HIV Risk Behavior Self-Report Reliability at Different Recall Periods

Few studies have investigated the optimal length of recall period for self-report of sex and drug-use behaviors. This meta-analysis of 28 studies examined the test-retest reliability of three commonly used recall periods: 1, 3, and 6 months. All three recall periods demonstrated acceptable test-retest reliability, with the exception of recall of needle sharing behaviors and 6-months recall of some sex behaviors. For most sex behaviors, a recall period of 3 months was found to produce the most reliable data; however, 6 months was best for recalling number of sex partners. Overall, shorter periods were found to be more reliable for recall of drug-use behaviors, though the most reliable length of recall period varied for different types of drugs. Implications of the findings and future directions for research are discussed

The relationship between hand hygiene and health care-associated infection: it’s complicated

Mary-Louise McLaws Healthcare Infection and Infectious Diseases Control, School of Public Health and Community Medicine, UNSW Medicine, UNSW Australia, Sydney, NSW, Australia Abstract: The reasoning that improved hand hygiene compliance contributes to the prevention of health care-associated infections is widely accepted. It is also accepted that high hand hygiene alone cannot impact formidable risk factors, such as older age, immunosuppression, admission to the intensive care unit, longer length of stay, and indwelling devices. When hand hygiene interventions are concurrently undertaken with other routine or special preventive strategies, there is a potential for these concurrent strategies to confound the effect of the hand hygiene program. The result may be an overestimation of the hand hygiene intervention unless the design of the intervention or analysis controls the effect of the potential confounders. Other epidemiologic principles that may also impact the result of a hand hygiene program include failure to consider measurement error of the content of the hand hygiene program and the measurement error of compliance. Some epidemiological errors in hand hygiene programs aimed at reducing health care-associated infections are inherent and not easily controlled. Nevertheless, the inadvertent omission by authors to report these common epidemiological errors, including concurrent infection prevention strategies, suggests to readers that the effect of hand hygiene is greater than the sum of all infection prevention strategies. Worse still, this omission does not assist evidence-based practice. Keywords: compliance, epidemiological principles, study design, bacteria, control, multiple drug resistanc

Dangerous practices in a hemodialysis unit in Vietnam identify from mixed methods

Background: Non-compliance with infection control practices poses a serious risk to patients receiving chronic hemodialysis. We aimed to identify the type and frequency of non-compliance with infection control practices in a hemodialysis unit in Vietnam where a large outbreak of hepatitis C infection had occurred. Methods: Mixed methods approach included observations and discussions of non-compliance with all 12 nurses at the Hemodialysis Unit, District-6 Hospital in Ho Chi Minh City. Observations of nursing care activities were made between September 2013 and January 2014. Compliance with hand hygiene and glove use during nursing care activities were classified according to the potential for a serious risk of transmission of infection and reported as percentages. Each nurse was expected to provide 11 nursing care activities to three patients assigned per hemodialysis sessions. Activities were to be given on an individual patient-centered care basis, that is, one patient was to receive all 11 activities by their assigned nurse. On completion of the observations all nurses were enrolled in a focus group where observed non-compliance was discussed and transcripts were examined for themes. Results: Hand hygiene compliance rate was low (27%, 95%CI 25%-28%, 1633/6140) regardless of classification of seriousness of risk from this breach. Although glove use (76%, 95%CI 74-78%, 1211/1586) and other personal protective equipment use (81%, 95%CI 78%-83%, 773/959) were high gloves were observed to be reused with multiple patients during a single nursing care activity provided to consecutive patients. Nurses explained the breakdown of providing nursing care activities on an individual patient-centered basis was a response to limited supply of gloves and hand hygiene facilities and was exacerbated by nursing being co-opted by overly demanding patients to provide services without delay. Conclusions: The adaption by the nurses to provide 11 single care activities to multiple consecutive patients in the absence of changing gloves and low hand hygiene compliance was potentially the central risk factor that facilitated the hepatitis C outbreak. Patient-centered care needs to be enforced to minimize multiple nurse-patient contacts that are associated with non-compliance classified as serious risk of infection transmission. Nurse empowerment to resist unreasonable patient demands may also be pivotal to assisting their compliance with hand hygiene and single patient-centered care. An audit program to measure infection control resources and practices may facilitate enforcement of the guidelines

