Main Wards Research Articles

P-772 Assisted reproductive technology and the risk of minor congenital heart defects in the newborn

Abstract Study question Are children conceived through assisted reproductive technology (ART) at higher risk of minor congenital heart defects (CHD) compared with naturally conceived (NC) children? Summary answer Contrary to previous studies children conceived through ART had similar risk of minor CHDs compared with children conceived naturally. What is known already Congenital heart defects (CHD) may precipitate cardiac arrhythmias, lead to thromboembolic events, culminate in heart failure or even sudden cardiac demise. A systematic review and meta-analysis showed an elevated odds ratio (OR) for diagnosis of any CHD among children conceived through in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) compared with NC children. Other studies indicate that ART is associated with an increased arterial blood pressure and vascular dysfunction in the pulmonary and systemic arterial vasculature. This association persists throughout childhood, adolescence, and early adulthood in individuals conceived through ART; this indicates a lasting impact on the cardiovascular circulatory system. Study design, size, duration The present study is a sub-study to the Copenhagen Baby Heart Study (CBHS), a prospective population-based cohort study of > 25 000 children born in the three main maternity wards in Copenhagen, Denmark, in 2016–2018. Transthoracic echocardiography (TTE) was performed on all children within 60 days of delivery and diagnosis of CHD was reviewed by a specialist in paediatric cardiology. Information regarding parental health, pregnancy, delivery, and the newborn was collected through Danish patient registries. Participants/materials, setting, methods This study includes all children conceived by ART in the CBHS (n = 1 784), and a matched group (1:4 by maternal age at birth) of NC children (n = 7 141). Exclusion criteria were genetic or chromosomal syndromes and heart surgery. Minor CHD was defined as an atrial (ASD) or ventricular septum defects (VSD), bicuspid aortic valve, coarctation of the aorta, pulmonary stenosis, or patent ductus arteriosus. We calculated ORs using logistic regression analyses. Main results and the role of chance The mean maternal age at birth was 34.9 (standard deviation [SD] ±4.4) and 35.1 years (SD ± 4.6) and the newborn mean age at TTE was 12.1 (SD ± 9.3) and 12.2 days (SD ± 9.4) in the ART and NC population, respectively. Parental CHD was registered in 40 (2.2 %) children in the ART group and 121 (1.7 %) in the NC group. Overall, 165 (9.2%) children conceived by ART and 611 (8.6%) NC children were diagnosed with a minor CHD. The most prevalent CHDs were VSD and ASD which accounted for 38.8 % and 35.2 % in children with CHD in the ART group, respectively, and 36.8 % and 33.9 % in children with CHD in the NC group. The unadjusted OR for minor CHD was 1.09 (95% CI 0.91–1.30). Adjustments for maternal age and parental CHD did not change the OR. There were no differences in ORs when stratifying by minor CHD type. We stratified by the method of ART: ICSI and IVF and frozen embryo transfer and fresh embryo transfer, and calculated risk of minor CHD comparing the methods and with NC children. We found no difference in any ORs, crude or adjusted. Limitations, reasons for caution Children born preterm, and children with severe minor and major CHDs, were underrepresented in the cohort indicating parents of such children chose not to participate in a research project that would include another hospital visit. Residual confounding is plausible because parental CHD diagnoses were retrieved from patient registries. Wider implications of the findings The number of children conceived through ART is increasing each year and previous research have found an increased risk of CHD in children conceived through ART. Our findings indicate no increased risk of minor CHD, providing comforting and significant information for advising individuals considering or undergoing ART treatment. Trial registration number NCT02753348

A pragmatic randomised controlled non-inferiority trial of open-door policy versus treatment as usual in urban psychiatric inpatient wards

