Moçambique. Manual de biossegurança e bioprotecção do instituto nacional de saúde / Biosafety and bioprotection manual of the national institute of health

Ao efectuarmos a revisão deste manual pretendemos apresentar uma nova dinâmica sobre os principais conceitos relativos a Biossegurança e Bioprotecção, suas interfaces essenciais e permitir que esses conhecimentos teóricos se desdobrem em acções práticas no dia-a-dia dos funcionários e colaboradores do e no INS, das re presentações locais, bem como da Rede de Laboratórios de Saúde Pública Humana do Sistema Nacional de Saúde (SNS). Nesta 2ª edição do manual iremos aprimorar os conceitos sobre Biossegurança, Bioprotecção, Biorisco e outros perigos que podem ocorrer em laboratórios, avaliação de riscos, níveis de biossegurança laboratorial, medidas de protecção individual e colectivas classifica das em barreiras primárias e secundárias, de controlo administrativos e de engenharia, adopção de boas práticas microbiológicas e de pro cedimentos (BPMP), medidas de precaução aceites universalmente e promoção da cultura do comportamento organizacional, iniciativas que induzam a manipulação segura de agentes e doenças emergentes e re-emergentes de carácter epidémico, endémico ou pandémico rumo a manutenção da segurança global em saúde…

Acidentes perfurocortantes entre acadêmicos de Odontologia / Accidents with cutting and piercing materials among Dentistry students

Os profissionais da saúde estão expostos aos mais diversos riscos ocupacionais durante a sua jornada de trabalhoeos cirurgiões-dentistas lideram o número de acidentes com materiais biológicos. Os atendimentos por acadêmicos de odontologia os deixam expostos aos riscos ocupacionais de forma semelhante aos profissionais da área. Este estudo teve o objetivo de avaliar prevalência e características dos acidentes com instrumentais perfurocortantesentre osacadêmicos de umcurso de Odontologia. Constatou-se prevalência de 28,85%de acidentes, com o maior percentual no 5° períodode curso,principalmente nasclínicas de Cirurgia e Endodontia. Apenas 20% dos afetados relataram a ocorrênciae a sonda exploradora foi o instrumental mais envolvido.Além disso,osacidentes ocorreram de forma igual no atendimento ao pacienteelavagem do instrumental. Portanto, faz-senecessário investimento em ações educativas e normativas permanentes para conscientização de acadêmicos sobre acidentes perfurocortantes (AU).

Health professionals are exposed to the most diverse occupational risks during their workday and dentists lead the number of accidents with biological materials. The assistance provided by dental students leaves them exposed to occupational risks in a similar way to professionals in the field. This study aimed to evaluate the prevalence and characteristics of accidents with cutting and piercing instruments among students of a Dentistry course. There was a prevalence of 28.85% of accidents, with the highest percentage in the 5th period of the course, mainly in the Surgery and Endodontics clinics. Only 20% of those affected reported the occurrence and the sickle probe was the instrument most involved. In addition, accidents occurred equally in patient care and washing of instruments. Therefore, it is necessary to invest in permanent educational and normative actions to raise the awareness of students about needlestick injuries (AU).

Epidemiología del traumatismo craneoencefálico grave pediátrico: 15 años de experiencia en una unidad de politraumatismos infantil / Epidemiology of severe head injuries in children: 15 years' experience in a pediatric polytrauma unit

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Impact of product safety changes on accidental exposures to liquid laundry packets in children.

