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1.
Unfallchirurg ; 123(1): 36-42, 2020 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-31243487

RESUMEN

BACKGROUND: Needlestick injuries (NSI) of healthcare personnel (HCP) are work-related accidents with a risk of transmission of blood-borne human immunodeficiency virus (HIV), hepatitis B and C viruses (HBV, HCV). Along with preventive measures to avoid accidental NSI, preventing the risk and diagnosis of an infection from NSI are given a high priority. Thus, follow-up monitoring of NSI is of great interest. OBJECTIVE: Evaluation of the follow-up monitoring after NSI with respect to early recognition of transmission of HIV, HCV and HBV as well as adherence and psychological burden of HCP. METHODS: Clinical and serological investigations of the injured HCP including determining the individual risk of infection in the situation of NSI, analysis of accident protocols by the accident insurance consultant and use of a self-developed standardized questionnaire. RESULTS: No virus transmissions from NSI were found during the observation period (23 March 2014 until 31 October 2017). A total of 112 NSI with infectious index patients (HIV 35.7%, HCV 54.5%, HBV 2.7%, coinfection 7.1%) and 3 incidents from unknown index patients were analyzed. Of the index patients six received the first diagnosis of a blood-borne infection (2 HCV infections, 4 HIV infections) after NSI. In nearly all incidents (98.3%) the HCP took measures to disinfect and flush the injury and 85.1% of the HCP exposed to HIV or unknown infection risk undertook postexposure prophylaxis (HIV-PEP) within 2 h and another 12.8% within 10 h. Follow-up examination was attended by 97.4% of the HCP, three quarters of the HCP felt concerned following NSI and 12.2% were very concerned. CONCLUSION: Through adequate management and follow-up of NSI low transmission rates can be achieved after exposure to blood-borne viruses within the occupational environment.


Asunto(s)
Infecciones por VIH , Hepatitis B , Hepatitis C , Lesiones por Pinchazo de Aguja , Patógenos Transmitidos por la Sangre , Infecciones por VIH/transmisión , Hepatitis B/transmisión , Hepatitis C/transmisión , Humanos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional , Estudios Prospectivos
2.
Praxis (Bern 1994) ; 108(16): 1047-1057, 2019.
Artículo en Alemán | MEDLINE | ID: mdl-31822230

RESUMEN

CME: Postexposure Prophylaxis Following Needlestick Injuries and Non-Occupational Exposures Abstract. Occupational exposures following needlestick injuries are far from being uncommon and require a standardised approach in counselling the respective healthcare worker. In addition, non-occupational exposures likewise cause consultations of A & E services. To inform the medical public on state of the art, postexposure prophylaxis following exposures that potentially carry a risk of infection with bloodborne illnesses (HBV, HCV, HIV), we summarized current policies. Special instances may require expert consultation, but will not be discussed here in detail as it would exceed the scope of our article.


Asunto(s)
Lesiones por Pinchazo de Aguja , Enfermedades Profesionales , Exposición Profesional , Profilaxis Posexposición , Humanos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional
3.
West Afr J Med ; 36(3): 283-285, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31622493

RESUMEN

BACKGROUND: Latent Tuberculosis (LTBI) affects approximately a third of the world population. Paediatric health workers caring for adolescent Tuberculosis (TB) patients in high TB endemic regions are particularly susceptible as they are exposed to TB in the community and in the work place. However, there is a paucity of reports on LTBI in paediatric health workers. OBJECTIVES: To identify the factors that could have resulted in latent TB in a paediatric health worker Methods/Results: We present a case of a 38-year old female paediatrician who was diagnosed with LTBI by a positive QuantiFERON-TB gold test during the routine new entry immigrant screening for tuberculosis on arrival in the United Kingdom for postgraduate studies. She was treated with three months course of Rifampicin and Isoniazid (plus pyridoxine). CONCLUSION: Latent TB infection may have been acquired from her involvement in the management of adolescents with adult type TB without the use of personal protective equipment. In this case, routine systematic screening of an at risk individual helped to eliminate TB infection. RECOMMENDATION: Paediatric health workers should use personal protective equipment when managing childhood TB and should also be routinely screened for latent TB.


Asunto(s)
Antituberculosos/uso terapéutico , Personal de Salud , Isoniazida/uso terapéutico , Tuberculosis Latente/tratamiento farmacológico , Mycobacterium tuberculosis/aislamiento & purificación , Piridoxina/uso terapéutico , Rifampin/uso terapéutico , Adolescente , Adulto , Técnicas de Laboratorio Clínico , Femenino , Humanos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional , Tuberculosis Latente/diagnóstico , Exposición Profesional , Resultado del Tratamiento
4.
Orv Hetil ; 160(41): 1607-1616, 2019 Oct.
Artículo en Húngaro | MEDLINE | ID: mdl-31587575

RESUMEN

More than 200 million HBV surface antigen (HBsAg) positive, hepatitis B virus (HBV) carriers live worldwide. Health-care personnel have increasing risk for aquiring the HBV infection. An effective vaccine is available against the infection, however, a certain proportion of the vaccinated patients do not respond to the vaccine depending on certain factors. Therefore, vaccine-induced immunity (anti-HBs) should be tested at health-care workers. For nonresponders, there are other vaccination strategies to try to achieve protection. This recommendation also provides a guidance for postexposure prophylaxis following occupational exposures against HBV infection. This is the first Hungarian recommendation about this topic. Orv Hetil. 2019; 160(41): 1607-1616.


