This thesis investigates the distribution of legionellae in water systems in the Royal Liverpool University Hospital (RLUH) and examines some of the factors that affect colonisation by these organisms. The effect of persistent contamination of the domestic water system on immunocompromised patients was monitored, and the envirorunental control of legionellae by various methods was assessed. A fluorescent monoclonal antibody (DFA) was evaluated for its ability to detect L. pneumophila in domestic and cooling water, and was highly sensitive and specific for this purpose. DFA detected non-culturable L. pneumophila in the cold water system (CWS) that were not recovered following heat shock procedures. Legionellae were not isolated from air conditioning humidifiers, and were rarely detected in cooling towers despite treatment with inadequate concentrations of biocide. A high pH assisted in preventing legionella colonisation. Calorifier sediment contained legionellae and high levels of insoluble copper oxides. Culture media and a low pH, released Cuions from sediment which were markedly inhibitory to legionellae. Low concentrations of Cuions were detected in domestic hot water. At temperatures below 60°C legionellae were detected in the hot water supply to the wards, and calorifiers were regularly re-seeded by legionellae returning from contaminated peripheral parts of the system. Legionellae were not detected in the HWS when 60°C was achieved. L. pneumophila sgps 6, 12 and L. bozemanii predominated in domestic water. L. pneumophila sgp 1 was detected on one occasion only in a cold water storage tank and a calorifier, and did not colonise any of the water systems. L. pneumophila sgps 6 and 12 were isolated from three nosocomial cases of Legionnaires' disease. Endemic legionellae prepared as yolk sac antigens, detected significant titres of legionella antibodies (~ 1 :64) in samples from six subjects which did not react ( < 1: 16) with the PHLS L. pneumophUa sgp 1 yolk sac antigen. Most raised titres were to L. pneumophila sgp 12, and the highest titre in heterologous responses identified the infecting serogroup of L. pneumophila. Routine culture of respiratory samples from susceptible patients. detected only one undiagnosed case of Legionnaires' disease. Legionellae were not detected in water from showers that were regularly flushed or irradiated with UV light. Re-colonisation of showers by legionellae was closely associated with the reappearance of amoebae. A trace heating element was effective at maintaining dead-legs at 50°C (± 1.5) and reduced legionellae in these sites. Legionellae proliferated where pipes and heating element were not adequately insulated. Re-circulating the HWS through dead-legs eradicated legionellae from this site but resulted in heavy colonisation of adjacent mixer valves. Automatic drain valves failed to prevent legionellae from colonising shower hoses and mixer valves, and hyperchlorination of shower hoses and water strainers had only a short term effect. Showers heated electrically at point of use were not colonised by legionellae entering in the CWS, or by wild strains of legionellae introduced with calorifier sediment. This appeared to be due to rapid throughput of water, extensive use of copper, and pasteurisation of calorifier contents following discharge of heat from the heating elements, after the shower ceased operating.

A research report submitted to the Faculty of Health Science, University of the Witwatersrand as partial fulfilment of the requirement of the degree in Masters of Public Health (Hospital Management) November 2014. Johannesburg, South Africa / Introduction - The implementation of infection prevention and control guidelines is important for the improvement of quality care in hospitals. This study aimed to identify gaps in the knowledge and attitudes of general assistants about infection control and to determine if their infection control practices are in line with current policies and guidelines. In investigating the practices of general assistants, the institution was assisted to identify gaps in knowledge and try to strengthen practices. Methodology: This descriptive cross-sectional study was conducted at Letaba hospital in Mopani district. The knowledge, attitudes and practices of 97 general assistants towards infection control at a given point in time was measured through a structured questionnaire which was administered to those who consented to participate. Purposive sampling was used as only those who were at work during the data collection period were included in the study. Results - This study revealed that over 50% of general assistants at Letaba hospital have only moderate knowledge about infection control. Fifty seven percent of general assistants reported moderately good infection control practices, while 23% practice infection control poorly. The majority (75%) of general assistants at Letaba hospital reported positive attitudes towards infection control. The results also show that the moderate score in knowledge affected the practice of infection control. Conclusion - This study shows that the knowledge and practice of infection at Letaba hospital is not optimal with regard to complying with infection control guidelines. It was, however, noted that attitudes towards infection control were good. Based on the fact that the attitudes were good, knowledge and practice can be improved with provision of appropriate supplies and strengthening training and supervision.

