Basic Preventive Measures Research Articles

Current Epidemiological Features of Viral Hepatitis B and C, Tuberculosis and HIV Infection In Psychiatric Hospitals

Background. Psychiatric hospitals, where patients with immunodeficiency often do not comply with basic preventive measures, as well as receiving a wide range of medical procedures, including parenteral ones, are the institutions of high risk of socially significant infections spreading.The aim was to study the current epidemiological features of parenteral hepatitis among various categories of mentally ill patients (with pulmonary tuberculosis and HIV infection) and medical personnel in a large psychiatric hospital.Materials and methods. Serological markers of hepatitis B (HB) and hepatitis C (HC) were determined in 8352 patients and 542 employees of a large psychiatric hospital using domestic diagnostic test systems.Results. Markers of HB and HC among patients were revealed in 7.2% of persons (HB — 2.8%, HC — 3.1%, and HB+HC — 1.4%). The analysis of sex, age and social characteristics of HBVand HCV-patients was conducted. Markers of HC were significantly more common in HIV-infected patients (44.4% of individuals); the main routes of transmission of HB and HC were intravenous drug use and sexual intercourse. Among patients with pulmonary tuberculosis, the maximum number of persons was found with markers of HB (44.3%) and HB+HC (38.2%); the main clinical form of pulmonary tuberculosis was represented by the infiltrative form (60.4%); in 53,7% of cases the bacillary forms were identified that pose a serious epidemiological risk in the spread of tuberculosis in the hospital. Analysis of the social structure showed that HBV+HC+HIV and pulmonary tuberculosis are characteristics of persons with aggravated social status. The most frequent factors of infection with HBV and HCV were longterm parenteral loading and intravenous drug use. The greatest factor of parenteral load was observed in mentally ill patients diagnosed with HB+HC accompanying tuberculosis. It was shown that the frequency of HBV and HCV markers detection among medical personnel depends on the department profile, work duration, frequency and risk of contact with blood during professional activity.Conclusion. A high level of comorbidity of mental disorders and socially significant infectious diseases (HIV infection, tuberculosis and HB and HC) has been established, which has a significant impact on the epidemic process of these infections. Preventive programmes established in hospitals and in the territories they serve should take into account their comorbidity. The necessity of specific and non-specific prevention of viral hepatitis in patients and medical staff of psychiatric hospitals is shown.

Current Epidemiological Features of Viral Hepatitis B and C, Tuberculosis and HIV Infection In Psychiatric Hospitals

Background. Psychiatric hospitals, where patients with immunodeficiency often do not comply with basic preventive measures, as well as receiving a wide range of medical procedures, including parenteral ones, are the institutions of high risk of socially significant infections spreading.The aim was to study the current epidemiological features of parenteral hepatitis among various categories of mentally ill patients (with pulmonary tuberculosis and HIV infection) and medical personnel in a large psychiatric hospital.Materials and methods. Serological markers of hepatitis B (HB) and hepatitis C (HC) were determined in 8352 patients and 542 employees of a large psychiatric hospital using domestic diagnostic test systems.Results. Markers of HB and HC among patients were revealed in 7.2% of persons (HB — 2.8%, HC — 3.1%, and HB+HC — 1.4%). The analysis of sex, age and social characteristics of HBVand HCV-patients was conducted. Markers of HC were significantly more common in HIV-infected patients (44.4% of individuals); the main routes of transmission of HB and HC were intravenous drug use and sexual intercourse. Among patients with pulmonary tuberculosis, the maximum number of persons was found with markers of HB (44.3%) and HB+HC (38.2%); the main clinical form of pulmonary tuberculosis was represented by the infiltrative form (60.4%); in 53,7% of cases the bacillary forms were identified that pose a serious epidemiological risk in the spread of tuberculosis in the hospital. Analysis of the social structure showed that HBV+HC+HIV and pulmonary tuberculosis are characteristics of persons with aggravated social status. The most frequent factors of infection with HBV and HCV were longterm parenteral loading and intravenous drug use. The greatest factor of parenteral load was observed in mentally ill patients diagnosed with HB+HC accompanying tuberculosis. It was shown that the frequency of HBV and HCV markers detection among medical personnel depends on the department profile, work duration, frequency and risk of contact with blood during professional activity.Conclusion. A high level of comorbidity of mental disorders and socially significant infectious diseases (HIV infection, tuberculosis and HB and HC) has been established, which has a significant impact on the epidemic process of these infections. Preventive programmes established in hospitals and in the territories they serve should take into account their comorbidity. The necessity of specific and non-specific prevention of viral hepatitis in patients and medical staff of psychiatric hospitals is shown.

