Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations

Abstract Health care-associated infections (HAI) are a major public health problem with a significant impact on morbidity, mortality and quality of life. They represent also an important economic burden to health systems worldwide. However, a large proportion of HAI are preventable through effective infection prevention and control (IPC) measures. Improvements in IPC at the national and facility level are critical for the successful containment of antimicrobial resistance and the prevention of HAI, including outbreaks of highly transmissible diseases through high quality care within the context of universal health coverage. Given the limited availability of IPC evidence-based guidance and standards, the World Health Organization (WHO) decided to prioritize the development of global recommendations on the core components of effective IPC programmes both at the national and acute health care facility level, based on systematic literature reviews and expert consensus. The aim of the guideline development process was to identify the evidence and evaluate its quality, consider patient values and preferences, resource implications, and the feasibility and acceptability of the recommendations. As a result, 11 recommendations and three good practice statements are presented here, including a summary of the supporting evidence, and form the substance of a new WHO IPC guideline

Privaros: A Framework for Privacy-Compliant Delivery Drones

We present Privaros, a framework to enforce privacy policies on drones. Privaros is designed for commercial delivery drones, such as the ones that will likely be used by Amazon Prime Air. Such drones visit a number of host airspaces, each of which may have different privacy requirements. Privaros provides an information flow control framework to enforce the policies of these hosts on the guest delivery drones. The mechanisms in Privaros are built on top of ROS, a middleware popular in many drone platforms. This paper presents the design and implementation of these mechanisms, describes how policies are specified, and shows that Privaros's policy specification can be integrated with India's Digital Sky portal. Our evaluation shows that a drone running Privaros can robustly enforce various privacy policies specified by hosts, and that its core mechanisms only marginally increase communication latency and power consumption

Design indicators for better accommodation environments in hospitals: inpatients’ perceptions

This is an Author's Accepted Manuscript of an article published in Intelligent Buildings International, 2012, [© Taylor & Francis], available online at: http://www.tandfonline.com/doi/abs/10.1080/17508975.2012.701186Several studies have found an association between the physical environment and human health and wellbeing that resulted in the postulation of the idea of evidence-based and patient-centred design of healthcare facilities. The key challenge is that most of the underpinning research for the evidence base is context specific, the use of which in building design is complex, mainly because of the difficulties associated with the disaggregation of findings from the context. On the other hand, integrating patients’ perspectives requires an understanding of the relative importance of design indicators, which the existing evidence base lacks to a large extent. This research was aimed at overcoming these limitations by investigating users’ perception of the importance of key design indicators in enhancing their accommodation environments in hospitals. A 19-item structured questionnaire was used to gather inpatients' views on a 5-point scale, in two Chinese hospitals. A principal component analysis (PCA) resulted in five constructed dimensions with appropriate reliability and validity (Cronbach’s alpha=0.888). The item, design for cleanliness, was ranked as most important, closely followed by environmental and safety design indicators. The item, entertainment facilities, was ranked lowest. The indicator, pleasant exterior view had the second lowest mean score, followed by the item, ability to customise the space. Age, accommodation type and previous experience of hospitalisation accounted for statistically significant differences in perceptions of importance of various constructed design dimensions

Improving patient safety in the operating theatre and perioperative care:obstacles, interventions, and priorities for accelerating progress

The publication of To Err Is Human in the USA and An Organisation with a Memory in the UK more than a decade ago put patient safety firmly on the clinical and policy agenda. To date, however, progress in improving safety and outcomes of hospitalized patients has been slower than the authors of these reports had envisaged. Here, we first review and analyse some of the reasons for the lack of evident progress in improving patient safety across healthcare specialities. We then focus on what we believe is a critical part of the healthcare system that can contribute to safety but also to error—healthcare teams. Finally, we review team training interventions and tools available for the assessment and improvement of team performance and we offer recommendations based on the existing evidence-base that have potential to improve patient safety and outcomes in the coming decade

The dynamics and implications of bacterial transmission events arising from the anesthesia work area

Health care-associated infections are a hospital-wide concern associated with a significant increase in patient morbidity, mortality, and health care costs. Bacterial transmission in the anesthesia work area of the operating room environment is a root cause of 30-day postoperative infections affecting as many as 16% of patients undergoing surgery. A better understanding of anesthesia-related bacterial transmission dynamics may help to generate improvements in intraoperative infection control and improve patient safety

Identification of polysubstance abuse in the parturient

Illicit drugs are widely used by inner city patients and their use by pregnant women has increased in recent years. The aim of this study was to determine the prevalence of polysubstance abuse among parturients at our institution who received no prenatal care (‘unbooked’) and to determine the accuracy of the Ontrak TesTcupTM an in vitro immunodiagnostic assay. We prospectively analysed urine from 50 ‘unbooked’ parturients and found that 26 (52%) tested positive for cocaine. Of these, six patients (23%) were also positive for morphine. All TesTcup™ results were confirmed by the hospital laboratory using alternate chemical methods. When comparing TesTcup™ to the hospital laboratory, there were no false positive or negative results. Given the high frequency of concomitant opioid abuse in cocaine‐abusing parturients, anyone suspected of cocaine abuse should be tested for other illicit substances. TesTcup™ is a clinically accurate test that allows the rapid assessment of several drugs of abuse, which may impact on anaesthetic care. Br J Anaesth 2001; 87: 488–9

Anaesthetic management of caesarean section in a patient with active recurrent genital herpes and AIDS-related dementia

We report the anaesthetic management of a pregnant patient with multiple manifestations of HIV infection who underwent Caesarean section. A 30-yr-old, HIV-positive, Haitian woman presented with acute psychosis at 28 weeks' gestation. A diagnosis of HIV dementia complex was made and haloperidol therapy was started. Five days after admission the patient was found to be in labour and tocolytic therapy with terbutaline was commenced. A vaginal lesion compatible with herpes simplex virus was observed which was treated with acyclovir. After 3 days of tocolytic therapy there were no further signs of preterm labour. Two weeks later, at 30 weeks' gestation, the patient's membranes ruptured spontaneously. The herpes labialis lesion was still present and urgent Caesarean section was begun using subarachnoid 0.75% bupivacaine 1.5 ml. The patient had no intraoperative problems and a 1700-g healthy male child was delivered