IPRC - 2019
Permanent URI for this collectionhttp://repository.kln.ac.lk/handle/123456789/20881
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Item Study on Hepatitis B immunization and Antibody Level in Health Care Workers, District Base Hospital, Wathupitiwala(International Postgraduate Research Conference 2019, Faculty of Graduate Studies, University of Kelaniya, Sri Lanka, 2019) Wijesooriya, L.I.; Jayawardana, G.P.C.; Rupasinghe, R.A.L.S.Introduction Hepatitis B virus (HBV) is a blood born pathogen leading to cirrhosis and hepatocellular carcinoma. It is transmitted mainly through contaminated blood or blood products from an infected person. It has the highest potential to transmit though prick injuries as one in three infected punctures. Therefore, health care workers (HCWs) are at great risk of contracting the infection during patient care. Hence, HBV immunization and having protective antibody levels are mandatory for HCWs.Item The Bacteriological Profile of Ear Infections: An Analysis from a Secondary Health Care Center of Sri Lanka(International Postgraduate Research Conference 2019, Faculty of Graduate Studies, University of Kelaniya, Sri Lanka, 2019) Wijesooriya, L.I.; Jayawardana, G.P.C.; de Silva, S.H.N.A.; Karunasekara, H.C.I.Introduction: Bacteria responsible for ear infections are diverse. Therefore, the treatment of such infections needs to be guided by the antibiotic sensitivity data. To prevent shift into the chronic form which leads the burden of morbidity and increased healthcare cost. Having a microbiological profile of ear infections with its antibiotic sensitivity pattern would minimize the burden. Objective: To find out the bacteriological profile and their antibiotic resistance pattern in patients with ear infections Methodology: A descriptive cross-sectional study was conducted prospectively from 01.10.2018 to 30.09.2019 involving sixty-two patients with clinically diagnosed otitis media or otitis externa by the . Organisms responsible were identified and their antibiotic sensitivity was recorded. Antibiotic sensitivity data of the most common organisms were analyzed. Data related to demography, clinical history and previous antibiotic therapy were noted. The level of significance was considered as P<0.05. Results: Of the sixty-two patients, 63% (39/62) had otitis externa whereas 37% (23/62) had otitis media. The difference was not significant statistically (P = 0.096). In 97% (60/62) of patients, the ear infection was unilateral and in 3% (2/62), it was bilateral. In 48% (30/62) of patients, the current presentation was the first episode, in 27% (17/62), it was the second, in 16% (10/62), it was the third and in 8% (5/62), it was beyond the third episode. In 89% (55/62), patients were treated with empirical antibiotics whereas, in 11% (7/62), the samples were obtained before antibiotics. Of the organisms causing ear infections, Pseudomonas–32% (20/62), Staphylococcus aureus–25% (15/62), Candida spp 12% (8/62), other fungal spp-3%, (2/62) Coliforms-3% (2/62), Proteus spp- %, (1/62), Streptococcus pneumoniae-2%, (1/62), mixed bacterial growth in 2% (1/62) and no bacterial growth in 19%, (12/62). According to ABST of Pseudomonas spp sensitivity was 85% (17/62) for piperacillin-tazobactam, 80% (16/62) for ceftazidime, 75% (15/62) for meropenem, 75% (15/62) for cefoperazone-sulbactam, 70% (14/62) for ticarcillin–clavulanic acid, 70% (14/62) for amikacin, 50% (10/ 62) for gentamicin, 50% (10/62) for Ciprofloxacin and 40% (8/62) for norfloxacin. Of the S. aureus, 66.7% (10/15) were methicillin-sensitive (MSSA) and 33.3% (5/15) were Methicillin-resistant (MRSA). According to ABST of MSSA, sensitivity was 100% for gentamicin, chloramphenicol, fusidic acid, teicoplanin and vancomycin, 90% (9/10) for clindamycin, 80% for co-trimoxazole, 70% (7/10) for ciprofloxacin, 60% (6/10) for erythromycin and 50% (5/10) for norfloxacin. Of MRSA, all were sensitive for vancomycin, teicoplanin and fusidic acid, 60% (3/5) were sensitive for clindamycin and none were sensitive for gentamicin, chloramphenicol, co-trimoxazole, ciprofloxacin, erythromycin and norfloxacin. Conclusion: Of ear infections, there was no significant difference between otitis externa and otitis media in proportions. Almost all had unilateral infections. Pseudomonas spp were the predominant bacterium identified and the S. aureus was the second. More than 75% of the Pseudomonas spp were sensitive to piperacillin-tazobactam, ceftazidime, meropenem and cefoperazone-sulbactam. The sensitivity was <50% for gentamicin and norfloxacin. MSSA was sensitive to most antistaphylococcal antibiotics. However, MRSA was sensitive only for limited antistaphylococcal antibiotics.Item A Single-Center Study on Intravenous Cannulation(International Postgraduate Research Conference 2019, Faculty of Graduate Studies, University of Kelaniya, Sri Lanka, 2019) Wijesooriya, L.I.; Jayawardana, G.P.C.; Rupasinghe, R.A.L.S.Introduction: Of the nosocomial infections, bloodstream infections are vital since it has potential to ends up with sepsis, which has high mortality. Of the hospital-acquired bloodstream infections, a significant proportion is associated with intravenous (IV) cannulation. Objective: To find out the compliance with the protocol for IV cannulation in practice. Methodology: A descriptive cross-sectional study was conducted observing a hundred IV cannulation done at a secondary care hospital, Sri Lanka following approval from hospital administration from 01-10-2018 to 30-10-2019. The study was conducted through an infection control nurse with no prior notice to the relevant ward/unit. Observations were recorded and the procedure was checked against the IV cannulation guidelines stated in the infection control