Asunto(s)
Personal de Salud , Vacunas contra Hepatitis B/administración & dosificación , Virus de la Hepatitis B/inmunología , Hepatitis B/prevención & control , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Vacunación , Comités Consultivos , Hepatitis B/transmisión , Humanos , Hungría , Inmunización , Profilaxis Posexposición , Guías de Práctica Clínica como Asunto , Profilaxis Pre-Exposición
5.
JAMA ; 322(9): 824-833, 2019 09 03.
Artículo en Inglés | MEDLINE | ID: mdl-31479137

RESUMEN

Importance: Clinical studies have been inconclusive about the effectiveness of N95 respirators and medical masks in preventing health care personnel (HCP) from acquiring workplace viral respiratory infections. Objective: To compare the effect of N95 respirators vs medical masks for prevention of influenza and other viral respiratory infections among HCP. Design, Setting, and Participants: A cluster randomized pragmatic effectiveness study conducted at 137 outpatient study sites at 7 US medical centers between September 2011 and May 2015, with final follow-up in June 2016. Each year for 4 years, during the 12-week period of peak viral respiratory illness, pairs of outpatient sites (clusters) within each center were matched and randomly assigned to the N95 respirator or medical mask groups. Interventions: Overall, 1993 participants in 189 clusters were randomly assigned to wear N95 respirators (2512 HCP-seasons of observation) and 2058 in 191 clusters were randomly assigned to wear medical masks (2668 HCP-seasons) when near patients with respiratory illness. Main Outcomes and Measures: The primary outcome was the incidence of laboratory-confirmed influenza. Secondary outcomes included incidence of acute respiratory illness, laboratory-detected respiratory infections, laboratory-confirmed respiratory illness, and influenzalike illness. Adherence to interventions was assessed. Results: Among 2862 randomized participants (mean [SD] age, 43 [11.5] years; 2369 [82.8%]) women), 2371 completed the study and accounted for 5180 HCP-seasons. There were 207 laboratory-confirmed influenza infection events (8.2% of HCP-seasons) in the N95 respirator group and 193 (7.2% of HCP-seasons) in the medical mask group (difference, 1.0%, [95% CI, -0.5% to 2.5%]; P = .18) (adjusted odds ratio [OR], 1.18 [95% CI, 0.95-1.45]). There were 1556 acute respiratory illness events in the respirator group vs 1711 in the mask group (difference, -21.9 per 1000 HCP-seasons [95% CI, -48.2 to 4.4]; P = .10); 679 laboratory-detected respiratory infections in the respirator group vs 745 in the mask group (difference, -8.9 per 1000 HCP-seasons, [95% CI, -33.3 to 15.4]; P = .47); 371 laboratory-confirmed respiratory illness events in the respirator group vs 417 in the mask group (difference, -8.6 per 1000 HCP-seasons [95% CI, -28.2 to 10.9]; P = .39); and 128 influenzalike illness events in the respirator group vs 166 in the mask group (difference, -11.3 per 1000 HCP-seasons [95% CI, -23.8 to 1.3]; P = .08). In the respirator group, 89.4% of participants reported "always" or "sometimes" wearing their assigned devices vs 90.2% in the mask group. Conclusions and Relevance: Among outpatient health care personnel, N95 respirators vs medical masks as worn by participants in this trial resulted in no significant difference in the incidence of laboratory-confirmed influenza. Trial Registration: ClinicalTrials.gov Identifier: NCT01249625.


Asunto(s)
Personal de Salud , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Gripe Humana/prevención & control , Gripe Humana/transmisión , Máscaras , Dispositivos de Protección Respiratoria , Adulto , Atención Ambulatoria , Femenino , Humanos , Incidencia , Control de Infecciones/métodos , Gripe Humana/diagnóstico , Gripe Humana/epidemiología , Masculino , Persona de Mediana Edad , Exposición Profesional , Infecciones del Sistema Respiratorio/prevención & control , Infecciones del Sistema Respiratorio/transmisión
6.
Artículo en Chino | MEDLINE | ID: mdl-31495113

RESUMEN

Objective: To understand the current situation of blood-borne occupational exposure among health care workers and evaluate the intervention effect of PDCA. Methods: Retrospective survey was adopted to investigate and analyze the blood-borne occupational exposure incidents in a hospital from January 2015 to December 2018, and to compare the intervention effects after PDCA management. Results: A total of 82 cases of occupational exposure occurred from 2015 to 2017, and only 9 cases happened after the implementation of PDCA intervention. The exposed population was mainly consisted of nurses (59 cases, 64.83%) , and mainly with low-working age (1-5 years) (56 cases, 61.54%) , and the main source of exposure was hepatitis B (34 cases, 37.36%) . In addition, after the implementation of PDCA, the vaccination rate of personnel was 77.78%, the standardized field treatment rate was 100%, the preventive drug use rate was 88.89%; The qualified rate of occupational protection assessment was higher than that before intervention, which all shows the difference was statistically significant (P<0.05) . Conclusion: With the guide of PDCA management, Strengthen the training of new employees or ones with low working years as well as their awareness of protection, and standardize the relevant operational procedures, which can significantly improve the prevention of blood-borne occupational exposure and stress management of medical staff.


