bluuebunny/crossref_metadata_2025 huggingface dataset:
Case simulations for permanent education in Primary Care – School of Patients DF
Authors: Cubas-Rolim E , Yung F R , Gripp M R , Oliveira C L A , Marques L A , Fagundes M C , Souza B V , Ribeiro L , Faria-Tostes E , Santana F
Published: October 2020

Background

In scenarios of vulnerability that include triple charge of diseases, permanent education in Primary Care and university is fundamental to allow greater access, efficiency and safety for users and health teams.

Objectives

The School of Patients DF was created as a tool for popular and technical health education, including case simulations for practice. It consists of standard technical content (Chapters), categorized by conditions and diseases, shared by Google Drive and used primarily in selected primary care units of Brazil's capital city.

Results

Technical simulations are performed in pairs, 1 participant acts as “patient” with script in hand (topics of the training) while the other acts as “health professional” as if in a regular visit. Simulations are timed for 10 minutes for consultation and 5 for feedback, boosting learning. Contents are based on guidelines and protocols from the Ministry of Health, Secretary of Health and Brazilian Community and Family Medicine Society. Since 2016 there have been realized over 1400 simulations, including weekly classes for last term medical students at the capital city federal university.

Conclusions

Simulations optimize the time necessary for permanent education (15 minutes blocks), avoiding limiting access for triage and consults, allowing smaller groups to train with greater focus and independent of computers or projectors.

Key messages

Standardizing training and practice bring benefit to patient care and safety. Simulations with structured physical examination are important both for professional as well as students.
Organizational well-being among healthcare workers of middle management: a pilot study
Authors: Piras I , Vivolo M , Portoghese I , Azara A , Piana A , Galletta M
Published: October 2020

Background

The organizational well-being assessment makes possible to identify risks for health in workers and organizations and to introduce health promotion actions in the workplace. The aim of the study is to analyze the organizational well-being among health professional managers who manage professional groups (e.g., nurses, midwives, physiotherapists) in hospital and identify potential main discomfort factors of these middle management workers.

Methods

A bicentric pilot study was performed in October 2019. A questionnaire with validated scales was administered to all the health professional managers of two Italian hospitals. The scales investigated variables such as distress, stress risk factors (e.g., physical and emotional workload, job control, job autonomy, role clarity, relationships, support), well-being, and job satisfaction.

Results

A self-reported questionnaire was administered to 38 out of 40 managers. They were male for 21% and female for 79%. The average age was 53.9 years. T-test analysis showed no significant difference between the two hospitals. The entire sample shows low general distress level, but 25% of the sample declares moderate distress and 8% high distress. The managers refer pace and workloads often (37%) or always (47%) excessive, they refer to not be able to 'detach' themselves from work issues when they get off work (60%) and to be too tired to live their lives (63%). They report that rarely (29%) or never (43%) have a say in how to do their job and refer that their direct supervisor is never available to listen their work problems (43%). The managers often or always perceive tension in working relationships (49%) and refer to do not have the needed support from colleagues (56%). Thirteen percent of managers applied for move into another ward.

Conclusions

This study shows that health professional managers experience general working discomfort and perceive problems with regard workload and poor support from colleagues and supervisors.

Key messages

Managers’ well-being can be compromised by both organizational and relationship factors. Middle management well-being should be improved to reduce distress risk and increase professional team efficacy.
The Italian validation of the revised Incivility in Nursing Education survey: preliminary results
Authors: Unim B , Santini M , Gambale G , Chiarini M , Nicoli M , De Vito C , Cattaruzza M S
Published: October 2020

Background

Incivility in nursing education is defined as rude or disruptive behaviors that can result into psychological or physiological distress for the people involved. Therefore, academic nursing incivility may seriously impact the nursing profession. The revised Incivility in Nursing Education (INE-R) is a validated instrument to measure academic incivility, but it is not available in Italian language. The aim of the study is to translate and validate the INE-R survey instrument with an Italian sample.

Methods

The Italian version of the INE-R survey was piloted for content and general linguistic clarity. It is currently administered online to nursing faculty (NF) and nursing students (NS) of Sapienza University of Rome. The survey explores uncivil behaviors and their frequency of occurrence among NF and NS. It also collects suggestions for improving the level of academic civility.

Results

To date, 33 responders (8 NF and 25 NS) have completed the survey, of which 45,5% consider incivility in their department a moderate problem. A common NF uncivil behavior was canceling class without warning (39%), while arriving late for class was common among NS (40%). The top strategies to improve the level of civility in nursing education are the adoption of codes of conduct that define acceptable and unacceptable behaviors (39%) and the provision of training for effective communication and conflict negotiation (33%). The main consequences of incivility in nursing education are inappropriate teaching practice and poor quality education (54,5%).

