Quality of hospital care evaluated by Danish nurses and doctors--based on experience from their own or a close family member's hospitalization

INTRODUCTION

No studies have systematically asked larger groups of health professionals about their own experience as patients. This study estimated the level of satisfaction with hospital care among health professionals based on experience from their own hospital admission or that of a close family member.

METHODOLOGY

A cross-sectional questionnaire study of 1995 doctors (41% women) and 1472 nurses (98% women) drawn randomly from union registers. Response rate: 70%.

RESULTS

Twenty-seven percent had themselves been hospitalized within the preceding five years, and 31% had followed a hospital stay for a close relative during the preceding two years. At least 85% were satisfied with these conditions: information from the hospital, nursing staff, and doctors before admission; quality of the sickroom; level of smoke exposure; quality of breakfast, lunch, and beverages; nursing staff's and doctors' communication with the patient, and; doctors' treatment and diagnostics. Dissatisfaction above 15% was seen for several other factors associated with facilities, care, and treatment. One severe observation was related to the degree of treatment complications, reported by 23% of the patients. When reporting on behalf of an admitted relative a tendency was found to be slightly more critical. Generally, the results of this study are in agreement with previous Danish studies on patient satisfaction.

CONCLUSION

The results of the present study indicate room for improvement in several respects in Danish hospital care: Better physical facilities, improved patient information, and a continuous quality surveillance to prevent treatment errors.

Prevention and control of infection in non-acute healthcare settings

This article discusses the main principles of infection prevention and control in non-acute healthcare settings. It explores the use of a set of ten tools developed by the Infection Control Nurses Association (ICNA) to audit infection prevention and control, using the standard statements and criteria within the tools as a checklist. The results of the audit of facilities, commodities and practice using the ICNA audit tools will help staff to identify areas of best practice and areas where improvements are needed to enhance patient care.

Blunt and penetrating object injuries in housekeepers working in a Turkish University Hospital

BACKGROUND

Hospitals have been described as hazardous work environments with an increase in job-related injuries. This situation creates great risks and hazards for housekeepers while carrying out their job.

METHODS

This descriptive study was performed on 402 housekeepers working in patient-care services in Turkey. The data of this study were collected using a questionnaire form. This form included 26 questions about general features of housekeepers and working units, blunt and penetrating object injuries in the past 3 months and hepatitis B virus immunization.

RESULTS

The majority of housekeepers (71.1%) are men, (54%) are graduates of primary school or are illiterate, and (73.6%) are married. Their mean age is 31.5 years; the mean length of employment is 3.2 years. Sixty-two point nine percent of them are working in medical/surgical units, 88.8% of them are working in routine cleaning, and 29.1% of them have been injured with various blunt and penetrating objects while working in hospital in the past 3 months. Only 26.6% of the housekeepers have been administered the hepatitis B vaccination.

CONCLUSION

This study showed a high frequency of blunt and penetrating object injuries in housekeepers. Therefore, more efforts are necessary to increase compliance with vaccination in housekeepers.

Control and Outcome of a Large Outbreak of Colonization and Infection with Glycopeptide-Intermediate Staphylococcus aureus in an Intensive Care Unit

BACKGROUND

Glycopeptide-intermediate Staphylococcus aureus (GISA) is emerging as a cause of nosocomial infection and outbreaks of infection and colonization in intensive care units (ICUs). We describe an outbreak of GISA colonization/infection and the ensuing control measures in an ICU and investigate outcomes of the affected patients.

METHODS

We describe an outbreak of GISA colonization and infection that affected 21 patients in a medical ICU at a tertiary care teaching hospital, as well as the measures taken to eradicate the GISA strain.

RESULT

Recognition of the outbreak was difficult. Infections, all of which were severe, were diagnosed in 11 of 21 patients. Patient isolation and barrier precautions failed when used alone. Addition of a stringent policy of restricted admissions, twice daily environmental cleaning, and implementation of hand decontamination with a hydroalcoholic solution led to outbreak termination. This was associated with increases in workload, despite a marked decrease in the number of admissions.

