Cross-sectional study of the prevalence, causes and management of hospital-onset diarrhoea.

BACKGROUND: The National Health Service in England advises hospitals collect data on hospital-onset diarrhoea (HOD). Contemporaneous data on HOD are lacking. AIM: To investigate prevalence, aetiology and management of HOD on medical, surgical and elderly-care wards. METHODS: A cross-sectional study in a volunteer sample of UK hospitals, which collected data on one winter and one summer day in 2016. Patients admitted ≥72 h were screened for HOD (definition: ≥2 episodes of Bristol Stool Type 5-7 the day before the study, with diarrhoea onset >48 h after admission). Data on HOD aetiology and management were collected prospectively. FINDINGS: Data were collected on 141 wards in 32 hospitals (16 acute, 16 teaching). Point-prevalence of HOD was 4.5% (230/5142 patients; 95% confidence interval (CI) 3.9-5.0%). Teaching hospital HOD prevalence (5.9%, 95% CI 5.1-6.9%) was twice that of acute hospitals (2.8%, 95% CI 2.1-3.5%; odds ratio 2.2, 95% CI 1.7-3.0). At least one potential cause was identified in 222/230 patients (97%): 107 (47%) had a relevant underlying condition, 125 (54%) were taking antimicrobials, and 195 (85%) other medication known to cause diarrhoea. Nine of 75 tested patients were Clostridium difficile toxin positive (4%). Eighty (35%) patients had a documented medical assessment of diarrhoea. Documentation of HOD in medical notes correlated with testing for C. difficile (78% of those tested vs 38% not tested, P<0.001). One-hundred and forty-four (63%) patients were not isolated following diarrhoea onset. CONCLUSION: HOD is a prevalent symptom affecting thousands of patients across the UK health system each day. Most patients had multiple potential causes of HOD, mainly iatrogenic, but only a third had medical assessment. Most were not tested for C. difficile and were not isolated.

Rural and remote obstetric care close to home: program description, evaluation and discussion of Sioux Lookout Meno Ya Win Health Centre obstetrics.

PROBLEM BEING ADDRESSED: Aboriginal and non-Aboriginal women in rural and remote settings struggle to access obstetric care close to home. Objective of the program: To deliver a full range of modern and safe obstetric care to 28 remote Aboriginal communities served by rural-based health care. PROGRAM DESCRIPTION: Rural family physicians provide intrapartum, cesarean delivery and anesthesia services to 350 rural, primarily Aboriginal women in a collegial, supportive environment. CONCLUSION: Rural and remote obstetric services need support before they fail. Patient volume, remote location and organizational culture are key elements. Evidence teaches us that outcomes are best when women deliver closer to home.

Hazards of Farming: Injury statistics suggest methods of prevention.

Farming is the most dangerous occupation in the industrialized world. Children, in particular, are at high risk for injury and disability. There is ample scope to improve this situation. Parents are the most important group to be educated. Emergency response services in rural areas are sometimes unable to provide optimum care for victims. Better surveillance methods need to be in place, both to gather information and to evaluate strategies aimed at prevention. Farm safety needs to be higher on the agenda for farmers, farm organizations, government, and health care professionals.

Responding to a human need--lecturer-practitioner in human sexuality.

It is well known that illness can have a traumatic effect on sexuality. Lecturer-practitioners in sexuality help people come to terms with this, and help nurses respond more effectively.

Effect of sample transport systems on survival of bacteria in ground beef.

The effects of two transport systems and cryoprotective agents on the survival of bacteria in ground beef samples were evaluated. Survival of Clostridium perfringens in ground beef samples after simulated transport (72 h) was higher (about 99%) in Dry Ice than in Trans Temp shipping units (-3 degrees C). There were no significant differences between the two transport systems in survival of coliforms, Escherichia coli, Staphylococcus aureus, or aerobic bacteria. Mixing ground beef samples at a ratio of 1:1 (wt/vol) with 10, 20, or 30% buffered solutions of dimethyl sulfoxide or glycerol before freezing improved the survival of C. perfringens and coliforms in both transport systems. Recovery of E. coli was significantly higher with the addition of 10% dimethyl sulfoxide before Dry Ice transport. Addition of 10% dimethyl sulfoxide resulted in a 100% recovery of both S. aureus and aerobic bacteria from ground beef after simulated transport in Trans Temp shipping units. The use of cryoprotective agents can improve the survival of bacteria during transport of ground beef samples.

Comparison of Single and Multiple Stage Sieve Samplers for Airborne Microorganisms 1, 3.

Single and multiple stage air samplers were evaluated under commercial conditions for enumerating airborne microbial particles in a plant in which swine were slaughtered and pork was further processed. Three volumes of air, 0.014, 0.028, (1 ft3), and 0.057 cu M were sampled in duplicate on each of 2 days (for airborne molds, yeasts, coliforms, and aerobic bacteria) in eight rooms where pork carcasses were handled and further processed. Unexpectedly, the microbial counts were low during this winter sampling. The single and multiple samplers yielded mean (log10) counts (n = 94) of 0.15 and 0.42; -0.23 and -0.36; 1.18 and 1.29; and -0.63 and -0.91 per 0.028 cm M; for molds, yeasts, aerobes and coliforms, respectively. The multiple sampler detected slightly greater numbers of molds and aerobic bacteria, but did not define the differences in aerobic bacterial numbers from among the various processing rooms as readily as the single stage sampler. Counts of coliforms were higher from the single than from the multiple stage sampler. The single stage sampler required only one petri dish per sample, as compared with six for the multiple stage sampler, so it required less medium and time for evaluating air for microorganisms.