A Descriptive Qualitative Study of Older Persons and Family Experiences with Extreme Weather Conditions in Northern Thailand.

Extreme weather can cause ill health in older persons due to a direct thermal effect on the body's thermoregulation and difficulties in maintaining a healthy lifestyle and accessing the health services they need. To understand experiences in relation to their exposures to extreme weather and how they responded to such weather conditions, including cold snaps, heat and air pollution in northern Thai communities, a descriptive qualitative study was conducted to uncover details and the essence of perspectives and experiences of older persons and family members. Three focus group discussions with 15 older persons and 15 family members occurred in three communities in Chiang Rai, a northern province of Thailand. Thematic analysis was performed. Experiences of older persons and families in relation to extreme weather conditions were described in five themes: local actions against weather changes, the double challenges, awareness and reactions to weather changes, protective and comfortable living environments, and mitigation of the impacts of weather conditions. Seasonal adaptability was key for older persons to stay safe and healthy during extreme weather changes. Heat, cold snaps, and air pollution made health and daily living routine maintenance among older persons challenging, especially among those with declining health. Older persons and families employed predictive and adaptive strategies to avoid and minimise extreme weather impacts and maximise their comfort and optimal living.

Prevalence and impacts of nosocomial infection in Thailand 2001.

OBJECTIVES: To study the prevalence and impacts of nosocomial infection (N.I.) in Thailand. MATERIAL AND METHOD: A point prevalence study on N.I. was carried out in 42 hospitals across Thailand in March 2001. The impacts of N.I. were done in the same hospitals by matched control groups in a period prevalence study March 12-25, 2001. RESULTS: The point prevalence rate of N.I. in 42 hospitals involving 18,456 patients across Thailand in March 2001 was 6.4%. The prevalence was higher in male than female patients (7.8% vs 5.0%). The prevalence rates of over 10% were found in 4 hospitals. The infection rate was highest in surgical followed in rank by medical, pediatric and orthopedic departments (9.1%, 7.6%, 6.1% and 5.8%) respectively. The commonest site of the infection was the lower respiratory tract, followed by urinary tract, surgical site and skin and soft tissue (34.1%, 21.5%, 15.0% and 10.5%). Gram-negative bacteria were isolated in 75.3% and gram-postive 18.4%. Penicillins, cephalosporins, aminoglycosides were the most used antimicrobials (31.2%, 25.2%, 12.3%). A period prevalence study on 53,882 patients during a 2 week period in March 2001 showed an infection rate of 2.5%. By matched control group study, an episode of N.I. was associated with 10.1 to 12.5 extra hospital days. The cost of antimicrobials for treatment of an episode of N.I. was 5919.50 baht (148 U.S. dollars). Thirteen point eight per cent of patients with N.I. died, 6.7% directly due to N.I. CONCLUSION: Nosocomial infection is common in hospitalized patients in Thailand and is associated high mortality rate and economic burden.

Development of national guidelines for the prevention and control of nosocomial infections.

OBJECTIVE: To develop a national evidence-based guidelines for the prevention and control of nosocomial infection. MATERIAL AND METHOD: Draft guidelines for the prevention and control of nosocomial infection were developed by the researchers and reviewed by a 10 member panel of experts. The guidelines were modified by brainstorming of 55 practitioners in July 2002. The guidelines were tested for their applicability in 20 hospitals across the country in 2002. The participants gave suggestions on the guidelines which were modified accordingly. The guidelines were finalized by brainstorming of the 55 practitioners in August 2003. RESULTS: National guidelines for the prevention and control of nosocomial infections were developed. Twenty-one topics were included. Modifications of the drafted guidelines were made four times according to the opinions of 10 experts, twice by brainstorming of 55 practitioners and by the suggestions of participants from 20 hospitals where they were tested. The practices in hospitals with different facilities were also suggested in the guidelines. CONCLUSION: National guidelines for prevention and control of nosocomial infection were formulated. Their application for use in every hospital and periodic reviews are expected.

Problems and obstacles in implementation of nosocomial infection control in Thailand.

