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    Are Soap, Paper Towel and Alcohol-based Disinfectants Easily Accessible in Intensive Care Units in Turkey?: Results of the Phokai Study
    (Galenos Yayincilik, 2018) Uyan, Ayse; Durmus, Gul; Sezak, Nurbanu; Ozdemir, Burcu; Kaygusuz, Turkkan; Oztoprak, Nefise; Ozdemir, Keyser; Aksoy, Firdevs; Ozgultekin, Asu; Koc, Meliha Meric; Oncul, Ahsen; Cagan Aktas, Sabahat; Isik, Burcu; Celebi, Giiven; Evik, Guliiz; Ozger, Selcuk; Harman, Rezan; Dindar Demiray, Emine Kubra; Ozkoren Calik, Sebnem; Alkan Ceviker, Sevil; Yildiz, Ilknur Esen; Isik, Mehmet Emirhan; Senol, Gunes; Sari, Sema; Dogan, Mustafa; Ugurlu, Kenan; Arslan, Mustafa; Akgul, Fethiye; Koc, Filiz; Kurekci, Yeim; Caglayan, Derya; Ucar, Mehmet; Gozukucuk, Ramazan; Elmaslar Mert, Habibe Tulin; Alay, Handan; Erdogan, Haluk; Demirel, Aslihan; Dogan, Nilgun; Kocak, Funda; Guven, Emre; Unsal, Guieser; Sipahi, Hilal; Yamazhan, Tansu; Arda, Bilgin; Ulusoy, Sercan; Sipahi, Oguz Resat
    Introduction: Hand hygiene is one of the most effective infection control measures to prevent the spread of healthcare-associated infections (HCAI). Water, soap, paper towel and hand disinfectant must be available and adequate in terms of effective hand hygiene. The adequacy of hand hygiene products or keeping water-soap and paper towel is still a problem for many developing countries like Turkey. In this multicenter study, we analyzed the adequacy in number and availability of hand hygiene products. Materials and Methods: This study was performed in all intensive care units (ICUs) of 41 hospitals (27 tertiary-care educational, 10 state and four private hospitals) from 22 cities located in seven geographical regions of Turkey. We analyzed water, soap, paper towel and alcohol-based hand disinfectant adequacy on four different days, two of which were in summer during the vacation time (August, 27th and 31st 2016) and two in autumn (October, 12th and 15th 2016). Results: The total number of ICUs and intensive care beds in 41 participating centers were 214 and 2357, respectively. Overall, there was no soap in 3-11% of sinks and no paper towel in 10-18% of sinks while there was no alcohol-based hand disinfectant in 1-4.7% of hand disinfectant units on the observation days. When we compared the number of sinks with soap and/or paper towel on weekdays vs. weekends, there was no significant difference in summer. However, on autumn weekdays, the number of sinks with soap and paper towel was significantly lower on weekend days (p<0.0001, p<0.0001) while the number of hand disinfectant units with alcohol-based disinfectant was significantly higher (p<0.0001). Conclusion: There should be adequate and accessible hand hygiene materials for effective hand hygiene. In this study, we found that soap and paper towels were inadequate on the observation days in 3-11% and 10-18% of units, respectively. Attention should be paid on soap and paper towel supply at weekends as well.
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    Development and validation of a modified quick SOFA scale for risk assessment in sepsis syndrome
    (Public Library Science, 2018) Cag, Yasemin; Karabay, Oguz; Sipahi, Oguz Resat; Aksoy, Firdevs; Durmus, Gul; Batirel, Ayse; Ak, Oznur; Kocak-Tufan, Zeliha; Atilla, Aynur; Piskin, Nihal; Akbas, Turkay; Erol, Serpil; Ozturk-Engin, Derya; Caskurlu, Hulya; Onal, Ugur; Erdogan, Haluk; Demirel, Aslihan; Dogru, Arzu; Harman, Rezan; Hamidi, Aziz Ahmad; Karasu, Derya; Korkmaz, Fatime; Korkmaz, Pinar; Eser, Fatma Civelek; Onem, Yalcin; Cesur, Sinem; Salmanogiu, Musa; Erdem, Ilknur; Diktas, Husrev; Vahaboglu, Haluk
    Sepsis is a severe clinical syndrome owing to its high mortality. Quick Sequential Organ Failure Assessment (qSOFA) score has been proposed for the prediction of fatal outcomes in sepsis syndrome in emergency departments. Due to the low predictive performance of the qSOFA score, we propose a modification to the score by adding age. We conducted a multicenter, retrospective cohort study among regional referral centers from various regions of the country. Participants recruited data of patients admitted to emergency departments and obtained a diagnosis of sepsis syndrome. Crude in-hospital mortality was the primary endpoint. A generalized mixed-effects model with random intercepts produced estimates for adverse outcomes. Model-based recursive partitioning demonstrated the effects and thresholds of significant covariates. Scores were internally validated. The H measure compared performances of scores. A total of 580 patients from 22 centers were included for further analysis. Stages of sepsis, age, time to antibiotics, and administration of carbapenem for empirical treatment were entered the final model. Among these, severe sepsis (OR, 4.40; CIs, 2.35-8.21), septic shock (OR, 8.78; CIs, 4.37-17.66), age (OR, 1.03; CIs, 1.02-1.05) and time to antibiotics (OR, 1.05; CIs, 1.01-1.10) were significantly associated with fatal outcomes. A decision tree demonstrated the thresholds for age. We modified the quick Sequential Organ Failure Assessment (mod-qSOFA) score by adding age (> 50 years old = one point) and compared this to the conventional score. H-measures for qSOFA and mod-qSOFA were found to be 0.11 and 0.14, respectively, whereas AUCs of both scores were 0.64. We propose the use of the modified qSOFA score for early risk assessment among sepsis patients for improved triage and management of this fatal syndrome.
