Patient Safety Culture, Infection Prevention, and Patient Safety in the Operating Room: Health Workers' Perspective.

Introduction: A hospital's patient safety culture affects surgical outcomes. Operating room safety culture has been overlooked despite the importance of patient safety. The AHRQ's Hospital Survey on Patient Safety Culture (HSOPSC) has been used worldwide to assess and enhance patient safety culture. This study examined how patient safety culture and infection prevention effect patient safety in the Operating Room (OR). Methods: This observational study used an online survey and included 143 OR workers. Descriptive statistics and multilinear regression were used to examine how patient safety culture and infection prevention affects level of patient safety. Results: Most responders worked in excellent-accredited general hospitals. Most responders were male, aged between 26 to 40 years old, and had bachelor's degrees. Most were hospital-experienced nurses. Less than half had worked in units for over ten years. Organizational Learning - Continuous Improvement; Teamwork and Handoffs; and Information Exchange had the most positive responses in the OR. However, Staffing, Work Pace, and Patient Safety ranked lowest. Organizational Learning - Continuous Improvement and Hospital Management Support for Infection Prevention Efforts were found to affect OR patient safety level perceptions. Conclusion: According to the findings of our study, the overall patient safety culture in the operating room remains weak which highlights the importance of continuing efforts to improve patient safety in the OR. Further study could be directed to identify organizational learning in infection prevention to enhance the patient safety in the OR.

Health Workers' Perspective on Patient Safety Incident Disclosure in Indonesian Hospitals: A Mixed-Methods Study.

Purpose: This study examined how health staff in Indonesian hospitals perceived open disclosure of patient safety incidents (PSIs). Patients and Methods: This study employed a mixed method explanatory sequential approach. We surveyed 262 health workers and interviewed 12 health workers. Descriptive statistical (frequency distributions and summary measures) analysis was performed to assess the distributions of variables using SPSS. We used thematic analysis for the qualitative data analysis. Results: We discovered a good level of open disclosure practice, open disclosure system, attitude toward open disclosure and process, open disclosure according to the level of harm resulting from PSIs in the quantitative phase. The qualitative phase revealed that most participants were confused about the difference between incident reporting and incident disclosure. Furthermore, the quantitative and qualitative analyses revealed that major errors or adverse events should be disclosed. The contradictory findings may be due to a lack of awareness of incident disclosure. The important factors in disclosing the incident are effective communication, type of incident, and patient and family characteristics. Conclusion: Open disclosure is novel for Indonesian health professionals. A good open disclosure system in hospitals could address several issues such as lack of knowledge, lack of policy support, lack of training, and lack of policy. To limit the negative implications of disclosing situations, the government should develop supportive policies at the national level and organize many initiatives at the hospital level.

Mechanism of spinal cord injury regeneration and the effect of human neural stem cells-secretome treatment in rat model.

BACKGROUND: Globally, complete neurological recovery of spinal cord injury (SCI) is still less than 1%, and 90% experience permanent disability. The key issue is that a pharmacological neuroprotective-neuroregenerative agent and SCI regeneration mechanism have not been found. The secretomes of stem cell are an emerging neurotrophic agent, but the effect of human neural stem cells (HNSCs) secretome on SCI is still unclear. AIM: To investigate the regeneration mechanism of SCI and neuroprotective-neuroregenerative effects of HNSCs-secretome on subacute SCI post-laminectomy in rats. METHODS: An experimental study was conducted with 45 Rattus norvegicus, divided into 15 normal, 15 control (10 mL physiologic saline), and 15 treatment (30 µL HNSCs-secretome, intrathecal T10, three days post-traumatic). Locomotor function was evaluated weekly by blinded evaluators. Fifty-six days post-injury, specimens were collected, and spinal cord lesion, free radical oxidative stress (F2-Isoprostanes), nuclear factor-kappa B (NF-κB), matrix metallopeptidase 9 (MMP9), tumor necrosis factor-alpha (TNF-α), interleukin-10 (IL-10), transforming growth factor-beta (TGF-ß), vascular endothelial growth factor (VEGF), B cell lymphoma-2 (Bcl-2), nestin, brain-derived neurotrophic factor (BDNF), glial cell line-derived neurotrophic factor (GDNF) were analyzed. The SCI regeneration mechanism was analyzed using partial least squares structural equation modeling (PLS SEM). RESULTS: HNSCs-secretome significantly improved locomotor recovery according to Basso, Beattie, Bresnahan (BBB) scores and increased neurogenesis (nestin, BDNF, and GDNF), neuroangiogenesis (VEGF), anti-apoptotic (Bcl-2), anti-inflammatory (IL-10 and TGF-ß), but decreased pro-inflammatory (NF-κB, MMP9, TNF-α), F2-Isoprostanes, and spinal cord lesion size. The SCI regeneration mechanism is valid by analyzed outer model, inner model, and hypothesis testing in PLS SEM, started with pro-inflammation followed by anti-inflammation, anti-apoptotic, neuroangiogenesis, neurogenesis, and locomotor function. CONCLUSION: HNSCs-secretome as a potential neuroprotective-neuroregenerative agent for the treatment of SCI and uncover the SCI regeneration mechanism.

