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Fulltext Identifying the nurses’ knowledge and practice on preventing ventilator-associated pneumonia in the intensive care unit, Queen Elizabeth Hospital 2, Sabah

Patricia Sator, Noorhafizah Ag Riun

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):43-43.
MyJurnal

Introduction: Ventilator-associated pneumonia (VAP) is defined as pneumonia that occurs 48-72 hours or there-after following endotracheal intubation. VAP increased health care costs due to hospital length of stay. Since VAP can be prevented, this study underscores the importance of identifying the current knowledge and practice on the prevention of VAP among the ICU nurses in Queen Elizabeth Hospital 2 (QEH2). The objective of this study is to determine the nurse’s knowledge and practice towards VAP prevention. Methods: The methodology used for this study is a cross-sectional study to evaluate nurses’ knowledge and practice in the ICU, QEH2. 82 ICU QEH2 nurs-es participated. Data were collected using a modified structured questionnaire based on the checklist of VAP data elements. The elements covered in the questionnaire consist of three parts, which are Part A on socio-demographic information, Part B on knowledge ventilator-associated pneumonia events and Part C on nurse’s prevention practice on ventilator-associated events. The data was analyzed using SPSS version 20. Results: The overall results of this study are 45.1% of the nurses were less knowledgeable on VAP prevention and this could lead to a prevalence of VAP in the unit. VAP is a new concept implemented in 2013, meaning that 48.53% (n=33) nurses who trained 2-5 years ago may have not covered VAP in their infection prevention and control training. Most of the ICU nurses did not profoundly practices on subglottic suction (35/82), hand hygiene prior suctioning (40/82), hand hygiene after ETT suction (16/82) and delirium risk assessment (1/82). As a discussion, this could mean the ICU nurses do not have adequate knowledge and practice awareness on VAP prevention. Conclusion: For the conclusion of this study, the nurses working in ICU, QEH2 practiced most of the recommended VAP prevention but not all. Continuous training on prevention for VAP in ICU needs to be review. The hospital management to ensure the availability of the facilities needed and the adoption of guidelines based on evidence-based practice.

Matched MeSH terms: Suction
Perinatal characteristics and outcome of neonates born in thick meconium-stained liquor

Ida, S.B.O., Teh, K.H., Quah, B.S.

Malaysian Journal of Paediatrics and Child Health, 2000;12(1):16-21.
MyJurnal

Meconium aspiration syndrome (MAS) frequently occurs in neonates born in thick meconium-stained liquor (TMSL). It continues to be a significant cause of neonatal morbidity and mortality despite aggressive approaches to intervention. This study aims to identify the perinatal characteristics of deliveries with TMSL associated with the development of MAS and to describe the outcome of those babies who developed MAS.
All newborns with TMSL born in Hospital Alor Setar, Kedah from 1 October 1998 to 30 April 1999 were prospectively studied. In the hospital, all newborns with TMSL were routinely admitted to the Special Care Nursery for observation. Relevant data regarding pregnancy, delivery, resuscitation and outcome of newborns with and without MAS were collected and analysed. The incidence of TMSL among hospital deliveries was 2.2% (95% C.I. 1.8-2.5%). Thirty-six percent (95% C.I. 28.4-44.7%) of newborns with TMSL developed MAS. Significant risk factors associated with the development of MAS were non-Malay mothers (p=0.04, OR=3.32), resuscitation by paediatric medical officers (p=0.02, OR=2.84) and direct tracheal suction during resuscitation (p=0.02, OR=2.61). The presence of non-Malay mothers or resuscitation by paediatric medical officers or direct tracheal suction during resuscitation gave a sensitivity of 88.2%, specificity of 36.7%, a positive predictive value of 44.1% and a negative predictive value of 84.6% for the development of MAS. Asphyxia, pneumothorax and persistent pulmonary hyper-tension occurred in 25.5%, 7.8% and 5.9% of the babies with MAS respectively. Mechanical ventilation was required in 51% and the mortality rate was 3.9%. In conclusion, the incidence of TMSL and MAS and the mortality rate of neonates with MAS were comparable with that in developed countries. The presence of any one of the significant risk factors had high sensitivity but low specificity for the development of MAS. Newborns were unlikely to develop MAS if all these risk factors were absent.

Matched MeSH terms: Suction
Fulltext Genome sequence of an unclassified pleosporales species isolated from human nasopharyngeal aspirate

Ng KP, Yew SM, Chan CL, Soo-Hoo TS, Na SL, Hassan H, et al.

Eukaryot Cell, 2012 Jun;11(6):828.
PMID: 22645233 DOI: 10.1128/EC.00133-12

Pleosporales is the largest order in the fungal class Dothideomycetes. We report the 36,814,818-bp draft genome sequence and gene annotation of UM1110, a Pleosporales isolate associated with unclassified genera that is potentially a new fungal species. Analysis of the genome sequence led to the finding of genes associated with fungal adhesive proteins, secreted proteases, allergens, and pseudohyphal development.

