scholarly journals Ventilation and detection of airborne SARS-CoV-2: elucidating high-risk spaces in naturally ventilated healthcare settings

2021 ◽  
Author(s):  
Ashley Styczynski ◽  
Caitlin Hemlock ◽  
Kazi Injamamul Hoque ◽  
Renu Verma ◽  
Chris LeBoa ◽  
...  
Keyword(s):  
High Risk ◽  
Natural Ventilation ◽  
Exposure Period ◽  
N Gene ◽  
Middle Income ◽  
Air Samples ◽  
Healthcare Settings ◽  
Infectious Risk ◽  
Ceiling Height ◽  
Outpatient Departments

Background: In healthcare settings in low- and middle-income countries, which frequently rely upon natural ventilation, the risk of aerosol transmission of SARS-CoV-2 remains poorly understood. We aimed to evaluate the risk of exposure to SARS-CoV-2 in naturally-ventilated hospital settings by measuring parameters of ventilation and comparing these findings with results of bioaerosol sampling. Methods: We measured outdoor and room CO2 to estimate absolute ventilation (liters per second [L/s]) from 9 hospitals in Bangladesh during October 2020 - February 2021. We estimated infectious risk across different spaces using a modified Wells-Riley equation. We collected air samples from these same spaces at 12.5 L/min over 30 minutes and performed RT-qPCR to detect SARS-CoV-2 N-gene. We used multivariable linear regression and calculated elasticity to identify characteristics associated with ventilation. Results: Based on ventilation of 86 patient care areas and COVID-19 case numbers, we found that over a 40-hour exposure period, outpatient departments posed the highest median risk for infection (5.4%), followed by COVID intensive care units (1.8%). We detected SARS-CoV-2 RNA in 18.6% (16/86) of air samples. Ceiling height and total open area of doors and windows were found to have the greatest impact on ventilation. Conclusion: Our findings provide evidence that naturally-ventilated healthcare settings may pose a high risk for exposure to SARS-CoV-2, particularly among non-COVID designated spaces, but improving parameters of ventilation can mitigate this risk.

scholarly journals Compliance with Standard Precautions and Its Relationship with Views on Infection Control and Prevention Policy among Healthcare Workers during COVID-19 Pandemic

2021 ◽  
Vol 18 (7) ◽  
pp. 3420
Author(s):  
Eliza Lai-Yi Wong ◽  
Kin-Fai Ho ◽  
Dong Dong ◽  
Annie Wai-Ling Cheung ◽  
Peter Sen-Yung Yau ◽  
...  
Keyword(s):  
High Risk ◽  
Infection Control ◽  
High Risk Group ◽  
Infection Prevention And Control ◽  
Prevention Policy ◽  
Standard Precautions ◽  
Healthcare Settings ◽  
Control And Prevention ◽  
And Control ◽  
Infection Control And Prevention

Background: Standard precautions prevent the spread of infections in healthcare settings. Incompliance with infection control guidelines of healthcare workers (HCWs) may increase their risk of exposure to infectious disease, especially under pandemics. The purpose of this study was to assess the level of compliance with the infection prevention and control practices among HCWs in different healthcare settings and its relationship with their views on workplace infection control measures during the COVID-19 pandemic. Methods: Nurses in Hong Kong were invited to respond to a cross-sectional online survey, in which their views on workplace infection and prevention policy, compliance with standard precautions and self-reported health during pandemics were collected. Results: The respondents were dissatisfied with workplace infection and prevention policy in terms of comprehensiveness (62%), clarity (64%), timeliness (63%), and transparency (60%). For the protective behavior, the respondents did not fully comply with the standard precautions when they were involved in medical care. Their compliance was relatively low when having proper patient handling (54%) and performing invasive procedures (46%). A multivariate analysis model proved that the level of compliance of the standard precautions was positively associated with the satisfaction on infection control and prevention policy among high risk group (0.020; 95% CI: 0.005–0.036), while older respondents had higher level of compliance among the inpatient and outpatient groups (coefficient range: 0.065–0.076). The higher level of compliance was also significantly associated with working in designated team and having chronic condition of the respondents among high-risk and inpatient groups. Conclusions: Standard precautions are the most important elements to reduce cross-transmission among HCWs and patients while the satisfaction on infection control and prevention policy would increase the compliance among the high-risk group. An overall suboptimal compliance and poor views on the infection prevention and control guidelines is a warning signal to healthcare system especially during pandemics.

