Entire Ward Research Articles

A GIS-based approach to determine the priority area for rainwater harvest in Kupang

Kupang, a pivotal economic and administrative hub in Nusa Tenggara Timur, Indonesia, faces recurring droughts resulting in crop failures, food insecurity, and health problems. Addressing this water crisis entails rainwater harvesting as a potential solution. This study establishes a comprehensive framework for prioritizing rainwater harvesting areas in Kupang. Using the weighted overlay method and open-source GIS software, our approach involves three stages: identifying drought and flood priority zones, defining suitability indicators, and quantifying the potential of rainwater harvesting systems. By leveraging climatological, geological, and hydrological information, we determine priority areas for drought and flood management. Our analysis of rainwater harvesting suitability integrates climatological information, land use and land cover mapping, runoff potential assessment, and water use index. Quantification of rainwater harvesting system requirements hinges on rooftop area and population data. The entire wards in Kupang are classified as high priorities for drought mitigation. Therefore, rainwater harvesting is a viable strategy for all wards. The most prioritized and in-demand wards, Oesapa, Sikumana, Lasiana, and Liliba, have the potential to install a minimum of 12,000 rainwater harvesting systems, each with a 1500-liter volume barrel.

Changes in Challenging Behaviors Accompanying Transition to a New Facility in Individuals with Intellectual Disabilities

Challenging behavior (CB), the most common example being extreme self-injurious or aggressive/destructive behavior, is often observed as a major behavior issue in individuals with severe intellectual disabilities. This study investigated how CB changed among residents of a facility for people with disabilities before and after it was restructured from a traditional format single room shared by two to three individuals with approximately 20 residents lived together to a format featuring private areas with two rooms per resident and a unitcare system. Twenty-one residents of Care Home A, which was rebuilt in the new care format, were selected. Care staff completed a questionnaire one month before, one month after, and six months after residents moved to the new facility. Scores were compared among each time point. The results revealed significant reductions in residents’ aggressive, stereotyped, and targeted behaviors, such as hitting their own head and fecal smearing. The major features of the restructured facility were a living space consisting of two private rooms per resident and a shift to unit care for the entire ward. These new features enabled residents to reduce destructive stimuli and made it easier to understand what to do in each private room.

Audit&Feedback in emergency care: a pre-post intervention study in Lazio (Italy)

Abstract Background Within EASY-NET Italian Programme (NET-2016-02364191), we evaluated the effectiveness of a structured Audit & Feedback (A&F) intervention in improving care quality for ST Elevation Myocardial Infarction (STEMI). Methods A&F intervention involved sending periodic reports via e-mail to participating hospitals in Lazio Region (about 5 million inhabitans). Volume, process and outcome indicators were calculated by hospital through Health Information System, compared with regional mean and target values. Health managers and clinicians were feedback recipients. Study design: pre-post intervention with control group (web-based regional periodic publication of indicators). Proportion of STEMI treated within 90 minutes with Percutaneous Transluminal Coronary Angioplasty (PTCA) was calculated in 2021 (pre) and in 2022 (post). Patients level adjusted Difference-in-Difference model (DID, 95% CI) was applied. Stepwise procedure identified individual (e.g. age, sex, clinical conditions) and hospital (e.g. hospital type) covariates entering in the model. Results A total of 19 hospitals were evaluated, 8 as controls. The number of analysed STEMI was 5084 (2651 in 2022) of which 3272 (1731 in 2022) in exposed hospitals. Overall, mean age 66 years, males 74.7%. Proportion treated with PTCA within 90 minutes in 2021 was 55.1% in exposed hospitals, and 57.9% in controls; in 2022 60.0% in exposed hospitals 66.4% in controls. Adjusted percentage difference in post/pre change between exposed and non-exposed hospitals was not significant in univariate and multivariate model (-3.6%, p = 0.218 and -4.4% p = 0.126). Conclusions These results cannot demonstrate a difference between exposed and not exposed hospitals. Possible explanations could be the short follow-up evaluated and the influence of covid-19 pandemic. In fact, several hospitals in both exposed and control group still had entire hospital wards dedicated to covid-19 management in 2021. Key messages • A&F methodology designed and implemented in EASY-NET project represents a challenging instrument to promote quality of care. • Monitoring hospital performance through periodical reporting allows continuous quality improvement.