Asunto(s)
Patógenos Transmitidos por la Sangre , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Cuerpo Médico , Exposición Profesional/prevención & control , Personal de Salud , Hepatitis B/epidemiología , Humanos , Enfermeras y Enfermeros , Enfermedades Profesionales , Estudios Retrospectivos , Vacunación/estadística & datos numéricos
7.
Cochrane Database Syst Rev ; 7: CD011621, 2019 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-31259389

RESUMEN

BACKGROUND: In epidemics of highly infectious diseases, such as Ebola Virus Disease (EVD) or Severe Acute Respiratory Syndrome (SARS), healthcare workers (HCW) are at much greater risk of infection than the general population, due to their contact with patients' contaminated body fluids. Contact precautions by means of personal protective equipment (PPE) can reduce the risk. It is unclear which type of PPE protects best, what is the best way to remove PPE, and how to make sure HCW use PPE as instructed. OBJECTIVES: To evaluate which type of full body PPE and which method of donning or doffing PPE have the least risk of self-contamination or infection for HCW, and which training methods increase compliance with PPE protocols. SEARCH METHODS: We searched MEDLINE (PubMed up to 15 July 2018), Cochrane Central Register of Trials (CENTRAL up to 18 June 2019), Scopus (Scopus 18 June 2019), CINAHL (EBSCOhost 31 July 2018), and OSH-Update (up to 31 December 2018). We also screened reference lists of included trials and relevant reviews, and contacted NGOs and manufacturers of PPE. SELECTION CRITERIA: We included all controlled studies that compared the effects of PPE used by HCW exposed to highly infectious diseases with serious consequences, such as Ebola or SARS, on the risk of infection, contamination, or noncompliance with protocols. This included studies that used simulated contamination with fluorescent markers or a non-pathogenic virus.We also included studies that compared the effect of various ways of donning or doffing PPE, and the effects of training in PPE use on the same outcomes. DATA COLLECTION AND ANALYSIS: Two authors independently selected studies, extracted data and assessed risk of bias in included trials. We planned to perform meta-analyses but did not find sufficiently similar studies to combine their results. MAIN RESULTS: We included 17 studies with 1950 participants evaluating 21 interventions. Ten studies are Randomised Controlled Trials (RCTs), one is a quasi RCT and six have a non-randomised controlled design. Two studies are awaiting assessment.Ten studies compared types of PPE but only six of these reported sufficient data. Six studies compared different types of donning and doffing and three studies evaluated different types of training. Fifteen studies used simulated exposure with fluorescent markers or harmless viruses. In simulation studies, contamination rates varied from 10% to 100% of participants for all types of PPE. In one study HCW were exposed to Ebola and in another to SARS.Evidence for all outcomes is based on single studies and is very low quality.Different types of PPEPPE made of more breathable material may not lead to more contamination spots on the trunk (Mean Difference (MD) 1.60 (95% Confidence Interval (CI) -0.15 to 3.35) than more water repellent material but may have greater user satisfaction (MD -0.46; 95% CI -0.84 to -0.08, scale of 1 to 5).Gowns may protect better against contamination than aprons (MD large patches -1.36 95% CI -1.78 to -0.94).The use of a powered air-purifying respirator may protect better than a simple ensemble of PPE without such respirator (Relative Risk (RR) 0.27; 95% CI 0.17 to 0.43).Five different PPE ensembles (such as gown vs. coverall, boots with or without covers, hood vs. cap, length and number of gloves) were evaluated in one study, but there were no event data available for compared groups.Alterations to PPE design may lead to less contamination such as added tabs to grab masks (RR 0.33; 95% CI 0.14 to 0.80) or gloves (RR 0.22 95% CI 0.15 to 0.31), a sealed gown and glove combination (RR 0.27; 95% CI 0.09 to 0.78), or a better fitting gown around the neck, wrists and hands (RR 0.08; 95% CI 0.01 to 0.55) compared to standard PPE.Different methods of donning and doffing proceduresDouble gloving may lead to less contamination compared to single gloving (RR 0.36; 95% CI 0.16 to 0.78).Following CDC recommendations for doffing may lead to less contamination compared to no guidance (MD small patches -5.44; 95% CI -7.43 to -3.45).Alcohol-based hand rub used during the doffing process may not lead to less contamination than the use of a hypochlorite based solution (MD 4.00; 95% CI 0.47 to 34.24).Additional spoken instruction may lead to fewer errors in doffing (MD -0.9, 95% CI -1.4 to -0.4).Different types of trainingThe use of additional computer simulation may lead to fewer errors in doffing (MD -1.2, 95% CI -1.6 to -0.7).A video lecture on donning PPE may lead to better skills scores (MD 30.70; 95% CI 20.14,41.26) than a traditional lecture.Face to face instruction may reduce noncompliance with doffing guidance more (OR 0.45; 95% CI 0.21 to 0.98) than providing folders or videos only.There were no studies on effects of training in the long term or on resource use.The quality of the evidence is very low for all comparisons because of high risk of bias in all studies, indirectness of evidence, and small numbers of participants. AUTHORS' CONCLUSIONS: We found very low quality evidence that more breathable types of PPE may not lead to more contamination, but may have greater user satisfaction. Alterations to PPE, such as tabs to grab may decrease contamination. Double gloving, following CDC doffing guidance, and spoken instructions during doffing may reduce contamination and increase compliance. Face-to-face training in PPE use may reduce errors more than video or folder based training. Because data come from single small studies with high risk of bias, we are uncertain about the estimates of effects.We still need randomised controlled trials to find out which training works best in the long term. We need better simulation studies conducted with several dozen participants to find out which PPE protects best, and what is the safest way to remove PPE. Consensus on the best way to conduct simulation of exposure and assessment of outcome is urgently needed. HCW exposed to highly infectious diseases should have their use of PPE registered and should be prospectively followed for their risk of infection in the field.


