Mixed methods study evaluating the implementation of the WHO hand hygiene strategy focusing on alcohol based handrub and training among health care workers in Faranah, Guinea

Introduction The most frequent adverse health events in healthcare worldwide are healthcare-associated infection. Despite ongoing implementation of the WHO multimodal Hand Hygiene (HH) Improvement Strategy, healthcare-associated infection rate continues to be twofold higher in low- than in high-income countries. This study focused on continued evaluation of HH compliance and knowledge. The mixed method approach, with inclusion of patients and care-givers, provided insight into challenges and facilitators of the WHO HH Improvement Strategy, and highlighted improvement points. Methods An uncontrolled, before-and–after intervention, mixed methods study in Faranah Regional Hospital was conducted from December 2017 to August 2019. The intervention implemented the WHO HH Strategy including HH training for healthcare workers (HCWs), and the relaunch of the local production of alcohol-based handrub (ABHR). A baseline assessment of HH knowledge, perception and compliance of HCWs was done prior to the intervention and compared to two follow-up assessments. The second follow-up assessment was complemented by a qualitative component. Results Overall compliance six months post-intervention was 45.1% and significantly higher than baseline but significantly lower than in first follow-up. Knowledge showed similar patterns of improvement and waning. The perception survey demonstrated high appreciation of the intervention, such as local production of ABHR. HCW’s were concerned about overconsuming of ABHR, however simultaneous quantitative measurements showed that consumption in fact was 36% of the estimated amount needed for sufficient HH compliance. Potential fields for improvement identified by HCWs to enhance sustainability were permanent ABHR availability, having a dedicated person with ownership over continuous simulation HH trainings including simulations to improve technique. Conclusion The study shows that the WHO multimodal HH strategy has a positive effect on HCW compliance and knowledge. Improvement points identified by local staff like sensitization on appropriate ABHR amount per HH action should be considered for sustainable HH improvement.Peer Reviewe

Implementation of the WHO hand hygiene strategy in Faranah regional hospital, Guinea

Healthcare-associated infections are the most frequent adverse events in healthcare worldwide, withlimited available evidence suggesting highest burden in resource-limited settings. Recent Ebola epidemicsemphasize the disastrous impact that spread of infectious agents within healthcare facilities can have, accentuatingthe need for improvement of infection control practices. Hand hygiene (HH) measures are considered to be themost effective tool to prevent healthcare-associated infections. However, HH knowledge and compliance are low,especially in vulnerable settings such as Guinea.The aim of PASQUALE (Partnership to Improve Patient Safety and Quality of Care) was to assess knowledge andcompliance with HH and improve HH by incorporating the WHO HH Strategy within the Faranah Regional Hospital(FRH), Guinea.Methods: In aPeer Reviewe

Mise en œuvre du plan d’action « hygiène des mains » de l’OMS à l’Hôpital Régional (HRF) de Faranah en Guinée

Contexte : les infections nosocomiales sont les effets indésirables des soins de santé les plus fréquents au monde. Le faible nombre d’éléments de preuve disponibles laisse supposer que les établissements aux ressources limitées sont les plus touchés. Les récentes épidémies d’Ebola mettent en relief les conséquences désastreuses que peut avoir la propagation d’agents infectieux au sein des établissements de santé, soulignant ainsi la nécessité d’améliorer les pratiques de contrôle des infections. Les pratiques d’hygiène des mains sont considérées comme le moyen de prévention le plus efficace contre les infections nosocomiales. Toutefois, l’observance des règles d’hygiène des mains et les connaissances en la matière sont faibles, en particulier dans les pays les plus vulnérables comme la Guinée. L’objectif du projet PASQUALE (Partenariat pour Améliorer la Sécurité des Patients et la Qualité des Soins) consistait à évaluer les connaissances et l’observance de l’hygiène des mains en introduisant la Stratégie Multimodale de l’Organisation Mondiale de la Santé (OMS) pour la Promotion de l’Hygiène des Mains à l’Hôpital Régional de Faranah (HRF) en Guinée. Méthodes : grâce à une approche participative, une équipe composée de membres du personnel et de la direction de l’HRF a été invitée à déterminer les priorités de l’hôpital avant de lancer le projet PASQUALE. Le comité d’hygiène local était habilité à renforcer ses activités et à prendre en charge le plan d’amélioration de l’hygiène des mains. Une évaluation de base sur les connaissances, la perception et l’observance de l’hygiène des mains a été effectuée des mois avant le début du projet. L’intervention principale a consisté à établir une production locale de solution hydro-alcoolique. L’efficacité du produit final a été analysée en liaison avec une formation adaptée aux besoins identifiés dans l’évaluation de base. Une évaluation de suivi a été menée immédiatement après la formation. L’efficacité de l’intervention de l’OMS a été évaluée par une comparaison non contrôlée avant-après. Résultats : le niveau initial de connaissance (13,0/25) a augmenté de manière significative pour atteindre 19,0/25 dans l’évaluation du suivi. L’observance de base de l’hygiène des mains était de 23,7 % et a connu une hausse importante en passant à 71,5 % dans le suivi. Cette observance a augmenté dans tous les groupes professionnels, hormis les sages-femmes et dans toutes les indications de l’hygiène des mains, le plus important ayant été constaté dans l’indication « Avant un geste aseptique ». L’augmentation de l’observance à l’hygiène a pu être associée avec l’intervention et est restée significative après l’ajustement des biais de confusion. La pharmacie locale est en mesure d’approvisionner toutes les unités de l’hôpital. L’approvisionnement local a augmenté par un facteur de dix la consommation mensuelle de solution hydro-alcoolique de l’hôpital.. Conclusion : Le Stratégie Multimodale de l’OMS est une méthode flexible et efficace pour améliorer les connaissances et l’observance de l’hygiène des mains dans un milieu aux ressources limitées. La production locale est une approche appropriée pour garantir un approvisionnement auto-suffisant de solution hydro-alcoolique aux hôpitaux régionaux comme l’HRF. Les approches participatives telles que l’appropriation de la stratégie par le comité d’hygiène permettent d’envisager le développement durable des objectifs du projet