scholarly journals LINC-28. EPIDEMIOLOGICAL CHARACTERISTICS AND SURVIVAL OUTCOMES OF CHILDREN WITH MEDULLOBLASTOMA TREATED AT THE NATIONAL CANCER INSTITUTE (INCA) IN RIO DE JANEIRO, BRAZIL

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii383-iii384
Author(s):  
Gabriela Oigman ◽  
Diana Osorio ◽  
Joseph Stanek ◽  
Jonathan Finlay ◽  
Denizar Vianna ◽  
...  
Keyword(s):  
High Risk ◽  
Maternal Education ◽  
Survival Outcomes ◽  
Middle Income ◽  
Female Ratio ◽  
High Risk Patients ◽  
Presenting Symptoms ◽  
Risk Patients ◽  
Epidemiological Characteristics ◽  
Standard Risk

Abstract BACKGROUND Medulloblastoma (MB), the most malignant brain tumor of childhood has survival outcomes exceeding 80% for standard risk and 60% for high risk patients in high-income countries (HIC). These results have not been replicated in low-to-middle income countries (LMIC), where 80% of children with cancer live. Brazil is an upper-middle income country according to World Bank, with features of LMIC and HIC. METHODS We conducted a retrospective review of 126 children (0–18 years) diagnosed with MB from 1997 to 2016 at INCA. Data on patients, disease characteristics and treatment information were retrieved from the charts and summarized descriptively; overall survival (OS) and event-free survival (EFS) were calculated using the Kaplan-Meier Method. RESULTS The male/female ratio was 1.42 and the median age at diagnosis was 7.9 years. Headache (79%) and nausea/vomiting (75%) were the most common presenting symptoms. The median time from onset of symptoms to surgery was 50 days. The OS for standard-risk patients was 69% and 53% for high-risk patients. Patients initiating radiation therapy within 42 days after surgery (70.6% versus 59.6% p=0.016) experienced better OS. Forty-five patients (35%) had metastatic disease at admission. Lower maternal education correlated with lower OS (71.3% versus 49% p=0.025). Patients who lived >40km from INCA fared better (OS= 68.2% versus 51.1% p=0.032). Almost 20% of families lived below the Brazilian minimum wage. CONCLUSIONS These findings suggest that socioeconomic factors, education, early diagnosis and continuous data collection, besides oncological treatment must be adressed to improve the survival of children with MB.

scholarly journals Finding Children with High Risk of Non-Vaccination in 92 Low- and Middle-Income Countries: A Decision Tree Approach

Vaccines ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 646
Author(s):  
Thiago M. Santos ◽  
Bianca O. Cata-Preta ◽  
Cesar G. Victora ◽  
Aluisio J. D. Barros
Keyword(s):  
High Risk ◽  
Decision Tree ◽  
Immunization Coverage ◽  
Risk Groups ◽  
Demographic And Health Surveys ◽  
Middle Income ◽  
Agenda 2030 ◽  
Middle Income Countries ◽  
Tree Approach ◽  
Low And Middle Income

Reducing vaccination inequalities is a key goal of the Immunization Agenda 2030. Our main objective was to identify high-risk groups of children who received no vaccines (zero-dose children). A decision tree approach was used for 92 low- and middle-income countries using data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys, allowing the identification of groups of children aged 12–23 months at high risk of being zero dose (no doses of the four basic vaccines—BCG, polio, DPT and measles). Three high-risk groups were identified in the analysis combining all countries. The group with the highest zero-dose prevalence (42%) included 4% of all children, but almost one in every four zero-dose children in the sample. It included children whose mothers did not receive the tetanus vaccine during and before the pregnancy, who had no antenatal care visits and who did not deliver in a health facility. Separate analyses by country presented similar results. Children who have been missed by vaccination services were also left out by other primary health care interventions, especially those related to antenatal and delivery care. There is an opportunity for better integration among services in order to achieve high and equitable immunization coverage.

