Disseminated trichosporonosis in a burn patient: meningitis and cerebral abscess due to Trichosporon asahii.

A 44-year-old diabetic female presented to a hospital in Jamaica with thermal burns. Trichosporon asahii was isolated from facial wounds, sputum, and a meningeal swab. Dissemination of the fungus was demonstrated in stained histological sections of the meninges and a brain abscess at autopsy. Pure growth of the fungus from patient samples submitted and an environmental isolate obtained from a wash basin in the hospital supported the diagnosis.

Surveillance of nosocomial "alert organisms" at the UHWI - 1995-1997 - Poster presentation

This survey was conducted to determine the types, prevalence and distribution of "alert" organisms within the UHWI. Continuous surveillance of "alert organisms" at the University Hospital has been conducted since 1995. Amongst the Gram positive isolates, Methicillin-resistant Coagulase-negative Staphylococci and Enterococci were more often reported (30 - 37 percent) than Methicillin-resistant Staph. aureus (9 - 13 percent) (MRSA). Pseudomonas aeruginosa accounted for the largest number of Gram-negative isolates (25 - 36 percent) followed by Acinetobacter and Klebsiellae (11 - 19 percent). Resistance to several groups of antibiotics was especially notable in Acinetobacter and Klebsiellae during 1997. Extended-spectrum betalactamase-producing Klebsiellae emerged in late 1996 (6.3 percent) and showed an increase in 1997 (37.1 percent). Ceftazidime-resistant Ps. Aeruginosa increased from 2.7 percent to 7.2 percent over the period. The types of organisms and their characteristic antibiogram can be used to direct further treatment and infection control policies.(AU)

The emergence of stenotrophomonas maltophilia as a pathogen in the UHWI

Stenotrophomonas maltophilia is a Gram-negative bacillus, which is known to occur in hospitals and especially in Intensive Care Units. We reported the emergence of the organism at the UHWI for the first time in 1996. During routine infection control surveillance, conducted by the Microbiology Department, Steno maltophilia was first identified in the ICU, UHWI in October 1996 and was the only case reported in that year. Isolates were obtained from blood, urine, sputum, trap sputum, wound, skin, catheter tips and environmental samplimg. Patient's clinical records were reviewed and an attempt made to determine possible risk factors. In 1997 there was a total of 7 patients with Steno. Matophilia with 4 (57 percent) of these coming from the ICU. Up to July 1999, 26 cases were isolated, of these 15 (58 percent cases) came from ICU. The organism was mainly resistant to Menonem, Imipenem, Gentamicin and sensitive largely to Ciprofloxacin and Ceftazidime. Since it was first reported in 1996, Steno. Malto has emerged as a significant pathogen at UHWI. Patients most at risk are those in the ICU. Its multi-drug-resistance characteristics distinguish it as a potentially dangerous nosocomial pathogen and impose the necessity for urgent action to prevent and control its spread.(AU)

Use of disinfectants and antiseptics in Jamaican health care institutions - a knowledge, attitudes, beliefs and practices study - abstract

Little has been published concerning choices and use of disinfectants and antiseptics in Caribbean health care institutions. This paper reports some findings from a cross-sectional study of knowledge, attitudes, beliefs and patterns of use concerning those chemicals. The study was carried out among 176 distributors or users from 12 public health care institutions in the cities and major rural towns of Jamaica. Most respondents acknowledged no distinction between the terms "disinfectant" and "antiseptic". Pharmacies gave the most accurate definitions. Fifteen per cent of all respondents failed to give any definition. In general, female respondents were better informed than males. Bleach, "Savlon" (R) and phenolics were the most commonly used disinfectants, while alcohol was seldom acknowledged for this purpose. Disinfectants were supplied sometimes as concentrates and sometimes in diluted form; they were not always stored appropriately and were often over- or under-diluted. Few respondents knew the recommended strengths for effective disinfection and chemosterilization. Concerning disinfectants, a small number of ancillary workers and registered nurses listed "smell" as their most important characteristic. Some persons believed that all disinfectants are safe and effective for all purposes. When supplies were short, inappropriate substitution occurred in 37 percent of cases. Policy guidelines for cleaning and disinfection are urgently needed in Jamaican health institutions. Education of health workers should stress appropriate selection, storage, and monitoring of the use of disinfectants and antiseptics. Pre-employment and in-service training of workers in infection control, including disinfectant use, is highly recommended (AU)

Knowledge, attitudes, beliefs and practices of health care personnel: on the use of disinfectants in health care facilities in Jamaica

