jueves, 20 de julio de 2017

Guidelines on viral inactivation of human blood plasma products

The present WHO Guidelines on viral inactivation and removal procedures intended to assure the viral safety of human blood plasma products were developed to complement the WHO Requirements for the collection, processing and quality control of blood, blood components and plasma derivatives”(1), in response to the above requests.
These Guidelines pertain to the validation and assessment of the steps for viral inactivation and removal employed in the manufacture of human blood plasma derivatives and virally inactivated plasma for transfusion, prepared either from plasma pools or from individual donations.It is hoped that this document, by summarizing current experience with well recognized methods, will help set expectations, serve as a guide to speed implementation, and ensure that implementation is appropriate.
Inevitably, individual countries may formulate different policies, not only in relation to procedures for validation and control, but also regarding donor selection and methods of blood screening. These Guidelines do not replace the requirements of regulatory authorities in various parts of the world (2–4); rather, they are primarily intended to assist those national regulatory authorities and manufacturers that are less familiar with viral decontamination processes.
The document does not address products of animal origin or those manufactured by recombinant techniques.
Guidelines on viral inactivation and removal procedures intended to assure the viral safety of human blood plasma products. World Health Organization, WHO Technical Report, Series No. 924, 2004.

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lunes, 10 de julio de 2017

DOUBLE GLOVING: Gloves, extra gloves or special types of gloves for preventing percutaneous exposure injuries in healthcare personnel

BACKGROUND: Healthcare workers are at risk of acquiring viral diseases such as hepatitis B, hepatitis C and HIV through exposure to contaminated blood and body fluids at work. Most often infection occurs when a healthcare worker inadvertently punctures the skin of their hand with a sharp implement that has been used in the treatment of an infected patient, thus bringing the patient's blood into contact with their own. Such occurrences are commonly known as percutaneous exposure incidents.
OBJECTIVES: To determine the benefits and harms of extra gloves for preventing percutaneous exposure incidents among healthcare workers versus no intervention or alternative interventions.
SEARCH METHODS: We searched CENTRAL, MEDLINE, EMBASE, NHSEED, Science Citation Index Expanded, CINAHL, NIOSHTIC, CISDOC, PsycINFO and LILACS until 26 June 2013.
SELECTION CRITERIA: Randomised controlled trials (RCTs) with healthcare workers as the majority of participants, extra gloves or special types of gloves as the intervention, and exposure to blood or bodily fluids as the outcome.
DATA COLLECTION AND ANALYSIS: Two authors independently assessed study eligibility and risk of bias, and extracted data. We performed meta-analyses for seven different comparisons.
MAIN RESULTS: We found 34 RCTs that included 6890 person-operations as participating units and reported on 46 intervention-control group comparisons. We grouped interventions as follows: increased layers of standard gloves, gloves manufactured with special protective materials or thicker gloves, and gloves with puncture indicator systems. Indicator gloves show a coloured spot when they are perforated. Participants were surgeons in all studies and they used at least one pair of standard gloves as the control intervention. Twenty-seven studies also included other surgical staff (e.g. nurses). All but one study used perforations in gloves as an indication of exposure. The median control group rate was 18.5 perforations per 100 person-operations. Seven studies reported blood stains on the skin and two studies reported self reported needlestick injuries. Six studies reported dexterity as visual analogue scale scores for the comparison double versus single gloves, 13 studies reported outer glove perforations. We judged the included studies to have a moderate to high risk of bias.We found moderate-quality evidence that double gloves compared to single gloves reduce the risk of glove perforation (rate ratio (RR) 0.29, 95% confidence interval (CI) 0.23 to 0.37) and the risk of blood stains on the skin (RR 0.35, 95% CI 0.17 to 0.70). Two studies with a high risk of bias also reported the effect of double compared to single gloves on needlestick injuries (RR 0.58, 95% CI 0.21 to 1.62).We found low-quality evidence in one small study that the use of three gloves compared to two gloves reduces the risk of perforation further (RR 0.03, 95% CI 0.00 to 0.52). There was similar low-quality evidence that the use of one fabric glove over one normal glove reduces perforations compared to two normal gloves (RR 0.24, 95% CI 0.06 to 0.93). There was moderate-quality evidence that this effect was similar for the use of one special material glove between two normal material gloves. Thicker gloves did not perform better than thinner gloves.There was moderate to low-quality evidence in two studies that an indicator system does not reduce the total number of perforations during an operation even though it reduces the number of perforations per glove used.There was moderate-quality evidence that double gloves have a similar number of outer glove perforations as single gloves, indicating that there is no loss of dexterity with double gloves (RR 1.10, 95% CI 0.93 to 1.31).
AUTHORS' CONCLUSIONS: There is moderate-quality evidence that double gloving compared to single gloving during surgery reduces perforations and blood stains on the skin, indicating a decrease in percutaneous exposure incidents. There is low-quality evidence that triple gloving and the use of special gloves can further reduce the risk of glove perforations compared to double gloving with normal material gloves. The preventive effect of double gloves on percutaneous exposure incidents in surgery does not need further research. Further studies are needed to evaluate the effectiveness and cost-effectiveness of special material gloves and triple gloves, and of gloves in other occupational groups.

