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Noonan RJ. What Are the Roots of the Nation's Poor Health and Widening Health Inequalities? Rethinking Economic Growth for a Fairer and Healthier Future. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024:2752535X241259241. [PMID: 38889922 DOI: 10.1177/2752535x241259241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Health inequalities are differences in health between groups in society. Despite them being preventable they persist on a grand scale. At the beginning of 2024, the Institute of Health Equity revealed in their report titled: Health Inequalities, Lives Cut Short, that health inequalities caused 1 million early deaths in England over the past decade. While the number of studies on the prevalence of health inequalities in the UK has burgeoned, limited emphasis has been given to exploring the factors contributing to these (widening) health inequalities. In this commentary article I will describe how the Government's relentless pursuit of economic growth and their failure to implement the necessary regulatory policies to mitigate against the insecurity and health effects neoliberal free market capitalism (referred to as capitalism herein) causes in pursuit of innovation, productivity and growth (economic dynamism) is one key driver underpinning this social injustice. I contend that if the priority really is to tackle health inequalities and ensure health for all then there is an imperative need to move beyond regulation alone to mitigate the worst effects of capitalist production; the goal of the economy has to change to fully restore the balance between economic growth and public health.
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Affiliation(s)
- Robert J Noonan
- Faculty of Health and Wellbeing, University of Bolton, Bolton, UK
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Gastaldi S, Accorgi D. Choosing between outsourcing contracts and in-house cleaning services: Dusting off the shadows on hospital environmental hygiene. Am J Infect Control 2024; 52:377-379. [PMID: 38141968 DOI: 10.1016/j.ajic.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/25/2023]
Affiliation(s)
- Silvana Gastaldi
- National Association of Nurses for Prevention of Hospital Infections (ANIPIO), Italy.
| | - Daniela Accorgi
- IPC Nurse, Department of Nursing and Obstetrics, Azienda USL Toscana Centro, Florence, Italy
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Goodair B, Reeves A. The effect of health-care privatisation on the quality of care. Lancet Public Health 2024; 9:e199-e206. [PMID: 38429019 DOI: 10.1016/s2468-2667(24)00003-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/30/2023] [Accepted: 01/05/2024] [Indexed: 03/03/2024]
Abstract
Over the past 40 years, many health-care systems that were once publicly owned or financed have moved towards privatising their services, primarily through outsourcing to the private sector. But what has the impact been of privatisation on the quality of care? A key aim of this transition is to improve quality of care through increased market competition along with the benefits of a more flexible and patient-centred private sector. However, concerns have been raised that these reforms could result in worse care, in part because it is easier to reduce costs than increase quality of health care. Many of these reforms took place decades ago and there have been numerous studies that have examined their effects on the quality of care received by patients. We reviewed this literature, focusing on the effects of outsourcing health-care services in high-income countries. We found that hospitals converting from public to private ownership status tended to make higher profits than public hospitals that do not convert, primarily through the selective intake of patients and reductions to staff numbers. We also found that aggregate increases in privatisation frequently corresponded with worse health outcomes for patients. Very few studies evaluated this important reform and there are many gaps in the literature. However, based on the evidence available, our Review provides evidence that challenges the justifications for health-care privatisation and concludes that the scientific support for further privatisation of health-care services is weak.
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Affiliation(s)
- Benjamin Goodair
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK.
| | - Aaron Reeves
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
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Goodair B. 'Accident and emergency'? Exploring the reasons for increased privatisation in England's NHS. Health Policy 2023; 138:104941. [PMID: 37979466 PMCID: PMC10933725 DOI: 10.1016/j.healthpol.2023.104941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/09/2023] [Accepted: 11/03/2023] [Indexed: 11/20/2023]
Abstract
England's NHS is experiencing rising privatisation as services are increasingly being delivered by private healthcare providers. This has led to concerns about the supposed benefit of this process on healthcare quality but the reasons for the increase - and whether processes prioritise quality - are not well understood. In-depth semi-structured interviews with 20 people involved in the commissioning process, sampled from 3 commissioning sites (regional health boards) are thematically analysed. Four key themes of reasons for outsourcing were identified: unmet need; the "choice agenda"; appetite for change amongst key individuals working at the commissioning body; and the impact of financial pressures. The study concludes that the experience of commissioners navigating the provision of healthcare with worsening social determinants of health and financial austerity means that decisions to use private providers based on anticipated quality are sometimes but not always possible - sometimes they constitute 'accidents', sometimes 'emergencies'.
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Affiliation(s)
- Benjamin Goodair
- Department of Social Policy and Intervention, University of Oxford, Barnett House, 32-37 Wellington Square, Oxford OX1 2ER, United Kingdom.
