Testers' compliance to the quality standards of HIV rapid testing services in Primary Health Care Facilities in Makete District, Tanzania

Background: HIV rapid testing services is one among key interventions in the controlling of HIV/AIDS. Despite availability of quality standards, the quality of HIV rapid testing services remains questionable since non-laboratory testers are allowed to conduct testing while they are not specialized in providing testing services. Objective: To evaluate the compliance to the quality standards of HIV rapid testing services provided by non-laboratory testers in Makete District, Tanzania Methods: An explanatory descriptive study employing quantitative approach of data collection was used. An observation of 23 non-laboratory testers performing HIV rapid tests, observation of HIV testing points and documents review was done in 23 testing points to collect data. Data were analyzed using a programmed excel sheet and a three-point scale was used to determine the level of compliance to quality standards. Results: Analysis shows that out of 23 testing points visited, the level of compliance to quality standards was lower for 22 (95.6%) testing points and moderate in 1 (4.4%) testing point. None of the testing point was highly complied to quality standards for HIV rapid testing services. Conclusion: The quality of HIV rapid testing services provided by non-laboratory testers is below the established quality standards for HIV rapid testing services.

Factors affecting bypass of local health care facilities in a tertiary hospital: A key to utilization of primary health care services

Background@#Bypass, is a pattern of seeking health care outside the local community where primary health care facilities are not efficiently utilized. It is common practice for patients to go directly to secondary or tertiary health facilities for primary health concerns, causing heavy traffic at the higher level facilities and corresponding over-utilization of resources.@*Objective@#This study aimed to determine factors associated in the bypass of health care facilities among outpatient department patients and to identify health care facility factors perceived important among patients.@*Method@#The study employed self-administered questionnaire with the assistance of trained research assistants among patients who sought consult at the Baguio General Hospital and Medical Center Outpatient Department during the study period of August 2018 – October 2018. Respondents were asked about demographic characteristics, health insurance status, referral status, health care facility factors and answer the Personal Satisfaction Questionnaire 18 (PSQ 18) survey.@*Results@#The questionnaire survey included 251 patients. The total rate bypassing of local health care facilities was 37.8%. Pearson chi square test revealed that educational attainment was associated with increased bypass of health care facilities (p=0.013). Factors such as age, sex, civil status, employment status, monthly income and health insurance status were significantly associated with bypass. Availability of medical doctors was the most prevelant factor in choosing a health care facility in both bypassers (36%) and non bypassers (46%). PSQ 18 survey revealed that patients are generally satisfied on the availment of health services in both bypassers (mean 3.78) and non bypassers (mean 3.89). The subscales in communication, time spent with doctor and accessibility and convenience were scored highest while technical quality was scored lowest on both groups.@*Conclusion@#Bypass of local health care facilities is a major health concern. Travelling longer distances for health care imposes unnecessary shift of direct health care costs into indirect costs such as transport. Increasing awareness of available local health care facilities and services together with its improvement might help decrease bypass especially on patients with lower educational attainment. The referral system and network of health care providers should be reinforced for better health care service delivery, patient satisfaction and lower health care cost.

Research of Transparency Measurement Scale on Medicine Use Information in Primary Health Care Facilities / 医药导报

Objective To develop transparency measurement scale on medicine use information in primary health care facilities. Methods The dimensions and items of scale were determined through literature review and expert consultation. The scale was used to investigate 100 primary health care facilities in eastern, central and western regions. Correlation coefficient analysis, Cronbach's coefficient, and exploratory factor analysis were used to select items. Five dimensions and 20 items were selected for the final scale. Cronbach's coefficient was used to evaluate the reliability of the formal scale. Factor analysis was used for construct validity evaluation. Results Dimensions were measured, including service processes, organization and regulation for pharmacy administration, patients informing and education, medicine catalogue, and the economic burden of patients. The scale had good reliability since overall Cronbach coefficient was 0. 844. Factor analysis extracted five common factors, total explaining 89. 69% of the cumulative variance, and the item distribution in five common factors was completely consistent with formal scale, indicating good construct validity. Conclusion This scale had good reliability and validity as a measurement tool to evaluate the transparency level of primary health care facilities in China.

