Hospital practice最新文献

{"title":"Contemporary NSTEMI management: the role of the hospitalist","authors":"C. Pollack, A. Amin, Tracy Y. Wang, S. Deitelzweig, Marc Cohen, D. Slattery, J. Fanikos, Christopher DiLascia, R. Tuder, S. Kaatz","doi":"10.1080/21548331.2020.1701329","DOIUrl":"https://doi.org/10.1080/21548331.2020.1701329","url":null,"abstract":"ABSTRACT Non-ST-segment elevation myocardial infarction (NSTEMI) is defined as elevated cardiac biomarkers of necrosis in the absence of persistent ST-segment elevation in the setting of anginal symptoms or other acute event. It carries a poorer prognosis than most ST-segment elevation events, owing to the typical comorbidity burden of the older NSTEMI patients as well as diverse etiologies that add complexity to therapeutic decision-making. It may result from an acute atherothrombotic event (‘Type 1’) or as the result of other causes of mismatch of myocardial oxygen supply and demand (‘Type 2’). Regardless of type and other clinical factors, the hospital medicine specialist is increasingly responsible for managing or coordinating the care of these patients. Following published guidelines for risk stratification and basing anti-anginal, anticoagulant, antiplatelet, other pharmacologic therapies, and overall management approach on that individualized patient risk assessment can be expected to result in better short- and long-term clinical outcomes, including near-term readmission and recurrent events. We present here a review of the evidence basis and expert commentary to assist the hospitalist in achieving those improved outcomes in NSTEMI. Given that the Society for Hospital Medicine cites care of patients with acute coronary syndrome as a core competency for hospitalists, it is essential that those specialists stay current on optimal NSTEMI care. Abbreviations: ACC: American college of cardiology; ACCOAST: comparison of prasugrel at the time of diagnosis in patients with non-ST elevation myocardial infarction; ACS: acute coronary syndrome; ADP: adenosine diphosphate; AHA: American heart association; ARB: angiotensin II receptor blocker; ASA: acetylsalicylic acid; CABG: coronary artery bypass graft: CAD: coronary artery disease; CCTA: coronary computed tomography angiography; cTn: cardiac troponin; CRUSADE: can rapid risk stratification of unstable angina patients suppress adverse outcomes with early implementation of the ACC/AHA guidelines; CURE: clopidogrel in unstable angina to prevent recurrent events; CURRENT: OASIS-7 clopidogrel and aspirin optimal dose usage to reduce recurrent events–seventh organization to assess strategies in ischemic syndromes; ECG: electrocardiogram; ED: emergency department; ESRD: endstage renal disease; ESC: European society of cardiology; FDA: food and drug administration; GRACE: global registry of acute coronary events; LVEF: left ventricular ejection fraction; MACE: major adverse cardiac event; MI: myocardial infarction; MVO2: myocardial oxygen demand; NSTEMI: non-ST-segment-elevation myocardial infarction; NTG: Nitroglycerin; PCI: percutaneous coronary intervention; plato: platelet inhibition and patient outcomes; PPI: proton pump inhibitor; PURSUIT: platelet glycoprotein IIb/IIIa in unstable angina: Receptor Suppression Using Integrilin Therapy; RAAS: Renin-Angiotensin-Aldosterone System; SHM: society of hospi","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"48 1","pages":"1 - 11"},"PeriodicalIF":0.0,"publicationDate":"2019-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2020.1701329","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46497299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validity, reliability and feasibility of nutrition screening tools NRS-2002 and MST administered by trained medical doctors in routine practice","authors":"T. Q. Cuong, M. Banks, M. Hannan-Jones, Do Thi Ngoc Diep, D. Gallegos","doi":"10.1080/21548331.2019.1699760","DOIUrl":"https://doi.org/10.1080/21548331.2019.1699760","url":null,"abstract":"ABSTRACT Background & aim: This study aims to prospectively assess the validity, reliability and feasibility of two nutrition screening tools NRS-2002 and MST combined with BMI (MST+BMI) after administration by medical doctors in hospitals in Ho Chi Minh City (HCMC) Viet Nam. Methods: Participants were 150 adult patients (validity study), 30 adult patients (reliability study) and 40 medical doctors (feasibility study) in three wards from three general public hospitals in HCMC. Area Under the ROC curve (AUC), sensitivity, specificity, positive predictive value, negative predictive value and percent of correctly classified were calculated to determine validity against SGA or BMI. Cohen’s kappa (κ) statistics were calculated to determine the reliability of NRS-2002 and MST+BMI. Viewpoints regarding the benefit and role of nutrition screening and the ease of use, acceptability and feasibility of NRS-2002 and MST+BMI were assessed among medical doctors using self-administered questionnaires with Likert scales to determine feasibility. Results: After completing by medical doctors the NRS-2002 and MST+BMI showed good validity (the sensitivity and specificity were 80.3% and 79.8% for NRS-2002 and were 81.8% and 84.5% for MST+BMI, respectively) and consistent reliability (κ: 0.72 & 0.75) against SGA or BMI. Medical doctors mostly agreed (93%) on the need for and benefits of nutrition screening. It took between two and 4 min to complete screening using NRS-2002 or MST+BMI. Over 82% of medical doctors indicated that the NRS-2002 and MST+BMI were easy to conduct. There was, however, lower agreement (73%), regarding the feasibility of implementing screening in their wards and hospitals. Conclusions: Both NRS-2002 and MST+BMI were valid, reliable and feasible for use by medical doctors for nutrition screening in hospitals in the resource sparse Vietnamese context. Additional activities are required to make nutrition screening more feasible.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"47 1","pages":"259 - 266"},"PeriodicalIF":0.0,"publicationDate":"2019-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2019.1699760","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45160660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors predicted with quality of life among hemodialysis patients in private hospital of Thailand","authors":"S. Dejvorakul, Ramesh Kumar, S. Srirojanakul, Niparat Panupichit, Ratana Somrongthong","doi":"10.1080/21548331.2019.1682879","DOIUrl":"https://doi.org/10.1080/21548331.2019.1682879","url":null,"abstract":"ABSTRACT Background: The quality of life (QOL) among the end-stage renal disease patients is an essential component for assessing the success of treatment. This study aimed to determine the factors predicted with quality of life among hemodialysis patients in private hospital of Thailand. Method: This cross-sectional study was conducted by interviewing 188 Thai patients with end-stage renal disease (ESRD), who were on hemodialysis (HD) at Sanamchan Hospital Bangkok. Patients with stable hemodynamic status without any history of mental illness were included in this study. However, those who could not properly communicate were excluded. The descriptive statistics and the multiple linear regression were applied to identify the predictive factors of quality of life (QOL) scores in the end-stage renal disease (ESRD) patients on maintenance hemodialysis (HD). The QoL was assessed in three components including kidney disease component score (KDCS) physical component score (PCS) and mental component score (MCS). Findings: More than half of the participants (57%) in this research were male and (44%) were unemployed. The mean average systolic value of the participants was 157 (25.12 SD) mmHg and the diastolic blood pressure was 81 (5.85 SD) mmHg. Average hematocrit (Hct) was 30.95 (4.38 SD), Kt/v was 1.86 (0.96 SD), and average normalized protein catabolic rate (nPCR) was 1.12 (1.09 SD). The age, income, patients with more than three associated diseases, enough expenses for living, frequency of dialysis per week, and duration of treatment was statistically significant with the kidney disease component score (KDCS) (F = 6.28, p < 0.05). Furthermore, the age, income, patients with more than three associated diseases, hematocrit (Hct) and frequency of dialysis per week were the statistically significant with the physical component score (PCS) (F = 4.99, p < 0.05) while patients with more than three associated diseases and enough expenses for living were the statistically significant with the mental component score (MCS) (F = 3.30, p ≤ 0.05). Conclusion: Study concluded that the factors like; age, expenses for living, frequency of dialysis, patients with more than three associated diseases were had a positive impact on the quality of life among the end-stage renal disease patients coming for dialysis in private hospital of Thailand.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"47 1","pages":"254 - 258"},"PeriodicalIF":0.0,"publicationDate":"2019-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2019.1682879","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47583348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjustments of medication dosages in patients with renal impairment in Botswana; findings and implications to improve patient care","authors":"A. Sheikh, G. Rwegerera, B. Godman, D. Habte","doi":"10.1080/21548331.2019.1685800","DOIUrl":"https://doi.org/10.1080/21548331.2019.1685800","url":null,"abstract":"ABSTRACT Background and aims: Medication dosage adjustments for renally impaired patients have not been studied in Botswana. This study was conducted to determine prescribing practices among patients with renal impairment in medical wards to improve future patient care. Methods: We conducted a retrospective study involving medical charts of patients admitted at a tertiary level hospital in Gaborone Botswana. Study participants included all patients admitted between August and October 2016 who were hospitalized for ≥24 h. ‘Drug prescribing in renal failure: dosing guidelines for adults and children'. was used to determine the extent of dosage adjustments. A logistic regression model was used to assess which patient