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In the South African context, upgrading to, and delivery of a basic water-supply service to small-community households is expected to bring benefits such as reduced exposure to contaminated drinking water. A basic water-supply service mostly means that water is distributed to the community via communal taps that are not on the households’ premises (DWA, 2003). While this is seen as an improvement, people still have to use plastic containers (mostly 20-25ℓ volume) to collect water from the taps and store in their houses (Nala et al., 2003). Authors report that, from a health-related microbial water quality perspective, the management (e.g. poor container-hygiene practices) of household containers cause microbial re-contamination of good quality water (Gundry et al., 2004; Jagals et al., 2004; Jensen et al., 2002). This implies that household container water pose a risk of microbial infection to an individual if used for drinking without any household level disinfection. Providing clean water to households, even thought they might still have to use the containers, does limit the extent of the recontamination because of consistent use with the clean water as opposed to when communities use these containers to source contaminated surface waters (Mokoena et al., 2010). When the supply system fails, which was reported to happen frequently in the study area (Rietveld et al., 2009), the affected communities will return to their original source of water, using the same containers to collect what is often contaminated water (Momba et al., 2006). While it is plausible that the probable risk of infection will change with these service inconsistencies, it has not conclusively been shown what the effect of it might be on risk. This submission demonstrates how a quantitative microbial risk assessment (WHO, 2004) can be used as a tool to assess these shifts in risk, offering another technique to assess the effectiveness of a small-community water supply service. The aim of the study was assess, after implementation with subsequent operation and maintenance of two small-community water supply schemes, the effect of service delivery on the annual risk of bacterial infection for individuals based on pathogenic E. coli in the water that the people in the community drink.

Thesis (MSc)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: The annual risk of infection (ARI), a measure of recent transmission, has been described as the most important parameter in tuberculosis (TB) epidemics. Nevertheless, mounting evidence suggests all factors contributing to TB transmission are not yet completely understood. This research was performed to investigate the role various parameters, e.g. overcrowding, period of infectivity, ventilation, and infectivity of source cases, play in TB transmission. An established airborne transmission risk model, the Wells-Riley equation (WRE), was modified to account for scenarios where unknown numbers of infectious individuals may be present. Subsequently, the ARI for three indoor locations conducive to TB transmission were calculated. Two locations (households and minibus taxis) were identified in a social mixing survey conducted within a South African community where TB is endemic as a part of this research. The third location (prison) was identified in an earlier independent study in the same community. The impact various interventions could have in reducing the ARI associated with each location was explored. Poor ventilation, severe overcrowding, extended exposure periods, and high incidence rates contributed to high TB transmission risks in each location. The household-associated ARI was related to the number of resident adults. Current TB control programs will only reduce the ARI if household ventilation levels are improved simultaneously. Similar reductions in the ARI could be achieved by trebling current ventilation levels or by separating child and adult sleeping areas. Neighbouring households can also contribute substantially to the ARI. The minibus taxi-associated ARI for drivers and commuters was considerable but readily reduced by opening windows or keeping the fresh-air fan on. Reducing TB case prevalence through active or passive case-finding would reduce the ARI substantially. The prison-associated ARI was proportional to levels of overcrowding. No single intervention, such as improved ventilation, decreased lock-up time, or improved case-finding, would decrease the ARI substantially, but concurrent implementation of all of them to meet national or international standards would. This research shows TB is not only transmitted in epidemics by highly infectious TB cases, but that any TB case, no matter how infectious, has the potential to infect susceptible people under the right conditions. / AFRIKAANSE OPSOMMING:Die jaarlikse infeksierisiko (ARI) – maatstaf van onlangse siekteoordrag – word as die belangrikste parameter in tuberkulose- (TB-)epidemies bestempel. Nietemin dui toenemende bewyse daarop dat nie álle faktore wat tot TB-oordrag bydra, volledig verstaan word nie. Hierdie navorsing is onderneem om ondersoek in te stel na die rol van verskillende parameters – byvoorbeeld oorbevolking, tydperk van aansteeklikheid, ventilasie en die aansteeklikheid van brongevalle – in TB-verspreiding. Gevestigde model vir die raming van siekteverspreiding deur die lug, die Wells-Riley-vergelyking (WRE), is aangepas vir scenario’s waar onbekende aantal aansteeklike individue moontlik aanwesig is. Daarna is die ARI bereken vir drie ingeslote ruimtes wat TB-oordrag bevorder. Twee van die ruimtes (huishoudings en minibustaxi’s) is ten tyde van die navorsing uitgewys in sosialevermengingsopname in Suid-Afrikaanse gemeenskap waar TB endemies is. Die derde ruimte (gevangenisse) is uitgewys in vroeëre onafhanklike studie in dieselfde gemeenskap. Die navorser het gevolglik bepaal watter moontlike impak verskillende intervensies op die verlaging van die ARI in elke ruimte het. Swak ventilasie, ernstige oorbevolking, verlengde blootstellingstydperke en hoë voorkomsyfers het in elke ruimte tot hoë TB-oordragrisiko bygedra. Die huishoudingsverwante ARI het verband gehou met die aantal volwassenes wat in die huis woon. Huidige TB-beheerprogramme sal slegs die ARI kan verlaag indien huishoudelike ventilasievlakke terselfdertyd verbeter word. Drie keer beter ventilasievlakke of die skeiding van kinders en volwassenes se slaapareas kan soortgelyke verlagings in die ARI teweegbring. Buurhuishoudings kan ook aansienlik tot die ARI bydra. Die minibustaxi-verwante ARI vir bestuurders en pendelaars was beduidend, maar kan betreklik maklik verlaag word deur vensters oop te maak of die varslugwaaier aan te hou. Die vermindering van die voorkoms van TBgevalle deur aktiewe óf passiewe gevalle-opsporing kan die ARI ook beduidend verlaag. Die gevangenisverwante ARI het met vlakke van oorbevolking verband gehou. Geen enkele intervensie soos beter ventilasie, korter toesluittye of beter gevalle-opsporing sal die ARI aansienlik verlaag nie, maar die gelyktydige inwerkingstelling van ál hierdie intervensies in pas met nasionale of internasionale standaarde kan wél. Hierdie navorsing toon dat TB in epidemies nie net deur hoogs aansteeklike TB-gevalle oorgedra word nie, maar dat enige TB-geval, ongeag hoe aansteeklik, die siekte in die regte omstandighede na vatbare mense kan oordra.

