NosocomiaL infection~ is it our fault?

.......السلام عليكم ورحمة الله وبركاته

"My 9-year-old daughter was recently released from the hospital after what was supposedly an uneventful tonsillectomy. Three days after her release, she had to be rushed back to the hospital from complications from a staph infection that I am sure she picked up from the hospital. Can I bring a medical malpractice suit against the hospital for the ensuing costs to treat this infection?"

I found this question from a medical malpractice website. Maybe many question like this has been rose before. When a patient is admitted to the hospital, he or she expects to receive treatment and emerge healthier than when they entered. However, oftentimes patients are exposed to certain conditions in which they can be subject to acquisition of an infection.

What the patient described may be a NOSOCOMIAL INFECTION, which is also known as a hospital-acquired infection. This type of hospital-acquired infection is typically absent during time of admission but diagnosed within the first 48 hours of course of stay in the hospital, or 30 days after their release.

The infection may be developed from the hospital admission, but we have to make things clear. There are 2 forms of nosocomial infections:

i) Endogenous /auto infection- the causative agents comes from the patients and the infection develop during the stay in the hospital as a result of patient’s decrease resistance. ii) Cross infection – the patients comes into contact with new infective agents and soon develops infection.

some classified it to be 3forms

MAIN ROUTES OF TRANSMISSION......
Route	Description
Contact transmission	The most important and frequent mode of transmission of nosocomial infections.
Droplet transmission	Occurs when droplets are generated from the source person mainly during coughing, sneezing, and talking, and during the performance of certain procedures such as bronchoscopy.
Airborne transmission	Occurs by dissemination of either airborne droplet nuclei (small-particle residue {5 µm or smaller in size} of evaporated droplets containing microorganisms that remain suspended in the air for long periods of time) or dust particles containing the infectious agent. Microorganisms transmitted by airborne transmission include Legionella, Mycobacterium tuberculosis and the rubeola and varicella viruses.
Common vehicle transmission	Applies to microorganisms transmitted to the host by contaminated items such as food, water, medications, devices, and equipment.
Vector borne transmission	Occurs when vectors such as mosquitoes, flies, rats, and other vermin transmit microorganisms.

Contact transmission is further divided into two subgroups: direct-contact transmission and indirect-contact transmission.

Routes of contact transmission
Route	Description
Direct-contact transmission	Involves a direct body surface-to-body surface contact and physical transfer of microorganisms between a susceptible host and an infected or colonized person, such as occurs when a person turns a patient, gives a patient a bath, or performs other patient-care activities that require direct personal contact. Direct-contact transmission also can occur between two patients, with one serving as the source of the infectious microorganisms and the other as a susceptible host.
Indirect-contact transmission	Involves contact of a susceptible host with a contaminated intermediate object, usually inanimate, such as contaminated instruments, needles, or dressings, or contaminated gloves that are not changed between patients. In addition, the improper use of saline flush syringes, vials, and bags has been implicated in disease transmission in the US, even when healthcare workers had access to gloves, disposable needles, intravenous devices, and flushes.

Factors predisposing a patient to infection can broadly be divided into three areas

• People in hospitals are usually already in a poor state of health, impairing their defense against bacteria – advanced age or premature birth along with immunodeficiency (due to drugs, illness, or irradiation) present a general risk, while other diseases can present specific risks - for instance, chronic obstructive pulmonary disease can increase chances of respiratory tract infection.

• Invasive devices, for instance intubation tubes, catheters, surgical drains, and tracheostomy tubes all bypass the body’s natural lines of defence against pathogens and provide an easy route for infection. Patients already colonised on admission are instantly put at greater risk when they undergo an invasive procedure.

• A patient’s treatment itself can leave them vulnerable to infection – immunosuppression and antacid treatment undermine the body’s defences, while antimicrobial therapy (removing competitive flora and only leaving resistant organisms) and recurrent blood transfusions have also been identified as risk factors
  

What I want to emphasis here, the infection is not solely arise from the hospital fault. However, the following steps taken by hospital personnel and guests can help in preventing the spread of infection and maintain a sanitary environment:

1. Proper sterilization of medical tools, dressings, and uniforms
2. Isolate patients with especially contagious illnesses
3. Frequent and proper hand washing
4. Use aprons and gloves at all times
5. Proper sterilization of all surfaces
6. Make sure to use alcohol rubs and antimicrobial agents when possible

Despite the best safety precautions, patients still may be infected when staying at a hospital. The thing is, if the infection is due to the negligent behavior of others, they may be entitled to financial compensation following a civil lawsuit. The hospital administration, staff and maintenance crews have a responsibility to provide optimal care to patients. If this does not happen and reckless behavior occurs, they should be held accountable for their actions. A medical malpractice lawyer can offer advice to patients injured by hospital acquired infection, regarding their rights to pursue a lawsuit against the hospital for all damages.

