Study on Patient's Perception on Medication Counseling at Community Pharmacy in Sub-urban Area of Nepal.

Background Community pharmacists are the primary contact point in a healthcare system who provide medication information to the patients and enable them to make appropriate decision regarding their therapy. Hence, this study explored patients' perception of community pharmacist based on medication counseling. Objective To study patient's perception on medication counseling by community pharmacist at Manohara Municipality, Kathmandu, Nepal Method A cross sectional study was conducted from November 2020 to April 2021 in population visiting pharmacies of Kageshwori Manohara Municipality of Kathmandu valley. A total of 384 participants included in the study were surveyed using a structured questionnaire exploring the content of medication counseling, level of satisfaction on counseling and use of various means of counseling. Descriptive data were presented in frequencies and percentages using EXCEL 2016. Result This study enrolled 384 participants out of which 354, 92.19% received medication counseling. The main reason of pharmacy visit was to obtain over the counter medicines, 262, 68.23%. Majority of the participants rated satisfied with informations provided on use of medication 218, 56.77%, duration of therapy 261, 67.97%, about side effects 211, 54.95% and on action to be taken following side effects 246, 64.06%. Most of the participants rated satisfied with counseling on storage 189, 49.22% and for referral 250, 65.10% while 201, 52.34% participants rated highly satisfied with advice on lifestyle and dietary changes required. Conclusion This study concludes that the patients' perception regarding the medication counseling by community pharmacist was acceptable. Thus pharmacists should be encouraged to support patients with their medication to promote patient care.

Surgical antibiotic prophylaxis administration practices.

SETTING: A referral hospital in Kavre, Nepal. OBJECTIVES: To assess 1) compliance with National Antibiotic Treatment Guidelines (NATG), specifically, whether the administration of surgical antibiotic prophylaxis (SAP) (initial dosing and redosing) was in compliance with NATG for patients who were and were not eligible, and 2) development of surgical site infections (SSIs) among patients who underwent surgery in the Department of General Surgery (July-December 2019). DESIGN: This was a retrospective cohort analysis. RESULTS: The analysis included 846 patients, of which 717 (85%) patients were eligible for SAP and 129 (15%) were ineligible. Of those eligible, 708 (99%) received the initial dose; while 65 (50%) of the ineligible did not receive any dose. Of those who received the initial dose, 164 (23%) were eligible for redosing. Of these, only 23 (14%) received at least one redosing and 141 (86%) did not receive it. Overall compliance with NATG was achieved in 75% (632/846) of patients. SSIs occurred in 23 (3%) patients, 8 (35%) of whom did not have SAP administered according to NATG. CONCLUSION: A relatively high overall compliance with NATG for SAP administration was reported. Recommendations were made to improve compliance among those who were ineligible for SAP and those who were eligible for redosing.

LIEU: Un hôpital de référence du district de Kavre, Népal. OBJECTIFS: Évaluer 1) le respect des directives nationales sur les traitements antibiotiques (NATG), plus particulièrement si l'administration d'une antibioprophylaxie chirurgicale (SAP) (dose initiale et nouvelle dose) respectait les directives NATG pour les patients qui y étaient ou non éligibles ; et 2) le développement d'infections du site opératoire (SSI) chez les patients ayant subi une intervention chirurgicale dans le service de Chirurgie Générale (juillet­décembre 2019). MÉTHODE: Il s'agissait d'une analyse de cohorte rétrospective. RÉSULTATS: L'analyse a inclus 846 patients, dont 717 (85%) étaient éligibles à une SAP et 129 (15%) n'y étaient pas éligibles. Parmi ceux qui y étaient éligibles, 708 (99%) ont reçu la dose initiale, alors que 65 (50%) des patients non éligibles n'ont reçu aucune dose. Parmi ceux ayant reçu la dose initiale, 164 (23%) étaient éligibles à une nouvelle dose. Parmi ces derniers, seuls 23 (14%) ont reçu au moins une nouvelle dose et 141 (86%) n'en ont pas reçu. Les directives NATG ont été respectées chez 75% (632/846) des patients. Des SSI ont été observées chez 23 (3%) patients ; pour huit (35%) de ces patients, la SAP n'avait pas été administrée conformément aux directives NATG. CONCLUSION: Un respect global relativement élevé des directives NATG pour l'administration de la SAP a été rapporté. Des recommandations ont été émises pour améliorer le respect de ces directives chez les patients non éligibles à la SAP et chez ceux éligibles à une nouvelle dose.

Incidence of healthcare-associated infections with invasive devices and surgical procedures in Nepal.

