Preventing Health Care–Associated Infections

The occurrence and undesirable complications from health care–associated infections (HAIs) have been well recognized in the literature for the last several decades. The occurrence of HAIs continues to escalate at an alarming rate. HAIs originally referred to those infections associated with admission in an acute-care hospital (formerly called a nosocomial infection), but the term now applies to infections acquired in the continuum of settings where persons receive health care (e.g., long-term care, home care, ambulatory care). These unanticipated infections develop during the course of health care treatment and result in significant patient illnesses and deaths (morbidity and mortality); prolong the duration of hospital stays; and necessitate additional diagnostic and therapeutic interventions, which generate added costs to those already incurred by the patient’s underlying disease. HAIs are considered an undesirable outcome, and as some are preventable, they are considered an indicator of the quality of patient care, an adverse event, and a patient safety issue.

REFERENCIA:
Amy S. Collins. Chapter 41. Preventing Health Care-Associated Infections. From Patient Safety and Quality: An Evidence-Based Handbook for Nurses: Vol. 2.

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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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How to conduct safe and dignified burial of a #ebola patient

Overview

This protocol provides information on the safe management of dead bodies and burial of patients who died from suspected or confirmed Ebola virus disease. These measures should be applied not only by medical personnel but by anyone involved in the management of dead bodies and burial of suspected or confirmed Ebola patients.  Twelve steps have been identified describing the different phases Burial Teams have to follow to ensure safe burials, starting from the moment the teams arrive in the village up to their return to the hospital or team headquarters after burial and disinfection procedures.

DOWNLOAD => How to conduct safe and dignified burial of a patient who has died from suspected or confirmed Ebola virus disease

Publication details 

Number of pages: 17
Publication date: October 2014
Languages: English
WHO reference number: WHO/EVD/Guidance/Burials/14.2

NEWS:

W.H.O. Issues New Guidelines on Safely Burying Ebola Victims

New WHO safe and dignified burial protocol - key to reducing Ebola transmission

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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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Plant-derived virus-like particles as vaccines

Virus-like particles (VLPs) are self-assembled structures derived from viral antigens that mimic the native architecture of viruses but lack the viral genome. VLPs have emerged as a premier vaccine platform due to their advantages in safety, immunogenicity, and manufacturing. The particulate nature and high-density presentation of viral structure proteins on their surface also render VLPs as attractive carriers for displaying foreign epitopes. Consequently, several VLP-based vaccines have been licensed for human use and achieved significant clinical and economical success. The major challenge, however, is to develop novel production platforms that can deliver VLP-based vaccines while significantly reducing production times and costs. Therefore, this review focuses on the essential role of plants as a novel, speedy and economical production platform for VLP-based vaccines. The advantages of plant expression systems are discussed in light of their distinctive posttranslational modifications, cost-effectiveness, production speed, and scalability. Recent achievements in the expression and assembly of VLPs and their chimeric derivatives in plant systems as well as their immunogenicity in animal models are presented. Results of human clinical trials demonstrating the safety and efficacy of plant-derived VLPs are also detailed. Moreover, the promising implications of the recent creation of "humanized" glycosylation plant lines as well as the very recent approval of the first plant-made biologics by the U. S. Food and Drug Administration (FDA) for plant production and commercialization of VLP-based vaccines are discussed. It is speculated that the combined potential of plant expression systems and VLP technology will lead to the emergence of successful vaccines and novel applications of VLPs in the near future.

REFERENCE:
Chen Q1, Lai H. Hum Plant-derived virus-like particles as vaccines. Vaccin Immunother. 2013 Jan;9(1):26-49.
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Happy "Día de Muertos" (Day of the Deaths)

       For our english-speaking visitors. Happy Halloween!. Here in  México is "Día de Muertos" (Day of the Deaths), on November 1st, and 2nd. This year we will be walking around deaths. momies, vampires, and Catrinas...
       Literary Calaveras (skulls)  are written as epitaphs for the living. It´s a fun  way to remember the deaths. In local newspapers publish Calaveras from living politicians, also a way to make fun of them.  Many calaveras were written about the individuals in a given profession. Butchers, teachers, priests, housekeepers, artists, mail carriers, and shopkeepers were all satirized by writers of calaveras. I´m giving you one...  People goes to the pantheons, to sing, eat, and remember their love ones. Also they dress up, cook special food and big parties. It´s a nice time to visit México.

