RESUMO

There are two common household disinfection interventions to prevent interhousehold transmission of cholera: household spraying, whereby a team disinfects cholera patients' households, and household disinfection kits (HDKs), whereby cleaning materials are provided to cholera patients' family members. Currently, both interventions lack evidence, and international agencies recommend HDK distribution; however, household spraying remains widely implemented. To understand this disconnect, we conducted 14 key informant interviews with international and national responders and a study in Haiti assessing HDK efficacy using two training modules including 20 household surveys and 327 surfaces samples before and after cleaning. During interviews, 80% of the international-level informants discussed evidence gaps for both interventions, and 60% preferred HDKs. Conversely, no national-level informants knew what an HDK was; therefore, they all preferred spraying. Informants discussed behavior changes, bleach perceptions, and implementation as facilitators and/or barriers to implementing both interventions. In households, training with demonstrations regarding the use of HDK led to increased reductions of Escherichia coli (P < 0.001) and Vibrio spp. (P < 0.001) on surfaces after participants cleaned the household compared with a hygiene promotion session only. These results emphasize the gap between the current international-level policy and the realities of cholera response programs, highlight the need for evidence to align household disinfection recommendations, and underscore the importance of the dissemination and training of responders and affected populations regarding methods to prevent intrahousehold cholera transmission.

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RESUMO

Low adoption and compliance levels for household water treatment and safe storage (HWTS) technologies have made it challenging for these systems to achieve measurable health benefits in the developing world. User compliance remains an inconsistently defined and poorly understood feature of HWTS programs. In this article, we develop a comprehensive approach to understanding HWTS compliance. First, our Safe Drinking Water Compliance Framework disaggregates and measures the components of compliance from initial adoption of the HWTS to exclusive consumption of treated water. We apply this framework to an ultraviolet (UV)-based safe water system in a cluster-randomized controlled trial in rural Mexico. Second, we evaluate a no-frills (or "Basic") variant of the program as well as an improved (or "Enhanced") variant, to test if subtle changes in the user interface of HWTS programs could improve compliance. Finally, we perform a full-cost analysis of both variants to assess their cost effectiveness (CE) in achieving compliance. We define "compliance" strictly as the habit of consuming safe water. We find that compliance was significantly higher in the groups where the UV program variants were rolled out than in the control groups. The Enhanced variant performed better immediately postintervention than the Basic, but compliance (and thus CE) degraded with time such that no effective difference remained between the two versions of the program.

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RESUMO

The operation of a health care facility, such as a cholera or Ebola treatment center in an emergency setting, results in the production of pathogen-laden wastewaters that may potentially lead to onward transmission of the disease. The research presented here evaluated the design and operation of a novel treatment system, successfully used by Médecins Sans Frontières in Haiti to disinfect CTC wastewaters in situ, eliminating the need for road haulage and disposal of the waste to a poorly-managed hazardous waste facility, thereby providing an effective barrier to disease transmission through a novel but simple sanitary intervention. The physico-chemical protocols eventually successfully treated over 600 m3 of wastewater, achieving coagulation/flocculation and disinfection by exposure to high pH (Protocol A) and low pH (Protocol B) environments, using thermotolerant coliforms as a disinfection efficacy index. In Protocol A, the addition of hydrated lime resulted in wastewater disinfection and coagulation/flocculation of suspended solids. In Protocol B, disinfection was achieved by the addition of hydrochloric acid, followed by pH neutralization and coagulation/flocculation of suspended solids using aluminum sulfate. Removal rates achieved were: COD >99%; suspended solids >90%; turbidity >90% and thermotolerant coliforms >99.9%. The proposed approach is the first known successful attempt to disinfect wastewater in a disease outbreak setting without resorting to the alternative, untested, approach of 'super chlorination' which, it has been suggested, may not consistently achieve adequate disinfection. A basic analysis of costs demonstrated a significant saving in reagent costs compared with the less reliable approach of super-chlorination. The proposed approach to in situ sanitation in cholera treatment centers and other disease outbreak settings represents a timely response to a UN call for onsite disinfection of wastewaters generated in such emergencies, and the 'Coalition for Cholera Prevention and Control' recently highlighted the research as meriting serious consideration and further study. Further applications of the method to other emergency settings are being actively explored by the authors through discussion with the World Health Organization with regards to the ongoing Ebola outbreak in West Africa, and with the UK-based NGO Oxfam with regards to excreta-borne disease management in the Philippines and Myanmar, as a component of post-disaster incremental improvements to local sanitation chains.

