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Falana ROA, Ogidan OC, Fajemilehin BR. Barriers to infection prevention and control implementation in selected healthcare facilities in Nigeria. Infect Dis Now 2024; 54:104877. [PMID: 38395258 DOI: 10.1016/j.idnow.2024.104877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 12/01/2023] [Accepted: 02/20/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE While infection prevention and control are of paramount importance, up until recently an assessment of implementation challenges and performance gaps was lacking. This study explored the barriers to infection prevention and control implementation at selected healthcare facilities, the objective being to find ways to improve their programs. MATERIAL AND METHOD A qualitative approach was applied. Purposive sampling was used to select thirty-three healthcare facilities in Ekiti State, Nigeria. They were globally assessed, and an Infection Prevention and Control team, represented by the Infection Prevention and Control referent in each of the selected facilities trained the participants. Data were collected using the Key Informant Interview Guide and analyzed by means of content and thematic analyses using Atlas.ti software. RESULTS Inadequate infection prevention and control materials, poor waste management, non-compliance of patients with infection prevention and control protocols, and poor infrastructure were identified as major barriers to infection prevention and control implementation. CONCLUSION The study concluded that a number of identified factors hindering infection prevention and control implementation in healthcare facilities in Ekiti State needed to be addressed.
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Affiliation(s)
- Rachael O A Falana
- Department of Nursing Science, Obafemi Awolowo University, Osun State, Nigeria.
| | - Oluwakemi C Ogidan
- Department of Nursing Science, Ekiti State University, Ado Ekiti, Ekiti State, Nigeria
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Wang YC, Wang LS, Hsieh TC, Chung HC. Factors affecting vancomycin-resistant Enterococcus faecium colonization of in-hospital patients in different wards. Tzu Chi Med J 2024; 36:83-91. [PMID: 38406568 PMCID: PMC10887344 DOI: 10.4103/tcmj.tcmj_117_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/22/2023] [Accepted: 09/26/2023] [Indexed: 02/27/2024] Open
Abstract
Objectives The prevalence of vancomycin-resistant Enterococcus faecium (VRE) infection at a medical center in Eastern Taiwan rose to 80.6%, exceeding the average prevalence of 55.6% among all medical centers nationwide during the same period. In recent years, the number of cases of VRE infection detected among hospitalized patients has increased annually. However, most of these patients in different wards are asymptomatic carriers. Therefore, restricting active screening to high-risk units will not improve the current situation, and it is necessary to review the risk factors for VRE colonization to provide a reference for future infection control policies. Materials and Methods Between 2014 and 2019, there were 3188 VRE-positive cultures reported at our institution, as per the electronic medical records system. Results In the medical and surgical wards, patients who received penicillin (odds ratios [ORs]: 2.84 and 4.16, respectively) and third-generation cephalosporins (ORs: 3.17 and 6.19, respectively) were at higher risk of VRE colonization. In intensive care units, the use of carbapenems (OR: 2.08) was the most significant variable. Conclusion This study demonstrated that the risk factors for VRE colonization differed between wards. Thus, policies should be established according to the attributes of patients in each ward, and active screening tests should be performed according to individual risks, instead of a policy for comprehensive mass screening.
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Affiliation(s)
- Yun-Cheng Wang
- Department of Infection Prevention and Control, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Lih-Shinn Wang
- Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | | | - Hui-Chun Chung
- Department of Nursing, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Department of Nursing, Tzu Chi University, Hualien, Taiwan
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Joshi A, Jiang Y, Jones P. Does wearing a surgical mask influence face touching by healthcare workers? A retrospective cohort study. Emerg Med Australas 2023; 35:120-125. [PMID: 36117397 PMCID: PMC10087437 DOI: 10.1111/1742-6723.14082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE At the start of the COVID-19 pandemic, healthcare workers (HCW) in our ED were advised against and actively discouraged from wearing masks when not seeing respiratory patients, as mask wearing was thought to increase the risk of droplet transmission by face touching. The primary objective of the present study was to determine whether HCW using face masks were more or less likely to touch their faces than those not wearing masks. METHODS We analysed six randomly selected hours of closed circuit television footage from our staff base. Face touches were recorded electronically by trained researchers. Generalised linear mixed models were used to compare the frequency and duration of face touches with and without face masks, controlling for individual clusters, adjusting for time of footage, duration on screen and staff role. RESULTS Data were collected from 187 HCW. Masks were worn in 231 (36%) of 642 screen sessions. Wearing a mask did not significantly change the odds of face touching (odds ratio 0.55, 95% confidence interval [CI] 0.30-1.01, P = 0.055) or duration of face touch (mean difference -1.45 s, 95% CI -8.84, 5.99, P = 0.71). For mucosal areas, a significant reduction in the odds of face touching was observed for mask wearers (odds ratio 0.21, 95% CI 0.11-0.43, P < 0.001) and on the frequency of mucosal touches (rate ratio 0.45, 95% CI 0.29-0.69, P < 0.001). CONCLUSIONS Mask wearing did not change face touching or the duration of face touches. However, significantly fewer mucosal touches were observed when wearing a mask, which may help to reduce nosocomial droplet transmission of viruses.
