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1.
BMC Infect Dis ; 14: 511, 2014 Sep 20.
Artículo en Inglés | MEDLINE | ID: mdl-25238976

RESUMEN

BACKGROUND: Alcohol-based hand rubs (ABHR) range in alcohol concentration from 60-95% and are available in a variety of delivery formats, such as rinses, gels, and foams. Recent studies suggest that some ABHR foams dry too slowly, thereby encouraging the use of inadequate volumes. This study investigates the influence of product volume, delivery format, and alcohol concentration on dry-time and antimicrobial efficacy of ABHR foams, gels and rinses. METHODS: ABHR dry-times were measured using volunteers to determine the influences of product volume, delivery format, and alcohol concentration. ABHR efficacies were evaluated according to the European Standard for Hygienic Hand Disinfection (EN 1500) using 3-mL application volumes rubbed for 30 s, and additionally, using volumes of the products determined to rub dry in 30 s. RESULTS: Volumes of six ABHR determined to rub dry in 30 s ranged from 1.7 mL to 2.1 mL, and the rate of drying varied significantly between products. ABHR dry-times increased linearly with application volume and decreased linearly with increasing alcohol concentration, but were not significantly influenced by product format. An ABHR foam (70% EtOH), rinse (80% EtOH), and gel (90% EtOH) each met EN 1500 efficacy requirements when tested at a volume of 3 mL, but failed when tested at volumes that dried in 30 s. CONCLUSIONS: Application volume is the primary driver of ABHR dry-time and efficacy, whereas delivery format does not significantly influence either. Although products with greater alcohol concentration dry more quickly, volumes required to meet EN 1500 can take longer than 30 s to dry, even when alcohol concentration is as high as 90%. Future studies are needed to better understand application volumes actually used by healthcare workers in practice, and to understand the clinical efficacy of ABHR at such volumes.


Asunto(s)
Desinfectantes/química , Etanol/química , Desinfección de las Manos/instrumentación , Bacterias/efectos de los fármacos , Química Farmacéutica , Desinfectantes/farmacología , Etanol/farmacología , Desinfección de las Manos/métodos , Humanos , Factores de Tiempo , Volatilización
2.
Afr Health Sci ; 23(1): 276-285, 2023 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-37545941

RESUMEN

Purpose: Intimate partner violence (IPV) and child loss disproportionately affect women in sub-Saharan Africa (SSA). Little research has examined the relationship between IPV and child loss in SSA. Methods: We used data from Demographic Health Surveys in 7 countries in SSA (Côte d'Ivoire, Democratic Republic of the Congo, Namibia, Sierra Leone, Togo, Zambia, and Rwanda). Women's Health Module questions assessed lifetime physical, sexual, and emotional IPV. Child loss was calculated as the difference between the number of child births and the number of living children. Logistic regression was conducted adjusting for age, marital status, educational attainment, location of residence, wealth, sexually transmitted infections, and country of origin. Data were weighted and analysed using STATA Software (14.0). Results: Among women who gave birth, approximately one third (31.7%) reported that they lost 1 or more children. Nearly half (44.3%) reported that they experienced physical IPV during their lifetime. Women who had experienced physical, emotional, or sexual IPV were significantly more likely to report a loss of 1 or more children (OR=1.20, 95% confidence interval (CI)= [1.08, 1.33]; OR=1.30, 95% CI= [1.16, 1.45]; OR=1.42, 95% CI= [1.23, 1.65], respectively) in comparison with women who had not experienced IPV controlling for potentially influential covariates. Women who were older, married, had lower educational attainment, and had lower income were more likely to have lost 1 or more children. Conclusion: These results suggest that women who experienced all types of and cumulative exposure to IPV may be more likely to lose a child in SSA.


