Background: Microbial keratitis is a sight-threatening disease. Empiric management is based on current regional microbial sensitivity patterns. Aim: This study aimed to describe the demographics and microbial patterns of keratitis at St John Eye Hospital and compare it with data from the same centre 10 years prior. Setting: A tertiary eye care centre in Soweto, South Africa. Methods: A retrospective cross-sectional study of the microbiological reports of patients treated for microbial keratitis between 01 January 2018 and 31 December 2018. Results: The median age of patients was 42 years (interquartile range [IQR]: 3–77) with a male predominance of 57.0% (n = 65/113). Culture positivity rate was 63.0% (n = 84/133). There was a predominance of Gram-positive organisms of 63.0% (n = 84/133). The most common Gram-positive organism was coagulase-negative Staphylococcus (CNS) (32.0%, 42/133), and the most common Gram-negative organism was Pseudomonas aeruginosa (6.0%, 8/133). Other common organisms were Staphylococcus aureus (14.0%, 18/133), Streptococcus pneumoniae (9.0%, 12/133) and Streptococcus viridans (5.0%, 6/133). Commonly used fluoroquinolones ciprofloxacin and moxifloxacin had resistance of 4.2% and 10.0%, respectively. Gentamicin had a resistance of 5.8%. Culture positivity rate increased compared to 2008 from 52% to 63%. There was an increase from 2008 to 2018 of Pseudomonas aeruginosa from 2% to 6%. There was little change in antibiotic resistance profiles between the two study periods (2008 and 2018). Conclusion: Culture positivity rate has increased at our institution and suggests improvements in detecting organisms and antibiotic susceptibilities. There does not seem to be any change in the susceptibilities of organisms between the study periods; therefore, it suggests current empiric management remains appropriate.

Background: Occupational exposure to ionising radiation may have detrimental health effects. Longer and more complex fluoroscopic procedures have placed interventionalists at increased occupational health risks especially for developing cataracts in the radiosensitive lenses of the eyes.Objectives: This study aimed to determine the prevalence of occupational related cataracts and describe the risk factors for cataracts in occupationally exposed interventionalists compared with unexposed doctors.Method: A cross-sectional study using multiple methods. A survey was conducted. The radiation workload was determined based on a self-administered questionnaire and dose area product values determined in previous studies. Both groups had slit lamp examinations. The data were analysed analytically using R software version 9.3.Results: The study included 98 interventionalists. The combined prevalence of posterior sub-capsular (PSC) and cortical cataracts was 18.8% in the exposed and 13.9% in the unexposed group. The prevalence of PSC cataracts in the exposed group was 5.9% and 2.8% in the unexposed group, with an odds ratio (OR) of 2.2 (95% confidence interval [CI]: 0.58; 8.61). Posterior sub-capsular cataracts were more common in the left eye. The increase in cataracts was not statistically significant in the exposed group but is of clinical significance.Conclusion: The findings are important as they highlight the need for greater vigilance for protecting the radiation healthcare workforce in a developing country setting.Contribution: The research is the first of its kind in South Africa and Africa and contributes to determining the prevalence in this highly skilled and occupationally vulnerable group.

Background: Back and neck pain are common in the general population and a common occupational condition. Occupationally related back and neck pain is common amongst ophthalmologists. Aim: The aim of this study was to determine the prevalence of back and neck pain amongst South African ophthalmologists. Setting: This was a survey that was conducted amongst South African ophthalmologists ( n = 324) and ophthalmologists-in-training ( n = 115). Methods: The response rate was 44.8% ( n = 197). There was no sampling and a hyperlink to an electronic questionnaire, hosted on the REDCap survey platform, was sent to 440 potential respondents. A descriptive analysis was carried out using STATA version 15. Ethical approval was obtained from the University of Witwatersrand. Results: Mean age was 47.1 years (standard deviation [s.d.] ± 12.1) and 62 (31.5%) women. The cohort was stratified into specialists ( n = 81, 41.1%), subspecialists ( n = 75, 38.1%) and ophthalmologists-in-training ( n = 41, 20.8%). Most of the participants ( n = 156, 79.2%) were qualified ophthalmologists. Respondents reported current back pain ( n = 124, 62.9%), lower back pain ( n = 66, 33.5%) and neck pain ( n = 76, 38.6%). The overall median pain rating (on a scale from 1 to 10) was 4. Respondents reported mild pain ( n = 71, 36%) and severe pain ( n = 35, 17.7%). Operating and using a slit lamp were pain aggravating factors in 36% ( n = 71) and 37.1% ( n = 73), respectively. Conclusion: Back and neck pain are prevalent amongst South African ophthalmologists and comparable to other ophthalmologists worldwide.