Therefore, it is critical that hospital staff take all appropriate measures to minimize the chance of an infection being allowed to spread amongst patients. Additionally, doctors and other hospital staff must be cognizant of symptoms occurring in patients in order to provide proper treatment early enough to prevent injury to the patient.

pic: infection at the surgical site


Resources:
1) Lecture note “Nosocomial Infection” by dr. Hera Nirwati, M. Kes
2) Medicalmalpractice.com
3) Nosocomial-Infections

"Traffic lights"

.......السلام عليكم ورحمة الله وبركاته

Green means go!
Yellow means either to go or to stop, but many take this as time to speeding..
Red means stop.

That is how the traffic lights works. "GREEN, YELLOW, and RED." The same color is used during emergency conditions. But, what does it means in triage? When someone need to be tagged? Who actually plays role in doing this? In time of emergency, we still have time for tagging people? TAG---sounds like tagging your friends on pictures or posts in the Facebook, right? No, no, no... it is not that simple. Let me explain further..

Triage Tags is a tool first responders and medical personnel use during a mass casualty incident. With the aide of the triage tags, the first-arriving personnel are able to effectively and efficiently distribute the limited resources and provide the necessary immediate care for the victims until more help arrives.

• The four colors of triage and they come in the form of:

*Black (Expectant) which entails pain medication only until death.

-The casualty is expected not to reach higher medical support alive without compromising the treatment of higher priority patients. Care should not be abandoned, spare any remaining time and resources after Immediate and Delayed patients have been treated

*Red (Immediate) which entails life threatening injuries.

-The casualty requires immediate medical attention and will not survive if not seen soon. Any compromise to the casualty's respiration, hemorrhage control, or shock control could be fatal.

*Yellow (Delayed) which entails non-life threatening injuries.

-The casualty requires medical attention within 6 hours. Injuries are potentially life-threatening, but can wait until the Immediate casualties are stabilized and evacuated.

*Green: (Minor or Minimal) which entails minor injuries.

-"Walking wounded," the casualty requires medical attention when all higher priority patients have been evacuated, and may not require stabilization or monitoring.

• A section informing medical personnel of the patient’s vital signs along with the treatment administered.
• A section on the patient’s demographics i.e., gender, residential address, etc. and the patient’s medical history.
• A section with a full pictorial view of the human body. The medical personnel indicate which parts of the body are injured.

The triage tags are placed near the head and are used to better separate the victims so that when more help arrives, the patients are easily recognizable.

Some examples of triage tag:

a) Typical triage tag, with 'tear-off' sections for decontamination and patient tracking

b) SMART tag

c) METTAG system in Japan

d) even a simple tape can be used as tag!

Triage is an essential function in Emergency Departments (EDs), where many patients may present simultaneously. Urgency refers to the need for time-critical intervention - it is not synonymous with severity.

The aim of the triage are:

1. To ensure that patients are treated in the order of their clinical urgency
2. To ensure that treatment is appropriately and timely.
3. To allocate the patient to the most appropriate assessment and treatment area
4. To gather information that facilitates the description of the departmental casemix.

Resources:
1) Emergency Department Triage (Pdf)
2) Triage In The Emergency Department (Pdf)
3) Wikipedia-Triage
4) Wikipedia-Triage tag

Managed Care~

.......السلام عليكم ورحمة الله وبركاته

Physical ills are the taxes laid upon this wretched life; some are taxed higher, and some lower, but all pay something. ~Lord Chesterfield

In old days, people were not so open in discussing about health insurance or finance. Besides, many of them will get angry when an insurance worker ask them,

“What if you are knocked by an accident, who will help you to pay all those expensive cost?”… “What will happen to your family; wife(s) and kids?”...

They thought that the workers deliberately praying for their bad luck and buying insurance only wasted their money, as if they will never hit by an accident or illness. They do not aware of the importance of the insurance.

“Prepare the umbrella before it rains!” This proverb is precisely applied in our daily lives. We as humans do not know what is going to happen in the future. Now we may be healthy, but if God wills, perhaps next week or tomorrow, we will be hit by a disease that we did not expect before. The question is, if the ‘something’ suddenly happened, are you ready to face the possibility of illness in the future? How does your financial plan? Do you aware that the cost of hospital + medical doctor’s fee + medicine is not cheap? Can you manage to pay all of them when the time comes?

