Background: The continuous education of healthcare workers (HCW) is considered as one of the key components of infection control programs. Since nurses are the frontline healthcare staff; their optimal and periodic training in basic infection control practices is essential. Objectives: The current study aimed at assessing the pre-existing knowledge and evaluating the effectiveness of one day educational activities to improve the knowledge regarding infection control practices. Methods: A whole day educational activity comprising didactic lectures and hands-on training on routine infection control practices was conducted for a group of 34 nursing staff. Cognitive gain was assessed using a pre-validated, pre-and posttest questionnaire. The participants' perceptions of the entire educational activity were scored based on a five-point Likert scale. Results: The average percentage of test score increased significantly from 19.71% (pretest score: 3.94 ± 2.3) to 76.69% (posttest score: 15.33 ± 2.4). The class-average normalized gain was 0.7097 (70.97%). The mode rating score of the participant's perception increased from 3 (good) to 4 (very good). Conclusions: Educational intervention had a significant impact on the improvement in the knowledge of nursing staff. Similar periodic interventions should be encouraged to facilitate the learning of HCWs on the best infection control practices.

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Phenotypic TB drug resistance, also known as drug tolerance, has been previously attributed to slowed bacterial growth in vivo. The increased activity and expression of efflux systems can lower the intracellular concentration of many antibiotics thus reducing their efficacy. We hypothesized that efflux pump activation and expression could be a risk factor for TB drug tolerance in patients initiated on treatment. Analyses of gene expression levels of six select efflux pumps associated with drug tolerance in Mycobacterium tuberculosis and its correlation with the cell’s ability to efflux ethidium bromide (a common efflux substrate) were assayed. Efflux pump gene expression differed significantly between the strains from treatment failures and treatment successes. Efflux of ethidium bromide by M. tuberculosis isolates revealed that isolates from treatment failures rapidly efflux ethidium bromide more than isolates from treatment successes or the H37Rv control strains. The efflux pumps efpA, jefA (Rv2459c), Rv1258c, p55 and mmpL7 may have a role in TB drug tolerance. Quantifying the expression levels of M. tuberculosis efflux pump genes may be a new method to diagnose clinically persistent tuberculosis. High efflux pump activity and expression at baseline can be associated with tuberculosis treatment failure even when the Mycobacterium tuberculosis does not have established resistance mutations.Journal of Medical and Biomedical Sciences (2017) 6(1), 8-17Keywords: drug resistance, Efflux, Mycobacterium tuberculosis, expression, treatment outcome

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