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BACKGROUND: This hospital-based cross-sectional study aims to investigate the epidemiologic and clinical characteristics of rotavirus group A (RVA) infection among children with acute gastroenteritis and to detect the most common G and P genotypes in Egypt. METHODS: A total of 92 stool samples were collected from children under five who were diagnosed with acute gastroenteritis. RVA in stool samples was identified using ELISA and nested RT-PCR. Common G and P genotypes were identified utilizing multiplex nested RT-PCR assays. RESULTS: RVA was detected at a rate of 24% (22 /92) using ELISA and 26.1% (24 /92) using VP6 nested RT-PCR. The ELISA test demonstrated diagnostic sensitivity, specificity, and accuracy of 91.7%, 100%, and 97.8%, respectively. G3 was the most prevalent G type (37.5%), followed by G1 (12.5%), whereas the most commonly detected P type were P[8] (41.7%) and P[6] (8.2%). RVA-positive samples were significantly associated with younger aged children (p = 0.026), and bottle-fed (p = 0.033) children. In addition, RVA-positive samples were more common during cooler seasons (p = 0.0001). Children with rotaviral gastroenteritis had significantly more frequent episodes of diarrhea (10.87 ± 3.63 times/day) and vomiting (8.79 ± 3.57 times/day) per day (p = 0.013 and p = 0.011, respectively). Moreover, they had a more severe Vesikari clinical score (p = 0.049). CONCLUSION: RVA is a prevalent cause of acute gastroenteritis among Egyptian children in our locality. The discovery of various RVA genotypes in the local population, as well as the identification of common G and P untypeable strains, highlights the significance of implementing the rotavirus vaccine in Egyptian national immunization programs accompanied by continuous monitoring of strains.
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Fezes , Gastroenterite , Genótipo , Infecções por Rotavirus , Rotavirus , Humanos , Gastroenterite/virologia , Gastroenterite/epidemiologia , Egito/epidemiologia , Estudos Transversais , Rotavirus/genética , Rotavirus/isolamento & purificação , Rotavirus/classificação , Infecções por Rotavirus/virologia , Infecções por Rotavirus/epidemiologia , Lactente , Pré-Escolar , Feminino , Masculino , Fezes/virologia , Ensaio de Imunoadsorção Enzimática , Hospitais , Prevalência , Recém-Nascido , Sensibilidade e Especificidade , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
Objectives: Falls are associated with increased morbidity, mortality, prolonged hospitalization and an increase in the cost of treatment in hospitals. They contribute to the deterioration of fitness and quality of life, especially among older patients, thus posing a serious social and economic problem. They increase the risk of premature death. Falls are adverse, costly, and potentially preventable. The aim of the study was to analyze the cost-effectiveness of avoiding one fall by nurse care provided by the nurses with higher education, from the perspective of the health service provider. Methods: The economic analysis included and compared only the cost of nurse intervention measured by the hours of care provided with higher education in non-surgical departments (40.5%) with higher time spend by nurses with higher education level an increase in the number of hours by 10% (50.5%) to avoid one fall. The time horizon for the study is 1 year (2021). Cost-effectiveness and Cost-benefit analysis were performed. All registered falls of all hospitalized patients were included in the study. Results: In the analyzed was based on the case control study where, 7,305 patients were hospitalized, which amounted to 41,762 patient care days. Care was provided by 100 nurses, including 40 nurses with bachelor's degrees and nurses with Master of Science in Nursing. Increasing the hours number of high-educated nurses care by 10% in non-surgical departments decreased the chance for falls by 9%; however, this dependence was statistically insignificant (OR = 1.09; 95% CI: 0.72-1.65; p = 0.65). After the intervention (a 10% increase in Bachelor's Degrees/Master of Science in Nursing hours), the number of additional Bachelor's Degrees/Master of Science hours was 6100.5, and the cost was USD 7630.4. The intervention eliminated four falls. The cost of preventing one fall is CER = USD 1697.1. Conclusion: The results of these studies broaden the understanding of the relationship among nursing education, falls, and the economic outcomes of hospital care. According to the authors, the proposed intervention has an economic justification.
