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  • Construction and validation of UV-C decontamination cabinets for filtering facepiece respirators APPLIED OPTICS Purschke, M., Elsamaloty, M., Wilde, J. P., Starr, N., Anderson, R., Farinelli, W. A., Sakamoto, F. H., Tung, M., Tam, J., Hesselink, L., Baer, T. M. 2020; 59 (25): 7585–95


    We present evidence-based design principles for three different UV-C based decontamination systems for N95 filtering facepiece respirators (FFRs) within the context of the SARS-CoV-2 outbreak of 2019-2020. The approaches used here were created with consideration for the needs of low- and middle-income countries (LMICs) and other under-resourced facilities. As such, a particular emphasis is placed on providing cost-effective solutions that can be implemented in short order using generally available components and subsystems. We discuss three optical designs for decontamination chambers, describe experiments verifying design parameters, validate the efficacy of the decontamination for two commonly used N95 FFRs (3M, #1860 and Gerson #1730), and run mechanical and filtration tests that support FFR reuse for at least five decontamination cycles.

    View details for DOI 10.1364/AO.401602

    View details for Web of Science ID 000571482900014

    View details for PubMedID 32902458

  • Pulse oximetry in low-resource settings during the COVID-19 pandemic. The Lancet. Global health Starr, N., Rebollo, D., Asemu, Y. M., Akalu, L., Mohammed, H. A., Menchamo, M. W., Melese, E., Bitew, S., Wilson, I., Tadesse, M., Weiser, T. G. 2020

    View details for DOI 10.1016/S2214-109X(20)30287-4

    View details for PubMedID 32628910

  • Value and Feasibility of Telephone Follow-Up in Ethiopian Surgical Patients. Surgical infections Starr, N., Gebeyehu, N., Tesfaye, A., Forrester, J. A., Bekele, A., Bitew, S., Wayessa, E., Weiser, T. G., Negussie, T. 2020


    Background: Surgical site infections (SSIs) represent a major cause of morbidity and mortality in Ethiopia. Lack of post-discharge follow-up, including identification of SSIs, is a barrier to continued patient care, often because of financial and travel constraints. As part of a surgical quality improvement initiative, we aimed to assess patient outcomes at 30 days post-operative with a telephone call. Patients and Methods: We conducted mobile telephone follow-up as part of Lifebox's ongoing Clean Cut program, which aims to improve compliance with intra-operative infection prevention standards. One urban tertiary referral hospital and one rural district general hospital in Ethiopia were included in this phase of the study; hospital nursing staff called patients at 30 days post-operative inquiring about signs of SSIs, health-care-seeking behavior, and treatments provided if patients had any healthcare encounters since discharge. Results: A total of 701 patients were included; overall 77% of patients were reached by telephone call after discharge. The rural study site reached 362 patients (87%) by telephone; the urban site reached 176 patients (62%) (p<0.001). Of the 39 SSIs identified, 19 (49%) were captured as outpatient during the telephone follow-up (p<0.001); 22 (34%) of all complications were captured following discharge (p<0.001). Telephone follow-up improved from 65%-78% in the first half of project implementation to 77%-89% in the second half of project implementation. Conclusion: Telephone follow-up after surgery in Ethiopia is feasible and valuable, and identified nearly half of all SSIs and one-third of total complications in our cohort. Follow-up improved over the course of the program, likely indicating a learning curve that, once overcome, is a more accurate marker of its practicability. Given the increasing use of mobile telephones in Ethiopia and ease of implementation, this model could be practical in other low-resource surgical settings.

    View details for DOI 10.1089/sur.2020.054

    View details for PubMedID 32301651

  • COVID-19 Preparedness within the Surgical, Obstetric and Anesthetic Ecosystem in Sub Saharan Africa. Annals of surgery Ademuyiwa, A. O., Bekele, A., Berhea, A. B., Borgstein, E., Capo-Chichi, N., Derbew, M., Evans, F. M., Feyssa, M. D., Galukande, M., Gawande, A. A., Gueye, S. M., Harrison, E., Jani, P., Kaseje, N., Litswa, L., Mammo, T. N., Mellin-Olsen, J., Muguti, G., Nabukenya, M. T., Ngoga, E., Ntirenganya, F., Rulisa, S., Starr, N., Tabiri, S., Tadesse, M., Walker, I., Weiser, T. G., Wren, S. M. 2020

