Types Of Health Care Personnel Research Articles

Current State and Trends of Gender Differences Among Health Care Personnel in Taiwan

<p>本研究旨在探討臺臺灣醫事人員的性別、年齡結構近況，並探討其未來變化趨勢。資料來源為2014年至2021年衛生福利部統計處公布之醫事人員登記資料。結果發現16類師級人員中，護理師女性占比最高(96.17%)，其次為營養師(90.57%)，最低的三類醫事人員則為中醫師(32.77%)、牙醫師(30.09%)、西醫師(21.16%)。上述五類醫事人員的男女比例在這8年都有逐漸平衡的趨勢，惟推估護理師約需184.5年才能達到男女人數相當，醫師則約需30~40年。此年數可作為職系性別平等的一項參考指標，提醒家庭、學校、社會加強男女醫事人員投入醫療工作的自由平等。</p> <p> </p><p> This study explored the gender and age distributions of health care personnel in Taiwan at present and in the future. Data from the Ministry of Health and Welfare for the 2014–2021 period were retrieved from a database containing the registration information of health care personnel. This study discovered that among 16 types of health care personnel, nurses and nutritionists had the highest and second highest proportions of women, respectively (nurses, 96.17%; nutritionists, 90.57%), whereas traditional Chinese medicine (TCM) physicians, dentists, and physicians had the lowest, second lowest, and third lowest proportions of women, respectively (TCM physicians, 32.77%; dentists, 30.09%; physicians, 21.16%). From 2014 to 2021, the gender distribution for these five types of health care personnel gradually became more balanced. However, the time required to achieve gender parity (indicated by the male-to-female ratio) was estimated to be approximately 184.5 years for nurses and approximately 30–40 years for physicians. These numbers of year can serve as references on the state of gender equality in health care professional fields; they also remind families, schools, and the societies to strengthen the gender freedom and equality for male and female to devote in health care professionals.</p> <p> </p>

Risk factors for transmission of carbapenem-resistant Enterobacterales to healthcare personnel gloves and gowns in the USA

Hospitals are sources for acquisition of carbapenem-resistant Entero-bacterales (CRE), and it is believed that the contamination of healthcare personnel (HCP) hands and clothing play a major role in patient-to-patient transmission of antibiotic-resistant bacteria. The aim of this study was to determine which HCP types, HCP-patient interactions, and patient characteristics are associated with greater transmission of CRE to HCP gloves and gowns in the hospital. This was a prospective observational cohort study that enrolled patients with recent surveillance or clinical cultures positive for CRE at five hospitals in four states in the USA. HCP gloves and gown were cultured after patient care. Samples were also obtained from patients' stool, perianal area, and skin of the chest and arm to assess bacterial burden. Among 313 CRE-colonized patients and 3070 glove and gown cultures obtained after patient care, HCP gloves and gowns were found to be contaminated with CRE 7.9% and 4.3% of the time, respectively. Contamination of either gloves or gowns occurred in 10.0% of interactions. Contamination was highest (15.3%) among respiratory therapists (odds ratio: 3.79; 95% confidence interval: 1.61-8.94) and when any HCP touched the patient (1.52; 1.10-2.12). Associations were also found between CRE transmission to HCP gloves or gown and: being in the intensive care unit, having a positive clinical culture, and increasing bacterial burden on the patient. CRE transmission to HCP gloves and gown occurred frequently. These findings may inform evidence-based policies about what situations and for which patients contact precautions are most important.

