Radiology imaging equipment and accessories as possible Fomites of Nosocomial pathogens

Thesis (MSc (Radiography))--Cape Peninsula University of Technology, 2019Background: Hospital-acquired infections (HAIs) known as nosocomial infections are a major challenge within the health-care environment. Although investment and time are continually spent on the eradication of HAIs, the problem still exists. The European Centre for Disease Prevention and Control (2015) reported that annually, 4,100,000 patients in Europe acquire additional diseases during their stay in the hospital resulting in 14,700 deaths. Nosocomial infections therefore contribute to the imbalance between resources for the management of hospitals. This is a particular challenge in developing countries like those in Sub-Saharan Africa, of which Ghana is part and, where very limited resources are available for the high volume of patient output. Radiology is a high technology service department that provides imaging to numerous inpatients and outpatients on a continuous basis. This means that items in the radiology department may serve as possible reservoirs for the transmission of nosocomial pathogens from one individual to another. Where Radiology resides within a health-care system that is unable to give adequate attention to the spread of nosocomial infections or even to proper infection control measures, HAIs becomes a real possibility. Aims: The aim of this study was to determine whether radiology imaging equipment and accessories for general radiography are possible fomites of nosocomial pathogens. The study also aimed at investigating the effectiveness of the disinfectant chemical agents (chlorine bleach/sodium hypochlorite and methylated spirits) used for cleaning surfaces at the research site. Furthermore, the study aimed to observe the cleaning procedures and practises by radiographers in general radiography. Methodology: The design of this research included an observational and an experimental phase. The study was conducted in the radiology department of a Teaching Hospital (TH) in Ghana. Swabbing, using wet sterile swab sticks was the method for sample collection. This was done on one occasion without cleaning of the selected x-ray equipment and accessories and another occasion after cleaning with the department’s preferred disinfectant chemical agents. The swab samples were then taken to the microbiology laboratory of the University of Ghana for culturing and identification. MacConkey and blood agar media were used to prepare the culture media. The prepared media were put into petri dishes and swab samples were inoculated onto the culture plates. Culture plates were then incubated for 24 hours, at a temperature of 37ºC. At the end of the incubation period, the culture plates were viewed macroscopically under a bright light, to identify any bacterial growth; according to their colony forming characteristics. Seven radiographers (n=7) were observed for a period of one month on the current cleaning procedures and practises in the radiology department. How thoroughly the equipment and accessories were cleaned (how much time spent per item) was recorded. Damp dusting (using cotton wool moistened with methylated spirits or chlorine bleach), cleaning equipment using methylated spirits or chlorine bleach after each contact with body fluid, hands washing after each patient using water and liquid soap, washing of hand randomly after patients (or in between patients) using water and liquid soap, were observed and recorded. Data was captured and analysed using the IBM SPSS Statistics Version 25. Results: The selected radiology imaging equipment and accessories swabbed were found to be contaminated with pathogens. Organisms identified were Staphylococcus aureus, Coagulase-negative staphylococci, Bacillus species(spp.), Shigella spp., Shigella sonnei., Klebsiella spp., Salmonella Paratyphi A, Salmonella Typhi, Providencia rettgeri, Enterobacter spp. and Citrobacter spp. Staphylococcus aureus was the predominate pathogenic isolate identified. A significant number of the Staphylococcus aureus and CoNS isolated was methicillin-resistant. Bacillus spp. was the predominant non-pathogenic isolate identified in the study. Statistically there was no significant difference (p=0.5835) between the total number of occurrences of bacterial isolates in both rooms after decontamination. The observation phase demonstrated that no documented protocol or infection control procedures were available. It was further observed that only one of the seven radiographers washed his/her hands after each patient, but that all radiographers practised hand washing and equipment cleaning when the procedure involved body fluid from patients. Conclusion: The research established that radiologic equipment and accessories were often exposed to pathogens and are therefore possible fomites of nosocomial pathogens. The effectiveness of the cleaning agents (methylated spirits and chlorine bleach) was not adequate. Radiographers partially practised infection control measures. Based on the findings of this study it recommended that a policy and procedure must be prepared and an awareness campaign/training of radiographers conducted. Other cleaning agents must also be investigated in a comparative study to determine the most effective agent (but still affordable within the resource constrained environment)

Clinical features of COVID-19 in Ghana: symptomatology, illness severity and comorbid non-communicable diseases

Objective: This analysis described the clinical features of COVID-19 in the early phase of the pandemic in Ghana.Methods: Data were extracted from two national COVID-19 treatment centers in Ghana for over 11 weeks(from March to May 2020). Descriptive and inferential statistics were performed. Modified Ordered Logistic and Negative Binomial Regression analysis were applied to establish factors associated with illness severity and Non-communicable Disease (NCDs) counts respectively. All analysis was conducted at the 95% confidence level (p-value ≤ 0.05) using Stata 16.Results: Among the 275 patients, the average age was 40.7±16.4, with a preponderance of males (54.5%). The three commonest symptoms presented were cough (21.3%), headache (15.7%), and sore throat (11.7%). Only 7.6% of the patients had a history of fever. Most patients were asymptomatic (51.65). Approximately 38.9% have an underlying co-morbid NCDs, with Hypertension (32.1%), Diabetes (9.9%), and Asthma (5.2%) being the three commonest. The odds of Moderate/severe (MoS) was significantly higher for those with unknown exposures to similar illness [aOR(95%CI) = 4.27(1.12-10.2)] compared with non-exposure to similar illness. An increased unit of NCD’s count significantly increased the odds of COVID-19 MoS illness by 26%[cOR(95%CI) =1.26(1.09-1.84)] and 67% (adjusting for age) [aOR(95%CI)=1.67(1.13-2.49)].Conclusion: The presence of cardiovascular co-morbidities dictated the frequency of reported symptoms and severity of COVID-19 infection in this sample of Ghanaians. Physicians should be aware of the presence of co-morbid NCDs and prepare to manage effectively among COVID-19 patients