A influência da alimentação na saúde do adolescente: uma revisão integrativa

Introdução: os adolescentes constituem um grupo considerado vulnerável em suas necessidades nutricionais, estilo de vida e influências ambientais. Objetivo: investigar na literatura a influência da alimentação na saúde do adolescente.Método: Revisão Integrativa de Literatura que incluiu estudos de Ensaio Clínico, publicados entre 2014 e 2018, disponíveis nas bases de dados PubMed (US National Library of Medicine) e BVS (Biblioteca Virtual de Saúde) e utilizou os descritores “Saúde do Adolescente” AND “Alimentação Saudável”. Resultados: dos 3.478 artigos, 41 foram eleitos, dos quais apenas nove foram selecionados para a discussão, por atenderem ao objetivo do estudo. A literatura analisada aponta que uma alimentação saudável melhora o estado nutricional dos adolescentes e também melhorou sua capacidade de aprender. Promove também o controle do diabetes, aumentando a ingestão de alimentos ricos em fibras, com baixo índice glicêmico. Em pacientes obesos, a adoção de um estilo de vida mais ativo com a redução do consumo de Junk food é a medida preventiva básica para a saúde metabólica. Conclusão: uma alimentação saudável e equilibrada na fase da adolescência promove a saúde com efeitos que podem se estender na fase adulta.

Main prophylactic measures in bariatric endoscopy. Spanish Expert Recommendations Guideline.

Bariatric endoscopy (BE) encompasses a number of techniques -some consolidated, some under development- aiming to contribute to the management of obese patients and their associated metabolic diseases as a complement to dietary and lifestyle changes. To date different intragastric balloon models, suture systems, aspiration methods, substance injections and both gastric and duodenal malabsorptive devices have been developed, as well as endoscopic procedures for the revision of bariatric surgery. Their ongoing evolution conditions a gradual increase in the quantity and quality of scientific evidence about their effectiveness and safety. Despite this, scientific evidence remains inadequate to establish strong grades of recommendation allowing a unified perspective on prophylaxis in BE. This dearth of data conditions leads, in daily practice, to frequently extrapolate the measures that are used in bariatric surgery (BS) and/or in general therapeutic endoscopy. In this respect, this special article is intended to reach a consensus on the most common prophylactic measures we should apply in BE. The methodological design of this document was developed while attempting to comply with the following 5 phases: Phase 1: delimitation and scope of objectives, according to the GRADE Clinical Guidelines. Phase 2: setup of the Clinical Guide-developing Group: national experts, members of the Grupo Español de Endoscopia Bariátrica (GETTEMO, SEED), SEPD, and SECO, selecting 2 authors for each section. Phase 3: clinical question form (PICO): patients, intervention, comparison, outcomes. Phase 4: literature assessment and synthesis. Search for evidence and elaboration of recommendations. Based on the Oxford Centre for Evidence-Based Medicine classification, most evidence in this article will correspond to level 5 (expert opinions without explicit critical appraisal) and grade of recommendation C (favorable yet inconclusive recommendation) or D (inconclusive or inconsistent studies). Phase 5: External review by experts. We hope that these basic preventive measures will be of interest for daily practice, and may help prevent medical and/or legal conflicts for the benefit of patients, physicians, and BE in general.

COVID-19: Common Prevention - Brief Review

Corona viruses (COVID-19) is a disease caused by novel corona virus that basically attacks the respiratory system in humans. Its common symptoms include mild fever and cough to severe distress and death. There is no any definite cure available for this disease. Frequent hand washing and proper social distance helps to prevent the disease. The objective of this short review was to have basic preventive measures in the early stage of COVID-19 outbreak.

Knowledge and practice of COVID-19 prevention among community health workers in rural Cross River State, Nigeria: implications for disease control in Africa.

