Changes in workflow to a University Pharmacy to facilitate compounding and distribution of antiseptics for use against COVID-19.

This article is a report from an experience about a work developed by Farmácia Universitária at UFRJ (FU-UFRJ) during the nCov-19 pandemic period. The aim of this work was to describe its contribution in the production of antiseptic supplies used to prevent contagion by the new coronavirus. The work routine at the pharmacy has been changed to allow the implementation of local workflow during the pandemic, and to adapt the protection rules to meet the safety measures. FU-UFRJ started to manipulate two antiseptic formulations: 70% ethyl alcohol and gel alcohol, which are included in the National Form, manufacturing around 100 L of these formulations, weekly, to donate to different health units. The experience enabled the adaptation to emergency health standards, planning and meaningful guidance to pharmacists and technicians to attend clinics at university hospitals, vaccination center and UFRJ city hall, in order to facilitate the access to adequate hand hygiene to the population.

Preparedness of health facilities providing HIV services during COVID-19 pandemic and assessment of their compliance to COVID-19 prevention measures: findings from the Tanzania Service Provision Assessment (SPA) survey.

INTRODUCTION: the increased demands of health facilities and workers due to coronavirus overwhelm the already burdened Tanzanian health systems. This study evaluates the current capacity of facilities and providers for HIV care and treatment services and their preparedness to adhere to the national and global precaution guidelines for HIV service providers and patients. METHODS: data for this study come from the latest available, Tanzania Service Provision Assessment survey 2014-15. Frequencies and percentages described the readiness and availability of HIV services and providers. Chi-square test compared the distribution of services by facility location and availability and readiness of precaution commodities and HIV services by managing authorities. RESULTS: availability of latex gloves was high (83% at OPD and 95.3% laboratory). Availability of medical masks, alcohol-based hand rub and disinfectants was low. Availability of medical mask at outpatient department (OPD) was 28.7% urban (23.5% public; 33.8% private, p=0.02) and 13.5% rural (10.1% public; 25.4% private, p=0.001) and lower at laboratories. Fewer facilities in rural area (68.4%) had running water in OPD than urban (86.3%). Higher proportions of providers at public than private facilities in urban (82.8% versus 73.1%) and rural (88.2% versus 81.6%) areas provided HIV test counseling and at least two other HIV services. CONCLUSION: availability of commodities such as medical masks, alcohol-based hand rub, and disinfectant was low while the readiness of providers to multitask HIV related services was high. Urgent distribution and re-assessment of these supplies are necessary, to protect HIV patients, their caregivers, and health providers from COVID-19.

COViD-19: Face Mask Effectiveness, Hand Sanitizer Shortages, and Rapid Medication Therapy Trials.

The COVID-19 pandemic is a rapidly evolving phenomenon that presents serious practical challenges and complex clinical considerations for health care workers, health care administrators, and policy formulators. The Senior Care Pharmacist carries periodic updates addressing matters relevant to pharmacotherapeutics and pharmacy practice as these relate to the care of older people in the time of the pandemic. The brief news items that are provided here are not intended to be substitutes for a careful and comprehensive consideration of the issues involved, but rather, they serve to provide initial awareness of concepts and to stimulate more complete situational analysis.

COVID-19-associated shortage of alcohol-based hand rubs, face masks, medical gloves, and gowns: proposal for a risk-adapted approach to ensure patient and healthcare worker safety.

The coronavirus disease 2019 (COVID-19) pandemic has caused a huge demand for alcohol-based hand rubs, medical gloves, face masks, and gowns in healthcare and from the public. More and more hospitals face a serious shortage of these articles. We propose a risk-adapted approach to ensure adequate patient and healthcare worker safety for as long as possible.

Building Local Capacity in Hand-Rub Solution Production during the 2014-2016 Ebola Outbreak Disaster: The Case of Liberia and Guinea.

