Comparison of doctors', nurses', politicians' and public attitudes to health care priorities

OBJECTIVES: The aim of this study was to investigate differences in attitudes concerning prioritisation in health care held by doctors, nurses, local politicians and the general public. METHODS: Four groups were established: a population sample of 2000 subjects, aged 18-70 years; a random sample of 1500 doctors of working age; a random sample of 1000 nurses of working age; and a sample of 2200 politicians involved in health and social care administration, mostly at the municipal level (altogether 6700 subjects). The main questionnaire contained, among other things, a list of 12 statements concerning ethical decisions regarding prioritisation in health care. Respondents were asked to indicate their level of agreement with each statement. RESULTS: Most respondents in all the groups felt able to express an opinion on the statements. Despite considerable professional and cultural differences between groups, the views were generally similar. On the whole, respondents supported liberal policies in which the community took responsibility for subsidising health care. When differences between groups occurred, it was usually the doctors who held discordant views. Doctors were less inclined to consider a patient's economic status as a determinant of priority for treatment than the other three groups. Both doctors and nurses were less punitive towards patients with self-induced diseases. And doctors and politicians were more likely to feel further cuts in health care expenditure were possible than was true for nurses and the public. CONCLUSIONS: While considerable uniformity of opinion exists on ethical issues of prioritisation between the principal interested parties, the views of doctors differ substantially on some matters. If prioritisation was left entirely to doctors, health care provision would not reflect the views of other groups in some important ways.     

Cadaveric donotransplantation: nurses' attitudes, knowledge and behaviour

Human organ transplantation is an important treatment for certain medical conditions, and for irreversible organ failure. There is a shortfall in the number of organs required for transplantation. The close and continuous proximity of nurses to potential donors and their families make them critical links in the organ donation process. Therefore, success in organ procurement may depend on nurses' awareness and integration of knowledge about donotransplantation (the process of organ/tissue donation and transplantation). Postal questionnaires were distributed throughout the United Kingdom (UK) to 2465 registered nurses, to assess their personal attitudes, knowledge and behaviour regarding cadaveric donotransplantation. One thousand, three hundred and thirty-three questionnaires were returned, a response rate of 54%. Overall, nurses held positive attitudes to donotransplantation, with 78% agreeing with organ donation and only 10% clearly being opposed. However, nurses were found to share ambivalent attitudes of altruism and fear which appear to surround decisions about donation. Factor analysis was used to further explore nurses' attitude structure. Six factors were confirmed providing a non-significant likelihood ratio fit (P = 0.468) and a well reproduced correlation matrix. The factors related to: (1) the value and contribution made by donotransplantation; (2) the unique idea of having another's tissue in one's own body; (3) the importance of organ donation; (4) the individual's moral, and nurses' professional rejection of the responsibility for organ/tissue donation; (5) the post-mortem mutilation of the body; and, (6) the potential distress donation may cause a bereaved family. Comparisons were made between certain of nurses' specialist groups and significant differences were found. Comparisons of factor scores between certain specialist groups or other strata were assessed by analysis of variance. Nurses working in renal units were significantly more in favour of donotransplantation than any other group of nurses.     

Dental hygienists and infection control: knowledge, attitudes and behaviour in Italy

This study evaluated knowledge, attitudes and behaviour regarding infection control of dental hygienists in Italy. Among the 185 responders to the self-administered mailed questionnaire, 91.3% agreed with the correct responses to the three questions on knowledge about infection prevention and control procedures chosen as an indicator of 'good' knowledge. However, 21% were uncertain whether, or disagreed that, dental instruments should be rinsed in water after contact with glutaraldehyde and 17.5% agreed that, or were uncertain whether, 10 min contact with glutaraldehyde provided sterilization. Only 36.5% knew all the five oral manifestations of acquired immunodeficiency syndrome (AIDS) (acute periodontal problems, candidiasis, hairy leukoplakia, herpes simplex virus, Kaposi's sarcoma) and this knowledge was significantly higher in dental hygienists with a lower number of years of practice. More than two-thirds used a steam sterilizer or glutaraldehyde for appropriate times and temperatures for disinfection/sterilization of instruments and used appropriate surface disinfection procedures. The correct application of disinfection or sterilization methods for instruments was more likely in the older respondents and in those who attended continuing education courses on infection control. A positive attitude was reported by the majority of dental hygienists who agreed that guidelines should be maintained and applied and was significantly more likely in younger respondents. Only 57.9% routinely follow all recommendations for infection control practices and their use was significantly higher in the older respondents. Educational programmes are needed for improving knowledge about oral manifestations of AIDS in order to support dentists to provide early diagnosis and about the correct use of procedures and universal precautions for preventing infections.     

