The adoption of systems-focused risk assessment techniques has not led to measurable improvement in the rate of patient harm. Why? In part, because these tools focus solely on understanding problems, and provide no direct support for... more
The adoption of systems-focused risk assessment techniques has not led to measurable improvement in the rate of patient harm. Why? In part, because these tools focus solely on understanding problems, and provide no direct support for designing and managing solutions (i.e., risk control). This second installment of a 2-part series on rebalancing risk management describes a structured approach to bridging this gap: The Active Risk Control (ARC) Toolkit. A pilot study is presented to show how ARC Toolkit can improve the quality of risk management practice.
In this article we call for a new approach to patient safety improvement, one based on the emerging field of evidence-based healthcare risk management (EBHRM). We explore EBHRM in the broader context of the evidence-based healthcare... more
In this article we call for a new approach to patient safety improvement, one based on the emerging field of evidence-based healthcare risk management (EBHRM). We explore EBHRM in the broader context of the evidence-based healthcare movement, assess the benefits and challenges that might arise in adopting an evidence-based approach, and make recommendations for meeting those challenges and realizing the benefits of a more scientific approach.
Airborne microorganisms results in nosocomial infections and are present in the air environment. Bacteriological air quality of hospital air environment is necessary to identify the airborne isolates responsible for these nosocomial... more
Airborne microorganisms results in nosocomial infections and are present in the air environment. Bacteriological air quality of hospital air environment is necessary to identify the airborne isolates responsible for these nosocomial infections. Samples were collected monthly from the designated sampling sites of three hospitals for a period of 12 months using the Settled Plate Methods on Nutrient Agar. The airborne bacterial colonies were characterized using the cultural, morphological and biochemical characteristics features. The mean airborne bacterial counts for Hospital 1 ranged from 2.35 + 1.36 ×10 2 cfu/m 3 to 44.01 + 12.09 ×10 2 cfu/m 3 that of Hospital 2 ranged from 2.09 + 0.45 ×10 2 cfu/m 3 to 86.44 + 14.99 ×10 2 cfu/m 3 while values for Hospital 3 ranged from 3.14 + 2.36 ×10 2 cfu/m 3 to 94.29 + 7.86 ×10 2 cfu/m 3. The evaluation of air quality revealed that hospital 3 had very high microbial load of 42.9% as compared to hospitals 1 and 2 with values of 24.1% and 27% respectively. The airborne bacterial isolates were characterized and identified to be Staphylococcus spp., Bacillus cereus, Bacillus subtilis, Comamonas spp, Providencia spp. and Alcaligenes spp. The Government owned hospitals had a higher microbial load than the other two privately-owned hospitals. More emphasis should be placed on this area of research because of the potential severity of the consequences of nosocomial infections. The Hospital managements, Ministry of Health, States and Federal Government, should establish a research database and set an acceptable range of isolated airborne flora in the hospital and other environments.
Avoidable patient harm is a major public health concern, and may already have surpassed heart disease as the leading cause of death in the US. While the public health community has contributed much to one aspect of patient harm... more
Avoidable patient harm is a major public health concern, and may already have surpassed heart disease as the leading cause of death in the US. While the public health community has contributed much to one aspect of patient harm prevention, infection control, the tools and techniques of public health have far
more to offer to the emerging field of patient safety science. Patient safety practice has become increasingly professionalized in recent years, but specialist degree programs in the field remain scarce. Healthcare organizations should consider graduate training in public health as an avenue for investing in the professional development of patient safety practitioners, and schools and programs of public health should support further research and teaching to support patient safety improvement.
BACKGROUND: Risk assessment is widely used to improve patient safety, but healthcare workers are not trained to design robust solutions to the risks they uncover. This leads to an overreliance on the weakest category of risk control... more
BACKGROUND: Risk assessment is widely used to improve patient safety, but healthcare workers are not trained to design robust solutions to the risks they uncover. This leads to an overreliance on the weakest category of risk control recommendations: administrative controls. Increasing the proportion of non-administrative risk control options (NARCOs) generated would enable (though not ensure) the adoption of more robust solutions.
OBJECTIVES: Experimentally assess a method for generating stronger risk controls: The Generating Options for Active Risk Control (GO-ARC) Technique.
METHODS: Participants generated risk control options in response to two patient safety scenarios. Scenario 1 (baseline): All participants used current practice (unstructured brainstorming). Scenario 2: Control group used current practice; intervention group used the GO-ARC Technique. To control for individual differences between participants, analysis focused on the change in the proportion of NARCOs for each group.
RESULTS: Control group: Proportion of NARCOs decreased from 0.18 at baseline to 0.12. Intervention group: Proportion increased from 0.10 at baseline to 0.29 using the GO-ARC Technique. Results were statistically significant. There was no decrease in the number of administrative controls generated by the intervention group.
CONCLUSION: The Generating Options for Active Risk Control (GO-ARC) Technique appears to lead to more robust risk control options.
