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Assessment of ventilation in low-resource healthcare settings: Montserrado County, Liberia—2022−2023
- Krithika Srinivasan, Ronan Arthur, Ashley Styczynski, Ethan Bell, Thomas Baer, Jorge Salinas
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 3 / Issue S2 / June 2023
- Published online by Cambridge University Press:
- 29 September 2023, p. s12
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Background: Mitigating the risk of nosocomial respiratory disease transmission in the healthcare facilities of low- and middle−income countries (LMICs) poses unique challenges because mechanical ventilation and mixed−mode strategies are often unavailable. Carbon dioxide (CO2) can serve as a proxy for ventilation and, hence, airborne infectious disease transmission risk in naturally ventilated spaces. We assessed the adequacy of ventilation in Liberian hospitals. Methods: We sampled 3 hospitals, both urban and rural, in Montserrado County, Liberia. Moreover, 3 CO2 meters were concurrently utilized to measure CO2 levels at a 1-meter height in every patient-care room in each facility. We recorded temperature, humidity, room dimensions, and number of people in the rooms. From these variables, we calculated absolute ventilation using the ASHRAE equation to determine areas with the highest risk of nosocomial respiratory disease transmission. We also recorded qualitative observations about the sampled spaces. Results: From August 2022 to February 2023, 39 rooms in 3 healthcare facilities were sampled. Initial quantitative findings show that only 8 rooms (21%) met the WHO-recommended ventilation rate of 60 L per second per person. The average ventilation rate per person in the adequately ventilated settings was 86 L per second per patient, compared to 19 liters per second per patient in inadequately ventilated rooms. Additionally, 467 ppm mean CO2 was noted in well-ventilated rooms compared to 895 ppm mean CO2 in inadequately ventilated rooms.
Initial qualitative observations showed that facilities with lower CO2 readings tended to be older constructions that likely had been constructed with airborne disease such as tuberculosis in mind. Willingness to open windows was limited by lack of window screens for malaria prevention, and there was a pervasive fallacy that air conditioning was a source of ventilation. Correspondingly, of the 31 inadequately ventilated rooms, 22 (71%) had operating air conditioning units compared with 4 (50%) of the 8 adequately ventilated rooms. Overall, of the 13 rooms without air conditioning, 7 (54%) were more frequently characterized by open windows compared to only 5 of 26 (28%) of rooms that did have air conditioners. Conclusions: Being prepared for the next respiratory disease outbreak and creating more resilient healthcare systems in LMICs requires a frameshift of prevention strategies. Measuring CO2 provides a simple strategy for identifying areas at highest risk for nosocomial respiratory disease transmission, which can be prioritized for low-cost environmental interventions, such as provision of window screens, as part of routine infection prevention and control efforts.
Disclosure: None
Best practice mechanisms for biodiversity conservation law and policy
- Callum Brockett, Katie Woolaston, Felicity Deane, Fran Humphries, Ethan Kumar, Amanda Kennedy, Justine Bell-James
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- Journal:
- Cambridge Prisms: Extinction / Volume 1 / 2023
- Published online by Cambridge University Press:
- 13 June 2023, e16
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Around the world, countries have introduced laws and policies designed to prevent species extinction. While there have been some success stories, overall, these laws and policies are routinely failing. Extinction rates continue to climb. However, the law is necessary to regulate the human-environment interactions that form the basis of the drivers of extinction and biodiversity loss, including land-clearing, the discharge of greenhouse gases and the introduction of invasive species. The purpose of this paper is to evaluate the literature specifically on biodiversity conservation law, to review and describe the commonalities in laws and legal systems that can be considered successful, or unsuccessful. Laws for the conservation of biodiversity form a critical component for minimising the drivers of extinction, with species extinction being an extreme outcome of biodiversity loss. We reviewed 128 publications from around the world to ascertain and synthesise best practices in law and policy that aim to protect and conserve biodiversity (herein termed ‘biodiversity conservation law’). The literature demonstrated that when it comes to biodiversity conservation law, the concept of ‘best practice’ is elusive, and does not necessarily equate to a reversal in species decline. Further, most western countries utilise the same legal mechanisms (also known as policy tools) for biodiversity conservation, although some countries implement these laws more effectively than others. In this paper, we explore and explain several common legal mechanisms discussed across the range of literature, including species listing and recovery plans, protected area regulation, stewardship, restoration, and offset and no net loss schemes. We also explore the necessity of biodiversity and climate mainstreaming across all laws and highlight the need to engage in genuine partnerships and collaborations with First Nations communities. This paper, and the principles explored herein, should assist law and policymakers to regulate more effectively and explain to those in the conservation sciences where research should be directed to improve the science-policy interface.