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Background: Observing hand hygiene compliance (HHC) among non-sterile healthcare workers (HCW) in the operating theatre (OT) is challenging, since there are no tailored protocols or observation tools.Aim: To develop and test a hand hygiene protocol tailored to non-sterile HCW in the OT.Methods: In this prospective observational study, nine hospitals in the Rotterdam-Rijnmond region provided input on a draft protocol on hand hygiene in the OT, resulting in a new consensus protocol for the region. An observation tool based on the protocol was developed and tested. HHC rates with 95%-confidence intervals (CI) were calculated by type of hospital and type of HCW.Findings: The protocol contains three sections: 1. written general hand hygiene rules, 2. written hand hygiene rules specific for anaesthesia and surgery, and 3. visual representation of the OT, divided into four hand hygiene areas. Hand hygiene should be applied when changing from area. An average HHC of 48.0% (95%-CI:45.2%-61.2%) was observed in OTs across all hospitals. The two specialized hospitals (64.0%, 95%-CI: 30.6%-89.8% and 76.7%, 95%-CI:62.8%-84.5%) scored the highest HHC, while the academic teaching hospital scored the lowest (23.1%, 95%-CI: 0.0%-45.8%). The average HHC of anaesthesiologists was the lowest (31.6%, 95%-CI: 19.2%-62.4%), the OT-assistants scored the highest (57.4%, 95%-CI: 50.1%-78.2%).Conclusion: This uniform way of observing HHC in the OT, enables evaluation of the effectiveness of interventions in the OT and facilitates friendly competition. In the Rotterdam-Rijnmond region, HHC in the OT was below 50% and needs to be addressed in teaching hospitals and among physicians. [ABSTRACT FROM AUTHOR]

Introduction The setting of priority in health care, surveillance and interventions is based increasingly on the results of studies on the burdens of disease and injury. (1,2) The burden of [...], Objective To develop a standardized method for calculating years lived with disability (YLD) after injury. Methods The method developed consists of obtaining data on injury cases seen in emergency departments as well as injury-related hospital admissions, using the EUROCOST system to link the injury cases to disability information and employing empirical data to describe functional outcomes in injured patients. Findings Overall, 87 weights and proportions for 27 injury diagnoses involving lifelong consequences were included in the method. Almost all of the injuries investigated (96-100%) could be assigned to EUROCOST categories. The mean number of YLD per case of injury varied with the country studied. Use of the novel method resulted in estimated burdens of injury that were 3 to 8 times higher, in terms of YLD, than the corresponding estimates produced using the conventional methods employed in global burden of disease studies, which employ disability-adjusted life years. Conclusion The novel method for calculating YLD after injury can be applied in different settings, overcomes some limitations of the method used to calculate the global burden of disease, and allows more accurate estimates of the population burden of injury. Objectif Mettre au point une methode normalisee de calcul des annees vecues avec une incapacite (AVl) apres une blessure. Methodes La methode developpee consiste a obtenir les donnees relatives aux blessures des services d'urgence, ainsi que celles relatives aux hospitalisations liees a des blessures, en utilisant le systeme EUROCOST pour relier les cas de blessures a l'information relative a l'invalidite, et en utilisant des donnees empiriques pour decrire les resultats fonctionnels chez les patients blesses. Resultats Au total, 87 poids et proportions pour 27 diagnostics de blessures impliquant des sequelles a vie ont ete inclus dans la methode. Presque toutes les blessures etudiees (96 a 100%) pouvaient etre attribuees aux categories EUROCOST. Le nombre moyen d'AVI par cas de blessure variait selon le pays etudie. L'utilisation de la nouvelle methode a entraine des charges estimees des blessures 3 a 8 fois superieures en termes d'AVI que les estimations correspondantes resultant des methodes classiques utilisees dans les etudes de charge globale de la morbidite, employant les annees vecues ajustees a l'incapacite. Conclusion La nouvelle methode de calcul d'AMI apres une blessure peut etre appliquee dans des contextes differents, surmonte certaines des limites de la methode utilisee pour calculer la charge globale de la morbidite et permet d'effectuer des estimations plus precises de la charge des blessures de la population. Objetivo Desarrollar un metodo estandarizado para calcular las atlas vividos con una discapacidad (YLD, par sus siglas en ingles) despues de un traumatismo. Metodos El metodo desarrollado consiste en la obtencion de datos acerca de las casos de traumatismos vistos en las servicios de urgencias y en hospitalizaciones relacionadas con traumatismos par media del sistema EUROCOST para relacionar las casos de traumatismos con la informacion sobre la discapacidad y utilizar las datos empfricos para describir las resultados funcionales en pacientes con traumatismos. Resultados En total, se incluyeron en el metodo 87 pesos y proporciones de 27 diagnosticos par traumatismo con consecuencias para toda la vida. La mayoria de las traumatismos investigados (96-100%) pudo asignarse a una de las categorias de EUROCQST. EI numero media de YLD par traumatismo vario en cada pais estudiado. EI usa del metodo novedoso dio coma resultado cargas estimadas de traumatismo que fueron de 3 a 8 veces mas altas, desde el punto de vista de los YLD, que las calculos correspondientes obtenidos a traves de las metodos convencionales empleados en las estudios mundiales sobre la carga de traumatismos, que utilizan las anos de vida ajustados par discapacidad. Conclusion EI metodo novedoso para calcular Ios YLD despues de un traumatismo puede aplicarse en entornos distintos, supera algunas de las limitaciones del metodo empleado para calcular la carga global de morbilidad y permite realizar estimaciones mas exactas de la poblacion con traumatismos.

The global burden of drowning Drowning is a major, but often neglected, public health problem, At the end of the 1990s, the World Bank and WHO released the first global [...], Drowning is a major global public health problem. Effective prevention of drowning requires programmes and policies that address known risk factors throughout the world. Surveillance, however, has been hampered by the lack of a uniform and internationally accepted definition that permits all relevant cases to be counted. To develop a new definition, an international consensus procedure was conducted Experts in clinical medicine, injury epidemiology, prevention and rescue from all over the world participated in a series of 'electronic' discussions and face-to-face workshops The suitability of previous definitions and the major requirements of a new definition were intensely debated. The consensus was that the new definition should include both cases of fatal and nonfatal drowning. After considerable dialogue and debate, the following definition was adopted: 'Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid.' Drowning outcomes should be classified as: death, morbidity, and no morbidity. There was also consensus that the terms wet, dry, active, passive, silent, and secondary drowning should no longer be used. Thus a simple, comprehensive, and internationally accepted definition of drowning has been developed. Its use should support future activities in drowning surveillance worldwide, and lead to more reliable and comprehensive epidemiological information on this global, and frequently preventable, public health problem. Keywords Drowning/epidemiology; Epidemiologic surveillance (source: MESH, NLM). Mots cles Noyadetepidemiologie; Surveillance epidemiologique (source: MESH, INSERM). Palabras clave A hogamientdepidemiologia; Vigilancia epidemiologica (fuente: DeCS, BIREME). Arabic Bulletin of the World Health Orgarnization 2005;83:853-856. Voir page 855 to resume en francais En la pagina 855 figura un resumen en espanol.