IntroductionOpen-door policy (ODP) is an approach to reduce coercion in psychiatric wards recommended by the World Health Organization and the Council of Europe. Observational studies from Switzerland and Germany have shown promising results in reducing coercion, but no RCTs have been conducted. Skeptics have been concerned the observational evidence could mask that ODP could increase risks and harms and / or increase the use of coercive measures staff use to assist patients with psychoses, while proponents have argued that de-escalation and alliance-building will result in no such increase.ObjectivesTo evaluate open-door policy in an openly randomised, ethical-board approved trial of all patients referred to ward care at the Lovisenberg Diaconal Hospital in Oslo, Norway.MethodsA 12-month pragmatic, randomised-controlled non-inferiority trial comparing two ODP and three TAU acute psychiatric wards. The trial was pre-registered (ISRCTN16876467) and conformed to CONSORT. Ethical committee exemption enabled waiver of consent rules for the study, meaning all regular patients were included. Patients were randomly assigned (2:3 ratio) by a clinical admissions team using an open list. The non-inferiority margin was 15 % on the primary outcome: the proportion of patient stays with one or more coercive measures, including involuntary medication, isolation/seclusion, and physical and mechanical restraints. Primary and safety analyses were based on intention-to-treat. Safety analyses included suicides and violent events against staff. Secondary outcomes were individual coercive measures, intensive care, resource use, and patient feedback.ResultsN=556 patients were included and randomised and were similar on all pre-admission demographics: Around 75% of patients were diagnosed with a psychotic disorder and were involuntarily admitted. Primary outcome: Use of coercive measures was within the non-inferiority margin (see table 1). Safety outcomes: No suicides occurred during ward care in any group. Violence against staff did not differ between study wards. Secondary outcomes: Use of intensive care (‘skjerming’) and number of days admitted was significantly less on open-door policy wards. Patients on open-door policy wards rated their experience of coercion and ward atmosphere better than patients on control wards.Table 1.Absolute and relative risk of being subjected to coercion on open-door policy or usual-treatment wards.Number (%) Main outcome Absolute Risk ODP wards (n=245) Absolute Risk TAU wards (n=311) Relative Risk (95% CI) Risk Difference (95% CI) Primary hypothesis confirmedOne or more coercive measures during the admission65 (26.5%)104 (33.4%)1.3 (0.97 to 1.6)6.9% (-0.7 to 14.5)YesConclusionsThis first RCT found open-door policy does not increase use of coercion or resource use. It does not harm staff or patients and is experienced as better by patients.Disclosure of InterestNone Declared

#58: Identification of the most frequent mistakes in the prescription of antibiotics using the “Time-out” strategy, in a pediatric hospital in Mexico City.

Abstract Background In 2019, the CDC estimated that each year more 2.8 million antibiotic resistant infections ocurr in the United States and more than 35,000 pepole die a a result.Usually in pediatrics, antibiotics are the most prescribed, reviews have demonstrated that 37 to 61% of hospitalized infants and children receive antibiotics and 20 to 50% of these prescriptions are unnecessary either the dosage or duration are incorrect. Antibiotic resistance is an increasing worldwide problem. Effective antimicrobial stewardship programs has been demostrated reduce the inappropriate use and optimizing antimicrobial selection, dosing, route, and duration of terapy, limiting the consequences such adverse drug, resistance and cost.4 The antibiotic time-out consists in reassessment of the continuing need and choise of aantibiotics when the clinical picture is clearer and we have more diagnostic information. Currently, in our institution there is no established stewardship program and the costs attributable to antimicrobial use have been estimated at 1.6 million dollars. The goal of this project was to identify the most common prescription mistakes using the “Time-out” strategy because of its structured applicability and simplified revision that guides antimicrobial use. Methods From May to October 2020, we carried out a time out evaluation for different antimicrobial prescriptions in the five main wards of the INP; it consisted of data collection through a mobile application where the prescriptions were documented and evaluated. We answered three questions: 1) Based on the patient′s clinical course and diagnostic test, is the use of these antibiotics justified? 2)Is the dose, interval and route of administration correct? 3) What is the estimated duration of treatment? An infectious disease specialist evaluated the antimicrobial prescriptions daily and, if necessary, modified or adjusted it during rounds. Our evaluation was carried out between 24 and 72 hours of treatment initiation. Results For a 6 month period, 196 antimicrobial prescriptions were evaluated through the time-out strategy. Of them, 48% were from de group of cephalosporins followed by the glycopeptides (16%) and carbapenems (14.3%). In 23% of cases they were not medically justified and 53% of them required either discontinuation, narrowing of broadening of spectrum. The prevalence of antibiotic prescription errors was 23%. In 30% of cases it was a dose per kg of body weight error, 61% total dose per day and 9% in duration of treatment. Of note, there were 26% of these prescriptions were instances where the antimicrobials were not prescribed by a pediatric infectious disease specialist where 67% was not found to be justified upon evaluation and 72% required discontinuation. Conclusions The implementation of an antimicrobial control program made it possible to identify the most common mistakes in antibiotic prescription in our hospital, confirming the relevance of these programs to reduce the inappropriate use of antimicrobial prescriptions, limiting the consequences such adverse effects drug, antimicrobial resistance and healthcare cost.

