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1.
In. The University of the West Indies, Faculty of Medical Sciences. Faculty of Medical Sciences, Research Day. St. Augustine, Caribbean Medical Journal, March 21, 2019. .
Não convencional em Inglês | MedCarib | ID: biblio-1025497

RESUMO

Objective: The point prevalence survey is a validated tool for measuring the quality of prescribing in the hospital setting. The objectives were to estimate the prevalence of hospital acquired infections, to assess the antimicrobial agent prescribed and determine if prescribers followed existing evidence-based antimicrobial policies subsequent to diagnosis of infection in patients. Design and Methodology: Day-of-survey records of patients in the intensive care unit and medical/surgical wards were examined at the institution, retrospectively. The extracted clinical data were recorded on the standardized data collection instruments (hospital, ward and patient forms) and analysed. Results: Of the 130 patients surveyed, 30 had an infection which occurred within 48 hours of admission. The most commonly reported infection type was urinary tract infections, evident in 9 (30.0%) patients, caused by Escherichia coli in 7 patients and Klebsiella pneumonia in 2 patients. Out of the 30 patients, 10 (33.3%) were awaiting laboratory reports at the time of the survey. Resistance was noted for Staphylococcus aureus and Escherichia coli, both of which were seen in 2 patients and Enterococcus spp. in 1 patient. The antimicrobial agent selected to treat these microorganisms should have been queried. Conclusions: Results of this survey imply that public health surveillance and prevention activities should be implemented to address appropriate treatment of hospital acquired infections. Recommendations to minimize the risk of resistance include: improving the availability of alcohol-based hand rub, the provision of single room and isolation capacity, antimicrobial guidelines for treatment of infection, judicious prescribing and proper surveillance of prescribed antimicrobials.


Assuntos
Humanos , Masculino , Feminino , Saúde Pública , Trinidad e Tobago , Região do Caribe/etnologia , Hospitais
2.
BMC infectious diseases ; 4(59): [1-7], Dec. 2004. tab
Artigo em Inglês | MedCarib | ID: med-17660

RESUMO

BACKGROUND: Tertiary care hospitals are a potential source for development and spread of bacterial resistance being in the loop to receive outpatients and referrals from community nursing homes and hospitals. The liberal use of third-generation cephalosporins (3GCs) in these hospitals has been associated with the emergence of extended-spectrum beta- lactamases (ESBLs) presenting concerns for bacterial resistance in therapeutics. We studied the 3GC utilization in a tertiary care teaching hospital, in warded patients (medical, surgical, gynaecology, orthopedic) prescribed these drugs. METHODS: Clinical data of patients (>or= 13 years) admitted to the General Hospital, Port of Spain (POSGH) from January to June 2000, and who had received 3GCs based on the Pharmacy records were studied. The Sanford Antibiotic Guide 2000, was used to determine appropriateness of therapy. The agency which procures drugs for the Ministry of Health supplied the cost of drugs. RESULTS: The prevalence rate of use of 3GCs was 9.5 per 1000 admissions and was higher in surgical and gynecological admissions (21/1000) compared with medical and orthopedic (8 /1000) services (p < 0.05). Ceftriaxone was the most frequently used 3GC. Sixty-nine (36%) patients without clinical evidence of infection received 3Gcs and prescribing was based on therapeutic recommendations in 4% of patients. At least 62% of all prescriptions were inappropriate with significant associations for patients from gynaecology (p < 0.003), empirical prescribing (p < 0.48), patients with undetermined infection sites (p < 0.007), and for single drug use compared with multiple antibiotics (p < 0.001). Treatment was twice as costly when prescribing was inappropriate. CONCLUSIONS: There is extensive inappropriate 3GC utilization in tertiary care in Trinidad. We recommend hospital laboratories undertake continuous surveillance of antibiotic resistance patterns so that appropriate changes in prescribing guidelines can be developed and implemented. Though guidelines for rational antibiotic use were developed they have not been re-visited or encouraged, suggesting urgent antibiotic review of the hospital formulary and instituting an infection control team. Monitoring antibiotic use with microbiology laboratory support can promote rational drug utilization, cut costs, halt inappropriate 3GC prescribing, and delay the emergence of resistant organisms. An ongoing antibiotic peer audit is suggested.


