Highlighting the need for more infection control practitioners in low- and middle-income countries.

Background: Many low- and middle-income countries struggle to implement, monitor and evaluate the efficacy of infection control (IC) measures within health care facilities. This hampers their ability to prevent nosocomial infections, identify emerging pathogens and rapidly alert officials to possible outbreaks. The lack of dedicated and trained IC practitioners (ICPs) is a serious deficit in the health care workforce, and is worsened by the lack of institutions that offer IC training. Discussion: While no single individual can entirely eliminate the risk of nosocomial transmission, there is literature to support the value of designated IC persons. Recommendations from the World Health Organization in 2008 and 2009 describe the need for this specialized cadre of workers, but many countries lack the national regulations to authorize, train and manage such professionals at the national or local level. This article provides an overview of how ICPs are trained and credentialed in several countries, and discusses approaches countries can use to train ICPs. Conclusion: Trained ICPs can help prevent future outbreaks and control nosocomial transmission of diseases in health care facilities. For this to occur, supportive national policies, availability of training institutions and local administrative support will be required.

Contexte : De nombreux pays à revenu faible et moyen ont du mal à mettre en œuvre, suivre et évaluer l'efficacité des mesures de lutte contre l'infection (CI) au sein des structures de santé. Ceci entrave leur capacité à prévenir les infections nosocomiales, à identifier les pathogènes émergents et à alerter rapidement les autorités en vue de flambées épidémiques éventuelles. La pénurie de praticiens dédiés et formés à la lutte contre les infections (PCI) est une lacune sérieuse dans la force de travail et elle est aggravée par le manque d'institutions qui offrent une formation en matière de CI.Discussion : Même si aucune personne isolée ne peut entièrement éliminer le risque de transmission nosocomiale, la littérature est en faveur de l'implication de personnes désignées pour la lutte contre les infections. Les recommandations de l'Organisation Mondiale de la Santé en 2008 et 2009 décrivent le besoin de cette cohorte de travailleurs spécialisés, mais de nombreux pays ne possèdent pas les règlements nationaux requis pour autoriser, former et gérer de tels professionnels au niveau national ou local. Cet article offre une vue d'ensemble de la façon dont les praticiens de la lutte contre les infections sont formés et accrédités dans plusieurs pays et il discute les approches auxquelles les pays peuvent recourir pour former les PCI.Conclusion : Des PCI peuvent contribuer à prévenir les futures flambées épidémiques et à contrôler la transmission nosocomiale des maladies dans les structures de santé. Pour aboutir à ce résultat, il est nécessaire de mettre en œuvre des politiques nationales de soutien, et de mettre à disposition des institutions de formation et un soutien administratif local.

Marco de referencia: Muchos países de ingresos bajos y medianos afrontan dificultades en la ejecución, la supervisión y la evaluación de las medidas de control de las infecciones (CI) en los establecimientos de atención de salud. Esta situación obstaculiza la capacidad de prevenir las infecciones nosocomiales, impide la detección de nuevos patógenos e impide la notificación oportuna a los funcionarios sobre los posibles brotes epidémicos. La carencia de personal médico capacitado y dedicado al control de las infecciones (PCI) constituye una importante deficiencia del personal de atención de salud y se agrava con la inexistencia de instituciones que dispensen una formación en este campo.Discusión: Si bien una sola persona no puede eliminar totalmente el riesgo de transmisión intrahospitalaria de las infecciones, las publicaciones científicas respaldan la utilidad de designar personas encargadas del CI en los establecimientos de salud. Las recomendaciones de la Organización Mundial de la Salud del 2008 y el 2009 describen la necesidad de contar con este grupo especializado de profesionales; sin embargo, muchos países carecen de normas nacionales que autoricen, capaciten y dirijan estos profesionales a escala nacional y local. En el presente artículo se ofrece una visión general sobre los métodos de capacitación y acreditación de los PCI en diversos países y se analizan las estrategias que pueden adoptar los países con el objeto de formar los PCI.Conclusión: La capacitación de PCI ayuda a prevenir la aparición de futuros brotes epidémicos y a controlar la transmisión de las infecciones en los establecimientos de atención sanitaria. Con el fin de lograrlo, se precisan políticas nacionales propicias, instituciones que dispensen la capacitación y apoyo administrativo al nivel local.

The impact of an emergency hiring plan on the shortage and distribution of nurses in Kenya: the importance of information systems.

OBJECTIVE: To analyse the effect of Kenya's Emergency Hiring Plan for nurses on their inequitable distribution in rural and underserved areas. METHODS: We used data from the Kenya Health Workforce Informatics System on the nursing workforce to determine the effect of the Emergency Hiring Plan on nurse shortages and maldistribution. The total number of nurses, the number of nurses per 100,000 population and the opening of previously closed or new heath facilities were recorded. FINDINGS: Of the 18,181 nurses employed in Kenya's public sector in 2009, 1836 (10%) had been recruited since 2005 through the Emergency Hiring Plan. Nursing staff increased by 7% in hospitals, 13% in health centres and 15% in dispensaries. North Eastern province, which includes some of the most remote areas, benefited most: the number of nurses per 100,000 population increased by 37%. The next greatest increase was in Nyanza province, which has the highest prevalence of HIV infection in Kenya. Emergency Hiring Plan nurses enabled the number of functioning public health facilities to increase by 29%. By February 2010, 94% of the nurses hired under pre-recruitment absorption agreements had entered the civil service. CONCLUSION: The Emergency Hiring Plan for nurses significantly increased health services in Kenya's rural and underserved areas over the short term. Preliminary indicators of sustainability are promising, as most nurses hired are now civil servants. However, continued monitoring will be necessary over the long term to evaluate future nurse retention. The accurate workforce data provided by the Kenya Health Workforce Informatics System were essential for evaluating the effect of the Emergency Hiring Plan.

