National prevalence survey in Brazil to evaluate the quality of microbiology laboratories: the importance of defining priorities to allocate limited resources

Antimicrobial resistance is a global problem. To plan preventive strategies, the accuracy of the information on infections and antimicrobial susceptibility is very important, requiring quality in microbiology laboratories. The objective of this study was to evaluate the proportion of laboratories that have minimal functioning conditions, execute basic routine, execute procedures related to quality, collaborate in Department of Hospital Infection Control and have advanced resources; evaluate the characteristics associated with minimal functioning conditions, basic routine execution, execution of procedures related to quality, collaboration in Department of Hospital Infection Control and advanced resources; classification of laboratories according to quality level. A survey was carried out to evaluate microbiology laboratories that served all Brazilian hospitals with at least 10 intensive care beds or that served hospitals involved in the government program of adverse event notification related to healthcare products. From April 2002 through December 2005 laboratory coordinators were interviewed about financing; infrastructure; human resources; equipment; procedures; quality control and safety. 530 hospitals were identified and 467 laboratories were visited by the interviewers. Laboratories were classified as: Level 0: no minimal functioning conditions; Level 1: minimal functioning conditions, but no execution of basic routine; Level 2: minimal functioning conditions and execution of basic routine; Level 3: minimal functioning conditions, execution of basic routine and execution of quality procedures; Level 4: minimal functioning conditions, execution of basic routine, execution of quality procedures and collaboration with the Department of Hospital Infection Control, but no advanced resources; Level 5: minimal functioning conditions, execution of basic routine, execution of procedures related to quality, collaboration with the Department of Hospital Infection Control and advanced resources. Findings: 85% of laboratories were considered Level 0; 7% Level 1; 6% were Level 2; 1% were Level 3 and 1% were Level 5. None were Level 4. Twelve laboratories did not perform Ziehl-Neelsen staining; 21 did not have Bunsen burners; 271did not have biological safety cabinets; 81 did not have standardized requisition forms and 3 did not have blood agar medium. More than 20% of laboratories without safety cabinets had automated systems. Hospitals part of the government adverse event notification program (p<0.001); public hospitals (p:0.01); teaching hospitals (p<0.001) and location in state capitals (p:0.001) were associated with having minimal conditions. Hospitals part of the government adverse event notification program (p:0.002), teaching hospitals (p:0.019), location in state capitals (p:0.039), laboratories serving more than one hospital (p<0.001) and geographic region (p:0.039) were associated with basic routine execution. Hospitals part of the government adverse event notification program (p:0.01) and location in state capitals (p<0.001) were associated with quality procedures execution. Public hospitals (p:0.01), location outside state capitals (p:0.008), serving hospitals that doesn't contract third part microbiology services (p:0.01) and geographic region (p<0.001) were associated with collaboration in Department of Hospital Infection Control. Hospitals part of the government adverse event notification program (p:0.03), public (p:0.04), teaching hospitals (p:0.01), location in state capitals (p<0.001) and serving more than one hospital (p:0.01) were associated with advanced resources. In conclusion, most laboratories did not have minimal functioning conditions. This quality assessment should guide investments and educational projects in the country.

Identifying eligible individuals for a prevalence survey is difficult in the absence of a disease register or a national population register. To develop a method to identify and invite eligible individuals to participate in a national prevalence survey while maintaining confidentiality and complying with privacy legislation. A unique identifier (based on date of birth, sex and initials) was developed so that database holders could identify eligible individuals, notify us and invite them on our behalf to participate in a national multiple sclerosis prevalence survey while maintaining confidentiality and complying with privacy legislation. Several organisations (including central government, health and non-governmental organisations) used the method described to assign unique identifiers to individuals listed on their databases and to forward invitations and consent forms to them. The use of a unique identifier allowed us to recognise and record all the sources of identification for each individual. This prevented double counting or approaching the same individual more than once and facilitated the use of capture-recapture methods to improve the prevalence estimate. Capture-recapture analysis estimated that the method identified over 96% of eligible individuals in this prevalence survey. This method was developed and used successfully in a national prevalence survey of multiple sclerosis in New Zealand. The method may be useful for prevalence surveys of other diseases in New Zealand and for prevalence surveys in other countries with similar privacy legislation and lack of disease registers and population registers.

