Body Fluid Contact Research Articles

Novel 3D Printed Biomaterials Based on Fish Scale Collagen and Plant Extracts and Its Hemostatic Efficacy

AbstractThis study focused on 3D printing‐preparation of novel biomaterials based on fish scale collagen and the following plant extracts: Eclipta alba L. Hassk leaf (EA), Piper betle L. leaf (PB), Perilla frutescens L. Britt leaf (PF), and Styphnolobium japonicum L. Schott flower bud (SJ). The characterizations of the obtained biomaterials were analyzed using infrared spectroscopy and stereo microscopy. Additionally, assessments of the biomaterials were conducted on the water contact angle, simulated body fluid contact angle, scratch resistance, color changes, and swelling degree in simulated body fluid. Furthermore, in‐vitro blood clotting time and the anti‐inflammatory ability of these biomaterials were also performed. The results indicated that the plant extracts contributed to modifying collagen, significantly improving the scratch resistance and water contact angle of the collagen/plant extract biomaterials. The plant extracts were dispersed consistently with the collagen matrix, impacting the vibrations of specific functional groups of collagen. Collagen/plant extract dressings exhibited great biocompatibility and anti‐inflammatory. The in‐vitro tests demonstrated that the ethanol EA extract notably enhanced the hemostatic effectiveness of collagen, suggesting the potential of collagen/plant extract biomaterials in hemostatic applications.

A systematic corrosion failure analysis of Li-ion powered hearing aids from various markets

Hearing aids (HA) are low-power electronic devices used worldwide. The ongoing trend in the HA industry has been to move towards Li-ion battery technology replacing conventional zinc-air batteries. The corrosion reliability of HA devices is a critical issue, due to their exposure to harsh user environments including body fluid contact, high humidity, and temperature. The combined effect of higher operating voltage (4.3 V) and design miniaturisation poses new risks for corrosion reliability. To fully understand the environmental reliability issues of the Li-ion powered HA, it is crucial to investigate field performance by conducting root cause failure analysis on the field-returned failed devices. This study investigated two different HA models (open vs. glued model). The analysis used a systematic FMEA-based approach to identify and understand failure modes, mechanisms, and potential causes using various analysis techniques (e.g., LOM, SEM&EDS, and ICP-OES). Furthermore, statistical analysis was conducted based on the repair data created by the global service centre to reveal the failure percentage, and time to failure of different components. Passive components, solder connections, and galvanic charging contact showed the highest failure percentages. The most common causes of corrosion failures were high levels of chloride ions, high humidity, flux residues, and insufficient coating protection.

GloveCare: a pilot study in preparation for a cluster crossover randomized controlled trial of non-sterile glove-based care in preventing late-onset infection in the NICU

BackgroundLate-onset infections (LOI) are a major cause of morbidity and mortality among patients in the neonatal intensive care unit (NICU). Gloving after hand hygiene may be a pragmatic approach to prevent infections that arise when healthcare workers’ hands transmit pathogens to neonates.ObjectiveTo determine the feasibility of conducting a multicenter, open-labeled randomized controlled trial (RCT) to determine whether a protocol that requires healthcare workers (HCWs) in a level 3 NICU to wear non-sterile gloves plus hand hygiene reduces the occurrence of a late-onset infection, compared to hand hygiene alone.MethodsIn this single-center pilot study, we recruited neonates admitted to the McMaster Children’s Hospital NICU from June 2017 to May 2018. The NICU was randomized to begin with the standard (control) arm for 6 months (June 2017 to Dec 2017), followed by the gloving (GloveCare) arm for 6 months (Jan 2018 to July 2018), with a 2-week washout period in-between to educate healthcare workers about gloving. We measured numerous feasibility outcomes including enrollment, event rate, and compliance with hand hygiene (Moment 1: before patient contact, Moment 2: before clean procedure, Moment 3: after body fluid contact, Moment 4: after patient contact) and gloving compliance.ResultsWe enrolled 750 neonates (390 Standard care, 360 GloveCare) and achieved 100% enrollment. We found higher hand hygiene compliance during the standard care arm compared to the GloveCare for all four moments of hand hygiene (Moment 1: 87% vs 79%, OR=1.86 (1.34, 2.59); Moment 2: OR=1.73 (1.00, 3.01); Moment 3: OR=1.11 (0.62, 1.98); Moment 4: OR=1.65 (1.27, 2.14)). We developed and validated a method to calculate glove compliance, which ranged from 48 to 85%, and was highest for moment 3 (doffing after a procedure or body fluid exposure risk). No adverse events were documented for patients or staff.DiscussionReduction in hand hygiene compliance in the GloveCare arm presents a pragmatic challenge in ascertaining the effectiveness of gloving to prevent LOI. Most LOIs were non-sterile-site infections, which is considered a less patient-important or clinically relevant outcome compared to sterile-site LOI. Ensuring efficient collection and validation of hand hygiene and gloving data is imperative.ConclusionThe pilot study demonstrated the feasibility of this intervention though modifications to improve hand hygiene compliance during GloveCare will be important prior to a multicenter cluster RCT to assess the efficacy of non-sterile glove-based care in preventing LOI in the NICU.Trial registrationClinicaltrials.gov, NCT03078335