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Casini B, Tuvo B, Scarpaci M, Totaro M, Badalucco F, Briani S, Luchini G, Costa AL, Baggiani A. Implementation of an Environmental Cleaning Protocol in Hospital Critical Areas Using a UV-C Disinfection Robot. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4284. [PMID: 36901293 PMCID: PMC10001687 DOI: 10.3390/ijerph20054284] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/24/2023] [Accepted: 02/25/2023] [Indexed: 06/18/2023]
Abstract
Improving the cleaning and disinfection of high-touch surfaces is one of the core components of reducing healthcare-associated infections. The effectiveness of an enhanced protocol applying UV-C irradiation for terminal room disinfection between two successive patients was evaluated. Twenty high-touch surfaces in different critical areas were sampled according to ISO 14698-1, both immediately pre- and post-cleaning and disinfection standard operating protocol (SOP) and after UV-C disinfection (160 sampling sites in each condition, 480 in total). Dosimeters were applied at the sites to assess the dose emitted. A total of 64.3% (103/160) of the sampling sites tested after SOP were positive, whereas only 17.5% (28/160) were positive after UV-C. According to the national hygienic standards for health-care setting, 9.3% (15/160) resulted in being non-compliant after SOP and only 1.2% (2/160) were non-compliant after UV-C disinfection. Operation theaters was the setting that resulted in being less compliant with the standard limit (≤15 colony-forming unit/24 cm2) after SOP (12%, 14/120 sampling sites) and where the UV-C treatment showed the highest effectiveness (1.6%, 2/120). The addition of UV-C disinfection to the standard cleaning and disinfection procedure had effective results in reducing hygiene failures.
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Affiliation(s)
- Beatrice Casini
- Department of Translational Research and the New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Benedetta Tuvo
- Department of Translational Research and the New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Michela Scarpaci
- Department of Translational Research and the New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Michele Totaro
- Department of Translational Research and the New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Federica Badalucco
- Department of Translational Research and the New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Silvia Briani
- Hospital Management, University Hospital of Pisa, 56126 Pisa, Italy
| | - Grazia Luchini
- Hospital Management, University Hospital of Pisa, 56126 Pisa, Italy
| | - Anna Laura Costa
- Department of Translational Research and the New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Angelo Baggiani
- Department of Translational Research and the New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
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Chen X, Zhang P, Zhang R, Li S, Cao R, Hu F, Jin YH, Lin L, Cai L, Feng B, Zhang C, Wang X. Development and validation of the regarding infection prevention and control among environmental service workers on knowledge, attitudes, practise, and experience questionnaire. Front Public Health 2023; 10:1062199. [PMID: 36699941 PMCID: PMC9869485 DOI: 10.3389/fpubh.2022.1062199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
Purpose This study aimed to develop and test the validity and reliability of the Knowledge, Attitudes, Practise, and Experience regarding Infection Prevention and Control-associated Questionnaire for environmental service workers. Design This study was a development and validation study of a questionnaire using multiple methods, including literature review, questionnaire survey, and Delphi technique. Methods Phase I of the study entailed the development of items through an extensive literature review and two round Delphi process with 15 experts specialised in infection prevention and control, environmental service worker management, or scale construction to examine the content validity of the questionnaire. Phase II involved administering the questionnaire to a convenience sample of 1,176 environmental service workers from the public hospital from 13 provinces in China to evaluate its construct validity and reliability. Findings In the two rounds of Delphi consultation, the recovery rate were 93.75 and 100%. Moreover, the expert authority coefficient was 0.93, and the coordination coefficients of expert opinions in the first round were as follows: correlation of 0.204 and importance of 0.249 for the first-level index; correlation of 0.128 and importance of 0.142 for the secondary index. In round two, the coordination coefficients of expert opinions were as follows: correlation of 0.221 and importance of 0.221 for the first-level indicators; correlation of 0.096 and importance of 0.101 for the secondary index. The results for the index were P < 0.05 for the two rounds. The pilot survey shows the instrument was excellent content validity (S-CVI/Ave = 0.989). The overall internal consistency was excellent (Cronbach's α = 0.967). The questionnaire ultimately comprised four first-level indices (knowledge, attitudes, practise, and experience) and 49 second-level indices. Conclusion The Questionnaire demonstrated good reliability and validity and is effective in measuring levels of infection prevention and control-related knowledge, attitudes, practise, and experience among environmental service workers. It will provide a tool for future national investigations of the current infection prevention and control situation among environmental service workers. Future research should explore determinants of environmental service workers' knowledge, attitudes, practise, and experience and associations between infection prevention and control knowledge, attitudes, practises, and experience.