Validity and Reliability of the Persian Translation of Dutch Residency Educational Climate Test and Analysis of Residents’ Learning Climate in Four Major Departments of Shiraz Medical School

Background: As one of the most important components of curriculums, the educational environment provides learners with a forum in which they can learn communication skills and other abilities such as critical thinking and clinical problem-solving. To improve this environment and consequently upgrade medical education, the current environment must be evaluated. Objectives: In a quest to adapt a valid and reliable instrument for this purpose, this study aimed to assess the reliability and validity of the Persian translation of Dutch Residency Educational Climate test (D-RECT) to measure the quality of the educational environment in the main clinical wards of Shiraz University of Medical Sciences. Methods: In a cross-sectional study, a forward Persian translation of the D-RECT questionnaire was translated and back-translated by two bilingual expert panels, and its reliability was determined in a pilot study. Then, 100 residents working at internal medicine, surgery, pediatrics, and gynecology wards were selected randomly to fill out the questionnaire. Data were analyzed using SPSS version 21 software. Results: The Persian translation of D-RECT had acceptable validity, reliability, internal consistency, and reproducibility. The reliability of the questionnaire was confirmed by Cronbach’s α of 0.95. Convergent validity was 0.61 to 0.90. Among the wards evaluated in this study, the educational environment was significantly better in the pediatric ward than in the other wards. Conclusions: The Persian translation of D-RECT validated in the studied departments seems to be an effective, valid, and reliable instrument for evaluating and comparing the quality of the current educational environment for residents in Iran. This evaluation can help improve training.

Clinical phenotypes of acute heart failure based on signs and symptoms of perfusion and congestion at emergency department presentation and their relationship with patient management and outcomes.

To compare the clinical characteristics and outcomes of patients with acute heart failure (AHF) according to clinical profiles based on congestion and perfusion determined in the emergency department (ED). Overall, 11 261 unselected AHF patients from 41 Spanish EDs were classified according to perfusion (normoperfusion=warm; hypoperfusion=cold) and congestion (not=dry; yes=wet). Baseline and decompensation characteristics were recorded as were the main wards to which patients were admitted. The primary outcome was 1-year all-cause mortality; secondary outcomes were need for hospitalisation during the index AHF event, in-hospital all-cause mortality, prolonged hospitalisation, 7-day post-discharge ED revisit for AHF and 30-day post-discharge rehospitalisation for AHF. A total of 8558 patients (76.0%) were warm + wet, 1929 (17.1%) cold + wet, 675 (6.0%) warm + dry, and 99 (0.9%) cold + dry; hypoperfused (cold) patients were more frequently admitted to intensive care units and geriatrics departments, and warm + wet patients were discharged home without admission. The four phenotypes differed in most of the baseline and decompensation characteristics. The 1-year mortality was 30.8%, and compared to warm + dry, the adjusted hazard ratios were significantly increased for cold + wet (1.660; 95% confidence interval 1.400-1.968) and cold + dry (1.672; 95% confidence interval 1.189-2.351). Hypoperfused (cold) phenotypes also showed higher rates of index episode hospitalisation and in-hospital mortality, while congestive (wet) phenotypes had a higher risk of prolonged hospitalisation but decreased risk of rehospitalisation. No differences were observed among phenotypes in ED revisit risk. Bedside clinical evaluation of congestion and perfusion of AHF patients upon ED arrival and classification according to phenotypic profiles proposed by the latest European Society of Cardiology guidelines provide useful complementary information and help to rapidly predict patient outcomes shortly after ED patient arrival.