Anthracnose Disease of Mango: Epidemiology, Impact and Management Options

Mango is one of the frequently cultivated seasonal fruit crops in several tropical and subtropical regions. It is consumed as whole fruits apart from serving as raw materials for most industries that are into mineral production. Mango production is, however, constrained by diseases, pests, and poor post-harvest handling of fruits. Anthracnose disease, caused by Colletotrichum gloeosporioides Penz and Sacc, is one of the most important yields limiting constraint in mango production across the globe. The disease occurs in both the field and post-harvesting. In the field, it affects aboveground parts, such as the stem, branches, leaves, flowers, and fruits. Anthracnose disease reduces the shelve life and marketability of mango fruit. In Ghana, anthracnose disease is responsible for about 30% yield/fruit loss. Most farmers do not control it, although some have resorted to the application of various fungicides not registered for mango anthracnose disease management in Ghana. This chapter will highlight on the importance of the disease on the mango industry in Ghana, control strategies currently employed thereby reducing the over-reliance on chemical control option and propose ways to minimize the effect of the disease in the country

“The Reality from the Myth”: The poor as main agents of forest degradation: Lessons from Ashanti Region, Ghana

The prevailing literature on poverty-environment links mostly presents a rather deterministic view of the nexus between poverty and the environment, revolving around the negative impact of the poor on the environment. Specifically, in Ghana, empirical evidence on the prevalence of forest degradation is sparse because the requisite data are often difficult to obtain. Using a qualitative approach, data collected through in-depth interviews with 45 randomly selected participants and 5 purposively selected key informants (Traditional Authorities) and using a thematic analysis, the poverty-environment, specifically the forest degradation nexus was verified. This cross-sectional study leads the authors to posit that poverty has a minimal negative effect on major forest degradation in Ghana. The study found that the poor were rather conscious, and future-oriented with regard to the environment, specifically forests owing to how their livelihoods and survival are directly linked to their immediate environment. The results suggest that the poverty-environment nexus could be country, or context-specific and varies between geographical and historical contexts. By implication, the seemingly universal assertion that the poor are those who cause major deforestation in communities could be problematic. Henceforth, the study maintains that it would be a fallacy to make generalisations that poverty is the main cause of major forest degradation, since the link between poverty and the environment is very context-specific. We argued on the premise that reduction of poverty in Ghana may not lead to the reduction of forest degradation. Joint implementation of holistic poverty-environment strategies that incorporate both the poor and the rich should be adopted to curb the wanton forest degradation in Ghana

A feminist critical discourse analysis of Ghanaian feminist blogs

Even though one of the aims of critical discourse analysis (CDA) is to demonstrate how social inequality, power abuse and discriminatory practices can be resisted, most studies have centered on the deconstruction of oppression and ideologically driven discrimination rather than the reconstruction of resistance. To fill this lacuna, the present paper examines the blogposts of Ghanaian feminists using feminist critical discourse analysis as an analytic framework. It analyzes resistance strategies utilized in the blogposts to criticize systematic gendering of privilege and inequality, and to foreground the voice and agency of Ghanaian/African women. Three resistance strategies were identified: (1) critiquing patriarchy, traditional gender norms and gender oppression, (2) resisting gender stereotypes and rewriting demeaning gender narratives, (3) calling out sexist attitudes and applauding women who resist such behavior. I argue that these strategies contribute to a feminist political critique of gendered social practices and relations aimed at effecting social emancipation and transformation. The paper ends by highlighting how the emancipatory discourse promoted by the blogs can be enhanced as part of a continuous striving for social justice for Ghanaian/African women

Clinical features of COVID-19 in Ghana : Symptomatology, illness severity and comorbid non-communicable diseases

Objective: This analysis described the clinical features of COVID-19 in the early phase of the pandemic in Ghana. Methods: Data were extracted from two national COVID-19 treatment centers in Ghana for over 11 weeks(from March to May 2020). Descriptive and inferential statistics were performed. Modified Ordered Logistic and Negative Binomial Regression analysis were applied to establish factors associated with illness severity and Non-communicable Disease (NCDs) counts respectively. All analysis was conducted at the 95% confidence level (p-value ≤ 0.05) using Stata 16. Results: Among the 275 patients, the average age was 40.7±16.4, with a preponderance of males (54.5%). The three commonest symptoms presented were cough (21.3%), headache (15.7%), and sore throat (11.7%). Only 7.6% of the patients had a history of fever. Most patients were asymptomatic (51.65). Approximately 38.9% have an underlying co-morbid NCDs, with Hypertension (32.1%), Diabetes (9.9%), and Asthma (5.2%) being the three commonest. The odds of Moderate/severe (MoS) was significantly higher for those with unknown exposures to similar illness [aOR(95%CI) = 4.27(1.12-10.2)] compared with non-exposure to similar illness. An increased unit of NCD’s count significantly increased the odds of COVID-19 MoS illness by 26%[cOR(95%CI) =1.26(1.09-1.84)] and 67% (adjusting for age) [aOR(95%CI)=1.67(1.13-2.49)]. Conclusion: The presence of cardiovascular co-morbidities dictated the frequency of reported symptoms and severity of COVID-19 infection in this sample of Ghanaians. Physicians should be aware of the presence of co-morbid NCDs and prepare to manage effectively among COVID-19 patients