CONCLUSION

This first description of a large outbreak of GISA colonization and infection underlines the importance of routine GISA-strain detection when methicillin-resistant S. aureus is isolated. Outbreak control may be difficult to achieve.

A bug's life

This article explains what methicillin-resistant Staphylococcus aureus (MRSA) is, how it is spread and what the real challenges are in healthcare settings in the UK. It explores the different strains of MRSA and points out the main ways to control their spread. It is intended to be a reference source for all nurses.

Task-based estimation of mechanical job exposure in occupational groups

OBJECTIVES

This study examined the validity of a common belief in epidemiology with respect to work-related musculoskeletal disorders, that individual mechanical job exposure is better estimated from tasks performed in the job than from the mean exposure of the occupational group.

METHODS

Whole-day recordings of upper trapezius electromyography were obtained from 24 cleaners and 23 office workers. Trapezius activity was analyzed in the level (gap time) and frequency (jerk time) dimensions. On the same day, the job of each person was divided into periods of active work and breaks by means of continuous observations. The bootstrap re-sampling technique was used with this database to compare task-based job exposure estimates with estimates based on the occupational mean. For a particular person, the task-based estimate was obtained by combining the average work and break exposures in the occupation with the personal time proportions of the two tasks in the job.

RESULTS

The task-based estimates were, in general, equivalent to, or less correct than, occupation-based estimates for both exposure parameters in both occupations and for individual exposures, as well as for group means. This was the result in spite of significant and consistent exposure differences between work and breaks, in particular among the cleaners.

CONCLUSIONS

Even if task exposure contrasts are large, task-based estimates of job exposures can be less correct than estimates based on the occupational mean. Since collecting and processing task information is costly, it is recommended that task-based modeling of mechanical exposure be implemented in studies only after careful examination of its possible benefits.

Educação continuada em um serviço terceirizado de limpeza de um hospital universitário

A educação continuada tem sido tema de constantes reflexões devido à rápida evolução tecnológica, que traz modificações na organização do trabalho, exigindo dos trabalhadores atualização de seus conhecimentos. No contexto desse novo paradigma tecnológico nas relações de produção e na organização do trabalho, foram analisadas as atividades de educação continuada desenvolvidas junto aos trabalhadores terceirizados que atuam no setor de limpeza de um hospital universitário e foi avaliado seu conhecimento em relação ao risco de contaminação do ambiente de trabalho e a importância de seu trabalho para a manutenção de sua saúde. Foram realizadas seis entrevistas semi-estruturadas junto a trabalhadores terceirizados do setor de Limpeza e duas com os responsáveis pela educação continuada desses trabalhadores, além de quatro períodos de observação das atividades desenvolvidas e o diário de campo. Todos os trabalhadores consideraram essencial a educação continuada, pois não tinham experiência prévia sobre a limpeza no trabalho hospitalar.

Reducing absenteeism in hospital cleaning staff: pilot of a theory based intervention

AIMS

To develop, pilot, and evaluate a workplace intervention to reduce sickness absence, based on a demand-control-support model of job strain.

METHODS

Changes in the working arrangements of hospital cleaning staff were introduced with the aim of increasing their control over work and the support received at work. The study design was quasi-experimental, with 221 cleaning staff in the intervention group and 91 catering staff in the control group. The dependent variable was the difference in percentage monthly sickness absence between the 12 months preceding and following the intervention. Differences in sickness absence between staff groups for each month after the intervention were compared with differences between staff groups for the equivalent month one year prior to it.

RESULTS

There was a significant reduction in the difference in sickness absence rates between the intervention and control group of 2.3% in the six months after the intervention, compared to the six months before. The difference was not maintained at 12 months.

CONCLUSIONS

These results suggest that a workplace intervention aimed at increasing control and support at work has a small effect on reducing sickness absence among hospital cleaning staff in the short term. Future research should seek to replicate this effect in larger, experimental studies, analyse postulated mediators of such theory based interventions, and develop interventions that maintain improvement.

