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1.
Toxicol Appl Pharmacol ; 429: 115694, 2021 10 15.
Article in English | MEDLINE | ID: mdl-34428445

ABSTRACT

Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a technique to directly deliver chemotherapeutic drugs in the abdomen for the treatment of peritoneal metastases. Pressurization improves the treatment efficacy but increases the risk of exposure for the medical/non-medical staff who can be exposed by dermal or ocular contact, or inhalation of aerosols containing the cytotoxic drugs. The aim of this study was to evaluate the risk of exposure for the medical/non-medical staff (nurses, surgeons, anaesthesiologists and cleaning personnel; n = 13) during PIPAC with oxaliplatin performed according to the protocol recommended in France. Blood samples were collected 1 h before and immediately after PIPAC, and urine samples 1 h before, and then 3 h and the morning after PIPAC. In the control, non-exposed group (n = 7), only one urine and blood sample were collected. Surface contamination in the operating room was assessed in water- and Surfanios-impregnated wipe samples. The total elemental platinum in each sample was quantified by inductively coupled plasma mass spectrometry, using a method adapted to quantify trace amounts (ng.L-1) in very low volumes (100 µl). No surface contamination was detected. Although 25% of urine samples in the exposed group contained platinum, no statistical difference was observed in urine and plasma samples collected before and after PIPAC and with the control group samples. These findings suggest that the French PIPAC protocol does not increase the risk of exposure to platinum in all staff categories involved. This protocol could be considered in future occupational policies and consensus statements. Trial registration: NCT04014426.


Subject(s)
Antineoplastic Agents/adverse effects , Drug Delivery Systems/adverse effects , Housekeeping, Hospital , Medical Staff, Hospital , Occupational Exposure/adverse effects , Occupational Health , Oxaliplatin/adverse effects , Peritoneal Neoplasms/drug therapy , Aerosols , Antineoplastic Agents/administration & dosage , Case-Control Studies , Environmental Monitoring , Humans , Oxaliplatin/administration & dosage , Peritoneal Neoplasms/secondary , Peritoneum , Pressure , Risk Assessment , Risk Factors
2.
BMC Infect Dis ; 21(1): 233, 2021 Feb 27.
Article in English | MEDLINE | ID: mdl-33639871

ABSTRACT

BACKGROUND: The risk of hepatitis B virus infection among medical waste handlers who undergo collection, transportation, and disposal of medical wastes in the health institutions is higher due to frequent exposure to contaminated blood and other body fluids. There is limited evidence on the seroprevalence of hepatitis B among medical waste handlers in eastern Ethiopia. The study was aimed at studying the seroprevalence of Hepatitis B Virus and associated risk factors among medical waste collectors at health facilities of eastern Ethiopia. METHODS: A facility-based cross-sectional study was conducted among randomly selected medical waste collectors from public health facilities in eastern Ethiopia from March to June 2018. A pre-tested and well-structured questionnaire was used to collect data on socio-demographic characteristics and hepatitis B infection risk factors. A2.5ml venous blood was also collected, centrifuged and the serum was analyzed for hepatitis B surface antigen using the instant hepatitis B surface antigen kit. Descriptive summary measures were done. Chi-square and Fisher exact tests were used to assess the risk of association. Multivariate logistic regression was conducted with 95% CI and all value at P-value < 0.05 was declared statistically significant. RESULTS: From a total of 260 (97.38%) medical waste collectors participated, HBV was detected in 53 (20.4%) of the participants [95%CI; 15.8, 25.6]. No significant differences were observed in the detection rates of HBV with respect to socio-demographic characteristics. In both bivariate and multivariable logistic regression analysis, being unvaccinated (AOR = 6.35; 95%CI = [2.53-15.96], P = 0.001), history of blood transfusion (receiving) (AOR; 3.54; 95%CI; [1.02-12.24], P = 0.046), history of tattooing (AOR = 2.86; 95%CI = [1.12-7.27], p = 0.03), and history of multiple sexual partner (AOR = 10.28; 95%CI = [4.16-25.38], P = 0.001) remained statistically significantly associated with HBsAg positivity. CONCLUSION: This cross-sectional study identified that HBV infection is high among medical waste collectors in eastern Ethiopia. Immunization and on job health promotion and disease prevention measures should be considered in order to control the risk of HBV infection among medical waste collectors in eastern Ethiopia.