Introductionin developing countries, community health workers (CHWs) are essential, for provision of behaviour change communication towards prevention of coronavirus 2019 (COVID-19) infection at rural grassroots level. We aimed at assessing their level of knowledge and practice of preventive measures in a developing country setting.Methodstotal enumeration of all CHWs in a rural local government area in southern Nigeria was carried out, using cross-sectional descriptive study design. Pretested self-administered 15-item questionnaire was used to assess knowledge of COVID-19 including basic epidemiology, virology, preventive measures and use of personal protective equipment (PPE). Practice of preventive measures was also assessed. Each correct response to knowledge question contributed one unit to the total score which was converted to percentage. Total knowledge score of 50% or greater was considered satisfactory.Resultscomplete data was obtained from eighty-six (86) respondents with mean age of 36.3±8.9 years (18-54 years). Mean total knowledge score was 28.14±12.8% (6.7 to 53.3%), and 9.3% (n=8) had score of at least 50%. Correct responses to appropriate sequence of putting on and removing personal protective equipment (PPE) were 5.8% (n=5) and 8.1% (n=7), respectively. Regular practice of use of face masks, goggles, gloves, and hand hygiene was found to be 50% (n=43), 12.8% (n=11), 30.2% (n=26), and 56.4% (n=48), respectively.Conclusioncommunity health workers are grossly underprepared for provision of health education on COVID-19, due to their poor level of knowledge. Their capacity building through workshops and effective continuing education program are urgently needed.

GLOBAL RESPIRATORY ILLNESS OUTBREAK COVID-19 AND ITS GLOBAL CONSEQUENCES: AN OVERVIEW

Global Respiratory illness outbreak COVID-19 is a new public health crisis threatening humanity across the globe with the emergence and spread from central China in late 2019. The virus originated around Wuhan, Hubei province, China in December 2019 in bats and was transmitted through unknown intermediary sources to humans. The clinical presentation of viral infection ranges from asymptomatic to severe pneumonia with acute pulmonary distress syndrome is designated as COVID-19. WHO has characterized the disease as a pandemic due to its severity, as well as the shifting of epidemic zones across the globe from epicentre zone, China through a different stage of transmission by contact or inhalation with infected droplets and the incubation period, varies between 2 - 14 days. Treatment is essentially supportive; the effective role of antiviral agents is yet to be established and secondly without knowing the entire genome sequence of COVID- 19, no drug or vaccine can be effectively administered. Prevention entails home isolation of suspected cases and those with mild illnesses and strict infection control measures at hospitals that include contact and droplet precautions. The highest risk of healthcare-associated transmission is in the absence of standard precautions, when basic infection prevention and control measures for respiratory infections are not in place, and when handling patients where COVID infection is yet to be confirmed. The pandemic acceleration of COVID-19 indicates that the initial sporadic spreading worst hit the epicentre, China. But later on, epidemic zone shifts to nearly all continents. Several countries are experiencing sustained local transmission, including Europe and America at the end of February 2020. Current status indicates that confirmed and death cases pattern is rapidly varied among the different continents and emerged as an alarming health crisis of the nd Era in countries like Italy, Spain, U.K, Iran, and the USA. Although India is now in the 2 stage of transmission and too rd far from the 3 stage but till government has already taken deceive control measures. At the same time some of the Asian countries like South Korea, Japan has been reporting a slowdown in the growth of COVID-19 cases due to adoption concept of "Testing is central" to outbreak response that leads to early detection to minimizes further spread. The proportion of asymptomatic cases is currently unknown and hampers the realistic assessment of the virus epidemic potential and complicates the outbreak response. WHO has already announced a large global trial, called SOLIDARITY th on 27 March 2020 which is focusing on the most promising panacea therapies including remdesivir; chloroquine and hydroxychloroquine; a combination of two HIV drugs, lopinavir, and ritonavir; and that same combination plus interferon-beta. The coronavirus (COVID-19) outbreak has already brought considerable human suffering and major economic disruption. In the current scenario, the exact global impact and extension of COVID 19 pandemic acceleration nd rd and reoccurrences of 2 and 3 waves are yet uncertain in globally. Therefore the corona pandemic is unprecedented in its global impact and reach, posing alarming challenges to policymakers, researchers and health workers.

Novel coronavirus: A capsule review for primary care and acute care physicians.

Novel coronavirus (nCoV) is a new emerging infectious agent causing coronavirus disease 2019 (COVID-19). Since the reporting of early cases of COVID-19 from China on December 29, 2019 till March 15, 2020, it has affected 1,42,539 humans in 135 countries, including 82 cases in India. As it is a difficult task for first-contact physicians, i.e. primary care and acute care physicians, to comprehend the fast-growing knowledge about nCoV and apply for prevention and care of suspected cases of COVID-19, we have tried to provide an updated capsule review of nCoV infection and management of COVID-19. It includes the evidence-based information on epidemiological determinants (agent, host, and environment) of the disease, its clinical features, clinical and laboratory diagnosis, basic infection prevention and control measures, and clinical management of COVID-19 cases. This review also includes the succinct summary of World Health Organization and Center for Diseases Control and Prevention interim guidelines (as of March 15, 2020) on nCoV.