Tailored positioning and number of hand rub dispensers: the fundamentals for optimized hand hygiene compliance

Availability of alcohol-based hand rub (ABHR) dispensers at positions adapted to the work flow of healthcare workers (HCWs) is decisive in order to carry out indication-based hand rubbing. Although requirements and guidelines regarding the positioning of ABHR dispensers are in place, scientific evidence is often lacking. In order to analyse the impact of the location and number of ABHR dispensers on hand hygiene performance, additional dispensers were systematically placed in patient rooms in a surgical 38-bed ward at Marburg University Hospital, Germany to complement the existing dispenser locations. ABHR use was monitored continuously before and after complementation using the NosoEx hand hygiene monitoring system. The ward had 53 dispensers before the intervention and 82 dispensers after the intervention. The addition of dispensers increased ABHR consumption across the entire ward. Before the intervention, mean consumption was 20.6 mL/patient-day, whereas mean consumption after the intervention was 25.3 mL/patient-day. Depending on the combination of dispenser locations, consumption increased through targeted supplementation in patient rooms. The presence of two or three dispensers per patient room resulted in significantly greater ABHR consumption compared with one dispenser per patient room. The preferred location combinations were entrance-front bed-back bed and entrance-foot end. ABHR consumption can be increased significantly by optimizing the position and number of dispensers. The outstanding factors are visibility and integrability of dispenser use into the work flow; in particular, a dispenser should be positioned in the entrance area. Recommendations should be optimized with regard to the required number and location of dispensers in patient rooms.

A CFD assessment on ventilation strategies in mitigating healthcare-associated infection in single patient ward

A promising ventilation strategy is an effective measure to enhance indoor air quality and protect the patients against healthcare-acquired infection. The Computational Fluid Dynamics (CFD) model represents a patient ward that was constructed using Computer-Aided Design (CAD) software. The simulated results were verified and validated based on the published data. A Renormalization Group (RNG) k-epsilon model based on the Eulerian approach was used to simulate the airflow turbulence, while a discrete phase model (DPM) based on the Lagrangian approach was used to predict the dispersion of airborne particles. This study examined four cases of ventilation strategies, with varying ventilation rates, positioning of supply air diffusers, and location of exhaust grilles. This study revealed that the installation of air curtain jet coupled with a ceiling-mounted air supply diffuser (case 3) above the patient-occupying zone has the highest wiping efficiency against the infectious particles. The utilization of ventilation strategy in case 3 managed to reduce the particle by approximately 3.3 times as compared to the baseline case. The study outcome also suggested that the exhaust grilles should be placed on the upper wall, to ensure a proper mixing of fresh air in the entire patient ward.

Evacuation Management of the Anaesthesiology and Resuscitation Department

The unexpectedly announced evacuation of a medical facility brings a number of complications and steps that must be managed in a very short period of time. The presented qualitative research was solved with the help of content retrospective analyzes of available scientific documents by means of a set keyword. Subsequently, from the proven analyzes, a system of evacuation groups and management of prioritization of patient evacuation was compiled using a significance tree. The result of the work is a unique decision-making mechanism for prioritizing patients who have a selection of patients in case of insufficient time to evacuate the entire ward. The proposed decision-making mechanism tries to eliminate the common paradigm of planned evacuation and applies elements of management of mental prioritization of patients from disaster medicine and war medicine to civilian crisis planning in healthcare.

