Thesis (MPH.) --University of Limpopo, 2019. / Background: The purpose of this study was to investigate the extent of adherence to Infection Prevention and Control (IP&C) practices and programs amongst healthcare workers (HCWs) in the neonatal ward at Charlotte Maxeke Central Hospital (CMCH). Methods: Quantitative research was conducted on 57 Clinicians directly providing care to the patients and 5 Health Care Workers indirectly providing care to the patients by means of supporting the environment and logistics where patients are being taken care. Data collection was done using structured questionnaires. Because the population was so small, all available HCWs, who were willing to participate in the study were selected to participate in the study. Furthermore, the SAS statistical software was used to describe and analyse data received from the data collection tools. Results: Two groups of respondents participated in the study which were (n=57) who in the neonatal ward at CMCH and Health Care Workers (n=5), most of the clinicians were having 1 – 4 years’ experience working in the neonatal unit at 54.6% followed by 5 – 9 years at 21.8%. Participants were in the age group ≤ 30 years at 39.3% followed by 31 – 40 years (32.1%) and least being at ≥ 51 years (5.4%). Clinicians included 46% of professional nurses, 28.6% Auxiliary Nursing Assistant, 16.1% student nurses and 8.9% medical doctors. The findings revealed that there are some areas where there’s inconsistent in using gloves when anticipating exposure to blood or body fluids, drying of hands after washing and removing jewellery during clinical care among clinicians particularly doctors, professional nurses and student nurses about IPC practices during clinical care. In Conclusion: There was inadequate compliance with IPC standards and there’s a need for regular trainings to improve the knowledge about IPCs and awareness of its importance among clinicians and health care workers in the neonatal unit. The IPC committee need to be revitalized by the hospital management to be able to undertake its mandate. Furthermore, the Hospital administration should provide copies of IPPC policy Guidelines in all wards/units and ensure effective implementation through vi constant supervision and adequate supplies and conduct regular audits to enhance compliance and implementation of IPPC policy. The study concluded that there was inadequate compliance with IPC and there’s a need for regular trainings to improve the knowledge about IPCs and awareness of its importance among clinicians and health care workers in the neonatal unit.

published_or_final_version / Politics and Public Administration / Doctoral / Doctor of Philosophy

published_or_final_version / Dentistry / Master / Master of Dental Surgery

A dissertation submitted to the Faculty of Science, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Master of Science. Johannesburg, 2016 / According to UNAIDS, there are ~36.9 million people infected with HIV-1 in the world. Of those, 25.8 million live in sub-Saharan Africa and 6.8 million in South Africa. HIV-1 subtype C accounts for over 95% of HIV infections in South Africa. HIV-1 retrovirus acquires mutations rapidly because of the viral reverse transcriptase. Naturally occurring polymorphisms distinguishing wild type C-SA PR from other proteases make it less susceptible to inhibitors. E35D↑G↑S is a C-SA PR variant with a double insertion in the flap region of the protease. The insertions and background mutations may decrease susceptibility to inhibitors as well as alter kinetic parameters due to increased flap flexibility. This study intended to characterise the effect of the mutations and insertions in E35D↑G↑S on structural, kinetic activity and drug susceptibility. Chemically-synthesised E35D↑G↑S autocatalyses rapidly, impeding further characterisation. There was no detectable overexpression of the E35D↑G↑S protease in Escherichia coli BL21 (DE3)pLysS and Rosetta 2® cells. If the protease is catalytically enhanced, attributed cytotoxicity may prevent overexpression of the protein. Increased autocatalytic activity could also prevent crystallisation. Inactive E35D↑G↑S D25A did not overexpress either, indicating that codon harmonisation with the expression host ought to be performed. C-SA PR was shown to be a predominantly beta-sheeted protein using circular dichroism spectroscopy. The KM of the fluorogenic substrate resembling the capsid/ p2 cleavage site for C-SA PR was 22.02 ±4.09 μM. The specific activity, catalytic turnover and catalytic efficiency of the wild-type C-SA PR protease were found to be 35.68 ±1.06 μmole.min-1.mg-1, 12.79 ±0.38 s-1 and 1.17 ±0.055 s-1.μM-1, respectively. The thermodynamics of binding of atazanavir, ritonavir and darunavir to C-SA PR were determined using isothermal titration calorimetry. The binding of atazanavir and ritonavir to C-SA PR is entropically driven and enthalpically opposed. However, the binding of darunavir to C-SA PR was found to be both entropically and enthalpically favourable. The dissociation constants of the inhibitors in the absence of substrate (Kd) are in the pico-molar range and increased by approximately one order of magnitude when saturating concentrations of substrate were introduced. Atazanavir, ritonavir and darunavir have dissociation constants (Kd) of 160.56 ±54.59 pM, 113.34 ±46.47 pM and 10.24 ±6.02 pM, respectively. Darunavir binds significantly tighter. Keywords: C-SA PR, E35D↑G↑S, insertion mutations, protease, autocatalysis, ITC.

