Consensus recommendations on the prevention and management of surgical site infections (SSI) in the Philippine setting

@#<p style="text-align: justify;">Over the years, strategies in the prevention and management of surgical site infections (SSI) of patients in the Philippines have never been standardized. Several guidelines released by international foreign bodies have been found to be either conflicting or inappropriate for adaptation in the local context.To address these issues, the Philippine College of Surgeons (PCS),in collaboration with the Philippine Hospital Infection Control Society (PHICS), Philippine Hospital Infection Control Nurses Association (PHICNA) and Operating Room Nurses Association of the Philippines, Inc. (ORNAP), initiated the development and adaptation of country-specific SSI guidelines in 2017. The new recommendations are based on the latest clinical practice guidelines released for the past five years and consensus by a panel of experts in the Philippines, through the assistance of a guideline development team engaged by PCS. Thirty-six (36) recommendations on different aspects of care were outlined. Implementation of an SSI surveillance program was also advised for health facilities.The new guidelines are intended to serve as the local benchmark for the prevention and management of SSI for surgeons and practitioners,taking into account their situation and experience in the Philippines. It is expected to improve the standard of care provided by health facilities and contribute to the reduction of the prevalence and incidence of SSI in the country</p>

An evaluation of the Medical Pool Placement and Utilization Program (MedPool PUP) of the Philippine Department of Health

OBJECTIVE: This study evaluates the effectiveness of the Medical Pool Placement and Utilization Program (MedPool PUP) of the Philippine Department of Health whose purpose is to augment the medical resource requirements of public hospitals.  METHOD: Mix method was used to gather data through a questionnaire survey sent by fax, email or postal mail. Beneficiary hospitals were selected and key informant interviews done to both the executive officers and the deployed medical pool physicians to further gain insights on the results of the survey.  RESULTS: A total of 75 public hospitals were beneficiaries of the MedPool PUP covering all hospital categories- Level 1, Level 2, Level 3 and Level 4 hospitals. Fifty-one hospitals responded to the survey. Justifications for requesting deployment include: a) need for additional physicians (43%), b) need for a medical specialist of a given clinical specialty (23%), c) need for accredited specialists to maintain a residency training accreditation (23%), d) need for substitute doctors while their regular doctors undergo training (8%) and e) need for a trainer of a specific medical specialty (2%). Almost all deployed doctors have finished a residency training program belonging to a medical specialty. Although the work descriptions covering the deployment of the MedPool doctors are focused on providing medical care to the patients, the contributions to the achievements of the hospitals s by the MedPool doctors go beyond these. They are also involved in medical training of other doctors, many are also given additional assignments in clinical administration and researches. Some also get involved in outreach services. Many exceptional contributions to the hospitals were given by the deployed doctors. In 12 out of 16 (75%) hospitals visited, the doctors deployed were able to introduce new clinical services such as heart surgery, ophthalmology, renal transplant, hepato-biliary surgery, automation of clinical laboratory procedures, among others. This is the primary basis for this study to conclude that the MedPool PUP is effective. CONCLUSION: The effectiveness of the MedPool PUP has been shown to go beyond augmenting the medical staffs of public hospitals in providing services. The doctors it deployed have contributed significantly in improving the clinical services by introducing new specialty services and enhancing existing ones. It is recommended that MedPool PUP be continued and strengthened to fill the needs of public hospitals based on a system of priorities. 

Gradients in wealth quintile and access to maternal care services: Reanalysis of data from the Philippines National and Demographic and Health Survey 2013

OBJECTIVE: To quantify the magnitude of difference in access to selected maternal care services among Filipino women who belong to different income groups.METHODS: Point and interval estimates of the inter-quintile difference in access to a selected maternal care services (family planning; antenatal care; facility-based delivery; skilled birth attendance; and postnatal care) were constructed using weighed coverage data from the Philippines National Demographic and Household Survey 2013. RESULTS: There is a generally increasing trend in inter-quintile differences in coverage from the lowest to the highest income quintile group (Q1-Q4 > Q1-Q3 > Q1-Q5 > Q1-Q2 > Q2-Q5 > Q2-Q4 > Q3-Q5 > Q3-Q4 > Q2-Q4 > Q4-Q5). Differences in maternal care access between wealth groups ranged from less than 1% for antenatal care (DQ2-Q3 - 0.4% [95% Cl - 1.9% to 1.1%]) to as much as 60% for facility-based delivery (DQ1-Q5 -58.4% [95% Cl - 61.2% to -55.6%]).  Such differences persist even between the two highest quintiles (facility based delivery DQ4-Q5 - 9.7% [95% Cl - 12.5% to -6.9%]).CONCLUSION: Gradients in access to selected maternal care services exist among Filipino women who belong to different wealth quintiles. The call for stakeholders, therefore, is to intensify efforts to narrow such gaps because, within and across communities, we affirm that no women "should die in the course of the normal process of reproduction" and no families must suffer the devastating consequences of such an occurrence. 

