Clinico-social parameters of diabetes among patientsutilizing emergency medical services

Background: Diabetes mellitus (DM) is increasing in its potential in developing countries. Rise in diabetic patients calling emergency medical services (EMS) is expected. It calls for thorough assessment of patients with DM utilizing EMS. In the present study, was to assess magnitude of DM among patients utilizing EMS and its clinico-social parameters.Methods: It was hospital record based observational study of patients calling EMS delivered by a tertiary care hospital in Pune, Maharashtra, India during 1st January 2013 to 31st December 2014. Patients with incomplete records were excluded. A person with medical background was trained to extract required information from hospital records. Patients with previously diagnosed DM were considered those who were on diet, oral hypoglycemic agents or taking insulin therapy and newly diagnosed patients with DM were considered those with the value of glycemia on admission >200 mg/dl in first 24 hours. Data analysis was done using SPSS 15.0 software.Results: 45.8% (894/1951) were Patients with DM out of that 78.19% (699/894) were known to have DM while 28.81% (195/1951) were new cases of DM. 5.1% (100/1951) patients had uncontrolled DM. DM was significantly more in >60 years age group and in urban residents (p<0.001). Patients with DM were significantly more to have breathlessness, altered sensorium and dyspnoea as major purpose to call EMS (p<0.001, <0.001 and 0.045 respectively). Other co-morbidities in the form of Hypertension, other cardiovascular abnormalities, COPD, CKD and history of CVA were significantly more among Patients with DM (p<0.001, except for COPD, p=0.027).Conclusions: There was a high burden of patients with DM on EMS. EMS teams should be well trained to diagnose and manage such emergencies. Mass awareness of screening for DM and its proper management will help to decrease such burden

An international prospective study of INICC analyzing the incidence and risk factors for catheter-associated urinary tract infections in 235 ICUs across 8 Asian Countries

Background: Identify urinary catheter (UC)-associated urinary tract infections (CAUTI) incidence and risk factors (RF) in 235 ICUs in 8 Asian countries: India, Malaysia, Mongolia, Nepal, Pakistan, the Philippines, Thailand, and Vietnam. Methods: From January 1, 2014, to February 12, 2022, we conducted a prospective cohort study. To estimate CAUTI incidence, the number of UC days was the denominator, and CAUTI was the numerator. To estimate CAUTI RFs, we analyzed 11 variables using multiple logistic regression. Results: 84,920 patients hospitalized for 499,272 patient days acquired 869 CAUTIs. The pooled CAUTI rate per 1,000 UC-days was 3.08; for those using suprapubic-catheters (4.11); indwelling-catheters (2.65); trauma-ICU (10.55), neurologic-ICU (7.17), neurosurgical-ICU (5.28); in lower- middle-income countries (3.05); in upper-middle-income countries (1.71); at public-hospitals (5.98), at private-hospitals (3.09), at teaching-hospitals (2.04). The following variables were identified as CAUTI RFs: Age (adjusted odds ratio [aOR] = 1.01; 95% CI = 1.01-1.02; P < .0001); female sex (aOR = 1.39; 95% CI = 1.21-1.59; P < .0001); using suprapubic-catheter (aOR = 4.72; 95% CI = 1.69-13.21; P < .0001); length of stay before CAUTI acquisition (aOR = 1.04; 95% CI = 1.04-1.05; P < .0001); UC and device utilization-ratio (aOR = 1.07; 95% CI = 1.01-1.13; P = .02); hospitalized at trauma-ICU (aOR = 14.12; 95% CI = 4.68-42.67; P < .0001), neurologic-ICU (aOR = 14.13; 95% CI = 6.63-30.11; P < .0001), neurosurgical-ICU (aOR = 13.79; 95% CI = 6.88-27.64; P < .0001); public-facilities (aOR = 3.23; 95% CI = 2.34-4.46; P < .0001). Discussion: CAUTI rate and risk are higher for older patients, women, hospitalized at trauma-ICU, neurologic-ICU, neurosurgical-ICU, and public facilities. All of them are unlikely to change. Conclusions: It is suggested to focus on reducing the length of stay and the Urinary catheter device utilization ratio, avoiding suprapubic catheters, and implementing evidence-based CAUTI prevention recommendations

