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2.
Sports Health ; 12(1): 51-57, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31660785

RESUMO

BACKGROUND: Athletic training rooms have a high prevalence of bacteria, including multidrug-resistant organisms, increasing the risk for both local and systematic infections in athletes. There are limited data outlining formal protocols or standardized programs to reduce bacterial and viral burden in training rooms as a means of decreasing infection rate at the collegiate and high school levels. HYPOTHESIS: Adaptation of a hygiene protocol would lead to a reduction in bacterial and viral pathogen counts in athletic training rooms. STUDY DESIGN: Cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: Two high school and 2 collegiate athletic training rooms were studied over the course of the 2017-2018 academic year. A 3-phase protocol, including introduction of disinfectant products followed by student-athlete and athletic trainer education, was implemented at the 4 schools. Multiple surfaces in the athletic training rooms were swabbed at 4 time points throughout the investigation. Bacterial and viral burden from swabs were analyzed for overall bacterial aerobic plate count (APC), bacterial adenosine triphosphate activity, influenza viral load, and multidrug-resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE). RESULTS: Overall bacterial load, as measured by APC, was reduced by 94.7% (95% CI, 72.6-99.0; P = 0.003) over the course of the investigation after protocol implementation. MRSA and VRE were found on 24% of surfaces prior to intervention and were reduced to 0% by the end of the study. Influenza was initially detected on 25% of surfaces, with no detection after intervention. No cases of athletic training room-acquired infections were reported during the study period. CONCLUSION: A uniform infection control protocol was effective in reducing bacterial and viral burden, including multidrug-resistant organisms, when implemented in the athletic training rooms of 2 high schools and 2 colleges. CLINICAL RELEVANCE: A standardized infection control protocol can be utilized in athletic training rooms to reduce bacterial and viral burden.


Assuntos
Infecções Comunitárias Adquiridas/prevenção & controle , Reservatórios de Doenças/microbiologia , Controle de Infecções/métodos , Instituições Acadêmicas , Infecções Comunitárias Adquiridas/transmissão , Desinfetantes/administração & dosagem , Infecções por Bactérias Gram-Positivas/prevenção & controle , Infecções por Bactérias Gram-Positivas/transmissão , Desinfecção das Mãos , Educação em Saúde , Humanos , Influenza Humana/prevenção & controle , Influenza Humana/transmissão , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Orthomyxoviridae/isolamento & purificação , Comportamento de Redução do Risco , Infecções Estafilocócicas/prevenção & controle , Infecções Estafilocócicas/transmissão , Enterococos Resistentes à Vancomicina/isolamento & purificação
3.
Curr Opin Ophthalmol ; 31(1): 28-32, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31770164

RESUMO

PURPOSE OF REVIEW: This article reviews the various challenges in infection control in eye clinics and successful measures taken to prevent nosocomial infections. RECENT FINDINGS: The Center for Disease Control recommends hand-washing when hands are visibly soiled, and after direct contact with patients, and inanimate objects such as medical equipment. Published studies have identified poor hygiene in clinical settings as a major cause of nosocomial outbreaks, particularly in cases of epidemic keratoconjunctivitis (EKC). Some studies of EKC outbreaks are able to support direct observation of hygiene lapses with molecular analysis that can match viral strains on particular instruments to those found in infected patients. Although most studies are about adenoviral infection and tonometer use, researchers have found viral and bacterial loads on other common surfaces, indicating a need for further research. SUMMARY: Proper hygiene in eye clinics requires special attention because of the potential to examine many patients at a time and because multiple instruments are often used during a single exam. Studies reinforce the link between hygiene and outbreak prevention, and more research can be done to determine the specific links between certain instruments and nosocomial infections.