High-Risk Interactions for Transmission of CRE to Health Worker Gloves or Gown: A Multicenter Cohort Study

Background: Carbapenem-resistant Enterobacteriaceae (CRE) are a serious threat to public health due to high associated morbidity and mortality. Healthcare personnel (HCP) gloves and gowns are frequently contaminated with antibiotic-resistant bacteria, including CRE. We aimed to identify patients more likely to transmit CRE to HCP gloves or gowns and HCP types and interactions more likely to lead to glove or gown contamination. Methods:Between January 2016 and August 2018, patients with a clinical or surveillance culture positive for CRE in the preceding 7 days were enrolled at 5 hospitals in California, Maryland, New York, and Pennsylvania. Ten HCP–patient interactions were observed for each patient and were recorded by research staff. Following patient care, but prior to doffing, the gloves and gown of each HCP were sampled for the presence of CRE. Results: We enrolled 313 CRE-colonized patients, and we observed 3,070 HCP interactions. CRE was transmitted to HCP gloves in 242 of 3,070 observations (7.9%) and to gowns in 132 of 3,070 observations (4.3%). Transmission to either gloves or gown occurred in 308 of 3,070 interactions observed (10%). The most frequently identified organism was Klebsiella pneumoniae (n = 171, 53.2%), followed by Enterobacter cloacae (n = 36, 11.2%), and Escherichia coli (n = 33, 10.3%). Patients in the intensive care unit (n = 177, 56.5%) were more likely to transmit CRE to HCP gloves or gown (OR, 1.65; 95% CI, 1.03–2.64) compared to those not in an ICU and adjusted for HCP type. The odds of CRE transmission increased with the number of different items touched near the patient (OR, 1.32; 95% CI, 1.21–1.44) and with the number of different items touched in the environment (OR, 1.13; 95% CI, 1.06–1.21). Respiratory therapists had the highest rates of transmission to gloves and gown (OR, 3.79; 95% CI, 1.61–8.94), followed by physical therapists and occupational therapists (OR, 2.82; 95% CI, 1.01–8.32) when compared to HCP in the “other” category. Manipulating the rectal tube (OR, 3.03; 95% CI, 1.53–6.04), providing wound care (OR, 2.81; 95% CI, 1.73–4.59), and touching the endotracheal tube (OR, 2.79; 95% CI, 1.86–4.19) were the interactions most strongly associated with CRE transmission compared to not touching these items and adjusted for HCP type. Conclusions: Transmission of CRE to HCP gloves and gowns occurs frequently. We identified interactions and HCP types that were particularly high risk for transmission. Infection control programs may wish to target infection prevention resources and education toward these high-risk professions and interactions.Funding: This work was supported by the CDC Prevention Epicenter Program (U43CK000450-01) and the NIH National Institute of Allergy and Infectious Diseases (R01 AI121146-01).Disclosures: None

Evaluation of Care Interactions Between Healthcare Personnel and Residents in Nursing Homes Across the United States

Background: Certain nursing home (NH) resident care tasks have a higher risk for multidrug-resistant organisms (MDRO) transfer to healthcare personnel (HCP), which can result in transmission to residents if HCPs fail to perform recommended infection prevention practices. However, data on HCP-resident interactions are limited and do not account for intrafacility practice variation. Understanding differences in interactions, by HCP role and unit, is important for informing MDRO prevention strategies in NHs. Methods: In 2019, we conducted serial intercept interviews; each HCP was interviewed 6–7 times for the duration of a unit’s dayshift at 20 NHs in 7 states. The next day, staff on a second unit within the facility were interviewed during the dayshift. HCP on 38 units were interviewed to identify healthcare personnel (HCP)–resident care patterns. All unit staff were eligible for interviews, including certified nursing assistants (CNAs), nurses, physical or occupational therapists, physicians, midlevel practitioners, and respiratory therapists. HCP were asked to list which residents they had cared for (within resident rooms or common areas) since the prior interview. Respondents selected from 14 care tasks. We classified units into 1 of 4 types: long-term, mixed, short stay or rehabilitation, or ventilator or skilled nursing. Interactions were classified based on the risk of HCP contamination after task performance. We compared proportions of interactions associated with each HCP role and performed clustered linear regression to determine the effect of unit type and HCP role on the number of unique task types performed per interaction. Results: Intercept-interviews described 7,050 interactions and 13,843 care tasks. Except in ventilator or skilled nursing units, CNAs have the greatest proportion of care interactions (interfacility range, 50%–60%) (Fig. 1). In ventilator and skilled nursing units, interactions are evenly shared between CNAs and nurses (43% and 47%, respectively). On average, CNAs in ventilator and skilled nursing units perform the most unique task types (2.5 task types per interaction, Fig. 2) compared to other unit types (P < .05). Compared to CNAs, most other HCP types had significantly fewer task types (0.6–1.4 task types per interaction, P < .001). Across all facilities, 45.6% of interactions included tasks that were higher-risk for HCP contamination (eg, transferring, wound and device care, Fig. 3). Conclusions: Focusing infection prevention education efforts on CNAs may be most efficient for preventing MDRO transmission within NH because CNAs have the most HCP–resident interactions and complete more tasks per visit. Studies of HCP-resident interactions are critical to improving understanding of transmission mechanisms as well as target MDRO prevention interventions.Funding: Centers for Disease Control and Prevention (grant no. U01CK000555-01-00)Disclosures: Scott Fridkin, consulting fee, vaccine industry (spouse)

