scholarly journals Occupational exposure to varicella zoster in a tertiary-care healthcare setting

2020 ◽  
pp. 1-2
Author(s):  
Zachary A. Yetmar ◽  
Debra K. Apenhorst ◽  
Melanie D. Swift ◽  
Priya Sampathkumar ◽  
Elena Beam
Keyword(s):  
Occupational Exposure ◽  
Tertiary Care ◽  
Healthcare Setting ◽  
Varicella Zoster

scholarly journals Occupational Exposure to Varicella Zoster in a Tertiary-Care Healthcare Setting

2020 ◽  
Vol 41 (S1) ◽  
pp. s333-s334
Author(s):  
Zachary Yetmar ◽  
Debra Apenhorst ◽  
Priya Sampathkumar ◽  
Elena Beam
Keyword(s):  
Occupational Exposure ◽  
Varicella Zoster Virus ◽  
Tertiary Care ◽  
Occupational Exposures ◽  
Inpatient Setting ◽  
Solid Organ ◽  
Immunocompromised Patients ◽  
Varicella Zoster ◽  
Delayed Initiation ◽  
Immunosuppressed Patients

Background: Disseminated varicella zoster virus (dVZV) infection is a feared complication of varicella zoster virus (VZV) reactivation in immunocompromised patients. The CDC recommends contact and airborne precautions for localized VZV in immunocompromised patients until dissemination has been ruled out. Pre-emptive isolation can be problematic for medical centers without access to negative-pressure rooms. When we identify a case of dVZV at our facility, we perform an investigation to identify occupational exposures. Methods: We conducted a retrospective, descriptive review of occupational exposure investigations related to dVZV from January 2016 to December 2018. We collected baseline characteristics of the dVZV patient, and we evaluated whether the exposure occurred due to a delay in diagnosis or a progression from “localized” to disseminated VZV disease. Results: We identified 21 immunosuppressed patients with dVZV whose infection resulted in an occupational exposure during the specified study period. Average age was 58.6 years, with 10 males and 12 females. The immunocompromised patients included 11 with hematologic malignancy, 5 with solid-organ malignancy, 3 with rheumatologic disease on immunosuppressive therapy, and 2 with a solid-organ transplant. Most of the exposures (72.7%) occurred in an inpatient setting. The exposures resulted from either delayed recognition of dVZV or delayed initiation of appropriate precautions for all of the immunosuppressed patients. Two additional exposures occurred as a result of a change from “localized” to “disseminated” VZV. These patients whose diagnosis changed from localized to dVZV were considered previously immunocompetent, and dissemination took place 2 days after seeking healthcare evaluation. Conclusions: Most occupational exposures to varicella zoster are the result of delayed initiation of appropriate isolation precautions due to delayed diagnosis of dVZV infection or failure to recognize the need for instituting precautions in disseminated disease. Instituting preemptive airborne precautions for immunocompromised patients with localized varicella zoster would be unlikely to reduce occupational exposures.Funding: NoneDisclosures: Consulting fee- Merck Priya Sampathkumar

scholarly journals A study on length of stay and its predictors among dengue patients in a tertiary care institute in Lucknow

2019 ◽  
Vol 6 (11) ◽  
pp. 4870
Author(s):  
Sandhya Mishra ◽  
Deepak Chopra ◽  
Nidhi Jauhari ◽  
Ausaf Ahmad
Keyword(s):  
Occupational Exposure ◽  
Length Of Stay ◽  
Hospital Admissions ◽  
Tertiary Care ◽  
Case Fatality ◽  
Length Of Hospital Stay ◽  
Care Hospital ◽  
Age Group ◽  
Cross Sectional ◽  
Early Arrival

Background: Dengue virus infection is a growing health problem and is prevalent throughout India. Research focusing on length of hospital stay and its predictors is scarce from India. This is important considering the burden of the disease during epidemics and impact on hospital admissions. Hence the study was conducted with the objectives to find out the factors influencing the length of stay in hospital of dengue patients.Methods: A cross sectional retrospective observational study conducted at a tertiary care hospital from August 2016 to October 2016. Data was retrieved from case sheets at Medical Record Department of 350 lab confirmed adult dengue patients admitted in the hospital.Results: The majority of patients admitted were of economically productive age group of 18-45 years and males indicating the occupational exposure to the vector of dengue. The study found that majority had length of stay of less than a week and as age increases the length of stay also increases (statistically significant). The nil case fatality and lesser number of mean days of symptoms before admission possibly indicate that early arrival of patients to hospital can lead to very low fatality rates. Further research required to find out the other predictors of length of stay.Conclusions: The study concludes that the dengue affects the economically productive age group and more males thereby indicating occupational exposure to the vector. The age of the patient can be used as an indicator to the length of stay in the hospital.

