Health care providers have a legal and ethical duty for the care of their patients and are required, therefore, to provide care in a safe way and a harm-free environment. Routine clinical practice is expected to be based on knowledge, skills, judgment, and attitudes needed for safe patient care.The field of infection prevention and control for, example, isan area where the expectations are high as the field is characterized by guidelines and standards, and failure to comply with recommended guidelines will mean a failure to meet the appropriate standard of care.

Infection prevention and control practice has evolved significantly over the years and health care professionals need to stay abreast with the new scientific literature to adapt to changing guidelines. This is particularly important as the threat of emerging infectious diseases like Ebola, SARS, avian influenza and multidrug-resistance are on the rise.

The skill sets required for the effective application of infection prevention and control is therefore indispensable for safe and quality patient care amidst enormous clinical challenges. For example, environmental surfaces and equipment frequently become contaminated with germs and can serve as an indirect source of transmission to patients and staff. Surgical procedures may result in secondary infections from contaminated devices with either endogenous or exogenous microorganisms. Needle stick injuries may result in blood borne infections such as HIV, hepatitis B, and Hepatitis C. Gaps in vaccination coverage for vaccine-preventable diseases may result in an outbreak. Natural or man-made disasters may also increase the burden of communicable diseases. Also, catheter-associated urinary tract infections, central line-associated bloodstream infection, ventilator-associated pneumonia, and surgical site infections together referred to as healthcare-associated infections (HAIs)are increasingly prevalent inpatient care environments. These HAIs often result from gaps in the application of aseptic techniques and standard precautions.

Besides the problem of HAIs, the prevalence of infections caused by multidrug-resistant organisms is also on the rise. The problem of antimicrobial-resistant infection is further compounded by the following: the continuous reluctance of pharmaceutical companies to invest in the search for new antimicrobials because of fear of the potential development of resistance; regulatory difficulties faced by public health bodies to effectively control access and proper use of antimicrobials and fundamental challenges in antimicrobial stewardship programs. Consequently, considering that every infection prevented is one that needs no treatment, infection prevention and control is undoubtedly an attractive way to mitigate the spread of infections and reduce the global burden of infectious diseases.

Despite the need and relevance of infection prevention and control in quality patient care, the day-to-day application is sometime overlooked or missed by health care professionals,partly because of knowledge gaps, negligence, or busy shifts. Continuous education and training is necessary to reawaken awareness and improve compliance.

The purpose of this guide is to provide health care professionals and their organizations with a practical resource for infection prevention and control.Contained within the guide is an introduction to infections including HAIs and infections caused by multi drug-resistant organisms, how they are transmitted, methods to control the spread, antimicrobial stewardship, standard precautions, transmission precautions, emergency response, the environment of care, and equipment reprocessing.

Without proper training on how infections are transmitted, including infection prevention and control standards, health care professionals may unconsciously fail to adhere to standard precautions and guidelines and this may enhance the transmission of pathogens.  Therefore, health care workers need adequate knowledge of the infectious process and the application of both standard and transmission-based precautions along with an optimum environment of care. To maintain quality in practice, health care professionals must seek to continuously improve their knowledge in infection prevention and control, as well as remain constantly vigilant to emerging microbial threats.

I encourage all health care professionals to take advantage of this professional development opportunity to enhance their competency and improve patient care.

The book is available on Amazon in both paperback and kindle eBook format .(https://www.amazon.com/gp/product/B07W81LM1B?pf_rd_p=2d1ab404-3b11-4c97-b3db-48081e145e35&pf_rd_r=GRA6XJ4YENM757J22ZCP)

About the author

Dr. Ayukekbong holds a Ph.D in medical science and is a board-certified infection preventionist (CIC). He is the founder and chief infection preventionist at EpiTech Public Health, Canada and also an instructor at Algonquin College, University of Ottawa. Through his organization, he has led the training of hundreds of health care professionals on infection prevention and control. His primary research interest is infectious disease surveillance and has published several papers within this field. He is a member of Infection prevention and control (IPAC) Canada and the Infection Control Africa Network (ICAN). He is a guest editor to the Canadian Journal of Infectious Diseases and Medical Microbiology, a member of the Editorial Board of the International Journal of Virology and AIDS, and also serves as an expert reviewer to several international scientific and public health journals.