Conclusions

Incivility in nursing education negatively affects teaching-learning process and can lead to emotional, or physical distress for faculty staff and students. There is therefore a need for specific policies and continuous monitoring on academic incivility to guarantee a healthy work and study environment. It is important to raise awareness among students and faculty while adopting zero-tolerance policy regarding incivility.

Key messages

Incivility in nursing education negatively affects teaching-learning process and can lead to emotional, or physical distress for the individuals involved. There is a need for specific policies and continuous monitoring on academic incivility to guarantee a healthy work environment.
The effectiveness of leadership: meta-analysis of trial, cross-sectional, and before after studies
Authors: Restivo V , Gaeta M , Odone A , Trucchi C , Battaglini A , Carli A , Capraro M , Minutolo G , Casuccio A , Favaretti C
Published: October 2020

Background

The clinical and surgical procedures are often based on scientifical evidence but 30-40% of patients do not receive treatment according to evidence based medicine. The main aim of this review and meta-analysis is to assess the effectiveness of leadership in healthcare setting.

Methods

It was conducted a literature research on MEDLINE, Pubmed and Scopus with publication year between 2015 and 2019. The inclusion criteria were studies involving healthcare workers that evaluated effectiveness of opinion leaders in improving behaviour of healthcare workers, according to clinical or patient related outcomes. The quality of studies were assesed with the NHLBI for before after studies and the NOS for other study designs. The effect of leadership was assessed as risk difference for all studies with the exception of cross sectional studies. For the last it was evaluated correlation between leadership level and outcome measurment.

Results

A total of 3,155 articles were screened and 284 were fully assessed including 22 of them in the final database: 1 randomized trial, 9 cross sectional and 12 before after studies. For the cross-sectional studies there was a correlation of 0.22 (95% CI 0.15-0.28) between leadership level and outcome measurment. In the metaregression analysis the only factor that increased the correlation was private setting (meta regression coefficent =0.52, p = 0.022). The pooled efficacy was 24% (95% CI 10%-17%) for before after studies. Furthermore, a higher effectiveness was revealed in studies conducted on multi professional (24%) than single professional (9%) healthcare workers.

Conclusions

According to results, the guidelines adherence and task performance increased in a setting with leadership implementation. The leadership effectiveness appears comparable to other strategies as audit and feedback used to implement evidence-based practice in worldwide healthcare.

Key messages

The translation of evidence into clinical practice is often difficult but this study suggests that leaderhip can had higher effectiveness in multiprofessional healthcare workers and private setting. The effectiveness of leadership in this review suggests that it can be of help in order to make aware healthcare professionals about effectiveness of comply with evidence-based practice.
Global PhD Programme in Public Health Sciences boosts international collaborative doctoral training
Authors: Bauwens J , Schulze M , Nocera S , Flahault A , Crivelli L , Walser A , Künzli N
Published: October 2020

Background

The Swiss School of Public Health's (SSPH+) Global PhD Programme in Public Health Sciences (GlobalP3HS) is a doctoral programme, promoting transnational education and mobility co-funded by the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 801076. Students from abroad absolve a PhD training at one of the 12 SSPH+ partner universities in Switzerland.

Objectives and Methods

GlobalP3HS aims to train the next generation of public health leaders in both the academic and non-academic sector. Specific attention was given to PhD studies under the “sandwich model” (SM) which fosters research of students from low/middle income countries (LMIC) conducting LMIC-relevant PhD studies in collaboration with an LMIC-based academic institution. The SM targets at increasing chances for LMIC-based postdoctoral careers. The five year programme (October 2018 to September 2023) provides 42-months fellowships to profit from PhD programmes at a Swiss university. Top-scoring candidates were selected in a transparent, merit-based procedure by an international jury, considering students' background and motivation; innovation; methodological quality; public health relevance; and feasibility of the proposed research.

Results

Out of 342 valid applications, the jury scored 147 as eligible (score 8-10). In total, 53 students (31 women) were successful in matching up with co-funding supervisors. PhD-students from 31 countries representing all global regions, including 21 PhD under the SM, are enrolled at seven Swiss SSPH+ partner universities.

Conclusions

GlobalP3HS is an innovative solution to strengthen global research collaborations. The SM abates “brain drain” as it clears the path for successful careers in LMICs, where graduates become change makers capitalising on solid academic collaborations with the SSPH+ network.

Key messages

GlobalP3HS trains PhD fellows in public health sciences to become change-making leaders in academic institutions and public health organisations. GlobalP3HS is an initiative from the Swiss School of Public Health strengthening equitable, fair, balanced, and innovative inter-university and global partnerships.
The communication between physicians and patients
Authors: Kucuk Bicer B
Published: October 2020

Background

The first appointment between the physician and the patient is unknown. The aim of the study was to evaluate the communicative skills of the physician with the patient through the eye of the latter.

