Abstract: Background: Excessive and inappropriate use of antimicrobial agents among hospitalized patients remains an important patient safety and public health issue worldwide. Not only does this behavior incur unnecessary cost but it is also associated with increased morbidity and mortality. The objective of this study is to obtain an insight into the prescribing patterns of antibiotics in surgical and medical wards, to help identify a scope for improvement in service delivery. Method: A simple point prevalence survey included a convenience sample of 200 patients admitted to medical and surgical wards in a government teaching hospital in Baghdad between October 2017 and April 2018. Data were collected by a trained pharmacy intern using a standardized form. Patient’s demographics and details of the prescribed antibiotics, including dose, frequency of dosing and route of administration, were reported. Patients were included if they had been admitted at least 24 hours before the survey. Patients under 18 years of age, having a diagnosis of cancer or shock, or being admitted to the intensive care unit, were excluded. Data were checked and entered by the authors into Excel and were subjected to frequency analysis, which was carried out on anonymized data to protect patient confidentiality. Results: Overall, 88.5% of patients (n=177) received 293 antibiotics during their hospital admission, with a small variation between wards (80%-97%). The average number of antibiotics prescribed per patient was 1.65, ranging from 1.3 for medical patients to 1.95 for surgical patients. Parenteral third-generation cephalosporins were the most commonly prescribed at a rate of 54.3% (n=159) followed by nitroimidazole 29.4% (n=86), quinolones 7.5% (n=22) and macrolides 4.4% (n=13), while carbapenems and aminoglycosides were the least prescribed together accounting for only 4.4% (n=13). The intravenous route was the most common route of administration, used for 96.6% of patients (n=171). Indications were reported in only 63.8% of cases. Culture to identify pathogenic organisms was employed in only 0.5% of cases. Conclusion: Broad-spectrum antibiotics are prescribed at an alarming rate. This practice may provoke antibiotic resistance and adversely affect the patient outcome. Implementation of an antibiotic stewardship program is warranted to enhance the efficacy, safety and cost-effectiveness of antimicrobial agents.
Abstract: Innovative medical technologies offer more effective medical care, with less risk to patient and healthcare personnel. Medical technology and devices when properly used provide better data, precise monitoring and less invasive treatments and can be more targeted and often less costly. The Intensive Care Unit (ICU) equipped with patient monitoring, respiratory and cardiac support, pain management, emergency resuscitation and life support devices is particularly prone to medical errors for various reasons. Many people in the developing countries now wonder whether their visit to hospital might harm rather than help them. This is because; clinicians in the developing countries are required to maintain an increasing workload with limited resources and absence of well-functioning safety system. A team of experts from the medical, biomedical and clinical engineering in Sweden and Bangladesh have worked together to study the incidents, adverse events at the ICU in Bangladesh. The study included both public and private hospitals to provide a better understanding for physical structure, organization and practice in operating processes of care, and the occurrence of adverse outcomes the errors, risks and accidents related to medical devices at the ICU, and to develop a ICT based support system in order to reduce hazards and errors and thus improve the quality of performance, care and cost effectiveness at the ICU. Concrete recommendations and guidelines have been made for preparing appropriate ICT related tools and methods for improving the routine for use of medical devices, reporting and analyzing of the incidents at the ICU in order to reduce the number of undetected and unsolved incidents and thus improve the patient safety.
Abstract: The objective of this study is to determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) harboring mecA genes from screening isolates among intensive care unit (ICU) patients. All MRSA screening isolates from ICU’s patients of Cipto Mangunkusumo Hospital during 2011 and 2014 were included in this study. Identification and susceptibility test was performed using Vitek2 system (Biomereux®). PCR was conducted to characterize the SCCmec of S. aureus harboring the mecA gene on each isolate. Patient’s history of illness was traced through medical record. 24 isolates from 327 screening isolates were MRSA positive (7.3%). From PCR, we found 17 (70.8%) isolates carrying SCCmec type I, 3 (12.5%) isolates carrying SCCmec type III, and 2 (8.3%) isolates carrying SCCmec type IV. In conclusion, SCCmec type I is the most prevalent MRSA colonization among ICU patients in Cipto Mangunkusumo Hospital.
Abstract: This paper addresses the design of hospital Intensive
Care Unit windows for the achievement of visual comfort and energy
savings. The aim was to identify the window size and shading system
configurations that could fulfill daylighting adequacy, avoid glare
and reduce energy consumption. The study focused on addressing the
effect of utilizing different shading systems in association with a
range of Window-to-Wall Ratios (WWR) in different orientations
under the desert clear-sky of Cairo, Egypt.
The results of this study demonstrated that solar penetration is a
critical concern affecting the design of ICU windows in desert
locations, as in Cairo, Egypt. Use of shading systems was found to be
essential in providing acceptable daylight performance and energy
saving. Careful positioning of the ICU window towards a proper
orientation can dramatically improve performance. It was observed
that ICU windows facing the north direction enjoyed the widest range
of successful window configuration possibilities at different WWRs.