Subject(s)
Hepatitis B/epidemiology , Housekeeping, Hospital/statistics & numerical data , Medical Waste Disposal/statistics & numerical data , Occupational Exposure/statistics & numerical data , Personnel, Hospital/statistics & numerical data , Adult , Community Health Centers/statistics & numerical data , Cross Infection/blood , Cross Infection/epidemiology , Cross Infection/etiology , Cross-Sectional Studies , Educational Status , Ethiopia/epidemiology , Female , Health Knowledge, Attitudes, Practice , Hepatitis B/blood , Hepatitis B/etiology , Hepatitis B Surface Antigens/blood , Hepatitis B virus/isolation & purification , Hepatitis B virus/physiology , Hospitals, Public/statistics & numerical data , Humans , Male , Medical Waste/adverse effects , Medical Waste/statistics & numerical data , Middle Aged , Occupational Exposure/analysis , Public Facilities/statistics & numerical data , Risk Factors , Seroepidemiologic Studies , Socioeconomic Factors , Surveys and Questionnaires , Young Adult
3.
Rheumatology (Oxford) ; 59(11): 3237-3249, 2020 11 01.
Article in English | MEDLINE | ID: mdl-32240310

ABSTRACT

OBJECTIVES: To investigate the diagnostic utility of different combinations of SI joint MRI lesions for differentiating patients with axial SpA (axSpA) from other conditions with and without buttock/pelvic pain. METHODS: A prospective cross-sectional study included patients with axSpA (n = 41), patients with lumbar disc herniation (n = 25), women with (n = 46) and without (n = 14) post-partum (birth within 4-16 months) buttock/pelvic pain and cleaning assistants (n = 26), long-distance runners (n = 23) and healthy men (n = 29) without pain. Two independent readers assessed SI joint MRI lesions according to the Spondyloarthritis Research Consortium of Canada MRI definitions and pre-defined MRI lesion combinations with bone marrow oedema (BME) and fat lesions (FAT), respectively. Statistical analyses included the proportion of participants with scores above certain thresholds, sensitivity, specificity, positive and negative predictive values and likelihood ratios. RESULTS: BME adjacent to the joint space (BME@joint space) was most frequent in axSpA (63.4%), followed by women with post-partum pain (43.5%), but was present in nearly all groups. BME adjacent to fat lesions (BME@FAT) and BME adjacent to erosions (BME@erosion) were only present in axSpA patients and in women with post-partum pain, but scores ≥3 and ≥4, respectively, were only seen in axSpA patients. FAT@erosion was exclusively recorded in axSpA patients. FAT@joint space and FAT@sclerosis were present in most groups, but with higher scores in the axSpA group. CONCLUSION: BME@joint space and FAT@joint space were frequent in axSpA but also in other conditions, reducing the diagnostic utility. FAT@erosion, and BME@FAT, BME@erosion and FAT@sclerosis above certain thresholds, were exclusively seen in axSpA patients and may thus have diagnostic utility in the differentiation of axSpA from other conditions.


Subject(s)
Adipose Tissue/diagnostic imaging , Bone Marrow Diseases/diagnostic imaging , Connective Tissue Diseases/diagnostic imaging , Edema/diagnostic imaging , Sacroiliac Joint/diagnostic imaging , Spondylarthritis/diagnostic imaging , Adult , Cross-Sectional Studies , Diagnosis, Differential , Female , Healthy Volunteers , Housekeeping, Hospital , Humans , Intervertebral Disc Displacement , Likelihood Functions , Low Back Pain , Lumbar Vertebrae , Magnetic Resonance Imaging/methods , Male , Middle Aged , Pelvic Pain , Postpartum Period , Prospective Studies , Running , Sensitivity and Specificity , Young Adult
4.
Int J Qual Health Care ; 32(2): 85-92, 2020 Apr 27.
Article in English | MEDLINE | ID: mdl-32060520

ABSTRACT

QUALITY CHALLENGE: The Sierra Leone (SL) Ministry of Health and Sanitation's National Infection Prevention and Control Unit (NIPCU) launched National Infection and Prevention Control (IPC) Policy and Guidelines in 2015, but a 2017 assessment found suboptimal compliance with standards on environmental cleanliness (EC), waste disposal (WD) and personal protective equipment (PPE) use. METHODS: ICAP at Columbia University (ICAP), NIPCU and the Centers for Disease Control and Prevention (CDC) designed and implemented a Rapid Improvement Model (RIM) quality improvement (QI) initiative with a compressed timeframe of 6 months to improve EC, WD and PPE at eight purposively selected health facilities (HFs). Targets were collaboratively developed, and a 37-item checklist was designed to monitor performance. HF teams received QI training and weekly coaching and convened monthly to review progress and exchange best practices. At the final learning session, a "harvest package" of the most effective ideas and tools was developed for use at additional HFs. RESULTS: The RIM resulted in marked improvement in WD and EC performance and modest improvement in PPE. Aggregate compliance for the 37 indicators increased from 67 to 96% over the course of 4 months, with all HFs showing improvement. Average PPE compliance improved from 85 to 89%, WD from 63 to 99% and EC from 51 to 99%. LESSONS LEARNED: The RIM QIC approach is feasible and effective in SL's austere health system and led to marked improvement in IPC performance. The best practices are being scaled up and the RIM QIC methodology is being applied to other domains.


