Efficacy of a Educational Tool to Improve Handrubbing Technique in Healthcare Workers

Introduction. Hand hygiene is a key component of infection control in healthcare. WHO recommends that healthcare workers perform six specific poses during each hand hygiene action. SureWash (Glanta Ltd, Dublin, Ireland) is a novel device that uses video-measurement technology and immediate feedback to teach this technique. We assessed the impact of self-directed SureWash use on healthcare worker hand hygiene technique and evaluated the device's diagnostic capacity.
Methods. A controlled before-after study: subjects in Group A were exposed to the SureWash for four weeks followed by Group B for 12 weeks. Each subject's hand hygiene technique was assessed by blinded observers at baseline (T0) and following intervention periods (T1 and T2). Primary outcome was performance of a complete hand hygiene action, requiring all six poses during an action lasting ≥20 seconds. The number of poses per hand hygiene action (maximum 6) was assessed in a post-hoc analysis. SureWash's diagnostic capacity compared to human observers was assessed using ROC curve analysis.
Results. Thirty-four and 29 healthcare workers were recruited to groups A and B, respectively. No participants performed a complete action at baseline. At T1, one Group A participant and no Group B participants performed a complete action. At baseline, the median number of poses performed per action was 2.0 and 1.0 in Groups A and B, respectively (p = 0.12). At T1, the number of poses per action was greater in Group A (post-intervention) than Group B (control): median 3.8 and 2.0, respectively (p<0.001). In Group A, the number of poses performed twelve weeks post-intervention (median 3.0) remained higher than baseline (p<0.001). The area under the ROC curves for the 6 poses ranged from 0.59 to 0.88.
Discussion. While no impact on complete actions was demonstrated, SureWash significantly increased the number of poses per hand hygiene action and demonstrated good diagnostic capacity.

Stewardson AJ, et al. Efficacy of a New Educational Tool to Improve Handrubbing Technique amongst Healthcare Workers. PLoS One. 2014; 9(9): e105866.

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Addressing climate change in healthcare settings

Publication details
Number of pages: 28
Publication date: 2009
Languages: English
Global climate change is no longer an ominous future threat but a dawning reality – one that is already creating disturbing shifts in the natural and human environment and eroding the delicate balance of our planet’s ecosystem and the species that depend on it.
This discussion draft is based on the World Health Organization’s (WHO) mandate from member states to develop “programmes for health systems that will contribute to reducing their own greenhouse gas emissions”. It also takes root in Health Care Without Harm’s (HCWH) more than 12 years of experience of working globally to transform the health sector so that it is no longer a source of harm to human health and the environment.
The paper begins to define a framework for analysing and addressing the health sector’s climate footprint – including identifying seven aspects of a climate-friendly hospital. It also draws on a series of examples from around the world that demonstrate that the health sector is indeed already beginning to provide leadership in this most important area of concern to the global community. This paper is the first step in a WHO project in collaboration with Health Care Without Harm (HCWH) aimed at addressing the climate footprint of the health sector.
World Health Organization and Health Care Without Harm. Healthy hospitals, healthy planet, healthy people: Addressing climate change in healthcare settings, 2009.
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Future Projections for #ebola outbreak