factors were associated with inappropriate dosage adjustment. Results: Twenty-nine percent (233/804) of patients had renal impairment. Of these, 184 patients with renal impairment were included in the final analysis. There were 1143 prescription entries, of which 20.5% (n = 234) required dosage adjustment for renal function but only 45.7% (n = 107) were adjusted correctly. Of note, 112 patients were prescribed at least one drug that required dosage adjustment and only 30.4% (n = 34) patients had all of their medications appropriately adjusted. Patient factors associated with inappropriate dosage adjustment included a higher number of medicines being prescribed. Mortality among patients with renal impairment was independently associated with higher scores of the Charlson comorbidity index and hospital stay duration of 1–7 days. Conclusion: The renal function status of patients was not sufficiently taken into account when prescribing medicines especially in patients with severely impaired kidney function in Botswana. Continuous medical education needs to be encouraged to address this, which is being implemented. We will be following this up in future studies.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"47 1","pages":"231 - 240"},"PeriodicalIF":0.0,"publicationDate":"2019-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2019.1685800","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41504151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The left ventricular ejection fraction: new insights into an old parameter","authors":"Tanya Dutta, D. Spevack, W. Aronow","doi":"10.1080/21548331.2019.1687247","DOIUrl":"https://doi.org/10.1080/21548331.2019.1687247","url":null,"abstract":"ABSTRACT Accurate evaluation of cardiac function has become increasingly important as the treatment of cardiac disease has become more complex. At the same time, technological advances allow greater accuracy and precision in cardiac measurements. Measurement of left ventricular ejection fraction (LVEF) has been a pillar of cardiac evaluation. Several noninvasive modalities are available to assess LVEF; each has advantages and limitations. This review examines various modalities used to measure LVEF and focuses on the relative strengths and weaknesses of each modality. In some clinical settings, however, LVEF may be too insensitive to convey subtle changes in LV contractility. In certain clinical situations, use of LVEF may be an insufficient measure of left ventricular systolic function. Global longitudinal strain is one such parameter that has shown promise for detecting subtle reductions in left ventricular contractility in subjects with chemotherapy-induced cardiotoxicity.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"47 1","pages":"221 - 230"},"PeriodicalIF":0.0,"publicationDate":"2019-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2019.1687247","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49312844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital administration response to physician stress and burnout","authors":"A. Rosenstein","doi":"10.1080/21548331.2019.1688596","DOIUrl":"https://doi.org/10.1080/21548331.2019.1688596","url":null,"abstract":"ABSTRACT Recent studies have documented the alarming degree of physician stress and burnout that has affected physician attitudes, behaviors, and performance. Growing dissatisfaction, irritability, and frustration has negatively impacted physician ideals and attitudes which can lead to compromised health care relationships with impaired communication, collaboration, and coordination that can adversely affect satisfaction, clinical performance, and patient outcomes of care. For the most part physicians on their own have a difficult time recognizing or admitting that they are working under stress and burnout conditions, and even if they do, are reluctant to do anything about it. In this regard it is essential for the organization(s) in which the physician is involved with to take a pro- active role in providing support services to help physicians address this issue in a more empathetic, effective, and constructive manner.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"47 1","pages":"217 - 220"},"PeriodicalIF":0.0,"publicationDate":"2019-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2019.1688596","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44168796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to continued administration of direct oral anticoagulants between acute hospital and subacute or chronic hospitals and geriatric health services facilities in Japan","authors":"H. Akiyama, Saki Nukui, Y. Hasegawa","doi":"10.1080/21548331.2019.1684650","DOIUrl":"https://doi.org/10.1080/21548331.2019.1684650","url":null,"abstract":"ABSTRACT Objectives: To investigate whether direct oral anticoagulant (DOAC) therapy at acute hospitals is continued after transfer to subacute or chronic hospitals and geriatric health services facilities in Japan. Methods: Acute hospitals routinely transfer patients to nearby subacute or chronic hospitals and geriatric health services facilities