Search

The aim of this study was to analyze the perceived risk of COVID-19 infection among health personnel in Lima and Callao. We followed a qualitative approach with a reflexive thematic analysis design. Fifteen participants were interviewed. It was found that the perception of the risk of infection revolved around previous knowledge, the emotional state went from fear to calm. Likewise, the perception was affected by the sociocultural influence of the work environment, institutional, relational, beliefs and service vocation; as well as by personal experiences, which include risk situations and negative emotional charge. It is concluded that the perception of risk is centered on knowledge and emotions, related to social, cultural, and individual aspects. [ABSTRACT FROM AUTHOR]

Debate rages over whether Canadian provincial and territorial governments should allow healthcare institutions to conscientiously object to providing medical assistance in dying (MAiD). This issue is likely to end up in court soon through challenges from patients, clinicians, or advocacy groups such as Dying With Dignity Canada. When it does, one key question for the courts will be whether allowing institutional conscientious objection (ICO) to MAiD respects (i.e., shows due regard for) the consciences of the objecting healthcare institutions, understood as unitary entities. This question has been thoroughly explored elsewhere in the academic literature. However, another key question has been underexplored. Specifically, precedent set by the Supreme Court of Canada's decision in Loyola High School v. Quebec (Attorney General) suggests that the courts will consider whether allowing ICO to MAiD respects the consciences of the personnel within objecting healthcare institutions. My answer to this question is no, by which I mean that allowing ICO to MAiD shows undue disregard for some consciences and undue regard for others. To justify this answer, I analyze the arguments that hold that allowing ICO in healthcare respects the consciences of the personnel within objecting healthcare institutions. My conclusion is that none of these personnel-based arguments succeed in the case of ICO to MAiD. Some fail because they are wrong about the nature of conscience and complicity. Others fail because they contradict the arguments' proponents' positions on conscientious objection by individual healthcare providers. Still others fail because they are internally inconsistent. [ABSTRACT FROM AUTHOR]

Background: With the rise in cases of Lassa fever in recent times in West Africa, the healthcare setting continues to pose significant risk especially among healthcare workers (HCWs) for diseases like Lassa fever that are transmitted via contact with blood and other body fluids. We therefore assessed the knowledge, attitude and practice (KAP) of infection prevention and control (IPC) one year after an outbreak of nosocomial transmission of Lassa fever in the study hospital. Methodology: A cross-sectional study of HCWs was conducted in Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, a tertiary hospital designated for Lassa fever treatment in southeast Nigeria. A total of 631 HCWs selected by systematic random sampling were surveyed using self-administered questionnaire to determine the KAP of IPC. Data analysis was done with EPI INFO version 7.2 and Microsoft Excel 2016, and Chi square statistic was used to examine relationship between variables at 5% level of significance. Results: Only 287 (51.1%) of the 562 respondent HCWs had good knowledge of IPC, 442 (78.6%) had good attitude towards IPC, and 268 (47.7%) had good practice of IPC. Socio-demographic predictors of IPC knowledge included being a medical laboratory scientist (AOR=0.5; 95% CI=0.29-0.83; p=0.009), tertiary education level (AOR=7.0; 95% CI=1.11-44.60; p=0.038), and work experience of ≥ 7 years (AOR=2.3; 95% CI=1.47-3.57; p<0.001). Male gender (AOR=1.9; 95% CI=1.06-3.42; p=0.031), nurse professional (AOR=6.5; 95% CI=2.67-15.81; p<0.001) and work experience of ≥ 7 years (AOR=2.5; 95% CI=1.37-4.54; p=0.003) were predictors of good attitude towards IPC. Also, nurse professional (AOR=3.1; 95% CI=1.79-5.20; p<0.001) and married status (AOR=1.6; 95% CI=1.05-2.55; p=0.028) were predictors of good practice of IPC among the respondents. Conclusions: The study demonstrated that knowledge and practice of IPC was low in the study location despite the interventions that had been instituted to improve the IPC framework. Therefore, there is need to adapt approaches that will influence behavior change towards IPC in the course of the in-service trainings being conducted in the hospital. [ABSTRACT FROM AUTHOR]

