Quality of nosocomial infection control in Thailand.

OBJECTIVE: To study the quality of nosocomial infection control with respect to structure and process. MATERIAL AND METHOD: Data collection by questionnaire and interview administrators and medical personnel in 57 hospitals in Thailand in 2002. RESULTS: Nosocomial infection control was implemented in all 57 hospitals. In every hospital, there was an infection control committee (ICC) and at least 1 infection control nurse (ICN). The quality of ICNs regarding knowledge, skill and time available for infection control needed to be improved. Surveillance methods of NI were not appropriate in many hospitals. Doctors were not interested in NI control and supply of certain materials was not adequate. Lack of support and co-operation of doctors and nurses was found. Service of certain departments needed to be revised in over 50%. Doctors and nurses not directly involved in NI controlled were not satisfied with current practices. CONCLUSION: Quality of NI control in Thailand has yet to be improved regarding structure and process. Better cooperation between NI control team and healthcare personnel needs to be developed.

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.

Evaluation of a training course in infection control for nurses.

OBJECTIVE: To evaluate the effectiveness of a training course in infection control for nurses. MATERIAL AND METHODS: A quasi-experimental study was performed from November 1, 2001 to December 31, 2002. The study was divided into three phases; 1) pre-intervention (November 1-30, 2001) to survey baseline data among participants, 2) intervention (January 1-31, 2002) to establish, develop and conduct the training course, 3) post-intervention (February 1, 2002 to December 31, 2002) to evaluate the effectiveness of the training program, and conduct a workshop for infection control project presentations. The research instruments consisted of questionaires and a focus group discussion guide. RESULTS: Forty-six nurses who had experience of working as infection control nurses (ICN) for more than one year and 46 hospital administrators were enrolled in the pre-interventional phase. Major problems identified among ICNs were inadequate knowledge, multiple simultaneous job descriptions, overwork and lack of collaboration from colleagues. After intervention, significant improvement was observed on their knowledge and confidence among ICNs (rating scale, 4.09 vs. 3.43; p< 0.001). All administrators agreed that the training course was beneficial to ICNs and believed that the problems in practices of IC would be solved. More satisfaction of ICNs among hospital administrators was also observed (97.7% vs. 28.3%; p< 0.001). CONCLUSION: The present study suggested that the training course to provide practical knowledge for ICNs be effective and should be conducted periodically to keep up with the advance in medical technology. An ICN network with other academic institutions should be established.

Program on nosocomial infection in the curricula of medicine, dentistry, nursing and medical technology in Thailand.

OBJECTIVES: To identify defects in the program on NI in curricula of medical, dental, medical technology and nursing schools. Impacts of the results of the study on the changes of the program were also evaluated MATERIAL AND METHOD: Questionnaires study of all 12, 8, 9 medical, dental, medical technology and 20 of 62 nursing schools. Data were collected and analyzed. Defects in the program of NI were identified and recommendation for improving was drafted in a workshop participated by curriculum directors and researchers. Results of the study were fedback to the schools enrolled. Changes of the program were later followed.. RESULTS: Program on NI was present in the curricula of 11 of 12 medical, some dental and medical technology but in none of the nursing schools. Education program varied in methods of teaching, hours and years of students. A few schools modified the program in their curricula by the results of the study and recommendation of a workshop participated in by researchers and program directors. CONCLUSION: Program on NI in the curricula of medical, dental, medical technology and nursing schools in Thailand varied in education methods, teaching hours and in student years. The present study results had little impact on changing the program. An evidence-based program on NI in medical, dentistry, medical technology and nursing is urgently needed.