Assuntos
Infecção Hospitalar/prevenção & controle , Desinfecção/métodos , Higiene das Mãos , Controle de Infecções/métodos , Oftalmologia/instrumentação , Esterilização/métodos , Instituições de Assistência Ambulatorial/normas , Humanos , Oftalmologia/normas
4.
Presse Med ; 48(12): 1536-1550, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31784255

RESUMO

Africa along side with south-east Asia are the epicentres of emerging and epidemic prone-infectious diseases and megacity biosecurity threat scenarios. Massive mobility and reluctance in the populations exposed to epidemic and emerging prone-infectious diseases coupled by a weak health system made disease alert and control measures difficult to implement. The investigation of virus detection and persistence in semen across a range of emerging viruses is useful for clinical and public health reasons, in particular for viruses that lead to high mortality or morbidity rates or to epidemics. Innovating built facility to safely treat patients with highly pathogenic infectious diseases is urgently need, not only to prevent the spread of infection from patients to healthcare workers but also to offer provision of relatively invasive organ support, whenever considered appropriate, without posing additional risk to staff. Despite multiple challenges, the need to conduct research during epidemics is inevitable, and candidate products must continue undergoing rigorous trials. Preparedness including management of complex humanitarian crises with community distrust is a cornerstone in response to high consequence emerging infectious disease outbreaks and imposes strengthening of the public health response infrastructure and emergency outbreak systems in high-risk regions.


Assuntos
Doenças Transmissíveis Emergentes/epidemiologia , Epidemias , Controle de Infecções , Doenças Transmissíveis Emergentes/prevenção & controle , Surtos de Doenças/prevenção & controle , Epidemias/prevenção & controle , Epidemias/estatística & dados numéricos , Saúde Global/normas , Saúde Global/tendências , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Controle de Infecções/tendências , Saúde Pública/normas , Saúde Pública/tendências , Administração em Saúde Pública/métodos , Administração em Saúde Pública/tendências
7.
BMC Health Serv Res ; 19(1): 689, 2019 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-31606053

RESUMO

BACKGROUND: Antimicrobial resistance is an increasing problem in hospitals world-wide. Following other countries, English hospitals experienced outbreaks of carbapenemase-producing Enterobacteriaceae (CPE), a bacterial infection commonly resistant to last resort antibiotics. One way to improve CPE prevention, management and control is the production of guidelines, such as the CPE toolkit published by Public Health England in December 2013. The aim of this research was to investigate the implementation of the CPE toolkit and to identify barriers and facilitators to inform future policies. METHODS: Acute hospital trusts (N = 12) were purposively sampled based on their self-assessed CPE colonisation rates and time point of introducing local CPE action plans. Following maximum variation sampling, 44 interviews with hospital staff were conducted between April and August 2017 using a semi-structured topic guide based on the Capability, Opportunity, Motivation and Behaviour Model and the Theoretical Domains Framework, covering areas of influences on behaviour. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. RESULTS: The national CPE toolkit was widely disseminated within infection prevention and control teams (IPCT), but awareness was rare among other hospital staff. Local plans, developed by IPCTs referring to the CPE toolkit while considering local circumstances, were in place in all hospitals. Implementation barriers included: shortage of isolation facilities for CPE patients, time pressures, and competing demands. Facilitators were within hospital and across-hospital collaborations and knowledge sharing, availability of dedicated IPCTs, leadership support and prioritisation of CPE as an important concern. Participants using the CPE toolkit had mixed views, appreciating its readability and clarity about patient management, but voicing concerns about the lack of transparency on the level of evidence and the practicality of implementation. They recommended regular updates, additional clarifications, tailored information and implementation guidance. CONCLUSIONS: There were problems with the awareness and implementation of the CPE toolkit and frontline staff saw room for improvement, identifying implementation barriers and facilitators. An updated CPE toolkit version should provide comprehensive and instructive guidance on evidence-based CPE prevention, management and control procedures and their implementation in a modular format with sections tailored to hospitals' CPE status and to different staff groups.