To assess the epidemiological impact of mass tuberculosis (TB) screening in the community and the prognosis of bacteriologically negative individuals with abnormal findings on chest radiography (CXR). A follow-up study consisting of two parts--a register match of notified TB cases with 22,160 participants in a national TB prevalence survey, and a repeat medical examination for the subjects of a prevalence survey with abnormal findings on CXR--was conducted 2 years after the prevalence survey in Cambodia. Thirty-four cases with new smear-positive TB were detected by register match, giving a standardised notification ratio of 0.38 (95%CI 0.27-0.52). An additional seven new smear-positive TB cases and 93 new smear-negative, culture-positive TB cases were detected by medical examination. The incidence rates of bacteriologically positive TB were 8.5% per year (95%CI 6.3-11.2) in cases with a CXR suggestive of active TB and 2.9% per year (95%CI 2.2-3.7) in those with a CXR with other abnormalities. Detection and treatment of smear-negative, culture-positive TB cases as well as smear-positive TB cases was associated with a rapid reduction in subsequent incidence of new smear-positive TB. Sputum culture-negative individuals with abnormal CXR findings are at a high risk of disease progression, and require follow-up and potentially preventive treatment.

The majority of antimicrobial stewardship programmes focus on prescribing in adult populations; however, there is a recognized need for targeted paediatric antimicrobial stewardship to improve the quality and safety of prescribing amongst this patient group. To describe the current epidemiology of antimicrobial prescribing in paediatric inpatient populations in Scotland to establish a baseline of evidence and identify priority areas for quality improvement to support a national paediatric antimicrobial stewardship programme. A total of 559 paediatric inpatients were surveyed during the Scottish national point prevalence survey of healthcare-associated infections and antimicrobial prescribing, 2016. The prevalence of antimicrobial prescribing was calculated and characteristics of antimicrobial prescribing were described as proportions and compared between specialist hospitals and paediatric wards in acute hospitals. Prevalence of antimicrobial use in paediatric inpatients was 35.4% (95% CI = 31.6%-39.4%). Treatment of community- and hospital-acquired infections accounted for 47.1% and 20.7% of antimicrobial use, respectively, with clinical sepsis being the most common diagnosis and gentamicin the most frequently prescribed antimicrobial for the treatment of infection. The reason for prescribing was documented in the notes for 86.5% of all prescriptions and, of those assessed for compliance against local policy, 92.9% were considered compliant. Data from national prevalence surveys are advantageous when developing antimicrobial stewardship programmes. Results have highlighted differences in the prescribing landscape between paediatric inpatient populations in specialist hospitals and acute hospitals, and have informed priorities for the national antimicrobial stewardship programme, which reinforces the need for a targeted paediatric antimicrobial stewardship programme.

In July 1984, the first national Australian Nosocomial Prevalence Survey collected data on 12,742 surgical patients from 265 hospitals. This sample represented 59% of public and private hospitals with 50 or more acute-care beds in Australia. The infection control officers at each hospital provided data on patients in a random sample of beds. The over-all surgical wound infection rate was 4.6%. The surgical wound infection rate was twice (5.4%) as high in public than in private (2.8%) hospitals. The infection rates were greater in larger hospitals in both the public and private sector. However, after adjusting for the other predictor factors that are noted below the infection rate did not show any particular pattern for the size of hospital. Clean surgery had a higher (4.8%) infection rate than did clean-contaminated surgery (2.9%). The infection rate for contaminated surgery was 15.0%. Men were found to have nearly twice (6.5%) the infection rate of women (3.4%). Infection rates were lowest in the 15-to-34 years' age-group and highest in those of over 55 years of age. These trends remained even after adjusting for the other risk factors for infection. The cost of surgical wound infections for all hospitals during the year of 1984 was estimated at approximately $60 million. We suggest that a concerted effort should be made to attempt to reduce the infection rate for clean surgery to 1% or less.

This paper compares costs for caring for patients according to common diagnosis groups in Australian public teaching, public non-teaching and private hospitals. Generally, the costs for general surgical procedures are highest in public teaching hospitals, followed by public non-teaching hospitals, and are lowest in private hospitals. However, the private sector is more expensive than the public sector for obstetric activities. The reasons for the differences appear to be the much higher 'overheads' in the public sector than in the private sector, and the longer hospital stay for obstetric patients in private hospitals. Managers of individual hospitals should examine the data in detail to determine if alternative approaches are appropriate.