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Acidentes por Quedas , Análise Custo-Benefício , Humanos , Acidentes por Quedas/prevenção & controle , Acidentes por Quedas/economia , Polônia , Masculino , Feminino , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Idoso , Estudos de Casos e Controles , Pessoa de Meia-Idade , Hospitais/estatística & dados numéricos , AdultoRESUMO
OBJECTIVE: Research on factors that modify the intention to donate blood voluntarily in the general population in Peru is scarce, and most of it are focused on health science personnel. The aim of the present study was to estimate the factors associated with the intention to donate blood in patients attending an outpatient clinic in a hospital in northern Peru. METHODS: A prospective unpaired study of cases (n=185) and controls (n=185) was designed. A case was defined as a patient who responded "if I would voluntarily donate blood in the future" to the initial filter question. The response variable was intention to donate blood and the exposure variables were sex, age, marital status, educational level, employment status, monthly income, religion, donation practices, and knowledge about donation. In addition, the motivations for blood donation were explored. To identify the associated factors, crude odds ratios (ORc) were calculated by means of generalized linear models, using the Poisson family, log link function and robust models; then the variables that showed a significant statistical association were adjusted by multivariate analysis, adjusting for sociodemographic variables, and the adjusted odds ratios (ORa) were obtained. RESULTS: In the multivariate analysis, male sex (ORa=1.37), having a high monthly income (ORa=1.26), professing the catholic religion (ORa=5.27), having a higher score in the knowledge questionnaire (ORa=1.04), having previously donated (ORa=1.64) and having a family member who had previously donated (ORa=1.72) increased the probability of intention to donate blood. On the other hand, older age (ORa=0.97) decreased said probability. CONCLUSIONS: Several factors associated with the intention to donate blood are identified, most of which were similar to previous studies. It is highlighted that a high level of knowledge, as well as previous donation experiences, increase the intention to donate blood.
OBJECTIVE: Las investigaciones sobre factores que modifiquen la intención de donar sangre voluntariamente en población general en Perú son escasas, y la mayoría se centran en el personal de Ciencias de la Salud. El objetivo del presente estudio fue estimar los factores asociados a la intención de donación de sangre en pacientes que acudían a consulta externa de un hospital del norte peruano. METHODS: Se diseñó un estudio de casos (n=185) y controles (n= 185) prospectivo no pareado. Se definió como caso al paciente que respondía "si donaría voluntariamente sangre en el futuro" a la pregunta filtro inicial. La variable respuesta fue la intención de donación de sangre y las de exposición fueron sexo, edad, estado civil, grado de instrucción, situación laboral, ingresos mensuales, religión, prácticas sobre la donación y conocimientos sobre la donación. Adicionalmente se exploraron las motivaciones para la donación de sangre. Para identificar los factores asociados se calcularon odds ratio crudos (ORc) mediante modelos lineales generalizados, haciendo uso de la familia Poisson, función de enlace log y modelos robustos; luego, las variables que mostraron asociación estadística significativa se ajustaron mediante análisis multivariado, ajustándolas por las variables sociodemográficas, y se obtuvieron los odds ratio ajustados (ORa). RESULTS: En el análisis multivariado aumentaron la probabilidad de intención de donación de sangre ser de sexo masculino (ORa=1,37), tener ingresos mensuales altos (ORa=1,26), profesar la religión católica (ORa=5,27), tener una mayor puntuación en el cuestionario de conocimientos (ORa=1,04), haber donado previamente (ORa=1,64) y que un familiar hubiera donado previamente (ORa=1,72). Por otro lado, la edad más avanzada (ORa=0,97) disminuyó dicha probabilidad. CONCLUSIONS: Se identifican diversos factores asociados a la intención de donación de sangre. Se resalta que el nivel de conocimientos elevado, así como experiencias previas en donación, aumentan la intención de donar sangre.
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Doadores de Sangue , Intenção , Humanos , Masculino , Peru , Feminino , Doadores de Sangue/psicologia , Doadores de Sangue/estatística & dados numéricos , Estudos Prospectivos , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Estudos de Casos e Controles , Hospitais , Fatores Socioeconômicos , MotivaçãoRESUMO
While conducting genomic surveillance of carbapenemase-producing Enterobacteriaceae (CPE) from patient colonisation and clinical infections at Birmingham's Queen Elizabeth Hospital (QE), we identified an N-type plasmid lineage, pQEB1, carrying several antibiotic resistance genes, including the carbapenemase gene bla KPC-2. The pQEB1 lineage is concerning due to its conferral of multidrug resistance, its host range and apparent transmissibility, and its potential for acquiring further resistance genes. Representatives of pQEB1 were found in three sequence types (STs) of Citrobacter freundii, two STs of Enterobacter cloacae, and three species of Klebsiella. Hosts of pQEB1 were isolated from 11 different patients who stayed in various wards throughout the hospital complex over a 13 month period from January 2023 to February 2024. At present, the only representatives of the pQEB1 lineage in GenBank were carried by an Enterobacter hormaechei isolated from a blood sample at the QE in 2016 and a Klebsiella pneumoniae isolated from a urine sample at University Hospitals Coventry and Warwickshire (UHCW) in May 2023. The UHCW patient had been treated at the QE. Long-read whole-genome sequencing was performed on Oxford Nanopore R10.4.1 flow cells, facilitating comparison of complete plasmid sequences. We identified structural variants of pQEB1 and defined the molecular events responsible for them. These have included IS26-mediated inversions and acquisitions of multiple insertion sequences and transposons, including carriers of mercury or arsenic resistance genes. We found that a particular inversion variant of pQEB1 was strongly associated with the QE Liver speciality after appearing in November 2023, but was found in different specialities and wards in January/February 2024. That variant has so far been seen in five different bacterial hosts from six patients, consistent with recent and ongoing inter-host and inter-patient transmission of pQEB1 in this hospital setting.
