Incidence and risk factors for nosocomial pneumonia among intubated patients in a provincial hospital, Eastern Thailand.

The present study was conducted to determine the incidence and risk factors for nosocomial pneumonia (NP) among intubated patients in a provincial hospital, eastern Thailand. Three hundred five intubated patients who voluntarily participated and signed informed consent were observed and medical records were collected. The respiratory secretion specimens from NP patients, diagnosed by doctors under the definition of the International Statistical Classification of Disease and Related Health Problems Tenth Revision (ICD-10), were collected for bacterial culture. Data from patients with and without NP were analyzed to identify risk factors. The results revealed that the incidence of NP was 38.4% (117/305 cases). Of 117 NP patients, 35% were positive on bacterial culture. The most frequently isolated bacteria were Klebsiella pneumoniae and Klebsiella spp (32%), and the incidence of methicillin resistant Stapylococcus aureus (MRSA) was 6%. Risk factors for NP from univariate analysis were (a) age more than 60 years (OR = 9.2, p < 0.001), (b) admitted to the ICU (OR = 1.7, p=0.042), (c) comatose (OR = 12.2, p < 0.001), (d) chronic pulmonary disease (OR = 5.3, p < 0.001), tuberculosis (OR = 14.3, p < 0.001), (e) smoking (OR = 7.1, p < 0.001), and (f) duration of intubation greater than 5 days (OR = 8.8, p < 0.001). After controlling for confounders using multivariate analysis, the significant risk factors were (a) age greater than 60 years (OR = 9.9, p < 0.001), (b) comatose (OR = 9.4, p = 0.031), (c) chronic pulmonary disease (OR = 5.2, p < 0.001), tuberculosis (OR=I 1.4, p = 0.003), (d) smoking (OR = 3.6, p < 0.001), and (e) duration of intubation more than 5 days (OR = 18.9, p < 0.001). When an intubated patient has these risk factors, they should be considered a potential risk for NP and preventive measures should be taken to reduce the risk.

Factors related to health-promoting behaviors among Thai middle-aged men.

OBJECTIVE: To study factors related to health promoting behaviors of Thai middle-aged men. STUDY DESIGN: Descriptive research. MATERIAL AND METHOD: Nine hundred and five Thai males, aged between 40-59 years, living in six provinces of Thailand, were selected by multi-stage random sampling. Data were collected using interview, physical examination, and laboratory test. RESULTS: Thai middle-aged men mostly perceived their health status as fair (85.6%). Health screening showed that 7.2% had hormone deficiency, 65.7% had slight prostatic hypertrophy, and 27.3% had erectile dysfunction symptoms. Overall health promoting behaviors were at moderate level (50.7%). Marital status, having annual health examination, social support, receiving health information, and health belief were significantly related to health promoting behaviors (p < 0.05). CONCLUSION: Providing health information through materials, media, and family members would also increase accessibility to health services and promote effective health-promoting behavior of Thai middle-aged men.

Risk behaviors and life skills towards sexually transmitted and blood-borne infections among Thai married couples.

OBJECTIVE: A cross-sectional study of 706 couples or 1,412 individuals with age 15-44 years was carried out to assess risk behaviors, life skill level, and its relationship, and to investigate HBV seromarkers, anti-HCV, and anti-HIV among individuals who voluntarily participated in blood screening. MATERIAL AND METHOD: All studied participants who voluntarily participated and signed consents were interviewed about risk behaviors and life skills. Only 166 individuals voluntarily participated in blood screening for HBVseromarkers, anti-HCV, and anti-HIV RESULTS: The results revealed that, of 1,412 individuals, 15.30% had a history of regular alcohol consumption, 11.26% had tattoos, 5.10% had a history of extramarital sex without using condoms, and 2.83% had a history of sex services. Males had significantly higher risk behavior scores than females, p < 0.0001. For life skills, 78.71% of the participants had the middle level of life skill scores. Males had relatively lower life skill scores than females, but it was not significant. The relationship between the levels of risk behavior scores and life skill scores showed significant association, p < 0.0001. Results from blood screening showed 31.33% ofHB V seromarker positive, 6.63% ofHBsAg positive, 1.21% ofanti-HCV positive, and 1.21% ofanti-HIV positive. CONCLUSION: The present study showed the significant association between the levels of life skill scores and the levels of risk behavior scores. The participants who had higher level of life skill scores had lower level of risk behavior scores.

Hepatitis B virus sero-markers, hepatitis C virus antibody and risk behaviors among middle age and older Thai males.