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Affiliation(s)
- Xiaohang Chen
- Institute of Hepatobiliary Diseases of Wuhan University, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Pan Zhang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ruhan Zhang
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shuting Li
- Department of Endocrinology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Rui Cao
- Department of Nursing, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Fen Hu
- Department of Nursing, Zhongnan Hospital of Wuhan University, Wuhan, China,Hubei Engineering Center for Infectious Disease Prevention, Control, and Treatment, Wuhan, China
| | - Ying-Hui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Likai Lin
- Institute of Hospital Management, Wuhan University, Wuhan, China
| | - Lin Cai
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Bilong Feng
- Department of Nursing, Zhongnan Hospital of Wuhan University, Wuhan, China,Hubei Engineering Center for Infectious Disease Prevention, Control, and Treatment, Wuhan, China,Bilong Feng ✉
| | - Chunhua Zhang
- Department of Nursing, Zhongnan Hospital of Wuhan University, Wuhan, China,Chunhua Zhang ✉
| | - Xinghuan Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China,Research Center of Wuhan for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, China,Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China,*Correspondence: Xinghuan Wang ✉
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Montgomery A, Lainidi O. Creating healthy workplaces in healthcare: Are we delaying progress by focusing on what we can do rather than what we should do? Front Public Health 2023; 11:1105009. [PMID: 36935666 PMCID: PMC10016614 DOI: 10.3389/fpubh.2023.1105009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/09/2023] [Indexed: 03/05/2023] Open
Abstract
All the available evidence points to the fact that healthcare is under considerable stress, and while change is urgently needed there is no quick fix; systemic and sustained changes in organizational cultures within healthcare are required. Moreover, the fragility of healthcare systems globally has been starkly exposed by the Coronavirus 2019 pandemic. We have gathered enough evidence to know what is driving poor wellbeing, and how these processes impact on quality of care and patient safety. Indeed, we have a good idea of what we need to do to improve the situation. Therefore, this begs a simpler question; If we know how to create healthy workplaces, why is it so difficult to achieve this in healthcare? In the following perspective paper, we will argue that we can do better if we address the following three issues: (1) we are ignoring the real problems, (2) limited successes that we are achieving are moving us further from tackling the real problems, (3) culture change is accepted as crucial, but we are not accepting what the evidence is telling us about healthcare culture. Tackling burnout is useful and necessary, but we must increase dignity among healthcare employees. Moreover, we need to train line managers to recognize and facilitate the need of employees to feel competent and be appreciated by others, while helping them set wellbeing boundaries.
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Affiliation(s)
- Anthony Montgomery
- Department of Psychology, Northumbria University, Newcastle upon Tyne, United Kingdom
- *Correspondence: Anthony Montgomery
| | - Olga Lainidi
- School of Psychology, University of Leeds, Leeds, United Kingdom
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Goodair B, Reeves A. Outsourcing health-care services to the private sector and treatable mortality rates in England, 2013-20: an observational study of NHS privatisation. Lancet Public Health 2022; 7:e638-e646. [PMID: 35779546 PMCID: PMC10932752 DOI: 10.1016/s2468-2667(22)00133-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The effects of outsourcing health services to for-profit providers are contested, with some arguing that introducing such providers will improve performance through additional competition while others worry that this will lead to cost cutting and poorer outcomes for patients. We aimed to examine this debate by empirically evaluating the impact of outsourced spending to private providers, following the 2012 Health and Social Care Act, on treatable mortality rates and the quality of health-care services in England. METHODS For this observational study, we used a novel database composed of parsable procurement contracts between April 1, 2013, and Feb 29, 2020 (n=645 674, value >£25 000, total value £204·1 billion), across 173 clinical commissioning groups (CCGs; regional health boards) in England. Data were compiled from 12 709 heterogenous expenditure files primarily scraped from commissioner websites with supplier names matched to registers identifying them as National Health Service (NHS) organisations, for-profit companies, or charities. We supplemented these data with rates of local mortality from causes that should be treatable by medical intervention, indicating the quality of health-care services. We used multivariate longitudinal regression models with fixed effects at the CCG level to analyse the association of for-profit outsourcing on treatable mortality rates in the following year. We used the average marginal effects to estimate total additional deaths attributable to changes in for-profit outsourcing. We provided alternative model specifications to test the robustness of our findings, match on background characteristics, examine the potential impact of measurement error, and adjust for possible confounding factors such as population demographics, total CCG expenditure, and local authority expenditure. FINDINGS We found that an annual increase of one percentage point of outsourcing to the private for-profit sector corresponded with an annual increase in treatable mortality of 0·38% (95% CI 0·22-0·55; p=0·0016) or 0·29 (95% CI 0·09-0·49; p=0·0041) deaths per 100 000 population in the following year. This finding was robust to matching on background characteristics, adjusting for possible confounding factors, and measurement error in our dataset. Changes to for-profit outsourcing since 2014 were associated with an additional 557 (95% CI 153-961) treatable deaths across the 173 CCGs. INTERPRETATION The privatisation of the NHS in England, through the outsourcing of services to for-profit companies, consistently increased in 2013-20. Private sector outsourcing corresponded with significantly increased rates of treatable mortality, potentially as a result of a decline in the quality of health-care services. FUNDING Wellcome Trust.