Assuntos
Enterobacteriáceas Resistentes a Carbapenêmicos , Infecção Hospitalar/prevenção & controle , Surtos de Doenças/prevenção & controle , Infecções por Enterobacteriaceae/prevenção & controle , Controle de Infecções/métodos , Adulto , Idoso , Antibacterianos/uso terapêutico , Inglaterra , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Adulto Jovem
8.
Parasit Vectors ; 12(1): 458, 2019 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-31547850

RESUMO

BACKGROUND: Schistosomiasis primarily affects poor and neglected communities due to their lack of safe water and sanitation facilities. In an effort to improve intervention strategies, the present study investigated the association of socio-demographic characteristics of women with their existing knowledge, perceptions and practices (KPP) in five urogenital schistosomiasis endemic rural communities in Zimbabwe. METHODS: In February 2016, a cross sectional study was conducted in which 426 women in rural Madziwa area, Shamva District were interviewed using a pretested structured questionnaire seeking their KPP and socio-demographic characteristics. Logistic regression analysis was performed to identify socio-demographic factors associated with the KPP variables. RESULTS: Among the 426 participants, 93.7% knew about schistosomiasis, while 97.7 and 87.5% understood the disease transmission and methods for prevention, respectively. A significantly higher percentage of women aged ≥ 30 years compared to those < 30 years indicated that infertility is a complication of untreated chronic schistosomiasis (OR: 1.7, 95% CI: 0.9-3.0). Compared to women who had no history of infection, those who had been infected before were more likely to think that they were currently infected (OR: 3.7, 95% CI: 2.4-6.0). Bathing in unsafe water sources was more common in non-apostolic compared to apostolic followers (OR: 2.1, 95% CI: 1.2-3.7). Sole use of unsafe water for domestic purposes was significantly higher in uneducated women compared to the educated (OR: 1.8, 95% CI: 1.0-3.1). Compared to women of the Chakondora community, those in Chihuri, Nduna and Kaziro were more likely to know that dysuria is a symptom of schistosomiasis while those in Chihuri were also likely to allow young children to perform water contact activities (OR: 2.9, 95% CI: 1.5-5.5). CONCLUSIONS: Despite the high level of schistosomiasis awareness, some women had inadequate knowledge about the mode of transmission and preventive measures for schistosomiasis. Socio-demographic characteristics were associated with the KPP of women. Thus, disease control efforts should consider socio-demographic factors, which may influence the knowledge, perceptions and practices of occupants in a given setting.


Assuntos
Transmissão de Doença Infecciosa/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Controle de Infecções/métodos , Mães , Esquistossomose/epidemiologia , Esquistossomose/prevenção & controle , Adolescente , Adulto , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , População Rural , Inquéritos e Questionários , Adulto Jovem , Zimbábue/epidemiologia
9.
JAMA ; 322(9): 824-833, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31479137

RESUMO

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.


Assuntos
Pessoal de Saúde , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Influenza Humana/prevenção & controle , Influenza Humana/transmissão , Máscaras , Dispositivos de Proteção Respiratória , Adulto , Assistência Ambulatorial , Feminino , Humanos , Incidência , Controle de Infecções/métodos , Influenza Humana/diagnóstico , Influenza Humana/epidemiologia , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional , Infecções Respiratórias/prevenção & controle , Infecções Respiratórias/transmissão
10.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(8): 880-882, 2019 Aug 10.
Artigo em Chinês | MEDLINE | ID: mdl-31484247

RESUMO

The recent developed diarrhea and acute respiratory infections surveillance systems were a breakthrough of the infectious disease surveillance and monitoring in Shanghai. This series "Infectious Disease Surveillance in Shanghai" briefly introduced current experiences of the updated surveillance systems, in order to provide evidences for promotion in other disease surveillance and to enhance the connection between different surveillance systems.