Influenza Vaccination of Healthcare Personnel by Work Setting and Occupation-U.S., 2014.

Routine influenza vaccination of healthcare personnel (HCP) can reduce influenza-related illness and its potentially serious consequences among HCP and their patients. Influenza vaccination has been routinely recommended for HCP since 1984. Data from the 2013 and 2014 National Health Interview Survey were analyzed in 2015. Kaplan-Meier survival estimated the cumulative proportion of HCP reporting 2013-2014 season influenza vaccination. Vaccination coverage by work setting and occupation were assessed. Multivariable logistic regression and predictive marginal analyses identified factors independently associated with vaccination among HCP. Influenza vaccination coverage was 64.9% among HCP aged ≥18 years (95% CI=60.5%, 69.3%), which was significantly higher compared with non-HCP among the same age group (41.0%, 95% CI=39.8%, 42.1%) (p<0.05). Vaccination coverage was higher among physicians (82.3%) and nurses (77.5%) than other types of HCP (range, 50.2%-65.6%). Coverage was higher among HCP working in hospitals (76.9%) versus other settings (range, 53.9%-60.2%). Characteristics independently associated with an increased likelihood of vaccination among HCP were older age, higher education, having more physician contacts, and having health insurance. Having never been married was independently associated with decreased likelihood of vaccination among HCP. Influenza vaccination coverage was higher among HCP than non-HCP, but still below the national target of 90%. Vaccination coverage varied widely by occupation type, work settings, and demographic characteristics. Evidence-based interventions, such as making vaccine available at no cost in the workplace and active promotion of vaccination, are needed to increase influenza vaccination among HCP in all healthcare settings.

Blind Insertion of Feeding Tubes in Intensive Care Units: A National Survey

Although most critically ill patients experience at least 1 blind insertion of a feeding tube during their stay in an intensive care unit, little is known about the types of health care personnel who perform these insertions or about methods used to determine proper positioning of the tubes. To describe results from a national survey of critical care nurses about feeding tube practices in their adult intensive care units. The questions asked included who performs blind insertions of feeding tubes and what methods are used to determine if the tubes are properly positioned. Data were collected from members of the American Association of Critical-Care Nurses via pencil-and-paper and online surveys. Results from both forms were combined for data analysis and were compared with practice recommendations of national-level organizations. A total of 2298 responses were obtained. Physicians perform more blind insertions of styleted feeding tubes than do nurses; in contrast, nurses place more nonstyleted tubes. Radiographic confirmation of correct position is mandated more often for blindly inserted styleted tubes (92.3%) than for nonstyleted tubes (57.5%). The 3 most commonly used bedside methods to determine tube location are auscultation for air injected via the tube, appearance of feeding tube aspirate, and observation for indications of respiratory distress. Recommendations from multiple national-level organizations to obtain radiographic confirmation that each blindly inserted feeding tube is correctly positioned before the first use of the tube are not adequately implemented. Auscultation is widely used despite recommendations to the contrary.

