Secondary Healthcare Hospitals Research Articles

ISOLATION AND CHARACTERIZATION OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS IN SELECTED HOSPITALS OF DUTSE METROPOLIS, JIGAWA STATE, NIGERIA

The purpose of this study was to examine the equipment used in five hospitals located in Jigawa state. Finding Methicillin-Resistant Staphylococcus aureus (MRSA) on hospital equipment in a few Dutse metropolitan hospitals was the main goal. Three hundred and fifty hospital instruments in all were swabbed and then examined. Tests for antibiotic susceptibility were conducted after S. aureus was isolated and identified. The isolates were most effectively treated by gentamicin and ciprofloxacin, according to the results. Primary healthcare facilities contained 31 S. aureus isolates and 16.67% MRSA isolates, whereas secondary healthcare hospitals had 48 S. aureus isolates and 55.56% MRSA isolates. There were 25 S. aureus isolates and 27.78% MRSA isolates from tertiary healthcare facilities. The mecA and blaZ genes' polymerase chain reaction (PCR) analyses revealed amplicons of 336 bp and 400 bp, respectively, which were in line with control samples. Six of the 11 isolates that were tested tested positive for mecA, suggesting resistance to methicillin, and nine tested positive for blaZ, indicating the synthesis of B-lactamase. In conclusion, patients, medical staff, and the general public are seriously threatened by the MRSA infection that exists in these facilities.

Prevalence of Antibiotic Use in Hospitalized COVID-19 Patients: An Observational Study in Secondary Healthcare Hospitals in Kosovo

INTRODUCTION: Globally, the high use of antibiotics among hospitalized patients diagnosed with COVID-19 has been reported despite evidence that bacterial coinfections are uncommon. This issue raised our concerns, as there was a report on high frequency of antibiotic resistant bacterial infections in COVID-19 patients admitted to the intensive care unit. Thus, we conducted a study to determine the prevalence of antibiotic use for hospitalized acute COVID-19 infection in secondary healthcare hospitals in Kosovo. MATERIALS AND METHODS: A cross sectional study was conducted among patients with acute COVID-19 admitted to secondary healthcare hospitals in Kosovo. A modified Infectious Diseases International Research Initiative (ID-IRI) questionnaire was used to collect information in 460 COVID-19 PCR positive patients. RESULTS: All studied patients (100%) were treated with antibiotics. An empirical antibiotics were used to cover Methicillin-resistant Staphylococcus aureus (MRSA) infections in 136 cases (29.6%), methicillin-susceptible Staphylococcus aureus (MSSA) infections in 86 cases (18.7%), atypical pathogen in 174 cases (37.8%), and Pseudomonas infections in 48 cases (10.4%). The most frequently used antibiotics were ceftriaxone/cefotaxime plus macrolide (149 cases; 31%), ceftriaxone/cefotaxime plus quinolone (85 cases; 17.7%), and co-amoxiclav plus fluoroquinolone (78 cases; 16.3%). Imipenem was most frequently used in the ICU (64 cases; 13.3%). CONCLUSION: Despite the antibiotic guidelines clearly stated that antibiotics should only be used in confirmed case of secondary bacterial infections including the COVID-19 patients, our study revealed that the overused of antibiotics remained unchanged. As the misused and overused of antibacterial has been shown to accelerate the emergence and spread of antibacterial resistant, the inappropriate practice should be changed.