Evaluation of the Care Safety of Patients with Surgical Interventions from a High-Complexity Institution in Medellín, Colombia / Segurança da atenção dos pacientes com intervenções cirúrgicas de uma instituição de alto nível de complexidade em Medellín, Colômbia / Seguridad de la atención de los pacientes con intervenciones quirúrgicas de una institución de alto nivel de complejidad en Medellín, Colombia

Abstract Objective. This work sought to evaluate care safety of patients with surgical interventions in the area of general surgery in terms of administrative problems in caring, incidents, and adverse events. Methods. This was an observational-type prospective descriptive study that followed up patients intervened surgically by the general surgery group of a tier IV hospital unit in the city of Medellín. Results. The study evaluated 182 patients who received complete follow up during the care process in the institution; of these, 59 (32.4%) received unsafe care (10 incidents, 9 problems with quality, and 40 adverse events); the remaining 123 (67.6%) had safe care of which, 28 developed complications in spite of not having had flaws in the care process. Regarding the health professionals responsible for patient care, we found that 57.4% of the adverse events was the responsibility of the treating physician and the remaining 42.6% was the responsibility of the nursing staff. Conclusion. The prevalence of adverse surgical events in this study was above that found in literature. Management of nursing care focused on improving the healthcare system in the area of surgery could reduce substantially not only the occurrence of flaw in caring, but also the economic burden upon the healthcare system.

Resumo Objetivo. Avaliar a segurança na atenção dos pacientes com intervenções cirúrgicas na área de cirurgia geral em termos de problemas administrativos para a atenção, incidentes e eventos adversos. Métodos. Estudo descritivo prospectivo de tipo observacional que realizou seguimento a pacientes intervidos cirurgicamente pelo grupo de cirurgia geral de uma unidade hospitalar de quarto nível de complexidade da cidade de Medellín (Colômbia). Resultados. Se avaliaram 182 pacientes a quem se lhes realizou o seguimento completo durante processo de atenção na instituição, de estes 59 (32.4%) tiveram atenção insegura (10 incidentes, 9 problemas com a qualidade e 40 eventos adversos); os 123 restantes (67.6%), atenção segura, dos quais, 28 desenvolveram complicações a pesar de não haver tido falha no processo de atenção. Com relação ao profissional da saúde responsável da atenção dos pacientes, encontramos que 57.4% dos eventos adversos foi responsabilidade do médico tratante e 42.6% restante foi responsabilidade do pessoal de enfermagem. Conclusão. A prevalência de evento adverso cirúrgico neste estudo foi superior à encontrada na literatura. A gestão do cuidado de enfermagem enfocada à melhora do sistema de atenção na área de cirurgia poderia reduzir substancialmente não só a ocorrência da falha da atenção senão também a carga econômica que isto implica ao sistema de atenção em saúde.

Resumen Objetivo. Evaluar la seguridad en la atención de los pacientes con intervenciones quirúrgicas en el área de cirugía general en términos de problemas administrativos para la atención, incidentes y eventos adversos. Métodos. Estudio descriptivo prospectivo de tipo observacional que realizó seguimiento a pacientes intervenidos quirúrgicamente por el grupo de cirugía general de una unidad hospitalaria de cuarto nivel de complejidad de la ciudad de Medellín (Colombia). Resultados. Se evaluaron 182 pacientes a quienes se les realizó el seguimiento completo durante proceso de atención en la institución, de ellos 59 (32.4%) tuvieron atención insegura (10 incidentes, 9 problemas con la calidad y 40 eventos adversos); los 123 restantes (67.6%), atención segura, de los cuales, 28 desarrollaron complicaciones a pesar de no haber tenido falla en el proceso de atención. Con relación al profesional de la salud responsable de la atención de los pacientes, encontramos que el 57.4% de los eventos adversos fue responsabilidad del médico tratante y el 42.6% restante fue responsabilidad del personal de enfermería. Conclusión. La prevalencia de evento adverso quirúrgico en este estudio fue superior a la encontrada en la literatura. La gestión del cuidado de enfermería enfocada a la mejora del sistema de atención en el área de cirugía podría reducir sustancialmente no solo la ocurrencia de la falla de la atención sino también la carga económica que ello conlleva al sistema de atención en salud.