BACKGROUND: There is a high risk of occupational exposure to tuberculosis among healthcare workers in endemic countries. Regular screening for tuberculosis among healthcare workers is not carried out in Nepal. Infection control measures... more
BACKGROUND: There is a high risk of occupational exposure to tuberculosis among healthcare workers in endemic countries. Regular screening for tuberculosis among healthcare workers is not carried out in Nepal. Infection control measures are also not routinely implemented. The aim of this study was to determine the prevalence of active tuberculosis among staff/students at Patan Hospital. METHODS: Participants were given a self-administered questionnaire and invited to undergo chest radiography. Cases were scored and reviewed based on predetermined criteria, and presumptive tuberculosis cases were invited to undergo sputum smear and culture. Participants were categorized according to the extent of patient contact and asked about history of tuberculosis medication. RESULTS: Among 560 participants, 76.8% had direct contact with patients. Fifty-eight (10.4%) gave history of cough >2 weeks. Based on symptom history and chest radiography, 20.0% (n=112) cases were reviewed, and 12.5% (n=14) of those reviewed had sputum tested for acid-fast bacilli. One participant had culture-positive tuberculosis. Fifty participants (8.9%) reported tuberculosis in the past, among which 42.0% (n=21) occurred after employment at Patan Hospital and 42.0% before joining Patan Hospital. Security staff, radiology technicians and ward cleaning staff had the highest proportion of cases with a history of tuberculosis.History of tuberculosis medication had no relation with age, sex, education, body mass index and smoking.The incidence rate of tuberculosis at Patan Hospital was 3.6 per 1000 person-years. CONCLUSIONS: Overall incidence of tuberculosis among healthcare workers is noteworthy. However, this study suggests when symptomatic tuberculosis occurs in healthcare worker at Patan Hospital, it is diagnosed and there is not a large pool of undiagnosed tuberculosis.
There is a high risk of occupational exposure to tuberculosis among healthcare workers in endemic countries. Regular screening for tuberculosis among healthcare workers is not carried out in Nepal. Infection control measures are also not... more
There is a high risk of occupational exposure to tuberculosis among healthcare workers in endemic countries. Regular screening for tuberculosis among healthcare workers is not carried out in Nepal. Infection control measures are also not routinely implemented. The aim of this study was to determine the prevalence of active tuberculosis among staff/students at Patan Hospital. Participants were given a self-administered questionnaire and invited to undergo chest radiography. Cases were scored and reviewed based on predetermined criteria, and presumptive tuberculosis cases were invited to undergo sputum smear and culture. Participants were categorized according to the extent of patient contact and asked about history of tuberculosis medication. Among 560 participants, 76.8% had direct contact with patients. Fifty-eight (10.4%) gave history of cough >2 weeks. Based on symptom history and chest radiography, 20.0% (n=112) cases were reviewed, and 12.5% (n=14) of those reviewed had sput...
Risk assessment is widely used to improve patient safety, but healthcare workers are not trained to design robust solutions to the risks they uncover. This leads to an overreliance on the weakest category of risk control recommendations:... more
Risk assessment is widely used to improve patient safety, but healthcare workers are not trained to design robust solutions to the risks they uncover. This leads to an overreliance on the weakest category of risk control recommendations: administrative controls. Increasing the proportion of non-administrative risk control options (NARCOs) generated would enable (though not ensure) the adoption of more robust solutions. Experimentally assess a method for generating stronger risk controls: The Generating Options for Active Risk Control (GO-ARC) Technique. Participants generated risk control options in response to two patient safety scenarios. Scenario 1 (baseline): All participants used current practice (unstructured brainstorming). Scenario 2: Control group used current practice; intervention group used the GO-ARC Technique. To control for individual differences between participants, analysis focused on the change in the proportion of NARCOs for each group. Proportion of NARCOs decre...
Introducción: Los sistemas de secreción bacterianos tipo IV tienen una variedad de funciones biológicas como el intercambio de material genético con otras bacterias y la translocación de ADN virulento, con sus proteínas efectoras, dentro... more
Introducción: Los sistemas de secreción bacterianos tipo IV tienen una variedad de funciones biológicas como el intercambio de material genético con otras bacterias y la translocación de ADN virulento, con sus proteínas efectoras, dentro de las células del huésped. Acinetobacter baumannii es un patógeno que causa infecciones en humanos y registra porcentajes altos de multiresistencia a fármacos. Objetivo: Relacionar el conocimiento so-bre los sistemas de secreción tipo IV con los patrones de resistencia y virulencia de Acinetobacter baumannii. Materiales y Métodos: Se realizó una buscada en PMC (NCBI) utilizando un conjunto de palabras claves. Resultados: De 133 artículos se analiza-ron 14 para establecer la relación entre los sistemas de secreción microbiano y la resistencia y virulencia de A. baumannii. Conclusiones: Los sistemas de secreción bacterianos tipo IV presentes en A. bau-mannii son una pieza clave en el enten-dimiento de los patrones de virulencia y resistencia. Palabra...
