Prevalence and effectiveness of an education program on intestinal pathogens in food handlers.

OBJECTIVES: To assess the prevalence of intestinal pathogens and the effectiveness of an education program in food handlers in a tertiary care hospital. MATERIAL AND METHOD: The prevalence of intestinal pathogens in food handlers was done by stool cultures for bacteria and microscopy for parasites. Treatment was given to those who had a positive stool examination. An education program on the acquisition of the pathogens and their prevention were given by lecture and distribution of handouts. Efficacy of the education program was evaluated by assessing the knowledge and the presence of pathogens before and after the education program. RESULTS: The study was done from January 2002 to March 2004. Risk factors for acquiring intestinal pathogens among food handlers were high regarding education level, housing, food hygiene and personal hygiene. Diarrheal diseases were common in food handlers and their relatives. Before the education program, 40.8% had intestinal pathogens, bacteria and parasites in almost similar proportions. Most common bacteria were Vibrio parahemolyticus, Plesiomonas shigelloides and Salmonella spp.; Blastocystis hominis, Giardia lambria and Endolimax nana were the frequently found intestinal parasites. Food handlers with the pathogens in stool were treated. After the education program subsequent investigation showed a significant reduction in stool pathogens and parasites but their knowledge and hand hygiene practice did not improve. CONCLUSION: The present study showed a high prevalence rate of intestinal pathogens in food handlers of a tertiary care hospital. The education program failed to improve their knowledge and hand hygiene practice for the prevention of the pathogens.

Bacterial contamination of vegetables served in hospitals.

OBJECTIVES: To study bacterial contamination of fresh vegetables before cleaning and before serving to patients in 14 hospitals. MATERIAL AND METHOD: Aerobic plate count was performed and emphasized on total viable aerobic bacteria, fecal coliform, fecal Escherichia coli and enteric pathogens in fresh vegetables including romaine lettuce, onion, parsley, celery and tomato before cleaning and before serving. Hospital nutrition officers who were involved in food purchasing and processing were interviewed. RESULTS: One hundred and six of 403 of fresh vegetable samples (26.3%) before cleaning were contaminated with > 10(7) colony forming unit per gram (CFU/gram) of viable aerobic bacteria, 106 of 178 samples (59.6%) contained MPN/fecal coliform >1,100 /gram, 78 samples (43.8%) contained MPN fecal E. coli >10/gram. Enteric bacteria were isolated from 7.2% of the total 304 samples including non typhoid Salmonella (1 sample), Vibrio cholerae non O1/O139 (7 samples) and Aeromonas species (14 samples). Forty of 396 ready to serve vegetable samples (10.1%) contained > 10(7) CFU/gram of viable aerobic bacteria. Seventy five of 183 (40.9%) samples contained >1,100 MPN fecal coliform/gram and 43 (23.5%) contained >10 MPN fecal E. coli/gram. Enteric bacteria were also detected in 7.6% of the samples including V. cholerae non O1/O139 (6 samples) and Aeromonas species (17 samples). There were three different ways in obtaining fresh vegetables to the hospitals: by auction (50%), wholesalers (21.4%) and retailers (14.2%). There were also different standards of transportation, packaging, delivery and food processing, particularly cleaning methods. CONCLUSION: Ready-to-eat fresh vegetables were contaminated in high percentages with microorganisms in the number that exceeded the standard. Better management is required to safeguard patients.

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.

Effectiveness and microbial contamination of an in-house alcohol-based hand rub.

OBJECTIVES: To evaluate the effectiveness and contamination of an in-house alcohol-based hand rub in a real clinical setting and to compare its effectiveness in bacterial reduction with that of a commercial product. MATERIAL AND METHOD: Effectiveness of the hand rub in bacterial reduction was compared to a commercial product using the modified antiseptic/disinfectant testing method of European Standard (EN 1500) in 12 volunteers. In-house alcohol-based hand rub in 50 clinical wards were serially collected and cultured to determine contamination. RESULTS: The bacterial reduction factor of the hand rub was comparable to that of the commercial product. There was no organisms grown from serial cultures of the in-house alcohol-based hand rub in use for 28 days. CONCLUSION: The in-house alcohol-based hand rub was effective and there was no contamination up to 28 days in use.

Strategies to improve hand hygiene practices in two university hospitals.

OBJECTIVE: To evaluate the strategies to improve hand hygiene practices among participants in two university hospitals. MATERIAL AND METHOD: A quasi-experimental study was performed from January 1, 2001 to December 31, 2004 at Siriraj Hospital and from January 1, 2004 to July 31, 2004 at the neonatal intensive care unit (NICU), Maharaj Nakorn Chiang Mai Hospital. The study was divided into three phases; 1) pre-intervention phase to identify factors associated with non-adherence in hand hygiene practices among participants, 2) intervention phase, 3) post-intervention phase to include observations to evaluate the effectiveness of interventions on hand hygiene practices among participants. Interventions at Siriraj Hospital included distribution of posters, leaflets, rewarding healthcare workers (HCWs) who suggest the most attractive name for alcohol gel and a handwashing slogan, and a parade to boost hand hygiene practice. Interventions at Maharaj Nakorn Chiang Mai Hospital included training, a reminder poster display, provision of alcohol-based handrubs and performance feedback. RESULTS: Six hundred and forty-six HCWs were observed before and after the non-invasive procedures and 404 HCWs were observed before and after an invasive procedure at Siriraj Hospital. At Maharaj Nakorn Chiang Mai Hospital, participants included 26 nursing personnel in the NICU. After intervention, significant improvement on handwashing was observed in both the invasive procedure (p<0.001) and non-invasive procedures (p<0.001) at Siriraj Hosptial. Significant improvement on handhygiene practice was also observed among participants at Maharaj Nakorn Chiang Mai Hosptial (p=0.001). CONCLUSION: Different strategies worked well in different institutions. The present study suggested the role of multi-faceted approaches to help improve handhygiene practices among HCWs.