Big-data analysis for carbon emission reduction from cars: Towards walkable green smart community

To achieve low carbon cities or green smart city, it is very important to foresee how we can reduce the number of cars in the residential communities without losing convenience and comfort of people. For that purpose, walkability is one of the key performance indicators expressing the environmental quality of a district. As the first step for creating a low-carbon smart community, this study attempts to evaluate the influence of walkability on traffic behavior of people by using mobile GPS data. Specifically, we statistically analyze the relationship between various walkability indices (centrality, betweenness, angularity, etc.) evaluated by road network data, and pedestrian movement estimated by mobile GPS data in the six main wards in Tokyo, Japan. The result suggests the usefulness of our approach for low-carbon smart community design rousing people’s walking activity. The walkability results and data are then compared to the results of a macrosimulation traffic model for the Sumida Ward of Tokyo to understand the impact that walkability may have on emissions if built environment conditions are improved in favor of a lesser automobile mode share.

Hospital Stay in Nosocomial Infections

A 9 month prospective study on nosocomial infections was held from August 1988 till April 1989 at the Department of Child Health, Medical School, Padjadjaran University, Hasan Sadikin Hospital Bandung. The purpose of the study was to compare the duration of hospitalization in patients with and without nosocomial infections. The Department of Child Health has 4 main wards, A2 (for low sosioeconomic families), A3 (for middle and high socioeconomic families), R-17 (for neonates) anda NICU. There were 4328 hospitalized pediatrica patients observed consisting of 293 children (29 9%) in A2, 485 (11.2%) in A3, 2487 (57.5%) in R-17, and 41 episodes in NICU, showing rates of 9.9% in A2, 4.5% in A3, 8.8% in R-17 and 65.1% in NICU. The means hospital stay of patients with nosocomial infecitons were 26.77 and 22.44 days in A2 and NICU, while in A3 and R-17 17.61 and 6.75 days. The means hospital stay of patients without nosocomial infecitons were 13.11 and 9.24 days in A2 and NICU, and 1 0.48 and 3.10 days In A3 and R-1 7. Length of stay specific nosocomial infeciton rate rose with the duration of hospitalization, with 3 2% of patients staying upt to 6 days, 16.7% of patients staying 7-13 days, 19.7% of patients staying 14 to 20 days, and 48,8% of patients staying 35 days or more. It can be concluded that the longer the length of stay, the higher the number of nosocomial infections. The overall mean hospital stay of patients with nosocomial infection was 2.4 times higher than that without nosocomial infection.

Quitting Breastfeeding Very Early after Caesarean Section-A Worrying Trend in Babylon Province

A cross-sectional study was conducted in Al-Hilla City, Babylon Province, Iraq, of 300 women who gave birth via Cesarean section at the two main maternity surgical wards in the city from a period from 1st of December 2017 to 15th of March, 2018.
 The mothers came from mixed urban and rural backgrounds. Socio-demographic and obstetric data were recorded. Neonatal data were extracted from the medical records of the labor and neonatal care wards. The study included mothers of all ages, one fifth (23%) of whom were teenagers and minors marrying at a very young age (31%). Unfortunately (64%) had poor or negative attitudes to breastfeeding. Lack of motivation and self-confidence are also major reasons for very early cessation of breastfeeding. This study cited that the Cesarean section per se is a major cause of quitting natural feeding. The patients were influenced by advice from not only close relatives but also doctors and health personnel after the Caesarean section.