Mischke C, Verbeek JH, Saarto A, Lavoie MC, Pahwa M, Ijaz S. Gloves, extra gloves or special types of gloves for preventing percutaneous exposure injuries in healthcare personnel. Cochrane Database Syst Rev. 2014 Mar 7;(3):CD009573. doi: 10.1002/14651858.CD009573.pub2. Review. PubMed PMID: 24610769.

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viernes, 7 de julio de 2017

Biodefense in the 21st century

Although bioweapons have not been used in modern warfare, and bioterror events are rare, it's an open question as to whether the norms that prohibit the use of biological weapons have an expiration date. Biological techniques and equipment that could be used to create new bioweapons are available and inexpen­sive, pathogens are plentiful, and some can even be made de novo. In his new book, Biosecurity Dilemmas, Christian Enemark describes the challenges that nations face in providing biosecurity today.

Dreaded Diseases, Ethical Responses, and the Health of Nations
Christian Enemark
Biosecurity Dilemmas examines conflicting values and interests in the practice of "biosecurity," the safeguarding of populations against infectious diseases through security policies. Biosecurity encompasses both the natural occurrence of deadly disease outbreaks and the use of biological weapons. Christian Enemark focuses on six dreaded diseases that governments and international organizations give high priority for research, regulation, surveillance, and rapid response: pandemic influenza, drug-resistant tuberculosis, smallpox, Ebola, plague, and anthrax. The book is organized around four ethical dilemmas that arise when fear causes these diseases to be framed in terms of national or international security: protect or proliferate, secure or stifle, remedy or overkill, and attention or neglect. For instance, will prioritizing research into defending against a rare event such as a bioterrorist attack divert funds away from research into commonly occurring diseases? Or will securitizing a particular disease actually stifle research progress owing to security classification measures? Enemark provides a comprehensive analysis of the ethics of securitizing disease and explores ideas and policy recommendations about biological arms control, global health security, and public health ethics.

Gronvall GK. Biodefense in the 21st century. Science. 2017 May 12;356(6338):588. doi: 10.1126/science.aan1118. PubMed PMID: 28495718.
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jueves, 29 de junio de 2017

Management of solid health-care waste at primary health-care centres

The objective of this document is to provide guidance for selecting the most appropriate for safely managing solid waste generated at Primary Health-Care centres (PHCs) in developing countries. The main tool of this guide consists of six decision-trees aimed at assisting the user in identifying appropriate waste management methods. The guide takes into consideration the most relevant local conditions, the safety of workers and of the general public as well as of environmental criteria.
This guide is composed of the following parts:
  • Basic risks associated with poor management of heath care waste.
  • Basic elements for safe health-care waste management (HCWM)
  • Parameters to assess before selecting HCWM options
  • Technical annexes describing HCWM options
  • Estimation of costs of the various options
  • Decision-trees, assisting the selection of HCWM options
  • This guide may also be used to evaluate existing practices related to health-care waste management. More detailed sources of information on handling and storage practices, technical options for treatment and disposal of wastes, training and personal protection, and assessment of a country’s situation, are presented in Annex A.

Management of solid health-care waste at primary health-care centres. A decision-making guide

Publication details
Number of pages: 54
Publication date: 2005
Languages: English, French
ISBN: 92 4 159274 5

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lunes, 19 de junio de 2017

Safe management of wastes from health-care activities

The waste produced in the course of health-care activities, from contaminated needles to radioactive isotopes, carries a greater potential for causing infection and injury than any other type of waste, and inadequate or inappropriate management is likely to have serious public health consequences and deleterious effects on the environment. This handbook – the result of extensive international consultation and collaboration – provides comprehensive guidance on safe, efficient, and environmentally sound methods for the handling and disposal of health-care wastes in normal situations and emergencies. Future issues such as climate change and the changing patterns of diseases and their impacts on health-care waste management are also discussed. For health-care settings in which resources are severely limited, the handbook pays particular attention to basic processes and technologies that are not only safe, but also affordable, sustainable, and culturally appropriate. The guide is aimed at public health managers and policy-makers, hospital managers, environmental health professionals, and all administrators with an interest in and responsibility for waste management. Its scope is such that it will find application in developing and developed countries alike.