This article is a theoretical essay aiming to reflect on the construction of clinical performance in Primary Health Care (PHC) based on Foucault's concept. Through an explanation of a fictitious case, arguments are developed in which we defend that the main biopolitical strategy used in the clinic performed in the PHC currently; is governmentality. We point out some of Foucault's theoretical-methodological tools, inscribed in the being-with-yourself or ethics phase, as possible analysis strategies to think about possibilities for the clinic extension, from the perspective of including the subject in its construction. In addition to the governance of behaviors, which lead to subjection through the use of governance devices, the notions of self-practices, self-knowledge, and parrhesia point to the possibility of building a clinic in PHC guided by an ethical relationship between professionals and health system users. [ABSTRACT FROM AUTHOR]

Background: Healthcare associated infections (HAIs) have been recognized as a critical challenge affecting the quality of healthcare services provided. A significant proportion of these infections result from cross-contamination of microorganisms which are often acquired and spread by direct contact with patients or contaminated adjacent environmental surfaces through the hands of healthcare workers (HCWs). The objectives of this study are to profile bacterial pathogens commonly found on the hands of health care workers while routinely attending to patients in the healthcare facility and to determine their antibiotic susceptibility pattern. Methodology: The fingers of the dominant hand of 300 HCWs at the Barau Dikko Teaching Hospital (BDTH), Kaduna, Nigeria, were imprinted on 5% Sheep blood, MacConkey, and Mannitol salt agar plates and incubated at 37°C for 24 hours. Bacteria isolates were identified by Gram staining and conventional biochemical tests. The susceptibility of isolated bacteria to selected antibiotics was determined by the modified Kirby-Bauer disk diffusion method and interpreted using the 2012 guidelines of the Clinical and Laboratory Standards Institute. Results: Bacteria were isolated from the hands of all 300 HCWs, with coagulase negative staphylococci (CONS) being the most frequent (67.0%, 201/300). Other bacteria identified were Staphylococcus aureus (23.7%, MRSA of 3%), Streptococcus pyogenes (2.7%), and Enterobacteriaceae (6%). The isolates were highly sensitive to ofloxacin 96.7% (290/300), augmentin 87.7% (263/300) and ceftriaxone 87.3% (262/300). Conclusion: This study demonstrates a high rate of contamination of hands of HCWs with potentially pathogenic bacteria, some of which were multidrug resistant. Concerted efforts should be made to implement programs dedicated to improve hand hygiene practices in the tertiary health care facility. [ABSTRACT FROM AUTHOR]

The emergence of a novel human ß coronavirus, severe acute respiratory syndrome coronavirus 2, which causes coronavirus disease 2019 (COVID-19), has developed into a global pandemic and public health emergency. The management of patients with burns must be adapted to this context. The aim of this systematic review is to identify the optimal protection measures during the COVID-19 pandemic and provide guidance of protective measures for burn surgeons. A systematic search of PubMed was performed for articles about COVID-19. "Burn units", "burns", "COVID-19", "health personnel", "protective devices", "severe acute respiratory syndrome coronavirus 2", "surgeons" and "telemedicine" were reviewed during the entire diagnosis and management process of burn patients. Eight articles were included, and five articles emphasized that burn care professionals should pay attention to prevent cross-infection. Only three articles reported in detail how burn care professionals should be protected during surgery in the operating room. These experiences and strategies can help burn care professionals work safely and effectively, and prevent both nosocomial infections and burn care professional infections during the global pandemic of COVID-19. [ABSTRACT FROM AUTHOR]