Saúde do trabalhador & terceirização: perfil de trabalhadores de serviço de limpeza hospitalar

Nas duas últimas décadas, a terceirização de serviços possibilitou a redução dos custos das empresas, pela racionalização de suas ações e exploração de relações precárias do trabalho. Esta pesquisa teve por objetivo traçar o perfil dos trabalhadores terceirizados, que atuavam no serviço de limpeza de um hospital universitário, identificar suas perspectivas em relação ao processo saúde-doença e ao seu futuro. Trata-se de um estudo descritivo, de abordagem quantitativa, com amostragem aleatória, com 50 trabalhadores. A maioria começou a trabalhar precocemente, 74% eram do sexo feminino e com baixa escolaridade. Dos entrevistados, 36% referiram doenças diagnosticadas pelo médico. No período estudado, 84% dos trabalhadores entrevistados realizaram consultas médicas, totalizando 181 consultas, resultando em média 3,6 consultas por trabalhador, sendo a mais freqüente, 56%, com o clínico geral. A análise dos dados possibilitou a identificação das perspectivas desses profissionais em relação ao processo saúde/doença e ao seu futuro.

Does disinfection of environmental surfaces influence nosocomial infection rates? A systematic review

OBJECTIVE

To review the evidence on the effects of disinfection of environmental surfaces in hospitals (as compared with cleaning without use of disinfectants) on the occurrence of nosocomial infections.

METHODS

Systematic review of experimental and nonexperimental intervention studies dealing with environmental disinfection or cleaning in different health care settings.

RESULTS

A total of 236 scientific articles were identified. None described a meta-analysis, systematic review, or randomized controlled trial. Only 4 articles described completed cohort studies matching the inclusion criteria. None of these studies showed lower infection rates associated with routine disinfection of surfaces (mainly floors) versus cleaning with detergent only.

CONCLUSIONS

Disinfectants may pose a danger to staff, patients, and the environment and require special safety precautions. However, targeted disinfection of certain environmental surfaces is in certain instances an established component of hospital infection control. Given the complex, multifactorial nature of nosocomial infections, well-designed studies that systematically investigate the role of surface disinfection are required.

The impact of environmental cleanliness on infection rates

Much has been said in recent years about the lack of environmental cleanliness in hospitals. The House of Lords Select Committee (1998) talked about falling standards in hospital cleaning and, more recently, the government acknowledged in The NHS Plan (Department of Health, 2000) that hospitals were unacceptably dirty. Such comments may affect people's perceptions of hospitals and, rather than regarding them as safe environments that promote healing, they may be viewed as dangerous places that might cause vulnerable patients greater harm. While it is known that about 10 per cent of hospital inpatients have a nosocomial infection at any one time (Emmerson et al, 1996), there is uncertainty about whether there is a sound evidence base to support the theory that dirty hospitals cause infection.

[Carpal tunnel syndrome and cleaning work: a binomial that should not be overlooked]

The Carpal tunnel syndrome is a common problem in various jobs, but not in the cleaning farms. A population of 99 women working in hospital cleaning activities was investigated to define if, although the risk assessment was negative for cumulative trauma diseases (CTD), the Occupational physician should search or not the CTS. We found that CTS prevalence in exposed group is higher than the common female population not exposed and the female workers are younger, so we can suppose the occupational risk exist although the negative risk assessment. The age and the working-age seem not to be determinant in the pathology of the disease, nether the different working-risks is, therefore the risk assessment doesn't consider other risk factor of the cleaning activities: strength, duration, frequency and recover time. This study confirms that the CTS seems to be a disease related with the cleaning workers and although the risk assessment is negative for CTD the Occupational physician should perform the health survaillance for CTD.

Workplace change and the internal labour market: evidence from the NSW hospital industry

After a decade of labour market reform and workplace change, increasing attention has focussed on public sector industries. In this paper, domestic and maintenance occupations in the hospital industry are examined, as previous work has focussed on nursing, with other occupations being largely ignored. Grimshaw and Rubery's (1998) model of internal labour markets is adopted as the preferred theoretical approach. This model, in acknowledging external factors, the role of workers, and custom and norms within the firm, provides a basis from which to examine labour use practices within the hospital industry.