Objectives Differences in COVID-19 outcomes may reflect variation in clinical expertise, institutional resources, and care coordination between academic teaching and non-teaching hospitals. We evaluated differences in patient characteristics, resource utilization, and mortality between hospital types during the early phase of the pandemic. Methods We conducted a retrospective cohort study of 2,767 adults (≥18 years) with COVID-19 presenting to five hospitals within the Johns Hopkins Health System between March 1 and 4 May 2020. Patient characteristics, clinical presentation, laboratory findings, and outcomes were compared between academic teaching and non-teaching hospitals. Group comparisons were performed using unpaired t-tests and chi-square tests. Multivariable logistic regression assessed the association between hospital teaching status and in-hospital mortality. A primary model included variables with minimal missing values, while a secondary model incorporated laboratory variables using complete-case analysis. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) and the Hosmer–Lemeshow goodness-of-fit test. Results Of 2,767 patients, 801 (29%) were evaluated at academic teaching hospitals. Patients at academic centers had higher comorbidity burden and more severe clinical presentation, whereas patients at non-teaching hospitals had lower access to healthcare resources. Emergency department length of stay (430 vs 269 minutes, p < 0.001), hospital length of stay (12.2 vs 4.4 days), and hospitalization costs ($55,868 vs $5,543, p < 0.001) were higher in teaching hospitals. Mortality was higher in non-teaching hospitals across both adjusted models. In the primary (n = 2,605) model (OR 6.86; 95% CI 5.18–9.10; AUC 0.70) and the secondary (n = 372) model (OR 13.4; 95% CI 7.28–24.7; AUC 0.82). Conclusions These findings suggest that structural differences, including resource availability and healthcare access, may contribute to disparities in COVID-19 outcomes. Non-teaching hospitals, while managing high volumes with limited resources, had markedly higher mortality despite lower comorbidity burden. Further investigation of system-level determinants of outcomes during public health emergencies is warranted.

BackgroundIn today’s companies, time management abilities have grown as a significant predictor of nurses’ success. Organizations have simplified their internal operations and flattened their organizational structures in an effort to increase productivity and cut expenses. As a result, successful time management skills are particularly crucial for nurses in recently restructured healthcare organizations. This study aimed at exploring factors influencing time management skills among Palestinian nurses.MethodsCross-sectional quantitative study of all nurses (715) working in private and government hospitals and primary healthcare centers in north Palestine was conducted. Time management skills were measured on a continuous scale using the Nursing Time Management Scale (NTMS), Arabic version. The scale measures various aspects of time management including goal setting, planning, scheduling, and organizing activities. The relationship between time management skills and background variables was assessed using the multivariate linear regression.ResultsThe average total score for NTMS scale was 63.39 out of a total score of 90. This score indicates relatively good time management skills among the respondents. The multivariate linear regression results showed that females obtained slightly lower scores than males, coefficient = -2.36, p = 0.043. Nurses in primary care centers had significantly higher scores than nurses who work at hospitals, coefficient = 4.47, p = 0.004. The type of healthcare organization emerged as a significant factor predicting time management skills. Nurses in private hospitals had worse time management skills than nurses in government hospitals, coefficient = -12.27, p < 0.001. Nurse supervisors had better time management skills than staff nurses, coefficient = 4.01, p = 0.023. Nurses working in non-teaching hospitals had worse time management skills than nurses in teaching hospitals, coefficient = − 3.86, p = 0.001. Nurses who did not attend a time management course had worse time management skills than nurses who attended time management course, coefficient = − 4.05, p = p < 0.001.ConclusionsHealthcare institutions should consider organizational and individual factors to improve the time management skills of their staff. Time management training interventions are proven and effective policies that are recommended to be adopted by all healthcare centers.

Introduction: There is a high burden of neonatal mortality and morbidity in India with wide variations. Many complex issues, including the organization of health care systems, may play a role in health outcomes. ‘Safe Care, Saving Lives’ (SCSL) is a collaborative initiative of ACCESS Health International, Aarogyasri Healthcare Trust (state-wide health insurance program), and state governments of Andhra Pradesh and Telangana. Goal: The primary goal of SCSL is to implement a series of Potentially Better Practices (PBPs) across several (public teaching, public non-teaching, and private) hospitals to improve neonatal outcomes. Methods: SCSL Program: SCSL adopted the Institute of Healthcare improvement’s (IHI) Model for …

