Effect of COVID-19 pandemic decisions on tertiary-level surgical services in Pietermaritzburg, KwaZulu-Natal Province, South Africa

BACKGROUND

The COVID-19 pandemic has led to the implementation of restrictive policies on theatre procedures, with profound impacts on service delivery and theatre output.

OBJECTIVES

To quantify these effects at a tertiary hospital in KwaZulu-Natal Province, South Africa.

METHODS

A retrospective review of morbidity and mortality data was conducted. The effects on emergency and elective caseload, intensive care unit (ICU) admissions from theatre, theatre cancellations and regional techniques were noted.

RESULTS

Theatre caseload decreased by 30% from January to April 2020 (p=0.02), ICU admissions remained constant, and theatre cancellations were proportionally reduced, as were the absolute number of regional techniques.

CONCLUSIONS

The resulting theatre case deficit was 1 260 cases. It will take 315 days to clear this deficit if four additional surgeries are performed per day.

Pivoting Dental Practice Management during the COVID-19 Pandemic-A Systematic Review

Background and Objectives: The aims of this systematic review were to identify additional infection control measures implemented in dental practice globally to prevent cross-infection and evaluate the psychological impacts of the pandemic among dental professionals. Materials and Methods: A sequential systematic literature search was conducted from December 2019 to 30 April 2020 through PubMed, CINAHL, Scopus, Google Scholar, Embase, and Web of Science databases. The search yielded the following results: "COVID-19" (n = 12,137), "Novel corona virus" (n = 63), "COVID-19 and dentistry" (n = 46), "COVID-19 and oral health" (n = 41), "Novel Corona virus and Dentistry" (n = 0), "dental health and Novel Coronavirus" (n = 26), and "dental practice and Novel Coronavirus" (n = 6). Results: After a careful review and eliminating articles based on inclusion and exclusion criteria, the final review included 13 articles. Management of infection control is discussed extensively in the literature and remains the main theme of many Coronavirus Disease 2019 (COVID-19) articles on dentistry. Telephone triage using a questionnaire, hand hygiene, personal protective equipment (PPE) for clinical and nonclinical staff, a preprocedural mouth rinse, and aerosol management have been discussed and implemented in few countries. Three studies recommended that elective treatments for patients with a temperature of >100.4 F or 38 °C should be postponed or performed in an airborne infection isolation room (AIIR) or negative-pressure room. Limiting the number of patients in the waiting area, the removal of shared objects, proper ventilation, and physical distancing were highly recommended. Psychological distress among dental professionals in relation to existing medical conditions and self-efficacy has been discussed. Conclusions: Although the COVID-19 pandemic has had a substantial impact on the dental profession worldwide, our review highlights many practice management approaches to adopt the new norm. More research highlighting evidence-based safety practices and multisectoral collaboration is required to help dental professionals make informed decisions and make the profession safe, both for the patient and dental professionals.

Logistic transport in extreme environments: the evolution of risk and safety management over 27 years of the polar traverse

In this article we seek to explain how safety mechanisms and risks evolve over time. The article focuses on a sociotechnical system, that of a polar traverse (a transport operation in a polar environment). In the study spanning a period of 27 years data were collected with ethnographic participative observations on three of the 56 traverses already achieved. Activities were traced from the whole 1398 daily reports and scale models of the convoy vehicles were used to reconstruct events during the traverses. Self-confrontation interviews were also conducted. A traverse feedback process was carried out which revealed that (1) whereas proactive safety is aimed at maintaining the continuous improvement of a system, reactive safety makes it possible to maintain the system's level of safety; (2) the development of redundancy and mixed technology contribute positively to the safety system. Improvements made to the safety system, its dynamics, and embodied resilience are discussed as well as the study limitations and implications. Practitioner summary: This article seeks to understand how safety has been ensured in logistical transport in extreme conditions in a case study extending over a period of more than 27 years. The study investigates how risks and safety mechanisms have evolved and the benefits of developing a traverse feedback process to improve safety. Abbreviations: IPEV: French Polar Institute (Institut Polaire Francais); DDU: Dumont d'Urville (French coastal antarctic station).

The relevance of U.S. Strategic Highway Safety Plans in a future context

While road safety in the United States (U.S.) has been continually improving since the 1970's, there are indications that these improvements are becoming increasingly difficult to sustain. Strategic Highway Safety Plans (SHSPs) are prepared by States to guide road safety management, however assessing the appropriateness of these plans remains a significant challenge, especially for the future in which they are to be applied. This study developed a new methodology to assess SHSPs from the perspectives of comprehensive system-based safety management and relevant future issues that can be applied before SHSPs are implemented, thereby avoiding long periods after implementation before assessing the appropriateness of the plans. A rating scale was developed and applied to assess 48 U.S. SHSPs against two key criteria: 1. a comprehensive framework for road safety, and 2. the anticipated changing, difficult and unpredictable nature of future transport and its context. The analysis concluded that current SHSPs have good national oversight with several strengths but were weak in some areas of content and did not address future challenges. Improvements are suggested to strengthen the plans' thoroughness by being consistent with systems theory and practice, as well as ways that these SHSPs can be more resilient to future circumstances. Implementing the recommendations in this paper provides the opportunity to adopt a system-based safety management practice that has been successful in other hazardous industries. Doing so is expected to most efficiently and effectively continue the recent improvements to road safety, which is likely to be increasingly difficult otherwise.