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Surtos de Doenças , Plasmídeos , beta-Lactamases , Humanos , Plasmídeos/genética , beta-Lactamases/genética , Infecções por Enterobacteriaceae/microbiologia , Infecções por Enterobacteriaceae/epidemiologia , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/isolamento & purificação , Klebsiella pneumoniae/efeitos dos fármacos , Proteínas de Bactérias/genética , Enterobacter cloacae/genética , Enterobacter cloacae/isolamento & purificação , Enterobacter cloacae/efeitos dos fármacos , Farmacorresistência Bacteriana Múltipla/genética , Infecção Hospitalar/microbiologia , Antibacterianos/farmacologia , Citrobacter freundii/genética , Citrobacter freundii/isolamento & purificação , Enterobacteriáceas Resistentes a Carbapenêmicos/genética , Enterobacteriáceas Resistentes a Carbapenêmicos/isolamento & purificação , Hospitais , EnterobacterRESUMO
Introduction Falls are the second leading cause of accidental or unintentional death worldwide. In hospital falls represent a relevant health problem, in particular after their increasing since Covid year 2020. The aim of this study is to evaluate correlation between falls and Covid infection. METHODS: Risk Management Unit at Mauriziano hospital analyzed in the present observational study possible correlation with Covid Pandemic and falls risk factors, through comparison of patients falls occurred during year 2021 in Covid and no-Covid wards. The primary outcome of the study is the evaluation of relationship between falls and Covid infection. The secondary outcome is identification of falls risk factors. RESULTS: No direct correlation between falls and Covid-19 infection was found. Among falls risk factors, the most interesting emerged is the fall itself that enhances the risk of relapse. DISCUSSION: Increasing in patients falls since 2020 could be affected indirectly by strong hospital organization modifications during Covid pandemic.
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Acidentes por Quedas , COVID-19 , Humanos , Acidentes por Quedas/estatística & dados numéricos , COVID-19/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Masculino , Idoso , Feminino , Idoso de 80 Anos ou mais , Pessoa de Meia-Idade , Hospitais/estatística & dados numéricos , Gestão de RiscosRESUMO
This qualitative study examines how regional health care capacity is associated with extreme heat event vulnerability.
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Calor Extremo , Humanos , Calor Extremo/efeitos adversos , Hospitais/estatística & dados numéricos , Estados UnidosRESUMO
Hand, foot, and mouth disease (HFMD) is an acute infectious illness primarily caused by enteroviruses. The present study aimed to describe the epidemiological characteristics of hospitalized HFMD patients in a hospital in Henan Province (Zhengzhou, China), and to predict the future epidemiological parameters. In this study, we conducted a retrospective analysis of general demographic and clinical data on hospitalized children who were diagnosed with HFMD from 2014 to 2023. We used wavelet analysis to determine the periodicity of the disease. We also conducted an analysis of the impact of the COVID-19 epidemic on the detection ratio of severe illness. Additionally, we employed a Seasonal Difference Autoregressive Moving Average (SARIMA) model to forecast characteristics of future newly hospitalized HFMD children. A total of 19 487 HFMD cases were included in the dataset. Among these cases, 1515 (7.8%) were classified as severe. The peak incidence of HFMD typically fell between May and July, exhibiting pronounced seasonality. The emergence of COVID-19 pandemic changed the ratio of severe illness. In addition, the best-fitted seasonal ARIMA model was identified as (2,0,2)(1,0,1)12. The incidence of severe cases decreased significantly following the introduction of the vaccine to the market (χ2 = 109.9, p < 0.05). The number of hospitalized HFMD cases in Henan Province exhibited a seasonal and declining trend from 2014 to 2023. Non-pharmacological interventions implemented during the COVID-19 pandemic have led to a reduction in the incidence of severe illness.