Subject(s)
Health Facilities/standards , Infection Control/organization & administration , Quality Improvement/organization & administration , Health Facility Administration , Housekeeping, Hospital/methods , Housekeeping, Hospital/organization & administration , Humans , Infection Control/methods , Medical Waste Disposal/methods , Personal Protective Equipment/statistics & numerical data , Quality of Health Care/standards , Refuse Disposal/methods , Sierra Leone
5.
Appl Nurs Res ; 51: 151229, 2020 02.
Article in English | MEDLINE | ID: mdl-31899041

ABSTRACT

INTRODUCTION: Contamination through the hands of professionals and surfaces is one of the main agents involved in health care-associated infections in health services. Flaws in the execution of hospital housekeeping can lead to the contamination of surfaces and health equipment though, representing a risk for patient safety and highlighting the need to maximize the quality of cleaning processes in these institutions. OBJECTIVE: To describe the profile of managers and environmental service workers (ESWs) in Brazilian hospitals. METHODS: A cross-sectional study was undertaken in January 2018, involving 155 participants, being 12 managers and 143 workers from the housekeeping team of two health institutions, being one private and the other public. RESULTS: Most participants were female (86%), with a mean age of 45 years and primary education level, 52% being outsourced workers. The participants positively assessed their job satisfaction, satisfaction with training, basic knowledge and performance; nevertheless, situations were identified that were perceived as risks for patient safety and occupational health. The questions involving motivational incentives received the lowest scores. CONCLUSION: Inconsistencies were found in the housekeeping professionals'. Preparation, indicating that the institutions studied do not value this type of service and that an investment policy in these workers' motivation is lacking.


Subject(s)
Housekeeping, Hospital/organization & administration , Housekeeping, Hospital/statistics & numerical data , Job Satisfaction , Workforce/organization & administration , Workforce/statistics & numerical data , Adult , Aged , Brazil , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Young Adult
6.
J Occup Environ Hyg ; 17(7-8): 343-352, 2020.
Article in English | MEDLINE | ID: mdl-32633703

ABSTRACT

Many studies into surface contamination of hospital environments have demonstrated that occupational exposure to cytotoxics through the dermal route remains a possible risk. In this study, we assess the actual dermal exposure of the hands of pharmacy technicians and cleaning personnel in a panel of hospitals performing tasks that pose a risk of exposure. We compare the dermal exposure to a tentative limit value for cyclophosphamide. Pharmacy technicians and cleaning personnel were asked for hand rinsing after performance of nine tasks previously identified as posing a risk of occupational exposure. All samples were analyzed for the presence and quantity of eight antineoplastic drugs. By using data on both the frequency of the performance of the tasks and the measured dermal contamination during these tasks, weekly exposure to the marker drug (cyclophosphamide) was calculated. In five Dutch hospitals, 70 hand rinse samples and 8 blanks were collected. These were analyzed and results were used to calculate weekly exposure. The tentative limit value used was 0.74 µg of cyclophosphamide. For cleaning personnel, all results remained below this threshold value. For pharmacy technicians, the compounding itself also remained well below the limit; however, the task involving preparatory work, as well as the checking of compounded drugs, had a 13% chance of exceeding the limit. All of the highest values were found when employees were not wearing gloves on these tasks. Cleaning personnel and pharmacy technicians compounding cytotoxic drugs in our study were sufficiently protected from occupational exposure. In contrast, pharmacy technicians who perform preparatory and finishing tasks (before and after the actual compounding) are not protected enough when they do not wear gloves.


Subject(s)
Antineoplastic Agents/analysis , Occupational Exposure/analysis , Personnel, Hospital , Pharmacy Technicians , Academic Medical Centers , Antineoplastic Agents, Alkylating/analysis , Cyclophosphamide/analysis , Drug Compounding/methods , Gloves, Protective , Hand , Hospitals, Community , Housekeeping, Hospital , Humans , Netherlands , Surveys and Questionnaires
7.
Br J Nurs ; 29(1): 8, 2020 Jan 09.
Article in English | MEDLINE | ID: mdl-31917933

ABSTRACT

Tracy Doherty, Assistant Director of Infection Prevention & Control, Our Lady of Lourdes Hospital, Drogheda, Co Louth, discusses the maintenance of a clean healthcare environment.


