Ambo 2009 pdf

Multivariable logistic regression of E. Overall, The most common resistance phenotypes were recorded for cefazolin Results of antimicrobial susceptibility testing of 43 E. Class Conc. Multidrug resistance MDR was observed in 6 E. The maximum number of antimicrobials class to which an iso- late demonstrated resistance was 5 Table 6. But, antimicrobial resistance in Ambo was higher Fig 1. Distribution of antimicrobial resistant E. Be- sides this, dogs harboring E. Antimicrobial resistance is a well-known global challenge in the management of bacterial infections.

In the current study, a The present finding was higher than the finding of Beutin et al. The present result is also lower than The difference in the prevalence of E. The other reason for the difference in prevalence among studies might be due to the volume of fecal samples collected rectal swab vs. The use of rectal swabs in the present study might have underestimated the prevalence of E.

The health status of the sampled dogs could be also another source of variation among the reports in that a higher prevalence is more likely from diarrheic dogs than apparently healthy dogs. Although cases of diarrheic dogs were not registered and quantified during the current study, it is known that E.

The significantly high prevalence of E. Although indoor dogs are expected to be at lower risk of E. Perhaps, due to the raw animal product feeding as well as the poor hygienic status of homemade diets of indoor dogs similar to that of outdoor dogs. Outdoor dogs feed on contaminated feeds such as leftover feed, dead poultry, and other animals, which might serve as vehicles for E. In the present study, several potential risk factors for the carriage of E.

Among these risk factors, multivariable logistic regression analy- sis revealed that study sites towns and Kebeles were important predictors of E. The reason behind the high prevalence in Gojo and Bako towns as compared to Ambo town is not well known. However, it might be due to the poor sanitary practices in the households and its surroundings, and inadequate sanitary facilities for people. Because animal feces are plenti- ful source of E.

Michel et al. Moreover, the cool and humid climatic condition of Gojo town is suitable for prolonged survival and infectivity of the bacteria. The significant difference in the prevalence of E. Antimicrobial resistance in bacteria is a phenomenon that has been in con- stant evolution since the introduction of antimicrobial drugs. Antimicrobial resistance has been suggested as one important therapeutic problem in veterinary and human medicine DACA, In this study, antimicrobial resistance of E.

Overall, moderately low antimicrobial resistance was found The antimicrobial susceptibility of E. This might be due to the less availability and utilization of these drugs in the country and study area. Susceptibility of E. The lower level of antimicrobial resistance observed against aztreonam, ceftriaxone, Unlike the present study, increased detection of pathogenic and non-pathogenic E. The present findings are also in line with the study conducted by Wedley who reported the pan-susceptibility to piperacillin-tazobactam and high susceptibility to aztreonam.

Dogs are generally the close companions of their human caretakers thereby providing opportunities for the exchange of antimi- crobial-resistant bacteria. The MDR in the current study Relatively high prevalence of MDR E. A Shaheem et al. A lower level of MDR E. A Davis et al. This variation in the level of antimicro- bial resistance could probably be attributed to the expression of resistant gene coded by the pathogen, which is associated with the emerging and re-emerging aspects of the isolates in different agro-ecology Reubaen and Owuna, Differences in the prevalence of resistance observed might also be due to differ- ences in the interpretation of the zone sizes, MICs observed, or differences in how intermediate measurements were classified Wedley et al.

Low level or absence of individual antimicrobial resistance in E. This observed a lower level of resistance to some antimicrobial drugs might also be due to acquiring either from contaminated feed and improperly managed leftover household human foods containing AMR E coli, which were normally given to dogs.

Feeding of dogs with animal products containing high levels of antimicrobial residues may contribute to the emergence of antimicro- 16 Ethiop. The emergence of antimicrobial resistance or MDR Therefore, attention should be given to the management of dogs, and the provision of safe feed and water, which might contain anti- microbial residues contributing to the source of the resistance.

According to the reports of DACA , antimicrobial resistance has been incriminated with higher mortality and morbidity, increased costs of treatment, and loss of productivity. The limitations of this study is that data on dog hygiene and environmen- tal hygiene was not captured during questionnaire survey. Besides, molecular studies aimed at determining virulence genes and pathotypes of E.

