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Predictors and Prevalence of Central Line Associated Blood Stream Infections Among Adult Patients in Critical Care Units -Kenyatta National Hospital
Mukiri Jocyline,
Inyama Hannah,
Maina Dorcas Waithira
Issue:
Volume 7, Issue 1, February 2018
Pages:
1-13
Received:
27 October 2017
Accepted:
7 December 2017
Published:
5 January 2018
Abstract: Most adult patients admitted in Critical Care Units (CCUs) have central venous catheters (CVCs). These catheters mostly remain in place for the entire period of hospitalization, hence the risk of developing Central Line Associated Bloodstream Infection (CLABSI). The burden of CLABSI has remained high despite the introduction of CLABSI care bundles increasing the morbidity, mortality, hospital stay and cost. Most CLABSIs are caused by factors attributed to patient characteristics, clinical care and institutional factors. The aim of this study was to determine the prevalence and predictors of CLABSIs among critically ill adult patients at CCUs of Kenyatta National Hospital. The study applied a cross-sectional descriptive design with stratified sampling and simple random sampling for each stratum. 86critical care nurses were selected from a total of 110 nurses using Yamane formulae. Medical records of critically ill patients’ that met the inclusion criteria were reviewed for the year 2015. An interviewee administered questionnaire and observation checklist were used to collect data from the nurses, and a data collection sheet was used to collect data from the medical records on prevalence of CLABSIs and patient characteristics. Descriptive statistics was used to summarize the data and inferential statistics (Chi-square test, Pearsons’ correlation) was used to establish relationships between variables. Data analysis was done using the Statistical Package for Social Sciences (SPSS) version 21.0. This study revealed that the prevalence of CLABSIs was 3.53%. Stepwise logistic regression revealed that, the patient predictors of CLABSIs in KNH CCUs were as follows; Neurological disorders as the underlying disease X2 (52) =15.249; 95% CI -0.199-0.158; P=0.946, increased length of hospitalization with CVC in situ X2 (52) =40.639; 95% CI 0.612-0.874; P< 0.001 and parenteral nutrition use X2 (52) =9.826; 95% CI 0.041-0.759; P=0.013. In addition, the nursing care related factors that predispose critically ill patients to CLABSIs in KNH CCUs were; Poor practices on hand hygiene before manipulation of infusion line which was observed in 81.8% of the CCNs, failure to remove unnecessary CVCs promptly, poor knowledge and practices on CVC maintenance and inadequate knowledge and outdated practices on changing intravenous administration system components.
Abstract: Most adult patients admitted in Critical Care Units (CCUs) have central venous catheters (CVCs). These catheters mostly remain in place for the entire period of hospitalization, hence the risk of developing Central Line Associated Bloodstream Infection (CLABSI). The burden of CLABSI has remained high despite the introduction of CLABSI care bundles ...
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Effects of Empowering Families on Improving Quality of Life for Children with Chronic Kidney Diseases
Amal Abdelrazik Fathalla Ahamed
Issue:
Volume 7, Issue 1, February 2018
Pages:
14-22
Received:
18 November 2017
Accepted:
4 December 2017
Published:
16 January 2018
Abstract: Background: One of the most chronic diseases can effect on quality of life for children and their families are chronic kidney diseases. It can cause direct adverse impact on children life. So, empowerment of family and children is essential to enhance and improve their quality of life. For this reason, the aim of this study was to evaluate the effect of the family empowerment model on the quality of life for children with chronic kidney diseases. It was hypothesized that children with chronic kidney diseases who received family empowerment model sessions will have better quality of life than children who did not. The design of this study was quasi experimental design. It was conducted in Menoufia University Hospital and Teaching Hospital in Shebin El-Kom in Menoufia governorate. For data collection, a purposive sample of 60 children with chronic kidney diseases and their parents was obtained from the previous mentioned settings. Tools of this study were Social characteristics sheet and the questionnaire of Core Ped QoL, version 4. The results of this study showed that significant improvement in quality of life after implementation of family empowerment model for children with chronic kidney diseases and their parents. It was concluded that that family empowerment model was effective in improved the quality of life for children with chronic kidney diseases. Therefore, this study recommended that this model to be used in inpatient and outpatient children's health care.
