Evaluation of Patient Safety Practices in a Hemodialysis Unit: A Cross- Sectional Study at a Tertiary Care Teaching Hospital in India

Inappropriate handling of biomedical waste (BMW) may pose serious threats to the health of patients and hospital personnel. Among all healthcare workers, staff nurses play a vital role in BMW management (BMWM). Thus, the present study aimed to determine the predictors of BMWM practices among staff nurses of a tertiary care teaching hospital in India. A prospective cross-sectional study was conducted among 150 staff nurses, working at a tertiary care teaching hospital in South India, from July to August 2018. Data were collected using a pretested, semi-structured, and self-administered questionnaire after taking their written informed consent. Regression analysis was carried out to identify the predictors of satisfactory BMWM practice status. Of the total 150 staff nurses, most of them were young females with a work experience of ≤ 5 years. Concerning knowledge scores, most staff nurses (63.3%) belonged to the moderate category, whereas a few (24%) were in the high category. Also, most of them (62.7%) were in the high category of attitude scores. For practice scores, half of the participants were in moderate and high categories, each. Female gender, attended training status, and moderate and high knowledge scores were significantly associated with satisfactory BMWM scores in unadjusted analysis. After adjusting for other independent variables, all these three factors were found significantly associated with satisfactory BMWM practice scores. The present study shows that the female gender, attending training in BMWM, and having a moderate and high knowledge of BMWM were significant predictors of satisfactory BMWM practice among staff nurses. Thus, all hospitals must periodically train their staff nurses to strengthen their BMWM practices. Safe BMWM leads to environmental protection and safeguards the health of patients, hospital personnel, and the public.

Surgical antibiotic prophylaxis (SAP) has been a boon in the prevention of surgical site infections (SSIs). This study was conducted to assess and evaluate the selection, timing, and duration of administration of SAP and their compliance withnational and international guidelines in a tertiary care teaching hospital in India. This retrospective study included the data collected from the central records department in a tertiary care teaching hospital on major surgeries conducted between January 1, 2018, and December 31, 2018, from the departments of ENT, general surgery, orthopedic surgery, and obstetrics and gynecology. The data was analyzed for the appropriateness of their indication for SAP administration, choice, timing, and duration of antibiotics, and compliance with the American Society of Health-System Pharmacists (ASHP) and Indian Council of Medical Research (ICMR) guidelines. Results and interpretation Out of the total 394 case records included, only 2.53% (n = 10) of the cases were given an appropriate antibiotic. The duration of SAP was appropriate only in 6.53% (n = 24), and the timing of SAP administration was appropriate only in 50.76% (n = 204). The most commonly used antibiotic was ceftriaxone (pre-operative 58.12% (n = 229) and post-operative 43.14% (n = 170)). Major inappropriateness was observed in the selection of antibiotics which may be attributed to the non-availability of cefazolin in the institute. The inappropriateness of the duration of the SAP may be attributed to the extra precautions taken by the treating physicians to prevent SSIs. The overall compliance of the surgical cases with respect to the ASHP and ICMR guidelines was less than 1%. Conclusion This study identified the lacuna between the guidelines for SAP and the clinical application of the same. It also identified the areas where quality improvement was needed which can be improved by implementing antimicrobial stewardship, especially the choiceand the duration of SAP administration.

Background & objectives:The models for implementation of antibiotic stewardship programme (ASP) in the acute care settings of developing countries are lacking. In most of the hospitals, patient turnover is high and a proper system for recording antibiotic-related information and tracking hospital-acquired infections is not in place. This pilot study was conducted in a tertiary care teaching hospital in north India to assess the feasibility of implementation of an ASP in a Medicine unit and to evaluate the effect of implementation as per the criteria applicable in this set up.Methods:A pre-post-quasi-experimental non-randomized study was conducted in two phases. In the first phase, current practices in the Medicine wards were observed. In the second phase, the ASP was implemented in a single Medicine unit, along with prospective audit and feedback, tracking of the process, as well as outcome measures. Patient risk stratification, blood culture on day one, day 3 bundle, dose optimization, de-escalation and intravenous to oral conversion of antibiotics were the key elements focused upon.Results:There was a significant improvement in the appropriateness of antibiotic prescription (66 vs. 86%, P<0.001) and reduction in the mean number of antibiotics used per person (4.41 vs. 3.86, P<0.05) along with decrease in the duration of hospital stay (17 vs. 14 days, P<0.05). There was a significant improvement in sending of blood cultures on day one during the stewardship phase (P<0.001).Interpretation & conclusions:The ASP approach used in our pilot study may be feasible and beneficial. However, it needs further confirmation in other settings and on a large scale.

