AOHP’s latest 2013 & 2014 Blood Exposure Study

The USA Association of Occupational Health Professionals in Healthcare (AOHP) has issued a press release on the publication of their 2013-14 survey of Blood exposure incidence among US healthcare workers (HCW).

The survey, AOHP’s third in their annual series, and in which 84 hospitals in 28 states participated in supplying their 2013 and 2014 data, shows a significant rise in exposure incidents among US HCW.

Using “per 100 occupied beds” as the denominator, the 2014 sharps injury (SI) rate of 33.3, is significantly higher than the 24.0 in AOHP’s 2011 survey, and significantly higher than the EPINet rate of 22.2 in 2001, the year safety engineered devices (SED) became mandatory.
Exposure incidents include the HCW being stuck with a blood-contaminated needle or having a patient’s blood or blood-contaminated fluids splashed onto them. Each such incident carries a small but definite risk of transmitting one or more of 60 diseases, the three most well-known being HIV, Hepatitis C and Hepatitis B.

The denominator showing the highest rise was “Occupied beds” and this may reflect  the inability of this denominator to reflect the increases in day-patients and outpatients. However, “Total FTE”, a mirror of total patient workload, also showed a rising trend.

The paper, authored by Carol Brown, Miranda Dally, myself and Linda Good, propose the rise may be due to:

  • increasing HCW workloads;
  • decreasing resources;
  • increasing day-patient and outpatient numbers, and
  • incorrect use of SED

Several hospitals stood out for their low exposure rates. Examples of their successful reduction-strategies were: Competency-based education at orientation and annually (and repeated with all injured HCW); Investigation of every sharps injury; Making SI rates transparent and known to all staff; Requiring a waiver to be requested for non-SED use; Holding HCW and Management responsible for their safety.

The published copyright paper may be purchased by emailing AOHP at [email protected]  A complimentary, pre-publication Author Copy , for personal use only, is available here.

AOHP’s fifth annual survey (2015 calendar year) is in progress with publication aim late 2016.

Zika: update on geography, precautions and sexual transmission

Last Friday I stated Zika was in theory capable of sexual spread, and on Tues Feb 2nd, the Texas Dept State Health Services confirmed a sexually transmitted case.

Prior to the Texas announcement only one sexually transmitted case had been confirmed – Foy et al in 2011 published a case in the wife of a Zika researcher returning to Colorado in 2008. Subsequently, Musso et al in 2013 found Zika in the semen of an infected Tahitian male.

Notwithstanding the above, CDC confirm transmission is primarily via mosquitoes (Aedes – they also transmit dengue, but not malaria), and rarely, to the foetus from infected mothers.

Zika is a mild disease, predominantly with no symptoms, but with 4,800 cases of microcephaly in Brazilian babies in the last 18 months, this aspect, and the rapidity of spread of the disease (up to 1.4 million cases in Brazil in 2015) caused WHO on Monday to classify ZIKA as a Public Health Emergency of International Concern (PHEIC).

By classifying Zika as a PHEIC, WHO mobilizes internationally the resources for research and action into the disease, its sequelae, and its prevention.

WHO state there should not be travel or trade restrictions with any Zika-active country and CDC state prevention is via classic anti-mosquito measures and have issued cautionary travel advice for pregnant females

The US has the relevant Zika Aedes species in the lower states and as yet mosquito-transmission has not been documented but, with returning travelers, there is the possibility of local Zika transmission

But if Zika was first discovered in Uganda monkeys in 1947 (first human case in 1952), then appeared in the Pacific in 2007 with the first major epidemic being in French Polynesia in 2013, how did it suddenly explode in Brazil? It was not the Brazil World Cup as originally thought. Musso examined the “fingerprint” of Zika isolates in infected countries and determined that during 2013-14:

  • The origin of introduction to French Polynesia is unknown
  • New Caledonia was infected from infected travelers returning from French Polynesia
  • French Polynesians brought the virus to Easter Island when attending the island’s Tapati Festival in early 2014
  • Other nearby Pacific countries were infected because inter-travel is common
  • In Aug 2014, teams from several of the above Pacific countries attended the World Canoe Championships in Rio de Janeiro. Musso suggests this introduced Zika to Brazil.

Now, in just 18 months, 28 countries have active Zika transmission.

Fortunately for New Zealand (where I live) the Ministry of Health state the subspecies of Aedes has not been found. But returning travelers with symptoms might need heed the Texas news. And spread via an accidental needlestick to an attending healthcare worker, although as yet undocumented, must also be a concern.

Does leisure activity lengthen your life or do you harm?