CLINICAL PROFILE OF CHILDREN REFRACTIVE ERRORS IN A SECONDARY HEALTH CARE HOSPITAL OF BEKASI WEST JAVA

Abstract
 Introduction & Objectives : The aim of this study was to study the pattern of refractive errors and its association among children visited Hermina Hospital Bekasi.
 Methods : A hospital based retrospective review was conducted on children visiting Ophthalmology Outpatient Clinic of Hermina Hospital Bekasi from October 2022 to February 2023.
 Results : A total of 104 children (208 eyes) aged 5-18 years were diagnosed with refractive errors. Mean age of presentation was 11.13±3.38 years with male to female ratio of 1:1.6. At the time of presentation, 50% children suffered from mild moderate visual impairment. Most of the children have mild (≤3.00D) refractive error (70.2%) with spherical equivalents ranged from +4.50 D to -10.00 D. Astigmatism was found in 166 eyes (79.8.%) followed by myopia (39;18.8%) and hypermetropia (3; 11.78%). Compound myopic astigmatism was the commonest type of astigmatism (131;79.4%). With regards to the age categories, 23.9% of the children aged 10-14 years had myopic spherical equivalents, compared with 13.1% of children between 5 and 9 years old.
 Conclusion : Refractive errors was a common diagnosis among children seen in our secondary health care hospital. Most of the children with refractive errors present with mild to moderate decrease in visual acuity and had benefited from an optical correction by glasses.

Association Between Length of Stay and Healthcare-Associated Infections among Inpatients in a Secondary Health Care Hospital

Association Between Length of Stay and Healthcare-Associated Infections among Inpatients in a Secondary Health Care Hospital

Vitamin D levels have a potential role in predicting the disease severity in COVID-19 positive pediatric patients

<p><strong>Background and Objective</strong>: The contagious and invasive nature has made coronavirus disease-19 (COVID-19) a critical health issue for the community. The lower respiratory tract is the major site of inflammation seen in COVID-19-positive individuals. Vitamin D (Vit D) has been proposed to have a positive role in immunomodulation, hence, this study aimed to determine the association between Vit D levels and the severity of COVID-19 in infected pediatric patients presenting at a secondary healthcare hospital in Pakistan.</p>
 <p><strong>Methods:</strong> This cross-sectional analytical study was conducted on 100 pediatric patients of the age range 1-18 years from March to December 2021. These patients were hospitalized and diagnosed with coronavirus disease with confirmed results on a real‐time reverse transcription-polymerase chain reaction. Blood samples of the patients were taken to monitor the baseline levels of markers of acute infection and Vit D levels. Patients with serum Vit D levels ≤ 20ng/ml were labeled with deficiency, those with levels 21-29ng/ml were presumed to have Vit D insufficiency whereas levels ≥30 ng/ml were considered normal.</p>
 <p><strong>Results:</strong> There were 57 (57%) males and 43 (43%) female pediatric patients. The mean age of the patients was 10.46 ± 4.25 years (1-18 years). The deficient Vit D level group had a greater frequency of pyrexia, weakness, cough, anosmia, headache, myalgia, and diarrhea. The levels of Vit D and severity of the disease were significantly associated (p-value = 0.027).</p>
 <p><strong>Conclusion: </strong>Pediatric patients with COVID-19 having optimum levels of Vit D were less likely to develop complications associated with the severity of the disease.</p>

Compliance with hand hygiene practices among nursing staff in secondary healthcare hospitals in Kuwait

BackgroundHand hygiene (HH) among healthcare workers, especially nurses, is the main preventive measure to control healthcare associated infections but compliance with hand hygiene (CwHH) remains low in various settings including Kuwait. This study aimed to assess the knowledge of, attitudes towards, and CwHH among nursing staff in secondary care hospitals in Kuwait.MethodsA cross-sectional study was conducted on nursing staff in all six secondary care hospitals in Kuwait. Data on knowledge of, attitudes towards, and self-reported CwHH were collected through a self-administered questionnaire that was developed based on WHO’s questionnaire, while the data on actual compliance were objectively collected through direct observation of nurses during routine care by two independent observers using WHO’s observation form.ResultsOf 829 nurses approached, 765 (92.2%) responded and participated. Of all participants, 524 (68.5%) were able to list “My Five Moments for Hand Hygiene” fully and appropriately. However, several misconceptions (e.g. air circulation in hospital is the main route of infection) about HH were found among the nurses. CwHH was (25.0%) by direct observation while self-reported compliance was (69.5%) each varied significantly (p < 0.001) between different hospitals. Female nurses compared to male nurses and non-Arab compared to Arab nationalities were more likely to report CwHH in multivariable analysis. Several items on knowledge of and attitudes towards HH were also associated with self-reported CwHH.ConclusionObserved CwHH among nursing staff in secondary care hospitals in Kuwait was low, which highlights the need to make more efforts to improve HH practices. Interventions that have been used elsewhere and found to be effective may be tested in Kuwait. Despite the good overall knowledge on HH among nurses, there are several misconceptions that need to be corrected.

