Hygienic practices among consultant anesthetists in teaching hospitals of Sindh Pakistan: A cross-sectional survey

Background: Infection susceptibility during anesthesia administration and surgical procedures continues to be a primary cause of morbidity and mortality, despite the advent of prophylactic antibiotics and advanced technology. During surgery, nosocomial infections frequently result in sepsis, highlighting the importance of Operation Theatre (OT) sanitation. Objectives: To evaluate the hygienic practices of anesthesiologists operating in teaching hospitals in Sindh, Pakistan. Methods: Using cross-sectional design, six-month survey of consultant anesthetists in Sindh's numerous educational institutions was conducted. A thorough, self-administered questionnaire was used to collect data on aspects of sanitation practices including knowledge of infection control, existing practices, perceived obstacles, and adherence to guidelines. Utilizing a sequential sampling procedure, participants meeting specific eligibility criteria were selected to represent a wide range of demographics, socioeconomic statuses, and healthcare delivery contexts. Results: The study contributed to closing the disparity between global standards and actual practices, thereby aligning with the global initiative to improve anesthesia hygiene practices. A total of 83 consultants were approached, but 18 declined, culminating in the analysis of data from 65 participants. Their mean age was 49.27+11.17 years. Participants were predominantly employed in private institutions (n=43) and had an average of 13.97 (SD=10.24) years of experience (p> 0.05).&nbsp

Impact of a standardised parenteral nutrition protocol: A quality improvement experience from a NICU of a developing country

Objective: Nutrition societies recommend using standardised parenteral nutrition (SPN) solutions. We designed evidence-based SPN formulations for neonates admitted to our neonatal intensive care unit (NICU) and evaluated their outcomes.Design: This was a quality improvement initiative. Data were collected retrospectively before and after the intervention.Setting: A tertiary-care level 3 NICU at the Aga Khan University in Karachi, Pakistan.Patients: All NICU patients who received individualised PN (IPN) from December 2016 to August 2017 and SPN from October 2017 to June 2018.Interventions: A team of neonatologists and nutrition pharmacists collaborated to design two evidence-based SPN solutions for preterm neonates admitted to the NICU.Main outcome measures: We recorded mean weight gain velocity from days 7 to 14 of life. The other outcomes were change in weight expressed as z-scores, metabolic abnormalities, PN-associated liver disease (PNALD), length of NICU stay and episodes of sepsis during hospital stay.Results: Neonates on SPN had greater rate of change in weight compared with IPN (β=13.40, 95% CI: 12.02 to 14.79) and a smaller decrease in z-scores (p\u3c0.001). Neonates in the SPN group had fewer hyperglycemic episodes (IPN: 37.5%, SPN: 6.2%) (p\u3c0.001), electrolyte abnormalities (IPN: 56.3%, SPN: 21%) (p\u3c0.001), PNALD (IPN: 52.5%, SPN: 18.5%) (p\u3c0.001) and sepsis (IPN: 26%, SPN: 20%) (p\u3c0.05). The median length of stay in NICU was 14.0 (IQR 12.0-21.0) for the IPN and 8.0 (IQR 5.0-13.0) days for the SPN group.Conclusions: We found that SPN was associated with shorter NICU stay and greater weight gain. In-house preparation of SPN can be used to address the nutritional needs in resource-limited settings where commercially prepared SPN is not available

Evaluation of the feasibility of the FAST-M maternal sepsis intervention in Pakistan: a protocol

Abstract Background Maternal sepsis is a life-threatening condition, defined by organ dysfunction caused by infection during pregnancy, childbirth, and the postpartum period. It is estimated to account for between one-tenth and half (4.7% to 13.7%) of all maternal deaths globally. An international stakeholder group, including the World Health Organization, developed a maternal sepsis management bundle called “FAST-M” for resource-limited settings through a synthesis of evidence and international consensus. The FAST-M treatment bundle consists of five components: Fluids, Antibiotics, Source identification and control, assessment of the need to Transport or Transfer to a higher level of care and ongoing Monitoring (of the mother and neonate). This study aims to adapt the FAST-M intervention and evaluate its feasibility in Pakistan. Methods The proposed study is a mixed method, with a before and after design. The study will be conducted in two phases at the Liaquat University of Medical and Health Sciences, Hyderabad. In the first phase (formative assessment), we will adapt the bundle care tools for the local context and assess in what circumstances different components of the intervention are likely to be effective, by conducting interviews and a focus group discussion. Qualitative data will be analyzed considering a framework method approach using NVivo version 10 (QSR International, Pty Ltd.) software. The qualitative results will guide the adaptation of FAST-M intervention in local context. In the second phase, we will evaluate the feasibility of the FAST-M intervention. Quantitative analyses will be done to assess numerous outcomes: process, organizational, clinical, structural, and adverse events with quantitative comparisons made before and after implementation of the bundle. Qualitative analysis will be done to evaluate the outcomes of intervention by conducting FGDs with HCPs involved during the implementation process. This will provide an understanding and validation of quantitative findings. Discussion The utilization of care bundles can facilitate recognition and timely management of maternal sepsis. There is a need to adapt, integrate, and optimize a bundled care approach in low-resource settings in Pakistan to minimize the burden of maternal morbidities and mortalities due to sepsis. </jats:sec