For those of you who (like me) are conscious their bodies are “getting older”, this recent JAMA review is very informative – and encouraging!

Personally, I find my mind does not know my body cannot do what it use to – until I injure myself!

Regular activity decreases my injury risk, but, after knee, back and hernia episodes, too much activity too soon is risky! So now I slowly but regularly increase my activity intensity – and injuries are fewer! And I’m “body-wiser”.

Hence I was delighted to read this article.

In a meta-analysis of 6 studies, 700,000 individuals (and 120,000 deaths), Arem, Moore, Patel, et al asked and answered 4 Q’s:

  • Does the recommended 75 mins activity per week decrease your mortality expectancy? Yes, 20% less risk
  • Does more activity give you more reduction in mortality risk? Yes, somewhat  (31-39% less risk)
  • Is there a level of activity beyond which no further decrease in mortality occurs? Yes, at 3-5 times the weekly recommendation
  • Does even more activity do you harm? No, at least not at 10 times the recommended activity level.

The full article is downloadable free at http://archinte.jamanetwork.com/article.aspx?articleid=2212267.

What patients wish for in hospitals

Let me sleep, and Oh, please knock on my door when entering.

Becker’s Hospital Review alerted me to the work of Peter Pronovost of  The Johns Hopkins. He recently reviewed patient surveys and with Jane Hill compiled the top ten wishes of hospital inpatients.

  1. Let me sleep. Do not take vitals throughout the night or draw blood between 10 p.m. and 6 a.m. unless it is critical. If it is critical, please make sure I understand. My sleep helps me recover and feel better.
  2. Keep the noise levels down at the nurses’ station. This is so important – especially at night when my sleep is needed. Turn off the TV, radio, computer screen, etc., at night in my room, so there’s not a glare or noise that can disturb my sleep.
  3. Don’t lose my personal belongings. Take an inventory and label everything with my name and medical record numberso my personal belongings do not get misplaced. These belongings are an extension of me and make me feel more at ease. Taking care of my stuff feels like you are taking care of me.
  4. Knock on the door before entering. This shows respect for me as an individual and my privacy. Introduce yourself to me, and shake hands or make eye contact when you do this. Call me by my preferred name (formal or first name).
  5. Please keep my white board current and up to date. It gives me a quick reference of who is caring for me and my daily plan. Provide a notebook at the bedside so I can keep all my important papers, cards from my health care team and other staff, etc. in one place. Please make sure my name and my location (nursing unit, room number and room phone) are listed on the front.
  6. Update me and my family if you notice changes in my condition. Keep communication open. Please keep me informed of delays. It lessens my anxiety during an already stressful time.
  7. Keep my room clean – mop the floors every day, wipe surfaces to prevent the spread of germs, empty my wastebasket and keep my bathroom really clean so it even smells clean. If you are my housekeeper, please introduce yourself to me and say hello. I like to know who is taking care of me.
  8. Listen to me and engage me in my care. Use plain language, and make sure I understand my plan of care.
  9. Please orient me to my room and the hospital, so I know where important things are located, how to work the television, how to order food and when my linens may be changed. I am a guest here and don’t know these things, yet these are important to me.
  10. Please maintain professionalism in ALL areas of the hospital. While you may be on your break, you are still a hospital employee and a reflection of the hospital. How I perceive you is often how I perceive the hospital and care that I am receiving.

The original article was published by US News & World Report – Health.

The top 10 Questions people ask Google

Just reading Becker’s Hospital Review.

It is fascinating to learn the questions we ask Google.

There are a myriad of categories including medical symptoms, dogs, movies, fashion,  diets and even celebrity pregnancies!

Here are a few “Top 10” that caught my eye…

Symptoms Questions Dog Questions Fashion Questions
1.     Flu 1.      Why do dogs wag their tail? 1.       How to walk in heels?
2.     Gallbladder Infection 2.      How to crate train your puppy? 2.      What to wear on the first day of school?
3.     Measles 3.      How to register a dog as a service animal? 3.      How to fray jeans?
4.     Listeria 4.      How to register a dog with the AKC? 4.      How to tie a shirt?
5.     Sinus Infection 5.      How to keep puppy from eating poop? 5.      What should a bride wear to the rehearsal dinner?
6.     Gastritis 6.      When do puppies get shots? 6.      What to wear booties with?
7.     Anxiety Attack 7.      Why do dogs chew their paws? 7.      What are mules shoes?
8.     H. Pylori Infection 8.      What breed is the ‘Target’ dog? 8.      What to wear to a wedding in the woods?
9.     Heat stroke 9.      How to paper train a puppy? 9.      How to dress up like Miranda Sings?
10. Lactose Intolerance 10.  How to stop dogs from biting? 10.   What color shoes goes with a black and blue dress?