Healthcare Personnel Perceptions of Hand Hygiene Monitoring Technology

To assess healthcare personnel (HCP) perceptions regarding implementation of sensor-based electronic systems for automated hand hygiene adherence monitoring. Using a mixed-methods approach, structured focus groups were designed to elicit quantitative and qualitative responses on familiarity, comfort level, and perceived impact of sensor-based hand hygiene adherence monitoring. A university hospital, a Veterans Affairs hospital, and a community hospital in the Midwest. Focus groups were homogenous by HCP type, with separate groups held for leadership, midlevel management, and frontline personnel at each hospital. Overall, 89 HCP participated in 10 focus groups. Levels of familiarity and comfort with electronic oversight technology varied by HCP type; when compared with frontline HCP, those in leadership positions were significantly more familiar with ([Formula: see text]) and more comfortable with ([Formula: see text]) the technology. The most common concerns cited by participants across groups included lack of accuracy in the data produced, such as the inability of the technology to assess the situational context of hand hygiene opportunities, and the potential punitive use of data produced. Across groups, HCP had decreased tolerance for electronic collection of spatial-temporal data, describing such oversight as Big Brother. While substantial concerns were expressed by all types of HCP, participants' recommendations for effective implementation of electronic oversight technologies for hand hygiene monitoring included addressing accuracy issues before implementation and transparent communication with frontline HCP about the intended use of the data.

Healthcare personnel resource burden related to in-clinic follow-up of cardiovascular implantable electronic devices: a European Heart Rhythm Association and Eucomed joint survey

A pilot European survey was conducted to assess the cumulative time spent by healthcare personnel for in-office follow-up of cardiac implantable electrical devices (CIEDs), including cardiac pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy (CRT) devices. Resource use data were collected during a session of in-clinic follow-up. Among 407 visits, 93% were scheduled and 7% unscheduled. Visit duration (total cumulative time) lasted a mean of 27 min for scheduled visits, and was ∼30% longer for unscheduled visits. Independent determinants of visit duration were: unscheduled visit (+7.6 min, P = 0.01), the need for device reprogramming (+7.5 min, P < 0.001), and the type of device checked, with CRT devices needing 9.1 and 6.6 more minutes than single- (P < 0.001) and dual-chamber devices (P = 0.002), respectively. Most visits involved two different types of healthcare personnel (239 of 407, 59%), simultaneously. The most frequent combination was the involvement of both a cardiologist and a nurse (216 of 407 visits with both of them only, and 65 additional visits with also an internal technician, an external technician, or both). Overall, an external technician was involved in 18% of visits. In 'real-world' practice, the follow-up of CIEDs nowadays requires important resources in terms of time dedicated by specialized personnel, corresponding to cardiologists, nurses, internal technicians, and external, industry-employed technicians. These observations should be the basis for addressing clinical, organizational, financial, and policy initiatives targeted to optimize follow-up procedures in order to face the increase in the number of patients treated with CIEDs expected for the next years.

Understanding and attitudes towards patient safety concepts in obstetrics

Objectives To measure attitudes of health personnel towards patient safety, and to determine how the concept of patient safety varies between maternal health centers and types of health care personnel. Methods A cross-sectional descriptive study included 35 primary heath centers in three governorates in Egypt. The subjects comprised all managers, physicians, nurses, pharmacists, and technicians. Results The overall mean for all questions and respondents was 3.89 ± 0.59 (scale 1–5). The safety climate mean was 3.64 ± 0.67. The percentage of respondents viewing the safety climate as positive was 36%. Only 7% of respondents had received feedback after referral of a case of severe pre-eclampsia. Conclusion The concept of patient safety in the centers studied is not as strong as desirable for the provision of reliable health care. The culture is one of a penalizing nature with suppressed error reporting, lack of proper communication, and feedback failure.