That is why we need to have the health insurance, as a preparation in time of difficulties. In Indonesia, healthcare is provided, and funded, through a number of channels; Public, Private, Individual payment, Social security, and external/overseas funding. There are the following four existing social security schemes in Indonesia:

• Jamsostek is the social insurance fund for private sector employers and their employees. It provides four programmes: Employment Injury, Death, Health Insurance, and a provident fund type Old Age Benefit.

• Taspen is the fund for civil servants. It provides a retirement lump-sum, and a pension programme.

• Askes provides Health Insurance cover for public sector employees and some others.

• Asabri is the counterpart fund for the armed forces and police. It provides similar lump-sum retirement benefits and pensions. The Armed forces also have some hospitals of their own.

As mentioned above, around 116,8 million people from 230 million Indonesia population in Year 2009 are covered by the health finance provided by PT Askes Indonesia, PT Jamsostek, PT Asabri or through Jamkesmas and any other insurance agency.

What is managed care?

Managed care combines financing and health care in a single entity with the aim of improving quality of care while at the same time controlling the cost. These providers make up the plan's network. Restrictive plans generally cost you less. More flexible plans cost more. There are three types of managed care plans available, such as:

• Health Maintenance Organizations (HMO) usually only pay for care within the network. You choose a primary care doctor who coordinates most of your care.
• Preferred Provider Organizations (PPO) usually pay more if you get care within the network, but they still pay a portion if you go outside
• Point of Service (POS) plans let you choose between an HMO or a PPO each time you need care

How does it work?

Managed care works through modifying the actions of doctors (or other professionals initiating care) to eliminate inappropriate treatments and ensure that cost effective practice is adopted.

by

1. Developing networks and selecting preferred providers;
2. Supplying incentives; and
3. Providing guidelines-or by a combination of these.

One of the major problems with healthcare in Indonesia is that poor or rural citizens simply aren't able to obtain the healthcare that they need. A lack of government funding, coupled with a need for the medical facilities to realize a profit, no matter how slight, means that lower class Indonesians are unable to afford the cost of treatment. This is not to say that healthcare in Indonesia is expensive, compared to the healthcare services in other Asian and European countries; however, to the local populace quality healthcare is virtually unobtainable. Those poor people will think twice to receive health care as they do not have enough money to pay for the treatment given. It is hoped with effective health insurance and financing by the government, health care in Indonesia will be better. =)

Resources:
1)Medline Plus: Managed Care
2)Social Health Insurance In Indonesia: Current Status And The Plan For National Health Insurance
3)Pacific Prime: Indonesia Medical Insurance News

Flu free in 24hours~~

.......السلام عليكم ورحمة الله وبركاته

The flu, medically known as influenza, is a common infection of the respiratory tract, including the nose, throat, bronchial tubes and lungs. The flu is caused by a virus and is very contagious. Every year 5 percent to 20 percent of the population gets the flu, and about 36,000 people die from flu-related complications, according to the National Institutes of Health.

The flu virus spreads from person to person when someone with the flu talks, coughs or sneezes. This shoots droplets contaminated with the flu virus into the air where they can be breathed in by others. The flu also spreads by touching an infected person or a surface contaminated by the virus, such as a contaminated drinking glass or doorknob.

There are three main types of viruses that can cause the flu: influenza type A virus, influenza type B virus, and influenza type C virus. Flu caused by influenza type C virus, is generally mild with symptoms similar to a cold and does not cause outbreaks in populations. Strains of Influenza type A virus are often at the root of global pandemics of flu, and strains of influenza type B virus can lead to outbreaks in smaller geographic locales.

Flu virus is easily spread, especially when the weather is uncertain. When flu attacks the body, of course, can interfere with your activities. Sore throat, sneezing, body limp, watery eyes, headache, and sometimes make your body shiver weakly laying on the bed. Want to quickly recover from this disease? There are ways you can increase your metabolism and free of the flu virus. Follow these simple steps, as quoted by The Sun.

Simak

Baca secara fonetik

1) Breakfast

After getting out of bed and feel the body does not fit, you should not miss breakfast. Breakfast is very important to fuel the body, especially when immunity declines.

Dutch Researchers said the breakfast will increase levels of gamma interferon in the blood that acts as a natural antiviral. So, do not skip breakfast. Eat something warm, like porridge or soup.

