The novel application and effect of an ultraviolet light decontamination strategy on the healthcare acquisition of carbapenem-resistant Enterobacterales in a hospital setting.

BACKGROUND: The role of the hospital environment as contributory to healthcare acquisition of multidrug-resistant organisms (MDROs) is increasingly recognized. Ultraviolet light decontamination can minimize the environmental bioburden, thereby potentially reducing healthcare acquisition. This effect has been demonstrated for typical environmental MDROs, e.g. meticillin-resistant Staphylococcus aureus, vancomycin-resistant entero-cocci, and Clostridioides difficile; however, its role in reducing carbapenem-resistant Enterobacterales (CRE) incidence rates is unclear. AIM: To evaluate the impact of continuous ultraviolet light (C-UV) on healthcare acquisition rates of CRE. METHODS: A 26-month pragmatic, prospective interventional study with addition of C-UV decontamination to standard cleaning was conducted in units at high risk for CRE acquisition. Introduction of C-UV followed a 12 month baseline period, with a two-month wash-in period. Implementation included terminal decontamination at discharge and a novel in-use protocol, whereby rooms occupied for ≥48 h were decontaminated during the course of the patients' in-hospital stay. Incidence density rates of CRE during the intervention period were compared to the baseline period using interrupted time series regression. Rates were adjusted for ward/admission prevalence and analysed according to C-UV protocol. FINDINGS: The in-use C-UV protocol demonstrated a significant negative association with the incidence density rate of CRE when adjusting for CRE admission rate (P = 0.0069). CRE incidence density rates decreased significantly during the intervention period (P = 0.042). Non-intervention units demonstrated no change in incidence density rates when adjusting for ward and/or admission prevalence. CONCLUSION: C-UV decontamination can potentially reduce healthcare acquisition of CRE when implemented with an in-use protocol.

Reimagining liver transplantation in South Africa: A model for justice, equity and capacity building - the Wits Donald Gordon Medical Centre experience.

The challenge of providing effective and integrated liver transplant services across South Africa's two socioeconomically disparate healthcare sectors has been faced by Wits Donald Gordon Medical Centre (WDGMC) since 2004. WDGMC is a private academic hospital in Johannesburg and serves to supplement the specialist and subspecialist medical training provided by the University of the Witwatersrand. Over the past 14 years, our liver transplant programme has evolved from a sometimes fractured service into the largest-volume liver centre in sub-Saharan Africa. The growth of our programme has been the result of a number of innovative strategies tailored to the unique nature of transplant service provision. These include an employment model for doctors, a robust training and research programme, and a collaboration with the Gauteng Department of Health (GDoH) that allows us to provide liver transplantation to state sector patients and promotes equality. We have also encountered numerous challenges, and these continue, especially in our endeavour to make access to liver transplantation equitable but also an economically viable option for our hospital. In this article, we detail the liver transplant model at WDGMC, fully outlining the successes, challenges and innovations that have arisen through considering the provision of transplant services from a different perspective. We focus particularly on the collaboration with the GDoH, which is unique and may serve as a valuable source of information for others wishing to establish similar partnerships, especially as National Health Insurance comes into effect.

Public attitudes to organ donation among a sample of urban-dwelling South African adults: a 2012 study.

BACKGROUND: Published literature suggests that attitudes toward organ donation in South Africa are generally positive. However, there has been a decline in the actual number of transplants taking place annually, which is not consistent with expressed positive attitudes. OBJECTIVES: Assess the attitudes of a representative sample of the urban-dwelling South African population toward organ donation and how these might affect transplant numbers. METHODS: A structured questionnaire was utilized to measure attitudes among a study population of 1048 adults in five major metropolitan areas of South Africa. Field work was undertaken by supervised field workers. Written informed consent was obtained from all participants. RESULTS: Eighty-nine percent (89%) of respondents had heard of organ donation, and 77% indicated that they would accept an organ transplant if necessary. Seventy percent (70%) of respondents specified they would be willing to donate their own organs after death, while 67% expressed willingness to donate a relative's organs after death. Participants were more positive about kidney donation than any other organ. CONCLUSION: Public attitudes toward organ donation among this population are generally positive. Recommendations include cultural and linguistic sensitivity in educational and advertising campaigns, as well as extensive research into other possible causes of organ shortage.