Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Homeopathy, Technikon Natal, 2001. / The purpose of this study was to test the relative effectiveness of extract, 3X and 8X homeopathic garlic (Allium sativum) dilutions on Candida albicans and nosocomial multidrug- resistant strains of Methicillin-resistant Staphylococcus aureus (MRSA), Eschericia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa in terms of bacteriostatic and bactericidal effects in order to validate the clinical use of garlic in patients infected by these organisms. The test organisms were provided by the Department of Microbiology at the University of Stellenbosch Medical School. A 1:2 aqueous extract was prepared from fresh garlic bulbs. From the extract the 3X and 8X dilutions were made in distilled water according to the method of the German Homeopathic Pharmacopoeia. In the experimental group, these three garlic preparations and standardised solutions of each of the five test organisms were serially added, in equal quantities, to nine samples of nutrient broth, incubated and optically evaluated for turbidity against McFarlane standards. Samples showing garlic activity were plated out, incubated and the Colony Forming Units (CFU's) counted. Similarly, in the control group, solutions of each of the five test organisms were added to nine samples of nutrient broth, incubated and optically evaluated for turbidity against McFarlane standards. The CFUs of the experimental and control groups were statistically compared by means of the Kruskal-Wallis test. III Those strains against which garlic exhibited a bactericidal effect (kill = >99,9%), were subjected to a timelkill experiment to determine the time required for the garlic to kill thew / M

Nosocomial infections present an important health problem with morbidity, and high mortality, prolongation hospital days, and increased direct costs of patient care. This article was conducted in a general hospital in order to determine the cost of nosocomial infections and increased length of hospitalization of it. The conclusion was that the high economic expense which nosocomial infection represents justifies measures to control this entity. Nosocomial infections are a major part of the problem of reemerging pathogens causing infectious diseases, affecting 5% of hospitalized patients. Provided an enhanced, integrated infection control program, it could be assessed that the medical and economic effects on the overall nosocomial infection will lower of actual health care costs by ¢C28000NTD each case of the intervention.

Infection control is an often neglected clinical subject in Hong Kong until the outbreak of severe acute respiratory syndrome (SARS) in 2003. A total of eight healthcare workers, including four medical doctors, succumbed as a result of nosocomial acquisition of SARS-coronavirus (SARS-CoV) at the time. Since then, the importance of infection control practice was much better appreciated by the frontline healthcare workers, as it can be a matter of life-or-death. My thesis summarized our research on the proactive infection control measures to prevent nosocomial transmission of respiratory and gastrointestinal viruses, to control emerging and endemic antibiotic-resistant bacteria, and on the management of unprecedented infection outbreaks in the hospital. Promotion of hand hygiene is the cornerstone of proactive infection control measures. By adopting the concept and practice of directly-observed hand hygiene, we demonstrated successful control of outbreaks and prevention for both respiratory and gastroenteritis viruses. Introduction of electronic devices for continuous monitoring of hand hygiene compliance in high risk clinical areas provides an opportunity for immediate feedback and timely education to frontline staffs. The global dissemination of multiple drug resistant organisms (MDROs) such as methicillin-resistant Staphylococcus aureus (MRSA), community-associated MRSA (CA-MRSA), vancomycin-resistant enterococcus (VRE), hypervirulent clone of Clostridium difficile, extended-spectrum beta-lactamase (ESBL) producing organisms, and the recently described carbapenem-resistant enterobacteriaceae (CRE), pose a great challenge to the infection control professionals. In Hong Kong, MRSA has been endemic for more than two decades. Although we proved that the appropriate use of single room isolation and hand hygiene can significantly reduce the incidence of nosocomial MRSA in the adult intensive care unit, the isolation facilities remain limited in the general medical and surgical units. Innovations are much in need to manage this old and persistent problem. Therefore, we demonstrated that use of antibiotics, in particular beta-lactams and fluoroquinolones, could increase the risk of environmental contamination by increasing microbial density of MRSA in the anterior nares by 2-3 log10 in as little as 1 week. We also found that some MRSA strains such as spa types t1081 and t037 were more transmissible. Based on these findings, we prioritized our isolation facilities for those patients who are heavily colonized or infected with highly transmissible spa-type t1081, especially when they are receiving antibiotic therapy. Along with our enhancement of hand hygiene practices and antibiotic stewardship program, the incidence of MRSA bacteremia per 1000-patient-days was the lowest among the seven hospital clusters in Hong Kong. We believe that our experience in the control of the MRSA can be extended to contain the spread of CA-MRSA and other MDROs. Besides the prevailing infectious diseases with high endemicity, we have to be vigilant against other potential outbreaks due to uncommon micro-organisms such as the polymicrobial outbreak in patients undergoing intermittent peritoneal dialysis caused by hospital renovation, the unprecedented outbreak of intestinal mucormycosis caused by Rhizopus microsporous among the patients with hematological malignancy, and the nosocomial outbreak of legionellosis in our locality. Extensive outbreak investigations were performed, which demonstrated that environmental factors were also important in causing nosocomial outbreaks. / published_or_final_version / Microbiology / Master / Doctor of Medicine

No description available.

