Preventing Worker Fatigue Among #Ebola Healthcare Workers #CDC

The National Institute for Occupational Safety and Health (NIOSH) and the Occupational Safety and Health Administration (OSHA) recognize that healthcare workers and responders involved with cases related to Ebola in the United States may be required to work longer or unusual shifts. This can involve extended shifts (more than 8 hours long), rotating or irregular shifts, or consecutive shifts resulting in more than the typical 40-hour work week. Long work hours may increase the risk of injuries and accidents and can contribute to poor health and worker fatigue.
Additionally, the personal protective equipment (PPE) required for working with Ebola patients can increase workers’ core body temperature, contributing significantly to fatigue. Although these guidelines are geared toward workers responding in the United States, the same concepts apply to those working in other countries.

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Chimpanzee Adenovirus Vector #Ebola Vaccine - Preliminary Report.

Background 

The unprecedented 2014 epidemic of Ebola virus disease (EVD) has prompted an international response to accelerate the availability of a preventive vaccine. A replication-defective recombinant chimpanzee adenovirus type 3-vectored ebolavirus vaccine (cAd3-EBO), encoding the glycoprotein from Zaire and Sudan species that offers protection in the nonhuman primate model, was rapidly advanced into phase 1 clinical evaluation. 

Methods 

We conducted a phase 1, dose-escalation, open-label trial of cAd3-EBO. Twenty healthy adults, in sequentially enrolled groups of 10 each, received vaccination intramuscularly in doses of 2×1010 particle units or 2×1011 particle units. Primary and secondary end points related to safety and immunogenicity were assessed throughout the first 4 weeks after vaccination. 

Results 

In this small study, no safety concerns were identified; however, transient fever developed within 1 day after vaccination in two participants who had received the 2×1011 particle-unit dose. Glycoprotein-specific antibodies were induced in all 20 participants; the titers were of greater magnitude in the group that received the 2×1011 particle-unit dose than in the group that received the 2×1010 particle-unit dose (geometric mean titer against the Zaire antigen, 2037 vs. 331; P=0.001). Glycoprotein-specific T-cell responses were more frequent among those who received the 2x1011 particle-unit dose than among those who received the 2×1010 particle-unit dose, with a CD4 response in 10 of 10 participants versus 3 of 10 participants (P=0.004) and a CD8 response in 7 of 10 participants versus 2 of 10 participants (P=0.07). 

Conclusions 

Reactogenicity and immune responses to cAd3-EBO vaccine were dose-dependent. At the 2×1011 particle-unit dose, glycoprotein Zaire-specific antibody responses were in the range reported to be associated with vaccine-induced protective immunity in challenge studies involving nonhuman primates. Clinical trials assessing cAd3-EBO are ongoing. (Funded by the Intramural Research Program of the National Institutes of Health; VRC 207 ClinicalTrials.gov number, NCT02231866 .).

REFERENCE:

Ledgerwood JE, et al; the VRC 207 Study Team. Chimpanzee Adenovirus Vector Ebola Vaccine - Preliminary Report. N Engl J Med. 2014 Nov 26. [Epub ahead of print] PubMed PMID: 25426834.

El virus de #Chikungunya

La fiebre chikungunya es una enfermedad vírica transmitida al ser humano por mosquitos infectados. Además de fiebre y fuertes dolores articulares, produce otros síntomas, tales como dolores musculares, dolores de cabeza, náuseas, cansancio y erupciones cutáneas.
Algunos signos clínicos de esta enfermedad son iguales a los del dengue, con el que se puede confundir en zonas donde este es frecuente. Como no tiene tratamiento curativo, el tratamiento se centra en el alivio de los síntomas. Un factor de riesgo importante es la proximidad de las viviendas a lugares de cría de los mosquitos. La enfermedad se da en África, Asia y el subcontinente indio. En los últimos decenios los vectores de la enfermedad se han propagado a Europa y las Américas. En 2007 se notificó por vez primera la transmisión de la enfermedad en Europa, en un brote localizado en el nordeste de Italia.