Positive impact of knowledge about tuberculosis and its treatment on treatment adherence among new smear-positive tuberculosis patients in ward E of Mumbai, Maharashtra, India

Background: Treatment nonadherence is major challenge before tuberculosis (TB) control activities. Treatment adherence is the result of interactions of various factors related to the patient, provider, health setup, type of illness, and sociocultural factors. Aim: The aim was to assess baseline knowledge of new smear-positive TB patients about their disease and treatment and to find its impact on treatment adherence. Methods: New sputum-positive TB patients initiated directly observed treatment short-course in ward E of Mumbai district in first two-quarters of the calendar year were enrolled in the study. They were interviewed by trained interviewer as per pretested semi-structured interview schedules to collect sociodemographic information and to assess their knowledge after verbal consent. Treatment adherence was noted by screening treatment cards after any final outcome of the treatment as per Revised National Tuberculosis Control Program. Data were entered in Microsoft excel and analyzed using SPSS 15.0 software (developed by IBM, Chicago, USA in 2007). Results: Out of 157 patients enrolled, 150 could be interviewed. The majority were in reproductive age group and from class IV and V socioeconomic class. Good knowledge about infectiousness, reasons behind TB, its spread, curability, and treatment duration was found in 29.5%, 28.8%, 16%, 59%, and 22.3%, respectively. 72/150 were treatment adherent and good knowledge about all these aspects was significantly associated with treatment adherence. Most significant association was found with good knowledge about infectiousness of TB (odds ratio: 1.764, P < 0.001). Conclusions: Thorough knowledge regarding TB and its treatment should be given to the TB patients at the initiation of the treatment may help to improve treatment adherence

Clinico-social parameters of diabetes among patientsutilizing emergency medical services

Background: Diabetes mellitus (DM) is increasing in its potential in developing countries. Rise in diabetic patients calling emergency medical services (EMS) is expected. It calls for thorough assessment of patients with DM utilizing EMS. In the present study, was to assess magnitude of DM among patients utilizing EMS and its clinico-social parameters.Methods: It was hospital record based observational study of patients calling EMS delivered by a tertiary care hospital in Pune, Maharashtra, India during 1st January 2013 to 31st December 2014. Patients with incomplete records were excluded. A person with medical background was trained to extract required information from hospital records. Patients with previously diagnosed DM were considered those who were on diet, oral hypoglycemic agents or taking insulin therapy and newly diagnosed patients with DM were considered those with the value of glycemia on admission &gt;200 mg/dl in first 24 hours. Data analysis was done using SPSS 15.0 software.Results: 45.8% (894/1951) were Patients with DM out of that 78.19% (699/894) were known to have DM while 28.81% (195/1951) were new cases of DM. 5.1% (100/1951) patients had uncontrolled DM. DM was significantly more in &gt;60 years age group and in urban residents (p&lt;0.001). Patients with DM were significantly more to have breathlessness, altered sensorium and dyspnoea as major purpose to call EMS (p&lt;0.001, &lt;0.001 and 0.045 respectively). Other co-morbidities in the form of Hypertension, other cardiovascular abnormalities, COPD, CKD and history of CVA were significantly more among Patients with DM (p&lt;0.001, except for COPD, p=0.027).Conclusions: There was a high burden of patients with DM on EMS. EMS teams should be well trained to diagnose and manage such emergencies. Mass awareness of screening for DM and its proper management will help to decrease such burden

Academic College of Emergency Experts in India′s INDO-US Joint Working Group (JWG) White Paper on the Integrated Emergency Communication Response Service in India: Much more than just a number!