Subject(s)
Cross Infection/etiology , Health Facility Environment , Cross Infection/prevention & control , Health Facility Environment/standards , Housekeeping, Hospital/standards , Humans , Infection Control
8.
BMC Infect Dis ; 19(1): 355, 2019 Apr 29.
Article in English | MEDLINE | ID: mdl-31035961

ABSTRACT

BACKGROUND: Cleaning and disinfection processes must be improved so that there is a reduction in environmental contamination of frequent-contact surfaces. The objective of this study was to evaluate cleaning and disinfection of surfaces at a specialized healthcare unit after an intervention program. METHODS: Exploratory, longitudinal, and correlational study carried out in a medium-complexity clinic. Two hundred and forty samples from five surfaces were collected during three phases: diagnosis; implementation of an intervention program; and evaluation of immediate and long-term effects. In total, 720 evaluations were made, performed through three monitoring methods: visual inspection; adenosine triphosphate bioluminescence assay (ATP); and aerobic colony count (ACC). The Wilcoxon, Mann-Whitney, and Fisher's Exact tests were run to analyze data statistically. RESULTS: Cleaning and disinfection of surfaces were not being performed properly in most cases. Failure rates of surfaces reached 37.5 and 100% when the ATP and ACC procedures were used, respectively. However, after an intervention program, an improvement occurred. Success rates increased by 43.96% (ATP) and 12.46% (ACC) in phase I, by 70.6% (ATP) and 82.3% (ACC) immediately after interventions, and by 76.52% (ATP) and 85.76% (ACC) two months after the changes, showing that the program was effective. CONCLUSION: The present study reveals that implementing intervention actions with a cleaning and healthcare team brings benefits to prevent the spread of pathogenic agents through frequently touched hospital surfaces.


Subject(s)
Disinfection/methods , Bacteria, Aerobic/cytology , Bacteria, Aerobic/isolation & purification , Housekeeping, Hospital , Longitudinal Studies , Luminescent Measurements , Outpatients , Statistics, Nonparametric
9.
Br J Nurs ; 28(13): 890-891, 2019 Jul 11.
Article in English | MEDLINE | ID: mdl-31303049

ABSTRACT

Emeritus Professor Alan Glasper, University of Southampton, discusses strategies used to keep patients in hospital safe from infection.


Subject(s)
Cross Infection/prevention & control , Infection Control/methods , Patient Safety , England , Food Storage/standards , Housekeeping, Hospital/standards , Humans , Hygiene/standards , State Medicine
10.
Epidemiol Infect ; 146(2): 276-282, 2018 01.
Article in English | MEDLINE | ID: mdl-29235431

ABSTRACT

The Joint Commission Centre for Transforming Healthcare's Web-based Targeted Solutions Tool (TST) for improving hand hygiene was implemented to elucidate contributing factors to low compliance rates of hand hygiene. Monitoring of compliance was done by trained unknown and known observers and rates of hospital-acquired infections were tracked and correlated against the changes in hand hygiene compliance. In total, 5669 of hand hygiene observations were recorded by the secret observers. The compliance rate increased from 75·4% at baseline (May-August 2014) to 88·6% during the intervention (13 months) and the control periods (P < 0·0001). Reductions in healthcare-associated infection rates were recorded for Clostridium difficle infections from 7·95 (CI 0·8937-28·72) to 1·84 (CI 0·02411-10·26) infections per 10 000 patient-days (P = 0·23), central line-associated blood-stream infections from 5·9 (CI 1·194-17·36) to 2·9 (0·7856-7·475) per 1000 device days (P = 0·37) and catheter-associated urinary tract infections from 5·941 (CI 1·194-17·36) to 0 per 1000 device days (P = 0·42). The top contributing factors for non-compliance were: improper use of gloves, hands full of supplies or medications and frequent entry or exit in isolation areas. We conclude that the application of TST allows healthcare organisations to improve hand hygiene compliance and to identify the factors contributing to non-compliance.