REFERENCIAS:

1. WHO Chikungunya factsheet ESP
2. Chikungunya: un nuevo virus en la región de las Américas
3. Cuidados para prevenir y tratar el chikungunya
4. CHIKUNGUNYA VIRUS. PATHOGEN SAFETY DATA SHEET - INFECTIOUS SUBSTANCES
5. CDC: Chikungunya
6. CDC: Chikungunya. Información para el público

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COURSE: Guidance for use of Personal Protective Equipment (PPE) During Management of Patients with #Ebola Virus

GO TO THE COURSE

The following informational materials demonstrate the procedures described in CDC guidance for donning and doffing (i.e., putting on and removing) personal protective equipment (PPE) for all healthcare providers entering the room of a patient hospitalized with known or suspected Ebola virus disease (Ebola). These informational materials are intended to promote patient safety and increase the safety of the healthcare provider.
Prior to working with Ebola patients, all healthcare providers involved in the care of Ebola patients must receive training and demonstrate competency in performing all Ebola-related infection control practices and procedures, specifically in donning and doffing proper PPE.

REFERENCE:
Guidance for Donning and Doffing Personal Protective Equipment (PPE) During Management of Patients with Ebola Virus 
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Control of #ebola virus disease - firestone district, Liberia, 2014

WSJ

On March 30, 2014, the Ministry of Health and Social Welfare (MOHSW) of Liberia alerted health officials at Firestone Liberia, Inc. (Firestone) of the first known case of Ebola virus disease (Ebola) inside the Firestone rubber tree plantation of Liberia. The patient, who was the wife of a Firestone employee, had cared for a family member with confirmed Ebola in Lofa County, the epicenter of the Ebola outbreak in Liberia during March-April 2014. To prevent a large outbreak among Firestone's 8,500 employees, their dependents, and the surrounding population, the company responded by 1) establishing an incident management system, 2) instituting procedures for the early recognition and isolation of Ebola patients, 3) enforcing adherence to standard Ebola infection control guidelines, and 4) providing differing levels of management for contacts depending on their exposure, including options for voluntary quarantine in the home or in dedicated facilities. In addition, Firestone created multidisciplinary teams to oversee the outbreak response, address case detection, manage cases in a dedicated unit, and reintegrate convalescent patients into the community. The company also created a robust risk communication, prevention, and social mobilization campaign to boost community awareness of Ebola and how to prevent transmission. During August 1-September 23, a period of intense Ebola transmission in the surrounding areas, 71 cases of Ebola were diagnosed among the approximately 80,000 Liberians for whom Firestone provides health care (cumulative incidence = 0.09%). Fifty-seven (80%) of the cases were laboratory confirmed; 39 (68%) of these cases were fatal. Aspects of Firestone's response appear to have minimized the spread of Ebola in the local population and might be successfully implemented elsewhere to limit the spread of Ebola and prevent transmission to health care workers (HCWs).

REFERENCE:
Reaves EJ, et al. Control of ebola virus disease - firestone district, Liberia, 2014. MMWR Morb Mortal Wkly Rep. 2014 Oct 24;63(42):959-65.
NEWS:
How Firestone Liberia’s unique approaches helped stem the spread of the ebola virus
Liberian Rubber Farm Becomes Sanctuary Against Ebola
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Cluster of #ebola cases among liberian and u.s. Health care workers in an ebola treatment unit and adjacent hospital - Liberia, 2014

aljazeera

The ongoing Ebola virus disease (Ebola) epidemic in West Africa, like previous Ebola outbreaks, has been characterized by amplification in health care settings and increased risk for health care workers (HCWs), who often do not have access to appropriate personal protective equipment. In many locations, Ebola treatment units (ETUs) have been established to optimize care of patients with Ebola while maintaining infection control procedures to prevent transmission of Ebola virus. These ETUs are considered essential to containment of the epidemic. In July 2014, CDC assisted the Ministry of Health and Social Welfare of Liberia in investigating a cluster of five Ebola cases among HCWs who became ill while working in an ETU, an adjacent general hospital, or both. No common source of exposure or chain of transmission was identified. However, multiple opportunities existed for transmission of Ebola virus to HCWs, including exposure to patients with undetected Ebola in the hospital, inadequate use of personal protective equipment during cleaning and disinfection of environmental surfaces in the hospital, and potential transmission from an ill HCW to another HCW. No evidence was found of a previously unrecognized mode of transmission. Prevention recommendations included reinforcement of existing infection control guidance for both ETUs and general medical care settings, including measures to prevent cross-transmission in co-located facilities

