scholarly journals The Risk of Cross Infection in the Emergency Department: A Simulation Study

2018 ◽  
Vol 39 (6) ◽  
pp. 688-693 ◽  
Author(s):  
Vicki Stover Hertzberg ◽  
Yuke A. Wang ◽  
Lisa K. Elon ◽  
Douglas W. Lowery-North
Keyword(s):  
Emergency Department ◽  
Health Workers ◽  
Detection System ◽  
Infection Risk ◽  
Chief Complaint ◽  
Cross Infection ◽  
Care Staff ◽  
Health Concern ◽  
Influenza Outbreak ◽  
Differential Risk

OBJECTIVESThe risk of cross infection in a busy emergency department (ED) is a serious public health concern, especially in times of pandemic threats. We simulated cross infections due to respiratory diseases spread by large droplets using empirical data on contacts (ie, close-proximity interactions of ≤1m) in an ED to quantify risks due to contact and to examine factors with differential risks associated with them.DESIGNProspective study.PARTICIPANTSHealth workers (HCWs) and patients.SETTINGA busy ED.METHODSData on contacts between participants were collected over 6 months by observing two 12-hour shifts per week using a radiofrequency identification proximity detection system. We simulated cross infection due to a novel agent across these contacts to determine risks associated with HCW role, chief complaint category, arrival mode, and ED disposition status.RESULTSCross-infection risk between HCWs was substantially greater than between patients or between patients and HCWs. Providers had the least risk, followed by nurses, and nonpatient care staff had the most risk. There were no differences by patient chief complaint category. We detected differential risk patterns by arrival mode and by HCW role. Although no differential risk was associated with ED disposition status, 0.1 infections were expected per shift among patients admitted to hospital.CONCLUSIONThese simulations demonstrate that, on average, 11 patients who were infected in the ED will be admitted to the hospital over the course of an 8-week local influenza outbreak. These patients are a source of further cross-infection risk once in the hospital.Infect Control Hosp Epidemiol 2018;39:688–693

scholarly journals Probable transmission routes of the influenza virus in a nosocomial outbreak

2018 ◽  
Vol 146 (9) ◽  
pp. 1114-1122 ◽  
Author(s):  
S. Xiao ◽  
J. W. Tang ◽  
D. S. Hui ◽  
H. Lei ◽  
H. Yu ◽  
...  
Keyword(s):  
Influenza Virus ◽  
Long Range ◽  
Index Patient ◽  
Infection Risk ◽  
Health Concern ◽  
Influenza Outbreak ◽  
Modelling Framework ◽  
Transmission Modes ◽  
Multi Agent ◽  
Best Fit

AbstractInfluenza is a long-standing public health concern, but its transmission remains poorly understood. To have a better knowledge of influenza transmission, we carried out a detailed modelling investigation in a nosocomial influenza outbreak in Hong Kong. We identified three hypothesised transmission modes between index patient and other inpatients based on the long-range airborne and fomite routes. We considered three kinds of healthcare workers’ routine round pathways in 1140 scenarios with various values of important parameters. In each scenario, we used a multi-agent modelling framework to estimate the infection risk for each hypothesis and conducted least-squares fitting to evaluate the hypotheses by comparing the distribution of the infection risk with that of the attack rates. Amongst the hypotheses tested in the 1140 scenarios, the prediction of modes involving the long-range airborne route fit better with the attack rates, and that of the two-route transmission mode had the best fit, with the long-range airborne route contributing about 94% and the fomite route contributing 6% to the infections. Under the assumed conditions, the influenza virus was likely to have spread via a combined long-range airborne and fomite routes, with the former predominant and the latter negligible.

Factors Affecting Discharges against Medical Advice in an Emergency Department of a Tertiary Care Center

2020 ◽  
Vol 2 (2) ◽  
pp. 31-35
Author(s):  
Trishna Shrestha ◽  
Sneha Pradhananga ◽  
Kabita Hada Batajoo ◽  
Manjita Bajracharya
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Health Care Costs ◽  
Medical Advice ◽  
Health Concern ◽  
Against Medical Advice ◽  
Factors Affecting ◽  
Tertiary Center ◽  
Care Costs ◽  
Leaving Against Medical Advice