Intensive care nurses' knowledge about the evidence-based guidelines of preventing central venous catheter related infection

OBJECTIVES: To determine intensive care unit (ICU) nurses' knowledge of evidence-based guidelines for preventing central venous catheter (CVC) related infection. METHOD: We used a validated multiple-choice questionnaire which was distributed to intensive care units between October and December 2006. We collected demographic data, like gender, years of ICU experience, number of ICU beds and whether respondents hold a special degree in intensive care. RESULTS: We collected 178 questionnaires from 11 intensive care units; the mean score was 3.66 on 10 questions (37%). Eighteen per cent knew that CVCs should be replaced on indication only, and 61% knew that this recommendation concerns also replacement over a guidewire. Recommendations for replacing pressure transducers and tubing every 4 days, and for using coated devices in patients requiring a CVC < 5 days in settings with high infection rates were recognized only by 48% and 66%, respectively. Regarding CVC dressings, 15% knew that these should be changed only when indicated and at least once weekly, and 35% recognized that both poly-urethane and gauze dressings can be recommended. Only 20% checked 2% aqueous chlorhexidine as recommended disinfection solution; 14% knew antibiotic ointments are not recommended because they trigger resistance. The recommendation to replace administration sets within 24 hours after administering lipid emulsions was recognized by 85%, but it was known by 5% only that these sets should be replaced every 96 hours when administering neither lipid emulsions nor blood products. Professional seniority and the number of intensive care beds in the ICU where nurses work showed not to be associated with better scores on the test. DISCUSSION: Knowledge regarding CVC-related infection is poor among Hungarian nurses. Prevention guidelines should be included in the nurse education curriculum as well as in continuing refresher nursing education programs.     

A survey to evaluate knowledge,attitudes, and practices associated with the risk of foodborne infection in a sample of Sicilian general population

Although foodborne infections contracted at home are frequent diseases worldwide, there is a general lack of information. Main purpose of this cross-sectional study was to evaluate knowledge, attitudes, and practices (KAP) of a sample of the general Sicilian population about the risk of contracting foodborne diseases. It was carried out through a web-based questionnaire to a Sicilian population sample. The questionnaire collected socio-demographic data, health issues, KAP and self-reported diseases. Scores were calculated for summarizing the results. A total of 373 subjects participated into the study. Overall, 65.15% of the participants were females, 48.26% of all respondents were aged between 18 and 29 years and over one-third were students (34.58%). At least one episode of vomiting/diarrhoea in the previous 3 months was reported by 119 respondents. Practices were associated with knowledge (R² = 0.02; p < 0.01) and attitudes (R² = 0.13; p < 0.001) although with low degree of correlation. A lower practice score was statistically significantly associated with both onset of foodborne transmitted infections in participants and among the cohabitants of participants. Our results confirm that foodborne disease can be strongly associated with food handling at home and with unsafe practices. Specific education on food safety could help to reduce the risk but the adoption of good practices of food manipulation is the real key to assure a reduction in food outbreaks in residences.     