One Step Fabrication and Application of Antibacterial Electrospun Zein/Cinnamon Oil Membrane Wound Dressing via In situ Electrospinning Process

Antibacterial wound dressing can benefit the wound healing by preventing bacterial infection, especially for the electrospun ones due to their porous structures and easily loading antibacterial drugs. However, it is challenging to apply the antibacterial electrospun wound dressing to covering the wound conveniently and safely. Here, we presented one step fabrication and application of antibacterial electrospun zein/cinnamon oil wound dressing via a handheld electrospinning setup. The prepared zein/cinnamon oil wound dressing showed gas permeability of (76.1–5.45) mm/s, hydrophilicity with zero body fluid contact angle, swelling stability after 24 h as well as antibacterial zones over 5 cm against both E. coli and S. aureus bacteria. Moreover, in situ electrospinning process can deposit the electrospun zein/cinnamon oil fibers directly onto the wound, meantime forming a wound dressing. The mice cut-wound model experiment demonstrated that the one step in situ fabrication and application of zein/cinnamon oil wound dressing could nearly heal the wound within 11 d.

Multifunctional hopeite nanocoating on Ti64 substrates by pulsed laser deposition and radio frequency magnetron sputtering for orthopedic implant applications: A comparative study

Functionalized implants demonstrate an upgraded approach in orthopedic implants, aiming to achieve long term success through improved bio integration. Bioceramic coatings with multifunctionality have arisen as an effective substitute for conventional coatings, owing to their combination of various properties that are essential for bio-implants, such as osteointegration and antibacterial character. In the present study, thin hopeite coatings were produced by Pulsed laser deposition (PLD) and radio frequency magnetron sputtering (RFMS) on Ti64 substrates. The obtained hopeite coatings were annealed at 500 °C in ambient air and studied in terms of surface morphology, phase composition, surface roughness, adhesion strength, antibacterial efficacy, apatite forming ability, and surface wettability by scanning electron microscope (SEM), X-ray diffraction (XRD), atomic force microscope (AFM), tensometer, fluorescence-activated cell sorting (FACS), simulated body fluid (SBF) immersion test and contact angle goniometer, respectively. Furthermore, based on promising results obtained in the present work it can be summarized that the new generation multifunctional hopeite coating synthesized by two alternative new process routes of PLD and RFMS on Ti64 substrates, provides effective alternatives to conventional coatings, largely attributed to strong osteointegration and antibacterial character of deposited hopeite coating ensuring the overall stability of metallic orthopedic implants.

Clinical profile and outcome of patients with Crimean Congo haemorrhagic fever: a hospital based observational study from Rajasthan, India.

Crimean Congo haemorrhagic fever (CCHF) is an emerging zoonotic infection with high mortality. Nosocomial spread is described secondary to body fluid contact. Patients meeting the case definition for viral haemorrhagic fever (VHF) from August to November 2019 were tested for CCHF after ruling out dengue, malaria, scrub typhus and leptospirosis in a tertiary teaching hospital in western Rajasthan, India. Diagnosis was confirmed using both quantitative reverse transcription polymerase chain reaction and immunoglobulin M/immunoglobulin G enzyme-linked immunosorbent assay for all patients. All hospital contacts were line listed and tested and symptomatic high-risk contacts received ribavirin post-exposure prophylaxis. Cohorting, personal protective equipment use and hand washing were employed to prevent nosocomial spread. Four patients tested positive for CCHF. We encountered uncommon initial presentations involving motor weakness and supraventricular tachycardia. Elevated serum lactate dehydrogenase and creatinine kinase were useful in clinical diagnosis. Only one patient survived despite ribavirin therapy. There was zero nosocomial transmission. A partial segment of nucleocapsid of amplified CCHF virus was 99.62% identical to the Afghanistan and Oman strains. The distribution of CCHF appears to be expanding, with CCHF emerging as endemic in Rajasthan, India. In this setting of high mortality, hand washing and PPE use prevented nosocomial transmission.