Red tape is an idiom that refers to excessive regulation or rigid conformity to formal rules that hinders or prevents action or decision-making. The study has been carried out in cath lab stores of Nizam's Institute of Medical Sciences, a tertiary care teaching hospital in Hyderabad. An empirical study of the data during the period of April 1, 2013 to March 31, 2014 has been done to identify situations which are causing increase in the administrative lead time. Personal interviews were conducted with all the personnel of cath lab stores and surgical stores. Files of purchases were reviewed. The indent date, date of PO and delivery date were noted. The following were observed.

Background: It is crucial for healthcare professionals to know how to report adverse drug reactions (ADRs). To improve reporting rates, it is essential to improve knowledge, attitude and practice (KAP) of healthcare professionals regarding Pharmacovigilance (PV) and adverse drug reactions (ADR) reporting. According to previous studies, there has been a lack of knowledge in nursing students regarding Pharmacovigilance (PV) and reporting of adverse drug reactions (ADR). Hence, this study was planned to assess the impact of educational intervention on nursing students' knowledge, attitude, and practice of pharmacovigilance at a tertiary care teaching hospital in India. Materials and Methods: This was an interventional study conducted among 93 BSc nursing students at a tertiary care teaching hospital, India. Each participant was explained the purpose of study and asked to fill in a questionnaire about their knowledge, attitude and practice of pharmacovigilance. The post-KAP questionnaire was re-circulated among participants at the end of the intervention and data was analyzed using Chi square test. Results: The study involved 93 BSc nursing students aged 21.52 ± 1.11 years, with a male to female ratio of 1:2. All statistical calculations were performed using Graph Pad prism v10.1.0. Results showed significant differences in understanding pharmacovigilance between pre-intervention and post-intervention, and a significant change in attitudes towards pharmacovigilance due to the educational intervention. A statistically greater proportion of students learned about Pharmacovigilance and ADR reporting forms. Conclusion: The Continuing Medical Education (CME) and group discussions significantly enhanced the knowledge and attitude of nursing students regarding pharmacovigilance.

Direct and indirect cost of myasthenia gravis: A prospective study from a tertiary care teaching hospital in India

Background: Appropriate selection of antimicrobial drugs is critical to optimize treatment of infections ad limit the spread of antimicrobial resistance. Antimicrobial resistance is a serious global problem of antimicrobial abuse and there is a growing consensus to urgently develop new strategies for prevention of resistance of bacteria to antimicrobial agents. Relatively few studies of knowledge, attitude and practice are published regarding antimicrobial resistance.Methods: To explore the perceptions of knowledge, attitude and practice of antimicrobial agent use and its resistance in medical professionals in a tertiary teaching care hospital in India. This study was a cross-sectional, questionnaire based study conducted in tertiary care teaching hospital in India for a duration of three months and on a sample size of 300. All medical teachers, residents and interns were included in studies. Questionnaire included 8 questions of knowledge, 10 questions of attitude and 8 questions of practice. The parameters on which the data was analysed were, gender-wise distribution of data, Age-wise distribution of data, hierarchy-wise distribution- Residents, Lecturers, Assistant Professors, Associate Professors, Professors, according to years of experience, Departmental survey. Some questions were assessed by Likert scale, whose responses ranged from always to never. Some questions were of yes and no type, others were multiple choice questions.Results: The majority of respondents were males (65.66%). Most of the participants were from 21-30years (44%) followed by 31-40 years (32.66%). Almost 77.6% participants had upto 5 years of experience in their respective field. Participants had good knowledge, positive attitude and followed a rational and fair practice about antimicrobial stewardship.Conclusions: Adequate training should be given to UGs and PGs about antimicrobial chemotherapy and its usage. It should be part of their curriculum- proper prescribing, dispensing and usage of AMA so as to promote judicious use of AMA.