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COVID-19 , Doença de Mão, Pé e Boca , Hospitalização , Estações do Ano , Humanos , Doença de Mão, Pé e Boca/epidemiologia , Doença de Mão, Pé e Boca/virologia , China/epidemiologia , Pré-Escolar , Masculino , Feminino , Estudos Retrospectivos , Lactente , Estudos Longitudinais , Criança , COVID-19/epidemiologia , Incidência , Hospitalização/estatística & dados numéricos , Criança Hospitalizada/estatística & dados numéricos , Adolescente , Hospitais/estatística & dados numéricos , SARS-CoV-2 , Recém-NascidoRESUMO
We study competing hospitals' incentives for quality provision in a dynamic setting where healthcare is an experience good. In our model, the utility a patient derives from choosing a particular provider depends on a subjective component specific to the match between the patient and the provider, which can only be learned through experience. We find that the experience-good nature of healthcare can either reinforce or dampen the demand responsiveness to quality and the hospitals' incentives for quality provision, depending on two key factors: the shape of the distribution of match-specific utilities and the cost relationship between quality provision and treatment volume. We establish conditions under which ignoring the experience dimension of healthcare leads to inaccurate assessments of the competitiveness of hospital markets.
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Competição Econômica , Humanos , Qualidade da Assistência à Saúde , Hospitais , Satisfação do PacienteRESUMO
In a 2021 ruling, the central medical disciplinary board changed the requirements regarding the divisions of responsibilities between health care providers by introducing the term 'lead clinician', placing more emphasis on the own professional responsibility of each care provider involved. The lead clinician oversees the continuity and coherence of care, coordinates between caregivers, and serves as a point of contact. Despite concerns about its implementation, national guidelines on responsibility division have adopted the lead clinician concept. However, translating these guidelines into clinical practice of hospitals poses challenges due to unclear responsibilities and the absence of ultimate accountability. Furthermore, variations in interpretation among institutions and professional groups could jeopardize patient safety. Clear standards for the lead clinician role that are coordinated from a national level are essential to mitigate these risks. Until then, it may be unwise for hospitals to relinquish the former role of the practitioner in lead.
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Hospitais , Humanos , Hospitais/normas , Países BaixosRESUMO
This study investigated whether hospital factors, including patient volume, unit level, and neonatologist staffing, were associated with variations in standardized mortality ratios (SMR) adjusted for patient factors in very-low-birth-weight infants (VLBWIs). A total of 15,766 VLBWIs born in 63 hospitals between 2013 and 2020 were analyzed using data from the Korean Neonatal Network cohort. SMRs were evaluated after adjusting for patient factors. High and low SMR groups were defined as hospitals outside the 95% confidence limits on the SMR funnel plot. The mortality rate of VLBWIs was 12.7%. The average case-mix SMR was 1.1; calculated by adjusting for six significant patient factors: antenatal steroid, gestational age, birth weight, sex, 5-min Apgar score, and congenital anomalies. Hospital factors of the low SMR group (N = 10) had higher unit levels, more annual volumes of VLBWIs, more number of neonatologists, and fewer neonatal intensive care beds per neonatologist than the high SMR group (N = 13). Multi-level risk adjustment revealed that only the number of neonatologists showed a significant fixed-effect on mortality besides fixed patient risk effect and a random hospital effect. Adjusting for the number of neonatologists decreased the variance partition coefficient and random-effects variance between hospitals by 11.36%. The number of neonatologists was independently associated with center-to-center differences in VLBWI mortality in Korea after adjustment for patient risks and hospital factors.
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Mortalidade Infantil , Recém-Nascido de muito Baixo Peso , Humanos , República da Coreia/epidemiologia , Recém-Nascido , Feminino , Masculino , Mortalidade Infantil/tendências , Mortalidade Hospitalar , Lactente , Neonatologia , Unidades de Terapia Intensiva Neonatal , Hospitais/estatística & dados numéricos , Idade Gestacional , Risco Ajustado/métodosRESUMO
BACKGROUND: Besides improving the quality of care, quality improvement initiatives often also intend to produce cost savings. An example is prehabilitation, which can reduce complication rates and the length of stay in the hospital. However, the process from utilization reductions to actual societal cost savings remains uncertain in practice. Our aim was to identify barriers and facilitators throughout this process. We used the implementation of prehabilitation in a Dutch hospital as a test case. METHODS: We held 20 semi-structured interviews between June and November 2023. Eighteen stakeholders were affiliated with the hospital and two with different health insurers. Nine interviews were held face-to-face and 11 via Microsoft Teams. The interviews were recorded and transcribed. The first transcripts were inductively coded by two authors, the subsequent transcripts by one and checked by another. Differences were resolved through discussion. RESULTS: We identified 20 barriers and 23 facilitators across four stages: reducing capacity, reducing departmental expenses, reducing hospital expenses and reducing insurer expenses. All participants expected that the excess capacity will be used for other priorities. This was perceived as highly valuable and as an efficiency gain. Other barriers to capture savings included the fear of losing resilience, flexibility, status and revenue. Misalignment between service contracts among hospitals and insurers can hinder the ability to financially incentivize cost reductions. Additionally, some contract types can hinder the transfer of hospital savings to insurers. Identified facilitators included shared savings agreements, an explicit strategy targeting all stages, and labor shortage, among others. CONCLUSION: This study systematically describes barriers and facilitators that prevent translating quality improvement initiatives into societal cost savings. Stakeholders expect that any saved capacity will be used for other priorities, including providing care due to the increasing demand. Capturing any cash savings does not occur automatically, emphasizing the need for a strategy targeting all stages.
