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Guidelines for infection control and prevention in anaesthesia in South Africa. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2021. [DOI: 10.36303/sajaa.2021.27.4.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Gaitan Gomez OL, Aristizabal P, Bueno Robles LS. Práctica de inyecciones seguras por parte del personal de la salud: revisión integrativa. INVESTIGACIÓN EN ENFERMERÍA: IMAGEN Y DESARROLLO 2020. [DOI: 10.11144/javeriana.ie22.pisp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Introducción: Las prácticas de inyecciones seguras han recobrado importancia en las últimas dos décadas, como consecuencia de las infecciones asociadas con su aplicación incorrecta. Objetivo: Analizar la evidencia disponible sobre las prácticas de inyecciones seguras ejecutadas por el personal de la salud en su práctica clínica. Método: Revisión integrativa de la literatura, realizada en 12 bases de datos entre 1999 y 2018. Resultados: Se seleccionaron 29 artículos y se identificaron prácticas riesgosas como el reúso de los dispositivos de inyección en el mismo paciente o en otros, fallas en la técnica aséptica, ausencia o no seguimiento del protocolo posexposición, reencapuchado de la aguja y ausencia de inmunización contra el virus de hepatitis B. Conclusiones: Los esfuerzos orientados a la seguridad del paciente deben enfocarse también en acciones concretas dirigidas a la administración de los medicamentos.
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Myburgh D, Rabie H, Slogrove AL, Edson C, Cotton MF, Dramowski A. Horizontal HIV transmission to children of HIV-uninfected mothers: A case series and review of the global literature. Int J Infect Dis 2020; 98:315-320. [PMID: 32615324 DOI: 10.1016/j.ijid.2020.06.081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Vertical transmission is the predominant route for acquisition of HIV infection in children, either in utero, intrapartum or postnatally through breast feeding. Less frequently, children may acquire HIV by horizontal transmission. Horizontal transmission may be healthcare-associated (infusion of HIV-contaminated blood products, use of contaminated needles, syringes and medical equipment, or through ingestion of HIV in expressed breastmilk). Community-acquired HIV transmission to children may occur following surrogate breastfeeding, pre-mastication of food, and sexual abuse. METHODS Children with suspected horizontally acquired HIV infection were identified by retrospective folder review of existing patients (2004-2014) and by prospective interview and examination of new patients (from 2009 onwards), at a hospital-based paediatric antiretroviral clinic in Cape Town, South Africa. The global literature on horizontal HIV transmission to children (1 January 1986-1 November 2019) was reviewed, to contextualize the local findings. RESULTS Among the 32 children with horizontal HIV transmission (15 identified retrospectively and 17 prospectively), the median age at first diagnosis was 79 months (interquartile range 28.5-91.5); most children (90.6%) had advanced HIV disease at presentation. HIV transmission was considered healthcare-associated in 15 (46.9%), community-associated in ten (31.3%), possibly healthcare or community-associated in five (15.6 %); and unknown in two children (6.3%). CONCLUSION Horizontal HIV transmission to children is an important public health issue, with prevention efforts requiring intervention at healthcare facility- and community-level. Greater effort should be made to promptly identify and comprehensively investigate each horizontally HIV-infected child to establish possible routes of transmission and inform future prevention strategies.
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Affiliation(s)
- D Myburgh
- Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa.
| | - H Rabie
- Division of Paediatric Infectious Diseases, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - A L Slogrove
- Division of Paediatric Infectious Diseases, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - C Edson
- Division of Paediatric Infectious Diseases, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - M F Cotton
- Division of Paediatric Infectious Diseases, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - A Dramowski
- Division of Paediatric Infectious Diseases, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
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Healthcare-associated infections in sub-Saharan Africa. J Hosp Infect 2013; 85:257-67. [DOI: 10.1016/j.jhin.2013.09.008] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 09/01/2013] [Indexed: 11/18/2022]
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Translation of biomedical prevention strategies for HIV: prospects and pitfalls. J Acquir Immune Defic Syndr 2013; 63 Suppl 1:S12-25. [PMID: 23673881 DOI: 10.1097/qai.0b013e31829202a2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Early achievements in biomedical approaches for HIV prevention included physical barriers (condoms), clean injection equipment (both for medical use and for injection drug users), blood and blood product safety, and prevention of mother-to-child transmission. In recent years, antiretroviral drugs to reduce the risk of transmission (when the infected person takes the medicines; treatment as prevention) or reduce the risk of acquisition (when the seronegative person takes them; preexposure prophylaxis) have proven to be efficacious. Circumcision of men has also been a major tool relevant for higher prevalence regions such as sub-Saharan Africa. Well-established prevention strategies in the control of sexually transmitted diseases and tuberculosis are highly relevant for HIV (ie, screening, linkage to care, early treatment, and contact tracing). Unfortunately, only slow progress is being made in some available HIV-prevention strategies such as family planning for HIV-infected women who do not want more children and prevention of mother-to-child HIV transmission. Current studies seek to integrate strategies into approaches that combine biomedical, behavioral, and structural methods to achieve prevention synergies. This review identifies the major biomedical approaches demonstrated to be efficacious that are now available. We also highlight the need for behavioral risk reduction and adherence as essential components of any biomedical approach.
