An outbreak of post-operative endophthalmitis in Lampang Hospital.

An outbreak of post-operative endophthalmitis involving 48 patients from October 1991 to October 1992 in Lampang Hospital was reported. There were 3 waves of clustered cases, i.e. from October 1991 to January 1992, April-June 1992, and August-October 1992. Investigation revealed several risk factors: defects in sterilization of surgical instruments, poor operating room hygiene, contaminated tap water and the use of multiple-dose fluids and medication. Bacteria isolated from vitreous fluid showed different bacteria, indicating multiple sources of infection or failure of asepsis. Each episode of infection was brought under control by removing the risk factors and emphasis on aseptic techniques. The value of an effective survey programme for the detection of post-operative endophthatmitis was emphasized.

Contamination of blood cultures by switch-needle and nonswitch-needle techniques in a paediatric ward.

To compare the contamination rates of blood culture between the conventional switching to a sterile needle before inoculation of blood culture bottles and the nonswitch-needle technique, we conducted a prospective crossover study in a pediatric infectious disease ward at Lampang Hospital, Thailand from November 1991 to December 1992. The total number of blood cultures was 764 in which 358 were in the switch-needle group and 406 in the nonswitch-needle group. The rates of contamination were almost identical among the two groups (6.15% v.s. 6.16%). It is concluded that careful skin preparation and good handwashing practices of the phlebotomists and assistant are more important factors than switching needles in reducing contamination during collection of blood for culture. Switching needle technique should be discontinued to reduce the risk of needlestick injury and the cost of blood culture.

Nosocomial infections in Lampang Hospital.

A continuous surveillance on N.I. was done in Lampang Hospital from October 1988 to March 1990. The incidence rate of N.I. in 58,355 patients was 3.5 per cent. The average duration of hospital stay was 20.5 days. The highest infection rate was found in intensive care units followed by the surgical and orthopaedic departments (16.8, 5.9, 5.0 per cent) respectively. Urinary tract was the commonest site (19.4 per cent), followed closely by surgical wound, skin and lower respiratory infections. The infection rate was highest in patients aged 25-44 years and the common causative bacteria were Pseudomonas species, Escherichia coli and Klebsiella species. During the study there were two outbreaks of N.I., namely eye infection and diarrhoea. Both were brought under control by simple measures. Excessive use of antimicrobials was also revealed in the study.