Occupational hazards, health conditions and personal protective equipment used among healthcare workers in hospitals, Thailand.

This cross-sectional study aimed to evaluate occupational hazards, health conditions and personal protective equipment used among healthcare workers. Information from the sample size of 1,128 healthcare workers were collected using questionnaires. The healthcare workers participated in this study were from five departments including inpatient, outpatient, surgery and anesthesia, nutrition service and hospital support services departments in five hospitals in Thailand. The results indicated that the majority of healthcare workers were female; these healthcare workers work 9.0 to 11.1 hours/day on average and were exposed to several chemical, biological and physical hazards. The healthcare workers in the nutrition service department reported the highest percentage of musculoskeletal disorder and respiratory problems. The highest percentage of skin problems were reported by healthcare workers in surgery and anesthesia department. The results showed musculoskeletal disorder, respiratory and skin problem significantly differed among healthcare workers in the five departments including the wrists/hands (p = 0.024), upper back (p = 0.009), chest pain symptoms (p = 0.004), and dry/wound symptoms (p = 0.013). Healthcare workers did not have adequate protection from work-related hazards in their workplace. Health education programs, control measures and organizational policies should be implemented to mitigate the hazards for healthcare workers in hospitals.

HEALTH STATUS, ENVIRONMENTAL LIVING CONDITIONS AND MICROBIAL INDOOR AIR QUALITY AMONG MIGRANT WORKER HOUSEHOLDS IN THAILAND.

A large number of migrants have move to cities in Thailand seeking employment. These people may be at increased risk for environmental health problems. We studied the health status, environmental living conditions and microbial indoor air quality (IAQ) among selected groups of migrant workers and their households in Mueang District, Samut Sakhon, central Thailand. We conducted a cross sectional study of 240 migrant workers and their households randomly selected by multistage sampling. The person responsible for hygiene at each studied household was interviewed using a structured questionnaire. Two indoor air samples were taken from each household (480 indoor air samples) to determine bacterial and fungal counts using a Millipore air tester; 240 outdoor air samples were collected for comparison. Ninety-nine point six percent of study subjects were Myanmar, 74.2% were aged 21-40 years, 91.7% had a primary school level education or lower and 53.7% had stayed in Thailand less than 5 years. Eight point three percent had a history of an underlying disease, 20.8% had a recent history of pulmonary tuberculosis in a family member within the previous year. Forty-three point eight percent had a current illness related to IAQ during a previous month. Twenty-one point three were current cigarette smokers, 15.0% were current alcohol consumers, and 5.0% exercises ≥3 times per week. Forty-nine point two percent never opened the windows of their bedrooms or living rooms for ventilation, 45% never cleaned their window screens, and 38.3% never put their pillows or mattresses in the sunlight. The mean(±SD) air bacterial count was 230(±229) CFU/m3 (outdoor air = 128±82 CFU/ m3), and the mean fungal count was 630(±842) CFU/m3 (outdoor air = 138±94 CFU/ m3). When the bacterial and fungal counts were compared with the guidelines of the American Conference of Governmental Industrial Hygienists, the bacterial counts in 6.5% of houses surveyed and the fungal counts in 28.8% of house surveyed were higher than the recommended levels (<500 CFU/m3). Bacterial and fungal counts in the sample households were not significantly correlated with household hygiene practice scores (p>0.05). There was a positive correlation between bacterial counts and fungal counts in household air samples, r=0.28, p<0.001.

Occupational Hazards in the Thai Healthcare Sector.

Healthcare personnel work in vulnerable conditions that can adversely impact physical and/or mental health. This paper aims to synthesize the state of knowledge on work-related illnesses, injuries, and risks experienced by Thai healthcare workers. We found that Thai healthcare personnel, like others worldwide, are at risk for injury related to needle sticks and sharp instruments; infectious diseases due to biological hazards exposure such as airborne pathogens and patient secretions; muscle pain due to workload and long duration of work; and psychological disorders related to stressful working conditions. Because detailed surveillance data are limited for the Thai healthcare workforce, we recommend that additional surveillance data on Thai healthcare workers' health outcomes be collected. Future research efforts should also focus on evidence-based interventions in order to develop methods to prevent and treat occupational health injuries and illnesses acquired in the workplace for Thai healthcare sector workers.