Asunto(s)
Personal de Salud , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Equipo de Protección Personal , Líquidos Corporales , Guantes Protectores , Fiebre Hemorrágica Ebola/prevención & control , Fiebre Hemorrágica Ebola/transmisión , Humanos , Ropa de Protección , Ensayos Clínicos Controlados Aleatorios como Asunto , Síndrome Respiratorio Agudo Grave/prevención & control , Síndrome Respiratorio Agudo Grave/transmisión
8.
BMC Infect Dis ; 19(1): 491, 2019 Jun 03.
Artículo en Inglés | MEDLINE | ID: mdl-31159777

RESUMEN

BACKGROUND: Medical masks are commonly used in health care settings to protect healthcare workers (HCWs) from respiratory and other infections. Airborne respiratory pathogens may settle on the surface of used masks layers, resulting in contamination. The main aim of this study was to study the presence of viruses on the surface of medical masks. METHODS: Two pilot studies in laboratory and clinical settings were carried out to determine the areas of masks likely to contain maximum viral particles. A laboratory study using a mannequin and fluorescent spray showed maximum particles concentrated on upper right, middle and left sections of the medical masks. These findings were confirmed through a small clinical study. The main study was then conducted in high-risk wards of three selected hospitals in Beijing China. Participants (n = 148) were asked to wear medical masks for a shift (6-8 h) or as long as they could tolerate. Used samples of medical masks were tested for presence of respiratory viruses in upper sections of the medical masks, in line with the pilot studies. RESULTS: Overall virus positivity rate was 10.1% (15/148). Commonly isolated viruses from masks samples were adenovirus (n = 7), bocavirus (n = 2), respiratory syncytial virus (n = 2) and influenza virus (n = 2). Virus positivity was significantly higher in masks samples worn for > 6 h (14.1%, 14/99 versus 1.2%, 1/49, OR 7.9, 95% CI 1.01-61.99) and in samples used by participants who examined > 25 patients per day (16.9%, 12/71 versus 3.9%, 3/77, OR 5.02, 95% CI 1.35-18.60). Most of the participants (83.8%, 124/148) reported at least one problem associated with mask use. Commonly reported problems were pressure on face (16.9%, 25/148), breathing difficulty (12.2%, 18/148), discomfort (9.5% 14/148), trouble communicating with the patient (7.4%, 11/148) and headache (6.1%, 9/148). CONCLUSION: Respiratory pathogens on the outer surface of the used medical masks may result in self-contamination. The risk is higher with longer duration of mask use (> 6 h) and with higher rates of clinical contact. Protocols on duration of mask use should specify a maximum time of continuous use, and should consider guidance in high contact settings. Viruses were isolated from the upper sections of around 10% samples, but other sections of masks may also be contaminated. HCWs should be aware of these risks in order to protect themselves and people around them.


Asunto(s)
Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Máscaras/virología , Personal de Hospital , Dispositivos de Protección Respiratoria/virología , Infecciones del Sistema Respiratorio/prevención & control , Infecciones del Sistema Respiratorio/virología , Virus/aislamiento & purificación , Adulto , China/epidemiología , Femenino , Unidades Hospitalarias/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Humanos , Control de Infecciones/métodos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Personal de Hospital/estadística & datos numéricos , Proyectos Piloto , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/transmisión , Virus/clasificación , Adulto Joven
9.
PLoS One ; 14(5): e0216598, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31063488