OBJECTIVES: To study the problems in implementation of nosocomial infection (NI) control in Thailand and strategies to overcome the obstacles. MATERIAL AND METHOD: Interviewing administrators, chair-persons of infection control committee and doctors. RESULTS: During June 2002 and August 2003, 255 persons were interviewed by infection control nurses using a set of questionnaires. Administrators, chair-persons of infection control committee, doctors in 32 hospitals across the country were enrolled by stratified random sampling. Policy on NI control was known to 95.3% and implementation to 81.2% of subjects. The main obstacles of NI control was the lack of incentive (66.7%) and support from administrators (30.2%). Hospital administrators set NI control at high priority, in only 40.9%, they could be motivated by regular presentation of NI data. Infection control nurses (ICN) should ideally work full-time (88.6%) but in reality, only 20.8% did so. The main problem for NI control was the shortage of ICN posts in most hospitals. This resulted in no career ladder and incentive for ICN. To overcome these problems, support from administrators, more education programs in NI control and provision of posts for ICN, are needed. CONCLUSION: The main problems and obstacles an implementation of NI control were the lack of support from administrators and the lack of the ICN post.

Problems in the management of medical waste in Thailand.

OBJECTIVES: To identify problems in the management of medical waste in Thailand for future development. MATERIAL AND METHOD: The study was done in 39 hospitals during June and July 2002 by interviewing medical personnel on knowledge and attitude in management of medical waste, observation of practice and checking the amount of medical waste in waste bags. Certain laboratory investigations were done in dustmen. RESULTS: The amount of medical waste was 0.41 kilogram per bed per day. Problems identified were inadequate knowledge in management, improper practices, high incidence of sharp injury at work. Laboratory tests in dustmen showed evidence of pulmonary tuberculosis in 3.4%, parasites and intestinal pathogens in stools 5.1% and positive for HBsAg in 8.5%. CONCLUSION: Improper management of medical waste was present in all hospitals. Risks of exposure and incidence of infection related to the management were at concerned levels. Education and practice guidelines are needed.

Skin flora of patients in Thailand.

BACKGROUND: Studies taken from different hospitalized patient populations, environments, and geographic regions reveal differences in the numbers and species of organisms colonizing the skin. Our aim was to determine the types and amounts of skin flora, and examine the factors associated with variations in microbial skin flora in patients in Thailand. METHOD: We studied 350 outpatients and 500 inpatients at Siriraj Hospital in Bangkok, Thailand. The skin at the forearm and the sternum of each patient was cultured by contact plate technique. RESULTS: The number of skin flora colony-forming units (CFUs) were correlated to the site of sampling. There was a significant correlation of CFUs between samples from the forearm and the sternum in patients who were hospitalized (r = 0.6; P <.001) and in outpatients (r = 0.5; P <.001). The numbers of micro-organisms on the sternum was significantly greater than the number cultured from the forearm for all patients. Inpatients had significantly more organisms on the the forearm and sternum compared with outpatients. High counts (CFUs > 600) were found more frequently in patients who were hospitalized; had chronic obstructive pulmonary disease, diabetes mellitus, or autoimmune diseases; and were undergoing operation and receiving antibiotics. Acinetobacter spp and methicillin-resistant Staphyloccoccus aureus were found more frequently in patients who were hospitalized. CONCLUSION: Skin flora of patients in tertiary care hospitals in Thailand has higher CFUs, and A baumannii is prevalent, especially in patients who are hospitalized.

Risk factors for Pseudomonas aeruginosa bacteremia in Thai patients.

A case control study to determine the risk factors for P. aeruginosa bacteremia was conducted in patients admitted to Siriraj Hospital in 1998. The case group consisted of 65 patients with P. aeruginosa bacteremia. There were 3 control groups. 65 patients with E. coli bacteremia, 64 patients with S. aureus bacteremia and 65 patients without bacteremia. Demographic information and potential risk factors i.e. type of infection, associated diseases/conditions, procedures/surgery, previous/current use of antibiotics and previous/current use of immunosuppressive/cytotoxic agents were extracted from the patients' medical records and compared. Univariate analysis revealed that the factors associated with P. aeruginosa bacteremia were infections acquired while hospitalized, hematologic malignancy, neutropenia, COPD, antibiotic receivers, cytotoxic agents receivers. However, multivariate analysis revealed that only hematologic malignancy, infections acquired while hospitalized and previous use of parenteral antibiotics were risk factors for P. aeruginosa bacteremia.