Assuntos
Diarreia/epidemiologia , Controle de Infecções/métodos , Vigilância da População/métodos , Vigilância em Saúde Pública/métodos , Doença Aguda , China/epidemiologia , Doenças Transmissíveis/epidemiologia , Surtos de Doenças , Humanos , Infecções Respiratórias/epidemiologia , Vigilância de Evento Sentinela
12.
Int J Antimicrob Agents ; 54(4): 400-406, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31419480

RESUMO

Candida auris (C. auris) is an emerging fungal pathogen causing invasive infections and outbreaks that have been difficult to control in healthcare facilities worldwide. There is a lack of current evidence for pragmatic infection prevention and control recommendations. The aim of this paper was to review the epidemiology of C. auris and identify best practices with a panel of experts, in order to provide guidance and recommendations for infection prevention and control measures based on available scientific evidence, existing guidelines and expert opinion. The Infection Prevention and Control working group of the International Society of Antimicrobial Chemotherapy organised an expert meeting with infection prevention and mycology experts to review recommendations for healthcare workers on infection prevention and control measures for C. auris at inpatient healthcare facilities. The most common interventions included: screening, standard precautions, cleaning and disinfection, inpatient transfer, outbreak management, decolonisation, and treatment.


Assuntos
Candida/isolamento & purificação , Candidíase/epidemiologia , Candidíase/prevenção & controle , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Controle de Infecções/métodos , Candidíase/microbiologia , Infecção Hospitalar/microbiologia , Instalações de Saúde , Humanos
14.
Rev Saude Publica ; 53: 68, 2019 Aug 19.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31432930

RESUMO

OBJECTIVE: To assess whether the incidence of hospital infection by a resistant microorganism decreased after the implementation of the restrictive measure of the National Health Surveillance Agency for the commercialization of antimicrobials. METHODS: A historical cohort study of medical records of adult patients admitted to a general and public hospital from May 2010 to July 2011. A cohort was formed with patients admitted in the period before the restrictive measure for the commercialization of antimicrobials (Phase I) and a second cohort was formed with patients admitted after the implementation of the restrictive measure (Phase II). RESULTS: The instantaneous risk of hospital infection by a resistant microorganism was estimated at seven by 1,000 people-time (95%CI 0.006-0.008) in Phase I, and four by 1,000 people-time (95%CI 0.003-0.005) in Phase II of the study. The differences between the survival curves in the different phases of the study and stratified by age group were also significant (p < 0.05). CONCLUSIONS: The results suggest that the implementation of the restrictive measure of the commercialization of antimicrobials by the National Health Surveillance Agency reduced the incidence of hospital infection by a resistant microorganism.


Assuntos
Antibacterianos/administração & dosagem , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/prevenção & controle , Resistência Microbiana a Medicamentos , Uso Excessivo de Medicamentos Prescritos/legislação & jurisprudência , Brasil , Estudos de Coortes , Monitoramento de Medicamentos , Uso de Medicamentos/legislação & jurisprudência , Feminino , Humanos , Controle de Infecções/métodos , Masculino , Pessoa de Meia-Idade , Uso Excessivo de Medicamentos Prescritos/efeitos adversos , Uso Excessivo de Medicamentos Prescritos/estatística & dados numéricos , beta-Lactamases/efeitos dos fármacos
15.
S D Med ; 72(8): 368-371, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31465642