Global commercial passenger airlines and travel health information regarding infection control and the prevention of infectious disease: What's in a website?

BackgroundAir travel has never been easier, cheaper or faster, with large volumes of people travelling around the world. These factors increase the risk of the spread of infectious diseases by air travel. Little is known, however, about the extent to which airlines provide information to passengers on infection control and measures to prevent the spread of infectious diseases. This study examined the websites of the global commercial passenger airlines to see if they contained information about infection control and prevention of infectious diseases and appraised the clinical usefulness of that information.MethodA cross-sectional text-based analysis of the 73 airline websites from the six global commercial passenger airline conglomerates was performed to identify information about infection control and prevention of infectious between July and August 2019.ResultsOf the 73 airline websites, less than half (n = 35, 28.6%) contained information deemed useful for passengers. While there was a range of general health advice within the websites, there was limited information about infection control and preventing infectious diseases. A minority of websites contained information about vaccination status prior to travel, and to a lesser extent handwashing and hand hygiene, with very few including disease-specific advice or preventive measures.ConclusionsAirline websites are an underutilised source of information for infection control and the prevention of infectious diseases. Providing passengers with information on basic infection control and prevention measures may support the global efforts against the spread of infectious diseases.

Women's knowledge of toxoplasmosis infection and basic prevention measures

Women's knowledge of toxoplasmosis infection and basic prevention measures

Successful control of a methicillin-resistant Staphylococcus aureus outbreak in a burn intensive care unit by addition of universal decolonization with intranasal mupirocin to basic infection prevention measures

Methicillin-resistant Staphylococcus aureus (MRSA) is frequently implicated in health care-associated outbreaks in burn intensive care units, incurring substantial morbidity and mortality to these high-risk patients and excess costs to health care systems. MRSA health care-associated infections (HAIs) were noted before and after the implementation of basic infection prevention measures and the subsequent implementation of universal decolonization with intranasal mupirocin. Pulsed-field gel electrophoresis was used to determine the relatedness of clinical isolates. A case-control study was conducted to characterize the risk factors for MRSA HAIs. Basic interventions failed to decrease the rate of MRSA HAIs, although compliance with these interventions was high throughout the study. MRSA HAIs decreased from 8.53 HAIs per 1,000 patient days before the implementation of intranasal mupirocin to 3.61 HAIs per 1,000 patient days after the implementation of intranasal mupirocin (P = .033). Pulsed-field gel electrophoresis disclosed 10 unique clones with no large clusters. The case-control study revealed a significant association between MRSA HAIs and lengths of stay, body surface area burned, intubation, pressor requirement, leukocytosis, lactic acidosis, development of pneumonia, MRSA colonization, and death. Basic environmental and behavioral interventions fell short of controlling a low-count, sporadic, and multiclonal MRSA outbreak in the burn intensive care unit of a tertiary medical center. However, the added implementation of universal decolonization with intranasal mupirocin was effective. Burn victims with greater disease severity were at higher risk for MRSA HAIs.

Modern system of psychoprophylaxis of autoagressive behavior in patients with bipolar affective disorder

The aim. To develop a pathogenetically justified system of psycho prophylaxis of auto-aggressive behavior in BAD patients on the basis of studying the features and formation. Material and methods of the research. To solve the goal, following the principles of bioethics and deontology, a comprehensive clinical, psychopathological and psycho-diagnostic examination of 117 patients with BAD with signs of auto-destructive behavior, of both sexes, at an average age of 40.5 ± 5.5 years was carried out. Research methods: clinical, psychopathological, psycho-diagnostic, statistical. Results. In the course of the work, it was found that 48.7 ± 2.4% of the surveyed registered an affective version of auto-aggressive behavior, 31.5 ± 1.9% - true, 19.8 ± 1.1% - a demonstrative version and described their features depending on the polarity of the affect. Auto-aggressive behavior in the manic episode of BAR was associated with the prevalence of irritable mania in combination with a high level of frustration in the sphere of active life and independence of actions, a high level of internality in the field of achievements and low failures in the industry. With a depressive episode of BAR - the prevalence of dreary depression, combined with a high level of frustration in the field of love and family relationships, a high level of internality in the field of family relationships and failures. With a mixed episode of BAR - a combination of irritable mania and anxious depression in combination with a pronounced degree of frustration in the material and domestic sphere, a high level of internality in the area of failures and a low level of internality in the field of performance. A pathogenetically substantiated system for the prevention of auto-aggressive behavior in patients with BAR has been developed, which consists of five stages: crisis therapy, a comprehensive diagnosis, basic and supportive therapeutic and preventive measures, and socio-psychological assistance. And it includes the use of methods of pharmacotherapy, psychotherapy and psychosocial therapy. Conclusions. Based on the obtained data in the course of the work, a pathogenetically substantiated system for the prevention of suicidal behavior of BAR patients has been developed, which consists of five stages: crisis therapy, a comprehensive diagnosis, main and supportive treatment and preventive measures, and socio-psychological assistance. The means of therapeutic influence at all stages were applied in the form of pharmacotherapy, psychotherapy and psychosocial care

