Hungarian Hospital Research Articles

Investigation of the conditions affecting the joining of Hungarian hospitals to an accreditation programme: a cross-sectional study

ObjectiveQuantitative studies have shown the various benefits for having accreditation in hospitals. However, neither of these explored the general conditions before applying for an accreditation. To close this gap, this...

PHP4 - The Analysis of the Number of Same-Day Surgery Cases in 2015 in Hungarian Hospitals

Over the past few years one day surgery has become more specific in health care systems throughout the world. This study analyzed the available same-day surgical procedures in the Hungarian health care system in the year 2015. Data were derived from the financial database of National Institute of Health Insurance Fund Administration and covering the year of 2015. We applied the usual performance indicators by comparing the actual number of same-day surgical interventions to the theoretical number of same-day surgical intervention which could have been performed by the hospitals among ideal circumstances. The number of cases was used to establish the rate of same-day surgical procedures. Hungarian hospitals were classified into the following groups: university clinical centers, county hospitals, city hospitals, specialized hospitals, Budapest’s hospitals, children’s hospitals and national health care institutes. 62.29% of the achievable same-day surgeries was accounted for by the publicly funded institutes in Hungary in 2015. We found that the rate of the above interventions was the highest in specialized hospitals (98.82%). The rate of the achievable same-day surgery’s case number was 60.03% in university clinical centers, which is lower than that in county hospitals (61.38%) and the city hospitals (66.90%), on the other hand, it is higher than the rate of Budapest’s hospitals (55.49%), children’s hospitals (50.66%), and national health care institutes (28.23%). Our results showed that in 2015 the specialized hospitals performed the most, while the national health care institutes performed the least case numbers regarding same-day surgeries in Hungary.

Penetration of Peripheral Vascular Interventions in Hungary

Our investigation aimed to analyse the penetration of peripheral vascular interventions among Hungarian hospitals, with special respect to the Clinical Center of the University of Pécs, a tertiary level university teaching hospital. Data analysed were taken from the database of the Hungarian National Health Insurance Fund Administration, covering the year 2015. We identified the patients with the Hungarian Diagnosis Related Groups (DRG) categories. We investigated the following DRG groups: 190 C, 190 D, 190 E, 190 F, 190 G, 190 H. Hospitals that had reported patients with these DRG codes were involved into the study. Our investigation focused on case numbers and percentage ratio. The general market share of the Clinical Center of the University of Pécs (CC-UP) was 5.0 % from all the active inpatient care services in 2015. Institutions performing 190C Percutaneous and other vascular surgeries (with the implantation of one or more stents or homograft) reported a total 1111 cases, out of which 135 (12%, which is the second largest market share: 2nd place) was reported by the CC-UP. Institutions performing 190D Percutaneous and other vascular surgeries without stent implantation reported a total 592 cases, according to reported performance, the CC-UP had 229 cases (38.7%, 1st place). Regarding 190E Percutaneous vascular surgeries with further treatment (with one or more stents) the reported number was a total of 1288 cases, out of which the CC-UP carried out 7 (0.5%, 28th place). The total number of 190F Percutaneous vascular surgeries without further treatment including stent implantation amounted to 822, and the CC-UP had 29 cases (3.5 %, 9th place). The case numbers and percentage ratio of peripheral vascular interventions performed at hospitals showed considerable differences, even in a tertiary level teaching hospital. Penetration rate of peripheral vascular interventions should be increased in Hungary.

Commercial strain-derived clinical Saccharomyces cerevisiae can evolve new phenotypes without higher pathogenicity.