Determinants of Patient’s Choice to Bypass the Closest Hospital: A Case Study of Punjab, Pakistan

Pakistan is a developing, 5th populous country with recession in economic indicators. Bypassing is the phenomenon that is widely discussed among the low income countries due to the less provision of health care facilities at primary health care centers. Secondary healthcare centers provide specialized level of diagnostic and treatment facilities while tertiary care hospitals provide specialized healthcare facilities at advance level. There is an impression of better health service facilities at tertiary care hospitals as compared to primary and secondary healthcare hospitals located near the patient’s homes. So, they prefer to go to tertiary care hospitals after bypassing the closest secondary care hospitals. The objective of this study was to evaluate the factors that caused patients to bypass the closest hospital. A well-structured questionnaire was developed to collect data through a stratified random sampling technique. Data were collected from three major tertiary care hospitals of Faisalabad, Lahore, and Multan in Punjab province. The dependent variable was in dichotomous form so, binary logistic model was applied to see the effects of several independent variables such as patient’s demographic and behavioral factors that were consisted on problem of inequality, severity of disease, competency of doctor, reputation of hospital, availability of ambulance, availability of own transport facility, recommendation from friend, referred from primary health care. Results revealed that all these variables had a positive and significant relationship with the patient decision to bypass the closest hospital except residential area, competency of doctor and reputation of hospital. It is suggested that Government should take measures to upgrade the primary health care units to minimize the problem of bypassing the closest hospital. It will reduce the financial burden of patients that automatically enhance their well-being.

Experience of a Medical Intern in a Secondary Healthcare Hospital in Mexico

In Mexico, medical training is characterized by 4 or 5 years of studies at a university campus, one year of undergraduate internship and one year of social service. The undergraduate internship is the theoretical-practical academic cycle that takes place in the clinical fields and is part of the curriculum of the medical career. Normally we expect to be able to choose a hospital with subspecialties or with prestige in our region. But no matter the type of hospital, the important thing is our attitude to work and learn.

Prevalence of Typhi DOT IGM positive results in COVID-19 patients at primary and secondary health care hospitals in Punjab, Pakistan.

Objective: To determine prevalence of Typhi dot IgM positive results in COVID-19 patients at primary and secondary health care hospitals in Pakistan. Study Design: Descriptive Cross-sectional study. Setting: Tehsil Head Quarter Hospital of Burewala and District Head Quarter Hospital of Vehari. Period: 1st March 2020 to 30th June 2020. Material &amp; Methods: Study was done among diagnosed cases of COVID-19 after taking ethical approval from ethical review board. Results were assessed by using SPSS version-24. Results: Males were predominant (71.30%) in our study as COVID-19 positives than the females. Most of the patients (51.70%) were from middle aged group, i.e. 31-60 years. Only 7.40% patients were from elder age group (more than 60 years). More than half of the patients (51.90%) were found to be positive with IgM typhi dot test. We repeated the tests and found the same results. We also calculated the prevalence of typhoid positive cases in COVID patients according to different demographic variables. As far as gender is concerned, our result was highly statistically significant when associated with typhoid positive results among COVID patients (P=0.0001). Males were predominantly having high rate of typhi dot IgM positives (71.30%) than females. Middle aged patients were found to be more affected by typhi dot positive results. Conclusion: It is concluded that there is a high and significant ratio of typhi dot positive results for IgM in COVID patients at Vihari district.

