Facility Policies Research Articles

Optimal Renewal Policy of Multi-functional Facilities

Optimal Renewal Policy of Multi-functional Facilities

2454. A Cluster of Gram-Negative Bloodstream Infections in Connecticut Hemodialysis Patients Associated with Contaminated Wall Boxes and Priming Buckets

BackgroundPatients requiring maintenance hemodialysis (HD) are at increased risk of bloodstream infections. We investigated a cluster of infections due to unusual Gram-negative bacilli that affected patients undergoing HD at an outpatient unit with 19 stations (Clinic A).MethodsA case was defined as a HD patient at Clinic A with >1 blood or urine culture positive for Delftia acidovorans, Enterobacter absuriae, or Burkholderia cepacia during the period February 1 – April 30, 2018. An investigation included review of patient records, facility policies, practice observation, environmental cultures, and a 1:4 case–control study. Controls were patients without bloodstream infection (BSI) during the outbreak period.ResultsThe cluster included 3 patients. Patient 1 had BSI due to D. acidovorans (2/08), E. absuriae (3/15) and B. cepacia (3/17). Patient 2 had BSI due to D. acidovorans (3/17 and 3/27) and S. maltophilia (4/5). Patient 3 had a urine culture positive for D. acidovorans and S. maltophilia (4/2). The case–control study showed that cases had been dialyzed more often than controls on the third shift (P < 0.0001) and at station 2 (P < 0.0001), where subsequently a wall box spent dialysate drain connection swab culture yielded D. acidovorans. E. absuriae was recovered from wall boxes and spent dialysate drain connection at two stations and from used prime buckets from two stations; one wall box culture grew S. maltophilia. D. acidovorans and E. absuriae patient isolates were not available for genomic analysis. Observations revealed that waste water was leaking onto the floor from several wall boxes, and that priming buckets were often rinsed with tap water after being disinfected with 1:100 bleach solution and not allowed to dry before reuse. Multiple deficiencies in hand hygiene and station disinfection were observed. No deficiencies in water treatment practices were identified. Multiple water cultures obtained in August were negative for the observed pathogens.ConclusionA cluster of unusual Gram-negative infections in outpatient HD patients was most likely due to exposures to contaminated wall boxes or priming buckets; poor hand hygiene and station disinfection can contribute to transmission to patients.Disclosures All authors: No reported disclosures.

Optimization of settlement land use through carbon footprint approach in The North Balikpapan

Limited land in the downtown area as well as the increasing amount of new activities centre causes residential development leads to North Balikpapan. This area is an urban fringe with vast protected forests as buffer zone and catchment area for the city and surrounding area. Land conversion in this area will increase hazard risk of inundation, water quality decrease and increased CO2 emissions. Therefore, development should be maintained environmental stability. One of the rights applicated approach is carbon footprint that is capable to measure the balance between production and absorption needs of CO2 emissions. To find the optimal land allocation, we used carbon footprint calculation from the household activities, identify the factors of settlement growth, and use Linear Programming analysis. Analysis’ results show that settlement activities in North Balikpapan produce 108.362,4 tCO2/year or equivalent with 618,50 Ha green space. Meanwhile, the development of settlement in North Balikpapan is affected by social demographic, developer initiative, environmental condition, public facilities availability, economical structure, and policy factors. According to those factors, optimal allocation of settlement area in North Balikpapan is only about 4,510.01 Ha. With that condition, it still able to absorb CO2 emissions from inside or outside the area around 2.751 tCO2/year.

Nursing Practice Related to Intermittent Catheterization: A Cross-Sectional Survey.

