Surgical Healthcare Workers Research Articles

Global surgery: Improving health in low-income countries

The aim of this report is to examine the definition of global surgery, discuss the problems and propose some suggestions. Global surgery aims to improve the surgical conditions to maintain a standard and equal surgical care, especially in low- and middle-income countries where burden of surgical diseases are increasing over the years. According to Lancet Commission on Global Surgery, 1.27 million more surgical healthcare workers will be required to provide minimal surgical workforce, by 2030. In resource-limited settings of the world-wide where medical education and post-graduation training programs are disrupted due to brain drain, instable conditions and economic reasons, sustaining a standard and accessible surgical care are possible by training surgeons.
 Bangladesh Journal of Medical Science Vol.20(3) 2021 p.483-486

No Nosocomial Transmission of SARS-CoV-2 between Healthcare Workers in Surgical Departments Unexposed to Covid-19 Patients

Abstract Background: Covid-19 infections are usually community-acquired, but nosocomial outbreaks among patients and/or exposed Healthcare Workers (HCW) exist. However, the risk of pure nosocomial SARS-CoV-2 transmission between HCWs remained unknown during the first pandemic wave, especially in the absence of exposure to hospitalized Covid-19 patients. Aim: During the first total lockdown, surgical HCW only cared emergency patients. This period is ideal to determine the epidemiology of purely inter-HCW transmission of Covid-19. Clinical Details: This study concerns the period of the total lockdown of the first wave in March-April 2020. It is performed in two different surgical services in Zurich Canton. Outcome: During the first wave of Covid-19, and in the absence of hospitalized Covid-19 patients, we found no confirmed nosocomial transmission of SARS-CoV-2 between HCWs. Conclusion: Nosocomial extensions of the community-based Covid-19 pandemic are reported, but not due to viral interchange between surgical HCWs in hospitals during a total lockdown and the lack of hospitalized Covid-19 patients. Keywords Healthcare workers; Nosocomial transmission; Occupational health; SARS-CoV-2; Surgical wards

Prevalence of methicillin-resistant Staphylococcus aureus colonisation among healthcare workers at a tertiary care hospital in southeastern China.

The aim of this study was to investigate the carriage rates of Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) among healthcare workers (HCWs) at a tertiary-care hospital in southeastern China and to analyse the epidemiological relatedness of the S. aureus isolates. A total of 242 pharynx swabs were collected in March-April 2016 from 242 HCWs working in seven different wards and departments. Isolates were identified as S. aureus based on morphology, coagulase test and Vitek test. Antimicrobial susceptibility testing was performed by using the Kirby-Bauer disk diffusion method. The epidemiological relatedness of the S. aureus isolates was determined by pulsed-field gel electrophoresis (PFGE). From the 242 HCWs, 70 (28.9%) S. aureus strains, including 10 (4.1%) MRSA strains, were identified during screening, with the highest MRSA rate detected in nurses (8/107; 7.5%). Carriage rates of S. aureus and MRSA among surgical HCWs were 30.0% (63/210) and 4.3% (9/210), respectively. Methicillin-susceptible S. aureus (MSSA) isolates were grouped by PFGE analysis into five similar groups (A-E), with most isolates belonging to groups D and E, accounting for 63.0% of isolates. Furthermore, two MRSA isolates from gastrointestinal surgery had identical PFGE patterns. The prevalence of S. aureus colonisation among HCWs was high in this hospital, although the MRSA carriage rate in surgical wards was low. The identical PFGE pattern detected in two MRSA isolates from the same surgical department supports that effective control for possible cross-infection should be implemented.

Determinants of good adherence to hand hygiene among surgical health care workers