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Affiliation(s)
- Benjamin Goodair
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK.
| | - Aaron Reeves
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
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Prevention and Control of Nosocomial Infections among Hospital Logistic Staff During the COVID-19 Pandemic. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:5020154. [PMID: 35190762 PMCID: PMC8858056 DOI: 10.1155/2022/5020154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 11/24/2021] [Accepted: 12/03/2021] [Indexed: 11/17/2022]
Abstract
Hospital logistics staff comprise a crucial, albeit easily overlooked, group in the prevention and control of hospital nosocomial infections, especially during the COVID-19 pandemic. From the perspective of hospital safety improvement, this paper describes the current situation and challenges in the prevention and control of nosocomial infections among hospital logistics staff. We also provide the following suggestions to improve nosocomial infections: (1) updating the learning system of nosocomial infections, (2) reinforcing the training of infections prevention, (3) properly arranging manpower and resources, and (4) improving the supervision and management system.
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Moon D, Kim S, Kim MH, Jeong D, Choi H. Contracting Out National Immunization Program Does Not Improve Vaccination Rate Nor Socioeconomic Inequality: A Case Study of Seasonal Influenza Vaccination in South Korea. Front Public Health 2021; 9:769176. [PMID: 34805079 PMCID: PMC8599130 DOI: 10.3389/fpubh.2021.769176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/11/2021] [Indexed: 12/03/2022] Open
Abstract
The objective of the present study was to investigate if the policy for contracting out the Korean influenza National Immunization Program (NIP) for individuals aged ≥ 65 years affects a reduction in vaccination inequality based on gender and socioeconomic position (SEP). In South Korea, initially only public health centers provided influenza vaccination for free; however, starting from the fall of 2015, the program was expanded to include private medical institutions. The policy was expected to improve overall vaccination rate and reduce its inequality, through improving access to vaccination. The present study analyzed how the gap in the vaccination rate changed between before and after contracting out. A multivariate logistic regression model stratified by gender and SEP of individuals aged ≥ 65 years was used. The study also analyzed changes in the unvaccinated rates between before and after contracting out based on an interrupted time series model. The gap in the unvaccinated rate based on SEP present prior to contracting out of the NIP for individuals aged ≥ 65 years did not decrease afterwards. In particular, the step changes were 0.94% (95% confidence interval [CI]: 0.00, 1.89) and 1.34% (95% CI: 1.17, 1.52) in men and women, respectively. In the pre-policy period, among women, the unvaccinated rate of the medical aid beneficiaries group was 1.22-fold higher (95% CI: 1.12, 1.32) than that of the health insurance beneficiaries, and the difference was not reduced post-policy implementation (odds ratio: 1.27, 95% CI: 1.20, 1.36). The findings of the study were that contracting out of the NIP was not effective in improving vaccination rate nor resolving vaccination inequality. Future studies should focus on identifying the mechanism of vaccination inequality and exploring measures for resolving such inequality.
