ghana =2000 docs, netherlands 16000

2.4 m docs/nurses extra needed to meet global shortage

cut poverty to 10-12% by 2015,
midwife preg ratio in ghana is 44% ,
amputations in africa due to landmines,
<5yr mortality a way of determining riches of country
deaths in africa due to ill health (LRTI)= 3.5m
diarrhoea= 2.2m deaths in children
ORT reduces death rate from 50 to 1%
12.1 refugees worldwide, 26m displaced due to conflict, 25m due to natural disaster, iraq is no 1
souce globally, zimbabwe for uk
uk ranked 16th interms of asylem seekers <2% total refugees come to uk (make up 0.4% of uk
population, they can only get care for emergencies, tb, n stis
26% us are obsese
170 children under detention 2007 in uk, 25000 in 2005
hep b and tb notifiable disease

anthrax

- bacillus anthracis (large non motile, non hemolytic gram +ve)

cutaneous: small papule/vesicle, ulcerates painless, surrounded by non pitting oedema

inhalation: fever chills, sob, effusion, mediastinal widening

intestinal: fever abdo pain, Diarrhoea, ascites, obstruction, peforation

source: animal skins, drum maker in gambia

ix: blood culture grows G+ in 2hrs, rx: ciprofloxacin, rifampicin and clindamycin, giv AIg

infection control team: health protection agency, local services and others (DEFRA, GDS)

4 working groups: clinical team, epidemiological and contacts investigation team, environmental
team, communication and media team

Needle stick injury

Control/action: multi agency incident control meeting, communications, emergency clinic

Risk assessment for hiv (48hrs), offer PEP, sourcing PEP/hepB vaccine

Random case study: 3 mnth sample; 18/20 –ve 4 hiv, hbv,hcv, 2 got pep not tested, 2 did not accept
pep/testing, 6month sample: all -ve (wot a load of sh**!)

Rabies

25th april 2008 dog in quarantine, imported from sri lanka dies, confirmed rabies, 2 ppl bitten, joint
management with HPU and Cfl
Risk assessment: quarantine staff, visitors, houses that received dogs etc

Exposure type: one of 3 index puppies, dogs at quarantine unit, dogs released from unit, rescue
personnel, bite to broken skin, contact with body fluids

PH actions: non vaccinated – HRIG, vaccine 5x

Partially vaccinated- vaccine 5x

Fully vaccinated- vaccine 2 x, ab levels (HRIG for bites)

HRIG omitted if contact = saliva/body fluid on to gloves

Risk assessment= questionare was made, 42 contacts in total: i sri lankan sergeon, 20 staff, 3
families with dogs, reception staff :13 at heathrow, 3 cargo handlers at heathrow, 4 animal charity
staff

Incomplete vaccine and :

bite= HRIG; contact= 2 or 5 doses of vaccine

full vaccine, contact with gloves, visitors no contact= no action

people who removed other dogs = reassurance and advice

all achieved via 5 teleconfronces, 53 emails, 65 phone calls (Defra, animal health, DH) advice to sri
lanka via IHR focal point

infection prevention and control team

costs £1b a year

health care associated infection: infection neither present or incubated at time of admission (early as
48hrs, most commonly after 2 weeks), 30% are preventable

alert organism: identified by lab based survalence (70% infections detected this way)

inc: mrsa, vancomycin resistant enterococci, multi drug resistant G-ve rods (ecoli, klebsiella), c diff

standard precautions: hand washing, ppe, sharps handling, disposal of clinical waste, dealing with
spills proply etc

isolation precautions: as above, wear aprons, clean stephs, wash hands

needle stick injury, risk of infection:

hbv: 1:3, hcv:1:30, hiv 1:300

where it happens: 37% AnE, 43%ward, 20% ICU, 22%theatres

hand hygiene very important

meningitis:

viral; self limiting

3 pathogens; neisseria meningitides, haemophillus influenza,strep P,

Risk factors: overcrowed, passive smoking, recent influenza A, asplenia, travel to Africa (group A),
hajj pilgrims (group W135), not doing of yoga

Transmission: resp drops, prolonged kissing

Nitifiable, give rifampicine prophylaxis to other neiboring contacts, se: colours the piss (lucozade),
inactivates ocp, antiepileptics, CI: preg and jaundice

10% population have throat carriage