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INTRODUCTION: Enteric fever, caused by Salmonella spp. is a major cause of morbidity and mortality worldwide and endemic in many developing countries including India and other South-East Asian countries. Blood culture is regarded as the gold standard for diagnosis. Currently, the standard serological method is tube agglutination with moderate sensitivity and specificity. Dot blot assay detecting IgM and IgG antibodies to a specific 50kD Outer Membrane Protein (OMP) antigen of Salmonella spp. is a simple, reliable, affordable and rapid test which can help in the early diagnosis of typhoid fever. AIM: To systematically evaluate the different diagnostic modalities against a composite reference standard for the better diagnosis of typhoid fever in clinically suspected cases of typhoid fever. MATERIALS AND METHODS: This cross-sectional, prospective analytical study was carried out at a tertiary care hospital attached to Medical College in central India from November 2011 to June 2013. A total of 163 blood samples, collected aseptically from patients clinically diagnosed of enteric fever, were tested using various component tests like blood culture, Tube Widal and Dot Enzyme Immuno Assay (Dot EIA) for IgG and/or IgM. Composite Reference Standard (CRS) was created for defining the confirmed cases of typhoid fever using the component tests, wherein culture positive and in absence of culture positivity any two component test positive patients were taken as confirmed cases. All the component tests were evaluated against the CRS for sensitivity, specificity, PPV and NPV and their significance in relation to the duration of illness using statistical tests of significance. RESULTS: Blood culture was positive in 16 (9.81%) whereas, Tube Widal, IgM, IgG and IgM+IgG in combination were positive in 88(54%), 58(35.58%), 30 (18.40%) and 75 (46.01%) respectively. Using a two test criteria of CRS framed, a total of 104 patients were considered as confirmed cases. Though specificity of blood culture was 100%, the sensitivity was low with significant detection rate in 1st week of illness. Tube Widal showed a sensitivity of 65.38% and specificity of 89.83% with significant detection rate in 2nd week. Dot blot assay for IgM, IgG and Combined IgM and IgG showed a sensitivity of 71.15%, 65.28% and 51.72% respectively whereas, the specificity was 10.16%, 47.45% and 74.57% respectively with significant detection rate in 2nd and 3rd week of illness. CONCLUSION: It can be concluded that though blood culture is still the gold standard, Dot blot assay found to have high sensitivity and good specificity might be a practical alternative test for the rapid diagnosis of typhoid fever if interpreted with care particularly using a composite reference standard. Further, it is reliable, simple to perform and rapid; results being available in 1 hour when compared to 48 hours for blood culture and 18 hours for Tube Widal test.
RESUMO
BACKGROUND: Infection due to hospital-acquired microbes is an evolving problem worldwide, and horizontal transmission of bacterial organism continues to cause a high nosocomial infection rate in health care settings. Most nosocomial infections are thought to be transmitted by the hands of health care workers.The application of hand hygiene is effective in reducing infection rates. OBJECTIVES: To assess the level of knowledge and attitude regarding hand hygiene practices amongst the health care professionals and to identify areas of gaps in their knowledge and attitude. MATERIALS AND METHODS: A cross-sectional study. RESULT: A total 160 respondents were studied about their knowledge and attitude towards hand hygiene practices and significant difference with a p-value of 0.0025 was observed regarding most frequent source of germs responsible for health care associated infections among resident and nurses. A significant difference with p-value of 0.0001 & 0.04 was observed in colonization due to jewellery and artificial nail among the study groups. The attitude regarding correct hand hygiene practices to be followed at all times was found to be better among nurses (62.5%) as compared to residents (21.3%) which was found to be highly significant with p-value <0.001. CONCLUSION: Present study highlights the need of repeated training sessions regarding hand hygiene practices among the health care workers to provide the current knowledge in the area with a behavioral change in attitudes and practices leading to reduction of nosocomial infections.
