Evaluation of policies regarding physicians infected with blood-borne pathogens.

OBJECTIVE: Formulating an effective approach to preventing surgeon-to-patient transmission of blood-borne pathogens has been controversial. The objective of our study was to evaluate current community hospital policies, if any, regarding restrictions on surgeons (general surgeons and obstetricians and gynecologists) infected with blood-borne pathogens operating on patients. DESIGN: A survey on hospital policies regarding surgeons infected with blood-borne pathogens was sent to infection control officers at Northern California community hospitals (n = 113). RESULTS: Forty-five hospitals responded to the survey. Of these, only 6 (13.3%) had a policy. Of the 39 (86.7%) that did not have a policy, only 3 hospitals were planning on implementing one. CONCLUSIONS: Many community hospitals are uninterested in instituting a policy regarding the practice of surgeons infected with blood-borne pathogens. Possible reasons include the lack of concern on the individual level, difficulty in defining exposure-prone procedures, and the nature of the relationship between medical staff and community hospitals.     

Assessment of quality assurance in HIV testing in health facilities in Lake Victoria zone, Tanzania

Tanzania is currently implementing the antiretroviral treatment programme, and has a target of putting about 400,000 eligible HIV infected individuals on treatment by 2008. This will involve screening a large number of people, which will require non-laboratory personnel to be involved in doing HIV testing. In order to guarantee reliable and quality HIV test results, there is a need to ensure that quality assurance (QA) procedures are followed from specimen collection, testing and reporting of results. In light of the above a survey was conducted to assess QA in HIV testing in health facilities in Lake Victoria zone, Tanzania. A total of 89 health facilities (29 hospitals, 34 health centres, 9 dispensaries and 17 voluntary and counselling testing centres) were surveyed. Only three (10.3%) health facilities reported performing Uniform II ELISA for HIV diagnosis. All other health facilities reported to be using HIV rapid tests Capillus and Determine. Five (5.6%) of health facility laboratories performed CD4 counts. Internal quality control (IQC) were performed in 21 (63.6%) of the hospitals. Kits for HIV testing were reported to be readily available by 54 (60.7%) of the facilities. Only 16 (18%) of the health facilities had standard operating procedures in place. Systems of equipment calibration were reported by 13 (14.6%) of the health facilities. Counselling services were available in all health facilities and all counsellors had received the 6-week mandatory training course. These findings show that most of health facilities in the Lake Victoria zone do not adhere to QA procedures in HIV testing. There is therefore, a need to establish a monitoring system to laboratories performing HIV testing for the purpose of ensuring QA procedures are done. Personnel doing HIV testing should be re-trained at a regular basis to cope with new techniques and ensure QA procedures are followed.     

Smoking policies in U.S. hospitals: current status

Hospitals can and should restrict cigarette smoking to promote a healthy environment and to exemplify health promoting behavior. Questionnaires to determine policies and programs relating to smoking were sent to the administrative heads of 360 randomly selected hospitals across the nation. Returns were received from 330 hospitals for a response rate of 91.7%. Only 1.2% of the hospitals surveyed totally banned smoking. Visitors, patients who smoked, and physicians were seen as most resistant to smoking restrictions. The majority of hospitals (56.0%) continued to sell cigarettes on the premises. States whose economies are involved with tobacco are more permissive than the others to a significant degree. Since the hospital administration is the primary force in implementing smoking policy, the smoking behavior of the administrator may affect institutional smoking policies. It does affect their attitude about hospital employee smoking and the health professional's responsibility about smoking to a significant degree. Thus, hospitals are not demonstrating leadership in creating safe nonsmoking environments for the patients, nor in offering smoking education programs to the community.     