REFERENCE:
Forrester JD et al. Cluster of Ebola Cases Among Liberian and U.S. Health Care Workers in an Ebola Treatment Unit and Adjacent Hospital — Liberia, 2014. MMWR Morb Mortal Wkly Rep. 2014 Oct 17;63(41):925-9.
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Biologically hazardous agents at work and efforts to protect workers' health: a review of recent reports

Because information on biological agents in the workplace is lacking, biological hazard analyses at the workplace to securely recognize the harmful factors with biological basis are desperately needed. This review concentrates on literatures published after 2010 that attempted to detect biological hazards to humans, especially workers, and the efforts to protect them against these factors. It is important to improve the current understanding of the health hazards caused by biological factors at the workplace. In addition, this review briefly describes these factors and provides some examples of their adverse health effects. It also reviews risk assessments, protection with personal protective equipment, prevention with training of workers, regulations, as well as vaccinations.

REFERENCE:
Rim KT, Lim CH. Biologically hazardous agents at work and efforts to protect workers' health: a review of recent reports. Saf Health Work. Jun 2014; 5(2): 43–52.

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Consolidated #Ebola Virus Disease Preparedness Checklist

The Consolidated Checklist for Ebola Virus Disease Preparedness is based on efforts by various national and international institutions, including WHO, CDC and UN OCHA.
It identifies 10 key components and tasks for both countries and the international community that should be completed within 30, 60 and 90 days respectively from the date of issuing this list. Minimal required resources in terms of equipment and material as well as human resources are defined. Key reference documents such as guidelines, training manuals and guidance notes will help the technical experts to implement required action in the key components.

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OSHA: Cleaning and Decontamination of #Ebola on Surfaces

Guidance for Workers and Employers in Non-Healthcare/Non-Laboratory Settings
Workers tasked with cleaning surfaces that may be contaminated with Ebola virus, the virus that causes Ebola hemorrhagic fever (EHF), must be protected from exposure. Employers are responsible for ensuring that workers are protected from exposure to Ebola and that workers are not exposed to harmful levels of chemicals used for cleaning and disinfection.
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Back to basics: hand hygiene and isolation

Purpose of review. Hand hygiene and isolation are basic, but very effective, means of preventing the spread of pathogens in healthcare. Although the principle may be straightforward, this review highlights some of the controversies regarding the implementation and efficacy of these interventions.
Recent findings. Hand hygiene compliance is an accepted measure of quality and safety in many countries. The evidence for the efficacy of hand hygiene in directly reducing rates of hospital-acquired infections has strengthened in recent years, particularly in terms of reduced rates of staphylococcal sepsis. Defining the key components of effective implementation strategies and the ideal method(s) of assessing hand hygiene compliance are dependent on a range of factors associated with the healthcare system. Although patient isolation continues to be an important strategy, particularly in outbreaks, it also has some limitations and can be associated with negative effects. Recent detailed molecular epidemiology studies of key healthcare-acquired pathogens have questioned the true efficacy of isolation, alone as an effective method for the routine prevention of disease transmission.
Summary. Hand hygiene and isolation are key components of basic infection control. Recent insights into the benefits, limitations and even adverse effects of these interventions are important for their optimal implementation.
Keywords: alcohol-based hand rub, hand hygiene, hospital acquired infections, isolation, WHO
REFERENCE:
G. Khai Lin Huang, et al.  Back to basics: hand hygiene and isolation. Curr Opin Infect Dis. Aug 2014; 27(4): 379–389.
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#VIDEOS: Lávate las manos, Octubre 15, #IWashMyHands #ebola

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Contact tracing during an #ebola outbreak

Persons in close contact with Ebola cases (alive or dead) are at higher risk of infection. All potential contacts of Ebola cases should be identified and closely observed for 21 days from the last day of exposure. Contacts that develop illness should be immediately isolated to prevent further transmission of infection. An effective system for contact tracing should be established at the onset of the outbreak. Early involvement and full cooperation of affected communities is critical for successful contact tracing.
This document provides guidance for establishing and conducting contact tracing during filovirus disease outbreaks. The guidance notes are based on extensive field experience in filovirus disease outbreak response in the WHO African region. The notes are intended for frontline epidemiologists, surveillance officers, health workers and other volunteers involved in contact tracing. National and sub-national emergency management committees and rapid response teams require these guidelines to plan, implement and monitor contact tracing.National emergency management committees are advised to adapt these guidance notes to the local context in their application