BACKGROUND: During the 2014-2015 Ebola outbreak in West Africa, the lack of infection prevention and control (IPC) measures in health care facilities amplified human-to-human transmission and contributed to the magnitude of this humanitarian disaster.Case ReportIn the summer of 2014, the Geneva University Hospitals (HUG; Geneva, Switzerland) conducted an IPC assessment and developed a project based on the local needs and their expertise with the support of the Swiss Agency for Development and Cooperation and the Humanitarian Aid Unit (SDC/HA; Bern, Switzerland). The project consisted of building local capacity in the production of alcohol-based hand-rub solution (ABHRS) based on the World Health Organization (WHO; Geneva, Switzerland) formula in non-Ebola health facilities at the peak of the outbreak in Liberia (Fall 2014) and during recovery in Guinea (September 2015) to promote safer care. Twenty-one pharmacists in Liberia and 22 in Guinea were trained and one years' worth of laboratory equipment, chemical products, containers for personal use, and bioethanol were delivered to 10 hospitals per country with more than 8,000 100 ml bottles of solution produced at the end of the project.DiscussionHand hygiene using hand-rub solution is a critical component of safer care, especially in health care settings lacking runnable water. Throughout the Ebola outbreak, it was a timely moment to promote hand-rub solution and to reinforce IPC measures in non-Ebola health facilities. During the project implementation, a substantial challenge was the unavailability of bioethanol in Liberia and Guinea. In the long run, sustainability of the production can become an issue as it depends heavily on the local government's financial and political commitment, the capacity to create an on-going demand for hand-rub solution in health facilities, the local purchase and replacement of the materials and chemical products, as well as the availability of continuous local partners' support. CONCLUSION: The project demonstrated that it was feasible to build local capacity in ABHRS production during an emergency and in limited-resource settings when materials and training are provided. Future programs in similar contexts should identify and address the factors of sustainability during the implementation phase and provide regular, long-term technical support. Jacquerioz BauschFA, HellerO, BengalyL, Matthey-KhouityB, BonnabryP, TouréY, KervillainGJ, BahEI, ChappuisF, HagonO. Building local capacity in hand-rub solution production during the 2014-2016 Ebola outbreak disaster: the case of Liberia and Guinea.. Prehosp Disaster Med. 2018;33(6):660-667.

Uso de dispensadores de solución alcohólica para higiene de manos por los visitantes a un hospital / No disponible

Introducción: La higiene de manos en los visitantes del hospital es un aspecto relevante en la prevención de infecciones pero se sabe poco acerca del uso que estos hacen de las soluciones hidroalcohólicas (SHA). El objetivo de este estudio es examinar las relaciones entre el uso de las SHA y los visitantes del hospital y posibles cambios en el comportamiento tras añadir señales informativas específicas. Métodos: Estudio observacional cuasi-experimental sobre el uso de SHA por los visitantes de un hospital de tercer nivel en Madrid durante los meses de febrero y marzo de 2017. Se observó el comportamiento antes y después de una intervención encaminada a aumentar la visibilidad de las SHA. Se realizó un análisis descriptivo de las variables de interés (grupo edad, sexo, visita en solitario o en grupo) y el cálculo de distribución de frecuencias absolutas y porcentajes para variables categóricas y la probable asociación de variables cualitativas. Resultados: El porcentaje de uso basal de las SHA fue del 2,7%, tras la intervención el porcentaje de uso bajó al 1,2% lo que supone un uso 53% menor (IC95%:0,23-0,93). En el horario de tarde realizaron 2,4 veces más HM que en el turno de mañana (IC95%: 1,22-4,74). Así mismo se encontró que los adultos jóvenes realizan la HM un 77% menos que los niños (IC95%: 0,06-0,85) y los ancianos, realizaban la HM un 78% menos (IC95%: 0,06-0,81). Conclusiones. El estudio demuestra que la HM en las personas que visitan el hospital es muy baja y que las intervenciones realizadas no resultaron efectivas. Es necesario cambiar la estrategia empleada con el objetivo de que los visitantes y pacientes conozcan el importante papel que desempeñan en la prevención de las infecciones relacionadas con el ámbito sanitario

Background: Hand hygiene among visitors is an important aspect in preventing health care associated infections, however, little is known about their use of alcohol based solutions (ABS). The purpose of this study is to examine the relationship between visitors and hand hygiene compliance (HHC) and how it is affected by visual signals. Methods: Observational, quasi- experimental study on the use of ABS by visitors was conducted in a third-level hospital in Madrid during February and March of 2017. The behavior was observed before and after an intervention aimed at increasing the visibility of the ABS. A descriptive analysis of the variables of interest (age group, sex, visit alone or in groups) and the probable association of qualitative variables was performed. Results: An initial 2,7% visitors used the ABS. After the intervention this percentage decreased to 1,2%, which implies 53% less (CI 95%:0,23-0,93) use of ABS. It was observed that hand hygiene was performed 2,4 times more frequently in the afternoon period than in the morning (CI 95%: 1,22-4,74). Young adults used the ABS 77% less than children (CI 95%: 0,06-0,85), and the elder used it 78% less (CI 95%: 0,06-0,81). Conclusions: The results suggest that hand hygiene compliance among visitors is very low and the interventions were not efficient. The strategies to improve hospital visitor’s hand hygiene should be increased/modified because it is an important measure to prevent health care-associated infections

Behavior-based interventions to improve hand hygiene adherence among intensive care unit healthcare workers in Thailand.

