Meticulous Hand Hygiene Research Articles

Africa (COVID-19) Vaccine Technology Transfer: Where Are We?

The rampant spread of the COVID-19 infection poses a grave and formidable challenge to global healthcare, with particular concern to the inhabitants of the African continent. In response to these pressing concerns, different strategies have been employed to combat the emergence of this insidious disease, encompassing crucial measures such as physical distancing, the utilization of face masks, meticulous hand hygiene, and widespread vaccination campaigns. Nevertheless, the economic realities faced by numerous African nations, characterized by their classification as "low-income countries (LICs)", present a formidable barrier to accessing and distributing approved vaccines to their populations. Moreover, it is essential to discuss the hesitancy of the European Union (EU) in releasing intellectual property rights associated with the transfer of vaccine technology to Africa. While the EU has been a key player in global efforts to combat the pandemic, there has been reluctance in sharing valuable knowledge and resources with African countries. This hesitancy raises concerns about equitable vaccine access and the potential for a prolonged health crisis in Africa. This review underscores the urgent imperative and need of establishing localized vaccine development and production facilities within Africa, necessitating the active involvement of governments and collaborative partnerships to achieve this crucial objective. Furthermore, this review advocates for the exploration of viable avenues for the transfer of vaccine technology as a means to facilitate equitable vaccine access across the African continent and also the cruciality and the need for the EU to reconsider its stance and actively engage in transferring vaccine technology to Africa through sharing intellectual property. The EU can contribute to the establishment of localized vaccine production facilities on the continent, which will not only increase vaccine availability but also promote self-sufficiency and resilience in the face of future health emergencies.

Congenital Cytomegalovirus

Congenital Cytomegalovirus

Hip Fracture Management during the COVID-19 Pandemic in South Korea.

BackgroundThe purpose of this study was to introduce a screening system for coronavirus disease 2019 (COVID-19), to evaluate the overall orthopedic management in hip fracture patients during the COVID-19 pandemic in South Korea, and to compare the surgical results in hip fracture patients during the COVID-19 pandemic with those of the previous year.MethodsHip fracture patients who visited emergency rooms were screened at the screening clinics before admission. The medical management was carried out with the medical staff wearing surgical masks, meticulous hand hygiene observed, and a minimum distance of 2 m between patients maintained. The demographics, operative parameters, and surgical results of patients treated during the pandemic were compared with those from the previous year.ResultsFrom January 2020 to July 21, 2020, 119 patients with hip fractures (33 men and 86 women) were admitted to our institution for surgical treatment. Five patients showed symptoms of pneumonia, but no patient was positive for COVID-19. The mortality rate during the study period was 4.2%, and none of the patients died due to COVID-19. The interval between admission and surgery and the length of hospital stay were significantly shorter (p = 0.008, p = 0.002) and the proportion of spinal anesthesia was greater in hip fracture patients during the COVID-19 pandemic compared to those from the previous year (p = 0.011).ConclusionsThe COVID-19 screening system for hip fracture patients has proven to be effective in preventing intrahospital spread of the disease. Hip fracture surgery performed during the COVID-19 pandemic has shown comparable results without any COVID-19 infection and COVID-19-related mortality.

Perinatal practical guidelines on COVID-19: what one should know to reduce the risk

Risk of COVID-19 in pregnant woman is the same as that in the general population but as pregnancy is a state of immunosuppression along with other physiological respiratory and immune changes. A pregnant woman might show more severe symptoms of COVID-19 infection. Health care employees should be permitted to meet pregnant women through managed home visits and with help of teleconsultations. Mothers should follow meticulous hand hygiene, respiratory etiquettes and social distancing because they have key role in restricting spread of infection. Protein rich diet, vitamin C, vitamin D, zinc, calcium, iron and folic acid are very necessary components to be consumed by antenatal woman. It may help to protect mother and baby by having certain vaccines during pregnancy such as the influenza, tetanus and Tdap vaccines. Pregnant women with major risk of exposure/COVID-19 symptoms and no emergency obstetric issues should be stated for testing outside the hospital. Pregnant women without urgent obstetric issues awaiting results should stay at home to self-isolate. Those with emergency obstetric issues should be managed in labour room devoted to COVID-19 patients. Mode of delivery depends upon obstetrical indication and health condition of mother. Regular assessment of respiratory condition should be done during labour along with continuous electronic foetal monitoring. The WHO encourage mothers with COVID-19 to hold and breastfeed their babies because close connection is essential for new-born but to reduce risk of transmission temporary separation of new born from mother with confirmed or suspected COVID-19 is considered strongly.