SETTING: Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu, Nepal. OBJECTIVES: 1) To report the incidence of health-care-associated infections (HAIs), 2) to compare demographic, clinical characteristics and hospital outcomes in those with and without HAIs; and 3) to verify bacterial types in HAI and community-acquired infections (CAIs) among inpatients with invasive devices and/or surgical procedures. DESIGN: This was a cohort study using secondary data (December 2017 to April 2018). RESULTS: Of 1,310 inpatients, 908 (69.3%) had surgical procedures, 125 (9.5%) had invasive devices and 277 (21.1%) both. Sixty-six developed HAIs (incidence = 5/100 patient admissions, 95% CI 3.9-6.3). Individuals with HAIs had a 5.5-fold higher risk of longer hospital stays (⩾7 days) and a 6.9-fold risk of being in intensive care compared to the surgical ward. Unfavourable hospital exit outcomes were higher in those with HAIs (4.5%) than in those without (0.9%, P = 0.02). The most common HAI bacteria (n = 70) were Escherichia coli (44.3%), Enterococcus spp. (22.9%) and Klebsiella spp. (11.4%). Of 98 CAIs with 41 isolates, E. coli (36.6%), Staphylococcus aureus (22.0%) and methicillin-resistant S. aureus (14.6%) were common. CONCLUSION: We found relatively low incidence of HAIs, which reflects good infection prevention and control standards. This study serves as a baseline for future monitoring and action.

LIEU: Hôpital de Dhulikhel, Hôpital Universitaire de Katmandu, Katmandu, Népal. OBJECTIFS: 1) Rapporter l'incidence des infections associées aux soins (HAI), 2) comparer les caractéristiques démographiques et cliniques et les résultats hospitaliers chez les patients atteints et non atteints de HAI ; et 3) vérifier les types bactériens des HAI et des infections communautaires (CAI) parmi les patients hospitalisés avec dispositifs invasifs et/ou ayant subi une intervention chirurgicale. MÉTHODE: Étude de cohorte réalisée en utilisant des données secondaires (décembre 2017 à avril 2018). RÉSULTATS: Sur 1 310 patients hospitalisés, 908 (69,3%) ont subi une intervention chirurgicale, 125 (9,5%) avaient des dispositifs invasifs et 277 (21,1%) avaient à la fois un dispositif invasif et subi une intervention chirurgicale. Au total, 66 ont contracté une HAI (incidence = 5/100 admissions de patients, IC 95% 3,9-6,3). Les patients atteints de HAI avaient un risque 5,5 fois plus élevé de séjour prolongé à l'hôpital (⩾7 jours) et un risque 6,9 fois plus élevé d'être admis en soins intensifs qu'en service de chirurgie. Les résultats défavorables à une sortie d'hôpital étaient plus fréquents chez ceux atteints de HAI (4,5%) que chez ceux non atteints de HAI (0,9%, P = 0,02). Les bactéries les plus fréquemment responsables de HAI (n = 70) étaient Escherichia coli (44,3%), Enterococcus spp. (22,9%) et Klebsiella spp. (11,4%). Sur 98 CAI avec 41 isolats, E. coli (36,6%), Staphylococcus aureus (22,0%) et S. aureus résistant à la méticilline (14,6%) étaient les plus fréquents. CONCLUSION: Nous avons observé une incidence relativement faible de HAI, ce qui reflète de bons standards de contrôle et de prévention des infections. Cette étude sert de référence à de futures actions et stratégies de suivi.

Analysis of Antimicrobial Drugs Usage Pattern and it's Cost Analysis in the Pediatric Department of a Tertiary Care Hospital.

Background Antimicrobials agents are the most widely and often imprudently used therapeutic drugs globally. The pediatric population comprises 20-25% of the total world population, and various acute and chronic diseases are prone to this group. It is also estimated that 50% to 85% of children are prescribed with antimicrobials in developed and developing countries. The misuse of antimicrobials not only contributes not only to the development of antimicrobial resistance but also results in economic burden on the health care system. Objective To analyze the antimicrobial usage and its cost analysis in the Pediatric department of a tertiary care hospital at sub-urban area. Method A hospital based retrospective study was conducted among patient (aged 1 to 18 years) admitted in pediatric ward and intensive care unit for at least 24 hours and dispensed at least one antimicrobial drug from January 2018 to December 2019. Data were collected from electronic medical record using a structured data collection form. The data was entered and analyzed using Microsoft Excel. A descriptive analysis was presented as mean ± (standard deviation) for the continuous variables and frequencies and proportions for categorical variables. Result Among the 1,281 patients, the antimicrobials were prescribed mostly in the respiratory tract infection (39.6%), followed by sepsis (19.75%), enteric fever (11.94%), seizure (10.07%), urinary tract infection (4.29%). Penicillins (1238 times) were highly prescribed followed by Cephalosporin (733 times), Nitro-imidazole (292 times), Aminoglycosides (180 times) and Fluoroquinolones (144 times). During study period in the Pediatric Department, approximately NRs. 1,619,121.11 was spent in the antimicrobial drugs and the highest expenditure was found to be in the Cephalosporin group of antimicrobials (NRs. 530,988.6), followed by Penicillin group of drug (NRs. 3,81,842.2). Conclusion The study concludes that the Penicillin groups of drugs were the most commonly prescribed drug and the highest cost was found to be in Cephalosporin group drugs followed by Penicillin group of drugs.

Hormonal Contraceptives Use and Their Adverse Effects: A Cross-sectional Study among the Women Visiting Tertiary Care Center.