Asunto(s)
Violencia de Pareja , Humanos , Femenino , Niño , Factores de Riesgo , Salud de la Mujer , Estado Civil , África del Sur del Sahara/epidemiología , Parejas Sexuales/psicología , Prevalencia
3.
Popul Health Manag ; 26(4): 232-238, 2023 08.
Artículo en Inglés | MEDLINE | ID: mdl-37590079

RESUMEN

The presence of depression among people with diabetes can substantially increase health care costs and reduce health care utilization. This study aimed at further elucidating the factors underlying the relationship between depressive disorders and health care utilization among people with diabetes. Data were obtained from the 2019 Behavioral Risk Factor Surveillance System, and the sample was limited to people with diabetes (n = 22,642). The independent variable was assessed by a lifetime diagnosis of depressive disorder, including depression, major depression, dysthymia, or minor depression. The dependent variable was cost-related health care utilization assessed as a response (yes/no) to whether participants had not seen a doctor due to costs in the past year. Logistic regression models examined the association between depressive disorders and health care utilization, adjusting for covariates incorporating weighting to account for study design. Overall, 25.2% of the people with diabetes reported having had a depressive disorder in their lifetime. People with diabetes who had ever been diagnosed with a depressive disorder were more likely to have reported not seeing a doctor due to costs in the past year (adjusted odds ratio: 1.82 [1.49, 2.28]). Findings from this study suggest a need for further research regarding the relationship between depression and cost-related health care utilization among people with diabetes.


Asunto(s)
Depresión , Diabetes Mellitus , Humanos , Depresión/epidemiología , Aceptación de la Atención de Salud , Costos de la Atención en Salud , Diabetes Mellitus/epidemiología , Diabetes Mellitus/terapia , Sistema de Vigilancia de Factor de Riesgo Conductual
4.
Prim Care Diabetes ; 17(2): 180-184, 2023 04.
Artículo en Inglés | MEDLINE | ID: mdl-36803970

RESUMEN

AIMS: To examine patterns of adherence to oral hypoglycemic agents among primary care patients with type 2 diabetes mellitus and to assess whether these patterns were associated with baseline intervention allocation, sociodemographic characteristics, and clinical indicators. METHODS: Adherence patterns were examined by Medication Event Monitoring System (MEMS) caps at baseline and 12 weeks. Participants (n = 72) were randomly allocated to a Patient Prioritized Planning (PPP) intervention or a control group. The PPP intervention employed a card-sort task to identify health-related priorities that included social determinants of health to address medication nonadherence. Next, a problem-solving process was used to address unmet needs involving referral to resources. Multinomial logistic regression examined patterns of adherence in relation to baseline intervention allocation, sociodemographic characteristics, and clinical indicators. RESULTS: Three patterns of adherence were found: adherent, increasing adherence, and nonadherent. Participants assigned to the PPP intervention were significantly more likely to have a pattern of improving adherence (Adjusted Odds Ratio (AOR)= 11.28, 95% confidence interval (CI)= 1.78, 71.60) and adherence (AOR=4.68, 95% CI=1.15, 19.02) than participants assigned to the control group. CONCLUSION: Primary care PPP interventions incorporating social determinants may be effective in fostering and improving patient adherence.


Asunto(s)
Diabetes Mellitus Tipo 2 , Humanos , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/efectos adversos , Cumplimiento de la Medicación , Atención Primaria de Salud
5.
Rheumatol Int ; 32(11): 3373-82, 2012 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-22045517