after acute stroke treatment. To elucidate the status of antithrombotic therapy, particularly DOAC therapy, we conducted a questionnaire survey of chief physicians at 33 subacute or chronic hospitals and geriatric health services facilities in the vicinity of Kawasaki City. Results: Responses were received from 23 hospitals and geriatric health services facilities (5 convalescent and rehabilitation hospitals, 5 chronic hospitals, 13 geriatric health services facilities). The number of convalescent hospitals responding, ‘no problem with DOAC administration’ before transfer to subacute or chronic hospitals and geriatric health services facilities increased from 4 (80%) at the introduction of DOACs to 5 (100%) presently. The number of chronic hospitals and geriatric health services facilities also increased from 1 (20%) to 3 (60%) and 4 (30.8%) to 5 (38.5%), respectively, albeit not significantly. The number of convalescent hospitals, chronic hospitals, and geriatric health services facilities requesting pre-transfer change of oral anticoagulants decreased from 20% to 0%, 60% to 40%, and 69.2% to 61.5%, respectively. All convalescent hospitals continued DOAC therapy after transfer. However, only 40.0% of chronic hospitals and 46.2% of geriatric health services facilities used DOACs in the present period. Warfarin was used instead at 3 (60%) chronic hospitals and 7 (53.8%) geriatric health services facilities and antiplatelet drugs were used at 1 hospital/facility each (20% and 7.7%, respectively). Nine (39.1%) hospitals and facilities cited high DOAC costs for the switch. Conclusions: Convalescent hospitals have incorporated DOAC use and readily accept patients receiving DOACs at transferring hospitals. Conversely, many chronic hospitals and geriatric health services facilities eventually switch from DOACs to warfarin or antiplatelet drugs due to cost. Efforts to resolve these barriers to continued administration of DOACs between acute hospitals and subacute or chronic hospitals and geriatric health services facilities in Japan are needed as soon as possible.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"47 1","pages":"249 - 253"},"PeriodicalIF":0.0,"publicationDate":"2019-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2019.1684650","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46189864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the views of medical staff in transforming a hospital into a health promoting hospital in Iran: a qualitative research","authors":"S. M. M. Hazavehei, Y. Hamidi, Seyedeh Melika Kharghani Moghadam, A. Karimi‐Shahanjarini","doi":"10.1080/21548331.2019.1688501","DOIUrl":"https://doi.org/10.1080/21548331.2019.1688501","url":null,"abstract":"ABSTRACT Objectives: One of the current concerns of hospitals is how to become a health promoting hospital (HPH). This qualitative research aimed at exploring the views of members of the medical staff in two Iran hospitals about the defined standards to transform the hospitals into a health promoting one. Methods: The research reported in this paper was a content analysis qualitative study. The license numbered (IR.UMSHA.REC.1395.388) was obtained from the ethics committee of Hamadan Medical Science University. Sampling was carried out through the snowballing method. Also, 55 interviews were conducted with the members of the medical staff. To collect data, the semi-structured interview guide was used based on the standards of HPHs. The framework analysis method was used to analyze the data qualitatively. Results: From three central questions on the basis of the main study question, nine themes were earned. Policies governing the hospitals were in the direction of converting them to health promoting organizations including the creation of a health promoting work environment, empowering personnel and health promoting corporate culture. Also, suggestions to create a HPH included improving management, paying attention to patients and their satisfaction, as well as increasing effective interpersonal relationships in the hospital. Conclusion: The findings showed that it can be a key strategy in this field to use staff’s solutions for the existing problems and their opinions on the challenges against establishing the standards for HPHs. People usually accept more comfortable and easy changes in decision-making and implementing processes of which they are involved.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"47 1","pages":"241 - 248"},"PeriodicalIF":0.0,"publicationDate":"2019-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2019.1688501","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49214810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative-effectiveness of ceftaroline and daptomycin as first-line MRSA therapy for patients with sepsis admitted to hospitals in the United States Veterans Health Care System.","authors":"Marilyn L Mootz, Rachel S Britt, Allison A Mootz, Grace C Lee, Kelly R Reveles, Kirk E Evoy, Chengwen Teng, Christopher R Frei","doi":"10.1080/21548331.2019.1676540","DOIUrl":"10.1080/21548331.2019.1676540","url":null,"abstract":"<p><p><b>Objectives</b>: This study compared hospital readmission and mortality for patients with sepsis who received ceftaroline or daptomycin as first-line MRSA therapy.