Prospective observational cohort study of reached protein and energy targets in general wards during the post-intensive care period: The PROSPECT-I study

Nutrition plays an essential role in the recovery of critical illness. In the post-Intensive Care Unit (ICU) period, patients typically return to oral nutrition gradually. However, studies quantifying nutritional intake in the post-ICU hospitalization period are scarce and formal guidelines are lacking. This study aims to describe energy and protein intake in detail over the entire post-ICU hospitalization period and explore associations between protein intake and clinical outcomes. A prospective observational single-center cohort study was conducted amongst post-ICU patients in general wards after a minimum ICU-stay of 72h and who received (par)enteral feeding for ≥24h in the ICU. Oral intake was assessed daily using food order lines and digital photography of meal leftovers. Other data, including amounts of (par)enteral nutrition, were collected from electronic medical records. The primary outcome was to identify energy and protein intake, and reached targets, in the post-ICU period. In addition, length of hospital stay after ICU discharge, readmission and mortality rates were compared between patients meeting protein targets or not. In total, 48 patients were included. Complete nutritional data of 34 patients were analyzed in the current study, adding up to a total number of 484 observational days, 1681 photos and 6634 food order lines. Inter-rater agreement was excellent (ICC 0.878). Overall mean energy and protein adequacy for all nutritional groups was 82.3% (SD 18.3) and 83.1% (SD 19.8). Only 51.2% of the study participants (n=21) reached overall >90% of prescribed protein targets during their entire post-ICU ward stay. The lowest intake was seen in the patient group with exclusively oral intake (median protein adequacy 75.5%), whereas patients with (supplemental) enteral nutrition (EN) all met >90% of their protein targets. Prescribed targets were below recommendations, and prescribed calories and proteins were neither ordered nor consumed. Discontinuation of EN resulted in immediate marked drops in energy (44.1%) and protein intake (50.7%). Subsequently, patients needed up to six days to reach protein targets again. No differences in clinical outcomes were observed. Most patients did not meet energy and protein targets in the post-ICU hospitalization period. Nutrition performance was highly dependent on the route of nutrition and was lowest among patients with oral intake only (despite of food fortification strategies and/or oral nutritional supplements). The best intake was observed in patients receiving (supplemental) EN. However, cessation of EN posed an immediate nutritional risk. No differences in clinical outcomes were found in this study. Our findings stress the need for follow-up studies to close the gap with individualized nutritional support in the post-ICU period to reach protein and energy targets.

Still Mrs. B.-An Ode to Personhood During the Pandemic.

Still Mrs. B.-An Ode to Personhood During the Pandemic.

Hospital Support for Siblings of Children With Illness in Japan.

Recent years have seen increased attention to the needs and support of siblings of children with chronic illness, and reports of intervention studies on siblings are gradually increasing worldwide. In Japan, the basic policy approved by the Cabinet in 2021 of The Basic Law for Child and Maternal Health and Development stipulates promoting support for the siblings of children with chronic illness, medical care, and disabilities. Simultaneously, practical reports are emerging. However, reports on the actual state of sibling support at medical institutions in Japan are limited. This study aimed to describe the actual state of support for siblings of children with illness in Japanese medical institutions using a cross-sectional design. Responses were obtained from 207 of 484 registered training facilities for Board-Certified Pediatricians of the Japan Pediatric Society through anonymous questionnaires investigating the actual state of siblings' support. Descriptive statistics were calculated, and the state of siblings' support was described. Fifty-two participants (25.1%) answered that the entire ward, including two outpatient departments, provided siblings' support, while 37 (17.9%) answered some staff made an effort, and 117 (56.5%) did not. Support mentioned included conversing with siblings, actively speaking to siblings, calling siblings' names, and counseling care through the parents. Of the 45 cases (21.7%) where siblings were invited to events and gatherings, 10 (22.2%) were siblings-centered events. Some cases involved collaboration with local sibling support groups such as non-profit organizations. This study clarified the actual state of siblings' support, and further expansion of this support is required.

