Pistols and Poise: Day 24 in Sierra Leone

Temperature gun - Mamadu Fever (>38C) is an early sign of Ebola so temperatures are taken several times a day at entry to Bldgs, and police roadblocks. Still “no touch” law, so taken with infrared pistol aimed at temple. Ocass misreads and need recheck – happen to me yesterday. 2nd was normal!Ocass 34C – so I check pulse for life signs.
 7 baskets on head lowres  Food on head lowres  I soon understood why many Sierra Leone women have great poise – it takes a straight back to walk with these loads atop their heads – and a very strong neck!PS. In 2nd Pic “Nor Pis Ya” is “No urinating here” in local Krio (creole)

Tried local dish FuFu this week – local colleague said “are you sure” and I bravely stated I like to try local cooked food. The fermented “roll” is from cassava flour and is consistency of playdough (it had pleasant sweet taste) – you dip it into soup – my soup was beef and fish and dark green vegetable and had a rancid taste. My colleague said it was dish only made on Saturdays – I tried as much as I could politely sustain. Very glad today’s Sunday!

At office this week, a colleague became very pale – she barely made it to the garden. I sourced water and cup and her colour returned eventually. A timely warning of “If you can’t peel it, don’t eat it”. I had tummy episode Thur but worked out it was the quantity of chilli in the goat-pepper soup – goodness the Sierra Leone’s love their chilli! I’m still checking if my lips are still there.

This week I was a millionaire! – at 5,000 Leones to 1US$, $200 makes you a millionaire. Jokes aside, I do not know how the SL people survive as prices are high compared to wages – of those that have work. A nurse manager earns about $12 a day.

This Fri, 2 of 3 Provinces are in 3 day “Lock Down”. No shopping, no traffic, no-one outdoors – everyone has to stay home. This is only 2nd in 6 months and is to enable 7,000 health workers to visit every home and advise on Ebola safety and hand out brochures – in an effort to eradicate the disease.

Sunday here – our day off – only 1 work mtg scheduled – 8 of us went to beach for lunch – an earned break.

Warm regards to you all, Terry

PS. Subscribe below if you wish to be alerted when I write a new post.

WHO launches Injection Safety campaign

I am fortunate to have spent two days at the Geneva WHO SIGN meeting where Dr Chan, WHO D-G launched the new Injection Safety campaign.

I am very excited because HCW sharps safety is an integral part of the campaign.

Even with safety engineered devices (SED), many countries are finding if difficult to further reduce their sharps injury incidence and this is the shot in the arm (forgive the pun) that they need.

As with WHO’s Hand Hygiene campaign, WHO will ask their 194 member countries to sign up to the campaign. Hopefully this will lead to the increased resources needed for more SED uptake and greater attention to competency-based SED training.

The campaign will require all signatories to exclusively use SED that meet WHO Prequal Standards (or their equivalent) by 2020.

I’m about to board a plane to Sierra Leone to assist for 2 months a CDC and WHO program to establish an Infection Control infrastructure throughout the 14 provinces. I’ll keep you updated via this website.

2nd Ebola UK military HCW sustains sharps injury

Two military HCW have been repatriated to UK following sharps injuries (SI) while assisting with Ebola patients in West Africa. Both HCW were flown immediately to UK and are under hospital observation. Neither is symptomatic. My heart goes out to the two HCW and their families.

Two injuries in a week in well-trained staff attending high transmission-risk patients is alarming.

Ebola, like 60 other blood-borne pathogens, may be transmitted via the percutaneous route, particularly if unsafe injection practices are used . Likewise, Ebola may be acquired by laboratory workers following accidental sharps injury, the first being reported in 1977.

Rubinson tells of the ensuing emotional roller-coaster following an Ebola sharps injury in Sierra Leone.

How did the injuries occur? Difficult patient/procedure/environment? Lack or incorrect use of safety devices? Many of us would benefit from knowing these details. Hopefully they will be published.

Lab tests from a blood-drop – no more phlebotomy sharps injuries?

At 19 Elizabeth Holmes started her high-tech lab-test company Theranos, – it’s now worth $9bill.

Fortune lauded her amazing technology but I see her work leading to the end of phlebotomy sharps injuries.

Theranos specializes in low-cost, rapid-turnaround lab tests – from a drop of blood!.
With more than 200 patents and another 200 in the wind, this not just a PKU, she and her team have developed over 200 lab tests achievable from a simple finger-prick – and hope to have 1,000 tests soon.

If this is phlebotomy of the future then sharps injuries from hollow-bore needles will become a thing of the past – you just need a finger-lancet – a safety finger lancet.

My recent audits of sharps container contents showed that safety engineered devices are not as commonly used as we thought – but another observation I made (unpublished) was that that (i) every lancet was a safety lancet, and (ii) every single safety lancet was activated correctly!

Thanks to Theranos, the future for phlebotomists looks very safe indeed.

Sharps safety devices – why is Australian use lower than USA?

Australian hospitals use less sharps safety devices than USA

Sharps injuries (SI) among Australian healthcare professionals (HCP) are three times that of USA.

The best way to reduce SI is to use safety engineered devices (SED). All Australian hospitals use SED – but to what extent?

To ascertain SED extent, you need to “dumpster dive” – you need look at sharps container contents. If Australian HCP are using less SED  it could be a contributing factor in the higher SI rate.

In my survey published online last week in Healthcare infection I examined the contents of 102 sharps containers from 27 hospitals in 5 Australian capital cities and found 30% of the 10,000 hollow-bore needles were SED.  A similar but smaller sampling in the U.S. revealed that 46% were SED.