Subject(s)
Bacteremia/epidemiology , Catheter-Related Infections/epidemiology , Clostridium Infections/epidemiology , Cross Infection/epidemiology , Guideline Adherence/statistics & numerical data , Hand Hygiene/statistics & numerical data , Personnel, Hospital , Urinary Tract Infections/epidemiology , Bacteremia/prevention & control , Catheter-Related Infections/prevention & control , Central Venous Catheters , Clostridium Infections/prevention & control , Cross Infection/prevention & control , Gloves, Protective , Housekeeping, Hospital , Humans , Laboratory Personnel , Nursing , Nutritionists , Oncology Service, Hospital , Quality Improvement , Saudi Arabia/epidemiology , Urinary Catheters , Urinary Tract Infections/prevention & control , Workforce
11.
Am J Ind Med ; 61(2): 157-166, 2018 02.
Article in English | MEDLINE | ID: mdl-29152784

ABSTRACT

BACKGROUND: Workplace violence is a substantial occupational hazard for healthcare workers in the United States. METHODS: We analyzed workplace violence injury surveillance data submitted by hospitals participating in the Occupational Health Safety Network (OHSN) from 2012 to 2015. RESULTS: Data were frequently missing for several important variables. Nursing assistants (14.89, 95%CI 10.12-21.91) and nurses (8.05, 95%CI 6.14-10.55) had the highest crude workplace violence injury rates per 1000 full-time equivalent (FTE) workers. Nursing assistants' (IRR 2.82, 95%CI 2.36-3.36) and nurses' (IRR 1.70, 95%CI 1.45-1.99) adjusted workplace violence injury rates were significantly higher than those of non-patient care personnel. On average, the overall rate of workplace violence injury among OHSN-participating hospitals increased by 23% annually during the study period. CONCLUSION: Improved data collection is needed for OHSN to realize its full potential. Workplace violence is a serious, increasingly common problem in OHSN-participating hospitals. Nursing assistants and nurses have the highest injury risk.


Subject(s)
Health Personnel , Hospitals , Occupational Injuries/epidemiology , Workplace Violence/statistics & numerical data , Adult , Emergency Service, Hospital , Female , Food Service, Hospital , Health Care Sector , Housekeeping, Hospital , Humans , Incidence , Laundry Service, Hospital , Male , Middle Aged , Multivariate Analysis , Nurses , Nursing Assistants , Occupational Health , United States/epidemiology
12.
J Healthc Manag ; 63(6): 383-394, 2018.
Article in English | MEDLINE | ID: mdl-30418366

ABSTRACT

EXECUTIVE SUMMARY: To assess the impact of military hospital expenditures on environmental services (EVS) on inpatient satisfaction, the authors collected Defense Health Agency TRICARE Inpatient Satisfaction Survey data from fiscal years 2011 through 2013, military hospital EVS spending and workload data, facility construction/renovation data, and military health system inpatient administrative claims data. Multivariate logistic regression for panel data was performed independently for medical/surgical and obstetric product lines and each satisfaction question. A statistically significant positive relationship was found between hospital EVS spending and patient satisfaction, with the highest expenditure levels generally exhibiting a greater association with satisfaction. Statistically significant increases in satisfaction with cleanliness were associated with higher levels of hospital expenditures on EVS.


Subject(s)
Hospitals, Military/economics , Housekeeping, Hospital/economics , Inpatients , Patient Satisfaction , Adolescent , Adult , Aged , Female , Humans , Logistic Models , Male , Middle Aged , Surveys and Questionnaires , United States , Young Adult
13.
Article in German | MEDLINE | ID: mdl-29633038

ABSTRACT

BACKGROUND: In addition to acute care hospitals, rehabilitation centres are increasingly confronted with multi-resistant pathogens. Long durations of stay and intensive treatments impose special hygienic challenges. MATERIAL AND METHODS: We investigated an extended spectrum beta-lactamase-Klebsiella pneumoniae (ESBL-K. pneumoniae) outbreak in a neurorehabilitation centre. We defined confirmed cases as patients who stayed in the centre during the outbreak period and from whom ESBL-K. pneumoniae was isolated with the outbreak sequence type. Probable cases had an epidemiological link to at least one confirmed case but no isolate for typing. Next generation sequencing (NGS) was performed on 53 isolates from patients. Environmental sampling was performed. Systematic microbiological screening was implemented and ESBL-K. pneumoniae-positive patients were cohorted in a designated ward. RESULTS: We identified 30 confirmed and 6 probable cases. NGS revealed three genetic clusters: Cluster 1 - the outbreak cluster - with isolates of 30 cases (sequence type ST15), Cluster 2 with 7 patients (ST405) and Cluster 3 with 8 patients (ST414). In two patients, the outbreak strain developed further antibiotic resistance, one with colistin resistance and the other carbapenem resistance. The outbreak ceased after strict isolation measures. DISCUSSION: Epidemiology and NGS results paired with the effectiveness of cohorting suggest that transmission occurred mainly from person to person in this outbreak. There was an apparent association of the probability to acquire ESBL-K. pneumoniae and treatment intensity, whereas infection rate was related to morbidity. The identification of the outbreak clone and additional clusters plus the development of additional antibiotic resistance shows the relevance of NGS and highlights the need for timely and efficient outbreak management.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Cross Infection/drug therapy , Disease Outbreaks , Drug Resistance, Multiple, Bacterial , Klebsiella Infections/drug therapy , Neurological Rehabilitation , Rehabilitation Centers , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/pharmacology , Cluster Analysis , Cohort Studies , Cross Infection/microbiology , Disinfection , Female , Germany , Housekeeping, Hospital , Humans , Klebsiella Infections/microbiology , Klebsiella pneumoniae/drug effects , Male , Middle Aged , Ventilators, Mechanical/microbiology
14.
J Pak Med Assoc ; 68(7): 1084-1089, 2018 Jul.
Article in English | MEDLINE | ID: mdl-30317307