Safe management of wastes from health-care activities

Edited by Yves Chartier, Jorge Emmanuel, Ute Pieper,Annette Prüss,
Philip Rushbrook, Ruth Stringer, William Townend,
Susan Wilburn and Raki Zghondi.
© 2014, WHO
ISBN 978 92 4 154856 4
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miércoles, 14 de junio de 2017

Sobre el Simposio de Bioseguridad 2017

Con gran entusiasmo se llevó a cabo el 9º Simposio de Bioseguridad organizado por AMEXBIO en la ciudad de Morelia Michoacán el pasado 7 al 10 de Junio 2017, con el tema "CONTENCIÓN HOSPITALARIA". Los cursos presimposio impartidos, como todos los años, incluyeron temas de gran relevancia para el trabajo diario en el manejo de patógenos, incluyendo: uso de equipo de protección personal, manejo de residuos RPBI, diseño de laboratorios, entre otros.
Durante el simposio de tocaron temas como la resistencia microbiana a los antibióticos, el control de infecciones hospitalarias, la gestión de riesgos, la salud ocupacional, la biología sintética, descontaminación entre otros. Entre las diversas noticias que se tuvieron este año, es que el próximo año el simposio se llevará a cabo en Puerto Vallarta, para conmemorar y festejar el 10º Simposio de la AMEXBIO. Resúmenes periodísticos del simposio se vieron publicados en: Arizona State University, Quadratín Michoacán, Provincia El Diario Grande de Michoacán, entre otros.
La Asociación como siempre agradece el patrocinio de MERRICK México, Camfil, Procequip, DUO, Métrix, Éviter, Microbios y Lab-Tech, ya que sin su apoyo, el simposio de 2017 no se llevaría a cabo.

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lunes, 5 de junio de 2017

Medidas de control de infecciones en la atención sanitaria de pacientes con enfermedades respiratorias agudas en entornos comunitarios

El propósito del presente documento es proporcionar a los instructores material para el adiestramiento de los agentes de salud comunitarios (ASC) y otro personal sanitario en la atención segura de los pacientes de ERA tanto en el hogar como en dispensarios de la comunidad. En él se presenta información acerca de ciertos tipos de ERA, como el SRAS y la gripe aviar, afecciones consideradas de potencial impacto internacional por suponer un riesgo para la salud pública mundial, pero también incluye información que se aplica a todas las ERA. La guía incluye instrucciones sobre el uso de equipo de protección personal (EPP) (por ejemplo, mascarillas y guantes), controles ambientales (limpieza y desinfección, eliminación de desechos) y otras estrategias (lavado de manos, cómo proceder en caso de tos, distancia de los pacientes) con el fin de reducir el riesgo de exposición. El contenido del presente documento recoge las orientaciones presentadas en Prevención y control de infección en enfermedades respiratorias agudas con tendencia epidémica y pandémica durante la atención sanitaria - Pautas provisionales de la OMS.


Medidas de control de infecciones en la atención sanitaria de pacientes con enfermedades respiratorias agudas en entornos comunitarios

Publication details
Publication date: 2009
  1. Download document (English)
  2. Chinese
  3. French
  4. Spanish
WHO reference number: WHO/HSE/GAR/BDP/2009.1
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lunes, 22 de mayo de 2017