Особливості епідемічного процесу гепатиту а та його зв’язок із накопиченням побутових полімерних відходів у довкіллі

In this work a sanitary-hygienic assessment of the features of the epidemic process for hepatitis A disease among the population has been conducted and its connection with the accumulation of household waste in the environment has been established On the whole territory of Ukraine an unstable epidemic situation with hepatitis A disease is noted. It is connected with a change in the main factors that affect the transmission of infection. Therefore, the issue of establishing a link between the spread of hepatitis A in the environment and the processes that provide it are relevant. To this end, the epidemiological features of hepatitis A in the Ivano-Frankivsk region were studied for improving the system of preventive and anti-epidemic measures involving specialists and equipment of the SI “Ivano-Frankivsk Regional Laboratory Centre of the Ministry of Health of Ukraine”. Calculations were made according to the statistical record of morbidity (reporting form № 2 and № 40). It is established that the main way of transmission of viral hepatitis A remains water from decentralized sources. In addition, the incidence of hepatitis A is characterized by uneven distribution and predominates in mountainous areas. For the period from 2011 to 2016 there is an active involvement of working-age people in the epidemiological process, whose share on average is 73.5%. The morbidity is almost equally widespread, both among the urban population and among the rural population. The peaks of the disease coincide in time with floods, when sewage networks and wastewater treatment plants did not cope with this volume of wastewater due to their clogging with household waste, mainly polymeric packages. Therefore, the barrier role of communal treatment facilities and the sewage system, in relation to the hepatitis A virus, is insufficient and requires the improvement of the technology of water purification and preparation. It is necessary to develop infrastructure to provide centralized water supply to the population of the mountainous areas of the region, where it is hygienically and economically justified. A promising direction for further scientific research is the development and implementation at the state level of basic preventive measures aimed at optimizing social and hygienic living conditions of the population and in the fight against hepatitis A, there is a technical and technological update of: communal systems of water supply, drainage, sanitary cleaning of the territory; organization of catering and trade and the prohibition of street trade, as well as mass immunization of the most vulnerable groups of the population; control over the provision and compliance with sanitary and hygiene norms and rules; prohibition of the production, use, import and payment or free distribution of polymer packages in Ukrainian territory. Key words : hepatitis A , epidemiology , communal hygiene , polymeric waste

Effects of heated medical elastic stockings on the prevention of deep venous thrombosis and hypothermia of lower limbs during posterior lumbar intervertebral fusion