Microbial air quality and bacterial surface contamination in ambulances during patient services.

OBJECTIVES: We sought to assess microbial air quality and bacterial surface contamination on medical instruments and the surrounding areas among 30 ambulance runs during service. METHODS: We performed a cross-sectional study of 106 air samples collected from 30 ambulances before patient services and 212 air samples collected during patient services to assess the bacterial and fungal counts at the two time points. Additionally, 226 surface swab samples were collected from medical instrument surfaces and the surrounding areas before and after ambulance runs. Groups or genus of isolated bacteria and fungi were preliminarily identified by Gram's stain and lactophenol cotton blue. Data were analyzed using descriptive statistics, t-test, and Pearson's correlation coefficient with a p-value of less than 0.050 considered significant. RESULTS: The mean and standard deviation of bacterial and fungal counts at the start of ambulance runs were 318±485cfu/m(3) and 522±581cfu/m(3), respectively. Bacterial counts during patient services were 468±607cfu/m(3) and fungal counts were 656±612cfu/m(3). Mean bacterial and fungal counts during patient services were significantly higher than those at the start of ambulance runs, p=0.005 and p=0.030, respectively. For surface contamination, the overall bacterial counts before and after patient services were 0.8±0.7cfu/cm(2) and 1.3±1.1cfu/cm(2), respectively (p<0.001). The predominant isolated bacteria and fungi were Staphylococcus spp. and Aspergillus spp., respectively. Additionally, there was a significantly positive correlation between bacterial (r=0.3, p<0.010) and fungal counts (r=0.2, p=0.020) in air samples and bacterial counts on medical instruments and allocated areas. CONCLUSIONS: This study revealed high microbial contamination (bacterial and fungal) in ambulance air during services and higher bacterial contamination on medical instrument surfaces and allocated areas after ambulance services compared to the start of ambulance runs. Additionally, bacterial and fungal counts in ambulance air showed a significantly positive correlation with the bacterial surface contamination on medical instruments and allocated areas. Further studies should be conducted to determine the optimal intervention to reduce microbial contamination in the ambulance environment.

Occupational risk towards blood-borne infections among ambulance personnel in a provincial hospital network in Thailand.

Health-care personnel working in an ambulance may be at risk for work-related infections, especially blood-borne infections. This cross-sectional study was conducted to assess occupational risks and their preventive practices for blood-borne infections among ambulance personnel working in a provincial hospital network. One hundred sixty-one personnel who voluntarily participated were interviewed using a structured questionnaire. The one-month history of risk exposures to blood-borne infections was collected. In order to cover the real situation of patient care practices among ambulance personnel during working, 30 ambulance runs were observed. Data from the questionnaire and field observation were analyzed and presented by descriptive statistics. The results indicated that 82% had a history of contact with jaundiced patients, and 95% had a history of contact with AIDS patients. Approximately, 63.4% had a history of contact with patients' blood through injuries; of these, 64.7% had needle stick injuries, and 24.5% had sharp injuries. Data for blood-borne preventive practices from interviews reported 82.6% wore disposaiole gloves when doing a blood puncture or giving intravenous fluid/blood. Only 54% broke off drug vials with a clean cloth or cotton wool to protect from an injury, in contradiction to recommended procedure. The mean score of preventive practices was 7.6±2.2; a score classified at a moderate level. However, data from field observations demonstrated only 30.3% of observed personnel (3/9) used aprons and goggles when contacting a large amount of blood, and only 11.1% (1/9) broke off drug vials with a clean cloths to protect from an injury. Continuous education and training, as well as the improvement of safety equipment are needed to better protect ambulance personnel from occupational risks.

Microbial Contamination on Used Surgical Masks among Hospital Personnel and Microbial Air Quality in their Working Wards: A Hospital in Bangkok.