Prevalence of Medication Errors in Admitted Patients at the Philippine General Hospital

Background. Medication errors are preventable events that can cause or lead to inappropriate drug use. Knowing the prevalence and types of errors can help us institute corrective measures and avoid adverse drug events. Objective. This study determined the prevalence of medication errors and its specific types in the four main service wards of a tertiary government training medical center. Methods. This is a retrospective, descriptive chart review study. From the master list of admissions, systematic sampling was done to retrieve the required number of charts. Relevant pages such as order sheets, nurses’ notes, therapeutic sheets were photographed. For prolonged admissions, only the first 7 days were reviewed. Each chart was evaluated by two people who then met and agreed on the errors identified. Results. The overall prevalence of medication errors is 97.8%. Pediatrics had the most (63.3/chart), followed by Medicine, OBGynecology, and Surgery (7.3/chart). The most common type of errors identified were prescribing, followed by compliance, then administration errors. Conclusion. Medication errors are present in the four main wards in our hospital. We recommend orientation of all incoming first year residents on proper ordering and prescribing of drugs, as well as a prospective observational study to determine true prevalence of all types of medication errors.

Morning Report in Main Wards of Teaching Hospitals: an Evaluation Report

Background and purpose: Morning Report is a traditional ritual in medical education programs; it includes a diverse group of teachers and learners with heterogeneous learning goals. We performed a cross-sectional survey of residents, medical students and staffs using a convenience sample. Methods: A 33-item survey was developed with the assistance of a pilot study and two focus groups. Our participants were from four different educational wards including Surgery, Internal Medicine, Pediatrics and Obstetrics & Gynecology. Results: 78% of the respondents stated that morning report sessions motivated them for self-directed learning and 70.3% of respondents stated that the format of morning report is good. 57.6% of respondents stated that discussed cases in the morning report are varied, 80% of the respondents experienced lack of appropriate feedback. 56.8% of the respondents stated discussion about the case results in better management of the patient, 39% stated that morning report results in resolving diagnosis problems. 50% of the respondents stated that there are enough communions between attending physician and student. There was not any significant difference between answers of residents, medical students and faculty members. We found considerable non-performance in attends (?) performance in running morning report sessions. Conclusions: Defining the roles of attends in optimizing learning, such as more attention towards developing problem solving and critical thinking skills and convergence between the attitudes and motivations of the learners and the teachers is strongly recommended. Keywords: MORNING REPORT, SURVEY, EDUCATION

Comparison of Medical Students’ and Teachers’ Perception about Clinical Educational Environment in Educational Hospital Wards

Background: Clinical training has an important section in medical students’ education. Creating a favorable learning environment plays an essential role in medical education. Since clinical teachers involve to clinical problem, clinical education environment evaluation can help to identify the negative and positive factors. This study was conducted to compare medical students’ and residents' perceptions and their teachers of the hospitals educational environment using the Dundee Ready Education Environment Measure (DREEM). Methods: This descriptive, analysis cross-sectional study was conducted in Kerman University of Medical Science, 2012. Using DREEM investigate the educational atmosphere four main clinical wards (Internal, Surgery, Pediatrics and Gynecology) in the educational hospitals of University. DREEM distributed to 230 participants, included 50 clinical teachers, 88 residents and 92 interns. Statistical analysis was done using SPSS 18. We were carried out Anova test to comparison means items. Results: The overall DREEM is 161/200for interns, 157/200 for residents and 123/140 for teachers. Generally tend to positive. There were significant difference in Learning domain (P<0.000) and atmosphere (P<0.000). There was no significant difference in teacher performance domain (0.127). Conclusions: DREEM scores are on the top of scoring except the perception of teachers in domain of learning that it can be causing of satisfies of their performance in learning environment. Participants assessed the educational environment as high level. Regarding the Perception of learning, teachers' performance, and learning atmosphere was viewed positively. So, it’s better to keep quality in high level in clinical wards.

