Infection Prevention Performance among Hospital Staff during Vaginal Birth: Results from a Criterion-Based Audit at a Zonal Referral Hospital in Tanzania

Background: Healthcare associated infections is a global burden and is one of the main causes of maternal and neonatal morbidity and mortality during the time of labour when admitted to the hospital. Healthcare workers´ hands are in most cases the vehicle for  transmission of microorganisms from patient to patient.Good hand hygiene practices at the bedside are a simple way of reducing  healthcare associated infections. The objective was to assess the impact of a criterion- based audit on infection prevention performance and knowledge during vaginal delivery at a hospital in Tanzania. The quantitative findings were discussed with staff to identify barriers and solutions to quality improvement.Methods: A mixed-method uncontrolled, before and after intervention study by criterion-based audit was performed at the labour ward at Kilimanjaro Christian Medical Centre. Criteria for best practice were established together with key staff based on national and international guidelines. Sixty clean procedures during vaginal birth were observed and assessed by a structured checklist based on the audit criteria. Baseline findings were discussed with staff and an intervention performed including a short training and preparation of alcohol-based hand rub. Hereafter another 60 clean procedures were observed, and performance compared to the care before the intervention.  Furthermore, a knowledge test was performed before and after the intervention.Results: Hand washing increased significantly after a procedure from 46.7% to 80% (RR=1.71 95% CI; 1.27 to 2.31), the use of alcohol-based hand rub before a procedure from 1.7% to 33.3% (p<.001), and the use of alcohol-based hand rub after procedure from 0% to 30% (p<.001). After the intervention the mean score for the knowledge test increased insignificantly from 59.3% to 65.3%, (mean difference = 6.1%, 95% CI; -4.69 to 16.88).Conclusion: The criterion-based audit process identified substandard care for infection prevention at the labour ward. An intervention of discussing baseline findings and a short training session and introducing alcohol-based hand rub resulted in improvements on infection prevention performance

Modellering af kø-opstuvning i en statisk rutevalgsmodel

Artiklen beskriver forbedring til de statiske rutevalgsmodeller, som anvendes i Landstrafikmodellen (LTM) og OTM, så de bedre kan håndtere trængsel i vejnettet. Trængsel opstår typisk som følge af flaskehalse i vejnettet eksempelvis ved tilkørselsrampe på motorvej eller kryds i byen. I takt med stigende trafik bliver det derfor mere påkrævet, at trafikmodellerne kan belyse konsekvenserne i forhold til eksisterende og fremtidige flaskehalse. Der foreslås en metode, som umiddelbart kan integreres med de nuværende rutevalgsmodeller i LTM og OTM. De nuværende speed-flow kurver udbygges med kø-ventetidsfunktioner, som anvendes udover kapacitetsgrænsen. Kø-ventetidsfunktionerne, som beskriver middelventetid i kø pr. køretøj, er estimeret ved hjælp af kø-teori og verificeret mod aktuelle rejsetidsmålinger. Derudover introduceres reduktionsfaktorer for at kunne håndtere multiple flaskehalse i vejnettet, som er mere eller mindre indbyrdes afhængige. Metoden er succesfyldt testet i Hovedstadsområdet. Det er således muligt at identificere eksisterende flaksehalse og beregne køretider i myldertid svarende til rejsetidsmålinger. Det anbefales at arbejde videre med henblik på implementering i LTM

Senescence and quiescence in adipose-derived stromal cells:Effects of human platelet lysate, fetal bovine serum and hypoxia

AbstractBackground aims. Adipose-derived stromal cells (ASCs) are attractive sources for cell-based therapies. The hypoxic niche of ASCs in vivo implies that cells will benefit from hypoxia during in vitro expansion. Human platelet lysate (hPL) enhances ASC proliferation rates, compared with fetal bovine serum (FBS) at normoxia. However, the low proliferation rates of FBS-expanded ASCs could be signs of senescence or quiescence. We aimed to determine the effects of hypoxia and hPL on the expansion of ASCs and whether FBS-expanded ASCs are senescent or quiescent. Methods. ASCs expanded in FBS or hPL at normoxia or hypoxia until passage 7 (P7), or in FBS until P5 followed by culture in hPL until P7, were evaluated by proliferation rates, cell cycle analyses, gene expression and β-galactosidase activity. Results. hPL at normoxia and hypoxia enhanced proliferation rates and expression of cyclins, and decreased G0/G1 fractions and expression of p21 and p27, compared with FBS. The shift from FBS to hPL enhanced cyclin levels, decreased p21 and p27 levels and tended to decrease G0/G1 fractions. Conclusion. Hypoxia does not add to the effect of hPL during ASC expansion with regard to proliferation, cell cycle regulation and expression of cyclins, p21 and p27. hPL rejuvenates FBS-expanded ASCs with regard to cell cycle regulation and expression of cyclins, p21 and p27. This indicates a reversible arrest. Therefore, we conclude that ASCs expanded until P7 are not senescent regardless of culture conditions