Analysis of Issues and Future Trends Impacting Drug Safety in South Korea

New drug safety issues are emerging that are beyond the existing medication safety management system. To pre-empt these problems, forecasting future drug safety trends and issues is a necessity. The objective of this study was to identify issues and future trends impacting drug safety using foresight methodologies. The study started by identifying global megatrends, trends in safety management of medicines, and key issues in drug safety. A total of 25 global megatrends were selected by extracting and clustering keywords from 26 reports concerning the future. Using the text-mining method, 10 trends in drug safety were identified from 3593 news articles. This study derived 60 issues which can arise from the trends, and finally, the 20 key issues with the highest urgency and impact scores were selected. Some examples of issues with high scores were as follows: illegal distribution of medicines, lack of technology for managing and utilizing big data, change in the pharmaceutical trade environment, lack of education and safety management for specific populations, lack of artificial intelligence-based technology for the safety management of medicines, and the prevalence of drug advertisements through social network services. The key issues could be used to establish plans for medication safety management.

[What regulations have launched autonomous communities to going forward on patient safety culture in healthcare organizations?]

INTRODUCTION

Patient Safety Culture is based on learning from incidents, developing preventive strategies to reduce the likelihood to happen and recognizing and accompanying those who have suffered unnecessary and involuntary harm derived from the health care received. To go ahead on patient safety culture entails facilitating the implementation of these behaviors and attitudes in healthcare professionals. Objective was to describe the regulations of some autonomous communities and national proposals for regulations changes.

MATERIAL AND METHODS

Search of normative changes made in the autonomous communities of Catalonia, Navarra and the Basque Country. Proposals for legislative changes at national level were agreed.

RESULTS

Activities and normative changes made in the autonomous communities of Catalonia, Navarre and the Basque Country are described and proposals for normative changes at the national level at short-term and long-term changes are made. In such a way that it is easier to advance in creating culture of patient safety in the whole National Health System CONCLUSION: Currently there is no global regulation that facilitates to advance in patient safety culture. Changes at the national legislation level are essential. It is at the Inter-territorial Council where the proposed legislative amendment should be defined, promoted by the representatives of the health systems of the autonomous communities.

Implementing Patient Safety Initiatives

Implementing change is difficult; few people want to wade into this area because of the challenge. However, it is highly rewarding and does not have to be complicated. Success requires a clear understanding of health care context, patient safety, and behavioral psychology. To achieve its goal, this article is divided into 3 parts: (1) the problem with engagement in health care, (2) patient safety in a new age, and (3) implementation.

Improvements in Radiation Monitoring Trending

One of the main goals for Radiation Safety Professionals is to help maintain radiation worker doses below administrative control levels. In the radiation safety field there is an increasing recognition of the value of dosimetry-related data that can be used to enhance safety programs and regulatory compliance. Mining radiation dosimetry data and rendering results in the form of dashboards provides insights for the Radiation Safety Professionals that could help improve the radiological protection programs effectiveness, enhances quality, and reduces cost. Quite often the professionals spend more time assembling data than analyzing for trends and acting to improve the radiation safety program. Data analysis tools were developed allowing the radiation safety professionals to perform surveillance on key parameters in the dosimetry program that can help identifying risks and insure early intervention. More than 2,200 institutions chosen from different industries were surveyed for more than 2 years after the implementation of this tool. Four indicators: dose per participant, collective dose, dosimeter return compliance, and number of workers exceeding ALARA levels were chosen as meaningful parameters in characterizing the health of the program. These parameters were tracked, analyzed, and compared to benchmarks developed based on more than 1 million monitored workers.

From sanctioning culture to safety culture: Let's stop making errors on error

The punitive culture continues to prevail in health care organizations that rely primarily on functional systems hierarchies based on conformity. This type of culture is recognized as a major source of an unacceptable number of medical errors. The safety culture has emerged as an imperative to improve the quality and safety of patient care, but also as a shield against the judgments targeted towards the caregivers (doctor and / or nurse) involved in an undesirable event. The safety culture allows a broader view of the error by analyzing both system failures and staff incompetence. Therefore, it places caregivers in their workplace with mutual interactions and protects them from "second victim" status. It is imperative to have a reflection on the safety culture that constitutes a proof of transparency and openness towards society about the mistake that remains taboo. This attitude will avoid the risk of "judicialization of health".