RESUMEN

OBJECTIVES: Nation-wide hepatitis B vaccination coverage among healthcare workers (HCWs) is not well researched in China. This study aims to investigate the self-reported hepatitis B vaccination status among HCWs in China. METHODS: We conducted a cross-sectional survey of health_care workers' vaccination statuses in 120 hospitals in China by collecting demographic and vaccination data. Univariate and multivariate logistic regression analysis were used to assess factors associated with hepatitis B vaccination coverage. RESULTS: Eighty-six percent (2,666/3,104) of respondents reported having received at least one dose of the hepatitis B vaccination and 60% (1,853/3,104) reported having completed ≥3 doses of the hepatitis B vaccination. Factors associated with completing ≥3 doses of the hepatitis B vaccination included workplaces offering free hepatitis B vaccination with vaccination management, age, medical occupation, hospital level, acceptable hepatitis B knowledge and having received training on hepatitis B. HCWs in workplaces offering a free hepatitis B vaccine with vaccination management were 1.4 times more likely (OR = 1.4, 95% CI: 1.1-1.8) to complete their hepatitis B vaccination compared to HCWs in workplaces that did not offer a free hepatitis B vaccine. Either the possession of acceptable hepatitis B knowledge or an age of 30-39 years increased the odds of complete hepatitis B vaccination by 1.3-fold (95% CIs: 1.1-1.5 and 1.1-1.7, respectively) over their referent category. The receipt of training on hepatitis B was also associated with a higher percentage of completing the hepatitis B vaccination (OR = 1.5, 95% CI: 1.2-1.8). The main self-reported reason for incomplete hepatitis B vaccination was "forgot to complete follow-up doses" among 43% (234/547) of respondents. Among those who never received any hepatitis B vaccination, only 30% (131/438) intended to be vaccinated. Obtaining immunity from work (40%) and hospitals that did not provide hepatitis B vaccination activities (40%) were the top reasons mentioned for refusing hepatitis B vaccination. CONCLUSIONS: The complete hepatitis B vaccination rate among HCWs in China is low, and the desire of HCWs for vaccination is indifferent; therefore, education campaigns are needed. In addition, a free national hepatitis B vaccination policy for HCWs that includes vaccination management should be prioritized to improve hepatitis B coverage among HCWs who are at-risk for HBV infection.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Vacunas contra Hepatitis B/administración & dosificación , Hepatitis B/prevención & control , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Exposición Profesional/prevención & control , Cobertura de Vacunación/estadística & datos numéricos , Vacunación/estadística & datos numéricos , Adulto , China/epidemiología , Estudios Transversales , Femenino , Hepatitis B/epidemiología , Hepatitis B/transmisión , Virus de la Hepatitis B/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios
10.
Internist (Berl) ; 60(6): 661-666, 2019 Jun.
Artículo en Alemán | MEDLINE | ID: mdl-31020354

RESUMEN

BACKGROUND: Health care workers (HCW) are at risk of occupational exposure to infectious diseases and can also transmit diseases to their patients. The related occupational disease (BK: "Berufskrankheit") is BK 3101. OBJECTIVE: Number of claims and confirmed claims of occupational infections, risk of infection depending on occupation and field of activity, kind of infectious diseases, limits and opportunities of prevention. MATERIALS AND METHODS: Selective literature search, particularly on data of accident insurance institutions regarding occupational infections among HCW. RESULTS: In 2017, BK 3101 was the fifth most common cause of confirmed occupational disease. The number of occupational infections in HCW has decreased over the last 22 years in Germany. The decrease was primarily due to lower rates of blood-borne infections. CONCLUSION: Occupational infections continue to be a risk for HCW. Preventive measures reduce the risk of infection among HCW as well as the nosocomial transmission among patients.


Asunto(s)
Control de Enfermedades Transmisibles , Personal de Salud/estadística & datos numéricos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Transmisión de Enfermedad Infecciosa de Profesional a Paciente/prevención & control , Revisión de Utilización de Seguros/estadística & datos numéricos , Enfermedades Profesionales , Exposición Profesional/prevención & control , Enfermedades Transmisibles/economía , Enfermedades Transmisibles/epidemiología , Alemania/epidemiología , Humanos , Enfermedades Profesionales/economía , Enfermedades Profesionales/epidemiología
11.
Ital J Pediatr ; 45(1): 47, 2019 Apr 11.
Artículo en Inglés | MEDLINE | ID: mdl-30975224

RESUMEN

BACKGROUND: Vaccine coverage of health care professionals against influenza is still low in Italy, as well as in other European countries. METHODS: Between March and May 2018, this study was performed to collect the opinions of Pediatric health care professionals, working in emergency departments, regarding the efficacy and safety of the influenza vaccine. An anonymous online survey was employed to evaluate socio-demographic and professional characteristics, knowledges, beliefs and attitudes. RESULTS: Five hundred four health care professionals completed the survey: 331 physicians, 140 nurses and 33 other health are professionals. During the 2017-18 season, 55.8% of physicians, 19.3% of nurses and 12.1% of other health care professionals had vaccinated against the influenza virus. Not vaccinated physicians and nurses with less than 40 years of age were fewer than not vaccinated physicians and nurses with more than 40 years of age. Nurses and other health care professionals were less trustworthy of the influenza vaccination, less aware of the possibility of contracting and transmitting influenza and other vaccine-preventable diseases. CONCLUSIONS: Insufficient adherence to the influenza vaccination in physicians, nurses and other health care professionals is a concern for those assisting high-risk patients, especially in emergency departments. Therefore, it is vital to promote education of health care professionals and students regarding vaccinations. High vaccine coverage should be embedded in the safe hospital paradigm and should become a goal for the hospital's directors.