Antibiotics: Practice and opinions of Cambodian commercial farmers, animal feed retailers and veterinarians

© 2016 The Author(s). Background: Cambodia has reported multidrug resistant bacteria in poultry, similar to other countries in the region. We visited commercial food animal farms to explore opinions and antibiotic practices on the farms. Methods: We used individual in-depth qualitative interviews with 16 commercial farmers, four feed retailers and nine veterinarians from food animal industry and government offices from the southwestern region of Phnom Penh. Transcribed interviews were thematically analysed. Results: Widespread antibiotic use occurred on all farms and was driven by four facilitators: belief that antibiotics were necessary for animal raising, limited knowledge, unrestricted antibiotic access, and weak monitoring and control systems. "If we treat ducks for two days and they aren't cured we change to human drugs. We cocktail 10 tablets of this, 10 tablets of that and 20 tablets of this one. Altogether 200 tablets are mixed in 100 or 200 L of water for the ducks to drink. No one taught me, just my experiences." Antibiotics were believed to be necessary for disease prevention. "On the first day when we bring in the chicks, we let them drink Enro [enrofloxacin] and vitamins to make them resist to the weather. We place them in the house and there are some bacteria in the environment. When they are newly arrived, we have to give them feed. So we're afraid they get diarrhea when they eat feed, we have to use Enro." All farmers used pre-mixed feed that veterinarians and feed retailers acknowledged contained antibiotics but not all listed the antibiotics. Farmers viewed pre-mixed feed as a necessary 'feed supplement' for growth promotion. "....The fatten supplement is mixed in feed. Pigs aren't growing well unless I use the supplement." Farmers and veterinarians were concerned that 'antibiotic residuals' in animal meat could harm human health. But they did not link this with antibiotic resistance. Conclusions: Antibiotic use in food animals was widespread and uncontrolled. Farmers focused on the benefits of food animal production rather than concerns about the consequences of antibiotic use. Therefore, education for prudent use of antibiotics in food animals and regulations are urgently needed in food animal farming in Cambodia

Hepatitis B and C virus infections among patients with end stage renal disease in a low-resourced hemodialysis center in Vietnam: a cross-sectional study

BackgroundHemodialysis services in Vietnam are being decentralised outside of tertiary hospitals. To identify the challenges to infection control standards for the prevention of bloodborne infections including hepatitis B virus (HBV) and hepatitis C virus (HCV) we tested the magnitude of HBV and HCV infections in the largest unit in Ho Chi Minh City servicing patients with end stage renal disease.MethodsAll 113 patients provided consent HBV surface antigen (HBsAg) and HCV core antigen (HCV-coreAg) testing. Positive patients were tested for viral genotypes. All participants completed a questionnaire on demographic characteristics, risk factors and previous attendance to other hemodialysis units.ResultsSeroprevalence of 113 patients enrolled was 7% (8/113, 95% CI 2.3%-11.8%) HBsAg, 6% (7/113, 95% CI 1.7%-10.6%) HCV-coreAg and 1% (1/113, 95% CI 0.8%-2.6%) co-infection. Having a HBV positive sexual partner significantly increased the risk of acquiring HBV (P = 0.016, Odds Ratio (OR) =29, 95% CI 2–365). Risk factors for HCV included blood transfusion (P = 0.049), multiple visits to different hemodialysis units (P = 0.048, OR = 5.7, 95% CI 1.2–27.5), frequency of hemodialysis (P = 0.029) and AST plasma levels >40 IU/L (P = 0.020, OR = 19.8, 95% CI 2.3–171). On multivariate analysis only blood transfusion remained significant risk factor for HCV (P = 0.027, adjusted OR = 1.2).ConclusionsHCV screening for HCV of blood products must improve to meet the infection prevention challenges of decentralizing hemodialysis services. The level of HCV and HBV in our hemodialysis unit is a warning that universal precautions will be the next challenge for decentralised hemodialysis services in Vietnam