Nevertheless, isolation of E. Conclusions The overall prevalence Study towns and study Kebeles are the important predictors of E. Most of the E. However, some of the isolates have developed multidrug resistance and might be a potential source of the spread of antimicrobial-resistant E. Further, large-scale epidemiological studies in- cluding the contribution of dogs in the transmission to humans, serotyping Ethiop.

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Magiorakos, A. Multidrug-resistant, extensively drug-resistant, and pan drug-resis- tant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. McConnell, A. This area of transition of care however has been sparsely researched Wood et al. This literature review deals with the clinical handover between paramedics and Emergency Department ED staff Physicians and nurses , specifically focusing on two frequently used patient handover acronyms and their effectiveness and limitations in facilitating a complete, concise, and structured clinical handover.

Given the unique requirements of each discipline, this review does not take into account the clinical handover among ED staff between shift changes or the clinical handover between ED and other hospital departments Intensive Care Unit, Medical, and Surgical floors. The primary objective of a clinical handover is the transfer and acceptance of professional responsibility and accountability of patient care among healthcare professionals Joint Commission Centre for Transforming Healthcare, Scope of the problem: Bruce and Suserud raised concerns that ambulance-borne patients transported to hospitals are usually the most seriously afflicted; therefore, the interplay between pre-hospital and hospital personnel is vital in conveying important health information at handover.

Although clinical handover information being lost in translation is not unique Solet et al. Bost et al. In a further study, Bost et al. Similarly, Gandhi et al.

The handover process will continue to be error-prone unless systems are put in place to improve communication, minimise risks, and effectively standardize the entire handover process.

Standardization of the handover protocol: Implementing standardized handover protocols has been found to improve the handover process by preventing communication related delays, errors, and omissions in patient care Iedema et al. The Joint Commission Centre for Transforming Healthcare identified the lack of standardized handover procedure as a validated root cause for failed handover communication. The Australian National Safety and Quality Health Service Standards also require health service organizations to implement an effective clinical handover through developing and implementing an organizational system for structured clinical handover.

Iedema et al. There are two guiding principles for standardization of a handover protocol; first, it should be tailored according to the discipline end users , and second, both the processes and the contents of the handover should be standardized in the order or form it is presented Arora and Johnson , Australian National Safety and Quality Health Service Standards Standardization of the processes implies identifying the entire steps in a clinical handover and then improving each of these steps, as well as identifying who should be present during a clinical handover.

Standardization of the contents will help in creating a shared set of expectations between the sender and receiver of the handover i. Although other acronyms exist Starmer et al. It was found to be the most frequently cited handover acronym in one systematic review Riesenberg, Leitzsch, and Little, In the hospital setting, SBAR provides a model for team members to share patient-specific information in a concise and structured format, and with a shared set of expectations between the sender and the receiver.

Although SBAR helps to structure communication, it does not explicitly specify the necessary data set in each of its components that needs to be communicated Table 1. Paramedics in some contexts have diverse educational and training backgrounds, and generally very limited knowledge of their patients due to the short duration of the encounter, hence the use of SBAR might lead to wide variations in the contents and order of information of the handover provided.

The paramedic has to convey multiple sets of information in each of the four components of SBAR in order for the clinical handover to be complete and omission free. Components of Information expected in the respective components SBAR Situation The sender Paramedic states who they are, identifies the patient, and then states what has happened for this handover communication to be taking place, i.

Background The sender conveys other information related to the chief complaint, past medical history, medication history, and allergies. Assessment The sender provides details regarding the Glasgow Coma Scale GCS , latest vital signs, trends, and physical examination findings, a brief assessment of the overall patient status, the most probable diagnosis, and what action and treatment have been provided so far.

Recommendations The sender finally, based on their interaction with the patient, states their recommendations for immediate actions, mentions if the patient is time critical or not, and makes sure the recipient reads-back and understands what information was conveyed.

Omission of contents that may appear insignificant can be a major cause of failed communication during handoffs Arora et al. In a randomized trial using a simulated on-call setting whereby telephone communications were taking place between nurses and physicians, Joffe et al. The background cues were communicated less often when SBAR was used, potentially highlighting a training issue with the use of SBAR by the study population who may have attempted to over-filter the information to be verbalised.