The purpose of this study was to describe nursing practice and clinical decision-making related to intermittent catheterization (IC). Cross-sectional survey. Three hundred forty-three nurses responded to the survey, yielding a margin of error of 5.3%. The majority (70%; n = 240) indicated they were RNs, and 15.6% stated they practiced as advanced practice nurses (nurse practitioners or clinical nurse specialists). Most (75.9%; n = 260) held at least one certification in rehabilitation, WOC, or urologic nursing. Most nurses (70.5%; n = 242) indicated 11 or more years of experience in their specialty practice. Data were collected via an electronic questionnaire that comprised 50 items and required 35 to 40 minutes to complete. Ten items queried demographic data and professional background, 13 queried facility policies and practice patterns related to use of IC, and 27 focused on various aspects of decision making regarding IC practice including 8 items related to catheter selection in 4 case scenarios. The questionnaire was completed online after viewing a written explanation of the purpose of the survey. Completion of the questionnaire acted as consent to study participation. All respondents indicated regularly teaching IC within their practice, and 61.2% (n = 210) stated they were confident that 70% or more of patients or caregivers understood the instructions. However, responses varied considerably when asked who they involved in IC education; less than half (48.1%; n = 165) responded that they included a lay caregiver or family member when teaching a patient to perform IC. Responses also varied when asked about who was included in this education; when asked about catheter selection in 4 clinical scenarios, 9.0% to 20.9% selected inappropriate catheters. Similarly, responses varied when they were asked about use of resources to guide IC practice; 25.4% (n = 87) indicated they relied on their own best practice. Findings from 343 nurses experienced in IC teaching showed considerable variability when asked about sources used to guide IC practice, who should be included in IC education, and catheter selection in 4 case scenarios. Additional research and evidence, and consensus-based resources such as clinical guidelines of a decision-making algorithm, are needed.

Surgical Instrument Decontamination: A Multistep Process.

Surgical instrument decontamination requires the collective input of facility leaders, OR staff members, and sterile processing department personnel. Individual accountability can ensure that instruments are cleaned according to the manufacturers' written instructions for use, appropriate regulations, and facility policies. Information about the instrument decontamination process-from point of use to sterilization-should help enable perioperative nurses to advocate for and participate in the appropriate implementation of the necessary process steps. Sterile processing department leaders should develop policies and procedures for decontamination of surgical instruments and devices and the various accountabilities for the process steps. They also should help provide education for their staff members and complete required documentation. This article reviews the steps of instrument cleaning and decontamination and provides a framework to help perioperative leaders and educators facilitate these steps in their work environments, prevent instrument damage, and help ensure safe patient care.

Can communication by the government improve trust and reduce risk perception?

ABSTRACTThe question addressed in this research is: Does a higher level of government risk communication regarding the location policy of risk facilities increase the public’s trust in the government and reduce risk perception? Based on a theoretical discussion, this study subdivided risk communication into participation, deliberation, and information transparency. The effects of each on government trust and risk perception were analyzed using a structural equation model (SEM). The results showed that guaranteeing various stakeholders’ participation and their roles in regard to the policy for locating high-risk facilities improved trust in the government, and thereby decreased risk perception. Second, the process of deliberation improved trust in the government as the administrator of risk management and effectively decreased negative risk perception. Third, providing transparency and sufficient information to the public did not have a statistically significant effect on government trust, but reduced risk perception.

AORN Position Statement on Perioperative Registered Nurse Circulator Dedicated to Every Patient Undergoing an Operative or Other Invasive Procedure

<scp>AORN</scp> Position Statement on Perioperative Registered Nurse Circulator Dedicated to Every Patient Undergoing an Operative or Other Invasive Procedure

Eat, play, live: a randomized controlled trial within a natural experiment examining the role of nutrition policy and capacity building in improving food environments in recreation and sport facilities

BackgroundRecreation and sport facilities often have unhealthy food environments that may promote unhealthy dietary patterns among children. In response, some Canadian provinces have released voluntary nutrition guidelines for recreation and sport facilities, however implementation has been limited. Organizational capacity building may overcome barriers to implementing guidelines. Eat, Play, Live was a randomized controlled trial embedded within a natural experiment that tested the impact of an 18 month capacity building intervention (CBI) in enhancing implementation of provincial nutrition guidelines, and whether nutrition guidelines were associated with positive changes. Primary outcomes were facility capacity, policy development and food environment quality.MethodsRecreation and sport facilities in three guideline provinces were randomized into a guideline + CBI (GL + CBI; n = 17) or a guideline only comparison condition (GL-ONLY; n = 15). Facilities in a province without guidelines constituted a second comparison condition (NO-GL; n = 17). Facility capacity, policy development, and food environment quality (vending and concession) were measured and compared at baseline and follow-up across conditions using repeated measures ANOVA and Chi-square statistics. Healthfulness of vending and concession items was rated as Do Not Sell (least nutritious), Sell Sometimes or Sell Most (most nutritious).ResultsThere were significant time by condition effects, with significant increases in facility capacity (mean ± SD: 30.8 ± 15.6% to 62.3 ± 22.0%; p < 0.01), nutrition policy development (17.6% developed new policies; p = 0.049), overall quality of the concession food environment (14.7 ± 8.4 to 17.5 ± 7.2; p < 0.001), and in the proportion of Sell Most (3.7 ± 4.4% to 11.0 ± 9.0%; p = 0.002) and Sell Sometimes vending snacks (22.4 ± 14.4% to 43.8 ± 15.8%; p < 0.001) in GL + CBI facilities, with a significant decline in Do Not Sell vending snacks (74.0 ± 16.6% to 45.2 ± 20.1%; p < 0.001).ConclusionsSignificant improvements in facility capacity, policy development and food environment quality occurred in recreation and sport facilities that were exposed to nutrition guidelines and participated in a CBI. Outcomes did not improve in facilities that were only passively or not at all exposed to guidelines. Ongoing capacity building may enhance implementation of voluntary nutrition guidelines, however food environments remained overwhelmingly unhealthy, suggesting additional scope to enhance implementation.Trials registrationClinical trials registration (retrospectively registered): ISRCTN14669997 Jul 3, 2018.