Health care seeking behaviour and expenditure pattern among Scrub Typhus patients attending a tertiary care hospital in Mysore city.

Background: Scrub typhus is one among the re-emerging infectious diseases throughout the world. Various studies conducted across India reveals that its public health importance is increasing. This study was conducted 1) To describe the socio-demographic and epidemiological profile of patients admitted with scrub typhus. 2) To assess the health care seeking behaviour of these patients. 3) To estimate the cost factors incurred in the current episode of illness. Methods: This prospective study was conducted from January to December 2013 among all lab confirmed cases of scrub typhus admitted to department of medicine and pediatrics of JSS Hospital, Mysore. The study subjects were interviewed with a pre-tested and structured questionnaire. Data regarding socio-demographic profile, epidemiological profile, disease outcome, health care seeking behaviour and cost factors incurred with current episode of illness were collected. Data entry and analysis were done with SPSS.v.22.0 using descriptive statistics like mean, standard deviations and inferential statistics like chi-square test. Results: Among 192 patients tested positive by Weil-Felix test and/or Immuno-Chromatographic Test (ICT) for scrub typhus majority 105 (54.7%) were males and were predominantly 135 (70.3 %) from rural areas. Mostly 172(89.6%) were unaware of any mite bite in the past. Majority 167 (87.0%) of them had visited atleast three Health Care Facilities (HCF) for treatment. The mean ± SD total duration of illness was 15.6 ± 4.1 days. Most 104 (54.2 %) of them had suffered from illness for 11-15 days. Majority 175 (91.1%) of them had recovered while 3 (1.6%) of them had succumbed to the condition. The median Total direct cost, total indirect cost and overall total cost were Rs. 7500 (7000-9500), Rs. 3000 (2500-3500) and Rs. 10500 (10000-13000) respectively. Most 104 (54.2%) of them spent from money borrowed from others, followed by 78 (40.6%) spent Out Of Pocket (OOP). Conclusion: People from rural areas, unskilled workers and children were affected predominantly. With timely diagnosis and appropriate treatment, significant morbidity and mortality could be prevented. Promotion of various public and private health insurance schemes among public would minimise the OOP expenditure and prevents debts.

Preliminary results of Lean method implementation in a pathology lab from Northeastern Brazil / Resultados preliminares da implantação da filosofia Lean em um laboratório de patologia

Oncologic care shows a growing and unmet demand, and requires the search for alternatives that allow the efficient use of limited resources, the building of autonomy, and the endeavour for continuous improvement of processes. In the present work, we present the implementation of Lean philosophy at a pathology laboratory of an oncology hospital. Among the preliminary results, we highlight the redefinition of the dynamics of the staff, and the physical reorganization of the area. Such important changes culminated in an expressive reduction of lead time, even with a significant increase in the monthly load of exams.

A assistência em oncologia possui uma demanda crescente e reprimida e requer a busca por alternativas que viabilizem o uso eficiente de recursos limitados, a construção de uma cultura laboral de autonomia dos colaboradores e a melhoria contínua dos processos. No presente trabalho, apresentamos a experiência de implantação da filosofia Lean em um laboratório de patologia especializado em oncologia. Entre os resultados preliminares, destacamos a redefinição da dinâmica de trabalho do corpo técnico e a reorganização física do laboratório. Tais alterações culminaram em uma expressiva redução do tempo total de execução, mesmo com o aumento significativo da carga mensal de exames.

A study to assess injection practices at different levels of health care facilities in district Gwalior, M.P., India.