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Dong L, Wang D, Gao J, Yan H. Doctor's injection prescribing and its correlates in village health clinics across 10 Provinces of Western China. J Public Health (Oxf) 2011; 33:565-70. [PMID: 21345884 DOI: 10.1093/pubmed/fdr019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Unsafe use and overuse of injection play an important role in transmission of very serious blood-borne infections. No studies have been conducted to investigate the levels and determinants of injection utilization in rural Western China. METHODS A total of 20 125 prescriptions were collected from 680 village clinics across 10 provinces of Western China. A generalized estimating equation logistic regression model was employed to examine the determinants of injection utilization. RESULTS The proportion of prescriptions with injection was 22.93%. Village doctors who had full-time medical education prescribed less injections than those without full-time education (OR = 0.65; 95% CI: 0.52, 0.80). The injection proportion was higher among children less than 3 years old in comparison with adults aged 18-44 years (OR = 1.72; 95% CI: 1.43, 2.08). The number of drugs in a prescription was also a significant predictor of injection (OR = 1.91; 95% CI: 1.77, 2.06). CONCLUSIONS Injection prescribing proportion in rural Western China was higher than that in India and lower than that in Cambodia. Injection prescribing was associated with the education of village doctor, patient age and diagnoses of diseases. The findings have important policy implications for recommendations on injection utilization in China.
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Affiliation(s)
- Lifang Dong
- Department of AIDS Control and Prevention, Shaanxi Center for Disease Control and Prevention, Xi'an, Shaanxi 710054, P.R. China
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Okwen MP, Ngem BY, Alomba FA, Capo MV, Reid SR, Ewang EC. Uncovering high rates of unsafe injection equipment reuse in rural Cameroon: validation of a survey instrument that probes for specific misconceptions. Harm Reduct J 2011; 8:4. [PMID: 21299899 PMCID: PMC3041680 DOI: 10.1186/1477-7517-8-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 02/07/2011] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Unsafe reuse of injection equipment in hospitals is an on-going threat to patient safety in many parts of Africa. The extent of this problem is difficult to measure. Standard WHO injection safety assessment protocols used in the 2003 national injection safety assessment in Cameroon are problematic because health workers often behave differently under the observation of visitors. The main objective of this study is to assess the extent of unsafe injection equipment reuse and potential for blood-borne virus transmission in Cameroon. This can be done by probing for misconceptions about injection safety that explain reuse without sterilization. These misconceptions concern useless precautions against cross-contamination, i.e. "indirect reuse" of injection equipment. To investigate whether a shortage of supply explains unsafe reuse, we compared our survey data against records of purchases. METHODS All health workers at public hospitals in two health districts in the Northwest Province of Cameroon were interviewed about their own injection practices. Injection equipment supply purchase records documented for January to December 2009 were compared with self-reported rates of syringe reuse. The number of HIV, HBV and HCV infections that result from unsafe medical injections in these health districts is estimated from the frequency of unsafe reuse, the number of injections performed, the probability that reused injection equipment had just been used on an infected patient, the size of the susceptible population, and the transmission efficiency of each virus in an injection. RESULTS Injection equipment reuse occurs commonly in the Northwest Province of Cameroon, practiced by 44% of health workers at public hospitals. Self-reported rates of syringe reuse only partly explained by records on injection equipment supplied to these hospitals, showing a shortage of syringes where syringes are reused. Injection safety interventions could prevent an estimated 14-336 HIV infections, 248-661 HBV infections and 7-114 HCV infections each year in these health districts. CONCLUSIONS Injection safety assessments that probe for indirect reuse may be more effective than observational assessments. The autodisable syringe may be an appropriate solution to injection safety problems in some hospitals in Cameroon. Advocacy for injection safety interventions should be a public health priority.
