Sunday, July 13, 2014

Infection Control: Basic Concepts and Practices

http://www.ific.narod.ru/Manual/Hands.htm


 
 Hand Hygiene

Introduction

The natural flora of the mouth and the bowel has bacterial concentrations up to 10^10 per ml and are significant reservoirs of nosocomial or hospital pathogens. In hospitalised patients, the skin may become colonised with multidrug resistant (MDR) pathogens, and infected wounds and other lesions are also potential sources of cross-infecting organisms. 

Pathogenic organisms from colonized and infected patients (and sometimes from the environment) transiently contaminate the hands of staff during normal clinical activities and can then be transferred to other patients. Hand transmission is one of the most important methods of spread of infectious agents in health care facilities. Proper hand hygiene is an effective method for preventing the transfer of microbes between staff and patients.

The microbial flora of the skin consists of resident and transient microorganisms. Resident organisms (e.g., coagulase negative staphylococci, diphtheroids) survive and multiply in the superficial skin layers. The transient microbial flora of the skin consists of recent contaminants that survive only for a limited period of time. These microorganisms (e.g., S. aureusE. coli, enterococci) may be acquired by contact with the normal flora or colonised or infected sites of the patient or from the inanimate hospital environment. If the skin of staff members' hands is damaged, the bacterial count on the skin becomes higher. There is also a risk for colonisation with bacteria not normally belonging to the hand flora.
Three levels of decontamination of hands are recognized.

Social handwashing with plain soap and water removes most transient microorganisms from moderately soiled hands.

Hygienic handwashing or disinfection is a procedure where an antiseptic detergent preparation is used for washing or hands are disinfected with alcohol (alcoholic rub). This is a more effective method to remove and kill transient microorganisms.

The distinction between the need for social handwashing and hygienic hand washing may not always be clear. A thorough social hand wash may be appropriate if disinfectants are not available.

Surgical handwashing is performed with the aim of removing and killing the transient flora and decreasing the resident flora in order to reduce the risk of wound contamination if surgical gloves become damaged. Agents are the same as for the hygienic hand wash.

A defined technique for decontamination of hands is probably of greater importance than the agent used. The technique presented in Figure 4.1 is recommended.

When to wash hands
Social handwashing
  • before handling food, eating
  • before feeding the patient
  • after visiting the toilet.
Hygienic handwashing or alcoholic rub
  • before and after nursing the patient
  • before performing invasive procedures
  • before caring for susceptible patients (such as the immunocompromised)
  • before and after touching wounds, urethral catheters, and other indwelling devices
  • before and after wearing gloves
  • after contact with blood secretions or else following situations in which microbial contamination is likely to have occurred
  • after contact with a patient known to be colonised with a significant nosocomial pathogen (such as MRSA, MDRKlebsiella)
An alcoholic hand rub, ideally from a dispenser at the patient's bedside is the most efficient and least time consuming procedure for hand decontamination.
Surgical handwashing
  • before all surgical procedures
Methods
Watches and rings reduce hand washing/disinfection effectiveness and should be removed during hand hygiene. Some suggest that they not be worn in patient care.

Social hand washing
In social hand washing, vigorous and mechanical friction is applied to all surfaces of lathered hands using plain soap and water for at least 10 seconds using a defined technique (Fig. 4.1). The hands are rinsed under a stream of water and dried with paper towel.  In the absence of running water, a clean bowl of water should be used. The bowl should be cleaned and water changed between each use. Alternatively, a drum with a drain spout could be elevated to serve as running water. Similarly, in the absence of paper towels, a small clean cloth could be used, but the towel should not be used for extended communal use and should be discarded after each use into a bag designated for laundering and reuse.
In places where there is frequent disruption of water supply, water should be stored in large receptacles whenever water is available. The water should be free from infectious agents.

Recommended hand wash agents
Hygienic hand washing/disinfection
Aqueous
  • 4% chlorhexidine gluconate/detergent solution
  • Povidone - iodine/detergent solution containing 0.75% available iodine
Wet hands with clean (running) water or, if not available, from water in a bowl. Apply cleanser (3-5 ml) depending on the product or thoroughly lather with soap.  Wash the hands for 10-15 seconds, applying friction over all hand surfaces, rinse and dry as described above.
Alcoholic
  • 0.5% chlorhexidine or povidone-iodine in 70% isopropanol or ethanol
  • 60% isopropanol or 70% ethanol without antiseptic
Apply not less than 3ml of the preparation to the hands and rub to dryness (approximately 30 seconds). Alcohol is more effective than aqueous antiseptic solutions, but a preliminary wash may be needed for physically soiled hands. Alcohol is an effective alternative when there is no water or towels readily available and there is need for rapid hand disinfection. Alcohol products with emollients added will cause less skin irritation and drying to hands (1-3% glycerol).