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Affiliation(s)
- Anil Joshi
- Adult Emergency DepartmentAuckland City Hospital, Auckland District Health BoardAucklandNew Zealand
| | - Yannan Jiang
- Department of StatisticsThe University of AucklandAucklandNew Zealand
| | - Peter Jones
- Adult Emergency DepartmentAuckland City Hospital, Auckland District Health BoardAucklandNew Zealand
- Department of SurgeryThe University of AucklandAucklandNew Zealand
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Wilson AM, Jones RM. Exploring spatial averaging of contamination in fomite microbial transfer models and implications for dose. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2022; 32:759-766. [PMID: 34743183 PMCID: PMC8571976 DOI: 10.1038/s41370-021-00398-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND When modeling exposures from contact with fomites, there are many choices in defining the sizes of compartments representing environmental surfaces and hands, and the portions of compartments involved in contacts. These choices impact dose estimates, yet there is limited guidance for selection of these model parameters. OBJECTIVE The study objective was to explore methods for representing environmental surface and hand contact areas in exposure models and implications for estimated doses. METHODS A simple scenario was used: an individual using their hands to contact their face and two microbially contaminated environmental surfaces. Four models were developed to explore different compartmentalization strategies: (1) hands and environmental surfaces each represented by one compartment, (2) hands represented by two compartments (fingertips vs. non-fingertip areas) while environmental surfaces were represented by one compartment, (3) hands represented by a single compartment and environmental surfaces represented by two compartments, and (4) hands and environmental surfaces each represented by two compartments. Sensitivity analyses were conducted to evaluate the influence of heterogeneous surface contact frequency, hand contact type, and hand dominance on dose. RESULTS Estimated doses were greatest when hand areas and environmental surfaces were each represented by two compartments, indicating that surface area "dilutes" contaminant concentration and decreases estimated dose. SIGNIFICANCE Model compartment designations for hands and environmental surfaces affect dose estimation, but more human behavior data are needed. IMPACT STATEMENT A common problem for exposure models describing exposures via hand-to-surface contacts occurs in the way that estimated contamination across human skin (usually hands) or across environmental surfaces is spatially averaged, as opposed to accounting for concentration changes across specific parts of the hand or individual surfaces. This can lead to the dilution of estimated contaminants and biases in estimated doses in risk assessments. The magnitude of these biases and implications for the accuracy in risk assessments are unknown. We quantify differences in dose for various strategies of compartmentalizing environmental surfaces and hands to inform guidance on future exposure model development.
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Affiliation(s)
- Amanda M Wilson
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, Salt Lake City, UT, USA.
- Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA.
- Department of Community, Environment & Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, 85721, USA.
| | - Rachael M Jones
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, Salt Lake City, UT, USA
- Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
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Wilson AM, Sleeth DK, Schaefer C, Jones RM. Transmission of Respiratory Viral Diseases to Health Care Workers: COVID-19 as an Example. Annu Rev Public Health 2022; 43:311-330. [DOI: 10.1146/annurev-publhealth-052120-110009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Health care workers (HCWs) can acquire infectious diseases, including coronavirus disease 2019 (COVID-19), from patients. Herein, COVID-19 is used with the source–pathway–receptor framework as an example to assess evidence for the role of aerosol transmission and indirect contact transmission of viral respiratory infectious diseases. Evidence for both routes is strong for COVID-19 and other respiratory viruses, but aerosol transmission is likely dominant for COVID-19. Key knowledge gaps about transmission processes and control strategies include the distribution of viable virus among respiratory aerosols of different sizes, the mechanisms and efficiency by which virus deposited on the facial mucous membrane moves to infection sites inside the body, and the performance of source controls such as face coverings and aerosol containment devices. To ensure that HCWs are adequately protected from infection, guidelines and regulations must be updated to reflect the evidence that respiratory viruses are transmitted via aerosols. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Amanda M. Wilson
- Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA;, ,
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Arizona, USA
| | - Darrah K. Sleeth
- Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA;, ,
| | - Camie Schaefer
- Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA;, ,