Optimization of prevention measures of septic complications in women with high infectious risk

2018 ◽  
pp. 108-113
Author(s):  
Yu.R. Feyta ◽  
◽  
V.I. Pyrohova ◽  
Keyword(s):  
High Risk ◽  
Postpartum Period ◽  
Comparison Group ◽  
Infectious Complications ◽  
Main Group ◽  
Septic Complications ◽  
Effective Prevention ◽  
Vaginal Gel ◽  
Infectious Risk ◽  
Treatment Techniques

Despite the introduction of modern diagnostic technologies, prophylaxis and treatment techniques in obstetrical practice, the incidence of postpartum purulent-septic complications (PPSC) remains rather high and is an important medical and social problem, as they take one of the leading places in the structure of maternal morbidity and mortality. The objective: to improve the management of parturient womenwith a perineal birth injury in anamnesis, as part of an effective prevention of purulent-septic complications of puerperium. Materials and methods. The study included 77parturient women. Main and comparative groups were formed by women with a violation of the integrity of the perineum in the previous labor and with a high risk of developing infectious complications in puerperium. Women of the main group (n = 24) during each vaginal examination in labor (and an additional injection in 15-30 minutes after the rupture of the membranes) and twice a dayat a dose of 5 ml for 5 days postpartum, an antiseptic agent in the form of a vaginal gel, which consists of: 0.02% decamethoxin (antiseptic component), 0.5% hyaluronic acid (regenerating component) and lactate buffer (regulatory component). The comparison group included 27 women, without using vaginal gel in laborand using traditional wound treatment techniques in the postpartum period. The control group consisted of 26 women with uncomplicated somatic status, physiological course of pregnancy and labor. The evaluation of the effectiveness of the prescribed treatment was based on subjective symptoms (pain, discomfort, burning in the region of the perineal sutures), clinical data (swelling, hyperemia, nature of suturing healing), generally accepted indicators in dynamics (bacterioscopy of vaginal contents, pH-metry of the vaginal environment). Results. At the background of the use of three-component vaginal gel in the main group, the level of injury of soft tissues of the birth canal in these deliveries was lower by 19.9% than in the comparison group, prevalence of the 1st degreeperineumruptures, decreased the need for repeated episio- and perineotomy, which reduced the duration stay at hospital and improved postpartum rehabilitation in relation to the comparison group. On the third day of puerperium, hyperemia and edema of the wound area in women of the main group were observed almost three times less compared with the comparison group. On the fifth day of the puerperium in the main group the complaints were insignificant and appeared on the average 5 times less often, the healing was by the primary tension without infectious complications. The use of vaginal gel reduced the number of leukocytes in wound secretions by shortening the time of wound epithelization (1.5 times faster than in the parous from the comparison group). On the fifth day of using vaginal gel, 2/3 of the patients observed normalization of the vaginal microflora, the restoration of pH was observed. The results indicate the benefits of early onset of prophylactic measures and high effectiveness of topical antiseptic therapy in women with high infectious risk. Conclusions.In order to prevent antibiotic resistance tactics of prevention of PPSC in the group of high-risk septic complications provides one of the elements of anintegrated approach to use local antiseptics. Inclusion of the latter into a complex of prophylactic and treatment measures in the management of a high-riskwomen in puerperium contributes to the reduction of traumatic and infectious complications and provides more favorable course of labor and the postpartum period. Key words: labor traumatism, postpartum purulent-septic complications, local antiseptic.

scholarly journals Audit of the management of patients at high risk of carbapenemase-producing enterobacteriaceae (CPE): Are we ready?