Introduction: Patients leaving against the advice of the treating team before being certified as fit is a major concern and challenge for the treating professionals as it possesses adverse medical outcomes. This study hence aimed at identifying the prevalence and major factors affecting such discharges so that advocacy can be done to help prevent it. Methods: A descriptive cross-sectional study was conducted at emergency department of a tertiary center in Lalitpur from 15th May 2019 to 15th August 2019. All the patients visiting the emergency department were included in the study and a non-probability purposive sampling method was used excluding the patients who denied giving reasons for them leaving against medical advice. Data was collected using pre-structured questionnaire and analyzed using SPSS-v21 software. Results: A hundred and fifteen patients (4.08%) left against medical advice out of 2812 patients who presented to emergency department. There were 63 male patients (54.8%), 75 patients of the total patients in the age group of 15-44 years (65.2%) and those living within a distance of 1km from the hospital (53%). The most common reason for the patients leaving against medical advice was found to be due to financial constraint (38.3%) followed by preference to other hospitals (16.5%). Conclusion: Patients leaving against medical advice possesses a small percentage of actual hospital admissions but is still a major health concern as it drastically increases the morbidity, re-admission rates and total health-care costs. Hence, understanding the general characteristics and predictors of such discharges is of utmost importance to help improve the patient outcome and reduce the health-care costs.  

scholarly journals A Synthetic Biology Approach Using Engineered Bacteria to Detect Perfluoroalkyl Substance (PFAS) Contamination in Water

2021 ◽  
Vol 186 (Supplement_1) ◽  
pp. 801-807
Author(s):  
Nathaniel A Young ◽  
Ryan L Lambert ◽  
Angela M Buch ◽  
Christen L Dahl ◽  
Jackson D Harris ◽  
...  
Keyword(s):  
Synthetic Biology ◽  
Dna Sequences ◽  
Detection System ◽  
The United States ◽  
Detection Methods ◽  
Health Concern ◽  
Contaminated Water ◽  
Engineered Bacteria ◽  
Synthetic Biology Approach ◽  
Rhodococcus Jostii

ABSTRACT Introduction Per- and polyfluoroalkyl substances (PFAS) are a class of synthetic compounds used industrially for a wide variety of applications. These PFAS compounds are very stable and persist in the environment. The PFAS contamination is a growing health issue as these compounds have been reported to impact human health and have been detected in both domestic and global water sources. Contaminated water found on military bases poses a potentially serious health concern for active duty military, their families, and the surrounding communities. Previous detection methods for PFAS in contaminated water samples require expensive and time-consuming testing protocols that limit the ability to detect this important global pollutant. The main objective of this work was to develop a novel detection system that utilizes a biological reporter and engineered bacteria as a way to rapidly and efficiently detect PFAS contamination. Materials and Methods The United States Air Force Academy International Genetically Engineered Machine team is genetically engineering Rhodococcus jostii strain RHA1 to contain novel DNA sequences composed of a propane 2-monooxygenase alpha (prmA) promoter and monomeric red fluorescent protein (mRFP). The prmA promoter is activated in the presence of PFAS and transcribes the mRFP reporter. Results The recombinant R. jostii containing the prmA promoter and mRFP reporter respond to exposure of PFAS by activating gene expression of the mRFP. At 100 µM of perfluorooctanoic acid, the mRFP expression was increased 3-fold (qRT-PCR). Rhodococcus jostii without exposure to PFAS compounds had no mRFP expression. Conclusions This novel detection system represents a synthetic biology approach to more efficiently detect PFAS in contaminated samples. With further refinement and modifications, a similar system could be readily deployed in the field around the world to detect this critical pollutant.

scholarly journals LO091: Non-urgent presentations to the emergency department: patients’ reasons for presentation

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S61-S61
Author(s):  
L. Krebs ◽  
R. Chetram ◽  
S.W. Kirkland ◽  
T. Nikel ◽  
B. Voaklander ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health Care Professionals ◽  
Access To Health Care ◽  
Health Concern ◽  
Patient Centeredness ◽  
Care Needs ◽  
Appropriateness Of Care ◽  
Access To Health ◽  
Access To Primary Care ◽  
Emergency Department Patients