El mar como catalizador de la geopolítica: de Mahan al auge chino

China es el Estado que mas ha crecido economica y militarmente en los ultimos lustros. Aunque sus fuerzas armadas todavia estan lejos de las estadounidenses, la enorme proyeccion comercial china y su politica de dotarse de facilidades en puertos de todos los continentes, unida a la creacion de una poderosa flota de alta mar, recuerdan el camino recorrido anos atras por otras grandes potencias. Pero China, a diferencia del Reino Unido del siglo XIX o de los Estados Unidos en el siglo XX, es mas bien una potencia del Rimland con un pie en el Heartland. Precisamente por ello, en este analisis de pone a prueba la capacidad china a partir del marco teorico derivado de la escuela que menos la favorece, es decir, la del poder naval de Mahan. La conclusion es que, a pesar de ciertos deficits en cuestiones puramente geograficas, muchos de los parametros en su dia definidos por Mahan avalan la candidatura china

Flexibility of deployment: challenges and policy options for retaining health workers during crisis in Zimbabwe

BackgroundZimbabwe experienced a socio-economic crisis from 1997 to 2008 which heavily impacted all sectors. In this context, human resource managers were confronted with the challenge of health worker shortage in rural areas and, at the same time, had to operate under a highly centralised, government-centred system which defined health worker deployment policies. This study examines the implementation of deployment policies in Zimbabwe before, during and after the crisis in order to analyse how the official policy environment evolved over time, present the actual practices used by managers to cope with the crisis and draw lessons. ‘Deployment’ here was considered to include all the human resource management functions for getting staff into posts and managing subsequent movements: recruitment, bonding, transfer and secondment. The study contributes to address the existing paucity of evidence on flexibility on implementation of policies in crisis/conflict settings.MethodsThis retrospective study investigates deployment policies in government and faith-based organisation health facilities in Zimbabwe before, during and after the crisis. A document review was done to understand the policy environment. In-depth interviews with key informant including policy makers, managers and health workers in selected facilities in three mainly rural districts in the Midlands province were conducted. Data generated was analysed using a framework approach.ResultsBefore the crisis, health workers were allowed to look for jobs on their own, while during the crisis, they were given three choices and after the crisis the preference choice was withdrawn. The government froze recruitment in all sectors during the crisis which severely affected health workers’ deployment. In practice, the implementation of the deployment policies was relatively flexible. In some cases, health workers were transferred to retain them, the recruitment freeze was temporarily lifted to fill priority vacancies, the length of the bonding period was reduced including relaxation of withholding certificates, and managers used secondment to relocate workers to priority areas.ConclusionFlexibility in the implementation of deployment policies during crises may increase the resilience of the system and contribute to the retention of health workers. This, in turn, may assist in ensuring coverage of health services in hard-to-reach areas.

Rethinking the Essential Facilities Doctrine for the EU Digital Economy

Although the essential facilities doctrine has not been applied recently anymore in EU competition enforcement, it is regularly referred to in EU policy discussions as a tool to open up markets in which ‘tech giants’ act as gatekeepers to consumers. Considering that the digital economy is not anymore driven by physical infrastructures, such as the bridges in the US Terminal Railroad case from which the essential facilities doctrine originates, other assets like data or rankings as the backbone of many digital markets may form the subject of essential facilities claims. Access to data or being ranked by an online platform can now be essential for businesses to compete in the market. Against this background, the paper explores whether there should be more room for competition interventions under the essential facilities doctrine in the digital economy, considering market characteristics, as well as the recent Google competition cases seemingly bypassing the essential facilities doctrine, and legislative and policy developments regulating access outside EU competition law. It is put forward that the essential facilities doctrine should be rethought in order to be effectively applied in the EU digital economy, in particular by aligning its application with the underlying economic interests.

