A survey of blood utilization in children and adolescents in a German university hospital

There are no detailed data on blood use with regard to diagnoses of recipients during infancy, childhood and adolescence. Available information on this issue is incomplete and no longer current. We conducted a survey of blood component use in children and adolescents in an acute-care university hospital in the greater area of Nuremberg between June 1994 and September 1996. Packed red blood cells (RBCs), fresh-frozen plasmas (FFPs) and platelet (PLT) components were evaluated for the recipients discharge diagnoses. Source study files were extracted from the hospital transfusion service and the medical records department. Transfused units were listed by broad diagnostic categories and leading diagnostic groups formed from principal diagnoses of the recipients according to the International Classification of Diseases , 9th edn (ICD-9). 34.3% of 2869 RBC cell units, 35.0% of 1095 FFP units and 5.0% of 1028 PLT components were used in patients with congenital diseases, mainly cardiac defects. The disease category neoplastic diseases was next most frequently associated with blood transfusion diagnosed in recipients of 23.9% of all RBCs, 15.6% of all FFP units and in 66.4% of all PLT units. Malignant diseases and benign haematological diseases (diagnostic categories II and IV) accounted for 68.9% of all costs of blood component transfusion. These findings demonstrate the increased importance of platelet transfusion for the organization of local and regional blood donation programmes and for cost analysis exercises. The study shows that detailed information on local blood use may be obtained quickly using available data collections of transfusion services and medical record departments.     

A prospective audit program to determine blood component transfusion appropriateness at a large university hospital: a 5-year experience

Predetermined transfusion guidelines, pretransfusion approval, and transfusion audits are useful tools in the education of those ordering blood components, potentially resulting in the reduction of inappropriate use of blood components. Our institution requires mandatory prospective audits for a proportion (10%) of packed red blood cell unit orders and all orders for fresh frozen plasma, platelets, and cryoprecipitate. Cases where the blood bank physician recommends against a transfusion and the ordering physician concurs, or when blood components are released against blood bank's recommendation, are referred to the transfusion committee. Transfusion committee members review the medical records to determine the circumstances surrounding the transfusion request as well as patient outcomes relating to their receiving or not receiving the transfusion. We analyzed 220 transfusion episodes brought before the transfusion committee from 2001 to 2005. The most requested blood component denied or changed was fresh frozen plasma. With only a few exceptions, the denial or change of blood components had no adverse effect on the patient. Nonetheless, these interventions were deemed appropriate by the transfusion committee. In most cases, blood components released based on the demand of the ordering physician, despite the advice of the blood bank physician, were deemed as inappropriate transfusions. This study therefore suggests that prospective audits of blood component orders can help reduce inappropriate transfusions and can be a valuable educational tool for the ordering physicians as well as for residents in training.     

A survey of the demographics of blood use

Epidemiological information was obtained by a series of questions to experts in the field of epidemiology of transfusion from the United States, England, Australia and Denmark. Although it became clear that the methods for collecting the data had differed between the countries, useful information was obtained for all questions. The data highlighted some major differences between the countries: the incident rate for red cell transfusion varied from 44.7 to 54.1 units, for platelets from 2.0 to 6.0 units and for plasma from 4.8 to 13.8 units transfused per 1000 population per year. Age and sex distribution of transfused patients was similar in all countries. Most of the red cell products are transfused to older recipients, and the distribution between men and women is approximately equal. The distribution for platelets is over a wider age range, and the difference between men and women is marked, with men predominating in all countries. The distribution for plasma is also directed to the elderly, and there is a predominance of men. The relationship between the disease or surgical procedure and the use of blood products was similar between countries. The use of red cells in cardiovascular surgery predominated. Neoplasms and digestive disorders were also prevalent. Neoplasms, including those relating to haematology, were the main use for platelets, but cardiovascular surgery was also important. In all countries, plasma is largely used in cardiovascular surgery. Two countries provided data relating to the number of units per transfusion episode including information relating to massive transfusion. In Australia, red cell use of >or=50 units per episode was largely associated with multiple traumas. In Denmark, it was associated with gastrointestinal bleeding and various medical requests.     