Background: WHO has declared Coronavirus 2019 (COVID-19) as pandemic on 11th March 2020. Hydroxychloroquine (HCQ) chemoprophylaxis has been approved by the Indian Council of Medical Research (ICMR) for asymptomatic healthcare workers treating suspected or confirmed COVID-19 cases and asymptomatic household contacts of confirmed patients. However, there is a scarcity of data regarding the efficacy and safety of HCQ for COVID-19 prophylaxis and treatment. Objective: The present study was designed to evaluate the adverse drug reaction (ADR) profile of HCQ prophylaxis among healthcare workers in a tertiary care teaching hospital in India. Methods: A Descriptive cross-sectional study was conducted in Kalpana Chawla Medical College and Hospital, Karnal for duration of 3 months (April-June 2020). The study was performed on the reported ADRs due to HCQ prophylaxis by the healthcare workers to the ADR monitoring centre of the institute during this period. Results: Gastrointestinal disturbance such as loose stool (16.4%) and hyperacidity (14.9%) were the most commonly reported ADRs during the study period. The incident rate of adverse drug reactions was 23.7%. The number of ADRs was found to be significantly (p&lt;0.01) more in female as compared to male. We have observed that most of the reactions were reported following the 1st day loading dose. Conclusions: Our results showed that gastrointestinal system was most commonly affected. Loose stool and hyperacidity were most frequently reported ADRs due to HCQ prophylaxis. Larger studies are required to ensure the safety of the use of HCQ as prophylaxis for COVID 19.

Aim The aim of the study is to identify therisk factors and mortality associated with central line-associated bloodstream infection (CLABSI) and to investigate the incidence and associated etiology in trauma patients admitted to the trauma ICU (TICU) of a tertiary care teaching hospital in Northern India. Materials and methods The study was a prospective study conducted in the trauma ICU of a tertiary care teaching hospital in India from November 2020 to October 2022. Adult patients >18 years of age who were on central line for >48 hours were included in the study. The automated blood culture system BacT/ALERT 3D (bioMérieux, Durham, NC) was used for microbial detection from blood samples. We recorded patients' daily progress, and catheter-related data was collected and used as variables. All the data was analyzed using the Statistical Package for Social Sciences (SPSS)version 22.0 (IBM SPSS Statistics, Armonk, NY)to evaluate the risk factors associated with CLABSI. Result A total of516 admissions occurred during the surveillance period, out of which352 patients fulfilled the inclusion criteria and were enrolled in the study. Out of these 352 patients, a total of 74 patients developed central line-associated bloodstream infection (CLABSI). Thus, the incidence of CLABSI was 16.4 per 1000 central line days and 13.2 per 1000 inpatient days with a 0.8 device utilization ratio (DUR). The most common organisms isolated from these CLABSI cases were Acinetobacter species (23%), followed by Escherichia coli(16.5%) and Staphylococcus aureus(15.6%). The independent healthcare-associated risk factors for CLABSI were longer length of ICU stay and prolonged duration of central venous catheterization. The most common comorbidity associated withCLABSI was diabetes mellitus (20.3%), followed by hypertension (14.8%), and the mortality rate was 41.9%. Conclusion The healthcare-associated risk factors such as longer length of ICU stay and prolonged duration of central venous catheterization are the risk factors for developing central line-associated bloodstream infections (BSI).

Background: The quality of life can be improved by enhancing the standards of the medical treatment at all levels of the healthcare delivery system. A medical audit oversees the observance of these standards. Prescription Audit offers the most comprehensive overview of performance, detailing parameter as per the check list of prescription audit. Aim: To monitor, evaluate and suggest modifications (if necessary) in the prescribing practices of medical practitioners. Methods: The observational study was conducted over a period of 6 months and data were collected from 1093 prescriptions collected from outpatient department of a tertiary care teaching hospital in India. Results: Total 1093 prescriptions were evaluated for the Audit, out of which 56.4% were Male & 43.6% were Female cases. Majority of the study subjects belonged to the age group of 40-59 years (32.4%). During the study mainly twelve parameter were assessed according to the checklist provided by the Hospital with total 1093 samples of prescription audit, only 2.2 % (280) cases had the non –compliance, 64.5% (8464) cases had compliance and 33.3% (4372) not applicable to this parameters. Conclusion: The results obtained from the study shows the prevailing prescribing habits at our institution. Many of the prescribing trends from this study are a cause of concern and need attention. This study reveals that the auditing of prescription in terms of rationality, it remains poor. The value of such audits in generating and testing hypotheses on inappropriate prescribing will definitely create an intervention to improve prescribing habits and ultimately patient care will be improved. Keywords: Prescription Auditing, Outpatient department, Tertiary care teaching hospital, Compliance & non-compliance.

