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13.6.1 Introduction
Humans are infected with Plasmodium protozoa when bitten by an infective female Anopheles mosquito vector.
The mosquito larvae develop within a few days, escaping their aquatic environment before it dries out. It is difficult, if not impossible, to predict when and where the breeding sites
will form, and to find and treat them before the adults emerge.
13.6.2 Patient’s Isolation
Malaria patient need not be nursed in isolation room. However, an air-conditioned or a naturally-ventilated room is preferred.
If a naturally-ventilated room is used, it is suggested to put mosquito nets to all the windows in the room.
If both facilities are not available, then the patients can be nursed in the general ward. Specific measures to avoid mosquito bites should be considered see under Prevention of
vector transmission.
13.6.3 Prevention of vector transmission
1. Source eliminationreduction for Malaria fever
Source elimination or reduction is the method of choice for mosquito control refer to Source eliminationreduction for Malaria fever.
2. Avoidance from mosquito bite
Specific measures on the avoidance from mosquito bite should be followed. Measures that have been described to avoid mosquito bites are:
•
insect repellents containing N,N-diethyl-3-methylbenzamide DEET, Adult-dose 95 DEET lasts as long as 10-12 hours, and 35 DEET lasts 4-6 hours. For
children, use concentrations of less than 35 DEET. Use sparingly and only on exposed skin. Remove DEET when no longer exposed. Please refer to PROPER
APPLICATION OF REPELLANT.
•
protective clothing the most effective is permethrin-impregnated. Avoid mosquitoes by limiting exposure during times of typical blood meals. Wearing
long-sleeved clothing may also prevent infection. •
insecticide-treated bed nets The use of insecticide-treated bed nets at night is useful as Anopheles mosquitoes bite during dawn and dusk.
•
insecticides- “knockdown resistance” may occur in some locations.
13.6 Malaria
Policies and Procedures on Infection Control
Ministry of Health Malaysia
190
•
Untreated bed nets form a protective barrier around persons using them. However, mosquitoes can feed on people through the nets, and nets with even a few small
holes provide little, if any, protection.
Anopheles mosquitoes bite during the dusk and dawn; hence, these measures must be taken during the late evening and throughout the night.
•
Fogging or area spraying is primarily reserved for emergency situations: halting epidemics or rapidly reducing adult mosquito populations when they have become
severe pests. Fogging and area sprays must be properly timed to coincide with the time of peak adult activity, because resting mosquitoes are often found in
areas that are difficult for the insecticide to reach.
Insecticide-treated bed net
Insecticide-treated bed nets ITNs are a form of personal protection that has repeatedly been shown to be useful in preventing Malaria andor Dengue transmission. ITNs
have been shown to reduce all-cause mortality by about 20. There are several types of nets available. Nets may vary by size, material, andor
treatment. Most nets are made of polyester but nets are also available in cotton, polyethylene, or polypropylene.
Currently, only pyrethroid insecticides are approved for use on ITNs. These insecticides have very low mammalian toxicity but are highly toxic to insects and
have a rapid knock-down effect, even at very low doses. Pyrethroids have a high residual effect. They do not rapidly break down unless washed or exposed to sunlight.
To maintain the efficacy of ITNs, the nets must be retreated at intervals of 6-12 months, more frequently if the nets are washed. Retreatment is done by simply dipping nets in
a mixture of water and insecticide and allowing the nets to dry in a shady place.
13.6.4 Proper Application Of Repellant
The environmental protection agency has issued guidelines regarding proper repellent application in order to maximize effectiveness and minimize side effects, which are par-
ticularly important when using DEET-based repellents: •
Use just enough repellent to lightly cover but not saturate the skin. •
Repellents should be applied to exposed skin, clothing, or both, but not under clothing. •
A thin layer can be applied to the face by dispensing repellent into the palms, rubbing hands together, and then applying to the face.
• Repellent should be removed from the palms after application to prevent contact with
the eyes, mouth, and genitals. •
Do not use repellents over cuts, wounds, inflamed, irritated, or eczematous skin. •
Do not inhale aerosols or get them into the eyes. •
Frequent reapplication of repellent is unnecessary. •
The areas treated with repellent should be washed with soap and water once the repellent is no longer needed.
Policies and Procedures on Infection Control
Ministry of Health Malaysia
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13.7.1 Introduction
• The incidence of fungal infections has increase in recent years as the
immunocompromised population increases. •
Candida infections are currently the fourth most common cause of bloodstream infections in ICUs and have led to the highest crude mortality rates for patients with
bloodstream infections. •
Data from Europe showed that 17 of microbiologically documented infections in ICUs were due to fungi, representing the fourth most common cause of nosocomial
bloodstream infections. •
The rate of candidemia in ICU patients has been estimated at 11000 patient days, less than half of such infections were caused by Candida albicans, and slightly
more than half were due to non-albicans Candida species. •
Hospital construction and renovation have been associated with an increased risk for nosocomial fungal infection, particularly aspergillosis, among severy immune-
compromised patient. •
The nonpathogenic fungi such as Trichosporon, Paeilomyces, acromium species, Mucormycosis agents and Dematiaceous are increasingly being identified as
nosocomial pathogens.
13.7.2 Candida Infection
• Risk factors for systemic fungal infections, particularly Candida infections, in ICU
patients include neutropenia, long-term central venous catheter access, colonization by Candida, exposure to broad-spectrum antibiotics, all forms of vascular
catheterization, mechanical ventilation, blood transfusions, hemodialysis, diabetes mellitus, steroid use, immunosuppression, parenteral feeding, and presence of urinary
catheters.
• Independent risk factors for Candida nosocomial infection in ICU patients include
length of previous broad spectrum antibiotic treatment, severity of underlying illness as measured by APACHE II score, and intensity of Candida colonization as
measured by the number of body sites colonized.
• Candida infections including candidemia can be transmitted via the hands of healthcare
workers, the evidence for cross infections particularly in the ICU’s has increased in the literature.
• There is a strong relationship between candida infections and hyperalimentation
using intravascular devices. •
Candiduria is especially common in patients receiving prolonged urinary catheterization and broad spectrum antimicrobial agents.
13.7 Fungal Infections 13.7 Fungal Infections
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