Bakgrund: Vårdrelaterade infektioner drabbar 65 000 patienter i Sverige varje år och utgör en tredjedel av landets vårdskador. Vårdrelaterade infektioner är en stor ekonomisk belastning i svensk sjukvård. Säker vård ingår i sjuksköterskans kärnkompetenser och innebär bland annat arbete med patientsäkerhet. Patientsäkerhetsarbetet innefattar vårdhygien. Omvårdnaden och hanteringen av centrala venösa infarter tillhör sjuksköterskans arbetsuppgifter, därför är det viktigt för sjuksköterskan att kunna identifiera infektionsrisker, samt ha kunskap om infektionsförebyggande åtgärder.Syfte: Att belysa infektionsrisker i sjuksköterskans arbete med centrala venösa infarter samt hur dessa infektioner kan förebyggas.Metod: Studien är en litteraturöversikt. Artiklarna är hämtade från databaserna PubMed och CINAHL. Efter kvalitetsgranskning och analys kvarstod 17 kvantitativa artiklar som inkluderades i resultatet. Analysen av artiklarna gjordes i tre steg enligt en modell av Friberg (2017).Resultat: Resultatet bildade sju underkategorier: riskfyllda arbetsmoment, vårdhygien, kateteriseringsdygn och vårdtid, kunskapsbrist, utbildning, implementering av lokala riktlinjer och policys och arbetsmiljö. Dessa bildade två huvudkategorier: Riskfaktorer och preventiva åtgärder. En del moment i sjuksköterskans arbete med centrala venösa infarter, samt bristande följsamhet till basala hygienrutiner ökade infektionsrisken. Felaktigt handhavande var bland annat relaterat till kunskapsbrist. Utbildningar avsedda för vårdpersonal om centrala venösa infarter ökade kunskapen och på sjukhus med utformade riktlinjer var följsamheten bättre.Slutsats: Infektionsrisker med centrala venösa infarter är bristande följsamhet till hygienrutiner, vissa arbetsmoment, fler kateteriseringsdygn och vårdlängd samt bristande kunskap. Utbildningar och riktlinjer ökar kunskapen och följsamheten till rutiner i omvårdnaden av centrala venösa infarter. En god arbetsmiljö och vårdhygien skapar förutsättningar som minskar risken för vårdrelaterade infektioner. / Background: Healthcare-related infections affects 65 000 patients in Sweden each year and stand for a third of healthcare-related injuries in the country. Healthcare-related infections is a major burden on the Swedish healthcare economy. Safe care is one of the nurse’s main competencies and involves among other things work with patient safety. Patient safety involves care hygiene. The nursing and management of central venous lines is one of the nurse’s tasks, therefore is it important for the nurse to be able to identify infection risks and have knowledge of preventive measures.Aim: To illuminate infection risks in the nurse's work with central venous lines and how these infections can be prevented.Method: The study is a literature review. The articles are taken from the databases PubMed and CINAHL. After quality review and analysis, 17 quantitative articles remained that were included in the results. The analysis of the articles was done by a three step model by Friberg (2017).Result: Seven subcategories were designed for each area: riskfilled work steps, care hygiene, catheterization days and care time, lack of knowledge, education, implementation of local guidelines and policies and work environment. Two main categories were then formed: Risk factors and preventive measures. Certain steps of the nurse's work with central venous lines and lack of compliance with basic hygiene routines increased the risk of infection. Wrongdoings were among other things related to lack of knowledge. Education intended for healthcare staff on central venous lines improved the knowledge and in hospitals with designed guidelines compliance was better.Conclusion: Infection risks associated with central venous lines are lack of compliance with hygiene routines, certain work steps, more catheterization days and length of care and lack of knowledge. Education and guidelines increase knowledge and compliance with routines in the care of central venous lines. A good working environment and care hygiene create conditions that reduce the risk of healthcare-related infections.