Assessment of Health Facilities for Airborne Infection Control Practices and Adherence

Introduction: Nosocomial transmission of airborne infections, such as H1N1, drug-resistant tuberculosis, and Nipah virus disease, has been reported recently and has been linked to the limited airborne infection control strategies. The objective of the current study was to assess the health facilities for airborne infection control (AIC) practices and adherence to the National AIC (NAIC) guidelines, 2010.
Materials and Methods: A cross-sectional study was conducted in 25 public and 25 private hospitals selected from five randomly selected districts in the state of Kerala. A checklist with 62 components was developed based on the NAIC guidelines. Frequencies, percentages, and mean with standard deviation were used to summarize facility risk assessment and compliance to guidelines.
Results: Most of the facilities had infection control committees 35 (70%). Annual infection control trainings were held for staff in 21 (42%) facilities. Twenty (40%) facilities were not familiar with NAIC guidelines. Counseling on cough etiquette at registration was practiced in 5 (10%) institutions. Cross ventilation was present in outpatient departments in 27 (54%) institutions. Sputum was disposed properly in 43 (86%) institutions. N95 masks were available in high-risk settings in 7 (14%) health facilities.
Conclusion: There exist deficiencies in adherence to all components of NAIC guidelines including administrative, environmental, and use of personal protective equipment in both government and private hospitals in the state.
REFERENCE:
Raj A, et al. Assessment of Health Facilities for Airborne Infection Control Practices and Adherence to National Airborne Infection Control Guidelines: A Study from Kerala, Southern India. Indian J Community Med. 2019;44(Suppl 1):S23–S26. doi:10.4103/ijcm.IJCM_25_19


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The pandemic influenza threat

Aims: This paper aims to summarise the growing literature concerning an imminent future influenza pandemic, from the primary care perspective.
Methods: Sources of literature were scanned and relevant material short-listed for further study from: (1) WHO and CDC websites; (2) PUBMED; and (3) papers mentioned in references of full-text papers.
Results: Outbreaks of avian influenza in Asia and elsewhere indicate that the world may be moving towards a pandemic influenza outbreak. The WHO Global Influenza Preparedness Plan 2005 unifies the world with the vision of tackling the next pandemic influenza outbreak as a global effort that includes healthcare provider and patient alike.
Conclusions: We need to update ourselves and keep our staff and patients informed to make infection control measures part of our daily activities. In areas where there are contacts with animal reservoirs of influenza A, patients need to be reminded that they need to protect themselves from being infected.
REFERENCIA:
Goh, Lee Gan, and Pak Yean Cheong. The pandemic influenza threat: a review from the primary care perspective. Primary care respiratory journal : journal of the General Practice Airways Group vol. 15,4 (2006): 222-7. doi:10.1016/j.pcrj.2006.04.193

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Procedimiento NIOSH para determinar la eficiencia de filtración N95

Este procedimiento establece los medios para asegurar que la eficiencia de filtración particulada de filtros N95 usados en respiradores sin energía enviados para aprobación, extensión de la aprobación o examinados durante las auditorias de productos certificados, reúne los estándares mínimos establecidos en la 42CFR, parte 84, subparte K, $84.181. Estos filtros o filtros de cartuchos pueden estar integrados a la construcción del respirador; montados individualmente, o en grupos de hasta tres; usados en conjunto con cartuchos o canastas para máscaras de gas estilo barbilla, montados al frente, y montados atrás; o usados en combinación con respiradores de gas-vapor o con abastecimiento de atmósfera.
REFERENCIA:
Procedure No, TEB-APR-STP-0059. Determination of particulate filter efficiency level for N95 series filters against solid particulates for non-powered, air purifying respirators standard tresting procedure (STP). NIOSH 2019Oct31.