Prescribing practices at a secondary healthcare setting of Islamabad, Pakistan: a descriptive cross-sectional study

Abstract Objectives Irrational drug utilization is one of the key factors behind therapeutic failure, the emergence of antibiotic resistance, and a high incidence of adverse effects worldwide. This study was designed to assess drug use patterns, based on World Health Organization (WHO)/INRUD core drug use indicators and some additional parameters, in the secondary healthcare hospital of Islamabad, Pakistan. Methods The outpatient department (OPD) of the healthcare facility was randomly visited from December 2019 to March 2020 to prospectively collect data from the prescriptions and conduct patient interviews. A total of 2290 prescriptions were included in this study. The data analysis was done through SPSS software v23.0. Key findings The average number of drugs prescribed per encounter was 3.37. Polypharmacy was positively correlated with the age of the patients. Only 4.8% of the drugs were prescribed by generic name. There was frequent (41.5%) use of antibodies. However, the proportion of injectable drugs (12.3%) was within the optimum limit. Essential components of a prescription notably diagnosis, dosage form, method of administration, and duration of therapy were frequently missing. 87% of the prescribed drugs were from the National Essential Medicines List. 80% of the total prescribed drugs were available in the hospital pharmacy. Only 30% of the patients had correct dosage information, while only 20% of the drugs were correctly labelled. Conclusion This study suggests frequent non-compliant prescribing practices including polypharmacy, use of a brand name, antibiotics overuse, compromised legibility and completeness of prescription and inadequate patient counselling and drug labelling, in the secondary healthcare hospital of Islamabad, Pakistan.

Biopsy-confirmed Genitourinary Tuberculosis in a Secondary Health Care Hospital: An Evidence-based Clinical Review.

IntroductionTuberculosis (TB) is a worldwide disease and remains a major public health problem in developing countries, with 95% of cases occurring in developing countries, including Indonesia. It is caused by Mycobacterium tuberculosis, an acid-fast aerobic bacillus. When M. tuberculosis infects other than lung, it is called extrapulmonary tuberculosis (EPTB). Among other organs, genitourinary tuberculosis (GUTB) is responsible for 30–40% of all EPTB cases.MethodsThe study was conducted in a secondary health-care hospital in central Jakarta over a five-year period. We took data from hospital’s medical records and collected all the positive histopathological reports on biopsied tissue of the genitourinary tract from 2014–2019.ResultsEleven patients showed positive histopathological results for TB on their biopsied genitourinary tissue. The genitourinary tracts involved were as follows: prostate (n=2), kidney (n=1), ureter (n=2), epididymis (n=1), epididymo-orchitis (n=1), bladder (n=4). All of them presented with specific genitourinary symptoms, such as lower urinary tract symptoms (LUTS) (n=8), dysuria (n=9), urinary retention (n=2), flank pain (n=6), and incontinence (n=1). Nine of 11 patients (81.8%) exhibited systemic manifestations, with fever being the most common (n=8), followed by malaise (n=6), dyspepsia syndrome (n= 4), and weight loss (n=3).DiscussionConsistent with other studies, our research found that the prevalence of GUTB is substantially decreased with advancing age. Kidney is the most common site infected in GUTB infection. GUTB is easily overlooked, because its signs and symptoms are usually typical of a conventional bacterial cystitis.ConclusionBecause of its insidious nature and late-onset symptoms, diagnosis of GUTB is often late to approach, leading to higher morbidity and even mortality rate. This leads into further complications of the disease, which are largely preventable by a correct and timely diagnosis followed by appropriate therapy.

