Building capacity for point of care alcohol-based handrub (ABHR) and hand hygiene compliance among health care workers in the rural maternity and surgical units of a hospital in Cameroon

BACKGROUND

Hand hygiene (HH) is challenging in health care, but particularly in resource-limited settings due to a lack of training, resources, and infrastructure. This study aimed to evaluate the implementation of wall-mounted alcohol-based handrub (ABHR) at the point of care (POC) on HH compliance among health care workers in a Cameroon hospital.

METHODS

It was a three-stage before and after study. The first stage involved baseline collection of ABHR utilization and HH compliance data. The second stage included the implementation of ABHR at the POC, supported by an implementation strategy involving HH training, monitoring and feedback, and HH champions. The third stage involved postimplementation data collection on ABHR use and HH compliance.

RESULTS

5,214 HH opportunities were evaluated. HH compliance significantly increased from 33.3% (baseline) to 83.1% (implementation stage) (P < .001) and to 87.2% (postimplementation stage) (P < .001). Weekly ABHR usage increased significantly during implementation (5,670 ml), compared to baseline, (1242.5 ml, P = .001), and remained high in postimplementation (7,740 ml).

CONCLUSIONS

Continuous availability of ABHR at POC, supported by implementation strategy, significantly increased HH compliance and ABHR use. Learning from this study could be used to implement ABHR at POC in other facilities.

Training a Continent: A Process Evaluation of Virtual Training on Infection Prevention and Control in Africa During COVID-19

BACKGROUND

Strengthening infection prevention and control (IPC) capacity was identified as a key intervention to prepare African Union member states to curb the COVID-19 pandemic. As part of the Africa Taskforce for Coronavirus, which helped implement the Africa Joint Continental Strategy for COVID-19 Outbreak response, the IPC Technical Working Group (IPC TWG) was convened to coordinate the development of IPC core components for preparedness, response, and recovery from COVID-19. As part of the IPC TWG's work, the Africa Centres for Disease Control and Prevention, in collaboration with the Infection Control Africa Network, delivered virtual IPC training sessions targeted to African Union member states. We aimed to undertake a process evaluation of this training to inform and improve both ongoing and future programming.

METHODS

The scope of the evaluation was agreed upon through discussion with the training organizers and advisory members and a design workshop. A mixed-methods approach was used; data collection was partly prospective and partly retrospective due to the rapid start of some of the training activities. Existing available data included: usage analytics, the content of questions posed during the webinar and community of practice, and participant feedback survey results. In addition, in-depth qualitative interviews were conducted with a sample of webinar participants.

RESULTS

The rapid development of this training was efficient and responsive. The training reached more than 3,000 participants across the 2 rounds, but the numbers varied substantially by location. Participants engaged well during the question period during each webinar, but the asynchronous community of practice was less utilized during the evaluation time frame. Many participants appreciated the African focus of the webinars and gave positive feedback on the practical and context-specific content.

CONCLUSIONS

The move toward online training provides an important opportunity to improve IPC across the African continent.

Safer primary healthcare facilities are needed to protect healthcare workers and maintain essential services: lessons learned from a multicountry COVID-19 emergency response initiative

Healthcare workers (HCWs) are at increased risk of infection from SARS-CoV-2 and other disease pathogens, which take a disproportionate toll on HCWs, with substantial cost to health systems. Improved infection prevention and control (IPC) programmes can protect HCWs, especially in resource-limited settings where the health workforce is scarcest, and ensure patient safety and continuity of essential health services. In response to the COVID-19 pandemic, we collaborated with ministries of health and development partners to implement an emergency initiative for HCWs at the primary health facility level in 22 African countries. Between April 2020 and January 2021, the initiative trained 42 058 front-line HCWs from 8444 health facilities, supported longitudinal supervision and monitoring visits guided by a standardised monitoring tool, and provided resources including personal protective equipment (PPE). We documented significant short-term improvements in IPC performance, but gaps remain. Suspected HCW infections peaked at 41.5% among HCWs screened at monitored facilities in July 2020 during the first wave of the pandemic in Africa. Disease-specific emergency responses are not the optimal approach. Comprehensive, sustainable IPC programmes are needed. IPC needs to be incorporated into all HCW training programmes and combined with supportive supervision and mentorship. Strengthened data systems on IPC are needed to guide improvements at the health facility level and to inform policy development at the national level, along with investments in infrastructure and sustainable supplies of PPE. Multimodal strategies to improve IPC are critical to make health facilities safer and to protect HCWs and the communities they serve.

[Work and vocational integration of psychosomatic patients--utilization and indications for a workload tryout program]

The effect of a professional workload test was assessed in a longitudinal study with 80 patients psychosomatic rehabilitation during and following their. In a second study indication criteria were tested with 358 consecutive patients. Participants in the workload program show an improvement of their work ability and job performance according to self-appraisal, superior appraisal and medical assessment. Work ability was still maintained 7 months after treatment. Patients with lasting work disability and unemployment not only show negative work-related attitudes, but also elevated psychological symptoms and a reduced quality of life. The program participants show high levels of psychological strain but also a stronger disposition to change the professional situation. Negative work-related and psychological consequences of lasting disability and unemployment deserve more attention in inpatient psychosomatic treatment.

[Integrated occupational work capacity evaluation in medical rehabilitation--experiences and prospects exemplified by psychosomatic rehabilitation]

Psychosomatic rehabilitation is often initiated when lasting work disability, loss of job, and pension application have occurred. After a review of the relevance of vocational strains and of predictors for reintegration, we present a model of an integrated work hardening programme in Psychosomatic Rehabilitation. Results for 64 patients are illustrated by case vignettes. Especially when lasting work disability and unemployment have undermined the patients' sense of competence and endurance, work hardening promotes return to work, realistic self-appraisal and vocational reorientation. The social and medical assessment and the coordination of vocational rehabilitation measures are improved. The implementation of a work hardening programme requires the provision of a variety of (unpaid) work opportunities, independent assessment of work performance by supervisors and social worker, psychological support and close cooperation with rehabilitation services.

Capillary zone electrophoresis of p-aminobenzoic acid derivatives of aldoses, ketoses and uronic acids

Aldoses, ketoses and uronic acids were derivatized with p-aminobenzoic acid and separated as their borate complexes by capillary zone electrophoresis, using a capillary tube of fused silica containing 150 mM borate buffer, pH 10.0, as carrier. The electrophoretic mobilities of 22 carbohydrates were determined and found to increase with increasing stability of the borate complexes formed. Besides the number of hydroxyl groups and the presence of substituents, complex stability depended most strongly on the configuration of the three vicinal hydroxyl groups at C2, C3 and C4. On-column UV monitoring at 285 nm allowed the detection of glucose with a lower mass detection limit of 15 fmol and a concentration sensitivity of 4 microM. Reproducible quantification of carbohydrates was achieved at least in the concentration range of 0.1-10 mM in reaction solutions by the relative peak area method, using cinnamic acid as internal standard. The method was applied successfully to the determination of the monosaccharide composition of polysaccharides extracted from Radix althaeae.