Fabrication of porous micro-nanostructured networks on Ti6Al4V for faster hydroxyapatite deposition in SBF

Abstract Surfaces with porous micro-nanostructured networks on Ti6Al4V substrates were successfully fabricated via sandblast, acid-alkali etching treatment. Wettability and hydroxyapatite (HA)-forming ability of the multilevel structured Ti6Al4V surfaces were investigated. Water contact angles and simulated body fluid (SBF) contact angles of 6 μl droplets on the resulting surfaces were as low as 0°, which could be attributed to the formation of hydrophilic TiO2 layer and larger specific surface area. Furthermore, after soaking in SBF for 1 day, a homogeneous HA layer was formed on the multilevel structured Ti6Al4V surface, whereas surface of original Ti6Al4V showed few HA precipitates even after 7 days of SBF immersion, suggesting that the fabricated structure was beneficial to faster HA deposition in SBF.

Updated Guidelines on Infection Prevention in Pediatric Ambulatory Settings

The American Academy of Pediatrics (AAP) recently released updated guidelines on infection control and prevention in pediatric outpatient settings. Key recommendations include mandatory influenza vaccination for all healthcare workers offered free to all staff, expanded guidance on infection control practices for children with cystic fibrosis, guidance on additional prevention procedures during community outbreaks of infectious diseases and recommendations on improving communication between healthcare facilities when referring potentially contagious patients. The new guidelines modify standard precautions by indicating that gloves are not required for diaper changes or some body fluid contact (nasal secretions and tears) in a well child, or when administering vaccines. In addition, efforts should be made to minimize exposure to infections from contaminated toys that cannot be cleaned including plush toys, cleaning toys in waiting rooms each day and encouraging families to bring their own toys or books to visits.

A study of hand hygiene technique in intensive care unit of a tertiary care hospital

Introduction: Hand hygiene (HH) has been characterized as the keystone and starting point in all infection control programs, with the hands of health-care faculty being the handler and advocates of infection in critically ill patients. Materials and Methods: This was a cross-sectional observational study using direct observation technique. A single observer collected all HH data. This single-observer study was conducted in the 45-bedded intensive care unit (ICU) of Mahatma Gandhi Hospital. HH compliance was monitored using the hand hygiene observation form developed by the World Health Organization. A nonidentified observer was used for monitoring compliance with HH. Results and Discussion: A total of 900 observations were recorded from health-care personnel in ICU. With respect to the personnel, the nursing department had the highest number of observations as 400 circulating nurses were sampled. There were also 110 senior consultants, 250 resident doctors, and 140 paramedical staffs. Of the total opportunities, nurses had the highest number of contacts (67%), followed by allied health-care workers (82.94%). The average compliance was about 75%, which differed significantly among health-care workers, with higher compliance among the nursing staff (82.9%) followed by allied staff (67%). Of the average overall compliance of 75%, maximum compliance was seen for moment 3, that is, the staffs were very careful after body fluid contact as it was perceived important for self-protection. The HH instances after patient contact (86.29%) also suggested similarly. The nurses' compliance was 64.40% before patient contact and 68.35% after touching surroundings. Conclusion: The observance of HH is still low in our local environment. Handwashing practices in our study show that health-care workers pay attention to HH, when it appears, there is a direct observable threat to their well-being. Educational programs need to be developed to address the issue of poor HH.

