Microbial killing activity of peracetic acid.

In vitro killing activity of peracetic acid (Perasafe) at a concentration of 0.26 per cent w/v was tested against Escherichia coli, Enterobacter cloacae, Klebsiella pneumoniae, Pseudomonas aeruginosa, Salmonella typhi, Salmonella paratyphi A, Acinetobacter baumannii, Sternotrophomonas maltophilia, Enterococcus faecium, Enterococcus faecalis, methicillin-resistant Staphylococcus aureus (MRSA), Bacillus subtilis spore, Mycobacterium tuberculosis and human immuno-deficiency virus type I. Exposure to Peracetic acid (0.26% w/v) for 10 minutes resulted in massive killing of all the aforementioned organisms and spore.

Bacterial infections in hospitalized patients in Thailand in 1997 and 2000.

Two surveys to determine the patterns of bacterial infections and trends in resistance to antibiotics of bacteria causing infections in patients admitted to hospitals in Thailand were conducted in 36 and 37 hospitals throughout Thailand in June 1997 and February 2000. Approximately 50 per cent of infections in hospitalized patients in Thailand were hospital-acquired infections. Urinary tract and lower respiratory tract were the most common sites of infections. Eighty per cent of infections were caused by gram negative bacteria. Gram negative bacteria causing infections in 2000 were more resistant to most commonly used antibiotics when compared with those in 1997. The prevalence of gram positive bacteria causing hospital-acquired infections significantly increased during this period. The trend of increase in resistance in most gram positive bacteria in 2000 was not clearly observed.

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.

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.

Infusion phlebitis in medical and surgical patients in Siriraj Hospital.

A study on infusion phlebitis was done in medical and surgical departments in Siriraj Hospitals from February to April 1992. Two hundred and eighty-one patients and 406 infusion sites were included. The infusion time was 40.6 +/- 31.9 hours. The incidence rate of phlebitis was 25.9%. There was no difference in its occurrence in medical and surgical patients. Dorsum of the hand was the site associated with low incidence and less severe phlebitis. The contrary applied to the forearm and arm. Plastic cannulae were associated with higher incidence, more severe phlebitis than steel needles, but this was not statistically significant. Intravenous antimicrobials were followed by higher incidence and more severe phlebitis. The value of early diagnosis of infusion phlebitis so as to halt its progress was also demonstrated in the study. In no case was the phlebitis, in the most severe form i.e. grade 5, encountered.

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.

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.

An outbreak of Norwegian scabies in a surgical ward.

An outbreak of Norwegian scabies in a surgical ward of a teaching hospital was reported. The source of infestation was an elderly diabetic. The epidemic involved 28 of 32 medical personnel in the ward and 3 family contacts. All infected individuals were given a two-course treatment with hexachlorcyclohexane gel. Control of the outbreak was achieved by strict handwashing after patient contact, application of gowns and gloves for contact with skin lesions and the treatment of infected persons. Norwegian scabies in institutions is on the rise, vigilance for its occurrence is needed.

Effects of education on the prevention of pressure sores.

A controlled study was done to evaluate the efficacy of written guidelines on the prevention of pressure sores. Thirty-three hospitals in Thailand were enrolled from February to April 1991. The incidence of pressure sores in the 6 week control period was 8.7 per cent compared to 6.5 per cent in the study phase. Reduction of the complication was found in all medical, surgical and intensive care departments. Practices on the prevention of pressure sores by nurses were significantly improved regarding: positioning, seating, not pulling, and bed-bathing of patients. Massaging the immobilized parts and the application of supporting devices were not increased by the education programme. This method of education is simple and appropriate for hospitals in Thailand.

Infusion-related phlebitis.

The incidence rate and risk factors of infusion-related phlebitis was studied in 1993. Thirty-five hospitals were enrolled. Data were collected from 6,256 infusion sites. Male and female patients were almost equal. Forearms were the commonest site of infusion, followed by hand and arm respectively. In 34.1 per cent the infusion was interrupted by complications of which 6.2 per cent was phlebitis. It was mild in most cases. Increased incidence rates of infusion related phlebitis were associated with: the use of plastic cannulas, dextrose containing solutions, administration at the sites other than hand and concomitant administration of antimicrobials. The incidence rate of phlebitis rose sharply after 24 hours of infusion. It is concluded that in addition to proper insertion and good nursing care, the avoidance of the above risk factors will lead to a lower incidence of infusion-associated phlebitis.