Background: Female genital mutilation (FGM) is a traditional harmful practice that can cause severe physical and psychological damages to girls and women. Increasingly, trained health-care providers carry out the practice at the request of families. It is important to understand the motivations of providers in order to reduce the medicalization of FGM. This integrative review identifies, appraises and summarizes qualitative and quantitative literature exploring the factors that are associated with the medicalization of FGM and/or re-infibulation. Methods: Literature searches were conducted in PubMed, CINAHL and grey literature databases. Hand searches of identified studies were also examined. The "CASP Qualitative Research Checklist" and the "STROBE Statement" were used to assess the methodological quality of the qualitative and quantitative studies respectively. A total of 354 articles were reviewed for inclusion. Results: Fourteen (14) studies, conducted in countries where FGM is largely practiced as well as in countries hosting migrants from these regions, were included. The main findings about the motivations of health-care providers to practice FGM were: (1) the belief that performing FGM would be less harmful for girls or women than the procedure being performed by a traditional practitioner (the so-called "harm reduction" perspective); (2) the belief that the practice was justified for cultural reasons; (3) the financial gains of performing the procedure; (4) responding to requests of the community or feeling pressured by the community to perform FGM. The main reasons given by health-care providers for not performing FGM were that they (1) are concerned about the risks that FGM can cause for girls' and women's health; (2) are preoccupied by the legal sanctions that might result from performing FGM; and (3) consider FGM to be a "bad practice". Conclusion: The findings of this review can inform public health program planners, policy makers and researchers to adapt or create strategies to end medicalization of FGM in countries with high prevalence of this practice, as well as in countries hosting immigrants from these regions. Given the methodological limitations in the included studies, it is clear that more robust in-depth qualitative studies are needed, in order to better tackle the complexity of this phenomenon and contribute to eradicating FGM throughout the world. [ABSTRACT FROM AUTHOR]

Introduction: Undetected hearing impairment among health personnel could affect their ability to obtain accurate blood pressure (BP) measurements with consequent negative impact on patient care. The aim of this paper was to determine the impact of operator hearing threshold on manual BP measurement. Methodology: A cross-sectional study involving 25 patients and 60 health personnel consisting of 25 doctors (Group 1), 25 nurses (Group 2), and 10 specially selected, normal hearing and trained control group (Group 3). Group 3 personnel measured BP of each patient and this was considered accurate. After preliminary training on BP measurement technique, one person each from Groups 1 and 2 measured BP of a patient using manual auscultation technique and then proceeded to have a screening pure tone audiogram (PTA) with threshold of the best hearing ear recorded. Results: Majority of personnel had normal hearing (PTA ≤25 dB), 22% had hearing threshold >25 dB on screening, with debilitating hearing loss noted in one person (2%). There was a complete agreement in BP measurements between participants with hearing threshold ≤25 dB and the control group, but in participants with threshold >25 dB, 100% recorded inaccurate diastolic BP and 64% recorded inaccurate systolic BP with tendency to underestimate systolic and overestimate diastolic BP. Conclusion: Hearing impairment is not uncommon among health personnel, resulting in inaccurate BP recordings. Audiograms should be obtained whenever health personnel notice frequent differences in measured BP compared to colleagues. Training on BP measurement technique resulted in accurate BP measurement by all normal hearing participants. [ABSTRACT FROM AUTHOR]

Résumé: Contexte: La recommandation de l’OMS et l’UNICEF d’utiliser le soluté de réhydratation orale (SRO) et les mesures diététiques pour traiter la diarrhée aiguë ne semble pas être appliquée par de nombreux personnels de santé en Afrique sub-saharienne d’où une morbi-mortalité infanto-juvéniles élevées. Objectif: Décrire les habitudes de prescription du personnel de santé lors de la diarrhée aiguë de l’enfant à Abidjan. Patients et méthodes: Étude transversale réalisée dans 52 structures sanitaires publiques non spécialisées d’Abidjan du 1er juin au 31 juillet 2012. Elle a porté sur les habitudes de prescription de 151 personnels de santé consentants prenant en charge des enfants. Résultats: Ce sont 100 médecins (pédiatre 18, DES en pédiatrie 28, généralistes 54) et 51 soignants qui ont été interviewés. L’âge moyen était de 39ans (25–59ans) ; la moyenne d’année d’exercice de 8,4 années (1–35ans). Les enquêtés affirmaient prescrire de façon systématique le SRO (53 %) et les mesures diététiques (28,5 %). Ils affirmaient conseiller la poursuite du lait maternel 97,4 %, le lait de régime 43 % et le régime alimentaire anti-diarrhéique 24,5 %. Les médecins prescrivaient plus le SRO et le régime alimentaire anti-diarrhéique par rapport au personnel soignant (32,8 vs 16,9 %, p <0,05) ; alors que la prescription des mesures diététiques simples était davantage le fait du personnel soignant (80,4 vs 58,1 %, p <0,005). Les enquêtés affirmaient prescrire des antibiotiques et des mesures adjuvantes respectivement dans 76,8 % et 97 %. Conclusion: Les habitudes de prescription du personnel de santé s’éloignent des recommandations de l’OMS et de l’UNICEF. La sensibilisation du personnel sur les directives de prise en charge de la diarrhée aiguë s’avère nécessaire pour l’amélioration du pronostic de cette affection. [ABSTRACT FROM AUTHOR]