BACKGROUND. On March 23, 2014, the World Health Organization (WHO) was notified of an outbreak of Ebola virus disease (EVD) in Guinea. On August 8, the WHO declared the epidemic to be a “public health emergency of international concern.”
METHODS. By September 14, 2014, a total of 4507 probable and confirmed cases, including 2296 deaths from EVD (Zaire species) had been reported from five countries in West Africa — Guinea, Liberia, Nigeria, Senegal, and Sierra Leone. We analyzed a detailed subset of data on 3343 confirmed and 667 probable Ebola cases collected in Guinea, Liberia, Nigeria, and Sierra Leone as of September 14.
RESULTS: The majority of patients are 15 to 44 years of age (49.9% male), and we estimate that the case fatality rate is 70.8% (95% confidence interval [CI], 69 to 73) among persons with known clinical outcome of infection. The course of infection, including signs and symptoms, incubation period (11.4 days), and serial interval (15.3 days), is similar to that reported in previous outbreaks of EVD. On the basis of the initial periods of exponential growth, the estimated basic reproduction numbers (R0 ) are 1.71 (95% CI, 1.44 to 2.01) for Guinea, 1.83 (95% CI, 1.72 to 1.94) for Liberia, and 2.02 (95% CI, 1.79 to 2.26) for Sierra Leone. The estimated current reproduction numbers (R) are 1.81 (95% CI, 1.60 to 2.03) for Guinea, 1.51 (95% CI, 1.41 to 1.60) for Liberia, and 1.38 (95% CI, 1.27 to 1.51) for Sierra Leone; the corresponding doubling times are 15.7 days (95% CI, 12.9 to 20.3) for Guinea, 23.6 days (95% CI, 20.2 to 28.2) for Liberia, and 30.2 days (95% CI, 23.6 to 42.3) for Sierra Leone. Assuming no change in the control measures for this epidemic, by November 2, 2014, the cumulative reported numbers of confirmed and probable cases are predicted to be 5740 in Guinea, 9890 in Liberia, and 5000 in Sierra Leone, exceeding 20,000 in total.
CONCLUSIONS: These data indicate that without drastic improvements in control measures, the numbers of cases of and deaths from EVD are expected to continue increasing from hundreds to thousands per week in the coming months.
Ebola Virus Disease in West Africa — The First 9 Months of the Epidemic and Forward Projections. NEJM 2014
Meltzer mi, et al. Estimating the Future Number of Cases in the Ebola Epidemic — Liberia and Sierra Leone, 2014–2015. MMWR 2015. September 23, 2014 / 63(Early Release);1-14. 

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The durability of examination gloves used on intensive care units

Background: The use of examination gloves is part of the standard precautions to prevent medical staff from transmission of infectious agents between patients. Gloves also protect the staff from infectious agents originating from patients. Adequate protection, however, depends on intact gloves. The risk of perforation of examination gloves is thought to correlate with duration of wearing, yet, only very few prospective studies have been performed on this issue.
Methods: A total number of 1500 consecutively used pairs of examination gloves of two different brands and materials (latex and nitrile) were collected over a period of two months on two ICU’s. Used gloves were examined for micro perforations using the “water-proof-test” according to EN 455–1. Cox-regression for both glove types was used to estimate optimal changing intervals.
Results: Only 26% of gloves were worn longer than 15 min. The total perforation rate was 10.3% with significant differences and deterioration of integrity of gloves between brands (p<0.001). Apart from the brand, “change of wound dressing” (p = 0.049) and “washing patients” (p = 0.001) were also significantly associated with an increased risk of perforation.
Conclusion: Medical gloves show marked differences in their durability that cannot be predicted based on the technical data routinely provided by the manufacturer. Based on the increase of micro perforations over time and the wearing behavior, recommendations for maximum wearing time of gloves should be given. Changing of gloves after 15 min could be a good compromise between feasibility and safety. HCWs should be aware of the benefits and limitations of medical gloves. To improve personal hygiene hand disinfection should be further encouraged.
Keywords: Hand hygiene, Examination gloves, Micro perforation, Glove change, Intensive care unit, Disinfection, Multi-barrier strategy
Hübner NO, et al. The durability of examination gloves used on intensive care units. BMC Infect Dis. 2013; 13: 226.
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Reporte de casos de #ébola en trabajadores de la salud en África