| | - Rachael M. Jones
- Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA;, ,
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Detection of SARS-CoV-2 genome on inanimate surfaces in COVID-19 intensive care units and emergency care cohort. Braz J Microbiol 2022; 53:213-220. [PMID: 34993920 PMCID: PMC8735889 DOI: 10.1007/s42770-021-00674-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 12/24/2021] [Indexed: 01/02/2023] Open
Abstract
Introduction Understanding the different transmission routes of SARS-CoV-2 is crucial in planning effective interventions in healthcare institutions. This study aimed to evaluate the presence of SARS-Cov-2 genome on inanimate surfaces in COVID-19 intensive care unit and emergency care cohorts. Methods This is a prospective cross-sectional study. Samples of the environmental surface of objects and furniture were collected between July 15 and October 15, 2020, at COVID-19 intensive and emergency care units. The presence of SARS-CoV-2 genome was determined by quantitative RT-qPCR. The positivity rate for SARS-Cov-2 genome is presented as the arithmetic mean of the sum of the values obtained in each collection. Values of 1.0, 0.5, and 0.0 were assigned for positive, indeterminate, and negative events, respectively. Results In the intensive care unit, 86% of samples collected at the stethoscope and bed rail surfaces were positive. In the emergency care unit, 43% of bathroom tap, bed rails, and bedside table samples were positive. SARS-CoV-2 genome was not detected at the computer mouse and keyboard. At the emergency care unit, 14.3% of the samples from the collection room armchair were positive. Conclusions SARS-CoV-2 genome can be found at the environmental surface of objects and furniture at COVID-19 care units. They can represent a potential source of indirect transmission pathway for COVID-19, especially within health service institutions.
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Overbey KN, Hamra GB, Nachman KE, Rock C, Schwab KJ. Quantitative microbial risk assessment of human norovirus infection in environmental service workers due to healthcare-associated fomites. J Hosp Infect 2021; 117:52-64. [PMID: 34403766 PMCID: PMC8978295 DOI: 10.1016/j.jhin.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Healthcare-associated norovirus outbreaks place a large burden on healthcare staff. Environmental service workers (ESWs), however, remain understudied despite high contact with potentially contaminated surfaces. Understanding the magnitude of the risk of norovirus infection in healthcare ESWs can protect workers and improve infection control. AIM This study simulated the risk of norovirus infection for unprotected ESWs after a single fomite contact, assuming no disinfection or protective equipment, in norovirus-positive patient rooms. In addition, the risk of secondary surface transmission from norovirus-exposed ESWs was simulated. METHODS A quantitative microbial risk assessment employing two-dimensional Monte Carlo simulation with parameters extracted from the literature was used to estimate norovirus infection from multiple fomite contact scenarios defined by: norovirus source (patient vomit/diarrhoea), location (bathroom/patient room) and target outcome (ESW/secondary illness). FINDINGS Unprotected ESWs have a maximum estimated risk of norovirus infection of 33% (1:3) for a single fomite contact in a room where a norovirus-positive patient had a diarrhoeal event. Patient vomit events lead to fomite contact risk estimates that are four orders of magnitude lower than those for diarrhoeal events. The estimated risk of secondary illness from touching a common surface is as high as 25% (1:4) after single fomite exposure following a diarrhoeal event. CONCLUSIONS A single fomite contact may lead to sizable risk of norovirus infection in ESWs if personal protective equipment and disinfection are not used appropriately. ESWs can also transfer virus to secondary surfaces, initiating further infections. Interventions are needed to reduce fomite transfer of norovirus, and protect patients and staff from nosocomial infections.
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Affiliation(s)
- K N Overbey
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - G B Hamra
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - K E Nachman
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - C Rock
- Division of Infectious Diseases, Johns Hopkins Medicine, Baltimore, MD, USA
| | - K J Schwab
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Steele M, Hurtado RR, Rychlik K, Bonebrake A, Bovee MC, O'Donnell A, Perryman J, Kociolek LK. Impact of an automated multiple emitter whole-room ultraviolet-C disinfection system on hospital acquired infections: A quasi-experimental study. Am J Infect Control 2021; 49:1200-1203. [PMID: 33774103 DOI: 10.1016/j.ajic.2021.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 11/16/2022]
Abstract
A quasi-experimental study performed in a pediatric hematology-oncology unit demonstrated that whole-room ultraviolet-C disinfection was associated with a significant reduction in hospital-onset Clostridioides difficile infection (P< .01, trend and level), but not healthcare-associated viral respiratory infections (P= .06 for trend, P= .36 for level) or central line-associated bloodstream infections (P> 0.75, trend and level).