The implementation of environmental health policies in health care facilities: The case of Malawi.

Establishing and maintaining safe and sufficient environmental health (EH) conditions in health care facilities (HCFs) is important to prevent and control infections. In 2018, the Government of Malawi finalized an environmental health policy that defines specific targets and programs for EH in healthcare settings. This and other related policies have been used since 2010 as a guide for EH practice in HCFs, but the implementation of these policies has been incomplete to-date. This study qualitatively examines the successes and shortcomings of implementing these policies in Malawi's public HCFs. Thematic analysis of interviews with 53 respondents from all levels of government was used to identify the successes of the policies and the barriers to effective implementation using Contextual Interaction Theory. The greatest identified strength lies in the design of the EH department and its ability to connect individual HCFs and EH actors directly to the policy-making level of government. Identified barriers to implementation include: insufficient financial support; lack of human resources; incomplete reporting; poor stakeholder coordination; and insufficient training of EH actors. We recommend refresher trainings for all EH actors, the establishment of a directorate level EH position, and strengthened coordination to improve the collection, analysis, and reporting of monitoring data to enable EH actors to advocate for the additional funding needed to develop programs for EH personnel and to apply effective EH interventions.

Performance analyses of statistical approaches for modeling electricity consumption of a commercial building in France

Energy consumption of buildings is an important component of national energy consumption, and, thus, developing accurate models for predicting future demand in buildings is essential for facility managers, electricity providers, and policy makers in tackling the energy scarcity. In this study, multiple linear regression (MLR), time series and Grey models were developed for estimating the HVAC electricity consumption of a commercial building located in Paris, France. The data was collected between June 2015 and April 2016. Weather variables (outdoor temperature, relative humidity, global radiation) and four dummy variables, which represent the working days, were taken into account in the regression analysis. Mean Absolute Error (MAE), Root Mean Square Error (RMSE), and Mean Squared Error (MSE) were selected for comparing the performance of the recommended models. The results show that MLR performs better with a RMSE of 18.3806 compared to time series and Grey model with RMSE of 20.5114 and 21.8478, respectively.

Implementation science approaches to enhance uptake of complex interventions in surgical settings.

Achieving practice change in the complex healthcare environment is difficult. Effective surgical care requires coordination of services across the continuum of care, involving interdisciplinary collaboration across multiple units, with systems and processes that may not connect effectively. Principles of enhanced recovery after surgery (ERAS) are increasingly being incorporated into facility policies and practice, but the literature reports challenges with both initial adherence and mid- to long-term sustainability. Greatest adherence is typically observed for the intraoperative elements, which are within the control of a single discipline, with poorest adherence reported for postoperative processes occurring in the complex ward environment. Using ERAS as an example, this perspective piece describes the challenges associated with implementation of complex interventions in the surgical setting, highlighting the value that implementation science approaches can bring to practice change initiatives and providing recommendations as to suggested course of action for effective implementation.

Optimal Operation of Urban Storm Detention Ponds for Flood Management

Operation of existing flood control facilities is one the efficient method for urban stormwater management. In order to quantitatively manage urban floods, operational policies of facilities should be adapted, before need to the enlargement of hydro-infrastructures with high expenditure. A new optimization based methodology is proposed in this paper for urban detention pond operation. The approach integrates an evolutionary algorithm known as Differential Evolution (DE) with EPA-SWMM simulation model to effectively manage detention storage capacities during flood periods. The proposed method is applied to in-line detention ponds at central part of Tehran Stormwater Drainage System (TSDS) to attain optimal rule curves of detention pond operation. Optimal rule curves are compared with the current method of operation and show that the proposed method can decrease network flooding of the smallest and largest extreme rainfall events more than75% and 30% respectively, and in average 55% considering all extreme rainfalls during 1979 to 2013. Therefore, the approach is recommended to replace with the current method of pond operating.

Health Care Provider Attitudes about the Safety of "Quick Start" Initiation of Long-Acting Reversible Contraception for Adolescents.

