ÁGUA INFECTADA E A CORRELAÇÃO COM A HEPATITE E

Hepatitis E infection is found worldwide and is common in low- and middle-income countries with limited access to essential water, sanitation, hygiene and health services. In these areas, the disease occurs in both outbreaks and sporadic cases. Outbreaks often follow periods of fecal contamination of drinking water supplies and can affect thousands of people. This article aims to raise awareness among the population about the risks of hepatitis E and mainly to highlight the correlation with water. This is an integrative review of the literature. Within the time window of the last five years. The results confirm the importance of drinking water and basic sanitation, as well as highlighting the lack of studies in this area. Therefore it is necessary to talk more about hepatitis E, this article has the legacy of being the basis for other reviews, highlighting that prevention is the most effective approach against infection, however it is necessary to maintain quality standards for public water supply and establish adequate human feces disposal systems, as well as personal hygiene care.A infecção por hepatite E é encontrada em todo o mundo e é comum em países de baixo e médio rendimento com acesso limitado a serviços essenciais de água, saneamento, higiene e saúde. Nessas áreas, a doença ocorre tanto em surtos quanto em casos esporádicos. Os surtos geralmente seguem-se a períodos de contaminação fecal do abastecimento de água potável e podem afetar milhares de pessoas. Esse artigo tem como objetivo conscientizar a população sobre os riscos da hepatite E e principalmente destacar a correlação com a água. Trata-se de uma revisão integrativa da literatura. Dentro da janela temporal dos últimos cinco anos. Os resultados confirmam a importância da água potável e saneamento básico, bem como evidenciam a falta de estudos nessa área. Por tanto é necessário falar mais sobre a hepatite E, esse artigo fica com o legado de ser base para outras revisões, ressaltando que a prevenção é a abordagem mais eficaz contra a infecção, entretanto é necessário manter padrões de qualidade para o abastecimento público de água e estabelecer sistemas adequados de eliminação de fezes humanas, bem como os cuidados de higiene pessoal

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)