OBJECTIVE: To assess the relationship of bacterial and fungal contamination on used surgical masks worn by the hospital personnel and microbial air quality in their working wards. METHODS: This is a cross-sectional study of 230 used surgical masks collected from 214 hospital personnel, and 215 indoor air samples collected from their working wards to culture for bacterial and fungal counts. This study was carried out at the hospital in Bangkok. Group or genus of isolated bacteria and fungi were preliminarily identified by Gram's stain and lacto-phenol cotton blue. Data were analyzed using paired t-test and Pearson's correlation coefficient at the significant level of p<0.050. RESULTS: Means and standard deviation of bacterial and fungal contamination on inside area of the used masks were 47 ± 56 and 15 ± 9 cfu/ml/piece, and on outside area were 166 ± 199 and 34 ± 18 cfu/ml/piece, respectively, p<0.001. The bacterial and fungal contamination on used masks from hospital personnel working in the male and female medical wards and out-patient department, as well as the bacterial and fungal counts of the indoor air sample collected from the same area were relatively higher than the other wards. The predominant isolated bacteria and fungi contaminated on inside and outside areas of the used masks and air samples were similar (Staphylococcus spp. and Aspergillus spp.; respectively). For its relationship, results found that bacterial and fungal counts in air samples showed significantly positive correlation with the bacterial contamination load on outside area of the used masks, r=0.16, p=0.018 and r=0.21, p=0.003, respectively. CONCLUSION: High bacterial contamination on outside area of the used masks was demonstrated, and it showed a significant correlation with microbial air quality of working wards.

Laboratory facility design and microbial indoor air quality in selected hospital laboratories.

Hospital laboratory is one of workplace areas contaminated with a variety of biohazards. A cross sectional study was conducted to assess the microbial air quality and facility design in the laboratories of four selected governmental hospitals (Hospitals A, B, C, and D) in Bangkok, Thailand. One hundred eighty-eight indoor air samples were collected from 40 laboratory rooms to investigate bacterial and fungal counts using the Millipore air tester. Forty air samples were collected from the waiting areas of those laboratories, and 16 outdoor air samples were collected to use for comparison. Additionally, those laboratory facilities were assessed following biosafety facility design (10 items). Results indicated that the facility design of laboratory in the Hospital A met most of items of the biosafety facility criteria. The rest met only seven items of the criteria. Means +/- standard deviation (SD) of bacterial counts of 253.1 +/- 247.7 cfu/m3, 236.8 +/- 200.1 cfu/m3, 304.4 +/- 264.2 cfu/m3, and 146.7 +/- 127.0 cfu/m3, and fungal counts of 500.8 +/- 64.2 cfu/ m3, 425.0 +/- 21.2 cfu/m3, 357.0 +/- 121.2 cfu/m3, and 355.7 +/- 86.8 cfu/m3 were found in hospital laboratories A, B, C and D, respectively. The isolated colonies of bacteria and fungi were identified as group or genus. It was found that the most common bacteria was Staphylococcus spp (84.1%, 76.0%, 72.1% and 80.5%, respectively), whereas, the most common fungi were Aspergillus spp and septate hyphae fungi (42.0%, 37.5%, 39.5%, and 45.7%; vs 38.6%, 56.2%, 52.1%, and 37.2%, respectively). These data may be valuable to develop interventions to improve the microbial indoor air quality among hospital laboratories and for preventing the laboratory-acquired infections.

Factors associated with hepatitis C infection among patients with skin diseases.