This study was undertaken to determine the type and estimate the prevalence of bacterial organisms on contact surfaces of five close-to-patient facilities in three veterinary health care settings within the Sokoto metropolis of... more
This study was undertaken to determine the type and estimate the prevalence of bacterial organisms on contact surfaces of five close-to-patient facilities in three veterinary health care settings within the Sokoto metropolis of north-western Nigeria. A total of 30 samples (10 from each setting) were collected and analysed using culture, microscopy and biochemical testing. Bacterial species isolated from samples in this study included the following: Bacillus sp. (27.3%), Staphylococcus aureus (15.9%), Listeria sp. (13.6%), Streptococcus sp. (11.4%), Salmonella sp. (6.8%), Escherichia coli (4.5%), Staphylococcus epidermidis (4.5%), Citrobacter sp. (2.3%), Klebsiella sp. (2.3%), Lactobacillus sp. (2.3%), Micrococcus sp. (2.3%), Pasteurella sp. (2.3%), Proteus sp. (2.3%), and Yersinia sp. (2.3%). A higher percentage (64.3%) of the total bacterial isolates were zoonotic in nature and hence of public health significance. Some pathogens have the potential of nosocomial spread. In this study, we seek to establish the first evidence of bacterial presence in the major veterinary health care settings in the Sokoto region of north-western Nigeria. Of particular interest is the hypothesis, which has not previously been formally tested, that nosocomial infections are especially likely to be implicated in both animals and occupational diseases in Nigeria. It was suggested that some of these isolates were associated with the risk of nosocomial and zoonotic infections and hence draws attention to the need to rigorously employ standard veterinary precautions as part of the hospitals infection control programme in an attempt to protect both patients and staff from infections.
Actualización de la bacteriología clínica moderna, se describen las bacterias que producen patología infecciosas y se estudia cada género bacteriano de importancia médica desde la perspectiva de su reciente ubicación taxonómica. ISBN:... more
Actualización de la bacteriología clínica moderna, se describen las bacterias que producen patología infecciosas y se estudia cada género bacteriano de importancia médica desde la perspectiva de su reciente ubicación taxonómica.
ISBN: 958-683-052-7
There is a high risk of occupational exposure to tuberculosis among healthcare workers in endemic countries. Regular screening for tuberculosis among healthcare workers is not carried out in Nepal. Infection control measures are also not... more
There is a high risk of occupational exposure to tuberculosis among healthcare workers in endemic countries. Regular screening for tuberculosis among healthcare workers is not carried out in Nepal. Infection control measures are also not routinely implemented. The aim of this study was to determine the prevalence of active tuberculosis among staff/students at Patan Hospital. Participants were given a self-administered questionnaire and invited to undergo chest radiography. Cases were scored and reviewed based on predetermined criteria, and presumptive tuberculosis cases were invited to undergo sputum smear and culture. Participants were categorized according to the extent of patient contact and asked about history of tuberculosis medication. Among 560 participants, 76.8% had direct contact with patients. Fifty-eight (10.4%) gave history of cough >2 weeks. Based on symptom history and chest radiography, 20.0% (n=112) cases were reviewed, and 12.5% (n=14) of those reviewed had sput...
There is a high risk of occupational exposure to tuberculosis among healthcare workers in endemic countries. Regular screening for tuberculosis among healthcare workers is not carried out in Nepal. Infection control measures are also not... more
There is a high risk of occupational exposure to tuberculosis among healthcare workers in endemic countries. Regular screening for tuberculosis among healthcare workers is not carried out in Nepal. Infection control measures are also not routinely implemented. The aim of this study was to determine the prevalence of active tuberculosis among staff/students at Patan Hospital. Participants were given a self-administered questionnaire and invited to undergo chest radiography. Cases were scored and reviewed based on predetermined criteria, and presumptive tuberculosis cases were invited to undergo sputum smear and culture. Participants were categorized according to the extent of patient contact and asked about history of tuberculosis medication. Among 560 participants, 76.8% had direct contact with patients. Fifty-eight (10.4%) gave history of cough >2 weeks. Based on symptom history and chest radiography, 20.0% (n=112) cases were reviewed, and 12.5% (n=14) of those reviewed had sput...
In this article we call for a new approach to patient safety improvement, one based on the emerging field of evidence-based healthcare risk management (EBHRM). We explore EBHRM in the broader context of the evidence-based healthcare... more
In this article we call for a new approach to patient safety improvement, one based on the emerging field of evidence-based healthcare risk management (EBHRM). We explore EBHRM in the broader context of the evidence-based healthcare movement, assess the benefits and challenges that might arise in adopting an evidence-based approach, and make recommendations for meeting those challenges and realizing the benefits of a more scientific approach.
