An outbreak of methicillin-resistant Staphylococcus aureus (M.R.S.A.) in a burn unit.

An outbreak of methicillin-resistant Staphyllococcus aureus (MRSA) in the burn unit of Siriraj Hospital from August 1990 to July 1991 was reported. Temporary decrease in the incidence of MRSA was observed during a period when no new cases were admitted. The incidence rose again after normal service resumed. Surveillance cultures in 29 patients from May to July 1991 grew MRSA in 19 patients (65.5 per cent). Infection by MRSA was found in 14 patients (48.3 per cent). Methicillin-resistant Staphylococcus aureus first appeared in these patients mainly during the first and second weeks of admission. Wound infections were the only manifestation in 14 patients. Four of the MRSA infected patients died of infection by organisms other than MRSA. Nasal carriage was found in 2 of 25 ward staff members. The cost of treatment for each episode of MRSA infection was as high as 19,322.90 baht. The epidemic of MRSA infections persisted despite all control measures resulting in temporary closure of the ward.

Use of antiseptics and disinfectants in Thailand 1990.

A survey by questionnaire was done in March and April 1990 on the use of antiseptics and disinfectants (A/D). Twenty-seven hospitals with 675 wards were enrolled. Results showed that the cost of A/D was 3.3 to 8.1 per cent of the total expenses for drugs. Essential A/D were available and used in most places. Many low level A/D, which have been excluded from modern hospitals, were still employed. Contamination of A/D was a real threat due to improper preparation, unclean containers and refill practices in many wards. Improper applications of A/D, namely: overuse, underuse, and wrong choices were found in many places. Textbooks and written guidelines were available but it is unlikely that they were referred to in practice. A national policy on the use of A/D and proper education to medical personnel are clearly needed.

The Second Thai National Prevalence Study on Nosocomial Infections 1992.

A prevalence study on N.I. in Thailand was repeated in 1992 to evaluate the efficacy of the ongoing control programme. The survey included 10,373 patients in 33 hospitals throughout Thailand. The prevalence rate of N.I. in this study was 7.3 per cent. When compared with a previous study done in 1988, it was found that the prevalence rate had decreased by 4.4 per cent. The reduction of N.I. occurred in all types of hospitals, and in all services. Major reduction was found in the age groups 5-14, 15-24 and 25-34 years, in orthopaedics, paediatrics and surgical departments. Lower respiratory tract infections were the commonest infection in this study while urinary tract infection was the commonest in 1988. Overuse of antimicrobials was discovered in this survey. The success in reduction of N.I. was attributed to the increase in N.I. activities. Campaigns against N.I. since 1988 seem effective and should be intensified.

A national study on surgical wound infections 1992.

A study on SWI was done in 33 hospitals in Thailand between March 16 and May 15, 1992 involving 15,319 surgical wounds. The average incidence rate of SWI as 2.7 per cent. It was highest in provincial hospitals. Patients aged under 10 years and 51-60 years had higher rates of SWI. It was most prevalent in the surgical department followed in rank by accident and orthopaedic departments respectively. Wound types were the most important denominator of SWI; the incidence of SWI in dirty, contaminated, clean-contaminated and clean wounds were 9.7, 5.1, 1.5 and 1.3 per cent respectively. Antimicrobial prophylaxis were used in 76.7 per cent of the wounds. Ampicillin, gentamicin and cloxacillin were the commonly used drugs. Prevention of SWI needs to be improved in provincial hospitals and in the use of prophylactic antimicrobials.

Contamination of mercurochrome and chlorhexidine-cetrimide in a teaching hospital.