RESUMEN

This study is an audit and a comparison of major infective complications in patients with granulomatosis with polyangiitis (GPA) and systemic lupus erythematosis (SLE). Data were collected on consecutive patients attending a single treatment approach, multidisciplinary vasculitis centre who met diagnostic criteria for GPA and SLE from 01/01/2006 to 30/06/2006. Immunosuppressive treatment is used in this clinic with guidelines targeting avoidance of neutropenia. For each patient, documentation was made of disease presentation, organ involvement and therapy used. A history of major infections requiring hospital admission and intravenous antimicrobials pre- and post-diagnosis was recorded. Patients with GPA received a higher cumulative dose of cyclophosphamide, had a higher median age, shorter period of follow-up and had lower mean and nadir absolute lymphocyte counts and nadir neutrophil counts. GPA patients had more major infections per patient years (P = 0.0027) and respiratory tract infections (P = 0.0031) per patient years. Relative risk (RR) of major infection was significantly increased with methylprednisolone, RR 11.1 (P = <0.0001), cyclophosphamide, RR 2.0 (P = 0.0246) and the intensive phase of treatment, RR 13.3 (P = <0.0001). Marked lymphopenia was common in both groups during follow-up and was associated with an increased risk of major infection (P = 0.0020). Major infections, in particular respiratory tract infections, are more common in those treated for GPA than SLE. This may be due to a combination of factors including greater doses and duration of methyprednisolone and cyclophosphamide. We recommend treatment strategies that aim not only to avoid neutropenia but that also identify lymphopenia as a risk factor for major infection.


Asunto(s)
Granulomatosis con Poliangitis/complicaciones , Infecciones/complicaciones , Lupus Eritematoso Sistémico/complicaciones , Adulto , Anciano , Antiinfecciosos/uso terapéutico , Ciclofosfamida/administración & dosificación , Ciclofosfamida/uso terapéutico , Femenino , Granulomatosis con Poliangitis/tratamiento farmacológico , Humanos , Inmunosupresores/administración & dosificación , Inmunosupresores/uso terapéutico , Infecciones/tratamiento farmacológico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Factores de Riesgo
6.
Appl Environ Microbiol ; 77(24): 8588-94, 2011 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-22003004

RESUMEN

A novel method has been developed for the evaluation of alcohol-based hand rubs (ABHR) that employs a hand contamination procedure that more closely simulates the in-use conditions of ABHR. Hands of human subjects were contaminated with 0.2 ml of a concentrated suspension of Serratia marcescens (ATCC 14756) to achieve baseline contamination between 8 and 9 log10 CFU/hand while allowing product to be applied to dry hands with minimal soil load. Evaluation of 1.5 ml of an ABHR gel containing 62% ethanol produced log10 reductions of 2.66 ± 0.96, 2.40 ± 0.50, 2.41 ± 0.61, and 2.33 ± 0.49 (means ± standard deviations) after 1, 3, 7, and 10 successive contamination/product application cycles. In a study comparing this low-volume contamination (LVC) method to ASTM E1174, product dry times were more realistic and log10 reductions achieved by the ABHR were significantly greater when LVC was employed (P < 0.05). These results indicate that a novel low-volume hand contamination procedure, which more closely represents ABHR use conditions, provides more realistic estimates of in-use ABHR efficacies. Based on the LVC method, log10 reductions produced by ABHR were strongly dependent on the test product application volume (P < 0.0001) but were not influenced by the alcohol concentration when it was within the range of 62 to 85% (P = 0.378).


Asunto(s)
Carga Bacteriana , Desinfectantes/administración & dosificación , Desinfección de las Manos/métodos , Desinfección de las Manos/normas , Mano/microbiología , Serratia marcescens/efectos de los fármacos , Serratia marcescens/aislamiento & purificación , Relación Dosis-Respuesta a Droga , Humanos , Resultado del Tratamiento
7.
AORN J ; 100(6): 641-50, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25453683

RESUMEN

Alcohol-based surgical scrubs (ABSSs) are used to prevent surgical site infections. Chlorhexidine gluconate (CHG) often is added to enhance persistent germicidal activity. The aim of this study was to determine the influence of ABSS product formulation on efficacy. We evaluated three commercially available ABSS formulations and one control alcohol formulation according to the surgical scrub methodology specified by the US Food and Drug Administration (FDA). Only one ABSS formulation met FDA efficacy requirements when tested at the manufacturer's recommended dosage. In contrast, two ABSS formulations, one of which contained CHG, failed to meet the FDA acceptance criteria for a 3-log10 reduction on day 5, meaning the formulations did not sufficiently reduce bacteria levels on hands on the fifth day of product application. The data suggest that recommendations to include CHG in ABSS formulations should be reconsidered, and product efficacy, skin tolerability, and user acceptability should be evaluated on a case-by-case basis.


