The epidemiology of sepsis in a district hospital emergency centre in Durban, KwaZulu natal

Clinical emergency care quality indicators in Africa: a scoping review and data summary

OBJECTIVES

Emergency care services are rapidly expanding in Africa; however, development must focus on quality. The African Federation of Emergency Medicine consensus conference (AFEM-CC)-based quality indicators were published in 2018. This study sought to increase knowledge of quality through identifying all publications from Africa containing data relevant to the AFEM-CC process clinical and outcome quality indicators.

DESIGN

We conducted searches for general quality of emergency care in Africa and for each of 28 AFEM-CC process clinical and five outcome clinical quality indicators individually in the medical and grey literature.

DATA SOURCES

PubMed (1964-2 January 2022), Embase (1947-2 January 2022) and CINAHL (1982-3 January 2022) and various forms of grey literature were queried.

ELIGIBILITY CRITERIA

Studies published in English, addressing the African emergency care population as a whole or large subsegment of this population (eg, trauma, paediatrics), and matching AFEM-CC process quality indicator parameters exactly were included. Studies with similar, but not exact match, data were collected separately as 'AFEM-CC quality indicators near match'.

DATA EXTRACTION AND SYNTHESIS

Document screening was done in duplicate by two authors, using Covidence, and conflicts were adjudicated by a third. Simple descriptive statistics were calculated.

RESULTS

One thousand three hundred and fourteen documents were reviewed, 314 in full text. 41 studies met a priori criteria and were included, yielding 59 unique quality indicator data points. Documentation and assessment quality indicators accounted for 64% of data points identified, clinical care for 25% and outcomes for 10%. An additional 53 'AFEM-CC quality indicators near match' publications were identified (38 new publications and 15 previously identified studies that contained additional 'near match' data), yielding 87 data points.

CONCLUSIONS

Data relevant to African emergency care facility-based quality indicators are highly limited. Future publications on emergency care in Africa should be aware of, and conform with, AFEM-CC quality indicators to strengthen understanding of quality.

Nurses' Knowledge on Sepsis Related to Mechanical Ventilation: An Intervention Study

BACKGROUND

Sepsis is a leading cause of mortality and morbidity worldwide. South African adult public critical care units experience incidences of sepsis on an ongoing basis. Nurses caring for mechanically ventilated adult patients in intensive care units (ICUs) need to base their nursing care on "surviving sepsis campaign" (SSC) guidelines to properly manage sepsis. Adequate knowledge on sepsis guidelines remains crucially indicated for nurses as they endeavor to maintain asepsis in critically ill patients.

PURPOSE

This study was conducted to assess the effect of an educational intervention on nurses' knowledge and practices of sepsis in mechanically ventilated adult patients in public ICUs.

METHODS

An intervention study, with quasi-intervention two-group, pretest-posttest design, was used to collect data using a self-administered, structured, pretest and posttest questionnaire designed to measure nurses' knowledge and practices on sepsis related to mechanical ventilation. The study was conducted between June and October 2018. An educational intervention was developed and validated. Five purposively selected public ICUs in the Eastern Cape, South Africa, were selected and assigned to three groups: Intervention Group 1 (ICUs 1 and 2), which received the full intervention (containing a 20-minute PowerPoint presentation, printed materials based on sections of the SSC guidelines, and monitoring visits bimonthly for 3 months); Intervention Group 2 (ICUs 3 and 4; receiving the same as Intervention Group 1 but with no monitoring visits); and the control group (ICU 5; receiving no intervention).

RESULTS

One hundred seventeen nurses completed the questionnaires at pretest, and 94 completed the questionnaires at posttest, producing a response rate of 79% and 80%, respectively. The results revealed a significant knowledge score increase between pretest and posttest for both Intervention Group 2 (53.28 ± 14.39 and 62.18 ± 13.60, respectively; p = .004) and the control group (56.72 ± 13.72 and 70.05 ± 12.40, respectively; p = .001). Similarly, a recommended practice score increase was shown for Intervention Group 2 (58.8 ± 9.63 and 62.80 ± 9.52, respectively), and a significant increase was shown for the control group (56.72 ± 7.54 and 63.29 ± 5.89, respectively; p = .002). Intervention Group 1 showed a detectable but not significant decline in knowledge (57.72 ± 13.99 and 54.61 ± 12.15, respectively) and recommended practice (61.22 ± 8.66 and 60.33 ± 7.83, respectively) scores.