Workplace violence prevention programs in hospital emergency departments

OBJECTIVE: Hospital violence is a growing concern, yet little is known about existing programs. This study compared workplace violence programs in high-risk emergency departments among a representative sample of 116 hospitals in California and 50 hospitals in New Jersey. METHODS: Information was collected through interviews, a facility walk-through, and review of written policies, procedures, and training material. Programs were scored on the components of training, policies and procedures, security, and environmental approaches. RESULTS: California had significantly higher scores for training and policies and procedures, but there was no difference for security and environmental approaches. Program component scores were not highly correlated. For example, hospitals with a strong training program were not more likely to have strong policies and procedures. CONCLUSIONS: Most hospitals in California and New Jersey had implemented a workplace violence prevention program, but important gaps were found.     

Policies for hospital sales programs: investigating differences in implementation.

The authors report the findings of a national survey of hospital sales programs. They measure the degree to which hospitals have implemented sales policies and examine differences between the hospitals.     

Occupational health policies and practices related to tuberculosis in health care workers in KwaZulu-Natal,South Africa

Setting:

Three district hospitals in KwaZulu-Natal, South Africa, with specialized drug-resistant tuberculosis (TB) wards.

Objective:

To increase understanding of the implementation of occupational health (OH) and infection control (IC) guidelines for the prevention and control of TB among health care workers (HCWs).

Design:

An operational cross-sectional study conducted between July and September 2011, consisting of interviews with OH and IC nurses and chart review of OH medical records.

Results:

Although general national and provincial OH policies are in place, no specific OH policies exist for hospital settings. Two of three hospitals had a full-time OH nurse and all had a full-time IC nurse. All hospitals offered TB symptom screening; however, only 19% of HCWs were screened in 2010. TB incidence among HCWs was 1958 per 100 000 population in 2010. All hospitals offered HIV counseling and testing; however, only 22% of staff were tested across sites. Two hospitals offered isoniazid preventive therapy to HIV-positive staff and reassigned these staff to low TB risk areas.

Conclusions:

While OH policies and procedures are in place, implementation of these policies and procedures is inconsistent. This potentially places HCWs at risk of acquiring TB. These findings support the need for strengthening OH and IC services to prevent TB.     

医院统计人员职业技能调查与继续教育设想

目的了解医院卫生统计人员的职业技能情况,为进一步的进行有针对性的培训提供依据.方法 采用自行设计的问卷,通过问卷方式对全军264名医院统计人员进行调查.调查表共分4部分、32个小项.调查内容包括人员基本情况、职业技能知识的掌握及应用情况以及希望得到哪些知识的培训等几个方面.结果 本次调查共发出问卷264份,收回有效问卷257份,回收率为97.3%.在被调查者中,男性37人,占14.4%,女性220人,占85.6%,平均年龄31.6岁.多数人为大专学历,占53.7%.职称构成以中级职称为主,占54.1%,从事统计工作的年限普遍较短.医院统计人员专业背景大多为非统计学专业,统计专业仅占16.7%.大部分人员职业技能水平偏低,普遍希望能够接受相应的职业技能培训.结论 各级卫生行政管理部门应该制定有针对性的医院卫生统计人员培训计划,提高医院卫生统计人员利用统计信息为医院管理服务的能力.     

Ethics policies on euthanasia in hospitals--A survey in Flanders (Belgium)

OBJECTIVE: To determine the prevalence, development, stance, and communication of written institutional ethics policies on euthanasia in Flemish hospitals. METHODS: Cross-sectional mail survey of general directors of all hospitals (n=81) in Flanders, Belgium. RESULTS: Of the 81 hospitals invited to participate, 71 (88%) completed the questionnaire. Of these, 45 (63%) had a written ethics policy on euthanasia. The Belgian Act on Euthanasia and centrally developed guidelines of professional organisations were the most frequently mentioned reasons for and sources used in developing ethics policies on euthanasia in hospitals. Up to one-third of hospitals reported that they developed the policy upon request from physicians or nurses, or after being confronted with a euthanasia request. Development and approval of institutional ethics policies occurred within a multidisciplinary context involving clinicians, ethicists, and hospital administrators. The majority of hospitals restrictively applied the euthanasia law by introducing palliative procedures in addition to legal due care criteria. Private Catholic hospitals, in particular, were more likely to be restrictive: euthanasia is not permitted or is permitted only in exceptional cases (in accordance with legal due care criteria and additional palliative care procedures). The majority of hospitals took the initiative to communicate the policy to hospital physicians and nurses. CONCLUSIONS: Since the enactment of the Belgian Act on Euthanasia in 2002, the debate on how to deal with euthanasia requests has intensified in Flemish hospitals. The high prevalence of written institutional ethics policies on euthanasia and other medical end-of-life decisions is one possible outcome of this debate.     

