In March 2002 the maternity unit at the Calderdale Royal Hospital in Yorkshire became accredited as a Baby Friendly Hospital. At assessment the hospital was the only hospital in the Yorkshire region to hold the award, and accreditation generated a groundswell of interest from other hospitals, eager to gather information on the implementation of the UNICEF Ten Steps to Successful Breastfeeding. This article is an account of how the Calderdale Royal Hospital improved standards of care for breastfeeding mothers and documents one approach to success. It follows the collaborative process leading to accreditation and includes information regarding the guidelines and literature developed to support and implement the initiative. A previous article (Vol 11(9): 556–64) focused on steps 1 and 2 of the Ten Steps to Successful Breastfeeding. This second article documents the implementation of Steps 3–10.

In March 2002 the maternity unit at the Calderdale Royal Hospital in Yorkshire became accredited as a ‘Baby friendly hospital’. This article is a personal account of how the Calderdale Royal Hospital improved standards of care for breastfeeding mothers and documents one approach to success. It follows the collaborative process leading to accreditation and includes information regarding the guidelines and literature developed to support and implement the initiative. This is the first of two articles documenting the process, and it focuses on Steps 1 and 2 of the Ten Steps to Successful Breastfeeding programme (UNICEF, 1998).

Seasonal variation in the incidence of peritoneal dialysis-related infections (PDRI) has been sparingly investigated, especially in the Mediterranean. Our aim was to explore this association in Malta. All PDRI occurring between Jan-2008 and Dec-2012 were retrospectively studied.A total of 137 patients were followed-up for a median time of 32.5 months (range: 2-81). During this time, 19% never had PDRI, 11.7% transferred permanently to hemodialysis and 6.6% received a kidney transplant. A total of 279 PDRI were identified, equating to 145 catheter-related infections (CRI) and 144 peritonitis episodes (including 10 catheter related peritonitis). A spring peak in the overall gram positive PDRI (0.61 vs. 0.34/patient-year-at-risk, P=0.05), together with a peak in gram negative peritonitis in the warm period (0.13 vs. 0.07/patient-year at risk, P=0.04) was identified. The incidence rate ratios (Confidence Interval) involving the overall gram positive PDRI, gram positive peritonitis, coagulase-negative Streptococci (CoNS) and Streptococci were 1.82 (1.18-2.82, P=0.007), 2.20 (1.16-4.16, P=0.02), 2.65 (1.17-6.02, P=0.02] and 3.18 (1.03-9.98, P=0.04) in spring when compared to winter. No significant difference in the overall PDRI, peritonitis or CRI rates between seasons or warm/cold period was identified.To our knowledge, this is the first study which examines the effect of seasons on the incidence of PDRI in the Mediterranean basin. Findings suggest that spring confers a higher risk for gram positive PDRIs, gram positive peritonitis, CoNS and Streptococcus, whilst the warm period was associated with a peak in the gram negative peritonitis.

BackgroundPatients suffering from autoimmune rheumatic diseases are at increased risk of developing infections, especially if they are on immunomodulatory treatment.ObjectivesThe aim of the study was to determine whether vaccination in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD) attending the Rheumatology Clinic at Mater Dei Hospital, is in concordance with the European League Against Rheumatism (EULAR) guidelines.Methods60 patients with AIIRD attending the Rheumatology Clinic were recruited for the audit. Demographic data and vaccination status were completed using the medical notes. Further information on their vaccination history and their perceived importance of vaccination was obtained by interviewing the patients. Approval to carry out this study was obtained from the University Research Ethics Committee.ResultsThe study included patients with a variety of AIIRD including rheumatoid arthrtitis, systemic lupus erythematosus, ankylosing spondylitis and psoriatic arthritis. 58% were females and the mean age was 62.4 years (range 24 to 81 years). Out of the 60 patients audited, 43 were on a synthetic disease modifying anti-rheumatic drug (sDMARD) alone, 6 were on a biologic drug alone, and 3 were on a combination of both a biologic drug and sDMARD. 13 patients were on glucocorticoids; of which 12 were also receiving a sDMARD. Information on vaccination history was found in the medical notes in only 2 cases.The influenza vaccine was taken in 44 patients (73.3%) of which it was taken yearly in 30 patients. Out of those who had taken the influenza vaccine, most of them claimed they had been advised to do so either by their general practitioner (43.2%) or through public health campaigns (27.3%). 32 patients (53.3%) claimed that they had the intention to take it the following year. The proportion of patients who took the influenza vaccine yearly was significantly higher in those above 65 years (p<0.001) and in those who had co-morbidities (including lung disease, diabetes and ischaemic heart disease) (p=0.024). 5 patients (8.3%) claimed they had taken the pneumococcal vaccine. All of these claimed they had been advised to do so by a hospital doctor. 38.3% claimed that they knew that they were at increased risk of infections because of their condition or treatment. Only 6.7% stated that they had been advised to take vaccination because of this.ConclusionsEven though this study may have under-estimated vaccination rates and advice given to patients because of recall bias, it has clearly shown that improved patient education on their infection risk and need for vaccination is required. This can be encouraged by having structured documentation of patients' vaccination status in the medical notes and by raising awareness of its importance within the Rheumatology Department.ReferencesVan Assen S, Agmon-Levin N, Elkayam O et al. EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 2001; 70:414–422.Disclosure of InterestNone declared

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