Evaluation of a training program for the prevention of lower back pain among hospital employees

An evaluation of a training program for the prevention of lower back pain (LBP) was conducted over a two-year period in the Regional Hospital of Le Mans, which is located in the west of France and employs 2400 staff. The training program was based on a multidisciplinary approach to worker training in the prevention of LBP and in ergonomic efforts in the workplace. Workers received theoretical training on LBP, patient handling and ergonomics, and on-the-job ergonomics instruction to help them to implement participative ergonomics in their working groups. A cohort of 136 employees attended classes on safe posture and patient handling, then received advice from instructors who observed them while they performed their typical workday tasks.

Effectiveness of a workplace risk assessment team in reducing the rate, cost, and duration of occupational injury

This study evaluated the effectiveness of a consultative workplace risk assessment team in reducing the rate and severity of injury among cleaners within a 600-bed hospital. Cohorts of Cleaning Services and Orderly Services staff ever employed within both a 4-year preintervention and a 3-year postintervention period were assigned to the intervention and comparison groups, respectively. The date, compensation claims' cost, and hours lost from work were obtained for each injury during the study period. Age, gender, work experience, and hours worked were ascertained for every subject whether injured or not. Reductions of two thirds in injury rate, 73% in cost rate, and 43% in duration rate were evident in the intervention group. In comparison, the orderlies experienced a postintervention increase in all three rates. The success of the workplace risk assessment team intervention supports the adoption of a participatory approach to reducing the rate and consequence of workplace injury.

Evaluation of bedmaking-related airborne and surface methicillin-resistant Staphylococcus aureus contamination

The number of airborne methicillin-resistant Staphylococcus aureus (MRSA) before, during and after bedmaking was investigated. Air was sampled with an Andersen air sampler in the rooms of 13 inpatients with MRSA infection or colonization. Sampling of surfaces, including floors and bedsheets, was performed by stamp methods. MRSA-containing particles were isolated on all the sampler stages-stage 1 (>7 microm diameter) to stage 6 (0.65-1.1 microm). The MRSA-containing particles were mostly 2-3 microm diameter before bedmaking and >5 microm during bedmaking. The number was significantly higher 15 min after bedmaking than during the resting period, but the differences in counts after 30 and 60 min were not significant. MRSA was detected on many surfaces. The results suggest that MRSA was recirculated in the air, especially after movement. To prevent airborne transmission, healthcare staff should exercise great care to disinfect inanimate environments. Further studies will be needed to confirm the level of MRSA contamination of air during bedmaking and establish measures for prevention of airborne transmission.

[Microbial environmental surveillance in a bone marrow transplant unit]

The aim of this study was to evaluate, after several years of application, in a bone marrow transplant (BMT) center of a Cagliari Hospital, the effectiveness of the disinfection protocol in minimizing the risk of environmentally transmitted infections. Microbial contamination of the air was evaluated every two months during normal activity using an SAS sampler. The contamination of surfaces was determined weekly, 2hrs after sanitation, using disposable surface contact plates. The results of environmental monitoring generally showed low values of microbial contamination of air and surfaces. Only two service rooms and two patient's rooms without own bathroom showed levels of microbial contamination slightly exceeding, in a few samplings, the values considered acceptable for environments at high risk of infections. From a qualitative point of view, the microrganisms isolated generally belonged to environmental species. In conclusion our study confirms the importance of microbial monitoring in the control and prevention of outbreaks of infections in BMT Units. This approach allows significant reduction in the level of contamination not only by improving cleaning procedures, but also by motivating the cleaning staff trough making them aware of their responsibilities.

Tackling the problem of poor ward cleanliness

Both the environment and equipment used in health-care facilities have been identified as sources of infection. The cleaning of any hospital environment must be carried out in a pre-planned, clearly structured and defined manner. Domestic staff need thorough basic training and regular updates.

A study of post-traumatic shingles as a work related injury

BACKGROUND

After chicken pox, the herpes varicella-zoster (HVZ) virus may remain dormant in the dorsal root ganglion until later reactivation causes shingles, characterized by painful dysesthesias and cutaneous vesicular eruptions along a unilateral dermatome. Shingles as a work-related injury has not been previously addressed in the medical literature. Case History We present a 50-year old female hospital employee who, while working, sustained an acute, traumatic hyperextension injury to her right wrist, hand, and fingers. Although she initially responded to treatment for flexor tendinitis, she suddenly developed shingles in the right C5-C6 dermatomes. She was treated with famcyclovir and her skin lesions resolved, but post-herpetic neuralgia persisted.