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Risk of transmission via medical employees of MERS

















Background: In 2015, South Korea experienced an outbreak of Middle East respiratory syndrome (MERS), and our hospital experienced a nosocomial MERS infection. We performed a comprehensive analysis to identify the MERS transmission route and the ability of our routine infection-prevention policy to control this outbreak.
Methods: This is a case–cohort study of retrospectively analysed data from medical charts, closed-circuit television, personal interviews and a national database. We analysed data of people at risk of MERS transmission including 228 in the emergency department (ED) and 218 in general wards (GW). Data of personnel location and movement, personal protection equipment and hand hygiene was recorded. Transmission risk was determined as the extent of exposure to the index patient: 1) high risk: staying within 2 m; 2) intermediate risk: staying in the same room at same time; and 3) low risk: only staying in the same department without contact.
Results: The index patient was an old patient admitted to our hospital. 11 transmissions from the index patient were identified; 4 were infected in our hospital. Personnel in the ED exhibited higher rates of compliance with routine infection-prevention methods as observed objectively: 93% wore a surgical mask and 95.6% washed their hands. Only 1.8% of personnel were observed to wear a surgical mask in the GW. ED had a higher percentage of high-risk individuals compared with the GW (14.5% vs. 2.8%), but the attack rate was higher in the GW (16.7%; l/6) than in the ED (3%; 1/33). There were no transmissions in the intermediate- and low-risk groups in the ED. Otherwise 2 patients were infected in the GW among the low-risk group. MERS were transmitted to them indirectly by staff who cared for the index patient.
Conclusions:  Our study provide compelling evidence that routine infection-prevention policies can greatly reduce nosocomial transmission of MERS. Conventional isolation is established mainly from contact tracing of patients during a MERS outbreak. But it should be extended to all people treated by any medical employee who has contact with MERS patients.
Trial registration: NCT02605109, date of registration: 11th November 2015.
REFERENCE:
Ki, Hyun Kyun et al. Risk of transmission via medical employees and importance of routine infection-prevention policy in a nosocomial outbreak of Middle East respiratory syndrome (MERS): a descriptive analysis from a tertiary care hospital in South Korea. BMC pulmonary medicine vol. 19,1 190. 30 Oct. 2019, doi:10.1186/s12890-019-0940-5

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Potential of Cell-Free Protein Synthesis

Cell-free protein synthesis (CFPS) system is a simple, rapid, and sensitive tool that is devoid of membrane-bound barriers, yet contains all the mandatory substrates, biomolecules, and machineries required for the synthesis of the desired proteins. It has the potential to overcome loopholes in the current in vivo production systems and is a promising tool in both basic and applied scientific research. It facilitates a simplified organization of desired experiments with a variety of reaction conditions, making CFPS a powerful tool in biological research. It has been used for the expansion of genetic code, assembly of viruses, and in metabolic engineering for production of toxic and complex proteins. Subsequently, CFPS systems have emerged as potent technology for high-throughput production of membrane proteins, enzymes, and therapeutics. The present review highlights the recent advances and uses of CFPS systems in biomedical, therapeutic, and biotechnological applications. Additionally, we highlight possible solutions to the potential biosafety issues that may be encountered while using CFPS technology.
REFERENCE:
Khambhati K, et al. Exploring the Potential of Cell-Free Protein Synthesis for Extending the Abilities of Biological Systems. Front Bioeng Biotechnol. 2019 Oct 11;7:248. doi: 10.3389/fbioe.2019.00248. eCollection 2019. Review. PubMed PMID: 31681738; PubMed Central PMCID: PMC6797904.

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Laboratory Safety: Handbook (Tuberculosis)

This guide has been developed to help reduce the risk of infection or injury, and protect the laboratory workforce and the wider community against unintentional exposures or releases of pathogenic biological agents. This handbook provides practical information and clear illustrations to assist laboratory staff in understanding the important safety issues related to the processing and management of samples potentially containing Mycobacterium tuberculosis.
The Laboratory Safety handbook is a practical guide for laboratory staff; it draws on decades of experience working in culture and DST laboratories, and references best practice documents released by WHO, the Global Laboratory Initiative, and The Union. The Handbook uses simple text and clear illustrations to assist laboratory staff in understanding the important safety issues involved in performing culture and DST. The TB Laboratory Safety handbook should be used with the Tuberculosis laboratory biosafety manual.
REFERENCE:
Laboratory Safety: Handbook
ISBN: 978-0-6486845-1-0 (PDF)
ISBN: 978-0-6486845-0-3 (Print)
© 2019 Global Laboratory Initiative
Global TB Programme
World Health Organization