Barrier Precautions in the Era of Multidrug Pathogens.

Purpose of reviewThere is a continuing debate regarding contact precaution (CP) usage for endemic multidrug-resistant organisms (MDROs). In this review, we examine current recommendations for CP and highlight differences in CP use between endemic and non-endemic MDROs.Recent findingsThe discontinuation of CP had no effect on the incidence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococci. The evidence regarding CP for extended-spectrum beta-lactamase producing Enterobacteriaceae is inconclusive, highlighting the need for more research to determine best infection control strategies. Carbapenem-resistant Enterobacteriaceae maintains a sporadic pattern in the USA, supporting current recommendations to use CP for colonized and infected patients. MDR Acinetobacter baumannii (MDR-AB) is extremely virulent and responsible for outbreaks in healthcare settings, emphasizing the need for CP use with MDR-AB infected patients. Candida auris (C. auris) is often misdiagnosed; it is resistant to UV light and quaternary ammonium low-level disinfection. Because little is known about the transmission of C. auris, significant caution and CP use are necessitated. There is little research on vancomycin-resistant S. aureus (VRSA) control strategies due to its rarity; thus, CP is strongly recommended.SummaryContact precautions are frequently part of a bundled infection control approach that involves meticulous hand hygiene, patient decolonization, chlorhexidine gluconate bathing, and reducing the use of invasive devices. Healthcare facilities should continue to utilize CP for non-endemic MDROs and the presence of endemic MDROs; however, CP may not add benefit to the current infection prevention bundle approach.

Who Should Use a Face Mask During COVID-19 Pandemic? An Evidence-Based Review

There is a lot of confusion about who should use face mask during this serious COVID-19 pandemic. Irrational use of masks has caused serious shortage of mask availability for frontline health-care workers, who really require it. Therefore, the authors have carried out this comprehensive evidence-based review to guide policy-makers for the rational use of the face mask in this crisis. Social distancing, meticulous hand hygiene and respiratory etiquettes are more important in curbing the COVID-19 infection transmission rather than use of face mask alone but people may use multilayer cloth face covering especially in the areas of significant community-based transmission of SARS-CoV-2. Frontline health-care workers essentially require the full set of personal protective equipment, including gown, gloves, goggles or face shields, shoe covers, and mask, preferably N95 or equivalent respirator when exposed to aerosols. In case, N95 or equivalent equipment is not available, and then, surgical mask can also protect them adequately during non-aerosol generating procedures, provided meticulous hand hygiene is practiced.

A Practical Decontamination Framework for COVID-19 Front-line Workers Returning Home.

A Practical Decontamination Framework for COVID-19 Front-line Workers Returning Home.

Managing head and neck cancer patients with tracheostomy or laryngectomy during the COVID-19 pandemic.

Head and neck cancer patients with tracheostomies and laryngectomies, as well as their healthcare providers, face unique challenges in the context of the current COVID‐19 pandemic. This document consolidates best available evidence to date and presents recommendations to minimize the risks of aerosolization and SARS‐CoV‐2 exposures in both the inpatient and outpatient settings. The cornerstones of these recommendations include the use of closed‐circuit ventilation whenever possible, cuffed tracheostomy tubes, judicious use of heat moisture exchange units, appropriate personal protective equipment for providers and patients, meticulous hand hygiene, and minimal manipulation of tracheostomy tubes.