Background: Injections are among the most commonly used medical procedure with an estimated 16 billion administrations each year worldwide. An overwhelming majority (90%-95%) of these injections are administered for curative purposes. Immunization accounts for around 3% of all injections. According to IPEN study, 03-06 billion injections administered annually in India. Estimates suggest that at least 50% of the world‟s injections administered each year are unsafe, particularly in developing countries. Most of the curative injections are unnecessary, ineffective or inappropriate. Purpose of current study was to assess and compare the knowledge, skill and practices at different levels of health care by health care providers regarding „Safe injection practices‟. Methods: The present study has been undertaken in the outdoor departments of government health care facilities of district Gwalior. The study was done at three places namely: Civil dispensaries, district hospital & medical college hospital - Madhav dispensary (Tertiary care hospital) from 1/7/12 - 28/2/13. Results: Only 10 (33.4%) of the providers were aware regarding blood borne injection borne by faulty injection practices, the same number knew about the reasons for wearing the gloves for both patient and personal safety. All the providers had 100% knowledge regarding safe injection practices but in practical many of the skills were lacking at all the health care facilities. Conclusion: There was a great disparity between knowledge and practice of health care provider regarding injection practices. They were quite aware about the transmission of diseases to them by the faulty injection practices but more efforts are needed to be done in this regard for the improvement for the use of safe injection practices in all the health care facilities.

Assessing the Diagnosis of Uncomplicated Malaria after Introduction of Malaria Rapid Diagnostic Tests.

Background: Morbidity and mortality resulting from malaria remains a serious obstacle for social and economic development. Accurate diagnosis and prompt treatment are therefore essential components of case management strategy. The aim of this study therefore was to examine the diagnostic procedure of uncomplicated malaria, and patients’ understanding and satisfaction of treatment in Community Health Care Facilities, three years after the deployment of Malaria Rapid Diagnostic Tests in Ghana. Methodology: A prospective and data collation was done randomly, by means of cluster and stratified multistage surveyat three government hospitals and three private pharmacies in Kumasi, Ghana, between July and September, 2013. Patients treated for uncomplicated malaria, while leaving the health facility, upon consent, were selected and requested to answer questionnaires which served as a source of data to address the objective of the study. Bivariate statistics from the SPSS v 19 was employed to predict the relationships between health institutions and mode of diagnosis, patients’ understanding and satisfaction of services. Results: Fifty-three (53) out of 65 patients responded. The study indicated presumptive diagnosis [44 (83.0%)] to be predominantly used over test-based diagnosis [9 (17.0%)]. The mean age of patients was 34.44±14.8 years (Range 17-66). Out of 52 patients who provided information on educational level, those with tertiary education were 24 (46.2%), secondary were 9 (17.3%), primary were 14 (26.9%) and no formal education were 14 (26.9%). Male patients were 25 (47.2%) and female 28 (52.8%). All 53 patients were given Artemisinin-based Combination Therapy at the various health facilities. Of 35 patients at hospitals/clinics, 15 (42.9%) rated “very good value” to explain their understanding and satisfaction of services provided, and of 18 patients from private pharmacies, 10 (55.6%) rated as “very good value”. Patients with tertiary education [14/25 (56.0%)] showed better understanding and satisfaction of services than those with no formal education [1/25 (4.0%)]. Not a single use of Malaria Rapid Diagnostic Tests for diagnosis was recorded. Conclusion: Diagnosis of malaria at the periphery of health systems is still mainly presumptive three years after deployment of the Malaria Rapid Diagnostic Test. Patients’ good rating on the diagnosis of uncomplicated malaria at private pharmacies, should be an advantage to introducing the Malaria Rapid Diagnostic Tests by healthcare practitioners.