A cross-sectional study of 1069 Thai males over 40 years of age was carried out to assess risk behaviors towards hepatitis B and C. All studied participants who voluntarily participated and signed informed consents were interviewed. One hundred eighty-seven volunteers participated in blood screening for hepatitis B virus (HBV) sero-markers and anti-hepatitis C virus (anti-HCV). The results reveal of 1069 subjects, 21.3% had tattoos, 18.4% had a history of regular alcohol consumption (drinking alcohol > or =5 days/week), and 16.4% had a history of extramarital sex without using condoms during the previous year. Results from blood screening showed 93.1% were positive for HBV sero-markers, 4.3% had a positive HBsAg, 58.8% had a positive anti-HBs, and 0.5% had a positive anti-HCV antibody. Nine subjects were positive for HBsAg or anti-HCV, most (7/9) had at least one risk behavior.

Nosocomial surgical site infection among Photharam Hospital patients with surgery: incidence, risk factors and development of risk screening form.

OBJECTIVE: A cross-sectional analytic study of 268 patients who received surgery at Photharam Hospital was conducted to assess the incidence and risk factors of nosocomial surgical site infection (SSI). MATERIAL AND METHOD: The studied patients who voluntarily participated and signed informed consents were interviewed Pus specimens from SSI patients diagnosed by use of CDC criteria were cultured After risk factor analysis, the risk screening form was developed and calculated by the Receiving Operating Curve. RESULTS: The results revealed that incidence of nosocomial SSI was 20.52% (55/268 cases). Of 55 SSIpatients, 45.46% were positive for bacterial culture. Risk factors for nosocomial SSI from univariate analysis were (a) age of patients > 60 years, OR = 1.91 (p = 0.043), (b) gender as male, OR = 2.20 (p = 0.024), (c) admitted ward as male surgical ward, OR = 2.42 (p = 0. 028), (d) current patients' illness as diabetes mellitus (DM), OR = 7.92 (p < 0.001) and tuberculosis, OR = 11.88 (p = 0.001), (e) abnormal ASA score, OR = 3.47 (p < 0.001), 60 smoking, OR = 3.72 (p < 0.001), (g) incorrect prophylactic drug use, OR = 2.98 (p = 0.002), (h) duration of admission > 10 days, OR = 4.87 (p < 0.001), and (i) wound dressing > 1 time/day, OR = 4.16 (p < 0.001). After multiple logistic regression analysis, the significant risk factors were (a) current patient's illness as DM, OR = 14.43 (p = 0.005), (b) smoking, OR = 13.18 (p = 0.001), (c) duration of admission > 10 days, OR = 4.88 (p = 0.032) and (d) wound dressing >1 time/day, OR = 23.32 (p < 0.001). The risk screening form was developed and showed approximately 65% sensitivity and 78% specificity when a cut-off score at risk > 18 was used CONCLUSION: This risk screening form should be considered in other hospitals. When a postoperative patients has a score of 18, they should be considered a potential risk for nosocomial SSI and preventive measures should be integrated to reduce the risk for nosocomial SSI.

Improving microbial air quality in air-conditioned mass transport buses by opening the bus exhaust ventilation fans.

The air quality in air-conditioned mass transport buses may affect bus drivers' health. In-bus air quality improvement with the voluntary participation of bus drivers by opening the exhaust ventilation fans in the bus was implemented in the Seventh Bus Zone of Bangkok Mass Transit Authority. Four bus numbers, including bus numbers 16, 63, 67 and 166, were randomly selected to investigate microbial air quality and to observe the effect of opening the exhaust ventilation fans in the bus. With each bus number, 9 to 10 air-conditioned buses (total, 39 air-conditioned buses) were included. In-bus air samples were collected at 5 points in each studied bus using the Millipore Air Tester. A total of 195 air samples were cultured for bacterial and fungal counts. The results reveal that the exhaust ventilation fans of 17 air-conditioned buses (43.6%) were opened to ventilate in-bus air during the cycle of the bus route. The means +/- SD of bacterial counts and fungal counts in the studied buses with opened exhaust ventilation fans (83.8 +/- 70.7 and 38.0 +/- 42.8 cfu/m3) were significantly lower than those in the studied buses without opened exhaust ventilation fans (199.6 +/- 138.8 and 294.1 +/- 178.7 cfu/m3), p < 0.0005. All the air samples collected from the studied buses with opened exhaust ventilation fans were at acceptable levels (< 500 cfu/m3) compared with 4.6% of the air samples collected from the studied buses without opened exhaust ventilation fans, which had high levels (> 500 cfu/m3). Of the studied buses with opened exhaust ventilation fans (17 buses), the bacterial and fungal counts after opening the exhaust ventilation fans (68.3 +/- 33.8 and 28.3 +/- 19.3 cfu/m3) were significantly lower than those before opening the exhaust ventilation fans (158.3 +/- 116.9 and 85.3 +/- 71.2 cfu/m3), p < 0.005.