Asunto(s)
Actitud del Personal de Salud , Servicio de Urgencia en Hospital , Vacunas contra la Influenza , Vacunación/estadística & datos numéricos , Adulto , Anciano , Competencia Clínica , Femenino , Personal de Salud/estadística & datos numéricos , Humanos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Transmisión de Enfermedad Infecciosa de Profesional a Paciente/prevención & control , Italia , Masculino , Cuerpo Médico de Hospitales/estadística & datos numéricos , Persona de Mediana Edad , Personal de Enfermería en Hospital/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto Joven
12.
West J Emerg Med ; 20(2): 191-197, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30881535

RESUMEN

Pertussis, commonly referred to as "whooping cough," is a highly contagious acute respiratory infection that has exhibited cyclical outbreaks throughout the last century. Although vaccines have provided some immunity, many populations, including infants and pregnant women, remain at risk for serious illness. Through the use of the novel "Identify, Isolate, Inform" (3I) tool, emergency department (ED) providers can readily recognize key symptoms of the disease and risk factors for exposure, thus curbing its transmission through early initiation of antimicrobial therapy and post-exposure prophylaxis. The three classic stages of pertussis include an initial catarrhal stage, characterized by nonspecific upper respiratory infection symptoms, which may advance to the paroxysmal stage, revealing the distinctive "whooping cough." This cough can persist for weeks to months leading into the convalescent stage. Household contacts of patients with suspected pertussis or other asymptomatic, high-risk populations (infants, pregnant women in their third trimester, and childcare workers) may benefit from post-exposure prophylactic therapy. The Pertussis 3I tool can also alert healthcare professionals to the proper respiratory droplet precautions during contact with a symptomatic patient, as well as isolation practices until antimicrobial treatment is in progress. ED personnel should then inform local public health departments of any suspected cases. All of these actions will ultimately aid public health in controlling the incidence of pertussis cases, thus ensuring the protection of the general public from this re-emerging respiratory illness.


Asunto(s)
Enfermedades Transmisibles Emergentes/prevención & control , Tos Ferina/prevención & control , Adulto , Antibacterianos/uso terapéutico , Diagnóstico Diferencial , Brotes de Enfermedades/prevención & control , Diagnóstico Precoz , Servicio de Urgencia en Hospital , Femenino , Personal de Salud , Humanos , Lactante , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Masculino , Aislamiento de Pacientes , Profilaxis Posexposición/métodos , Embarazo , Complicaciones Infecciosas del Embarazo/prevención & control , Salud Pública , Tos Ferina/transmisión
13.
J Infect Chemother ; 25(7): 489-493, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30827859

RESUMEN

BACKGROUND: Ebola virus disease (EVD) was endemic to Africa in 2014-2016. Supportive therapies have been shown to improve the outcome of EVD, and additional supportive therapy including blood transfusion therapy and external circulation could be needed in the event of a future global outbreak. However, pre-transfusion testing policies and guidelines have not yet been established in Japan. METHODS: We conducted a cross-sectional study of blood transfusion therapy for EVD patients at three designated hospitals for serious communicable diseases in Tokyo. In each hospital, we surveyed blood transfusion therapy policy, blood transfusion protocol, presence of a specialist in the department of transfusion medicine, facility capacity for pre-transfusion compatibility testing, and types of personal protective equipment available. RESULTS: One hospital had a cross-matched compatible blood transfusion policy, one had a cross-matched compatible blood transfusion policy only when the patient's ABO and RhD type is previously known, and the third had not created a policy. Two hospitals had a department of transfusion medicine. These two hospitals had a special testing unit for serious communicable diseases, while the other had a portable unit for testing. There were no major differences noted in available personal protective equipment. CONCLUSION: Policies and protocols differ among hospitals. The choice of blood transfusion policy and pre-transfusion testing is largely dependent on equipment and human resources. Further discussion is required to develop national guidelines for blood transfusion therapy in patients with serious communicable diseases, including countermeasures against complications and ethical issues related to the safety of patients and healthcare workers.


Asunto(s)
Transfusión Sanguínea/normas , Enfermedades Transmisibles/terapia , Fiebre Hemorrágica Ebola/terapia , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Reacción a la Transfusión/prevención & control , Enfermedades Transmisibles/transmisión , Estudios Transversales , Personal de Salud/normas , Fiebre Hemorrágica Ebola/transmisión , Humanos , Políticas , Guías de Práctica Clínica como Asunto , Ropa de Protección/normas , Tokio
14.
Can J Cardiol ; 35(3): 320-325, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30744921

RESUMEN

The clinical status of HIV infection has changed dramatically with the introduction of combined antiretroviral therapy. Patients with HIV are now living long enough to be susceptible to chronic illnesses, such as coronary disease and nonischemic cardiomyopathy, which can be consequences of the combined antiretroviral therapy treatment itself. Cardiovascular diseases are a major source of morbidity and mortality in HIV-positive patients. Increasingly, such patients might be candidates for the full range of cardiac surgical interventions, including coronary bypass, valve surgery, and heart transplantation. There has been a shift from offering palliative procedures such as pericardial window and balloon valvuloplasty, to more conventional and durable surgical therapies in HIV-positive patients. We herein provide an overview of the contemporary outcomes of cardiac surgery in this complex and unique patient population. We review some of the ethical issues around the selection and surgical care of HIV-positive patients. We also discuss strategies to best protect the surgical treatment team from the risks of HIV transmission. Finally, we highlight the need for involvement of dedicated infectious disease professionals in a multidisciplinary heart team approach, aiming at the comprehensive care of these unique and complex patients.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Enfermedades Cardiovasculares , Infecciones por VIH , Transmisión de Enfermedad Infecciosa de Paciente a Profesional , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/ética , Procedimientos Quirúrgicos Cardíacos/métodos , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/cirugía , Infecciones por VIH/complicaciones , Infecciones por VIH/transmisión , Humanos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/ética , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Gestión de Riesgos
15.
Health Secur ; 17(1): 18-26, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30779606