CONCLUSIONS

It was felt that her shingles was causally related to her occupational injury since trauma (previously reported to precipitate shingles) was her only risk factor and the timing and location of the lesions corresponded closely to the occupational injury. In addition to appropriately diagnosing and treating their patients, workers' compensation physicians often must determine if a particular condition was caused by the original work-related incident. Clinicians who treat trauma patients and injured workers should be aware of post-traumatic shingles and understand the causal relationship of this uncommon but clinically important phenomenon.

An evaluation of hospital cleaning regimes and standards

A four-part study assessing cleanliness in up to 113 environmental surfaces in an operating theatre and a hospital ward is reported. Surfaces were assessed visually, using microbiological methods and ATP bioluminescence. Results from a preliminary random survey indicated variability in cleanliness. These results were then used to select sites for monitoring before and after routine cleaning, over a 14-day period. Using published microbiological and ATP specifications 70 and 76% of these sites were unacceptable after cleaning. Visual assessment was a poor indicator of cleaning efficacy with only 18% considered unacceptable. Sites most likely to fail in the ward were in the toilet and kitchen, areas which are frequently implicated in the spread of infectious intestinal disease. Operating theatre sites had lower ATP results but 61% of sites would be considered unacceptable. There was no significant difference in general microbiological or ATP results overall before and after routine cleaning. Although some important hand contact sites showed no significant difference, overall there was a significant decrease in staphylococcal and enterobacteria counts in the ward but not in the operating theatre after cleaning. The routine cleaning programmes used did not include a biocide and cleaning using a hypochlorite based sanitizer gave much lower values. The results are discussed in relation to infection control, cleaning audits and cleaning schedules: an integrated cleaning monitoring programme using ATP bioluminescence in conjunction with visual and microbiological assessments is recommended.

[Microbiological conditions of hospital beds before and after terminal cleaning]

INTRODUCTION

The hospital's environment keeps a close relationship with hospital infection, which may promote focus of contact and transmission. The terminal cleaning of patient unit represents one way to control microbiological environmental contamination. The study has as its main objective to evaluate the microbiological conditions of hospital mattresses before and after cleaning.

METHODS

Rodac plates were utilized for specimen collection with culture medium - blood agar plate. The patients beds were chosen by criteria established before hand and the places for specimen collection in the mattress were chosen by aleatory drawing. To the study of numerical alteration related to the positivity of plates before and after cleaning, Goodman' statistics tests were used.

RESULTS

From 52 mattress investigated, 520 culture plates were done from which 514 (98,8%) had a positive culture, 259 before cleaning and 255 after cleaning showing a reduction of positive cultures in only 4 plates after cleaning.

CONCLUSIONS

The number of plates with countable and countless colonies suggests that the cleaning, as it is done, instead of reducing the microorganism is dislocating it to other areas of the mattress keeping the microbiological condition as it was before the cleaning process.

[Occurrence of allergens on hospital premises]

The occurrence of allergens from the house-dust mites Der p 1, Der f 1 and Der m, and from dogs (Can f 1) and cats (Fel d 1) was assessed in Viborg Hospital. Three hundred samples collected in a standardized manner were analysed for allergens by ELISA technique. In only one dust sample was the total occurrence of mite allergens marginally above the sensitization threshold level of 2,000 ng mite allergens/g dust. For Fel d 1 a threshold level for sensitization or symptoms of 8,000 ng Fel d 1/g dust has been proposed; none of the dust samples contained this concentration. A low occurrence of Can f 1 was found. One dust sample contained 8,902 ng Can f 1, while the remainder exhibited lower concentrations. Efficient cleaning and adequate ventilation can reduce allergens in public buildings, but it is impossible to remove all allergens from upholstered furniture. Avoidance of such furniture in wards and outpatient departments which receive allergic patients might be considered.