The proposal for an integrated national emergency number for India is garnering a lot of enthusiasm and stimulating debate. This ambitious project has a two-part paradigm shift to set in; the first being the integration into a single number and the infrastructure required for setting up and operating this number such that a call can be received and identified. The second is the submerged part of the iceberg: That of the ability to respond to a call and deliver the appropriate emergency service. The first part is more technical and has potential precedents like the 911 phone hotline, for example, to emulate. The main premise of this paper is that the second part is a rather subjective exercise largely determined by the realities of existing public infrastructure in a specific geographical area with respect to emergency services management, especially medical care. Consequently, we highlight the key areas of both precall preparedness and postcall execution that need to be reviewed prior to going live with an integrated number on a national scale

Six-year multicenter study on short-term peripheral venous catheters-related bloodstream infection rates in 204 intensive care units of 57 hospitals in 19 cities of India: International Nosocomial Infection Control Consortium (INICC) findings

•We report peripheral venous catheters (PVC)-related BSI rates from 2013 to 2019.•We collected prospective data from 204 ICUs in 57 hospitals in 19 cities of India.•We followed 7,513 ICU patients for 296,893 bed-days and 295,795 PVC-days.•We identified 863 PVC-related BSIs, amounting to a rate of 2.91/1,000 PVC-days. Short-term peripheral venous catheters-related bloodstream infections (PVCR-BSIs) rates have not been systematically studied in developing countries, and data on their incidence by number of device-days are not available. Prospective, surveillance study on PVCR-BSI conducted from September 1, 2013 to May 31, 2019 in 204 intensive care units (ICUs), members of the International Nosocomial Infection Control Consortium (INICC), from 57 hospitals in 19 cities of India. We applied US INICC definition criteria and reported methods using the INICC Surveillance Online System. We followed 7,513 ICU patients for 296,893 bed-days and 295,795 short term peripheral venous catheter (PVC)-days. We identified 863 PVCR-BSIs, amounting to a rate of 2.91/1,000 PVC-days. Mortality in patients with PVC but without PVCR-BSI was 4.14%, and 11.59% in patients with PVCR-BSI. The length of stay in patients with PVC but without PVCR-BSI was 4.13 days, and 5.9 days in patients with PVCR-BSI. The micro-organism profile showed 68% of gram negative bacteria: Escherichia coli (23%), Klebsiella spp (15%), Pseudomonas aeruginosa (5%), and others. The predominant gram-positive bacteria were Staphylococcus aureus (10%). PVCR-BSI rates found in our ICUs were much higher than rates published from industrialized countries. Infection prevention programs must be implemented to reduce the incidence of PVCR-BSIs

Examining the impact of a 9-component bundle and the INICC multidimensional approach on catheter-associated urinary tract infection rates in 32 countries across Asia, Eastern Europe, Latin America, and the Middle East

Background: Catheter-Associated Urinary Tract Infections (CAUTIs) frequently occur in the intensive care unit (ICU) and are correlated with a significant burden. Methods: We implemented a strategy involving a 9-element bundle, education, surveillance of CAUTI rates and clinical outcomes, monitoring compliance with bundle components, feedback of CAUTI rates and performance feedback. This was executed in 299 ICUs across 32 low- and middle-income countries. The dependent variable was CAUTI per 1,000 UC days, assessed at baseline and throughout the intervention, in the second month, third month, 4 to 15 months, 16 to 27 months, and 28 to 39 months. Comparisons were made using a 2-sample t test, and the exposure-outcome relationship was explored using a generalized linear mixed model with a Poisson distribution. Results: Over the course of 978,364 patient days, 150,258 patients utilized 652,053 UC-days. The rates of CAUTI per 1,000 UC days were measured. The rates decreased from 14.89 during the baseline period to 5.51 in the second month (risk ratio [RR] = 0.37; 95% confidence interval [CI] = 0.34-0.39; P < .001), 3.79 in the third month (RR = 0.25; 95% CI = 0.23-0.28; P < .001), 2.98 in the 4 to 15 months (RR = 0.21; 95% CI = 0.18-0.22; P < .001), 1.86 in the 16 to 27 months (RR = 0.12; 95% CI = 0.11-0.14; P < .001), and 1.71 in the 28 to 39 months (RR = 0.11; 95% CI = 0.09-0.13; P < .001). Conclusions: Our intervention, without substantial costs or additional staffing, achieved an 89% reduction in CAUTI incidence in ICUs across 32 countries, demonstrating feasibility in ICUs of low- and middle-income countries.Revisión por pare

