Preventing nosocomial infections: improving compliance with standard precautions in an Indonesian teaching hospital.

Standard precautions can prevent transmission of micro-organisms. This study investigated hand hygiene, handling of needles and use of personal protective equipment in an Indonesian teaching hospital, and performed a multi-faceted intervention study to improve compliance. An intervention was performed in an internal medicine ward and a paediatric ward, consisting of development of a protocol for standard precautions, installation of washstands, educational activities and performance feedback. Before, during and after the intervention, observers monitored compliance with hand hygiene, safe handling of needles and use of gloves, gowns and masks. A gynaecology ward served as the control. Unobtrusive observations were performed to check for an influence of the observers on the overt observations. In total, 7,160 activities were observed. Compliance with hand hygiene increased from 46% to 77% in the internal medicine ward and from 22% to 62% in the paediatric ward. Before the intervention, no safe recapping of needles was recorded in either ward. After the intervention, 20% of needles were recapped safely. Inappropriate gown use decreased in the internal medicine ward. There were no significant changes in use of gloves and masks. There may have been an effect of the overt observations in the paediatric ward, but there was no effect in the internal medicine ward. There were no significant changes in the control ward, except for a decrease in the use of gloves. In conclusion, compliance with hand hygiene procedures improved significantly due to an intervention project focused on education and improved facilities. Compliance with safe handling of needles improved slightly due to introduction of the one-handed method for safe recapping of used needles.

Culture of Salmonella typhi and Salmonella paratyphi from blood and bone marrow in suspected typhoid fever.

We studied the yield of blood and bone marrow (BM) cultures in 145 patients clinically suspected of typhoid fever (TF) in Indonesia. The objectives were to compare the positivity of blood culture using 3 ml versus 10 ml of blood and to examine in how far specific antibiotic treatment for TF interfered with the positivity of BM culture. Blood for culture was collected before antibiotic treatment was initiated in hospital and BM 1 to 10 days after the start of treatment. Cultures were performed with Oxgall subcultured on SS agar. Seventy-nine per cent of patients was treated for 14 days or more with oral chloramphenicol, 18% with chloramphenicol followed by ampicillin or cotrimoxazol and 3% with other antibiotics. Cultures were positive for Salmonella typhi or S-paratyphi A in 57 of the 145 patients (39.3%) when 3 ml of blood was cultured and in 58 (40%) when 10 ml of blood was cultured. BM culture was positive despite antibiotic treatment in 70 patients (48.2%); this positivity was significantly greater than that of blood cultures (p < 0.05). When we considered the positivity of BM culture in relation to the number of days on antibiotics in hospital, the yield of BM culture remained apparently unchanged during the first 5 days of treatment. This may be the consequence of slow elimination of S.typhi or S.paratyphi by the antibiotics used and could be responsible for relapses.