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Penetración de etoxi- y butoxietanoles a través de un guante desechable de nitrilo

El propósito de este estudio fue investigar la penetración de los glicoléteres, 2-etoxietanol (2-EE) y 2-butoxietanol (2-BE) a través de guantes de examen desechables de nitrilo usando un módulo ASTM modificado de circuito cerrado. Los dos éteres de glicol puro desafiaron el guante de nitrilo púrpura sin polvo, sin forro, sin forro, de Kimberly-Clark. Sus parámetros de permeación se midieron con la ayuda de una celda de permeación de circuito cerrado ASTM F739 de 2.54 cm utilizando recolección de agua a 35.0 ± 0.5oC en un baño de agua con bandeja móvil y cromatografía de gases capilar-espectrometría de masas para cuantificación. Cada conjunto de experimentos consistió en cuatro células de permeación estándar con agua como solvente de recolección. La tasa de permeación en estado estacionario para 2-EE de 4,83 ± 0,45 µg / cm2 / min fue aproximadamente 4 veces mayor que la de 2-BE (1,27 ± 0,11 µg / cm2 / min). La penetración del 2-BE más no polar fue menor que para el 2-EE. Ambos solventes excedieron el umbral de tiempo normalizado de ASTM en el módulo de prueba de circuito cerrado. Las muestras de guantes no pasaron los criterios de permeabilidad definidos por Kimberly Clark y Ansell. Tales guantes no se recomiendan como equipo de protección personal para la exposición al 2-butoxietanol o al 2-etoxietanol, incluso para exposiciones de períodos muy cortos. Los fabricantes de guantes deberían reconsiderar el método de prueba de permeación existente para compuestos de baja volatilidad y aplicar el módulo de circuito cerrado debido a una mayor sensibilidad y precisión.
REFERENCIA:
Banaee S, Que Hee SS. Permeation of ethoxy- and butoxy- ethanols through a disposable nitrile glove. Ind Health. 2019 Nov 2. doi: 10.2486/indhealth.2019-0146. [Epub ahead of print] PubMed PMID: 31685784.

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Bat Research Networks and Viral Surveillance

Bat research networks and viral surveillance are assumed to be at odds due to seemingly conflicting research priorities. Yet human threats that contribute to declines in bat populations globally also lead to increased transmission and spread of bat-associated viruses, which may pose a threat to global health and food security. In this review, we discuss the importance of and opportunities for multidisciplinary collaborations between bat research networks and infectious disease experts to tackle shared threats that jeopardize bat conservation as well as human and animal health. Moreover, we assess research effort on bats and bat-associated viruses globally, and demonstrate that Western Asia has limited published research and represents a gap for coordinated bat research. The lack of bat research in Western Asia severely limits our capacity to identify and mitigate region-specific threats to bat populations and detect interactions between bats and incidental hosts that promote virus spillover. We detail a regional initiative to establish the first bat research network in Western Asia (i.e., the Western Asia Bat Research Network, WAB-Net), with the aim of integrating ecological research on bats with virus surveillance to find “win-win” solutions that promote bat conservation and safeguard public and animal health across the region.
REFERENCE:
Phelps, Kendra L et al. Bat Research Networks and Viral Surveillance: Gaps and Opportunities in Western Asia. Viruses vol. 11,3 240. 10 Mar. 2019, doi:10.3390/v11030240

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CDC’s Antibiotic Resistance Threats in the United States, 2019


DOWNLOAD REPORT
CDC’s Antibiotic Resistance Threats in the United States, 2019 (2019 AR Threats Report) includes the latest national death and infection estimates that underscore the continued threat of antibiotic resistance in the U.S.
According to the report, more than 2.8 million antibiotic-resistant infections occur in the U.S. each year, and more than 35,000 people die as a result. In addition, 223,900 cases of Clostridioides difficile occurred in 2017 and at least 12,800 people died.
Dedicated prevention and infection control efforts in the U.S. are working to reduce the number of infections and deaths caused by antibiotic-resistant germs, but the number of people facing antibiotic resistance is still too high. More action is needed to fully protect people.
CDC is concerned about rising resistant infections in the community, which can put more people at risk, make spread more difficult to identify and contain, and threaten the progress made to protect patients in healthcare. The emergence and spread of new forms of resistance remains a concern.
The report lists 18 antibiotic-resistant bacteria and fungi into three categories based on level of concern to human health—urgent, serious, and concerning—and highlights:

