Prevalence and impacts of nosocomial infection in Thailand 2001.

OBJECTIVES: To study the prevalence and impacts of nosocomial infection (N.I.) in Thailand. MATERIAL AND METHOD: A point prevalence study on N.I. was carried out in 42 hospitals across Thailand in March 2001. The impacts of N.I. were done in the same hospitals by matched control groups in a period prevalence study March 12-25, 2001. RESULTS: The point prevalence rate of N.I. in 42 hospitals involving 18,456 patients across Thailand in March 2001 was 6.4%. The prevalence was higher in male than female patients (7.8% vs 5.0%). The prevalence rates of over 10% were found in 4 hospitals. The infection rate was highest in surgical followed in rank by medical, pediatric and orthopedic departments (9.1%, 7.6%, 6.1% and 5.8%) respectively. The commonest site of the infection was the lower respiratory tract, followed by urinary tract, surgical site and skin and soft tissue (34.1%, 21.5%, 15.0% and 10.5%). Gram-negative bacteria were isolated in 75.3% and gram-postive 18.4%. Penicillins, cephalosporins, aminoglycosides were the most used antimicrobials (31.2%, 25.2%, 12.3%). A period prevalence study on 53,882 patients during a 2 week period in March 2001 showed an infection rate of 2.5%. By matched control group study, an episode of N.I. was associated with 10.1 to 12.5 extra hospital days. The cost of antimicrobials for treatment of an episode of N.I. was 5919.50 baht (148 U.S. dollars). Thirteen point eight per cent of patients with N.I. died, 6.7% directly due to N.I. CONCLUSION: Nosocomial infection is common in hospitalized patients in Thailand and is associated high mortality rate and economic burden.

Problems in the management of medical waste in Thailand.

OBJECTIVES: To identify problems in the management of medical waste in Thailand for future development. MATERIAL AND METHOD: The study was done in 39 hospitals during June and July 2002 by interviewing medical personnel on knowledge and attitude in management of medical waste, observation of practice and checking the amount of medical waste in waste bags. Certain laboratory investigations were done in dustmen. RESULTS: The amount of medical waste was 0.41 kilogram per bed per day. Problems identified were inadequate knowledge in management, improper practices, high incidence of sharp injury at work. Laboratory tests in dustmen showed evidence of pulmonary tuberculosis in 3.4%, parasites and intestinal pathogens in stools 5.1% and positive for HBsAg in 8.5%. CONCLUSION: Improper management of medical waste was present in all hospitals. Risks of exposure and incidence of infection related to the management were at concerned levels. Education and practice guidelines are needed.

A study on powdering of reusable surgical gloves.

OBJECTIVES: To study the need of powdering surgical gloves and to produce a powdering machine. MATERIAL AND METHOD: The need of powdering surgical gloves was done by questionnaires to directors or chiefs of purchase departments in 29 hospitals across the country. The practice in powdering surgical gloves was given by chiefs of the central sterile supply department (CSSD). A powdering machine was produced by the researchers in consultation with CSSD personnel in a hospital. The quality of powdering surgical gloves was evaluated by infection control nurses in the hospital. Cost comparison was done by a health economist. RESULTS: The study in 2002 revealed that all of the 29 hospitals used recycled surgical gloves. Powdering of surgical gloves was done by hand in 27.6% and by powdering machine in 62.10%. Corn powder was used in 55.2% and talc in 41.4%.Defects in powdering ranged from 1.1% to 51.7%. No defects was found in surgical gloves powdered by the machine produced by the researchers. The costs for powdering and one pair of reused surgical gloves were 0.10 and 5.59 baht respectively. CONCLUSION: Surgical gloves were reused in all hospitals in Thailand The powdering machine was effective and was not difficult to make.

A study for the production of containers used in the diagnosis and prevention of infection.

OBJECTIVES: 1. To study the need of containers used in the diagnosis and prevention of infection. 2. To produce the containers, 3. To test the practicability of the product. MATERIAL AND METHOD: - The study on the need of the containers was done by questionnaires answered by nurses and microbiology laboratory technicians in 56 hospitals. - The containers were produced by the researchers who later had them tested for their practicability by nurses and technicians in the same hospitals. - The study was done during 2002-2004. RESULTS: Fifty-six hospitals were enrolled by stratified random sampling. Questionnaires were responded by 424 nurses and 35 microbiology laboratory technicians. Sputum trap, body fluid and feces containers and needle disposal box were studied and the need for commercial products was 31.1%, 31.1%, 32.3% and 99.5% respectively. Sixteen percent to 58.5% of these containers were bought and 14.3% to 68.6% were home-made. Sputum trap, body fluid and feces containers, and needle disposal boxes were produced and tested by 400 nurses and 32 laboratory technicians. The products were evaluated as satisfactory in 59.4% to 80.0%. The lid of the needle disposal box designed as saw tooth was not convenient for use and was later modified to various slits. The costs of the containers produced were 1.3% to 29.8% of available commercial products. CONCLUSION: Sputum trap, body fluid and feces containers and needle disposal boxes of reasonable prices were needed in Thailand. These containers could be produced locally and were much cheaper than available commercial ones.