Saccharomyces cerevisiae is one of the most important microbes in food industry, but there is growing evidence on its potential pathogenicity as well. Its status as a member of human mycobiome is still not fully understood. In this study, we characterize clinical S. cerevisiae isolates from Hungarian hospitals along with commercial baking and probiotic strains, and determine their phenotypic parameters, virulence factors, interactions with human macrophages, and pathogenicity. Four of the clinical isolates could be traced back to commercial strains based on genetic fingerprinting. Our observations indicate that the commercial-derived clinical isolates have evolved new phenotypes and show similar, or in two cases, significantly decreased pathogenicity. Furthermore, immunological experiments revealed that the variability in human primary macrophage activation after coincubation with yeasts is largely donor and not isolate dependent. Isolates in this study offer an interesting insight into the potential microevolution of probiotic and food strains in human hosts. These commensal yeasts display various changes in their phenotypes, indicating that the colonization of the host does not necessarily impose a selective pressure toward higher virulence/pathogenicity.

Spectrum and antibiotic resistance of uropathogens between 2004 and 2015 in a tertiary care hospital in Hungary.

Surveillance of the bacterial spectrum and antibiotic-resistance patterns of locally occurring uropathogens is essential to serve as a basis for empirical treatment of urinary tract infections (UTIs), as antibiotic-resistance rates may vary geographically with significant differences between countries and regions, and with time. We retrospectively analysed all urine samples taken in the department of urology in a tertiary care hospital in Hungary from January 2004 to December 2015.Results/Key findings. The five most commonly occurring bacteria were Escherichia coli, Enterococcus faecalis, Klebsiella pneumoniae, Pseudomonas aeruginosa and Proteus mirabilis. Resistance of Escherichia coli to ciprofloxacin increased significantly from 19 to 25 %. Although the resistance of Escherichia coli against cephalosporins showed an increasing trend, it still remained generally low. However, resistance rates of K. pneumoniae to cephalosporins were very high, reaching 60 %, due to the high rate of extended-spectrum-β-lactamase-positive Klebsiella strains. We observed a significant increase in the rate of carbapenem-resistant Pseudomonas aeruginosa. Fluoroquinolones cannot be recommended for empirical treatment in our region. Cephalosporins can be a good empirical choice for treating Gram-negative UTIs, but should be avoided when multi-drug resistant (MDR) bacteria are suspected. Increases in the rate of carbapenem-resistant Pseudomonas aeruginosa, and in the general rate of MDR bacteria, are both a very alarming trend. We recommend practising prudent antibiotic policy, preferably using antibiotics with the narrowest possible spectrum.

Association between the application of ISO 9001:2008 alone or in combination with health-specific standards and quality-related activities in Hungarian hospitals.

To investigate how International Organization for Standardization (ISO) 9001 and the Hungarian Health Care Standards (HHCS) certifications are associated with quality management, patient safety, patient rights and human resource management activities. A cross-sectional study was implemented using the 2009 Hungarian hospital survey's database. Hungary. Fifty-three general hospitals were included in the statistical analysis. No intervention was carried out in the study. The outcomes included the percentage of compliance in the dimensions of quality management, patient safety, patient rights, human resource management and the overall score for each hospital, and they were grouped according to the hospitals' certifications. Sixteen hospitals did not have either ISO 9001 or HHCS certifications, 19 had ISO 9001 certification only and 18 had both. Hospitals with ISO 9001 alone or in combination with the HHCS significantly outperformed hospitals with no certifications in terms of quality management and human resource management activities but not in terms of patient safety or patient rights activities. Combined, the two models provided the highest median levels in all cases. Nevertheless, no significant differences were observed when the hospitals with both certifications were compared with hospitals with ISO 9001 only. Although the combination of ISO 9001 and the HHCS showed the best results, the benefits were not decisive. Furthermore, although the HHCS include standards addressing patient safety, no direct association was found with regard to compliance. Thus, further investigation is required to understand this enigma.

Correlation between prescribed daily dose, seizure freedom and defined daily dose in antiepileptic drug treatment.

