scholarly journals Surgical antibiotic prophylaxis use and infection prevalence in non-cosmetic breast surgery procedures at a tertiary hospital in Western Australia—a retrospective study

PeerJ ◽  
2018 ◽  
Vol 6 ◽  
pp. e5724 ◽  
Author(s):  
Ainslie Lavers ◽  
Wai Siong Yip ◽  
Bruce Sunderland ◽  
Richard Parsons ◽  
Sarah Mackenzie ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Breast Surgery ◽  
Length Of Hospital Stay ◽  
Surgical Site Infections ◽  
Tertiary Hospital ◽  
Drug Dosage ◽  
Cross Sectional Study ◽  
Infection Prevalence ◽  
Cross Sectional ◽  
The Impact

Background Surgical site infections (SSIs) are a common complication following breast surgery procedures, despite being considered a clean surgery. The prevalence of SSIs can be minimised with the appropriate use of antibiotic prophylaxis as outlined in the Australian Therapeutic Guidelines (eTG). The aims of this study were to evaluate adherence to the eTG for antibiotic prophylaxis in breast surgery procedures at a Western Australian teaching hospital following an update of the guidelines in 2014 and examine the impact of prophylactic antibiotics on SSI incidence and length of hospital stay. Method A retrospective cross-sectional study which reviewed medical records from a random sample of 250 patients selected from 973 patients who underwent breast surgical procedures between February 2015 and March 2017. Results Overall adherence to current eTG occurred in 49.2% (123/250) of operations. Pre-operative and post-operative antibiotics were prescribed in 98.4% (246/250) and 11.2% (28/250) operations respectively. Adherence rates to three specific elements of the eTG (drug prescribed, drug dosage and timing of administration) were 91.6% (229/250), 53.6% (134/250) and 86.4% (216/250) respectively. For the 14.4% (36/250) patients with relevant drug allergies, there was zero adherence to the eTG. Overall recorded SSI prevalence was low at 5.2% (13/250). The mean length of stay in patients (2.3 ± 1.7 days) was not influenced by level of eTG adherence (p = 0.131) or SSIs (p = 0.306). Conclusion These data demonstrate a significant improvement in overall adherence to the eTG from 13.3% to 49.2% (p =  < 0.001). The level of detected SSIs in this study was low. Further improvement is necessary with respect to prescribing appropriate antibiotic dosages and for those with allergies.

scholarly journals Predictors of Surgical site infections among patients undergoing open urological surgery at a Tertiary hospital, Tanzania: A cross sectional study

2019 ◽  
Author(s):  
Joel Paschal Manyahi ◽  
Upendo Kibwana ◽  
Victor Sensa ◽  
Sydney C Yongolo ◽  
Eligius Lyamuya
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Surgical Site Infections ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Urological Surgery ◽  
Contaminated Wound ◽  
Wound Class

Abstract Background Surgical site infection (SSI) is one of the major hospital acquired infections highly associated with prolonged hospitalization, morbidity and mortality. In open urological surgeries, little is known on magnitude and factors associated with development of SSI. Methods and Materials This was a cross-sectional prospective observational study performed between August 2015 and March 2016 at Muhimbili National hospital (MNH), Dar es Salaam, Tanzania. All patients who underwent open urological surgery and met inclusion criteria were consecutively enrolled, and followed up for 30 days. Patients´ and operative characteristics were recorded using standard structured questionnaires. Wound/ pus swabs were collected from patients with clinical evidence of SSI for bacteriological processing. Data analysis was performed using SPSS version 20. Results Of 182 patients who underwent open urological surgery, 22% developed SSI. Pre-operative urinary tract infection (aOR 9.73, 95%CI 3.93-24.09, p<0.001) and contaminated wound class (aOR 24.997, 95%CI 2.58-242.42, p = 0.005) were independent predictors for development of SSI. Shaving within 30 hrs before surgical procedure was found to be protective for developing SSI (aOR 0.26, 95%CI 0.09-0.79, p = 0.02). Escherichia coli (20/40) was the most predominant pathogen in SSI followed by Klebsiella pneumoniae (7/40) and S. aureus (6/40). Gram-negative bacteria were highly resistant to ceftriaxone, gentamicin, amoxicillin-clavulanic acid and trimethoprim-sulfamethoxazole. Conclusion SSI was high in open urological interventions. Pre-operative urinary tract infection and contaminated wound class predicted SSI. Bacteria causing SSI were highly resistant to commonly used antibiotics.