Six-year multicenter study on short-term peripheral venous catheters-related bloodstream infection rates in 727 intensive care units of 268 hospitals in 141 cities of 42 countries of Africa, the Americas, Eastern Mediterranean, Europe, South East Asia, and Western Pacific Regions: International Nosocomial Infection Control Consortium (INICC) findings

Short-term peripheral venous catheter-related bloodstream infection (PVCR-BSI) rates have not been systematically studied in resource-limited countries, and data on their incidence by number of device days are not available. Prospective, surveillance study on PVCR-BSI conducted from September 1, 2013, to May 31, 2019, in 727 intensive care units (ICUs), by members of the International Nosocomial Infection Control Consortium (INICC), from 268 hospitals in 141 cities of 42 countries of Africa, the Americas, Eastern Mediterranean, Europe, South East Asia, and Western Pacific regions. For this research, we applied definition and criteria of the CDC NHSN, methodology of the INICC, and software named INICC Surveillance Online System. We followed 149,609 ICU patients for 731,135 bed days and 743,508 short-term peripheral venous catheter (PVC) days. We identified 1,789 PVCR-BSIs for an overall rate of 2.41 per 1,000 PVC days. Mortality in patients with PVC but without PVCR-BSI was 6.67%, and mortality was 18% in patients with PVC and PVCR-BSI. The length of stay of patients with PVC but without PVCR-BSI was 4.83 days, and the length of stay was 9.85 days in patients with PVC and PVCR-BSI. Among these infections, the microorganism profile showed 58% gram-negative bacteria: Escherichia coli (16%), Klebsiella spp (11%), Pseudomonas aeruginosa (6%), Enterobacter spp (4%), and others (20%) including Serratia marcescens. Staphylococcus aureus were the predominant gram-positive bacteria (12%). PVCR-BSI rates in INICC ICUs were much higher than rates published from industrialized countries. Infection prevention programs must be implemented to reduce the incidence of PVCR-BSIs in resource-limited countries

Decreasing central line-associated bloodstream infections rates in intensive care units in 30 low- and middle-income countries: An INICC approach

Background: Central line (CL)-associated bloodstream infections (CLABSIs) occurring in the intensive care unit (ICU) are common and associated with a high burden. Methods: We implemented a multidimensional approach, incorporating an 11-element bundle, education, surveillance of CLABSI rates and clinical outcomes, monitoring compliance with bundle components, feedback of CLABSI rates and clinical outcomes, and performance feedback in 316 ICUs across 30 low- and middle-income countries. Our dependent variables were CLABSI per 1,000-CL-days and in-ICU all-cause mortality rates. These variables were measured at baseline and during the intervention, specifically during the second month, third month, 4 to 16 months, and 17 to 29 months. Comparisons were conducted using a two-sample t test. To explore the exposure-outcome relationship, we used a generalized linear mixed model with a Poisson distribution to model the number of CLABSIs. Results: During 1,837,750 patient-days, 283,087 patients, used 1,218,882 CL-days. CLABSI per 1,000 CL-days rates decreased from 15.34 at the baseline period to 7.97 in the 2nd month (relative risk (RR) = 0.52; 95% confidence interval [CI] = 0.48-0.56; P < .001), 5.34 in the 3rd month (RR = 0.35; 95% CI = 0.32-0.38; P < .001), and 2.23 in the 17 to 29 months (RR = 0.15; 95% CI = 0.13-0.17; P < .001). In-ICU all-cause mortality rate decreased from 16.17% at baseline to 13.68% (RR = 0.84; P = .0013) at 17 to 29 months. Conclusions: The implemented approach was effective, and a similar intervention could be applied in other ICUs of low- and middle-income countries to reduce CLABSI and in-ICU all-cause mortality rates.Revisión por pare