Theses and dissertations (Health Sciences)
Permanent URI for this collectionhttp://ir-dev.dut.ac.za/handle/10321/12
Browse
Search Results
Item Assessment of nurses' hand hygiene practices in primary health care clinics of eThekwini Municipality(2018) Mufamadi, Ntheno Grace; Sibiya, Maureen NokuthulaBackground Hands of heath care workers are known to be the main vehicle in the transmission of infectious agents in the health care setting. Hand hygiene is an essential, cheap, simple, effective and the corner stone in infection and control strategies, and it plays a major role in reduction of health care associated infections. The focus on hand hygiene has been hospital based because of the health care associated infections within those settings. The high utilization of the primary health care (PHC) clinics, the complexity and comprehensiveness of the services rendered in PHC clinics, the more invasive procedures that are being performed in PHC clinics and the studies on hand hygiene that were focused mainly in hospitals setting motivated the study on the assessment of hand hygiene practices in PHC clinics. Aim of the study The aim of the study was to assess hand hygiene practices of nurses in the PHC facilities of eThekwini municipality. Methodology This study was a descriptive, observational and survey study design in a quantitative paradigm, conducted in three PHC clinics with high caseload. The non-probability, purposive sampling method was used to select PHC clinics. The study population were the nurses from the three selected PHC clinics. An adapted Infection Control Self-Assessment Tools for PHC Facilities was used to collect data. An adapted self-reported World Health Organisation Hand Hygiene Knowledge Questionnaire for Health Care Workers Assessment Tool was used to assess knowledge and training in hand hygiene. Data was analysed using SPSS version 22.0. Inferential statistics were used to determine the relationship between the variables. Results The results showed that in all the three PHC clinics, hand hygiene was performed more frequently after contact with patients than before contact with patients in both invasive and non-invasive procedures. The commonly used method of hand hygiene was hand rubbing with alcohol hand rub than hand washing. In observing whether the hand rubbing steps were followed, this was done significantly less than half the time (p=<.0005). The average knowledge score across all questions was 73.64% and there was no significant correlation between knowledge and percentage of time using HH.Item Origins and control of bacterial contamination during spinal manipulation(2018) Amod, Fariya; Swalaha, Feroz Mahomed; Reddy, PoovendhreeBackground: Research has revealed that healthcare workers’ hands serve as a source and vehicle for the transmission of micro-organisms within the healthcare sector, thus resulting in nosocomial infections, better known as healthcare-associated infections. The chiropractic profession is traditionally known as a hands-on profession, where the fundamental treatment protocol includes manual manipulation of the spine. In order to perform these procedures hand-to-patient interaction is required, resulting in skin-to-skin contact. Poor hand hygiene practice has been attributed by the World Health Organization as the primary cause for the spread of micro-organisms within the healthcare environment. Unwashed hands harbour microbes, thus increasing contamination levels and subjecting patients to these potential pathogens. This study aimed to determine the presence and transfer of bacterial contamination occurring during spinal manipulation, as well as analysing the efficacy of decontaminants used by chiropractic practitioners against the isolated bacteria cultivated. Research design: The study was located in the quantitative experimental paradigm and conducted as a cross-sectional investigation. Method: Samples were obtained from chiropractors’ hands before and after spinal manipulation. Samples were then serially diluted, plated in duplicate (using the spread plate technique) and incubated for 24-48 hours at 37°C. Viable counts of colony forming units (CFUs) were then enumerated in order to verify the presence of bacteria on the chiropractors’ hands, as well as to establish the direction of transfer occurring during spinal manipulation. Macroscopic and microscopic characteristics of each bacterial isolate were used to identify the bacteria cultivated. A modified Kirby Bauer technique was used to ascertain the efficacy of decontaminants commonly used by chiropractors, against the isolated bacteria obtained from their hands. Results: Bacterial flora were present on 100% of the chiropractors hands both pre- and post-spinal manipulation. A mean of 16,456 (27,718) cfu/ml⁻¹ were enumerated from the samples collected from the chiropractors’ hands during manipulation. A paired t-test indicated a significant difference noted in the viable count of bacteria found on the chiropractors’ hands before and after manipulation (p<0.001). A significant difference was observed in the viable count of bacteria post-manipulation (70%), as opposed to the pre- manipulation readings (30%).This was indicative of a higher rate of bacteria being transferred from the patient to the chiropractor during spinal manipulation. The majority of the microorganisms identified were either primary or opportunistic pathogens. Staphylococci were most prevalent in the pre-spinal manipulation readings accounting for 53% of the colonies, followed by micrococci with 39%, bacilli with 4%, Staphylococcus aureus with 3% and streptococci with 1%. Pseudomonas spp. were present but uncommon. Escherichia coli were not present on the chiropractors’ hands in any of the samples obtained pre-manipulation. The post-manipulation readings constituted a high prevalence of micrococci accounting for 57% of the colonies, followed by staphylococci with 32%, Pseudomonas spp. with 5%, E. coli with 3%, Staphylococcus aureus with 2% and bacilli with 1%. Streptococci were present but uncommon. The decontaminants tested were most effective against gram-positive bacteria such as Bacillus, Micrococcus, Staphylococcus, Staphylococcus aureus and Streptococcus. The bacteria isolated were most susceptible to the D-Germ hand disinfectant, while the Dis-Chem instant hand sanitizer was the least effective decontaminant tested. Ciprofloxacin was the antibiotic used as a positive control. A significant difference was noted between the performance of the positive control and the decontaminants on the bacteria isolated. Conclusions and recommendations: The study proved the presence of primary and opportunistic pathogens found on the chiropractors’ hands. These included Staphylococcus spp., Micrococcus spp., Bacillus spp., Pseudomonas spp., E. coli, Streptococcus spp. and Staphylococcus aureus. A higher rate of bacteria was observed being transferred from the patient to the chiropractor during spinal manipulation. The majority of the microorganisms identified were either primary or opportunist pathogens, thus predisposing both the patient and the chiropractor to potential infection. A significant difference was noted between the performance of the positive control and the decontaminants on the bacteria isolated. None of the decontaminants were as effective against the bacteria isolated as the positive control. It can therefore be deduced that each bacterial flora was not removed by some of the decontaminants currently used by chiropractic practitioners in practice.