OBJECTIVE: The present study attempted to assess factors associated with positive anti-HCV among patients with skin diseases. MATERIAL AND METHOD: A retrospective analysis of 3,496 subjects' history profiles from the HCV antibody surveillance projects performed from 2000 to 2007. Only 150 subject profiles with skin diseases were included in the analysis of factors associated with positive anti-HCV Patient profiles including socio-demographic parameters, the main risk behavior or risk exposure, types of skin diseases, anti-HIV status, and results of anti-HCV were analyzed using Chi-square test or Fisher's exact test. RESULTS: Results revealed that only 10 from 150 studied patients (6.7%) were positive for anti-HCV antibody. Patient profiles including socio-demographic parameters, the main risk behavior or risk exposure, types of skin diseases, and anti-HIV status among patients with or without anti-HCV were compared and analyzed to assess factors associated with positive anti-HCV. It was found that patient's income, types of skin disease, and anti-HIV status were significantly associated with positive anti-HCV among this group, p = 0.0240, p = 0.0053 and p = 0.0462, respectively. CONCLUSION: This analysis found three studied factors including patient's income, types of skin disease, and anti-HIV status to be significantly associated with HCV infection in patients with skin diseases. However, a large-scale work should be done to confirm the present study.

Microbial counts and particulate matter levels in indoor air samples collected from a child home-care center in Bangkok, Thailand.

OBJECTIVE: To assess the microbial count (bacteria and fungi) and particulate matter with sizes less than 10 microm (PM10) level in indoor air of a child home-care center in Bangkok. MATERIAL AND METHOD: A total of 287 air samples were collected from the indoor air of twenty households which were part of a child home-care center to assess bacterial and fungal counts (212 samples) and PM10 levels (66 samples). Additionally, fifty-two and twenty-six outdoor air samples were collected to compare microbial count and PMo10 levels. RESULTS: It was found that means + standard deviation (SD) for bacterial and fungal counts in the child home-care center were 527.8 +/- 230.9 cfu/m3 and 514.6 +/- 256.7 cfu/m3, respectively (those in outdoor air samples were 264.6 +/- 179.7 cfu/m3 and 308.7 +/- 217.3 cfu/m3, respectively). The mean +/- SD of PM10, level was 125.1 + 48.0 pg/m3 (that in outdoor air samples was 120.1 +/- 66.9 microg/m3). When compared with the levelfor the indoor air quality guideline, 47.2% and 47.6% of total air samples had bacterial and fungal counts higher than the recommended levels and 47.0% of total air samples had PM10 levels higher than the recommended level. CONCLUSION: The present study found that about 47% of total air samples collected from the child home-care center had bacterial and fungal counts and PM10 levels higher than the recommended levels. These results may affect the health of a child who spends most of his/her time in this center Some intervention or preventive endeavors should be undertaken, including periodic cleaning and maintenance of the ventilation systems and adoption of a regular schedule for room cleaning should be implemented.

Hepatitis B seromarkers, hepatitis C antibody, and risk behaviors in married couples, a bordered province of western Thailand: Hepatitis B seromarkers, hepatitis C antibody, and risk behaviors.

BACKGROUND: Married couples constitute a target group for reducing the risk of infections with hepatitis B virus (HBV) and hepatitis C virus (HCV). OBJECTIVES: This study attempted to assess HBV seromarkers, anti-HCV-positive rates, and risk behaviors among married couples in a bordered province of western Thailand. MATERIALS AND METHODS: A cross-sectional study of 114 married couples aged 15-44 years was performed. Approximately 25-30 married couples were randomly selected from 4 districts in a province of western Thailand. All study participants who participated voluntarily were interviewed using structured questionnaires. Their blood specimens were collected to screen for HBV seromarkers (HBsAg, anti-HBs, and anti-HBc) and anti-HCV. RESULTS: Approximately 21.1% of husbands and 2.6% of wives had a history of extramarital sex without using a condom; 18.4% of husbands and 4.4% of wives had tattoos; and 18.4% and 3.5%, respectively, consumed alcohol regularly. Additionally, 4.4% of husbands and 2.6% of wives had a history of sexual contact before marriage. In the serological study, 10.5% of husbands and 5.3% of wives were HBsAg-positive, and 1.8% of husbands and 0.9% of wives were anti-HCV-positive. Among HBsAg-positive subjects, 15/18 had spouses who were positive for any HBV marker, and 1 had a spouse who was HBsAg- and anti-HBc positive. Three participants were positive for anti-HCV (2 males and 1 female). One anti-HCV-positive male had a history of regular alcohol consumption and extramarital sex without a condom, and another had a history of intravenous drug use. The anti-HCV-positive female had a history of sexual contact before marriage. CONCLUSIONS: This study found high percentages of risk behaviors and HBsAg positivity among married couples in a bordered province of western Thailand, especially in husbands. These findings support the evidence of HCV transmission via sexual contact and intravenous drug use.