Background: Inadequate and inappropriate knowledge of handling of healthcare waste may have serious health consequences. The best BMW management (BMWM) methods aim at avoiding generation of waste or recovering as much as waste as possible, rather than disposing. Adequate knowledge about the health hazard of hospital waste, proper technique and methods of handling the waste, and practice of safety measures is unsatisfactory between health providers. In view of the foregoing, we performed a qualitative study in a tertiary care teaching hospital in India to explore the perceptions of the nursing personnel working in the hospital regarding health care waste management.&#x0D; Aims and Objective: The present study was performed to assessing knowledge, attitude of nursing personnel regarding biomedical waste management.&#x0D; Materials and Methods: A cross sectional observational study conducted at the different indoor wards of tertiary care hospital of Lucknow. The sample for this study were sixty nursing personnel dealing with care of admitted patient and engaged to perform routine medical procedure like blood sampling, intravenous fluid administration, bed sore dressing etc. Quantitative data of subjects recorded were age of the subject, year of experience and training of BMW management. Qualitative data recorded were knowledge related to BMW management, colour of bin regarding waste disposal and practice of waste management guideline during routine medical procedure&#x0D; Results: Majority (75%) of subject were having working experience less than ten year and 21.7% of subject were having working experience between 10 to 20 year. Study results showed that 16.7% of subjects have taken training of BMW management before starting the job and 73.3% of subjects have not taken any training of BMW. Knowledge regarding BMW of study subjects showed that majority (77%) have average knowledge, 21.6% of subjects have good knowledge and rest 6.7% of subjects have poor knowledge of BMW management.&#x0D; Conclusion: The awareness and practices of the BMW management varied among nursing personnel and were not found to be satisfactory. For effective implementation of biomedical waste management practices in the hospitals continuous training program is mandatory to improve their knowledge and practice.&#x0D; Keywords: Bio-medical waste, Nursing personnel, knowledge, Practice

Background: COVID-19 vaccine precaution dose has emerged as an essential tool to control the spread of COVID-19 infections worldwide. The acceptance of vaccines is influenced by various factors such as knowledge, perception of the likelihood of COVID-19 spread, vaccine safety, logistics, vaccine efficacy, and perceived risk. Aim and Objectives: This study aimed to assess knowledge, attitude, and practice of COVID-19 vaccine precaution dose among health-care professionals (HCPs) at a tertiary care teaching hospital. Materials and Methods: A cross-sectional study was conducted among 147 participants using a self-designed, semi-structured, and pre-validated questionnaire circulated through Google Forms to HCPs. Results: The results showed that all the participants were aware of the COVID-19 vaccine precaution dose. However, only 68.49% of the participants had received the dose. The major source of information was the World Health Organization. About 79.4% of the participants were worried about serious unknown long-term effects of the precautionary dose, but the majority were willing to take it without any hesitation. About 14.3% of the participants experienced side effects, with pain at the injection site being the most common. Conclusion: The study demonstrates that participants had a good understanding of the COVID-19 precaution dose, but their attitudes were slightly lesser compared to their knowledge, and also, there was a lot of hesitation with respect to practicing the COVID-19 vaccine precaution dose.