 

For the 42 other categories see https://www.google.com/trends/topcharts#vm=cat&geo=US&date=2015&cid.

WHO prioritises world Epidemic Threats

A panel of experts met at WHO Geneva this week to prioritise the top five to ten emerging pathogens likely to cause severe outbreaks in the near future, and for which few or no medical countermeasures exist.

These diseases are a blueprint for R&D preparedness to help control potential future outbreaks.

The initial list, to be reviewed annually, comprises:

Three other diseases were designated as ‘serious’, requiring action by WHO to promote R&D as soon as possible; these were chikungunya, severe fever with thrombocytopaenia syndrome, and Zika.

Other diseases with epidemic potential – such as HIV/AIDSTuberculosisMalaria,Avian influenza and Dengue – were not included in the list because there are major disease control and research networks for these infections, and an existing pipeline for improved interventions.

Sierra Leone is at ZERO – it’s official!

On Sat Nov 7th, WHO officially declared Sierra Leone free of Ebola – after 42 Ebola-free days.

Jubilationn in Sierra Leone

I have watched and waited for each of the 42 days and on Sat Nov 7th, while in USA, I sat at my laptop watching the National Ebola Response Centre‘s Ebola Clock click the seconds down to ZERO .

Surprisingly the website did not erupt into digital fireworks as I expected, perhaps because they are now on a 90 days of enhanced surveillance as it is not quite “over” – neighbouring Guinea still has a few Ebola cases.

What I guarantee is the music- and fun-loving people of Sierra Leone will be celebrating for days, maybe weeks. God knows they deserve it!

It was a privilege to be a tiny part of the recovery.

 

 

A shared syringe – and $80mill bill

With social media and education outreach, major outbreaks of Bloodborne Pathogens (BBP) should be a thing of the past. Not so.

Alarm bells rang when 11 new HIV cases occurred in Nov-Jan in a small Indiana community – double that normally seen in a year .

This “handful of cases” from shared syringes among opioid drug users, had grown to 26 cases when reported in Feb by the Indiana State Department of Health, and by March had grown to 79 cases. By April the number had risen to 135 cases, 84% of whom were coinfected with HCV.

In a US CDC-Medscape Expert Commentary released this week, the number is now at 170 HIV cases, almost all HCV coinfected. The article states, “The lifelong medical care costs alone for treating the persons …will be more than $80 million“.

WHO in 2004 examined the alarming increase in BBP transmission among drug injectors and after a review of over 200 publications concluded that: the evidence for BBP reduction with needle and syringe exchange programs (NSEP) was overwhelming; NSEP need be country-wide; and any contrary legislation needs be repealed.

PS. Proudly, Australia and New Zealand were two of the first countries to use NSEPs nationally – and now via vending machines!

Interestingly, USA banned federal funding of NSEP in 1988, removed the ban in 2009, and reinstated the ban in 2011 (the legislation does not ban NSEPs; just federal funding of them). Opponents of federal support for NSEPs argue that it signals governmental acceptance of, and would facilitate the uptake of, illegal drug use. WHO says not so. Thankfully, in 2011, at least 221 non federal NSEPs operated in the US.

CDC recommends drug injectors be referred to “programs that provide access to sterile injection equipment.” A wise, evidence-based recommendation.

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Travel history is essential – not just for Ebola

There are many lethal, more frequently occurring diseases than Ebola, entering our countries.

Recently, on the chat room of USA Assoc. for Professionals in Infection Control & Epidem (APIC), members have asked how much longer hospitals should ask patients about overseas travel (to alert staff for Ebola).

Malaria is another reason why travel history must CONTINUE to be sought.

Several decades ago as a Malariologist in a developing country, I strove to remind colleagues in developed countries to ALWAYS ask a travel history when any patient presented with fever, chills or headache (FC&H). I have seen a patient walk in unassisted with FC&H at 5pm, and die from P. falciparum cerebral malaria at midnight.

The deaths of two tourists from cerebral malaria in a Springfield Missouri motel last month shows how rapidly and insidiously this disease can kill travelers. And underpins why travel history is essential if patients present with fever to an emergency dept.

In 2011 USA hit an all-time high with nearly 2,000 cases of malaria being diagnosed in travellers.  In 2012 1,687 cases of Malaria were diagnosed in USA, with 1,683 (99.8%) occurring in travelers. Six of the cases died.

Ebola pales into the background in the face of other imported diseases for which a travel history is needed for diagnosis.