manual of Sri Lanka. Results: Of the 100 cannulations procedures, 90 were from wards and 10 from the preliminary care unit and four from the intensive care unit. In none of the procedures, the healthcare worker (HCW) himself or herself was introduced to the patient. In all procedures, physicians’ recommendation for cannulation was checked and patient details were verified with bed head ticket. Allergy for plaster or povidone-iodine was inquired in 70%. The cannulation procedure was explained to the patient in 83%. The patients’ preference as to which arm the cannula should insert was inquired in 28% of patients. Patients’ non-dominant arm was used for cannulation in 52% and patients’ dominant hand was used for cannulation in 48%. The selected insertion site was disinfected with 70% alcohol and allowed to dry in 24%. After cleaning, the tentative puncture site was touched by HCW in 58% cannulation and not so in 42%. Following the procedure, the cannula was secured with plaster in all calculations. The cannula was flushed with normal saline in 89% of cannulation procedures. Entry ports of cannula kept closed when not in use in 94%. The clinical waste following cannulation was disposed into an appropriate bin in 96%. The date of cannula insertion was labeled on the plaster over cannula in 69% and it was not labeled in 31%. After the procedure, hand washing was performed by 44% and not at 56%. The patient was thanked for the compliance in 24% of cannulation and not so in 76%. In all cannulation procedures, the procedure was not recorded in patient records. Conclusion: Before cannulation, verification of patient details and the physician’s recommendation was highly satisfactory. However, the cleaning of the cannulation site before the procedure was highly unsatisfactory. Flushing the cannula, which is against the guidelines, was observed in 89%. Securing the cannula was satisfactory but label the date of cannulation was poor and recording of the cannulation was not observed following any cannulation. Waste disposal following cannulation was satisfactory. Ethics relating to patient handing such as explain the procedure to the patient was satisfactory but introduce the HCW by himself/herself to the patient, obtain consent,Item An Observational Study on Urinary Catheterization with Emphasis on Infection Control Practices(International Postgraduate Research Conference 2019, Faculty of Graduate Studies, University of Kelaniya, Sri Lanka, 2019) Wijesooriya, L.I.; Jayawardana, G.P.C.; Rupasinghe, R.A.L.S.Introduction: Urinary tract infections (UTI) are predominant nosocomial infections. Of them, catheter-associated UTI (CA-UTI) is prevailing. Of the reasons behind CA-UTI, factors associated with catheterization plays a vital role. Identification of such reasons would scrutinize the preventive measures of CA-UTI. Objective: To find out the compliance with standards in the urinary catheterization. Methodology: A descriptive-cross-sectional study was conducted observing hundred urinary catheterizations done at a secondary-care hospital in Sri Lanka during 01-10-2018 to 15-10-2019. The study was conducted through the hospital infection control nurse. Study observations, including measures taken before, during and after each catheterization were recorded. The observations were assessed against the catheterization guidelines provided in the infection control manual of Sri Lanka. The level of satisfaction in each measure was considered when the correct measure was followed in >75% of catheterizations. Results: Of the 100 catheterizations, 85 were from wards, 11 in the preliminary care unit and four in the intensive care unit. Before the catheterization, patients’ privacy was secured in 96% of patients. Healthcare worker (HCW) was introduced by himself/herself to the patient in none of the catheterizations. In all cases, patients’ details were confirmed with the patient records (name, age, admission number) in the bed head ticket. In 64% of patients, they were inquired for relevant allergies (plaster, povidone or latex). In 86% of cases, HCW explained the catheterization procedure to patients and obtained verbal consent. Requirements for the procedure were checked in the catheterization tray in 97% of cases. Washing hands with soap and water and wear sterile gloves were observed in 66% of catheterizations. Catheterization was done by a medical officer in 55% and 45% was done by a nurse. However, the cleaning of patients’ genital area before catheterization was done by a medical officer in 9%, nurse in 32% and a laborer in 59% of patients. During the procedure, the urethra was lubricated with sterile anesthetic gel in 34% and the catheter was lubricated with anesthetic gel in all catheterizations. After catheterization, the catheter bulb was inflated with the ideal volume of water in all cases and the catheter was anchored to thigh securely with plaster in 87%. Urine bag kept below the level of the bladder in all cases. Following catheterization, the patents’ perineal area was cleaned in 31% of patients. In 96% of catheterizations, HCWs washed hands after the procedure. Documentation of procedure in the BHT was done in none. Conclusion: Satisfactory measures were taken in the pre-catheterization stage as explaining the procedure to the patient, obtain consent and verify patient details. However, measures were unsatisfactory as inquiring about relevant allergies, wash hands, and wear sterile gloves before the procedure. Though trained personnel did the catheterization, the same person did not do the cleaning of the perineal area, which is very important. After catheterization, cleaning of the perineal area was not performed in majority and recording of the procedure was not satisfactory at all.