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Affiliation(s)
- Molly Steele
- Ann & Robert H. Lurie Children's Hospital of Chicago.
| | | | - Karen Rychlik
- Ann & Robert H. Lurie Children's Hospital of Chicago
| | | | - Maria C Bovee
- Ann & Robert H. Lurie Children's Hospital of Chicago
| | | | | | - Larry K Kociolek
- Ann & Robert H. Lurie Children's Hospital of Chicago; Department of Pediatrics, Northwestern University Feinberg School of Medicine
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Health Beliefs and Compliance of Standard Precautions of COVID-19 among Employed Nurses. JOURNAL OF EDUCATION AND COMMUNITY HEALTH 2021. [DOI: 10.52547/jech.8.3.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Oh HS, Ryu M, Yang Y. Characteristics of hand-to-environment contact during indoor activities in daily life among Korean adults using a video-based observation method. Osong Public Health Res Perspect 2021; 12:187-195. [PMID: 34102046 PMCID: PMC8256303 DOI: 10.24171/j.phrp.2021.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 05/13/2021] [Indexed: 11/05/2022] Open
Abstract
Objectives The aim of this study was to describe the characteristics of hand-to-environmental contact (HEC) and to identify the factors influencing HEC behavior in Korean adults’ indoor daily life. Methods Thirty participants were enrolled from January 14 to February 12, 2018 after providing informed consent for being videotaped. Data were collected by recording their indoor daily lives for 2 hours, resulting in 4,732 HEC cases. To ensure the accuracy and reliability of the HEC readings, 3 training sessions were conducted for the videotape readers. Rereading and verifying randomly selected data ensured the validity of intra- and inter-reader readings. Results The most frequent contact items were phones, papers, computer accessories, and furniture surfaces. The contact density (frequency-duration/min) was highest for category II (items occasionally shared by others, 56.8), followed in descending order by category I (items for individual use, 35.9), and category III (public use items, 3.4). Significant differences in contact density were found according to participants’ demographic characteristics. Conclusion As mobile phones were the most frequent contact item, regular and strict mobile phone cleansing or disinfection strategies are needed, in addition to preventative measures taken for category II and III items. Avoiding sharing personal items with others, refraining from unnecessary HEC, and maintaining strict hand hygiene are recommended.
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Affiliation(s)
- Hyang Soon Oh
- Department of Nursing, College of Life Science and Natural Resources, Sunchon National University, Suncheon, Korea
| | - Mikyung Ryu
- Department of Nursing, College of Nursing and Public Health, Daegu University, Daegu, Korea
| | - Youngran Yang
- College of Nursing, Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Korea
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de Arriba-Fernández A, Molina-Cabrillana MJ, Serra Majem L. [Evolution of adherence to hand hygiene in health care professionals in a third level hospital in relation to the SARS-CoV-2 pandemic]. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2021; 34:214-219. [PMID: 33829723 PMCID: PMC8179943 DOI: 10.37201/req/150.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/20/2021] [Accepted: 02/22/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Proper hand hygiene is the main measure in the prevention and control of infection associated with healthcare. It describes how the pandemic period of 2020 has influenced the evolution of the degree of compliance with hand hygiene practices in health professionals at the Hospital Universitario Insular de Gran Canaria with respect to previous years. METHODS Descriptive cross-sectional study of direct observation on compliance with the five moments of hand hygiene in the 2018-2020 period. Adherence is described with the frequency distribution of the different moments in which it was indicated. RESULTS Total adherence has increased from 42.5% in 2018, to 47.6% in 2019, and 59.2% in 2020 (p <0.05). Total adherence was greater in the moments after contact with the patient (67%) than in the moments before contact (48%). The area with the highest adherence was dialysis (83%). There is a greater adherence in open areas than in hospitalization areas (65% vs 56%). Higher adherence was determined in physicians (73%) and nurses (74%), than in nursing assistants (50%) (p<0.05). CONCLUSIONS In 2020 there was an increase in adherence to hand hygiene compared to previous years. A higher percentage of adherence was determined in physicians and nurses than in nursing assistants. We consider that the current SARS-CoV-2 pandemic has played a relevant role in this increase in adherence.
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Affiliation(s)
- A de Arriba-Fernández
- Alejandro de Arriba-Fernández, Universidad de Las Palmas de Gran Canaria. Paseo Blas Cabrera Felipe "Físico", 310, Las Palmas Gran Canaria. Spain.