Introduction: Some low acuity Emergency Department (ED) presentations are considered non-urgent or convenience visits and potentially avoidable with improved access to primary care. This study explored self-reported reasons why non-urgent patients presented to the ED. Methods: Patients, 17 years and older, were randomly selected from electronic registration records at three urban EDs in Edmonton, Alberta (AB), Canada during weekdays (0700 to 1900). A 47-item questionnaire was completed by each consenting patient, which included items on whether the patient believed the ED was their best care option and the rationale supporting their response. A thematic content analysis was performed on the responses, using previous experience and review of the literature to identify themes. Results: Of the 2144 eligible patients, 1408 (65.7%) questionnaires were returned, and 1402 (65.4%) were analyzed. For patients who felt the ED was their best option (n = 1234, 89.3%), rationales included: safety concerns (n = 309), effectiveness of ED care (n = 284), patient-centeredness of ED (n = 277), and access to health care professionals in the ED (n = 204). For patients who felt the ED was not their best care option (n = 148, 10.7%), rationales included a perception that: access to health professionals outside the ED was preferable (n = 39), patient-centeredness (particularly timeliness) was lacking in the ED (n = 26), and their health concern was not important enough to require ED care (n = 18). Conclusion: Even during times when alternative care options are available, the majority of non-urgent patients perceived the ED to be the most appropriate location for care. These results highlight that simple triage scores do not accurately reflect the appropriateness of care and that understanding the diverse and multi-faceted reasons for ED presentation are necessary to implement strategies to support non-urgent, low acuity care needs.

scholarly journals Use of Emergency Department Data to Monitor and Respond to an Increase in Opioid Overdoses in New Hampshire, 2011-2015

2017 ◽  
Vol 132 (1_suppl) ◽  
pp. 73S-79S ◽  
Author(s):  
Elizabeth R. Daly ◽  
Kenneth Dufault ◽  
David J. Swenson ◽  
Paul Lakevicius ◽  
Erin Metcalf ◽  
...  
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
New Hampshire ◽  
Syndromic Surveillance ◽  
Situational Awareness ◽  
The United States ◽  
Chief Complaint ◽  
Public Health Response ◽  
Syndromic Surveillance System ◽  
Icd Codes

Objectives: Opioid-related overdoses and deaths in New Hampshire have increased substantially in recent years, similar to increases observed across the United States. We queried emergency department (ED) data in New Hampshire to monitor opioid-related ED encounters as part of the public health response to this health problem. Methods: We obtained data on opioid-related ED encounters for the period January 1, 2011, through December 31, 2015, from New Hampshire’s syndromic surveillance ED data system by querying for (1) chief complaint text related to the words “fentanyl,” “heroin,” “opiate,” and “opioid” and (2) opioid-related International Classification of Diseases ( ICD) codes. We then analyzed the data to calculate frequencies of opioid-related ED encounters by age, sex, residence, chief complaint text values, and ICD codes. Results: Opioid-related ED encounters increased by 70% during the study period, from 3300 in 2011 to 5603 in 2015; the largest increases occurred in adults aged 18-29 and in males. Of 20 994 total opioid-related ED visits, we identified 18 554 (88%) using ICD code alone, 690 (3%) using chief complaint text alone, and 1750 (8%) using both chief complaint text and ICD code. For those encounters identified by ICD code only, the corresponding chief complaint text included varied and nonspecific words, with the most common being “pain” (n = 3335, 18%), “overdose” (n = 1555, 8%), “suicidal” (n = 816, 4%), “drug” (n = 803, 4%), and “detox” (n = 750, 4%). Heroin-specific encounters increased by 827%, from 4% of opioid-related encounters in 2011 to 24% of encounters in 2015. Conclusions: Opioid-related ED encounters in New Hampshire increased substantially from 2011 to 2015. Data from New Hampshire’s ED syndromic surveillance system provided timely situational awareness to public health partners to support the overall response to the opioid epidemic.

scholarly journals Visual loss from mismanaged ocular injury with foreign body impaction: A Case Report

2018 ◽  
Vol 4 (2) ◽  
pp. 198-204
Author(s):  
Ifedayo O. Akintoye ◽  
Caroline O. Adeoti
Keyword(s):  
Foreign Body ◽  
Health Workers ◽  
Hospital Setting ◽  
Tertiary Hospital ◽  
Health Concern ◽  
Ocular Injury ◽  
Eye Injuries ◽  
Health Extension Workers ◽  
Foreign Body Impaction ◽  
Upper Lid