Work constraints leads to accident: Questionnaire validity and a qualitative interpretation of the cutoff point

French-speaking ergonomists conceive constraint as a work situation in which the worker has his power to act, think and decide reduced or hampered, which can facilitate the occurrence of work accidents. A questionnaire with five items was elaborated to measure constraint addressed to nursing staff members. From February to September 2013, a census was carried out at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil, one of the biggest hospital complexes in the world. The census response rate was approximately 92%. The construct validity and criterion’s of the questionnaire was checked. After the former, four items remained, two of these measured time constraint and the other two Personal Protection Equipment constraint. The gold standards of the criterion validity were work accident involving exposure to biological fluid (WABIF) caused by sharp objects, WABIF through patient’s body fluid contact and work incident (or almost accident) involving these two kinds of WABIF. Criterion validity was performed with both Item Response Theory (IRT) and Classical Test Theory (CTT) paradigms using logistic regression. Only WABIF by contact and incident got criterion validity. The results of the IRT paradigm showed that it is possible to go beyond the CTT cutoff point and reach a more qualitative interpretation when a relationship is established between the cutoff point value and the b parameter value of the category of each item. Hence, we find the intensity of the item (represented by its category) sufficient to him/her being at that risk.

Hand Hygiene Compliance in the Setting of Trauma Resuscitation

IntroductionHealthcare-associated infections are a significant health burden, and hand hygiene (HH) is an essential prevention strategy. World Health Organization (WHO) 2009 guidelines recommend washing hands during five moments of patient care; 1)before touching a patient; 2)before a clean procedure; 3)after body fluid exposure; and 4)after touching a patient or 5)patient surroundings. HH opportunities at these 5 moments are frequent and compliance is low (22-60%). Infection risk is particularly high in trauma patients, and HH compliance during active trauma resuscitation has yet to be evaluated. Materials and MethodsUsing video surveillance, all healthcare worker (HCW)-patient interactions for 30 patients were retrospectively reviewed for HH compliance according to WHO guidelines and glove use during initial resuscitation at a level-1 trauma center. Results342 HCW-patient interactions and 1034 HH opportunities were observed. HH compliance with the WHO moments was 7% (71/1034) overall; 3% (10/375) before patient contact, 0% (0/178) before a clean procedure, 11% (2/19) after body fluid contact, 15% (57/376) after patient contact and 2% (2/86) after contact with the environment. Glove use was more common, particularly before (69%) and after (47%) patient contact and after body fluid contact (58%). No HH was observed before clean procedures, but HCW donned new gloves 75% of the time before bedside procedures. If donning/removing gloves was included with HH as compliant, compliance was 57% overall. ConclusionHH opportunities are frequent and compliance with WHO HH guidelines may be infeasible, requiring significant amounts of time that may be better spent with the patient during the golden hour of trauma resuscitation. In an era where more scrutiny is being applied to patient safety, particularly the prevention of inpatient infections, more research is needed to identify alternative strategies (e.g. glove use, prioritizing moments) that may more effectively promote compliance in this setting.

Neonatal Ebola infection: An Interesting Issue in Pediatric Infectious Disease

Dear Editor, Ebola virus infection is a current global concern (1). This infection caused several deaths in Africa in 2015 (1). Ebola virus infection can occur in any age group. In pediatrics, the mortality rate of Ebola is very high (2). Neonatal Ebola infection is a particular area of interest. The first issue to be discussed is transplacental transmission and congenital Ebola infection in newborns. Infection in pregnant women can affect newborns (3, 4). In the current outbreak, Oduyebo et al. recently reported a case of Ebola in a mother infected in her third trimester who delivered a stillborn fetus (5). A previous report from Congo also recounted a case of a stillborn fetus (6). It seems that the infection is very virulent, and the affected fetus does not usually survive. Nevertheless, Ebola infection among the newborns has been observed. According to the report from Congo by Formenty et al., the youngest case was a five-dayold newborn, and there is high mortality among newborns even when the clinical presentation is only a fever (7). In Uganda, a case was reported in a three day old. A similar, very high fatality rate among newborns was also observed (8). The possibility of perinatal infection can be seen in these cases from Congo and Uganda where there was no evidence of Ebola infection in the mother during pregnancy (7, 8). Intrafamilial transmission from other members of the family to the neonates via body fluid contact is proposed (7, 8). In a recent publication in Am J Infect Control, the transmission of Ebola to a newborn through contact with the mother’s body fluid was reported (9). In conclusion, as seen in clinical practice, neonatal Ebola virus infection has a very high mortality rate. Practitioners should be made aware of this risk.