OBJECTIVES: To evaluate the impact of the ASTM International (formerly American Society of Testing Materials) safety standard and associated product safety changes on accidental exposures to liquid laundry packets (LLPs) in children. METHODS: The National Poison Data System was queried for reports of accidental exposures to LLPs in children <6 years old received from 01 July 2012 to 31 December 2018. In 2014, ASTM International began developing a standard specifying voluntary product changes to reduce the risk of LLP exposures in young children. Product changes were made between 2013 and 2016. Exposures were grouped into baseline, transition, and post periods based on the timing of the standard's implementation. Exposure counts and sales adjusted rates were compared between the baseline and post period for all exposures and exposures involving healthcare facility (HCF) evaluation, HCF admission, and major medical outcomes. RESULTS: A total of 73,942 accidental exposures in children <6 years old were reported (baseline: 10,229, 13.8%; transition: 43,507, 58.8%; post: 20,206, 27.3%). The percentage of exposures involving HCF evaluation (41.5% to 33.8%), HCF admission (4.5% to 1.9%), and major medical outcomes (0.6% to 0.1%) decreased from the baseline to post period. Sales adjusted rates of all exposures decreased 57.4% (4.920-2.094 exposures/1 million packets sold). Decreases also occurred in HCF evaluations (65.0% decrease; 2.026-0.708 exposures/1 million packets sold), HCF admissions (81.4% decrease; 0.218-0.041 exposures/1 million packets sold), and major medical outcomes (90.9% decrease; 0.030-0.003 exposures/1 million packets sold). CONCLUSIONS: The morbidity of accidental exposures to LLPs in children decreased substantially following implementation of the ASTM International safety standard. Ongoing monitoring should be performed to determine if additional safety measures are required.

Impacto de la normativa autonómica para la prevención de accidentes pirotécnicos / Impact of regional laws on firework accident prevention

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Conceptualization of Major Stakeholders in Emergency Management of Childcare Facilities.

This study aims to conceptualize the key stakeholders in emergency management of childcare facilities for applicable nations by referring to the Korean case. Qualitative content analysis is the main methodology used. Unique features are gathered from the Korean literature on childcare facilities and then summarized; however, universal principles from the English language literature on international childcare facilities are emphasized. The analysis of five major stakeholders in Korean childcare facilities, namely, governments, community personnel, parents, childcare providers, and children, shows that their current efforts are directed only at general safety management. Multi-hazard management or an integrated approach in terms of social work is thus provided as an alternative for not only Korea but also other nations.

Monitoring of Low-Level Wind Shear by Ground-based 3D Lidar for Increased Flight Safety, Protection of Human Lives and Health.

Low-level wind shear, i.e., sudden changes in wind speed and/or wind direction up to altitudes of 1600 ft (500 m) above-ground is a hazardous meteorological phenomenon in aviation. It may radically change the aerodynamic circumstances of the flight, particularly during landing and take-off and consequently, it may threaten human lives and the health of passengers, people at the airport and its surrounding areas. The Bratislava Airport, the site of this case study, is one of the few airports worldwide and the first in Central Europe that is equipped with a Doppler lidar system, a perspective remote sensing tool for detecting low-level wind shear. The main objective of this paper was to assess the weather events collected over a period of one year with the occurrences of low-level wind shear situations, such as vertical discontinuities in the wind field, frontal passages and gust fronts to increase the level of flight safety and protect human lives and health. The lidar data were processed by a computer algorithm with the main focus on potential wind shear alerts and microburst alerts, guided by the recommendations of the International Civil Aviation Organisation. In parallel, the selected weather events were analyzed by the nearby located meteorological radar to utilize the strengths of both approaches. Additionally, an evaluation of the lidar capability to scan dynamics of aerosol content above the airport is presented.

The New Path to Improve Construction Safety Performance in China: An Evolutionary Game Theoretic Approach.

Evidence shows that there are many work-related accidents and injuries happening in construction projects and governments have taken a series of administrative measures to reduce casualties in recent years. However, traditional approaches have reached a bottleneck due to ignoring market forces, and thus new measures should be conducted. This study develops a perspective of safety performance (SP) for construction projects in China and puts forward a conception of the safety information system by using several brainstorming sessions to strengthen the safety supervision of participants in the construction industry. This system provides rating information to the public, and bad performance contractors enter into a blacklist which will influence their economic activities. Considering the limited rationality of government and various contractors, this paper builds a reasonable evolutionary game model to verify the feasibility of the safety information system. The analysis results show that there is not a single set of evolutionarily stable strategies (ESSs), as different situations may lead to different ESSs. The efficiency of applying the safety information system (the blacklist) in the construction industry can be proved by reducing the government's safety supervision cost and by enhancing construction safety at the same time.