2017 ◽  
Vol 18 (6) ◽  
pp. 296-300 ◽  
Author(s):  
Lasantha Ratnayake ◽  
Amy Harris ◽  
Doreen Ko ◽  
Linda Hawtin
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
High Risk ◽  
Individual Risk ◽  
Risk Status ◽  
Healthcare Settings ◽  
The Uk ◽  
Individual Risk Factors ◽  
Routine Assessment ◽  
Relevant Section

Background: Incidence of carbapenemase-producing enterobacteriaceae (CPE) in the UK is increasing. In 2013, Public Health England (PHE) published a toolkit to control spread of CPE within healthcare settings. Aim: To assess compliance to hospital CPE policy (adapted from PHE) in the identification, isolation and screening of suspected CPE patients. Methods: Admission booklets of 150 patients were evaluated to see whether the relevant section had been completed to identify high-risk CPE patients. Where necessary, patients were interviewed or their GPs were contacted to assess their CPE risk. Additionally, 28 patients screened for CPE were audited to assess compliance to screening and isolation. Findings: Only 23 patients out of 147 (15.6%) were risk assessed on admission. Risk status of 27 (18.4%) patients could not be assessed due to lack of data. Fifteen patients out of 28 (54%) screened for CPE were identified and isolated on admission. Ten out of 19 patients (53%) had three screens 48 h apart. Discussion: This audit highlights difficulties in screening based on individual risk factors as the majority of patients were not screened on admission and documentation on isolation and screening was poor. More needs to be done to raise awareness of the requirements for routine assessment, isolation and screening.

scholarly journals Malnutrition in the UK: where does it begin?

2010 ◽  
Vol 69 (4) ◽  
pp. 465-469 ◽  
Author(s):  
C. A. Russell ◽  
M. Elia
Keyword(s):  
High Risk ◽  
Hospital Admissions ◽  
Care Home ◽  
Healthcare Services ◽  
Care Homes ◽  
Sheltered Housing ◽  
Nutrition Screening ◽  
Good Opportunity ◽  
Outpatient Departments ◽  
The Uk

More than 3 million individuals are estimated to be at risk of malnutrition in the UK, of whom about 93% live in the community. BAPEN's Nutrition Screening Week surveys using criteria based on the ‘Malnutrition Universal Screening Tool’ (‘MUST’) revealed that 28% of individuals on admission to hospital and 30–40% of those admitted to care homes in the previous 6 months were malnourished (medium+high risk using ‘MUST’). About three quarters of hospital admissions and about a third of care home admissions came from their own homes with a malnutrition prevalence of 24% in each case. Outpatient studies using ‘MUST’ showed that 16–20% patients were malnourished and these were associated with more hospital admissions and longer length of stay. In sheltered housing, 10–14% of the tenants were found to be malnourished, with an overall estimated absolute prevalence of malnutrition which exceeded that in hospitals. In all cases, the majority of subjects were at high risk of malnutrition. These studies have helped establish the magnitude of the malnutrition problem in the UK and identified the need for integrated strategies between and within care settings. While hospitals provide a good opportunity to identify malnourished patients among more than 10 million patients admitted there annually and the five- to six-fold greater number attending outpatient departments, commissioners and providers of healthcare services should be aware that much of the malnutrition present in the UK originates in the community before admission to hospitals or care homes or attendance at outpatient clinics.