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Redução de Custos , Pesquisa Qualitativa , Melhoria de Qualidade , Humanos , Participação dos Interessados , Países Baixos , HospitaisRESUMO
BACKGROUND: The benefits of lean adoption in healthcare include improved process efficiency and quality of patient care. However, research indicates that lean implementation in healthcare, and specifically hospitals, is often not sustained. Furthermore, there is a need for maturity models that guide lean implementation, specifically in hospitals. This study develops a prescriptive maturity model named the Sustaining of Lean Adoption in Hospitals Roadmap (SOLAR) that acts as a practical guideline for the sustainable adoption of lean in hospitals. METHODS: The SOLAR has three theoretical foundations, namely lean implementation success factors in hospitals, implementation science, and change management theory. A systematic literature review was conducted to determine the lean implementation success factors in hospitals as the first building block. Secondly, practices from implementation science were used to create the action items in the SOLAR. Ten change steps were elicited from change management theory as the third theoretical building block of the roadmap. We refined the roadmap through three Delphi rounds that verified its useability in hospitals. RESULTS: The final SOLAR consists of four maturity phases (prepare, plan, experiment and learn, and sustain) and includes action items for each phase related to the hospital's strategy, resources, engaging of people, and culture. The action items and change management steps shown in the SOLAR are not intended as an exhaustive list but provide guidelines on aspects hospitals must consider when they aim to adopt lean sustainably. CONCLUSIONS: The strong theoretical base of the SOLAR enables hospitals to safely experiment and learn which implementation methods are best suited to their unique environment. The SOLAR is, therefore, an actionable guideline that informs both academics and practitioners involved in lean adoption in hospitals. This roadmap can guide future retrospective longitudinal or action research.
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Técnica Delphi , Humanos , Melhoria de Qualidade , Gestão da Qualidade Total , Administração Hospitalar , Hospitais/normas , Gestão de Mudança , Eficiência OrganizacionalRESUMO
The cost estimation and assessment of healthcare waste treatment systems (HCWTSs) for preventing financial and environmental damage are essential. This work reports economic analyses of treatment of hazardous-infectious waste based on WHO approach in HCWTSS of 43 hospitals in Tehran, Iran. The waste generation rate for total hospital waste in 43 HCWTSS was 4.42 ± 2.77 kg/active-bed/day. The mean of chemical, sharps, infectious, and general wastes in 43 HCWTSS were 13.79 ± 19.71, 30.29 ± 37.46, 336.28 ± 291.31, and 539.6 ± 383.13 kg/day, respectively. Economic analyses proved that general hospitals spent 1.63 times more than specialized hospitals on treating hazardous-infectious waste per year. The annual cost of treating each kilogram of hazardous healthcare waste in studied HCWTSS was 0.3 dollars. A range of total annual costs in 43 HCWTSS was limited to 7.9-118 thousand dollars. The results of ANOVA test demonstrated that the age and performance levels of hospitals significantly affect the annual capital and operating costs, respectively. Hence, improving recycling knowledge and increasing source-separated recycling should be considered to control the costs in HCWTSS. The results of this work have implications for the hospital managers in especially developing countries to evaluate previously unknown economic analyses and policies and take action to control wasted costs in HCWTSS.