Reviews of Science for Science Librarians: Ebola Virus Disease

Ebola virus disease is a viral hemorrhagic fever found most commonly in Central Africa. It was first documented in 1976 in Central Africa. The natural host for the virus is unknown, but fruit bats have been suggested as the natural reservoir. Transmission of the virus occurs through body and body fluid contact. There are five subtypes. Ebola Zaire is the most deadly. In 2014 the virus spread from Central to West Africa. Prevention of the spread of the virus includes increasing awareness about the disease, rapid recognition, and proper access and means to isolate infected persons. Reducing the risk of infection requires extensive education and resources. Current treatment includes isolation of the infected and supportive care. There have been delays in vaccine development and production by restrictions placed on testing vaccines on chimpanzees to inoculate wild animals in Africa. Investigational uses of drugs to boost immune responses have been tried, and testing has resumed to find a vaccine to protect humans.

Initial stage of the inclined impact of a smooth body on a thin fluid layer

The two-dimensional problem of the oblique impact of a free rigid body with a smooth flat bottom on a thin layer of an ideal incompressible fluid is considered. The initial stage of the impact when the body motion is accompanied by the formation of jets on the boundary of the body-fluid contact zone is investigated. The problem is solved jointly, i.e., the fluid flow initiated by the body motion and the motion of the body itself are determined simultaneously. A priori the “body-fluid” contact zone is unknown and determination of its time evolution represents a significant difficulty and the method of asymptotic matched expansions is used to overcome this difficulty. A system of integro-differential equations is obtained and the motion of the body under the action of hydrodynamic loads is investigated numerically on the basis of this system. It is shown that the hydrodynamic force exerted on the body during the impact is maximum precisely in the initial stage; therefore, the motion of the body varies fairly significantly in time considered.

Occupational blood exposure among unlicensed home care workers and home care registered nurses: Are they protected?

Little is known about the risk of blood exposure among personnel providing care to individual patients residing at home. The objective of this study was to document and compare blood exposure risks among unlicensed home care personal care assistants (PCAs) and home care registered nurses (RNs). PCAs self-completed surveys regarding blood and body fluid (BBF) contact in group settings (n = 980), while RNs completed mailed surveys (n = 794). PCAs experience BBF contact in the course of providing care for home-based clients at a rate approximately 1/3 the rate experienced by RNs providing home care (8.1 and 26.7 per 100 full time equivalent (FTE), respectively), and the majority of PCA contact episodes did not involve direct sharps handling. However, for PCAs who performed work activities such as handling sharps and changing wound dressings, activities much more frequently performed by RNs, PCAs were at increased risk of injury when compared with RNs (OR = 7.4 vs. 1.4) and (OR = 6.3 vs. 2.5), respectively. Both PCAs and RNs reported exposures to sharps, blood, and body fluids in the home setting at rates that warrant additional training, prevention, and protection. PCAs appear to be at increased risk of injury when performing nursing-related activities for which they are inexperienced and/or lack training. Further efforts are needed to protect home care workers from blood exposure, namely by assuring coverage and enforcement of the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogen Standard [Occupational Safety and Health Administration. 1993. Frequently Asked Questions Concerning the Bloodborne Pathogens Standard. Available at: http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS &p_id=21010#Scope. Accessed May 30, 2008].

Impact of Wearable Alcohol Gel Dispensers on Hand Hygiene in an Emergency Department

Compliance with hand hygiene (HH) by health care workers is widely recognized as the most effective way to decrease transmission of infection among patients. However, compliance remains poor, averaging about 40%. A potential barrier to compliance is convenience and accessibility of sinks or alcohol hand sanitizer dispensers. The purpose of this study was to assess the use of a personal alcohol gel dispensing system, compared with the traditional wall-mounted alcohol gel dispenser and sinks in an urban hospital's emergency department (ED). This was a quasi-experimental trial of a personal wearable alcohol hand sanitizer dispenser. Observations of ED staff HH were performed in the month before intervention and during three intervention phases over a 2.5-month period. A total of 757 HH opportunities were observed: 112 before and 432 after patient contact, 72 after contact with the patient's environment, 24 before invasive procedures, and 117 after body fluid contact. HH compliance improved during the first intervention period, but improvement was not sustained. There was no significant improvement in HH from baseline to the final intervention period. The wearable alcohol gel dispenser was used for 9% of HH episodes. Availability of a wearable dispenser was not associated with a significant improvement in use of alcohol products for HH. These results support other studies in which only transient success was reported with a single intervention; greater success in sustaining increased HH compliance has been reported with use of multimodal approaches in which increased availability of products may be a part of the intervention.