Development of Antibiogram for Secondary Health care Hospital

Antibiotics resistance is an emerging problem in the management for infectious diseases. Patients are many a time prescribed with antibiotics without knowing that particular antibiotic sensitivity pattern with respect to the infectious microorganism. This study aims to detect the type of microbes causing certain infections in the hospital and also to detect the sensitivity pattern of the antibiotics to these microbes. We conducted a prospective study for six months on the neonates who were admitted in NICU. The blood samples were collected from these neonates before the administration of antibiotics. The swab samples were also collected from various places of this hospital to detect the types of microorganisms present in the hospital and to study the sensitivity of the antibiotics toward these microbes. The antibiotics used in this study were Gentamicin, Ampicillin, Cefotaxime, Amikacin, Piperacillin, Meropenam, and Vancomycin. Staphylococcus aureus and Streptococcus pneumoniae were found to be the most common pathogens implicated in neonate's infection. All the organisms showed absolute sensitivity mostly to Ampicillin, Gentamicin, and Piperacillin and resistant to Cefotaxime, Amikacin, and Vancomycin. Staphylococcus aureus, Streptococcus pneumoniae, Hemophilus infleunzae, Kleibseilla pneumoniae, Escherichia coli were the most common microorganism found in the swab samples collected from the hospital. Most of these microorganisms shows sensitivity towards Ampicillin, Gentamicin, and Meropenam but were resistance to Cefotaxime, Amikacin, and Vancomycin. A routine bacterial surveillance of prevalent organisms and the study of the sensitivity patterns of the pathogens responsible for neonatal infection should be made an essential component for neonatal care. This information from many parts of the country will be important in policymaking on antimicrobial use not only locally but also internationally.

Incidence and sociodemographic profile of scabies in paediatric patients attending secondary health care hospital

Incidence and sociodemographic profile of scabies in paediatric patients attending secondary health care hospital

1783. Implementation of New Strategy for Real-time Antimicrobial Stewardship (ASP) in a Secondary Healthcare Hospital, in Mexico City

BackgroundReal-time antimicrobial stewardship programs are associated with improved time to optimal an effective therapies and decreased unnecessary antimicrobial use. However, these programs are often expensive and need special hardware or software for their implementation. Real-time communication technologies based on smartphones and texting media applications have not been used previously as a tool that emulates these clinical decision support programs (CDSP). We evaluated the clinical impact of implementing this technologies as fundamental part of an ASP in a Secondary Healthcare Hospital. Preauthorization, prospective audit, and feedback interventions were combined into a texting media group alert, composed by infectious diseases physicians, pharmacists, microbiologist and epidemiology department, which evaluated and decided the best treatment option in a real-time period consisting of 2 hours for each patient. Preauthorization rules included carbapenems, glycopeptides, quinolones, clindamycin, Linezolid, and amphotericin.MethodsWe conducted an observational and descriptive study for the total number of interventions in a 3-year period. Data collection included hospital service for application, authorization or restriction, consumption in terms of defined daily dose, economic outcomes, nosocomial bacteria’s resistance patterns, and overall mortality rates.ResultsA total of 8,004 interventions were carried out; only 7.7% (636) were unanswered within the 2 hour period. Emergency department (34.35%) and Internal Medicine (24.6%) were the most monitored services. The most restricted ones were Surgery and Intensive Care Unit with at least 25% of prescriptions. The most restricted antibiotics were piperacillin/tazobactam, clindamycin and quinolones, restraining up to 80%. Saving cost represents US$130,000.00 for colisitin and US$64,800.00 for carbapenems. The isolates of P. aeruginosa and A. baumanii resistant decreased by 75% and the overall mortality rate for nosocomial infections, were not increased.ConclusionThis is the first report in Mexico of an ASP that incorporates mobile phone technology as a part of real-time surveillance program that emulates CDSP and allows to know in detail the correct use of antibiotics, saving costs and decreasing bacterial resistancesDisclosures All authors: No reported disclosures.