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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Preguntas sobre #ébola

Las preguntas se recibirán hasta el Viernes 31 de Octubre, 2014.

El formato para las preguntas ha sido desactivado. Gracias por participar!

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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.

DESCARGA 1   /   DESCARGA OPCIONAL
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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.
DESCARGA A   /   DESCARGA B

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Mobile phones carry the personal microbiome of their owners

Most people on the planet own mobile phones, and these devices are increasingly being utilized to gather data relevant to our personal health, behavior, and environment. During an educational workshop, we investigated the utility of mobile phones to gather data about the personal microbiome — the collection of microorganisms associated with the personal effects of an individual. We characterized microbial communities on smartphone touchscreens to determine whether there was significant overlap with the skin microbiome sampled directly from their owners. We found that about 22% of the bacterial taxa on participants’ fingers were also present on their own phones, as compared to 17% they shared on average with other people’s phones. When considered as a group, bacterial communities on men’s phones were significantly different from those on their fingers, while women’s were not. Yet when considered on an individual level, men and women both shared significantly more of their bacterial communities with their own phones than with anyone else’s. In fact, 82% of the OTUs were shared between a person’s index and phone when considering the dominant taxa (OTUs with more than 0.1% of the sequences in an individual’s dataset). Our results suggest that mobile phones hold untapped potential as personal microbiome sensors.

REFERENCE
Meadow JF, et al. Mobile phones carry the personal microbiome of their owners. PeerJ. 2014; 2: e447.
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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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Día Mundial del Lavado de Manos, Octubre 15

Este 15 de Octubre, la Organización Mundial de la Salud, en conjunto con la UNICEF celebran el Día Mundial del Lavado de Manos. Esta es una oportunidad para recordar a todos la importancia del Lavado de Manos. Infórmate y distribuye la información acerca de la importancia del lavado de manos en: http://globalhandwashing.org
Descarga los posters y manuales de la campaña de la UNICEF AQUI.

OTROS MATERIALES Y RECURSOS (INGLÉS)

• Hand Hygiene Interactive Training Course

This course and promotional materials review key concepts of hand hygiene and other standard precautions to prevent healthcare-associated infections.

• Educational resources

Promotional materials (Posters).

• Hand hygiene in healthcare facilities

A variety of resources including guidelines for providers, patient empowerment materials, the latest technological advances in hand hygiene adherence measurement, frequently asked questions, and links to promotional and educational tools.

• WHO Tools for training and education

All health-care workers require clear and comprehensive training and education on the importance of hand hygiene, the "My 5 Moments for Hand Hygiene" approach and the correct procedures for handrubbing and handwashing.

• Water related hygiene

Hygiene refers to behaviors that can improve cleanliness and lead to good health, such as frequent hand washing, face washing, and bathing with soap and water. In many areas of the world, practicing personal hygiene etiquette is difficult due to lack of clean water and soap. Many diseases can be spread if the hands, face, or body are not washed appropriately at key times.

• WHO video on hand hygiene (DOWNLOAD)

• NEJM VIDEO ON HAND HYGIENE (SEVERAL LANGUAGES)

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#VIDEOS: Lávate las manos, Octubre 15, #IWashMyHands #ebola

COMPARTA ESTOS VIDEOS

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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Practicability of Hygienic Wrapping of Touchscreen Operated Mobile Devices in a Clinical Setting

Background. To prove effectiveness of wrapping tablet computers in order to reduce microbiological contamination and to evaluate whether a plastic bag-covered tablet leads to impaired user satisfaction or touchscreen functionality.
Materials and Methods. Within a period of 11 days 115 patients were provided with a tablet computer while waiting for their magnetic resonance imaging examination. Every day the contamination of the surface of the tablet was determined before the first and after the final use. Before the device was handed over to a patient, it was enclosed in a customized single-use plastic bag, which was analyzed for bacterial contamination after each use. A questionnaire was applied to determine whether the plastic bag impairs the user satisfaction and the functionality of the touchscreen.
Results. Following the use by patients the outside of the plastic bags was found to be contaminated with various bacteria (657.5 ± 368.5 colony forming units/day); some of them were potentially pathogenic. In contrast, the plastic bag covered surface of the tablet was significantly less contaminated (1.7 ± 1.9 colony forming units/day). Likewise, unused plastic bags did not show any contamination. 11% of the patients reported problems with the functionality of the touchscreen. These patients admitted that they had never used a tablet or a smartphone before.
Conclusions. Tablets get severely contaminated during usage in a clinical setting. Wrapping with a customized single-use plastic bag significantly reduces microbiological contamination of the device, protects patients from the acquisition of potentially pathogenic bacteria and hardly impairs the user satisfaction and the functionality of the touchscreen.