A specialized wound-healing center concept: importance of a multidisciplinary department structure and surgical treatment facilities in the treatment of chronic wounds

The optimal way to improve prophylaxis and treatment of patients with problem wounds is to create an independent multidisciplinary wound-healing center that focuses on all types of problem wounds and has an outpatient clinic, as well as an inpatient ward. An integrated wound-healing department concept should be a standard in wound healing. A department structure containing both an outpatient clinic and inpatient ward, employing full-time personnel, allows the development of all features vital for optimal wound treatment. These are standardized treatment plans, access to relevant objective investigative methods and surgical approaches, a higher degree of continuity in treatment, increased patient satisfaction, greater potential for education and training, and improved possibilities for basic and clinical research in healing and care. The Copenhagen Wound Healing Center, Copenhagen, Denmark, and the University Center of Wound Healing, Odense, Denmark, are examples of this type of department. Initial results have demonstrated that these concept centers have resulted in improved rates of healing in patients with leg ulcers and have decreased the necessity for major amputations. The structure of the centers also offers greater opportunities for both basic and clinical research and provides expert education for all types of health care personnel. The centers were created in an attempt to establish an expert function in wound healing that would be fully integrated into the Danish national health care system. This model may, with individual modifications, be applicable for both industrialized and developing countries. In case it is impossible to realize the model in its entirety, alternative center concepts should be considered.

Hard-to-Reach Providers: Targeted HIV Education by the National AIDS Education and Training Centers

A national system of AIDS Education and Training Centers (AETCs) has received federal funding since 1987 to provide education to health care personnel (HCP) about HIV infection. The purpose of this study is to describe how AETC program personnel define and recognize HCP who are hard to reach and educate about HIV and to clarify the issues that make providers hard to reach. Twenty-three semistructured telephone interviews were used to collect data from AETC faculty and staff. Respondents were asked to identify the types of HCP who are hard to reach and to discuss why they are hard to reach. Themes identified to establish which HCP are hard to reach include specific professional groups (especially physicians and dentists) as well as providers who treated less than 10 HIV-infected clients and some HIV-expert clinicians. Themes identified to establish why they are hard to reach include convenience, isolation, and attitudes. Analysis posits that hard-to-reach HCP fall into identifiable categories: "already know the information," "don't know they don't know the information," "don't think they need to know the information," or "don't want to know the information." Respondents also identified innovative ways to approach hard-to-reach providers.

Clerkship students' attitudes towards patients and health care personnel:Implications for medical Education

Background : The former shtdies and observations indicate that medical shtdents vary considerably in their attitudes towards patients and health care personnel. Objectives: To study the attihtde of clerkship students towards select£:d types of patient and selected types of health care personnel. Methods : A quantitative cross-sectional study was conducted among clerkship students. The subjects received a self­ administered questionnaire with a covering letter explaining the project and outlining terms and conditions for participation. Since twenty-one subjects did not return the questionnaire, data analysis was based on ill questionnaires. The items were 5-poinf Likert-type. The internal consistency of the items was 0.706. Factor analysis was used in order to load the individual attitudinal items into main factors. Results : There is a significant association between sex and attitudes towards medical personnel. Clerkship students showed a more positive attihtde towards acute illness than chronic illness. The clerkship students responded more positively towards the health personnel than towards the patients. The results are discussed in terms of the impact of clerkship students' attitudes on patients and health personnel. Some possible justifications for these findings are discussed. Conclusions : Developing key skills within the medical curriculum, especially communication and information technology skills are essential Key Words: medical students, ati1tvde, view, health care team, patients, iran

A new concept of a multidisciplinary wound healing center and a national expert function of wound healing.

