APSIC Abstracts on Occupational Health

The following abstracts on the topic of occupational health are from the meeting of the eighth International Congress of the Asia Pacific Society of Infection Control (APSIC), held in Bangkok, Thailand, Feb. 12-15, 2017.

Reference: Antimicrobial Resistance & Infection Control. Abstracts from the 8th International Congress of the Asia Pacific Society of Infection Control (APSIC) Volume 6, Supplement 2. February 2017.

O1: Safety of 4-dose vial presentation of the pneumococcal non-typeable Haemophilus influenzae protein D-conjugate vaccine in infants: a phase III randomized study

Khalequ Zaman, Sheikh Farzana Zaman, Farzana Zaman, Asma Aziz, Sayeed-Bin Faisal, Magali Traskine, Javier Ruiz-Guiñazú, Dorota Borys

Background
The 4-dose vial (with preservative) of pneumococcal non-typeable Haemophilus influenzae protein D-conjugate vaccine (PHiD-CV, GSK Vaccines) was developed to improve logistics of and adherence to immunization programmes. The aim of this study was to assess reactogenicity and safety of the investigational PHiD-CV 4-dose vial presentation in infants.

Materials and methods
In this phase III, mono-centre, observer-blind study (NCT02447432) conducted in Bangladesh, 6-10-week-old infants, randomized 1:1, received primary vaccination with either PHiD-CV 4-dose (4-dose group) or PHiD-CV 1-dose vial (preservative-free, 1-dose group) at 6/10/18 weeks of age. DTPw-HBV/Hib and polio vaccines were (co)-administered at 6/10 weeks of age. Solicited and unsolicited adverse events (AEs) within 4 and 31 days post-vaccination, respectively, and serious AEs (SAEs) throughout the study were assessed.

Results
The total vaccinated cohort comprised 160 infants in each group. The most commonly reported PHiD-CV injection site and general solicited AEs were pain (after 13.1% and 13.4% of doses in 4-dose and 1-dose groups, respectively) and irritability/fussiness (after 23.3% and 26.6% of doses, respectively). The overall/dose incidences of other injection site (redness and swelling; 2.4%-5.9%) and general AEs (drowsiness, loss of appetite and fever [axillary temperature ≥37.5 °C]; 10.0%-15.6%) were within similar ranges between groups. Unsolicited AEs were reported after 2.1% and 3.7% of doses, and SAEs were reported for 4 and 9 infants in 4-dose and 1-dose groups, respectively, none was considered as vaccination-related. Two infants died (sepsis, 4-dose; septic shock, 1-dose).

Conclusions
PHiD-CV 4-dosevial presentation (with preservative) had an acceptable reactogenicity and safety profile, similar to PHiD-CV 1-dose vial (preservative-free) in infants.

O2: Immunogenicity of 4-dose vial presentation of pneumococcal non-typeable Haemophilus influenzae protein D-conjugate vaccine in infants: a phase III randomized study

Khalequ Zaman, Sheikh Farzana Zaman, Farzana Zaman, Asma Aziz, Sayeed-Bin Faisal, Magali Traskine, Javier Ruiz-Guiñazú, Dorota Borys

Background
To facilitate multi-dose use, GSK Vaccines developed the pneumococcal non-typeable Haemophilus influenzae protein D-conjugate vaccine (PHiD-CV) 4-dose vial, which contains preservative. The aim of this study was to demonstrate non-inferiority of the immunogenicity of investigational PHiD-CV 4-dose versus licensed 1-dose vial presentation in infants.

Materials and methods
In this phase III, observer-blind study (NCT02447432) conducted in Bangladesh, 6-10-week-old infants, randomized 1:1, received PHiD-CV primary vaccination at ages 6/10/18 weeks with either 4-dose (4-dose group) or 1-dosevial (preservative-free, 1-dose group). DTPw-HBV/Hib and polio vaccines were (co)-administered at ages 6/10 weeks. Immune responses (antibodies against pneumococcal serotypes [22F-ELISA] and opsonophagocytic activity [OPA]; anti-protein D antibodies [ELISA]) were measured. Non-inferiority of PHiD-CV 4-dose versus 1-dose for each vaccine pneumococcal serotype (VT) and vaccine-related serotype 19A (confirmatory objectives) in terms of antibody geometric mean concentration (GMC) ratios was assessed.

Results
Of 320 vaccinees, 154 (4-dose) and 146 (1-dose) were included in the according-to-protocol cohort for immunogenicity. Non-inferiority criterion (upper limit of 2-sided 95% confidence interval of the antibody GMC ratios [1-dose/4-dose] <2-fold) was met for each VT and 19A. For each VT, ≥97.9% of infants in each group had antibody concentrations ≥0.2 μg/mL, except for 6B (84.4%, 4-dose; 84.9%, 1-dose) and 23F (89.0%, 4-dose; 94.5%, 1-dose); for 19A, ≥80.1% of infants in both groups. OPA for each VT and 19A, and anti-protein D responses were within similar ranges between groups.