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    Hand Hygiene Compliance in Some Intensive Care Units of Turkey: Results of Multicentre Asklepeion Study
    (Galenos Yayincilik, 2018) Onal, Aye Uyan; Aksoy, Firdevs; Azak, Emel; Koc, Meliha Meric; Ceviker, Sevil Alkan; Hatipoglu, Cigdem Ataman; Gozukucuk, Ramazan; Sehmen, Emine; Ugurlu, Kenan; Senol, Gunes; Durmus, Gul; Mert, Habibe Tulin Elmaslar; Alay, Handan; Koc, Filiz; Caglayan, Derya; Dikis, Demet; Korkmaz, Nilay Bilgili; Kucuker, Nilgiin Deniz; Kepeli, Nurhayat; Ulusoy, Behiye; Barik, Sukran Askit; Pullukcu, Husnu; Sipahi, Hilal; Arda, Bilgin; Ulusoy, Sercan; Sipahi, Oguz Resat
    Introduction: Hand hygiene is one of the most cost-effective infection control measures. In this multicenter Study we analysed the hand hygiene compliance observation results of 15 hospitals in Turkey. Materials and Methods: This study was performed in intensive care units (ICUs) of 15 hospitals (Eight terriary-care educational hospitals, six state hospitals and one private hospital) from 11 cities from six regions of Turkey The observations were made by infection control practitioners according to the World Health Organization - Five Moments for Hand Hygiene (WHO-5) indications rule for hand hygiene and overall compliance rates were calculated. Observations were unblinded (healthcare professionals knew that they were observed). The study period included 2015 and 2016 calendar years. Results: There was a statistically significant increase in hand hygiene compliance rates in 2016 versus 2015. The overall number of hand hygiene indications and compliance in 2015 and 2016 were 60071/78116-76,9% and 66551/83607-79,6% (p=0.0001), respectively. Nurses were the most compliant group in both years. The highest compliance was in after body fluid exposure indication (88.2%-2015 and 91.4%-2016) while the lowest compliance was in before patient contact indication (61.3%-2015 and 65%-2016). Conclusion: The presented data suggest that under unblinded observations, hand hygiene compliance seems to be in relatively acceptable rates in Turkey. Centers with compliance rates below 50 percentile rates in any of the 5 moments should increase efforts to enhance compliance in that indication.
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    Is Nurse Workforce Sufficient in Intensive Care Units in Turkey. Results of the Multicenter Karia Study
    (Galenos Yayincilik, 2017) Uyan, Ayse; Durmus, Gul; Sezak, Nurbanu; Pepe, Fatmanur; Kaygusuz, Turkkan; Oztoprak, Nefise; Ozdemir, Kevser; Aksoy, Firdevs; Erol, Serpil; Koc, Meliha Meric; Oncul, Ahsen; Cagan Aktas, Sabahat; Caskurlu, Hulya; Celebi, Guven; Kandemir, Ozlem; Ozger, Selcuk; Harman, Rezan; Demiray, Kubra; Ari, Alpay; Alkan Ceviker, Sevil; Esen Yildiz, Ilknur; Menekse, Sirin; Senol, Gunes; Sari, Sema; Dogan, Mustafa; Ugurlu, Kenan; Arslan, Mustafa; Akdemir, Irem; Firat, Pinar; Kurekci, Yesim; Caglayan, Derya; Ucar, Mehmet; Gozukucuk, Ramazan; Elmaslar Mert, Habibe Tulin; Alay, Handan; Erdogan, Haluk; Demirel, Aslihan; Dogan, Nilgun; Kocak, Funda; Guven, Emre; Unsal, Guleser; Sipahi, Hilal; Isikgoz Tasbakan, Meltem; Arda, Bilgin; Ulusoy, Sercan; Sipahi, Oguz Resat
    Introduction: In this multicenter study, we analysed the magnitude of healthcare worker (HCW) [infection control practitioner (ICP), nurses and others] workforce in hospitals participated in the study. Materials and Methods: This study was performed in 41 hospitals (with intensive care units-ICU) located in 22 cities from seven regions of Turkey. We analysed the ICP workforce, nursing and auxiliary HCW (AHCW) workforce in ICUs, number of ICU beds and occupied beds in four different days [two of which were in summer during the vacation time (August 27 and 31, 2016) and two others in autumn (October 12 and 15, 2016)]. The Turkish Ministry of Health (TMOH) requires two patients per nurse in level 3 ICUs, three patients per nurse in level 2 ICUs and five patients per nurse in level 1 ICUs. There is no standardization for the number of AHCW in ICUs. Finally, one ICP per 150 hospital beds is required by TMOH. Results: The total number of ICUs, ICU beds and ICPs were 214, 2377 and 111, respectively in he 41 participated centers. The number ICPs was adequate only in 12 hospitals. The percentage of nurses whose working experience was <1 year, was; 19% in level 1 ICUs, 25% in level 2 ICUs and 24% in level 3 ICUs. The number of patients per nurse was mostly <5 in level 1 ICUs whereas the number of patients per nurse in level 3 ICUs was generally >2. The number of patients per other HCW was minimum 3.75 and maximum 4.89 on weekdays and on day shift while it was minimum 5.02 and maximum 7.7 on weekends or on night shift. When we compared the number of level 1, 2 and 3 ICUs with adequate nursing workforce vs inadequate nursing workforce, the p value was <0.0001 at all time points except summer weekend night shift (p=0.002). Conclusion: Our data suggest that ICP workforce is inadequate in Turkey. Besides, HCW workforce is inadequate and almost 1/4 of nurses are relatively inexperienced especially in level 3 ICUs. Turkish healthcare system should promptly make necessary arrangements for adequate HCW staffing.