Double or Single Gloves

Surgical gloves should form an efficient barrier between surgeons and patients to prevent cross infection. Single gloves (SGs) have long been reported unsafe, and usage of double gloves (DGs) is still not universal. No study has reported the usage of DGs in pediatric orthopedic operations. The aim of this study was to assess the efficacy of DGs versus SGs in prevention of body fluid contact between patients and surgeons during pediatric orthopedic surgery. After 150 pediatric orthopedic operations, DGs and SGs were collected and tested for perforations. Gloves were tested for size, site, and number of perforations among principal surgeons, assistant surgeons, and scrub nurses. Gloves were not changed during long surgical procedures and were changed only if perforations were identified and recorded. The DGs used were Maxitex Duplex, powder-free indicator gloves and the SGs were of Gammex-Ansell. One hundred unused gloves of each group were tested as controls. Medical records of the patients were reviewed for age, sex, type of operation, duration of operation, and any postoperative wound infection. The data were entered in database and analyzed using SPSS package. The data were compared between double and SGs using t test with a level of statistical significance at P less than 0.05. Five hundred twenty-six DGs and 316 SGs were tested. Forty-three perforations were detected in DGs (8.1%). Outer gloves were breached in 7.8% and inner in 0.3% as compared with SGs in which 28 (8.7%) were perforated. In DGs, 4% had multiple perforations compared with 11.9% in SGs. There was a statistical significance (P<0.001) when the perforations of inner gloves were compared with the SGs. None of the inner perforations were recognized during surgery, but the outer gloves of the DGs were recognized in 71% as compared with 9% in SGs (P<0.001). The majority of perforations were seen in the nondominant hand in surgeons and assistants hands, whereas scrub nurses had 85% of perforations in the dominant hand. The index finger was the site of perforations in DGs (53.4%; SGs, 43%). The inner gloves were breached only when the outer glove was found to be perforated. The duration of surgery had a direct impact on the number of perforations. There were no perforations in DGs in less than 60 minutes as compared with 3 (10.7%) in SGs. Between 60 and 120 minutes, the perforations in the DGs were 11, and in SGs, 21. During the study period, 4 patients had surgical site infection. Three were superficial and one deep-seated infection. In 3 patients with infection, the gloves were found to be perforated, and 1 patient with infection had no perforations in the gloves. Our study confirms that DGs are safer than SGs during pediatric orthopedic operations. In the event of nonavailability of DGs, SGs should be changed on an hourly basis during long procedures. Lastly, there exists a relationship between surgical site infection and glove perforations.

The Impact of Gown-Use Requirement on Hand Hygiene Compliance

Hand hygiene compliance remains low, despite its effectiveness in preventing infections. Gowns are routinely used to reduce dissemination of organisms within hospitals. Use of gowns is time consuming and costly, and their effectiveness, compared with that of hand hygiene alone, is debated. Among the arguments supporting a gown-use requirement is the potential to boost awareness of infection control, leading to improved hand hygiene compliance. Hand hygiene compliance was recorded in a 14-month crossover trial comparing compliance at 2 intensive care units during periods with and without a gown-use requirement. During 170 h of observation, 1619 hand hygiene opportunities were recorded. Compliance was 10% before care was given and 36% after care was given. Compliance with glove and gown use was 62% and 63%, respectively. After-care hand hygiene compliance for nurses, physicians, and therapists was 40%, 38%, and 22%, respectively. Compliance after patient contact, body fluid contact, and other in-room activity was 42%, 48%, and 22%, respectively. For periods with and without a gown-use requirement, overall after-care compliance (37% vs. 34%) and rates by personnel and activity type were similar. In the subgroup of patients on contact precautions, hand hygiene compliance during the period with a gown-use requirement versus the period without a gown-use requirement was 11% versus 10% (P=.85) before care was given and 45% versus 39% (P=.09) after care was given. In this subgroup, after adjustment for type of in-room activity, medical personnel, intensive care unit, and observer, the predicted after-care hand hygiene compliance during periods with and without a gown-use requirement was 48% versus 41% (P=.02). The hypothesis that a gown-use requirement might improve hand hygiene compliance in the intensive care unit could not be confirmed. In the subgroup of patients on contact precautions, improvement in hand hygiene compliance associated with the gown-use requirement was small and did not affect precare rates.

