Sukru Oksuz

Compliance and efficacy of hand rubbing during in-hospital practice.

Objective: To compare alcohol-based hand rubbing with hand washing using antimicrobial soap regarding antimicrobial efficacy and compliance with routine practice in hospital and intensive care units. Subjects and Methods: From February to June 2003, 35 nurses were randomly selected from a nursing staff of 141 and divided into two groups: hand rubbing and hand washing groups. Hand cultures were obtained before and after health care procedures. The nurses were observed on days 1, 7 and 14 of the study, in order to determine compliance and efficacy of the hand hygiene methods. Results: A total of 368 routine patient care activities were observed during the study period. Hand rubbing with alcohol-based solutions significantly reduced the bacterial contamination of the hands of the nurses more than hand washing with an antimicrobial soap (54 and 27%, respectively; p < 0.01). Compliance was also better in the hand rubbing group than in the hand washing group (72.5 and 15.4%, respectively; p < 0.001). Compliance with hand rubbing was markedly lower among the nurses who had experience of more than 3 years in hospital practice. Both hand rubbing and hand washing compliance were poorer among nurses working inintensive care units than among nurses working in the other hospital wards. Generally, after taking off gloves, nurses preferred hand washing to hand rubbing. Conclusion: These data indicate that alcohol-based hand rubbing reduces mean bacterial counts on the hands of nurses more effectively than hand washing with antimicrobial soaps, and compliance rates with hand rubbing were also higher than with hand washing. Nevertheless, the compliance with hand rubbing was markedly lower in more experienced nurses.

Assessment of HAV and HEV seroprevalence in children living in post-earthquake camps from Düzce, Turkey.

The aim of the study was to investigate the prevalance of enterically transmitted hepatitis among children living in post-earthquake camps, and to assess the efficacy of the measurements during and after the disaster in Düzce and Golyaka. In the second half of 1999, North-western Turkey, was struck by two massive earthquakes in less than 3months. The first, on 17 August 1999, involving Golyaka, was struck, measuring between 7.4 and 7.8 on the Richter scale. Irregularity about providing clean water and necessary sanitary facilities were observed after the first earthquake because of confusion. The second quake, on 12 November 1999, which rated 7.2 on the Richter scale, shook Düzce. Necessary precautions were applied rapidly at the second quake about shelter, clean drinking water, food and control of distribution of the aids by government and civil aid organisations. Anti-HEV(IgG) and anti-HAV(IgG) antibodies were determined in 476 sera of the children who was living in six camps. HAV prevalence of the children who were living in Düzce and Golyaka temporary houses was 44.4 and 68.8% respectively, OR: 0.37, CI 95%: 0.22–0.61, p=0.0005. HEV prevalence of the children was 4.7 and 17.2% respectively, OR: 0.24, CI 95%: 0.11–0.51, p=0.0007. In conclusion, HAV and HEV prevalence of children were lower than that in endemic areas but higher than that in developed countries. This study has pointed out the importance of providing urgent need of the sufficient sanitary facilities after disasters for preventing or reducing the incidence of enterically transmitted hepatitis, especially in the regions which were at risk for various disasters. Essential precautions such as providing clean water and food supply must be taken and an emergency action plan for preventing the infectious disease must be prepared before disasters such as earthquakes.

Hand carriage of Candida species and risk factors in hospital personnel.

The hands of healthcare workers (HCWs) are considered to be important for colonisation and infection of Candida spp. The objective of this study was to evaluate the rate of Candida carriage on the hands of the hospital personnel the potential risk factors. Samples were collected from the hands of 214 (139 female and 75 male) hospital personnel working at Duzce Medical Faculty Hospital, Duzce, Turkey. Of these, 88 were nurses, 62 resident doctors, 21 laboratory workers, 30 officers and 13 dining room personnel. The hands of all participants were tested by culture with the broth wash technique. Overall, 34.1% of the people analysed were found to harbour Candida spp. on their hands: 30.7% were nurses, 25.8% resident doctors, 28.6% laboratory workers, 84.6% dining room personnel and 43.3% officers. Candida carriage rates of the dining room personnel were higher than found in the other groups (P = 0.001). Isolated Candida species were C. parapsilosis (38.4%), C. tropicalis (26.0%), C. albicans (23.3%), C. kefyr (11.0%) and C. globosa (1.4%). Candida carriage rate was higher in the glove‐using group (35.1%) than the non‐glove using group (7.1%, P = 0.031). We concluded that carriage of Candida species on the hands of personnel was common especially in non‐medical staff. Wearing gloves was found to be related to increased rates of Candida carriage in the nurse group. Candida parapsilosis was the most frequently colonising species that may be a predisposing condition for nosocomial infections transmitted with the hands of HCWs. Hospital personnel should be educated for regular hand washing practice for preventing Candida colonisation.