Surgical hand washing/disinfection
Agents for surgical hand washing are the same as for the hygienic hand wash. The difference is the time of scrub that is increased to 2-3 min and should include wrists and forearms. If an alcoholic preparation is used, two applications of 5ml each rubbed to dryness are suggested.
  • Sterile disposable or autoclavable nailbrushes may be used to clean the fingernails only, but not to scrub the hands.
  • A brush should only be used for the first scrub of the day.
  • After hand washing with soap and water, a hand rub with an alcoholic base formulation (70%) should be used if possible. This enhances the destruction or inhibition of resident skin flora.
  • Sterile towels should be used to dry the hands thoroughly after washing and before alcohol is applied.
Important Points to Note
  • When bar soap is in use, it should be kept dry to prevent contamination with microorganisms that grow in moist conditions.
  • Liquid soap dispensers should be regularly cleaned and maintained.
  • Gloves should not be regarded as a substitute for hand hygiene. A glove is not always a complete impermeable barrier (20-30% of surgical gloves are punctured during surgery). However, gloves reduce very substantially the number of microorganisms being transferred to the patient or to the HCW who is wearing the gloves. Gloves also provide some protection against the transmission of blood-borne viruses.
  • In an epidemic situation, hand hygiene and the use of gloves are important protective measures to prevent the transmission of infectious agents to susceptible patients or staff. The same glove must not be worn from one patient to another patient, or between clean and dirty procedures on the same patient.
  • An alcoholic rub or hand wash should be performed after removing gloves and before sterile gloves are worn.
In areas where gloves are not readily available, latex gloves can be washed with soap and water, dried, powdered, sterilized or high level disinfected and reused. Sterilisation is preferable for surgical procedures.

Minimal requirements
  • Watches and rings reduce hand washing effectiveness and should be removed.
  • Wash hands with soap and water and dry thoroughly with a clean towel at the start of a clinical shift or if hands become grossly soiled.
  • Decontaminate hands with a hand disinfectant or alcoholic rinse or rub between each patient contact.
  • Perform a surgical scrub before each operation.
  • Wear gloves as necessary to reduce transfer of organisms to patient and to reduce transmission of blood borne viruses.
Bibliography
  1. Standard principles for preventing hospital-acquired infections. Journal of Hospital Infection 2001;47(Suppl):S21-S37.
  2. Guideline for Hand Hygiene in Healthcare Settings - 2002. MMWR 2002;51(RR-16):1-44.

Thursday, July 10, 2014

Are relief groups underperforming on emergency response?

https://www.devex.com/news/are-relief-groups-underperforming-on-emergency-response-83835

International Development Business

EMERGENCY RESPONSE

Are relief groups underperforming on emergency response?

By Carlos Santamaria08 July 2014
A view of the Zaatari refugee camp in Jordan, where many Syrian refugees are staying. A new report by the Médecins Sans Frontières highlights areas where emergency response need improvement. Photo by:Mohamed Azakir / World Bank / CC BY-NC-ND
International aid organizations are not responding to humanitarian emergencies as well as they should because they put more emphasis on reporting results and fundraising than actual development work, according to French medical group Médecins Sans Frontières.
MSF  — with a long history of criticizing the U.N. for its role in such situations —  said in a new report published on Monday that humanitarian work on the ground “has been undervalued and under-prioritized” in favor of avoiding risks and securing funding for current and future programs in countries like the Democratic Republic of the Congo, South Sudan and Syria.
That’s why the humanitarian response to the crises in these conflict-ridden nations lacks the technical capacity that well-funded top international NGOs in theory should be able to deploy, the survey adds. The report also accused organizations of leaning heavily toward “easier projects” when faced with logistical or access difficulties.
And — as expected — the French medical group singled out the United Nations.
"The current U.N. system inhibits good decision-making, in particular in displacement crises where a number of UN agencies have a responsibility to respond," Joanne Liu, MSF's outspoken international president, noted in the report, while co-author Sandrine Tiller defined the way the world body works in these countries as “just a chain of subcontracts" that passes on the responsibility from U.N. agencies to an implementing iNGO, then a local NGO, “and at the end, there's no one in the field.”
It’s not uncommon for such grave humanitarian emergencies as those in the DRC, South Sudan or Syria to brew sentiments of frustration between and among aid organizations — and MSF in particular has always been quite vocal about how they view the current status quo in emergency work.
Just in the past year, the organization first claimed that U.N. agencies were not delivering on their pledges to prepare adequately for the rainy season in South Sudan, and then accused them of an “appalling performance” in their response to the crisis in the Central African Republic.
Do you agree with MSF? If you are an aid worker responding to a humanitarian emergency, please share your thoughts by leaving us a comment below, joining ourLinkedIn discussion or emailing us at news@devex.com. If you wish to remain anonymous, you may contact the author directly at carlos.santamaria@devex.com.
Read more development aid news online, and subscribe to The Development Newswire to receive top international development headlines from the world’s leading donors, news sources and opinion leaders — emailed to you FREE every business day.