scholarly journals HIV: Infection Control Issues For Oral Healthcare Personnel

2007 ◽  
Vol 8 (3) ◽  
pp. 1-12
Author(s):  
Geza T. Terezhalmy ◽  
Michaell A. Huber
Keyword(s):  
Occupational Exposure ◽  
Infection Control ◽  
Hiv Infection ◽  
Healthcare Setting ◽  
Essential Elements ◽  
Needlestick Injury ◽  
Healthcare Personnel ◽  
Emotional Impact ◽  
Control Plan ◽  
Exposure Prevention

Abstract Aim To present the essential elements of an infection control/exposure control plan in the oral healthcare setting with emphasis on HIV infection. Methods and Materials A comprehensive review of the literature was conducted with special emphasis on HIV-related infection control issues in the oral healthcare setting. Results Currently available knowledge related to HIV-related infection control issues is supported by data derived from well-conducted trials or extensive, controlled observations, or, in the absence of such data, by best-informed, most authoritative opinion available. Conclusion Essential elements of an effective HIV-related infection control plan include: (1) education and training related to the etiology and epidemiology of HIV infection and exposure prevention; (2) plans for the management of oral healthcare personnel potentially exposed to HIV and for the follow-up of oral healthcare personnel exposed to HIV; and (3) a policy for work restriction of HIV-positive oral healthcare personnel. Clinical Significance While exposure prevention remains the primary strategy for reducing occupational exposure to HIV, knowledge about potential risks and concise written procedures that promote a seamless response following occupational exposure can greatly reduce the emotional impact of an accidental needlestick injury. Citation Huber MA, Terezhalmy GT. HIV: Infection Control Issues For Oral Healthcare Personnel. J Contemp Dent Pract 2007 March;(8)3:001-012.

scholarly journals Non-Clinical Variables Influencing Cesarean Section Rate According to Robson Classification

Medicina ◽  
2020 ◽  
Vol 56 (4) ◽  
pp. 180
Author(s):  
Noemi Strambi ◽  
Flavia Sorbi ◽  
Gian Marco Bartolini ◽  
Chiara Forconi ◽  
Giovanni Sisti ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Tertiary Care ◽  
Healthcare Setting ◽  
Care Hospital ◽  
Public Practice ◽  
Clinical Variables ◽  
Robson Classification ◽  
Vaginal Deliveries ◽  
Significant Difference ◽  
Private And Public

Background and Objectives: The incidence of cesarean section (CS) has progressively increased worldwide, without any proven benefit to either the mother or the newborn. The aim of this study was to evaluate the association between CS rates and both clinical and non-clinical variables, while applying the Robson classification system. Materials and Methods: This is a retrospective observational study of pregnant women delivering at a tertiary care hospital between 2012 and 2017, either under public or private healthcare. The overall CS rate, and the elective and non-elective CS rate, divided by classes of Robson, were determined. The rate of vaginal deliveries and CSs was compared between the public and private setting. The distribution of incidence of non-elective CSs and their main indications were analyzed between daytime and nighttime. Results: 18,079 patients delivered during the study period: 69.2% delivered vaginally and 30.8% by CS. Robson class 5 was the most frequent (23.4%), followed by class 2B (16.8%). Of the 289 private practice deliveries, 59.2% were CSs. The CS rate was significantly higher in private compared to public practice: 59.2% and 30.4%, respectively (OR 3.32, 95% CI 2.62 ± 4.21). When only considering elective CSs, a statistically significant difference was found in Robson class 5 between private and public practice, with the latter having more CSs (94.2% and 83.8%, respectively (p = 0.046)). The rate of non-elective CS was significantly lower during nighttime than during daytime (17.2% vs. 21.5%, p < 0.01). During daytime, the higher incidence of CS occurred between 4:00 and 4:59 pm, and during nighttime between 9:00 and 9:59 pm. Failed induction was significantly more common as an indication to CS during daytime when compared to nighttime (p = 0.01). Conclusions: This study identified two non-clinical variables that influenced the CS rate: the type of healthcare setting (private vs. public) and the time of the day. We believe that these indications might be related more to the practitioner attitude, rather than objective delivery complications.

Usefulness of a Rapid Human Immunodeficiency Virus-1 Antibody Test for the Management of Occupational Exposure to Blood and Body Fluid

2005 ◽  
Vol 26 (9) ◽  
pp. 768-774 ◽  
Author(s):  
Michael L. Landrum ◽  
Clarissa H. Wilson ◽  
Luci P. Perii ◽  
Sandra L. Hannibal ◽  
Robert J. O'Connell
Keyword(s):  
Occupational Exposure ◽  
Medical Center ◽  
Tertiary Care ◽  
Cost Savings ◽  
Occupational Exposures ◽  
Antibody Test ◽  
Stress Reaction ◽  
Post Exposure Prophylaxis ◽  
Potential Cost ◽  
Tertiary Care Medical Center