Methods

This descriptive study has been conducted in the clinics of a university hospital in Ankara. After physical examination a questionnaire, including socio-demographic properties and relations between the physician and patient, was applied under observation to 200 participants.

Results

Of the participants 56.5% were female, 47.5% were under 30 and 45.5% were high school, 16.0% were university graduates. 60% stayed in the examination room for 10 and 32.5% 5 minutes. 62% stated the conditions in the examination room were totally satisfied, 10% were partially and 28% were unsatisfied. “My doctor accepted me with a smiling face” has received the highest positive answer during initial communication with 78%, while “My doctor had a conversation with me” has got the lowest positive answer with 44%. “My doctor paid special attention to my privacy” has been to one to receive the highest positive answer during examination(90.5%), the lowest positive answer was “My doctor took notice of my social and cultural values”(45%). After examination, “My doctor was very kind and friendly” has received the highest positive answer(89%). “He listened to my opinions for the treatment” has been given lowest positive point 55%. “I recommend my doctor to other people” was accepted by 95.2%. Ages over 30 had more positive answers than younger participants in every item whereas two were significant (p < 0,05). Male had given more positive answers in every item and 8 items were significant (p < 0,05). “He listened to my opinions for the treatment” item received positive answer from 80% of those with a secondary education degree and 48% for the high school or university graduates (p = 0.023).

Conclusions

The manner that was used for communication in clinic was acceptable by the patients.

Key messages

The regulations/awareness of patient-physician rights the communication between the physician and patient has been favourably affected by the increasing satisfaction of patients from health services. Patients still have problems related to communication while their checkups in hospitals. Communication skills must be taught in internships also.
Self-evaluation of the success of the main core skills taught in six years of medical education
Authors: Kucuk Bicer B , İlhan S
Published: October 2020

Background

The aim of medical education before graduation is to train qualified physicians who have the knowledge, skills and attitudes that can provide qualified services, who can improve themselves continuously, acquire problem-solving skills and have clinical competence. We would like to determine how the interns feel about their practice and knowledge and just before the field.

Methods

A questionnaire was developed by the medical education specialist according to the curriculum. Every skill was majored from 1(insufficient)-10(sufficient) points. The questionnaire was tested with 10 students. The forms made of 25 questions were sent by Google forms and 172 (51%) interns replied. Ethical approval was taken from the university committee.

Results

Of the participants 62.3% was female and 61.1% was born in 1995. 18.1% of the students repeated the class. 29.2% of interns gave a score of 5 and below to the question of gaining the ability to make the diagnosis of the patient. 40.3% didn't gain the ability to make decisions on both the therapy and the tests; %93 didn't gain the implementation of intrauterine device skill, 20.9% didn't gain the ability to suture, %15.3 didn't gain the ability of CPR. 40.3% thought that they're not clinically sufficient.

Conclusions

The medical education and the curriculum might be revised and the theoric burden on students can be reduced. Moreover pratical skills can be thought on more simulators and simulated patients.

Key messages

The curriculum used in medical faculties should evolve more to practical based patient services. Medical students can evaluate themselves and can make the need assessment for thrown training.
Caring for refugees: Training the health workforce towards structural competence and responsibility
Authors: Ziegler S , Kratochwill S , Jahn R , Bozorgmehr K , Rast E
Published: October 2020

Background

Providing high-quality health care to superdiverse populations of newly arrived refugees poses specific structural, organisational, communicative, ethical and medical challenges that medical students in Europe are often not systematically prepared for. We created a clinical elective, to enable future doctors to identify and address the needs of refugee-patients and deliver high quality care to this population.

Objectives

We provided medical, structural, administrative, communicative and socio-cultural knowledge and skills training through seminars (24 h) and field placements (2 days) in a reception centre clinic for refugees. The training aimed at stimulating a systematic professional, personal, scientific, and political reflection, to foster social accountability, and raise awareness for the special situation of vulnerable groups. The didactic concept built on multidisciplinary lectures, student centred teaching, and research-oriented learning. Mainly qualitative summative and formative evaluations were applied to improve the course and examine training outcomes.

Results

A total of 112 students completed the elective over four terms, 50 evaluated it, of which 80% considered it worthwhile. Self-reported competencies in caring for refugee patients were low at the beginning and increased after course completion. The most important learning outcomes were knowledge of the asylum-law, gaining a multi-perspective view through multiple disciplinary lenses as well as professional, ethical, interpersonal and political insights during practical experience and reflection.

Conclusions

A multidisciplinary course that combines theory, practice and reflection, can prepare students for the complex challenges medical professionals face in caring for refugees. This could help strengthen their professional role as advocates of health equity. Our innovative didactical approach, course and evaluation concept can inspire the creation and implementation of similar courses elsewhere.