Objective To develop a kind of heated medical elastic stockings to prevent the occurrence of deep vein thrombosis (DVT) and hypothermia in patients with lumbar degenerative diseases undergoing posterior lumbar intervertebral fusion (PLIF) . Methods A total of 180 patients with lumbar degenerative diseases undergoing PLIF from February 2015 to August 2017 were selected by purposive sampling method, and divided into routine group (group A) , normal elastic stockings (group B) , heated medical elastic stockings (group C) according to the sequence of operation time, with 60 cases in each group. On the premise of routine thermal protection measures and DVT basic preventive measures, group A did not wear stretch socks, group B wore normal elastic stockings, and group C wore heated medical elastic stockings. Patients in the group B and C were treated with normal and heated stretch stockings during anesthesia preparation 1 hour prior to surgery. The incidence rate of lower extremity DVT and hypothermia in each group was calculated by monitoring deep veins blood flow velocity of both lower limbs, D-dimer, foot temperature and the core temperature at each time node during the operation. Results In group C: left femoral superficial vein velocity was (17.47±3.07) cm/s; right femoral superficial vein velocity was (16.95±3.25) cm/s; left popliteal vein blood flow velocity was (16.03±3.37) cm/s; right popliteal vein blood flow velocity was (16.37±3.39) cm/s. All the results above were higher than those in group A and B (P<0.01) . The D-dimer were (587±129) μg/L at the end of surgery and (392±119) μg/L 24 h after surgery in group C, which were significantly lower than group A and B (P<0.01) . The incidence of DVT at the end of operation and 24 hour postoperation in group A was 8.3% and 15.0%, while 5.0% and 5.0% in group B respectively. There was no DVT occurrence in group C at the two time points, and the difference was statistically significant (P<0.01) . Comparing foot temperature and core temperature of each time point, it was significantly higher in group C than group A and B (P<0.05) . There were 8 cases of hypothermia in group C, and the incidence rate was 12.5%, which were both significantly lower than that in group A (56.7%) and group B (40.0%) (P<0.01) . Conclusions The heated elastic stockings can effectively reduce the risk of DVT and hypothermia in the patients with lumbar degenerative diseases undergoing PLIF and can be popularized in clinical practice. Key words: Venous thrombosis; Compression stockings; Hypothermia; Prevention

Methicillin-resistant Staphylococcus aureus has greater risk of transmission in the operating room than methicillin-sensitive S aureus

Methicillin-resistant Staphylococcus aureus (MRSA) is a pathogenic S aureus strain characteristic associated with increased patient morbidity and mortality. The health care system needs to understand MRSA transmissibility in all settings to improve basic preventive measures to generate sustained reductions in invasive MRSA infections. Our primary aim was to compare intraoperative transmissibility of MRSA versus methicillin-sensitive S aureus (MSSA) isolates. S aureus isolates (N = 173) collected from 274 randomly selected operating room environments (first and second case of the day in each operating room, a case pair) at 3 hospitals underwent systematic-phenotypic and genomic processing to identify clonally related transmission events. Confirmed transmission events were defined as at least 2 S aureus isolates obtained from ≥2 distinct intraoperative reservoirs sampled within or between cases in a study unit that were epidemiologically and clonally related. We explored the relationship between clonal transmission and methicillin resistance with Poisson regression analysis. We identified 58 clonal transmission events. MRSA isolates were associated with increased risk of clonal transmission compared with MSSA isolates (adjusted incidence risk ratio [IRR], 1.68; 95% confidence interval [CI], 1.13-2.49; P = .010; unadjusted IRR, 1.85; 95% CI, 1.23-2.77; P = .003, respectively). MRSA isolates are associated with increased risk of intraoperative transmission. Future work should examine the impact of the attenuation of intraoperative MRSA transmission on the incidence of invasive MRSA infections.

Rapid health assessment of newly arriving refugees at Adjumani Refugee Camps, Northern Uganda, August 2016

Introduction : fresh political clashes in South Sudan led to an influx of >40,000 refugees to Adjumani District, Northern Uganda in July 2016. This influx overstretched Adjumani Refugee Camp’s capacity to manage refugees, potentially creating a fertile ground for disease outbreaks. We conducted a Rapid Health Assessment to assess health status, identify potential public health threats, and recommend evidence-based interventions. Methods : we used a structured questionnaire to collect data among a convenient sample of refugees through face-to-face interviews. We interviewed health workers using a standardized checklist on the availability of essential health services. We determined the presence of Global Acute Malnutrition (GAM) using mid-upper arm circumference. We collected data on water, sanitation, hygiene promotion and shelter through on-site observations and record reviews. Refugees voluntarily sought participation during the assessment. Results : we interviewed 197 refugees. The ratio of latrine stances to persons was 1:223 (vs. recommended 1:50). Water supply was 7.8 liters/person/day (vs. recommended 15 liters). Of 131 refugees who had various ailments, 49 (37%) did not utilize the health services provided by relief agencies. Of the 197 refugees interviewed, 175 (89%) did not have mosquito nets. GAM was present in 520 (6.8%) of 7,544 children aged 6–59 months screened at the Elegu border. A double portion for lunch and supper was served once, and supper was eaten without heating. We observed poor hygienic practices, including open defecation, use of unsafe water collected from a nearby river for drinking and daily utility, poor sewage drainage, and overcrowding in shelters. Hand-washing facilities were insufficient. Self-disposal of placentae post-delivery was reported. Conclusion : inadequacies in basic sanitary supplies, hygienic practices, and disease prevention measures make this refugee camp vulnerable for disease outbreaks. We recommended provision of hand-washing facilities, safe water, excreta disposal facilities, and health education to the refugees.