A study on the contamination of antiseptics was done in a teaching hospital, during March and April 1989. Ninety-five samples of 9 antiseptics from 23 wards were cultured. Results showed that 2 of 12 and 3 of 5 samples of mercurochrome and chlorhexidine-cetrimide compound were contaminated. This led to a wider scale study on the two products. It was found that over one-half of the samples of mercurochrome and 6 of 54 samples of chlorhexidine-etrimide compound were contaminated. Mercurochrome was contaminated by gram-positive and chlorhexidine-cetrimide compound by gram-negative bacteria. Contamination of mercurochrome was found in samples taken from the pharmacy and wards, and of chlorhexidine-cetrimide compound from wards only. Mercurochrome was removed from the hospital formulary and the use of chlorhexidine-cetrimide compound was more restricted.

Universal precautions: knowledge, compliance and attitudes of doctors and nurses in Thailand.

A study on the knowledge, compliance and attitudes of doctors and nurses on "universal precautions" (U.P.) was done by questionnaire in April 1993. Four hundred and sixty-nine doctors and 4,554 nurses from 35 hospitals throughout Thailand responded. Almost all doctors and nurses understood the definition of U.P.. The latter were correctly applied in less than half of the personnel. A significant number of doctors and nurses required HIV screening tests and isolation of patients with HIV infections. Most doctors and nurses knew that sharp injuries were the most important cause of acquiring HIV infection in health-care settings. Those who are more vulnerable to injury would take more precautions. Up to a quarter of doctors and nurses did not fully understand how to use protective barriers properly. The practice of handwashing needs to be improved. Both doctors and nurses were willing to take care of HIV infected patients. They supported the application of U.P. as a safety measure. Welfare support for health-care workers who have contacted HIV at work is also expected.

Basic elements for the control of nosocomial infection in Thai hospitals.

A survey on the basic elements for the control of N.I. was done in 38 hospitals in Thailand in 1991. Manpower shortage was found in one half of them. Service by the microbiological laboratory was under-utilized. Good guidelines on N.I. control needed to be more widely adopted. Capacity of C.S.S.D. lagged behind demands in most hospitals. Water supply was of most concern and needed to be improved in all. Waste-water treatment plants were needed in about one half of the hospitals. Personnel working in catering did not receive adequate screening for communicable diseases in one-half. Workers in the laundry department needed education on infection prevention in about one-third of hospitals. Improper disposal of infectious waste was found in one-quarter. The results of the study indicated that a comprehensive programme is needed for improving the efficacy of N.I. control in Thailand.

Does indication sheet reduce unnecessary urethral catheterization?

The study on the effect of indication sheet on the decision of doctors in ordering urethral catheterization was done in thirteen hospitals randomly selected from all regions of Thailand. 16,959 patients in medical and surgical wards were included between April and May 1989. The rates of urethral catheterization did not change by the influence of indication sheet. However, urethral catheterization without proper indications was reduced from 27.0 per cent in the control group to 14.3 per cent in the experiment group. The indication sheet was accepted in 96.5 per cent of the occasions when doctors prescribed urethral catheterization. The indication sheet changed the doctors' decision and hence reversed the order in 3 events (0.8%). It is concluded that indication sheet was well accepted by doctors and could reduce urethral catheterization without proper indications.

A national prevalence study on nosocomial infections 1988.

A National survey of N.I. in Thailand was done in April 1988. Twenty-three hospitals throughout the country were enrolled. Of the 6,805 patients studied, 52 per cent were males and 48 per cent were females. The prevalence rate of nosocomial infections was 11.7 per cent. The highest rate was found in the second biggest (regional) hospitals (18.8%). There were minor variations in the rates of infection in each age group. The infection rate was highest in intensive care units (35.1%) followed by orthopaedic (20.4%) and paediatric (15.7%) departments respectively. Urinary infections were the commonest (25.8%). Surgical wound infections ranked second (19.6%). Skin infections were as high as 11.8 per cent. P. aeruginosa were the commonest bacterial isolates (22%) followed by E. coli (18.1%) and Klebsiella species (14.0%). Antimicrobials were prescribed in 52 per cent of patients, and, in a large number, for prophylactic purposes. It is concluded that N.I. are the main health problems affecting more than 200,000 patients annually in Thailand. Urgent studies and interventions are clearly needed.