Matched MeSH terms: Suction
Fulltext The 50% and 95% effective doses of desflurane for removal of the classic laryngeal mask airway in spontaneously breathing anaesthetised adults

Hui MT, Subash S, Wang CY

Anaesthesia, 2011 Apr;66(4):274-7.
PMID: 21401540 DOI: 10.1111/j.1365-2044.2011.06620.x

The 50% and 95% effective doses of desflurane for removal of the classic laryngeal mask airway after suction of the upper airway, in anaesthetised spontaneously breathing adult patients, are not known. To determine these, we studied 38 healthy patients, aged between 18 and 44 years. The target desflurane concentration in each individual patient was determined by the Dixon up-and-down method. When the predetermined target end-tidal desflurane concentration reached steady state, we kept a constant end-expiratory partial pressure between the alveolus and the brain for 10 min before attempting to remove the classic laryngeal mask airway after suctioning the upper airway. The initial desflurane target concentration was set at 6% and up-down desflurane increments were 0.1%. This continued until there were at least six crossover pairs. From the probit analysis, the 50% effective dose of desflurane was 5.29% (95% CI 5.132-5.379%) and the 95% effective dose was 5.55% (95% CI 5.429-6.394%).

Matched MeSH terms: Suction
Fulltext Edwardsiella tarda septicemia with underlying multiple liver abscesses

Yousuf RM, How SH, Amran M, Hla KT, Shah A, Francis A

Malays J Pathol, 2006 Jun;28(1):49-53.
PMID: 17694959 MyJurnal

Edwardsiella tarda has recently been described as a member of the family Enterobacteriaceae. The genus Edwardsiella contains three species; E. hoshinae, E. ictaluri and E. tarda. Edwardsiella tarda is the only species which has been recognised as pathogenic to humans, especially in those with an underlying disease. The most common presentation is watery diarrhoea. Extra intestinal infections have been reported infrequently. Humans seem to be infected or colonised with Edwardsiella through ingestion or inoculation of a wound. This report is of a patient with multiple liver abscesses due to E. tarda who later developed bacterial peritonitis and septicaemic shock.

Matched MeSH terms: Suction
Prospective randomized clinical trial on suction elastic band ligator versus forceps ligator in the treatment of haemorrhoids

Ramzisham AR, Sagap I, Nadeson S, Ali IM, Hasni MJ

Asian J Surg, 2005 Oct;28(4):241-5.
PMID: 16234072

This prospective randomized clinical trial was undertaken to compare the use of a single-operator vacuum suction ligator and the traditional forceps ligator in terms of pain perception following the procedure, intra-procedure bleeding and other complications.

Matched MeSH terms: Suction
Auricular pseudocyst in the tropics: a multi-racial Singapore experience

Tan BY, Hsu PP

J Laryngol Otol, 2004 Mar;118(3):185-8.
PMID: 15068513

Endochondral pseudocyst of the auricle is an uncommon condition that affects predominantly Chinese males, with many reports studying this condition in homogenous Chinese populations. There have been few large-scale reports describing the features of this disease among the other Asian groups. In one of the largest series described to date, we report the epidemiological features, clinico-pathologic characteristics, and success of surgical treatment in 40 patients of different Asian groups presenting with pseudocyst of the auricle. Results showed a Chinese predominance (90 per cent), followed by Malays (five per cent) and Eurasians (five per cent). All had unilateral presentations apart from one patient. Most (55 per cent) presented within two weeks of auricular swelling. Few (10 per cent) had a history of trauma. The pseudocysts predominantly affected the concha (61 per cent). Surgery comprised excision of the anterior wall followed by local pressure application. Only 2.5 per cent had recurrence after surgery. These findings confirm earlier understood features of this disease while revealing some notable variations.

Matched MeSH terms: Suction
Fulltext Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious diseases

Kumbargere Nagraj S, Eachempati P, Paisi M, Nasser M, Sivaramakrishnan G, Verbeek JH

Cochrane Database Syst Rev, 2020 Oct 12;10(10):CD013686.
PMID: 33047816 DOI: 10.1002/14651858.CD013686.pub2