Background Although defined daily doses (DDD) for antiepileptic drugs (AED) have been assigned only in combination therapy, based on the literature, most patients take them in monotherapy. Furthermore, discrepancies between DDD and prescribed daily dose (PDD) were observed. Objective First, to determine PDDs of AEDs and to reveal PDD/DDD ratio among seizure free versus not seizure free patients in everyday clinical practice. Second, to test the applicability of 75% cut-off of DDD to achieve seizure freedom. Furthermore, to find out what factors might influence PDD. Setting Outpatient data files at a Hungarian university hospital were studied. Methods A retrospective, 20-year cross-sectional database was compiled from 1282 epileptic outpatients' files. Main outcome measure Seizure freedom and PDD were used as outcome measures. Results The mean DDD% of all prescribed AEDs increased steadily from monotherapy, through bitherapy towards polytherapy (p<0.0001). Most seizure free patients took AEDs in doses in the range of ≤75% of DDDs in monotherapy and bitherapy. Older AEDs (carbamazepine and valproate) were given in a significantly higher mean dose in bitherapy in the seizure free group. Among the newer types, only levetiracetam and lamotrigine had a significantly higher DDD% in mono-, bi-, and polytherapy. Confirmed by logistic regression analysis, gender, age, type of epilepsy, and number of AEDs had a significant impact on the value of 75% DDD. Conclusion No significant unfavourable impact of the lower ratio of PDD/DDD on the outcome of achieving seizure freedom has been confirmed. As a measure of seizure freedom, 75% of DDD may be used, although individual therapy must be emphasised. Precisely quantified DDD would provide a more accurate calculation of other derived values.

Evaluation of the Brussells Questionnaire as a screening tool for obstructive sleep apnea syndrome

Introduction. Obstructive sleep apnea syndrome (OSAS) has been recently shown to be associated with an increased risk of traffic accidents. Expensive and not widely available polysomnography (PSG) is the gold standard for diagnosing OSAS. The questionnaire developed by the Obstructive Sleep Apnoea Working Group in 2013 in Brussells (termed the Brussels Questionnaire) was created as a screening strategy for those who apply for a driver’s license. Aim. The aim of this study was to evaluate the sensitivity and specificity of the Brussels Questionnaire for detecting OSAS. Material and Methods. 285 patients who reported to the Sleep Disorders Centre of the Neurology Department of the Hungarian Defence Forces Military Hospital for the portable monitoring (PM) completed the Brussels Questionnaire. A score of 10 or higher out of 24 indicated a high risk of OSAS. The results of the questionnaire were then compared with the results of the PM as well as of the polysomnography (PSG) when available. Results. After the comparison of the results obtained with PM and the Brussels Questionnaire, the sensitivity and specificity of the questionnaire were calculated and amounted 0.64 and 0.49, respectively. After the comparison of the results obtained with PSG and the Brussels Questionnaire, the sensitivity and specificity of the questionnaire were calculated and amounted 0.83 and 0.55, respectively. The score of 10 points was found to be the optimal cut-off value. Conclusions. The Bruxelles Questionnaire is a simple screening tool for OSAS in candidates for driver’s license, with a sensitivity of 0.64 and a specificity of 0.49. Its specificity and sensitivity are similar to those of other frequently used questionnaires.