Conclusions
Immunogenicity of PHiD-CV 4-dose vial (with preservative) was non-inferior to 1-dose vial (preservative-free) in terms of antibody GMC ratios for each VT and 19A post-primary vaccination in infants.

O3: Multi-interventional strategy to reduce percutaneous injuries in a non-profit private hospital

Wendy Wai Yee Lam, May Chow, Lucy Choy, Joseph Kam

Background
Percutaneous injuries resulting from contaminated sharp devices among healthcare workers (HCWs) is a major concern of staff safety in hospitals, with increased risk HIV, hepatitis B and C infections. Percutaneous injuries were at top five risks in our hospital in 2010-2013, with >60% of injuries related to operating theatre (OT). We aimed to study the impact of a multi-interventional strategy on incidence of percutaneous injuries at a non-profit private care hospital in Hong Kong.

Materials and methods
Canossa Hospital (Caritas) is a 148-bed non-profit private care hospital treating approximately 10,000 patients yearly with 400 HCWs. Between 9-10 incidents of percutaneous injury occurred annually in 2010-2013. From 2013, a multi-interventional strategy was introduced to reduce incidence of percutaneous injuries, including: identifying risks of bloodborne infections exposure, formulation of ward policy guidelines, staff education and training to create safe workplace environment, enhancement of reporting system, individual counseling by infection control nurse, provision of safety-engineered sharps devices (e.g. needle counter in OTs), verbal-visual reminder (meetings, posters). Compliance audits were performed in OTs after implementation.

Results
Number of percutaneous injuries declined from between 9-10 incidents in 2010-2013 to 5 and 3 incidents in 2014 and 2015 respectively. The proportion of injured staff showed an initial decrease of 50% (p = 0.1, chi-square test) in 2014 and then significant reduction of 70% (p < 0.05) in 2015.

Conclusions
We achieved reduction in percutaneous injuries using multi-interventional strategy. Implementation of guideline formulation, education, individual counselling after incident, verbal-visual reminders, safety devices and performance audits led to an improvement in hospital staff safety.

O4: Epidemiology of sharp injury in a Malaysian teaching hospital

Sharifah Azura Salleh, Razila Yacob, Siti Rokiah Yusof, Nordiah Awang Jalil1

Background
Accidental sharp injury with the risk of contracting blood-borne infection is a major occupational hazard for healthcare workers (HCWs). The aim of this study is to look at the epidemiology of sharp injury in U
Kebangsaan Malaysia Medical Centre (UKMMC) between 2013 and 2016.

Materials and methods
All sharp injury incidents were included. Data was obtained from the record of HCWs with sharp injury incident reported to Infection Control Unit UKMMC between 2013 and August 2016.

Results
Total of 312 incidence of sharp injury reported over the 4 years study period. The highest incidence was in 2013 with 97 reported cases, followed by 81 cases in 2015, 79 cases in 2014 and 55 in 2016. The top 3 locations that reported sharp injury during the 4 years were Medical Wards (69 cases), General Operating Theatre (30 cases) and Surgical Ward (30 cases). During this study period, 19.6% cases occurred sharp injury in relation to blood taking procedure (n = 61). Waste collection is the second commonest situation for sharp injury at 13.8% of reports (n = 43) and 35 cases reported during disposing sharps into sharp bins (11.2%). Doctors reported the highest incident with 126 cases (40.4%) while nurses reported 62 cases (19.9%) and various groups of HCWs constitutes the remaining 39.7%.

Conclusions
All HCWs are at risk of sharp injury however certain groups are at higher risk. The rate of sharp injury is persistently high despite the ongoing education program for HCWs in our institution.

O5: Effects of increasing flu vaccination coverage on staff sick leaves: incremental cost benefit analysis

Jose Paulo Flor, Nicolo Andrei Añonuevo, Marko Bautista, V Jay De Roxas, Justine Vergara, Maria Lourdes Millan, Marion Kwek, Jose Lito Acuin

Background
Influenza can be a serious disease, since health care workers may care for or live with people at high risk for influenza-related complications. This study aimed to increase staff vaccination rates in 2015 and to know whether the additional cost is serving its worth, which shows the incremental cost - benefit ratio of increasing vaccine coverage.

Materials and methods
In 2015, the team conducted unit by unit information campaigns through floor to floor dissemination of information about free vaccination in the Employee Health Clinic, and lastly “I am Asian” jackets were provided to staff who underwent the vaccination.

Results
In 2014, the team vaccinated 820 employees (73% vaccination rate) among 1117 total number of employees. While in 2015, vaccination of 1030 employees (88% vaccination rate) among 1174 total number of employees was conducted. In 2016, 1379 employees (89% vaccination rate) among 1544 total number of employees were vaccinated. This represented an additional 427 employees who got vaccinated in 2016. The number of sick leave days decreased by 40%, from 96 days in 2014 to 58 days in 2015. We assumed conservatively that each sick leave day cost the hospital 468.00 pesos.