Background: Hand hygiene is the main pillar on standard precautions (hospital infection prevention), and of increasing concern. Nevertheless few is known about cognitive, attitude, perception and motivational determinants of hand hygiene’s health care workers in a surgical arena where they have never been exposed to amultimodal hand hygiene campaign. Methods: Cross-sectional study in a 900-bed university teaching hospital in Barcelona (Spain). A confidential self-administered and validated questionnaire survey was conducted in a sample of 176 surgical units’ healthcare workers (medical and nursing) before a multimodal Hand hygiene (HH) campaign started. Results: A total of 172 questionnaires were returned (response rate 97.7%), 54 (30.7%) were physicians, 75 (42.6%) were nurses and 47 (26.7%) nursing assistants. The median years of institution experience was 13.00 years (IQR 20.0), 68.8% were women, 21% were from the General Surgery ward, 21.6% were from the Urology, 39.8% from the Orthopedics and 17.6% from the Vascular Surgery ward. The self HH compliance estimated was 77.47(DE17.74), being in 107 participants (63.7%) higher than 80%. Knowledge determinants were poorly ranked as determinants of hand hygiene (OR 1.08, CI95% 1,02—1.15), while motivation to improve the hand hygiene compliance (OR 0.59, CI95% 0,39—0.88) and medical staff (OR 0.11, CI95% 0.02—0.55) or nurses (OR 0.15, CI95% 0.04—0.66) versus nursing assitants were higly ranked as determinants, independently of positive perception about hand hygiene, gender, attitude toward HH and years of institutional experience. Conclusion: In a setting of absent exposure to hand hygiene campaign, knowledge about hand hygiene, motivation and profesional status are strongly in favor of hand hygiene, rather than behavioral beliefs, independently of gender, more than 10 years of institution experience, and professional category. These results are quite different from that observed in an extensive exposure to hand hygiene campaigns where behavioral beliefs and the perception of high self-efficacy are related to hand hygiene compliance rather than reasoning. This additional insight should be considered in settings that have never been exposed to promotion activities about standard precautions.

Universal Precautions and Surgery in Sierra Leone: The Unprotected Workforce

Surgical patients and healthcare workers in sub-Saharan Africa are at an increased risk of contracting HIV. Sierra Leone is one of the poorest countries in the world and has a documented HIV prevalence rate of 2%. Because surgeons and other healthcare staff in sub-Saharan Africa are at risk for HIV exposure from their patients, an assessment of protective supplies and equipment was considered essential. A Society of International Humanitarian Surgeons team in cooperation with the Sierra Leonean Ministry of Health and Sanitation undertook a survey of HIV-protective supplies and equipment at government hospitals in Sierra Leone. The presence of eye protection, sterile gloves, aprons, functioning suction machines, and sharps containers was recorded and compared with a local mission hospital and a local private hospital. Only 20% of government hospitals in Sierra Leone have adequate stores of sterile gloves or eye protection. Suction pumps and aprons are available in only 30-40% of facilities, respectively, and only half have functioning sterilizers and sharps containers. The mission and private hospitals were fully stocked. Although surgical healthcare workers are at risk for exposure to HIV, resources for their protection at government hospitals in Sierra Leone are severely lacking. The Society of International Humanitarian Surgeons is developing a program to provide protective supplies and equipment to hospitals in Sierra Leone, but additional efforts by other organizations working to decrease the spread of HIV are essential.

Outbreak of Pertussis Among Healthcare Workers in a Hospital Surgical Unit

In September 1999, a pertussis outbreak was detected among surgical staff of a 138-bed community hospital. Patients were exposed to Bordetella pertussis during the 3-month outbreak period. To describe the outbreak among surgical staff, to evaluate implemented control measures, and to determine whether nosocomial transmission occurred. Clinical pertussis was defined as acute cough illness with a duration of 14 days or more without another apparent cause; persons with positive culture, PCR, or serologic test results were defined as having laboratory-confirmed pertussis. Surgical healthcare workers (HCWs) were interviewed regarding pertussis symptoms, and specimens were obtained for laboratory analysis. Patients exposed to B. pertussis during an ill staff member's 3-week infectious period were interviewed by phone to determine the extent of nosocomial spread. A total of 53 HCWs assigned to the surgical unit and 146 exposed patients. HCWs with pertussis were defined as case subjects; HCWs without pertussis were defined as non-case subjects. Twelve (23%) of 53 HCWs had clinical pertussis; 6 cases were laboratory confirmed. The median cough duration in the 12 case subjects was 27 days (range, 20-120 days); 10 (83%) had paroxysms. Eleven (92%) of 12 case subjects and 28 (86%) of 41 non-case subjects received antibiotic treatment or prophylaxis. Seven case subjects (58%) reported they always wore a mask when near patients. Of 146 patients potentially exposed to pertussis from the 12 case subjects, 120 (82%) were interviewed; none reported a pertussis-like illness. Surgical staff transmitted B. pertussis among themselves; self-reported data suggests that these HCWs did not transmit B. pertussis to their patients, likely because of mask use, cough etiquette, and limited face-to-face contact. Control measures might have helped limit the outbreak once pertussis was recognized.