Dermatophytes in the rural area of Duzce, Turkey

A total of 227 subjects (112 were male and 115 female), who were residents of the rural region of Duzce, were examined for dermatomycosis. A total of 120 samples (47 nail fragments, 73 skin scales) were collected from 81 patients for mycological analysis on the basis of the results of clinical evaluation. All specimens collected were analysed by direct microscopy and culture. Positive results were detected in the cultures of 53 (44.1%) of the 120 samples. About 46 (86.7%) samples also presented positive results in direct microscopy. In the cases of seven samples positive results were found in culture and negative results with direct microscopy. Both culture and direct microscopy presented negative results in 67 (55.8%) samples. The most frequently isolated aetiological agents were 33 Trichophyton rubrum (62.2%), and nine T. mentagrophytes (16.9%). In conclusion, traditional and religious habits such as cohabitation and performing ritual ablutions may affect the prevalence of dermatophyte infections. The performance of ritual ablutions is not in itself a risk factor for acquiring dermatophyte infection; rather it is not drying the extremities after ablutions, that is the main risk factor for this group. Tinea capitis was not found in any of the subjects in spite of the fact that it is one of the most common infectious conditions in children. This is the first paper to report the prevalence of fungal infections in Duzce, a western Black Sea region of Turkey.

Dermatophytoses in forestry workers and farmers

To assess the frequency of superficial mycoses in forestry workers and farmers in the rural region of Duzce, a total of 467 residents of the rural region were examined for dermatomycosis infection. Of these, 349 were forestry workers and 118 farmers. All specimens collected were analysed by direct microscopy and culture. Tinea pedis et manus was found in 23 (19.4%), and onycomycosis in 21 (17.7%) farmers. Tinea pedis et manus was found in 50 (14.3%), and onycomycosis in 28 (8%) forestry workers. One tinea corporis, two tinea inguinalis and two erosio interdigitalis cases were determined in the farmer group but no cases of tinea corporis, tinea inguinalis, or erosio interdigitalis were found in the forestry group. In total, five tinea versicolor cases were found in the two groups on clinical examination but no agent positivity was yielded in mycological cultures. The most frequently isolated agent in the two groups was Trichophyton rubrum. The frequencies of superficial mycosis and onychomycosis were found to be higher in the farmer group than in the forestry group, although similar aetiological agents were isolated in both groups. The farmers had greater rates of contact with pathogenic fungi present in soil as well as from infected farm animals than the foresters; furthermore, animal husbandry, and the wearing of rubber shoes and nylon socks were more frequent in the farmer group. These results suggest that habits such as the wearing of rubber shoes and nylon socks, and the practice of animal husbandry may be the most important factors in determining the frequency of superficial mycoses and aetiological agents in forestry workers and farmers. To our knowledge, there is no previous report about dermatophytoses in forestry workers.

Hand carriage of Candida occurs at lesser rates in hospital personnel who use antimicrobial hand disinfectant

Abstract Background: The hands of hospital personnel are considered to be important for colonization and infection of patients with Candida spp. The aim of this study was to evaluate the effectiveness of different hand disinfectants in reducing the carriage of Candida species on the hands of hospital personnel. Methods: A controlled study was conducted at Duzce University School of Medicine Hospital. Eighty hospital personnel were included in the trial. Subjects were divided into 4 groups according to hand hygiene procedures: group 1, hand rubbing with alcohol-based solution; group 2, hand washing with 4% chlorhexidine gluconate; group 3, hand washing with 7.5% povidone–iodine; group 4, hand washing with plain soap and water. The hands of all participants were tested by culture with the broth wash technique. Results: Hand carriage of Candida spp. was lower in the 4% chlorhexidine gluconate group (10.5%, p = 0.006), in the 7.5% povidone–iodine group (18.7%, p = 0.043), and in the alcohol-based hand rub group (21.1%, p = 0.048) compared to the group washing hands with plain soap and water (50%). Conclusions: The use of hand disinfectant containing antimicrobial agents is more effective than hand washing with water and soap in reducing carriage of Candida on the hands of hospital personnel. It is recommended that hospital personnel use an antimicrobial hand disinfectant in units where there is a high risk of Candida infection.