• Stage 1 pressure ulcers are difficult to diagnose. Several prevalence studies have shown that almost half of the pressure ulcers identified are stage 1. The present study investigated the importance of stage 1. The following research questions were formulated: Is there a difference between the prevalence of stage 1 pressure ulcers identified in the institutions participating in the present study and that found in the other institutions participating in the Dutch National Prevalence Survey? What percentage of stage 1 pressure ulcers are reversible within a few hours? What is the clinical course of stage 1 pressure ulcers? Which patient characteristics and preventive interventions are related to the clinical course of stage 1?• The study used a prospective, descriptive and comparative design.• All patients of six long‐term care hospitals and six acute care hospitals in whom stage 1 pressure ulcers were identified during the 1999 National Prevalence Survey in the Netherlands were followed for 1 week (acute care hospitals; n=68 patients) or 2 weeks (long‐term care hospitals; n=115 patients).• The patients were reassessed using the questionnaire developed for the National Prevalence Survey (patient characteristics, assessment of risk of pressure ulcers, characteristics of the pressure ulcers and use of preventive methods) on the same day as the national survey itself, and again after 3 days, after 7 days and after 14 days (only long‐term care hospitals).• The results showed fewer stage 1 pressure ulcers in the institutions participating in the present study than in the National Prevalence Survey, the difference being almost 50%. The first reassessment found the prevalence of stage 1 to be further reduced by an average of almost 50%, a reduction which was greater for the long‐term care hospitals than for the acute care hospitals. However, some of the ulcers that had disappeared reappeared in subsequent reassessments.• In the long‐term care hospitals, 8.7% of the stage 1 pressure ulcers deteriorated to a higher stage, vs. 22.1% in acute care hospitals.• No significant patient characteristics were found to affect the course of stage 1, except that women in acute care hospitals more often had a stage 1 pressure ulcer at the first reassessment than men.• In general, patients whose stage 1 ulcer deteriorated were undergoing more preventive interventions; not all differences were significant.• We conclude that, although stage 1 is reversible in most cases, it can be interpreted as an important warning sign for nurses and patients to act. If no adequate interventions are applied, the pressure ulcer may deteriorate.

Stage 1 pressure ulcers are difficult to diagnose. Several prevalence studies have shown that almost half of the pressure ulcers identified are stage 1. The present study investigated the importance of stage 1. The following research questions were formulated: Is there a difference between the prevalence of stage 1 pressure ulcers identified in the institutions participating in the present study and that found in the other institutions participating in the Dutch National Prevalence Survey? What percentage of stage 1 pressure ulcers are reversible within a few hours? What is the clinical course of stage 1 pressure ulcers? Which patient characteristics and preventive interventions are related to the clinical course of stage 1? The study used a prospective, descriptive and comparative design. All patients of six long-term care hospitals and six acute care hospitals in whom stage 1 pressure ulcers were identified during the 1999 National Prevalence Survey in the Netherlands were followed for 1 week (acute care hospitals; n = 68 patients) or 2 weeks (long-term care hospitals; n = 115 patients). The patients were reassessed using the questionnaire developed for the National Prevalence Survey (patient characteristics, assessment of risk of pressure ulcers, characteristics of the pressure ulcers and use of preventive methods) on the same day as the national survey itself, and again after 3 days, after 7 days and after 14 days (only long-term care hospitals). The results showed fewer stage 1 pressure ulcers in the institutions participating in the present study than in the National Prevalence Survey, the difference being almost 50%. The first reassessment found the prevalence of stage 1 to be further reduced by an average of almost 50%, a reduction which was greater for the long-term care hospitals than for the acute care hospitals. However, some of the ulcers that had disappeared reappeared in subsequent reassessments. In the long-term care hospitals, 8.7% of the stage 1 pressure ulcers deteriorated to a higher stage, vs. 22.1% in acute care hospitals. No significant patient characteristics were found to affect the course of stage 1, except that women in acute care hospitals more often had a stage 1 pressure ulcer at the first reassessment than men. In general, patients whose stage 1 ulcer deteriorated were undergoing more preventive interventions; not all differences were significant. We conclude that, although stage 1 is reversible in most cases, it can be interpreted as an important warning sign for nurses and patients to act. If no adequate interventions are applied, the pressure ulcer may deteriorate.

Bibliometrics and French healthcare institutions from 2004 to 2014

ObjectivesTo determine whether the European Commission Eurobarometer survey of 27 European Union (EU) member states produces reliable smoking prevalence estimates when compared to national prevalence survey data, and to identify...

Operating room quality in Portuguese hospitals

Acute care hospitals participating in the Dutch national pressure ulcer prevalence survey use the results of this survey to compare their outcomes and assess their quality of care regarding pressure ulcer prevention. The development of a model for case-mix adjustment is essential for the use of these prevalence rates as an outcome measure. The development of a valid model for case-mix adjustment to compare the prevalence rates in the acute care hospitals that participated in the 1998 Dutch pressure ulcer prevalence survey, for the purpose of performance comparisons among the hospitals. Cross-sectional design. Subjects were patients residing in the 43 acute care hospitals that participated in the national pressure ulcer prevalence survey on May 26, 1998. The study examined the validity of a model for case-mix adjustment of pressure ulcer prevalence rates and compared hospitals to evaluate the impact of adjusted prevalence rates on their performance. A logistic model was developed for case-mix adjustment, using age, malnutrition, incontinence, activity, mobility, sensory perception, friction and shear, and ward specialty. This model was found to have content, construct, and internal validity. Case-mix adjustment influenced the hospitals' performance. The data of the national pressure ulcer prevalence survey can be used to develop a valid model for case-mix adjustment. Conclusions about the quality of care were influenced by the use of case-mix adjusted outcomes as a measure of this quality.