Video Relay Interpreting and Overcoming Barriers in Health Care for Deaf Users: A Scoping Review (Preprint)

2021 ◽  
Author(s):  
Minerva Rivas Velarde ◽  
Caroline Jagoe ◽  
Jess Cuculick
Keyword(s):  
Health Care ◽  
Sign Language ◽  
Scoping Review ◽  
Secondary Analysis ◽  
Healthcare Services ◽  
Eligibility Criteria ◽  
Middle Income ◽  
Middle Income Countries ◽  
Healthcare Settings ◽  
Study Selection

UNSTRUCTURED Abstract Objectives To identify existing evidence regarding the use of Video Remote Interpretation (VRI) in healthcare settings. To assess if VRI technology can enable deaf-users to overcome interpretation barriers and improve communication outcomes between them and health care personnel. Design Scoping review. Data sources Seven medical research databases (Medline, Web of Science, Embase, Google Scholar) from 2006 and bibliographies and citations of relevant papers. Searches included articles in English, Spanish and French. Eligibility criteria for study selection Original articles about the use of VRI for Deaf or Hard of Hearing sign language users (DHH) for, or within, healthcare. Results From the original 176 articles identified, 120 were eliminated after reading the article title and abstract, and 41 articles were excluded after they were fully read. Fifteen articles were selected for inclusion. Four were literature reviews; four were surveys, three qualitative studies; and one mixed-methods study that combined qualitative and quantitative data, one brief communication, one quality improvement report and one secondary analysis. This scoping review identified a knowledge gap regarding the quality of interpretation and training of sign language interpretation for healthcare. It also shows that this area is under researched and evidence is scant. All evidence was from high-income countries which is particularly problematic given that the majority of DHH persons live in low- and middle-income countries. Conclusions Furthering our understanding on the use of VRI technology is pertinent and relevant. Available literature shows that VRI may enable deaf-users to overcome interpretation barriers and can potentially improve communication outcomes between them and health personnel within healthcare services. For VRI to be acceptable, sign language users require a VRI system supported by devices with large screen and a reliable internet connection, as well as qualified interpreters trained on medical interpretation.

Effectiveness of pregravid preparation in women of high infectious risk

2018 ◽  
pp. 31-35
Author(s):  
T.G. Romanenko ◽  
◽  
O.M. Sulimenko ◽  
Keyword(s):  
High Risk ◽  
Bacterial Vaginosis ◽  
Pregnant Women ◽  
Risk Group ◽  
Intrauterine Infection ◽  
Vaginal Candidiasis ◽  
Placental Dysfunction ◽  
Infectious Risk ◽  
Group I ◽  
Group Ii

The article presents the results of the effectiveness of the combined antimicrobial drug Guinex Forte, the effect of which is caused by metronidazole and miconazole, and the Orgil tablets at the stage of pregravid preparation in women of high-risk group, with regard to the development of placental insufficiency of infectious genesis and intrauterine infection. The objective: is to demonstrate the effectiveness of pregravid preparation for the normalization of vaginal biocenosis in pregnant women of high infectious risk. Materials and methods. 150 pregnant women were investigated, of which 100 with a high risk of infectious risk for placental dysfunction and intrauterine infection: Group I – 50 pregnant women who did not undergo pregravid preparation; Group II – 50 pregnant women who planned pregnancy and conducted pregravid preparation for prevention and treatment of bacterial vaginosis and vaginal candidiasis; Control group consisted of 50 pregnant women who gave birth again, without obstetrical and extragenital pathology in history. per vaginum. Results. In pregnant women in Group II, an intermediate type of dysbiosis was 1.2 times less likely than in pregnant women of group I, and vice versa, normocenosis was achieved 9.7 times more often in pregnant women who received pregravid preparation. After the therapy in the pregravid period, in pregnant women of group II in the first trimester of pregnancy quantitative and qualitative indices of biocenosis of the vagina were approaching, in most cases, to normal. In general, the spectrum of the microflora decreased from 21 to 14 species due to the reduction of pathogenic forms of staphylococci, streptococci, enterobacteria, E. coli, klebsiela, cornebacteria and clostridia. In patients of group II, the concentration of representatives of resident flora increased (lactobacillus Lg 5.06±0.7 CFU / ml and bifidobacterium-Lg 4.4±0.6 CFU / ml) and close to normal. Conclusion. Our proposed scheme of therapy and prevention of dysbiotic conditions in the pregravid period, in women of high infectious risk group led to a decrease in bacterial contamination of maternity paths of pregnant women in group II, which contributes to the restoration of vaginal microbiocenosis and positively affects the course of pregnancy, the condition of the fetus and the newborn. Key words: pregravid preparation, bacterial vaginosis, vulvovaginal candidiasis, placental dysfunction of infectious genesis, intrauterine infection.