Three Congolese medics have been detained over the murder of a World Health Organization (WHO) doctor who was fighting an Ebola outbreak in Democratic Republic of Congo, a military prosecutor said on Wednesday.

Cameroonian doctor Richard Valery Mouzoko Kiboung was shot dead on April 19 in an attack on a hospital in the eastern city of Butembo.

The arrested doctors will be prosecuted for “terrorism” and “criminal conspiracy,” Lieutenant-Colonel Jean-Baptiste Kumbu Ngoma, military prosecutor for Butembo in North Kivu province, told AFP.

The three are accused of holding meetings on April 14 to plot the assassination of Mouzoko, he added.

The WHO said Mouzoko had been deployed as part of a medical team to help rein in the Ebola outbreak which started last August in North Kivu.

The prosecutor said the doctors were “among the moral authors” of the attack on Mouzoko. He said one more doctor was being sought in the case.

In a letter to the mayor of Butembo, the local doctors’ association expressed indignation at the arrests and said they would go on strike if their colleagues were not released within 48 hours.

But the military prosecutor dismissed their demands as “out of the question”.

“It’s a delicate situation. As a man has died, we absolutely have know the truth about what happened,” the coordinator of the fight against Ebola in the DR Congo, Jean-Jacques Muyembe, told AFP.

More than 1,800 people have died from the virus in the past year.

The outbreak is the second deadliest on record, after the epidemic that struck West Africa in 2014-2016, which killed more than 11,300 people.

Efforts to roll back the highly contagious haemorrhagic fever have been hampered not only by fighting but also by resistance within communities to preventative measures, care facilities and safe burials.

Attacks on health workers have had a devastating effect, with seven murdered and more than 50 seriously hurt, according to an unofficial tally.

After the killing of Mouzoko in April, WHO chief Tedros Adhanom Ghebreyesus said: “We will not be intimidated… we will finish our work.”

Source: AFP

Malaria has killed more than 1,800 people in Burundi this year, the United Nations (UN)’s humanitarian agency says, a death toll rivaling a deadly Ebola outbreak in the neighboring Democratic Republic of the Congo.

In its latest situation report, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) said 5.7 million cases of malaria had been recorded in Burundi in 2019 — a figure roughly equal to half its entire population.

Of those cases, a total of 1,801 died from the mosquito-borne disease in Burundi between January 1 and July 21, OCHA said.

The tiny country of 11 million people in the African Great Lakes region has still not declared a national emergency, despite OCHA saying the outbreak crossed “epidemic proportions” in May.

“The national malaria outbreak response plan, which is currently being validated, has highlighted a lack of human, logistical and financial resources for effective response,” OCHA said in its latest weekly bulletin on humanitarian emergencies.

“All stakeholders, including the national authorities and partners are called upon to provide the requisite resources to mount a robust response to this event before it escalates.”

A lack of preventative measures like mosquito nets, climatic changes, and increased movements of people from mountain areas with low immunity to malaria were driving the crisis, OCHA said.

‘Many crises’

An OCHA official told AFP that “the decision to declare an epidemic is the sovereignty of the Burundian state.”

The country declared a malaria epidemic in March 2017, when it recorded 1.8 million cases and 700 deaths, but is resisting doing the same now.

A senior government official, who declined to be named, said the government did not want to admit weaknesses ahead of elections set for 2020.

“We are less than a year away from the presidential election. [President Pierre] Nkurunziza, who is facing many crises, does not want to recognize what could be considered a failure of his health policy,” the official told AFP.

Burundi has been in crisis since 2015, when Nkurunziza ran for a third term and was re-elected in elections boycotted by most of the opposition.

At least 1,200 people were killed and more than 400,000 displaced in violence the UN says was mostly carried out by state security forces.

Nkurunziza announced in 2018 that he would not stand again, confounding critics who accused him of working to extend his grip on power.

UN investigators said in July that “drastic” steps were needed to boost democratic freedoms in Burundi if the government wanted the elections to be considered credible.

Burundi, one of the poorest countries in the region, abuts the Democratic Republic of the Congo, where the second-worst Ebola outbreak in history has killed more than 1,800 people amid fears the infectious fever could spread beyond its borders.

But malaria is a much bigger killer on the continent.