2) Fight viruses with the bustle

Prolonged stress can indeed make you sick, because the immune system is weakened. But, you can use it to fight the flu. The trick is, make yourself busy. This can reduce the coming flu symptoms; disclosed Professor Jim Horne, an expert from the University of Loughborough

3) Moderate exercise

Researchers from the University of Massachusetts found that people who perform light physical activity less susceptible to upper respiratory infections, compared with those who did not move much. The researchers believe that moderate exercise would be able to strengthen immune function due to increased production of white blood cells.

If you exercise, you will see two benefits, said Charles Matthews (one of the researchers). One, you are not susceptible to the flu. Two, if you have a cold, will usually recover quickly. You can do meditation or breathing exercises for better body fit.

4) Consumption foods that high in protein

According to experts, eating foods high in protein will make you full longer. Besides it is also good for stamina. A nutritionist, Dr Sarah Schenker, said protein is required to boost our immune system.

5) Drinking green tea

Drink a warm green tea in the afternoon; it will make the body warm. According to Canadian researchers green tea can promote the development of the body against viruses. In green tea, there found a chemical compound that can halt replication or duplication of virus activity.

6) Warm yourself

Wear warm clothing. This can help you to fight the flu. But, use loose clothing to keep your blood circulation smoothly.

7) Rest enough

It is said that we ideally should sleep around eight hours everyday. According to the research, lacking of rest will decrease the immune system up to 50%. So, for our body to be healthy in the next day, get enough sleep at night.

Others, you also can eat oranges as it contains Vitamin C that serve as an antioxidant.
Honey too helps in curing many diseases.

nyum2~~~

Believe it or not? Just give these remedies a try! ;)

Resources:
1) http://id.news.yahoo.com/viva/20101201/tls-bebas-dari-virus-flu-dalam-24-jam-34dae5e.html

Disaster 4) Let's DONATE, show them WE CARE!

.......السلام عليكم ورحمة الله وبركاته

I would like to recall here that the disaster of Mt. Merapi eruption from 26^th Oct till 5^th Nov has done a widespread disruption including human lives, houses, plants, animals, and field work. The so-called disaster of the year, Merapi eruption 2010 is the worst eruption since 1870s.

Maybe the news are no longer become the main topic on television or radios like before, and people all around the world slowly forgetting about it, but I believe it is not that simple to all the VICTIMs and also to US who indirectly affected by the disaster. Some said that got victims who can not see the flash of the cameras as it will reminds them to the eruptions. See how strong is the impact to the locals.

After the big eruption, on 5^th Nov, Merapi started to slow down its activity. Then, around 90% of them started to go back to their villages, to see what are still remain after the disaster and continue their lives as usual. Unfortunately, the rest (remaining 10%) are now HOMELESS. They have no place to go. No where to return! These evacuees are now placed at the Posko Maguwoharjo (Stadium), Yogyakarta while waiting for the next plan from the government. They are altogether around 6,500 people, who live in not-so-proper condition. As our volunteer team said, they just sleep on the floor; without mattress, and some of them without any blanket to cover their body especially at night in such open place during this raining season. From the observation, we can see that they are likely to suffer from dyspepsia, headache, common cold, acute pharingitis and so on. Despite after all they going through, they still look calm and strong. They accept all these as the God’s will. Can not imagine if we were at their place!

Besides serving them medically, providing them with food and supplies, many activities is carried out by volunteers to cheer them out. The children were so happy when they can meet their superheroes such as “Batman”, “Spiderman”, the “Riders” and many more. Some volunteers also share some stories and playing interactively with them. ANTV (the local television company) also take part in not only making their day but also giving them interesting prices in term of money, household, vehicles and working tools by their TV show, “Deal; 2milyar Peduli”. After the eruption, I believe their emotional are distracted by the lost they are facing, and this kind of games and winning prizes will help to reduce the depression and reduce the stress, then improve their Psychological Health.

Do not know what you can do and where to channel your donation? For further details, you can visit some of my friend’s blogs regarding this issue. You can also hear stories from their visit. We work in a system, which is to achieve the same goal; To help them in need!

1) William’s blog

2) Alia’s blog

3) Ain’s blog

4) Hafiz’s blog

5) Fazrul’s blog

6) Ruhana's blog

In collecting donation, it is wise to meet these criteria:

- the donation given benefits the recipient (suitable with the type, place and population of the recipients)

- respect for the recipient’s wishes and authority (provide what they need)

- no double standard in delivering the donation (be equal to all)

- good communication between the donor and recipient (avoid mis-comm.)

Resources:
1) Lecture note: Logistic ManagementSupport by dr. Sulanto Salleh-Danu, Sp. FK