The impact of PHCC infection control protocol in high-risk primary healthcare centers in the prevention of healthcare MERS-CoV outbreaks

SUMMARYA pandemic influenza A(H1N1) 2009 outbreak in a summer school affected 117/276 (42%) students. Residential social contact was associated with risk of infection, and there was no evidence for transmission associated with the classroom setting. Although the summer school had new admissions each week, which provided susceptible students the outbreak was controlled using routine infection control measures (isolation of cases, basic hygiene measures and avoidance of particularly high-risk social events) and prompt treatment of cases. This was in the absence of chemoprophylaxis or vaccination and without altering the basic educational activities of the school. Modelling of the outbreak allowed estimation of the impact of interventions on transmission. These models and follow-up surveillance supported the effectiveness of routine infection control measures to stop the spread of influenza even in this high-risk setting for transmission.

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The impact of pharmacist shortage on the inventory management of medicines at primary healthcare centres in East Java, Indonesia

Pharmacy Education ◽

10.46542/pe.2021.212.814 ◽

2021 ◽

pp. 8-14

Author(s):

Abdul Rahem ◽

Umi Athiyah ◽

Catur Dian Setiawan ◽

Andi Hermansyah

Keyword(s):

Inventory Management ◽

Primary Healthcare ◽

Medicine Management ◽

The Impact ◽

Primary Healthcare Centers

Background: Pharmacists are the only people authorised to manage the medicines inventory. However, in the case of pharmacist shortage, other personnel may take over this function. This is particularly the case in most primary healthcare centers (puskesmas) in Indonesia. Aim: To compare the outcome of medicine inventory management between pharmacists and non-pharmacists in primary healthcare centres (PHCs). Methods: A survey of 146 puskesmas in East Java was conducted involving 73 pharmacists and 73 non-pharmacist staff. This study was conducted from July to January 2020. Each respondent completed a questionnaire focusing on the inventory aspects of medicine management. Results: Purchasing accuracy is higher for pharmacists (90%) than for non-pharmacists (68%). Pharmacists manage the inventory more efficiently with only 2% of the drugs expired and wasted while non-pharmacist staff wasted 16% of the drugs and 18% of the drugs expired. Conclusion: The role of pharmacists in medicine inventories is vital as they carry out more efficient and accurate medicine management.

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High-Risk International Clones of Carbapenem-Nonsusceptible Pseudomonas aeruginosa Endemic to Indonesian Intensive Care Units: Impact of a Multifaceted Infection Control Intervention Analyzed at the Genomic Level

mBio ◽

10.1128/mbio.02384-19 ◽

2019 ◽

Vol 10 (6) ◽

Cited By ~ 6

Author(s):

Andreu Coello Pelegrin ◽

Yulia Rosa Saharman ◽

Aurélien Griffon ◽

Mattia Palmieri ◽

Caroline Mirande ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Intensive Care ◽