The World Health Organization recorded nearly 220 million cases of the parasitic illness in 2017, with an estimated 435,000 deaths. More than 90 percent of malaria cases and deaths have been in Africa.

(Source: Agencies)

As France prepares to host the Global Fund Replenishment Conference on fighting AIDS, experts warn against complacency in the global fight against HIV. France leads in some areas of the battle but has some catching up to do in others.

The United Nations Programme on HIV and AIDS released its 2019 Global Update on Tuesday, reporting that of the nearly 38 million people known to have the human immunodeficiency virus (HIV), 14.6 million are still without access to antiretroviral therapy (ART).

Though the report focuses primarily on eastern and southern Africa, the regions most seriously affected, acting executive director of UNAIDS Gunilla Carlsson emphasised that even high-income, more developed nations must continue to be vigilant in their defence against the spread of HIV.

“HIV is not over. The so-called Western world still needs to keep an eye on the key populations: gay men, sex workers, drug users and transgender people,” Carlsson told FRANCE 24. “There is still a need to make sure that these people are not marginalised.”

Peter Ghys, one of the researchers who worked on the UN’s report, echoed Carlsson’s appeal to address certain populations very specifically. He offered the example of the increasingly popular preventative measure Pre-Exposure Prophylaxis. Known by its acronym PrEP, the strategy involves taking daily HIV-fighting medicines that, when used correctly, are proven to be 100 percent effective at preventing infection.

“Overall, our approach to tackling HIV is similar worldwide, but there are certain differences,” Ghys told FRANCE 24. “Much of the transmission in Western Europe is between gay men, which is much less of a concern in southern Africa. So in Europe, increasing access to PrEP is key.”

Awareness isn’t enough

While France is considered one of the leaders in HIV awareness in Europe, alongside the UK, the 2019 Global Update reports that France has yet to reach the top tier of countries who have taken initiatives against HIV. Those countries that have achieved 90 percent awareness of, treatment for and suppression of HIV – known as the 90/90/90 – include both “high-income” countries such as the UK and lower income nations like Namibia.

Though significant efforts have been made in France, co-coordinator of Collectif Sida 33, Maryse Tourne, is unsurprised that France has yet to achieve 90/90/90 status.

“We are always behind Anglo-Saxon countries when it comes to identifying and treating people with HIV,” she told FRANCE 24. The Bordeaux-based collective (AIDS 33) seeks to promote disease prevention and treatment in the city and nationwide.

“General doctors, specialists, all public health workers should be encouraging patients to get tested,” Tourne added. “We need everyone.”

As France looks to boost the percentage of people living with AIDS who are receiving treatment from 83 to 90 percent, according to UN estimates, Ghys noted that Western Europe should be following the same basic strategies promoted by the UN for reducing mortality rates worldwide.

“The most important thing is for all people who have been diagnosed with HIV to start treatment immediately, instead of waiting for their bodily systems to degrade and deteriorate,” he said. “What is true in France and in Western Europe is also the case in Africa. Both populations are dealing with similar issues.”

In terms of practical responses, Ghys underscores that awareness can only be the start of the solution.

“In part it’s awareness, but it’s also condom use, harm reduction for drug users, circumcision and PreP,” he said. “Stopping the spread of AIDS is related to scaling up all those programmes.”

‘But what about women?‘

The UN estimates that approximately 170,000 adults and children are living with HIV in France, with an estimated 30,000 of whom (17.6 percent) are not on the lifesaving ART treatment.

One French study conducted in 2006 estimated the population of MSM, or men who have sex with men, in France to be 330,000. Less than half of those men (44.5 percent) regularly use condoms, according to the European Centre for Disease Prevention and Control, which likely contributes to the 14 percent of MSM with HIV, compared to 0.3 percent of the general population.

“There has been a drastic decrease in government funding for contraceptives … it’s concerning,” said Tourne. “PrEP is effective, but it’s not a substitute for contraception.”

The EU estimates that 86 percent of French MSM are aware that they carry HIV, and 78 percent are receiving antiretroviral therapy. However, there is far less data available on the 45,000 women (age 15 and over) living with the virus in France.

“Females are always forgotten when we talk about HIV,” Tourne said, emphasising that more attention should be paid to sex workers, a high-risk population that is predominantly female. “PrEP is very effective at preventing infection in men, but what about women?”