Students performance vs. hospital performance in the labor market for medical interns and residents. Do hospitals perform better due to asymmetry in information available to them relative to students?

This paper concerns the labor market for medical interns and residents in the U.S., and in particular, the question of whether the current matching mechanism between graduating medical students and hospitals is 'informationally inefficient'. It was found that overall students performed better than hospital programs in contrast to the common claim that hospitals are more likely to perform better due to seeming superiority in analyzing publicly available information or through access to non-publicly available information. We also conducted a similar analysis for the different specialty programs. In six specialty programs the students' performance was better than hospitals, in two specialty programs the hospitals performance was better than the students and in 14 specialty programs the difference in performance was not statistically different from zero. Thus, only in two cases the hypothesis that the specialty market is informationally inefficient cannot be rejected using the data available. It should be noted that this market is atypical (compared with other labor markets) in that we can test whether it is informationally inefficient by using a practical definition adopted from the field of finance.     

Underestimation of snakebite mortality by hospital statistics in the Monaragala District of Sri Lanka

Estimates of snakebite mortality are mostly based on hospital data, although these may considerably underestimate the problem. In order to determine the accuracy of hospital-based statistics, data on snakebite mortality in all hospitals in the Monaragala District of Sri Lanka were compared to data on snakebite as the certified cause of death for the district, for the 5-year period between 1999 and 2003. Data were cross-checked in a sample of hospitals and divisional secretariats within the district. Hospital statistics did not report 45 (62.5%) of the true number of snakebite deaths in the Monaragala District. Twenty-six (36.1%) of the victims either did not seek, or had no access to, a hospital. Another 19 (26.4%) had arrived at hospital, but had done so too late to receive treatment. Our study confirms the limitations of official hospital-based mortality data on snakebite.     

Ethics policies on euthanasia in hospitals—A survey in Flanders (Belgium)

ObjectiveTo determine the prevalence, development, stance, and communication of written institutional ethics policies on euthanasia in Flemish hospitals.MethodsCross-sectional mail survey of general directors of all hospitals (n = 81) in Flanders, Belgium.ResultsOf the 81 hospitals invited to participate, 71 (88%) completed the questionnaire. Of these, 45 (63%) had a written ethics policy on euthanasia. The Belgian Act on Euthanasia and centrally developed guidelines of professional organisations were the most frequently mentioned reasons for and sources used in developing ethics policies on euthanasia in hospitals. Up to one-third of hospitals reported that they developed the policy upon request from physicians or nurses, or after being confronted with a euthanasia request. Development and approval of institutional ethics policies occurred within a multidisciplinary context involving clinicians, ethicists, and hospital administrators. The majority of hospitals restrictively applied the euthanasia law by introducing palliative procedures in addition to legal due care criteria. Private Catholic hospitals, in particular, were more likely to be restrictive: euthanasia is not permitted or is permitted only in exceptional cases (in accordance with legal due care criteria and additional palliative care procedures). The majority of hospitals took the initiative to communicate the policy to hospital physicians and nurses.ConclusionsSince the enactment of the Belgian Act on Euthanasia in 2002, the debate on how to deal with euthanasia requests has intensified in Flemish hospitals. The high prevalence of written institutional ethics policies on euthanasia and other medical end-of-life decisions is one possible outcome of this debate.     

Diffusion of surgical technology. An exploratory study.