To identify characteristics associated with provider attitudes on the safety of "Quick Start" initiation of long-acting reversible contraception (LARC) for adolescents. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We conducted a cross-sectional survey of providers in public-sector health centers and office-based physicians (n=2056) during 2013-2014. Overall, the prevalence of considering "Quick Start" initiation of LARC for adolescents as safe was 70.9% for implants and 64.5% for intrauterine devices (IUDs). Among public-sector providers, those not trained in implant or IUD insertion had lower odds of perceiving the practice safe (adjusted odds ratio [aOR], 0.32; 95% confidence interval [CI], 0.25-0.41 for implants; aOR 0.42; 95% CI, 0.32-0.55 for IUDs), whereas those practicing at health centers that did not receive Title X funding had lower odds of perceiving the practice safe for IUDs (aOR, 0.77; 95% CI, 0.61-0.98). Among office-based physicians, lack of training in LARC insertion was associated with lower odds of perceiving "Quick Start" initiation to be safe for IUDs (aOR, 0.31; 95% CI, 0.12-0.77). Those specializing in adolescent medicine had higher odds of reporting "Quick Start" initiation of LARC as safe (implants: aOR, 2.21; 95% CI, 1.23-3.98; IUDs: aOR, 3.37; 95% CI, 1.39-8.21) compared with obstetrician-gynecologists. Approximately two-thirds of providers considered "Quick Start" initiation of LARC for adolescents safe; however, there were differences according to provider characteristics (eg, Title X funding, training in LARC insertion, specialty). Targeted LARC insertion training and dissemination of evidence-based family planning guidance and implementation into facility and practice-level policies might increase access to "Quick Start" initiation of LARC for adolescents.

REDUCING POLICY OF PUBLIC FACILITIES AND THE ACCESSIBILITY TO FLOOD EVACUATION SITES

REDUCING POLICY OF PUBLIC FACILITIES AND THE ACCESSIBILITY TO FLOOD EVACUATION SITES

Reducing resupply time with additive manufacturing in spare part supply chain

Abstract Recently, Additive Manufacturing (AM) has started to be considered as an alternative to Conventional Manufacturing (CM) in the spare part production, due to the negligible set-up times that AM has with respect to CM and the possibility of producing small batches. However, AM production times are usually larger than those of CM, making the choice between them not as obvious as it may seem. In this paper, the impact of AM is studied in a single-echelon supply chain under the assumption of infinite production capacity of the production facility and (S-1, S) inventory policy. Results are obtained by using analytical Markov Chain models.

Challenges Of Rural Women In Agricultural Production And Food Sufficiency In Cross River State, Nigeria

This study focuses on the involvement of women in agricultural production in Cross River State, Nigeria. The objective is to ascertain the contributions of women to food sufficiency in the state and the challenges they face in course of their farming process. The study attempted to answer the following research questions; what is the level of contribution of women in agriculture to food sufficiency in Cross River State? What are the inhibiting challenges to agricultural production by women in Cross River State? A total of 900 women across the State were examined to capture their involvement and contribution to agricultural production as well as the challenges they face in this process. Data was generated through questionnaire, interview and observation and were analyzed with simple percentage technique and presented on tables and graph. The study discovered that women in agriculture in cross river are active contributors to food sufficiency through the remarkable increase in their crop production index. Second; women are faced with challenges that inhibit robust food production in the state such as land restriction, limited access to capital/access to credit, gender inequality/discrimination and lack of storage facility. On the basis of this the study advocates policy change to give women access to more land and credit facilities. Traditional norms that hinder women access to land be relaxed through government conscious pressure on local culture. Robust assistance to fund women agriculture should become the priority of the state and the local governments through conscious policy of soft credit facilities with minimal collateral.

IPTEKS KEBIJAKAN PEMBERIAN FASILITAS KREDIT DI HOTEL FOUR POINTS BY SHERATON MANADO

Management of hospitality industry should determine and apply non-cash payment policy and credit facility policy, as one of the way to increase sales and maximize profit for the company. Credit facility policy by hotel management causes the appearance of receivable. The purpose of this study was to identify credit policy applied at hotel Four Points by Sheraton Manado. Based on the study that has been done, management of hotel Four Points by Sheraton Manado has determine several policies for companies that want to get credit facility. The policies consider these four elements: Credit period, Credit standards, Collection policy, and Cash discount. Suggestion for each departments related to sales cycle is to understand and follow the Standard Operating Procedure (SOP) while performing their tasks.Keywords : Credit, Hotel, Account Receivable, Operational Activities, Tourism