Asunto(s)
Desinfectantes , Etanol/administración & dosificación , Infección de la Herida Quirúrgica/prevención & control , Bacterias/aislamiento & purificación , Clorhexidina/administración & dosificación , Clorhexidina/análogos & derivados , Recuento de Colonia Microbiana , Humanos , Infección de la Herida Quirúrgica/microbiología
8.
Food Environ Virol ; 6(2): 140-4, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-24728950

RESUMEN

The objectives of this study were to determine the movement of a virus throughout a household and the impact of an alcohol-based hand sanitizer (ABHS) on reducing the movement and exposure of the virus to household members. Bacterial virus MS-2 was used as the surrogate for human enteric and respiratory viruses. Seven households with families having at least two children in the age range of 2-18 living in the home were used in this study. The hands of one adult family member were contaminated with 1 × 10(8). MS-2 bacteriophage in each home. After 8 h, the hands of each family member (10 fingers) and 20 frequently touched fomites were sampled to determine baseline contamination without intervention. Within 8 h, MS-2 was detected on all of the family member's hands and most of the fomites. The intervention consisted of providing the families in all selected homes with bottles of an ABHS, which were placed in the kitchen, bathrooms, and nurseries. Smaller individual bottles were provided for each family member greater than 12 years old to place in purses, pockets, backpacks, etc. The families were instructed to use the ABHS one time or three times during the day. For one and three uses, a statistically significant reduction of virus on un-inoculated and inoculated hands of ~99% occurred within 8 h. Similar reductions occurred on fomites throughout the households (97-99%). These results demonstrate that the use of an ABHS can significantly reduce transfer of a virus to the hands, and to the commonly touched surfaces within the household.


Asunto(s)
Etanol/farmacología , Desinfectantes para las Manos/farmacología , Virosis/transmisión , Fenómenos Fisiológicos de los Virus/efectos de los fármacos , Virus/efectos de los fármacos , Adolescente , Adulto , Niño , Preescolar , Familia , Femenino , Artículos Domésticos , Humanos , Higiene , Masculino , Virosis/virología , Adulto Joven
9.
Infect Control Hosp Epidemiol ; 34(3): 299-301, 2013 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-23388365

RESUMEN

In vivo efficacies of 2 alcohol-based hand rub (ABHR) products (gel and foam) were evaluated at a volume of 1.1 mL. Both met US Food and Drug Administration log(10) reduction requirements after a single application and 10 consecutive applications. This is the first study to identify ABHR formulations capable of meeting efficacy requirements with a single-dispenser actuation.


Asunto(s)
Antiinfecciosos Locales/administración & dosificación , Equipos y Suministros de Hospitales/normas , Etanol/administración & dosificación , Desinfección de las Manos/normas , Mano/microbiología , Femenino , Geles , Humanos , Masculino , Ensayo de Materiales , Factores de Tiempo
10.
Am J Infect Control ; 41(1): 39-44, 2013 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-22750034

RESUMEN

BACKGROUND: Alcohol-based hand rubs play a key role in reducing the transmission of pathogens in acute care settings, especially as part of a comprehensive hand hygiene program. However, their use in long-term care facilities (LTCFs) has been virtually unstudied. METHODS: Infection data, including those meeting McGeer et al and the Pennsylvania Patient Safety Authority's surveillance definitions, for lower respiratory tract infections (LRTIs) and skin and soft-tissue infections (SSTIs), as well as hospitalization data were collected in a 174-bed LTCF for 22 months (May 2009 to February 2011). In March 2010, a comprehensive hand hygiene program including increased product availability, education for health care personnel (HCP) and residents, and an observation tool to monitor compliance, was implemented. RESULTS: Infection rates for LRTIs were reduced from 0.97 to 0.53 infections per 1,000 resident-days (P = .01) following the intervention, a statistically significant decline. Infection rates for SSTIs were reduced from 0.30 to 0.25 infections per 1,000 resident-days (P = .65). A 54% compliance rate was observed among HCP. CONCLUSION: This study demonstrates that the use of alcohol-based hand rubs, as part of a comprehensive hand hygiene program for HCP and residents, can decrease infection rates in LTCFs.


