Infection prevention and control (IPC) at a Lassa fever treatment center before and after the implementation of an intensive IPC program

Background: Infection prevention and control (IPC) programs are important to control the Lassa Fever (LF) outbreak. We reported IPC's status at the Federal Medical Centre, Owo, southwest Nigeria, before and after implementing the IPC program during a surge in the LF outbreak. Methods: We conducted a longitudinal observational study among five health care professionals at the Federal Medical Centre, Owo, between February 2019 and May 2019 using the IPC Assessment Framework (IPCAF). The tool has eight core components with a score of 0-100 per component and provided a baseline assessment of the IPC program and evaluation after three months. We interviewed relevant unit heads and IPC committee members in the first phase. In the second phase, we designed and implemented the IPC program, and in the third phase, we conducted a repeat interview similar to the first phase. The program initiated included training healthcare workers and providing relevant IPC items according to identified gaps and available funding. Results: We interviewed five health care professionals, two female nurses, and three male doctors responsible for organizing and implementing IPC activities at the Federal Medical Centre, Owo, with an in-depth understanding of IPC activities.  The overall IPC level score increased from 318.5 at baseline to 545 at three months later. IPC improvements were reported in all the components, with IPC education and training [baseline (20), final (70)], IPC guidelines [baseline (50), final (92.5)] and monitoring/audits of IPC practices and feedback [baseline (40), final (82.5)] recording the highest improvements. Healthcare-associated infection [baseline (10), final (25)], and built environment, materials, and equipment for IPC [baseline (43.5), final (55)] had the least improvement. Poor motivation to adopt recommended changes among hospital staff were major issues preventing improvements. Conclusion: Promotion of IPC program and activities should be implemented at the Federal Medical Centre, Owo.   References World Health Organization, WHO. Lassa fever. Available from: https://www.who.int/health-topics/lassa-fever/#tab=tab_1. [Accessed on 11 October 2020] Nigeria Centre for Disease Control. Lassa fever. Available from: https://ncdc.gov.ng/diseases/factsheet/47. [Accessed on 11 October 2020]. World Health Organization, WHO. Lassa fever. Available from: https://www.who.int/news-room/fact-sheets/detail/lassa-fever. [Accessed on 11 October 2020]. Ijarotimi IT, Ilesanmi OS, Aderinwale A, Abiodun-Adewusi O, Okon IM. Knowledge of Lassa fever and use of infection prevention and control facilities among health care workers during Lassa fever outbreak in Ondo state, Nigeria. Pan Afr Med J. 2018; 30:1-13. https://doi.org/10.11604/pamj.2018.30.56.13125 Mateer EJ, Huang C, Shehu NY, Paessler S. Lassa fever–induced sensorineural hearing loss: A neglected public health and social burden. PLoS Negl Trop Dis. 2018;12(2):1-11. https://doi.org/10.1371/journal.pntd.0006187 Ijarotimi I., Oladejo J., Nasidi A, Jegede O. Lassa fever in the State Specialist Hospital Akure, Nigeria: Case report, Contact tracing and outcome of hospital contacts. Int J Infect Trop Dis. 2016;3(1):20-28. https://doi.org/10.14194/ijitd.3.1.4 Ireye F, Ejiyere H, Aigbiremolen AO, Famiyesin OE, Rowland-Udoh EA, Ogeyemhe CO, Okudo I, Onimisi AB. Knowledge, attitude and infection prevention and control practices regarding Lassa fever among healthcare workers in Edo State, Nigeria. Int J Prev Treat. 2019;8(1):21-27. https://doi.org/10.5923/j.ijpt.20190801.03 World Health Organization. Infection prevention and control assessment framework at the facility level. 2018; 2016:1-15. Available from: https://www.who.int/infection-prevention/tools/core-components/IPCAF-facility.PDF?ua=1 [Accessed on 11 October 2020]. World Health Organization, WHO. Communicable disease surveillance and response systems - Guide to monitoring and evaluating. Epidemic and pandemic alert and response. Published online 2006:90. doi: rr5305a1 [pii] Ousman K, Kabego L, Talisuna A, Diaz J, Mbuyi J, Houndjo B, et al. The impact of Infection Prevention and control (IPC) bundle implementation on IPC compliance during the Ebola virus outbreak in Mbandaka/Democratic Republic of the Congo: A before and after design. BMJ Open. 2019;9(9):1-6. https://doi.org/10.1136/bmjopen-2019-029717 Nzinga J, Mbindyo P, Mbaabu L, Warira A, English M. Documenting the experiences of health workers expected to implement guidelines during an intervention study in Kenyan hospitals. Implement Sci. 2009;4(1):1-9. https://doi.org/10.1186/1748-5908-4-44. Ataiyero Y, Dyson J, Graham M. Barriers to hand hygiene practices among health care workers in sub-Saharan African countries: A narrative review. Am J Infect Control. 2019 May;47(5):565-573. https://doi.org/10.1016/j.ajic.2018.09.014. Gilbert GL, Kerridge I. The politics and ethics of hospital infection prevention and control: a qualitative case study of senior clinicians’ perceptions of professional and cultural factors that influence doctors’ attitudes and practices in a large Australian hospital. BMC Health Serv Res. 2019; 19(212). https://doi.org/1186/s12913-019-4044-y. &nbsp

Threats from antibiotics : a serious environmental concern

Antibiotics are bioactive substances, used as human and animal medicines for illness prevention, disease treatment and growth promotion. They are considered to be pseudo persistent given their continuous input in the environment. Antibiotics enter agro ecosystems through several routes such as wastewater irrigation, soil application, animal manures or bio-solids which are mostly biologically active thus creating potential risks to the environment. They are present in different environmental matrices at low concentrations as residues. Antibiotic residues enter the environment primarily via urine, feces and manure from humans and animals after they have taken the medication, as well as from manufacturing wastewater. These residues contaminate the soil, surface water, and groundwater by leaching or runoff and ultimately breed antibiotic-resistant bacteria (ARB) and genes (ARG). These triune threat viz antibiotics, ARB and ARG have not been effectively removed by various treatment in wastewater treatment plants. Here, we put together existing knowledge and aim at providing in-depth knowledge to the extent to which a wide range of treatment processes determine the ultimate fate of antibiotic-bred threats (ARB and ARG) in conventional and advanced wastewater treatment. The use of antibiotics is inevitable, hence studies focusing on minimizing their discharge into the environment viz-a-viz support future regulatory measures are of great importance

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways