ABSTRACT
Abstract: Keyword: Nosocomial infection, Infection control, Hand hygienePrevention of nosocomial infections is an important activity in allhospitals carried out by the Infection Control Committee. The major goal of thisactivity is to protect patients, healthcare workers, visitors, and others in thehealthcare environment from nosocomial infection. Nurses have an important roleto reduce the transmission of nosocomial pathogens. Contact transmission is themost frequent mode of transmission in the hospital. This article describes clinicalclassification of skin bacteria, the evidence for hand transmission of microbialpathogens during patient care, persistence of clinically relevant on dry inanimatesurface, comparison of hand washing agent and alcohol-compound hand rubs.Hand hygiene is considered the most important measure for nosocomial infection.
ABSTRACT
Abstract Comparison of Amphotericin B Induced Nephrotoxicity between 6 Hours vwesus 24 Hours Continuous Infusion: A Randomized Controlled Trial On-umar Banpamai MD* Kumthorn Malathum MD*** Somnuek Domrongkitchaiporn MD*** Weerawat Manosuthi MD**** Sasivimol Rattanasiri MSc (Biostatistics)***** *Division of Infectious Diseases, Department of Medicine, BMA Medical College and Vajira Hospital **Division of Infectious Diseases, Department of Medicine, Ramathibodi Hospital, Mahidol Unrversity ***Division of Nephrology, Department of Medicine, Ramathibodi Hospital, Mahidol Unrversity **** Department of Medicine, Bamrasnaradura Institute *****Clinical Epidemiology Unit, Ramathibodi Hospital, Mahidol Unrversity Objective: To compare nephrotoxicity and infusion-related reactions between 6 hours versus 24 hours infusion of amphotericin B. Study design: Prospective, randomized controlled study. Subjects: Seventy-two patients who required amphotericin B therapy for various indications, between August 2004 and March 2005 at Department of Medicine, Ramathibodi Hospital and Bamrasnaradura Institute were randomly allocated to receive either 6 hours or 24 hours infusion of amphotericin B. Methods: Thirty-five patients received continuous infusion of amphotericin B for a period of 6 hours as a control group and 37 patients for a period of 24 hours as a study group. Creatinine clearance, serum potassium (k+), serum magnesium ( Mg+ ), fractional excretion of potassium and magnesium were determined in all patients once a week. Infusion-related side effects of both regimens were also recorded throughout the study. Main outcome measures: Creatinine clearance at 7 and 14 days after receiving amphotericin B, infusion-related side effects, fractional excretion of potassium and magnesium. Results: Creatinine clearance at day 7 and day 14 in study group were 83.922.9 and 81.822.5 ml/min. In control group, creatinine clearance at day 7 and day 14 were 62.7 25.3 and 51.718.9 ml/min. These levels in study group were higher than control group significantly (p-value 0.05). The incidence of renal impairment, defined as doubling of baseline serum creatinine, in study and control group were 2.7% and 45.7% that was different significantly (p-value 0.001). The incidences of infusion-related reactions other than thrombophlebitis were significantly lower in study group. Fractional excretion of statistically different between the two groups. Conclusion: The creatinine clearance, the incidence of renal impairment and infusion-related reactions in continuous 24-hour infusion of amphotericin B were lower than 6-hour infusion. Key word: amphotericin B, creatinine clearance, fractional excretion Vajira Med J 2006 ; 50 : 153 - 164
ABSTRACT
Background and objective: Extended-spectrum β-lactamase (ESBL)-producing organisms have been reported among nosocomial pathogens. The objective of this study is to determine the risk factors for nosocomial infections in adults caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E-coli) or Klebsiella pneumoniae (K. pneumoniae) in regional and provincial government hospitals in Thailand.Methods: A nested case-control study was conducted, and the patients were enrolled between July 1 and December 31, 2007. We compared 288 patients with nosocomial infections caused by ESBL-producing E. coli or K. pneumoniae to 288 hospital-matched controls with nosocomial infections caused by non ESBL-producing E. coli or K. pneumoniae.Results: The independent risk factors associated with nosocomial infections caused by ESBL producing strains included Charlson comorbidity index (Odds ratio=1.18, 95% confidence interval (CI) =1.06-1.31, p-value=0.001) and previous third generation cephalosporin use (OR=4.82, 95% CI=3.23-7.21, p-value \< 0.001).Conclusion: This is the first nested case-control study regarding the risk factors of nosocomial infections caused by ESBL-producing organisms. The Charlson comorbidity index and previous third-generation cephalosporin use were the contributing factors of nosocomial infections caused by these organisms. An emphasis on appropriate use of the third-generation cephalosporins as well as effective infection control measures in patients with high comorbidity index are needed to reduce the incidence of nosocomial infections caused by these organisms.
ABSTRACT
Abstract: The purpose of this descriptive study was to determine the incidence and characteristies of occupational exposure to blood and body fluid and infectious consequence among healthcare workers (HCWs) and to predict the type of HCWs at risk of occupational hazard in Ramathibodi Hospital from January 1, 2004 through December 31, 2006. Throughout the 3-year surveillance, there were 448blood and body fluid exposures. Of these 448 accurrences 331 (73.9%) were women. The average age was 27.64 years. Most of them (79.0%) were between the ages of 19-30 years. The majority of them were nursing staff (29.5%) and medical students (22.5%). Medical wards were the most common places where HCWs exposed to blood and body fluid by accident. Concerning working experience, 66.7% had less than 5-year experiences. The blood and body fluidincidence rate per 100 HCWs was 8.2 for medical students, 5.4 for residents and 1.7 for nursing students. Medical students had the highest risk to have an accident, considering the nursing students as the reference group. Regarding the activities undertaken at the time of injury, 231 accidents (51.6%) happened in the process of using sharp devices, and 42.4% were needle stick. Sources of infection were patients who had positive results for anti-HIV (15%) and HBsAg (4.2%). However, a 3-year sureillance found that none of the HCWs had positive results of these diseases. Education of occupational infection with bloodborne pathogens should be a priority of the hospital program for infection control. Training of HCWs on safe handling and disposal of needles and sharps devices and hepatitis B vaccination of all HCWs are required to reduce transmission.
ABSTRACT
Abstract: Older persons are susceptible to infection because of several factors related to aging process, such as poor defense mechanism, poor circulation, prone to tissue breakdown, and delayed healing process. In addition, older persons tend tohave chronic illness, such as parkinsonism, stroke, and diabetes, which further put them at risk of infection. Some older persons receive immunosuppressants as atreatment of diseases. Presentations of infection in older patients are commonly atypical, for example, afebrile or even hypothermia, less pain from the inflammation process, and less obvious leukocytosis. On the other hand, most common characteristics arealteration of consciousness and anorexia. When hospitalized, older patients tend to have prolonged length of hospital stay because of infection, either as a presenting problem or as the complication. When compared to younger patients, delayed recoveryand the mortality rate are more common. Therefore, care of older patients needs special considerations from health care personnel. This article aims to present common infections in older patients including: urinary tract infection, pneumonia, infected pressure sores, skin and soft tissue infection, osteomyelitis, septic arthritis, intraabdominal infection, and fever of unknown origin, as well as to address key clinical management.