The impact of an emergency hiring plan on the shortage and distribution of nurses in Kenya: the importance of information systems

Objective:To analyse the effect of Kenya's Emergency Hiring Plan for nurses on their inequitable distribution in rural and underserved areas.Methods We used data from the Kenya Health Workforce Informatics System on the nursing workforce to determine the effect of the Emergency Hiring Plan on nurse shortages and maldistribution. The total number of nurses; the number of nurses per 100 000 population and the opening of previously closed or new heath facilities were recorded. Findings Of the 18 181 nurses employed in Kenya's public sector in 2009; 1836 (10) had been recruited since 2005 through the Emergency Hiring Plan. Nursing staff increased by 7in hospitals; 13in health centres and 15in dispensaries. North Eastern province; which includes some of the most remote areas; benefited most: the number of nurses per 100 000 population increased by 37. The next greatest increase was in Nyanza province; which has the highest prevalence of HIV infection in Kenya. Emergency Hiring Plan nurses enabled the number of functioning public health facilities to increase by 29. By February 2010; 94 of the nurses hired under pre-recruitment absorption agreements had entered the civil service.Conclusion The Emergency Hiring Plan for nurses significantly increased health services in Kenya's rural and underserved areas over the short term. Preliminary indicators of sustainability are promising; as most nurses hired are now civil servants. However; continued monitoring will be necessary over the long term to evaluate future nurse retention. The accurate workforce data provided by the Kenya Health Workforce Informatics System were essential for evaluating the effect of the Emergency Hiring Plan

Sustained high levels of stored drinking water treatment and retention of hand-washing knowledge in rural Kenyan households following a clinic-based intervention.

Nyanza Province, Kenya is characterized by poor water quality and high diarrhoea prevalence. To address these problems, nurses in a maternal and child health clinic in Homa Bay, Kenya were trained in household water chlorination with a locally available, social marketed product, and in six steps of proper hand washing. They were asked to communicate this information to their clients. Interviews immediately following the training by nurses were conducted on 220 clients, of whom 168 (76%) reported being taught both procedures during their clinic visit. After 2 weeks, free chlorine residuals were present in stored drinking water in 67 out of 98 (68%) clients' homes and, 1 year later, in 36 out of 51 (71%) clients' homes. After 2 weeks, all six hand-washing steps were correctly demonstrated by 41 (44%) out of 93 clients, and by 17 out of 51 (34%) 1 year later. This brief, practical intervention shows promise for vulnerable populations.

The use of self-expandable metal stents in the palliation of malignant bowel obstruction.

Palliation of malignant gastrointestinal obstruction is a major aspect of oncology. We assessed the efficacy of stents in the palliation of gastric outlet, duodenal and colonic obstruction. We undertook a retrospective study of 35 consecutive patients who were referred for stent insertion with palliative intent from June, 1999 to March, 2003. Thirty-two stents were successfully placed in 30 patients. Technical success rate was 86% (30/35 patients). Of the patients who had successful insertion, 83% had complete relief of symptoms. In 1 patient the stent failed to expand. There was no procedure related mortality. Median survival was 1.6 months (range, 0-14.8). The conclusion was that self-expandable metal stents provide an effective method of palliation in malignant gastrointestinal obstruction, with high clinical and technical success rates and low complication rates.

Methotrexate associated Peyronie's disease in the treatment of rheumatoid arthritis.

We describe two patients with rheumatoid arthritis treated with methotrexate (MTX) who developed Peyronie's disease during the course of their treatment. In one of the patients the penile fibrosis resolved on stopping the drug. The other patient's penile fibrosis partially resolved on stopping the drug. We suggest that Peyronie's disease can be a side-effect of MTX in the treatment of rheumatoid arthritis.

Proteolytic inactivation of the luciferase from the luminous marine bacterium Beneckea harveyi.

The enzymatic activity of bacterial luciferase from Beneckea harveyi (a heterodimer, Mr = approximately 79,000) is rapidly lost upon treatment with trypsin or chymotrypsin. Under nondenaturing conditions, the proteolytically inactivated molecule has the same apparent molecular weight as the native enzyme, and appears to be relatively stable to further proteolytic degradation. Gel electrophoresis in sodium dodecyl sulfate of the products of this digestion shows that only the alpha subunit is degraded during the time of these experiments, and its rate of loss is the same as the rate of loss of light-producing activity. The action of either protease produces a species with mobility indicative of a molecular weight of about 28,000 and smaller fragments, and an unaltered beta subunit.