Pollution levels and characteristics of phthalate esters in indoor air in hospitals

The concentrations of phthalate esters (PAEs) in Chinese hospitals were investigated by simultaneously determining concentrations of gas- and particle-phase PAEs. PAEs were detected in two third-class first-grade hospitals, two second-class first-grade hospitals, and a community health service center. Hospital drugstores had the highest concentration (24.19μg/m3), which was 1.54 times that of newly decorated houses. The second highest concentration was found in the transfusion rooms, averaging 21.89μg/m3; this was followed by the concentrations of PAEs in the nurse's workstations, the wards, and the doctor's offices, with mean concentrations of 20.66, 20.0, and 16.92μg/m3, respectively. The lowest concentrations were found in the hallways (16.30μg/m3). Of the six different kinds of PAEs found, major pollutants included diethyl phthalates, dibutyl phthalates, butylbenzyl phthalates and di(2-ethylhexyl) phthalates, comprising more than 80% of all PAEs present. Meanwhile, a comparison between different wards showed that PAE concentrations in the maternity wards were 1.63 times higher than in the main wards. Based on known health hazards, our results suggest that the PAEs seriously influence the health of the pregnant women and babies; therefore, it is of great importance to take the phthalate concentrations in hospitals into consideration. In addition, hospital indoor air was more seriously contaminated than the air of newly decorated houses.

Molecular surveillance of candidemia due to Candida albicans among cancer patients during 2009 to 2013 by microsatellite typing

BackgroundSince the high morbidity and mortality of candidemia among cancer patients, the epidemiology has been underlined. In recent years, Candida species genotyping has been established, which could provide detail characteristics of epidemiology and has been underscored for candidemia preventing strategies. MethodsData of cancer patients with candidemia and hospitalized in Tianjin Medical University Cancer Institute and Hospital (TMUCIH) during 2009–2013 were reviewed. Species identification was carried out by using VITEK-2 Compact. Microsatellite typing was performed for molecular analysis. SPSS 20.0 and MVSP 3.22 software were used for statistical and clustering analysis, respectively. ResultsTotal of 36 isolates of Candida albicans were recovered from 36 cancer patients with nosocomial candidemia in TMUCIH during the period of 2009–2013 included in the study. Total of 17 genotypes were identified and 2 of them were endemic genotypes, which caused 21 (58.3%) of 36 episodes of candidemia. Hepatobiliary oncology, ICU and gastrointestinal oncology were the main wards of infections due to endemic strains. Gastrointestinal cancer and insertion of a nasogastric tube were the predictors of infections caused by endemic strains (p = 0.014 and p = 0.041, respectively). For the 36 cases, crude mortality was up to 30.6%, and there was no significant difference between infections due to endemic and non-endemic strains (p = 0.077). ConclusionsThis study proved that endemic stains of C. albicans could exist for a long period and mainly in a few wards. Patients with gastrointestinal cancer or nasogastric tube insertion were more sensitive to endemic C. albicans.