A gel-based PCR method to differentiate sheeppox virus field isolates from vaccine strains

Abstract Background Sheeppox (SPP) and goatpox (GTP) caused by sheeppox virus (SPPV) and goatpox virus (GTPV), respectively of the genus Capripoxvirus in the family Poxviridae, are severely afflicting small ruminants’ production systems in Africa and Asia. In endemic areas, SPP and GTP are controlled using vaccination with live attenuated vaccines derived from SPPV, GTPV or Lumpy skin disease virus (LSDV). Sometimes outbreaks occur following vaccination. In order to successfully control the spread of the virus, it is essential to identify whether the animals were infected by the field strain and the vaccine did not provide sufficient protection. Alternatively, in some cases the vaccine strain may cause adverse reactions in vaccinated animals or in rare occasions, re-gain virulence. Thus, diagnostic tools for differentiation of virulent strains from attenuated vaccine strains of the virus are needed. The aim of this study was to identify an appropriate diagnostic target region in the capripoxvirus genome by comparing the genomic sequences of SPPV field isolates with those of the most widely used SPP vaccine strains. Results A unique 84 base pair nucleotide deletion located between the DNA ligase gene and the VARV B22R homologue gene was found only in SPPV vaccines derived from the Romanian and Yugoslavian RM/65 strains and absent in SPPV field isolates originated from various geographical locations of Asia and Africa. In addition, we developed and evaluated a conventional PCR assay, exploiting the targeted intergenic region to differentiate SPPV vaccine virus from field isolates. The assay produced an amplicon size of 218 bp for the vaccine strains, while the SPPV field isolates resulted in a 302 bp PCR fragment. The assay showed good sensitivity and specificity, and the results were in full agreement with the sequencing data of the PCR amplicons. Conclusion The developed assay is an improvement of currently existing diagnostic tools and, when combined with a capripox virus species-specific assay, will enhance SPP and GTP diagnosis and surveillance and facilitate epidemiological investigations in countries using live attenuated SPP vaccines. In addition, for laboratories with limited resources, the assay provides a simple and cost-effective alternative for sequencing

An HRM assay to differentiate sheeppox virus vaccine strains from sheeppox virus field isolates and other capripoxvirus species

International audienceSheep poxvirus (SPPV), goat poxvirus (GTPV) and lumpy skin disease virus (LSDV) affect small ruminants and cattle causing sheeppox (SPP), goatpox (GTP) and lumpy skin disease (LSD) respectively. In endemic areas, vaccination with live attenuated vaccines derived from SPPV, GTPV or LSDV provides protection from SPP and GTP. As live poxviruses may cause adverse reactions in vaccinated animals, it is imperative to develop new diagnostic tools for the differentiation of SPPV field strains from attenuated vaccine strains. Within the capripoxvirus (CaPV) homolog of the variola virus B22R gene, we identified a unique region in SPPV vaccines with two deletions of 21 and 27 nucleotides and developed a High-Resolution Melting (HRM)-based assay. The HRM assay produces four distinct melting peaks, enabling the differentiation between SPPV vaccines, SPPV field isolates, GTPV and LSDV. This HRM assay is sensitive, specific, and provides a cost-effective means for the detection and classification of CaPVs and the differentiation of SPPV vaccines from SPPV field isolates

Additional file 2: of A gel-based PCR method to differentiate sheeppox virus field isolates from vaccine strains

Figure S1. Gel picture of PCR products for the remaining capripoxvirus samples. These sample were tested in this study, but not presented in Fig. 2 of the manuscript. The PCR products of 218 bp, 302 bp and 338 bp represent SPPV vaccine strains, SPPV field isolates/GTPVs, and LSDVs respectively. First row: MM = 50 bp DNA ladder; a = positive control plasmid of the SPPV field isolates; b = positive control plasmid of the SPPV vaccine strain; c = Negative control; Lane 5 to 15 (sample 23 to 33 in Table 1 of the manuscript). Second row: MM = 50 bp; Lane 2 to 14 (sample 34 to 46 in Table 1 of the manuscript). (PDF 104 kb

Additional file 4: of A gel-based PCR method to differentiate sheeppox virus field isolates from vaccine strains

Figure S3. Gel picture of PCR for the non-capripoxvirus samples tested in this study. MM = 50 bp DNA ladder; a = positive control plasmid of the SPPV field isolates; b = positive control plasmid of the SPPV vaccine strain; c = Negative control; 1–5 (ORF viruses); 6 (BPSV); 7–8 (Mccp); 9 (cDNA, PPRV); 10 (BOHV-1); 11 (BOHV-2). (PDF 45 kb

Additional file 3: of A gel-based PCR method to differentiate sheeppox virus field isolates from vaccine strains

Figure S2. Determination of the limits of detection of the PCR assay. Defined amount for the plasmid genotype standard (104, 103, 100, 80, 60, 40, 20, 10, 1 and 0) for SPPV vaccine (A) and SPPV field isolates (B) were tested in parallel reactions and run on agarose gel. (PDF 77 kb

Additional file 1: of A gel-based PCR method to differentiate sheeppox virus field isolates from vaccine strains

Table S1. Non-capripoxvirus samples tested for specificity study. (DOCX 16 kb