About the author

Carlos stamaria 400x400 v2
Carlos Santamaria
As associate editor for breaking news, Carlos Santamaria supervises Devex's Manila-based news team and the creation of our daily newsletter. Carlos joined Devex after a decade working for international wire services Reuters, AP, Xinhua, EFE and Philippine social news network Rappler in Madrid, Beijing, Manila, New York and Bangkok. During that time, he also covered natural disasters on the ground in Myanmar and Japan.

AU Assembly Decision, Establishment, and Roadmap\Time for African Centre for Disease Control and Prevention

The information listed below are excepts from the African Union 1st African Ministers of Health meeting jointly convened by the AUC and WHO April 14-17, 2014 in Luanda, Angola  to discuss the establishment of an African Centre for Disease Control and Prevention.   Proposed location and roadmap\timeline for implementation are provided in the following proposal annexes.

BEMA





ANNEX 1 

AU Assembly Decision on ACDCP
                                                                              Assembly/AUDec.499 (XXII)

Decision on the Establishment of an African Centre for Disease Control and Prevention (ACDCP)
Doc.  Assembly/AU/16/(XXII)Add.4

The Assembly,

1.  RECALLS the Abuja Declaration of 16 July 2013;

2.  TAKES NOTES of the proposal of Ethiopa to host the Centre in Addis Ababa;

3.  STRESSES the urgency of establishing the Centre;

4.  REQUESTS the Commission to work out the modalities, in collaboration of
     with the Governments of the Federal Democratic Republic of Ethiopia and
     other interested Member States including the legal, structural and financial
     implications relating to the centre and to submit a report in January 2015
     to the Assembly.




ROADMAP

The ACDCP could be operational by the end of the first quarter of 2015 if everything goes according to plan. To that end, a roadmap is proposed below:

ROADMAP TO ESTABLISHMENT OF THE ACDCP

TASK                                 DESCRIPTION                                     TIME-LINE
Stakeholders meeting   Inaugural meeting to discuss the operationalization of ACDCP.         June 2014

Stakeholders meeting   Meeting of relevant experts to discuss the legal requirements  
                                  and implications.                                                                             June 2014

Situation analysis         Recruitment of a consultant to map the existing regional facilities 
                                  (centres of excellence, capacity building organizations, etc.) providing
                                  support to African countries.
                                  This could include a feasibility study in terms of current national and 
                                  subnational networks available, and cost-benefit analysis of the Centre. 
                                         -----------------                                                                                            
                                  Recruitment of a consultant to undertake a desk review of disease patterns 
                                  and map hot-spots with a quantification of the work to be done to address 
                                  the disease burden.
                                         -----------------
                                  This could also include mapping of capacities, taking into account the 
                                  work already done by other stakeholders such as WHO/AFRO in supporting 
                                  countries for capacity assessment                                                   July-August 2014

Stakeholders meeting:
planning                       Based on the outcome of the situation analysis, a site for the headquarters 
                                   will be identified, a human resource plan developed, priority activities identified,
                                   and centres identified.                                                                  September 2014

Financial valuation        Following elaboration of the structure and activities, a financial evaluation may be
                                   carried out to assess the costs of running the ACDCP.                  October 2014

Expanded stakeholders meeting
                                   The meeting is aimed at mobilizing resources. Participants will include 
                                   representatives of countries, AUC, UN agencies, development partners 
                                   and other potential financial contributors.                                       November 2014

Stakeholders technical meeting
                                     The meeting will develop the ACDCP’s standard operating guidelines, staff ToRs 
                                     and guidelines for supporting African countries. The meeting will also develop
                                     procurement plans, human resource recruitment plans, etc.           November 2014

Operationalization         Staff will be recruited, equipment procured, office space secured and demand created.                                                                                                                                       March 2015

Business development    Exploring new area of work, creating demand and mobilizing resources.
                                                                                                                                      On -going







Wednesday, July 9, 2014

REVISIT AND IMPLEMENT. African Union: African Centre for Disease Control, Prevention (ACDCP)



Now is the time for Nigeria to take the 'leap' in in responding to the Ebola Pandemic for AU member states to recognize its ability to respond to this and future disease outbreaks especially in the identification, response, and recovery.


http://www.dailytimes.com.ng/article/fg-wants-african-centre-disease-control-prevention-nigeria