Pattern and outcome of paediatric medical admissions at the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu: a five year retrospective review (2007 – 2011)

Background : Most health information from Nigeria and other developing countries are based on hospital records which although may not be a true representative of the whole population, they serve as pointers. Such information has shown that infections and malnutrition remain the leading causes of morbidity and mortality , although non-communicable diseases also pose substantial threat to child health. Objective : To review the pattern, trend and outcome of paediatric admissions at the University of Nigeria Teaching Hospital over a five year period. Methods : Patients admitted into the main pediatric wards of the hospital over a five year period were reviewed, through information obtained from their case notes. Neonates, surgical and trauma patients as well as patients admitted into the children’s emergency room were excluded. Results : Infections (44.5%) were the leading causes of hospital admissions while non-communicable diseases were the leading causes of death in this study with an overall mortality rate of 9%. Conclusion : Despite all efforts over the years, infections continue to pose serious challenges to child health in developing countries. At the same time, non-communicable diseases are taking over as leading causes of mortality. Therefore, as we make stronger efforts to tackle infections and malnutrition, we should make provisions for improved diagnosis and management of non-communicable diseases. Key words : Outcome, Paediatric, medical admissions, Enugu.

Cold and heat impact on human comfort in the Bahía Blanca Estuary Harbours (Argentina)

The aim of the present work was to study the human comfort at working hours related to the number of persons attended in the main hospital wards in two harbours located on the north coast of the Bahía Blanca estuary. For this purpose, the wind chill and humidex indexes were calculated and compared. Ingeniero White harbour is situated at the head of the estuary while Rosales port is located at its mouth. Meteorological data from both harbours was measured during the period 1999-2001. The results show that wind chill index is an average 2.9º C below the actual mean temperature in winter (9.5ºC). The humidex is 3º C above the actual mean temperature in summer (23.9ºC). The greatest discomfort is experienced from noon to night during this season. No significant thermal differences were observed between the inner and outer region of the Bahía Blanca estuary. However, enough evidence has been found to prove that the winter and summer indexes may be related to workers' health.

OHP-072 Study of Use of Colistin in a Serbian Clinical Centre

BackgroundColistin (polymyxin E) is a mixture of cyclic polypeptides colistin A and B and it remains one of the last-resort antibiotics for multidrug resistant species of Pseudomonas and Acinetobacter. The...

Comparative Study of Antibacterial Susceptibility Patterns of the Bacteria Isolated from Patients' Blood Samples over Two Periods

Problem statement: Due to continuous changes in the frequencies and antibacterial susceptibility patterns of nosocomial pathogens, periodical surveillance of these fluctuations could help the clinicians to treat hospitalized patients more efficiently whenever empirical therapies need to be considered. This study was conducted to compare the prevalence of the bacteria recovered from bloodstream samples by Bactec 9240, over the two periods of 2001-2004 and 2005-2008 and to evaluate their antibacterial susceptibility patterns. Approach: Totally, 3622 culture positive blood samples were analyzed over the periods. Antibacterial susceptibility patterns of the isolates were determined by standard disk diffusion (Kirby-Bauer) method. The data were compared in terms of quantity and quality of the pathogens and based on their distributions in three main wards. Results: Changes were observed in bacterial composition and frequencies of them, between the two periods. Compared with the first pried, increased frequencies of antibiotic resistant bacteria such as S. aureus, enterococci, acintobacter and pseudomonas were noticed in the second period. Most patients were admitted to pediatrics, followed by adults and neonates wards. Increased antibiotic resistance of the majority of the bacteria in the second period indicates the decreased efficacy of corresponding antibiotics. However, overall efficacy of some antibiotics such as ciprofloxacin and amikacin against Gram positive bacteria preserved. Conclusion: Trend of composition of the bacteria from first to second period could suggest the domination of antibiotic resistant bacteria over the sensitive ones. Appropriate strategies including strict control measures and rational prescription of the effective antibiotics may retard the trend accordingly. Vancomycin and imipenem were the most active antibiotics against Gram positive and negative bacteria. Combination of these two antibiotics is highly recommended for empirical therapy.