Knowledge of H7N9 avian influenza and intention to adopt preventive behaviours among Chinese poultry farmers: a cross-sectional study

BackgroundPoultry farmers are at high risk of H7N9 avian influenza infection. H7N9 influenza-related knowledge is the precondition motivating poultry farmers to adopt preventive behaviours against H7N9 infection. This study aimed to examine what elements of the knowledge were associated with poultry farmers' protection intention using the protection motivation theory (PMT). MethodsIn this cross-sectional study, using stratified random sampling method, we recruited poultry farmers from 36 villages of three cities (Suqian, Nantong, and Zhenjiang city) representing the northern, central, and southern Jiangsu Province, one of the major provinces affected by H7N9 outbreaks. We assessed H7N9 influenza-related knowledge with 25 dichotomous questions (ask for ‘know/don't know’ responses). Each element of PMT (perceived severity and vulnerability of H7N9 infection, perceived self-efficacy and response efficacy of adopting preventive behaviours) was measured using four items on a seven-point Likert scale ranging from “very strongly disagree” to “very strongly agree”. Exploratory Factor Analysis (EFA) was done to explore the types or elements of protective knowledge. We used structural equation modelling (SEM) to examine the associations between different types of knowledge and PMT constructs and protection intention. Ethical approval was given by local veterinary authorities and verbal consent was obtained from each participant before completing the survey. FindingsBetween Nov 5, 2013 and Jan 20, 2014, we recruited 297 poultry farmers (226 [76%] of whom were male; 112 farmers from Suqian, 96 from Nantong, and 89 from Zhenjiang). The EFA revealed four main knowledge types: symptoms, self-protection measures at work, basic preventive measures, and routine hygiene. The SEM showed that knowledge of symptoms (β=0·135, p=0·018) and self-protection measures at work (β=0·141, p=0·004) were positively associated with self-efficacy. Knowledge of symptoms (β=0·211, p<0·0001) and self-protection measures at work (β=0·343, p<0·0001) were also positively associated with response efficacy. Knowledge of basic preventive measures was negatively associated with perceived vulnerability (β=–0·165, p<0·001), while positively associated with self-efficacy (β=0·309, p<0·0001) and response efficacy (β=0·276, p<0·0001). Routine hygiene knowledge was positively associated with perceived vulnerability (β=0·120, p=0·013) and response efficacy (β=0·225, p<0·0001). Perceived vulnerability (β=0·312, p<0·0001), self-efficacy (β=0·129, p=0·034), and response efficacy (β=0·642, p<0·0001) were positively associated with protection intention. InterpretationDespite the limitation of small sample size from only one province, potentially under-representing the true knowledge level of poultry farmers in China, these findings reveal that different types of knowledge have various mechanisms influencing poultry farmers' intention to adopt preventive behaviours against H7N9 infection. These findings highlight the directions for intervention design for future avian influenza prevention. FundingNational Natural Science Foundation of China (71573221).

Infection After Orthopaedic Trauma: Prevention and Treatment

Trauma to the extremities is disproportionately represented in casualties of recent conflicts, accounting for >50% of injuries sustained during operations in Iraq and Afghanistan. Infectious complications have been reported in >25% of those evacuated for trauma, and 50% of such patients were treated in the intensive care unit (ICU). Osteomyelitis has been reported in 9% (14% of intensive care unit patients), and deep-wound infection in 27% of type III open-tibia fractures. Infections complicating extremity trauma are frequently caused by multidrug-resistant bacteria and have been demonstrated to lead to failure of limb salvage, unplanned operative take-backs, late amputations, and decreased likelihood of returning to duty. Invasive fungal infections of extremities have also presented a unique challenge in combat-injured patients, particularly in those with blast injuries with massive transfusion requirements and high injury severity scores. Infection prevention should begin at the time of injury and, although context-specific depending on the level of care, includes appropriate irrigation, surgical debridement, wound care and coverage, fracture fixation, and antibiotic prophylaxis, in addition to basic infection prevention measures. Clinical practice guidelines to address infection prevention after combat trauma (including extremity infection) were developed in 2007 and revised in 2011, with endorsement from the Surgical Infection Society and the Infectious Disease Society of America. Nevertheless, significant challenges remain, including austere environments of care, multiple transitions of care, and lack of coordinated efforts in prevention. Treatment of established infections is optimally multidisciplinary, particularly when deep wounds, bone, and joints are involved. Surgical debridement of overtly infected or necrotic tissue is necessary, with particularly aggressive margins if invasive fungal infection is suspected. Infected nonunion frequently requires the use of prosthetic materials for fixation, potentiating biofilm formation, and complicating medical therapy. Antibiotic therapy should be targeted at results of deep wound and bone cultures. However, this is complicated by frequent contamination of wounds, requiring differentiation between potential pathogens in terms of their virulence and decreased culture recovery in patient who have frequently received previous antibiotics. Lessons learned in infection prevention and treatment of orthopaedic trauma from combat can serve to inform the care of patients injured in natural disasters and noncombat trauma.

