Last data update: May 20, 2024. (Total: 46824 publications since 2009)
Records 1-5 (of 5 Records) |
Query Trace: Panlilio AL [original query] |
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Updated US Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis
Kuhar DT , Henderson DK , Struble KA , Heneine W , Thomas V , Cheever LW , Gomaa A , Panlilio AL . Infect Control Hosp Epidemiol 2013 34 (9) 875-92 This report updates US Public Health Service recommendations for the management of healthcare personnel (HCP) who experience occupational exposure to blood and/or other body fluids that might contain human immunodeficiency virus (HIV). Although the principles of exposure management remain unchanged, recommended HIV postexposure prophylaxis (PEP) regimens and the duration of HIV follow-up testing for exposed personnel have been updated. This report emphasizes the importance of primary prevention strategies, the prompt reporting and management of occupational exposures, adherence to recommended HIV PEP regimens when indicated for an exposure, expert consultation in management of exposures, follow-up of exposed HCP to improve adherence to PEP, and careful monitoring for adverse events related to treatment, as well as for virologic, immunologic, and serologic signs of infection. To ensure timely postexposure management and administration of HIV PEP, clinicians should consider occupational exposures as urgent medical concerns, and institutions should take steps to ensure that staff are aware of both the importance of and the institutional mechanisms available for reporting and seeking care for such exposures. The following is a summary of recommendations: (1) PEP is recommended when occupational exposures to HIV occur; (2) the HIV status of the exposure source patient should be determined, if possible, to guide need for HIV PEP; (3) PEP medication regimens should be started as soon as possible after occupational exposure to HIV, and they should be continued for a 4-week duration; (4) new recommendation-PEP medication regimens should contain 3 (or more) antiretroviral drugs (listed in Appendix A ) for all occupational exposures to HIV; (5) expert consultation is recommended for any occupational exposures to HIV and at a minimum for situations described in Box 1 ; (6) close follow-up for exposed personnel ( Box 2 ) should be provided that includes counseling, baseline and follow-up HIV testing, and monitoring for drug toxicity; follow-up appointments should begin within 72 hours of an HIV exposure; and (7) new recommendation-if a newer fourth-generation combination HIV p24 antigen-HIV antibody test is utilized for follow-up HIV testing of exposed HCP, HIV testing may be concluded 4 months after exposure ( Box 2 ); if a newer testing platform is not available, follow-up HIV testing is typically concluded 6 months after an HIV exposure. |
Assessment of management policies and practices for occupational exposure to bloodborne pathogens in dialysis facilities
Mbaeyi C , Panlilio AL , Hobbs C , Patel PR , Kuhar DT . Am J Kidney Dis 2012 60 (4) 617-25 BACKGROUND: Occupational exposure management is an important element in preventing the transmission of bloodborne pathogens in health care settings. In 2008, the US Centers for Disease Control and Prevention conducted a survey to assess procedures for managing occupational bloodborne pathogen exposures in outpatient dialysis facilities in the United States. STUDY DESIGN: A cross-sectional survey of randomly selected outpatient dialysis facilities. SETTING & PARTICIPANTS: 339 outpatient dialysis facilities drawn from the 2006 US end-stage renal disease database. PREDICTORS: Hospital affiliation (free-standing vs hospital-based facilities), profit status (for-profit vs not-for-profit facilities), and number of health care personnel (≥100 vs <100 health care personnel). OUTCOMES: Exposures to hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV); provision of HBV and HIV postexposure prophylaxis. MEASUREMENTS: We calculated the proportion of facilities reporting occupational bloodborne pathogen exposures and offering occupational exposure management services. We analyzed bloodborne pathogen exposures and provision of postexposure prophylaxis by facility type. RESULTS: Nearly all respondents (99.7%) had written policies and 95% provided occupational exposure management services to health care personnel during the daytime on weekdays, but services were provided infrequently during other periods of the week. Approximately 10%-15% of facilities reported having HIV, HBV, or HCV exposures in health care personnel in the 12 months prior to the survey, but inconsistencies were noted in procedures for managing such exposures. Despite 86% of facilities providing HIV prophylaxis for exposed health care personnel, only 37% designated a primary HIV postexposure prophylaxis regimen. For-profit and free-standing facilities reported fewer exposures, but did not as reliably offer HBV prophylaxis or have a primary HIV postexposure prophylaxis regimen relative to not-for-profit and hospital-based facilities. LIMITATIONS: The survey response rate was low (37%) and familiarity of individuals completing the survey with facility policies or national guidelines could not be ascertained. CONCLUSIONS: Significant improvements are required in the implementation of guidelines for managing occupational exposures to bloodborne pathogens in outpatient dialysis facilities. |
Feasibility of selected prophylactic barriers in arrestance of airborne bacterial vegetative cells and endospores