Intrapartum-related events affecting the newborn

2018 ◽  
pp. 150-154
Author(s):  
Saima Aftab ◽  
Lauren Schaeffer ◽  
Lian Folger ◽  
Anne CC Lee
Keyword(s):  
High Risk ◽  
Secondary Prevention ◽  
Neonatal Resuscitation ◽  
Birth Asphyxia ◽  
Obstetric Care ◽  
Middle Income ◽  
Neonatal Deaths ◽  
Under Five ◽  
Middle Income Countries ◽  
Child Deaths

This chapter addresses the causes, burden, and interventions for intrapartum-related events, or ‘birth asphyxia’. Intrapartum-related neonatal deaths are among the leading causes of under-five child deaths, and account for 26% of all newborn deaths. An estimated one in ten babies will need some help to start breathing at birth. Approximately 98% of intrapartum deaths occur in low- and middle-income countries, as high rates of home births and unattended deliveries remain challenges. High-risk pregnancies should be monitored closely and deliver in facilities with capacity for obstetric and neonatal management. Here we present the evidence for interventions for primary and secondary prevention (including obstetric care, neonatal resuscitation), and tertiary prevention for infants with acute complications.

scholarly journals Implementation of Multicolor Melt Curve Analysis for High-Risk Human Papilloma Virus Detection in Low- and Middle-Income Countries: A Pilot Study for Expanded Cervical Cancer Screening in Honduras

2018 ◽  
pp. 1-8 ◽  
Author(s):  
Scott A. Turner ◽  
Sophie J. Deharvengt ◽  
Kathleen Doyle Lyons ◽  
Jorge Arturo Plata Espinal ◽  
Ethan P.M. LaRochelle ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
High Risk ◽  
Medical Center ◽  
Virus Detection ◽  
The United States ◽  
Middle Income ◽  
Rural Village ◽  
Middle Income Countries ◽  
Dartmouth Hitchcock Medical ◽  
Low And Middle Income

Purpose Cervical cancer is a leading cause of cancer-related mortality in low- and middle-income countries (LMICs) and screening in LMICs is extremely limited. We aimed to implement on-site high-risk human papillomavirus (hrHPV) DNA testing in cohorts of women from an urban factory and from a rural village. Methods A total of 802 women were recruited for this study in partnership with La Liga Contra el Cancer through the establishment of women’s health resource fairs at two locations in Honduras: a textile factory (n = 401) in the city of San Pedro Sula and the rural village of El Rosario (n = 401) in Yoro. Participants received a routine cervical examination during which three sterile cytobrushes were used to collect cervical samples for testing. hrHPV genotyping was performed using a hrHPV genotyping assay and a real-time polymerase chain reaction instrument. Results hrHPV status across all participants at both sites was 13% hrHPV positive and 67% hrHPV negative. When hrHPV status was compared across all three testing sites, hrHPV-positive rates were approximately equal among the factory (13%), village (12%), and confirmatory testing at Dartmouth-Hitchcock Medical Center (Lebanon, NH; 14%). hrHPV genotype was compared across sites, with HPV16 showing the highest infection rate (15%), followed by HPV59 (12%), and HPV68 (11%). There was a low prevalence of HPV18 observed in both populations compared with the hrHPV-positive population in the United States. Conclusion In collaboration with oncologists and pathologists from La Liga Contra el Cancer, we were able to provide a continuum of care once health-fair testing was performed. We established a method and implementation plan for hrHPV testing that is sustainable in LMICs.

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