Risk assessment towards tuberculosis among hospital personnel: administrative control, risk exposure, use of protective barriers and microbial air quality.

A recent increase in the rate of tuberculosis among hospital personnel has led to a greater concern about the risk of Mycobacterium tuberculosis transmission in the hospital. A cross-sectional study was conducted to assess the risk of tuberculosis infection among hospital personnel of a governmental hospital in Bangkok by applying hospital tuberculosis control strategies, including administrative control, risk exposure, use of protective barriers when in contact with TB patients, and microbial air quality in the studied wards. Fourteen members of the infection control committee (ICC) and 118 hospital personnel were interviewed regarding the infection control policy and its implementation. The history of TB exposure at work and the use of protective barriers when in contact with TB patients were recorded for the studied hospital personnel. Air samples in the studied wards were collected to investigate bacterial and fungal counts. The results reveal that all the studied ICC members and more than 85% of studied hospital personnel knew the infection control policy and attempted to implement it. However, 35.71, 37.50, 80.90,93.93, and 88.46% of personnel working in ER, OPD, ICU, female medical ward, and male medical ward, respectively, implemented the TB isolation policy. More than 80% of studied personnel had histories of exposure to TB patients, but only 52.73% (31.57% in OPD to 80.00% in ICU) used the appropriate barriers (N95) when in contact with TB patients. Air samples collected from the studied wards, except ICU, had high bacterial and fungal counts (> 500 cfu/m3). These findings show that hospital personnel working in the studied wards, except ICU, were at risk for tuberculosis infection. The hospital ICC should advertise the use of TB standard precautions to hospital personnel and provide a ventilation system for reducing the microbial counts in the air of the studied wards.

Microbial air quality in mass transport buses and work-related illness among bus drivers of Bangkok Mass Transit Authority.

The air quality in mass transport buses, especially air-conditioned buses may affect bus drivers who work full time. Bus numbers 16, 63, 67 and 166 of the Seventh Bus Zone of Bangkok Mass Transit Authority were randomly selected to investigate for microbial air quality. Nine air-conditioned buses and 2-4 open-air buses for each number of the bus (36 air-conditioned buses and 12 open-air buses) were included. Five points of in-bus air samples in each studied bus were collected by using the Millipore A ir Tester Totally, 180 and 60 air samples collected from air-conditioned buses and open-air buses were cultured for bacterial and fungal counts. The bus drivers who drove the studied buses were interviewed towards histories of work-related illness while working. The results revealed that the mean +/- SD of bacterial counts in the studied open-air buses ranged from 358.50 +/- 146.66 CFU/m3 to 506 +/- 137.62 CFU/m3; bus number 16 had the highest level. As well as the mean +/- SD of fungal counts which ranged from 93.33 +/- 44.83 CFU/m3 to 302 +/- 294.65 CFU/m3; bus number 166 had the highest level. Whereas, the mean +/- SD of bacterial counts in the studied air-conditioned buses ranged from 115.24 +/- 136.01 CFU/m3 to 244.69 +/- 234.85 CFU/m3; bus numbers 16 and 67 had the highest level. As well as the mean +/- SD of fungal counts which rangedfrom 18.84 +/- 39.42 CFU/m3 to 96.13 +/- 234.76 CFU/m3; bus number 166 had the highest level. When 180 and 60 studied air samples were analyzed in detail, it was found that 33.33% of the air samples from open-air buses and 6.11% of air samples from air-conditioned buses had a high level of bacterial counts (> 500 CFU/m3) while 6.67% of air samples from open-air buses and 2.78% of air samples from air-conditioned buses had a high level of fungal counts (> 500 CFU/m3). Data from the history of work-related illnesses among the studied bus drivers showed that 91.67% of open-air bus drivers and 57.28% of air-conditioned bus drivers had symptoms of work-related illnesses, p = 0.0185.

Hepatitis C virus infection among Thai blood donors: antibody prevalence, risk factors and development of risk screening form.