CONCLUSIONS

The availability of SSC guidelines was found to have increased knowledge on sepsis related to mechanical ventilation, although including monitoring visits as part of the educational intervention was not found to have a positive effect on increasing knowledge and practices. Further studies are required to explore factors contributing to improving knowledge and practices on sepsis related to mechanical ventilation and the effect that various educational interventions have in this context.

The potential of FT-IR spectroscopy for improving healthcare in sepsis - An animal model study

Fourier Transform-Infrared (FT-IR) absorption spectroscopy has been used to investigate pathophysiological changes caused by sepsis. Sepsis has been defined as a potentially fatal organic dysfunction caused by a dysregulated host response to infection and can lead a patient to risk of death. This study used samples consisting of the blood plasma of mice which were induced to sepsis state, compared to a healthy group using FT-IR associated with attenuated total reflectance (ATR) spectroscopy. For statistical analysis, principal components analysis (PCA) and linear discriminant analysis (LDA) were applied, independently, to the second derivative spectra of both the fingerprint (900-1800 cm^-1) and the high wavenumber (2800-3100 cm^-1) regions. The technique efficiently differentiated the blood plasma of the two groups, sepsis and healthy mice, the analysis indicating that fatty acids and lipids in the blood samples could be an important biomarker of sepsis.

Pattern of infectious diseases in northern Iran: An approach to internal medicine management

BACKGROUND

Despite the development of their prevention and treatment, infectious diseases cause high mortality, many disabilities and inadequate living conditions worldwide. The aim of this study was to evaluate the pattern of infectious diseases in northern Iran with an approach to internal medicine management.

METHODS

This cross-sectional research was conducted in 2019 on all 7095 infectious diseases patient records that referred to Ghaemshahr Razi Hospital, Mazandaran Province, Iran during 2012-2018. A checklist prepared by investigator was used to collect the data. The extracted data were coded and entered into SPSS 22 and analyzed using K2 and independent t-test at p<.05.

RESULTS

The mean age of the study patients was 29.7±26.4. 4372 (61%) of the cases were males and the mean duration of hospitalization was 41.6±33.5. Age was significantly correlated to infectious diseases (P=.001). Gastroenteritis was the most common infectious disease among the men and women with 2442 (60.5%) and 1594 (39.47%), respectively. Based on the Pearson's correlation test, the relationship between leptospirosis, brucellosis, pulmonary tuberculosis, shigellosis, sepsis and infectious mononucleosis with gender, habitation, admission mode, discharged mode and age was significant (p<.05).

CONCLUSION

As the high frequent diseases were gastroenteritis, leptospirosis, brucellosis and sepsis and an increasing trend was in the prevalence of gastroenteritis, leptospirosis and lung tuberculosis, health system managers should consider training courses, preventive strategies, real-time interventions, increased hospital bed rate for patients with infectious diseases and so on.

Presentation and outcome of suspected sepsis in a high-HIV burden, high antiretroviral coverage setting

Objective:

To define sepsis syndromes in high-HIV burden settings in the antiretroviral therapy (ART) era. Methods: We characterized a prospective cohort of adults presenting to a tertiary emergency department in Harare, Zimbabwe with suspected community-acquired sepsis using blood and urine cultures, urine tuberculosis lipoarabinomannan (TB LAM), and serum cryptococcal antigen (CrAg) testing. The primary outcome was 30-day all-cause mortality.

Results:

Of 142 patients enrolled 68% (n = 96/142, 95% confidence interval (CI) [60–75%]) were HIV-positive, 41% (n = 39/96, 95% CI [31–50%]) of whom were ART-naïve. Among HIV-positive patients, both opportunistic pathogens (TB LAM-positivity, 36%, 95% CI [24–48%]; CrAg-positivity, 15%, 95% CI [7–23%]) and severe non-AIDS infections (S. pneumoniae urine antigen-positivity 12%, 95% CI [4–20%]; bacteraemia 17% (n = 16/96, 95% CI [9–24%]), of which 56% (n = 9/16, 95% CI [30–80%]) were gram-negative organisms) were common. Klebsiella pneumoniae recovered from blood and urine was uniformly resistant to ceftriaxone, as were most Escherichia coli isolates. Acknowledging the power limitations of our study, we conclude that relative to HIV-negative patients, HIV-positive patients had modestly higher 30-day mortality (adjusted hazard ratio (HR) 1.88, 95% CI [0.78–4.55]; p = 0.16, and 3.59, 95% CI [1.27–10.16], p = 0.02) among those with and without viral suppression, respectively.

Conclusion:

Rapid point-of-care assays provide substantial clinically actionable information in the setting of suspected sepsis, even in areas with high ART coverage. Antimicrobial resistance to first-line antibiotics in high burden settings is a growing threat.