Nursing aspects of infection control in developing countries.

The quality of the infection control programme in developing countries is determined by the resource allocation to the health sector and the health care delivery system. These depend to a great extent on the socio-economic development of the country. Morbidity and mortality from communicable infections, such as diarrhoeal diseases and malaria are high. There is often an irregular water and electricity supply. Essential material resources, e.g. paper towels, gowns, gloves, masks and disinfectants may not be available and some disposable materials have to be re-used. Most hospitals have no infection control programme due to the lack of awareness of the problem or absence of trained personnel in infection control practices. Developing countries differ in many ways from each other, often having dissimilar cultures and languages and state of socio-economic development. Solutions will emerge only if there is co-operation between countries and provision of assistance, where appropriate, from wealthier countries.

Outbreak of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit.

An outbreak of methicillin-resistant Staphylococcus aureus (MRSA) occurred in a neonatal intensive care unit (NICU) over a period of 2 months involving 16 babies, mainly of low birth weight. Arbitrary grouping of the isolates showed that there were apparently three different strains involved in the outbreak, as determined only by antibiogram. Twenty-three out of 27 isolates were allocated to 'group 1' based on antibiotic sensitivity pattern. Control of spread of the MRSA in the unit was difficult because of some technical constraints but eradication was finally achieved by cohort nursing and treatment with topical mupirocin in paraffin base. All MRSA isolates were resistant to gentamicin, erythromycin, tetracycline and at least four other antibiotics but sensitive to vancomycin. Overcrowding, limited space, inadequate cleaning of the equipment and initial lack of correct attitude to scrupulous handwashing techniques, all appeared to contribute to the ease of spread of the strains involved.

Device-day infection rates - a surveillance component system for intensive care units at Security Forces Hospital, Riyadh, Saudi Arabia.

A surveillance component system for Intensive Care Units (ICUs) designed to account for major extrinsic risk factors for nosocomial infections using device days as the denominator has been advocated. A study of the surveillance component system in ICUs was conducted in Security Forces Hospital (SFH), Riyadh, Saudi Arabia, from February 1993 to January 1994 to verify the validity and compare the device-related infection rates with the infection rates based on patient admission and patient days. The standard recommended method was used in data collection. Device-associated infection rates vary by ICU types and device exposure. The surgical ICU (SICU) had the highest pneumonia rate while the pediatric ICU (PICU) had the lowest, being 22.0 and 6.4 per 1000 ventilator days respectively. Bacteremia was highest in the PICU with 20.7/1000 intravascular catheter days. The urinary tract infection rate of 11.4/1000 urinary catheter days was the highest in the medical ICU (MICU). These were statistically significant (P>0.001). The conclusion from the demonstration of these variables is that the use of the surveillance component system gives specific information on the effect of invasive devices in the occurrence of infection related to their use in the various ICUs. It permits the calculation of risk-specific infection rates, being a marker for the unit's invasive practices. Improved handwashing and the wearing of sterile gloves reduced the central intravascular catheter bacteremia rate in PICU from 20.7 to 10.0/1000 catheter days.

Pyogenic meningitis in Ibadan, Nigeria. A 15-month prospective study.

Between January 1976 and March 1977, cerebrospinal fluid samples from 2130 patients at University College Hospital, Ibadan, Nigeria were examined, 130 patients were shown to have pyogenic meningitis. The commonest causative bacteria were Streptococcus pneumoniae (53.8%), Haemophilus influenzae (23%), Neisseria meningitidis (7.7%) and Klebsiella spp. (3%). Most of the infections occurred in very young children: 47% of all patients were under 1 year of age, and 69% were under 5 years old. The overall case fatality rate was 30% (Strep. penumoniae infection 28.6%, H. influenzae and N. meningitidis infection both 20%). All 4 patients with klebsiella infection died. There was a noticeable increase in the incidence of Strep. pneumoniae strains showing resistance to tetracycline, between 1974 and 1976, and this was attributed to the widespread use and abuse of the antibiotic among the general population. Two strains of H. influenzae were found to be resistant to ampicillin; such strains have not previously been reported from Nigeria. The results of the study support the use of a combination of ampicillin and gentamicin in the initial treatment of pyogenic meningitis in Ibadan.

Septicaemia in the tropics. A prospective epidemiological study of 146 patients with a high case fatality rate.

A prospective study showed that during the first 6 months of 1976, 146 patients out of a total of 3938 admitted to a hospital in Nigeria were suffering from septicaemia, or developed the condition while in hospital. Findings differed from those reported from developed countries in that the majority of infections were community acquired, those most frequently and severely affected were the very young, and salmonella spp. and Staphylococcus aureus were the most important pathogens. However, other gram-negative organisms, particularly klebsiella spp. and Pseudomonas aeruginosa also occurred frequently among the very young, in whom they produced a high mortality. The type of epidemiological pattern, and the bacteria responsible for the bloodstream infections reflect a differing age structure of the population in tropical countries from that in temperature developed countries, as well as the fact that bacterial infections are still one of the most important causes of illness and hospital admission among tropical communities.