High Risk ◽

Infection Control ◽

Intensive Care Units ◽

Clinical Data ◽

Prevention Measures ◽

Content Type ◽

Control Intervention ◽

The Impact

ABSTRACT Infection control effectiveness evaluations require detailed epidemiological and microbiological data. We analyzed the genomic profiles of carbapenem-nonsusceptible Pseudomonas aeruginosa (CNPA) strains collected from two intensive care units (ICUs) in the national referral hospital in Jakarta, Indonesia, where a multifaceted infection control intervention was applied. We used clinical data combined with whole-genome sequencing (WGS) of systematically collected CNPA to infer the transmission dynamics of CNPA strains and to characterize their resistome. We found that the number of CNPA transmissions and acquisitions by patients was highly variable over time but that, overall, the rates were not significantly reduced by the intervention. Environmental sources were involved in these transmissions and acquisitions. Four high-risk international CNPA clones (ST235, ST823, ST375, and ST446) dominated, but the distribution of these clones changed significantly after the intervention was implemented. Using resistome analysis, carbapenem resistance was explained by the presence of various carbapenemase-encoding genes (blaGES-5, blaVIM-2-8, and blaIMP-1-7-43) and by mutations within the porin OprD. Our results reveal for the first time the dynamics of P. aeruginosa antimicrobial resistance (AMR) profiles in Indonesia and additionally show the utility of WGS in combination with clinical data to evaluate the impact of an infection control intervention. (This study has been registered at www.trialregister.nl under registration no. NTR5541). IMPORTANCE In low-to-middle-income countries such as Indonesia, work in intensive care units (ICUs) can be hampered by lack of resources. Conducting large epidemiological studies in such settings using genomic tools is rather challenging. Still, we were able to systematically study the transmissions of carbapenem-nonsusceptible strains of P. aeruginosa (CNPA) within and between ICUs, before and after an infection control intervention. Our data show the importance of the broad dissemination of the internationally recognized CNPA clones, the relevance of environmental reservoirs, and the mixed effects of the implemented intervention; it led to a profound change in the clonal make-up of CNPA, but it did not reduce the patients’ risk of CNPA acquisitions. Thus, CNPA epidemiology in Indonesian ICUs is part of a global expansion of multiple CNPA clones that remains difficult to control by infection prevention measures.

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Review: Primary healthcare in six sub-Saharan African countries: an impact assessment using a systematic review

Internet Journal of Medical Update - EJOURNAL ◽

10.4314/ijmu.v14i1.5 ◽

2021 ◽

Vol 14 (1) ◽

pp. 22-29

Author(s):

Oladayo Nathaniel Awojobi ◽

Jane Temidayo Abe ◽

Oluwatoyin Adenike Adeniji

Keyword(s):

Primary Healthcare ◽

Healthcare Services ◽

Developed Countries ◽

African Countries ◽

Working Paper ◽

Quantitative Studies ◽

Healthcare Accessibility ◽

Sub Saharan ◽

The Impact ◽

Primary Healthcare Centers

Primary healthcare is provided in most developing and developed countries to enhance healthcare accessibility for the population. This study accesses the impact of primary healthcare in six Sub-Saharan countries. A systematic search for qualitative and quantitative studies published before the end of 2017 was conducted online. Inclusion criteria were met by 6 studies, one each from Ghana, Malawi, Nigeria, Tanzania, Zambia and Zimbabwe. Five studies are peer-reviewed, and one is a working paper. Three studies reported on the impact of primary healthcare on healthcare accessibility. Four studies reported on the role healthcare resources play in enhancing primary healthcare services. Two other studies mentioned how cost-sharing mechanism led to an increase in healthcare utilization and how the reduction in user changes in all primary healthcare centers led to the reduction in out-of-pocket spending on healthcare services in a short-term. Primary healthcare offers access and utilization to healthcare services in most countries. It also offers protection against the detrimental effects of user fees. However, concerted efforts are still needed in most African countries in revitalizing the operations of primary healthcare centers for the improvement of healthcare services.

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PrimaryCare@COVID-19: the implementation of digital monitoring services for patients with chronic diseases during the Covid-19 pandemic (Preprint)

10.2196/preprints.24181 ◽

2020 ◽

Author(s):

Luis Velez Lapão ◽

Mariana Santos ◽

Melanie Maia ◽

Vasco Pedrosa ◽

Jorge Seixas ◽

...

Keyword(s):