Thesis (M. Nurs.)--University of Hong Kong, 2007.

Thesis (M. Sc. Med.)--University of Sydney, 2007. / Title from title screen (viewed 15 October 2008). Submitted in fulfilment of the requirements for the degree of Master of Science in Medicine to the Discipline of Medicine, Faculty of Medicine. Includes bibliographical references. Also available in print form.

Thesis (Ph. D.)--University of Hong Kong, 2009. / Includes bibliographical references (p. 187-204). Also available in print.

published_or_final_version / Mechanical Engineering / Doctoral / Doctor of Philosophy

This dissertation examines factors associated with healthcare-associated infections (HAIs) in four acute care hospitals located in New York City. Specifically, this investigation focuses on the role that the physical environment plays with regard to patient-to-patient transmission. The initial analyses describe the scope of the problem by reporting the incidence of HAIs and antimicrobial resistance over a seven-year period in the study institutions. In total, 19,052 HAIs were identified among 761,426 discharges. HAI rates fell over time within all hospitals and for all organisms and infection types included in the study, and the odds of acquiring an HAI decreased significantly over time for all organisms. Resistance levels were stable for Enterococcus spp., Staphylococcus aureus, Acinetobacter baumannii, and Streptococcus pneumoniae. Multidrug resistance increased for Pseudomonas aeruginosa and decreased for Klebsiella pneumoniae, though imipenem resistance among K. pneumoniae climbed sharply in 2011. A systematic literature review is presented to summarize what is known and unknown about how patients’ exposure to infected or colonized concurrent roommates and prior bed occupants affects their risk of developing HAIs. Eighteen articles meeting the inclusion criteria were identified. More than half reported at least one statistically significant positive association between the infection/colonization status of a roommate or previous room occupant and the development of HAIs. Only a single article identified a statistically significant negative association. The remainder found no associations that reached statistical significance, though this may be due to the fact that they were insufficiently powered. The dissertation concludes with a matched case-control study designed to quantify the association between having a prior bed occupant or roommate with a positive blood, respiratory, urine, or wound culture and subsequent infection with the same organism. In a multivariable analysis controlling for patient characteristics and mutually controlling for each exposure, the odds of being exposed to a prior bed occupant with the same organism were 5.83 (95% Confidence Interval [3.62, 9.39]) times greater for cases versus controls and the odds of being exposed to a roommate with the same organism were 4.82 [3.67, 6.34] times greater.

Background: With the increasing survival rate of early preterm infants and the extensive use of invasive health care procedures, the nosocomial infection rate is on the rise in the past decade in the neonatal intensive care unit (NICU). The patients in NICU are a unique and highly vulnerable population, including preterm infants and infants requiring surgery. Nosocomial infection (NI) is associated with the majority of infectious complications of infants, resulting in morbidity and mortality. Close surveillance, accurate measurement, and promotion of full awareness of the risk factors of infection are essential to nosocomial infection control. Previous research had pointed out some factors related to the NI in other countries, and further research is still much needed to reveal the incidence of NI and further analyze the risk factors in China. Objectives: The objectives of this study were to assess incidence and epidemiologic profile of nosocomial infection in NICU of China, and to identify the main risk factors of nosocomial infections. Methods: This was a retrospective cohort with a nested case control study. All data were collected from the database of the medical records of all the patients who were admitted to the Guangzhou Women and Children’s Medical Center (N=1653) during December 2009 to May 2012.Infection rate, infection density and central line-associated bloodstream infection rate were estimated. Stepwise regression model yielded adjusted odds ratio (OR) of potential risk factors for NI. Results: The infection rate in NICU during the study period was 6.2 episodes per 100 patients (6.0-6.4 episodes per 100 patients). Infection density was 4.2 episodes per 1000 patient-days each year (95%CI=3.4-5.0 episodes per 1000 patient-days). The infection rate of ventilation-related pneumonia was 3.4 episodes per 1000 Mechanical Ventilation (MV) days. (95%CI= 3.2-3.5 episodes per MV patient-days).Central line-associated bloodstream infection rate was 5.4 episodes per 1000 central line days (95%CI= 5.1-5.6episodes per central line days). Overall, infants with gestational age >32weeks, longer duration of receipt of parenteral nutrition and longer duration of receipt of probiotics were significantly less likely to have NI (adjusted ORs= 0.35, 0.94 and 0.88, respectively). Congenital malformation, multiple birth, receipt of vein or arterial catheter, receipt of surgical operation and gastric tube feeding were significantly more likely to have NI(adjusted ORs=4.43,3.24 and 3.88, respectively). And longer duration of using prophylactic antibiotic was significantly more likely to have NI (adjusted OR=1.13). Conclusion: Our study provided information to the prevention strategies of nosocomial infections and improvement of health care service.We described the nosocomial infection rate, infection density and device-related infection rate, seasonal distribution, the type of infection and the pathogens identified to reveal the profile of nosocomial infection of NICU in Guangzhou, China.Andwe identified the association between intrinsic factors of infants and health care procedures with NI. Multicenter prospective study can be conducted in the future to investigate the specific risk factors on different birth weight or gestational age in China. / published_or_final_version / Public Health / Master / Master of Public Health