Adverse drug reactions causing admission to a paediatric hospital: a pilot study

It is known that adverse drug reactions (ADRs) cause admission to hospital in adults and children. A recent adult study showed that ADRs are an important and frequent cause of hospital admission. The objective of this study is to develop methodology to ascertain the current burden of ADRs through a prospective analysis of all unplanned admissions to a paediatric hospital. Prospective observational study over a 2-week period. There were 19 admissions to the main hospital wards related to an ADR, giving an estimated incidence of 4%, with the ADR directly leading to the admission in 71% of cases. There were no deaths attributable to ADR. 33% of the reactions were possibly avoidable. The drugs most commonly implicated in causing admissions were anti-neoplastic agents. The most common reactions were neutropenia, vomiting and diarrhoea. The health burden of ADRs in the paediatric population is likely to be significant. This pilot study will be used to inform a much larger prospective study providing more detailed evidence of the burden of ill-health from ADRs in children. This larger study will add to a body of research aiming to identify drug-related problems within children to aid paediatric pharmacovigilance. This study provides knowledge regarding the methodology to be used for a larger study investigating ADRs in children. The study will allow authors who wish to replicate the study in their own populations (internationally) to avoid some of the pitfalls in planning a large epidemiological study of paediatric ADRs. The study also provides an estimate of the incidence and problem of admissions caused by ADRs in a UK paediatric population.

Assessing Hand Hygiene Resources and Practices at a Large African Teaching Hospital

To gather baseline data on hand hygiene (HH) practices in an African hospital with a newly established infection prevention and control team. Cross-sectional, observational study. Setting. Komfo Anokye Teaching Hospital, a large teaching hospital in Ghana with approximately 1,000 beds. All hospital staff with patient contact were eligible for assessment of HH practices. HH observations were conducted using a standardized data collection tool and method based on the World Health Organization's "5 Moments of Hand Hygiene." Small-group interviews were conducted to gather additional information on perceptions of HH and barriers to its use. HH resource needs were also assessed using a standardized tool. HH was attempted in 12% of the opportunities and was performed appropriately in 4% of the opportunities. Most main wards (89%) had at least 1 functional HH station. The most commonly identified barriers to HH were limited resources and lack of knowledge on appropriate times to perform HH. We developed and applied tools to evaluate HH resources and practices in a large African hospital. These assessments were undertaken to guide future efforts to improve HH at this hospital but can also serve as a model of the way to perform a systematic assessment at acute care hospitals in developing countries.

Epidemiology and Antibacterial Susceptibility Patterns of Bloodstream Infections, 2001-2004: An Experience with BACTEC 9240 in Southern Iran

This study was conducted to determine the prevalence of bacteria recovered from bloodstream samples by Bactec 9240 at our hospital wards and to evaluate their antibacterial susceptibility patterns. During January 2001 through December 2004, 9407 referred blood samples in Bactec bottles from admitted patients at three main wards, neonates, pediatrics and adults at Nemazee Hospital, affiliated to Shiraz University of Medical Sciences in Shiraz were processed. Positive cultures were purified and identified according to standard methods. Sensitivity of bacteria to different antibiotics was determined by Kirby-Bauer disk diffusion method. Staphylococcus aureus 132(25%), Escherichia coli 64(12.1%) and Pseudomonas aeruginosa 52(9.8%) were the most pathogenic bacteria which were recovered from the blood samples. Pathogenic microorganisms were isolated from blood samples of 305 (57.8%) at pediatrics, from 181 (34.2%) at adults and from 42 (8%) at neonates wards. The highest antibiotics activities against gram positive isolates observed for vancomycin (98.4%), chloramphenicol (86.4%) and ciprofloxacin (77.4%), while in gram negative bacteria imipenem (96.1%), ciprofloxacin (83%) and amikacin (77.9%), were effective antibiotics. Frequency of isolated bacteria at pediatrics compared to adults and neonates wards were approximately two and seven folds high, respectively which indicates special attention should be paid to pediatrics patients both in prevention and treatment aspects. Vancomycin and imipenim are the effective antibiotics and could cover majority of gram positive and negative bacteria. Therefore, combined administrations of these antibiotics seems mandatory for empirical therapy.