Factors contributing to the delay in the initiation of treatment of patients enrolled in the TB DOTS program in a highly-urbanized city in the Philippines

OBJECTIVE: The main objective of the study is to determine the factors which contribute to the delay in the initiation of treatment of TB patients enrolled in the TB control program in a highly urbanized city in the Philippines.METHODS: A descriptive, cross-sectional study was conducted in 14 health centers in the city; from which the proportion of TB patients who experienced delay in the initiation of treatment (>1 day after diagnosis) was obtained through records review. The health system and patient factors which contributed to the patients' delay were determined through face-to-face interviews. The information obtained was analyzed with supplemental information from interviews with selected health workers in the tuberculosis control program of the city. RESULTS: These showed that 20.95% of the TB patients enrolled in the TB control program of the city experienced delay in the initiation of treatment. They experienced a mean delay of 9.48 days. The health system and patient factors which affected the patients the most were the referral system (24.5%) and conflict between treatment and work or household responsibilities (22.4%), respectively.CONCLUSION: These existing delay imply he need to implement interventions directed to improving current measures to control TB in the country.

Health information privacy in the Philippines: Trends and challenges in policy and practice

CONTEXT: Evolution of the scope and context of privacy and confidentiality brought about by use of information and communications technology in healthcare. OBJECTIVE: To review the legal, professional and ethical landscape of health information privacy in the Philippines. METHODOLOGY: Systematic review of literature and policy frameworks. RESULTS: Philippine laws jurisprudence recognize and protect privacy of health information as a general rule; impose upon individual practitioners and institutions the obligation to uphold such right; and may apply in both the traditional and eHealth milieu. There is no existing policy framework that addresses issues relating to [a] access to health information by non-health professionals, [b] use of health information for non-health purposes, and [c] rules relating to collection, storage and utilization of electronically-derived or -stored information. A privacy culture, on either the provider's or client's side, is also lacking in the country. CONCLUSION: Technological developments have outpaced policy and practice. There is a need to unify the patchwork of regulations governing the privacy of health information; advocate for a privacy culture among professionals and patients alike; fortify the evidence base on patient and provider perceptions of privacy; and develop and improve standards and systems to promote health information privacy at the individual and institutional levels. 

Health human resource needs of government hospitals in the Philippines

OBJECTIVE: To describe the health human resource needs of government hospitals in the Philippines.METHODS: All 733 licensed government hospitals were included in a survey except 75 of them which the Department of Health have been deploying medical specialists and medical officers to augment the needs of these 75 hospitals.RESULTS: A total of 96 government hospitals responded to the self-administered survey questionnaire sent to them. Analysis showed 20% to 29% among the level 2, level 3 and level 4 hospital responders have their Chief of Hospitals still without a master's education degree as required by the Department of Health. Fifty-nine percent (59%) of all hospitals do not have nearby medical educational institutions while 28% of them do not have nearby nursing educational institutions.The greatest need, however, is in the adequacy of the number of doctors and nurses. The minimum required number of doctors and nurses has not been met based on the staffing pattern standards set by the Department of Health for the different hospital categories and by the required 40 work hours per week set for civil servants.CONCLUSION: The decline in the adequate number of health human resources noted to start when local public hospitals were devolved from the national government to the local government units in 1991. With this inadequacy, one cannot expect these public hospitals to provide even fair quality of hospital care; thus, the need for the national government to intervene.

Contribution of private sector hospitals in the detection and treatment of tuberculosis

OBJECTIVE: To describe the outcomes of implementation of a public-private mix Directly Observed Treatment Short-course (DOTS) strategy for tuberculosis (TB) prevention and control in a highly-urbanized city in the Philippines.METHODS: Data on case-finding and case-holding activities of two facilities engaged as part of the public-private mix DOTS (PPMD) from 2006-2013 were abstracted from reports submitted to, and validated by, the city National Tuberculosis Program (NTP) coordinator. Additionality to local case-finding efforts was measured through case detection and case notification rates, while effectiveness of case-holding mechanisms was measured through determination of treatment outcomes of new smear-positive cases.RESULTS: A total of 314 cases of tuberculosis (average of 40 cases annually) were reported by the two facilities for the period 2006 to 2013. Most of the discovered cases of TB were new cases (81%). Fifty nine percent (59%) were bacteriologically confirmed TB cases through sputum microscopy. New smear-positive cases of TB increased the local case detection rate by an average of four percentage points for the observation period. In absolute terms, this translates to an addition by private institutions of five new smear-positive cases per 100,000 population to those reported by public facilities from 2006 to 2013. Proportionately, the two private hospitals contributed an average of 5% to the total new smear-positive cases detected in the city from 2006 to 2013. In terms of treatment outcome of the cohort of smear positive patients admitted from 2006 to 2012, seven out of ten cases were cured (mean cure rate of 70%), and nearly all (90%) were successfully treated. Over the observation period, the cure rate among new smear-positive cases increased from 50% in 2006 to 86% in 2012, and was comparable to the national benchmark of 85% in 2011 and 2012. On the other hand, treatment success rates were highly variable, but have remained above the 80% mark starting 2007.CONCLUSION: Engaging private healthcare providers to practice DOTS as the main strategy for TB prevention and control has had some modest impact on local NTP accomplishments. Current efforts need to be scaled up to include a wider range of private practitioners. A triple win situation for the patient, the private practitioner and NTP should be the end goal of all such efforts.