Asunto(s)
Infección Hospitalaria/prevención & control , Higiene de las Manos/métodos , Higiene de las Manos/organización & administración , Control de Infecciones/métodos , Control de Infecciones/organización & administración , Cuidados a Largo Plazo/métodos , Infección Hospitalaria/epidemiología , Instituciones de Salud , Hospitalización/estadística & datos numéricos , Humanos , Prevalencia , Infecciones del Sistema Respiratorio/epidemiología , Infecciones de los Tejidos Blandos/epidemiología , Estados Unidos/epidemiología
11.
Infect Control Hosp Epidemiol ; 34(3): 302-5, 2013 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-23388366

RESUMEN

This study determined whether surrogate organisms can predict activity against Clostridium difficile spores and compared the efficacy of hand hygiene preparations against C. difficile. Our data suggest that surrogate organisms were not predictive of C. difficile spore removal. Four preparations were significantly more effective than tap water at removing C. difficile.


Asunto(s)
Antiinfecciosos Locales/farmacología , Bacillus/efectos de los fármacos , Clostridioides difficile/efectos de los fármacos , Desinfección de las Manos , Clorhexidina/análogos & derivados , Clorhexidina/farmacología , Humanos , Peróxido de Hidrógeno/farmacología , Ácido Peracético/farmacología , Valor Predictivo de las Pruebas , Jabones/farmacología , Hipoclorito de Sodio/farmacología , Esporas Bacterianas/efectos de los fármacos , Triclosán/farmacología , Agua/farmacología
12.
J Food Prot ; 75(7): 1303-9, 2012 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-22980014

RESUMEN

Pathogenic strains of Escherichia coli and human norovirus are the main etiologic agents of foodborne illness resulting from inadequate hand hygiene practices by food service workers. This study was conducted to evaluate the antibacterial and antiviral efficacy of various hand hygiene product regimens under different soil conditions representative of those in food service settings and assess the impact of product formulation on this efficacy. On hands contaminated with chicken broth containing E. coli, representing a moderate soil load, a regimen combining an antimicrobial hand washing product with a 70% ethanol advanced formula (EtOH AF) gel achieved a 5.22-log reduction, whereas a nonantimicrobial hand washing product alone achieved a 3.10log reduction. When hands were heavily soiled from handling ground beef containing E. coli, a wash-sanitize regimen with a 0.5% chloroxylenol antimicrobial hand washing product and the 70% EtOH AF gel achieved a 4.60-log reduction, whereas a wash-sanitize regimen with a 62% EtOH foam achieved a 4.11-log reduction. Sanitizing with the 70% EtOH AF gel alone was more effective than hand washing with a nonantimicrobial product for reducing murine norovirus (MNV), a surrogate for human norovirus, with 2.60- and 1.79-log reductions, respectively. When combined with hand washing, the 70% EtOH AF gel produced a 3.19-log reduction against MNV. A regimen using the SaniTwice protocol with the 70% EtOH AF gel produced a 4.04-log reduction against MNV. These data suggest that although the process of hand washing helped to remove pathogens from the hands, use of a wash-sanitize regimen was even more effective for reducing organisms. Use of a high-efficacy sanitizer as part of a wash-sanitize regimen further increased the efficacy of the regimen. The use of a well-formulated alcohol-based hand rub as part of a wash-sanitize regimen should be considered as a means to reduce risk of infection transmission in food service facilities.