The study of the knowledge, attitudes and practices on th e use of disinfectants in health care institutions was conducted during February and March 1993. The study sought to determine baseline data and to compare the pattern of usage by users of these chemicals as related to infection control measures. This cross-sectional study focused on the different categories of health care personnel who are directly responsible for the distribution, maintenance and uses of disinfectants and antiseptics in hospital and health centres. Twelve institutions (6 hospitals and 6 health centres) of the various types were selected by taking a stratified, systematic sample with random starting point. Self administered and face to face interviews were carried out using a questionnaire. Two hundred health care personnel were selected, 176 responded a response rate of 88 percent. The none responses were mainly from the self administered category. Marginal interviewees showed a reluctance and abstained. The data indicated low ratings on the overall knowledge and attitudes of health care personnel. The results have shown statistical significance in some of these responses, for example: (a) the definiton of the disinfectant and antiseptic. (b) the recommended strength and minimum contact times documented for the three most frequently used disinfectants and antiseptics. This knowledge is especially useful as this will alleviate mis-approriateness in the use of these chemicals. Health care personnel exhibited positive attitudes in the use of disinfectants and antiseptics as infection control measures. However, these positive attitudes did not coincide with the observed practices. Differences were observed in attitudes among the various groups. For example: The question of the most important characteristic of a disinfectant/antiseptic, 78 percent to 84 percent identified germicidal (killing effect) as the most important. The study presents very important implications for ongoing efforts in prevention and control of infections in health care facilities in Jamaica. This study has revealed the necessity for improvement of serious deficiencies in some crucial areas, especially in the services of disinfection cleaning measures (AU)

Infection in a multidisciplinary intensive care unit at the University Hospital of the West Indies

The records of 1,252 patients were reviewed to determine the incidence of infection, mortality and associated risk factors in our multi-disciplinary intensive care unit (MD-ICU) during the period 1977 to 1982. The infection rate and the mortality rate were 24 percent and 22 percent respectively. The mortality rate in the infected group was 25 percent. The infection rate was higher in the intra-abdominal and trauma group as compared to the cardio-thoracic group (P<0.05). The incidence of ICU-acquired respiratory tract infection (41 percent), wound infection (17 percent) and urinary tract infection (15 percent) was significantly different from non-ICU acquired infections (P<0.05). The commonest site of infection was the respiratory tract (37 percent). The incidence of infection was directly related to the duration of medical devices left in situ and the length of stay in the unit (more than seven days) (AU)

Prediction of post-operative wound infection by a simple score system

Eight hundred and twenty-nine surgical patients were monitored for post-operative wound infections as well as associated risk factors from January to December 1980 at the University Hospital of the West Indies. Age over 50 years,diabetes mellitus, duration of pre-operative hospitalisation, urgency of operation, duration of operation > 2 hours and the degree of wound contamination were found to be association with increased risk of infection. A simple score system has devised to predict the overall risk of infection. A simple score system has been devised to predict the overall risk of wound infection in general surgical patients (AU)

Nosocomial surgical infections: incidence and cost in a developing country

Eight hundred twenty-nine patients were monitored for nosocomial surgical infections from January to December 1980 at the University Hospital of the West Indies. Two hundred twenty-five patients (27 percent) had 189 post-operative infections (POWI) and 295 other nosocomial infections with an average of 2.1 infections per infected patients. The incidence of POWI was 22.8 percent, varying from 7.3 percent in clean to 82.2 percent in infected wounds. The most common organisms isolated were gram-negative bacilli and Staphylococcus aureus. The most frequent nosocomial infection other than was urinary tract infection (27.8 percent). A statistically signifcant number of urinary tract infections and septicemias were associated with the use of medical devices such as indwelling urethral catheters and central venous pressure lines (p < 0.001). Septicemia was frequently associated with operations on the lower gastrointestinal and hepatobiliary tracts ( p < 0.001). The postoperative stay of an infected patient was prolonged by an average of 18 days. The total excess cost of hospitalization for the infected patients was U.S. $170,000 (AU).

Safety and immunogenicity of a new Haemophilus influenzae type b vaccine in infants under one year of age

64 healthy infants, 2-3 months old, were randomly assigned to one of three vaccination groups which either diphtheria-pertussis-tetanus (DPT) vaccine, Haemophilus influenzae type b capsular polysaccharide polyribosyl-ribitol phosphate (PRP) vaccine, or PRP+P (with pertussis adjuvant) vaccine in three doses at intervals of two months. Local and systemic reactions occurred most frequently after DPT vaccination and least frequently for PRP alone. Data for 60 infants from whom complete sera sets were available indicated that 70 percent of the infants who received three doses of PRP+P showed two fold or greater increases in titers of antibody to PRP with final values above the level assumed to give protection against invasive H. influenzae type b disease (>0.15 ug/ml). In contrast, less than 10 percent of infants who received PRP vaccine alone showed 2-fold or greater increases (Summary)