Hand hygiene compliance by health care workers at a teaching hospital, Kingston, Jamaica.

INTRODUCTION: Consistent practice of hand hygiene (HH) has been shown to reduce the incidence and spread of hospital acquired infections. The objectives of this study were to determine the level of compliance and possible factors affecting compliance with HH practices among HCWs at a teaching hospital in Kingston, Jamaica. METHODOLOGY: A prospective observational study was undertaken at the University Hospital of the West Indies (UHWI) over a two weeks period. Trained, validated observers identified opportunities for hand hygiene as defined by the WHO "Five Hand Hygiene Moments" and recorded whether appropriate hand hygiene actions were taken or missed. Observations were covert to prevent the observer's presence influencing the behaviour of the healthcare workers (HCWs) and targeted areas included the intensive care units (ICUs), surgical wards and surgical outpatient departments. A ward infrastructure survey was also done. Data were entered and analysed using SPSS version 16 for Windows. Chi-square analysis using Pearson's formula was used to test associations between 'exposure' factors and the outcome 'compliance'. RESULTS: A total of 270 hand hygiene opportunities were observed and the overall compliance rate was 38.9%. No differences were observed between the various types of HCWs or seniority. HCWs were more likely to perform hand hygiene if the indication was 'after' rather than 'before' patient contact (p = 0.001). CONCLUSION: This study underscores the need for improvement in HH practices among HCWs in a teaching hospital. Health education with particular attention to the need for HH prior to physical contact with patients is indicated.

Leadership in surgery for public sector hospitals in Jamaica: strategies for the operating room.

The barriers to health care delivery in developing nations are many: underfunding, limited support services, scarce resources, suboptimal health care worker attitudes, and deficient health care policies are some of the challenges. The literature contains little information about health care leadership in developing nations. This discursive paper examines the impact of leadership on the delivery of operating room (OR) services in public sector hospitals in Jamaica.Delivery of OR services in Jamaica is hindered by many unique cultural, financial, political, and environmental barriers. We identify six leadership goals adapted to this environment to achieve change. Effective leadership must adapt to the environment. Delivery of OR services in Jamaica may be improved by addressing leadership training, workplace safety, interpersonal communication, and work environment and by revising existing policies. Additionally, there should be regular practice audits and quality control surveys.

Colonic perforation: a lethal consequence of cannabis body packing.

Body packing is one method of smuggling cannabis across international borders. The practice is prevalent in Jamaica. There has been one reported death from this practice in medical literature. We report a second fatal case of cannabis body packing, reinforcing the dangerous nature of this practice.

Revisiting current strategies for primary prevention of motorcycle collisions in Jamaica.

Motorcycle Road Traffic Collisions place a heavy burden on emergency medical services in Jamaica. We explore the existing strategies and legislative policies that may prevent or reduce the severity of these injuries in Jamaica. This is an important aspect of health care as it may minimize the impact of these preventable injuries on the limited resources of the health services.

Arteriovenous fistulas as vascular access for hemodialysis: The preliminary experience at the University Hospital of the West Indies, Jamaica.

BACKGROUND: The demand for vascular hemodialysis access creation is steadily increasing. To satisfy the demand, a vascular access team was established at the University Hospital of the West Indies, Jamaica. The outcomes of this practice are reported. METHODS: A retrospective study of all patients who had permanent vascular dialysis access established at the University Hospital of the West Indies between January 1, 2002, and December 31, 2006, was performed. Data were analyzed using SPSS version 12.0 (SPSS Inc, USA). A direct anastomosis between an autogenous artery and vein was considered an arteriovenous fistula (AVF). When prosthetic material was used, the access was considered to be an arteriovenous graft. Accesses that were nonfunctional after six weeks of maturation were considered to be primary failures, while those that failed after previous successful dialysis were considered to be secondary failures. Primary patency was defined as the interval between access placement and the first intervention for failure. Secondary patency was the interval between access placement and abandonment. Cumulative patency was defined as the number of accesses that remained patent over a given time period, regardless of the number of interventions performed. RESULTS: Of 41 patients, nine were excluded due to incomplete data. Final analyses were performed on 32 patients with a mean (± SD) age of 42.3±15.3 years (range 18 to 66 years, median 43 years). The access type was an AVF in 100% of cases, which included distal radiocephalic fistulas in 27 patients, brachial-cephalic fistulas in three patients and proximal radiocephalic fistulas in two patients. Operations were performed in four (12.5%) incident and 28 (87.5%) prevalent dialysis patients. The mean delay between initiation of dialysis and AVF creation was 21.2±26.1 months (range one to 94 months, median 10 months). There were eight (25%) primary failures. Of the remaining 24 patients, there were seven (29.2%) secondary failures from thrombosis. There was primary patency for a mean of 723.9±422.1 days (range 199 to 1314 days, median 678 days). Only one (4.2%) patient had thrombectomy to prolong AVF function, resulting in secondary patency for 439 days. Cumulative patency was 62.5%, 33.3%, 25% and 4.2% for one, two, three and four years, respectively. CONCLUSIONS: The rate of AVF creation for end-stage renal disease patients in this setting far exceeds the target goals set forward by the National Kidney Foundation published updated Dialysis Outcomes Quality Initiative (NKF/DOQI) Guidelines and the Centers for Medicaid & Medicare Services Fistula First initiative. This is being achieved with acceptable rates of morbidity and patency. There is room for improvement in postoperative surveillance to increase early detection of failing accesses and allow for increased utility of interventions for assisted patency.