Introduction: Le but de cette étude était de déterminer la fréquence de la tuberculose (TB) chez le personnel de santé du secteur public en charge des patients tuberculeux et d'évaluer les facteurs de risque de contracter la tuberculose chez ce personnel au Burundi. Méthodes: Il s'agit d'une étude transversale à visée analytique réalisée auprès de 300 travailleurs prestant dans 30 centres de dépistage et de traitement de la TB (CDT) au Burundi du 16 octobre au 15 novembre 2012. Les paramètres sociodémographiques et professionnels ainsi que l'antécédent de vaccination BCG de travailleurs ayant été touché par la TB ont été analysé et comparé à ceux de travailleurs qui ne l'ont pas été. Le seuil de signification a été fixé à p<0,05. Résultats: La fréquence de la TB chez le personnel de santé est de 15%. Le risque de souffrir de la TB est de près de 4 fois chez les travailleurs âgés d'au moins 50 ans (OR=3,73 ; 1,53-9,08), chez ceux qui n'ont jamais reçu de vaccin de BCG (OR=3,73 ; 1,24-11,03), chez ceux qui n'ont pas de cicatrice vaccinale de BCG (OR=3,80 ; 1,67-8,62) et chez ceux qui travaillent depuis au moins 6 ans dans un CDT (OR=3,79 ; 1,44-9,96) ; ce risque est de 9 fois chez ceux qui sont mariés (OR=9,42 ; 1,26-70,23), de 8 fois chez ceux qui n'aèrent pas leurs salles de travail (OR=8,20 ; 1,48-48,23) et de 6 fois chez ceux qui ont comme profession nettoyeur ou aide-soignant (OR=6,12 ; 2,92-12,82). Par contre, aucune corrélation statistiquement significative n'a été observée entre le fait de souffrir de la TB et le sexe mais aussi le nombre d'heures de contact d'un travailleur avec un patient tuberculeux (p>0,05). Conclusion: L'âge, l'antécédent de vaccination de BCG ainsi que la majorité de paramètres professionnels sont en association avec la maladie TB des travailleurs de CDT. D'où, la maîtrise de certains facteurs de risque s'avère important pour faire face au fardeau de la TB parmi le personnel hospitalier. [ABSTRACT FROM AUTHOR]