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Affiliation(s)
- Daseul Moon
- People's Health Institute, Seoul, South Korea
| | - Saerom Kim
- People's Health Institute, Seoul, South Korea.,Department of Public Health, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Myoung-Hee Kim
- Research Institute of Public Health, National Medical Center, Seoul, South Korea
| | - Dawoon Jeong
- Division of Health Policy, Research Center, Korean Institute of Tuberculosis, Cheongju, South Korea
| | - Hongjo Choi
- Department of Preventive Medicine, Konyang University College of Medicine, Daejeon, South Korea
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11
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Berry LL, Letchuman S, Ramani N, Barach P. The High Stakes of Outsourcing in Health Care. Mayo Clin Proc 2021; 96:2879-2890. [PMID: 34412855 DOI: 10.1016/j.mayocp.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/13/2021] [Accepted: 07/06/2021] [Indexed: 11/16/2022]
Abstract
Outsourcing in health care has become increasingly common as health system administrators seek to enhance profitability and efficiency while maintaining clinical excellence. When clinical services are outsourced, however, the outsourcing organization relinquishes control over its most important service value: high-quality patient care. Farming out work to an external service provider can have many unintended results, including inconsistencies in standards of care; harmful medical errors; declines in patient and employee satisfaction; and damage to clinicians' morale and income, and to the health organization's culture, reputation, and long-term financial performance. Research on outsourcing in the areas of emergency medicine, radiology, laboratory services, and environmental services provides concerning evidence of potentially large downsides when outsourcing is driven by short-term cost concerns or is planned without diligently considering all of the ramifications of not keeping key clinical and nonclinical services in-house. To better equip health system leaders for decision-making about outsourcing, we examine this body of literature, identify common pitfalls of outsourcing in specific clinical and nonclinical health services and scenarios, explore alternatives to outsourcing, and consider how outsourcing (when necessary) can be done in a strategic manner that does not compromise the values of the organization and its commitment to patients.
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Affiliation(s)
- Leonard L Berry
- Mays Business School, Texas A&M University, College Station, TX; Institute for Healthcare Improvement, Boston, MA.
| | | | - Nandini Ramani
- Mays Business School, Texas A&M University, College Station, TX
| | - Paul Barach
- Wayne State University School of Medicine, MI; Jefferson College of Population Health, Philadelphia, PA; Interdisciplinary Research Institute for Health Law and Science, Sigmund Freud University, Vienna, Austria
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12
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Assadian O, Harbarth S, Vos M, Knobloch JK, Asensio A, Widmer AF. Practical recommendations for routine cleaning and disinfection procedures in healthcare institutions: a narrative review. J Hosp Infect 2021; 113:104-114. [PMID: 33744383 DOI: 10.1016/j.jhin.2021.03.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 12/12/2022]
Abstract
Healthcare-associated infections (HAIs) are the most common adverse outcomes due to delivery of medical care. HAIs increase morbidity and mortality, prolong hospital stay, and are associated with additional healthcare costs. Contaminated surfaces, particularly those that are touched frequently, act as reservoirs for pathogens and contribute towards pathogen transmission. Therefore, healthcare hygiene requires a comprehensive approach whereby different strategies may be implemented together, next to targeted, risk-based approaches, in order to reduce the risk of HAIs for patients. This approach includes hand hygiene in conjunction with environmental cleaning and disinfection of surfaces and clinical equipment. This review focuses on routine environmental cleaning and disinfection including areas with a moderate risk of contamination, such as general wards. As scientific evidence has not yet resulted in universally accepted guidelines nor led to universally accepted practical recommendations pertaining to surface cleaning and disinfection, this review provides expert guidance for healthcare workers in their daily practice. It also covers outbreak situations and suggests practical guidance for clinically relevant pathogens. Key elements of environmental cleaning and disinfection, including a fundamental clinical risk assessment, choice of appropriate disinfectants and cleaning equipment, definitions for standardized cleaning processes and the relevance of structured training, are reviewed in detail with a focus on practical topics and implementation.
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Affiliation(s)
- O Assadian
- Regional Hospital Wiener Neustadt, Wiener Neustadt, Austria; Institute for Skin Integrity and Infection Prevention, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK.
| | - S Harbarth
- Infection Control Programme and Division of Infectious Diseases, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - M Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - J K Knobloch
- Institute for Medical Microbiology, Virology and Hygiene, Department for Infection Prevention and Control, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - A Asensio
- Preventive Medicine Department, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - A F Widmer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
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13
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Casini B, Tuvo B, Cristina ML, Spagnolo AM, Totaro M, Baggiani A, Privitera GP. Evaluation of an Ultraviolet C (UVC) Light-Emitting Device for Disinfection of High Touch Surfaces in Hospital Critical Areas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3572. [PMID: 31554297 PMCID: PMC6801766 DOI: 10.3390/ijerph16193572] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/17/2019] [Accepted: 09/20/2019] [Indexed: 11/17/2022]
Abstract
Implementation of environmental cleaning and disinfection has been shown to reduce the incidences of healthcare-associated infections. The effect of an enhanced strategy for terminal room disinfection, applying the pulsed xenon-based ultraviolet light no-touch disinfection systems (PX-UVC) after the current standard operating protocol (SOP) was evaluated. In a teaching hospital, the effectiveness in reducing the total bacterial count (TBC) and in eliminating high-concern microorganisms was assessed on five high-touch surfaces in different critical areas, immediately pre- and post-cleaning and disinfection procedures (345 sampling sites). PX-UVC showed only 18% (15/85) of positive samples after treatment compared to 63% (72/115) after SOP. The effectiveness of PX-UVC was also observed in the absence of manual cleaning and application of a chemical disinfectant. According to the hygienic standards proposed by the Italian Workers Compensation Authority, 9 of 80 (11%) surfaces in operating rooms showed TBC ≥15 CFU/24 cm2 after the SOP, while all samples were compliant applying the SOP plus PX-UVC disinfection. Clostridium difficile (CD) spores and Klebsiella pneumoniae (KPC) were isolated only after the SOP. The implementation of the standard cleaning and disinfection procedure with the integration of the PX-UVC treatment had effective results in both the reduction of hygiene failures and in control environmental contamination by high-concern microorganisms.