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RESUMO

The establishment of rules to manage Health Care Waste (HCW) is a challenge for the public sector. Regulatory agencies must ensure the safety of waste management alternatives for two very different profiles of generators: (1) hospitals, which concentrate the production of HCW and (2) small establishments, such as clinics, pharmacies and other sources, that generate dispersed quantities of HCW and are scattered throughout the city. To assist in developing sector regulations for the small generators, we evaluated three management scenarios using decision-making tools. They consisted of a disinfection technique (microwave, autoclave and lime) followed by landfilling, where transportation was also included. The microwave, autoclave and lime techniques were tested at the laboratory to establish the operating parameters to ensure their efficiency in disinfection. Using a life cycle assessment (LCA) and cost analysis, the decision-making tools aimed to determine the technique with the best environmental performance. This consisted of evaluating the eco-efficiency of each scenario. Based on the life cycle assessment, microwaving had the lowest environmental impact (12.64 Pt) followed by autoclaving (48.46 Pt). The cost analyses indicated values of US$0.12 kg(-1) for the waste treated with microwaves, US$1.10 kg(-1) for the waste treated by the autoclave and US$1.53 kg(-1) for the waste treated with lime. The microwave disinfection presented the best eco-efficiency performance among those studied and provided a feasible alternative to subsidize the formulation of the policy for small generators of HCW.

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RESUMO

Se realizó un estudio descriptivo y retrospectivo de los gastos en materiales, equipos y recursos humanos ocasionados por la atención brindada a los pacientes con dengue en el Hospital General Santiago durante 1997, que permitió establecer diferencias entre los consumos normales y los que requirió la epidemia. Se depuraron los gastos provocados por los servicios de pruebas diagnósticas y se demostró que los gastos en el Departamento Central de Esterilización se elevaron en condiciones anormales como las del período epidémico investigado, siendo los servicios de atención priorizada y de medios diagnósticos los mayormente afectados; de ahí la necesidad de que el personal de la Central de Esterilización sea una fuerza de trabajo diestra, capaz de ejecutar su labor con calidad y actuar en cada caso con precisión y sin ocasionar demoras innecesarias, que garanticen la más óptima atención a los pacientes, dada la masividad con que éstos llegan al hospital. Las roturas de materiales obedecieron generalmente a la participación activa, en función de la atención directa a los pacientes, por personal de apoyo de otras unidades que no mantenían la misma disciplina del hospital, así como la incorporación de alumnos de medicina y enfermería de diferentes niveles

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RESUMO

The use of disposable materials in the clinical laboratories has significantly reduced the use of glass and other reusable materials, due to their low cost. However, the increase in its price has demanded to reuse them in laboratories from developing countries. The purpose of this prospective and parallel trial was to determine the efficacy of disinfection of five procedures among 7088 Petri dishes (PD) filled with selective media for Gram negative organisms (MacConkey, XLD and Salmonella-Shigella agar) in comparison with 2150 new PD. The first procedure was a strong washing with detergent (1821 PD); the second was the same method followed by immersion in a warm (50-60 degrees C) sodium hypochlorite solution (0/6%) (2127 PD); the third was similar to the former and followed by microwave irradiation at 700 watts for 15 min (1542 PD); the fourth was a rinse with warm (50-60 degrees C) tap water followed by microwave irradiation (958 PD), and the fifth was a rinse with warm tap water (640 PD). The following results were obtained: the rate of contamination was 0.165, 0.2, 0.07, 0.8, 1.4 y 0, respectively; the cost of labor on 1000 PD 10.7, 15.8, 22.4, 9.3, 2.7 y 103.5 US dollars;the initial investment 136.7, 139.5, 623.5, 613, 128.7 y 103.5 US dollars; the time of performance (hours) 5.5, 9.8, 18.3, 13.5, 5 y 0; the number of reused PD to amortise the initial investment 1324, 1350, 6038, 5937, 1247 and no value; and the saving per thousand PD was 92.5, 82.5, 80.7, 93.9, 100.4, and 0 US dollars. Our data show that: procedures 1,2 and 3 were more efficacious than procedures 4 and 5 (p is less than 0.001); although, the third procedure had less contamination the initial investment and the small potential saving do not support its use, and the first and the second methods may be reliable procedures for disinfection of PD as part of a program of reusing disposable medical devices.

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