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Abstract
OBJECTIVE To characterize the presence and magnitude of viruses in the air and on surfaces in the rooms of hospitalized patients with respiratory viral infections, and to explore the association between care activities and viral contamination. DESIGN Prospective observational study. SETTING Acute-care academic hospital. PARTICIPANTS In total, 52 adult patients with a positive respiratory viral infection test within 3 days of observation participated. Healthcare workers (HCWs) were recruited in staff meetings and at the time of patient care, and 23 wore personal air-sampling devices. METHODS Viruses were measured in the air at a fixed location and in the personal breathing zone of HCWs. Predetermined environmental surfaces were sampled using premoistened Copan swabs at the beginning and at the end of the 3-hour observation period. Preamplification and quantitative real-time PCR methods were used to quantify viral pathogens. RESULTS Overall, 43% of stationary and 22% of personal air samples were positive for virus. Positive stationary air samples were associated with ≥5 HCW encounters during the observation period (odds ratio [OR], 5.3; 95% confidence interval [CI], 1.2-37.8). Viruses were frequently detected on all of the surfaces sampled. Virus concentrations on the IV pole hanger and telephone were positively correlated with the number of contacts made by HCWs on those surfaces. The distributions of influenza, rhinoviruses, and other viruses in the environment were similar. CONCLUSIONS Healthcare workers are at risk of contracting respiratory virus infections when delivering routine care for patients infected with the viruses, and they are at risk of disseminating virus because they touch virus-contaminated fomites.
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Carrillo-Diaz M, Lacomba-Trejo L, Del Valle-González A, Romero-Maroto M, González-Olmo MJ. Anxiety and facial self-contacts: possible impact on COVID-19 transmission in dental practice. BMC Oral Health 2021; 21:200. [PMID: 33879144 PMCID: PMC8056369 DOI: 10.1186/s12903-021-01564-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/12/2021] [Indexed: 02/02/2023] Open
Abstract
Background The purpose was to analyse the associations between dental and trait anxiety, fear of COVID-19 and the duration and frequency of spontaneous hand-to-face contact (self-contact). Methods A cross-sectional design was carried out with 128 adult patients from four dental clinics in Madrid, during the confinement, from March 15 to May 15. The patients’ movements in the waiting room were monitored with Microsoft Kinect Software, also completed the Trait anxiety subscale of the STAI, the COVID-19 Fear and the S-DAI questionnaire.
Results Associations were observed between the duration and frequency of facial, mask and eye contact with trait anxiety and dental fear was determined only by the frequency of this self-contact. Trait anxiety is associated with dental anxiety and with fear of COVID-19. Although facial self-contact is higher in women, it also rises in men as dental fear increases. Moreover, dental anxiety is a good predictor of trait anxiety and the incidence of facial self-contact. Conclusions Understanding the possible associations between biopsychosocial factors, such as trait anxiety, dental anxiety and self-contact is important. It may help to prevent the spread of COVID-19 in the population as well as enabling the formulation of effective interventions to improve oral health care through the implementation of dental care programmes. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01564-6.
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Affiliation(s)
- María Carrillo-Diaz
- Orthodontic and Pediatric Dentistry Department, Rey Juan Carlos University, Avda de Atenas s/n 28922, Alcorcón, Madrid, Spain
| | - Laura Lacomba-Trejo
- Faculty of Psychology, Department of Personality, Assessment and Psychological Treatments, University of Valencia, Av. Blasco Ibáñez, 21, 46010, Valencia, Spain
| | - Antonio Del Valle-González
- Orthodontic and Pediatric Dentistry Department, Rey Juan Carlos University, Avda de Atenas s/n 28922, Alcorcón, Madrid, Spain
| | - Martín Romero-Maroto
- Orthodontic and Pediatric Dentistry Department, Rey Juan Carlos University, Avda de Atenas s/n 28922, Alcorcón, Madrid, Spain
| | - María José González-Olmo
- Orthodontic and Pediatric Dentistry Department, Rey Juan Carlos University, Avda de Atenas s/n 28922, Alcorcón, Madrid, Spain.