AbstractObjective:To describe the usefulness of the OraQuick Rapid HIV-1 Antibody Test (OraSure Technologies, Bethlehem, PA) in cases of occupational exposure regarding its use with source-patient sera, effects on post-exposure prophylaxis (PEP) use, potential cost savings, and effects on healthcare worker (HCW) stress reaction symptoms.Design:Before-and-after analysis.Setting:A 269-bed, tertiary-care medical center with adjacent clinics.Participants:All source-patients and HCWs experiencing an occupational exposure during the study period.Methods:Use of the OraQuick test with patient sera was validated prior to its use for occupational exposures. Exposures from January 1 through July 10, 2003 (enzyme immunoassay [EIA] group) and July 11 through December 31, 2003 (OraQuick group) were retrospectively reviewed and the use and cost of PEP was compared for each group. Randomly selected HCWs from both groups completed a survey to assess their stress reaction symptoms.Results:After exclusion, there were 71 exposures in the EIA group and 79 in the OraQuick group. OraQuick results were 100% concordant with the reference standard of EIA and Western blot using patient sera. The mean number of doses ingested per course of PEP was significantly higher for HCWs in the EIA group (3.8; range, 0 to 6) compared with the OraQuick group (1.2; range, 0 to 3; P = .016). Cost analysis revealed a mean savings of $6.62 with the OraQuick test per occupational exposure. Although the survey failed to detect an overall reduction in HCW stress reaction symptoms using OraQuick for source-patient testing, 11 HCWs in the EIA group had repetitive thoughts of the exposure compared with 5 in the OraQuick group (P= .049).Conclusion:Because of the reduction in ingested doses of unnecessary PEP and reduced cost of occupational exposure management with their use, rapid HJV-antibody tests should be the preferred method for source-patient testing following an occupational exposure.

Controlling Varicella in the Healthcare Setting: Barriers to Varicella Vaccination Among Healthcare Workers

1999 ◽  
Vol 20 (7) ◽  
pp. 516-518 ◽  
Author(s):  
Mahmooda Qureshi ◽  
Steven M. Gordon ◽  
Belinda Yen-Lieberman ◽  
David G. Litaker
Keyword(s):  
Patient Care ◽  
Varicella Zoster Virus ◽  
Virus Vaccine ◽  
Healthcare Workers ◽  
Healthcare Setting ◽  
Direct Patient Care ◽  
Varicella Vaccination ◽  
Varicella Zoster ◽  
Varicella Zoster Virus Vaccine

AbstractWe surveyed healthcare workers to determine factors that may influence acceptance of varicella-zoster virus vaccine. Of 2,801 workers tested, 90 were susceptible to varicella; of workers offered vaccination, 68% accepted. Workers providing direct patient care were 3.7-fold more likely than other workers to accept VZV vaccination (P=.04).

Occupational Exposure to HIV: Experience at a Tertiary Care Center

1998 ◽  
pp. 1102-1109 ◽  
Author(s):  
Robert B. Swotinsky ◽  
Kathleen A. Steger ◽  
Carol Sulis ◽  
Sandra Snyder ◽  
Donald E. Craven
Keyword(s):  
Occupational Exposure ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center

scholarly journals A study on clinical characteristics of herpes zoster in a tertiary care center

2017 ◽  
Vol 3 (1) ◽  
pp. 79
Author(s):  
Rachana R. ◽  
Shivaswamy K. N. ◽  
Anuradha H. V.
Keyword(s):  
Herpes Zoster ◽  
Clinical Characteristics ◽  
Care Center ◽  
Tertiary Care ◽  
Age Groups ◽  
Age Group ◽  
Female Ratio ◽  
Varicella Zoster ◽  
Medical College ◽  
Male To Female

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Herpes zoster (HZ), also known as shingles, derived from the Latin word Cingulum, for “girdle”. This is because a common presentation of HZ involves a unilateral rash that can wrap around the waist or torso like a girdle. HZ results due to reactivation of an earlier latent infection with the varicella zoster virus (VZV) in dorsal root ganglia. It occurs at all age groups, common over 60 years of age. It is estimated that in non-immune populations, approximately 15 cases per 1000 people occur per year. The objective of the study was to study the clinical characteristics in patients with uncomplicated herpes zoster.</span></p><p class="abstract"><strong>Methods:</strong> A total of 72 patients attending dermatology OPD at Ramaiah medical college between June 2013 to September 2014 were recruited after obtaining informed consent. A detailed history regarding onset of rash, pain, progression, duration and distribution of the lesions were recorded. Demographic information including age, sex, and any other co morbidities noted. Tzanck smear and serology for HIV was done where-ever necessary.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Of the 72 patients, females outnumbered males [M=35(48.61%), F=37 (51.39%)] with male to female ratio of 0.9 to 1. The mean age of presentation was 58±18 years. Majority of the patients (54%) were in the age group of 51 to 70 years followed by 31-50 years (25%). Least number of cases (9%) was in the age group of 21 to 30 years. Of the 72 subjects, thoracic involvement was noted in 30.6%, followed by lumbar (22%), and trigeminal (16%). Cervical (4%) and sacral (2%) involvement was the least. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Herpes zoster commonly occurs in old age and the presenting symptom being pain and burning sensation. Thoracic dermatome is the commonest site. Immunocompromised states like diabetes, malignancy and HIV can increase the risk of developing herpes zoster.</span></p>

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