Colletotrichum gloeosporioides is the causal agent of anthracnose disease of mangoes. Infection occurs when humidity is high and rain-dispersed spores germinate and form an appressorium on immature mangoes. The infection then becomes quiescent until the fruit is harvested. On ripe fruit infection is visible as black, sunken lesions on the surface. At the pre-harvest stage, the disease is controlled with the application of a range of fungicides, and at the post-harvest stage by hot benomyl treatment. The extensive use of benomyl, both pre- and post-harvest, has resulted in the occurrence of isolates of C. gloeosporioides resistant to this fungicide. To devise an alternative strategy of disease control, the potential for biological control of anthracnose has been investigated. Potential microbial antagonists of C. gloeosporioides were isolated from blossom, leaves and fruit of mango, and screened using a series of assay techniques. In total 650 microorganisms, including bacteria, yeasts and filamentous fungi, were isolated and tested for their inhibition of growth of C. gloeosporioides on malt extract agar. Of these 650 isolates, 121 inhibited the fungus and were further tested on their ability to inhibit spore germination in vitro. Of these, 45 isolates, all bacteria and yeasts, were inoculated onto mangoes, which were artificially inoculated with C. gloeosporioides, and assessed for their potential to reduce the development of anthracnose lesions. A further selection was made, and 7 isolates were chosen to be used in a semi-commercial trial in the Philippines. This final screening procedure yielded two potential candidates for field trials, isolate 204 (identified as Bacillus cereus) and isolate 558 (identified as Pseudomonas fiuorescens). A field trial involving pre-harvest application of the biological control agent, was conducted using isolate 558. This isolate was chosen for this purpose since in in vitro experiments it significantly reduced germination of C. gloeosporioides spores. In the field trial 558 was applied in combination with nutrients and compared to treatments which had received no treatment or which had received conventional fungicide (benomyl) application. On spraying, high numbers of 558 were recorded on the leaf surface, but no reduction in post-harvest development of disease was observed. Failure of disease control was attributed to rapid death of the bacterium on the phylloplane. Inpost-harvest trials, isolates 204 and 558 were both tested in combination with different application methods, including the addition of sticker, peptone, fruit wax or a sucrose polyester. Application of 204 did not reduce disease development. Application of 558, however, did significantly reduce anthracnose development compared to the control fruit. No additional benefit was achieved by incorporating the bacteria in peptone, fruit wax or sucrose polyester. The mode of action of isolate 558 was investigated in detail. There was no evidence for parasitism taking place, or the production of volatile compounds, in the suppression of disease development. No antibiotic compounds were detected, but isolate 558 did produce a siderophore. A sharp increase in pH was also observed in culture media in which 558 was grown. Disease control may result from a combination of these two factors.

Aim: to investigate regularities of the spread of oral microflora during manipulations performed by the dental orthopedist and evaluate the individual protection equipment and measures to prevent the spread of infections used by dentists and to improve them. Objectives 1. To investigate the formation of a spray and its spreading during preparation of the solid dental tissues. 2. To investigate the distribution of the mixture formed of the fluid of the oral cavity and cooling fluid in the work zone of the dentist’s in the course of preparation of solid dental tissues; to evaluate and optimize the effectiveness of suction systems. 3. To investigate the contamination of the plaster teeth models with oral microflora through alginate and silicon impressions and suggest the most optimal method of their disinfection. 4. To evaluate the efficacy of exposure to 0.12% chlorhexidine gluconate aqueous solution as a prophylactic agent used before starting dental procedures. 5. To determine changes in microbial contamination of the dentist’s protective face shield after preparation of the solid dental tissues. 6. To determine the level of usage of the individual protection equipment and measures to prevent the spread of infections among Lithuanian dentist. Novelty and practical significance of the research work. The following results characterize the novelty and practical significance of this research ; - an original methodology has been... [to full text]