With her organisation, Tourne often does testing “in the field”, seeking out people at high risk for infection and offering them free screenings. However, she notes that France needs to go further if it wants to become HIV-free.

“There are too many people with HIV in France who remain undiagnosed, who are carrying viruses or diseases and don’t even know it,” Tourne insisted. “We have to establish more testing and consultation centres – ones located in high-risk areas, that stay open late, and that can respond appropriately to the needs of those at risk.”

‘The last mile’

The Global Fund to Fight AIDS, Tuberculosis and Malaria announced last May that France would host the sixth annual Replenishment Conference in Lyon this October. The goal of the conference is to raise money to fund projects that are part of the United Nations political declaration on ending AIDS, made by the UN General Assembly in 2016.

“We are extremely grateful to President [Emmanuel] Macron for leading efforts to renew and expand our impact, to the benefit of millions of people,” said Peter Sands, executive director of the Global Fund, in a statement.

As one of the founding partners of the Global Fund and its second-largest donor, France has been called a “pioneer” in its efforts to combat the AIDS epidemic worldwide, but UNAIDS workers are clear that the financial gap remains significant.

“The gap between the resources available and the resources estimated to be needed is slightly over $7 billion (€6.2 billion),” explained Ghys. “In 2017, it was around $6 billion, so the amount of available resources is decreasing. That is not the direction that the world should be going when it comes to support for AIDS. It is an issue of global solidarity.”

UNAIDS Director Carlsson is adamant that the UN Sustainable Development goal of ending the AIDS epidemic by 2030 is still achievable, but says that people have to remain dedicated to the cause.

“It is possible to control AIDS. We know what works, but we need to walk the last mile together,” she said. “We all have to galvanise and make sure that we don’t stop supporting low-income countries too early. We committed to ending AIDS worldwide, and we owe it to them to keep that promise.”

Source: France 24

The number of people killed by an outbreak of cholera in the North and Far North regions of Cameroon has risen from two in April to 48, officials of the Ministry of Public Health told Xinhua on Wednesday.

Arabo Saidou, an official of the ministry said 775 others have been diagnosed with the disease.

“The outbreak of the disease is caused by failure to abide with hygienic regulations. Access to drinking water is very difficult in this semi-arid part of the country and people tend to drink just anything.” Saidou said.

On Monday, Cameroon’s Minster of Public Health, Manaouda Malachie, said the situation was “alarming” stressing on the need for the population to respect “basic hygiene rules”.

“The public should take necessary measures to improve hygiene in their homes in order to help the government’s efforts to control the disease.” Saidou noted.

For many years, cholera has been a common occurrence in Cameroon’s northern regions where floods during raining season are recurrent.

In April, health officials of the country said cholera killed at least two people and 19 suspected cases registered in North region, barely four months after the government declared the country free of the disease.

Source: Xinhuanet

A young woman lies in intensive care at Liberia’s Phebe Hospital.

Her mother comes running in with the drugs she needs, but the doctor shakes his head. It is too late.

“When patients come, we are obliged to send (family members) out to get drugs. Sometimes by the time they get back (the) patients are dead,” laments Dr Jefferson Sibley, the hospital’s medical director.

“People are dying in front of our eyes, and we cannot do anything.”

Battered by years of civil war and then in 2014-16 by the worst Ebola epidemic in history, Liberia’s health sector is on its knees.

The crumbling infrastructure lacks almost everything — medicine, beds, equipment, ambulances, even a reliable electricity supply.

Phebe, in central Bong county, is the second largest hospital in Liberia, with 200 beds and seven doctors on its staff.

Despite chronic shortages, it still manages to treat at least 2,500 patients every month.

“We are supposed to get supplies from the ministry of health and the National Drug Services (NDS) but we haven’t received supplies for almost a year,” Sibley told AFP.

“We can’t do anything about it.”

Malaria was the cause of death of the woman in the intensive care unit.

She was 25.

– ‘Only the mercy of God’ –

According to the World Health Organization, total health expenditure per person per year is about $100 (87 euros) in Liberia, among the lowest in the world.

There is fewer than one regional or district hospital per 100,000 people in the country of about 4.7 million.

In 2010, accordiong to the latest available data, there were eight hospital beds per 10,000 people.