Meticillin-resistant Staphylococcus aureus Contact Screening Strategy in a Low Prevalence Setting; a Nested Case-Control Study

SummaryBackgroundThe optimal screening strategy in hospitals to identify secondary cases after contact with a meticillin-resistant Staphylococcus aureus (MRSA) index patient in a low prevalence setting is not well defined. We aimed at identifying factors associated with documented MRSA transmissions.MethodSingle center, retrospective, nested case-control study. We evaluated the screening strategy in our 950 bed tertiary care hospital from 2008 – 2014. Room and ward contacts of MRSA index patients present at time of MRSA identification were screened. We compared characteristics of Staphylococcus aureus Protein A (spa)-type matched contact patients (cases) to negative or spa-type mismatched contact patients (controls).ResultsAmong 270,000 inpatients from 2008 – 2014, 215 MRSA screenings yielded 3013 contact patients, and 6 (0.2%) spa-type matched pairs. We included 225 controls for the nested case-control study. The contact type for the cases was more frequently “same room” and less frequently “same ward” compared with the controls (P = 0.001). Also, exposure time was longer for cases (median of 6 days [IQR 3–9]) than for controls (1 day [0–3], P=0.016).ConclusionThe extensive MRSA screening strategy revealed only few index/contact matches based on spa-typing. Prolonged exposure time and a shared room were significantly associated with MRSA transmission. A targeted screening strategy may be more useful in a low prevalence setting than screening entire wards.

Adapting to the Unpredictable. My Experience as a Neurosurgeon-Hypnologist Offering Treatment to Health Professionals in a Covid-19 Converted Hospital

Adapting to the Unpredictable. My Experience as a Neurosurgeon-Hypnologist Offering Treatment to Health Professionals in a Covid-19 Converted Hospital

Real-time locating systems to improve healthcare delivery: A systematic review.

Modern health care requires patients, staff, and equipment to navigate complex environments to deliver quality care efficiently. Real-time locating systems (RTLS) are local tracking systems that identify the physical locations of personnel and equipment in real time. Applications and analytic strategies to utilize RTLS-produced data are still under development. The objectives of this systematic review were to describe and analyze the key features of RTLS applications and demonstrate their potential to improve care delivery. We searched MEDLINE, SCOPUS, and IEEE following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria were articles that utilize RTLS to evaluate or influence workflow in a healthcare setting. We summarized aspects of relevant articles, identified key themes in the challenges of applying RTLS to workflow improvement, and thematically reviewed the state of quantitative analytic methodologies. We included 42 articles in the final qualitative synthesis. The most frequent study design was observational (n = 24), followed by descriptive (n = 12) and experimental (n = 6). The most common clinical environment for study was the emergency department (n = 12), followed by entire hospital (n = 7) and surgical ward (n = 6). The focus of studies changed over time from early experience to optimization to evaluation of an established system. Common narrative themes highlighted lessons learned regarding evaluation, implementation, and information visibility. Few studies have developed quantitative techniques to effectively analyze RTLS data. RTLS is a useful and effective adjunct methodology in process and quality improvement, workflow analysis, and patient safety. Future directions should focus on developing enhanced analysis to meaningfully interpret RTLS data.

Le fil institutionnel en période Covid : utilisation de la plateforme Discord au CMPA

The COVID crisis led hospitals to reorganize care services and to develop innovative strategies to provide care at a distance. In our health care and education centre for adolescents, which provides both long-term psychiatric care and high school education, inpatients and outpatients were mostly confined at home. In order to ensure continuity of care as well as maintain institutional ties, different communication tools were used. Among them, we particularly relied upon Discord (social network initially designed for gamers) which allowed us to set up an entire virtual ward, maintain individual and group care programmes as well as team meetings. This innovation generated a number of preliminary questions and precautions which guided our decisions regarding the server settings. The outcome of this experiment is globally positive, both quantitatively and qualitatively, even if care at a distance showed its limits. Despite the involvement and creativity of health professionals, the confinement period disrupted and even led to the discontinuation of some care projects.