Sleep-related breathing disorders in Hungarian patients with Parkinson’s disease

Introduction. Typical symptoms of Parkinson’s disease (PD) are motor symptoms. However, the non-motor symptoms, which may occur in any phase of the disease, are now in the center of the clinical attention. These symptoms include neuropsychiatric dysfunctions, dysautonomy, sleep disorders, and sensory symptoms, such as pain. Sleep disorders are common in PD patients. Aim. The aim of our study was to estimate the prevalence and characteristics of obstructive sleep apnea syndrome (OSAS) in patients with PD. We also wanted to analyze the sleep architecture in Parkinson’s disease using polysomnography. Material and methods. 50 patients who had visited the Neurology Department of Hungarian Defence Forces Military Hospital between February 2014 and April 2016 were recruited for the study. Every patient with idiopathic Parkinson’s disease stage 1 to 3 was included, regardless of their sleeping complaints. Every patient underwent nocturnal, in-laboratory polysomnography, the results of which were subsequently assessed by a somnologist. Sleep stages were distinguished and the Apnea-Hypopnea Index (AHI) was calculated according to the recommendations of the Task Force of the American Academy of Sleep Medicine. Results. The total in-laboratory sleep time ranged from 189 minutes to 501 minutes, with the mean value of 298 minutes. Total sleep time was reduced (&lt; 5 hours) in 28 patients (56%). Sleep latency was prolonged (&lt; 0.5 hours) in 33 patients (&gt; 66%). In older patients (≥ 75 years old), the sleep latency was longer. The normal sleep efficiency of &gt; 85% was seen in only 8 patients. The sleep efficiency ranged from 56% to 89%, with a mean value of 74.1%. 9 patients in our study group had 3 rapid eye movement (REM) sleep episodes, 37 patients had 2 REM episodes and 4 patients had only 1 REM episode. There was a negative correlation between the score on Epworth Sleepiness Scale (ESS) and the number of REM episodes. REM sleep onset latency was prolonged (&gt; 2 hours) in 82% (n = 42) of our patients. Periodic limb movements in sleep (PLMS) were seen in 18 patients. There was a negative correlation between age and PLMS index. All the patients in our study who had been diagnosed with restless leg syndrome (RLS) had PLMS . Sleep latency was prolonged in 7 out of 17 patients suffering from RLS. 64% (n = 32) of our patients were diagnosed with OSAS. The prevalence of severe, moderate and mild OSAS was 22%, 32% and 10%, respectively. Patients with moderate and severe OSAS (AHI &gt; 15 hours) had higher age than patients without OSAS (p &lt; 0.005). The mean ESS score was higher in OSAS patients (p = 0.05). Snoring was present in 78% of the OSAS patients. Apnea witnessed by a partner was the most specific symptom, present in 92% of OSAS patients. We did not find significant differences between the groups with and without OSAS in regard of UPDRS (unified PD rating scale) and Hoehn &amp; Yahr’s modified evaluation scale and Schwab &amp; England’s functional evaluation scale. Conclusions. OSAS is a common sleep disorder in PD patients. It has a higher prevalence in older PD patients and it is associated with greater daytime sleepiness. Snoring is the most sensitive symptom, and apneas witnessed by a partner are the most specific symptom of OSAS in PD patients.

Zsuzsanna Kossuth - the first volunteer nurse at Hungary and her activities in the War of Independence (1848-1849)

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70 - Spectrum and susceptibility of uropathogens between 2004 and 2015 in a tertiary care hospital in Hungary

70 - Spectrum and susceptibility of uropathogens between 2004 and 2015 in a tertiary care hospital in Hungary

Antibiotic use in the Hungarian hospitals in the last two decades (1996-2015)

Growing bacterial resistance threatens public health, which can be tempered by prudent antibiotic use. To quantify systemic antibacterial use in Hungarian hospitals. Consumption data were analysed using the Anatomical-Therapeutic-Chemical - Defined Daily Dose (ATC/DDD) methodology. Data were standardized for patient turnover and also for population to enable international benchmarking. Hospital antibiotic use was quite constant (22.4 ± 1.5 DDD/100 patient-days), but its composition changed substantially. The use of parenteral products rose gradually (in 1996 26.4% and in 2015 41.6%). The pattern of use was homogenised due to the headway of co-amoxiclav use. A substantial increase of fluoroquinolone (2.3 vs. 4.2 DDD/100 patient-days) and third generation cephalosporin (1.0 vs. 2.9 DDD/100 patient-days) use was detected. In parallel the use of narrow spectra penicillins diminished. Hungarian hospital antibiotic use is low. The causes and the justification of this low use together with the internationally outstanding use of certain antibacterials should be addressed in future studies. Orv. Hetil., 2016, 157(46), 1839-1846.