Summarizing societal guidelines regarding bronchoscopy during the COVID-19 pandemic.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for pandemic coronavirus disease 2019 (COVID-19), is predominantly transmitted via large droplets and fomites. However, healthcare workers (HCW) participating in aerosol-generating procedures such as bronchoscopy, endotracheal intubation, upper gastrointestinal endoscopy, otolaryngological procedures involving the upper airway and tracheotomy are also at risk for aerosol-transmitted infection. Given the well-documented asymptomatic SARS-CoV-2 infection with viral shedding, infectious aerosol might also be generated from asymptomatic patients as community prevalence rises. Several bronchology societies have issued guidelines regarding bronchoscopy during the COVID-19 pandemic.1-5 However, none are comprehensive and significant uncertainty remains regarding in whom to perform bronchoscopy and how to perform it safely in this rapidly changing clinical environment. No data specific to bronchoscopy in COVID-19 are yet available, so most recommendations are expert opinion derived from observations made during prior respiratory viral outbreaks including SARS, Middle East respiratory syndrome (MERS) and influenza. Tables 1 and 2 summarize existing guidelines regarding bronchoscopy in patients not suspected of harbouring SARS-CoV-2 and in those known or suspected to be suffering from COVID-19, respectively. All societies reviewed recommend postponing elective procedures and limiting the number of staff participating in any procedure to minimize the use of personal protective equipment (PPE) and reduce known or occult exposure to infectious aerosol. All considered known or suspected COVID-19 to be a relative contraindication to bronchoscopy, given the uncertainty of its benefit and clear risks to participating staff. Table 3 represents a consolidation of existing guidelines regarding bronchoscopy in patients with and without COVID-19. N95 or FFP3 if significant community prevalence Consider daily re-used N95 or FFP3 if low supply Avoid atomized or nebulized lidocaine Sedation to minimize cough Consider paralysis to minimize cough in general anaesthesia Avoid atomized or nebulized lidocaine Sedation to minimize cough Consider paralysis to minimize cough in general anaesthesia Consider air circulation time per local air controls Consider sterilizing surfaces In procedures which cannot be deferred, infection of HCW may occur from any of the three transmission modes discussed above. Protective measures against infectious aerosols include use of respirator-level respiratory protection, negative pressure rooms where feasible and avoidance of devices that purposefully produce aerosols including nebulizers or atomizers which can be contaminated with virus after a cough or sneeze with subsequent aerosolization. Recommendations to avoid open tube rigid bronchoscopy, jet ventilation and interruption of an otherwise closed ventilation circuit by repeatedly removing and re-introducing the bronchoscope are intended to reduce high-flow and high-shear conditions which generate aerosol droplets. Measures protecting against droplet transmission include covering the patient's nose and mouth with a simple medical mask (which can be slotted to permit transmask, transnasal or transoral flexible bronchoscopy), minimizing cough pharmacologically, and a full complement of barrier PPE (gown, gloves, cap and wrap-around eye protection). Fomite transmission may be reduced by using disposable bronchoscopes in known COVID-19 patients, sterilizing surfaces which might have been contaminated by respiratory secretions or droplets, proper removal of PPE and meticulous hand hygiene. There appears to be a particular dearth of information regarding optimal post-procedure decontamination procedures. Data specific to bronchoscopy in the COVID-19 era are urgently needed. National and international bronchology societies should work together to rapidly develop pertinent research endeavours and strive to provide their members with the most comprehensive and up-to-date recommendations possible. More than a few lives depend on them. We would like to acknowledge contributors to the COVIDBronch Initiative, an international network of airway specialists created to foster research and the rapid acquisition and dissemination of knowledge regarding the performance of airway procedures during the COVID-19 pandemic. No authors report any financial or non-financial conflicts of interest pertinent to this work. No aspect of this work has been previously published nor is under consideration by any other journals. Early drafts of included tables were previously shared among a small group of airway professionals via non-public social media.