Bacteremia caused by VanC-type enterococci in a university hospital in Japan: a 6-year survey

We retrospectively examined the clinical and microbiological characteristics of bacteremia caused by intrinsically vancomycin-resistant (VanC-type) enterococci in a university hospital in Japan. Five cases of Enterococcus gallinarum and four of Enterococcus casseliflavus bacteremia were identified during the 6 years of the survey. Of the nine cases, five were related to neutropenic states with hematologic diseases and four were related to biliary tract infection with hepatobiliary or pancreatic diseases. VanC-type enterococci were associated with 12% of all the enterococcal bacteremias, indicating that these species cause bacteremia more frequently in Japan than in previously reported areas.     

Nosocomial infections in intensive care unit in a Turkish university hospital: a 2-year survey

Objective To determine epidemiology and risk factors for nosocomial infections in intensive care unit (ICU).Design Prospective incidence survey.Setting An adult general ICU in a university hospital in western Turkey.Patients All patients who stayed more than 48 h in ICU during a 2-year period (2000–2001).Measurements and results The study included 434 patients (7394 patient-days). A total of 225 infections were identified in 113 patients (26%). The incidence and infection rates were 56.8 in 1000-patient days and 51.8%, respectively. The infections were pneumonia (40.9%), bloodstream (30.2%), urinary tract (23.6%) and surgical site infections (5.3%). Pseudomonas aeruginosa (22.6%), methicillin-resistant Staphylococcus aureus (22.2%) and Acinetobacter spp. (11.9%) were frequently isolated micro-organisms. Median length of stay with nosocomial infection and without were 13 days (Interquartile range, IQR, 20) and 2 days (IQR, 2), respectively (P<0.0001). In logistic regression analysis, mechanical ventilation [odds ratio (OR): 16.35; 95% confidence interval (CI): 8.26–32.34; P<0.0001), coma (OR: 15.04; 95% CI: 3.41–66.33; P=0.0003), trauma (OR: 10.27; 95% CI: 2.34–45.01; P=0.002), nasogastric tube (OR: 2.94; 95% CI: 1.47–5.90; P=0.002), tracheotomy (OR: 5.77; 95% CI: 1.10–30.20; P=0.04) and APACHE II scores 10–19 (OR: 10.80; 95% CI: 1.10–106.01; P=0.04) were found to be significant risk factors for nosocomial infection. Rate of nosocomial infection increased with the number of risk factors (P<0.0001). Mortality rates were higher in infected patients than in non-infected patients (60.9 vs 22.1%; P<0.0001).Conclusion These data suggest that, in addition to underlying clinical conditions, some invasive procedures can be independent risk factors for nosocomial infection in ICU.     

Informed consent for blood transfusion: a regional hospital survey

Ninety-two hospitals in a three-state mid-Atlantic region were surveyed to determine their policy toward obtaining written informed consent for transfusion and to examine the content of written consent documents and the process by which consent is obtained. Of 81 hospitals responding, 50 (62%) required written informed consent. Hospitals with fewer than 200 beds were more likely to require written informed consent. The attending physicians had responsibility for obtaining consent in 28 (57%) of 49 institutions, most often on the day or evening before surgery. Twenty-seven of 48 forms mentioned complications: hepatitis in 80 percent, human immunodeficiency virus infection in 46 percent, nonhemolytic reactions in 32 percent, and hemolysis in 25 percent. Alternatives to allogeneic transfusion were mentioned infrequently; eight hospital forms listed autologous transfusion options and only two mentioned designated donation. The reading level required to comprehend 34 consent forms submitted was grade 14.6, which has been attained by only 23 percent of the adult United States population. Although the majority of respondent institutions require written informed consent, those forms, per se, do not document that the fundamental tenets of informed choice have been applied to the decision to transfuse blood.     