PHS94 - Market Share of Addictology According To The System of Diagnosis Related Groups (DRGS) In Hungary

In 1993 a Diagnosis Related Groups-like financing system was introduced in Hungary including all the Hungarian acute care hospitals. The aim of the study is to analyse the market share of addictology, the capacity and performance data of addictology according to the progressivity levels and Diagnosis Related Groups (DRGs) in Hungary. The data derive from the financial database of the National Health Insurance Fund Administration of Hungary for the year 2015. The study includes the analysis of the number of hospital beds, the DRG weights, the financial cases and average lenght of stay. Addictology care was available in 11 Hungarian hospital in 2015. It means that among the 20 counties in Hungary, in 9 county addictology services are not available. The market share of addictology in in-patients care was 0.5 % from acute care hospital beds and 0.16 % from the total DRG cost-weights. The market share of addictology from financial cases was 0.19% and 0.43 % from total hospital days. The average length of stay of patients admitted to addictology wards was 12.3 days/patient, sginificantly higher than the average of all acute care specialty (5.3 days). Hungarian patients have limited access to acute addictology services. In 9 counties out f 20 addictology services are not available. In order to improve patients’ access to addictology care, its market share should be increased.

Knowledge of Emergency Contraceptive Pills among Hungarian Women Presenting for Induced Abortion or Seeking Emergency Contraception.

Aim: To compare the differences in contraceptive characteristics and the knowledge of emergency contraception (ECP) among women who used ECP after unprotected intercourse and those who sought an abortion. Methods: A questionnaire survey was conducted in a Hungarian university hospital among women for whom ECP was prescribed after unprotected intercourse (n = 940) as well as women who presented for the termination of pregnancy (n = 1592) between January 1, 2005 and November 20, 2006. Their knowledge of ECP and their experience with and attitudes toward ECP use were targeted. Results: The availability of ECP was well known (87.9 %), but it was still greatly underutilized: applied by only 13 of the 1592 women who resorted to abortion. Primarily, the ECP group consisted of those who experienced a condom failure significantly more often (odds ratio [OR] = 4.1), followed by those cases where ECP applications was a consequence of not using any kind of contraception (OR = 3.8). Fewer than one third (32 %) of the abortion seekers had previously used ECP, and only one fifth knew how to obtain it. Appropriate awareness of ECP was influenced by information obtained from health-care providers (adjusted odds ratio [AOR] = 3.93) or school education (AOR = 1.82). Conclusions: More thorough education is needed to provide a deeper knowledge of ECP use during contraceptive counseling for women seeking abortion, including those contraceptive mishaps where unintended pregnancy can be prevented by ECP.

In memoriam: Dr. Andrew Czeizel.

In memoriam: Dr. Andrew Czeizel.

Legionella prevalence and risk of legionellosis in Hungarian hospitals.

Nosocomial legionellosis is a growing concern worldwide. In Hungary, about 20% of the reported cases are health-care associated, but in the absence of legal regulation, environmental monitoring of Legionella is not routinely performed in hospitals. In the present study, 23 hospitals were investigated. The hot water distribution system was colonized by Legionella in over 90%; counts generally exceeded the public health limit value. Hot water temperature was critically low in all systems (<45 °C), and large differences (3-38 °C temperature drop) were observed within buildings, indicating insufficient circulation. Most facilities were older than 30 years (77%); however, new systems (n = 3) were also shown to be rapidly colonized at low hot water temperature. Vulnerable source of drinking water, complex distribution system, and large volume hot water storage increased the risk of Legionella prevalence (OR = 28.0, 27.3, 27.7, respectively). Risk management interventions (including thermal or chemical disinfection) were only efficient if the system operation was optimized. Though the risk factors were similar, in those hospitals where nosocomial legionellosis was reported, Legionella counts and the proportion of L. pneumophila sg 1 isolates were significantly higher. The results of environmental prevalence of legionellae in hospitals suggest that the incidence of nosocomial legionellosis is likely to be underreported. The observed colonization rates call for the introduction of a mandatory environmental monitoring scheme.