RESUMEN

This article describes a large-scale scenario designed to test the capabilities of a US biocontainment unit to manage a pregnant woman infected with a high-consequence pathogen, and to care for a newborn following labor and spontaneous vaginal delivery. We created and executed a multidisciplinary functional exercise with simulation to test the ability of the Johns Hopkins Hospital biocontainment unit (BCU) to manage a pregnant patient in labor with an unknown respiratory illness and to deliver and stabilize her neonate. The BCU Exercise and Drill Committee established drill objectives and executed the exercise in partnership with the Johns Hopkins Simulation Center in accordance with Homeland Security and Exercise Program guidelines. Exercise objectives were assessed by after-action reporting and objective measurements to detect contamination, using a fluorescent marker to simulate biohazardous fluids that would be encountered in a typical labor scenario. The immediate objectives of the drill were accomplished, with stabilization of the mother and successful delivery and resuscitation of her newborn. There was no evidence of contamination when drill participants were inspected under ultraviolet light at the end of the exercise. Simulation optimizes teamwork, communication, and safety, which are integral to the multidisciplinary care of the maternal-fetal unit infected, or at risk of infection, with a high-consequence pathogen. Lessons learned from this drill regarding patient transportation, safety, and obstetric and neonatal considerations will inform future exercises and protocols and will assist other centers in preparing to care for pregnant patients under containment conditions.


Asunto(s)
Reanimación Cardiopulmonar , Contención de Riesgos Biológicos/métodos , Parto Obstétrico , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Complicaciones Cardiovasculares del Embarazo , Entrenamiento Simulado/métodos , Femenino , Hospitales , Humanos , Recién Nacido , Embarazo , Resultado del Embarazo
16.
BMC Oral Health ; 19(1): 7, 2019 01 09.
Artículo en Inglés | MEDLINE | ID: mdl-30626370

RESUMEN

BACKGROUND: Infection is one of the most crucial problems in health care services worldwide. It is considered one of the most important causes of morbidity and mortality associated with clinical, diagnostic and therapeutic procedures. Therefore, the purpose of this study was to investigate knowledge, attitude, and compliance with recommended infection control guidelines among dental faculty members and students at King Saud University, Riyadh, Kingdom of Saudi Arabia. METHODS: A cross-sectional study was conducted to obtain information regarding knowledge, attitude, and compliance with recommended infection control guidelines. The sample (n = 317) comprised of dental faculty members and students (3rd, 4th and 5th year) in both male and female campuses of College of Dentistry (KSU). This questionnaire contained three parts (knowledge, attitude, and compliance) and was distributed to the participants. After validation of the survey, data were collected, entered and analyzed by SPSS software. RESULTS: A total of 317 dental faculty members and students participated in this study. Out of the total study subjects, 141 (44.5%) were female and 176 (55.5%) were male. A comparison between dental faculty members and students was made based on their knowledge, attitude, and compliance, which resulted in almost equal percentages of knowledge (49.6, 49.0% respectively). In addition, it revealed that faculty members' attitude toward infection control in the dental clinic was more positive compared to their compliance with the infection control guidelines (70.6, 65.2% respectively) while with the students it was vice versa (67.2, 69.6% respectively). There is no statistically significant difference in the knowledge and attitude of dental faculty members and students regarding infection control guidelines (P > 0.05). CONCLUSION: Our study showed that dental undergraduate student and faculty members at KSU demonstrated a good adherence to infection control guidelines. On the other hand, there was a lack in the knowledge of the basics of infection control standards.


Asunto(s)
Actitud del Personal de Salud , Docentes de Odontología/psicología , Adhesión a Directriz , Conocimientos, Actitudes y Práctica en Salud , Control de Infección Dental/métodos , Control de Infección Dental/normas , Estudiantes de Odontología/psicología , Infección Hospitalaria/prevención & control , Estudios Transversales , Femenino , Guías como Asunto , Humanos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Masculino , Arabia Saudita
17.
Expert Rev Vaccines ; 18(1): 5-13, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-30501454

RESUMEN

INTRODUCTION: Vaccinations of healthcare workers (HCWs) aim to directly protect them from occupational acquisition of vaccine-preventable diseases (VPDs) and to indirectly protect their patients and the essential healthcare infrastructure. However, outbreaks due to VPDs continue to challenge healthcare facilities and HCWs are frequently traced as sources of VPDs to vulnerable patients. In addition, HCWs were disproportionately affected during the current measles outbreak in Europe. Areas covered: We reviewed the recent published information about HCWs vaccinations with a focus on mandatory vaccination policies. Expert commentary: Although many countries have vaccination programs specifically for HCWs, their vaccination coverage remains suboptimal and a significant proportion of them remains susceptible to VPDs. The increasing vaccination hesitancy among HCWs is of concern, given their role as trusted sources of information about vaccines. Mandatory vaccinations for HCWs are implemented for specific VPDs in few countries. Mandatory influenza vaccination of HCWs was introduced in the United States a decade ago with excellent results. Mandatory vaccinations for VPDs that may cause significant morbidity and mortality should be considered. Issues of mistrust and misconceptions about vaccinations should also be addressed.