ABSTRACT

Patients are the key stakeholders of any hospital and it is important to satisfy them. The objective of this study was to compare the quality of hospitals within Rashidabad; a town in rural Sindh operated by Rashid Memorial Welfare Organization (RMWO), with District Headquarter hospital Tando Allahyar. A cross sectional survey, based on a questionnaire designed in congruence with literature, regarding the hospital quality was conducted on 150 patients in October 2016. The target population was defined as patients getting treatment at hospitals within Rashidabad; whose estimate was reported by RMWO as 2000 per week. Hospital quality index (HQI) was framed in the light of quality of staff, ward, pain management practices and hygiene which includes food. Logistic Regression was applied on HQI that showed dependence of perception about hospital quality on age, hospital location and patient's health. Results were significantly in favour of hospitals within Rashidabad.


Subject(s)
Hospitals, District/standards , Hospitals, Urban/standards , Patient Satisfaction , Quality of Health Care , Adolescent , Adult , Cross-Sectional Studies , Female , Food Safety , Health Care Surveys , Housekeeping, Hospital/standards , Humans , Male , Middle Aged , Pain Management/standards , Pakistan , Patients' Rooms/standards , Personnel, Hospital/standards , Young Adult
15.
BMC Infect Dis ; 17(1): 85, 2017 01 18.
Article in English | MEDLINE | ID: mdl-28100179

ABSTRACT

BACKGROUND: Cleaning of environmental surfaces in hospitals is important for the control of methicillin-resistant Staphylococcus aureus (MRSA) and other hospital-acquired infections transmitted by the contact route. Guidance regarding the best approaches for cleaning, however, is limited. METHODS: In this study, a mathematical model based on ordinary differential equations was constructed to study MRSA concentration dynamics on high-touch and low-touch surfaces, and on the hands and noses of two patients (in two hospitals rooms) and a health care worker in a hypothetical hospital environment. Two cleaning interventions - whole room cleaning and wipe cleaning of touched surfaces - were considered. The performance of the cleaning interventions was indicated by a reduction in MRSA on the nose of a susceptible patient, relative to no intervention. RESULTS: Whole room cleaning just before first patient care activities of the day was more effective than whole room cleaning at other times, but even with 100% efficiency, whole room cleaning only reduced the number of MRSA transmitted to the susceptible patient by 54%. Frequent wipe cleaning of touched surfaces was shown to be more effective that whole room cleaning because surfaces are rapidly re-contaminated with MRSA after cleaning. Wipe cleaning high-touch surfaces was more effective than wipe cleaning low-touch surfaces for the same frequency of cleaning. For low wipe cleaning frequency (≤3 times per hour), high-touch surfaces should be targeted, but for high wipe cleaning frequency (>3 times per hour), cleaning should target high- and low-touch surfaces in proportion to the surface touch frequency. This study reproduces the observations from a field study of room cleaning, which provides support for the validity of our findings. CONCLUSIONS: Daily whole room cleaning, even with 100% cleaning efficiency, provides limited reduction in the number of MRSA transmitted to susceptible patients via the contact route; and should be supplemented with frequent targeted cleaning of high-touch surfaces, such as by a wipe or cloth containing disinfectant.


Subject(s)
Cross Infection/prevention & control , Disinfection/methods , Infection Control/methods , Methicillin-Resistant Staphylococcus aureus , Staphylococcal Infections/prevention & control , Environmental Microbiology , Hospitals , Housekeeping, Hospital/methods , Humans , Models, Theoretical , Patients' Rooms , Staphylococcal Infections/microbiology , Staphylococcal Infections/transmission
16.
Appl Microbiol Biotechnol ; 101(2): 771-781, 2017 Jan.
Article in English | MEDLINE | ID: mdl-27771740