  • Estimated infections and deaths since the 2013 report
  • Aggressive actions taken
  • Gaps slowing progress

The report also includes a Watch List with three threats that have not spread resistance widely in the U.S. but could become common without a continued aggressive approach.
REFERENCE:
Biggest Threats and Data. CDC 2019. https://www.cdc.gov/drugresistance/biggest-threats.html

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#BOOK: Preventing Transmission of Pandemic Influenza and Other Viral Respiratory Diseases

200 pages | 6 x 9
ISBNs:
Paperback: 978-0-309-16254-8
Ebook: 978-0-309-21429-2
In 2008, the Institute of Medicine (IOM) published the report Preparing for an Influenza Pandemic: Personal Protective Equipment for Healthcare Workers. At the time of that report, the major influenza-related concern was avian influenza (H5N1). As novel H1N1 influenza A became a reality in 2009, the many unknowns about the virulence, spread, and nature of the virus raised to the forefront issues regarding personal protective equipment (PPE) for healthcare personnel. A major issue was the nature of respiratory protection required because much remains to be learned about the mechanisms of influenza transmission. This report comes at a time when controversies continue on issues related to PPE for healthcare personnel, while at the same time, new horizons in PPE research and attention to PPE innovations offer promise of improvements in healthcare worker safety. Keeping the research momentum going is critical, because between pandemics the focus of research efforts often moves to other issues and the nation remains underprepared.
CONTENT:

  1. Introduction
  2. Understanding the Risk to Healthcare Personnel
  3. Designing and Engineering Effective PPE
  4. Using PPE: Individual and Organizational Issues
  5. Policy Research and Implementation: Healthcare Systems, Standards, and Certification

REFERENCE:
Institute of Medicine. 2011. Preventing Transmission of Pandemic Influenza and Other Viral Respiratory Diseases: Personal Protective Equipment for Healthcare Personnel: Update 2010. Washington, DC: The National Academies Press.

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COURSE: Pandemic influenza- Introduction

Overview: Pandemic influenza is an acute viral disease of the respiratory tract. It occurs when an influenza virus that was not previously circulating among people and to which most people have no immunity emerges and transmits among people. This course provides a general introduction to the disease through a short video lecture and quizzes to test your knowledge. It targets personnel preparing to respond to pandemic influenza outbreaks, including medical professionals, public health officials, incident managers and risk communication experts.
Learning objective: By the end of this course, participants should be able to:

  • describe transmission, symptoms and treatment for pandemic influenza;
  • introduce key pharmaceutical and non-pharmaceutical interventions; and
  • understand influenza pandemic phases and key public health challenges.

Course duration: Approximately 1 hour.
Certificates: No certificate available at this time.
Self-paced
Language: English
Basic (Basique)

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Correlating Penetration with Biofilm Activity and Viability

Disinfectant biofilm penetration and its effect on biofilm aerobic activity and viability are still unclear. In this study, free chlorine and monochloramine were applied until full biofilm penetration occurred, and their effects on biofilm aerobic activity and viability were investigated in three–dimensions throughout the entire biofilm depth, extending previous work where viability analysis was limited to the upper biofilm (50 μm depth), free chlorine penetration did not reach completion, and only one–dimensional (depth) profiles were obtained. The free chlorine and monochloramine biofilm concentration profiles were correlated spatially and temporally with aerobic microbial activity and cell–membrane integrity based viability using a combination of (1) microelectrode measurements for disinfectant penetration and (2) Live/Dead BacLight staining, cryo–cross–sectioning, and confocal micrographs analysis for viability measurements throughout the entire biofilm depth. Compared to monochloramine, free chlorine penetration (1) was slower, (2) led to a greater decrease in biofilm thickness from sloughing, and (3) corresponded directly with a viability decrease. In addition, biofilm heterogeneity led to minor differences in either disinfectant’s biofilm penetration, and prior biofilm exposure to monochloramine provided little impact to subsequent free chlorine biofilm penetration.
REFERENCE:
Lee WH, Pressman JG, Wahman DG. Three-Dimensional Free Chlorine and Monochloramine Biofilm Penetration: Correlating Penetration with Biofilm Activity and Viability. Environ Sci Technol. 2018;52(4):1889–1898. doi:10.1021/acs.est.7b05215


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Surveillance of laboratory exposures to human pathogens and toxins: Canada 2018.