Hepatitis C virus (HCV) infection is an important blood-borne infection in many countries, including Thailand. For epidemiological surveillance and controlling the infection, 2167 blood donors were screened for antibody to HCV by an enzyme immunoassay method and interviewed by using a structured questionnaire which consisted of personal health history and some risk behaviors. The prevalence and risk factors were assessed and the risk screening form was developed. The results revealed that the prevalence of anti-HCV was 2.90%. Male blood donors had relatively higher anti-HCV positive rate than females (3.21% vs 1.77%). The significant risk factors from univariate analysis were: (a) gender as male, OR = 1.94 (p = 0.042), (b) education to the primary level, OR = 4.15 (p < 0.001), (c) occupation as laborer or agriculture workers, OR = 2.87 (p < 0.001), police and military, OR = 1.82 (p = 0.046), (d) residence in a rural area, OR = 3.09 (p < 0.001), (e) a history of receiving blood or blood products, OR = 5.21 (p < 0.001), (f) a history of tattooing, OR = 1.70 (p = 0.043), (g) a history of IDU (Infecting Drug Use), OR = 41.43 (p < 0.001), (h) a history of STDs (sexually transmitted diseases) in the last year, OR = 3.87 (p = 0.021), and (i) a history of sexual service, OR = 4.24 (p = 0.017). After multivariate analysis, four variables related to HCV infection among the studied samples included education to the primary level, OR = 3.34 (p = 0.0036), occupation as a laborer or agriculture worker, OR = 2.14 (p = 0.0092), a history of receiving blood or blood products, OR = 4.13 (p = 0.0029), and a history of IDU, OR = 3.82 (p < 0.0001).The risk screening form was developed using risk scores. The validity was calculated by the Receiving Operating Curve. The sensitivity of this form was approximately 55.3% and the specificity was 85.7% when a cut-off score at risk > or =7 was used. If the cut-off score was > or =6, the screening form showed 77.1% of specificity and 61.3% sensitivity. This risk screening form should be applied not only for blood donation but also for pre-marital health screening.

Sero-epidemiological study of hepatitis A virus infection among hill-tribe youth and household environmental sanitation, a hill-tribe community in northern Thailand.

A cross-sectional analytic study of 190 hill-tribe youth in a community in the north of Thailand was conducted to investigate the sero-prevalence of HAV and factors related to positive anti-HAV antibody. The studied youth, whose ages ranged from 15 to 24 years, were interviewed about socio-economic status and personal hygiene. Blood specimens were collected to detect anti-HAV by ELISA commercial kit. Household environmental sanitation conditions were observed and drinking water samples were screened for bacterial contamination using SI2 medium. Following the anti-HAV assay, the studied youth were divided into two groups: anti-HAV positive, and anti-HAV negative. The studied variables of the two groups were analyzed by chi2 test to find factors related to anti-HAV positivity. The results revealed that 87% of the studied youth were positive for anti-HAV. There was no statistically significant difference between age group/gender and anti-HAV positivity, p = 0.46 and 0.16, respectively. Approximately 35.79 to 45.79% washed their hands with soap before preparing food, before eating and after using the latrine. About 88% did not improve the potability of their drinking water. The results of screening for bacterial contamination in drinking water samples found that 73.53% were contaminated with coliform bacteria. Factors related to positive anti-HAV antibody included monthly income, number of household members, use of latrine, hand-washing with soap after using latrine, household refuse management and control of insects and rodents; p = 0.04, 0.007, 0.013, 0.008, <0.001 and <0.001, respectively. The findings suggested that appropriate household environmental management should be improved in this community to reduce HAV transmission.

Hepatitis B carrier among married hilltribe women in northern Thailand.

A cross-sectional study of 540 married Akha and Lisaw women of reproductive age was conducted in Chiang Rai Province, Thailand, between June 1st and August 31st, 1999, in order to determine the seroprevalence of HBsAg and identify the risk factors for chronic HBsAg carriage. HBsAg was detected by the reverse passive hemagglutination technique (RPHA). Data were obtained by questionnaires and serological testing. There were 164 Lisaws and 376 Akhas: most were illiterate (88.71%) and the annual family income was < or = 9,999 baht (50.93%). The seroprevalence of HBsAg was 8.15%. Logistic regression analysis, controlling for possible confounding factors, revealed that one to five injections in the year prior to the study increased the risk of HBsAg carriage by a factor of 4.84 (95% CI = 1.42-16.49); more than six injections increased the risk by a factor of 5.84 (95% CI = 1.47-23.18).

Seroprevalence of hepatitis B, hepatitis C and human immunodeficiency virus among blood donors, Phitsanulok Regional Blood Center, Thailand.

Human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV) infections are important blood-borne infections in many countries including Thailand. For epidemiological surveillance and controlling these infections, a cross-sectional group of 2,167 blood donors were screened for HBsAg, antibodies to HCV and HIV by enzyme immunoassay methods. The results revealed that the prevalence of HBsAg positive among studied blood donors was 4.61%, anti-HCV was 2.90% and anti-HIV was 0.69%. When the prevalence was classified by selected socio-demographic variables, it was found that variables including age, gender, marital status and occupation were significant for HBsAg positive rate (p=0.0068, p=0.0019, p=0.0048 and p=0.0017, respectively). For anti-HCV prevalence, studied variables including educational level, occupation and domicile were significant (p<0.0001, p=0.0027, and p<0.0001, respectively), while only educational level was a significant variable for anti-HIV prevalence (p=0.0021). These findings suggest that we should present integrated information and educational programs for preventing and controlling HBV, HCV and HIV transmission among this target group.