Latest articles about Public Health http://www.longwoods.com http://blogs.law.harvard.edu/tech/rss Fri, 10 Jul 2009 11:03:33 -0400 Fri, 10 Jul 2009 11:03:13 -0400 FeedForAll v2.0 (2.0.2.9) http://www.feedforall.com We read the six commentaries about our paper with great interest. It is clear from the breadth of the contributors' expertise that controlling the spread of infectious diseases in healthcare settings is indeed a multi-factorial problem that requires a team-based multidisciplinary response. Indeed, it is this multi-factorial nature that makes improving our record all the more challenging. For example, one could focus on, and sustain significant improvements in, cleaning and yet have a limited impact on infection rates because of poor compliance with hand hygiene and isolation procedures. http://www.longwoods.com/product.php?productid=20929 C564B144-5F2D-4079-99DD-7178420766E6 Fri, 10 Jul 2009 11:03:13 -0400 The increasing attention to healthcare-associated infections is essential and long overdue. The authors of the lead article point out that standardization is a key dimension of quality. We, as healthcare providers, must leave behind the historical approach of "accommodating" broad clinical variation in practice, tolerance of low compliance in applying clear evidence that enhances outcome, and accommodating intransigent, colleagues who reject infection control practices. We know from the behavioural literature that unless an issue affects "me," buy-in is significantly limited; clearly, we must help each person in the chain of care feel an impact. There is much we can do, and each of us must demand change. http://www.longwoods.com/product.php?productid=20928 EF3A0331-35CB-432D-99E4-95A9AC7EE20A Fri, 10 Jul 2009 11:02:53 -0400 The commentary was prepared in response to the manuscript "Healthcare-Associated Infections as Patient Safety Indicators," by Gardam, Lemieux, Reason, van Dijk and Goel. Healthcare-associated infections are a severe patient safety hazard. Current patient safety initiatives targeting increased healthcare worker hand hygiene to prevent some of these infections have had limited effect. This commentary describes recent advances in electronic sensing and computational power that have provided new options to increase hand hygiene compliance as a step toward reducing healthcare-associated infections. Smart electronics can provide reasoning about a healthcare worker's circumstance and prompt the worker to perform hand hygiene when necessary. These novel approaches in technology development have tremendous potential to enhance the hand hygiene of healthcare workers and can support the prevention of this significant problem for patients in our hospitals. http://www.longwoods.com/product.php?productid=20927 FDC27700-5E15-4F7A-ABC8-BE431D75690E Fri, 10 Jul 2009 11:02:35 -0400 Healthcare-associated infections (HAIs), important threats to patient safety, are considered differently from other adverse events. Gardam and his colleagues discuss several reasons for this and outline approaches that may bring about changes in attitudes and enhance HAI prevention. We comment on the potential preventability of HAIs, the need for improved communication strategies and the different vision of the role of infection control personnel suggested by Gardam et al. Recent developments in infection control structure and management and patient safety in Quebec are summarized. http://www.longwoods.com/product.php?productid=20926 9FE78716-4646-4C37-9AAD-B6E94B4D1CEA Fri, 10 Jul 2009 11:02:19 -0400 The authors of "Healthcare-Associated Infections as Patient Safety Indicators" correctly identify healthcare-associated infections (HAIs) as a growing problem with severe consequences. In contrast to most literature, their article acknowledges the importance of environmental cleaning. The paper presents credible reasons why HAIs are treated as lesser threats than other adverse events. It also appropriately emphasizes prevention and calls for multiple interventions, including reducing occupancy rates. This commentary provides additional evidence of the critical role of environmental cleaning and posits that the devaluation of cleaning and other support services lies at the heart of governments' and administrators' inadequate response to HAIs. Staff cuts and contracting out are both a motivating factor and a consequence of this devaluation. The commentary concludes with recommendations. http://www.longwoods.com/product.php?productid=20925 F642F45C-C39F-42D5-A8CF-E316745E9E28 Fri, 10 Jul 2009 11:01:52 -0400 The lead paper, "Healthcare-Associated Infections as Patient Safety Indicators," written by Gardam, Lemieux, Reason, van Dijk and Goel, puts forward the design of healthcare facilities as one of many strategies to improve patient safety with respect to healthcare-associated infections. This commentary explores some of the issues in