Ionising radiation (IR) is increasingly being used in diagnostic and therapeutic procedures and offers increased benefits to patients but poses an increased occupational health risk to operators. The consistent use and monitoring of radiation health care workers’ dosimeters is an important part of the process for ensuring adequate monitoring and control of IR in the workplace. There is however often inconsistent dosimeter utilisation among these workers. The aim of this study was to report on the dosimeter utilisation and dosimetry practices in South African interventionalists. We conducted a survey and did in-depth and group interviews to evaluate dosimetry practices and the factors influencing these practices. We used STATA 15 to do a descriptive analysis of the quantitative data. A thematic analysis of the qualitative data was done using a deductive and inductive approach. There were 108 respondents (35 radiologists, 41 adult cardiologists, 32 paediatric cardiologists). The majority overall (65.8%), and in each category were males. The median age was 44 (interquartile range (IQR) 31–66)) and the median years worked with fluoroscopy was 10 years (IQR 1–32). Overall interventionalists (55%) ranked their perceived occupation risk as 2/10. Thirteen per cent of all interventionalists reported never using a personal dosimeter (PD), 58% reported wearing it >70% of the time. Inconsistent and inappropriate use of PDs emerged strongly from the qualitative data. There was poor dosimeter utilisation in this study. Participants were not aware of the role of medical physics departments. Evaluation of dosimetry practices as a means of monitoring and improving radiation safety in the catheterisation laboratory must be improved to create an improved culture of radiation safety and protection.

The COVID-19 pandemic has presented an unprecedented global health challenge. A number of key initiatives have been launched in response, including the People’s Vaccine – a call for COVID-19 testing, supportive treatment and vaccines to be made freely available to all people. However, technical support for this initiative will be needed for the accomplishment of its goals, particularly in relation to the future global COVID-19 vaccine rollout. To this end, we propose the establishment of a Technical Team that can bring together the streams of public health intelligence, implementation science and global health diplomacy. Emerging from the People’s Vaccine initiative, such a team would not only support its objectives but could also develop critical capacities and institutional memory. This could be of value in collaborative efforts aimed at addressing global health challenges beyond COVID-19.

Background: Ionising radiation (IR) is an occupational hazard for interventionalists. Dry eye syndrome may develop. There may be damage to the corneal epithelium, causing irritation and ulceration. Radiation-induced cataracts commonly develop in the posterior sub-capsular (PSC) region of the lens and are more common in the left eye. Aim: The aim of this study was to describe the ophthalmological findings in South African interventionalists occupationally exposed to IR. Setting: This study was conducted in South Africa. Methods: A prospective cross-sectional study was conducted. Interventional radiologists (25), adult cardiologists (42) and paediatric cardiologists (31) were recruited at conferences and included in the study. Convenience sampling was used. Participants completed a survey that collected data on their demographics, their cataract risk factors and co-morbid diseases, their occupational history, their radiation safety practices and their training in occupational history. Participants' eyes were examined using a slit lamp after dilation of the eyes. Ethics clearance was obtained and each participant gave informed consent. A descriptive analysis was done. Results: The median age of the 98 interventionalists screened was 43.5 years. They worked with radiation for a median of 7.5 years. Cataracts occurred in the left eye of 17 (17.3%) participants and in the right eye of nine (9.2%). There were five (5.1%) PSC cataracts in the left eye and one (1%) in the right eye. The vitreous was abnormal in 19.4% of participants. The tear break-up time was abnormal in 48% of participants. Conclusion: Ionising radiation is an occupational hazard posing a risk to interventionalists' eyes. They are at increased risk of cataracts and dry eye syndrome, which can affect their occupational performance and quality of life. Education can positively influence the radiation safety practices of interventionalists that could reduce the detrimental effects of IR on their eyes.