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.

Needlesticks and cuts with sharp objects in Siriraj Hospital 1992.

A study on needlesticks and cuts with sharp objects was done by a set of questionnaires in Siriraj Hospital in March 1992. The response rate of 3,600 sets of questionnaires was 80.8%. The recalled incidence rate of injuries in the previous 6 months was 51.5%. Needlesticks were the commonest accident followed by cuts by broken glass and medical equipment respectively. Bore needles were the most important cause of injury. Recapping and improper disposal of used needles were prevalent. With the same incidence rate of such injuries, it was estimated that 5.9 persons will be HIV infected annually in Thailand.

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.

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.

Comparison of costs for disposable and reusable syringes and needles in Siriraj Hospital.

The costs for disposable and re-usable syringes and needles were compared in Siriraj Hospital, in July 1988. Data were collected from all wards regarding number of items used or replaced. Labour costs for recycling re-usable items were estimated by close observation. The costs for disposable and re-usable syringes and needles were 498,039.50, 193,874.45, 69,410.00 and 27,366.95 baht respectively. It can be concluded that re-usable items cost only 36 per cent of disposable ones. It is evident that re-usable syringes and needles should be appropriate for hospitals in Thailand at present.

Pre-operative shaving and wound infection in appendectomy.

The study on the effects of shaving the skin on wound infections after appendectomy was done in 80 patients in 1988 in Siriraj Hospital. Patients were divided randomly into two groups, 40 patients each, a control and an experiment group. The control group had their skin shaved and the experiment group did not. Data showed no difference in: demography, preoperative admission time, interval between skin preparation and surgery, thickness of subcutaneous tissue, operating time, and suture materials. Shaving of the skin resulted in no alteration in bacteria found on the skin, on the walls of the wound before closing. Stitch abscesses were the only wound infection found in 3 patients in each group. It is concluded that skin shaving, though it did not increase wound infection rate, had no beneficial effect on wound infection in appendectomy.

Efficacy of DESMANOL® for surgical hand scrub.

The comparative study of Desmanolฎ and Hibiscrubฎ was carried out in order to test the efficacies of eliminating microorganisms from surgeons’ hands. Thirty surgical residents of Siriraj Hospital were enrolled in the study. Each subject’s hands and forearms were scrubbed with Desmanol and Hibiscrub on different occasions few days apart by random sequence. Prior to each scrubbing, the hand and forearm were cultured quantitatively by cotton swab technique. The culture was repeated after scrubbing. The coagulase negative staphylococci, micrococci and bacillus were found in almost all the subjects’ hands before scrubbing with both solutions at the quantity of 104 cfu. The other organisms cultured from 10 to 20% of subjects’ hands were S. aureus and gram negative bacilli at 102 to 103 cfu. Seventy percent of the subjects’ hands in both groups had negative culture after scrubbing. The organisms cultured from 30% of the subjects were coagulase negative staphylococci, micrococci and bacillus. However, the colony counts of these organisms were 100-fold decrease from those before scrubbing. No strains of S. aureus or gram negative bacilli were cultured after scrubbing.

Patients colonized by antibiotic resistant bacteria--a potential source of infections in the medical wards.

Bacterial colonization was studied in 12 non-infected female patients admitted into one medical ward, Siriraj hospital, Bangkok, from March to June 1988. Swabs were taken on the first day of admission, then every other day until discharge, from six sites; i.e. anterior nares, vault of axilla, hands, anterior chest, abdomen and toe web. The times and total number of swabbing were 52 and 312 respectively. All patients were colonized with bacteria. S. epidermidis was found in all patients. S. aureus was found in 9 patients, 48 times (15.4%). Methicillin-resistant S. aureus (M.R.S.A.) was identified in 4 patients on 10 occasions (3.2%). Gram-negative bacilli were isolated in 11 of 12 patients, and the number of positive samples was 60 (19.2%). All bacteria were highly resistant to the commonly used antimicrobials. The study failed to show that colonization increased with the duration of hospitalization. It is concluded that the majority of patients who had been colonized with pathogenic bacteria were important sources of infections in the medical ward.