Ocular injury occurs commonly and it may lead to visual impairment if it is not properly managed. We report the case of a 35-year old man with a retained infected ocular foreign body in his right eye following an injury. The foreign body was not discovered despite consulting non-ophthalmologists at a Maternity Centre and an Optical Shop over a period of ten days.  At presentation at the Specialist Hospital, he was unable to see with swelling of the eyelid, red eye and discharge. On examination, the visual acuity in the affected eye was NLP and an infected stick that penetrated the eyeball was discovered in the superonasal aspect of sclera covered by the swollen upper lid. This resulted in endophthalmitis, cataract and blindness of that eye. Ocular injuries must be promptly referred to the ophthalmologist for appropriate care and to prevent complications. The case clearly showed a diagnostic and therapeutic challenge for paramedics who encounter eye injuries outside the tertiary hospital setting. Therefore, this report raises public health concern intended to increase awareness on the management of eye injuries. The incorporation of Primary Eye Health into Primary Health Care along with training and re-training of Community Health Extension Workers, General Practitioners and other rural health workers cannot be overemphasized.

scholarly journals Investigating the relationship between how a chief complaint is expressed and the patient workflow

2020 ◽  
Vol 6 (2) ◽  
pp. 63-67
Author(s):  
Sajjad Ahmadi ◽  
Niloufar Pouresmaeil ◽  
Farima Najjarian ◽  
Samad Shams Vahdati ◽  
Maryam Rahimpour Asenjan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Room ◽  
Emergency Departments ◽  
Descriptive Analysis ◽  
Critical Role ◽  
Kidney Injury ◽  
Chief Complaint ◽  
Final Decision ◽  
Bloody Stool ◽  
The Relationship

Objective: Emergency departments and hospital emergency departments are important due to their critical role in providing urgent medical care to patients in dire need of medical interventions. Checking bottlenecks in new conditions and planning to reduce bed occupancy and hospitalization is needed. The purpose of this study is to investigate the relationship between the patient’s chief complaint and their departure to the emergency room. Methods: From non-traumatic patients referred to the emergency department of Imam Reza Hospital during 2018, about 57000 patients were selected and enrolled in the study. Then, age, sex, initial diagnosis, time of the final decision, and time of departure from the emergency department as well as hospitalization ward were included in the checklist. Patients whose documentation was incomplete were excluded. Data were entered into SPSS software version 15.0 and descriptive statistics (normal distribution, average of time, minimum time and maximum time, confidence interval, mode, and median, etc) were used for descriptive analysis and linear regression was used to analyze the correlation among findings. Results: There was a significant relationship between chief complaint and the length of stay in the emergency department (P = 0.046) and patients with dyspnea due to heart disease, bloody vomit, bloody stool, constipation, jaundice, anemia, decreased level of consciousness, diabetes, complications of diabetes, shortness of breath and kidney injury stayed longer in the emergency room compared to other complaints. Conclusion: The patient’s manner of expressing and chief complaint has an impact on the length of time they wait to leave the emergency room. Also, most patients with problems related to internal medicine have the longest time in the emergency room; in particular gastrointestinal patients have the longest stay in the emergency room.

scholarly journals Developing a brief motivational intervention for young adults admitted with alcohol intoxication in the emergency department – Results from an iterative qualitative design

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246652
Author(s):  
Jacques Gaume ◽  
Véronique S. Grazioli ◽  
Sophie Paroz ◽  
Cristiana Fortini ◽  
Nicolas Bertholet ◽  
...  
Keyword(s):  
Emergency Department ◽  
Young Adults ◽  
Alcohol Intoxication ◽  
Nominal Group ◽  
Health Concern ◽  
Motivational Intervention ◽  
Intervention Model ◽  
Structured Interviews ◽  
Qualitative Design ◽  
Brief Motivational Intervention

Background Unhealthy alcohol use among young adults is a major public health concern. Brief motivational interventions for young adults in the Emergency Department (ED) have shown promising but inconsistent results. Methods Based on the literature on brief intervention and motivational interviewing efficacy and active ingredients, we developed a new motivational intervention model for young adults admitted in the ED with alcohol intoxication. Using an iterative qualitative design, we first pre-tested this model by conducting 4 experimental sessions and 8 related semi-structured interviews to evaluate clinicians’ and patients’ perceptions of the intervention’s acceptability and feasibility. We then conducted a consultation meeting with 9 international experts using a nominal group technique. The intervention model was adjusted and finally re-tested by conducting 6 new experimental sessions and 12 related semi-structured interviews. At each round, data collected were analyzed and discussed, and the intervention model updated accordingly. Results Based on the literature, we found 6 axes for developing a new model: High level of relational factors (e.g. empathy, alliance, avoidance of confrontation); Personalized feedback; Enhance discrepancy; Evoke change talk while softening sustain talk, strengthen ability and commitment to change; Completion of a change plan; Devote more time: longer sessions and follow-up options (face-to-face, telephone, or electronic boosters; referral to treatment). A qualitative analysis of the semi-structured interviews gave important insights regarding acceptability and feasibility of the model. Adjustments were made around which information to provide and how, as well as on how to deepen discussion about change with patients having low levels of self-exploration. The experts’ consultation addressed numerous points, such as information and advice giving, and booster interventions. Discussion This iterative, multi-component design resulted in the development of an intervention model embedded in recent research findings and theory advances, as well as feasible in a complex environment. The next step is a randomized controlled trial testing the efficacy of this model.