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Jones RM. Contribuciones relativas de las vías de transmisión de la COVID-19 entre el personal sanitario que presta atención a pacientes. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2021; 18:S61-S69. [PMID: 33822691 DOI: 10.1080/15459624.2021.1877053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
RESUMENLas vías de transmisión de la COVID-19 desde pacientes infectados al personal de la salud son actualmente objeto de debate, pero su consideración resulta fundamental para la selección del equipo de protección personal. El objetivo de este documento es explorar las contribuciones de tres vías de transmisión-contacto, gota e inhalación-al riesgo de infección de COVID-19 adquirida por el personal sanitario en el ámbito laboral. El método consistió en la evaluación cuantitativa de los riesgos microbianos y de un modelo de exposición cuyos posibles parámetros se basaron en datos específicos del virus SARS-CoV-2 cuando se disponía de ellos. El hallazgo clave fue que las vías de transmisión por gotas e inhalación predominan sobre la vía de contacto, contribuyendo en promedio 35%, 57% y 8.2% a la probabilidad de infección cuando no se usa equipo de protección personal. En promedio, 80% de la exposición a la inhalación ocurre cuando el personal sanitario está cerca de los pacientes. La contribución relativa de las gotas y la inhalación depende de la emisión de SARS-CoV-2 en las partículas respirables (<10 μm) a través de la exhalación, y la inhalación se vuelve predominante, en promedio, cuando la emisión supera las cinco copias genéticas por minuto. La concentración prevista del SARS-CoV-2 en el aire de la habitación del paciente es baja (<1 copia del gen por m3 en promedio) y probablemente se encuentre por debajo del límite de cuantificación de muchos métodos de muestreo del aire. Los resultados demuestran el valor que supone la protección respiratoria del personal sanitario y que el muestreo de campo puede no ser lo suficientemente sensible para verificar la contribución que realiza la inhalación del SARS-CoV-2 al riesgo de infección de COVID-19 adquirida por el personal. La emisión e ineficacia del SARS-CoV-2 en gotas respiratorias de diferente tamaño es aún una brecha en el conocimiento, fundamental para comprender y controlar la transmisión de la COVID-19.
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Affiliation(s)
- Rachael M Jones
- Departamento de Medicina Familiar y Preventiva, Facultad de Medicina, Universidad de Utah, Salt Lake City, Utah
- Centro Rocky Mountain de Salud Ambiental y Ocupacional, Universidad de Utah, Salt Lake City, Utah
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15
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Jones RM. Relative contributions of transmission routes for COVID-19 among healthcare personnel providing patient care. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2020; 17:408-415. [PMID: 32643585 DOI: 10.1080/15459624.2020.1784427] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
The routes of COVID-19 transmission to healthcare personnel from infected patients is the subject of debate, but is critical to the selection of personal protective equipment. The objective of this paper was to explore the contributions of three transmission routes-contact, droplet, and inhalation-to the risk of occupationally acquired COVID-19 infection among healthcare personnel (HCP). The method was quantitative microbial risk assessment, and an exposure model, where possible model parameters were based on data specific to the SARS-CoV-2 virus when available. The key finding was that droplet and inhalation transmission routes predominate over the contact route, contributing 35%, 57%, and 8.2% of the probability of infection, on average, without use of personal protective equipment. On average, 80% of inhalation exposure occurs when HCP are near patients. The relative contribution of droplet and inhalation depends upon the emission of SARS-CoV-2 in respirable particles (<10 µm) through exhaled breath, and inhalation becomes predominant, on average, when emission exceeds five gene copies per min. The predicted concentration of SARS-CoV-2 in the air of the patient room is low (< 1 gene copy per m3 on average), and likely below the limit of quantification for many air sampling methods. The findings demonstrate the value of respiratory protection for HCP, and that field sampling may not be sensitive enough to verify the contribution of SARS-CoV-2 inhalation to the risk of occupationally acquired COVID-19 infection among healthcare personnel. The emission and infectivity of SARS-CoV-2 in respiratory droplets of different sizes is a critical knowledge gap for understanding and controlling COVID-19 transmission.
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Affiliation(s)
- Rachael M Jones
- Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, Salt Lake City, Utah
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16
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Jones P, Roberts S, Hotu C, Kamona S. What proportion of healthcare worker masks carry virus? A systematic review. Emerg Med Australas 2020; 32:823-829. [PMID: 32578915 PMCID: PMC7361325 DOI: 10.1111/1742-6723.13581] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Concerns have been raised by healthcare organisations in New Zealand that routine mask use by healthcare workers (HCW) may increase the risk of transmission of SARS-CoV-2 through increased face touching. Routine mask use by frontline HCW was not recommended when seeing 'low risk' patients. The aim of this review was to determine the carriage of respiratory viruses on facemasks used by HCW. METHODS A systematic review was conducted with structured searches of medical and allied health databases. Two authors independently screened articles for inclusion, with substantial agreement (k = 0.66, 95% CI 0.54-0.79). Studies that at least one author recommended for full text review were reviewed in full for inclusion. Two authors independently extracted data from included studies including the setting, method of analysis and results. There was exact agreement on the proportion of virus detected on masks. RESULTS We retrieved 1233 titles, 47 underwent full text review and five studies reported in four articles were included. The studies were limited by small numbers and failure to test all eligible masks in some studies. The proportion in each study ranged from 0 (95% CI 0-10) to 25% (95% CI 8-54). No study reported clinical respiratory illness as a result of virus on the masks. CONCLUSIONS Although limited, current evidence suggests that viral carriage on the outer surface of surgical masks worn by HCW treating patients with clinical respiratory illness is low and there was not strong evidence to support the assumption that mask use may increase the risk of viral transmission.