Lessons from implementing a mass vaccination campaign in a highly-urbanized city in the Philippines

OBJECTIVE: To document the the processes and outcomes of a measles-rubella supplemental immunization activity implemented in Pasay City, Philippines.METHODS: Review of proceedings of meetings, memoranda, manuals, and reports. Interviews with field monitors, supervisors and vaccination teams, and key members of the project technical group.RESULTS: A total of 60,685 children age 9 to >72 months were reached during the campaign, representing 75% of the estimated eligible population. On the other hand, 1,453 children were unimmunized because of [a] scheduled or documented prior immunization with a measles-containing vaccine (n = 1,154), and [b] refusal of parents due to religious or cultural reasons (n = 237). The successful completion of the measles-rubella supplemental immunization activity (MR-SIA) was grounded on appropriate timing of project implementation; a clearly identified problem; the existence of linkages between stakeholders at the national and sub-national level; strong local chief executive support; the availability of resources to support project implementation; a clear policy statement; and implementation policy guided by an organizational structure and tailored project plans.CONCLUSION: In this paper, we have shown that the success of public health programs and projects rely not only on technical soundness of the intervention or adequate resource mobilization, but require wide grassroots support that is guided by an able leadership and clear policy.

The epidemiology of child drowning injury in the Philippines

OBJECTIVE: This paper aims to quantify the magnitude of drowning injury related deaths among children in the Philippines, to form the evidence base for national policies for drowning prevention. METHOD: Retrospective review and analysis of published data on child drowning injury (1963-2003) in the Philippines. RESULTS: At least 3,000 Filipinos of all ages die annually from drowning injury (0.43% of deaths), more than a third of which (35.6%) are children under 14 years. Mortality is highest among children ages 1-4 years compared to other age groups [Mortality Rate (MR) 6.4 vs. 3.8 per 100,000]. Child drowning mortality rates have remained largely unchanged from 1963 to 2003, belying its under recognition as a public health priority. There is also a paucity of local data to adequately describe the epidemiology of child drowning in the Philippines. CONCLUSION: In the Philippines, drowning deaths disproportionately account for 5% of deaths for 1-4 year olds. Drowning prevention could be a 'low-hanging fruit' in the quest to meet the Millenium Development Goals (MDG's) set for 2015. There is a need for better surveillance of child drowning deaths to guide policy formulation for its prevention and treatment in the Philippines.

The sinking of the MV Doña Paz - A critique on maritime disaster preparedness in the Philippines: An analysis of the event

OBJECTIVE: To discuss the various factors contributory to the fatalities that resulted from the sinking of the MV Dona Paz. METHODS: Review of the pre-disaster, disaster and post-disaster events surrounding the sinking of the MV Dona Paz, as well as the subsequent response by the government and responsible agencies to the disaster. RESULTS: The Sinking of the MV Dona Paz, along with the loss of more than 4,000 precious lives, is but a footnote in the long litany of misfortunes plaguing the Philippine maritime industry. A closer look into the events and circumstances leading to this tragedy demonstrates a confluence of equipment and system inadequacy on one hand and human error and lack of preparedness on the other. CONCLUSION: Multiple factors account for the occurence of this tragedy, along with other maritime disaster incidents dotting the long maritime history of the Philippines. A cursory analysis of these factors may lead to recommendations that can prevent similar occurrences in the future and mitigate damage to property and loss of life. The policy implications of these findings are discussed in a subsequent paper.

The sinking of the MV Doña Paz - A critique on maritime disaster preparedness in the Philippines: Policy implications

OBJECTIVE: To discuss the various factors contributory to maritime disaster preparedness in the Philippines, in the context of the sinking of the MV Dona Paz and formulate recommendations to address these factors. METHOD: Review of the state of maritime preparedness in the pre-disaster setting and the post-disaster response following the sinking of the MV Dona Paz by the government and responsible agencies. A scrutiny of the state of preparedness of concerned agencies and subsequent response to the disaster was conducted with the objective of formulating recommendations which may lead to prevention and mitigate loss of lives. RESULTS: Multiple factors accounted for the occurrence of this tragedy. These factors include an inherent risk due to the geography of shipping industry and its labor force. Economic conditions prevent both the industry and government agencies from upgrading vessels and communications equipment. Lack of enforcement of existing regulations allows vessels to sail overloaded and at times manned by less-than-qualified crew. Delayed response and deficient post-disaster medical response may have led to a disproportionately high mortality. CONCLUSIONS: The systems inadequacies of the Philippine maritime disaster response mechanism are highlighted by the Dona Paz tragedy. Many of the factors contributing to the disproportionately high incidence of maritime disasters in the Philippines and the resulting loss of limb may be preventable. Recommendations on regulation and enforcement, disaster preparedness, search and rescue, and medical response are discussed.