scholarly journals Pharmacotherapeutic follow-up in a respiratory intensive care unit: description and analysis of results

2018 ◽  
Vol 16 (2) ◽  
Author(s):  
Ana Carolina de Souza e Silva ◽  
Domingos Sávio de Carvalho Sousa ◽  
Eunice Bobô de Carvalho Perraud ◽  
Fátima Rosane de Almeida Oliveira ◽  
Bruna Cristina Cardoso Martins
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Pharmacist ◽  
Anatomical Therapeutic Chemical ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Respiratory Intensive Care Unit ◽  
The Impact

ABSTRACT Objective: To describe and evaluate the pharmacotherapeutic follow-up by a clinical pharmacist in an intensive care unit. Methods: A descriptive and cross-sectional study carried out from August to October 2016. The data were collected through a form, and pharmacotherapeutic follow-up conducted by a clinical pharmacist at the respiratory intensive care unit of a tertiary hospital. The problems recorded in the prescriptions were quantified, classified and evaluated according to severity; the recommendations made by the pharmacist were analyzed considering the impact on pharmacotherapy. The medications involved in the problems were classified according to the Anatomical Therapeutic Chemical Classification System. Results: Forty-six patients were followed up and 192 pharmacotherapy-related problems were registered. The most prevalent problems were missing information on the prescription (33.16%), and those with minor severity (37.5%). Of the recommendations made to optimize pharmacotherapy, 92.7% were accepted, particularly those on inclusion of infusion time (16.67%), and dose appropriateness (13.02%), with greater impact on toxicity (53.6%). Antimicrobials, in general, for systemic use were drug class most often related to problems in pharmacotherapy (53%). Conclusion: Pharmacotherapeutic follow-up conducted by a pharmacist in a respiratory intensive care unit was able to detect problems in drug therapy and to make clinically relevant recommendations.

scholarly journals Maternity handover in Kerala: a cross sectional study

2018 ◽  
Vol 5 (9) ◽  
pp. 3760 ◽  
Author(s):  
Aadil Sheikh ◽  
Jessica Dunphy ◽  
Claire Humphries ◽  
Christina MacArthur ◽  
Semira Manaseki-Holland
Keyword(s):  
Healthcare Provider ◽  
Tertiary Care ◽  
Obstetric Care ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Community Health Services ◽  
High Rate ◽  
Sectional Study ◽  
Cross Sectional ◽  
The Impact

Background: The objective of the study was to explore the referral system from the community to hospital obstetric care in Kerala, India.Methods: Cross-sectional study. A total of 206 obstetric inpatients in 3 hospitals in Kerala, India completed an orally-administered questionnaire regarding referral and attitudes towards healthcare information.Results: Among 206 respondents, 19 (9%) had been referred from another healthcare provider.  In multivariate analysis, referral was independently associated with being in a tertiary hospital (p<0.001). At total of 17 referred women received a document containing hand-written notes from their previous healthcare provider. Just 3 of the documents available to view were formal referral documents; others were test results and/or hospital notes. A total of 170 (86%) of the 206 women thought that receiving documents such as referral letters was important; mostly because it helped them understand their condition and explain it to others (91%).Conclusions: A high rate of self-referral (91%) was reported by obstetric inpatients. It appears that some women who are referred do not receive a formal referral document. Participants thought that receiving referral documents was important. A strong health system requires transfer of information between primary and secondary/tertiary care services, which India is seeking to develop. Further research is needed into why women are not accessing community health services and the impact of the content of referral documents on patient care. 

scholarly journals Reducing surgical site infections and mortality among obstetric surgical patients in Tanzania: a pre-evaluation and postevaluation of a multicomponent safe surgery intervention