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Affiliation(s)
- Peter Jones
- School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Sally Roberts
- Department of Microbiology, Auckland District Health Board, Auckland, New Zealand
| | - Cheri Hotu
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Sinan Kamona
- Department of Emergency Medicine, Auckland City Hospital, Auckland, New Zealand
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17
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Khazaei S, Bashirian S, Jenabi E, Barati M, Karimi-Shahanjarini A, Moeini B, Rezapur-Shahkolai F, Karami M, Khazaei M, Hashemi SZ, Ataei A, Eskandari Z, Fazli Z. COVID-19 Preventive Behaviors and its Related Beliefs among Health Workers: The Role of Threat and Coping Appraisals. JOURNAL OF EDUCATION AND COMMUNITY HEALTH 2020. [DOI: 10.29252/jech.7.3.221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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18
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Al‐Ani AH, Prentice RE, Rentsch CA, Johnson D, Ardalan Z, Heerasing N, Garg M, Campbell S, Sasadeusz J, Macrae FA, Ng SC, Rubin DT, Christensen B. Review article: prevention, diagnosis and management of COVID-19 in the IBD patient. Aliment Pharmacol Ther 2020; 52:54-72. [PMID: 32348598 PMCID: PMC7267115 DOI: 10.1111/apt.15779] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The current COVID-19 pandemic, caused by SARS-CoV-2, has emerged as a public health emergency. All nations are seriously challenged as the virus spreads rapidly across the globe with no regard for borders. The primary management of IBD involves treating uncontrolled inflammation with most patients requiring immune-based therapies. However, these therapies may weaken the immune system and potentially place IBD patients at increased risk of infections and infectious complications including those from COVID-19. AIM To summarise the scale of the COVID-19 pandemic, review unique concerns regarding IBD management and infection risk during the pandemic and assess COVID-19 management options and drug interactions in the IBD population. METHODS A literature review on IBD, SARS-CoV-2 and COVID-19 was undertaken and relevant literature was summarised and critically examined. RESULTS IBD patients do not appear to be more susceptible to SARS-CoV-2 infection and there is no evidence of an association between IBD therapies and increased risk of COVID-19. IBD medication adherence should be encouraged to prevent disease flare but where possible high-dose systemic corticosteroids should be avoided. Patients should exercise social distancing, optimise co-morbidities and be up to date with influenza and pneumococcal vaccines. If a patient develops COVID-19, immune suppressing medications should be withheld until infection resolution and if trial medications for COVID-19 are being considered, potential drug interactions should be checked. CONCLUSIONS IBD patient management presents a challenge in the current COVID-19 pandemic. The primary focus should remain on keeping bowel inflammation controlled and encouraging medication adherence.
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Affiliation(s)
- Aysha H. Al‐Ani
- Department of GastroenterologyThe Royal Melbourne HospitalMelbourneVic.Australia
| | - Ralley E. Prentice
- Department of GastroenterologyThe Royal Melbourne HospitalMelbourneVic.Australia
| | - Clarissa A. Rentsch
- Department of GastroenterologyThe Royal Melbourne HospitalMelbourneVic.Australia
| | - Doug Johnson
- Victorian Infectious Diseases UnitThe Royal Melbourne HospitalMelbourneVic.Australia
| | - Zaid Ardalan
- Department of GastroenterologyThe Royal Melbourne HospitalMelbourneVic.Australia
| | - Neel Heerasing
- Department of GastroenterologyThe Royal Melbourne HospitalMelbourneVic.Australia
| | - Mayur Garg
- Department of GastroenterologyThe Royal Melbourne HospitalMelbourneVic.Australia
| | - Sian Campbell
- Victorian Infectious Diseases UnitThe Royal Melbourne HospitalMelbourneVic.Australia
| | - Joe Sasadeusz
- Victorian Infectious Diseases UnitThe Royal Melbourne HospitalMelbourneVic.Australia
| | - Finlay A. Macrae
- Department of GastroenterologyThe Royal Melbourne HospitalMelbourneVic.Australia
| | - Siew C. Ng
- Department of Medicine and TherapeuticsInstitute of Digestive DiseaseState Key Laboratory of Digestive DiseasesLi Ka Shing Institute of Health ScienceThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
| | - David T. Rubin
- Inflammatory Bowel Disease CenterUniversity of Chicago MedicineChicagoILUSA
| | - Britt Christensen
- Department of GastroenterologyThe Royal Melbourne HospitalMelbourneVic.Australia
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19
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Bashirian S, Jenabi E, Khazaei S, Barati M, Karimi-Shahanjarini A, Zareian S, Rezapur-Shahkolai F, Moeini B. Factors associated with preventive behaviours of COVID-19 among hospital staff in Iran in 2020: an application of the Protection Motivation Theory. J Hosp Infect 2020; 105:430-433. [PMID: 32360337 PMCID: PMC7194681 DOI: 10.1016/j.jhin.2020.04.035] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/23/2020] [Indexed: 12/22/2022]
Abstract
This study was conducted to predict the preventive behaviours of healthcare workers (HCWs) towards COVID-19 based on the Protection Motivation Theory (PMT). This cross-sectional and analytical study was conducted on 761 HCWs in Hamadan, Iran, using multi-stage random sampling. The preventive behaviours against COVID-19 among HCWs were assessed at a relatively desirable level. Based on the PMT, threat and coping appraisal were predictors of protection motivation to conduct COVID-19 preventive behaviours (P<0.001). The intention was also predictive of COVID-19 preventive behaviours (P<0.001). Consideration of personnel's self-efficacy and their knowledge regarding the effectiveness of protective behaviours in designing staff training programmes are recommended.