Key messages

The health workforce needs training to identify, address and help compensate respective barriers to health care and foster equal opportunities to health for refugees. A multidisciplinary teaching concept, tailored to specific target groups can help make future doctors and nurses in Europe fit for their responsibility and work in plural and ever changing societies.
Management model of primary health services and interprofessional practice in Brazil
Authors: Silva J A M , Souza G C , Mininel V A , Agreli H F , Peduzzi M , Ogata M N , Machado M L T , Feliciano A B , Sampaio S F , Pedro W J A
Published: October 2020

Background

Brazilian primary health care is organized by decentralized Family Health Strategy composed with interprofessional teams. This study focused on finding out how are the relationship between the management model of primary health services and interprofessional practice.

Methods

Qualitative study, part of a mixed-methods sequential explanatory design. Thirteen semi-structured interviews were conducted with health managers from six Brazilian municipalities. Data were collected between October and December 2018 and applied content analysis.

Results

The results allow three major content categories, 1) “Characteristics of management models to support interprofessional practice”: continuous communication among managers, health care professional and patients is the principal attribute of management. The interviewed mentioned the need to communicate with teams using regular meetings and technological resources. They recognize the availability of interprofessional practice in favour of dialogue, shared decision and physical space. In order to patient engagement, they adopted open communication with patients focused on spontaneous demands. 2)”Management actions for comprehensive care”: the interviewed recognized the lack of services integration and interprofessional teams. They mentioned participatory management strategies as team meetings in health services and engagement in public health council to shared health planning. 3)”Challenges for management interprofessional practice”: Challenges considered the lack of permanent policies focused on patient needs, frequent changes of the municipal managers and health care professionals, the lack of planning actions, and the need to meet spontaneous management demands.

Conclusions

Management practices can support interprofessional practice and comprehensive care however challenges are related to non-permanent policies, unplanning actions and spontaneous management demands.

Key messages

Communication is the principal attribute of the management model of primary health services to reinforce interprofessional practice. Compreehensive care depends on patient and interprofessional teamwork engagement for share decision making.
Education through Health Work: the knowledge and practice of health professionals in Brazil
Authors: Barreto L , Dal Poz M
Published: October 2020

Background

The Study discusses education through health work in Brazil through socio-historical and political-economic analysis to face the movement for reorienting professional training in health. Workforce planning, successful experiences and alternatives in inter-ministerial programs show a policy of professional training in health with an international influence on the health paradigm for tackling social inequalities (WHO, 2006). Importance of the research lies in the analysis of the health needs of the population with no answers. Guiding question inserts the dissociated character between the professional training model of higher education schools in health and the work redefined by the Unified Health System (SUS).

Methods

Integrative Bibliographic Review of documents related to the model of training through health work in the database of the Virtual Health Library (VHL), Mapping of Interministerial Programs to design the model for reorienting the National Policy for Permanent Education in Health (PNEPS) and National Curricular Guidelines (DCN's). The selected information sources with inclusion criteria used studies in the form of articles, ministerial documents and professional training.

Results

Brazil portrays the replacement of the health care model by SUS and by the political ordering of professional health education curricula, however, higher education institutions, still remain resistant.

Conclusions

The curricular reorientation is identified in successful experiences of higher education courses and practices, creation of the Secretariat for Management through Health Work (SGTES), insertion of inter-ministerial education programs through health work that promote change through alternative curricula within health schools.

Key messages

Education through health work. Professional training in health. Interministerial education / health programs.
Prevalence of intestinal parasites and associated risk factors in primary school children, Lahore
Authors: Abdul Latif A , Butt A , Mansha M , Fatima S , Farooq A
Published: October 2020

Intestinal parasites are the major reasons for deaths all over the world especially in the third world. Poverty, poor sanitation, unclean drinking water, moist environment are the conditions for these parasitic ailments. Poor personal hygiene among children is considered an effective cause of parasitic invasion. In present study the prevalence of intestinal parasites and their associated risk factors were determined among the school children of Lahore. A total of 150 faecal samples were collected from the children of 3-15 years of age belonging to Private and Government Schools. Different techniques like Direct smear method, Formalin ether concentration, Sedimentation and McMaster were used to identify different stages of intestinal parasites. The parasites found were Giardia lamblia (4.66%), Entamoeba histolytica (3.3%), Ascaris lumbricoides (4.66%), Taenia saginata (4%), Hymenolepis nana (2%), Trichuris trichura (2.66%) and Enterobius vermicularis (4%). A. lumbricoides was found to the most frequent of all parasites. The prevalence was higher among the children, with poor hygiene, having lack of education especially of mothers because they play a big role in child's upbringing and maintaining his good health. Educating cleanness alertness on parasitic diseases and application of helpful strategies for parents to raise socioeconomic circumstances may decrease the load of infection.

