Effectiveness of disinfectant wipes for decontamination of bacteria on patients' environmental and medical equipment surfaces at Siriraj Hospital.

OBJECTIVE: To determine the effectiveness of Virusolve+ disinfectant wipes and PAL disinfectant wipes for decontamination of inoculated bacteria on patients' environmental and medical equipment surfaces at Siriraj Hospital. MATERIAL AND METHOD: Tryptic soy broths containing MRSA and XDR A. baumannii were painted onto the surfaces of patient's stainless steel bed rail, patient's fiber footboard, control panel of infusion pump machine and control panel of respirator. The contaminated surfaces were cleaned by either tap water, tap water containing detergent, Virusolve+ disinfectant wipes or PAL disinfectant wipes. The surfaces without any cleaning procedures served as the control surface. The contaminated surfaces cleaned with the aforementioned procedures and control surfaces were swabbed with cotton swabs. The swabs were streaked on agar plates to determine the presence of MRSA and XDR A. baumannii. RESULTS: MRSA and XDR A. baumannii were recovered from all control surfaces. All surfaces cleaned with tap water or tap water containing detergent revealed presence of both MRSA and XDR A. baumannii. However the amounts of bacteria on the surfaces cleaned with tap water containing detergent were less than those cleaned with tap water alone. All surfaces cleaned with PAL disinfectant wipes also revealed presence of both MRSA and XDR A. baumannii. However the amounts of bacteria on the surfaces cleaned with PAL disinfectant wipes were less than those cleaned with tap water containing detergent. No bacteria were recovered from all surfaces cleaned with Virusolve+ disinfectant wipes. CONCLUSION: Virusolve+ disinfectant wipes were more effective than tap water; tap water containing detergent and PAL disinfectant wipes for decontamination of bacteria inoculated on patients environmental and medical equipment surfaces at Siriraj Hospital.

Microbial and heavy metal contamination of treated hospital wastewater in Thailand.

OBJECTIVES: To determine the microbial and heavy metal contamination of treated hospital wastewater MATERIAL AND METHOD: Methods of treating wastewater were acquired by questionnaires. Chlorine concentration, pH, bacteria and parasites in treated wastewater were tested in the individual hospitals. Heavy metal concentrations were measured by atomic absorption spectrophotometry. RESULTS: In 2002, 72 hospitals were included in the present study. The common methods of treating wastewater were activated sludge and oxidation ditch. Bacteria exceeded standard numbers, pathogenic bacteria and parasites were found in two-thirds of the hospitals. Heavy metals, namely lead, chromium and cadmium, in the hospital effluent did not exceed standard concentrations. CONCLUSION: Micro-organisms exceeding standard levels were found in treated wastewater in two-thirds of the hospitals. Lead, chromium and cadmium levels in hospital effluent were in an acceptable range.

Antimicrobial susceptibility of community and hospital acquired bacteria.

OBJECTIVES: To study the antibiotic susceptibility of common community- and hospital-acquired bacteria in Thailand. MATERIAL AND METHOD: Eight common bacterial pathogens were studied in 24 hospitals across Thailand in 2002-2003. Isolates of clinically proven infections were tested for their susceptibility by agar-based disc diffusion method. RESULTS: A total of 9,091 isolates of target bacteria were studied. Community and hospital acquired bacteria accounted for 54.9% and 45.1% respectively. Community acquired Escherichia coli, Klebsiella pneumoniae, Acinetobacter spp., Enterobacter spp., Staphylococcus aureus were more susceptible to antimicrobials compared to hospital acquired strains. The difference in susceptibility of community-acquired vs hospital acquired Pseudomonas aeruginosa, Coagulase-negative staphylococci and Enterococcus spp. was less impressive indicating the spread of hospital strains into the community. Bacteria isolated from the blood stream were more susceptible to antimicrobials compared to those from the lower respiratory tract, urinary tract and surgical sites. Acinetobacter spp. and Enterococcus spp. were less susceptible to antimicrobials compared to others. CONCLUSION: Decreased susceptibility to antimicrobials was found in all bacteria tested. The susceptibility to commonly used antimicrobials of community-acquired bacteria decreased to a critical level indicating the widespread resistant bacteria to the community.

Catheter-associated urinary tract infection.