Daily Times Nigeria

FG Wants African Centre for Disease Control, Prevention in Nigeria

The Federal Government has requested that the proposed African Centre for Disease Control and Prevention (ACDCP)’ be set up in Nigeria, Minister of Health, Dr Onybuchi Chukwu, said.
Chukwu said  in Luanda that the request was made to the Conference of African Union Ministers of Health and World Health Organisation.
Chukwu cited the Nigeria Centre for Disease Control (NCDC) as a yardstick for the request, saying Nigeria was the first in Africa to establish such a centre.
He said that the Nigeria centre had been doing well in conducting researches on disease outbreak, prevention and other public health issues.
`` Nigeria, so far, has the best disease surveillance system according to WHO, on the continent of Africa.
``Actually, Nigeria was the first to offer to host the African Centre for Disease Control followed by Ethiopia and since then we have been working toward it.
``It was inconclusive, though Ethiopia brought it up, the decision was that we should still do more consultation and I believe what we are saying here is part of that consultation,’’ he said.
Chukwu said many countries outside Africa, including the U.S., supported the ACDCP initiative.
``The idea is to have a strengthened centre for disease control so that when we have an outbreak it will take the lead in investigation and treatment,’’ he said.
Chukwu recalled that Nigeria was the first country to host its neighbours in 2012 to discuss disease control.
He said WHO recognised that meeting as the first of its kind in the world that a country initiated.
``What we need is what we always say since 2010 when we first called that meeting on cross border infection control.
``Infections do not care for passport or visa, diseases just move across borders, not something a single country can curtail.
``You will see what has happened recently, an outbreak started in Guinea before you knew it, it spread to three other countries,’’ he said.
Chukwu commended President Goodluck Jonathan for his support for the establishment of the Nigeria Centre for Disease Control and Prevention.
On the establishment of African Medicine Agency, Chukwu said Nigeria was still in the lead as no other country in the continent had been able to establish a similar body to National Agency for Food Administration and Control (NAFDAC).
He said NCDC, NAFDAC and FRSN were three institutions in Nigeria that had not been replicated in other countries.
``So, Nigeria is solidly behind this establishment of a common body that can regulate drugs within Africa, ‘’he said.
Chukwu lauded ministers of health in Africa for doing much regarding the health sector, including the establishment of African Public Health Fund.

Tuesday, July 8, 2014

Liberia: U.S. Government Donates Personal Protective Equipment to Support the Response to the Ebola Outbreak

http://allafrica.com/stories/201407031354.html

Liberia:  U.S. Government Donates Personal Protective Equipment to Support the Response to the Ebola Outbreak


PRESS RELEASE
Monrovia — The U.S. Government has donated another supply of Personal Protective Equipment (PPE) to the World Health Organization to support the international response to the Ebola outbreak which is affecting Liberia, Guinea, and Sierra Leone.
The donation, including aprons, face masks, gowns, caps and cadaver bags, are in addition to a previous donation by the U.S. Government. Last week, the U.S. Government made a similar donation, including rubber boots, coveralls and gloves, which will protect health workers who are at the forefront of providing essential care to patients who are suspected or confirmed to have the Ebola virus. Health workers who use the protective equipment as recommended are protected from exposure to blood or body fluids from infected patients.
In presenting the items, the U.S. Agency for International Development (USAID) Liberia Mission Director, John Mark Winfield, said the U.S. Government is committed to helping in the fight against the spread of the Ebola virus.
World Health Organization Representative to Liberia Dr. Nestor Ndayimirije, who received the donations, immediately passed the essential equipment to the Ministry of Health and Social Welfare, and thanked the U.S. Government for the donations, which he said will help boost Liberia’s response to the Ebola virus.

Dr. Ndayimirije said partnership was important in the fight against the outbreak, and urged stakeholders to unite to improve the response by making sure no health worker is infected and dies because of the lack of protective gear.
In receiving the PPE, Liberia’s Chief Medical Officer, Dr. Bernice Dahn, warned that communities and religious institutions should not try to serve as health facilities. She said Liberians are still in the denial stage, which is fuelling a deterioration of the situation. “At this point, you do not know what you are dealing with,” Dr. Dahn said. “So, don’t keep sick people in your homes or facilities. “
Three weeks ago, Liberia experienced a second wave of the outbreak. Since that time, more than 30 persons have died of the disease.
The U.S. Government has provided additional support to Liberia, Guinea and Sierra Leone to mitigate the Ebola outbreak, which includes supplying materials and messaging in communities to prevent the spread of Ebola, training environmental health technicians, financial support for deployment of field teams to the WHO Africa Regional Office and WHO's Global Outbreak Alert and Response Network (GOARN), training of health workers in contact tracing, and the provision of essential supplies for collection, preservation, transport and analysis of blood specimens.

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