Key messages

Educating cleanness alertness on parasitic diseases and application of helpful strategies for parents to raise socioeconomic circumstances may decrease the load of infection. Health is Wealth.
The role of water distribution system in HCAIs
Authors: Mazzitelli F , Genovese C , D'Amato S , La Fauci V , Maisano D , Costa G B , Ceccio C , Squeri R
Published: October 2020

Introduction

The water distribution system in hospitals may constitute a source of healthcare-associated infections. Understanding the means of acquisition, sources and reservoirs of nosocomial pathogens is crucial for developing methods to reduce the incidence of nosocomial infections. The aim of our study was to evaluate the microbiological contamination by Pseudomonas aeruginosa in the water system of the University Hospital “G. Martino” in Messina over a period of nine years, in order to a) clarify possible relationship between the presence of aerators and contamination, b) to highlight the presence of a yearly variation and c) to verify the statistical difference between microbiological contamination of taps with and without filters.

Materials and

Methods

We carried out a retrospective study for nine year through the collection of water samples that were analysed for total bacteria count and Pseudomonas aeruginosa. The differences between the results recorded over the nine-year study period were evaluated using variance analysis. P values of < 0.05 were considered statistically significant. Software R was used for statistical assessment.

Results

We analysed a total of 6168 samples with a positive rate of 9.31% and a decreasing trend over the nine years to a value of 2.44% (p < 0.001), due to the elimination of the aerators of taps without filters and also to the introduction of filters in taps of high-risk wards and surgical rooms. We found statistical difference between taps with or without filter (p < 0.001) and a higher positive rate during the summer season compared to the other months. Also, an increase of the positivity rate was detected in some year due to the lack of monthly replacement of the filter.

Conclusions

These results reveal a high level of contamination of taps by opportunistic bacteria with severe implications especially for high-risk settings and therefore, the need to improve the management of these devices.

Key messages

Particular attention must be reserved to the water distribution systems in hospitals in order to prevent the spread of healthcare associated infections. The continued application and strengthening of guidelines and procedures is essential to limit the spread of multidrug resistant pathogens.
Legionella and agar cultures in healthcare facilities waters: a monitoring study in North-East Italy
Authors: Chirico L , Righini M , Bravo G , Mellace F , Cocconi R
Published: October 2020

Background

Water healthiness is fundamental in medical facilities. Monitoring Legionella spp. and agar cultures concentration is therefore very important. This study looks into these parameters to examine possible criticalities that could need interventions.

Methods

We collected 399 Legionella and 82 agar cultures withdrawals between November 2019 and February 2020 from 157 detection points (like taps and showers) in 31 structures of four health districts. Withdrawals referred to the 4 quarters of year 2019 (t1, t2, t3, t4). Legionella values were expressed in colony forming units (CFU)/l; agar cultures in CFU/ml. We performed a non-parametric analysis to compare mean values between districts. We used the statistical software package SAS version 9.4 for Windows, setting the significance level at α = 0.05.

Results

45% of structures presented at least one positive withdrawal for Legionella (in six we found positivity in more than 1 quarter). Concerning Legionella concentration, we found significant difference between districts in t2 (p = 0.012) and between wards of one district in t3 (p < 0.05). We observed agar positive values in 11 structures (in four cases in more than 1 quarter). In t4 we found a very significant difference (p < 0.0001) between agar values in the four districts, while in t3 we observed a non significant association (p = 0.067). In t3 we found a significant difference for agar values between wards of one district (p = 0.025). We finally considered the simultaneous presence or absence of Legionella and agar positivities: without considering quarters division, we observed accordance (both present or both absent) in 60 detection points, while in 34 points we didn't find it.

Conclusions

Data provided by this study show that Legionella is rather present in our districts, revealing an association with concentration of CFU in agar. Disinfecting operations should be implemented considering the differences between districts to provide a safe water in every ward.

Key messages

Water quality monitoring in healthcare facilities is fundamental to provide a safe and healthy environment. Legionella spp. and agar cultures concentrations depend by quarter and spot considered; focused operations should be taken into account to improve disinfection quality.
Antimicrobial resistance surveillance, intensive care units of a tertiary care hospital, Islamabad
Authors: Noreen N , Dil S , Ullah Khan N , Naveed I
Published: October 2020

Background

Hospital Acquired Infections (HAIs) are the emerging threat in the health care facilities around the globe. Most of Intensive Care Unit(ICU)patients are frequently on broad spectrum antimicrobials, this induces selective antibiotic pressure which leads to development of Antimicrobial Resistance (AMR) among the microorganisms of ICUs. Objective was to study the occurrence of different types of HAIs in patients admitted to various ICUs of and the AMR pattern of the bacterial pathogens isolated from them.