Davidson CS , Green CF , Gibbs SG , Panlilio AL , Jensen PA , Jin Y , Scarpino PV . Am J Infect Control 2011 39 (7) 581-6 BACKGROUND: Transmission of infection by airborne agents is a risk for health care personnel, patients, and visitors. This risk is heightened in regions without access to environmental controls and personal protective equipment. The ability of 2 prophylactic barriers (ie, semitransparent netting for insect control) to arrest bioaerosols was assessed for potential use within the malarial zones. METHODS: Barriers (pore sizes of 0.8 mm and 0.25 mm) were challenged with bioaerosols of vegetative cells and endospores of Bacillus anthracis strain Sterne 34F2 using a bioaerosol chamber. Barriers were also challenged with airborne inert polystyrene latex particles of known diameters (0.1, 0.43, 0.6, 1.3, 3.2, and 8.0 mcm), and the arrestance provided by barrier with the 0.25 mm pore size was expressed as a function of aerodynamic diameter of challenge aerosols. RESULTS: Barrier with the 0.8 mm pore size provided no significant arrestance of aerosols, whereas the barrier with the 0.25 mm pore size provided an 8% arrestance of vegetative cells and a 13% arrestance of endospores. No arrestance at or below the 0.6 mcm particle size was observed. CONCLUSION: The level of arrestance provided by these prophylactic barriers does not justify their use as a sole method of preventing transmission. |
Method for evaluating the relative efficiency of selected N95 respirators and surgical masks to prevent the inhalation of airborne vegetative cells by healthcare personnel
Davidson C , Green CF , Panlilio AL , Jensen PA , Stover BH , Roselle G , Gibbs SG , Scarpino PV . Indoor Built Environ 2011 20 (2) 265-277 Aerosol droplet-and airborne-transmitted diseases are an important healthcare concern. The anthrax attacks of 2001, severe acute respiratory syndrome outbreaks in 2003 which resulted in transmission to numerous healthcare personnel (HCP) and concerns about smallpox as a bioterrorist agent have contributed to heightened concern about airborne infectious agents. Respirators and surgical masks can provide respiratory protection against such airborne diseases but their efficacy needs to be assessed. This study describes a method for quantitatively assessing the relative efficiency of respiratory protective equipment (RPE) when challenged with a bioaerosol. Five surgical masks, three N95 respirators and three surgical N95 respirators were evaluated. All are commercially available and used in US healthcare settings. Bacterial aerosols of vegetative Bacillus anthracis strain Sterne 34F2 (a surrogate for pathogenic B. anthracis) were generated with a six-jet Collison nebuliser. To mimic human respiratory breathing, an automated breathing simulator (ABS) calibrated to normal tidal volume and active breathing rate (500 mL/breath and 20 breath/min, respectively) was used. Respirators were placed on manikin head-forms designed for use in cardiopulmonary resuscitation training and used in our investigation as surrogates for HCP. The method showed that a Collison nebuliser could generate monodisperse bacterial aerosol to effectively test RPE total inward leakage. Also, the AGI-30 air samplers, combined with the ABS, provided an accurate method of quantifying RPE relative efficiency. For the 11 RPE this ranged from 34% to 69% with statistically significant differences between several RPE models. We conclude that neither RPE type nor brand name was an indicator of RPE relative efficiency. |
Tuberculosis epidemiology, diagnosis and infection control recommendations for dental settings: an update on the Centers for Disease Control and Prevention guidelines
Cleveland JL , Robison VA , Panlilio AL . J Am Dent Assoc 2009 140 (9) 1092-9 BACKGROUND: Although rates of tuberculosis (TB) in the United States have decreased in recent years, disparities in TB incidence still exist between U.S.-born and foreign-born people (people living in the United States but born outside it) and between white people and nonwhite people. In addition, the number of TB outbreaks among health care personnel and patients has decreased since the implementation of the 1994 Centers for Disease Control and Prevention (CDC) guidelines to prevent transmission of Mycobacterium tuberculosis. In this article, the authors provide updates on the epidemiology of TB, advances in TB diagnostic methods and TB infection control guidelines for dental settings. RESULTS: In 2008, 83 percent of all reported TB cases in the United States occurred in nonwhite people and 17 percent occurred in white people. Foreign-born people had a TB rate about 10 times higher than that of U.S.-born people. New blood assays for M. tuberculosis have been developed to diagnose TB infection and disease. Changes from the 1994 CDC guidelines incorporated into CDC's "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005" include revised risk classifications, new TB diagnostic methods, decreased frequencies of tuberculin skin testing in various settings and changes in terminology. CLINICAL IMPLICATIONS: Although the principles of TB infection control have remained the same, the changing epidemiology of TB and the advent of new diagnostic methods for TB led to the development of the 2005 update to the 1994 guidelines. Dental health care personnel should be aware of the modifications that are pertinent to dental settings and incorporate them into their overall infection control programs. |
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