The study presents an empirical analysis of the diffusion patterns of five surgical procedures. Roles of payer mix, regulatory policies, physician diffusion, competition among hospitals, and various hospital characteristics such as size and the spread of technologies are examined. The principal data base is a time series cross-section of 521 hospitals based on discharge abstracts sent to the Commission on Professional and Hospital Activities. Results on the whole are consistent with a framework used to study innovations in other contexts in which the decisions of whether to innovate and timing depend on anticipated streams of returns and cost. Innovation tends to be more likely to occur in markets in which the more generous payers predominate. But the marginal effects of payer mix are small compared to effects of location and hospital characteristics, such as size and teaching status. Hospital rate-setting sometimes retarded diffusion. Certificate of need programs did not.     

Perioperative antibiotic prophylaxis in Spanish hospitals: results of a questionnaire survey. Hospital Pharmacy Antimicrobial Prophylaxis Study Group.

A questionnaire survey was sent to a random sample of the Spanish network of National Health System public acute-care hospitals. Of responding institutions (representing 25% of Spanish hospital beds), nearly 75% had active surveillance programs for the prevention and control of surgical-site infections (SSIs), but only 20% performed postdischarge surveillance. Overall, perioperative antibiotic prophylaxis (PAP) was used in 84% of all surgical procedures. For 77% of procedures, there were written guidelines for the choice and use of PAP. Cefazolin was the most commonly used antibiotic (38%). Duration of PAP was shorter than 24 hours in 75% of procedures, and only a single dose was given in 52% of procedures. PAP was commonly used in breast (52%) and inguinal hernia repair (69%) procedures, as well as in laparoscopic abdominal surgery (86%). In summary, the use of PAP in Spanish hospitals is adequate, but improvements can be made in the frequency of prolonged PAP and in the use of broad-spectrum antibiotics. Surveillance systems for SSI, including postdischarge follow-up, also should be improved.     

Medical student training in the performance of diagnostic laboratory procedures

A study was conducted to determine what diagnostic laboratory procedures medical students recalled being taught during pre-clerkship training, how well they felt they could perform these procedures on entrance to and exit from their clerkship year, and the estimate of frequency of personal performance during the clerkship year. Surveys were mailed to 223 graduating senior students of a medical school. They were asked to supply data regarding 15 pre-selected procedures. In only seven cases did a majority of students recall being taught a procedure. Higher percentages of students who trained at health science centres and a Veterans Administration hospital recalled being taught procedures compared to students who trained at community hospitals. In general, students who performed their pre-clerkship training at the health science centres rated their ability to perform procedures without assistance on entrance to the clerkship year higher than the other two groups. Students who performed at least one half of their clerkships at a health science centre rated their ability to perform procedures without assistance at the termination of their clerkship year higher than those who performed a majority of clerkships at community hospitals. The former group also reported a higher frequency of performance of the procedures than the community hospital group. Most of the procedures for all groups, however, were performed at a rate of less than one/month.     

Institutionalization of quality improvement programs in Korean hospitals.

OBJECTIVE: To investigate the institutionalization of quality improvement (QI) programs in Korean hospitals, in which organizational efforts to improve the quality of care have been made only recently. DESIGN: A cross-sectional study based upon an initial telephone contact and follow-up mail survey. STUDY PARTICIPANTS: All hospitals with 400 beds or more, 100 as of 1997, were contacted in the initial telephone survey. The survey questionnaire was then sent to all of 28 hospitals found to have a QI department; 26 hospitals returned the completed questionnaire. RESULTS: Hospitals that had larger bed capacities, that provided tertiary levels of care or that were in urban areas were found to have a higher tendency to establish QI departments. These QI departments most frequently cited improvement of patient satisfaction as one of their overall missions. They also reported that their most important responsibilities were monitoring performance and preparing for the two national Korean hospital assessment programs. Participating in these hospital assessment programs helped them to initiate and develop their QI activities. The main difficulties they had in performing their QI programs stemmed from lack of knowledge and resources. These survey findings indicate that hospital assessment programs significantly aided Korean hospitals to institutionalize their QI programs. At the same time, the survey data indicate that the hospital assessment programs may emphasize short-term benefits from QI activities at the expense of long-term QI institutionalization. CONCLUSION: QI programs have not as yet been fully institutionalized in Korean hospitals. More support for QI structure and organizational preparation at both the national and organizational levels will be needed.     