An outbreak of two strains of OXA-48 producing Klebsiella pneumoniae in a teaching hospital

SummaryOXA-48 producers can be difficult to detect in clinical specimens due to phenotypic low-level resistance to carbapenems. Additionally, low infection rates make clinical specimens poor sentinels for the presence of OXA-48 producers within a healthcare institution.We report an outbreak of OXA-48-producing Klebsiella pneumoniae (OXAKp) that was discovered following culture of OXAKp in a urine specimen from a patient with no known risk factors for acquisition. Widespread screening across medical wards in the trust revealed evidence of transmission across several wards. Samples from 60 patients were positive for OXAKp. Five patients had OXAKp clinical infection, four of whom were treated with ceftazidime/avibactam. Variable number tandem repeat analysis of the OXAKp isolates revealed two predominant strain types clustered around two groups of wards.Infection prevention measures included isolation and cohort nursing of infected and colonized patients, restriction of affected ward areas to new admissions, stringent hand hygiene and use of personal protective equipment. Environmental cleaning of patient areas was carried out using chlorine-releasing disinfectants and hydrogen peroxide vapour. Entire wards were decanted to enable effective cleaning of empty ward areas. The outbreak lasted almost five months and is estimated to have cost around £400 000.During the course of the outbreak, there were five reported prescription and administration incidents related to confusion between ceftazidime and ceftazidime/avibactam. No patient harm resulted from these incidents and the implementation of brand name prescribing for ceftazidime/avibactam prevented further incidents.

Personal protective equipment during the coronavirus disease (COVID) 2019 pandemic - a narrative review.

Personal protective equipment has become an important and emotive subject during the current coronavirus disease 2019 epidemic. Coronavirus disease 2019 is predominantly caused by contact or droplet transmission attributed to relatively large respiratory particles which are subject to gravitational forces and travel only approximately 1 metre from the patient. Airborne transmission may occur if patient respiratory activity or medical procedures generate respiratory aerosols. These aerosols contain particles that may travel much longer distances and remain airborne longer, but their infective potential is uncertain. Contact, droplet and airborne transmission are each relevant during airway manoeuvres in infected patients, particularly during tracheal intubation. Personal protective equipment is an important component, but only one part, of a system protecting staff and other patients from coronavirus disease 2019 cross-infection. Appropriate use significantly reduces risk of viral transmission. Personal protective equipment should logically be matched to the potential mode of viral transmission occurring during patient care - contact, droplet or airborne. Recommendations from international organisations are broadly consistent, but equipment use is not. Only airborne precautions include a fitted high-filtration mask, and this should be reserved for aerosol generating procedures. Uncertainty remains around certain details of personal protective equipment including use of hoods, mask type and the potential for re-use of equipment.

Surface sampling within a pediatric ward—how multiple factors affect cleaning efficacy

The objectives of this study were to assess the number of organisms present on different surfaces within a clinical environment before and after cleaning took place, and to identify the impact of cleaning. The study involved extensive 2-week microbiological environmental monitoring of an entire ward before and after cleaning; the ward was located within a pediatric hematology-oncology ward comprised of a day unit and outpatient ward. Tryptone soya agar contact plates were used to take a total of 1,160 surface samples before and after cleaning from 55 predetermined sites. Samples were taken from representative surfaces throughout the ward representing a variety of materials, surface heights, functions, and distances from patients, as well as both high-touch and infrequently touched surfaces. After surface cleaning was undertaken within the ward, there was a significant difference between the amount of colony-forming units (CFUs) recovered before and after cleaning (P < .0001). Cleaning produced an average CFU reduction of 68% throughout the ward environment. The corridor was the most contaminated area within the ward. There were differences in the CFUs among the various areas within the ward, which were cleaned with varying efficiency. The surface material, who interacted with the surface, levels of initial contamination, perceived risk, and perceived cleanability were all found to have a varying impact on the cleaning effectiveness. To the authors' current knowledge, this is the only study to assess cleaning within a pediatric ward by taking samples directly before and after cleaning. The standard of cleaning undertaken within the ward is open for discussion, and these data highlight the need for an improved cleaning intervention and can provide insight into the multitude of factors that must be considered when designing an effective training protocol.

Fundamental care for people with cognitive impairment in the hospital setting: A study combining positive organisational scholarship and video-reflexive ethnography.