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Resíduos Perigosos , Eliminação de Resíduos de Serviços de Saúde , Eliminação de Resíduos de Serviços de Saúde/economia , Eliminação de Resíduos de Serviços de Saúde/métodos , Resíduos Perigosos/economia , Irã (Geográfico) , Humanos , Hospitais , Resíduos de Serviços de Saúde/economia , Reciclagem/economiaRESUMO
BACKGROUND: In longitudinal health services research, hospital identification using an ID code, often supplemented with several additional variables, lacks clarity regarding representativeness and variable influence. This study presents an operational method for hospital identity delimitation and a novel longitudinal identification approach, demonstrated using a case study. METHODS: The conceptualisation considers hospitals as evolving entities, identifying "similar enough" pairs across two time points using an automated similarity matrix. This method comprises key variable selection, similarity scoring, and tolerance threshold definition, tailored to data source characteristics and clinical relevance. This linking method is tested by applying the identification of minimum caseload requirements-related German hospitals, utilizing German Hospital Quality Reports (GHQR) 2016-2020. RESULTS: The method achieved a success rate (min: 97.9% - max: 100%, mean: 99.9%) surpassing traditional hospital ID-code linkage (min: 91.5% - max: 98.8%, mean: 96.6%), with a remarkable 99% reduction in manual work through automation. CONCLUSIONS: This method, rooted in a comprehensive understanding of hospital identities, offers an operational, automated, and customisable process serving diverse clinical topics. This approach has the advantage of simultaneously considering multiple variables and systematically observing temporal changes in hospitals. It also enhances the precision and efficiency of longitudinal hospital identification in health services research.
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Hospitais , Humanos , Alemanha , Hospitais/estatística & dados numéricos , Hospitais/normas , Estudos Longitudinais , Pesquisa sobre Serviços de Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/normasRESUMO
The recent rise of active shootings calls for adequate preparation. Currently, the "Run, Hide, Fight" concept is widely accepted and adopted by many hospitals nationwide. Unfortunately, the appropriateness of this concept in hospitals is uncertain due to lack of data. To understand the "Run, Hide, Fight" concept application in hospitals, a review of currently available data is needed. A systematic review was done focusing on the "Run, Hide, Fight" concept using multiple databases from the past 12 years. The PRISMA flow diagram was used to systematically select the articles based on specific inclusion and exclusion criteria. The measurements were subjective evaluations and survival probabilities post-concept. One agent-based modeling study suggested a high survival probability in non-medical settings. However, there is a paucity of data supporting its effectiveness and applicability in hospitals. Literature suggests a better suitable concept, the "Secure, Preserve, Fight" concept, as a response protocol to active shootings in hospitals. The effectiveness of the "Run, Hide, Fight" concept in hospitals is questionable. The "Secure, Preserve, Fight" concept was found to be designed more specifically for hospitals and closes the gaps on the flaws in the "Run, Hide, Fight" concept.
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Hospitais , Humanos , Planejamento em Desastres/normas , Planejamento em Desastres/tendências , Armas de Fogo/estatística & dados numéricos , Hospitais/normas , Hospitais/tendências , Incidentes com Feridos em Massa/estatística & dados numéricosRESUMO
BACKGROUND: Several healthcare-associated infection outbreaks have been caused by waterborne Pseudomonas aeruginosa exhibiting its ability to colonize water systems and resist conventional chlorine treatment. This study aims to investigate the occurrence of Pseudomonas aeruginosa in hospital drinking water systems and the antimicrobial resistance profiles (antibiotic and chlorine resistance) of isolated strains. METHODS: We investigated the presence of Pseudomonas aeruginosa in water and biofilms developed in nine hospital water systems (n = 192) using culture-based and molecular methods. We further assessed the survival of isolated strains after exposure to 0.5 and 1.5 ppm concentrations of chlorine. The profile of antibiotic resistance and presence of antibiotic resistance genes in isolated strains were also investigated. RESULTS: Using direct PCR method, Pseudomonas aeruginosa was detected in 22% (21/96) of water and 28% (27/96) of biofilm samples. However, culturable Pseudomonas aeruginosa was isolated from 14 samples. Most of P. aeruginosa isolates (86%) were resistant to at least one antibiotic (mainly ß-lactams), with 50% demonstrating multidrug resistance. Moreover, three isolates harbored intI1 gene and two isolates contained blaOXA-24,blaOXA-48, and blaOXA-58| genes. Experiments with chlorine disinfection revealed that all tested Pseudomonas aeruginosa strains were resistant to a 0.5 ppm concentration. However, when exposed to a 1.5 ppm concentration of chlorine for 30 min, 60% of the strains were eliminated. Interestingly, all chlorine-resistant bacteria that survived at 30-minute exposure to 1.5 ppm chlorine were found to harbor the intI1 gene. CONCLUSIONS: The detection of antimicrobial resistant Pseudomonas aeruginosa in hospital water systems raises concerns about the potential for infections among hospitalized patients. The implementation of advanced mitigation measures and targeted disinfection methods should be considered to tackle the evolving challenges within hospital water systems.