Risk factors for acquisition of multidrug-resistant Enterobacterales among international travellers: a synthesis of cumulative evidence.

Recent studies have shown that over 50% of people travelling to Southeast Asia return colonized with multidrug-resistant Enterobacterales (MRE) including carbapenemase-producing Enterobacterales. Importation of MRE by travellers and subsequent spread to family members, communities and healthcare facilities poses real risks that have not yet been adequately assessed. This systematic review and meta-analysis aims to quantify the risk factors and interventions for reducing the risk of MRE acquisition among international travellers. A systematic search was conducted in PubMed, Web of Science and Scopus for analytical epidemiological studies containing data post-2000 that assessed the risk factors to acquire and/or interventions to reduce the risk of MRE acquisition in travellers. Two researchers independently screened all the studies and extracted the information, and disagreements were resolved through consensus. The proportions of MRE acquisition by the region of destination and the odds ratio (OR) for the different risk factors and/or interventions were pooled using the inverse variance heterogeneity model. A total of 20 studies (5253 travellers from high-income countries) were included in the meta-analysis. South Asia [58.7%; 95% confidence interval (CI), 44.5-72.5%] and Northern Africa (43.9%; 95% CI 37.6-50.3%) were the travel destinations with the highest proportion of MRE acquisition. Inflammatory bowel disease (OR 2.1; 95% CI 1.2-3.8), use of antibiotics (OR 2.4; 95% CI 1.9-3.0), traveller's diarrhoea (OR 1.7; 95% CI 1.3-2.3) and contact with the healthcare system overseas (OR 1.5; 95% CI 1.1-2.2) were associated with MRE colonization. Vegetarians (OR 1.4; 95% CI 1.0-2.0) and backpackers (OR 1.5; 95% CI 1.2-1.8) were also at increased odds of MRE colonization. Few studies (n = 6) investigated preventive measures and found that consuming only bottled water/beverages, meticulous hand hygiene and probiotics had no protective effect on MRE colonization. International travel is an important driver for MRE spread worldwide. Future research needs to identify effective interventions to reduce the risk of MRE acquisition as well as design strategies to reduce local transmission on return.

Skin Impact of Alcohol-Based Hand Rubs vs Handwashing.

Skin Impact of Alcohol-Based Hand Rubs vs Handwashing.

Efficacy of interventions to improve hand hygiene compliance in neonatal units: a systematic review and meta-analysis.

Healthcare-associated infections (HCAIs) cause significant morbidity and mortality in neonatal intensive care units (NICUs). Meticulous hand hygiene is the most effective strategy to prevent HCAI. However, hand hygiene compliance (HHC) is low, especially in ICUs. Hence, we aimed to evaluate the efficacy of strategies for improving HHC in NICUs. A systematic review of the literature and meta-analysis were carried out. PubMed, EMBASE, Cochrane CENTRAL and CINAHL were searched in October 2013. PRISMA guidelines were followed. The quality of included studies was assessed by the Newcastle-Ottawa scale (NOS). Sixteen eligible non-randomised studies were included. A total of 27,155 hand hygiene moments were observed. Meta-analysis using a random effects model indicated that a range of strategies, such as educational campaigns, musical parodies, reminders, easy access to hand hygiene sanitisers, UV sensors and performance feedback, improved HHC [odds ratio (OR) 2.04; 95% confidence interval (CI) 1.40, 2.97]. Significant statistical heterogeneity was noted. Studies which specifically provided performance feedback at either the individual or group levels reported a more significant improvement in HHC compared to those that did not (OR 2.81; 95% CI 1.32, 5.96 vs. OR 1.55; 95% CI 1.13-2.11). Strategies to improve HHC in NICUs seem to be more effective when they include performance feedback at the personal or group levels. Randomised controlled trials (RCTs) specifically assessing the benefits of performance feedback in improving HHC are needed.