Continuing medical education activities of specialists working in secondary health care hospitals in Eastern Anatolian Region

Continuing medical education activities of specialists working in secondary health care hospitals in Eastern Anatolian Region

Rate of referral from primary health care to secondary health care among governmental hospitals in Taif governorate, KSA

Background: Referral system is facing difficulties worldwide. In Saudi Arabia, particularly, our doctors always complain of referral system. Objective: To measure the referral rate from primary- to secondary health-care services, evaluate secondary health-care opinion regarding referral from primary care, and measure the feedback rate from secondary health-care physicians. Materials and Methods: A cross-sectional approach was carried out, which included currently working doctors in a governmental secondary health-care hospital who received referral from primary-care centers in Taif, in addition to a manager of each primary health care center (PHCC) inside the Taif area. Data were collected by using two forms. The first form was a questionnaire that collected data from physicians. It included personal data of the doctors and doctors’ judgment regarding referral process in PHCC and what can improve the quality of referral system and make it more useful to the patients. The second form was a checklist used to collect data from managers of involved PHCC inside the Taif area. Result: The study included 112 physicians working in secondary health-care governmental hospitals in Taif. Their age ranged between 25 and 60 years with a mean of 40.4 years and standard deviation of 9.2 years. Men represented 70.5% of them. The commonest reported reasons for referral from PHCCs were seeking specialized treatment (42.9%), more assessment of patients (40.1%), and diagnosis of difficult cases (21.4%). Almost three quarters of them (77.7%) considered referring notes to be more informative if the referring doctor was a family physician. More than half of the physicians (52.5%) reported that they never issued feedback notes to PHCCs regarding referred cases, whereas 20.8% of them reported that they always issued such notes. Older physicians (>50 years) provided feedback referral notes either always or sometimes at a significantly higher rate than younger physicians (76.5% versus 50% among those aged between 41 and 50 years and 30.8% among those aged 40 years or younger). The difference was statistically significant. Conclusion: This study highlighted some of the inadequacies in the effectiveness of the referral system in a PHCC from the perspective of physicians working in governmental secondary-care hospitals in Taif and suggested various ways of dealing with them.

Campus Community Partnership in Bedside Teaching: Staff Development Program at a Secondary Health Care Hospital in Malaysia

Bedside teaching is an essential component of medical education and provides the learners an opportunity to use nearly all of their senses. A comprehensive physical examination can provide a diagnosis of more than 70% of diseases.1 Sometimes it is thought that bedside teaching is applicable only to the hospital setting which is not true. Bedside teaching skills can apply to any situation where the teaching occurs in the presence of the patient, including the secondary care hospital, the long-term care facility or in the office setting.2

Laparoscopic Helica Thermal Coagulation for the Treatment of Early Endometriosis

Objectives: The aim of this study was to assess the safety and clinical outcome of Helica thermal coagulation (TC) for the treatment of pelvic pain symptoms and infertility caused by early endometriosis. Materials and Methods: A prospective, observational study was conducted at a secondary health care hospital in Cumbria, United Kingdom. Forty-three (43) women, with either pelvic pain symptoms, infertility, or both and diagnosed with minimal or mild endometriosis at laparoscopy, were included in the study. Eleven (11) women complained of pelvic pain symptoms only and 18 had infertility only, whereas 14 complained of both. All women were treated on a day-case basis. The revised American Fertility Society classification was used to stage endometriosis. Laparoscopic Helica TC was used to ablate all visible endometriotic spots. Relief of pelvic pain symptoms and conception were assessed up to 6 months after the procedure. Complications occurring during or after the procedure were recorded. Results: All women completed the study up to 6 months of follow-up. Eighteen (18) of 25 (18/25) women (72%) had satisfactory relief of pelvic pain symptoms at 6 months. The cumulative pregnancy rate was 34% (11/32). Six (6) pregnancies were spontaneous and occurred 1 month after the procedure, whereas 5 pregnancies were recorded at 3–6 months. No surgical complications were encountered. Conclusions: Conservative laparoscopic surgery using Helica TC is simple, very safe, and effective at relieving pelvic pain symptoms and improving fertility in women with early-stage endometriosis. Large, randomized, controlled trials on the efficacy of this procedure are needed. (J GYNECOL SURG 23:45)