In Jenepeleta, a village 30 kilometres (19 miles) from the hospital in Phebe, Regina Kollie, 45, is trying to lower the fever of the youngest of her five children, a four-year-old girl.

Like many in the region, Regina sought help in traditional medicine and gathered leaves with which to wash her daughter, following the advice of a healer.

The treatment is not working and the child’s fever has raged for days. But going to the hospital is not an option.

“I don’t have the money to take my daughter to Phebe. The ambulance used to help us in these cases, but we don’t see it any more,” Regina says, weeping.

“The two ambulances we had are broken down,” Sibley confirmed, noting the vehicles had been “instrumental when it comes to saving lives”.

The ambulances “used to go for pregnant women, children and other people who are seriously ill in the villages… and bring them to us,” he said.

But now if there is an emergency case, “only the mercy of God can help.”

– Surgery by storm lantern –

“We have so many problems, but the key problem is that no funding is coming to the hospital,” said Sibley.

“We find ourselves indebted to vendors. People we take fuel from, people we take drugs from, all of them refuse to supply us because we owe them lots of money. The hospital owes $300,000 (265,000 euros) to vendors.”

The hospital’s electricity is frequently cut off, plunging it into darkness at night and forcing the lone surgeon to carry out operations by the light of storm lanterns.

A shortage of medicines is also crippling Liberia’s largest national health facility, the John F. Kennedy Hospital in Monrovia, says its medical director Jerry Brown.

“There are some drugs you can’t find in local pharmacies and government regulations prohibit us from procuring drugs currently from pharmaceutical companies outside the country,” the chief doctor told AFP.

“Our next source of drugs is the National Drug Services,” but it provides only enough to treat the most vulnerable, including children.

The hospital was negotiating with the ministries of health and finance for authorisation to buy directly from manufacturers, Brown said.

Health Minister Wilhelmina Jallah said the problem stemmed from the previous government, under which hospitals ran up big debts by obtaining drugs and fuel on credit.

“We have inherited all these debts, and the vendors no longer want to give us credits,” she said. “We have to pay some of these debts so that we can open the credit lines.”

In a sign of progress, eight container-loads of drugs had arrived, and these will help to ease shortages, she said.

AFP

After a prison sentence for crimes he committed while stoned, Eric Ndem, a drug user in Cameroon’s economic capital Douala, said he wanted to end such a way of life.

Ndem, 38, a homeless person, is among many drug users in Douala, which is believed to be a center of illegal narcotics activities.

According to estimates by Cameroon’s national anti-drug committee (CNLD) in 2018, 21 percent of the country’s population have already tried hard drugs.

In many ways, the Cameroonian government is coming to Ndem’s rescue by putting in place various programs and structures to check the abuse of illicit drugs.

Owona Noah, an addictionologist and public health expert, works in a government-sponsored drug prevention center named “La vie” (meaning “life” in French) in the capital Yaounde.

His job is to change the behavior of drug addicts and help them reintegrate into the society as “responsible people.”

“We receive a patient who is suffering from a psychological or psychiatric problem (because of drug consumption)… But once the patient goes back to his community, home, or job side, he is likely to start facing the same stressful situations that caused the psychological trauma again,” Owona said.

“That’s where we intervene to facilitate the socio-professional integration of the patient so that he can participate again in the development of his community,” he added.

According to Cameroon’s Ministry of Public Health, such centers have been created in all the 10 regions of the country since 2015.

“In five or 10 years if things continue to evolve in the right way, we will have very few mental disorder patients caused by drugs in the community,” Owona said.

According to him, about 60 patients have visited his center in April and May, and “a good number” of drug addicts have already stopped abusing drugs after consultation.

As part of the measures to battle against drug abuse and trafficking, the Cameroonian government has also established a health care control brigade in the Ministry of Public Health.

“We conduct sensitization campaigns against drug abuse not only in colleges but also universities. We work in collaboration with forces of law and order,” said Joseph Ekoum, who heads the brigade in the Littoral region with Douala as its regional capital.

“We also act as what we called health police. This means that we have control posts at the various entries of the city frontiers. We have two control posts, at the airport and seaport. These are two places where the illicit products can easily enter,” he added.

Ekoum is proud that such tactics and collaboration with government forces has produced “outstanding” results.