2021 ◽  
Vol 6 (12) ◽  
pp. e006788
Author(s):  
Edwin Charles Ernest ◽  
Augustino Hellar ◽  
John Varallo ◽  
Leopold Tibyehabwa ◽  
Margaret Mary Bertram ◽  
...  
Keyword(s):  
Surgical Site Infections ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Middle Income ◽  
Surgical Safety ◽  
Safe Surgery ◽  
Low Middle Income Countries ◽  
Utilisation Rate ◽  
Surgical Teams ◽  
The Impact

IntroductionDespite ongoing maternal health interventions, maternal deaths in Tanzania remain high. One of the main causes of maternal mortality includes postoperative infections. Surgical site infection (SSI) rates are higher in low/middle-income countries (LMICs), such as Tanzania, compared with high-income countries. We evaluated the impact of a multicomponent safe surgery intervention in Tanzania, hypothesising it would (1) increase adherence to safety practices, such as the WHO Surgical Safety Checklist (SSC), (2) reduce SSI rates following caesarean section (CS) and (3) reduce CS-related perioperative mortality rates (POMRs).MethodsWe conducted a pre-cross-sectional/post-cross-sectional study design to evaluate WHO SSC utilisation, SSI rates and CS-related POMR before and 18 months after implementation. Our interventions included training of inter-professional surgical teams, promoting use of the WHO SSC and introducing an infection prevention (IP) bundle for all CS patients. We assessed use of WHO SSC and SSI rates through random sampling of 279 individual CS patient files. We reviewed registers and ward round reports to obtain the number of CS performed and CS-related deaths. We compared proportions of individuals with a characteristic of interest during pre-implementation and post implementation using the two-proportion z-test at p≤0.05 using STATA V.15.ResultsThe SSC utilisation rate for CS increased from 3.7% (5 out of 136) to 95.1% (136 out of 143) with p<0.001. Likewise, the proportion of women with SSI after CS reduced from 14% during baseline to 1% (p=0.002). The change in SSI rate after the implementation of the safe surgery interventions is statistically significant (p<0.001). The CS-related POMR decreased by 38.5% (p=0.6) after the implementation of safe surgery interventions.ConclusionOur findings show that our intervention led to improved utilisation of the WHO SSC, reduced SSIs and a drop in CS-related POMR. We recommend replication of the interventions in other LMICs.

Breast surgery on the post-operative well-being of women: a cross-sectional study

2020 ◽  
Author(s):  
Jessica Ranieri ◽  
Fabiana Fiasca ◽  
Federica Guerra ◽  
Antonella Mattei ◽  
Dina Di Giacomo
Keyword(s):  
Breast Reconstruction ◽  
Breast Surgery ◽  
Radical Mastectomy ◽  
Psychological Adaptation ◽  
Well Being ◽  
Cross Sectional Study ◽  
Long Term Effects ◽  
Cross Sectional ◽  
Reconstruction Surgery ◽  
The Impact

Abstract Background. Mammoplasty is the most common surgery that is used for both breast augmentation in healthy women (aesthetic plastic) and breast reconstruction (disease-related plastic) in women who have been diagnosed with and surgically treated for regional breast cancer with radical mastectomy (MRM). When compared to breast reconstruction surgery, aesthetic breast surgery is perceived to result in more favourable aesthetic outcomes.. This study aimed to examine the long-term effects of mammoplasty on the psychological adaptation of women.Methods. A total of 44 30–50-year-old women participated in this study. They were divided into two groups based on the type of breast surgery that they had undergone (augmentation surgery [AS] vs. reconstruction surgery [RS]) and the time that had elapsed since their surgery (≤ 3 years vs. > 3 years). Results. Our findings suggest that the psychological well-being of women who undergo AS declines over time. The women who had undergone AS ≤ 3 and > 3 years earlier did not differ in any of the indicators of emotional functioning. The only exception was their level of satisfaction with their breasts.We examined the impact of mammoplasty on the satisfaction levels and well-being of women who had undergone RS (after MRM). As expected, they were less satisfied with their breasts than those who belonged to the AS group However, this was true only among those who had undergone their surgery ≤ 3 years earlier.Conclusions. In conclusion, our findings underscore the need to provide psychological support to those who have undergone AS and RS. To shorten the adaptation process and enhance their mental well-being, personalised psychological interventions should be provided.