According to recommendations from the Facility Guidelines Institute (FGI) of the American Institute of Architects (AIA), World Health Organization (WHO) and Center for Disease Control and Prevention (CDC), a common engineering approach to isolation room design is to maintain the air ventilation rate at a minimum of 12 air changes per hour (ACH) for mixing and dilution, and a negative pressure in the room to direct airflow inwards, instead of leaking outwards. / In collaborations with physicians in the Respiratory Division and the Intensive Care Unit (ICU) at the Chinese University of Hong Kong (CUHK), a series of experiments were carried out to verify the ventilation performance of an All room at the Princess Margaret Hospital (PMH). Experiments investigated the effects of ACH, the control of airflow direction, the air tightness of the automatic swing door and the application of positive pressure ventilation procedures, such as high flow rate oxygen masks, jet nebulizers and NPPV. These were extensively tested in two different isolation rooms of the Prince of Wales Hospital (PWH) and PMH, under common clinical circumstances and environmental conditions. / Many patients with severe respiratory infection require supportive therapy for respiratory failure. Common interventions involve supplemental oxygen to improve tissue oxygenation. In the worst scenario, mechanical ventilation via non-invasive positive pressure ventilation (NPPV) may be required. Since a large amount of aerosols is generated during these interventions, there is a great risk of spreading infectious aerosols from the respiratory tract of the patient to the surrounding environment. / The aerodynamic data in this thesis infonns architects and engineers on how to improve the hospital ward ventilation design so as to avoid aerosol and ventilation leakage. Ultimately, it is hoped that this work may play a role in preventing devastating nosocomial outbreaks in the future. / The design of airborne infection isolation (AII) room has become one of the major research domains following the emergence of the global concern of acute respiratory diseases in this century. These include severe acute respiratory syndrome (SARS) in 2003, H5N1 avian influenza, and pandemic influenza H1N1 in 2009. All of which have claimed thousands of lives. Even with the current stringent design and practice guidelines, nosocomial infection of healthcare workers (HCWs) and inpatients continues to occur. This implies that there might be limitations in current isolation ward designs. / The experiments implemented a high-fidelity human patient simulator (HPS) which could be programmed with different lung breathing conditions and oxygen flow rate settings. The patient exhaled air dispersion distances and airflow patterns were captured in detail with a non-intrusive, laser light sheet, smoke particle scattering technique, designed for this thesis. Thin laser light sheets were generated by a high energy YAG laser with custom cylindrical optics. Smoke concentration in the patient exhaled air and leakage jets was estimated from the intensity of light scattered, which was then expressed as nonnalized particle concentration contours using computer programs developed for this study. / The study quantitatively revealed the distinctive patient exhaled airflow patterns and the extent of bioaerosol, generated directly from the patient source with the application of different oxygen delivery interventions for different patient lung conditions and oxygen flow rates. It was found that contamination was more critical during the administration of oxygen therapies, which is common in clinical circumstances. Source control is therefore the most efficient and effective approach to the reduction and even elimination of patient exhaled bioaerosol contaminants. Thus, when working in an isolation room environment, full preventive measure should be taken and it is essential to consider the location of mechanical vents and the patient exhaled airflow patterns. It has also been shown in experiment that applications of bacterial viral filter could be a solution to the problem. / Chow, Ka Ming. / Advisers: Puay Peng Ho; Jin Yeu Tsou. / Source: Dissertation Abstracts International, Volume: 73-09(E), Section: A. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 115-147). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

