BackgroundTB transmission in healthcare facilities is an important public health problem, especially in the often-overcrowded settings of HIV treatment scale-up. The problem is compounded by the emergence of drug resistant TB. Natural ventilation is a low-cost environmental control measure for TB infection control where climate permits that is suited to many different areas in healthcare facilities. There are no published data on the effect of simple structural modifications to existing hospital infrastructure to improve natural ventilation and reduce the risk of nosocomial TB transmission.The purpose of this study was to measure the effect of simple architectural modifications to existing hospital waiting and consulting rooms in a low resource setting on (a) improving natural ventilation and (b) reducing modelled TB transmission risk.MethodsRoom ventilation was measured pre- and post-modification using a carbon dioxide tracer-gas technique in four waiting rooms and two consulting rooms in two hospitals in Lima, Peru. Modifications included additional windows for cross-ventilation (n = 2 rooms); removing glass from unopenable windows (n = 2); creation of an open skylight (n = 1); re-building a waiting-room in the open air (n = 1). Changes in TB transmission risk for waiting patients, or healthcare workers in consulting rooms, were estimated using mathematical modelling.ResultsAs a result of the infrastructure modifications, room ventilation in the four waiting rooms increased from mean 5.5 to 15; 11 to 16; 10 to 17; and 9 to 66 air-changes/hour respectively; and in the two consulting rooms from mean 3.6 to 17; and 2.7 to 12 air-changes/hour respectively. There was a median 72% reduction (inter-quartile range 51–82%) in calculated TB transmission risk for healthcare workers or waiting patients. The modifications cost

The objective of this paper is to present the situational status of the National Health Research System of Peru (NHRS), the lessons learnt during the building process, the opportunities to improve it and the challenges. A description of the functions of the peruvian NHRS is done, in relation to governance, legal framework, research priorities, funding, creation and sustainability of resources and research production and utilization. It describes that in Peru we excert governance in research, we count with regulations, policy and research priorities, these last developed in the framework of a participatory, inclusive process. The conclusion reached is that the challenges of the peruvian NHRS are to consolidate the governance and to develop the mechanisms to articulate the stakeholders involved in research, to improve the resources allocation for research and innovation, to elaborate a plan for the development of human resources dedicated to research, to develop institutions and regional competences in order to perform research, and to link research in order to solve problems and make national research policies sustainable.

Peru has performed many efforts to identify national health research priorities since 1974 through processes historically planned based on expert opinions, with little impact. It was decided to generate a change in the management of research in order to overcome the weaknesses of the previous processes, applying a methodology with a participative and decentralized approach. In order to establish the regional and national research priorities of the key stakeholders, the Instituto Nacional de Salud (Peru) developed a process of citizenship consult through three phases i) advocacy and workshops in 20 regions; ii) a workshop for the analysis of the Concerted National Health Plan with 200 experts in Lima; iii) the national forum, with 500 representatives in 50 working tables. The research priorities of Peru for the period 2010- 2014 are: research to recognize the problems of health human resources, to recognize the mental health problems, impact evaluations of the social programs for reduction of children malnutrition, impact evaluation of social programs of the actual interventions in maternal mortality and operative research and impact evaluation of interventions in communicable diseases.

Backgound The members of the so-called ESKAPE group ( Enterococcus faecium , Staphylococcus aureus , Klebsiella pneumoniae , Acinetobacter baumannii , Pseudomonas aeruginosa and Enterobacter spp.) are a frequent cause of severe infection, ranking among the most relevant causes of hospital infections. In Peru, few studies, often focused in a single ESKAPE microorganism, have been performed, but none providing an overall and comprehensive long-time analysis of the antibiotic resistance of ESKAPE microorganisms. In the present study, the evolution of antimicrobial resistance levels of ESKAPE microorganisms isolated during 2009 - 2010 (Period 1) and 2012 - 2014 (Period 2) in a IV-level hospital in Lima was analyzed. Materials and Methods ESKAPE microorganisms were isolated from inpatients clinical samples. Bacterial identification, as well as antimicrobial susceptibility levels for up to 29 antimicrobial agents and presence of Extended-Spectrum β-Lactamases (only established in K. pneumoniae ) were determined using automatic methods. Results Of 9,918 clinical isolates, 1,917/3,777 (50.8%) [JAN/2009-JUN/2010 (Period 1)] and 4764/6141 (46.4%) [JAN/2012-DEC/2014 (Period 2)] belonged to the ESKAPE group ( P <0.0001). ESKAPE were more frequent in the intensive care unit (ICU) ( P <0.0001). E. faecium decreased from 5.1% to 4.1% ( P <0.5), S. aureus from 10.5% to 7.0% ( P <0.05), and P. aeruginosa from 12.9% to 11.6% ( P <0.05), while, A. baumannii increased from 5.0% to 6.7% ( P <0.05), mainly related to an increase in ICU isolates (8.4% vs. 17.1%; P <0.05). Overall, high levels of antimicrobial resistance were detected, but with few exceptions ( e.g. vancomycin in E. faecium ), antibiotic resistance levels remained stable or lower in Period 2. Contrarily, A. baumannii showed significantly increased resistance to different cephalosporins, carbapenems and amoxicillin plus sulbactam. Conclusion The introduction of a successful extensively drug-resistant A. baumannii clone in the ICU is suspected. The isolation of ESKAPE and levels of antibiotic resistance levels have reduced over time.