Methods

It was a retrospective descriptive study based on culture reports of the patients admitted to surgical, Medical ICU of tertiary care hospital during period from March 2019 to October 2019.

Results

Most common culture positive clinical specimen received was tracheal aspirate(35.3%) followed by exudate(22.7%).Pseudomonas from blood specimens were the most common organisms isolated; whereas Escherichia coli was the predominant organism found in urine, exudate and sterile fluid specimens. About 25% infections were HAIs, out of which pneumonia(7.24%)was the most common. Analysis of antimicrobial susceptibility pattern revealed that most of Gram-Negative Bacilli(GNB) was Multi Drug Resistant(MDR) resistant to three or more class of antibiotics such as cephalosporins, aminoglycosides, tetracyclines and fluoroquinolones.

Conclusions

Increasing trend of AMR among hospital acquired pathogens such as MDR-GNBs,MRSA and VRE pose a great threat to critically ill patients of ICUs. Study on AMR surveillance is the need of the hour as it helps the centers to generate local antibiogram which further helps in formulating the national data. Hence, such studies will be a stepping stone in establishing antimicrobial stewardship and regulate the antimicrobial resistance in future

Key messages

Study on AMR surveillance is the need of the hour. such studies will be a stepping stone in establishing antimicrobial stewardship and regulate the antimicrobial resistance in future.
Analytical approach for a better control of environmental contamination
Authors: Bosco R , Gambelli S , Urbano V , Cevenini G , Messina G
Published: October 2020

Background

The environment of hospital rooms plays a role on Hospital Acquired Infections. Objects may be repository of germs and have a role on cross contamination, mainly in high-touch surfaces. Proper sanitation and disinfection procedures are needed.

Aims

i) to highlight the different probabilities of microbial contaminations in Hospital, ii) to assess whether the use of a UVC device (UVC-D), after standard disinfection procedures, improves the level of hygiene.

Methods

Between November 2019 and February 2020 a cross sectional study in a real clinical context was conducted. Investigations were carried out in double rehabilitation rooms with patients admitted for at least 48h. 16 preliminary Petri dishes (PD) were used in one rehabilitation room and bathroom, to assess the contamination level after deep disinfection procedures (T0). Matched comparisons were made after the use of UVC-D, 3 points/room and 1 point/bathroom, 3 minutes each(T1). At T0 we estimated the probability of contamination to select the following sampling. Six rooms and bathrooms were investigated using randomized spots. PD were incubated at 36 °C and colony forming unit (CFU) counted at 48h. Descriptive statistic and Wilcoxon test were performed to assess the levels of contamination between (T0) and (T1).

Results

At T0 we have a mean of 5.83 CFU/PD (CI 3.79-7.86) and a median of 1.0 CFU/PD (min 0 - max 118); at T1 mean is 0.28 CFU/PD (CI 0.15-0.40) and median of 0 CFU/PD (min 0-max 5). Significant reduction of contamination was achieved between T0 and T1 (p < 0.001). 83,33% of the contamination sites had 0 CFU/PD after using UVC-D.

Conclusions

The probability approach has driven the selection of the highest contaminations spots. Standard disinfection, followed by using UVC-D, significantly reduces contamination assuring a lower probability of cross contamination and risk of infection.

Key messages

Analytical approach to assess the contamination level of room to address with greater precision the points with higher risk of cross contamination. The UVC technology assures better results when associated with standard sanitation procedure decreasing the risk of hospital acquired infections.
Ventilator-Associated Pneumonia: Incidence and risk factors six intensive care units in Tunisia
Authors: Cheikh A Ben , Bhiri S , ketaka N , Gara A , Khefacha S , Rejeb M Ben , Latiri H Said
Published: October 2020

Background

Ventilator-Associated Pneumonia (VAP) continues to cause significant morbidity, mortality, and hospital costs, especially in the intensive care unit (ICU). This study aimed to determine incidence and factors associated with VAP in six ICUs of the University Hospital-Sahloul (Sousse, Tunisia) in 2018.

Methods

We conducted a prospective observational cohort study over a three months period in six ICUs of the University Hospital-Sahloul (Sousse, Tunisia) in 2018. All patients hospitalized with mechanical ventilation (MV) for more than 48 hours in the ICUs were included. Logistic regression with the stepwise method of Hosmer and Lemeshow was used to identify factors associated with VAP.