Mopping up hospital infection

Hospital cleaning is a neglected component of infection control. In the UK, financial constraints have forced managers to re-evaluate domestic services and general cleaning has been reduced to the bare minimum. Services have been contracted out in some hospitals, which has further lowered standards of hygiene. Control of infection personnel believe that cleaning is important in preventing hospital-acquired infections but they do not manage domestic budgets and have failed to stop their erosion. It is difficult to defend high levels of hygiene when there is little scientific evidence to support cleaning practices. This review examines the common micro-organisms associated with hospital-acquired infection and their ability to survive in the hospital environment. It also describes studies which suggest that comprehensive cleaning disrupts the chain of infection between these organisms and patients. It is likely that restoring hygienic standards in hospitals would be a cost-effective method of controlling hospital-acquired infection. Furthermore, good cleaning is achievable whereas the enforcement of hand washing and good antibiotic prescribing are not.

The role of the hospital environment in the epidemiology of multi-resistant bacteria

The aim of this study was to use published data to assess the importance of the hospital environment as a possible secondary reservoir of multi-resistant bacteria capable of colonizing or infecting patients. This should make it possible to develop appropriate measures for preventing cross contamination in medical environments. Multi-resistant bacteria often contaminate the environment of the colonized or infected patients, and survive for long periods. However, measures proposed to reduce contamination and reduce the potential for cross infection such as disinfection when the patient is discharged, the use of materials with intrinsic antibacterial activity and the wearing of gloves by everyone entering the room whether or not they intend to actually touch the patient, have yet to be evaluated as part of an overall strategy to prevent infection with multi-resistant bacteria.

Communication patterns and group composition: implications for patient-centered care team effectiveness

To assess how diversity affects team communication and to identify strategies to improve communication and patient care, focus groups of care production team members were held in two case study hospitals that have implemented the patient-centered care model. Results indicate that care production team members generally support patient-centered care as a model that can work effectively in practice, even in an urban environment in which diversity concerns can affect team cohesiveness and communication. Successful implementation of the model, however, requires that hospitals consistently employ management strategies and reward structures that reinforce the value of teamwork and emphasize training and staff development. Key steps that healthcare executives can undertake to improve the performance of care production teams are detailed in this article and center around the following themes: team involvement in process improvement; a heightened emphasis on training (i.e., team and diversity training for all team members, task focused training for nonlicensed care givers; and leadership training for RNs); and the implementation of team-based reward and incentive structures.

Active tuberculosis in a deployed field hospital

During the deployment of U.S. troops to the former Republic of Yugoslavia in support of Operation Joint Endeavor and the Dayton Peace Accords from December 1995 to December 1996, members of a deployed field hospital were exposed to a case of active tuberculosis from a local civilian worker. Tuberculin skin testing of civilian contacts of the index patient revealed 76% reactivity. Testing of exposed unit members revealed a 1.3% conversion rate upon redeployment, versus a 2.0% conversion rate for redeployed soldiers as a whole. More importantly, tuberculin skin testing of locally hired civilian workers as a whole revealed a 44% background positive rate, raising significant force-protection concerns and highlighting the role of occupational medicine and the need for screening of civilian employees in operations other than war.

'Light' and 'heavy' work in the housekeeping service of a hospital

Work is organized based in part on the perceptions, by managers and workers, of workers, their abilities and the characteristics of the work to be done. Physical tasks in factories and services have often been divided into 'light' and 'heavy', a division that often corresponds formally or informally to gender. We have observed the work of cleaners on wards and in offices in an acute-care hospital, using several indicators of workload to identify and characterize typical work situations. 'Heavy' work was characterized by neutral postures, walking, repetitive movements involving the articulations of the upper limb pushing a 1-6 kg (wet or dry) mop, with occasional more intense effort. 'Light' work was characterized by flexed postures, walking, rapid repetitive movements involving the articulations of the upper limb and light weights (dusting) or 1-3 kg weights (emptying wastebaskets), with more occasional intense effort. We did not discover any compelling reason to divide cleaning into 'light' and 'heavy' work. Task assignment by sex may appear to be a solution to excessive job demands which would be better addressed by job re-design.