To clarify how high-quality fundamentals of care for people with dementia and/or delirium were practised in a specialist geriatric evaluation and management unit. Older people with cognitive impairment represent a significant number of people who are admitted to hospital. They are at increased risk of dying, readmission and long hospital stays, relative to those without cognitive impairment. There is an urgent need to elucidate the conditions that underpin safe and high-quality fundamental care for these patients and their families. Using the innovative methodologies of positive organisational scholarship in healthcare and video-reflexive ethnography, this 18-month study was conducted within an inpatient geriatric evaluation and management unit for people with dementia and/or delirium in South Australia. Patients, family members and staff members (managerial, clinical and nonclinical) participated by allowing researchers to document ethnographic fieldwork notes and film their practices and/or accounts thereof; and/or interpreting digital recordings with researchers in order to make sense of data in a process of co-analysis. This study is reported using Standards for Reporting Qualitative Research reporting guidelines. High-quality fundamental care for people with dementia and/or delirium in hospital and their families was associated with the special space of the hospital unit; an aptitude for people with dementia; a capacity to translate person-centred fundamentals of care from rhetoric to reality; and an appreciation for teamwork. This study clarified how teams working in hospital can practise high-quality fundamentals of care for older people with dementia and/or delirium. Delivery of high-quality fundamental care in this setting was dependent, not only on nurses, but the entire ward team working cohesively in a "weave of commitment." Efforts to improve fundamental care for people with cognitive impairment need to encompass values and philosophy of person-centred care, including the contributions by all staff to care delivery.

Introducing the nurse practitioner into the surgical ward: an ethnographic study of interprofessional teamwork practice.

The first nurse practitioners in surgical care were introduced into Swedish surgical wards in 2014. Internationally, organisations that have adopted nurse practitioners into care teams are reported to have maintained or improved the quality of care. However, close qualitative descriptions of teamwork practice may add to existing knowledge of interprofessional collaboration when introducing nurse practitioners into new clinical areas. The aim was to report on an empirical study describing how interprofessional teamwork practice was enacted by nurse practitioners when introduced into surgical ward teams. The study had a qualitative, ethnographic research design, drawing on a sociomaterial conceptual framework. The study was based on 170 hours of ward-based participant observations of interprofessional teamwork practice that included nurse practitioners. Data were gathered from 2014 to 2015 across four surgical sites in Sweden, including 60 interprofessional rounds. The data were analysed with an iterative reflexive procedure involving inductive and theory-led approaches. The study was approved by a Swedish regional ethics committee (Ref. No.: 2014/229-31). The interprofessional teamwork practice enacted by the nurse practitioners that emerged from the analysis comprised a combination of the following characteristic role components: clinical leader, bridging team colleague and ever-present tutor. These role components were enacted at all the sites and were prominent during interprofessional teamwork practice. The participant nurse practitioners utilised the interprofessional teamwork practice arrangements to enact a role that may be described in terms of a quality guarantee, thereby contributing to the overall quality and care flow offered by the entire surgical ward team.

The effect of pharmacy restriction of clindamycin on Clostridium difficile infection rates in an orthopedics ward

A high consumption of clindamycin was noted in an orthopedics ward with high rates of Clostridium difficile infection (CDI). We restricted clindamycin for the entire ward. A reduction of 88% in CDI (1.07 to 0.12 × 1,000 patients-days, P = .056) and 84% for all-cause diarrhea (2.40 to 0.38 × 1,000 patients-days, P = .021) was achieved. Clindamycin was reduced 92.61% without an increase in other antibiotics. We identified high consumption of clindamycin as a risk factor for CDI.

Architektur und Design psychiatrischer Einrichtungen

The physical environment of mental health institutions is regarded as a therapeutic agent within the treatment. There is only little scientific evidence on the consequences of architecture and design on psychiatric patients available. A systematic review was conducted on studies from adult mental health institutions. 25 studies were included into the review. Pre-post-studies and control group conditions were predominant study designs. Randomized controlled trials were not available. Interventions reached from art installations up to entire ward renovations. Outcome indicators were rather heterogeneous, including psychopathology, behavioural observations and aggression incidents. Overwhelmingly, the studies revealed positive results of interventions into the physical environment. We found positive outcomes independent from the intervention in detail. This result should be interpreted in the light of the generally low study quality and further methodological problems.