Recompression treatment for decompression illness: 5-year report (2003-2007) from National Centre for Hyperbaric Medicine in Poland

A serious diving accident can occur in recreational diving even in countries where diving is not very popular due to the fact that diving conditions there are not as great as in some tropical diving locations. The estimated number of injured divers who need recompression treatment in European hyperbaric facilities varies between 10 and 100 per year depending on the number of divers in the population, number of dives performed annually, and number of hyperbaric centres in the country. In 5 years of retrospective observation in Poland (2003-2007) there were 51 cases of injured recreational divers recorded. They either dived locally or after returning home by air from a tropical diving resort. All of them were treated with recompression treatment in the National Centre for Hyperbaric Medicine in Gdynia which has capability to treat any patient with decompression illness using all currently available recompression schedules with any breathing mixtures including oxygen, nitrox, heliox or trimix. The time interval between surfacing and first occurrence of symptoms was significantly lower in the group of patients with neurological decompression sickness or arterial gas embolism (median 0.2 hours) than in the group of patients with other types of decompression sickness (median 2.0 hours). In both groups, there were different types of recompression tables used for initial treatment and different number of additional sessions of hyperbaric oxygenation (HBO) prescribed, but the final outcome was similar. Complete resolution of symptoms after initial recompression treatment was observed in 24 cases, and this number was increased to 37 cases after additional HBO sessions (from 1 to 20). In the final outcome, some residual symptoms were observed in 12 cases. In 2 cases initial diagnosis of decompression sickness type I was rejected after initial recompression treatment and careful re-evaluation of diving profiles, risk factors and reported symptoms

Pneumoperitoneum after diving – two clinical cases and literature review

Pneumoperitoneum after diving is a rare symptom. Diagnosis and treatment strongly depends on the primary source of the air in the abdominal cavity. There are two main sources of air entering the perineum: perforation of the gastrointestinal tract and pulmonary barotrauma. The management is different and additionally, in both cases, the decompression sickness and arterial gas embolism as consequences of inappropriate decompression phase of the diving should be included in the clinical diagnosis and treatment. The multidisciplinary team including hyperbaric physicians and surgeons is necessary for proper management of such cases. In this paper two cases of pneumoperitoneum of different origins are presented and similar cases reported in the literature are discussed. 1 National Center fo

Detection and Analysis of <i>Clostridioides difficile</i> Spores in a Hospital Environment

Clostridioides difficile, due to its long survival time in a hospital environment, is considered to be one of the most frequent factors in healthcare-associated infections. Patient care requires not only rapid and accurate diagnosis, but also knowledge of individual risk factors for infections, e.g., with C. difficile, in various clinical conditions. The goal of this study was to analyse the degree of contamination of a hospital environment with C. difficile spores. Culturing was performed using C diff Banana BrothTM medium, which enables germination of the spores of these bacteria. Samples were collected from inanimate objects within a hospital environment in a specialist hospital in Poland. The results of the study demonstrated the presence of 18 positive samples of Clostridioides spp. (15.4%). Of these, C. difficile spores were detected in six samples, Clostridioides perfringens in eight samples, Clostridioides sporogenes in two samples and Clostridioides innocuum and Clostridioides baratii in one sample each. Among the six samples of C. difficile, a total of four strains which produce the B toxin were cultured. The binary toxin related to ribotype 027 was not detected in our study. Nosocomial infection risk management is a significant problem, mainly concerning the issues of hygiene maintenance, cleaning policy and quality control, and awareness of infection risk

Level of Knowledge of Medical Staff on the Basis of the Survey in Terms of Risk Management, Associated with Clostridioides difficile Infections

Infections caused by the toxigenic strains of Clostridioides difficile in the hospital environment pose a serious public health problem. The progressive increase in hospital infections in Poland indicates that risk management is a tool that is not used in an effective way and significantly differs from the goals set by the Leading Authorities, the Ministry of Health and its subordinate units. Systematic education of medical personnel constitutes the basic element of rational risk management aimed at reducing the number of infections as it allows for the transfer of knowledge, development of appropriate organizational procedures, and improves internal communication. This paper presents the results of a survey conducted in hospital facilities throughout Poland. The study dealt with what medical personnel know about channels of transmission and prevention of Clostridioides difficile infections in the hospital setting, professional training and risk management in terms of reducing the number of infections. The survey reveals that Clostridioides difficile continues to be a serious problem in the inpatient care system. Procedures and management strategies implemented by hospitals in order to limit the spread of the pathogen are predominantly focused on short-term action, which does not lead to a real improvement in terms of hospitalized patients’ safety. The infection risk management system was assessed at a fairly low level. The obtained research results confirmed the research hypotheses that had been formulated

Application of a Novel PM Model to Assess the Risk of Clostridioides difficile Infections in Medical Facilities as a Tool for Improving the Quality of Health Services and the Safety of Patients

Infections with multi-drug resistant microorganisms associated with the provision of health services have become an acute problem worldwide. These infections cause increased morbidity as well as mortality and are a financial burden for the healthcare system. Effective risk management can reduce the spread of infections and thus minimize their number in hospitalized patients. We have developed a new approach to the analysis of hazards and of exposure to the risk of adverse events by linking the patient&rsquo;s health record system to the entire infrastructure of the hospital unit. In this study, using the developed model, we focused on infections caused by the Clostridioides difficile bacterium, as they constitute a significant number of nosocomial infections in Poland and worldwide. The study was conducted in a medical facility located in the central part of Poland which provides tertiary care. In the proposed PM model, a risk analysis of hospital acquired infections at the Intensive Care and Anesthesiology Unit combined with the hospital&rsquo;s technical facilities and organizational factors was conducted. The obtained results indicate the most critical events which may have an impact on potential hazards or risks which may result from the patient&rsquo;s stay at the specific ward. Our method can be combined with an anti-problem approach, which minimizes the critical level of infection in order to determine the optimal functioning of the entire hospital unit. Research has shown that in most situations the spread dynamics of nosocomial infections can be controlled and their elimination may be attempted. In order to meet these conditions, the persons responsible for the daily operation of the medical facility and its individual wards have to indicate potential events and factors which present a risk to the hospitalized patients. On the basis of a created spreadsheet directions for improvement may be finally established for all potential events, their frequency may be minimized, and information may be obtained on actions which should be undertaken in a crisis situation caused by the occurrence of a given phenomenon. We believe that the proposed method is effective in terms of risk reduction, which is important for preventing the transmission of multi-drug resistant microorganisms in the hospital environment