception of quality of life amongst end stage renal failure patients undergoing haemodialysis.

AIMS: The objective of the study was to examine the quality of life amongst the end stage renal disease (ESRD) haemodialysis patients in Malaysia. MATERIALS AND METHODS: A cross sectional descriptive study was conducted on 72 ESRD patients at a Dialysis Centre in Malaysia. The modified KDQOL-SF™ subscales, kidney disease-targeted scale and 36 item health survey scale questionnaires were used. RESULTS: The overall health rating was 66.73 ± 11.670 indicating good quality of life. There was no significant difference between quality of life for the different domains according to gender (p >0.05). However, there were significant differences between quality of life in the domain of burden of kidney disease. Physical functioning deteriorated significantly with age (p=0.012) while social functioning was lowest in the 50-65 years age group (p=0.037). Those who had no morbidities had significantly better scores on the effects of kidney (p=0.036), burden of kidney disease (p=0.011) and physical functioning (p=0.025). CONCLUSIONS: Patients undergoing haemodialysis have been found to have good quality of life despite having ESRD. It is therefore of paramount importance to constantly monitor the standard of care for these patients to enable them to live their life to the fullest.

Cigarette smoking and the influencing factors among adolescents in a secondary school in Malaysia.

BACKGROUND: Smoking has always been a huge problem in Malaysia and its surrounding nations. The purpose of this study was to determine the prevalence of cigarette smoking and to identify the influencing factors associated with smoking habits among adolescents. MATERIALS AND METHODS: This cross-sectional study was carried out on 226 respondents, using a questionnaire which had 4 sections: socio-demographic data, personal information, family information and social information. Data was analyzed using SPSS® version 16. For categorical variables, comparisons were made using Chi-square and for numerical variables a t-test was performed. RESULTS: The current smoker prevalence rate was 20.8% which showed a significant association between smoking and individual factors: level of knowledge on the effects of smoking (p < 0.05), significant association was seen between smoking and marital status of parents, smoking status of male siblings and various other aspects of the individuals themselves. CONCLUSIONS: Concerted efforts involving various parties should be taken to curb or prevent this problem or the number of teenage smokers in the country will increase. This in the long run will invite problems to the well being of the adolescents themselves, their families, community and the nation as a whole.

Study on advanced life support devices in the ambulances for emergency cases in Klang Valley, Malaysia.

BACKGROUND AND AIMS: In an effort to improve pre-hospital care, the authors assessed the availability and utility of ambulance devices. The study aimed to identify commonly used devices for managing emergency cases in Klang Valley of Malaysia. MATERIALS AND METHODS: This was a prospective study comprising of 1075 emergency ambulances running on 30 days. The study analyzed the availability and utilization of life support equipment in nine ambulance providers of Klang Valley in Malaysia. The devices were classified into: (a) airway and ventilation, (b) immobilization and haemorrhage control and (c) communication. The percentage of device utilization was analysed using computerised software. RESULTS: Results showed only one ambulance service had complete equipment in accordance to international standards. In term of utilisation of life support equipment, oxygen delivery devices were used in 493 (45.86%) runs. The most used devices in immobilisation and haemorrhage control were:- (a) scoop stretcher in 321 (29.86%) runs, (b) wound dressings in 250 (23.26%) runs and (c) rigid spinal board in 206 (19.16%) runs. Two-way radios were used in 745 (69.30%) runs while mobile phones were used in 429 (39.91%) runs. CONCLUSION: In conclusion, ambulances in Klang Valley had a large variation in the availability of life support devices. This emphasizes a need for standardization of equipment.

Information needs of family members of critically ill patients in intensive care unit of a tertiary hospital.