En el reporte publicado el día de ayer, la organización mundial de la salud actualiza los datos de la situación epidemiológica del ébola en África. En resumen, existen 5335 casos reportados (probables, confirmados y sospechosos), con 2622 muertes hasta el 14/Sep/2014. Los países afectados son Guinea (942 casos, 601 muertes), Liberia (2710 casos, 1459 muertes), Sierra Leona (1673 casos, 562 muertes), Nigeria (21 casos, 8 muertes), y Senegal (1 caso, 0 muertes).
Dentro del reporte se hace mención de los casos registrados en trabajadores de la salud, que como resultado del trabajo de atención a pacientes con ébola, han resultado infectados con ébola. En el reporte de situación por países, claramente el país mas afectado es Liberia con 85 muertes de 172 casos reportados. En total de todos los países se han reportado 151 muertes de 318 casos de ébola. 
Los casos de los trabajares de la salud, es por lo tanto una de las más alarmantes, dado que son ellos quienes realizan las funciones del control de la epidemia, atención y cuidado de pacientes. Sin trabajadores de la salud, difícilmente podrá controlarse la epidemia, agravado por el hecho de que estos países cuentan con muy bajo número de médicos y enfermeras.

Tabla. Resumen de infecciones por ébola en trabajadores de la salud. 14/Sep/2014. 
Guinea     30         61
Liberia     85        172
Nigeria     5        11
Sierra Leona     31        74
TOTAL     151        318

WHO: Ebola Response Roadmap Situation Report 18 September 2014
REPORTE DE CASOS ACTUALIZADO WHO: Ebola Response Roadmap Situation Report 24 September 2014
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Fatal meningococcal disease in a laboratory worker - california, 2012

Occupationally acquired meningococcal disease is rare. Adherence to recommendations for safe handling of Neisseria meningitidis in the laboratory greatly reduces the risk for transmission to laboratory workers. A California microbiologist developed fatal serogroup B meningococcal disease after working with N. meningitidis patient isolates in a research laboratory (laboratory A). The California Department of Public Health (CDPH), the local health department, the California Division of Occupational Safety and Health (CalOSHA), and the federal Occupational Safety and Health Administration (OSHA) collaborated on an investigation of laboratory A, which revealed several breaches in recommended laboratory practice for safe handling of N. meningitidis, including manipulating cultures on the bench top. Additionally, laboratory workers had not been offered meningococcal vaccine in accordance with Advisory Committee on Immunization Practices (ACIP) recommendations and CalOSHA Aerosol Transmissible Diseases Standard requirements. In accordance with OSHA and CalOSHA regulations, laboratory staff members must receive laboratory biosafety training and use appropriate personal protective equipment, and those who routinely work with N. meningitidis isolates should receive meningococcal vaccine.
Sheets CD, et al. Fatal meningococcal disease in a laboratory worker - california, 2012. MMWR Morb Mortal Wkly Rep. 2014 Sep 5;63(35):770-2.
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UNICEF recruiting healthcare workers & other specialists

Ebola Crisis Response

The current crisis in West Africa is the largest Ebola outbreak ever reported, with 26 million people, including over 4.5 million children living in affected areas.

UNICEF is on the ground, working with community and religious leaders, youth organizations and others to fight widespread misconceptions about the disease and improve hygiene practices. UNICEF is also providing water and sanitation services to the affected communities, particularly through the procurement of water, sanitation and hygiene equipment and supplies -- as well as appropriate training for the health and medical partners.

As part of our drive to tackle the Ebola outbreak in West Africa, UNICEF seeks committed professionals, ready to be deployed immediately to countries in the affected area in the domains of Health and Nutrition, Communication for Development and Water and Sanitation.

Do you have the skills, competency and technical knowledge that we seek? Are you available to be deployed on short notice? UNICEF would like to hear from you.

Apply to our vacancies below and help our response to the Ebola crisis.

This page will be updated regularly to reflect our vacancies below in Ebola affected countries.

For more information, or if you have difficulties in applying, contact us at eRecruitment@unicef.org.

