Effect of an education program on the prevention of ventilator-associated pneumonia: A multicenter study.

OBJECTIVE: To evaluate the effect of an educational program targeted on modifiable risk factors on ventilator-associated pneumonia (VAP) rates. MATERIAL AND METHOD: After a preliminary study on VAP risk factors was conducted at one teaching hospital, a pre- and post-interventional study was then performed on 12 hospitals in Thailand from January 1, 2002 to June 30, 2003. Each hospital randomly selected 20 patients, who were on mechanical ventilation to be enrolled The study was divided into two phases; 1) pre-intervention, 2) post-intervention. Data collected included patients 'demography and risk factors for VAP During pre-interventional phase, data on risk factors for VAP was analyzed and fedback to healthcare providers in the wards by an infection control nurse (ICN) of the individual hospital. An educational programme on the prevention of VAP was introduced by the ICN. Ventilator-associated pneumonia rates and their risk factors were continuously monitored during the post-interventionl phase. RESULTS: Two hundred and forty four patients in the pre-interventional phase and 254 patients in the post-interventional phase were included. There was no significant difference in the demography between these two patient populations. After the intervetion, there was a significant improvement in hand-hygiene practices (p<0.001) among healthcare providers and increased use of sucralfate (p=0.05) for stress ulcer prophylaxis. Ventilation-associated pneumonia rate (40.5% vs. 24%; p<0.001) and crude mortality rate associated with VAP (12.3% vs. 8.7%; p<0.001) were also reduced CONCLUSION: The educational programme targeted on modifiable risk factors for prevention of VAP was effective and should be considered as an intervention to reduce VAP rates in developing countries.

Microbial contamination of antiseptics and disinfectants.

OBJECTIVE: To study the bacterial contamination of antiseptics and disinfections in-use and the risk factors for contamination. MATERIAL AND METHOD: Bacterial contamination of antiseptics and disinfectants was done by culturing in-use solutions. Eight commonly used solutions were studied: alcohol 70%, chlorhexidine 4%, and 0.5%, povidone iodine 7.5% and 10%, tincture iodine 1-2%, lysol 2% and sodium hypochlorite 0.5%. RESULTS: The following risk factors for contamination were found : preparation by unskilled personnel, improper containers and prolonged use. Contamination with bacteria were found in 1.8% of 16,142 samples tested Highest rate of contamination was found in Lysol 2%. There was no contamination of povidone iodine 10% and tincture iodine 1-2%. Bacterial contamination of antiseptics and disinfectants was highest in provincial hospitals and was not found in university hospitals. The rates of contamination correlated with the duration of use. Most bacteria isolated were those found in the environment. CONCLUSION: The contamination of in-use antiseptics and disinfectants was as high as 1.8%. Risk factors for contamination were improper preparation and prolonged use.

A study on the application of pasteurization of medical equipment.

OBJECTIVES: To study the need of pasteurization of medical equipment and the possibility of production of pasteurizer in Thailand. MATERIAL AND METHOD: The need of pasteurization of medical equipment was studied by a set of questionnaires to heads of the central sterile supply department (CSSD) and head ward nurses in 29 hospitals across Thailand. Efficacy of pasteurization was demonstrated by disinfection with an imported pasteurizer. A pasteurizer was later produced by the researchers and had it tested for efficacy in disinfection. RESULTS: There were 26 items of medical equipment that could be disinfected by pasteurization. The number of the equipment was 6.2 pieces per bed per week. Disinfection of the equipment was done in C.S.S.D. as well as in patient's wards. The imported pasteurizer was efficacious in disinfection. The pasteurizer made by researchers was convenient for use, not expensive to manufacture and the operating cost for disinfection was 2 to 6 folds less than that done by ethylene oxide gas. CONCLUSION: Pasteurization is effective in disinfection and is applicable to certain heat labile medical equipments. A pasteurizer is not difficult to produce, cheap and the operating cost is low. Pasteurization should be more widely applied in Thailand

Thailand Antimicrobial Resistance Containment and Prevention Program.

The Thailand Antimicrobial Resistance (AMR) Containment and Prevention Program was founded to develop, co-ordinate and implement AMR Containment and Prevention (AMRCP) operational actions in Thailand following the 'One Health' approach. This article summarises the ten AMRCP operational actions initiated during the initial phase of the programme from 2012 to 2016: estimating the national AMR burden; establishing the dynamics of AMR chains to understand how AMR in Thailand develops and spreads; developing a national AMRCP infrastructure; developing laboratory and information technology systems for surveillance of AMR, antibiotic use and hospital-acquired infections; regulating the use and distribution of antibiotics in humans and food animals; generating local evidence for promoting responsible use of antibiotics and efficient practices for infection prevention and control; designing AMRCP campaigns; creating an AMRCP package; implementing the AMRCP package in selected pilot communities; and conducting research and development on diagnostics, therapy and prevention of antimicrobial-resistant bacterial infections. The programme's core campaign is to stop producing AMR by promoting responsible use of antibiotics, and to stop the acquisition and transmission of AMR by promoting good sanitation and hygiene as well as compliance with infection control and prevention practices.