Assuntos
Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Feminino , Antibacterianos/farmacologia , Cefalosporinas/farmacologia , Farmacorresistência Bacteriana , Uso de Medicamentos/legislação & jurisprudência , Hospitais , Testes de Sensibilidade Microbiana , Política Pública , Trinidad e Tobago
3.
Rev. panam. salud publica ; 14(3): 193-200, Sept. 2003. tab
Artigo em Inglês | MedCarib | ID: med-17005

RESUMO

Objective. To assess the microbial contamination of disinfectants and antiseptics in major hospitals on the Caribbean island of Trinidad. Methods. For this cross-sectional study, disinfectants and antiseptics were sampled from the pharmacy departments, the pediatric/neonatal wards, and the surgical wards of four hospitals. The samples were cultured for aerobic bacteria on nutrient agar using the surface plating method. The antibiotic sensitivity of bacterial isolates was determined by the disk diffusion method, using 14 antimicrobial agents. We studied a total of 180 samples: 60 of chlorhexidine gluconate (Habitane), 60 of chlorhexidine gluconate and cetrimonium bromide (Savlon), and 60 of methylated spirit. Results. Of the 180 samples studied, 11 of them (6.1 percent) were contaminated by aerobic bacteria. All bacteria isolated were Pseudomonas spp. Of the 11 contaminated samples, 6 of them (54.5 percent) occurred at the pharmacy level while 5 (45.5 percent) were from diluted pre-use or in-use samples in the pediatric/neonatal wards or the surgical wards. Chlorhexidine gluconate and cetrimonium bromide accounted for 9 of the 11 contaminated disinfectants/antiseptics (81.8 percent), and chlorhexidine gluconate accounted for the remaining 2 (18.2 percent). Only two of the four hospitals had contaminated disinfectant/antiseptic samples. All 24 isolates of Pseudomonas spp. tested were resistant to one or more of the 14 antimicrobial agents tested, with the prevalence of resistance to ciprofloxacin, norfloxacin, tobramycin, and gentamicin being 58.3 percent, 50.0 percent, 45.8 percent, and 41.7 respectively. Conclusions. Our results show that contaminated disinfectants/antiseptics pose a health risk to patients, particularly in the pediatric and surgical wards. The high prevalence of resistance to antimicrobial agents exhibited by the Pseudomonas spp. that were isolated is of special theraputic concern (AU)


Assuntos
Humanos , Humanos , Desinfetantes/efeitos adversos , Hospitais , Trinidad e Tobago , Controle de Infecções , Pseudomonas/patogenicidade , Países em Desenvolvimento
4.
Rev. panam. salud p£blica ; 14(3): 193-200, Sept. 2003. tab
Artigo em Inglês | MedCarib | ID: med-17463

RESUMO

OBJECTIVE: To assess the microbial contamination of disinfectants and antiseptics in major hospitals on the Caribbean island of Trinidad. METHODS: For this cross-sectional study, disinfectants and antiseptics were sampled from the pharmacy departments, the pediatric/neonatal wards, and the surgical wards of four hospitals. The samples were cultured for aerobic bacteria on nutrient agar using the surface plating method. The antibiotic sensitivity of bacterial isolates was determined by the disk diffusion method, using 14 antimicrobial agents. We studied a total of 180 disinfectant/antiseptic samples: 60 of chlorhexidine gluconate (Hibitane), 60 of chlorhexidine gluconate and cetrimonium bromide (Savlon), and 60 of methylated spirit. RESULTS: Of the 180 samples studied, 11 of them (6.1 percent) were contaminated by aerobic bacteria. All bacteria isolated were Pseudomonas spp. Of the 11 contaminated samples, 6 of them (54.5 percent) occurred at the pharmacy level while 5 (45.5 percent) were from diluted pre-use or in-use samples in the pediatric/neonatal wards or the surgical wards. Chlorhexidine gluconate and cetrimonium bromide accounted for 9 of the 11 contaminated disinfectants/antiseptics (81.8 percent), and chlorhexidine gluconate accounted for the remaining 2 (18.2 percent). Only two of the four hospitals had contaminated disinfectant/antiseptic samples. All 24 isolates of Pseudomonas spp. tested were resistant to one or more of the 14 antimicrobial agents tested, with the prevalence of resistance to ciprofloxacin, norfloxacin, tobramycin, and gentamicin being 58.3 percent, 50.0 percent, 45.8 percent, and 41.7 percent, respectively. CONCLUSIONS: Our results show that contaminated disinfectants/antiseptics pose a health risk to patients, particularly in the pediatric and surgical wards. The high prevalence of resistance to antimicrobial agents exhibited by the Pseudomonas spp. that were isolated is of special therapeutic concern