Chronic Diseases ◽

Primary Healthcare ◽

Primary Care Physicians ◽

Design Science ◽

Digital Health ◽

Healthcare Providers ◽

Healthcare Services ◽

Healthcare Provision ◽

The Impact ◽

Primary Healthcare Centers

BACKGROUND The COVID-19 pandemic is straining health systems and disrupting the delivery of healthcare services, in particular for the elderly and those with chronic conditions, who are particularly vulnerable to COVID-19 infection. OBJECTIVE The aim of this project is to support primary healthcare provision with a digital health platform that will allow primary care physicians and nurses to remotely manage the care of patients with chronic diseases or COVID-19 infections. METHODS The project followed the 6 steps of the Design Science implementation methodology framework: problem identification and motivation, definition of the objectives aligned with Goal-oriented care, artefact design and development, solution demonstration, evaluation, and communication. RESULTS The digital platform was developed for the specific objectives of the project and successfully piloted in three primary healthcare centers in the Lisbon Health Region. The health professionals were able to safely and thoroughly manage their first patients remotely with high degrees of satisfaction. The first COVID-19 messages were sent to the patients, addressing infodemic issues. CONCLUSIONS Although still in the first steps of implementation, we are seeing promising results with a positive uptake by healthcare providers and patients. Further research is planned to evaluate the impact on patient’s health related outcomes. We are confident that this platform could be scaled-up to all primary healthcare centers in Portugal in the next months, ready to tackle a second wave of COVID-19.

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The impact of an enhanced infection control protocol on molar root canal treatment outcome – a randomised clinical trial

International Endodontic Journal ◽

10.1111/iej.13605 ◽

2021 ◽

Author(s):

Shatha Zahran ◽

Shanon Patel ◽

Garrit Koller ◽

Francesco Mannocci

Keyword(s):

Clinical Trial ◽

Treatment Outcome ◽

Infection Control ◽

Root Canal ◽

Randomised Clinical Trial ◽

Root Canal Treatment ◽

Control Protocol ◽

The Impact

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Assessing the impact of simplified HCV care on linkage to care amongst high-risk patients at primary healthcare clinics in Malaysia: a prospective observational study

BMJ Open ◽

10.1136/bmjopen-2021-055142 ◽

2021 ◽

Vol 11 (12) ◽

pp. e055142

Author(s):

Jessica Markby ◽

Sonjelle Shilton ◽

Xiaohui Sem ◽

Huan Keat Chan ◽

Rosaida Md Said ◽

...

Keyword(s):

Viral Load ◽

High Risk ◽

Observational Study ◽

Primary Healthcare ◽

Scale Up ◽

Load Test ◽

Cirrhotic Patients ◽

Primary Healthcare Clinics ◽

The Impact ◽

Hcv Testing

IntroductionTo achieve the elimination of hepatitis C virus (HCV), substantial scale-up in access to testing and treatment is needed. This will require innovation and simplification of the care pathway, through decentralisation of testing and treatment to primary care settings and task-shifting to non-specialists. The objective of this study was to evaluate the feasibility and effectiveness of decentralisation of HCV testing and treatment using rapid diagnostic tests (RDTs) in primary healthcare clinics (PHCs) among high-risk populations, with referral of seropositive patients for confirmatory viral load testing and treatment.MethodsThis observational study was conducted between December 2018 and October 2019 at 25 PHCs in three regions in Malaysia. Each PHC was linked to one or more hospitals, for referral of seropositive participants for confirmatory testing and pretreatment evaluation. Treatment was provided in PHCs for non-cirrhotic patients and at hospitals for cirrhotic patients.ResultsDuring the study period, a total of 15 366 adults were screened at the 25 PHCs, using RDTs for HCV antibodies. Of the 2020 (13.2%) HCV antibody-positive participants, 1481/2020 (73.3%) had a confirmatory viral load test, 1241/1481 (83.8%) were HCV RNA-positive, 991/1241 (79.9%) completed pretreatment assessment, 632/991 (63.8%) initiated treatment, 518/632 (82.0%) completed treatment, 352/518 (68.0%) were eligible for a sustained virological response (SVR) cure assessment, 209/352 (59.4%) had an SVR cure assessment, and SVR was achieved in 202/209 (96.7%) patients. A significantly higher proportion of patients referred to PHCs initiated treatment compared with those who had treatment initiated at hospitals (71.0% vs 48.8%, p<0.001).ConclusionsThis study demonstrated the effectiveness and feasibility of a simplified decentralised HCV testing and treatment model in primary healthcare settings, targeting high-risk groups in Malaysia. There were good outcomes across most steps of the cascade of care when treatment was provided at PHCs compared with hospitals.

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