Significance of methicillin-resistant Staphylococcus aureus (MRSA) survey in a university teaching hospital

 We experienced a methicillin-resistant Staphylococcus aureus (MRSA) outbreak in two wards at our medical school teaching hospital during the period of July–September 1997. To determine whether these MRSA clinical isolates were associated with environmental factors, we conducted two sequential MRSA surveys of the hospital staff and surroundings in wards with outbreaks (wards 1 and 2) and in one ward without an outbreak (ward 3) in April 1998 (ward 1 only) and in March 1999 (wards 1, 2, and 3). In the two sequential surveys, MRSA strains were detected mainly from white coats. MRSA strains isolated from fingers in the first survey were decreased in the second survey. The pulsed-field gel electrophoresis (PFGE) patterns of the strains isolated in the two surveys were classified into five types (A–E). Type D, including the outbreak pattern of the MRSA in ward 1 in 1997, was reduced between the first and second surveys by managing microbiological hygiene, suggesting that the outbreak was controlled in ward 1. On the other hand, the strains isolated in the second survey in ward 2 were mainly type E, which was also common among clinical isolates from ward 2 during the latter half of 1998 to 1999. This suggested a high probability of cross-infection between the patients and the hospital staff in the ward. Our observations suggest that doctors and nurses should be cautious that their coats might be contaminated with the prevailing strains of MRSA. We also concluded that the surveys were very useful for the successful management of MRSA infections. Received: July 29, 2002 / Accepted: December 6, 2002 RID="*" ID="*" Yasuyuki Yoshizawa (chairman), Yukio Oshima, Fujio Numano, Kenichi Sugihara, Kenichi Shinomiya, Naoki Yamamoto, Nobuo Nara, Kimiyoshi Hirakawa, Keisuke Amou, Masato Yasuhara, Junko Koike, Kiyoshi Noda, Fumiaki Marumo, Kozo Takase, Toru Sakamoto, and Takasuke Imai RID="*" ID="*" Hospital Infection Control Committee members Acknowledgments We appreciate Dr. Vernon L. Moore for his critical review and Dr. M. Nishibori for the survey methods, and the staff of the Division of Microbiology, Hyogo Prefectural Institute of Public Health, for performing the software analysis.     

Indications for therapeutic plasma exchange at a university hospital and a regional blood center

The AABB guidelines for therapeutic plasma exchange (TPE) are divided into four categories: I. TPE is "standard and acceptable therapy," II. "generally accepted," III. "insufficient evidence to evaluate efficacy," and IV. "data suggest no therapeutic efficacy." Since little is known about the implementation of these guidelines, and since the indications for TPE may vary, depending upon an institution's patient mix, this study reviewed the indications and their categories for two co-located institutions. A retrospective review of the indications for all patients undergoing TPE from January 1, 1994 to December 31,1997 at Emory University Hospital (EUH), a tertiary-care teaching hospital, and the American Red Cross (ARC), a regional blood center, using AABB criteria (ASFA criteria used when not rated [NR] by AABB) was conducted. Categories I/II represented 75% and 88% of cases (EUH and ARC, respectively), while Categories III/IV/NR (NR as used below is "not rated" by both AABB and ASFA criteria; n is number of patients) were 25% and 12% of indications, respectively (P =0.002). Cases at EUH (n=101) were I, 62%; II, 13%; III, 3%; IV, 13%; and NR, 9%. Cases at ARC (n=359) were I, 77%; II, 11%; III, 9%; IV, 0%; and NR, 3% (P<0.001). No Category IV patients underwent TPE at ARC (13% at EUH). Thrombotic thrombocytopenic purpura (TTP) was the most common indication for TPE at both centers. The majority of the procedures were "appropriate" (Categories III/); several disorders ( approximately 10%) for which TPE was utilized at both centers were NR by both AABB and ASFA guidelines. Indications for TPE may differ, depending on the type of requesting institution. Physicians requesting TPE for patients with disorders in Categories III/IV/NR should be more strongly encouraged to enter their patients into controlled trials to best evaluate the efficacy of TPE in inadequately-studied clinical situations. This might best be accomplished at university hospitals, where requests for Category III/IV/NR may be higher. A need exists for periodic updating of the AABB guidelines to include those diseases for which new information is available with regard to the potential therapeutic role of TPE.     

A survey of head injuries in a general hospital.

