Hygiene and health: Effects, experiences, and expertise of “Clean India Campaign” from a tertiary care hospital

Background: The current happenings in the country for the good should be of importance in the crucial places and the critical phases of life, i.e., hospitals and during hospitalization, even for normal life processes. The current “Clean India Campaign” is a catalyst for hospitals for improvements in hygiene. Objective: The objective of this study is to define and describe the impact of multifaceted infection control and hygienic practices by all on hospital-acquired infections (HAIs) in the pediatric age group. Materials and Methods: Implementation of multifaceted infection control policies was ensured along with the health educationfor hygienic practices by all, including attendants of patients and patients when possible. These were rigorously enforced with the renewed enthusiasm since the launch of “Clean India Campaign” from January 2015. The setting was “Paediatric Wing” of a tertiary care hospital catering to a large army cantonment, and also, referred cases. The outcome measures were the incidence of HAIs. Results: The incidence rate of HAIs was 2.91% (July 2013-December 2014) and declined to 1.59% (January 2015-June 2016) (relative risk: 0.547, 95% confidence interval: 0.409-0.733; p=0.0001). The most significant decline in HAI in our study has been in that of gastrointestinal infections (RR: 0.428%, 95% CI: 0.241-0.761; p=0.0034). Overall, the results of preventiveactions were rewarding (RR: 0.547, 95% CI: 0.409-0.733; p=0.0001). Conclusion: The mission “Clean India Campaign” and the WHO’s vision “clean care is safer care” lead to prevention and reduction of HAIs. Implementation of multifaceted infection control interventions is impactful. Hygienic practices teaching should be for both caregivers and caretakers.&nbsp

Pediatric surgery experiences of a tertiary referral hospital: International Classification of Diseases spectrum for teaching, planning, and scaling up services

Introduction: Pediatric surgery provides the opportunity to intervene positively in a wide array of diseases with potential lifelong impact. Objective: The objective of this study was to evaluate the significance of pediatric surgery under vast circumstances. Materials and Methods: All children in the age group of 0–10 years operated in a tertiary care hospital were analyzed. Grouping of cases was done using the International Statistical Classification of Diseases and Related Health Problems 10th Revision (International Classification of Diseases [ICD]-10)-WHO Version (2016) and incorporating terminology from the ICD-11 Beta Draft. Results: “Developmental anomalies” accounted for 79.1% of cases, while 20.9% were “acquired conditions requiring surgical intervention.” The common congenital malformations were those of the genital organs (17%), followed by those of the digestive (13%) and nervous system (13%), urinary system (12%), circulatory system (8%), and cleft lip and palate (7%). The essential surgery package for congenital anomalies should include expertise in repair of cleft lip and palate, anomalies of genital, digestive, nervous, urinary, and musculoskeletal system. Referral to superspecialty center is required only for “congenital malformations of the circulatory system.” Conclusion: Majority of the workload (79.1%) due to “developmental anomalies” points toward need for skills in correcting these, restoring anatomy for the proper growth, and physiological functioning. Inclusion of indirect inguinal hernia in the Chapter 20 ‘Developmental anomalies’ (ICD-11) will contribute to correct international comparisons and guide planning

Evidence-based focused approach for fulfillment of aims: Experiences of an asthma clinic

Background: A new health system for the 21st century should be based on the best scientific knowledge, according to the Institute of Medicine, US. Objective: We have evaluated the effectiveness of asthma clinic providing comprehensive care based on the best available scientific evidence. Materials and Methods: This intervention study was conducted in a tertiary care hospital having a devoted asthma clinic for the  comprehensive management. All children diagnosed as having asthma were included, and data of cases managed from July 2014 to June 2016 were analyzed. Intervention - comprehensive management of asthma including assessment, monitoring, health education, avoidance of triggers, management of comorbid conditions, appropriate medications, written asthma action plan, and counseling for follow-up. Outcome measures were treatment direction, asthma control, emergency visits, and hospitalizations. Results: 260 children were treated over a 2-year period. The effects of focused approach with progressive expertise lead to statistically significant benefits over the two successive years from July 2014 to June 2015 and July 2015 to June2016. These were in: (i) Treatment direction: Cases requiring stepping up of treatment decreased from 36.49% to 17.24% (relative risk [RR]: 0.473 [95% confidence interval {CI}: 0.249-0.895]); p=0.01229, (ii) asthma control: Cases with not well-controlled asthma decreased from 16.44% to 7.02% (RR 0.427: [95% CI: 0.199-0.914]); p=0.045, (iii) emergency department visits decreased from 35.62% to 21.05% (RR 0.591: [95% CI: 0.39-0.897]), p=0.00766, (iv) hospitalizations decreased from 16.44% to 5.26% (RR 0.32: [95% CI: 0.135-0.757]), p=0.00462. Conclusion: Establishing an asthma clinic and progressive expertise leads to significant beneficial results