A 'nice to have' or a 'non-negotiable': South African healthcare workers' knowledge, attitudes, practices and perceptions of vaccination

Background: Non-immune healthcare workers (HCWs) are at high risk of contracting and transmitting vaccine-preventable diseases. Data on the knowledge, attitudes and practices (KAP) of African HCWs regarding the World Health Organization (WHO)-recommended vaccinations is limited. Objectives: We aimed to describe the KAP of HCWs regarding the WHO-recommended vaccinations, namely, those against hepatitis B, polio, diphtheria, measles, rubella, meningococcus, influenza, varicella and pertussis, and to assess the facilitators of, and barriers to, HCW vaccine uptake. Methods: This was a cross-sectional study. A self-administered KAP survey was completed by 300 clinical (nurses, doctors, allied health) and non-clinical (laboratory, pharmacy, administrative, household staff and porters) HCWs at Tygerberg Hospital, Cape Town, from June to October 2018. Data were analysed using Stata Statistical Software version 13.0 IC to generate mean scores for KAP. Individual question scores were compared across job categories (clinical vs non-clinical) using Pearson's chi-square test. Results: Most of the study participants were female (n = 228, 76.0%), aged 18­40 years (n = 190, 63.3%) and employed as clinical staff (n = 252, 84.0%). The overall mean KAP scores were 57.1%, 68.4% and 39.9%, respectively; clinical HCWs scored significantly higher than non-clinical HCWs in all three topics (p < 0.001). HCWs believed vaccines to be effective (n = 254, 84.7%) and safe with few side effects (n = 219, 73.0%). Vaccine uptake was highest for hepatitis B (n = 247, 82.3%), followed by measles (n = 159, 53.0%) and diphtheria/tetanus (n = 101, 33.7%), and lowest for influenza (n = 68, 22.7%). Common reasons for vaccination included HCWs wanting to protect themselves, their families and their patients. Fear of side effects and lack of workplace access were common reasons for not vaccinating. Conclusion: Clinical HCWs had better KAP regarding vaccination than non-clinical HCWs. Strategies to improve HCW vaccine uptake should focus on vaccination education and facilitation of workplace access to vaccination.

Personal protective equipment (PPE) in a pandemic: Approaches to PPE preservation for South African healthcare facilities

Personal protective equipment (PPE) is key to protecting healthcare workers from COVID-19 infection, but the pandemic has disrupted supply chains globally and necessitated rapid review of the scientific evidence for PPE re-use. In South Africa, where the COVID-19 epidemic is still developing, healthcare facilities have a short window of opportunity to improve PPE supply chains, train staff on prudent PPE use, and devise plans to track and manage the inevitable increases in PPE demand. This article discusses the available PPE preservation strategies and addresses the issue of decontamination and re-use of N95 respirators as a last-resort strategy for critical shortages during the pandemic

Central-line-associated bloodstream infections in a resource-limited South African neonatal intensive care unit

Background. The rate of central-line-associated bloodstream infection (CLABSI) in South African (SA) public sector neonatal intensive care units (NICUs) is unknown. Tygerberg Children's Hospital (TCH), Cape Town, introduced a neonatal CLABSI surveillance and prevention programme in August 2012.Objectives. To describe CLABSI events and identify risk factors for development of CLABSI in a resource-limited NICU.Methods. A retrospective case-control study was conducted using prospectively collected NICU CLABSI events matched to four randomly selected controls, sampled from the NICU registry between 9 August 2012 and 31 July 2014. Clinical data and laboratory records were reviewed to identify possible risk factors, using stepwise forward logistic regression analysis.Results. A total of 706 central lines were inserted in 530 neonates during the study period. Nineteen CLABSI events were identified, with a CLABSI rate of 5.9/1 000 line days. CLABSI patients were of lower gestational age (28 v. 34 weeks; p=0.003), lower median birth weight (1 170 g v. 1 975 g; p=0.014), had longer catheter dwell times (>4 days) (odds ratio (OR) 5.1 (95% confidence interval (CI) 1.0 - 25.4); p=0.04) and were more likely to have had surgery during their NICU stay (OR 3.5 (95% CI 1.26 - 10); p=0.01). Significant risk factors for CLABSI were length of stay >30 days (OR 20.7 (95% CI 2.1 - 203.2); p=0.009) and central-line insertion in the operating theatre (OR 8.1 (95% CI 1.2 - 54.7); p=0.03). Gram-negative pathogens predominated (12/22; 54%), with most isolates (10/12; 83%) exhibiting multidrug resistance. Conclusion. The TCH NICU CLABSI rate is similar to that reported from resource-limited settings, but exceeds that of high-income countries. Prolonged NICU stay and central-line insertion in the operating theatre were important risk factors for CLABSI development. Intensified neonatal staff training regarding CLABSI maintenance bundle elements and hand hygiene are key to reducing CLABSI rates