This study is relevant because paramedics often use wireless technology to provide pre-arrival information to the ED Staff in an abridged form. Loseby, Hudson, and Lyon argue that the SBAR does not prompt paramedics to convey key points in a trauma patient such as mechanism of injury, the injuries sustained, and the clinical interventions performed.

There is however support for the adoption and further evaluation of a trauma handover template, since it can provide valuable structure to the face-to-face handover and reduce information loss Evans et al. The IMIST-AMBO tool guides the paramedic not only to structure the communication but also to remember the necessary data set that need to be conveyed during an urgent or emergent clinical handover.

When IMIST-AMBO was used, there was a consistent ordering of the information, greater frequency of the necessary data set being conveyed and a reduction in information repetition. Overall it met the informational expectations of ED clinicians. A second analysis of the implementation of the IMIST- AMBO protocol revealed that the amount of information given by paramedics had increased while the duration of handovers had been reduced from 96 to 83 seconds Dean, Further research studies are however needed to understand its acceptance by paramedics across different global health systems and to identify training requirements necessary to ensure correct implementation of this tool.

Paramedics have to adopt a handover tool which is easy to remember, concise, complete, tailored to paramedic-ED handover, and which should also align with the informational expectations of the ED staff, for medical as well as trauma patients. Each letter in the IMIST-AMBO tool prompts the paramedic to provide ED staff a specific set of information about a clinical case that is essential to convey Table 2 , while not clouding the clinical handover with other unnecessary information.

The template used can be seen in Appendix 1. For Emergency Department staff, the information related to mechanism of injury, GCS, vital signs, and trends in treatment takes priority over the information related to allergies, medications, and past medical history in terms of criticality in order to determine if the patient requires immediate attention or can be triaged to a lower level of priority.

It does not provide details on other aspects of clinical handover such as training for implementation and human factors aspects such as attentiveness, mutual respect, adherence to protocols, and cultural and language differences among people involved in handover. All of these constitute the potential barriers to an effective handover and are presented in more details in Table 3. Lack of staff training about the handover process Wood et al Lack of information about the patient care process where the sender might have little knowledge about the patient being transferred Joint Commission Centre for Transforming Healthcare, Lack of active listening and attention by the receiver Wood et al The receiver might have competing priorities and is unable to focus on the transferred patient Joint Commission Centre for Transforming Healthcare, Expectations differ between senders and receivers of patients in transition Joint Commission Centre for Transforming Healthcare, Lack of understanding or respect between paramedic and ED staff Wood et al.

Inadequate amount of time provided for complete and successful handover Joint Commission Centre for Transforming Healthcare, This could be due to pressure of achieving time targets imposed by the Ambulance Service Key Performance Indicators or competing priorities in the Emergency Department.

Issues with the environment, such as noise and interruptions Evans et al, , Wood et al Table 3: Commonly expected barriers to an effective handover. Several handover tools based on acronyms or mnemonics have been created to improve information transfers. A concise tailored handover tool is needed for the unique paramedic-ED handover interface.

Conclusion: Paramedics have to adopt a handover tool which is concise yet provides all key clinical information, tailored to the paramedic-ED handover interface, and which also aligns with the informational expectations of the Emergency Department staff, for medical as well as trauma patients. Gathering information during the short duration of care in an uncontrolled pre-hospital environment may be challenging for paramedics.

The IMIST-AMBO tool which is specifically designed for the paramedic-ED handover interface prompts the transfer of key clinical information that is explicitly structured and well-ordered in terms of criticality to cater for routine pre-hospital care, without clouding the clinical handover with other unnecessary information for the ED clinician.

The SBAR tool, in contrast, is a situational briefing model adapted from the military. It does not explicitly prompt for some of the patient related information, which may lead to omission or non-conveyance of key elements during paramedic-ED staff handover.

This however requires both paramedic and ED staff to understand the similarities and cross matching between both tools, which can be achieved by Joint training on the subject. Accessed June 13, Ahmed, J. Impact of a structured template and staff training on compliance and quality of clinical handover.

International Journal of Surgery, 10 9 , Arora, V. A model for building a standardized hand-off protocol. Joint Commission journal on quality and patient safety, 32 11 , Arora, V. Communication failures in patient sign-out and suggestions for improvement: a critical incident analysis. Bost, N.