Four Smart Steps: Fall Prevention for Community-Dwelling Older Adults.

Falls are associated with enormous costs in morbidity and early mortality, as well as loss of safe, independent lifestyles for community-dwelling older adults. The purpose of this quality improvement project was to implement an author-designed, easy-to-remember guide to fall prevention for community-dwelling older adults and enhance their awareness and knowledge of fall risks in the home. A Four Smart Steps Fall Prevention program (exercise, eye exams, home safety, and primary care visits) presented fall prevention education for community-dwelling older adults. The project was implemented at a senior center by registered nurses and evaluated through an anonymous questionnaire. The desired outcome was an increase in safety awareness and knowledge of fall prevention for community-dwelling older adults. Community-dwelling older adults with enhanced education on fall prevention will be more likely to be able to live independently within a safe environment.

Research on complex air leakage method to prevent coal spontaneous combustion in longwall goaf.

Spontaneous combustion of coal is one of the major hazards threatening production safety during longwall mining. Mining-induced voids, which provide passages for air leakage, are the key factor triggering spontaneous combustion of coal in longwall goafs. In this study, a comprehensive method, which combined pressure balance, grouting injection, and filling fissures, was proposed to prevent spontaneous combustion of coal in longwall goafs with complex air leakage. Field engineering practice was carried out in Sitai Coal Mine in China. The results demonstrated that with the application of the proposed method, in the working face, the concentration of CO was decreased from 31ppm to 0 and the air leakage quantity was decreased from 261 to below 80 m3min-1. The gas samples analysis from the gob areas also indicated that concentrations of O2 and CO were successively decreased, indicating that the risk of spontaneous combustion of coal in goafs was eliminated. The above mentioned analysis indicates that, the method proposed in this study is useful and efficient. Successful application of this technology could provide reference for the treatment of other coal mines.

Older Adults' Perceptions of Their Fall Risk and Prevention Strategies After Transitioning from Hospital to Home.

Falls are common adverse events following hospital discharge. However, prevention programs are not tailored for older patients transitioning home. To inform development of transitional fall prevention programs, nine older adults designated as being at risk of falls during hospitalization who were recently discharged home were asked about their perceptions of fall risk and prevention, as well as their knowledge and opinion of materials from the Centers for Disease Control and Prevention Stopping Elderly Accidents, Deaths & Injuries Initiative. Using the constant comparative method, five themes were identified: Sedentary Behaviors and Limited Functioning; Prioritization of Social Involvement; Low Perceived Fall Risk and Attribution of Risk to External Factors; Avoidance and Caution as Fall Prevention; and Limited Falls Prevention Information During Transition from Hospital to Home. Limited awareness of and engagement in effective fall prevention may heighten recently discharged older adults' risks for falls. Prevention programs tailored to the post-discharge period may engage patients in fall prevention, promote well-being and independence, and link hospital and community efforts. [Journal of Gerontological Nursing, 45(1), 23-30.].

Railway safety climate: a study on organizational development.

The safety climate of an organization is considered a leading indicator of potential risk for railway organizations. This study adopts the perceptual measurement-individual attribute approach to investigate the safety climate of a railway organization. The railway safety climate attributes are evaluated from the perspective of railway system staff. We identify four safety climate dimensions from exploratory factor analysis, namely safety communication, safety training, safety management and subjectively evaluated safety performance. Analytical results indicate that the safety climate differs at vertical and horizontal organizational levels. This study contributes to the literature by providing empirical evidence of the multilevel safety climate in a railway organization, presents possible causes of the differences under various cultural contexts and differentiates between safety climate scales for diverse workgroups within the railway organization. This information can be used to improve the safety sustainability of railway organizations and to conduct safety supervisions for the government.

Catching Quality Before It Falls: Preventing Falls and Injuries in the Adult Emergency Department.