A survey of knowledge, attitudes, and behavior of Italian dentists toward immunization

This study assessed the knowledge, attitude, and compliance to immunization guidelines among dental health-care professionals in Italy. A questionnaire was mailed to a random sample of 1000 dentists on demographic and professional characteristics; knowledge regarding infectious diseases that can be acquired/transmitted by the dentist and the vaccinations recommended; attitudes regarding the vaccinations; self-assessed information about previous vaccinations. A total of 369 dentists responded. Only 44.1 and 32.4% correctly indicated all infections that can be acquired or transmitted during their activity. Half of the dentists knew that they should be vaccinated against hepatitis B and influenza and this knowledge was significantly higher in those older, who correctly indicated that hepatitis B and influenza can be acquired and transmitted during their activity, and in those with a positive attitude towards vaccinations. Those younger, involved in specialties with low blood contact, and who did not know that hepatitis B and influenza are vaccinations recommended, were more likely to believe that is important for them to receive vaccinations. A large proportion (85.7%) reported receiving the hepatitis B vaccine, but only 56.2% the three doses. Those with a lower number of years of activity, those who knew that hepatitis B can be acquired by the dentist, those who did not need information, and those who were informed from guidelines, educational courses, and dental associations were more likely to have received the three doses or to be natural immunizated. Training and educational interventions are needed to improve knowledge and immunization coverage.     

National survey of hospital infection control organization in Italian public hospitals

A questionnaire was mailed to 1073 Italian public hospitals in an attempt to find out if infection control programmes existed, the type of programme used and available resources. After two attempts a total of 54.9 per cent of the hospitals responded to the request and of these 16.1 per cent claimed to have an infection control programme. Sixty-six per cent of the hospitals who have a control programme also have a system of continuous surveillance whilst the remainder investigated epidemics only. Infection control programmes were encountered most frequently in paediatrics, obstetrics and surgical departments. The organisms most often surveyed were the salmonellas, other types of enterobacteria, staphylococci and streptococci.     

中国医院手卫生知识知晓及依从性现状调查

目的了解我国医务人员手卫生知识知晓及依从性现状,为进一步推进手卫生工作提供科学依据。方法采用多中心研究的方式,对全国200所医院2015年手卫生知识知晓率及依从性数据进行回顾性调查。结果医务人员手卫生方法知晓率为86.5%,手卫生指征知晓率为82.5%;保洁员手卫生指征知晓率最低（69.9%）,其次是其他实习和进修生（70.2%）、医技人员（79.8%）;护理员手卫生方法知晓率最低（76.9%）,其次是其他实习和进修生（81.0%）、保洁员（82.4%）;二级医院知晓率均低于三级医院,不同级别医院中区县级医院知晓率均最低。手卫生依从率为70.1%,正确率为74.9%;其他实习和进修生的依从率、正确率均处于较低水平（分别为61.4%和60.9%）;不同级别医院中地市级医院依从率及正确率均最低,非教学医院依从率及正确率均低于教学医院。结论我国基层医院是手卫生的薄弱环节,实习生、进修生、护理员和保洁员是手卫生的薄弱群体,应加强手卫生管理,进一步提升手卫生知识知晓和依从性水平。     

A survey of nutrition knowledge, practice, attitudes and behaviour of general practitioner trainees in Ireland

Background: Medical research has acknowledged the relationship between nutrition and the development of chronic diseases, as well as the interaction between disease and nutritional status. However, nutrition education in the medical curriculum has been far from adequate. The present study was undertaken to examine the current status of nutrition awareness amongst general practitioner trainees throughout Ireland. Methods: A self-administered questionnaire (Q1) was used to assess the nutrition knowledge, attitudes, practice and behaviour of one hundred final year general practitioner trainees. A second questionnaire (Q2) was sent to the relevant medical faculties to ascertain the level of nutrition taught within the medical curricula. Results: The overall response rate to Q1 was 52% (34 females, 18 males). Respondents showed little awareness that nutrition had been included in their medical training. Q2 verified that nutrition mostly featured in the biochemistry component of the medical curricula. The results indicate the need to improve basic nutritional knowledge and its application in clinical practice. The disparity between the perceived importance of nutrition and personal lifestyle behaviours concurred with other studies. Conclusion: The general practitioner trainees were ill equipped to appreciate and value the extent of dietetic intervention for nutrition-related problems in clinical practice.     

