Characteristics and determinants of Thailand's declining birth rate in women age 35 to 59 years old: data from the Fourth National Health Examination Survey.

OBJECTIVE: To describe characteristics and determinants of Thailand's declining birth rate using national representative survey data. MATERIAL AND METHOD: The Fourth National Health Examination Survey was conducted between 2008 and 2009. Four stages of stratified probability samples, proportionate to size, were used to represent the whole Thai population. Information from women aged 35 to 59 years old was included in the analysis. Curve estimation was used to characterize the correlation between the number of children ever born and the age of married and un-married women. Binary logistic regression analysis was used to identify predictors of having fewer than two children among ever married women. RESULTS: Of all 4120 women, the number of children decreased sharply among the oldest women aged 45 to 59 years old, decreased less sharply for women younger than 45 years of age, reached the lowest level at the age of 37 and 38 years old, and then increased minimally among the younger women surveyed. Among those who were ever married (n = 3,761), the independent predictors of having one or no child instead of having two or more children were aged 45 to 49 compared to 50 to 59 years old (OR = 1.66; 95% CI = 1.37-2.00), age 35 to 44 compared to 50 to 59 years old (OR = 1.39; 95% CI = 1.16-1.68), living in households with wealth index level 3 compared to level 1 (OR = 1.28; 95% CI = 1.01-1.63), urban residence (OR = 1.33; 95% CI = 1.14-1.57), attaining secondary school education (OR = 1.35; 95% CI = 1.11-1.64), and having junior college diploma or higher level of education compared to elementary or no education (OR = 1.81; 95% CI = 1.39-2.34). CONCLUSION: Birth rate of Thai women declined steeply in the past then less steeply, and might have begun to rise minimally in recent years. Younger age, living in an urban area, and having higher socioeconomic status were predictors of having fewer than two children.

Roles of infection control nurses in Royal Thai Army hospitals.

OBJECTIVE: To study the performance according to the assigned roles of infection control nurses (ICNs) in Royal Thai Army hospitals. MATERIAL AND METHOD: Interviewing ICNs in 6 hospitals. RESULTS: During April and May 2002, 11 ICNs in 6 hospitals were interviewed. Two hospitals had been accredited and 4 were applying for hospital accreditation. Full-time ICNs were identified in 5 and part-time in 6. The ICNs were graduated with bachelor and master degrees in 5 and 6 respectively. Two ICNs graduated with master degree in IC. All could perform their roles in administration, education, surveillance, personnel health, consultation and quality improvement. Only 7 ICNs had experience in outbreak investigation. None were principle investigators in research except for their master degrees. The main problem was the absence of ICNs posts in all except 1 hospital. CONCLUSION: Infection control nurses in Royal Thai Army hospitals in the present study could perform their roles according to assignment except involvement in outbreak investigation in some and in research as the principle investigators in all.

Roles of infection control nurses in community hospitals.

OBJECTIVES: To evaluate the roles of infection control nurses (ICNs) and to detect problems, obstacles during work and needs for support in community hospitals. MATERIAL AND METHOD: A descriptive study, data from interview and questionnaire survey of 2 ICN from HA awarded hospitals and 146 IC nurses from hospitals applied for HA. RESULTS: From April to May 2002, questionnaires were returned for 115 (81.56%) plus 7 interviews for a total of 122 samples. The practiced HA IC roles included counseling (86.5%), surveillance (83.1%), administration (82.8%), employee health (82%), education (80%), quality development (76.3%), epidemic investigation (72.2%) and research (10.4%). The major problems and obstacles included inadequate IC knowledge, multiple responsibilities, inadequate cooperation, less administrative support, inadequate budget and documents. CONCLUSION: The present study suggested that the IC research role was the least done because of inadequate knowledge, too heavy work load and lack of administrative support.

Roles of infection control nurses in regional hospitals.