REFERENCE;
Hammon M, et al. (2014) Practicability of Hygienic Wrapping of Touchscreen Operated Mobile Devices in a Clinical Setting. PLoS ONE 9(9): e106445. doi:10.1371/journal.pone.0106445
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Review on #Ebola vaccines

Introduction. Ebolaviruses cause severe viral hemorrhagic fever in humans and non-human primates, with case fatality rates of up to 90%. Currently, neither a specific treatment nor a vaccine licensed for use in humans is available. However, a number of vaccine candidates have been developed in the last decade that are highly protective in non-human primates, the gold standard animal model for Ebola hemorrhagic fever.
Areas covered. This review analyzes a number of scenarios for the use of ebolavirus vaccines, discusses the requirements for ebolavirus vaccines in these scenarios, and describes current ebolavirus vaccines. Among these vaccines are recombinant Adenoviruses, recombinant Vesicular Stomatitis viruses, recombinant Human Parainfluenza viruses and virus-like particles. Interestingly, one of these vaccine platforms, based on recombinant Vesicular Stomatitis viruses, has also demonstrated post-exposure protection in non-human primates.
Expert opinion. The most pressing remaining challenge is now to move these vaccine candidates forward into human trials and towards licensure. In order to achieve this, it will be necessary to establish the mechanisms and correlates of protection for these vaccines, and to continue to demonstrate their safety, particularly in potentially immunocompromised populations. However, already now there is sufficient evidence that, from a scientific perspective, a vaccine protective against ebolaviruses is possible.

REFERENCE;
Hoenen T, Groseth A & Feldmann H. Current Ebola vaccines. Expert Opin Biol Ther 2012; 12(7): 859–872.
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Aviso preventivo de viaje por #ebola a países africanos

La Secretaria de Salud Federal, a través del Unidad de Inteligencia Epidemiológica y Sanitaria emite el siguiente aviso preventivo de viaje ante los brotes de Enfermedad por Virus del Ébola, en GUINEA, LIBERIA, SIERRA LEONA, NIGERIA Y SENEGAL en el continente Africano, actualizado al 03 de Octubre de 2014.
La Secretaría de Salud reitera la recomendación de evitar viajes no esenciales a Guinea, Liberia, Sierra Leona, Nigeria y Senegal debido a la evolución del brote de Enfermedad por el Virus del Ébola.

DESCARGAR AVISO PDF     /      DESCARGAR AVISO WORD

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People, planet and profits: the case for greening operating rooms

Green Healthcare

Over the past 40 years, the health care industry has undergone radical changes in the types of products it uses and its waste disposal practices. In the 1980s, concerns about the spread of blood-borne diseases prompted a shift from reusable to single-use devices, resulting in increases in waste production.
The most recent environmental data on health care in Canada show that in 2008 the sector generated about 1.46% of Canada’s total greenhouse gas emissions and in 2001 was a source of 1% of total solid waste. Canadian hospital activities were the second most energy-intensive activity in the commercial and institutional sector in 2008, consuming the equivalent annual energy of 440 000 Canadian homes. In 2007, US health care facilities contributed 8% of total greenhouse gas emissions, disposed of more than 4 billion pounds (1 lb = 0.45 kg) of waste and were the second-largest contributor to landfills after the food industry.
Few Canadian hospitals have published their ecological footprints (a calculation of the bioproductive land and water required to sustain a population). However, in 2001, Lions Gate Hospital in Vancouver, British Columbia, reported a footprint of 2841 hectares (ha) or 719 times its actual area. In 2006, London Health Sciences Centre in London, Ontario, reported a footprint of 63 074 global hectares or about 384 times its actual area.
It is ironic that our efforts in hospitals to improve the health of patients contribute detrimentally to the health of the ecosystem. In 2009, the World Health Organization emphasized that hospitals have responsibilities in making health care more sustainable.
REFERENCE:
Kagoma Y, et al. People, planet and profits: the case for greening operating rooms. CMAJ. Nov 20, 2012; 184(17): 1905–1911.
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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.

Download opcion 2

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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.
REFERENCES:
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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