Identification and characterization of CTX-M-15 producing Klebsiella pneumoniae clone ST101 in a Hungarian university teaching hospital

We investigated the molecular epidemiology of extended spectrum β-lactamase (ESBL) producing Klebsiella pneumoniae isolates derived from the teaching hospitals of University of Pécs, Pécs, Hungary in the time period 2004-2008. Molecular typing, antimicrobial susceptibility testing, detection of common β-lactamase genes (bla(CTX-M), bla(TEM) and bla(SHV)) and virulence associated traits (hypermucoviscosity, magA, k2a, rmpA, siderophores, type 1 and 3 fimbria, biofilm formation, serum resistance) were performed for 102 isolates. The results showed the presence of three major ciprofloxacin resistant CTX-M-15 producing clones (ST15 n = 69, ST101 n = 10, and ST147 n = 9), of which ST15 was predominant and universally widespread. Considering distribution in time and place, ST101 and ST147 were detected at fewer inpatient units and within a narrower time frame, as compared to ST15. Beside major clones, eleven minor clones were identified, and were shown to harbour the following β-lactamase genes: six clones carried bla(CTX-M), four clones harboured bla(SHV-5) and one clone possessed both bla(CTX-M) and ESBL type bla(SHV). Among the SHV-5 producing K. pneumoniae clones a novel sequence type was found, namely ST1193, which harboured a unique infB allele. Different virulence factor content and peculiar antimicrobial susceptibility profile were characteristic for each clone. In contrast to major clone isolates, which showed high level resistance to ciprofloxacin, minor clone isolates displayed significantly lower MIC values for ciprofloxacin suggesting a role for fluoroquinolones in the dissemination of the major K. pneumoniae clones. This is the first description of the CTX-M-15 producing K. pneumoniae clone ST101 in Hungary.

Hosting while being hosted: A perspective of Hungarian migrant hospitality workers in London, UK

Labour mobility in the hospitality industry involves a wide range of affective processes. Emotional responses in challenging situations for migrant hospitality workers significantly affect their social interactions and working efficiency. This paper explores the impact of emotions upon hospitality employees’ evaluation of their experiences while working in the UK. The empirical research focussed on hospitality employees’ emotions and perceptions about the host country in the different phases of migration. Further, migrants’ adjustment capacities and emotional responses in challenging situations were analysed. In 2011, 78 semi-structured interviews were conducted with Hungarians who had post-accession working experience in the hospitality industry in London, UK. Results suggest that migrant hospitality employees’ emotional responses related to the mismatch between anticipated and lived experiences have a key role in social interactions and on their working efficiency. The practical implications of this study are for recruiting agencies and hospitality industry employers on how to alleviate migrant workers’ emotional difficulties and how to enhance their working efficiency.

Hand hygiene practice in motherland of semmelweis

The hand disinfection is the most important part of prevention in healthcare associated infections. This, and one of the WHO guidances (Global Patient Safety Challange) created our test in a Hungarian hospital where we measure the hand hygiene compliance, before and after training. We used three different methods for measurements: microbiological sampling from healthcare workers hands, inspection of the hand hygiene technique, reduction measure of the disinfectant amount.

Quantitative impact of direct, personal feedback on hand hygiene technique

This study investigated the effectiveness of targeting hand hygiene technique using a new training device that provides objective, personal and quantitative feedback. One hundred and thirty-six healthcare workers in three Hungarian hospitals participated in a repetitive hand hygiene technique assessment study. Ultraviolet (UV)-labelled hand rub was used at each event, and digital images of the hands were subsequently taken under UV light. Immediate objective visual feedback was given to participants, showing missed areas on their hands. The rate of inadequate hand rubbing reduced from 50% to 15% (P < 0.001). However, maintenance of this reduced rate is likely to require continuous use of the electronic equipment.