Infection control practices are a critical element in home-based care for people living with HIV/AIDS. It involves principles and procedures used to minimize the risk of spreading infections in home-based care. Infection control practices help to prevent morbidity, mortality rates and improve health for the volunteer caregivers and the patients. However, most previous studies on home-based care have focused on burdens of care, perceptions of rewards, quality of care and challenges faced by caregivers. Therefore, it is not clear how and to what extent infection control practices are carried out in home-based care. The purpose of this study is to explore the experiences of home-based care coordinators and volunteer caregivers regarding infection control practices in home-based care. Qualitative interviews were conducted with ten home-based care coordinators/project managers and ten focus group discussions were conducted with volunteer caregivers. An interview guide and a focus group schedule with open ended questions were used. Volunteer caregivers in home-based care organizations were faced with practical challenges regarding infection control practices that posed a threat to their work and health. The received insufficient infection control material resources such as gloves, masks and sanitizers. They also mentioned to have received poor quality gloves that easily broke, poor quality aprons that were not tight; easily blown by the wind and also thin masks that could not filter the bad odour. Other challenges that they faced included, insufficient water supply; insufficient knowledge on infection control and lack of cooperation from some patients and some family members regarding the use of protective clothing especially gloves and masks. Most volunteer caregivers were ridiculed by some family, community members and friends. Sometimes they could not access some patient due to HIV related stigma and discrimination. However, volunteers developed various strategies of dealing with these challenges such as replacing the torn gloves with plastics, carrying 2.5 litres of water, educating patients and family members about the importance of wearing gloves and practicing infection control. These findings require the government, NGOs, funders and donors to form a forum with volunteer caregivers to discuss the supply of materials. They need to establish a central administration that will be responsible for allocating adequate and quality materials for infection control practices. This central administration should also be responsible for supervising HBCOs including monitoring and evaluating infection control practices. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2012.

Objectives: To develop and validate a survey that can be used to measure key infection prevention and control (IP&C) structures and processes in LTC facilities. Methods: This study was designed using a three-phase methodology. In Phase I, six structural and process composite indices were developed based on the 2004 PHAC recommendations for IP&C in LTC and other literature. During the second phase of the study, a group of 7 experts in LTC IP&C used the Delphi methodology to validate and further develop the survey based on group consensus. Five Safety Principles published by the Institute of Medicine were also provided to the experts so they could be used to complement and further develop the concepts covered by the survey. The Delphi phase began in April and ended in October 2007; 114 worksheets were sent to experts to support the consensus-reaching process. Once the validity of a survey draft had been established based on expert-group consensus, it was pilot-tested in Phase III using 20 randomly selected LTC facilities in Fraser Health. Findings: The three-phase methodology used in this study was very useful and innovative way to further develop and validate the literature-based survey developed in Phase I for IP&C in long term care. In addition, by merging two bodies of knowledge and thought into the process, concepts and components that are not explicitly described in IP&C literature yet were felt to be key in program success, were incorporated into the measurement tool. Using Delphi, the experts expressed a need for IP&C professionals working in LTC to increase their knowledge, understanding and use of safety theory and strategies. They also felt that interdisciplinary work, the development of a culture of safety, and the development clear and simple IP&C systems are key ways in which infections can be prevented and outbreaks quickly controlled. In Phase III, the pilot-study analysis demonstrated the utility, validity and reliability of the survey. In addition, the analysis showed that there is a tendency for facilities to have lower levels of components within the Leadership Index and the ICP Index.

There is an increase in HIV/AIDS and other blood borne diseases. Health care workers are often exposed to blood and body fluids and thus prone to blood borne infections. Preventative measures can be taken to prevent health workers from contracting these diseases. However, health care workers need to stringently apply these measures. Universal precautions against blood borne infections include diligent hygiene practices, such as hand washing and drying, appropriate handling and disposal of sharp objects, prevention of needle stick or sharp injuries, appropriate handling of patient care equipment and soiled linen, environmental cleaning and spills management, appropriate handling of waste as well as protective clothing such as gloves, gowns, aprons, masks and protective eyewear. This study is aimed at investigating compliance with universal precautions in operating theatres in Northern KwaZulu–Natal as well as perceptions of registered nurses working in these operating theatres regarding factors influencing compliance in order to contribute to measures to limit the risk of infection to patients and health care workers. A sequential explanatory design, mixed–method (quantitative and qualitative) was used to explore the use of universal precautions in operating theatres in the Northern Kwa–Zulu Natal. In the first phase, the sample consisted of practices in operating theatres of six hospitals and one regional hospital in area 3 of Kwa–Zulu Natal. The adapted structured checklist based on an established document developed by the MASA Committee for Science and Education (1995) was pilot tested. The collected data was statistically analysed and interpreted with the help of a statistician using SPSS. The results of Phase 1 were used as a base for the Phase 2 questions. Three focus group interviews were conducted with professional nurses who were observed during Phase 1 at the selected hospitals. Findings from quantitative data show that although health care workers take precautions to prevent infections, they do not attain full compliance to universal precautions. The qualitative data indicated that the reasons for non–compliance amongst others were the lack of knowledge of universal precautions, communication factors, resources, including maintenance of equipment, lack of supplies and shortage of human resources and attitudes of health care workers. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2012.