PROBLEM: Although hospital falls and injuries are a significant patient safety concern, research is limited regarding falls and injuries in the emergency department. The purpose of this quality improvement project is to identify and implement evidence-based interventions to prevent patient falls and injuries in the emergency department. METHODS: Literature was reviewed to identify best practices for fall prevention in the emergency department. Data sources included Journal Storage, PubMed, Cumulative Index for Nursing and Allied Health Literature, and Cochrane Database of Systematic Reviews. A retrospective chart review and root cause analysis was completed on fall-related risk reports over a 19-month period at a specific emergency department. Multifactorial fall prevention interventions were implemented in March 2017, which included nursing educational sessions, patient education handout, and high-fall-risk patient identification signs. RESULTS: Post-implementation, zero falls were sustained in April 2017. The average number of falls between April and December 2017 was 5.2 falls/month. Completion of the fall-risk assessment tool ranged between 47 to 90 percent. The patient education handout was provided up to 40 percent of the time. The use of fall risk signs outside patient rooms occurred up to 43 percent of the time. DISCUSSION: The emergency department is a unique environment with complex patient populations. Multifactorial interventions should be used to identify and prevent patient falls and injuries. Multiple change strategies and leadership support are essential to sustain changes. Future research should be conducted regarding the use of fall risk assessments and fall prevention strategies specific to the emergency department.

[Work accidents and automatic circuit reclosers in the electricity sector: beyond the immediate causes]. / Acidentes de trabalho e os religadores automáticos no setor elétrico: para além das causas imediatas.

The Brazilian electricity sector has recorded high work-related mortality rates that have been associated with outsourcing, used to cut costs. In order to decrease the power outage time for consumers, the industry adopted the automatic circuit recloser as the technical solution. The device has hazardous implications for maintenance workers. The aim of this study was to analyze the origins and consequences of work accidents in power systems with automatic circuit recloser, using the Accident Analysis and Prevention (AAP) model. The AAP model was used to investigate two work accidents, aimed to explore the events' organizational origins. Case 1 - when changing a deenergized secondary line, a worker received a shock from the energized primary cable (13.8kV). The system reclosed three times, causing severe injury to the worker (amputation of a lower limb). Case 2 - a fatal work accident occurred during installation of a new crosshead on a partially insulated energized line. The tip of a metal cross arm section strap touched the energized secondary line and electrocuted the maintenance operator. The circuit breaker component of the automatic circuit recloser failed. The analyses revealed how business management logic can participate in the root causes of work accidents through failures in maintenance management, outsourced workforce management, and especially safety management in systems with reclosers. Decisions to adopt automation to guarantee power distribution should not overlook the risks to workers in overhead power lines or fail to acknowledge the importance of ensuring safe conditions.

O setor elétrico brasileiro registra elevados índices de mortalidade por acidentes de trabalho que vêm sendo associados à terceirização, introduzida como forma de rebaixamento de custos. Para diminuir o tempo de interrupção do fornecimento de energia aos consumidores, o setor adotou, como solução tecnológica, o religador automático. Essa medida apresenta características perversas para os trabalhadores de manutenção. O objetivo deste estudo é analisar origens e consequências de acidentes de trabalho em sistemas elétricos dotados de religador automático utilizando o Modelo de Análise e Prevenção de Acidentes (MAPA). O MAPA foi usado na investigação de dois acidentes de trabalho visando a explorar as origens organizacionais dos eventos. Caso 1 - ao trocar linha secundária desenergizada, um trabalhador foi atingido por cabo primário energizado (13,8kV). O sistema foi religado três vezes, agravando as lesões (amputação de membro inferior). Caso 2 - acidente de trabalho fatal ocorrido durante instalação de cruzeta nova, em linha energizada, parcialmente isolada. A extremidade de uma mão francesa metálica encostou na linha secundária energizada e eletrocutou o operador de manutenção. O componente desligador do religador automático não funcionou. As análises contribuem para desvelar como a lógica de gestão de negócios pode participar nas origens de acidentes de trabalho via falhas da gestão de manutenção, da gestão de força de trabalho de terceiras e, em especial, da gestão de segurança em sistemas dotados de religadores. As decisões pela automação para garantir a distribuição de energia não podem negligenciar os riscos aos trabalhadores da rede elétrica e, tampouco, deixar de reconhecer a importância do controle sobre as condições de segurança.