Check the full list of vacancies at: 

WHO guidelines on hand hygiene in health care

The WHO guidelines on hand hygiene in health care provide health-care workers (HCWs), hospital administrators and health authorities with a thorough review of evidence on hand hygiene in health care and specific recommendations to improve practices and reduce transmission of pathogenic microorganisms to patients and HCWs.
The present guidelines are intended to be implemented in any situation in which health care is delivered either to a patient or to a specific group in a population. Therefore, this concept applies to all settings where health care is permanently or occasionally performed, such as home care by birth attendants. Definitions of health-care settings are proposed in Appendix 1.
WHO guidelines on hand hygiene in health care
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WHO Antimicrobial resistance: global report on surveillance 2014

     Antimicrobial resistance (AMR) threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi. An increasing number of governments around the world are devoting efforts to a problem so serious that it threatens the achievements of modern medicine. A post-antibiotic era – in which common infections and minor injuries can kill – far from being an apocalyptic fantasy, is instead a very real possibility for the 21st Century. This WHO report, produced in collaboration with Member States and other partners, provides for the first time, as accurate a picture as is presently possible of the magnitude of AMR and the current state of surveillance globally.
     The report makes a clear case that resistance to common bacteria has reached alarming levels in many parts of the world and that in some settings, few, if any, of the available treatments options remain effective for common infections. Another important finding of the report is that surveillance of antibacterial resistance is neither coordinated nor harmonized and there are many gaps in information on bacteria of major public health importance. Strengthening global AMR surveillance is critical as it is the basis for informing global strategies, monitoring the effectiveness of public health interventions and detecting new trends and threats. As WHO, along with partners across many sectors moves ahead in developing a global action plan to mitigate AMR, this report will serve as a baseline to measure future progress.
WHO Antimicrobial resistance: global report on surveillance 2014
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Reducing Needle Stick Injuries in Healthcare Occupations

Needlestick injuries frequently occur among healthcare workers, introducing high risk of bloodborne pathogen infection for surgeons, assistants, and nurses. This systematic review aims to explore the impact of both educational training and safeguard interventions to reduce needlestick injuries. Several databases were searched including MEDLINE, PsycINFO, SCOPUS, CINAHL and Sciencedirect. Studies were selected if the intervention contained a study group and a control group and were published between 2000 and 2010. Of the fourteen studies reviewed, nine evaluated a double-gloving method, one evaluated the effectiveness of blunt needle, and one evaluated a bloodborne pathogen educational training program. Ten studies reported an overall reduction in glove perforations for the intervention group. In conclusion, this review suggests that both safeguard interventions and educational training programs are effective in reducing the risk of having needlestick injuries. However, more studies using a combination of both safeguards and educational interventions in surgical and nonsurgical settings are needed.
Yang L, Mullan B. Reducing needle stick injuries in healthcare occupations: an integrative review of the literature. ISRN Nurs. 2011;2011:315432.
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Infection Control During Filoviral Hemorrhagic Fever Outbreaks #Ebola

Breaking the human-to-human transmission cycle remains the cornerstone of infection control during filoviral (Ebola and Marburg) hemorrhagic fever outbreaks. This requires effective identification and isolation of cases, timely contact tracing and monitoring, proper usage of barrier personal protection gear by health workers, and safely conducted burials. Solely implementing these measures is insufficient for infection control; control efforts must be culturally sensitive and conducted in a transparent manner to promote the necessary trust between the community and infection control team in order to succeed. This article provides a review of the literature on infection control during filoviral hemorrhagic fever outbreaks focusing on outbreaks in a developing setting and lessons learned from previous outbreaks. The primary search database used to review the literature was PUBMED, the National Library of Medicine website.

  1. Raabea VN, Borcherta M. Infection control during filoviral hemorrhagic Fever outbreaks. J Glob Infect Dis. 2012 Jan;4(1):69-74.
  2. CDC Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus
  3. WHO Interim Infection Prevention and Control Guidance for Care of Patients with Suspected or Confirmed Filovirus Haemorrhagic Fever  in Health-Care Settings, with Focus on Ebola => DESCARGA OPCIONAL
  4. Health Canada. Interim Biosafety Guidelines for Laboratories Handling Specimens from Patients Under Investigation for Ebola Virus Disease
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