This paper reports the incidence of head injuries as patients attended a general hospital Accident & Emergency Department. The survey was carried out over a twelve-month period. The Accident & Emergency Department of Luton & Dunstable Hospital sees approximately 60,000 new patients every year. It is situated in close proximity to the M1 motorway and other major road systems. Facilities are available on site for computerised tomography from Monday to Friday between 9:00 am and 5:00 pm. At other times, if it is considered necessary after consultations with our neurosurgical colleagues, they are referred to the Royal Free Hospital, 30 miles away.     

Psychiatric consultations in a southern university hospital

BACKGROUND: Differences in psychiatric referral rates among demographic groups of general hospital patients between 1995 and 1998 in a southern university setting were studied. The contribution of suicide attempts to referral rates was assessed. METHODS: The study was done by analysis of hospital admission and psychiatric consultation data. RESULTS: Psychiatric consultations were done in 844 (2%) of 41,681 admissions. Among patients without suicide attempts, those between ages 30 and 59, whites, and internal medicine admissions had higher referral rates. Age, race, and admitting service were independently associated with psychiatric referral rates. CONCLUSIONS: Findings support previous research showing that psychiatric referral depends on a variety of factors that may be patient-related, disease-related, and/or physician-related. Physicians' motivations to refer or not, organizational barriers or facilitators, disease-related, and/or patient-related factors (eg, age and race) need to be assessed further as determinants for requesting psychiatric consultation.     

Pre-operative autologous blood donation and transfusion-related adverse reactions: A 14-year experience at a university hospital

Objective

The objective of this study was to determine the rate of adverse reactions to pre-operative autologous blood donation (PAD) transfusion in a single institution over a 14-year period.

Computer use in an urban university hospital: technology ahead of literacy

The linkage of patient safety and care quality to the implementation of computerized information systems assumes that clinical staff are skilled with computers. Nurses and nursing support staff increasingly require computers to carry out their work. Minimum computer competencies for nurses have been identified. The determination of whether the current nursing workforce has acquired these competencies remains uncertain. We administered a self-assessment survey to nurses and nursing support staff to determine proficiency with computer skills they might perform at work. Respondents reported inadequacies in basic and work-related computer skills. More than 28% scored themselves as having fair or poor proficiency on all skills, and more than 50% as fair or poor on five of 11 skills. Respondents over age 50 and those graduating before 1984 tended to score proficiency lower. Our study suggests that many nurses and nursing support staff may not have the minimum computer competencies to effectively and efficiently perform their work.     

Serological survey of hepatitis B virus (HBV) markers in out- and in-patients in a university hospital

Of a total of 13,596 patients and 1,876 blood donors in a university hospital examined, 550 (4.1%) patients and 31 (1.7%) donors possessed hepatitis B surface antigen (HBsAg) in their blood. The higher incidence of HBsAg in the patient population than in the blood donors verified the view that medical personnel and hospitalized patients are at increased risk of acquiring HBV infection. To assess the actual hazard of the HBsAg-positive patients, we examined hepatitis Be antigen (HBeAg) and its antibody (anti-HBe) status of 228 HBsAg-positive patients and found that 39 (18%) were positive for HBeAg and 168 (74.5%) were positive for anti-HBe. This indicated that only one fifth of the HBsAg-positive patients should be drawn attention in terms of HBV transmission within a hospital.     

The excessive use of urinary catheters in patients hospitalized in university hospital wards

This cohort study included 254 adult patients who used a urinary catheter (UC) during their hospitalization in a university hospital ward. The following were evaluated: catheter use, indication, time of permanence, urinary infection density, mortality, and hospital stay. Throughout the studied period, 14% of the hospitalized patients received UC, totaling 1735 UC-day. In 23% of cases, the procedure had not been prescribed, and neither was its indication documented. The average time of UC use was 6.8 days. Among clinical patients, the indication for UC was inadequate in 29%; time of permanence was considered inadequate in 49% of clinical patients and in 66.9% of surgical patients. Patients with inadequate UC use had more urinary tract infections (RR 1.86 IC95% 1.4 to 3.04) and longer hospital stay (11.9 and 8.9 days, p=0.002). This study permitted to identify flaws in the care process that are potentially changeable and important to avoid urinary tract infection by urinary catheter use.