RESUMO

BACKGROUND: Clostridium difficile is a major pathogen responsible for nosocomial infectious diarrhea. After a spike in Clostridium difficile infection (CDI) cases, the focus team identified several cases of inappropriate sampling, i.e., asymptomatic patients being tested. We hypothesized that the inappropriate samples were leading to a high number of false-positive cases. We explored appropriate patient stool sampling as a strategy for reducing the number of asymptomatic cases in a 275-bed rural community hospital. METHODS: We conducted a prospective cohort study of inpatients to determine if appropriate stool sampling would result in a reduction in false positive Clostridium difficile cultures and decrease incidence of Clostridium difficile. We developed a checklist that would guide the nurse to improve the sampling process. RESULTS: The study implementation period ran from July through December 2016, with comparison to a control cohort in the prior six months. From Jan. 16 to May 15, the control group consisted of 461 inpatients, of which 89 tested positive for CDI 32.3 per 10,000 patient days. Of those 89 positive cases, 74 were identified as healthcare acquired infection (HAI) 26.8 per 10,000 patient days. Of these HAIs, 25 (33.8 percent) were inappropriate samples. In comparison, among the study period cohort of 277 inpatients, 46 inpatients tested positive for CDI 16.9 per 10,000 patient days, of which 26 were HAIs 9.5 per 10,000 patient days. During the study period, three samples (11.5 percent) were determined to be inappropriate. After the checklist implementation, the proportion of incorrect samples decreased from 33.8 percent to 11.5 percent. The number of HAI/patient days decreased form 0.024 percent to 0.08 percent. Similarly, the number of CDI/patient days also decreased from 0.295 percent to 0.15 percent. CONCLUSION: Implementation of a simple checklist prior to collection of stool sample proved to be effective in reducing the number of inappropriate samples sent for CDI testing, with a subsequent decrease in hospital acquired Clostridium difficile infections reported.


Assuntos
Lista de Checagem , Infecções por Clostridium , Clostridium difficile , Infecção Hospitalar , Controle de Infecções/métodos , Infecções por Clostridium/diagnóstico , Infecção Hospitalar/diagnóstico , Erros de Diagnóstico/prevenção & controle , Diarreia , Humanos , Estudos Prospectivos
17.
BMC Infect Dis ; 19(1): 755, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31464601

RESUMO

Although the title of the Special Issue is 'Airborne Microbiome' the manuscripts received have highlighted a variety of peripheral, yet related aspects of this. The contributions are a mixture of primary research, reviews and commentaries, including: new methods to explore environmental niches where such microbes may grow, their detection and characterisation in the human host, which pathogens are present in the respiratory tract and can be exhaled in human breath to potentially spread via the airborne route, and some strategies for their control. Finally, a historical-to-current overview explores human-microbial interactions, including problems with sampling and detection methods, drug resistance, the role of super-spreaders and issues around research funding.


Assuntos
Microbiologia do Ar , Microbiota , Infecções Respiratórias/transmissão , Aerossóis , Expiração , Humanos , Controle de Infecções/métodos , Sistema Respiratório/microbiologia
18.
Afr J Prim Health Care Fam Med ; 11(1): e1-e8, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31296014

RESUMO

BACKGROUND: Tuberculosis (TB) is a major global health challenge, and South Africa is one of the high-burden countries. A national TB infection control (TBIC) guideline has stipulated three areas of infection control at health facilities: work practice and administrative control, environmental control, and personal protection for health workers. AIM: The aim of this study was to identify the gaps and address the challenges in institutional TBIC. SETTING: The district hospital and a primary health care clinic within the Mossel Bay sub-district in the Western Cape. METHODS: According to the national TBIC draft guideline, a quality improvement cycle was used to evaluate and improve TBIC. Each facility had an existing infection and prevention control and occupational health and safety team, which were used as the audit teams. RESULTS: A baseline assessment was followed by a set of interventions, which did not show a significant improvement in TBIC. The difference between the pre- and post-intervention TB screening rate was not statistically significant. An assessment of time interval between 101 patients presenting with TB symptoms and diagnosed with TB was 4 days at baseline and post-intervention. Most of the anticipated improvements were dependent on the health workers' adherence to the local TBIC policies, which emerged as an unexpected finding. CONCLUSION: We found good managerial commitment reflected by the presence of various policies, guidelines, specific personnel and committees to deal with infection control in general. This study has created awareness about TBIC among staff and pointed out the complexity of health workers' behaviour towards adhering to policies.