Background and Aim: The applicability of internationally-accepted infection control guidelines in rural Indonesia is questionable due to differences in resources availability and local contexts. Infection control barriers specific to rural Indonesia therefore need to be identified to assist in developing targeted infection control programs that are resource- and context-appropriate at the institutional, regional and national levels. Methods: This mixed methods study of ten healthcare facilities (hospitals and clinics, public and private) in a rural Indonesian district, all with severely limited resources, explored clinical practices in four areas: intravenous therapy, antibiotic usage, instrument reprocessing and hand hygiene. The quantitative methods used included univariate, multivariate and survival analyses of primary and secondary clinical data. The qualitative methods included a grounded theory analysis of observations, short and in-depth interviews and focus group discussion data. These two components of the study were synthesised to ascertain the magnitude and underlying factors of healthcare-associated infection risks and barriers to infection control programs. Findings: Inappropriate clinical practices caused excessive and unrecognised risks of primary bloodstream infection, surgical site infection, blood borne virus infection, and the development and spread of multi-resistant bacteria. The four diverse clinical practice areas exhibited common and interwoven underlying factors, which were: healthcare workers?? inadequate clinical knowledge, a lack of managerial support, and cultural beliefs shared by the healthcare workers and community members that prevailed over evidence-based knowledge. Non-clinical factors from inside and outside the healthcare facilities were inter-related and cannot be separated from the ensuing clinical practice inadequacies. An analytical framework that categorises infection control barriers into clinical and non-clinical domains as well as internal and external factors is therefore proposed to ensure a comprehensive infection control program design. Conclusion: The current clinically-focused infection control programs are likely to have limited and temporary results in rural Indonesia due to barriers being in the main non-clinical in origin. An effective and sustainable infection control program needs to concurrently address basic clinical practice improvements and the underlying managerial, attitudinal and cultural barriers. This public health aspect of infection control is often neglected yet crucial for the success of any infection control program in rural Indonesia.

This project describes the development of a curriculum for an infection control liaison program to be implemented in a large, regional health care institution. A curriculum module was designed to both support and challenge practising nurses to utilize critical thinking skills to guide their decision making regarding infection control practices. The author describes the process of curriculum development and presents a final curriculum product. The implementation is presented to demonstrate that the teaching of factual knowledge and skills can be integrated with higher level skills such as critical thinking, problem solving and decision making. Throughout this project, emphasis is placed on educational theory and on the practising health professional as the learner. / Thesis / Master of Science (Teaching)

No description available.

Acinetobacter baumannii is an important nosocomial pathogen, frequently associated with morbidity and mortality in immunocompromised patients due to the immuno-ablative treatments, neutropenia and prolonged hospitalization. The ability of A. baumannii to survive in the healthcare setting makes it a frequent problematic pathogen in cancer centres. Much of the interest in A. baumannii has been attributed to its remarkable rapid acquisition of resistance mechanisms A. baumannii is an excellent example of genetic plasticity, with its ability to acquire and express resistance in plasmids and chromosome particularly to carbapenems The aim of this thesis is to look at the molecular epidemiology and resistance mechanisms of 34 non-duplicate A. baumannii in two cancer centres in Cairo, Egypt. Initial sequencing of the ubiquitous blaOXA-51-like gene revealed a large diversity within the strains, with eight different genes identified: blaOXA-64, blaOXA-65, blaOXA-66, blaOXA-69, blaOXA-71, blaOXA-78, blaOXA-94, blaOXA-89/100. Typing with Pulsed-field Gel Electrophoresis (PFGE) showed an overall similarity at only 28.69% between the isolates, with variation in pattern for isolates with similar blaOXA-51-like genes. Typing with Multilocus Sequence Typing (MLST) identified 6 new Sequence Types: ST408 - ST414, in addition to ST331 and ST108 which have been previously found in other regions of the world. All three OXA-type carbapenemases: blaOXA23, blaOXA40 and blaOXA58, responsible for conferring carbapenem resistance were found in the collection studied. Insertion sequences ISAba1, ISAba2 and ISAba3 have been found to upregulate the expression of blaOXA genes. ISAba1 was found upstream of blaOXA23 in 18 strains in this collection The first report of ISAba2 was identified upstream of a blaOXA-51-like gene in this collection. Additionally, ISAba3 was bracketing the blaOXA58 genes, and two isolates harboured hybrid promoters with IS1006 and IS1008 interrupting the upstream ISAba3 sequence. Resistance to Ceftazidime was mediated by Extended-spectrum β-lactamase (ESBL) genes belonging to PER-like group: blaPER-1, blaPER-7 and the first report of blaPER-3 gene and its genetic environment in A. baumannii. In conclusion, this study shows the diversity exhibited by A. baumannii in Egypt. The various resistance mechanisms illustrate the ability of A. baumannii in acquiring and expressing resistance genes, either on plasmids or in the chromosome. Furthermore, the results indicate an urgent need to strict infection control policies and surveillance of antimicrobial use in Egyptian hospitals.