Preventing catheter-associated bloodstream infections: a survey of policies for insertion and care of central venous catheters from hospitals in the prevention epicenter program.

OBJECTIVE: To determine the extent to which evidence-based practices for the prevention of central venous catheter (CVC)-associated bloodstream infections are incorporated into the policies and practices of academic intensive care units (ICUs) in the United States and to determine variations in the policies on CVC insertion, use, and care. DESIGN: A 9-page written survey of practices and policies for nontunneled CVC insertion and care. SETTING: ICUs in 10 academic tertiary-care hospitals. PARTICIPANTS: ICU medical directors and nurse managers. RESULTS: Twenty-five ICUs were surveyed (1-6 ICUs per hospital). In 80% of the units, 5 separate groups of clinicians inserted 24%-50% of all nontunneled CVCs. In 56% of the units, placement of more than two-thirds of nontunneled CVCs was performed in a single location in the hospital. Twenty units (80%) had written policies for CVC insertion. Twenty-eight percent of units had a policy requiring maximal sterile-barrier precautions when CVCs were placed, and 52% of the units had formal educational programs with regard to CVC insertion. Eighty percent of the units had a policy requiring staff to perform hand hygiene before inserting CVCs, but only 36% and 60% of the units required hand hygiene before accessing a CVC and treating the exit site, respectively. CONCLUSION: ICU policy regarding the insertion and care of CVCs varies considerably from hospital to hospital. ICUs may be able to improve patient outcome if evidence-based guidelines for CVC insertion and care are implemented.     

从新医改方案看公立医院落实公益性的难点及其对策

我国公立医院的属性是公立,资产属于国家,而经营行为,明显走上了营利性道路。公立医院公益性淡化的根源在于：政府主导责任缺失、补偿机制扭曲、资源配置不合理、公立医院公益性意识淡化。落实公立医院的公益性质,要坚持政府主导,增加政府投入,强化行业监管;坚持推进改革,完善医院运行机制。     

Voluntary reporting of health care personnel seasonal influenza vaccination rates and the impact of universal policies in Illinois hospitals

Objective

In 2009, voluntary public reporting of hospital health care personnel (HCP) vaccination rates began in Illinois. We describe our experience over 3 influenza seasons and examine the impact universal policies have had on performance.

Methods

A secure website was used to report monthly HCP vaccination rates by each participating hospital. Overall and individual hospital performance was publicly reported each month.

Results

In the first two seasons, there were 11 hospitals reporting with an average end of season rate of 76% (2009–2010) and 81% (2010–2011). In the 2011–2012 season, there were 22 hospitals reporting, 9 of which had a new universal policy for HCP influenza vaccination. The average 2011–2012 end of season rate was 72% for hospitals with a voluntary program and 95% for hospitals with a universal policy. HCP were also vaccinated earlier in the influenza season when a universal policy was in place, providing greater benefit over time.

Conclusion

Public reporting of HCP influenza vaccination rates may contribute to implementation of universal employee vaccination policies. Hospitals with universal policies have higher vaccination rates than those with voluntary vaccination programs.     

The effects of positive incentive programs on physician chart completion

It seems evident that both concurrent review programs and positive incentive programs have been implemented by a number of facilities in which little, if any, monitoring has occurred. Only half of the hospitals performing concurrent analysis provided statistics concerning the percentage of daily discharges arriving in the medical record department complete. Only one fourth of the hospitals provided information concerning the number of incomplete and delinquent medical records before and after the implementation of concurrent review. These data underscore the need for medical record administrators to evaluate the effectiveness of various strategies used to improve completion of medical records. Likewise, only a few of the hospitals that have implemented an incentive program for chart completion were able to provide all of the requested statistics concerning their chart status prior to and following the implementation of their programs. The results of the study indicate that numerous innovative procedures have been implemented in hospitals, with varying degrees of impact on the number of incomplete and delinquent medical records. The use of positive incentive programs in conjunction with punitive action is effective in helping to reduce the number of incomplete medical records.