Perspective of health professionals on hand hygiene in a tertiary care center in Pakistan.

OBJECTIVE: To determine the awareness of postgraduate residents and nurses working in a tertiary care hospital about hand hygiene. METHODS: The cross-sectional study was conducted in October 2018 at The Children's Hospital and the Institute of Child Health, Lahore, Pakistan, and comprised postgraduate residents and nurses. Data was collected using a 31-item self-administered inventory. Data analysis was done using SPSS 21. RESULTS: Of the 360 subject, 152(42.2%) were postgraduate residents and 208(57.8%) were nurses. Overall score of knowledge 202(56%) was low compared to attitude 260(72%) and practice 283(78.6%). The combined score of all three domains was 245(68%), indicating moderate awareness. Postgraduate residents had significantly better knowledge 98(64%) compared to nurses 104 (50%) (p=0.01), while nurses had better attitude score 159(76.4%) compared to the residents 103(68%) (p<0.05). The practice subscale score was not significantly different between the groups (p>0.05). CONCLUSIONS: Both postgraduate residents and nurses showed moderately satisfactory knowledge, attitude and practice towards hand hygiene.

Echocardiographic determinants of LV functional improvement after transcatheter aortic valve replacement.

BACKGROUND: Transcatheter aortic valve replacement (TAVR) is an established therapy in high-risk patients with severe aortic stenosis. Among patients with reduced left ventricular ejection fraction (LVEF), it is unclear which patients will derive maximal benefit from TAVR. METHODS: Clinical and echocardiographic data of patients with severe aortic stenosis and low LVEF (≤50%) who underwent TAVR at a single institution during 2009-2013 were retrospectively analyzed. Patients were divided into 2 groups post-TAVR based on improved LV function (Group A = ΔLVEF ≥ 10%) versus persistent LV dysfunction (Group B = ΔLVEF<10%). Echocardiographic parameters were assessed for their association with LVEF change post-TAVR. Kaplan-Meier analysis was performed to generate survival estimates. RESULTS: Of 382 patients who underwent TAVR, 60 patients had low LVEF, LV function failed to improve ≥10% in 50% of patients following the procedure (Group B). At baseline echocardiograms, Group B had higher LVEF, stroke volume (SV), SV index; and lower E, E/E', and estimated pulmonary arterial systolic pressure (PASP) compared to Group A. Higher mortality was found in Group B compared to the Group A (p = 0.003) with a significantly shorter survival (Group A = 3.3 ± 0.1 years vs Group B = 2.7 ± 0.2 years, p = 0.003). One-year event free survival was 53.3% in Group B compared to 93.3% in Group A, with a stable trend over ensuing years (5-year survival; 53.3% versus 90.0%, p = 0.003). CONCLUSIONS: In patients undergoing TAVR with depressed LV function, those who failed to improve were more likely to have relatively higher LVEF, SV, and SVI; and lower E, E/E', and PASP at baseline. Mortality rates were found to be higher in persistent LV dysfunction group. © 2015 Wiley Periodicals, Inc.