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Biomedical subjects

W H Seto

Publications and source records attributed to W H Seto.

At least 55 records · Page 3Linked to original sources

Infection of a shunt by Mycobacterium fortuitum: case report.

Mycobacterium fortuitum is a rare cause of central nervous system infection; however, shunt infection caused by this organism has not been reported. We report a case of shunt infection subsequent to insertion of a ventriculoatrial shunt for obstructive hydrocephalus caused by a cerebellar hematoma. The shunt infection was controlled by removal of the shunt and a combination of systemic and intraventricular administration of amikacin, and oral administration of ofloxacin. The case is discussed and the pertinent literature reviewed.

Anti-Bacterial Agents↗

Streptococcus zooepidemicus (Lancefield group C) septicaemia in Hong Kong.

The clinical findings relating to 11 patients in Hong Kong (HK) and to 43 patients described elsewhere, all with Streptococcus zooepidemicus septicaemia, are reviewed. There was a particular association with cardiovascular disease (27%) with seven cases of endocarditis, three of abdominal aortic aneurysm and two of deep venous thrombosis. Associations not previously reported included two cases of pharyngitis and two patients with persistent post-operative fever. The overall mortality was 22%. Both human and porcine strains of S. zooepidemicus from HK did not hydrolyse aesculin in contrast to the aesculin-positive biotypes reported previously. HK strains also had very mucoid colonies and capsules of hyaluronic acid were seen in electron micrographs. Samples of chromosomal DNA, extracted by means of HindIII restriction endonuclease, of strains from human beings and pigs were identical. The MIC of penicillin for all strains was less than or equal to 0.03 mg/l but the MBC for all was greater than 32 mg/l. Penicillin alone is generally sufficient for cure but combination with an aminoglycoside may be indicated in seriously ill patients. In our locality, pigs were incriminated as a possible source of human infection whereas consumption of contaminated dairy products is important elsewhere.

Adult↗

Evaluation of staff compliance with 'influencing' tactics in relation to infection control policy implementation.

The efficacy of 'influencing' tactics for inducing compliance to infection control policies was assessed in 20 Hong Kong hospitals. In phase 1, 45 infection control nurses (ICNs) were surveyed on the frequency of use of possible tactics. Twenty-three of the more frequently used tactics were selected for phase 2 in which a random sample of 881 nurses were questioned on whether they would willingly, reluctantly or not comply with these tactics. Based on factor analysis of the responses in phase 2, six dimensions of compliance were identified. These were, in their order of effectiveness in achieving compliance: professional-resources (providing specialized or expert help); professional-respect (esteeming others as fellow professionals); coalition (obtaining staff support), ingratiation (cultivating goodwill), hierarchical (exerting pressure derived from rank) and non-communicative (ignoring or disregarding other's point of view).

Attitude of Health Personnel↗

A new semiquantitative culture method for early detection of surgical incisional wound infection.

A semiquantitative culture technique for early detection of surgical wound infection was done by rolling a segment of a plastic intravenous catheter across a blood agar plate after insertion into the most inflamed part of the wound on postoperative day 3. Patients were monitored daily for purulent discharge until healing. Of the 53 wounds studied, 44 (83%) had no growth or low-density superficial colonization on the blood agar (generally less than 15 colony-forming units and within the upper 1.5 cm of the catheter). None of these 44 wounds was subsequently infected; therefore, these colonies represented colonization. Of the 9 wounds (17%) that yielded greater than 15 colony-forming units and a diffuse subcutaneous pattern (colonies below the upper 1.5 cm of the catheter), all developed purulent discharge with a positive culture of the same organisms found by semiquantitative culture. This result differed significantly (P less than .01) from the 44 wounds without subsequent infection. This semiquantitative technique has the potential to distinguish infection from colonization and may be useful in diagnosing surgical wound infection.

Bacteria↗

Rapid endoscopy room diagnosis of Campylobacter pylori-associated gastritis in children.