Fatal Fulminant Clostridium difficile Colitis in an Immunosuppressed Individual

Clostridium difficile infection (CDI) is one of the most common nosocomial infections with close to half a million cases occurring in United States annually. It has substantial morbidity with up to 2.5% of patients requiring colectomy and mortality rates of up to 16%. We here present a very impressive case of rapidly progressing and ultimately fatal- severe complicated CDI in a relatively young hospitalized patient. A 53-yearold woman with comorbidities of HIV- AIDS, seizure disorder, congestive heart failure presented with diarrhea, dyspnea, productive cough and fever of 101oF. Patient had a pertinent history of two preceding episodes of CDI that were treated with intravenous (I.V) metronidazole and peroral (P.O) vancomycin. Physical examination revealed a febrile patient with hypotension and a diffusely tender abdomen. Initial laboratory values were significant for severe metabolic acidosis (pH-7.11), anemia (Hemoglobin-8.1gm/dL), leukocytosis (18.7 k/μL), elevated serum creatinine (1.7 mg/dL) and hypoalbuminemia (2.3 gm/dL). Computerized tomography (CT) scan of abdomen showed severe pancolitis with surrounding mesenteric infiltration and ascites (Figure-1). Patient had positive stool C. difficile toxin assay. Patient was diagnosed with severe complicated CDI and was started on P.O and rectal vancomycin (500mg every 6 hours); and I.V metronidazole (500mg every 8 hours). Patient had transient improvement over the next five days but had sudden deterioration with hypotension requiring vasopressor support and worsened leukocytosis (70 k/ μL). Patient underwent an emergent laparotomy with colectomy. Specimens revealed a markedly dilated colon (13cm in maximal circumference) with tan-red, granular and edematous mucosa covered by patchy yellow-green friable membrane-like material- giving a polypoid appearance (Figure-2). Histology was consistent with pseudomembranous colitis. Patient unfortunately had progressive worsening of acidosis and multiorgan dysfunction ultimately resulting in her death. Unfortunately this case, though not unique, serves as a stark reminder of the significant morbidity and mortality involved with CDI in spite of aggressive therapy- especially in an immunosuppressed individual. A practicing physician should be acutely aware of emerging hypervirulent strains, novel risk factors that have been identified. The importance of basic preventive measures such as hand washing and food preparation safety cannot be over-emphasized.Figure 1Figure 2

Infection control in the operating room: is it more than a clean dish?

Healthcare-associated infections (HCAIs) are driven by a complex interplay between host defenses, pathogen traits, and pathogen transmission. A better understanding of each of these factors is required to extend infection control beyond antibiotic therapy to improvements in basic preventive measures that can achieve sustained HCAI reductions. The purpose of this article is to review recent advancements in our understanding of these issues for the operating room environment. The importance and implications of intraoperative bacterial transmission have been solidified, and hyper transmissible, virulent, and antibiotic resistant bacterial strains have been characterized. As a result, a best practice for improved intraoperative infection control has been delineated. Little advancement has been made in our understanding of the efficacy of higher inspired oxygen concentrations, improved postoperative glucose control, perioperative normothermia, and prophylactic antibiotic selection, timing, and dose for HCAI prevention. Recent work has led to the development of evidence-based hand hygiene, environmental cleaning, patient decolonization, and intravascular catheter design and handling improvement strategies. Evidence suggests that a best practice for postoperative infection control is a multimodal program that utilizes these interventions to target patient, provider, and environmental reservoirs in parallel. The development of novel diagnostic tools for targeted attenuation of hyper virulent, transmissible and resistant strains/strain characteristics is indicated to improve patient decolonization efforts.