Laboratory Biorisk Management Strategic Framework for Action

Although laboratory biosecurity is a relatively new concept to many, biosafety has been an established discipline for several decades. These fields have recently been elevated in prominence for a number of reasons, including laboratory acquired infections associated with SARS, the anthrax attacks in the US postal service, and renewed interest in the Biological Weapons Convention (BWC), together with emerging issues relating to the rapid growth of biotechnology and concerns over the potential for illicit use of such technologies.
However, despite significant investments in this field during the last decade, and progress made in strengthening biorisk management, many countries remain without effective regulatory and oversight mechanisms, and levels of awareness are often low amongst regulators and laboratory personnel alike. In addition, basic information relating to laboratory design and operating parameters is often confusing, with a lack of evidence to underpin many commonly used controls.
Developing countries in particular often struggle to implement solutions which have been designed for use in other parts of the world where different working conditions prevail. Adequate support services are also needed to operate laboratories. However, effective supplier networks, maintenance provision and other basic measures are often unavailable to those most in need.
At present there is no overarching framework or global strategy in this area to provide strategic direction to ensure that investments are planned and implemented appropriately to meet these needs. Without such strategic planning, biorisk management runs the danger of failing to meet the objective of delivering solutions that allow countries to build stand-alone capacity and capability.
This plan sets out a basis and rationale for WHO’s role in supporting the measures and mechanisms required to move towards the objective of supporting safe and secure environments in and around every laboratory in the world.

Laboratory Biorisk Management Strategic Framework for Action 2012–2016
Publication details
Number of pages: 16
Publication date: 2012
Languages: English
WHO reference number: WHO/HSE/2012.3

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lunes, 1 de mayo de 2017

Prevalence and characterization of murine leukemia virus contamination in human cell lines

Contaminations of cell cultures with microbiological organisms are well documented and can be managed in cell culture laboratories applying reliable detection, elimination and prevention strategies. However, the presence of viral contaminations in cell cultures is still a matter of debate and cannot be determined with general detection methods. In the present study we screened 577 human cell lines for the presence of murine leukemia viruses (MLV). Nineteen cell lines were found to be contaminated with MLV, including 22RV1 which is contaminated with the xenotropic murine leukemia virus-related virus variant of MLV. Of these, 17 cell lines were shown to produce active retroviruses determined by product enhanced reverse transcriptase PCR assay for reverse transcriptase activity. The contaminated cell lines derive from various solid tumor types as well as from leukemia and lymphoma types. A contamination of primary human cells from healthy volunteers could not be substantiated. Sequence analyses of 17 MLV PCR products and five complete MLV genomes of different infected cell lines revealed at least three groups of related MLV genotypes. The viruses harvested from the supernatants of infected cell cultures were infectious to uninfected cell cultures. In the course of the study we found that contamination of human genomic DNA preparations with murine DNA can lead to false-positive results. Presumably, xenotransplantations of the human tumor cells into immune-deficient mice to determine the tumorigenicity of the cells are mainly responsible for the MLV contaminations. Furthermore, the use of murine feeder layer cells during the establishment of human cell lines and a cross-contamination with MLV from infected cultures might be sources of infection. A screening of cell cultures for MLV contamination is recommended given a contamination rate of 3.3%.

Uphoff CC, Lange S, Denkmann SA, Garritsen HS, Drexler HG. Prevalence and characterization of murine leukemia virus contamination in human cell lines. PLoS One. 2015 Apr 30;10(4):e0125622. doi: 10.1371/journal.pone.0125622. eCollection 2015. PubMed PMID: 25927683; PubMed Central PMCID: PMC4416031.
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lunes, 24 de abril de 2017

LIBRO: Prevención de las infecciones nosocomiales, 2a edicíon, Guía práctica

Prevencíon de las infecciones nosocomiales, 2a edicíon, Guía práctica Prevention of hospital-acquired infections, 2nd edition. A practical guide
Índice Contents
Introducción Introduction
Capítulo I. Epidemiología de las infecciones nosocomiales Chapter I. Epidemiology of nosocomial infections
Capítulo II. Programas de control de infecciones Chapter II. Infection control programmes
Capítulo III. Vigilancia de las infecciones nosocomiales Chapter III. Nosocomial infection surveillance
Capítulo IV. Forma de abordar los brotes Chapter IV. dealing with outbreaks
Capítulo V. Prevención de las infecciones nosocomiales  Chapter V. Prevention of nosocomial infections
Capítulo VI. Prevención de las infecciones nosocomiales endémicas comunes Chapter VI. Prevention of common endemic nosocomial infections
Capítulo VII. Precauciones para el control de infecciones durante la atencíon del paciente Chapter VII. Infection control precautiopns in patient care 
Capítulo VIII. Medio ambiente Chapter VIII. Environment
Capítulo IX. Uso de antimicrobianos y farmacorresistencia Chapter IX. Antimicrobial use and antimicrobial resistance
Capítulo X. Prevención de infecciones del personal Chapter X. Preventing infections of staff
Anexo 1. Lecturas recomendadas Annex 1. Suggested further reading
Anexo 2. Recursos disponibles en Internet Annex 2. Internet resources

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