El sector eléctrico brasileño registra elevados índices de mortalidad por accidentes de trabajo, que están siendo asociados a la tercerización, introducida como forma de reducción de costes. Para disminuir el tiempo de interrupción de la energía a los consumidores, el sector adoptó como solución tecnológica, el reconectador automático. Esta medida presenta características perversas para los trabajadores del sector de mantenimiento. El objetivo de este estudio es analizar los orígenes y consecuencias de los accidentes de trabajo en sistemas eléctricos dotados de reconectador automático, utilizando el Modelo de Análisis y Prevención de Accidentes (MAPA). El MAPA se usó en la investigación de dos accidentes de trabajo, con el objetivo de explorar las causas organizativas de los eventos. Caso 1 - al cambiar la línea secundaria sin energía, un trabajador fue alcanzado por un cable primario con energía (13,8kV). El sistema se reconectó tres veces, agravando las lesiones (amputación de miembro inferior). Caso 2 - accidente de trabajo fatal ocurrido durante la instalación de una cruceta nueva, en una línea con energía, parcialmente aislada. La extremidad de una cruceta metálica cayó en la línea secundaria con energía y electrocutó al obrero de mantenimiento. El componente que desconectaba el reconectador automático no funcionó. Los análisis contribuyen a desvelar cómo la lógica de gestión de negocios puede ser partícipe en las causas de accidentes de trabajo, vía fallos en la gestión del mantenimiento, de la gestión de fuerza de trabajo de terceras personas y, en especial, de la gestión de seguridad en sistemas dotados de reconectadores. Las decisiones de la automatización para garantizar la distribución de energía no pueden obviar los riesgos para los trabajadores de la red eléctrica y tampoco dejar de reconocer la importancia del control sobre las condiciones de seguridad.

The Outcome and Patterns of Traumatic Brain Injury in the Paediatric Population of a Developing Country Secondary to TV Trolley Tip-Over.

BACKGROUND: Television (TV) trolley tip-over incidences are common and can cause significant morbidity and mortality in children. This study was aimed at analyzing the pattern and outcomes of head injuries resulting from TV trolley tip-over. METHOD: We conducted a medical chart review of children with TV trolley tip-over head injuries from January 2009 to April 2016. We collected data on demographics, the mechanism of injury, clinical and radiological features of the injury, and outcomes. Outcomes were measured by means of the Glasgow Outcome Scale (GOS) at 6 months (except in 1 case). A descriptive analysis was carried out using SPSS v19. RESULT: Twenty-two children were included in the study (median age 23.5 months). Sixteen children were male. Most of the children (n = 16) were aged 12-35 months. The median Glasgow Coma Scale score on admission was 15. The median Rotterdam Score for the patients was 2.0. Common symptoms upon admission were vomiting, irritability, scalp laceration, and bruises. Median length of hospital stay was 3 days. Skull bone fractures were present in 12 children. Other CT findings included contusions, extradural and subdural haematomas, intraventricular haemorrhage, and pneumocranium. Surgical intervention was required in 4 cases. Although most of the patients made a good recovery (GOS = 5), 1 patient developed a mild disability and another died in hospital. CONCLUSION: TV trolley tip-over is most common in toddlers and can lead to significant head injury and mortality. This can be avoided by parental supervision and adjustments in the household.

Acidentes de trabalho e os religadores automáticos no setor elétrico: para além das causas imediatas / Work accidents and automatic circuit reclosers in the electricity sector: beyond the immediate causes / Accidentes de trabajo y reconectadores automáticos en el sector eléctrico: más allá de las causas inmediatas

