Latex Gloves: More harm than good!
C.
DE BEER, J. CILLIERS
Department of Dermatology, Tygerberg Hospital and
University of Stellenbosch.
P.J.
TRUTER
School of Life Sciences, Cape Technikon.
P.C. POTTER
Department of Allergology, Groote Schuur Hospital.
Abstract
Health care workers (HCW) use latex gloves daily to prevent transmission of
microbial and viral organisms to and from patients and specimens.
Repeated exposure to latex proteins (through direct skin contact or
mucous membrane absorption) causes the formation of circulating latex-specific
antibodies and increases the risk of sensitization.
HCW have the highest risk to develop latex hypersensitivity (LH).
Early detection of antibodies or predisposing factors (e.g. atopy or
impaired skin barrier function) could assist in the identification and
management of risk groups and limit possible sensitisation.
An experimental group with high latex exposure is compared to a control group
from low or no exposure areas at Tygerberg Hospital, Cape Town.
A questionnaire targeted a thorough history of past and present latex
exposure and identified risk factors in all subjects.
A complete physical examination confirmed possible clinical signs and
symptoms of risk factors and LH. Atopy
was evaluated by means of clinical diagnostic criteria, complete haematogram and
total serum IgE. Latex-specific IgE
antibodies were measured immunometrically.
Skin prick tests were performed on subjects with negative in vitro
results, but with symptoms suggestive of LH.
An overall 20,8% prevalence of LH in personnel of the Tygerberg Academic
Hospital was found. Only 28,6 % of
these patients suspected that they had LH, while 7,3% did not suspect and a
further 35,7% did not know of underlying LH.
In the high exposure areas alone, the prevalence reached a value of
30,7%. It is imperative to start
instituting safety measures to manage the affected personnel and reduce or even
prevent additional staff exposure and further rise in LH.
Prevention will in the long term be far more cost-effective than
management of sensitized individuals.
The Use of a Mobile Laboratory for Tuberculosis Tracing
in the Rural Free State
C.C. JORDAAN, M.N. JANSE VAN RENSBURG, P.L. BOTHA
Department of Medical Microbiology, University of
the Free State.
Abstract
We have used a mobile laboratory (ML) to assist the existing health care
services in the tracing and diagnosis of tuberculosis patients and to improve
the control and treatment of tuberculosis (TB).
The visit to a rural area by the ML was co-ordinated with the local
health care services. The clinic to
be visited was provided (2 weeks prior to the visit) with specimen containers
for distribution among suspected TB cases.
Ziehl-Neelsen stained Smears were examined microscopically in the ML.
During April 1996 to October 1937 our ML visited fifteen regions in our
province. The ML visited several
clinics in a day. Of the 3218 specimens examined, 54 were positive (1,67%) and
32 were cultured. The Qwa-Qwa
region yielded the most positive specimens (18/359; 5%).
Many problems were encountered of which lack of co-operation between the clinic
staff and the ML was the most important. Even
though some clinics were visited twice, only a portion of the possible specimens
were received. Approximately 7800
organisms are necessary for a sputum specimen to be positive.
Because of the poor quality of most of the specimens, it is possible that
many were falsely negative. These
and other problems will have to be overcome (e.g.
by education and training of health workers) if the ML is to become fully
effective.
Tuberculosis (TB) is one of the most common opportunistic infections in Africa
and is a major public health problem world wide. TB accounts for more than 80% of all communicable diseases
notified in South Africa and is at present regarded as one of the most serious
health problems affecting the country. Black
and coloured communities are particularly at risk of developing TB.
The essence of tuberculosis control lies in identifying all patients with
the disease and treating them fully. This
requires screening of high-risk groups, education of the public to ensure early
diagnosis, adequate tracing of contacts, and the implementation of an effective
anti-tuberculosis treatment regimen.
Case finding, especially in the rural areas can be a major problem.
TB case finding depends predominantly on voluntary self-presentation,
which in turn is influenced by symptom recognition, cultural and social
influences. There are also enabling
factors such as time, money and trained health workers4.
Appropriate and accessible health services are needed to control any
disease. The South African TB
control programme provides some of the enabling factors such as free treatment
and clinic-based rather than hospital-based services.
By using a mobile laboratory (ML) we have attempted to assist the
existing health care services in the tracing and diagnosis of tuberculosis
patients with the view to improving the control and treatment of the disease.
The Evaluation of b-Lactamase
Inhibitor Combinations for Detection of Organisms Producing Extended-Spectrum b-Lactamases
using the Double-Disc Test
M. SNYMAN, J. PITOUT, C. JORDAAN
Department of Medical Microbiology, University of
the Free State.
Abstract
A study was undertaken to compare the following b-lactamase inhibitors, amoxycillin/clavulanic acid tame), ampicillin/sulbactam
(sam) and piperacillin 1 tazobactam (tzp) for detection of organisms producing
extended spectrum b-lactamases
using the double disc (DD) test.
The DD test as described by Jatlier etal, was performed on 35 control strains
and 59 clinical strains (including Klebsiella pneumoniae, K.oxytoca, Esherichia
coli, Proteus mirabilis, Enterobacter cloacae and E. aerogenes) producing different types of b-lactamases. This test was
repeated on days 3, 7, 14, 21 and 28.
The results of the different combinations on day 1 compared as follows:
sensitivity of amc 98,6%, tzp 87,8 % and sam 77 %; specificity of all three was
90%. Similar results for all three
were obtained on days 3 and 7, but on day 28 the sensitivity of amc declined to
43,2 % , tzp to 35,1% and sam to 32,4%. Amc
proved to be the most sensitive combination for detecting ESBL-producing
organisms. The interpretation with
tzp was highly subjective (except for E. aerogenes)
and sam fared poorly especially when an organism produced more than 1 b-lactamase.
We recommended that amc be replaced every 7 days with fresh discs and tzp should
be further investigated for detection of ESBLs, in organisms producing Bush
group 1 b-lactamases. Enterobacteriaceae
producing extended-spectrum b-lactamases
(ESBLs) are an important cause of failure of therapy with the expanded-spectrum
cephalosporins but some organisms do not appear resistant to these agents in
routine susceptibility tests. Therefore,
it is necessary for a clinical microbiology laboratory to implement a special
test such as a double-disc (DD) test designed for detecting organisms producing
ESBLs. Although this is generally a
reliable test, there are several limitations.
One such limitation is that only fresh amoxycillin/clavulanic acid discs
should be used because of the instability of clavulanic acid.
This additional cost puts an unnecessary financial burden on the
cost-effective running of a clinical microbiology laboratory.