ABSTRACT

Terminal disinfection and daily cleaning have been performed in hospitals in Taiwan for many years to reduce the risks of healthcare-associated infections. However, the effectiveness of these cleaning approaches and dynamic changes of surface microbiota upon cleaning remain unclear. Here, we report the surface changes of bacterial communities with terminal disinfection and daily cleaning in a medical intensive care unit (MICU) and only terminal disinfection in a respiratory care center (RCC) using 16s ribosomal RNA (rRNA) metagenomics. A total of 36 samples, including 9 samples per sampling time, from each ward were analysed. The clinical isolates were recorded during the sampling time. A large amount of microbial diversity was detected, and human skin microbiota (HSM) was predominant in both wards. In addition, the colonization rate of the HSM in the MICU was higher than that in the RCC, especially for Moraxellaceae. A higher alpha-diversity (p = 0.005519) and a lower UniFrac distance was shown in the RCC due to the lack of daily cleaning. Moreover, a significantly higher abundance among Acinetobacter sp., Streptococcus sp. and Pseudomonas sp. was shown in the RCC compared to the MICU using the paired t test. We concluded that cleaning changes might contribute to the difference in diversity between two wards.


Subject(s)
Bacteria/classification , Bacteria/isolation & purification , Disinfection/methods , Environmental Microbiology , Hospitals , Housekeeping, Hospital/methods , Bacteria/genetics , Cluster Analysis , DNA, Bacterial/chemistry , DNA, Bacterial/genetics , DNA, Ribosomal/chemistry , DNA, Ribosomal/genetics , Humans , Intensive Care Units , Metagenomics , Phylogeny , RNA, Ribosomal, 16S/genetics , Sequence Analysis, DNA , Taiwan
17.
Palliat Med ; 31(1): 63-71, 2017 01.
Article in English | MEDLINE | ID: mdl-27160701

ABSTRACT

BACKGROUND/AIM: Palliative care is based on multi-professional team work. In this study, we investigated how cleaning staff communicate and interact with seriously ill and dying patients as well as how cleaning staff cope with the situation of death and dying. DESIGN: Sequential mixed methods, consisting of semi-structured interviews, focus groups, and a questionnaire. Interviews and focus group discussions were content analyzed and results were used to create a questionnaire. Quantitative data were submitted to descriptive analysis. SETTING: Large university clinic in southern Germany. PARTICIPANTS: A total of 10 cleaning staff participated in the interviews and 6 cleaning staff took part in the focus group discussion. In addition, three managerial cleaning staff participated in a separate focus group. Questionnaires were given to all cleaning staff ( n = 240) working at the clinic in September 2008, and response rate was 52% (125/240). RESULTS: Cleaning staff described interactions with patients as an important and fulfilling aspect of their work. About half of participants indicated that patients talk with them every day, on average for 1-3 min. Conversations often revolved around casual topics such as weather and family, but patients also discussed their illness and, occasionally, thoughts regarding death with cleaning staff. When patients addressed illness and death, cleaning staff often felt uncomfortable and helpless. CONCLUSION: Cleaning staff perceive that they have an important role in the clinic-not only cleaning but also supporting patients. Likewise, patients appreciate being able to speak openly with cleaning staff. Still, it appears that cleaning staff may benefit from additional training in communication about sensitive issues such as illness and death.


Subject(s)
Housekeeping, Hospital , Palliative Care/psychology , Personnel, Hospital/psychology , Professional-Patient Relations , Terminal Care/psychology , Adaptation, Psychological , Adult , Aged , Communication , Female , Focus Groups , Germany , Humans , Male , Middle Aged , Young Adult
18.
Int J Qual Health Care ; 29(1): 32-39, 2017 Feb 01.
Article in English | MEDLINE | ID: mdl-27920249

ABSTRACT

OBJECTIVE: To evaluate the impact of implementing continuous quality improvement (CQI) methods on patient's experiences and satisfaction in Tanzania. DESIGN: Cluster-randomized trial, which randomly allocated district-level hospitals into treatment group and control group, was conducted. SETTING: Sixteen district-level hospitals in Kilimanjaro and Manyara regions of Tanzania. PARTICIPANTS: Outpatient exit surveys targeting totally 3292 individuals, 1688 in the treatment and 1604 in the control group, from 3 time-points between September 2011 and September 2012. INTERVENTION: Implementation of the 5S (Sort, Set, Shine, Standardize, Sustain) approach as a CQI method at outpatient departments over 12 months. MAIN OUTCOME MEASURES: Cleanliness, waiting time, patient's experience, patient's satisfaction. RESULTS: The 5S increased cleanliness in the outpatient department, patients' subjective waiting time and overall satisfaction. However, negligible effects were confirmed for patient's experiences on hospital staff behaviours. CONCLUSIONS: The 5S as a CQI method is effective in enhancing hospital environment and service delivery; that are subjectively assessed by outpatients even during the short intervention period. Nevertheless, continuous efforts will be needed to connect CQI practices with the further improvement in the delivery of quality health care.


