Staphylococcus aureus carriage in selected kindergartens in Klang Valley

Introduction: Nasal colonisation of S. aureus in healthy children was 18% to 30%. One to three percent of them were colonised by Methicillin-resistant Staphlycoccus aureus (MRSA). Although MRSA infection has become increasingly reported, population-based S. aureus and MRSA colonisation estimates are lacking. The main objective of this study was to determine the prevalence of S. aureus carriage among children. Methods: Nasal samples for S. aureus culture were obtained from 250 children from three kindergartens in the Klang Valley, after consent was obtained from the children and their parents. Swabs were transported in Stuart medium, and inoculated on mannitol-salt agar within four hours of collection. Identification and disk diffusion test were done according to guidelines. Polymerase chain reaction was done on MRSA isolates for the presence of mecA and lukS/FPV genes. Results: Overall prevalence of S. aureus and MRSA carriage were 19.2% (48/250) and 1.6% (4/250) respectively. mecA gene was present in all isolates, 50% isolates carried Panton-Valentine leucocidin (PVL) gene. Sccmec type I was found in 2 isolates and the remaining isolates has Sccmec type V. Conclusion: The prevalence of S. aureus and MRSA carriage were similar to other studies. However, risk of contracting severe infection might be higher due to presence of PVL gene in half of the MRSA isolates

Healthy hands: development and evaluation of a knowledge transfer program

Introduction: Children in pre-schools are at high risk of getting infections due to overcrowding, minimal awareness of basic hygiene and lack of immunity against microorganisms. Hand hygiene practice should be started at home where parents set good example, followed by formal education in pre-schools, primary and secondary school. This study aimed to develop a comprehensive program on hand hygiene practice in pre-schools. This paper presents the developmental aspects of the program material and the results of its evaluation process in a selected pre-school. Methods: Stage of development involved preparation of song, lyric, video clip, infographic and tablet application. The module was introduced during an intervention day called ‘Healthy Hands’ day. The acceptance of the module was evaluated before and after the intervention day. Evaluation was done by assessing pre-school children by face-to-face interview about knowledge on hand hygiene techniques and routine, such as before or after certain activities. Results: We managed to compose a song in three languages (Malay, English & Arabic), produced a video clip, an infographic and tablet application. A total of 227 children participated. Post intervention evaluation showed significant (p<0.001) increase of knowledge for eight out of eleven handwashing steps. The knowledge on hand hygiene routine i.e. after toilet, after playing outdoor, after sneezing and after playing with pet was also increased significantly. Conclusion: This comprehensive knowledge transfer program significantly improved the children’s hand hygiene techniques and routine and is recommended to be integrated into pre-school curriculum

Electronic hand hygiene quality and duration monitoring in pre-school children: a feasibility study

Background: Hand hygiene is regarded as the most important measure to prevent spread of infectious diseases. The aim of this study was to assess the feasibility of a prototype application in an electronic device in educating, stimulating and monitoring hand hygiene quality in young children. Method: A pre-school was provided with an interactive hand hygiene application for two months. The device features an online administrator dashboard for data collection and for monitoring the children's hand washing steps and duration. A good hand washing is defined as hand washing which comprise all of the steps outlined in the World Health Organization (WHO) guidelines. Results: The prototype managed to capture 6882 hand wash performed with an average of 20.85 seconds per hand wash. Washing hands palm to palm was the most frequent (79.9%) step performed, whereas scrubbing fingernails and wrists were the least (56%) steps performed. Conclusions: The device is a good prototype to educate, stimulate and monitor good hand hygiene practices. However, other measures should be undertaken to ensure sustainability of the practices

Community acquired pneumonia in Malaysia: is Streptococcus pneumoniae an important pathogen?

Previous data on etiological agents isolated from adult patients with community acquired pneumonia (CAP) in Malaysia has showed very low percentage of Streptococcus pneumoniae. Thus, we used immunochromatography test (ICT) and real-time polymerase chain reaction (PCR) in addition to conventional culture methods for S. pneumoniae detection. We found that the detection rate was highest by real time PCR reaction (50%) in contrast to 10% by ICT, 2% from blood and 0% from sputum cultures. This molecular method had contributed to a rise in percentage of S. pneumoniae detection accounting for 51.1% of all etiological cases in CAP and the second commonest organism after Chlamydophila pneumoniae (63.8%), followed by M. pneumoniae (27.7%) and L. pneumophila (17%). We have also found that 10.6% of the etiological agents of CAP were not known indicating that other specific organisms including viruses have not been identified. Both ICT and PCR demonstrated sensitivities of 100%, with specificities of 91.3 and 55.6%, respectively, using culture techniques as the “gold standard”. Thus from this finding, they will become potential tools in the future for the diagnosis of S. pneumoniae in CAP, for the epidemiological importance and prevention as well as for early antibiotic management

Effect of hand hygiene intervention on the absenteeism of pre-school children in Klang Valley, Malaysia: a quasi-experimental study

Background: Absenteeism amongst pre-school children is often due to illnesses such as hand, foot, and mouth disease, acute gastroenteritis, cold and flu, which are easily spread amongst them. This is because of weak immunity and lack of knowledge on proper hand hygiene. This quasi-experimental study assessed the efficacy of an intervention consisting of a hand hygiene education programme, along with digital tools in bringing about a change in behaviour and health conditions amongst pre-school children in Klang Valley, Malaysia. Methods: A total of 377 school children, male and female, aged 5–6 years old, participated and were assigned to either the intervention or a control group. During the 2 months intervention period, children in the test group were trained on proper hand hygiene practices and techniques with the aid of the interactive android-based tablets. The numbers of absent days of all the children were recorded for 2 months before the intervention and during the intervention. Results: In the test group, there was a 25% increase in the total number of absent days from the pre-intervention period to the intervention period, a much lesser increment observed as compared to that of control group in which the increase was much higher at 89%. Results showed a significant difference (P < 0·05) between the absenteeism rates for the test and control group during the intervention period. Conclusion: These results suggest that proper education and intervention increase hand hygiene compliance, which may help decrease school absenteeism due to illness; however, a longer study duration may be necessary to evaluate the benefit further

Effectiveness of comprehensive hand hygiene module on preschool children in Klang Valley, Malaysia

Preschool children are exposed to infectious diseases such as hand, foot, and mouth disease and colds due to their close relationship with other children at school and their weak immune systems. It has been proven that proper hand hygiene practices can curb the risk of developing these illnesses. This effectiveness study aimed to test a hand hygiene module developed for preschool children at 2 public preschools owned by Majlis Agama Islam Wilayah Persekutuan in Klang Valley, Malaysia. A total of 356 children were involved in this study; of them, 49% were boys, 45.2% were 5 years old and the rest were 6 years old