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Biofilmes , Cloro , Hospitais , Pseudomonas aeruginosa , Microbiologia da Água , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/genética , Pseudomonas aeruginosa/isolamento & purificação , Cloro/farmacologia , Humanos , Biofilmes/efeitos dos fármacos , Biofilmes/crescimento & desenvolvimento , Infecções por Pseudomonas/microbiologia , Infecções por Pseudomonas/epidemiologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/epidemiologia , Antibacterianos/farmacologia , Doenças Transmitidas pela Água/microbiologia , Doenças Transmitidas pela Água/epidemiologia , Farmacorresistência Bacteriana Múltipla , Testes de Sensibilidade Microbiana , Desinfetantes/farmacologia , Água Potável/microbiologiaRESUMO
OBJECTIVE: Chemical, biological, radiological, and nuclear (CBRN) events with multiple casualties are rare events, but preparedness is crucial for hospitals to respond properly. This study evaluated the preparedness and disaster planning of German hospitals for CBRN incidents. METHODS: In a cross-sectional study, German hospitals with level III (highest level) emergency departments were surveyed using an online questionnaire focusing on risk assessment, infrastructure, hospital disaster planning, and preparedness for CBRN events. RESULTS: Between June and July 2023, 50 hospitals were surveyed. 62.5% of the hospitals had a section on chemical incidents in their disaster plan. A decontamination facility was available in 29.8% of the hospitals and chemical protective suits in 46.8%. The minority of the hospitals trained the correct handling of personal protective equipment (PPE) (39.1%) regularly or had frequent CBRN drills (21.3%). Most hospitals had the infrastructure for medical isolation (93.6%). CONCLUSIONS: The level of CBRN preparedness is heterogeneous for German hospitals. Most were well prepared for infectious patients, but only half of all hospitals had sufficient PPE for chemical incidents and only 30% had a decontamination facility available. Overall, the level of CBRN preparedness is still insufficient and needs further improvement.
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Planejamento em Desastres , Hospitais , Estudos Transversais , Alemanha , Humanos , Inquéritos e Questionários , Hospitais/estatística & dados numéricos , Hospitais/normas , Planejamento em Desastres/métodos , Planejamento em Desastres/estatística & dados numéricos , Defesa Civil/métodos , Defesa Civil/estatística & dados numéricos , Defesa Civil/normasRESUMO
In this work, the antibiotic resistance, biofilm formation capability, and clonal relatedness of 50 A. baumannii isolates collected from three hospitals in Ardabil city, Iran, were evaluated. Antibiotic sensitivity and biofilm formation of isolates were determined by disk diffusion and microtiter-plate methods, respectively. Molecular typing of isolates was also performed using repetitive sequence-based PCR (REP-PCR). The majority of isolates were resistant to cephems, aminoglycosides, and carbapenems, with 80 % classified as multi-drug resistant (MDR). While, only isolates collected from blood and tracheal were resistant to colistin. Additionally, 42 isolates (84 %) had biofilm formation capability. According to rep-PCR results, 34 isolates showed similar banding patterns, while 16 isolates had unique banding patterns. Finally, based on the molecular analysis, there was a direct relationship between biofilm formation and the antibiotic resistance of isolates. In other words, MDR isolates had a higher ability to form biofilm.
Assuntos
Infecções por Acinetobacter , Acinetobacter baumannii , Antibacterianos , Biofilmes , Farmacorresistência Bacteriana Múltipla , Testes de Sensibilidade Microbiana , Biofilmes/crescimento & desenvolvimento , Biofilmes/efeitos dos fármacos , Humanos , Antibacterianos/farmacologia , Infecções por Acinetobacter/microbiologia , Irã (Geográfico) , Farmacorresistência Bacteriana Múltipla/genética , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/genética , Acinetobacter baumannii/isolamento & purificação , Acinetobacter baumannii/fisiologia , Tipagem Molecular , Reação em Cadeia da Polimerase , Colistina/farmacologia , Adulto , Hospitais , Masculino , Feminino , Genótipo , Pessoa de Meia-IdadeRESUMO
Hypertension is a persistent systemic Blood Pressure reading of 140/90 mm Hg or greater which is a preventable cause of cardiovascular disease morbidity and mortality. To assess non-adherence to appointment follow-up and its associated factors among Hypertensive patients in the follow-up clinics in South Gondar Hospitals 2023. Institutional-based cross-sectional study design was employed in hospitals in South Gondar from January to February to assess missed appointment follow-up and its associated factors among Hypertensive patients in follow-up clinics. There is one comprehensive specialized hospital and 9 primary hospitals in this zone. Using simple random methods four hospitals were selected by lottery method. The sample was calculated by using the single population proportion formula. The collected data was entered into Epi data version 3.1 and exported to Statistical Package for Social Sciences version 26 for analysis. Bivariate and multivariable logistic regression analysis was performed to determine the association factors. A total of 401 hypertensive patients on hypertensive follow-up were involved with a response rate of 95.02%. Age ranged from 25 to 86 years with a median age of 58.47 years. Of the total of participants, 211 (52.6.) were rural residents. Among the total hypertensive patients in the hypertensive follow-up clinic, 39.2% were non-adherent for their appointment follow-up. Living far from follow-up health facility (AOR: 2.53; 95% CI 1.349-4.743), absence of perceived symptoms (AOR: 4.98; 95% CI 2.888-8.590), patient complaints Pill burdens (AOR: 3.50; 95% CI 2.108-5.825), and poor Awareness about complication of hypertension (AOR: 2.62; 95% CI 1.471-4.673) were significantly associated with missing of their appointment follow-up for the most hypertensive patients. The prevalence of non-adherence to medical follow-up in hypertension is high as compared to different national health policy recommendations. Distance from the health facility, absence of perceived symptoms, Pill burdens, and lack of knowledge about complications of hypertension were significantly associated with Missed appointment follow-up in Hypertensive patient.