Results

Overall, 110 patients were enrolled. The mean age of patients was 44 ± 25 years. Of them, 66.4% were male. The median duration of MV was 5 days [2-16]. The incidence of VAP was 32% and the density incidence was 33/1000 ventilator days. The most common organism were Pseudomonas aeruginosa (n = 14). Of them, 12 were ceftazidime-resistant and thee were resistant to imipenem. Independent risk factors associated with VAP in ICU were history of antibiotic therapy during last 6 months (p = 0.007), tracheotomy (p < 0.001) and reintubation (p < 0.001).

Conclusions

VAP rates in our ICUs were very high. Antimicrobial stewardship programs involving pharmacists and physicians must be elaborated to optimize the antibiotic prescribing. Mechanical ventilation require more-effective interventions control in our hospital.

Key messages

Ventilator-Associated Pneumonia rates were very high. Independent risk factors associated with Ventilator-Associated Pneumonia were history of antibiotic therapy during last 6 months, tracheotomy and reintubation.
SARS-CoV-2: Sanitize a hospital
Authors: De Caro F , Moccia G , Borrelli A , Annecchiarico A , Cioffi G , Campanella A , Motta O , Caputo V , Boccia G , Capunzo M
Published: October 2020

Issue

During the SARS-CoV-2 pandemic, several critical issues emerged. One of these was to identify which was the best terminal disinfection strategy for hospital rooms of a COVID-19. Description of the problem. Our University Hospital adopted ozone disinfection two years ago, recognized internationally as a 'safe gas' and is an excellent disinfectant for its characteristics of attacking and oxidizing each type of organic and inorganic compound and specifically also works against SARS-CoV-2.

Results

23 ozone generators were purchased, 20 ozonizers were assigned to departments with high environmental sanitation needs, 3 ozonizers supplied to the ozonator team. For the correct use of the equipment, 200 operators were trained in a certified way. The rooms are ozonated with pre-established frequency and whenever a COVID-19 patient is cared for. The ozonation team sanitizes rooms in wards that are not equipped but that may have hosted patients with carriers. Indications have been given in all the wards to create the ozonation room, that can be used as an ozone disinfection chamber, where it is possible to place garrisons and furnishings, even large-sized, that cannot be disinfected in other ways (in addition to sanitization with hypochlorite). The team also provides for the ozonation of ambulances with a predetermined periodicity or in the case of transport of patient carrying SARS-CoV-2. All activities are monitored with a special traceability card.

Lessons

Terminal disinfection of environments that have hosted patients with COVID-19. Terminal disinfection of the devices used on patients with COVID-19. Increased safety for operators carrying out environmental sanitation.

Key messages

Fight SARS-COV-2 with ozone. Disinfecting with ozone is safety for everyone.
Risk factors for sharps injuries and the prevalence of blood borne infections among paramedics
Authors: Gańczak M , Topczewska K , Korzen M
Published: October 2020

Background

Although paramedics constitute a group of medical professionals continually at risk for sharps injuries (SI), possibly resulting in occupationally acquired bloodborne infections (BBI), data on blood exposures in this group are rather scant.

Objectives

To assess the incidence and selected risk factors for SI and to estimate the prevalence of BBI among paramedics.

Methods

An anonymous cross-sectional serosurvey, with ELISA system used to detect anti-HBc/anti-HCV/anti-HIV, was conducted among paramedics from 10 randomly selected ambulance stations in West Pomerania, Poland, between December 2018-October 2019. Knowledge about infection-control procedures was assessed with the use of 10 multiple choice questions.

Results

Response rate: 93%. Among 286 participants (76.5% males, Me age 37 years, Me length of practice 14 years) 19.6% sustained ≥ 1 SI in the preceding year (Me = 6.0, range 1-100); 50.8% of incidents were not reported. Regarding the most recent SI - the most often it took place in an ambulance (45.9%), during an emergency procedure (76.3%) and was caused by a hollow-bore needle (60.7%); in 66.1% of cases the device did not have a safety feature. Risk factors for SI were as follows: 52.6% paramedics did not use safety engineered devices at work, 52.2% reported recapping a needle in the preceding year, 5.5% irregularly used gloves; 3.4% had never participated in infection control training. The mean knowledge score was 2.6. The lack of infection control training was associated with higher odds (OR 4.64) of a SI. HBV vaccination coverage was 95.6%. Anti-HBc were found in 7.3% participants, no anti-HCV/anti-HIV positive paramedics were recognized.

Conclusions

Frequent SI, about half of those unreported, are important risk factors which could contribute to occupational HBV infections reported among paramedics. The risk of SI could be reduced by supply with safety engineered devices, safe work practices and an adequate training in infection-control procedures.