Conclusions
Annual influenza vaccination incurs at most a net cost of 77 centavos or 770 pesos for the current workforce of 1,000 staff members. This is a cost beneficial intervention which must be continued. For this reason, in 2016, the team used the quadrivalent vaccine which cost 650 pesos. This will determine the cost benefit ratio of this enhanced program in 2017.

O6: Cost implications and control of adult varicella among healthcare workers in a tertiary hospital in Manila Doctors Hospital, Philippines

Aisa Jensen Lee, Melecia A. Velmonte, Silverose Ann A. Bacolcol, Allan Alde, Keitleen Chavez, Arlene Joy Esteban

Background
In 2015, there have 17 documented cases of adult varicella zoster virus (VZV) among healthcare workers in a tertiary hospital in the Philippines. The purpose of this study was to determine the cost implications of the occurrence of VZV among healthcare workers and control the transmission of the virus.

Materials and methods
From 2015 to 2016, the Infection Prevention and Control Office conducted an outbreak investigation on the cases of VZV among healthcare workers. This involved contact tracing and review of medical history of the healthcare workers. A survey on the immunization history of all healthcare workers (HCW) was done. Outbreak control was also recommended through vaccination of all exposed that have no active immunity on the virus. The calculated cost of the treatment for HCWs was done.

Results
Result of the investigation revealed that 18% of the cases are cross transmission from one healthcare worker to his other co-workers. Most of the healthcare workers who are on the prodromal stage of the virus still reported to work. The cost of the treatment per personnel who have VZV was calculated at 23,400 PHP (479 USD) while the cost of the VZV is at 4,000 PHP (83 USD). Among all HCWs 68% have no active immunity to VZV while 60% have no vaccination to VZV.

Conclusions
There is a need to strengthen VZV information campaign among HCW. Mandatory immunization of all susceptible staff to VZV must be recommended and barriers to vaccination uptake among HCWs must be studied. Reiteration of the sick leave policy must be emphasized.

O7: Nursing experience with one postoperative oral cancer patient using transdisciplinary care model

Ching-I Ting

Background
Oral cancer patients are susceptible to postoperative structural defects of tissues such as in the orofacial region and jaw bones, which cause changes in the facial appearance, defects of physical functions such as dysphagia, slurred speech and eating difficulties and consequent negative impacts on quality of life. Each of these patients, therefore, represents a highly complicated case with multiple problems and requires collaboration between a wider range of specialty departments on case discussion and provision of care to reduce their postoperative complications and improve their quality of life.

Materials and methods
The healthcare provided to the patient and the family through the transdisciplinary care model included: (1) alleviation of wound pain for the patient; (2) planning of training sessions for rehab from dysphagia; and (3) continuing coaching for the patient’s mother on caregiving for the patients at home.

Results
This paper, based on the reason for and the definition of transdisciplinary care, presents for the reference of clinical practitioners leaders of medical institutions a specifically addressed strategy of evidence-based transdisciplinary practice, integrating the care plans suggested by all the teams and providing healthcare and rehab plan that reduced and improved the patient’s wound pain and dysphasia.

Conclusions
The evidence-based clinical practice of transdisciplinary care is a key trend of care in medical environments. Using transdisciplinary evidence-based care as the foundation helps healthcare professionals across disciplines to understand and respect the spirit of collaborative care and obtain best treatment strategies through communications, thereby providing good quality of care.

O8: Infection control on air ambulance

Sunisa Dissayasriroj

Background
The introduction of ASEAN Economic Community (AEC) and Thai government’s policy in creating an international center for medical treatment, there has been a significant increase in number of patients travelling into Thailand for treatments. Patients are travelling on commercial aircrafts as well as air ambulance when their conditions are urgent or critical. Air ambulance is a well-recognized method of transportation by the insurance company which Medical Wings has been serving patient from around the world since 1999. At Medical Wings, we focus on Safety, quality care and infection control. On occasion, we receive patient from facility which is not able to adequately assess infectious disease so our medical team are the first group to meet patient and preparation is the utmost important in a successful mission. We aimed to prevent the exposure of patients, visitors and healthcare workers to communicable or infectious diseases by stressing maintenance of sound habits in personal hygiene and individual responsibility in infection control, monitoring and investigating potentially harmful infectious exposures, providing care to personnel for work-related illnesses, identifying infection risks related to employment and instituting appropriate preventive measures.

Materials and methods
1.Employee health, 2.Post-handover surveillance, 3.Isolation Precautions, 4.Disinfection & sterilization, 5.Patient care, 6.Education & training, 7.Environmental control, 8. Research

Results
1. Patient’s infection rate 0%, 2.HAIs rate 0%, 3. Results of swab test and microbial air sampler: pre & post deep cleaning effective more than 99.9%, 4. Employee satisfaction rate more than 90%

Conclusions
We focus directly to prevent infection. Educating medical and non-medical caregivers are our key strategy.