OBJECTIVES: To study the incidence, risk factors, clinical outcomes and antibiotic costs of catheter-associated urinary tract infections (CAUTI) in patients with indwelling urinary catheter for one week and longer MATERIAL AND METHOD: Patients in neurology and neurosurgery wards in a teaching hospital were studied. Patients with UTI before catheterization and in whom the catheter was removed before one week were excluded. Urine cultures were done immediately after catheterization and 3 times a week there after. Patients were followed for symptoms of UTI for 1 week after catheter removal, for 4 weeks without evidence of UTI or until discharge. RESULTS: One hundred and one patients met the inclusion criteria. The incidence of CA UTI was 73.3%. High incidence of CAUTI was found in the first 2 weeks after catheterization. About one-half of the patients with CAUTI had a single episode and were symptomatic. None of the 132 episodes of CAUTI were associated with secondary bacteremia. Risk factors for CAUTI identified were prolonged catheterization and change of the catheter Nosocomial pathogens were found in urine and yeast was the commonest. Eleven patients (14.9%) with CAUTI died and only in 2, CAUTI was considered a contributory factor for mortality. The cost of antimicrobials for treating one episode of CAUTI was 8,180 baht and this rose to 49,983 baht for CAUTI associated with concurrent infections at other sites. CONCLUSION: Catheter-associated urinary tract infection was common. Uropathogens were nosocomial micro-organisms with high incidence of resistance to antimicrobials. Impacts on morbidity, mortality and costs were substantial. Better management of urinary catheter is to be explored and implemented.

Development of quality indicators of nosocomial infection control.

OBJECTIVES: To study the rates of catheter associated urinary tract infection (CAUTI), Ventilator-associated pneumonia (VAP), Central venous catheter blood stream infection (CVCBSI) and surgical site infection (SSI) in Thai hospitals. The rates of the infections will be used as quality indicators. MATERIAL AND METHOD: Active surveillance in 38 hospitals in Thailand during 2003-2004. Risk stratification of NI rates and utilization of devices were calculated. RESULTS: The rates of CAUTI, VAP, CVCBSI and SSI were obtained. Pooled means, and rates of NI at 10, 25, 50, 75 and 90 percentiles were calculated for CAUTI, VAP, CVCBSI. The infection rates were also presented for each type of hospital. The above NI rates were comparable to those reported by the National Nosocomial Infection Surveillance System (NNIS) in the United States. Surgical site infection was studied in 21 procedures with risk index categories 0-2. The rates of SSI in the present study was lower than those in the U.S. study due to different methods of study. CONCLUSION: The risk stratified rates of CAUTI, VAP, CVCBSI and SSI were obtained. They were similar to a larger scale of study in the United States. The NI rates could be used for evaluating the efficacy of NI control in Thai hospitals.

Effectiveness of comprehensive implementation of individualized bundling infection control measures for prevention of health care-associated infections in general medical wards.

BACKGROUND: The prevalence of health care-associated infections (HAIs) in general medical wards at Siriraj Hospital in Bangkok, Thailand remains at 10% even after infection control measures were launched. The present study aimed to determine the effectiveness of comprehensive individualized bundling infection control measures in reducing HAIs and to identify the lowest possible rate of HAIs in general medical wards. METHODS: This was a cluster randomized controlled study conducted in 8 general medical wards (4 control wards and 4 intervention wards) at Siriraj Hospital. The patients hospitalized in the control wards received regular health care, as well as regular measures for preventing HAIs. The patients hospitalized in the intervention wards received additional measures. Each patient in the intervention wards was visited by the infection control team once a day until he or she left the hospital. The infection control team identified risk factors for developing HAI in each patient, coordinated with the local health care team to eliminate or minimize such risk factors, and encouraged responsible personnel to comply with the appropriate infection control measures for each patient. RESULTS: Between January and April 2009, there were 954 patients (9,650 hospitalization-days) in the intervention wards and 920 patients (9,777 hospitalization-days) in the control wards. The patient characteristics were comparable in the 2 groups. The prevalence of HAI was significantly lower in the intervention wards compared with the control wards (5.6% vs. 9.2%; P = .003). Six episodes of HAI in patients in the intervention wards could have been avoided. CONCLUSION: Comprehensive individualized bundling infection control measures were effective in reducing the prevalence of HAIs in general medical wards. The target overall prevalence of HAIs in general medical wards should not exceed 4.9%.