Abstract: Background: One of the most chronic diseases can effect on quality of life for children and their families are chronic kidney diseases. It can cause direct adverse impact on children life. So, empowerment of family and children is essential to enhance and improve their quality of life. For this reason, the aim of this study was to evaluate the effe...
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Determinants of Adherence to Antiretroviral Among HIV Positive Adolescents at Comprehensive Care Clinic, Gertrude’s Children Hospital, Nairobi, Kenya
Wambugu Naomi,
Gatongi Peter,
Joe Mbuthia,
Mokaya Joshua,
Taratisio Ndwiga
Issue:
Volume 7, Issue 1, February 2018
Pages:
23-30
Received:
17 October 2017
Accepted:
2 November 2017
Published:
17 January 2018
Abstract: Antiretroviral drugs (ARVs) requires adherence of more than 95% for adequate viral suppression. The consequences of poor adherence are failure of viral suppression, decrease CD4 cell count, disease progression, drug resistance, risk of transmission of resistance virus and limited future treatment options. Published data on adherence to ARVs in Kenyan adolescents is limited. The purpose of this study was to determine the ARVS adherence level and describe the healthcare system, medication and social environmental factors affecting this adherence among Human Immune-deficiency Virus (HIV) positive adolescents. This was a descriptive cross-sectional study, where 185 patients aged 10-18 years who had been on ARVs for at least two years were systematically and randomly selected. Only 129 respondents who were HIV fully disclosed were interviewed using a structured questionnaire about their experience taking ARVs. Adherence was measured based on a composite score derived from a three questions adherence tool developed by Center for Adherence Support Evaluation (CASE). Data was also collected via Focused Group Discussion, Key Informant Interviews and from records retrieval. Data analysis was done using Epi data software 3.1 with statistical significance set at p<0.05. Overall, 185 patients were selected but 129 disclosed patients were interviewed; 52.7% males and 47.3% females, estimated level of adherence of 67.34% and the main (63.6%) reason for missing therapy was forgetting. Long waiting time in the clinic and stigmatization were other factors found to affect adherence. The CASE Index Tool depicted high reliability with a Cronbach’s α=0.696. The results showed a significant positive correlation between CD4 counts and adherence (Rh0=0.255, p=0.003) and a significant inverse correlation between Viral Load levels and Adherence (Rh0= -0.189, p=0.031). Therefore, the 67.34% adherence level to ART reported in this study is below optimum adherence of 95%. This study gives the following recommendations; (a) Policy review on HIV disclosure procedures with training of health workers on it (b) Put fitting strategies to improve patients’ ability to impact on forgetfulness (c) Clinic staff to adopt the use of CASE Tool in assessing adolescent’s adherence to ARVs.
Abstract: Antiretroviral drugs (ARVs) requires adherence of more than 95% for adequate viral suppression. The consequences of poor adherence are failure of viral suppression, decrease CD4 cell count, disease progression, drug resistance, risk of transmission of resistance virus and limited future treatment options. Published data on adherence to ARVs in Keny...