Resumo: O setor elétrico brasileiro registra elevados índices de mortalidade por acidentes de trabalho que vêm sendo associados à terceirização, introduzida como forma de rebaixamento de custos. Para diminuir o tempo de interrupção do fornecimento de energia aos consumidores, o setor adotou, como solução tecnológica, o religador automático. Essa medida apresenta características perversas para os trabalhadores de manutenção. O objetivo deste estudo é analisar origens e consequências de acidentes de trabalho em sistemas elétricos dotados de religador automático utilizando o Modelo de Análise e Prevenção de Acidentes (MAPA). O MAPA foi usado na investigação de dois acidentes de trabalho visando a explorar as origens organizacionais dos eventos. Caso 1 - ao trocar linha secundária desenergizada, um trabalhador foi atingido por cabo primário energizado (13,8kV). O sistema foi religado três vezes, agravando as lesões (amputação de membro inferior). Caso 2 - acidente de trabalho fatal ocorrido durante instalação de cruzeta nova, em linha energizada, parcialmente isolada. A extremidade de uma mão francesa metálica encostou na linha secundária energizada e eletrocutou o operador de manutenção. O componente desligador do religador automático não funcionou. As análises contribuem para desvelar como a lógica de gestão de negócios pode participar nas origens de acidentes de trabalho via falhas da gestão de manutenção, da gestão de força de trabalho de terceiras e, em especial, da gestão de segurança em sistemas dotados de religadores. As decisões pela automação para garantir a distribuição de energia não podem negligenciar os riscos aos trabalhadores da rede elétrica e, tampouco, deixar de reconhecer a importância do controle sobre as condições de segurança.

Abstract: The Brazilian electricity sector has recorded high work-related mortality rates that have been associated with outsourcing, used to cut costs. In order to decrease the power outage time for consumers, the industry adopted the automatic circuit recloser as the technical solution. The device has hazardous implications for maintenance workers. The aim of this study was to analyze the origins and consequences of work accidents in power systems with automatic circuit recloser, using the Accident Analysis and Prevention (AAP) model. The AAP model was used to investigate two work accidents, aimed to explore the events' organizational origins. Case 1 - when changing a deenergized secondary line, a worker received a shock from the energized primary cable (13.8kV). The system reclosed three times, causing severe injury to the worker (amputation of a lower limb). Case 2 - a fatal work accident occurred during installation of a new crosshead on a partially insulated energized line. The tip of a metal cross arm section strap touched the energized secondary line and electrocuted the maintenance operator. The circuit breaker component of the automatic circuit recloser failed. The analyses revealed how business management logic can participate in the root causes of work accidents through failures in maintenance management, outsourced workforce management, and especially safety management in systems with reclosers. Decisions to adopt automation to guarantee power distribution should not overlook the risks to workers in overhead power lines or fail to acknowledge the importance of ensuring safe conditions.

Resumen: El sector eléctrico brasileño registra elevados índices de mortalidad por accidentes de trabajo, que están siendo asociados a la tercerización, introducida como forma de reducción de costes. Para disminuir el tiempo de interrupción de la energía a los consumidores, el sector adoptó como solución tecnológica, el reconectador automático. Esta medida presenta características perversas para los trabajadores del sector de mantenimiento. El objetivo de este estudio es analizar los orígenes y consecuencias de los accidentes de trabajo en sistemas eléctricos dotados de reconectador automático, utilizando el Modelo de Análisis y Prevención de Accidentes (MAPA). El MAPA se usó en la investigación de dos accidentes de trabajo, con el objetivo de explorar las causas organizativas de los eventos. Caso 1 - al cambiar la línea secundaria sin energía, un trabajador fue alcanzado por un cable primario con energía (13,8kV). El sistema se reconectó tres veces, agravando las lesiones (amputación de miembro inferior). Caso 2 - accidente de trabajo fatal ocurrido durante la instalación de una cruceta nueva, en una línea con energía, parcialmente aislada. La extremidad de una cruceta metálica cayó en la línea secundaria con energía y electrocutó al obrero de mantenimiento. El componente que desconectaba el reconectador automático no funcionó. Los análisis contribuyen a desvelar cómo la lógica de gestión de negocios puede ser partícipe en las causas de accidentes de trabajo, vía fallos en la gestión del mantenimiento, de la gestión de fuerza de trabajo de terceras personas y, en especial, de la gestión de seguridad en sistemas dotados de reconectadores. Las decisiones de la automatización para garantizar la distribución de energía no pueden obviar los riesgos para los trabajadores de la red eléctrica y tampoco dejar de reconocer la importancia del control sobre las condiciones de seguridad.