警务人员艾滋病职业暴露的知识、态度、信念及行为调查

目的 对警务人员进行艾滋病职业暴露知识的调查,为进一步在警务人员中开展预防知识培训提供依据.方法 采用保密和匿名的问卷调查,对人口密集的广州市越秀区130位警务人员进行调查.结果警务人员在执行任务时存在大量的职业暴露危险因素,而且警务人员缺乏必要的应对能力.约40%的警务人员缺少自我防护意识;71名警务人员表示有过艾滋病职业暴露的危险,占62.83%,还有30人不确定有无,此两者共占89.38%;77%的警察不清楚职业暴露事件基本处理步骤.结论 所调查警务人员对艾滋病防治知识的了解缺乏深度,亟待加强艾滋病职业暴露相关教育与培训.     

Questionnaire-based survey on structural quality of hospitals and nursing homes for the elderly,their staffing with infection control personal,and implementation of infection control measures in Germany

From January to May 2012, 1,860 hospitals throughout Germany received a questionnaire encompassing 77 items. Additionally, 300 outpatient care services and 310 nursing homes for elderly in Berlin also received a 10-item questionnaire asking on their implemented infection control practices. All questionnaires were anonymous. A total of 229 completed questionnaires from hospitals, 14 questionnaires from outpatient care services, and 16 questionnaires from nursing homes were eligible for further analysis.The lack of Infection Control physicians was identified as the largest issue. In hospitals sized 400–999 beds a gap of 71%, and in hospitals sized ≥1,000 beds a gap of 17% was reported. Depending on the number of hospital beds, 13–29% of hospitals sized ≥100 beds reported not havening one infection control nurse. Since based on the number of beds in larger institutions or in facilities caring for high-risk patients several infection control nurses may be required, the deficiency in infection control nurses may even be higher, particularly in secondary and tertiary care facilities. Furthermore, the analysis revealed that the legal requirements for surveillance and reporting of notifiable infectious diseases have not yet been implemented in 11% of the facilities. The implementation of antibiotic strategies did show significant gaps. However, deficiencies in the implemented measures for the prevention of surgical site infections were less frequent. Yet 12% of the participants did not have a dedicated infection control concept for their surgical services. Eight percent of hospitals were not prepared for an outbreak management and 10% did not have established regulations for wearing surgical scrubs. Deficiencies in waste disposal and the control of air-conditioning systems were also noted. Based on the results of this survey, conclusions on the optimal resource allocation for further improvement of patient safety may be drawn.While all participating nursing homes had some sort of infection control consultation, this only applied to 12 out of 16 outpatient nursing services. However, all 16 nursing services worked on the basis of an implemented infection control plan. Though legally binding hygiene recommendations have not yet been implemented for nursing homes, the necessity of infection control to assure patient safety has obviously been recognised throughout these services.     

A survey of dietetics professionals' knowledge of and attitudes toward cholesterol management

Dietetics professionals in Wisconsin (n = 687) were surveyed to assess their knowledge, attitudes, practices, experience, and educational interests regarding cholesterol management. The survey, conducted to guide the development of cholesterol education programming in the state, found that most dietetics professionals are familiar with and support the guidelines of the National Cholesterol Education Program (NCEP). Ninety-three percent of dietetics professionals responding to the survey believe that reducing serum cholesterol levels will reduce the risk of heart disease; the same percentage of respondents were familiar with NCEP guidelines for detecting and treating blood cholesterol levels and knew which cholesterol levels should be treated. Seventy-three percent were familiar with the American Heart Association step 1 diet, and 69% were familiar with the step 2 diet. On average, survey respondents defined a cholesterol level of 6.12 mmol/L as “high risk”; this value is almost identical to the NCEP definition. Respondents were optimistic about patients' ability to reduce their blood cholesterol levels through dietary modifications. Dietetics professionals are interested in education on cholesterol management, although individual educational interests vary depending on the respondent's area of practice.