    View details for DOI 10.1097/SLA.0000000000003964

    View details for PubMedID 32301806

  • Comment on "COVID-19 Preparedness Within the Surgical, Obstetric, and Anesthetic Ecosystem in Sub Saharan Africa". Annals of surgery Starr, N. n., Weiser, T. G. 2020

    View details for DOI 10.1097/SLA.0000000000004096

    View details for PubMedID 32433299

  • Improvement of WHO Surgical Safety Checklist Use in Emergency Operations in a Low Human Development Index Setting Starr, N. E., Gebeyehu, N., Tesfaye, A., Alemu, S. B., Habteyohannes, T., Wayessa, E., Forrester, J. A., Mammo, T. N., Weiser, T. G. ELSEVIER SCIENCE INC. 2019: S133
  • Qualitative outcomes of Clean Cut: implementation lessons from reducing surgical infections in Ethiopia. BMC health services research Mattingly, A. S., Starr, N., Bitew, S., Forrester, J. A., Negussie, T., Bereknyei Merrell, S., Weiser, T. G. 2019; 19 (1): 579


    BACKGROUND: Clean Cut is a six month, multi-modal, adaptive intervention aimed at reducing surgical infections through improving six critical perioperative processes: 1) handwashing/skin preparation, 2) surgical gown/drape integrity, 3) antibiotic administration, 4) instrument sterility, 5) gauze counts, and 6) WHO Surgical Safety Checklist use. The aim of this study was to elucidate themes across Clean Cut implementation sites in Ethiopia to improve implementation at future hospitals.METHODS: We conducted semi-structured interviews of 20 clinicians involved in Clean Cut at four hospitals. Participation was limited to Clean Cut team members and included surgeons, anesthetists, operating room (OR) nurses, ward nurses, OR managers, quality improvement personnel, and hospital administrators. Audio recordings were transcribed and coded using qualitative software. A codebook was inductively and iteratively derived between two researchers, tested for inter-rater reliability, and applied to all transcripts. We conducted thematic analysis to derive our final qualitative results.RESULTS: The interviews revealed barriers and facilitators to the implementation of Clean Cut, as well as strategies for future implementation sites. Key barriers included material resource limitations, feelings of job burden, existing gaps in infection prevention education, and communication errors during data collection. Common facilitators included strong hospital leadership support, commitment to improved patient outcomes, and organized Clean Cut training sessions. Future strategies include resource assessments, creating a sense of responsibility among staff, targeted training sessions, and incorporating new standards into daily routine.CONCLUSIONS: The findings of this study highlight the importance of engaging hospital leadership, providers and staff in quality improvement programs, and understanding their work contexts. The identified barriers and facilitators will inform future initiatives in the field of perioperative infection prevention.

    View details for DOI 10.1186/s12913-019-4383-8

    View details for PubMedID 31419972

  • Provision of surgical care in Ethiopia: Challenges and solutions GLOBAL PUBLIC HEALTH Kelly, C. M., Starr, N., Raykar, N. P., Yorlets, R. R., Liu, C., Derbew, M. 2018; 13 (11): 1691–1701


    With the lowest measured rate of surgery in the world, Ethiopia is faced with a number of challenges in providing surgical care. The aim of this study was to elucidate challenges in providing safe surgical care in Ethiopia, and solutions providers have created to overcome them. Semi-structured interviews were conducted with 10 practicing surgeons in Ethiopia. Following de-identification and immersion into field notes, topical coding was completed with an existing coding manual. Codes were adapted and expanded as necessary, and the primary data analyst confirmed reproducibility with a secondary analyst. Qualitative analysis revealed topics in access to care, in-hospital care delivery, and health policy. Patient financial constraints were identified as a challenge to accessing care. Surgeons were overwhelmed by patient volume and frustrated by lack of material resources and equipment. Numerous surgeons commented on the inadequacy of training and felt that medical education is not a government priority. They reported an insufficient number of anaesthesiologists, nurses, and support staff. Perceived inadequate financial compensation and high workload led to low morale among surgeons. Our study describes specific challenges surgeons encounter in Ethiopia and demonstrates the need for prioritisation of surgical care in the Ethiopian health agenda.LCoGS: The Lancet Commission on Global Surgery; LMIC: low- and middle-income country.

    View details for PubMedID 29448900