<b>Methods</b>: This retrospective comparative-effectiveness study included adults ≥18 years old hospitalized in the United States Veterans Health Care System with sepsis between 10/1/2010-9/30/2014, who received ceftaroline or daptomycin within 14 days of hospital admission as the first antibiotic effective against methicillin resistant <i>Staphylococcus aureus</i> (MRSA). Patients with pneumonia, and those who received both study drugs, were excluded. Baseline characteristics were compared using Chi-square, Fischer's exact, Student's t, and Wilcoxon Rank Sum tests. Patient outcomes were compared with multivariable logistic regression models.<b>Results</b>: 409 patients were included (ceftaroline = 67, daptomycin = 342). Ceftaroline patients were older, less likely to be Black, more likely to have diabetes with complications, and had higher Charlson comorbidity scores. Median (interquartile range) time from admission to drug initiation was 1 (0-1) day for ceftaroline and 1 (1-3) day for daptomycin (p = 0.01). Unadjusted hospital readmission rates for ceftaroline and daptomycin, respectively, were: 30-day (25%/37%, p = 0.06), 60-day (27%/44%, p = 0.008), and 90-day (28%/46%, p = 0.01). Unadjusted mortality rates were: in-hospital (7%/12%, p = 0.4), 30-day (3%/9%, p = 0.1), 60-day (6%/12%, p = 0.2), and 90-day (7%/15%, p = 0.1). In multivariable models with all divergent baseline characteristics included as covariates, patients treated with ceftaroline were less likely to experience (OR, 95% CI): 30/60/90-day hospital readmission (0.54, 0.29-0.98; 0.42, 0.23-0.76; 0.42, 0.23-0.75) and 30/60/90-day mortality (0.23, 0.04-0.82; 0.34, 0.10-0.93; 0.34, 0.11-0.86).<b>Conclusion</b>: In patients with sepsis, ceftaroline was associated with fewer hospital readmissions and lower mortality as compared to daptomycin. Prospective investigations in larger, more generalized cohorts are needed to examine outcomes with specific MRSA therapies.</p>","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"47 1","pages":"186-191"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2019.1676540","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46433142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare-associated infections including neonatal bloodstream infections in a leading tertiary hospital in Botswana","authors":"Pinkie Mpinda-Joseph, Bene D Anand Paramadhas, G. Reyes, Mompoloki Maruatona, Mamiki Chise, Baphaleng B Monokwane-Thupiso, S. Souda, C. Tiroyakgosi, B. Godman","doi":"10.1080/21548331.2019.1650608","DOIUrl":"https://doi.org/10.1080/21548331.2019.1650608","url":null,"abstract":"ABSTRACT Background: Healthcare-associated infections (HAIs) increase morbidity, mortality, length of hospital stay and costs, and should be prevented where possible. In addition, up to 71% of neonates are prone to bloodstream infections (BSI) during intensive care due to a variety of factors. Consequently, the objectives of this study were to estimate the burden of HAIs and possible risk factors in a tertiary hospital in Botswana as well as describe current trends in bacterial isolates from neonatal blood specimen and their antibiotic resistance patterns. Methods: Point Prevalence Survey (PPS) in all hospital wards and a retrospective cross-sectional review of neonatal blood culture and sensitivity test results, with data abstracted from the hospital laboratory database. Results: 13.54% (n = 47) of patients had HAIs, with 48.9% (n = 23) of them lab-confirmed. The highest prevalence of HAIs was in the adult intensive care unit (100% – n = 5), the nephrology unit (50% – n = 4), and the neonatal intensive care unit (41.9% – n = 13). One-fourth of HAIs were site unspecific, 19.1% (n = 9) had surgical site infections (SSIs), 17% (n = 8) ventilator-associated pneumonia/complications, and 10.6% (n = 5) were decubitus ulcer infections. There were concerns with overcrowding in some wards and the lack of aseptic practices and hygiene. These issues are now being addressed through a number of initiatives. Coagulase Negative Staphylococci (CoNS) was the commonest organism (31.97%) isolated followed by Enterococci spp. (18.03%) among neonates. Prescribing of third-generation cephalosporins is being monitored to reduce Enterococci, Pseudomonas and Acinetobacter spp. infections. Conclusions: There were concerns with the rate of HAIs and BSIs. A number of initiatives are now in place in the hospital to reduce these including promoting improved infection prevention and control (IPC) practices and use of antibiotics via focal persons of the multidisciplinary IPC committee. These will be followed up and reported on.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"47 1","pages":"203 - 210"},"PeriodicalIF":0.0,"publicationDate":"2019-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2019.1650608","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44762039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}