Nosocomial infections and the challenges of control in developing countries

Nosocomial infection is a recognized public health problem world-wide with a prevalence rate of 3.0-20.7and an incidence rate of 5-10. It has become increasingly obvious that infections acquired in the hospital lead to increased morbidity and mortality which has added noticeably to economic burden. However; after about three decades of nosocomial infection surveillance and control world-wide; it still remains an important problem for hospitals today. Studies have shown that most hospitals in developing countries especially Africa; have no effective infection control programme due to lack of awareness of the problem; lack of personnel; poor water supply; erratic electricity supply; ineffective antibiotic policies with emergence of multiply antibiotic resistant microbes; poor laboratory backup; poor funding and non-adherence to safe practices by health workers. It is recommended that the cost of hospital infection control programme should be included in the health budget of the country and fund allocated for the infection control committee for routine control purposes and to bear the cost of outbreaks. There is need for adequate staffing and continuous education of staff on the principles of infection control; especially hand washing which is the single most important effective measure to reduce the risks of cross infection

Methicillin Resistance in Staphylococcus aureus: a Review of the Molecular Epidemiology; Clinical Significance and Laboratory Detection Methods

BACKGROUND: Despite the volume of knowledge; enhanced surveillance and infection control measures adopted by health care institutions to address the endemicity and frequent disease outbreaks by methicillin-resistant Staphylococcus aureus (MRSA) in hospitals and health care facilities worldwide; infections due to this organism are still responsible for about 50of hospital acquired S. aureus infections; with increasing morbidity and mortality. OBJECTIVE: To provide regional clinicians with current information on the molecular epidemiology; laboratory detection and clinical aspects of MRSA. METHODS: A review of published literatures on MRSA in Medical Libraries and bibliographic citations on PubMed; Medline and Africa Index Medicus on molecular epidemiology and clinical diseases caused by MRSA and the assessment of the recent laboratory diagnostic approaches. RESULTS: This review showed that there has been intercontinental spread of some highly pathogenic clones of MRSA threatening to create public health hazard of unprecedented proportion; with the greatest challenge to mankind; being the development of resistance to multiple antibiotics; which in recent times had included resistance to vancomycin and other glycopeptides; the only antibiotic group effective against it. Added to this burden is the emergence of more virulent strains of community-associated MRSA (CAMRSA) which at the turn of the century; has been increasingly reported to cause infections and outbreaks in populations without predisposing risk factors; with attendant high morbidity and mortality. CONCLUSION: There is need for active MRSA surveillance by healthcare institutions in Africa to identify potential outbreaks; and vigilance in the enforcement of infection control measures such as rational prescription of antibiotics; handwashing; disinfection and sterilization that can limit the emergence and spread of more resistant clones of MRSA