Subject(s)
Outpatient Clinics, Hospital/statistics & numerical data , Patient Satisfaction/statistics & numerical data , Quality Improvement/organization & administration , Female , Housekeeping, Hospital/statistics & numerical data , Humans , Male , Outpatients/psychology , Quality of Health Care/statistics & numerical data , Surveys and Questionnaires , Tanzania , Time Factors
19.
J Prev Med Hyg ; 58(2): E177-E183, 2017 Jun.
Article in English | MEDLINE | ID: mdl-28900359

ABSTRACT

INTRODUCTION: Contamination of hospital surfaces plays an important role in the transmission of several healthcare-associated microorganisms, therefore methods for evaluating hospital surfaces' cleaning gain particular importance. Among these, there are visual inspection, quantitative microbiology, fluorescent markers and adenosine triphosphate (ATP) bioluminescence. The latter seems to provide interesting features, detecting the presence of ATP on surface (as Relative Light Units, RLU), a proxy of organic matter and microbial contamination. Several studies have investigated the effectiveness of this technology; with this research, we aim to summarize the most significant results. METHODS: A systematic review was conducted. The keywords (namely, "ATP", "bioluminescence", "hospital" and "surfaces") were searched in PubMed/MEDLINE and Scopus databases, in order to find relevant data, from January 2000 to October 2014. After the selection, we globally considered 27 articles. RESULTS: Most of the studies were conducted in United Kingdom and in USA. Different threshold RLU benchmark values were identified by analyzed studies. Fourteen of these researches compared the ATP bioluminescence with microbiological methods, 11 identified a significant correlation between the two methods, although poor or not complete for 5. DISCUSSION: ATP bioluminescence is not a standardized methodology: each tool has different benchmark values, not always clearly defined. At the moment, we can say that the technique could be used to assess, in real time, hospital surfaces where cleanliness is required, but not sterility.


Subject(s)
Adenosine Triphosphate/analysis , Environmental Microbiology , Housekeeping, Hospital/standards , Infection Control/standards , Luminescent Measurements , Colony Count, Microbial , Environmental Monitoring , Equipment Contamination , Humans
20.
Rev Esc Enferm USP ; 51: e03239, 2017 Jun 12.
Article in English, Portuguese | MEDLINE | ID: mdl-28614441

ABSTRACT

OBJECTIVE: Investigating the prevalence and factors associated with minor psychiatric disorders (MPDs) in Hospital housekeeping workers. METHOD: A cross-sectional study carried out in 2013 with workers from the cleaning service of a public university hospital in Rio Grande do Sul, Brazil. Data were collected through a form containing sociodemographic, occupational, habits and health variables. The Self-Reporting Questionnaire-20 was used in order to evaluate MPDs. RESULTS: The study population consisted of 161 workers. The overall prevalence of suspected MPD was 29.3%. The chances of suspected MPDs were higher in workers with Effort-Reward Imbalance, those who did not have time or who occasionally had time for leisure activities, and those taking medications. CONCLUSION: The prevalence of MPDs was similar to that found in the literature for health workers. Therefore, we consider it important to include these workers in institutional programs for continuing health education. OBJETIVO: Investigar a prevalência e os fatores associados aos Distúrbios Psíquicos Menores (DPMs) em trabalhadores do Serviço Hospitalar de Limpeza. MÉTODO: Estudo transversal, realizado em 2013, com trabalhadores do serviço de limpeza de um hospital universitário público do Rio Grande do Sul, Brasil. Os dados foram coletados por meio de um formulário contendo variáveis sociodemográficas, laborais, hábitos e saúde. Para avaliação dos DPMs utilizou-se do Self-Reporting Questionnaire-20. RESULTADOS: A população do estudo foi composta pelos 161 trabalhadores. A prevalência global para suspeição de DPM foi de 29,3%. As chances de suspeição de DPMs foram maiores nos trabalhadores em Desequilíbrio Esforço-Recompensa, nos que não tinham ou às vezes tinham tempo para o lazer e naqueles que faziam uso de medicação. CONCLUSÃO: A prevalência de DPMs assemelhou-se à encontrada na literatura em trabalhadores da área saúde. Portanto, considera-se importante a inclusão desses trabalhadores em programas institucionais de educação permanente em saúde.


Subject(s)
Housekeeping, Hospital , Mental Disorders/epidemiology , Occupational Diseases/epidemiology , Personnel, Hospital , Adult , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Prevalence , Risk Factors , Severity of Illness Index , Young Adult
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