Background: Occupational exposure to ionising radiation poses potential health risks to radiation workers unless adequate protection is in place. The catheterisation laboratory is a highly contextualised workplace with a distinctive organisational and workplace culture. Objective: This study was conducted to understand the culture of radiation protection (CRP). Methods: This study was a qualitative study and data were collected through 30 in-depth and 6 group interviews with 54 purposively selected South African interventionalists (interventional radiologists and cardiologists). The participants included a diversity of interventionalists who varied in sex, geographic location and years of experience with fluoroscopy. The transcribed data were analysed thematically using a deductive and inductive approach. Results: ‘Culture of radiation protection’ emerged as a complex theme that intersected with other themes: ‘knowledge and awareness of radiation’, ‘radiation safety practice’, ‘personal protective equipment (PPE) utilisation’ and ‘education and training’. Conclusion: Establishing and sustaining a CRP provides an opportunity to mitigate the potentially detrimental health effects of occupational radiation exposure. Education and training are pivotal to establishing a CRP. The time to establish a culture of radiation in the catheterisation laboratory is now.

Objective: This study explored personal protective equipment (PPE) availability and PPE utilization among interventionalists in the catheterization laboratory, which is a highly contextualized workplace. Methods: This is a cross-sectional study using mixed methods. Participants (108) completed a survey. A hyperlink was sent to the participants, or they were asked to complete a paper-based survey. Purposively selected participants (54) were selected for individual (30) or group (six) interviews. The interviews were conducted at conferences, or appointments were made to see the participants. Logistic regression analysis was performed. The qualitative data were analyzed thematically. Results: Lead glasses were consistently used 10.2% and never used 61.1% of the time. All forms of PPE were inconsistently used by 92.6% of participants. Women were 4.3 times more likely to report that PPE was not available. PPE compliance was related to fit and availability. Conclusions: PPE use was inconsistent and not always available. Improving the culture of radiation protection in catheterization laboratories is essential to improve PPE compliance with the aim of protecting patients and operators. This culture of radiation protection must include all those involved including the users of PPE and the administrators and managers who are responsible for supplying sufficient, appropriate, fitting PPE for all workers requiring such protection. (C) 2018 Occupational Safety and Health Research Institute, Published by Elsevier Korea LLC.

Exposure to ionising radiation may have deterministic and stochastic health effects, which include skin changes, chromosomal aberrations, cataracts and carcinomas. Formalised training in radiation safety and protection improves knowledge on the subject and facilitates greater compliance in safety practices. This qualitative study included 54 interventionalists (adult and paediatric cardiologists, and interventional radiologists). The participants were purposively selected and interviewed to explore their perceptions about radiation safety. A thematic analysis of the transcripts was done using a deductive and inductive approach. Findings showed participating cardiologists had less knowledge about radiation safety than participating radiologists. Cardiologists reported little or no formal training on radiation safety and did not display a culture of radiation safety. There was no consensus on how the training gap should be addressed. There is a perceived need to change and enhance the radiation safety culture among interventionists, and the participants proffered some ideas. These included the need for re-curricularisation of cardiologists' training to create awareness of radiation safety practices.

To the Editor: On 11 November 2015, the National Department of Health (NDoH) published the National Public Health Institute of South Africa (NAPHISA) Draft Bill 2015 for public comment. The aim of the Draft Bill is: '[t]o provide for the establishment of the National Public Health Institute of South Africa in order to conduct disease and injury surveillance and to provide specialised public health services, public health interventions, training and research directed towards the major health challenges affecting the population of the Republic.'

Background: Bee venom allergy is an important cause for anaphylaxis and may have potentially fatal consequences. At-risk occupations include florists, horticulturists, farmers, bakers, fruit sellers, foresters and beekeepers. Control measures include changing jobs, wearing protective clothing, controlling the distance between beehives and the work place, and farming with less aggressive species. Management of a sting depends on the severity of the response and ranges from local topical treatments to intensive care admission for anaphylaxis. Findings: The patient had an anaphylactic reaction and epinephrine was not timeously administered because the nursing sister was not familiar with the use of the EpiPen®. The viability of the nursing sister's thumb was threatened after she accidentally dispensed the epinephrine into her thumb as a result of her panic. Hospital management was prompt and both patients were treated appropriately. The nursing sister had an informal meeting to address the incident but was not issued with a warning. The patient was re-instructed on the use of the EpiPen® and continued working in his job. Conclusion and recommendations: In this case, venom desensitisation should be considered, and it is questionable that the man should continue working in this environment. The patient had near fatal consequences as a result of poor initial emergency care management. New nursing personnel need to be adequately inducted on the first day of a new job; this cannot be delayed as in this case. Workers with known allergies to bee stings need to be frequently re-instructed on the use of self-injectable epinephrine; co-workers should also be trained.