Assuntos
Desinfetantes , Anti-Infecciosos Locais , Hospitais , Controle de Infecções , Pseudomonas , Trinidad e Tobago
5.
West Indian med. j ; 50(Suppl 7): 23, Dec. 2001.
Artigo em Inglês | MedCarib | ID: med-76

RESUMO

Health related issues have played a critical role in Caribbean history. From the time of the earliest European presence, disease posed a serious challenge to life in the region. Matters worsened with the introduction of large numbers of Africans and Asians into the colonies, for the disease environment became more complicated. Western medicine was unprepared to deal with the situation. There was a lack of knowledge among the European population of many of the diseases. Thus, the provision of health care institutions was always high on the agenda of the European colonizers. However, the provision of these services was affected by a number of factors, not the least of which was the perception that some races were less vulnerable to disease than others. The result is that services provided were able to satisfy existing demand. This paper examines the health care facilities that were provided by the population of Trinidad and Tobago since 1900. The paper begins with an outline of earliest institutions and a discussion of the philosophy which guide their operations. The discourse then turns to the emergence of modern hospital institutions in the colony and the history of these institutions since 1900. The paper argues that in the development of hospital services there is a history of overwhelming demand which was never satisfied. The paper argues further that the underlying philosophy of the hospital institutions never really changed and that is the basic reason for the inadequacy of these services which remains a feature of the history of the hospitals of Trinidad and Tobago. (AU)


Assuntos
História do Século XX , História do Século XIX , Hospitais/história , Assistência à Saúde/história , Instalações de Saúde/história , Trinidad e Tobago
6.
West Indian med. j ; 50(Suppl 4): 11-4, Sept. 2001.
Artigo em Inglês | MedCarib | ID: med-295

RESUMO

At the beginning of the 20th century, Barbados was described as the most unhealthy place in the British Empire; at the end of the century, it is considered amongst the healthiest of developing countries. At the start of the century the statistics were harsh; for example, there was an infant mortality rate of 400 per 1000 live births. It is now between 10 and 15 per live births. In the last two-thirds of the century, there was a series of ongoing revolutions in Education, Public Health and Hospital Services that affected the health status favourably. The revolution in education was enhanced by the provision of University education starting with Medicine at Mona, Jamaica. Training of doctors expanded to Barbados in 1967 and has been an essential ingredient in the medical care revolution of the last third of the century. In 1953, the first Public Health Centre was opened and Barbados can now boast the most modern public health and primary care facilities. However, modern lifestyles are associated with an epidemic of obesity, diabetes mellitus and hypertension. HIV/AIDS has emerged as a major problem. Health in the 21st century will need to look at lifestyles - the effects of the internal combustion engine, the availability of tools of violence, the lure of `illegal drugs', personal relationships and gender as well as the driving forces behind the associated lifestyles. (AU)


Assuntos
História do Século XX , Humanos , Assistência à Saúde/história , Saúde Pública/história , Barbados , /história , Hospitais/história
7.
Caribbean health ; 1(2): 9-10, 1998.
Artigo em Inglês | MedCarib | ID: med-17328

