NepMed Repository :: Browsing by Author "Nepal, D"

Browsing by Author "Nepal, D"

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Accuracy of 7-8-9 Rule for Endotracheal Tube Placement in Nepalese Neonates
(Nepal Paediatric Society (JNPS), 2011) Paudel, KP; Nepal, D; Mahaseth, C
Abstract: Introduction: Neonatal intubation is done for cardiopulmonary resuscitation, hypoxemia, and hypercapnia, for surfactant therapy or for airway protection. When correctly placed, endotracheal tube (ETT) tip should be at mid tracheal position which is half way between the clavicles and the carina to prevent complications of ventilation. Objective: To assess the accuracy of 7-8-9 Rule in neonates at Kanti Children’s hospital. Methodology: Prospective observational study was conducted in neonates who required oral intubations from July 2009 to December 2009 at NICU of Kanti Children’s Hospital. The initial ETT depth of insertion was determined using admission weight in the 7-8-9 Rule calculation. This depth was compared to the midtracheal depth to determine clinical accuracy of the 7-8-9 Rule. Results: Mean gestation age of the 69 infants was 36.01 weeks (26 to 42 weeks) and weight was 2411 g( 900 g to 3800 g ). 7 (10.1%) neonates weighed 1000 g or less, 19 (27.5%) weighed between 1001 to 2000 g, 31 ( 44.9%) weighed between 2001 to 3000 g, 12(17.4%) weighed between 3001 to 4000 g. The accuracy of 7-8-9 rule in clinical setting with auscultation and Chest x-ray resulted in ETT depth 0.11 cm above midtracheal position. (-1.5 to 1.5 cm). Using this rule ET tube was placed 0.11 cm above the mid tracheal position. Conclusions: The 7-8-9 Rule appears to be an accurate clinical method for endotracheal tube placement in Nepalese neonates.
Knowledge, Attitude and Practice of Health Care Institutions and their Staff Involved in Hospital Solid Waste Management
(Institute of Medicine, 2017) Banstola, D; Banstola, R; Nepal, D; Baral, P
Abstract Introduction: Knowledge, attitude, and practice (KAP) among health care workers are first key steps in developing a successful infection control program. Without good knowledge, attitude and practice, hospital waste cannot be managed effectively. The hospital waste possesses specific problems due to presence of sharps, infectious and hazardous materials in it. The unmanaged hospital solid wastes not only affect patients, attendants, nurses and medical personnel but also have impact on general population, scavengers and sanitary personnel handling waste. On account of lack of knowledge, attitude and practice of health care institutions and their staff, hospital solid waste can be a source for transmission of infectious diseases like AIDS, Hepatitis B, Hepatitis C, Tetanus, Diarrhea, Tuberculosis, Cholera and so on. Methods: It is a descriptive cross-sectional study conducted among the waste management staff working in 14 health care institutions (HCIs) of Pokhara Sub-Metropolitan City, Kaski district, Nepal. Semi- structured, self administered questionnaire consisting of questions on knowledge, attitude and practice on hospital waste management were prepared for conducting in-depth interviews and information was recorded as provided by key respondents. Housekeeping officer, senior nurse and senior waste collector/handler of each sampled health care institutions were taken as key respondents to collect information for questionnaire survey. Results: This study assigned that 21.43% of housekeeping officers, 35.71% of senior nurses and 28.57% of senior waste collectors received training on hospital solid waste management. Out of the 14 HCIs surveyed, 100% of them were provided with face mask and utility gloves; 35.71% were provided with boots; 14.28% were provided with plastic apron and trousers; 7.14% were provided with eye protector and no single institution provided helmet, long sleeved shirt and respirator to waste handling staff. The study also examined that 35.71% of housekeeping officers, 50% of senior nurses, and 14.29% of senior waste collectors were vaccinated against Hepatitis B. On the other hand, 85.71% of housekeeping officers, 85.71% of senior nurses, and 71.43% of senior waste collectors were vaccinated against Tetanus. Conclusion: Knowledge, attitude and practice on hospital solid waste management were not given due attention by the HCIs and their staff involved in hospital waste management. The waste handlers were unaware about their health. The lack of awareness and accountability from actors in health care waste management lacked of well trained human resources were the major challenges to promote effective health care waste management system. Hospital solid waste management should be operated by well trained and well motivated personnel. Key respondents who should be one of the group of actors in each health care institution (HCI) should be related to waste management field and well trained to understand architecture, and chemistry of the problem. Key words: Attitude, knowledge, hospital staff, practice, waste management
Management of Hospital Solid Wastes: A study in Pokhara Sub- Metropolitan City
(Institute of Medicine, 2017) Bastola, D; Bastola, R; Nepal, D; Baral, P
Abstract Introduction: Hospital waste can be defined as the total waste stream that is generated from health care establishments. Health care wastes usually consist of sharps, human or animal tissues or body parts, their body fluids and other infectious materials produced during the course of treatment. Methods: For the purpose of the study, population was defined in terms of the medical hospital, having inpatient facilities located within Pokhara Sub-Metropolitan City (PSMC). The total numbers of health care institutions (HCIs), having inpatient facilities, were 14 and all were sampled for the study. Questionnaires were prepared to meet the objectives of the study. Results: Various categories of health care waste have been generated in the health care institutions of PSMC which depend on size of individual health care facility, types of medical specialties practiced, and nature of HCIs. Waste generated from health care activities have been categorized as general or non-hazardous waste, and hazardous waste and are separately segregated into 4 different categories, like general waste, infectious wastes, sharps, and saline bottles. Conclusion: Most health care institutions in Pokhara Sub-Metropolitan City depend upon the municipality services for the disposal of health care waste materials collected. The municipality disposed the waste without any segregation and treatment in the sanitary land fill site treating them as a municipal solid waste. There is no separate mechanism for the proper treatment of medical wastes. There should be integrated waste management system and centralized waste management system managed by the municipality under health care waste management act to solve the gravity of problems. If it is not improved the problem of serious environmental health problem will arise in future thus an appropriate management of hospital solid waste should be undertaken. Keywords: hospital waste, health care institution, waste management
Neonatal hyperbilirubinaemia and its early outcome
(Institute of Medicine, 2009) Nepal, D; Bastola, D; Dhakal, AK; Mishra, U; Mahashetha, C
Abstract Introduction: Jaundice is an important cause of morbidity in the neonatal period, especially in the 1st week of life. our Objective of the study was to find out early outcome of babies admitted in Kanti Children Hospital with neonatal jaundice (NNJ) and its association with other co-morbidities. Methods: This is a retrospective study conducted in tertiary care paediatric hospital from 1st March to1st June 2009. Altogether 73 babies were included in the study. Results: Male babies outnumbered females (72.6% vs. 27.4%). Only 2.4% babies were near-term. Low birth weight (LBW) babies constituted 19.2% of the study population. Clinical sepsis as defined by WHO criteria was observed in 86.3% of babies. Nearly 50% of the babies had serum bilirubin of 15-19.9 mg/dl. Most of the babies (94.5%) improved with 5.5% of mortality. Conclusions: hyperbilirubinaemia is one of the most common causes of hospital admission in our nursery and it is associated with various other clinical morbidities. Phototherapy is effective in most of the time, but exchange transfusion should also be carried out when phototherapy fails. Causes of hyperbilirubinaemia should be searched extensively especially to rule out haemolysis. Keywords: Hyperbilirubinaemia, kernicterus, neonates, phototherapy

Browsing by Author "Nepal, D"

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