balancing infection prevention and control priorities with other needs and values brought to the design process. This balance is challenged not only by a lack of supporting evidence but also by the superficial nature in which infection prevention and control are often discussed within a design context. For the physical environment to support any patient safety initiative, the design of the processes must be developed in conjunction with that of the physical environment so that compliance can be natural and convenient. Finally, consideration is given to the value of documenting decision-making related to infection prevention and control in facility design and ongoing assessments of existing facilities. http://www.longwoods.com/product.php?productid=20924 822534A9-2C05-482D-B4E4-5110C41A31BE Fri, 10 Jul 2009 11:01:34 -0400 Gardam, Lemieux, Reason, van Dijk and Goel argue that healthcare-associated infections (HAIs) are "a pressing and imminent concern in the context of patient safety." Accreditation Canada supports the position taken by these authors. The prevention and control of two HAIs of great concern, methicillin-resistant Staphylococcus aureus and Clostridium difficile, are an integral part of the Accreditation Canada program. A coordinated approach to combating HAIs and developing a culture of infection prevention and control is necessary, one that involves front-line healthcare professionals, senior leadership, national and provincial partners and the public. Since 2005, Accreditation Canada has increasingly strengthened the accreditation program in this area through a number of new strategies, including enhanced standards, required organizational practices, performance measures and indicators and the introduction of education programs. Optimizing the value of accreditation through an integrative approach with organizations' quality improvement programs will contribute to effectively combating HAIs and developing a culture of infection prevention and control. http://www.longwoods.com/product.php?productid=20923 3651CEFA-B2F8-4147-95E9-E4C1EEE8C16F Fri, 10 Jul 2009 11:01:15 -0400 Healthcare-associated infections (HAIs) are a pressing and imminent patient safety concern as they cause substantial preventable morbidity and mortality. Despite this, there is a strong tendency for healthcare administrators and providers to view them as far less of a threat to patient safety than adverse events such as medication administration errors and falls. Further, validated strategies to prevent HAIs are frequently slow to be adopted. This paper reviews two HAIs of increasing visibility and importance - namely, methicillin-resistant Staphylococcus aureus and Clostridium difficile - and discusses the pivotal importance of hand hygiene and environmental cleaning in their prevention. Possible reasons why HAIs are approached differently from other patient safety issues are discussed, including the false sense of security created by the advent of antibiotics, the lack of randomized controlled trials supporting infection-control interventions and the systemic multifactorial causes of HAIs that result in a need for interventions that go far beyond traditional clinical boundaries. Suggested strategies to improve patient safety with respect to HAIs are provided, including a focus on the role of potential links to accreditation; the role of public reporting; healthcare facility design; change management strategies; visible leadership and role modelling; collaboration between facilities and with public health; reducing hospital overcrowding; and accountability and funding. Finally, the impact of the burgeoning interest of the media, the threat of legal liability and the well-being of healthcare providers are discussed. http://www.longwoods.com/product.php?productid=20922 0A8FBF4A-679F-440D-8A00-24CCD1740AFE Fri, 10 Jul 2009 11:00:25 -0400 We conducted a public poll to assess the public's perception about changes in HIV prevalence and its causes in a township in western Uganda. The main questions related to the declining HIV prevalence and its interpretation, as well as to the "Ugandan success story." The study used a qualitative methodology; we interviewed 68 citizens in eight focus group discussions. The majority stated that the HIV prevalence had declined in their town. Of those respondents, most cited behaviour changes related to Uganda's ABC strategy as their explanation of the declining trends. Those who said that a decline in HIV had taken place also stated that they believed in the Ugandan success story. Our study concludes that it is important to involve the public on important health issues such as HIV/AIDS in order to obtain more valid results by combining scientific findings with public/indigenous knowledge. http://www.longwoods.com/product.php?productid=20548&cat=570&page=1 E1A81289-702C-42F2-8272-DABD880DD0DB Fri, 17 Apr 2009 13:56:57 -0400