Workplace violence and hospital security programs: regulatory compliance, program benchmarks, innovative strategies

The authors describe the issue of workplace violence in hospitals, a New Jersey state law and regula- tions regarding workplace vio- lence in healthcare, and some innovative strategies that are being utilized to help reduce the occurrence and risk of violence. The authors also discuss compli- ance with the New Jersey regula- tions.

Trends in needlestick injury incidence following regulatory change in Ontario, Canada (2004-2012): an observational study

BACKGROUND

A number of jurisdictions have used regulation to promote the adoption of safety-engineered needles as a primary solution to reduce the risk of needlestick injuries among healthcare workers. Regulatory change has not been complemented by ongoing efforts to monitor needlestick injury trends which limits opportunities to evaluate the need for additional investment in this area. The objective of this study was to describe trends in the incidence of needlestick injuries in Ontario prior to and following the establishment of regulation to promote the adoption of safety-engineered needles.

METHODS

An observational study of needlestick injuries obtained from two independent administrative data sources (emergency department records for the treatment of work-related disorders and workers' compensation claims) for a population of occupationally-active adults over the period 2004-2012.

RESULTS

Comparing the year prior to the regulation being established (2006) to three years after the regulation came into effect (2011), needlestick injury rates in the health and social services sector that were captured by workers' compensation claims declined by 31% and by 43% in the work-related emergency department records. Rates of workers' compensation claims associated with needlestick injuries declined by 31% in the hospital sector, by 67% in the long-term care sector and have increased by approximately 1% in nursing services over the period 2004-2012.

CONCLUSIONS

Two independent administrative data sources documented an overall reduction in needlestick injuries in the province of Ontario following a regulatory requirement to adopt safety-engineered needles; however, a substantial burden of occupational needlestick injuries persists in this setting.

How can radio frequency identification technology impact nursing practice?

Radio frequency identification (RFID) technology can save nurses time, improve quality of care, en hance patient and staff safety, and decrease costs. However, without a better understanding of these systems and their benefits to patients and hospitals, nurses may be slower to recommend, implement, or adopt RFID technology into practice.

Bangladesh: currently the worst, but possibly the future's best

Garment workers in Bangladesh producing clothing for international brands have experienced repeated factory fires and building collapses in the last 10 years, resulting in more than 1,600 deaths and hundreds of disabling injuries. After the Tazreen Fashion fire in December 2012 and the Rana Plaza building collapse in April 2013, more than 190 international clothing brands and retailers signed an "Accord on Fire and Building Safety" with two international union federations. Full implementation of the provisions of the Accord would change "business as usual" in Bangladesh's garment industry and set a positive example for other countries and other industries with global supply chains. The components, challenges, and controversies of the Accord are detailed in the article.

Recent advances to address European Union Health Security from cross border chemical health threats

The European Union (EU) Decision (1082/2013/EU) on serious cross border threats to health was adopted by the European Parliament in November 2013, in recognition of the need to strengthen the capacity of Member States to coordinate the public health response to cross border threats, whether from biological, chemical, environmental events or events which have an unknown origin. Although mechanisms have been in place for years for reporting cross border health threats from communicable diseases, this has not been the case for incidents involving chemicals and/or environmental events. A variety of collaborative EU projects have been funded over the past 10 years through the Health Programme to address gaps in knowledge on health security and to improve resilience and response to major incidents involving chemicals. This paper looks at the EU Health Programme that underpins recent research activities to address gaps in resilience, planning, responding to and recovering from a cross border chemical incident. It also looks at how the outputs from the research programme will contribute to improving public health management of transnational incidents that have the potential to overwhelm national capabilities, putting this into context with the new requirements as the Decision on serious cross border threats to health as well as highlighting areas for future development.

Veteran's vision on 45 years' change

Even for a company where many employees have contributed long service, with 45 years under his belt at commercial washroom and showering system manufacturer, Kohler Mira, the company's commercial marketing manager on the Rada brand, Roy Minett, has seen his share of change. HEJ editor, Jonathan Baillie, recently met with the acknowledged expert on water hygiene and safety issues for a look around the company's Cheltenham headquarters, where the 'voice of Rada' was happy to share some of the changes he has seen during an extremely varied career, explain some of the innovations incorporated into washroom and showering products targeted at healthcare applications under the Rada brand name, and offer his thoughts on future trends.