Traditional healer's knowledge and implications to the management and control of HIV/AIDS in Arusha, Tanzania

Due do limited coverage of conventional health care services in Tanzania, a number of HIV/AIDS patients are consequently being cared for and managed by traditional healers. Knowledge of 132 traditional healers on HIV/AIDS was assessed through a questionnaire that sought among other things the symptoms that these traditional healers associate with HIV/AIDS. Seventy-seven (61%) healers claimed to be treating HIV/AIDS patients. Twenty-five percent (33 healers) had poor, 52.3% (69 healers) had moderate, 22.7% (30 healers) had good knowledge of HIV/AIDS. Sixty-nine (52%) among the traditional healers mentioned six and thirty (23%) healers mentioned more than six symptoms associated with HIV/AIDS as outlined by the WHO clinical HIV staging system. Almost all the healers were aware that HIV/AIDS is spread sexually and through body fluid contact and claimed that precautionary measures are taken to avoid spread of the disease. Knowledge on HIV/AIDS infection from mother to child during pregnancy, at delivery and through breastfeeding was poor for most healers. It seems most traditional healers meet HIV/AIDS patients in their terminal stages when HIV/AIDS-related opportunistic infections are highly manifest, a situation exemplified by the recorded symptoms that were not specific or directly related to HIV/AIDS. There is a need to impart the appropriate knowledge in the identified deficient areas to avoid possibilities of further spread of the disease through the traditional medicine delivery system Keywords: Traditional healers, knowledge, HIV/AIDS, TanzaniaTanzania Health Research Bulletin Vol. 8 (2) 2006: pp. 95-100

Atlas of Travel Medicine and Health

Travel medicine is a field that requires in-depth knowledge about disease epidemiology. Whether providing pretravel evaluations or posttravel consultations, the travel medicine specialist must be up to date on disease epidemiology. Pretravel evaluations require counseling the traveler to avoid risks from diseases specific to the itinerary. Posttravel consultations demand recognition of possible diseases on the basis of areas visited as well as specific exposures. A pictorial depiction of disease distribution can be a useful tool in determining risks of diseases to the traveler and can complement the existing resources for clinicians. Atlas of Travel Medicine and Health, a book and accompanying CD-ROM by J. Chiodini and L. Boyne, contains basic information that can be used to provide pretravel advice. Its major sources are the World Health Organization and U.K. Department of Health and the Public Health Laboratory Service guidelines. The book is organized into three sections. Section One describes general risks and precautions, such as food and water, animal contact, vector-borne diseases, fresh water exposure, and blood and body fluid contact. Section Two contains descriptions and maps of some diseases that may be encountered by travelers. Section Three contains country-specific information about malaria, immunizations, and other health considerations for the more popular destinations. The format is organized, the content is basic, and the book is easy to read. Although the intended audience is healthcare professionals, the information can be easily used by the traveler. Some maps have incorporated the topography to indicate specific malaria risk, depending on elevation, which is a nice feature. Because Section Three only focuses on popular destinations, many countries with malaria risk are not included. The section can be improved with consistent use of color, a more detailed key, and by adding major tourist centers and cities. Although the authors do not intend to cover an exhaustive list of diseases or countries, another important improvement would be the inclusion of all countries infected with or endemic for yellow fever. Diseases such as leishmaniasis, Lyme disease, and acute mountain sickness deserve mention in Section Two but are not currently discussed. Finally, the CD-ROM is generally easy to use, but Section Two on the CD-ROM could be improved by changing the orientation of the maps. We live in a world of movement. The mobility of populations globally leads to the potential spread of infectious diseases and to the rapid change of disease distribution as demonstrated by outbreaks of dengue, meningococcal disease, and severe acute respiratory syndrome (SARS). An ideal atlas for travel medicine should be able to reflect recent outbreaks in addition to the general distribution of diseases. To do so would require frequent updates of the atlas. Currently, the Atlas of Travel Medicine and Health is suitable for healthcare professionals and travelers who desire brief summaries on some travel-related illnesses, but it must be used in conjunction with more comprehensive references.