Asunto(s)
Contaminación de Alimentos/prevención & control , Servicios de Alimentación/normas , Desinfección de las Manos , Jabones/farmacología , Bacterias/crecimiento & desarrollo , Recuento de Colonia Microbiana , Desinfectantes/farmacología , Etanol/farmacología , Geles , Humanos , Higiene , Recursos Humanos
13.
Am J Infect Control ; 40(6): 521-5, 2012 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-22264743

RESUMEN

BACKGROUND: Use of alcohol-based hand rubs (ABHRs) effectively reduces transmission of pathogenic microorganisms. However, the impact of alcohol concentration and format on product efficacy is currently being debated. METHODS: Two novel ABHR formulations containing 70% ethanol were evaluated according to American Society for Testing and Materials E1174 (Health Care Personnel Handwash [HCPHW]) and European Norm (EN) 1500 global standards. Additionally, using E1174, the efficacy of these formulations was compared head-to-head against 7 representative commercially available ABHRs and 2 World Health Organization recommended formulations containing alcohol concentrations of 60% to 90%. RESULTS: The novel ABHR formulations met efficacy requirements for both HCPHW and EN 1500 when tested at application volumes typically used in these methods. Moreover, these formulations met HCPHW requirements when tested at a more realistic 2-mL product application. In contrast, the commercial ABHRs and World Health Organization formulations failed to meet HCPHW requirements using a 2-mL application. Importantly, product performance did not correlate with alcohol concentration. CONCLUSION: Product formulation can greatly influence the overall antimicrobial efficacy of ABHRs and is a more important factor than alcohol concentration alone. Two novel ABHRs based on 70% ethanol have been formulated to meet global efficacy standards when tested at volumes more representative of normal product use in health care environments.


Asunto(s)
Alcoholes/administración & dosificación , Química Farmacéutica/métodos , Desinfectantes/administración & dosificación , Desinfección de las Manos/métodos , Humanos , Resultado del Tratamiento , Organización Mundial de la Salud
14.
J Food Prot ; 73(12): 2296-300, 2010 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-21219752

RESUMEN

The risk of inadequate hand hygiene in food handling settings is exacerbated when water is limited or unavailable, thereby making washing with soap and water difficult. The SaniTwice method involves application of excess alcohol-based hand sanitizer (ABHS), hand "washing" for 15 s, and thorough cleaning with paper towels while hands are still wet, followed by a standard application of ABHS. This study investigated the effectiveness of the SaniTwice methodology as an alternative to hand washing for cleaning and removal of microorganisms. On hands moderately soiled with beef broth containing Escherichia coli (ATCC 11229), washing with a nonantimicrobial hand washing product achieved a 2.86 (±0.64)-log reduction in microbial contamination compared with the baseline, whereas the SaniTwice method with 62 % ethanol (EtOH) gel, 62 % EtOH foam, and 70 % EtOH advanced formula gel achieved reductions of 2.64 ± 0.89, 3.64 ± 0.57, and 4.61 ± 0.33 log units, respectively. When hands were heavily soiled from handling raw hamburger containing E. coli, washing with nonantimicrobial hand washing product and antimicrobial hand washing product achieved reductions of 2.65 ± 0.33 and 2.69 ± 0.32 log units, respectively, whereas SaniTwice with 62 % EtOH foam, 70 % EtOH gel, and 70 % EtOH advanced formula gel achieved reductions of 2.87 ± 0.42, 2.99 ± 0.51, and 3.92 ± 0.65 log units, respectively. These results clearly demonstrate that the in vivo antibacterial efficacy of the SaniTwice regimen with various ABHS is equivalent to or exceeds that of the standard hand washing approach as specified in the U.S. Food and Drug Administration Food Code. Implementation of the SaniTwice regimen in food handling settings with limited water availability should significantly reduce the risk of foodborne infections resulting from inadequate hand hygiene.


Asunto(s)
Bacterias/crecimiento & desarrollo , Desinfectantes/farmacología , Contaminación de Alimentos/prevención & control , Desinfección de las Manos , Higiene , Recuento de Colonia Microbiana , Etanol/farmacología , Manipulación de Alimentos/métodos , Mano/microbiología , Humanos , Medición de Riesgo , Jabones/farmacología
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