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.