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Affiliation(s)
- Beatrice Casini
- Department of Translational Research, N.T.M.S., University of Pisa, via San Zeno, 37/39-56127 Pisa, Italy.
| | - Benedetta Tuvo
- Department of Translational Research, N.T.M.S., University of Pisa, via San Zeno, 37/39-56127 Pisa, Italy.
| | - Maria Luisa Cristina
- Department of Health Sciences, University of Genoa, via Pastore, 1-16132 Genoa, Italy.
| | - Anna Maria Spagnolo
- Department of Health Sciences, University of Genoa, via Pastore, 1-16132 Genoa, Italy.
| | - Michele Totaro
- Department of Translational Research, N.T.M.S., University of Pisa, via San Zeno, 37/39-56127 Pisa, Italy.
| | - Angelo Baggiani
- Department of Translational Research, N.T.M.S., University of Pisa, via San Zeno, 37/39-56127 Pisa, Italy.
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14
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Glasper A. Keeping patients safe from hospital-acquired infection. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2019; 28:890-891. [PMID: 31303049 DOI: 10.12968/bjon.2019.28.13.890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Emeritus Professor Alan Glasper, University of Southampton, discusses strategies used to keep patients in hospital safe from infection.
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15
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Casini B, Righi A, De Feo N, Totaro M, Giorgi S, Zezza L, Valentini P, Tagliaferri E, Costa AL, Barnini S, Baggiani A, Lopalco PL, Malacarne P, Privitera GP. Improving Cleaning and Disinfection of High-Touch Surfaces in Intensive Care during Carbapenem-Resistant Acinetobacter baumannii Endemo-Epidemic Situations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102305. [PMID: 30347749 PMCID: PMC6209904 DOI: 10.3390/ijerph15102305] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/10/2018] [Accepted: 10/17/2018] [Indexed: 01/31/2023]
Abstract
Aims: High-touch surfaces cleaning and disinfection require the adoption of effective and proper executed protocols, especially during carbapenem-resistant Acinetobacter baumannii (CRAB) endemo-epidemic situations. We evaluated the effectiveness and residual disinfectant activity of disposable pre-impregnated wipes (Modified Operative Protocol, MOP) in reducing environmental bioburden versus a two-step Standard Operative Protocol (SOP) in a 12-bed Intensive Care Unit. Methods: Five high-touch surfaces were cleaned and disinfected either according to the SOP (alcohol-based cleaning and chlorine-based disinfection) or using quaternary ammonium compounds-based disposable wipes (MOP). Sampling was performed before each procedure and at 0.5, 2.5, 4.5 and 6.5 h after (560 sites). Total viable count (TVC) was evaluated according to Italian hygiene standard (<50 CFU/24 cm2). Clinical and environmental CRAB strains isolated were genotyped. Results: On non-electromedical surfaces the difference between TVC before procedure and at each of the following times was significant only for the MOP (p < 0.05, Wilcoxon test). Using the MOP, only 7.4% (10/135) of sites showed TVC >50 CFU/24 cm2 (hygiene failures) versus 18.9% (25/132) after SOP (p < 0.05, Fisher’s Exact test). On infusion pumps a higher number of hygiene failures was observed after the SOP (7/44, 15.9%) compared with the MOP (4/45, 8.9%). Genotyping highlighted a common source of infection. Conclusion: On high-touch surfaces, the use of disposable wipes by in-house auxiliary nurses may represent a more effective alternative to standard cleaning and disinfection procedure performed by outsourced cleaning services, showing effectiveness in reducing microbial contamination and residual disinfection activity up to 6.5 h.
