Strengthening Routine Immunization Services in an Angolan Comuna: The Fight against the Burden of Unvaccinated Children in the Sustainable Development Goals Era.

In May 2018, the non-governmental organization (NGO) Doctors with Africa CUAMM began to implement an intervention to strengthen Chiulo Hospital's public health section to deliver immunization services in Mucope Comuna, Ombadja District. We aimed to evaluate the effect of this intervention. During the intervention period, actions such as staff training, improvement in the monitoring of vaccine stockpile, and the involvement of Community Health Workers were performed. The effects of the intervention on the number of vaccine doses administered were examined using negative binomial regression. Doses administered were 14,221 during the intervention period and 11,276 in the pre-intervention one. The number of administered doses was 26% higher (95% CI 9%-45%) in the intervention period than in the pre-intervention period. This was driven by vaccine doses administered during outreach sessions, where a statistically significant increase of 62% (95% CI 28%-107%) was observed. Regarding individual vaccines, statistically significant increases in the number of doses were observed for OPV2 (76%), OPV3 (100%), Penta3 (53%), PCV3 (53%), and Rota2 (43%). The NGO interventions led to improved delivery of immunization services in the study area. Greater increases were observed for vaccine doses that are more likely to be missed by children.

Public Health since the beginning: Neonatal incubators safety in a clinical setting.

BACKGROUND: The role of environmental cleaning as an effective measure to contain the diffusion of Healthcare Associated Infections (HAIs) has already been demonstrated. Among medical devices, neonatal incubators have been recognized as a source of pathogens involved in the spread of HAIs. Aim of the study was to assess the efficacy of a disinfection protocol for neonatal incubators. METHODS: The cross sectional study took place in the "Neonatal Pediatric Unit" of the Teaching Hospital of Siena: twenty incubators, used for critical newborns, were swabbed in 13 sampling points before and after the implementation of the disinfection protocol. Sanitation procedures were performed by trained staff, implementing the product Umonium38® Neutralis as disinfectant. Different culture media for the identification of the microbial contamination were adopted: plates were incubated for the proper time and the results were referred to Colony Forming Units (CFUs)/swab per point. Descriptive statistical analysis was performed. It was also evaluated the 95% confidence interval (C.I.) of the mean and the percentage of CFUs reduction by the bootstrap bias corrected and accelerated resampling method. RESULTS: Matched points analyzed were 313. The average CFUs percentage of reduction was 93.5% [C.I. 90.6-95.9%]: it was higher, 97.0% [C.I. 94.1-99.1%], in points placed inside the incubators structure compared to the 88.4% [C.I. 83.6-93.0%] obtained outside. CONCLUSION: The disinfection protocol achieved good results. Routine surveillance and supervision of the various aspects of the disinfection processes (procedures, staff and disinfectants) could guarantee a safe environment during the first days of babies' life, avoiding harmful conditions for the newborns' health.

Time Effectiveness of Ultraviolet C Light (UVC) Emitted by Light Emitting Diodes (LEDs) in Reducing Stethoscope Contamination.

Today it is well demonstrated that stethoscopes can be as contaminated as hands, which are a recognized source of Health-Care Associated Infections (HCAIs). Ultraviolet C (UVC) light has proven disinfection capacity and the innovative UVC technology of Light Emitting Diode (LED) shows several potential benefits. To verify whether the use of UVC LEDs is effective and reliable in stethoscope membrane disinfection after prolonged use, a pre-post intervention study was conducted. A total of 1668 five-minute cycles were performed on two UVC LEDs to simulate their use; thereafter, their disinfection capacity was tested on stethoscope membranes used on a previously auscultated volunteer. Then, a further 1249 cycles were run and finally the LEDs were tested to assess performance in reducing experimental contamination by Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli on the stethoscope membrane. Baseline volunteer contamination identified 104 Colony Forming Units (CFUs) while treated Petri dishes had 12 and 15 CFUs (p < 0.001). Statistically significant differences (p < 0.001) were also found relating to the reduction of specific bacteria: in particular, after treatment no CFU were observed for S. aureus and E. coli. UVC LEDs demonstrated the capacity to maintain high levels of disinfection after more than 240 h of use and they were effective against common microorganisms that are causative agents of HCAIs.

Use of a fluorescent marker for assessing hospital bathroom cleanliness.

A fluorescent marker was used to assess the efficacy of daily cleaning in hospital en suite bathrooms. We applied the marker on 218 surfaces and we assigned a score according how completely the mark had been removed. We found significant statistical differences among different surfaces and wards (P < .05). Microbiologic contamination and marker removal score did not seem to be correlated. Differences in cleanliness may indicate discrepancies in cleaning procedures. Fluorescent marker proved to be a practical and effective method and it could be adopted as a first-level control system to assess hospital cleanliness.