BACKGROUND: The Laboratory Incident Notification Canada (LINC) surveillance system monitors laboratory incidents reported under the Human Pathogens and Toxins Act. The year 2018 marks the third complete year of data.
OBJECTIVE: To describe the laboratory exposure and laboratory-acquired infection incidents that occurred in Canada in 2018 compared to previous years, and then by sector, human pathogens and toxins involved, number of affected persons, incident type and root causes.
METHODS: Laboratory incidents that occurred in 2018 were reported through the LINC system. The number of laboratory incidents, people exposed and laboratory-acquired infections were compared to previous years, then the incidents were analyzed by sector, human pathogen or toxin involved, the type of incident, people exposed, route of exposure and root causes. Microsoft Excel 2016 was used for descriptive analysis.
RESULTS: In 2018, there were 89 exposure incidents to human pathogens and 235 people were exposed. There were five suspected and one confirmed laboratory-acquired infections. This was approximately twice the number of exposure incidents that were reported in 2017 (n=44) and 2016 (n=46). The highest number of exposure incidents occurred in the academic and hospital sectors, and the ratio of incidence to licences was the lowest in the private sector. The majority of incidents (n=50; 56%) involved Risk Group 2 human pathogens that were manipulated in a Containment Level 2 laboratory. Most exposures were related to sharps or procedures and the most common people exposed were laboratory technicians. Human interaction and standard operating procedures were the leading root causes.
CONCLUSION: Although overall the annual incidence of laboratory exposures in Canada remains relatively low, the incidence was higher in 2018 than in previous years. Whether this is a true increase in incidence or an increase in reporting is not known at this time as baseline estimates are still being established.
REFERENCE:
Choucrallah, D et al. Surveillance of laboratory exposures to human pathogens and toxins: Canada 2018. Canada communicable disease report = Releve des maladies transmissibles au Canada vol. 45,9 244-251. 5 Sep. 2019, doi:10.14745/ccdr.v45i09a04

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#BOOK: The Use and Effectiveness of Powered Air Purifying Respirators in Health Care

80 pages | 6 x 9
ISBNs:
Paperback: 978-0-309-31595-1
Ebook: 978-0-309-31598-2
Protecting 18 million United States health care workers from infectious agents - known and unknown - involves a range of occupational safety and health measures that include identifying and using appropriate protective equipment. The 2009 H1N1 influenza pandemic and the 2014 Ebola virus outbreak in West Africa have called raised questions about how best to ensure appropriate and effective use of different kinds of personal protective equipment such as respirators, not only to promote occupational safety but also to reduce disease transmission.
The Use and Effectiveness of Powered Air Purifying Respirators in Health Care is the summary of a workshop convened by the Institute of Medicine Standing Committee on Personal Protective Equipment for Workplace Safety and Health to explore the current state of practices and research related to powered air purifying respirator (PAPRs) and potential updates to performance requirements. Presentations and discussions highlighted current health care practices using PAPRs and outlined the research to date on the use and effectiveness of PAPRs in health care settings with a focus on the performance requirements. The Use and Effectiveness of Powered Air Purifying Respirators in Health Care focuses on efficacy, current training, maintenance, supplies, and possible enhancements and barriers to use in inpatient, clinic, nursing home, and community (home) settings. This report also explores the strengths and weaknesses of using various approaches to health care PAPR standards.
REFERENCE:
Institute of Medicine. 2015. The Use and Effectiveness of Powered Air Purifying Respirators in Health Care: Workshop Summary. Washington, DC: The National Academies Press. https://doi.org/10.17226/18990.