Introduction: L'hépatite virale B est une affection à haut risque pour le personnel de santé. Au Cameroun, la vaccination contre le virus de l'hépatite B n'est pas obligatoire pour le personnel de santé. Le but de l'étude était d'évaluer l'état vaccinal contre l'hépatite virale B et la prévalence de l'Antigène HBs au sein du personnel médical et paramédical de l'Hôpital Central de Yaoundé. Méthodes: Il s'agissait d'une étude prospective, transversale menée à l'Hôpital Central de Yaoundé du 1er juillet au 31 octobre 2011. Toute personne membre du corps médical et paramédical ayant signée la fiche de consentement éclairé était incluse dans l'étude. Ceux ayant refusé de signer la fiche de consentement éclairé ou dont la fiche d'enquête n'avait pas été complètement remplie étaient exclus de l'étude. Une recherche systématique de l'antigène HBs était effectuée chez chaque personne incluse dans l'étude. Résultats: Au total 282 personnes ont participé à l'étude sur 760, soit un taux de participation de 37,1%. Les personnes ne connaissant pas leur statut sérologique vis-à-vis du virus de l'hépatite B était au nombre de 221 (85%). Deux cent vingt-cinq (86,5%) personnes n'étaient pas vaccinées contre l'hépatite B. Les personnes ayant reçu moins de 3 doses du vaccin contre l'hépatite virale B étaient au nombre de 23 (8,8%). Douze personnes (4,6%) déclaraient avoir reçu les 3 doses du vaccin contre l'hépatite virale B. La prévalence de l'antigène HBs était de 6,6% (n=12). Conclusion: Cette étude montre que la prévalence de l'hépatite virale B reste élevée chez le personnel de l'Hôpital Central de Yaoundé (6,6%). Il ya un besoin de sensibilisation du personnel médical aux risques liés à l'exercice de leur profession. [ABSTRACT FROM AUTHOR]

Objective To study the attitudes, concerns, perceived impact, coping strategies, knowledge on avian influenza (AI) and personal protection measures, and institutional and personal preparedness for AI among all Indonesian primary healthcare workers (PHW). Methods Questionnaire survey of PHW from four public primary healthcare clinics in South Jakarta ( n = 333), with Singaporean PHW from 18 such clinics as controls ( n = 1321). Twelve focus group discussions with 51 South Jakarta PHW were also conducted. Quantitative and qualitative data were analysed separately with statistical and thematic analysis, respectively, then combined. Results South Jakarta PHW had positive attitudes but major concerns about contracting AI, difficulties in diagnosing human AI and inadequacy of personal protection provided. South Jakarta PHW are less knowledgeable about AI and use of personal protection equipment, and reported poorer awareness, availability and participation in AI preparation activities. Only 3% of South Jakarta PHW received influenza vaccination in the preceding 6 months and few felt prepared for AI. Conclusions South Jakarta primary healthcare workers are not well prepared for avian influenza. There is an urgent need to build their primary healthcare capacity to protect them and contain this global health threat. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of scaling up antiretroviral treatment (ART) on the working environment and motivation of health workers in South Africa; and to suggest strategies to minimize negative effects and maximise positive effects. Methods Exploratory interviews with health managers and senior clinical staff were used to identify locally relevant work environment indicators. A self -reported Likert scale questionnaire was administered to a randomly selected cohort of 269 health professionals at health facilities in KwaZulu Natal and Western Cape provinces of South Africa that included ART delivery sites. The cohort was disaggregated into ART and non-ART groups and differences between the two compared with Fisher’s exact test and the non-parametric Mann–Whitney U-test. Results The ART sub-cohort reported: (i) a lighter workload ( P = 0.013), (ii) higher level of staffing ( P = 0.010), (iii) lower sickness absence ( P = 0.032), (iv) higher overall job satisfaction ( P = 0.010), (v) poorer physical state of their work premises ( P = 0.003), and (vi) higher staff turnover ( P = 0.036). Conclusion Scale-up affects the work environment in ways that influence workers’ motivation both positively and negatively. A net negative balance is likely to drive staff out-migration, undermine the quality of care and compromise the capacity of the programme to achieve significant scale. As health workers are the most important element of the health system, a comprehensive and systematic understanding of scale-up impacts on their working conditions and motivation needs to be an integral part of any delivery strategy. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The vaccination of hospital staff decreases patient mortality and disorganization of services due to sick leave. The main aim of our study was to determine the Clermont-Ferrand University hospital (CHU) personnel’s motivations for or against antiflu vaccination to increase the effectiveness of prevention campaigns. Design: An autoquestionnaire with multiple choices was given to the 7601 CHU staff in May 2005. It documented socioprofessional characteristics, vaccinal status, and reasons for vaccination, nonvaccination, or stopping antiflu vaccination. Results: The answer rate was 26.5% (2011 autoquestionnaires returned) and representative of the CHU staff. The rate of vaccination in 2004 was 36.35% with a strong correlation between vaccination and former influenza infection (p <0.001). Five of the six principal reasons for vaccination were altruistic including the first two: avoiding transmission to patients (61.8%) and his family (59.8%). The main reason for stopping was the lack of time. The reasons for nonvaccination were linked to a feeling of invulnerability: conviction of not being at risk, of being too young, or in good health. Conclusions: The Haute Autorité de santé’s objective of vaccinal coverage against influenza for 75% of the health professionals requires their active compliance. The effectiveness of future campaigns could aim at improving knowledge by insisting particularly on the young age of the risk populations. The lack of time can be compensated by offering on-site vaccination, including at night and by proposing larger schedules for vaccination. [Copyright &y& Elsevier]