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Affiliation(s)
- Mbah P Okwen
- Health Sector, Netherlands Development Organization (SNV), No 10 Cowstreet, Bamenda,PO Box 5069, Bamenda,NWR, Cameroon
| | - Bedes Y Ngem
- Department of Statistics, Bali District Health Services, No 1 Lamsi Street, BaliPO Box 42, BaliNWR, Cameroon
| | - Fozao A Alomba
- Bali District Health Services, No 1 Lamsi Street, BaliPO Box 42, BaliNWR, Cameroon
| | - Mireille V Capo
- Water, Sanitation and Hygiene Sector, Netherlands Development Organization (SNV) No 10 Cowstreet, Bamenda,PO Box 5069, Bamenda,NWR, Cameroon
| | - Savanna R Reid
- School of Community Health Sciences, University of Nevada at Las Vegas, 431 Sunburst Dr., Henderson, NV 89002, USA
| | - Ebong C Ewang
- District Hospital Bali, No 1 Lamsi Street, BaliPO Box 42, BaliNWR, Cameroon
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Reid S, Dawad S, Van Niekerk AA. Iatrogenic HIV transmission in South Africa: Evidence, estimates and moral perspectives. S Afr Fam Pract (2004) 2010. [DOI: 10.1080/20786204.2010.10874029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Dlugovitzky D, Notario R, Martinel-Lamas D, Fiorenza G, Farroni M, Bogue C, Stanford C, Stanford J. Immunotherapy with oral, heat-killed, Mycobacterium vaccae in patients with moderate to advanced pulmonary tuberculosis. Immunotherapy 2010; 2:159-69. [DOI: 10.2217/imt.09.90] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A research investigation to evaluate the potential of an oral preparation of Mycobacterium vaccae SRL172 (NCTC 11659) as an immunotherapeutic has been carried out in ten patients with moderate to advanced pulmonary tuberculosis at Carrasco Hospital, Argentina. Comparison was made between oral and injected M.vaccae sharing a mutual control group. Clinical, bacteriological, hematological, radiological and immunological assessments all showed comparable benefits for both injected and oral treatment over those achieved with chemotherapy alone. The only significant difference between results of injected and oral M.vaccae was the failure of the latter to reduce TNF-α production by cultured mononuclear cells. A more intensive regime for the oral preparation was used, which as an addition to the directly observed therapy, short-course, treatment should improve results in both drug susceptible and drug-resistant cases. A Phase II Good Clinical Practice trial is now required.
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Affiliation(s)
- Diana Dlugovitzky
- Universidad Nacional de Rosario, Santa Fe 3100, (2000) Rosario, Argentina
| | - Rodolfo Notario
- Universidad Nacional de Rosario, Santa Fe 3100, (2000) Rosario, Argentina
| | | | - Gladys Fiorenza
- Universidad Nacional de Rosario, Santa Fe 3100, (2000) Rosario, Argentina
| | - Miguel Farroni
- Hospital I. Carrasco de Rosario, Boulevard Avellaneda 1402, 2000 Rosario, Argentina
| | - Christina Bogue
- Hospital I. Carrasco de Rosario, Boulevard Avellaneda 1402, 2000 Rosario, Argentina
| | - Cynthia Stanford
- Centre for Infectious Disease & International Health, Windeyer Institute of Medical Sciences, UCL, 46 Cleveland Street, London W1T 4JF, UK
| | - John Stanford
- Centre for Infectious Disease & International Health, Windeyer Institute of Medical Sciences, UCL, 46 Cleveland Street, London W1T 4JF, UK
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Abstract
With recent implementation of studies specifically designed to empirically assess the contribution of both sexual and blood-borne exposures to local HIV transmission in sub-Saharan Africa, and with the arrival of a new generation of investigators, a picture of HIV transmission routes of improved validity is emerging. Seven years ago the International Journal of STD & AIDS (IJSA) began actively encouraging reexamination of the prevailing view that penile-vaginal sex was driving African HIV epidemics, welcoming debate via manuscript submission and presentation of fresh scientific evidence. Although the IJSA-published dissenting views have largely been ignored, dismissed or fiercely resisted by established HIV researchers and allied health agencies, new approaches may yet elicit more rational, evidence-based responses. Several such contributions appear in IJSA's present theme issue on aspects of HIV epidemiology in Africa. The focus on recent empiric data, rather than on modelling or speculation, no longer leaves reasonable doubt that sexual behaviours are insufficient to explain 'Why Africa?' It is fitting that this progress was encouraged, from beginning to end, by long-time, and now departing IJSA Editor-in-Chief, Dr Wallace Dinsmore.
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Reid S. Unsafe health care in Africa: a joint statement of the research agenda. Int J STD AIDS 2009; 20:879-80. [DOI: 10.1258/ijsa.2009.009412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Savanna Reid
- School of Community Health Sciences, University of Nevada at Las Vegas, USA
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