ICU windows facing south enjoyed a reasonable number of
configuration options as well. By contrast, the ICU windows facing
the east orientation had a very limited number of options that provide
acceptable performance. These require additional local shading
measures at certain times due to glare incidence. Moreover, use of
horizontal sun breakers and solar screens to protect the ICU windows
proved to be more successful than the other alternatives in a wide
range of Window to Wall Ratios. By contrast, the use of light shelves
and vertical shading devices seemed questionable.
Abstract: Hospitals, everywhere, are considered heavy energy consumers. Hospital Intensive Care Unit spaces pose a special challenge, where design guidelines requires the provision of external windows for daylighting and external view. Window protection strategies could be employed to reduce energy loads without detriment effect on comfort or health care. This paper addresses the effectiveness of using various window strategies on the annual cooling, heating and lighting energy use of a typical Hospital Intensive Unit space. Series of experiments were performed using the EnergyPlus simulation software for a typical Intensive Care Unit (ICU) space in Cairo, located in the Egyptian desert. This study concluded that the use of shading systems is more effective in conserving energy in comparison with glazing of different types, in the Cairo ICUs. The highest energy savings in the West and South orientations were accomplished by external perforated solar screens, followed by overhangs positioned at a protection angle of 45°.
Abstract: Estimation of the magnitude and causes of poisoning
was the objective of the current study. A retrospective study of
medical records of all poisoning children admitted to Benghazi
Children Hospital in Libya from January 2008 up to December 2010.
Number of children admitted was 244; the age ranged from less than
one to 13 years old. Most of cases were admitted with mild symptom
and the majority of them were boys. Only few cases admitted to
intensive care unit and there was no mortality recorded through the
period of study. Age group 1 to 3 years (50.8%) had the highest
frequency of admission and the peak of admission was during
summer. The most common cause of admission was due to ingestion
of medication (53.69%), House hold product exposure (26.64%) was
the second causes of admission while, 19.67% of admissions were
due to Food poisoning. Almost all admitted cases were accidental and
medicines were the most consumed substances in addition, improper
storage of toxic agents were the first risk factor of poisoning. Present
results indicated that, children poisoning seems to be a common
pediatric care problem which need to control and prevent.
Abstract: Leave of absence is important in maintaining a good
status of human resource quality. Allowing the employees temporarily
free from the routine assignments can vitalize the workers- morality
and productivity. This is particularly critical to secure a satisfactory
service quality for healthcare professionals of which were typically
featured with labor intensive and complicated works to perform. As
one of the veteran hospitals that were found and operated by the
Veteran Department of Taiwan, the nursing staff of the case hospital
was squeezed to an extreme minimum level under the pressure of a
tight budgeting. Leave of absence on schedule became extremely
difficult, especially for the intensive care units (ICU), in which
required close monitoring over the cared patients, and that had more
easily driven the ICU nurses nervous. Even worse, the deferred leaves
were more than 10 days at any time in the ICU because of a fluctuating
occupancy. As a result, these had brought a bad setback to this
particular nursing team, and consequently defeated the job
performance and service quality. To solve this problem and
accordingly to strengthen their morality, a project team was organized
across different departments specific for this. Sufficient information
regarding jobs and positions requirements, labor resources, and actual
working hours in detail were collected and analyzed in the team
meetings. Several alternatives were finalized. These included job
rotating, job combination, leave on impromptu and cross-departmental
redeployment. Consequently, the deferred leave days sharply reduced
70% to a level of 3 or less days. This improvement had not only
provided good shelter for the ICU nurses that improved their job
performance and patient safety but also encouraged the nurses active
participating of a project and learned the skills of solving problems
with colleagues.
Abstract: Nosocomial (i.e., hospital-acquired) infections
(NI) is a major cause of morbidity and mortality in hospitals. NI
rate is higher in intensive care units (ICU) than in the general
ward due to patients with severe symptoms, poor immunity,
and accepted many invasive therapies. Contact behaviors
between health caregivers and patients is one of the infect
factors. It is difficult to obtain complete contact records by
traditional method of retrospective analysis of medical records.
This paper establishes a contact history inferential model
(CHIM) intended to extend the use of Proximity Sensing of
rapid frequency identification (RFID) technology to
transferring all proximity events between health caregivers and
patients into clinical events (close-in events, contact events and
invasive events).The results of the study indicated that the
CHIM can infer proximity care activities into close-in events
and contact events.
The infection control team could redesign and build optimal
workflow in the ICU according to the patient-specific contact
history which provided by our automatic tracing system.
Abstract: We consider a single-echelon, single-item inventory
system where both demand and lead-time are stochastic. Continuous
review policy is used to control the inventory system. The objective
is to calculate the reorder point level under stochastic parameters. A
case study is presented in Neonatal Intensive Care Unit.