scholarly journals UNIVERSAL PRECAUTION KNOWLEDGE LEVELS IN POSTGRADUATE STUDENTS FACULTY OF DENTISTRY

2021 ◽  
Vol 1 (Volume 1 No 1) ◽  
pp. 71-79
Author(s):  
Sri Sarwendah ◽  
Syarif Suwondo ◽  
Irena Nisa Harliani
Keyword(s):  
Health Workers ◽  
Care Staff ◽  
Health Care Staff ◽  
Universal Precaution ◽  
Validity And Reliability ◽  
Cross Sectional ◽  
Universal Precautions ◽  
Postgraduate Students ◽  
Level Of Knowledge ◽  
High Level

ABSTRACT Universal precautions are one way to prevent the transmission of disease, which is transmitted by blood and all body fluids, including saliva, either from the patient to health worker and from patient to another patient. Patients should be treated as infected with the disease and potentially infectious every time. This action should be done by all health care staff in the risk of cross-infection between patients, and health workers can be minimized. Basic universal precautions include immunization, hand washing, personal protective equipment, medical equipment management, and hospital waste management. This study aims to describe the level of knowledge about universal precautions in postgraduate students Faculty of Dentistry Universitas Jenderal Achmad Yani Cimahi (Unjani). This study used a descriptive design by cross-sectional. Collection data for research using a questionnaire containing 20 questions tested for validity and reliability, then a questionnaire filled out by respondents as many as 40 people. Presentation of research data is processed and presented to illustrate the level of knowledge in postgraduate students of frequency distribution table. The results showed that most of postgraduate students has a high knowledge (60%), postgraduate students with a moderate level of knowledge (27.5%), and postgraduate students with the knowledge that a low level (12.5%). Conclusions of the research showed that the majority postgraduate students about universal precaution is at a high level.

scholarly journals Factors associated with hypertension in Pakistan: A systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0246085
Author(s):  
Muhammad Riaz ◽  
Ghazala Shah ◽  
Muhammad Asif ◽  
Asma Shah ◽  
Kaustubh Adhikari ◽  
...  
Keyword(s):  
Public Health ◽  
Urban Areas ◽  
Health Workers ◽  
Health Concern ◽  
Case Control Studies ◽  
Cross Sectional ◽  
Mortality And Morbidity ◽  
Negatively Associated ◽  
Factors Associated ◽  
Health Related

Background High blood pressure is an important public health concern and the leading risk factor for global mortality and morbidity. To assess the implications of this condition, we aimed to review the existing literature and study the factors that are significantly associated with hypertension in the Pakistani population. Methods We conducted several electronic searches in PubMed, ISI Web of Science, PsycINFO, EMBASE, Scopus, Elsevier, and manually searched the citations of published articles on hypertension from May 2019 to August 2019. We included all studies that examined factors associated with hypertension regardless of the study design. To assess the quality of the research, we used the Newcastle-Ottawa Quality Assessment Scale. We also conducted meta-analyses using the DerSimonian & Laird random-effects model to collate results from at least three studies. Results We included 30 cross-sectional and 7 case-control studies (99,391 participants country-wide) in this review and found 13 (35.1%) to be high-quality studies. We identified 5 socio-demographic, 3 lifestyle, 3 health-related, and 4 psychological variables that were significantly associated with hypertension. Adults aged between 30–60 years who were married, living in urban areas with high incomes, used tobacco, had a family history of hypertension, and had comorbidities (overweight, obesity, diabetes, anxiety, stress, and anger management issues) were positively associated with hypertension. On the other hand, individuals having high education levels, normal physical activity, and unrestricted salt in their diet were negatively associated with hypertension. Conclusion We found several socio-demographic, lifestyle, health-related, and psychological factors that were significantly (positively and negatively) associated with hypertension. Our findings may help physicians and public health workers to identify high-risk groups and recommend appropriate prevention strategies. Further research is warranted to investigate these factors rigorously and collate global evidence on the same.

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