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   Table of Contents - Current issue
May-August 2020
Volume 8 | Issue 2
Page Nos. 37-71

Online since Monday, December 21, 2020

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Audit on hand hygiene and use of personal protective equipment: Prevention of nosocomial transmission of COVID-19 p. 37
Indranath Roy
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Attitude and beliefs about surgical safety checklist in a North Indian tertiary care hospital, a decade later of World Health Organisation checklist Highly accessed article p. 39
Lovenish Bains, Anurag Mishra, Daljit Kaur, Pawan Lal, Lalit Gupta, Vikas Malhotra
Background: Avoidable surgical complications account for a large proportion of preventable medical injuries and deaths globally. Surgical safety checklist (SSCL) is evidence‑based, internationally accepted valid instrument, which has been found to reduce postoperative morbidity and mortality; the benefits of which are most striking in low and middle‑income countries (LMICs) Despite implementation in many hospitals throughout the country, there is still lack of awareness and concern in many LMICS health care facilities towards SSCL and its use, even after a decade of World Health Organisation (WHO) checklist. Methods: This was a single centre e-survey to assess the knowledge, attitudes and beliefs about the WHO‑surgical checklist, in which 65.4% (138) surgeons, 25.1% (53) anaesthetists and 9.5% (20) nurses participated. Results: Majority believed that the use of SSCL improves the safety of procedures, improves communication amongst theatre staff and will result in a reduction in errors in theatre, yet there was no commitment for the use of SSCL. Although all theatre personnel support implementation and use of SSCL; however, hierarchical issues, lack of administrative support, lack of training, logistics and timing, high patient volume and overburdened residents, lack of co‑ordinator or leadership role and shortage of workforce can be impediment to effective use. Discussion: Nurses and junior doctors play a crucial role. Commitment rather than compliance and teamwork will be the key, ably supported by education and training which should be mandatory for all operation theatre stakeholders. Therefore, any measure that can potentially improve patient safety should be embraced and benefits of SSCL be told to motivate them and enhance participation for patient safety. Committed leadership, knowledge sharing and periodic trainings, interdisciplinary communication, feedback and regular audits can define and determine effective implementation process.
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Seroprevalence of hepatitis C infection in patients undergoing haemodialysis in a tertiary care centre p. 48
Anjali Nair Vinayakumar, Reena John
Introduction: Hepatitis C virus (HCV) infection is a major health problem among these patients in developing countries like India. This could be either due to a non-adherence to strict infection control measures or the unavailability of vaccine to prevent HCV infection. Objectives of the Study: This study aims to estimate the prevalence of HCV infection in patients undergoing haemodialysis and assess the major risk factors, the efficacy of infection control measures in the dialysis unit by studying the seroconversion rates from HCV negative to HCV positive and also formulate ways to prevent the nosocomial spread of HCV infection in the dialysis unit. Materials and Methods: This was a cross-sectional study carried out among 250 patients undergoing haemodialysis in the dialysis unit of a tertiary care centre. They were tested for the presence of anti-HCV antibody by enzyme linked immunosorbent assay. Results: The seroprevalence of HCV infection among the patients undergoing haemodialysis as per this study is 4.8%. The risk factors identified were age >50, prolonged duration of dialysis and multiple blood transfusions. One significant observation was of the probability of lateral spread of HCV infection within the dialysis unit. Conclusions: Although there is no consensus regarding machine dedication between HCV non-infected and HCV-infected patients, we found that using dedicated HD machines had an important role in reducing HCV transmission in our dialysis unit. However, risk prevails if any seronegative patient acts as HCV carrier.
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Practice gaps and challenges to effective patient safety culture in a tertiary hospital in Nigeria p. 54
Amaka Y Ezeuko, Chinomnso C Nnebue, Raymond C Okechukwu, Chigozie O Ifeadike
Background: Knowledge and experiences of inefficiencies, odds and difficulties in patient safety culture (PSC) maintenance in health-care systems can facilitate the development and implementation of better strategies. Objective: The aim is to determine the practice gaps and challenges to effective PSC in Nnamdi Azikiwe University Teaching Hospital, (NAUTH) Nnewi, Nigeria. Materials and Methods: This was a cross-sectional survey conducted from June to November 2016 in NAUTH Nnewi, Nigeria. Data were collected through mixed methods:-self-administered structured questionnaire survey (QS), focus group discussions (FGD) and key informant interviews (KII). Stratified sampling technique was used for the QS, while the convenience sampling technique. was employed in the FGD and KII. Data were analysed using the Statistical Package for the Social Sciences version 22. Results: Challenges to the effective promotion of PSC each relate to gaps in either poor staff strength or punitive response to the error report. The challenges reported from the FGD are lack of training and re-training programmes (61%), poor team spirit and low staff capacity (56%). From the KII >80% reported non-availability of PSC unit, patient safety committee, patient safety guideline/policy, nor standard operation procedure while (61%) reported that management effort to provide enabling patient safety environment was adequate. Conclusions: This study found challenges to effective PSCsuch as poor training, staff strength, team spirit cum communication, excessive work hours and fear of punitive response to the error report. This buttresses the need for urgent attention to these areas of weakness through awareness and educational programmes on PSC, adequate staffing and prompt information dissemination.
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Applying patient safety principles in public safety in the COVID-19 scenario p. 60
Thanjavur S Ravikumar, Aravindakshan Rajeev, Shikha Yadav
COVID-19 has overwhelmed the health systems all over the world. Using a methodology for finding excess deaths due to illnesses, we estimated the statistics for the countries which had their first case of coronavirus infection in January 2020. For illustration, the avoidable harm in the USA was 160,988 and that of the UK was 38,857 until the 2nd week of August 2020. Geographic distribution of excess deaths was plotted on GeoDa® shaded map. Spatial error model showed that early and vigorous testing reduced the mortality load. Strategy has to be worked out to contain the pandemic using the appropriate public health tools.
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Nasal carriage of methicillin-resistant Staphylococcus aureus amongst healthcare workers of intensive care unit of a tertiary care centre in South India: An observational cross-sectional study p. 64
Abhishek Thanuja Jayadhar, Ashish Jitendranath, Amalu Ann Thomas, GS Sarika
Staphylococcus aureus is one of the dangerous pathogens causing infections in both community level and hospital setting. This study aims to find the carrier rate of S. aureus and a resistant strain of the bacterium–methicillin-resistant S. aureus (MRSA). Sterile cotton swabs (saline moistened) were used to collect the nasal samples from the healthcare workers (HCWs) of different intensive care units. The isolation S. aureus was done by standard bacteriological procedures. Antibiotic susceptibility testing of all isolates was performed by modified Kirby–Bauer disc diffusion method. Methicillin resistance of S. aureus was identified using cefoxitin disc diffusion test. One hundred and forty-one nasal swabs were processed (104 nurses, 27 doctors and 10 non-medical staff). Amongst the 141 nasal swabs processed, 18.4% of HCWs were carriers of S. aureus, out of which 9.9% tested positive for MRSA. To prevent the colonisation of HCWs by S. aureus and avoid cross infection amongst patients, proper hand hygiene practices are vital. Creating an awareness and periodic screening is yet another task needed to tackle this crisis.
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Impact of COVID-19 in non-COVID hospitals: Do we need a pandemic to augment healthcare worker and patient safety? p. 68
Areena Hoda Siddiqui, HN Tripathi, R Harsvardhan
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A virtual birth companion! – Yet another application of virtual reality during the COVID-19 pandemic p. 70
Vijayan Sharmila, Thirunavukkarasu Arun Babu
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