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Involvement of Patients’ Families in Care of Critically Ill Patients at Kenyatta National Hospital Critical Care Units
Pauline Muthoni Maina,
Samuel Kimani,
Blasio Omuga
Issue:
Volume 7, Issue 1, February 2018
Pages:
31-38
Received:
28 October 2017
Accepted:
9 December 2017
Published:
19 January 2018
Abstract: Patients assess the likely benefits and risks of a recommended treatment or investigation and make a decision to either accept or refuse treatment. When a patient loses the capacity to participate meaningfully in decision making, a means should exist to ensure decisions that represent the patient’s goals, preferences, and interests are made. This means is substitute decision making, and it usually occurs when a spouse, partner, close family member, or friend assumes this responsibility on behalf of the incapacitated patient. Limited involvement in patient care activities at the hospital can lead to distress in the family as well as challenge family members in assuming the likely expected role when the patient returns home. This study aimed at determining the nature and extent of family/substitute decision makers’ involvement in care of the critically ill patients, guiding policies and the perspectives of nurse managers on involvement in Kenyatta National Hospital (KNH) critical care units (CCUs). This was a descriptive cross sectional study with family members and CCU nurse managers as the study participants. Key informants’ interviews and in depth interviews were conducted. The sample size was 52 family members and four nurse managers. Quantitative data was analyzed using Statistical Package for Social Sciences (SPSS) version 21.0 and descriptive content analysis for qualitative data. Family members reported emotional distressed from the admission of a family member to the critical care unit. However their level of satisfaction with the extent of involvement was above average at a mean of 6.5. The activity mostly involved in was sharing of general information at 57.7% (n=30) with 36.5% (n=19) feeling they should have been provided with in depth information regarding the patients care. The key themes from interviews with family members were: limited information involvement, guilt feeling, and appreciation. Nurse Managers reported KNH has a closed visiting policy with none feeling it should be changed to an open policy. They also unanimously agreed that family members should be involved in care of the critically ill patients through information sharing and counseling. Two nurse managers felt primary care nurses should involve families in general nursing activities such as oral care with all agreeing that the nurses don’t involve families in these activities. There was a statistical relationship (p<0.05 at a 95% confidence interval and R2=0.689) between the perspectives of nurse managers and the nature and extent of involvement of family members in care.
Abstract: Patients assess the likely benefits and risks of a recommended treatment or investigation and make a decision to either accept or refuse treatment. When a patient loses the capacity to participate meaningfully in decision making, a means should exist to ensure decisions that represent the patient’s goals, preferences, and interests are made. This m...
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Assessment of Knowledge, Attitude and Practice of Disaster Preparedness among Tikur Anbessa Specialized Hospital Health Care Workers, Addis Ababa, Ethiopia
Ashenafi Habte,
Adamu Addisie,
Aklilu Azazh
Issue:
Volume 7, Issue 1, February 2018
Pages:
39-48
Received:
4 January 2016
Accepted:
20 January 2016
Published:
31 January 2018
Abstract: Back ground: Disasters are parts of human life; they will never ask for permission to occur in particular area. The world over, they have been caused disastrous complications, disrupting human lives, and exposing the world economy to untold cost. In times of disasters, hospitals are among the most crucial institutions as they are considered as sanctuaries where victims seek ministration. Although major disasters are always to be expected, past disasters and more recent events shows that communities are not yet fully prepared. Objective: The study was intended to assess current awareness, attitude, and practice of the health care workers regarding disaster preparedness and to find out what arrangements were in place should a disaster occur at the hospital. Methodology: The study utilized both quantitative and qualitative research methods. Data collection was made through self-administered questionnaires and semi- structured key informant interview. A total of 290 respondents were participated in the study. Data analysis: Quantitative data were analyzed using descriptive statistics with Epi-info and Statistical Package for Social Sciences (SPSS). Qualitative data were analyzed after organizing into themes and summaries. Result: About half of (50.8%) health care workers had good knowledge about hospital disaster preparedness and its plan. The remaining 49.2%) had low knowledge. Their general attitude towards the issue was largely positive as 64.8% of respondents had favorable attitude. Low practice (8.3%) of disaster preparedness at the hospital was observed. Moreover, the hospital had neither nor disaster preparedness plan nor other forms of arrangements and preparations for occurrence of disasters. Conclusion and recommendations: The present study found that the health care workers at the hospital had fair awareness and largely positive attitude on disaster preparedness. As the national health policy has not given sufficient attention to hospitals disaster preparedness, there were negligible arrangements in place at the hospital. Therefore, much effort is still expected from all stakeholders including Federal Ministry of Health and managements of hospital.
Abstract: Back ground: Disasters are parts of human life; they will never ask for permission to occur in particular area. The world over, they have been caused disastrous complications, disrupting human lives, and exposing the world economy to untold cost. In times of disasters, hospitals are among the most crucial institutions as they are considered as sanc...
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