Submitted in partial compliance with the requirements for a Master Degree in Technology: Chiropractic at the Durban University of Technology, 2009. / Background: Research has indicated the majority of bacteria on chiropractic adjustment beds (beds), can persist on dry inanimate surfaces for months. Thus, insufficient disinfection procedures create continuous sources of pathogens endangering patients and healthcare workers alike. This research study aimed to assess the beds as reservoirs for micro-organisms, at a chiropractic teaching clinic (clinic) in South Africa. Method: A selection of samples obtained from the headrests and armrests of the beds were serially diluted, plated in duplicate (using the spread plate technique) and incubated for 24-48 hours at 37°C. After inspection for the presence of micro-organisms, those present were enumerated to determine their quantities, the microbial build-up throughout the day, as well as the degree of the transmission from the patients to the beds during treatment. The incidence of the micro-organisms was established, along with their identities, using microscopic and macroscopic characteristics. These micro-organisms were also used to assess the efficacy of the disinfectant currently in use by the clinic. Results: Microbial growth was present on 89.4% of the beds sampled. The quantities of the micro-organisms increased significantly (p=0,027) from 7:30 am to 16:30 pm, with the median increasing from 25 colony forming units (cfu) / cm2 to 714 792 cfu/ cm2. The microbial build-up was highly significant (p<0.001), with a median of 346 cfu/ cm2 at 7:30 am and 10:30 am; increasing to 162 291 cfu/ cm2 by 13:30 pm and 250 million cfu/ cm2 by 16:30 pm. There was also a significant increase (p<0.001) in the quantity of micro-organisms during treatment with a median of 0 cfu/ cm2 before treatment that rose to 23 479 cfu/cm2 after treatment, indicating that the micro-organisms present on the beds were being deposited by the patient`s skin during the treatment. The most prevalent micro-organisms identified were Staphylococci and Serratia, with an average of 59% and 40% of colonies; while Micrococci and Bacilli were relatively uncommon. No growth was evident after 5 minutes of exposure to the disinfectant during the growth inhibition test. For the Kirby Bauer test, the average size of the zone of inhibition increased as the dilution decreased. The disinfectant is effective but more so against the Gram-positive than the Gram-negative bacteria. The disinfectant was 5,0, 5,5 and 5,6 times more effective than phenol in eradicating Staphylococci, Serratia and Bacilli, respectively. Conclusions and Recommendations: This study showed that micro-organisms were present on the beds. Staphylococci and Serratia have been implicated in many healthcare associated infections. The present disinfectant is effective, but should be used in between every patient. A different or additional disinfectant that is more effective against the Gram-negative bacteria should be considered for future use.

Submitted in partial compliance with the requirements for a Master Degree in Technology: Chiropractic at the Durban University of Technology, 2009. / Background: Research has indicated the majority of bacteria on chiropractic adjustment beds (beds), can persist on dry inanimate surfaces for months. Thus, insufficient disinfection procedures create continuous sources of pathogens endangering patients and healthcare workers alike. This research study aimed to assess the beds as reservoirs for micro-organisms, at a chiropractic teaching clinic (clinic) in South Africa. Method: A selection of samples obtained from the headrests and armrests of the beds were serially diluted, plated in duplicate (using the spread plate technique) and incubated for 24-48 hours at 37°C. After inspection for the presence of micro-organisms, those present were enumerated to determine their quantities, the microbial build-up throughout the day, as well as the degree of the transmission from the patients to the beds during treatment. The incidence of the micro-organisms was established, along with their identities, using microscopic and macroscopic characteristics. These micro-organisms were also used to assess the efficacy of the disinfectant currently in use by the clinic. Results: Microbial growth was present on 89.4% of the beds sampled. The quantities of the micro-organisms increased significantly (p=0,027) from 7:30 am to 16:30 pm, with the median increasing from 25 colony forming units (cfu) / cm2 to 714 792 cfu/ cm2. The microbial build-up was highly significant (p<0.001), with a median of 346 cfu/ cm2 at 7:30 am and 10:30 am; increasing to 162 291 cfu/ cm2 by 13:30 pm and 250 million cfu/ cm2 by 16:30 pm. There was also a significant increase (p<0.001) in the quantity of micro-organisms during treatment with a median of 0 cfu/ cm2 before treatment that rose to 23 479 cfu/cm2 after treatment, indicating that the micro-organisms present on the beds were being deposited by the patient`s skin during the treatment. The most prevalent micro-organisms identified were Staphylococci and Serratia, with an average of 59% and 40% of colonies; while Micrococci and Bacilli were relatively uncommon. No growth was evident after 5 minutes of exposure to the disinfectant during the growth inhibition test. For the Kirby Bauer test, the average size of the zone of inhibition increased as the dilution decreased. The disinfectant is effective but more so against the Gram-positive than the Gram-negative bacteria. The disinfectant was 5,0, 5,5 and 5,6 times more effective than phenol in eradicating Staphylococci, Serratia and Bacilli, respectively. Conclusions and Recommendations: This study showed that micro-organisms were present on the beds. Staphylococci and Serratia have been implicated in many healthcare associated infections. The present disinfectant is effective, but should be used in between every patient. A different or additional disinfectant that is more effective against the Gram-negative bacteria should be considered for future use.

Submitted in fulfillment of the requirements for the degree of Master of Technology: Emergency Medical Care, Durban University of Technology, Durban, South Africa, 2013. / Background In the Emergency Medical Services (EMS), paramedics play a vital role in the treatment of critically ill or injured patients, as they are often the first link or point of contact for the patient in the healthcare setting. They may therefore also play a vital role in the prevention and control of the transmission of communicable diseases, provided that proper infection control measures are in place. The objectives of the study There is presently no national policy on communicable diseases and infection control that is specifically designed for use in the South African prehospital environment. Given the paucity of research in the area, qualitative multiple case studies were conducted to develop an ambulance specific disinfection protocol and to evaluate its effectiveness in the public sector EMS in the eThekwini District of KwaZulu-Natal. Methodology The study comprised of three phases. In the first phase focus group discussions were conducted to identify the factors needed to develop a disinfection protocol. The study population consisted of both operational and management staff from the EMS under study. The first four focus groups consisted of eight to ten EMS operational staff each and the fifth focus group consisted of five EMS management staff. Thereafter, the information gathered was used in conjunction with internationally accepted guidelines to develop an ambulance specific disinfection protocol (Phase Two). The third phase entailed the implementation of the protocol at seven ambulance bases in the eThekwini health district and the evaluation of the protocol with the use of an open-ended questionnaire at two weeks and four weeks after implementation. A single ambulance crew and their immediate supervisor from each base were utilized in this phase. Conclusion and recommendations An ambulance specific disinfection protocol was developed and implemented in the EMS under study. During the development, implementation and evaluation of the protocol, many themes with regard to infection control in EMS were identified. These themes were used to better understand the present situation in EMS in relation to infection control and in the formulation of recommendations to assist in the improvement of the present situation. The researcher recommended that all EMS staff require training and education with regard to infection control and prevention. The development and implementation of a protocol and policy document for infection control specifically for EMS is required. There is a need for the deployment of more ambulances and the employment of more operational EMS staff together with the appointment of Infection Control Supervisors at all ambulance bases. Without adequate infrastructure needed to meet infection control and prevention requirements, there may be a serious risk to both staff and the patients they serve. / M