Background & objectives:In this study we describe the epidemiological data, comorbidities, clinical symptoms, severity of illness and early outcome of patients with coronavirus disease 2019 (COVID-19) from a tertiary care teaching hospital in New Delhi, India.Methods:In this preliminary analysis of a prospective observational study, all adult patients admitted to the screening intensive care unit (ICU) of the institute who fulfilled the WHO case definition of COVID-19 and confirmed to have SARS-CoV-2 infection by reverse transcription-polymerase chain reaction were included. Demographics, clinical data and 24 h outcome were assessed.Results:The preliminary analysis of 235 patients revealed that the mean age was 50.7±15.1 yr and 68.1 per cent were male. Fever (68.1%), cough (59.6%) and shortness of breath (71.9%) were the most common presenting symptoms. Hypertension (28.1%) and diabetes mellitus (23.3%) were the most common associated comorbid illnesses. Patients with mild, moderate, severe and critical illness were 18.3, 32.3, 31.1 and 18.3 per cent, respectively, at the time of ICU admission. The proportions (95% confidence interval) of patients requiring any form of oxygen therapy, oxygen therapy by high-flow nasal cannula and invasive mechanical ventilation were 77, 21.7 and 25.5 per cent, respectively, within 24 h of hospital admission. The 24 h ICU mortality was 8.5 per cent, and non-survivors had higher respiratory rate (P<0.01, n=198) and lower baseline oxyhaemoglobin saturation (P<0.001, n=198) at presentation and higher baseline serum lactate (P<0.01, n=122), total leucocyte count (P<0.001, n=186), absolute neutrophil count (P<0.001, n=132), prothrombin time (P<0.05, n=54) and INR (P<0.05, n=54) compared to survivors.Interpretation & conclusions:Nearly half of the patients presented with severe and critical disease and required high-flow nasal oxygen or invasive mechanical ventilation at admission. Severity of the presenting respiratory illness, haematological parameters and lactate rather than age or presence of comorbidity predicted early death within 24 h.

Background: Skin is one of the most common targets of adverse drug reactions (ADRs) The practice of pharmacovigilance all over the world is 5% whereas in India, it is below 1%. Hence, the purpose of our study is to monitor and analyze the suspected cutaneous adverse drug reactions (ACDRs) reported at our tertiary care teaching hospital, to characterize the nature and predictability, severity and preventability of ACDRs and identify most common drugs causing cutaneous ACDRs so that they can be given cautiously and with keen surveillance.Methods: An observational study was conducted in patients attending outpatient and inpatient department for a period of 3 years. All ACDRs of patients were referred by health care professionals and the diagnosis were made by concern doctors. The recorded data was filled in the ADR form obtained from pharmacovigilance program of India (2011) and Central Drug Standard Control Organization (CDSCO) website.Results: Out of 1399 ADR reports analyzed, 564 reports (40.31%) were of ACDRs, female to male ratio was 0.85. Redness (44.32%) was most common symptom, followed by itching (44.14%) and rash (19.14%). Antimicrobials (43.97%), NSAIDS (21.63%), Anti-retroviral therapy drugs (13.65%) were common groups. As per WHO-UMC causality classification, modified Hartwig and Siegel severity scale, Thornton and Schumock preventability scale, ACDRs were probable, mild and possibly preventable respectively.Conclusions: Effective ADR monitoring plays a role in safety of medicines. So, awareness regarding early diagnosis and prompt treatment should be created among the health care professionals and reporting of ACDRs should be regularly practiced by all the departments.

Background: Coronary artery disease (CAD) is characterized by the narrowing or obstruction of coronary arteries, leading to inadequate blood supply to the heart. In India, CAD has become a major public health issue, particularly in the North Eastern Zone. This study aims to illuminate CAD, its causes, and its unique prevalence patterns within India, with a specific focus on the North Eastern Zone. Methods: A cross-sectional study was conducted over a year at a tertiary care teaching hospital in India's North Eastern Zone. A sample of 154 patients with coronary artery disease was selected through structured questionnaires, clinical examinations, vital signs assessments, and 12-lead ECGs. Data analysis was done with proper equipment. Results: The study revealed an overall CAD prevalence of 4.24% among 2468 patients attending the Medicine OPD. Males had a higher prevalence across age groups, except for the 20-30-year-olds, where no females participated. Urban areas exhibited a significantly higher CAD prevalence (68.83%) compared to rural areas (31.17%). Statistically significant gender differences were observed in several risk factors, with males more likely to exhibit hypertension, hyperlipidemia, diabetes mellitus, obesity, smoking, and ischemic heart disease. Urban residents also showed a higher prevalence of various CAD risk factors compared to rural residents, except for alcohol consumption, which was more common in rural areas. Conclusions: The findings corroborate existing literature, highlighting gender disparities and urban-rural differences in CAD prevalence and risk factors. This study contributes valuable insights into CAD epidemiology in India, particularly in the North Eastern Zone.