The paper concludes a high proportion of Australian HCP are unnecessarily at risk of SI while handling sharps. Recommendations include more widespread SED evaluation and adoption (automatic and semi-automatic SED where feasible), repetitive competency training and safety-ownership. Legislation may be indicated.

Click here for access to Abstract and Author copy for this study

Buttering Bread is an Infection Control Strategy!

Buttering bread stopped a plague.

In the 16th century, Copernicus (yes, the physician and astronomer) commanded the Allenstein castle in Prussia which was besieged by Teutonic Knights. A “plague” in the castle rendered many soldiers ill, including Copernicus. He divided the people into various diets and noted that the contagion was related to bread intake.

Soldiers atop the castle worked 12 hour shifts and took lunch while on duty (no workers’ rights there!). Copernicus determined that the bread-loaf was contaminated when accidentally dropped on the floor whilst being carried up the narrow steep stairs to the turrets by untrained staff pressed into waitering. The staff put the dropped bread back on the tray but as it was black in colour, the contamination with dirt and pathogens was not noticed.

A friend suggested coating the loaf with a light-coloured spread so they would detect if it had been dropped. They used churned cream and when eaters elected to clean or reject visibly dirtied bread, the epidemic halted. The practice was publicised by Copernicus’ colleague, BUTTENADT, secretary to the Apothecaries and Physicians Guild. The practice of BUTTENADTING later became popular with the people and the shortened form of the word became BUTTERING.

PS (TG). The epidemic would not have been THE plague (Yersinia pestis – spread by flea bites) but likely to have been any one of several diseases transmitted from rat faeces. Must be coincidence that the word “butter” is derived from the Greek Bouturon (“cow-cheese”). And for those whose bread always falls butter-side down – that’s fundamental physics and the height of your table!

Great to have neighbours with wine connections

Vanya Cullen of Cullen Wines??

Wine is another love my wife Jenny and I share.

In our kitchen we have a large poster ranking Australia’s top wines – you can imagine our excitement when our neighbors Christine and Mana popped in to ask could they bring over their guest to share a wine with us – their guest? –  Vanya Cullen of Cullen wines! Cullen’s “Diana Madeline” (named after Vanya’s mother) is on top row of the poster!

Wow! – we were having wine royalty for drinks! What do we serve!? After a wee while in our cellar fondling bottles we chose a ’98 Lakes Folly and decanted and aired it, hoping it would “stand the company”. When Vanya entered carrying a 2005 Diana Madeline we knew we had a contest!

We all agreed the Lakes was smooth, elegant and up with good Bordeaux as Max intended. And the Diana Madeline … we have never sampled a wine so balanced – we thought it would last for years – then Vanya said “I’d like to try this in 30-40 years time! Vanya rattled off at least 6 descriptive adjectives that immediately magnetized our noses to our glass and with many inhalations and memory synapses, we recognized 3-4. What a learning experience it was to have a diva vintner as our tutor! We had to pinch ourselves – we were drinking one of Australia’s top wines – with the woman who made it!

Cullen’s has a homestead in which guests can stay. You can bet what our next visit to Western Australia will entail.

Sharps injury rate may be due to non-use and non-activation of safety devices

Our recent study of Sharps injury (SI) incidence in USA shows there has been little reduction in overall SI incidence in last 10 years. This is puzzling as, under OSHA law, every hospital must use safety engineered devices (SED) wherever commercially available and clinically feasible, review their Exposure Control Plan and new technology annually, and maintain a log of all SI. We also know that every hospital is conscious of their SI incidence and is striving to reduce it. So why hasn’t the national incidence decreased?

In a recent publication to investigate one possible reason for the above, I audited a sample of 18 sharps containers from 5 Florida healthcare facilities. The results were disturbing – over half of the sharps were NOT SED, and of the SED, 22% were NOT activated. It is only a sampling of one region in one state but my experience tells me these results may reflect a national phenomenon.

These results indicate that:

  • less SED are being used than thought (do staff have non-official access to non-SED?), and
  • more SED are non-activated than thought (do staff not see need to always activate?).

Non-use and non-activation of SED may be one explanation for the lack of falling SI incidence in USA.

Are you a healthcare professional?

  • If so, how do we correct this?
  • Under what circumstances do you see HCP:
    • not using SED?
    • not activating SED?

I’d like to hear your feedback and opinions

Survey reveals USA sharps injury prevention is not meeting goals

This is my first blog so please forgive any ineptness – I felt I should quickly get the word out to as many as I could. My recent national survey with my colleague Linda Good estimated that 322,000 US healthcare personnel (HCP) sustain sharps Injuries (SI) each year – but that disturbing news is compounded by the fact that our results show there has been no significant decrease in this figure since 2001. And this is in a developed country that has enacted sharps injury specific laws (NSPA 2001) – think of the plight of HCP in developing countries with scarce resources for safety devices.

Sharps injuries (penetrating injuries of the skin by a cutting/pointy item) among HCP can transmit over 60 different diseases (AJIC 2006) the three most published being HIV/AIDS, Hepatitis B and Hepatitis C. With Hepatitis B, the risk of getting disease from a positive patient is a worrying 1 in 30. This worrying is an important but often neglected facet. HCP often have to wait months for confirmation of “All clear” and have to modify their sexual and maternal practices while waiting, and this takes a huge emotional toll on injured HCP. I know of 4 marriages that have broken under this stress.

Along with many colleagues I am striving to bring this situation to the notice of politicians, healthcare administrators and managers, and the public. We need put zero back on the radar. We need find a new vigor to protect these workers – it may be more intense, repetitive, competency-based education, HCP ownership of their safety, or technology less dependent on human behavior, but a change must occur.