Neonatal sepsis: Progress towards improved outcomes

Neonates are predisposed to infections during the perinatal period due to multiple exposures and a relatively compromised immune system. The burden of disease attributed to neonatal infections varies by geographic region and maternal and neonatal risk factors. Worldwide, it is estimated that more than 1.4 million neonatal deaths annually are the consequence of invasive infections. Risk factors for early-onset neonatal sepsis (EOS) include prematurity, immunologic immaturity, maternal Group B streptococcal colonization, prolonged rupture of membranes, and maternal intra-amniotic infection. Intrapartum antimicrobial prophylaxis administered to GBS-colonized women has reduced the burden of disease associated with early onset GBS invasive infections. Active surveillance has identified Gram-negative pathogens as an emerging etiology of early-onset invasive infections. Late-onset neonatal sepsis (LOS) attributable to Gram-positive organisms, including coagulase negative Staphylococci and Staphylococcus aureus, is associated with increased morbidity and mortality among premature infants. Invasive candidiasis is an emerging cause of late-onset sepsis, especially among infants who receive broad spectrum antimicrobial agents. Prophylactic fluconazole administration to very low birthweight (VLBW) neonates during the first 6 weeks of life reduces invasive candidiasis in neonatal intensive care units with high rates of fungal infection. Prevention of healthcare associated infections through antimicrobial stewardship, limited steroid use, early enteral feeding, limited use of invasive devices and standardization of catheter care practices, and meticulous hand hygiene are important and cost-effective strategies for reducing the burden of late-onset neonatal sepsis.

Patient colonized with multiresistant bacteria and dental practice

It is impossible to know with certainty which patients are colonized with multiresistant bacteria, but the risk is known to be associated with certain factors. The guideline, in dental practice, for prevention of the spread of multiresistant bacteria is to strictly follow recommended universal infection control practices. This applies to instrument and dental unit hygiene, surface decontamination and to working hygiene, including the use of adequate personal barrier protection and adherence to meticulous hand hygiene.

Phlebotomy tourniquets- vectors for bacterial pathogens

Nosocomial infection is a significant problem. Good hand hygiene is the single most effective preventive measure. However, maintaining a clean patient environment is also necessary. Studies have shown that objects...

Norovirus outbreak in a pediatric oncology unit

Objective. Norovirus (NV) is an etiologic agent of outstanding importance that can cause severe epidemic gastroenteritis in day-care centers, schools, nursing homes, and hospitals. Therefore NV requires foremost attention as a pathogen responsible for epidemics of gastroenteritis in immunocompromised inpatients. In this study, a NV outbreak in a pediatric oncology unit is described and the consequences for this high-risk population are discussed.Material and methods. Stool and vomitus samples from 11 patients were tested for NV and other relevant viruses during the outbreak by reverse transcriptase-polymerase chain reaction (RT-PCR) and/or enzyme-linked immunosorbent assay (ELISA) (whenever an appropriate ELISA was available). Norwalk virus PCR amplifications were sequenced and phylogenetic analysis was performed.Results. The index patient and the chain of infection were identified. Follow-up investigation surprisingly demonstrated viral shedding for a maximum of 140 days (median 23 days). Three patients experienced severe or life-threatening symptoms, probably related to NV infection.Conclusions. In the event of an outbreak of gastroenteritis (involving two or more symptomatic patients) in a pediatric oncology unit, the search for NV in stool or vomitus specimens should be initiated in good time. As long as the data are limited regarding whether a detectable viral antigen or RNA in stools represents an infectious virus, patients have to be isolated as long as the diagnostic assays remain positive. During the acute phase of the illness, health-care workers should wear masks in addition to practicing meticulous hand hygiene with a disinfectant of proven activity against NV. Pediatric oncology patients must be closely monitored during follow-up investigations as they may shed the virus for months. There is some evidence from the outbreak described here that those patients face a greater risk of severe NV-related complications.