Active surveillance of hospital-acquired infections in South Africa: Implementation, impact and challenges

Background. Hospital-acquired infections (HAIs) are a significant although unquantified burden in South Africa. Lack of adequate surveillance compounds this problem.Objective. To report on the establishment and outcomes of a unit-specific surveillance system for hospital-acquired infections, based on international standards, in a private academic hospital.Methods. Active unit-specific surveillance of device-associated infections (DAIs) was introduced over a 2-year period. The surveillance system was based on the US National Healthcare Safety Network (NHSN) utilising standardised definitions. Analysis of DAI rates and device utilisation was done according to Centers for Disease Control and Prevention methods. Comparative analysis using study-derived annualised data and existing NHSN data was done.Results. Surveillance results of DAI rates showed significant reductions in intensive care unit-related ventilator-associated pneumonia (42%) and central line-associated bloodstream infections (100%) over a 3-year period. Substantial variations in DAI rates and utilisation ratios between wards highlight the importance of unit-specific surveillance.Conclusions. Active surveillance requires a significant investment in resources and is a sustained operational challenge, although equally significant benefits are derived from a better understanding of HAIs with more targeted interventions and efficient use of resources. A robust surveillance system is an essential component of any healthcare infection prevention and control programme and is a prerequisite to contextualising the HAI burden of hospitals

Minimum inhibitory concentration-guided antimicrobial therapy – the Achilles heel in the antimicrobial stewardship agenda

The global problem of resistance to antimicrobials has resulted in a co-ordinated drive to use antimicrobial agents more responsibly. At a clinical level this is promoted through antimicrobial stewardship which demands appropriate use through optimal drug selection. Many factors play a role in this process of selection, antimicrobial susceptibility and the pharmacodynamics of the drug being two key determinants. Yet the detail provided by current diagnostic antimicrobial susceptibility testing is suboptimal and does not allow for adequate dose optimisation. The minimum inhibitory concentration (MIC) which underlies all antimicrobial susceptibility testing is largely ignored in the decision-making process of optimal drug selection. Understanding and application of MIC-guided antimicrobial therapy is desperately needed if antimicrobial stewardship is to truly fulfil its mandate

On the geodetic stability of the Goddard Optical Research Facility

Seismic observations of earthquakes and blasts, geologic analysis of Landsat images, and a search of the historical record was examined. However, no evidence for tectonic motion was found. Some faulting is present in the area but no evidence of seismic activity was found. No elastic resonances in the range from 0.3 to 15 Hz were found. It is concluded that, except for ground water induced changes, the facility is stable at least to the 0.5 cm level

Manual for 70 mm hand-held photography from Skylab

A manual and atlas used on the Skylab mission for hand-held photography are presented. The manual covers terrain, environmental, meteorological, and dim light photography while the atlas covers sections from the Army Map Service 1:40.000,000 world map, a glossary of geologic terms, geologic maps, and recommended exposure times

Bacterial contamination of re-usable laryngoscope blades during the course of daily anaesthetic practice

Background and objectives. Hospital-acquired infections (HAIs) are largely preventable through risk analysis and modification of practice.Anaesthetic practice plays a limited role in the prevention of HAIs, although laryngoscope use and decontamination is an area of concern.We aimed to assess the level of microbial contamination of re-usable laryngoscope blades at a public hospital in South Africa.Setting. The theatre complex of a secondary-level public hospital in Johannesburg.Methods. Blades from two different theatres were sampled twice daily, using a standardised technique, over a 2-week period. Samples werequantitatively assessed for microbial contamination, and stratified by area on blade, theatre and time using Fisher’s exact test.Results. A contamination rate of 57.3% (63/110) was found, with high-level contamination accounting for 22.2% of these. Commoncommensals were the most frequently isolated micro-organisms (79.1%), but important hospital pathogens such as Enterobacter species and Acinetobacter baumannii were isolated from blades with high-level contamination. No significant difference in the level of microbial contamination by area on blade, theatre or time was found (p<0.05).Conclusions. A combination of sub-optimal decontamination and improper handling of laryngoscopes after decontamination results in significant microbial contamination of re-usable laryngoscope blades. There is an urgent need to review protocols and policies surrounding the use of these blades

Anaesthetists’ knowledge of surgical antibiotic prophylaxis: a prospective descriptive study

Background: Surgical site infection (SSI) is the second most common hospital-acquired infection and results in increased morbidity and mortality and a longer hospital stay. Surgical antibiotic prophylaxis (SAP) is one component of broader strategies to reduce rates of SSI. Adherence to SAP guidelines is largely sub-optimal globally, with knowledge of appropriate SAP being an important factor that affects this. The study’s objective was to describe awareness amongst anaesthetists at university-affiliated hospitals of available SAP guidelines and to describe their knowledge on the subject. Comparisons between senior and junior anaesthetists were to be made.Methodology: A prospective descriptive study design using a self-administered questionnaire was employed. The study population was the anaesthetists in a university-affiliated Department of Anaesthesiology in Johannesburg, South Africa.Results: The analysis included 135 completed questionnaires from the department’s anaesthetists. A total of 15.6% of participants followed a specific guideline in their practice, 28% for senior anaesthetists vs. 4.2% for junior anaesthetists. The overall mean score for knowledge was 56.2%, 59.3% for senior anaesthetists vs. 53.6% for junior anaesthetists, which was statistically significant (p-value < 0.001). Overall knowledge was found to be poor and, specifically, knowledge regarding indication for prophylaxis, antibiotic re-dosing interval and duration of prophylaxis was poor.Conclusion: The anaesthetists had poor knowledge regarding SAP. While the difference in knowledge between senior and junior anaesthetists was statistically significant, is it likely that this difference would not be substantial enough to have a clinical impact. The authors recommend interventions to improve the knowledge of the anaesthetists regarding SAP as well as the development of local SAP guidelines.Keywords: anaesthetist, antibiotics, knowledge, perioperative, surgical prophylaxis, surgical site infectio

Electric-field-induced displacement of a charged spherical colloid embedded in an elastic Brinkman medium

When an electric field is applied to an electrolyte-saturated polymer gel embedded with charged colloidal particles, the force that must be exerted by the hydrogel on each particle reflects a delicate balance of electrical, hydrodynamic and elastic stresses. This paper examines the displacement of a single charged spherical inclusion embedded in an uncharged hydrogel. We present numerically exact solutions of coupled electrokinetic transport and elastic-deformation equations, where the gel is treated as an incompressible, elastic Brinkman medium. This model problem demonstrates how the displacement depends on the particle size and charge, the electrolyte ionic strength, and Young's modulus of the polymer skeleton. The numerics are verified, in part, with an analytical (boundary-layer) theory valid when the Debye length is much smaller than the particle radius. Further, we identify a close connection between the displacement when a colloid is immobilized in a gel and its velocity when dispersed in a Newtonian electrolyte. Finally, we describe an experiment where nanometer-scale displacements might be accurately measured using back-focal-plane interferometry. The purpose of such an experiment is to probe physicochemical and rheological characteristics of hydrogel composites, possibly during gelation

The infrared interferometer spectrometer experiment for the Mars Mariner 1971 orbital mission

Infrared interferometer spectrometer for Mariner spacecraft in Mars orbi

A Geophysical Atlas for Interpretation of Satellite-derived Data

A compilation of maps of global geophysical and geological data plotted on a common scale and projection is presented. The maps include satellite gravity, magnetic, seismic, volcanic, tectonic activity, and mantle velocity anomaly data. The Bibliographic references for all maps are included