OBJECTIVE: To evaluate behavioral-based interventions to improve hand hygiene (HH) among healthcare workers (HCWs) at a Thai tertiary care center. METHODS: A quasi-experimental study was performed in 6 intensive care units with computer-generated allocation. Baseline demographic characteristics, self-reported stage of HH behavioral commitment, and observed HH adherence were examined from January 1, 2012, through December 31, 2012 (preintervention), and from January 1, 2013, through December 31, 2013 (postintervention). Self-reported HH was categorized by the stages construct from the Transtheoretical Model of Health Behavior Change. The intensive care unit group randomization was to either standard-of-care HH education every 3 months (S1), intensified HH interventions (S2), or intensified HH interventions plus increased availability of alcohol-based handrub throughout the unit (S3). RESULTS: Among 125 HCWs from 6 intensive care units (42 in S1, 41 in S2, 42 in S3) there were 1,936 total HH observations; most HCWs (100 [ 80%]) were nurses or nurse assistants. Compared with preintervention, overall postintervention HH adherence improved in HCWs assigned to S2 (65% vs 85%; P=.02) and S3 (66% vs 95%; P=.005) but not S1 (68% vs 71%; P=.84). Improvement in HH adherence was demonstrated among HCWs who reported lower stages of HH commitment in S2 (21% vs 84%; P<.001) and S3 (24% vs 89%; P<.001) and in HCWs who self-reported higher stages of commitment in S3 (78% vs 96%; P<.001). CONCLUSIONS: HCW HH programs may benefit from stage-based tailored strategies to promote sustained HH adherence.

Effect of varying the number and location of alcohol-based hand rub dispensers on usage in a general inpatient medical unit.

We sequentially increased the number of wall-mounted alcohol-based hand rub dispensers in a small medical unit to evaluate effects on hand hygiene performance. Above a certain point, addition of more dispensers did not increase hand hygiene frequency, which appeared to be influenced more by location than by total number of dispensers.

Estratégia para promover a higienização das mãos em unidade de terapia intensiva / Strategy to promote hand hygiene in intensive care unit / Estrategia de promoción a la higienización de las manos en unidad de cuidados intensivos

Realizou-se um estudo observacional prospectivo para avaliar o efeito de uma estratégia para promover a adesão da higienização das mãos a esse procedimento por profissionais de saúde de uma unidade de terapia intensiva. Foi aplicado um instrumento estruturado para coleta de dados de adesão à higienização das mãos por profissionais de saúde antes e após intervenção em unidade de terapia intensiva de hospital da região noroeste do Paraná em 2009. Para análise dos dados, taxa de adesão pela razão entre o número de procedimentos realizados e o número de alertas que requerem o procedimento foi medido. Também foram utilizados os testes qui-quadrado e exato de Fisher para comparação dos dados antes e após a intervenção. Após a intervenção, houve aumento significativo na taxa geral de conformidade de 21,7% para 28%, p = 0,039, na categoria de técnicos de enfermagem, em anti-séptico de fricção, antes do contato com o paciente antes dos procedimentos limpos e assépticos. Em contrapartida, a adesão não melhorou entre enfermeiros, médicos e momentos após o contato com o paciente. A intervenção associada ao incentivo ao uso de preparações alcoólicas contribuiu para melhorar significativamente a adesão geral à higienização das mãos pelos profissionais de saúde.

A prospective observational study was conducted to evaluate the effect of a strategy to promote hand hygiene adhesion to this procedure by health professionals in an intensive care unit. It was applied a structured instrument to collect data regarding adhesion to hand hygiene by healthcare workers before and after an intervention in an intensive care unit of a hospital in the northwestern region of Paraná in 2009. For data analysis, the rate of accession by the ratio between the number of procedures performed and number of alerts requiring the procedure was measured. It was also used used chi-square and Fisher exact tests for comparison of data before and after intervention. After the intervention, a significant increase in overall compliance rate of 21.7% to 28%, p = 0.039, in the category of nursing technicians, in rubbing antiseptic, before contact with the patient before the clean and aseptic procedures. In contrast, adhesion did not improve among nurses, doctors and moments after the contact with the patient. The intervention associated with the encouragement of the use of alcoholic preparations contributed to significantly improve overall adhesion to hand hygiene by health professionals.

Estudio observacional prospectivo para evaluar el efecto de una estrategia de promoción a la higienización de las manos, en la adhesión de los profesionales de la salud, en una Unidad de Cuidados Intensivos (UCI). Se utilizó un instrumento estructurado para los datos referentes a la adhesión a la higienización de las manos de los sujetos, antes y después de una intervención en una UCI de un hospital de la Región Noroeste de Paraná en 2009. Para el análisis de los datos, se midió el índice de adhesión por la razón entre el número de higienizaciones realizadas y el número de indicaciones que requerían el procedimiento. Se utilizaron las pruebas Chi-cuadrado y exacta de Fisher para la comparación de los datos antes y después de la intervención. Hubo aumento significativo en la tasa de adhesión global a la higienización de las manos, de un 21,7% a un 28%, p= 0,039, en la categoría de los técnicos de enfermería, en la fricción antiséptica, antes del contacto con el paciente y antes de los procedimientos limpios y asépticos. Por otro lado, la adhesión no mejoró entre los enfermeros, médicos y en los momentos posteriores al contacto con el paciente. La intervención con énfasis en la promoción de higienización de las manos, asociada al incentivo de la utilización de preparaciones alcohólicas, contribuyó para mejorar significativamente la adhesión global a la higienización de las manos por los profesionales de salud.