UNLABELLED: BACKGROUND AND AIMS. The experience in intensive care unit (ICU) has created an intense emotional situation both to patients and their family members. The aim of this study was to determine the family members information needs of critically ill patients in ICU. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted on 200 family members of patients admitted in ICU. A face to face interview was conducted and a self-report questionnaire of the Critical Care Family Needs Inventory (CCFNI) was used. RESULTS: Findings reported CCFNI five sub-attributes that ranked from highest to lowest included: support (mean 39.13 ± 6.189); proximity (mean 27.17 ± 3.384); information (mean 24.25 ± 3.093); assurance (mean 22.67 ± 1.862) and comfort (mean 16.24 ± 2.776). There were no significant differences in needs between family members with different gender (p >0.05). However, there were significant differences in support needs between family members with admission to ICU with (t=-2.111; p <0.05). There were significant differences in assurance needs (F=3.542; p <0.05) and information needs (F=3.681; p <0.05) between family members with age. There were no significant differences in needs between family members with different education level (p >0.05) whereas assurance needs were significant differences with education level of (F=3.542; p <0.05). CONCLUSION: The results suggest that family members perceived support and proximity as the most crucial need. Comfort need was viewed as least important. Although this study was conducted in a tertiary hospital, the findings could still provide insight for nurses to improve the delivery of care to patients and family members.

The quality of life among coronary heart disease patients at a teaching hospital.

BACKGROUND AND AIMS: Quality of life after acute coronary heart disease amongst patients is important outcome factor in deliberations of patient's care. The main aim of the study was to examine the quality of life amongst acute CHD patients. MATERIALS AND METHODS: A cross sectional descriptive study was conducted after an acute attack amongst coronary heart disease (CHD) patients in Universiti Kebangsaan Malaysia Medical Centre (UKMMC).The Medical Outcomes Short Form 36 (SF-36) comprised of 36 items used to measure quality of life which comprised of 4 domains of physical component summary were physical function, role physical, bodily pain, and general health and 4 domains of mental component summary were vitality, social function, emotional role, and mental health. A total of 108 respondents were recruited for this study. RESULTS: The findings showed that CHD. Respondents possessed good level of quality of life with total score of (59 ± 22). The total score of physical domain had mean and SD of 56 ± 24, while the total scores of the mental domain had mean and SD of 62 ± 27. There were significant differences between the general health components of quality of life with educational status of the CHD patients with (F= 5.433, p<0.05). There were significant differences in role physical components of quality of life with income (F= 3.144, p<0.05). CONCLUSION: The cardiac rehabilitation program would have deliberately improved their needs and conditions whilst hospitalization. These results have implications in which CHD patients should be evaluated with regard to their continuity of care.

The ideal measurement of the quality of life in post stroke patients: an urban study.

OBJECTIVE: There is paucity of literature on the measurement of the quality of life in post stroke patients in the developing countries. The main objective of this study was to determine the quality of life (QOL) of post stroke patients. MATERIALS AND METHODS: A cross-sectional study was conducted on 107 post stroke patients in two centers. The data was obtained during the period of January 2009 till May 2009 using purposive sampling method. A total of 68 males and 39 females participated in this study. Stroke Specific Quality Of Life (SS-QOL) version 2.0 was used. Cronbach's alpha values for SS-QOL ranged between 0.73 and 0.89. RESULTS: The mean ± SD of the QOL score was 141.79 ± 40.32. The mean ± SD of the age was 65.47 ± 11.79 years. Result showed significant negative association between age and QOL of post stroke patients (r = - 0.199, p= 0.040). Domains mostly affected by stroke compared to pre-stroke were mobility (69%) and energy (64%). There were two domains in SS-QOL significantly predicted the QOL of post stroke patients. These domains were work and productivity (ß= 2.277, t= 2.145, p= 0.035) and thinking (ß= 1.927, t= 2.567, p= 0.012). CONCLUSION: Few items from this measurement tool may not be appropriate in a developing country because of the different cultural background. There is a need to develop appropriate post stroke patient measurement tool based on local practice.