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Affiliation(s)
- Beatrice Casini
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy.
| | - Anna Righi
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy.
| | - Nunzio De Feo
- Anesthesia and Intensive Care Unit PS, University Hospital, 56124 Pisa, Italy.
| | - Michele Totaro
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy.
| | - Serena Giorgi
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy.
| | - Lavinia Zezza
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy.
| | - Paola Valentini
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy.
| | | | - Anna Laura Costa
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy.
| | - Simona Barnini
- Unit of Microbiology, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy.
| | - Angelo Baggiani
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy.
| | - Pietro Luigi Lopalco
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy.
| | - Paolo Malacarne
- Anesthesia and Intensive Care Unit PS, University Hospital, 56124 Pisa, Italy.
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16
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Vos MC, Galetzka M, Mobach MP, Van Hagen M, Pruyn AT. Exploring cleanliness in the Dutch facilities management industry: a Delphi approach. FACILITIES 2018. [DOI: 10.1108/f-09-2017-0092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to identify antecedents that influence perceived cleanliness by consulting experts and end-users in the field of facilities management (facility service providers, clients of facility service providers and consultants). Business models were evaluated to understand why some antecedents are adopted by practitioners and others are not.
Design/methodology/approach
A qualitative study, with end-users (n = 7) and experts (n = 24) in the field of facilities management, was carried out to identify antecedents of perceived cleanliness. Following the Delphi approach, different research methods including interviews, group discussions and surveys were applied.
Findings
Actual cleanliness, cleaning staff behaviour and the appearance of the environment were identified as the three main antecedents of perceived cleanliness. Client organisations tend to have a stronger focus on antecedents that are not related to the cleaning process compared to facility service providers.
Practical implications
More (visible) cleaning, maintenance, toilets, scent, architecture and use of materials offer interesting starting points for practitioners to positively influence perceived cleanliness. These antecedents may also be used for the development of a standard for perceived cleanliness.
Originality/value
A basis was created for the development of an instrument that measures perceived cleanliness and includes antecedents that are typically not included in most of the current standards of actual cleanliness (e.g. NEN 2075, ISSA).
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17
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Toffolutti V, McKee M, Stuckler D. Evidence Points To 'Gaming' At Hospitals Subject To National Health Service Cleanliness Inspections. Health Aff (Millwood) 2018; 36:355-361. [PMID: 28167726 DOI: 10.1377/hlthaff.2016.1217] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Inspections are a key way to monitor and ensure quality of care and maintain high standards in the National Health Service (NHS) in England. Yet there is a perception that inspections can be gamed. This can happen, for example, when staff members know that an inspection will soon take place. Using data for 205 NHS hospitals for the period 2011-14, we tested whether patients' perceptions of cleanliness increased during periods when inspections occurred. Our results show that during the period within two months of an inspection, there was a significant elevation (2.5-11.0 percentage points) in the share of patients who reported "excellent" cleanliness. This association was consistent even after adjustment for secular time trends. The association was concentrated in hospitals that outsourced cleaning services and was not detected in those that used NHS cleaning services.
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Affiliation(s)
- Veronica Toffolutti
- Veronica Toffolutti is a postdoctoral researcher in health economics at the University of Oxford, in the United Kingdom
| | - Martin McKee
- Martin McKee is a professor of European public health at the London School of Hygiene and Tropical Medicine, in the United Kingdom
| | - David Stuckler
- David Stuckler is a professor of political economy and sociology at the University of Oxford
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18
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Dunne SS, Ahonen M, Modic M, Crijns FRL, Keinänen-Toivola MM, Meinke R, Keevil CW, Gray J, O'Connell NH, Dunne CP. Specialized cleaning associated with antimicrobial coatings for reduction of hospital-acquired infection: opinion of the COST Action Network AMiCI (CA15114). J Hosp Infect 2018; 99:250-255. [PMID: 29550388 DOI: 10.1016/j.jhin.2018.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/05/2018] [Indexed: 02/07/2023]
Abstract
Recognized issues with poor hand hygiene compliance among healthcare workers and reports of recontamination of previously chemically disinfected surfaces through hand contact emphasize the need for novel hygiene methods in addition to those currently available. One such approach involves antimicrobial (nano) coatings (AMCs), whereby integrated active ingredients are responsible for elimination of micro-organisms that come into contact with treated surfaces. While widely studied under laboratory conditions with promising results, studies under real-life healthcare conditions are scarce. The views of 75 contributors from 30 European countries were collated regarding specialized cleaning associated with AMCs for reduction of healthcare-associated infection. There was unanimous agreement that generation of scientific guidelines for cleaning of AMCs, using traditional or new processes, is needed. Specific topics included: understanding mechanisms of action of cleaning materials and their physical interactions with conventional coatings and AMCs; that assessments mimic the life cycle of coatings to determine the impact of repetitive cleaning and other aspects of ageing (e.g. exposure to sunlight); determining concentrations of AMC-derived biocides in effluents; and development of effective de-activation and sterilization treatments for cleaning effluents. Further, the consensus opinion was that, prior to widespread implementation of AMCs, there is a need for clarification of the varying responsibilities of involved clinical, healthcare management, cleaning services and environmental safety stakeholders.