REFERENCES:
Contact tracing during an #ebola outbreak
CDC poster: What is contact tracing?
Australasian Contract Tracing Manual
Development of a risk assessment tool for contact tracing people after contact with infectious patients while travelling by bus or other public ground transport: a Delphi consensus approach
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Detailed Hospital Checklist for #Ebola Preparedness

Lohud.com

Every hospital should ensure that it can detect a patient with Ebola, protect healthcare workers so they can safely care for the patient, and respond in a coordinated fashion. Many of the signs and symptoms of Ebola are non-specific and similar to those of many common infectious diseases, as well as other infectious diseases with high mortality rates. Transmission can be prevented with appropriate infection control measures.
In order to enhance our collective preparedness and response efforts, this checklist highlights key areas for hospital staff -- especially hospital emergency management officers, infection control practitioners, and clinical practitioners -- to review in preparation for a person with Ebola arriving at a hospital for medical care. The checklist provides practical and specific suggestions to ensure your hospital is able to detect possible Ebola cases, protect your employees, and respond appropriately.
While we are not aware of any domestic Ebola cases, now is the time to prepare, as it is possible that individuals with Ebola in West Africa may travel to your city, exhibit signs and symptoms of Ebola, and present to facilities.

REFERENCES:

• CDC Detailed Hospital Checklist for Ebola Preparedness
• Ebola infection control. WHO guideline
• AIDE-MEMOIRE. For infection prevention and control in a health care facility 

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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.

REFERENCE:
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.

REFERENCE:
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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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.

REFERENCE:
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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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.
REFERENCE:
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.
REFERENCE:
WHO Antimicrobial resistance: global report on surveillance 2014

     SLIDE SET   |    INFOGRAPHIC   |   SUMMARY

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.@WHO & CDC Interim Guidelines for #Ebola

CDC ebola print resources

• 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  => PDF opcional

This document provides a summary of infection prevention and control (IPC) measures for those providing direct and non-direct care to patients with suspected or confirmed cases of Filovirus haemorrhagic fever (HF), including Ebola or Marburg haemorrhagic fevers, in health-care facilities (HCFs). It also includes some instructions and directions for those managing the implementation of IPC activities. These IPC measures should be applied not only by health-care professionals but by anyone in direct contact with patients (e.g., visitors, family members, volunteers), as well as by those not in contact with patients but potentially exposed the virus through contact with the environment (e.g., c leaners, laundry, house-keepers, security).

• CDC Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus
• CDC Interim Guidance for Specimen Collection, Transport, Testing, and Submission for Persons Under Investigation for Ebola Virus Disease in the United States
• CDC Interim Guidance for Monitoring and Movement of Persons with Ebola Virus Disease Exposure
• CDC Ebola Guidance for Airlines
• CDC Guidance for Safe Handling of Human Remains of Ebola Patients in U. S. Hospitals and Mortuaries
• CDC ebola print resources
• CDC Information for Healthcare Workers

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Safe management of wastes from healthcare activities - Second edition

The waste produced in the course of health-care activities, from contaminated needles to radioactive isotopes, carries a greater potential for causing infection and injury than any other type of waste, and inadequate or inappropriate management is likely to have serious public health consequences and deleterious effects on the environment. This handbook – the result of extensive international consultation and collaboration – provides comprehensive guidance on safe, efficient, and environmentally sound methods for the handling and disposal of health-care wastes in normal situations and emergencies. Future issues such as climate change and the changing patterns of diseases and their impacts on health-care waste management are also discussed.
For health-care settings in which resources are severely limited, the handbook pays particular attention to basic processes and technologies that are not only safe, but also affordable, sustainable, and culturally appropriate. The guide is aimed at public health managers and policy-makers, hospital managers, environmental health professionals, and all administrators with an interest in and responsibility for waste management. Its scope is such that it will find application in developing and developed countries alike.
REFERENCIA:
Safe management of wastes from healthcare activities - Second edition
DESCARGA OPCIONAL
Edited by Yves Chartier, Jorge Emmanuel, Ute Pieper,Annette Prüss,
Philip Rushbrook, Ruth Stringer, William Townend,
Susan Wilburn and Raki Zghondi.
© 2014, WHO
ISBN 978 92 4 154856 4
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