From 2010 to 2014, this collaboration has led to the seizure of 320 kg of cocaine and 30 kg of heroine, according to figures from the Ministry of Public Health. Recent statistics are unavailable.

The local civil society is also working closely with the government to enhance anti-drug sensitization campaign among the youth, primary victim of narcotics, according to CNLD’s finding.

Dadjio Emilienne teaches philosophy in a high school in Yaounde. At the same time, she is a member of a local non-governmental organization (NGO) whose mission is to educate young Cameroonians about the harmful effects of drugs.

“As we now know that drug abuse is causing havoc in school milieu, we think it is important to meet young people and tell them about the consequences of consuming drugs,” Dadjio said.

During the field campaigns, Dadjio urged young people to never start the drug, “because it is a road of no return.”

Source: Xinhuanet

A four-year-old boy with a history of stomach pain, vomiting and abdominal distension eventually landed on the operating table where surgeons manually removed dozens of “writhing” worms that had been living in his intestines.

The boy, who was not named in the case report but was said to live in Cameroon, West Africa, had no history of deworming since birth, which is typically a common practice in that region, Fox News reports.

The youngster’s mum had taken him to hospital after three days of stomach pain, vomiting and severe constipation.

He had also experienced bloating for around six months, according to an article published in the Journal of Medical Case Reports. After being admitted, doctors carried out a number of tests and diagnosed the boy with ascariasis — a parasitic worm infection in the small intestine.

Doctors manually removed dozens of worms living in the stomach of a four-year-old.

“Ascariasis is the leading helminthic infection worldwide, with its peak prevalence noticed in children aged 2-10 years,” the authors wrote in the shocking article, which was published on May 24. “Although mainly asymptomatic, chronic and heavy infestation could lead to severe complications such as malnutrition, poor physical and cognitive development as well as intestinal obstruction.”

Upon examination, the boy’s doctors recognised a small bowel obstruction, which prompted them to make a 2cm cut. Surgeons then removed “bundles of ascaris lumbricoides worms” manually and “by milking through the stoma”.

The boy was given nutrients to rehydrate him and administered with paracetamol intravenously before doctors could operate.

Three days after being admitted, surgeons discovered his bowels were blocked by a “mass of writhing worms”.

An estimated 807 million to 1.2 billion people in the world are infected with ascaris lumbricoides — parasitic worms known as soil-transmitted helminths, according to the Centers for Disease Control and Prevention (CDC). The parasites live in the intestine, and eggs are passed in the faeces of infected people. If an infected person defecates outside, or if the faeces of an infected person are used in fertiliser, eggs are deposited on the soil. The eggs can then mature into a form of the parasite that is infective.

The shocking find was recorded recently in the Journal of Medical Case Reports.

Infection can occur when hands or fingers that have contaminated dirt on them are put in the mouth or by consuming vegetables or fruits that have not been carefully cooked, washed or peeled, according to the CDC. Heavy infections cause intestinal blockage and may impair growth in children. Other symptoms may present as a cough due to the migration of the worms through the body. It can be treated with medication, but in the boy’s case, surgeons decided to operate.

After the surgery, doctors dewormed the boy and his family members with an oral dose of mebendazole, and he was released after seven days. One week later, surgeons recorded his wounds had healed.

The authors noted that the boy’s case points to a larger public health issue in Cameroon, where deworming programs are affected by lack of funding and access in high-risk areas.

Source: News.Com

Cameroon has declared a public emergency after reporting a polio case in its far north, four years after the virus disappeared from the country, the health ministry said on Thursday.

The confirmed case of polio type 2 was found in the Mada area in the remote north bordering Chad and Nigeria, the ministry said in a statement.

It declared a “new polio epidemic following the confirmation of a case of poliovirus type 2 detected in samples.”

A source at the ministry said the outbreak may have been caused in part by a refusal of vaccinations and the cross-border movement of people in the area.

Polio is a highly infectious viral disease which mainly affects young children and can result in permanent paralysis. There is no cure and it can only be prevented through immunisation.

International polio vaccination efforts have run into problems in Pakistan and Afghanistan. Militants and religious leaders in rural areas often tell locals immunisation is part of a shadowy conspiracy to weaken their faith.

Source: AFP