Assuntos
Fidelidade a Diretrizes/estatística & dados numéricos , Controle de Infecções/métodos , Melhoria de Qualidade/organização & administração , População Rural , Tuberculose/prevenção & controle , Instituições de Assistência Ambulatorial , Hospitais de Distrito , Humanos , África do Sul
19.
BMC Infect Dis ; 19(1): 610, 2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31296177

RESUMO

BACKGROUND: Lassa fever (LF) is a viral hemorrhagic disease caused by the Lassa virus (LASV) and endemic in West African countries with an estimation of 300,000 to 500,000 cases and 5,000 deaths annually. The Margibi County Health Team of Liberia received a report of an unidentified febrile illness case from the Kakata district. We conducted the investigation to identify the causative agent and the source of infection to support treatment, control and prevention interventions. CASE PRESENTATION: We identified LASV in the blood specimens' of two patients by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). Both the confirmed cases have manifested respiratory distress, weakness, and difficulty of swallowing, muscle, joint and back pains, and vomiting with blood. The symptoms started with mild fever and gradually developed. Initially, the primary health facilities have miss-diagnosed the patients as malaria and respiratory tract infections. The primary health facilities have referred the patients to the referral hospital as the patients have failed to respond to antimalarial and antibiotics. The hospital suspected LF and sent blood specimens to the National Reference Laboratory while the patients were on supportive treatment in the isolation room. At the time when the laboratory result returned to the hospital, the patients died of LF illness before ribavirin administered. CONCLUSIONS: Our investigation revealed that the two hospitalized and deceased febrile cases were associated with LASV. The primary health facilities have failed to recognize the cases as suspected LF at the earliest time possible. The clinicians and health facilities, especially primary health facilities, need to consider LF as a differential diagnosis when the patient failed to respond to anti-malaria and broad-spectrum antibiotics.


Assuntos
Febre Lassa/diagnóstico , Adulto , Surtos de Doenças , Feminino , Humanos , Controle de Infecções/métodos , Febre Lassa/epidemiologia , Febre Lassa/etiologia , Vírus Lassa/genética , Libéria/epidemiologia , Masculino , Pessoa de Meia-Idade , Gravidez , Complicações Infecciosas na Gravidez/virologia
20.
Surg Infect (Larchmt) ; 20(7): 577-580, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31298620

RESUMO

Background: Within the United States, surgical site infections (SSIs) have now become the most common hospital-acquired infection and impact 2%-5% of all surgical patients. It is estimated that approximately 60% of SSIs could be prevented through improved adherence to pre-existing practice guidelines. Methods: The myriad of contributing factors leading to SSIs highlights the need for a multi-faceted approach. Although collaboration and coordination among providers and patients represents a requirement of any sustainable solution, it also creates a space and possible role for innovative technologies and mobile applications utilizing patient-generated health data (PGHD). Results: Upon analysis of hospital practice, we have identified substantial variability in documentation, peri-operative care, and post-discharge instruction with regard to SSI prevention and incision care techniques. This variability is further exacerbated by a loss of information within each transition of patient care. As a result, a patient's risk of SSI often becomes dictated by their provider's preferred (and sometimes arbitrary) peri-operative practices and their own initiative in following poorly explained pre-operative instructions. The quality and efficiency of any subsequent SSI treatment similarly rests on a seemingly inconsistent approach with poor patient instruction for the post-discharge setting. Conclusions: Surgical site infection risk can be mitigated successfully through reliable performance of several evidence-based process measures within the operating room, which are now at the guideline level. However, optimal performance only happens when teams and patients are aligned and truly believe both that the evidence is correct, and that SSIs are preventable. The journey toward this goal will be an iterative process that may take months to years. Although technology can be complementary, it cannot replace human passion for harm prevention.


Assuntos
Comunicação em Saúde/métodos , Controle de Infecções/métodos , Participação do Paciente/métodos , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/prevenção & controle , Telemedicina/métodos , Humanos , Estados Unidos
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