A modified urease broth test was used in 109 gastric biopsy specimens of children that yielded a 96% sensitivity and a 100% specificity rate for Campylobacter pylori infection. The longest reaction time was less than or equal to 4 min. The correlation between the degree of C. pylori infection and the reaction time was found to be highly significant (gamma = 0.78, p less than 0.001). Patients were examined as outpatients, and immediate medications were prescribed for eradication of the bacteria on the basis of the urease broth test results. This is the first report on the use of this modified rapid urease test for the diagnosis of C. pylori infection in children.

Adolescent↗

Evaluating the efficacy of the infection control liaison nurse in the hospital.

The infection control liaison nurse (ICLN) is a nurse in the ward, appointed to participate in education for infection control, and to liaise between the ward and the infection control nurse (ICN). The efficacy of ICLNs was evaluated when a guideline on urinary catheter care was introduced in a 1000-bed hospital in Hong Kong. The 27 public wards were divided randomly into a test (24 wards) and control group (three wards), and ICLNs were appointed in the test group by the nursing administration. For education, the ICN conducted in-service lectures for both groups, while in the test group, the ICLNs also conducted tutorials for all ward nurses. Before and after the education programme, prevalence surveys were conducted to detect incorrect practices on urinary catheter care. Three practices were evaluated: the securing of catheters, presence of kinking and the use of urinary bags with a drainage spigot. Before education, the percentage of incorrect practices in the test groups was 63%, which was comparable to the 68% of the control group (P = 0.40, chi 2 = 0.71). After education, the percentage of incorrect practices in the test group (36%) was significantly lower than the 48% in the control group (P less than 0.05, chi 2 = 4.25). This indicates that ICLNs can indeed enhance the education programme for infection control.

Evaluation Studies as Topic↗

Septicemia caused by cysteine-dependent Escherichia coli.

A case of septicemia and urinary tract infection caused by cysteine-dependent Escherichia coli in a 70-year-old woman with bilateral staghorn calculi is described. This is the second report of a cysteine-dependent E. coli bacteremia. The bacterium was falsely susceptible to ampicillin and co-trimoxazole when tested on a medium without cysteine supplement.

Aged↗

The role of communication in the alteration of patient-care practices in hospital--a prospective study.

In infection control, ward practices often need alteration, as in Queen Mary Hospital, Hong Kong, when a policy was introduced to discontinue the recapping of needles among nurses. Nine randomly selected wards were divided into three groups (A, B and C) of 3 wards each. From an initial survey, nurses were divided into those who agreed with the discontinuation (the 'agreeables') and those who did not (the 'non-agreeables'). Methods used to introduce the policy included a simple announcement through the nursing hierarchy in group A (control), a passive method (posters and pamphlets) was added in group B and both passive and active methods (in-service lectures) were used in group C. Five weeks later, behavioural change was assessed by another survey and by an unannounced direct needle-count. Only 21% of the nurses changed their practice by simple announcement. For the 'agreeables', 85% changed by the passive method and no further improvement was observed when the active method was added. However, 83% of the 'non-agreeables' changed their practice when the active method was used while the passive method alone changed only 21%. Six months later, a third survey indicated that when the active method was included the change persisted at over 85%, while a 36% change was noted for the 'agreeables' who were only exposed to the passive method.

Communication↗

Hospital use of chlorine disinfectants in a hepatitis B endemic area--a prevalence survey in twenty hospitals.

A survey was conducted to assess the uses of chlorine disinfectants in twenty hospitals in Hong Kong. In the 149 areas visited, the charge nurses were interviewed on the use of chlorine disinfectants. A high proportion of uses (44%) were not at the recommended dilution and only 88 (57%) of the 154 samples were within +/- 10% of the manufacturers quoted chlorine content. Samples with inadequate chlorine were found among all six types of chlorine disinfectants, although sodium dichloroisocyanurate tablets conformed to the quoted strength on 88% occasions. Higher usage frequency and better dilution practices were noted for hospitals with a disinfectant policy.

Chlorine↗