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Managing epidemics

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This manual provides concise and up-to-date knowledge on 15 infectious diseases that have the potential to become international threats, and tips on how to respond to each of them.
The 21st century has already been marked by major epidemics. Old diseases - cholera, plague and yellow fever - have returned, and new ones have emerged - SARS, pandemic influenza, MERS, Ebola and Zika. These epidemics and their impact on global public health have convinced the world's governments of the need for a collective and coordinated defense against emerging public health threats and accelerated the revision of the International Health Regulations (2005), entered into force in 2007. Another Ebola epidemic, another plague epidemic or a new influenza pandemic are not mere probabilities, the threat is real. Whether transmitted by mosquitoes, other insects, via contact with animals or person-to-person, the only major uncertainty is when and where they, or a new, but equally lethal epidemic, will emerge. These diseases all have the potential to spread internationally highlighting the importance of immediate and coordinated response. The diseases covered are: Ebola virus disease, lassa fever, Crimean-Congo haemorrhagic fever, yellow fever, Zika, chikungunya, avian and other zoonotic influenza, seasonal influenza, pandemic influenza, Middle-East respiratory syndrome (MERS), cholera, monkeypox, plague, leptospirosis and meningococcal meningitis. Although originally developed as guidance for WHO officials, this publication is available to a wide readership including all frontline responders - communities, government officials, non-State actors and public health professionals - who need to respond rapidly and effectively when an outbreak is detected.
REFERENCE:
Managing epidemics: Key facts about major deadly diseasesAuthors: World Health Organization
Number of pages: 255 Publication date: May 2018 Languages: English
ISBN: 978-92-4-156553-0

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A cryogel-based bioreactor for water treatment applications


The aim of this study was to develop and test a non-diffusion limited, high cell density bioreactor for biodegradation of various phenol derivatives. The bioreactor was obtained using a straightforward one-step preparation method using cryostructuration and direct cross-linking of bacteria into a 3D structured (sponge-like) macroporous cryogel composite material consisting of 11.6% (by mass) cells and 1.2-1.7% polymer, with approximately 87% water (in the material pores). The macroporous cryogel composite material, composed of live bacteria, has pore sizes in the range of 20-150 μm (confirmed by SEM and Laser Scanning Confocal Microscopy). The enzymatic activity of bacteria within the cryogel structure and the effect of freezing on the viability of the cross-linked cells was estimated by MTT assay. Cryogels based on Pseudomonas mendocina, Rhodococcus koreensis and Acinetobacter radioresistens were exploited for the effective bioremediation of phenol and m-cresol, and to a lesser extent 2-chlorophenol and 4-chlorophenol, utilising these phenolic contaminants in water as their only source of carbon. For evaluation of treatment scalability the bioreactors were prepared in plastic "Kaldnes" carriers to improve their mechanical properties and allow application in batch or fluidised bed water treatment modes.
REFERENCE:
Berillo DA, et al. A cryogel-based bioreactor for water treatment applications. Water Res. 2019 Apr 15;153:324-334. doi: 10.1016/j.watres.2019.01.028. Epub 2019 Jan 31. PubMed PMID: 30739074.

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#BOOK: Global Guidelines for the Prevention of Surgical Site Infection

The first ever Global guidelines for the prevention of surgical site infection () were published on 3 November 2016, then updated in some parts and published in a new edition in December 2018. They include a list of 29 concrete recommendations on 23 topics for the prevention of SSI in the pre-, intra and postoperative periods, which are based on 28 systematic reviews of the evidence.
For the 2018 update, the membership of the guidelines development group () was broadened to include an additional eight anaesthesiology experts. The 2018 edition of the guidelines includes the revision of the recommendation regarding the use of 80% fraction of inspired oxygen (high ) in surgical patients under general anaesthesia with tracheal intubation and the update of the section on implementation. Between 2017 and 2018,  re-assessed the evidence on the use of high FiO2 by updating the systematic review related to the effectiveness of this intervention to reduce  and commissioning an independent systematic review on adverse events potentially associated with it. Based on the updated evidence, the GDG decided to revise the strength of the recommendation from strong to conditional.
REFERENCIA:
Global Guidelines for the Prevention of Surgical Site Infection. Geneva: World Health Organization; 2018. ISBN 978-92-4-155047-5. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536404/ 

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