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Affiliation(s)
- S S Dunne
- Centre for Interventions in Infection, Inflammation and Immunity (4i) and Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - M Ahonen
- Faculty of Technology, Satakunta University of Applied Sciences, Rauma, Finland
| | - M Modic
- Department of Surface Engineering and Optoelectronics, Jozef Stefan Institute, Ljubljana, Slovenia
| | - F R L Crijns
- Department of Bèta Sciences and Technology, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | | | - R Meinke
- Department of Infection Control and Prevention, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - C W Keevil
- Centre for Biological Sciences, Faculty of Natural and Environmental Sciences, University of Southampton, Southampton, UK
| | - J Gray
- Birmingham Children's Hospital, Birmingham, UK
| | - N H O'Connell
- Centre for Interventions in Infection, Inflammation and Immunity (4i) and Graduate Entry Medical School, University of Limerick, Limerick, Ireland; Clinical Microbiology, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - C P Dunne
- Centre for Interventions in Infection, Inflammation and Immunity (4i) and Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
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19
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Ni K, Chen B, Jin H, Kong Q, Ni X, Xu H. Knowledge, attitudes, and practices regarding environmental cleaning among environmental service workers in Chinese hospitals. Am J Infect Control 2017; 45:1043-1045. [PMID: 28343703 DOI: 10.1016/j.ajic.2017.02.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 02/15/2017] [Accepted: 02/16/2017] [Indexed: 11/28/2022]
Abstract
We conducted a study using a face-to-face survey to assess knowledge, attitudes, and practices of environmental service workers (ESWs) concerning routine cleaning and disinfection at 3 tertiary hospitals in China. There were 115 (89.1%) respondents who agreed that environmental cleaning can contribute to keep patients safe, whereas 63 (48.8%) reported they were very willing to make cleaning practices better. Only 15 (11.6%) ESWs agreed they were in risk of nosocomial infections during daily cleaning. Our findings suggest that the level of ESWs' knowledge regarding cleaning practices was passable, but the awareness of occupational safety and health was weak. There is a need to introduce sustained education and training aimed at ESWs.
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Affiliation(s)
- Kaiwen Ni
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Bingbing Chen
- Department of Disinfection Surveillance and Vector Control, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Hui Jin
- Department of Disinfection Surveillance and Vector Control, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Qingxin Kong
- Department of Disinfection Surveillance and Vector Control, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Xiaoping Ni
- Department of Disinfection Surveillance and Vector Control, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Hong Xu
- Department of Disinfection Surveillance and Vector Control, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China; Field Epidemiology Training Program of Zhejiang Province, Hangzhou, China.
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20
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21
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Ashton C, Manthorpe J. The Views of Domestic Staff and Porters when Supporting Patients with Dementia in the Acute Hospital: An Exploratory Qualitative Study. DEMENTIA 2017; 18:1128-1145. [PMID: 28463027 DOI: 10.1177/1471301217707085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is increasing recognition that very many hospital patients have dementia but there are many concerns about the quality of care and support they receive. Consequently there have been numerous calls for hospital staff to have dementia training. While cleaning or domestic staff and porters form considerable parts of the hospital workforce they are infrequently considered in discussions of dementia care training and practice. This exploratory study aimed to investigate the experiences of domestic staff and porters working in an acute hospital setting who are in contact regularly with patients with dementia. Semi-structured interviews were undertaken in 2016 with seven domestic staff and five porters in one English acute hospital to investigate their views and experiences. Data were analysed thematically by constant comparison technique and theoretical sampling. Themes were identified and realistic concepts developed. Participants observed that caring attitudes and behaviour in their encounters with patients with dementia are important but challenging to put into practice. Several would have valued more information about dementia. Some noted situations in the hospital stay that seemed particularly difficult for patients with dementia such as travelling to different parts of the hospital for treatments. The study suggests the need for improving the dementia-related knowledge and skills of all non-clinical staff especially those new to the NHS. The impact of witnessing dementia symptoms and distress on emotional well-being requires further research so that ancillary staff can improve the hospital stay of patients with dementia.
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Affiliation(s)
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, UK
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