The Role of Human Neural Stem Cell Secretomes on the Repair of Spinal Cord Injury Post-laminectomy in Rattus norvegicus Through the Analysis of Basso-Beattie-Bresnahan Score Locomotors, Interleukin-10, Matrix Metalloproteinase 9, and Transforming Growth Factor-ß.

STUDY DESIGN: Experimental animal study. PURPOSE: This study aims to investigate the effects of treatment with human neural stem cell (HNSC) secretomes on subacute spinal cord injury (SCI) post-laminectomy by analyzing interleukin-10 (IL-10), matrix metalloproteinase 9 (MMP9), transforming growth factor-ß (TGF-ß), and Basso-Beattie-Bresnahan (BBB) score locomotors as expressions of neurological recovery. OVERVIEW OF LITERATURE: In the United States, SCI has a recovery rate of 0.08%, tetraplegia 58.7%, and paraplegia 40.6%. Therapeutic approaches to SCI have focused on modulating the secondary cascade to prevent neurological deterioration and glial scar formation. Increasing evidence has shown that the success of cell-based SCI therapy is attributed to the secretomes rather than the cells themselves, but the effect of treatment with HNSC secretomes in SCI is unclear. METHODS: This experimental study investigated 15 Rattus norvegicus rats that were divided into three groups: (1) normal, (2) SCI+nonsecretome, and (3) SCI+secretome (30 µL, intrathecal Th10). Model subacute SCI post-laminectomy was performed in 60 seconds using an aneurysm Yasargil clip with a closing forceps weighing 65 g (150 kdyn). At 35 days post-injury, the specimens were collected, and the immunohistochemicals of IL-10, MMP9, and TGF-ß were analyzed. Motor recovery was evaluated based on the BBB scores. RESULTS: The SCI post-laminectomy of rats treated with HNSC secretomes showed improvements in their locomotor recovery based on the BBB scores (p =0.000, mean=18.4) and decreased MMP9 (p =0.015) but had increased the levels of IL-10 (p =0.045) and TGF-ß (p =0.01). CONCLUSIONS: These results indicate that the factors associated with the HNSC secretomes can mitigate their pathophysiological processes of secondary damage after SCI and improve the locomotor functional outcomes in rats.

The mechanism of human neural stem cell secretomes improves neuropathic pain and locomotor function in spinal cord injury rat models: through antioxidant, anti-inflammatory, anti-matrix degradation, and neurotrophic activities.

Background: Globally, spinal cord injury (SCI) results in a big burden, including 90% suffering permanent disability, and 60%-69% experiencing neuropathic pain. The main causes are oxidative stress, inflammation, and degeneration. The efficacy of the stem cell secretome is promising, but the role of human neural stem cell (HNSC)-secretome in neuropathic pain is unclear. This study evaluated how the mechanism of HNSC-secretome improves neuropathic pain and locomotor function in SCI rat models through antioxidant, anti-inflammatory, anti-matrix degradation, and neurotrophic activities. Methods: A proper experimental study investigated 15 Rattus norvegicus divided into normal, control, and treatment groups (30 µL HNSC-secretome, intrathecal in the level of T10, three days post-traumatic SCI). Twenty-eight days post-injury, specimens were collected, and matrix metalloproteinase (MMP)-9, F2-Isoprostanes, tumor necrosis factor (TNF)-α, transforming growth factor (TGF)-ß, and brain derived neurotrophic factor (BDNF) were analyzed. Locomotor recovery was evaluated via Basso, Beattie, and Bresnahan scores. Neuropathic pain was evaluated using the Rat Grimace Scale. Results: The HNSC-secretome could improve locomotor recovery and neuropathic pain, decrease F2-Isoprostane (antioxidant), decrease MMP-9 and TNF-α (anti-inflammatory), as well as modulate TGF-ß and BDNF (neurotrophic factor). Moreover, HNSC-secretomes maintain the extracellular matrix of SCI by reducing the matrix degradation effect of MMP-9 and increasing the collagen formation effect of TGF-ß as a resistor of glial scar formation. Conclusions: The present study demonstrated the mechanism of HNSC-secretome in improving neuropathic pain and locomotor function in SCI through antioxidant, anti-inflammatory, anti-matrix degradation, and neurotrophic activities.