BACKGROUND: Many dental procedures produce aerosols (droplets, droplet nuclei and splatter) that harbour various pathogenic micro-organisms and may pose a risk for the spread of infections between dentist and patient. The COVID-19 pandemic has led to greater concern about this risk.
OBJECTIVES: To assess the effectiveness of methods used during dental treatment procedures to minimize aerosol production and reduce or neutralize contamination in aerosols.
SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases on 17 September 2020: Cochrane Oral Health's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (in the Cochrane Library, 2020, Issue 8), MEDLINE Ovid (from 1946); Embase Ovid (from 1980); the WHO COVID-19 Global literature on coronavirus disease; the US National Institutes of Health Trials Registry (ClinicalTrials.gov); and the Cochrane COVID-19 Study Register. We placed no restrictions on the language or date of publication.
SELECTION CRITERIA: We included randomized controlled trials (RCTs) and controlled clinical trials (CCTs) on aerosol-generating procedures (AGPs) performed by dental healthcare providers that evaluated methods to reduce contaminated aerosols in dental clinics (excluding preprocedural mouthrinses). The primary outcomes were incidence of infection in dental staff or patients, and reduction in volume and level of contaminated aerosols in the operative environment. The secondary outcomes were cost, accessibility and feasibility.
DATA COLLECTION AND ANALYSIS: Two review authors screened search results, extracted data from the included studies, assessed the risk of bias in the studies, and judged the certainty of the available evidence. We used mean differences (MDs) and 95% confidence intervals (CIs) as the effect estimate for continuous outcomes, and random-effects meta-analysis to combine data. We assessed heterogeneity.
MAIN RESULTS: We included 16 studies with 425 participants aged 5 to 69 years. Eight studies had high risk of bias; eight had unclear risk of bias. No studies measured infection. All studies measured bacterial contamination using the surrogate outcome of colony-forming units (CFU). Two studies measured contamination per volume of air sampled at different distances from the patient's mouth, and 14 studies sampled particles on agar plates at specific distances from the patient's mouth. The results presented below should be interpreted with caution as the evidence is very low certainty due to heterogeneity, risk of bias, small sample sizes and wide confidence intervals. Moreover, we do not know the 'minimal clinically important difference' in CFU. High-volume evacuator Use of a high-volume evacuator (HVE) may reduce bacterial contamination in aerosols less than one foot (~ 30 cm) from a patient's mouth (MD -47.41, 95% CI -92.76 to -2.06; 3 RCTs, 122 participants (two studies had split-mouth design); very high heterogeneity I² = 95%), but not at longer distances (MD -1.00, -2.56 to 0.56; 1 RCT, 80 participants). One split-mouth RCT (six participants) found that HVE may not be more effective than conventional dental suction (saliva ejector or low-volume evacuator) at 40 cm (MD CFU -2.30, 95% CI -5.32 to 0.72) or 150 cm (MD -2.20, 95% CI -14.01 to 9.61). Dental isolation combination system One RCT (50 participants) found that there may be no difference in CFU between a combination system (Isolite) and a saliva ejector (low-volume evacuator) during AGPs (MD -0.31, 95% CI -0.82 to 0.20) or after AGPs (MD -0.35, -0.99 to 0.29). However, an 'n of 1' design study showed that the combination system may reduce CFU compared with rubber dam plus HVE (MD -125.20, 95% CI -174.02 to -76.38) or HVE (MD -109.30, 95% CI -153.01 to -65.59). Rubber dam One split-mouth RCT (10 participants) receiving dental treatment, found that there may be a reduction in CFU with rubber dam at one-metre (MD -16.20, 95% CI -19.36 to -13.04) and two-metre distance (MD -11.70, 95% CI -15.82 to -7.58). One RCT of 47 dental students found use of rubber dam may make no difference in CFU at the forehead (MD 0.98, 95% CI -0.73 to 2.70) and occipital region of the operator (MD 0.77, 95% CI -0.46 to 2.00). One split-mouth RCT (21 participants) found that rubber dam plus HVE may reduce CFU more than cotton roll plus HVE on the patient's chest (MD -251.00, 95% CI -267.95 to -234.05) and dental unit light (MD -12.70, 95% CI -12.85 to -12.55). Air cleaning systems One split-mouth CCT (two participants) used a local stand-alone air cleaning system (ACS), which may reduce aerosol contamination during cavity preparation (MD -66.70 CFU, 95% CI -120.15 to -13.25 per cubic metre) or ultrasonic scaling (MD -32.40, 95% CI - 51.55 to -13.25). Another CCT (50 participants) found that laminar flow in the dental clinic combined with a HEPA filter may reduce contamination approximately 76 cm from the floor (MD -483.56 CFU, 95% CI -550.02 to -417.10 per cubic feet per minute per patient) and 20 cm to 30 cm from the patient's mouth (MD -319.14 CFU, 95% CI - 385.60 to -252.68). Disinfectants ‒ antimicrobial coolants Two RCTs evaluated use of antimicrobial coolants during ultrasonic scaling. Compared with distilled water, coolant containing chlorhexidine (CHX), cinnamon extract coolant or povidone iodine may reduce CFU: CHX (MD -124.00, 95% CI -135.78 to -112.22; 20 participants), povidone iodine (MD -656.45, 95% CI -672.74 to -640.16; 40 participants), cinnamon (MD -644.55, 95% CI -668.70 to -620.40; 40 participants). CHX coolant may reduce CFU more than povidone iodine (MD -59.30, 95% CI -64.16 to -54.44; 20 participants), but not more than cinnamon extract (MD -11.90, 95% CI -35.88 to 12.08; 40 participants).
AUTHORS' CONCLUSIONS: We found no studies that evaluated disease transmission via aerosols in a dental setting; and no evidence about viral contamination in aerosols. All of the included studies measured bacterial contamination using colony-forming units. There appeared to be some benefit from the interventions evaluated but the available evidence is very low certainty so we are unable to draw reliable conclusions. We did not find any studies on methods such as ventilation, ionization, ozonisation, UV light and fogging. Studies are needed that measure contamination in aerosols, size distribution of aerosols and infection transmission risk for respiratory diseases such as COVID-19 in dental patients and staff.

Matched MeSH terms: Suction