An independent, multidisciplinary wound healing center in an accepted national expert function of wound healing is the optimal way to improve prophylaxis and treatment of patients with problem wounds. A clinical perspective analysis. An independent, multidisciplinary wound healing center focusing on all types of problem wounds, organized as a university hospital department, and integrated in an expert function in the national health care organization of Denmark. Patients with all types of problem wounds referred to and treated in the center during the first years of its existence provided a model for a new multidisciplinary structure for treatment of wound patients in the health care system. During the first 3 years of the fully functioning wound healing center, a total of 23 802 patient consultations were performed in the outpatient clinic, and 1014 patients with problem wounds were hospitalized in the inpatient ward. The surgical concept of the center has resulted in improved healing rates in patients with leg ulcers and decreased rates of major amputations. The outpatient function has resulted in a decrease in the number of patients transported in beds to the center. This structure provides better opportunities for basic and clinical research as well as for establishing expert education for all types of health care personnel. The center's structure has been the background for establishing an expert function in wound healing, allowing the wound healing area area to be fully integrated in the Danish National Health Care System. Overall, the concept and structure of the center have enhanced the knowledge and understanding of wound problems and increased the status of wound healing and patient care. Establishing multidisciplinary centers integrated into an accepted national expert function of wound healing is an optimal way to improve the clinical outcome of prophylaxis and treatment of all types of problem wounds. This model, with minor adjustments, may be applicable for both industrialized and developing countries.

Health care USA: understanding its organization and delivery

Care USA, Eighth Edition, offers students of health administration, public health, medicine, and related fields a wide-ranging overview of America's health care system. Combining historical perspective with analysis of current trends, this expanded edition charts the evolution of modern American health care, providing a complete examination of its organization and delivery while offering critical insight into the issues that the U.S. health system faces today. From a physician-dominated system to one defined by managed care and increasingly sophisticated technology, this essential text explains the transformation underway and the professional, political, social, and economic forces that guide it today and will in the future. Balanced in perspective and comprehensive in its coverage, Care USA, Eighth Edition, provides students with a clearly organized, straightforward illustration of the complex structures, relationships and processes of this rapidly growing industry, including thoroughly updated information throughout, on the progress and impact of the Affordable Care Act (ACA). The Eighth Edition has been thoroughly revised to reflect recent developments in this dynamic industry. The latest edition features: * A comprehensive overview of the complex and evolving U.S. health care system, plus revised data, material and analysis throughout. * Updated information on the progress and impact of the Affordable Care Act (ACA) * New information on the efforts of hospitals to reduce medical errors, such as the Institute for Care Improvement's 100,000 Lives Initiative * Update Department of Labor estimates of number and types of health care personnel. * Provide an historical overview of Medicare and Medicaid programs: definitions and history * Explain the role of Managed Care as the primary mode of US health insurance coverage * Updated long term care industry trends * A thoroughly revised chapter on Mental services including a new discussion of preventive behavioral services, and recent developments from the Freedom Commission on Mental Health

AMA's Role in Recognizing New Health Occupations

For more than a decade, voices from multiple sectors have decried the proliferation and fragmentation of allied health occupations. The American Medical Association has opposed the multiplication of new categories of allied health personnel when the need for them has not been demonstrated. At the same time, however, the AMA has contended that some new types of health care personnel are indeed necessary and desirable. Each new occupation that emerges cannot be dismissed summarily under the rubric of proliferation or fragmentation, for not all proliferation is unnecessary, nor is all fragmentation divisive. Some new occupations arise in response to needs generated by new technologies, new delivery modes, or newly developed bodies of knowledge. The AMA attempted to rationalize its process of recognizing emerging health occupations in 1970 when it adopted Guidelines for the Development of New Health Occupations , which contain criteria for recognizing new health occupations. Such recognition is for

AMA's role in recognizing new health occupations

For more than a decade, voices from multiple sectors have decried the proliferation and fragmentation of allied health occupations. The American Medical Association has opposed the multiplication of new categories of allied health personnel when the need for them has not been demonstrated. At the same time, however, the AMA has contended that some new types of health care personnel are indeed necessary and desirable. Each new occupation that emerges cannot be dismissed summarily under the rubric of proliferation or fragmentation, for not all proliferation is unnecessary, nor is all fragmentation divisive. Some new occupations arise in response to needs generated by new technologies, new delivery modes, or newly developed bodies of knowledge. The AMA attempted to rationalize its process of recognizing emerging health occupations in 1970 when it adopted<i>Guidelines for the Development of New Health Occupations</i>, which contain criteria for recognizing new health occupations. Such recognition is for