Assuntos
Agendamento de Consultas , Hipertensão , Humanos , Hipertensão/epidemiologia , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Adulto , Estudos Transversais , Idoso de 80 Anos ou mais , Etiópia/epidemiologia , Seguimentos , Cooperação do Paciente/estatística & dados numéricos , HospitaisRESUMO
Background: Winter pressures are a familiar phenomenon within the National Health Service and represent the most extreme of many regular demands placed on health and social care service provision. This review focuses on a part of the pathway that is particularly problematic: the discharge process from hospital to social care and the community. Although studies of discharge are plentiful, we identified a need to focus on identifying interventions and initiatives that are a specific response to 'winter pressures'. This mapping review focuses on interventions or initiatives in relation to hospital winter pressures in the United Kingdom with either discharge planning to increase smart discharge (both a reduction in patients waiting to be discharged and patients being discharged to the most appropriate place) and/or integrated care. Methods: We conducted a mapping review of United Kingdom evidence published 2018-22. Initially, we searched MEDLINE, Health Management Information Consortium, Social Care Online, Social Sciences Citation Index and the King's Fund Library to find relevant interventions in conjunction with winter pressures. From these interventions we created a taxonomy of intervention types and a draft map. A second broader stage of searching was then undertaken for named candidate interventions on Google Scholar (Google Inc., Mountain View, CA, USA). For each taxonomy heading, we produced a table with definitions, findings from research studies, local initiatives and systematic reviews and evidence gaps. Results: The taxonomy developed was split into structural, changing staff behaviour, changing community provision, integrated care, targeting carers, modelling and workforce planning. The last two categories were excluded from the scope. Within the different taxonomy sections we generated a total of 41 headings. These headings were further organised into the different stages of the patient pathway: hospital avoidance, alternative delivery site, facilitated discharge and cross-cutting. The evidence for each heading was summarised in tables and evidence gaps were identified. Conclusions: Few initiatives identified were specifically identified as a response to winter pressures. Discharge to assess and hospital at home interventions are heavily used and well supported by the evidence but other responses, while also heavily used, were based on limited evidence. There is a lack of studies considering patient, family and provider needs when developing interventions aimed at improving delayed discharge. Additionally, there is a shortage of studies that measure the longer-term impact of interventions. Hospital avoidance and discharge planning are whole-system approaches. Considering the whole health and social care system is imperative to ensure that implementing an initiative in one setting does not just move the problem to another setting. Limitations: Time limitations for completing the review constrained the period available for additional searches. This may carry implications for the completeness of the evidence base identified. Future work: Further research to consider a realist review that views approaches across the different sectors within a whole system evaluation frame. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR130588) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 31. See the NIHR Funding and Awards website for further award information.
Every year, the National Health Service struggles with huge care demands from people with heart and lung problems. This 'mapping review' aimed to chart the evidence around what has been done to minimise winter pressures related to discharge planning, by helping people leaving hospital sooner, and by optimising integrated care (also known as 'collaborative care') and to make suggestions for future research. Good research evidence was identified for three specific approaches: Acute medical units: these units provide rapid assessment, diagnosis and treatment for adults referred by their general practitioner or the emergency department. Discharge to assess: this involves discharging patients who need care services but not an acute hospital bed. Patients are either discharged home or are transferred to an appropriate community setting with short-term funded support while their future care needs are assessed. Hospital at home: this approach provides patients with the care they need at home instead of in hospital (also known as virtual wards). The evidence for many other activities to reduce winter pressures was weaker, coming from case studies, conference presentations or small, low methodological quality (poorly designed or executed) research studies. The review identified many different initiatives with diverse names or labels and it is also important to consider how implementing an initiative in one setting might affect another setting. Further research is recommended around what works best for which patient groups, under what circumstances and why, based on common processes within the different initiatives and across the whole health and social care system.