Front-line ownership: generating a cure mindset for patient safety

Great advances have been made in standardization and human factors engineering that have reduced variability and increased reliability in healthcare. As important as these advances are, the authors believe there is another important but largely ignored layer to the safety story in healthcare that has prevented us from progressing. In the field of infection prevention and control (IPAC), despite great attempts over several decades to improve compliance with hand hygiene, surveillance, environmental cleaning, isolation protocols and other control measures, very significant challenges remain. We believe this failure is in part due to the power gradients, often dysfunctional relationships and lack of safety mindfulness that exist in hospitals and healthcare more generally. Furthermore, safety culture requires different approaches and considerable ongoing attentiveness. If this is the case, and the authors contend in this paper that it is, then the role of the front line is much more important than many of our healthcare safety and IPAC approaches suggest.

[Nuclear energy and environment: review of the IAEA environmental projects]

The review of the environmental projects of the International Atomic Energy Agency is presented. Basic IAEA documents intended to protect humans and the Environment are considered and their main features are discussed. Some challenging issues in the area of protection of the Environment and man, including the impact of nuclear facilities on the environment, radioactive waste management, and remediation of the areas affected by radiological accidents, nuclear testing and sites of nuclear facilities are also discussed. The need to maintain the existing knowledge in radioecology and protection of the environment is emphasised.

Patient safety in the developing world: new frontiers

Patient safety is not only a vitally important concept for nurses and doctors in the developed world, but is also essential for those in the developing world. Consequently, the World Health Organization (WHO) has launched the WHO African Partnership for Patient Safety (APPS) project, which brings together nurses, doctors and other health professionals in both UK and African hospitals to enhance patient safety. This article will discuss the APPS project alongside a report (WHO, 2008) from the Regional Director, Regional Office for Africa, which outlines key patient safety challenges and opportunities. Some are particularly relevant to hospitals in the developed world, whereas others can apply to all hospitals.

Recent healthcare reports reveal patient safety failings

John Tingle discusses two important new reports, one from NCEPOD highlighting major failings in the perioperative care of surgical patients and the other from the CQC, the Mental Health Act Annual Report 2010/11 . Both reports point to a common theme of failings in the consent to treatment of patients.

Is patient safety improving? National trends in patient safety indicators: 1998-2007

CONTEXT

Emphasis has been placed on quality and patient safety in medicine; however, little is known about whether quality over time has actually improved in areas such as patient safety indicators (PSIs).

OBJECTIVE

To determine whether national trends for hospital PSIs have improved from 1998 to 2007.

DESIGN, SETTING, AND PARTICIPANTS

Using PSI criteria from the Agency for Healthcare Research and Quality, PSIs were identified in the Nationwide Inpatient Sample (NIS) for all eligible inpatient admissions between 1998 and 2007. Joinpoint regression was used to estimate annual percentage changes (APCs) for PSIs.

MAIN OUTCOME MEASURE

Annual percent change for PSIs.

RESULTS

From 1998 to 2007, 7.6 million PSI events occurred for over 69 million hospitalizations. A total of 14 PSIs showed statistically significant trends. Seven PSIs had increasing APC: postoperative pulmonary embolism or deep vein thrombosis (8.94), postoperative physiological or metabolic derangement (7.67), postoperative sepsis (7.17), selected infections due to medical care (4.05), decubitus ulcer (3.05), accidental puncture or laceration (2.64), and postoperative respiratory failure (1.46). Seven PSIs showed decreasing APCs: birth trauma injury to neonate (-17.79), failure to rescue (-6.05), postoperative hip fracture (-5.86), obstetric trauma-vaginal without instrument (-5.69), obstetric trauma-vaginal with instrument (-4.11), iatrogenic pneumothorax (-2.5), and postoperative wound dehiscence (-1.8).

CONCLUSION

This is the first study to establish national trends of PSIs during the past decade indicating areas for potential quality improvement prioritization. While many factors influence these trends, the results indicate opportunities for either emulation or elimination of current patient safety trends.

The social determinants of health and the patient safety paradigm

This article extends the thesis presented in the paper by Tingle, Gibson and Ferrante (2011) that the patient safety agenda needs to operate within a new paradigm. We will introduce the social determinants of health (SDH) as an emerging discourse in global public health. The SDH advocate social and health equity among nations and individuals, and within countries and communities. It has become a key driver for policy makers, health researchers and public health professionals (Raphael, 2011). This article will demonstrate that the paradigmatic lens of SDH offers the opportunity to develop a more upstream analysis of the patient safety agenda based on health systems.

An interview with James L. Reinertsen. Interview by Penny Carver

Dr. Reinertsen reflects on improvements in the past decade in the quality and safety of health care and identifies the greatest challenges now facing health care leaders.

An interview with John H. Eichhorn. Interview by Joseph Conigliaro

Anesthesiology, with its development of practice standards, helped create the patient safety movement, states Dr. Eichhorn, and "can continue to be the role model and to lead the way in patient safety for all of health care.