OBJECTIVES: To evaluate the roles of infection control nurses (ICNs) in regional hospitals and to detect problems, obstacles in practice and needs for support. MATERIAL AND METHOD: A descriptive study by interview and questionnaire survey of 16 ICNs from regional hospitals appling for HA. RESULTS: From February to April 2002, a study by interview and questionnaires was done in 16 ICNs from 10 regional hospitals applying for HA. Most of the ICNs practised IC roles according to HA criteria except for hospital employee health, NI surveillance and research. The major problems and obstacles included the lack of IC positions, inadequate ICNs, lack of support from hospital administrative personnel, too heavy work load, lack of: IC experts, budget for IC, equipment, IC research data and education material. CONCLUSION: The present study suggested that roles of ICNs in hospital employee health, NI surveillance and research were inadequate because of the lack of full time ICNs, too heavy a work load, lack of: IC consultants supply and administrative support.

Roles of infection control nurses in provincial hospitals.

OBJECTIVE: To study the roles of infection control nurses (ICNs) in provincial hospitals. MATERIAL AND METHOD: Interview using a semi-structured interview form. RESULTS: Nine hospitals were enrolled by stratified sampling and 11 ICNs were included. Interview was done by the researcher during April and May 2002. All ICNs were female and in middle-aged group. Their mean experience in IC was 6.4 +/- 4.5 years. All ICNs could perform their duties according the roles set by the Department of Nursing in surveillance, personnel health, education, consultation, administration and quality improvement. Only about one half had experience in outbreak investigation and research. The commonest problems were excessive workload, lack of co-operation of medical personnel and lack of budget for immunization. CONCLUSION: All sampled ICNs in provincial hospitals performed their roles except only one half were involved in outbreak investigation and research.

Development of quality indicators for sterilization practices of the central sterile supply department.

OBJECTIVE: To develop quality indicators for assessing the performance of central sterile supply department. (CSSD). MATERIAL AND METHOD: Quality indicators for sterilization in CSSD were searched by literature review and by current situation analysis by 79 infection control nurses (ICNs) and 83 heads of CSSD. Quality indicators were drafted and subsequently validated by 5 experts. The feasibility and applicability of the quality indicators were tested in 37 ICNs and 34 heads of CSSD. The quality indicators were finally refined by a forum of 5 experts and 5 representatives from CSSD. RESULTS: A total of 30 quality indicators were developed. These include 9 indicators for structure, 12 for process and 9 for output of CSSD. The quality indicators were deemed appropriate for the assessment of the quality of CSSD in Thailand. CONCLUSION: Thirty indicators were developed for assessing the quality of CSSD.

Evaluation of a training course in infection control for nurses.

OBJECTIVE: To evaluate the effectiveness of a training course in infection control for nurses. MATERIAL AND METHODS: A quasi-experimental study was performed from November 1, 2001 to December 31, 2002. The study was divided into three phases; 1) pre-intervention (November 1-30, 2001) to survey baseline data among participants, 2) intervention (January 1-31, 2002) to establish, develop and conduct the training course, 3) post-intervention (February 1, 2002 to December 31, 2002) to evaluate the effectiveness of the training program, and conduct a workshop for infection control project presentations. The research instruments consisted of questionaires and a focus group discussion guide. RESULTS: Forty-six nurses who had experience of working as infection control nurses (ICN) for more than one year and 46 hospital administrators were enrolled in the pre-interventional phase. Major problems identified among ICNs were inadequate knowledge, multiple simultaneous job descriptions, overwork and lack of collaboration from colleagues. After intervention, significant improvement was observed on their knowledge and confidence among ICNs (rating scale, 4.09 vs. 3.43; p< 0.001). All administrators agreed that the training course was beneficial to ICNs and believed that the problems in practices of IC would be solved. More satisfaction of ICNs among hospital administrators was also observed (97.7% vs. 28.3%; p< 0.001). CONCLUSION: The present study suggested that the training course to provide practical knowledge for ICNs be effective and should be conducted periodically to keep up with the advance in medical technology. An ICN network with other academic institutions should be established.