Wrong Answer: A. Washington D.C. (USA), 1983-84, HIV, contaminated blood transfusions
Right Answer:The Houseman's Tale, a 1975 novel by Colin Douglas, is a darkly humorous, outrageous, and eventually influential portrayal of the life of a junior doctor in the context of the hepatitis epidemic. It was composed by Douglas, who was a house physician in Edinburgh during the outbreak. In June 1969, with the construction of a new Medical Renal Unit (MRU), the hepatitis outbreak in Edinburgh started. In April 1969, the first occurrence was discovered after blood was transfused to a patient suffering from chronic renal failure (CRF). The patient contracted hepatitis 51 days after receiving the transfusion. Subsequently, the infection progressed, with more cases appearing 58 and 90 days later, ultimately reaching a critical mass by December 1969. The MRU's dialysis machines, which lacked adequate safeguards, were found to be the source of the epidemic. Because it was a permanent fixture that was not changed with the blood lines, the dialysis machine's venous pressure gauge became contaminated with infected blood from the first patient. It was believed that this contamination could spread infectious blood to other patients through new lines that were linked to the same machine. The chronic dialysis area, general wards, operating theatres, transplant unit, and laboratories were among the sites where the virus propagated within the institution. Contact with contaminated blood, urine, or faeces; needle sticks, wounds, and contaminated dialysis equipment were all possible entry points. Employees who came into contact with these substances could potentially get infections through cuts or other skin or mucous membrane breaks. The Nuffield Transplantation Surgery Unit at the Western General Hospital (WGH) and the MRU at the Royal Infirmary of Edinburgh (RIE) were among the many Edinburgh hospitals hit by the epidemic. Forty cases of clinical hepatitis were reported between June 1969 and August 1970, despite the fact that measures were already in place to prevent the spread. Twelve members of staff, including nurses, technicians, and surgeons, as well as two home contacts and twenty-six patients, were impacted. Two transplant surgeons, seven patients, and two lab technicians all lost their lives in the epidemic. During the acute phase, the Australia antigen was positive in all dialysis patients with clinical hepatitis. The renal unit at Guy's Hospital in London was temporarily closed due to an outbreak that affected 69 patients, 32 of whom were employees. This outbreak was similar to others that happened at other renal units in the UK. Additionally, units in Birmingham and London's Charing Cross were impacted. The city of Edinburgh had the greatest number of deaths caused by hepatitis. Lord Rosenheim headed an advisory panel that included 15 doctors, surgeons, and other healthcare professionals from around the UK in response. To reduce the transmission of hepatitis, the panel proposed several measures, including limiting blood transfusions, screening for the Australia antigen, regulating the transfer of patients between units, instituting home dialysis as early as possible, and studying the feasibility of safer dialysis machines. In addition, they emphasised the significance of working together with the Public Health Laboratory Service and taking care as laboratory personnel in order to control infections. In Edinburgh, the use of a venous pressure isolator and the extension of tubing were precautions taken to avoid contamination of the dialysis machines and the patient's blood. Infected patients were dialysed in different wards, and the Nuffield Transplantation Surgery Unit and the MRU temporarily stopped accepting new patients. To lessen the likelihood of infections in hospitals, staff wore protective gear, and those patients who were able to do so moved to dialysis at home. Professor B.P. Marmion oversaw the inquiry into the epidemic, and it was determined that the severity of the infection was due to a mix of Hepatitis B and, maybe, Hepatitis C. The impact of the outbreak on infection control methods is still felt today, as demonstrated by the charge nurse's award of an Member of the Order of the British Empire (MBE) for her dedication.
Wrong Answer: C. Nairobi (Kenya), 1948-49, MRSA, infected AV fistula
Wrong Answer: D. New Delhi (India), 1988-89, small pox, poor hygiene practices among MRU staff
Wrong Answer: A. AKI is less common in patients receiving ECMO. This is incorrect because AKI is quite common in patients receiving ECMO due to factors such as hemodynamic instability, systemic inflammatory response, and the potential nephrotoxic effects of medications used in critical care. The severe illness and complex interventions associated with ECMO increase the risk of kidney injury.
Wrong Answer: B. The use of ECMO is associated with a decreased risk of requiring renal replacement therapy (RRT). This is incorrect as ECMO does not decrease the risk of requiring RRT. In fact, patients on ECMO often require RRT due to the severity of their condition and the frequent occurrence of AKI in this patient population.
Right Answer:C. Continuous renal replacement therapy (CRRT) is preferred over intermittent hemodialysis (IHD) in ECMO patients due to better hemodynamic stability. This is correct because CRRT provides continuous and gentle fluid and solute removal, which is better tolerated hemodynamically in critically ill patients on ECMO. CRRT is preferred as it avoids the rapid fluid shifts and potential for hypotension seen with IHD.
Wrong Answer:D. The initiation of ECMO always results in immediate improvement in kidney function. This is incorrect. The initiation of ECMO does not necessarily lead to immediate improvement in kidney function. In fact, AKI may persist or even worsen initially due to the critical state of the patient and the complexities involved in ECMO management.