The impact of AIDS and the dread of acquiring HIV infection from patients have led to the resurgence in infection-control practices among health care workers. Recent reports of blood-borne pathogen transmission in health care settings, including oral health, have caused considerable public health concern. Transmission has been reported from patient to patient, patient to health care workers, but rarely from health care worker to patient. The risks of dental clinicians acquiring serious infections have been well documented but the risk to dental assistants has received less attention, especially in South Africa. Aim: To assess infection-control practices of dental assistants and their level of adherence to universal precautions in public health care facilities in Limpopo Province. Objectives: To establish the prevalence and the type of occupational exposures among dental assistants working in public health care facilities in Limpopo Province. Methods: A cross-sectional survey was conducted among dental assistants in Limpopo Province in 2005. The study population comprised all 73 employees who performed the functions of a dental assistant in public dental facilities. A self-administered questionnaire was used to collect information regarding work experiences and training, infection-control practice and knowledge, and the nature, incidences and reporting of any occupational exposures they had experienced. A follow-up telephone call was made to these dental assistants, after they had received the questionnaire, to re-iterate the importance of the survey and to request them to complete and return the questionnaire in the prepaid envelope they had been given. The facilities were clustered according to the six districts in Limpopo Province. Ethical approval was given by the University of the Witwatersrand and the Department of Health and Welfare in Limpopo Province. Results: Fifty-nine dental assistants returned the completed questionnaire, giving a response rate of 80.8%. Epi Info Version 3.3.2 programme was used to analyze the data. The majority of respondents were female (95%), with a mean age of 40.2 years (age range 23-54). More than 90% of the respondents had no formal training for their occupation, half (49.1%) did not have any health training, 22% were auxiliary nurses, 18.6% were “correspondence-trained” assistants who had been trained via distance learning and had no practical clinical training and only 10.2% of the respondents had received training at a technikon or university . The majority of the dental facilities (57.6%) had one dental assistant working alone, followed by those with two or three assistants (39.5%). The number of respondents assisting more than two oral clinicians in a day was 93.3%. The mean number of clinicians assisted per day was 3.8. The total numbers of dental assistants who experienced occupational exposures while working at the various dental clinics were 26 (44.1%), with 11.5% experiencing multiple injuries within the preceding six months. Auxiliary nurses and trained assistants were significantly more likely than untrained assistants to be aware of universal precautions, their protective effects, needle stick protocols, and of the need for personal protective equipments to be worn for all procedures (p=0.001). Compliance with infection-control practices was low overall. More than twothirds of the assistants routinely wore gloves during procedures. The lowest compliance reported was the use of protective eye shields, whilst more than 62.7% were not vaccinated against hepatitis B virus. More than two-thirds of the assistants were injured in the process of removing and or cleaning instruments; 65.3% of the injuries were direct punctures. Twenty-three percent did not report the injury. The risk of injury for the untrained assistants was 9.9 times higher than that for auxiliary nurses, p=0.008. A small percentage (23.8%) of those with sharp injuries was placed on antiretroviral drugs. Surprisingly, a significant high percentage of respondents were given wound cleaning only as treatment of their occupational exposures (78.4%) and sharp injuries (83%). Conclusion and recommendation More than 90% of the respondents had no formal training for their occupation. Dental assistants were understaffed and had increased workload. The greatest incidence of injury was associated with the handling of sharp objects, and this included recapping used needles. Occupational exposures to infectious material were found to be relatively high whilst compliance to some basic infection-control guidelines was low among dental assistants. The training of dental assistants should be regulated. More suitably qualified dental assistants should be appointed and existing ones should be given inservice training on the importance of infection-control practices and compliance with universal precautions.

Cross infection is a global health problem. The cost for cross infection increases every year. Florence Nightingale focused her attention on preventing cross infections by using good hygiene and as a nurse that is one of your more important tasks. Nurses have guidelines for how hygiene should be implemented in practice. The aim of this study is to investigate factors that influence nurses´ compliance to guidelines regarding hygiene. A literature review was used to analyze scientific articles related to the topic. The result showed that education increases nurses´ compliance to follow guidelines. Furthermore compliance to hand hygiene was higher after contact with the patient then before. The result also showed that the nurses were more worried about attracting an infection from the patient then giving an infection to the patient. The studies revealed that nurses want more education about guidelines and the latest research on the subject. The authors think that nurses need more education about hygiene in order to understand the importance of following guidelines. Nurses also need time for both reading updated information infection control and implementing the hygiene guidelines more frequently in practice.