Background Hormonal contraceptives are one of the most commonly used means of contraception. Lack of contraception may lead to large family size, increased preexisting illness on pregnancy, social and economic instability, risk of unsafe abortion and so on. This may also lead to unintended pregnancies which may alter the outcomes of pregnancies as well. However, improper uses are associated with several serious adverse effects. Therefore, to achieve the optimum benefit with the least adverse effects, safe and effective use of these agents with monitoring of their pattern of use and patient compliance is very essential. Objective To investigate the usage of hormonal contraceptives and the adverse effects associated with them. Method A cross-sectional study was conducted in a family planning center of a tertiary care hospital. All women of reproductive age using hormonal contraceptives for at least 1 month were included in this study. Informed consent was taken from the patients and interviewed using a structured questionnaire. Statistical analysis was performed by using SPSS 20. Result Among the 105 participants under this study, the mean (±SD) age was 29.08 (± 6.12) years. A majority (42, 40.0%) of them were using injectables. The average duration of use of hormonal contraceptives was 25.1 months ± 31.8 while a majority (60, 57.1%) were using contraceptives from < 3 months. Less chance of missed dose was the major reason (26.8%) for choosing injectable. Adverse effects were reported by 75.2% of the patients. The most common adverse effect was menstrual abnormalities (21.7%). Conclusion Among various hormonal contraceptives, injectables were more commonly used. The majority of the participants responded to use injectables because of the least chance of missing the dose. The most common adverse effect reported was menstrual abnormalities.

Investigating the Efficacy of Triple Drug Therapy and Sequential Drug Therapy in the Eradication of Helicobacter Pylori with Respect to Antigen Stool test: A Pilot Study.

Background Helicobacter pylori is one of the most prevalent infectious disease worldwide. The treatment regimens involve mainly two therapies: Standard Triple drug therapy and Sequential drug therapy. Several studies have shown that the sequential therapy has higher eradication rates of H. pylori than the standard triple drug therapy and since proper study on sequential drug therapy and standard triple drug therapy is still lacking in Nepal, this study is attempted to compare efficacy of Sequential Drug Therapy in the eradication of H. pylori in gastritis with respect to the Standard triple drug therapy. Objective To investigate the efficacy of Triple Drug Therapy and Sequential Drug Therapy in the eradication of Helicobacter pylori with respect to Antigen Stool test. Method This study was the prospective study conducted in 62 patients attending the Department of Gastroenterology, Dhulikhel Hospital, meeting the inclusion criteria who were confirmed as H. pylori positive by histopathology and stool antigen test. Patients were randomized into two groups. One group prescribed with Standard triple drug regimen and another group with Sequential drug regimen. Eradication of H. pylori infection was confirmed by repeating the stool antigen test at least five weeks after the completion of the regimen. Result Among the 62 participants included in this study, 54.5% of them were males. Among the study population, the eradication achieved by standard triple drug therapy was 87.8% and 89.6% with Sequential drug therapy. Higher numbers (82.3%) of patients were compliant to the prescribed medication. Forgetfulness was the main reason for missing the dose (91%) of the non-compliant patients. Conclusion The study revealed an equal efficacy of both Standard Triple drug regimen and Sequential drug regimen in the eradication of H. pylori infection. Further, Stool antigen test can be preferred as a non-invasive test, for diagnosis of H. pylori infection, monitoring the response to treatment and in epidemiological studies.

Health Care Associated Infection and Trend of Antimicrobial Resistance in Tertiary Care Hospital -A Study in Low Income Setting.

Background Antimicrobial resistance (AMR) and healthcare-associated infections (HAIs) are among the most serious public health problems and overall estimate indicates that at any point, over 1.4 million people are suffering from health care associated infection globally. According to the WHO report, the frequency of nosocomial infection is 10% in South East Asia where as 7% in developed countries. The increasing trend of AMR in pathogenic bacteria leads to complication to treat HAIs and failure in treatment and rise in mortality. Objective The study was conducted with the objective of to explore the incidence of different types of HAIs and AMR pattern in the patients admitted in a tertiary care hospital. Method The cross-sectional study was conducted at the tertiary care hospital and the patient who are one year or older and admitted for more than 48 hours were included in this study. The criteria for classification of HAIs were adapted from Centers for Disease Control. All the samples were collected then antibiotic sensitivity testing was conducted according to CLSI standards. Data were collected using a structured data collection form. Data were entered in EpiData software and analyzed using SPSS version 22. Result Among 2326 patients, female was slightly higher than male patients, where 77 (3.3%) patients experienced at least one episode of HAIs. The surgical site infection (71.42%) is the most common infection followed by Catheter Associated Urinary Tract Infection (18.18%) and Health Care Associated Pneumonia (6.49%). Mean hospitalization days is higher with HAI (14.5 days) compared to non-HAI (6.6 days). Out of 909 specimens, urine, sputum and blood were higher in numbers, where 217 bacterial isolates were isolated with Escherichia coli (83 isolates) was the most common bacteria. It is found that Escherichia coli bacterial isolates were resistance to most common antibiotics. Conclusion The study concludes that surgical site infection is the most common healthcareassociated infection and Escherichia coli is the most common bacteria responsible for HAIs. Further, surgical site infection being the most common infection, there is an urgent need to take effective infection prevention and control prevention.