Asunto(s)
Personal de Salud , Vacunación/métodos , Vacunas/administración & dosificación , Susceptibilidad a Enfermedades , Humanos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Transmisión de Enfermedad Infecciosa de Profesional a Paciente/prevención & control , Programas Obligatorios , Cobertura de Vacunación , Negativa a la Vacunación
19.
Rev Med Interne ; 40(4): 238-245, 2019 Apr.
Artículo en Francés | MEDLINE | ID: mdl-30297152

RESUMEN

The transmission of an infectious disease can occur through exposure to blood or other potentially infectious body fluids, particularly in the event of skin-puncture injuries for healthcare workers, and during sexual intercourse. These situations are known as accidental blood exposures and sexual exposures respectively. Combined actions carried out have allowed to significantly reduce risks, either to healthcare professionals (by standard precautions, provision of safety devices, Hepatitis B vaccination made compulsory in the 1990s, antiretroviral post-exposure prophylaxis that should be initiated as soon as possible after exposure), or to people engaging in unprotected sex (by prevention messages, condom promotion, and antiretroviral post-exposure prophylaxis). In any case, treatment of people infected by chronic diseases such as HBV or HIV, as well as possible drug eradication of HCV, are key for decreasing post-exposure risk of disease transmission. Post-exposure prophylaxis should be initiated as early as possible and intended for use only in patients with high-risk exposures. Knowledge of source person serostatus, information of exposed person on prevention, benefits and risks of treatment, and follow-up procedure are key points. Procedures to be followed in the event of an exposure must be known by all. Arrangements set up to allow risk assessment and management of exposed people rely on hospital services operating on a permanent basis.


Asunto(s)
Control de Infecciones , Transmisión de Enfermedad Infecciosa de Paciente a Profesional , Exposición Profesional , Enfermedades Virales de Transmisión Sexual , Virosis , Infecciones por VIH/sangre , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Personal de Salud/estadística & datos numéricos , Hepatitis B/sangre , Hepatitis B/prevención & control , Hepatitis B/transmisión , Hepatitis C/sangre , Hepatitis C/prevención & control , Hepatitis C/transmisión , Humanos , Control de Infecciones/métodos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/estadística & datos numéricos , Exposición Profesional/prevención & control , Exposición Profesional/estadística & datos numéricos , Profilaxis Posexposición/métodos , Factores de Riesgo , Enfermedades Virales de Transmisión Sexual/epidemiología , Enfermedades Virales de Transmisión Sexual/transmisión , Virosis/epidemiología , Virosis/prevención & control , Virosis/transmisión
20.
Am J Infect Control ; 47(1): 13-17, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-30268592

RESUMEN

BACKGROUND: Health care workers (HCWs) are significant vectors for transmission of multidrug-resistant organisms among patients in intensive care units (ICUs). We studied ICU patients on contact precautions, colonized with vancomycin-resistant Enterococcus (VRE), to assess whether bacterial burden is associated with transmission to HCWs' gloves or gowns, a surrogate outcome for transmission to subsequent patients. METHODS: From this prospective cohort study, we analyzed 96 VRE-colonized ICU patients and 5 HCWs per patient. We obtained samples from patients' perianal area, skin, and stool to assess bacterial burden and cultured HCWs' gloves and gowns for VRE after patient care. RESULTS: Seventy-one of 479 (15%) HCW-patient interactions led to contamination of HCWs' gloves or gowns with VRE. HCW contamination was associated with VRE burden on the perianal swab (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.19, 1.57), skin swabs (OR, 2.14; 95% CI, 1.51, 3.02), and in stool (OR, 1.95; 95% CI, 1.39, 2.72). Compared with colonization with Enterococcus faecalis, colonization with Enterococcus faecium was associated with higher bacterial burden and higher odds of transmission to HCWs. CONCLUSIONS: We show that ICU patients with higher bacterial burden are more likely to transmit VRE to HCWs. These findings have implications for VRE decolonization and other infection control interventions.


Asunto(s)
Carga Bacteriana , Enterococcus faecalis/aislamiento & purificación , Enterococcus faecium/aislamiento & purificación , Infecciones por Bacterias Grampositivas/transmisión , Personal de Salud , Transmisión de Enfermedad Infecciosa de Paciente a Profesional , Enterococos Resistentes a la Vancomicina/aislamiento & purificación , Anciano , Anciano de 80 o más Años , Heces/microbiología , Femenino , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Perineo/microbiología , Equipo de Protección Personal/microbiología , Estudios Prospectivos , Recto/microbiología , Medición de Riesgo
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