Correlation of Clinical Score and Serum Acetylcholinesterase Level as a Predictor of Outcome among Patients with Acute Organophosphate Poisoning Admitted in Emergency Ward of a Tertiary Hospital

2019 ◽  
Vol 2 (2) ◽  
pp. 19-27
Author(s):  
R Chaudhary ◽  
R Bhandari ◽  
G Malla ◽  
M. Poudel ◽  
M Lamsal
Keyword(s):  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Clinical Score ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Organophosphate Poisoning ◽  
Emergency Ward ◽  
Cross Sectional ◽  
Spearman's Rho ◽  
Spearman’S Rho

Background: Monitoring a patient's serum acetylcholinesterase (AChE) status after clinical score of organophosphate poisoning enables the verification of exposure to anticholinesterase agents. Methods: A cross-sectional study was conducted among the patients fulfilling the inclusion criteria and was categorized according to POP (Peradeniya Organophosphorus Poisoning) score. The study was conducted at a tertiary hospital for one year in the period of Jan 2016 to Dec 2016. POP score was applied and serum acetylcholinesterase level was determined in the lab. Spearman’s rho coefficient method was applied for correlation. Results: Seventy four patients survived in emergency ward who presented within (4.1 ± 2.9; 95% confidence interval [CI], 3.43- 4.80; P= 0.021) hours of ingestion of OP compounds, POP score 3 (Q1, Q3, 2, 4), serum AChE 2221 (Q1, Q3, 768.5, 4703.5) IU/L with 9 ( Q1,Q3, 8.75, 34.75) mg of atropine used, 94% received PAM for 5 (Q1, Q3, 3, 7) days of hospital stay. Four patients died within (7.5 ± 5.4; 95% CI, -1.16- 16.16; P= 0.021) hours of presentation, POP score of 4 (Q1, Q3, 4, 7.75), serum AChE 588 (Q1, Q3, 173, 1912) IU/L, atropine used 170 (Q1, Q3, 152.5, 297) mg, 5.1% received PAM for 3.5 (Q1, Q3, 1, 11.25) days of hospital stay. Spearman’s rho coefficient showed well correlation between POP score and serum AChE level (coefficient -0.356; P= 0.001), POP score for the need of atropine (coefficient= 0.536; P= 0.001). Serum AChE also correlated with the length of hospital stay (coefficient= 0.414; P= 0.001) compared to POP score (coefficient= 0.420; P= 0.001). Conclusions: The higher degree of POP score correlated to higher degree of serum acetylcholinesterase derangement, need for atropine, PAM and length of hospital stay. Thus, it enhances in the prediction of outcome among patients with acute organophosphate poisoning at index visit.

Anxiety and depression during pregnancy in the era of COVID-19

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Rasha E. Khamees ◽  
Omima T. Taha ◽  
Tamer Yehia M. Ali
Keyword(s):  
Pregnant Women ◽  
Depression Scale ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Anxiety And Depression ◽  
P Value ◽  
Cross Sectional ◽  
Kuwait University ◽  
Multiparous Women ◽  
The Impact

Abstract Objectives This study aimed to evaluate anxiety and depression in pregnant women during this global disease. Methods This was a cross-sectional study recruiting 120 pregnant women. The study was conducted at the outpatient clinic of a tertiary hospital. We recruited women attending for antenatal care. Anxiety was evaluated using an Arabic validated Kuwait University Anxiety Scale (KUAS). Depression was evaluated using a validated Arabic form of the Edinburgh Postnatal Depression Scale (EPDS). Results The study included 48 (40%) nulliparous and 72 (60%) multiparous women. The mean KUAS scores for nulliparous and multiparous women were 45.27±10.78 and 47.28±10.62. Both nulliparous and multiparous women had a fairly high possibility of depression. Fifty-three (44.2%) of them reported scores ≥ of 14. Ninety-three (77.5%) women thought that COVID-19 pandemic would affect their pregnancies. There was a significant association between the number of women reporting fear related to the COVID-19 pandemic and their KUAS and EPDS scores (p-value <0.001 each). Conclusions COVID-19 affected the mental health of pregnant women to a great extent. Care should be directed to measures that would decrease the impact of this pandemic on vulnerable populations.

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