Incidence of bacterial infections and colonisation in patients admitted to a tuberculosis hospital
- Authors: Annear, Dale John
- Date: 2018
- Subjects: Medical microbiology , Microbiology Bacteriology Tuberculosis -- Hospitals -- South Africa
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/21482 , vital:29526
- Description: Patients with drug resistant tuberculosis (TB) are treated with multiple antibiotics including moxifloxacin, linezolid, and meropenem, which puts them at greater risk for colonisation by multi-drug resistant (MDR) bacteria. The objectives of this study were to: (i) assess the antimicrobial prescribing patterns practiced within the hospital by retrospective patient file review; (ii) determine the spectrum of bacterial colonisation in TB patients upon admission and during hospitalisation; (iii) identify bacterial isolates and evaluate antimicrobial susceptibility profiles; (iv) detect antimicrobial resistance genes in the bacterial isolates by PCR and DNA sequencing; and (v) investigate genetic relatedness of Klebsiella pneumoniae isolates using Multi Locus Sequence Typing. Nasal, groin and rectal swabs [for the detection of extended spectrum beta lactamases (EBSLs), carbapenem-resistant Enterobacteriaceae (CRE), vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA)] were analysed from a cohort of patients (n=37) admitted either from the community (n = 28) or from other healthcare facilities (n=9) to a TB hospital. Swab samples were collected at admission and at four week intervals thereafter during hospitalization. Identification and antimicrobial susceptibility testing of bacterial isolates (n=62) were determined at the National Health Laboratory Services (NHLS) by the VITEK-MS and Vitek 2 systems respectively. Additional antimicrobial susceptibility testing was conducted by Sensititre Gram Negative Xtra (GNFX2) MIC plates. PCR and DNA sequencing were used for detection of resistance genes. Patients (n=13/37; 35%) were colonized by MDR bacteria (ESBLs [n=11], MRSA [n=2]) on admission. Colonization rates were lower in patients admitted from the community (9/28; 32%) compared to those transferred from other healthcare facilities (4/9; 44%). All admitted patients who did not exhibit colonization at baseline and who were resident within the hospital for longer than 4 weeks (17/37; 46% of total patients) became colonised by an ESBL-producing Enterobacteriaceae species. No patients acquired MRSA during hospitalisation. Among ESBL Enterobacteriaceae, Escherichia coli (41/62; 66%) and K. pneumoniae [14/62; 23%]) predominated. Nineteen percent (7/37) of patients demised during their hospitalization. Both the Vitek system and Sensititre Gram Negative Xtra (GNFX2) MIC plates susceptibilities were similar for most antimicrobials, however there were discrepancies for tigecycline susceptibility profiles. A high number of isolates exhibited resistance to aminoglycosides and fluoroquinolones. Genes encoding for ESBLs (CTX-M-14, CTX-M-15, SHV-28, OXA-1, and OXY-2-9) were detected among ESBL Enterobacteriaceae. Two Enterobacteriaceae isolates with reduced carbapenem susceptibility did not contain carbapenemase-encoding genes. MLST revealed unique sequence types and genetic diversity among the K. pneumoniae isolates from hospitalised patients. However, the source and colonization routes of these isolates could not be determined, which requires further investigation. This study provides insight into the spectrum of bacterial pathogen colonisation in hospitalised TB patients and suggests a review of infection control programs and practices at the TB hospital.
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- Date Issued: 2018
Critical factors for the successful implementation of the proposed national health insurance system in South Africa
- Authors: Cortje, Gareth Frederick
- Date: 2012
- Subjects: National health insurance -- South Africa -- Nelson Mandela Bay Municipality , National health services -- South Africa -- Nelson Mandela Bay Municipality
- Language: English
- Type: Thesis , Masters , MBA
- Identifier: vital:8783 , http://hdl.handle.net/10948/d1013090
- Description: South Africa has a complex healthcare system. The provision and financing of health care in South Africa occur within two fundamentally different systems: the public healthcare sector and non-governmental not-for-profit organisations, on the one hand, and the private healthcare system, on the other hand. The socioeconomic status of an individual in South Africa is the primary determinant of the system through which he or she will receive access to healthcare. The healthcare services provided by the public and private sectors are perceived to be unequal. The introduction of healthcare reforms by the South African government through the National Health Insurance (NHI) aims to address these disparities. The primary objective of this study was to contribute to the successful implementation of the proposed South African NHI by identifying critical success factors that would impact such implementation. A sample of managerial representatives of the following healthcare institutions in the Nelson Mandela Bay Municipality (NMBM) was drawn: Large private hospitals groups; Eastern Cape Department of Health; Independent medical practitioners groups; South African Dental Association; Pharmacy Association of South Africa; Optometrist Association of South Africa. A total of 250 questionnaires were distributed among these institutions and approximately 233 usable questionnaires were returned (response rate 93.2 percent). A literature review was conducted to identify the various viewpoints (critical success factors, as well as positive and negative perceptions) on NHIs in other countries, as well as the proposed one in South Africa. About 43 of such viewpoints were identified. The 233 respondents were surveyed on these 43 viewpoints. The empirical results revealed the following three critical success factors for the successful implementation of the South African NHI: The projected benefits for stakeholders, with specific reference to medical aid schemes; the projected benefits to the private healthcare sector in servicing the public sector; and strategic leadership. The empirical results also showed that the healthcare managers, who serve the poor versus the affluent geographical areas of the NMBM, differ with regard to their projected success of the NHI. Finally, the study highlighted these health managers’ general perceptions about the envisaged benefits and shortcomings of the NHI.
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- Date Issued: 2012
The influence of selected elements of service quality provided by Chinese fine-dining restaurants in Port Elizabeth
- Authors: Zhao, Feng
- Date: 2009
- Subjects: Hospitality industry -- South Africa -- Port Elizabeth -- Quality control , Restaurants -- Customer services -- South Africa -- Port Elizabeth
- Language: English
- Type: Thesis , Masters , MTech
- Identifier: vital:9339 , http://hdl.handle.net/10948/1088 , Hospitality industry -- South Africa -- Port Elizabeth -- Quality control , Restaurants -- Customer services -- South Africa -- Port Elizabeth
- Description: A good understanding of customer expectations is very important to service providers. Since the Chinese first came to South Africa and started their restaurant businesses. Chinese fine-dining restaurants have become more and more popular. Identifying the customer expectations and Chinese fine-dining restaurant owner perceptions will help Chinese service providers to understand better the restaurant businesses. To ensure the development of the Chinese restaurant business in South Africa, it is very important to understand what South African customers want, whether there are differences between the Chinese restaurant owner perceptions of the service quality and South African customer expectations of the service quality. This would depend on the customers’ preferences, and provide a positive contribution to customer decision-making. Therefore, it is essential to understand and identify what is customer expectations are, what the management perceptions are and the differences between them. 5 In order to achieve the objectives of the research, the following approach was followed: Factors that influence the customer expectations and management perceptions are explained. Five factors used to measure the service quality of Chinese fine-dining restaurants are identified, namely reliability, responsiveness, assurance, empathy, tangibility. The responses to the questionnaire were collected and analysed to determine the extent to which factors are both important to customer expectations and management perceptions.
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- Date Issued: 2009