Key messages

Most risk factors for sharps injuries among Polish paramedics are modifiable. Continuous exposure to sharps injuries should be taken into account while assessing paramedics’ risk for acquiring an occupational blood-borne infection.
A Mycobacterium chimaera infection after 12 years since cardiac surgery: a case report
Authors: Fabricci M , Vacchi O G B , Scarpis E , Brunelli L , Nalon S , Livi U , Cocconi R
Published: October 2020

Issues

Mycobacterium chimaera bacterium, firstly identified in 2004, is mainly present in drinking water but is generally not harmful for human health. Incubation period ranges from 3 to 72 months, with a median of 17 months. Clinical signs are fever, weakness and weight loss. The infection has a lethality rate of 50%. Invasive infections are associated to the use of Heater-Cooler-Devices (HCD) in cardiovascular surgery.

Description of the Problem

This work reports on an unexpected Mycobacterium chimaera infection case occurred after a time period much longer than what literature reports for both incubation and surgical infection. In January 2007, a 67-year-old man underwent cardiac surgery for an aortic dissection Stanford type A, with implantation of an ascending aorta prosthesis at Udine Academic Hospital (Italy). After a chronic heart failure relapse occurred in September 2018, he developed fever of unknown origins, sepsis, and then he underwent surgery to substitute the vascular prothesis. In January 2019 the clinical condition of the patient got worse and he died in September 2019.

Results

The first level bacterial culture turned out to be positive for Mycobacteria, so the second level molecular biology test was carried out with GenoType NTM-DR. This analysis revealed a specific positivity for Mycobacterium chimaera. The confirmation test on the Heater-Cooler-Device (HCD) could not be carried out as this device was scrapped since years.

Lessons

This case report suggests that Mycobacterium chimaera incubation period can be extremely variable. Therefore, when performing differential diagnosis, it should be considered even for those patients who underwent cardiac surgery more than 5 years prior clinical manifestation. We suggest extending the current ECDC's exposure criteria, assuming that incubation period could cover the entire patient's life.

Key messages

Mycobacterium chimaera can have an incubation period much longer than what is usually described in literature and ECDC guidelines. This report can be considered a starting point to improve the hospital infection control surveillance system in hospitals performing cardiac surgery.
Physical activity in relation to wellbeing among newly arrived refugees in Sweden
Authors: Sjögren Forss K , Mangrio E , Leijon M , Grahn M , Zdravkovic S
Published: October 2020

Background

In the light of the growing number of refugees that the world has faced during the last years it is reasonable to suggest that the number with both physiological and mental health needs will raise and result in increased public health challenges. Physical activity with its well documented positive impact on both mental and physical health might be one way for refugees to promote health. The importance of investigating participation in physical activity in this group and the impact it might have on their health and wellbeing cannot be underestimated. Few studies exists in the field and therefore, this study aimed to investigate physical activity in relation to mental well-being, vitality, stress and sleep quality among newly arrived refugees in Sweden.

Methods

The study was based on the results from a survey, conducted in 2015 - 2016 among newly arrived adult refugees who spoke Arabic, Pashto, Somali or Dari, participated in a mandatory public integration support programme in the Scania region of Sweden and agreed to participate in the survey. Ultimately 681 participants completed the survey (a response rate of 39,5%).

Results

We found a significant association between physical activity and mental well-being, vitality, stress and sleep quality among newly arrived refugees.

Conclusions

Newly arrived refugees need to be informed about the importance of prioritising physical activity for their health and wellbeing, regardless of their external circumstances, and supported in their attempts to do so.

Key messages

There is a significant association between physical activity and mental well-being, vitality, stress and sleep quality among newly arrived refugees. Newly arrived refugees need to be informed about the importance of prioritising physical activity for their health and wellbeing, and supported in their attempts to do so.
When there is no sleep: forced migration and the social determinants of health during post-migration
Authors: Ona F
Published: October 2020

Attending to and addressing the public health needs of forced migrants, especially those who experience torture due to their identities as sexual minorities, is increasingly challenging in socio-political landscapes that may negatively impact access to health resources and health care services. A great deal of public health intervention work has focused on pre-migration and migration contexts but post-migration contexts remain less developed in regards to the social determinants of health. The significance of post-migration challenges to refugee and asylum seekers' health need to integrate social determinants of health frameworks that meaningfully engage with the risk and protective factors in the complex sociocultural conditions in post-migratory experiences that include social, economic and political factors that impinge on housing, legal representation, employment, education food security and health access. This presentation provides findings from an integrated biopsychosocial and spiritual intervention that focused on LGBTQ refugee and asylum-seeking populations seeking health care services at a health clinic in North America. These findings recommend horizontal approaches that engage in transdisciplinary teams that address physical, emotional, social, spiritual and mental health arenas to engage in a social determinants of health framework.

Key messages

Integrated, trauma-responsive biopsychosocial and spiritual interventions may be most effective post-migration. Increased public health activism must support post-migration health interventions.