There is an increase in HIV/AIDS and other blood borne diseases. Health care workers are often exposed to blood and body fluids and thus prone to blood borne infections. Preventative measures can be taken to prevent health workers from contracting these diseases. However, health care workers need to stringently apply these measures. Universal precautions against blood borne infections include diligent hygiene practices, such as hand washing and drying, appropriate handling and disposal of sharp objects, prevention of needle stick or sharp injuries, appropriate handling of patient care equipment and soiled linen, environmental cleaning and spills management, appropriate handling of waste as well as protective clothing such as gloves, gowns, aprons, masks and protective eyewear. This study is aimed at investigating compliance with universal precautions in operating theatres in Northern KwaZulu–Natal as well as perceptions of registered nurses working in these operating theatres regarding factors influencing compliance in order to contribute to measures to limit the risk of infection to patients and health care workers. A sequential explanatory design, mixed–method (quantitative and qualitative) was used to explore the use of universal precautions in operating theatres in the Northern Kwa–Zulu Natal. In the first phase, the sample consisted of practices in operating theatres of six hospitals and one regional hospital in area 3 of Kwa–Zulu Natal. The adapted structured checklist based on an established document developed by the MASA Committee for Science and Education (1995) was pilot tested. The collected data was statistically analysed and interpreted with the help of a statistician using SPSS. The results of Phase 1 were used as a base for the Phase 2 questions. Three focus group interviews were conducted with professional nurses who were observed during Phase 1 at the selected hospitals. Findings from quantitative data show that although health care workers take precautions to prevent infections, they do not attain full compliance to universal precautions. The qualitative data indicated that the reasons for non–compliance amongst others were the lack of knowledge of universal precautions, communication factors, resources, including maintenance of equipment, lack of supplies and shortage of human resources and attitudes of health care workers. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2012.

Objectives: To develop and validate a survey that can be used to measure key infection prevention and control (IP&C) structures and processes in LTC facilities. Methods: This study was designed using a three-phase methodology. In Phase I, six structural and process composite indices were developed based on the 2004 PHAC recommendations for IP&C in LTC and other literature. During the second phase of the study, a group of 7 experts in LTC IP&C used the Delphi methodology to validate and further develop the survey based on group consensus. Five Safety Principles published by the Institute of Medicine were also provided to the experts so they could be used to complement and further develop the concepts covered by the survey. The Delphi phase began in April and ended in October 2007; 114 worksheets were sent to experts to support the consensus-reaching process. Once the validity of a survey draft had been established based on expert-group consensus, it was pilot-tested in Phase III using 20 randomly selected LTC facilities in Fraser Health. Findings: The three-phase methodology used in this study was very useful and innovative way to further develop and validate the literature-based survey developed in Phase I for IP&C in long term care. In addition, by merging two bodies of knowledge and thought into the process, concepts and components that are not explicitly described in IP&C literature yet were felt to be key in program success, were incorporated into the measurement tool. Using Delphi, the experts expressed a need for IP&C professionals working in LTC to increase their knowledge, understanding and use of safety theory and strategies. They also felt that interdisciplinary work, the development of a culture of safety, and the development clear and simple IP&C systems are key ways in which infections can be prevented and outbreaks quickly controlled. In Phase III, the pilot-study analysis demonstrated the utility, validity and reliability of the survey. In addition, the analysis showed that there is a tendency for facilities to have lower levels of components within the Leadership Index and the ICP Index.