Résumé: Quelques études ont été effectuées sur l'efficacité des mesures barrière pour la protection des professionnels de santé au contact avec des patients infectés lors d'épidémies de maladies virales à transmission respiratoire comme la grippe saisonnière, le syndrome respiratoire aigu sévère (SRAS) ou le syndrome respiratoire du Moyen-Orient (MERS). Elles permettent plus facilement d'associer le contact contaminant et son effet que les études en population générale. Elles ne gomment pas le fait que lors d'épidémies, les soignants sont soumis dans leur vie extraprofessionnelle aux risques communautaires. Some studies have been carried out on the effectiveness of barrier measures for the protection of healthcare professionals in contact with patients infected during epidemics of viral respiratory diseases such as seasonal influenza, severe acute respiratory syndrome (SARS) or Middle East respiratory syndrome (MERS). They make it easier to associate contaminating contact and its effect than studies in the general population. They do not erase the fact that during epidemics, carers are subject in their extra-professional life to community risks. [ABSTRACT FROM AUTHOR]

Health care personnel are confronted in their work to a variety of risks: biological, chemical, physical and allergic. The aim of this study was to assess the prevalence of asthma and allergic disorders, as well as reactions to latex and antiseptics in hospitals and health care centers in eight cities in Morocco. This door-to-door cross sectional study was carried out from May to August 2001. A self-administered, anonymous questionnaire was used to collect the data. Of the 3906 individuals screened, 2831 were included. 53.8% were female, 46.2% male; 16.6% were physicians, 55.5% paramedics, 14.9% manual workers, 11.3% administrators and 1.7% were biologists. The response rate was 73.2%. The mean age was 40.5 years. Prick tests (PT) were done in 496 patients only; the allergenic extracts used included Dermatophagoides pteronyssinus and D. farinae, five grass pollen mix, German cockroach and latex (Stallergenes). The data were analyzed using Epi-Info 6 software. The prevalence of asthma, rhinitis, conjunctivitis, eczema and urticaria was, respectively, 10.4%, 22.8%, 17.4%, 14.0% and 13.5%. A history of drug allergy was reported by 10.7% of the patients; 7.3% reported allergy to an antibiotic. Clinical reactions to latex were reported by 7.1%, to formaldehyde by 7.4% and to glutaraldehyde by 1.0%. The positive PT rate to latex was 5.2%. The prevalence rate of the above-mentioned disorders was significantly higher in patients reporting a parental or familial history of atopy, as well as in women and in biologists. Asthma was considered to be occupational in 2% of the subjects. The prevalence of asthma, rhinitis, conjunctivitis as well as allergy to latex and formaldehyde did not vary significantly according to the city of residence. Latex contact caused urticaria in 5.1%, rhinitis in 3.9%, eczema in 3.1%, conjunctivitis in 2.1%, difficulty in breathing with wheezing in 1.0% and anaphylactic shock in 0.1% of the subjects. Our results show that the risk of allergies in health care personnel in Morocco exists and allergies are of sufficient prevalence that attention must be directed to identifying the risk factors and strategies developed for their management and prevention. [Copyright &y& Elsevier]