Browsing by Author "Shrestha, Anjana"
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Publication A Quality Improvement Initiative to Shorten the Duration of Hospital stay of Preterm / Low Birth Weight Babies with Special Focus on Infant and Family Centered Developmental care(Perinatal Society of Nepal (PESON), 2025) Twanabasu, Sajal; Subedi, Bhusan Kumar; Homagain, Sushan; Maskey, Sujina; Shrestha, Anjana; Shrestha, KritiAbstract: Introduction: Infant and family-centered developmental care (IFCDC) incorporates neurodevelopment, parental involvement, parent-infant bonding, and enabling sensory environment. The focus is on minimizing the separation between child and parents and ensuring parental involvement in the care of babies right after birth. This not only helps in optimal neurodevelopmental outcomes but also early discharge of preterm babies as parents will be confident in taking care of their preterm, low birth weight (LBW) babies. IFCDC is not adopted by most neonatal units in Nepal. Aim statement: To reduce the duration of hospital stay of preterm/LBW babies from 10.5 days to 8 days (20% reduction) with a special focus on infant and family-centered developmental care. Methods: This is a hospital-based quality improvement project conducted at a 50-bed governmental district hospital located at a rural setup outside Kathmandu valley in Bagmati province of Nepal. Baseline data on infant length of stay (LOS) was evaluated using the hospital records. Problems were identified using a fishbone diagram. Process and outcome indicators were formulated and analyzed. Multiple Plan-Do-Study-Act (PDSA) cycles were conducted to achieve the desired target. Results: The average duration of the hospital stay was reduced from the pre-intervention period of 10.5 days to 8 days after incorporating IFCDC which persisted during the post-intervention of 4 weeks. Conclusion: Our study has shown that the duration of hospital stay of preterm babies is reduced when IFCDC is adopted. IFCDC is a win-win approach and needs to be adopted in all the neonatal units across the country.Publication Multidrug resistant Escherichia coli isolated at National Public Health Laboratory, Nepal(2025) Acharya, Jyoti; Shrestha, Anjana; Rijal, Nisha; Jha, Runa; Rijal, Komal Raj; Sharma, Supriya; Banjara, Megha Raj; Ghimire, PrakashBackground: Antimicrobial resistance in Escherichia coli is mostly associated with ß-lactamases and carbapenemases enzyme production resulting in treatment challenges. This study was conducted with the aim to detect and characterize antimicrobial resistance in E. coli isolates. Methods: A cross-sectional study was conducted during 2018-2022, at National Public Health Laboratory where the clinical specimens (24636) received were processed for identification and characterization of antimicrobial resistance following conventional & advanced methods. Antibiotic susceptibility tests were performed by Modified Kirby Bauer disc diffusion and Minimum inhibitory concentrations using VITEK2 compact (Biomeriux). The isolates were tested for extended-spectrum ?-lactamases and Carbapenemase production following Clinical Laboratory Standards Institute guidelines. Results: Bacterial growth was observed in 9% (2166/24636) of the specimens, of which 44% (959) were E. coli. Among the 959 E. coli isolates, 320 were reconfirmed with VITEK-MS (Biomeriux). Phenotypic multi-drug resistance was observed in 75% (240/320) of the isolates with 62% (197/320) extended-spectrum ?-lactamases, 12% (39/320) AmpC-ß-lactamase, 10% (31/320) serine carbapenemases and 7% (22/320) Metallo-ß-lactamase while 3% (9/320) produced three types of enzymes. The extended-spectrum-?-lactamase producing E. coli were sensitive to Tigecycline (100%), Amikacin (92%), Imipenem (87%), and Meropenem (84%). Carbapenemase producers were sensitive to Tigecycline (100%), with 61% to Amikacin. Extensive-drug resistance was observed in 2% (7/320) of the isolates, with Colistin resistance in one. Conclusions: The findings highlight alarmingly high antimicrobial resistance in E. coli posing significant challenges in treatment. Early detection of multi-drug resistant isolates in healthcare settings is crucial to combat antimicrobial resistance. Keywords: ?-lactamase; carbapenemases; extensive-drug resistance; metallo-ß-lactamase; multidrug resistance