Sharps Injury in Hospital Universiti Kebangsaan Malaysia (HUKM): Experiences of Health Care Workers and Students

Sharps injury among health care workers in HUKM has received serious attention lately due to the possible transmission of diseases like HIV, Hepatits B and Hepatitis C, which can cause serious consequences for the victim. The aim of the study was to gain a deeper understanding of the emotional problems experienced by health care workers who had incurred a sharps injury and the coping strategies adopted by them to overcome the problem. A 28 item semi-structured questionnaire was designed by the supervisors and the researcher as there was no existing questionnaire to be adopted, as no research had been carried out in this area prior to this. The target group consisted of 64 health care workers of different categories working in HUKM. Data was collected over a period of five months from November 2000 to March 2001. The results of the study revealed that the most frequently injured were the staff nurses, nearly 90% of whom were emotionally upset and were worried that they might contract a disease. There was no significant difference in the emotional stress experienced by the different categories of the health care workers, all were equally upset about the injury but each category of staff adopted different methods to overcome the tragedy. Open comments and opinions about prevention and the management of the sharps injury in HUKM as given by the respondents here are taken into account. Several views given by the participants were explored and discussed. Finally, several implications for nursing and recommendations have been presented.

Faecal prevalence of extended-spectrum Beta-lactamase (ESBL)-producing coliforms in a geriatric population and among haematology patients.

Antimicrobial resistance to the extended-spectrum cephalosporins is increasingly reported worldwide. In the local setting, nosocomial infections with multi-resistant Gram-negative bacilli are not uncommon and are a growing concern. However, there is limited data on the carriage rates of such organisms in the local setting. In May 2001, a prospective study was carried out to determine the enteric carriage rates of ceftazidime-resistant Gram negative bacilli (CAZ-R GNB) among residents of nursing homes and from in-patients of the geriatric and adult haematology wards of University Malaya Medical Centre. Ceftazidime-resistant Gram-negative bacilli (CAZ-R GNB) were detected in 25 samples (30%), out of which 6 were from nursing home residents, 5 from geriatric in-patients and 14 from the haematology unit. A total of 28 CAZ-R GNB were isolated and Escherichia coli (10) and Klebsiella pneumoniae (7) were the predominant organisms. Resistance to ceftazidime in E. coli and Klebsiella was mediated by extended-spectrum beta-lactamases (ESBLs). Although the majority of the CAZ-R GNB were from patients in the haematology ward, the six nursing home residents with CAZ-R GNB were enteric carriers of ESBL-producing coliforms. Prior exposure to antibiotics was associated with carriage of ESBL organisms and to a lesser extent, the presence of urinary catheters.

S-allyl cysteine reduces oxidant load in cells involved in the atherogenic process.

Oxidation of low-density lipoprotein (LDL) and activation of the pleiotropic transcription factor nuclear factor kappa B (NF-kappaB), are often the chemical and molecular alterations associated with the development of the atherosclerotic lesion. We have reported previously on the antioxidant properties of a garlic compound, S-allyl cysteine (SAC), and its ability to inhibit damage caused by oxidative stress in bovine endothelial cells. In this study, the antioxidant effects of SAC were further determined, using several in vitro assay systems. First, we determined the effect of SAC on Cu2+-induced oxidation of LDL. Varying concentrations of SAC were co-incubated with a standardized Cu2+/LDL solution, and LDL-oxidation was then ascertained by determining the formation of thiobarbituric acid reactive substances (TBARS). SAC inhibited LDL-oxidation at an optimum concentration of 1 mM. In another experiment, we determined the effects of SAC on oxidized-LDL (ox-LDL) activation of J774 murine macrophages and human umbilical vein endothelial cells (HUVEC). Cells were grown on 96-well plates, preincubated with SAC at 37 degrees C and 5% CO2 for 24 h, washed, and exposed to ox-LDL for 24 h. Levels of hydrogen peroxide (H2O2) were determined by a fluorometric assay. In both cell lines, SAC exhibited dose-dependent inhibition of H2O2 formation. We also studied the effects of SAC on NF-kappaB activation in HUVEC using tumor necrosis factor-a (TNF-alpha) or H2O2 as stimulators. Cells were grown in 75 cm2 flasks at 37 degrees C and 5% CO2 and were preincubated with SAC 24 h before stimulation with TNF-alpha or H2O2. Nuclear extracts were then prepared and NF-kappaB activation was determined using an electrophoretic mobility shift assay with a 32P-labeled probe. SAC exhibited dose-dependent inhibition of NF-kappaB activation. Our data suggest that SAC may act via antioxidant mechanisms to inhibit the atherogenic process.