RESUMO

Public hospitals throughout the Caribbean are struggling to meet demands from the public for quality services. The problems that have fuelled public concern include long waiting times, rudeness by staff, and poor clinical care. Some senior administrators attribute public dissatisfaction to the 'Miami' or 'Cable TV effect'. The theory is that Caribbean people have unrealistic standards of expectations of their hospitals due to the influence of the images of USA healthcare that they have experienced on the mainland USA or seen on television. Quite a number of hospitals have attempted to launch quality improvement programmes.... Despite all this effort quality initiatives in public hospitals in most Caribbean countries have not been sustained. Nurses who have been trained in QA have been restricted to working on nursing QA programmes. Laboratory based quality initatives have been very much restricted to laboratory services. And quality manuals lie on shelves collecting dust. Public hospitals have very little to show for all these efforts. It is important to know why 'quality' has not taken off if we are to do better in the future(AU)


Assuntos
Qualidade da Assistência à Saúde/organização & administração , Qualidade da Assistência à Saúde/normas , Hospitais/normas , Região do Caribe
10.
Kingston; Center for International Health, Boston University; May 1994. [80] p.
Monografia em Inglês | MedCarib | ID: med-2485
11.
St. George's; Grenada. Ministry of Health; 1994. 21 p.
Monografia em Inglês | MedCarib | ID: med-3421

RESUMO

The management plan to be implemented during a disaster at the Princess Alice Hospital is covered, including pre-disaster procedures and the procedures to be followed in the event of a disaster. Duties and responsibilities of persons involved in the management of the hospital during the period of a disaster are given


Assuntos
Planejamento em Desastres/métodos , Desastres/prevenção & controle , Hospitais
12.
Mount Hope; EWMSCA; 1994. 27 p. maps.
Monografia em Inglês | MedCarib | ID: med-16169

RESUMO

This booklet documents the performance of all clinic and ward operations within the Institution, including Auxillary Services such as, Pharmacy, Social Work, Physiotherapy and Nutrition and Dietetics. Pertinent information is illustrated in Statistical Format accompanied by supporting statements on the overall performances/progress of each area. Comparisons are also given and are illustrated through graphs for greater clarity. (AU)


Assuntos
Humanos , Hospitais/estatística & dados numéricos , Trinidad e Tobago , /estatística & dados numéricos , Hospitais Gerais/estatística & dados numéricos , Região do Caribe
14.
Anon.
Kingston; Caribbean Food and Nutrition Institute; 1994. 71 p.
Monografia em Inglês | MedCarib | ID: med-16470
18.
St. George's; s.n.; Dec. 1991. 23 p.
Monografia em Inglês | MedCarib | ID: med-15049

RESUMO

Presents details on the existing health services and facilities available in Grenada. The public health system is described as being developed around the concept of primary health care (PHC) and consist of the following infrastructure: a general hospital, two district hospitals, a mental hospital and a PHC services network consisting of six health care centres and thirty medical stations. Details of other aspects of the system such as environmental health, pharmaceutical services, psychiatry and medical personnel are also given. Outlines the plans and priorities for the development of the system during the period 1992-1994


Assuntos
Humanos , Serviços de Saúde/organização & administração , Instalações de Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Planos e Programas de Saúde , Saúde Ambiental , /organização & administração , Pessoal de Saúde , Serviços de Saúde Mental/organização & administração , Atenção Secundária à Saúde/organização & administração , Hospitais
19.
Washington, DC; PAHO/WHO; 1991. xi,195 p.
Monografia em Inglês | MedCarib | ID: med-16168

RESUMO

Material presented in the manual will be useful for those who study health services, those who are currently defining strategies, and those who are executing and evaluating health actions


Assuntos
Humanos , Hospitais/classificação , Hospitais/estatística & dados numéricos , Região do Caribe , Hospitais/tendências , Acreditação/tendências , Países em Desenvolvimento
20.
Roseau; s.n; Aug. 1991. 16 p.
Monografia em Inglês | MedCarib | ID: med-4966

RESUMO

Focuses on the hospitalization program in the country


Assuntos
Atenção Terciária à Saúde , Hospitais , Dominica
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