Microbial counts and particulate matter levels in roadside air samples under skytrain stations, Bangkok, Thailand.

In conditions with heavy traffic and crowds of people on roadside areas under skytrain stations in Bangkok, the natural air ventilation may be insufficient and air quality may be poor. A study of 350 air samples collected from the roadside, under skytrain stations in Bangkok, was carried out to assess microbial counts (210 air samples) and particulate matter (PM10) levels (140 samples). The results reveal the mean +/- standard deviation bacterial counts and fungal counts were 406.8 +/- 302.7 cfu/m3 and 128.9 +/- 89.7 cfu/m3, respectively. The PM10 level was 186.1 +/- 188.1 microg/m3. When compared to recommended levels, 4.8% of air samples (10/210 samples) had bacterial counts more than recommended levels (> 1,000 cfu/ m3) and 27.1% (38/140 samples) had PM10 levels more than recommended levels (> 120 microg/m3). These may affect human health, especially of street venders who spend most of their working time in these areas.

Microbial air quality and standard precaution practice in a hospital dental clinic.

OBJECTIVE: A cross-sectional study was carried out to assess standard precaution practices among dental personnel and to investigate microbial counts in indoor air samples collected from a hospital dental clinic before and during dental works. MATERIAL AND METHOD: Thirty dental personnel who voluntarily participated were interviewed using a questionnaire towards demographic information and standard precaution practices between May and August 2007. Additionally, 138 indoor air samples (72 from dental treatment units, 48 from dental supporting units and offices and 18 from patient waiting area) were collected before and during dental works for 6 days (Monday to Saturday) to investigate bacterial and fungal counts. Data were analyzed by using descriptive statistics. Paired t-test was used for analyzing the difference of mean + standard deviation between microbial counts before and during dental procedures. The statistical significance was expressed in term of p-value and the critical level was set at alpha = 0.05. RESULTS: The results revealed that standard precaution practices towards wearing personal protective equipments regularly during dental procedures ranged from 50% to 100%, whereas, cleaning and disinfecting dental unit after each patient treatment and cleaning dental unit water lines with antiseptics every week were done regularly only 36.7%. The mean score of standard precaution was 8.4 +/- 2.5 (moderate level, total score of 13). The means of bacterial and fungal counts in air samples collected from dental treatment units significantly increased during dental procedures when compared with those collected before dental works (p < 0.001), whereas, those were not significantly different in the dental supporting units and offices, p > 0.05. CONCLUSION: This study demonstrated the moderate level of standard precaution practice score among studied dental personnel and significantly higher microbial counts (bacterial and fungal counts) in air samples collected from dental treatment units during dental procedures were demonstrated. To reduce the occupational risk among this group, standard precaution practices should be strengthened.

Health responsibilities of an aging Thai male workforce.

OBJECTIVE: To examine the health responsibilities of an aging Thai male workforce and its related factors. MATERIAL AND METHOD: A descriptive study was conducted with 417 male workers aged 45-60 who were working in 4 regions of Thailand. Data were collected between October 2004 and February 2005 using self-administered questionnaires. Health responsibility was measured at the frequency of the participants personal health practices relating to the health seeking, participation in health promoting activities, and having health check-ups. Statistical analyses used were percentage, mean, and multiple regression analysis. RESULTS: Results showed that subjects had health responsibility at moderate level (Mean = 17.2 +/- 4.7). Lowest mean of health responsibility was found in participation in health promotion activities/club area (Mean = 1.9 +/- 1.0). Social support, perceived health status, and monthly income (p < 0.05) altogether could explain 17.7% of variance in health responsibility. CONCLUSION: Health responsibility of an aging workforce should be enhanced through support from family, friends, and co-workers.

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.

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.

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.

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.

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.