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Affiliation(s)
- S Bashirian
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, IR Iran
| | - E Jenabi
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, IR Iran
| | - S Khazaei
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, IR Iran
| | - M Barati
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, IR Iran
| | - A Karimi-Shahanjarini
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, IR Iran
| | - S Zareian
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, IR Iran
| | - F Rezapur-Shahkolai
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, IR Iran
| | - B Moeini
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, IR Iran
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20
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Hand hygiene and the novel coronavirus pandemic: the role of healthcare workers. J Hosp Infect 2020; 105:776-777. [PMID: 32201339 PMCID: PMC7270549 DOI: 10.1016/j.jhin.2020.03.017] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 01/10/2023]
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21
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Respiratory viruses on personal protective equipment and bodies of healthcare workers. Infect Control Hosp Epidemiol 2019; 40:1356-1360. [DOI: 10.1017/ice.2019.298] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
AbstractObjective:To characterize the magnitude of virus contamination on personal protective equipment (PPE), skin, and clothing of healthcare workers (HCWs) who cared for patients having acute viral infections.Design:Prospective observational study.Setting:Acute-care academic hospital.Participants:A total of 59 HCWs agreed to have their PPE, clothing, and/or skin swabbed for virus measurement.Methods:The PPE worn by HCW participants, including glove, face mask, gown, and personal stethoscope, were swabbed with Copan swabs. After PPE doffing, bodies and clothing of HCWs were sampled with Copan swabs: hand, face, and scrubs. Preamplification and quantitative polymerase chain reaction (qPCR) methods were used to quantify viral RNA copies in the swab samples.Results:Overall, 31% of glove samples, 21% of gown samples, and 12% of face mask samples were positive for virus. Among the body and clothing sites, 21% of bare hand samples, 11% of scrub samples, and 7% of face samples were positive for virus. Virus concentrations on PPE were not statistically significantly different than concentrations on skin and clothing under PPE. Virus concentrations on the personal stethoscopes and on the gowns were positively correlated with the number of torso contacts (P < .05). Virus concentrations on face masks were positively correlated with the number of face mask contacts and patient contacts (P < .05).Conclusions:Healthcare workers are routinely contaminated with respiratory viruses after patient care, indicating the need to ensure that HCWs complete hand hygiene and use other PPE to prevent dissemination of virus to other areas of the hospital. Modifying self-contact behaviors may decrease the presence of virus on HCWs.
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22
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Reddy SC, Valderrama AL, Kuhar DT. Improving the Use of Personal Protective Equipment: Applying Lessons Learned. Clin Infect Dis 2019; 69:S165-S170. [DOI: 10.1093/cid/ciz619] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Abstract
Unrecognized transmission of pathogens in healthcare settings can lead to colonization and infection of both patients and healthcare personnel. The use of personal protective equipment (PPE) is an important strategy to protect healthcare personnel from contamination and to prevent the spread of pathogens to subsequent patients. However, optimal PPE use is difficult, and healthcare personnel may alter delivery of care because of the PPE. Here, we summarize recent research from the Prevention Epicenters Program on healthcare personnel contamination and improvement of the routine use of PPE as well as Ebola-specific PPE. Future efforts to optimize the use of PPE should include increasing adherence to protocols for PPE use, improving PPE design, and further research into the risks, benefits, and best practices of PPE use.
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Affiliation(s)
- Sujan C Reddy
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy L Valderrama
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David T Kuhar
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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