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- Southern African Journal of Critical Care
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- Volume 26, Issue 1, 2010
Southern African Journal of Critical Care - Volume 26, Issue 1, 2010
Volume 26, Issue 1, 2010
Author P. BrysiewiczSource: Southern African Journal of Critical Care 26 (2010)More Less
We are proud to announce the formation of the first emergency nurses' society in South Africa. The society was established during the 2nd EMSSA 'Emergency Medicine in the Developing World' Conference held on 24 - 26 November 2009 at the Cape Town International Conference Centre, an achievement made possible by the efforts of a number of dedicated emergency nurses throughout South Africa and considerable support from the Emergency Medicine Society of South Africa (EMSSA).
Source: Southern African Journal of Critical Care 26 (2010)More Less
The President, Professor Mervyn Mer, and several council members recently had a fruitful meeting with the national Minister of Health, Dr Aaron Motsoaledi. The Minister listened to a presentation on the goals of the Critical Care Society and stressed the Department of Health's commitment to rebuild academic medicine and strengthen management in the health services, and his support for protocol-driven patient care. A partnership between the Society and the Department of Health will be fostered.
Source: Southern African Journal of Critical Care 26 (2010)More Less
This issue of SAJCC presents three original articles from South African researchers. Two of these look at the increasing problem of nosocomial infection in intensive care units. This is an area of increasing public awareness, given the recent publicity on deaths of six neonates from nosocomial infection in a major teaching hospital. Nosocomial infections are more likely to occur in patients with neurological impairment, increased therapeutic intervention and prior antibiotic administration. Hand disinfection before and after every patient contact is clearly vital and difficult to achieve in units where there is not a one-to-one nurse-to-patient ratio, as is the case in some state hospital intensive care units. In this issue, Kindness and Brysiewicz evaluate the knowledge and implementation by nurses of a new infection control protocol in a cardiothoracic ICU. They show that while knowledge and compliance improved the results were not ideal, although infection rates appeared to decrease. The point is that it is not enough to impose stricter infection control measures. Staff members should be involved in the development of new protocols so that they come to 'own the process'. As this paper demonstrates, it is crucial to measure the outcome of newly implemented strategies so that further changes can be made if necessary.
Author G.A. RichardsSource: Southern African Journal of Critical Care 26, pp 6 –10 (2010)More Less
We face a crisis with regard to antibiotic resistance. Highly pathogenic, pan-resistant Gram-negative (GN) or highly resistant Gram-positive (GP) infections are increasingly prevalent in the intensive care unit and in the general wards. Whereas no intervention will eradicate resistance, it is essential that antibiotic management be optimised both to improve efficacy and to extend the lifespan of drugs that are currently available.
Evaluation of a protocol to control methicillin-resistant Staphylococcus aureus (MRSA) in a surgical cardiac intensive care unitSource: Southern African Journal of Critical Care 26, pp 11 –18 (2010)More Less
Methicillin-resistant Staphylococcus aureus (MRSA) is a major health care problem in intensive care units.
Purpose. To evaluate how nurses implement the methicillin-resistant S. aureus protocol (MRSAP) in a surgical cardiac intensive care unit (SCICU), and to evaluate the change in MRSA infection rates after implementation of the protocol.
Methods. The knowledge of nursing staff and their compliance to the MRSAP were assessed with a survey questionnaire and by conducting observations in the unit. Screening compliance and the reduction in infection rates were investigated using a retrospective records review.
Results. There was an 88% (23 respondents) awareness of the MRSAP, but knowledge of the detailed content was variable. The staff were satisfied with the existing standards of infection control in the SCICU (85%, 22), and 64% (142) of the observed nurse-patient contacts complied with routine hygiene measures, such as hand hygiene. Few actual cases of MRSA infection were identified during the study period. Owing to the small number of cases it was not possible to test for the significance of this difference at SCICU level, but a chi-square test on the hospital MRSA cases for the same period demonstrated a highly significant reduction (χ2=6.2 × 10-41, df=1, p<0.0001).
Conclusions. There was evidence to support efficacy of the MRSAP in the reduction of MRSA infections.
Soluble triggering receptor expressed on myeloid cells (s-TREM-1) from endotracheal aspirates in critically ill patients : A potential marker of the dynamic inflammatory burden of the lower respiratory tractSource: Southern African Journal of Critical Care 26, pp 19 –24 (2010)More Less
Objectives. The study was designed to evaluate the role of soluble triggering receptor expressed on myeloid cells (s-TREM-1) measured in samples of endotracheal aspirates from critically ill, intubated patients as a marker of inflammation or pneumonia.
Methods. The Clinical Pulmonary Infection Score (CPIS), a commonly utilised clinical predictor of ventilator associated pneumonia (VAP), was calculated for each patient at the same time as endotracheal aspirates were obtained using sterile techniques, in order to correlate the CPIS with s-TREM-1 concentrations determined in the laboratory using a validated enzyme-linked immunosorbent assay (ELISA) procedure.
Results. Thirty patients with intensive care unit stays ranging from 2 to 39 days were included in the study. s-TREM-1 was detectable in endotracheal aspirates from all patients, and a wide range of concentrations from 13 to <4 000 pg/ml was observed. The mean s-TREM-1 concentrations for patients with a CPIS <6 (N=15) and for those with a CPIS ≥6 were 592 (standard error of the mean (SEM) 288) and 382 (SEM 119) pg/ml, respectively (p>0.05).
Conclusions. s-TREM-1 is readily detectable and quantifiable in endotracheal aspirates from critically ill patients, but does not correlate with the CPIS. The wide range of measured s-TREM-1 concentrations suggests that this pro-inflammatory marker may reflect a progressive increase in the dynamic inflammatory burden of the lower respiratory tract as colonisation by microbial pathogens leads to ventilator-associated tracheobronchitis (VAT) and ultimately VAP. Serial determinations of s-TREM-1 in this setting may therefore be of greater value than the CPIS in differentiating VAT from VAP and provide an alternative threshold for the initiation of empiric antimicrobial therapy.
The effect of penetrating trunk trauma and mechanical ventilation on the recovery of adult survivors after hospital dischargeSource: Southern African Journal of Critical Care 26, pp 25 –32 (2010)More Less
Objectives. To establish whether survivors of penetrating trunk trauma recover adequately and spontaneously following critical illness.
Material and methods. A prospective observational study was conducted. Intubated and ventilated males and females with penetrating trunk trauma (SV group (mechanical ventilation (MV) <5 days, N=13), LV group (MV ≥5 days, N=29)) were recruited from four intensive care units. Dynamometry, lung function tests, 6-minute walk distance (6MWD), oxygen uptake and quality of life (QOL), assessed with the short form-36 English UK version (SF-36) questionnaire, were recorded over a 6-month period following discharge. Results were compared with a healthy control group (N=40).
Results. In the LV group, 6MWD was reduced in comparison wit h controls at 1 (p=0.00) and 3 months (p=0.00) after discharge. Morbidity correlated with 6MWD at 3 (p=0.03) and 6 months (p=0.02), and there was a reduction in strength at 1, 3 and 6 months relative to the SV group and controls (p=0.00 - 0.04). In addition, intensive care unit and hospital length of stay correlated with muscle strength at 1 and 3 months for these subjects. SF-36 physical health domains were significantly reduced for LV group subjects up to 6 months compared with the SV group and controls (p=0.00 - 0.02).
Conclusion. SV group subjects recovered adequately and spontaneously within 3 months of discharge. LV group subjects, however, had significant limitations in exercise capacity, muscle strength and physical components of QOL up to 6 months after discharge. Persistent impairment of function is related to duration of illness and immobility.