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EXCERPTA MEDICA (EM BASE). BIOLOGICAL ABSTRACTS (BIOSIS). SCIENCE CITATION INDEX (SCISEARCH). CURRENT CONTENTS/CLINICAL MEDICINE Published by the Health and Medical Publishing Group Pty Ltd, Co registration 2004/022032/07, a subsidiary of the South African Medical Association, 28 Main Road (Cnr Devonshire Hill Road), Rondebosch.

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Editor LANCE MICHELL Nursing Science Editor NICOLA FOUCHÉ Assistant Editor EMMA BUCHANAN Technical Editors MARIJKE MAREE ROBERT MATZDORFF PAULA VAN DER BIJL MELISSA RAEMAEKERS Senior News Journalist CHRIS BATEMAN Head of Publishing ROBERT ARENDSE Production Manager EMMA COUZENS Art Director SIOBHAN TILLEMANS Design & DTP TRAVIS ARENDSE Distribution Manager EDWARD MACDONALD Sales Director DIANE SMITH Tel. (012) 481-2069 Sales Team

AZAD YUSUF, LISA REID, KEITH HILL, ANDREW CROSS, SALIE PETERSEN, MARI VENTER, JACQUELINE HERBST, TERSIA COETZEE, ANDRE MYBURGH Associate Editors ANDREW ARGENT (UCT) SATS BHAGWANJEE (Wits) DEAN GOPALAN (University of KwaZulu-Natal) IVAN JOUBERT (UCT) DAVID LINTON (Hadasa University, Jerusalem) RUDO MATHIVA (Wits) MERVYN MER (Wits) SAM MOKGOKONG (MEDUNSA) FATIMA PARUK (UCT) HELEN PERRIE (Wits) GUY RICHARDS (Wits) JUAN SCRIBANTE (Wits) ISSN 1562-8264

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CONTENTS

News 34

Editorial

• Stewardship in health care, in the nursing profession, and of self 38 Nicki Fouché

Articles

• A survey of oral care practices in South African intensive care units 42 Helen Perrie, Juan Scribante, Sonja Windsor

• Oral chlorhexidine in the prevention of ventilator-associated pneumonia

in critically ill adults in the ICU: A systematic review 48 Olivia Snyders, Oswell Khondowe, Janet Bell

November 2011 Vol. 27 No. 2

SAJCC

THE OFFICIAL SOUTHERN AFRICAN JOURNAL OF CRITICAL CARE

From Nature for Life

Pentaglobin

^®

is an enriched immunoglobulin which confers passive immunity that results in:

¹

l Bactericidal effect due to natural antibacterial antibodies

l Enhancement of the phagocytosis of pathogens l Neutralisation of bacterial toxins

l Scavenging of activated complement factors

Pentaglobin

^®

is indicated for replacement therapy in:

²

l Primary antibody deficiency syndromes l Secondary antibody deficiency states

REFERENCES: 1. Data on file. 2. Package Insert published December 2000.

S4 Pentaglobin^® 10 ml Ampoule. Each 1 ml of the solution contains 50 mg human plasma protein. Reg. No. 28/30.2/0007.

S4 Pentaglobin^® 50 ml infusion bottle. Each 1 ml of the solution contains 50 mg Human plasma protein. Reg. No.

28/30.2/0009. For full prescribing information, refer to the package insert. Further information is available on request to the holder of the certificate of registration. Holder of the certificate of registration: Pharmaplan (Pty) Ltd. Company Reg. No.

1996/017921/07. 106 16th Road, Midrand, South Africa, +27 11 652 0950. www.pharmaplan.co.za 138177

IgM- enriched human

immunoglobulins for intravenous use

Pentaglobin ^®

Act in time – Treat in time

Improve patient outcome with Pentaglobin®

Pentaglobin® significantly increases the survival rate of patients with severe bacterial infections

¹

Patient Infusion rate

l Neonates and infants 1.7 ml /kg/hr via infusion pump l Children and adults 0.4 ml /kg/hr via infusion pump Directions for use in Intravenous Infusion

²

Alternatively:

The first 100 ml at 0.4 ml/kg/hr then 0.2 ml/kg/hr continuously until 15 ml/kg is reached within 72 hours.

Immunoglobulin concentration and distribution

^{1, 2}

IgM IgG IgA

l Concentration in Pentaglobin

^®

(mg/100 ml) 600 3800 600 l Distribution in Pentaglobin

^®

(%) 12 % 76 % 12 % l Mean concentration in plasma (mg/100 ml) 125 1150 225

l Mean distribution in plasma (%) 8 % 77 % 15 %

Basis: Plasma volume

of a 70 kg patient is

2.8 litres