Occupational health systems across selected public healthcare facilities in the Philippines

OBJECTIVE: The study aimed to collect data on the occupational health systems implemented across selected healthcare facilities in the Philippines, including: (1) governance system for occupational health and safety (OHS), (2) OHS information systems, (3) OHS financing systems, (4) technology and related systems for OHS, (5) the OHS workforce, and (6) the delivery of OHS services.METHODS: The data were collected through a walkthrough survey of the selected facilities as well as through the review of records and relevant documents found in the facilities.RESULTS: Governance and financing systems for OHS are not present in any of the facilities. 3 out of the 13 hospitals studied have employee medical records, accident/incident reports while none of the 19 facilities have Workplace Environment Monitoring Reports (WEM), implying the lack of OHS information systems. Due to the lack of a financing mechanism for occupational health services, there is a lack of OHS technology in the facilities which include but are not limited to the presence of an Immunization and Post-Exposure Program (present in 7 out of 13 hospitals and none of the 6 RHUs studied). 1 out of 19 facilities reported to having personnel delegated for OHS activities in their facility. Lastly, 1 out of 19 facilities have emergency treatment and medical facilities for their employees, indicating inadequate OHS service delivery in the facilities studied.CONCLUSIONS: Standards and laws such as the Philippine OHS Standards and Department of Health (DOH) Administrative Order (AO) 2012-0020 have provisions with regard to OHS in these facilities, and stricter implementation of these provisions could help in filling in the gaps in the OHS systems in these facilities. This will provide a healthy workforce capable of giving better healthcare services to the general population.

A Clinical and Epidemiological Study of Scabies in Korea: A Multicenter Prospective Study / 대한피부과학회지

BACKGROUND: Scabies is an old and common contagious skin disease. The incidence of scabies has decreased through the economic growth of Korea. However, recent outbreaks in medical facilities have created a suspicion that the infection of scabies is an emerging public health problem. OBJECTIVE: We evaluated the epidemiological and clinical aspects of patients diagnosed with scabies in Korea. This prospective study follows the retrospective study already performed by the same authors in 2011. METHODS: A multicenter, prospective study of scabies was performed at 25 hospitals in Korea. We included 914 patients who were diagnosed with scabies. Microscopic examination revealed scabies mites or eggs, or clinical improvement after treatment. Patients were asked to provide information on scabies, especially regarding the contact source, and the physicians examined them. RESULTS: Of the participants, 432 patients were men and 482 were women. Patients aged younger than 10 years and 60~69 years were the most common groups. Scabies more commonly affected patients during the fall and winter. Of the patients, 68.0% were thought to be infected at their homes, followed by nursing homes or hospitals (25.7%), and 31.6% through contact with other patients or, occasionally, staff members, including caregivers. CONCLUSION: We confirmed that scabies is an emerging threat in institutions, especially medical facilities. In addition, we suggest that public and in-hospital education is essential to minimize the problems associated with scabies.

Choice of health-care facility after introduction of free essential health services in Nepal

Background: Choice of health‑care services depends on patients’ characteristics and the features of health‑care facilities available. In Nepal, a significant proportion of health care is provided through the private sector, despite the introduction of free essential health care for all citizens in 2008. We sought to determine whether people chose private or public facilities in the first instance for acute health problems. We also assessed the reasons for their choice. Materials and Methods: A cross‑sectional survey was done by use of a questionnaire administered to 400 household heads in Jhapa district, Nepal. Results: 272 (68%) respondents sought treatment from public health‑care facilities in the first instance. On adjusted analysis, illiterate people were more likely to choose public facilities than people with higher secondary education (OR 5.47, P = 0.002). Similarly, lower‑caste and religious‑minority respondents were more likely to choose public facilities than disadvantaged janajati (OR 2.33, P = 0.01). Among respondents who used public facilities, 174 (64.0%) and 109 (40.0%) stated that that their choice was based on financial accessibility and physical accessibility, respectively. Among respondents who used private facilities, 65 (50.7%) and 54 (42.1%) said their choice was based on adequacy of resources/services and health‑care delivery, respectively. Conclusion: A substantial portion of respondents used public health‑care facilities in the first instance, mainly because of financial and physical accessibility rather than adequacy of resources or better health‑care delivery. These results may indicate a positive impact of removal of user fees for public health‑care facilities in Nepal, especially for impoverished people.

Epidemiological and Clinical Study of Scabies in Korea: Multicenter Retrospective Study / 대한피부과학회지

BACKGROUND: Scabies is one of the common skin diseases observed in developing countries. The incidence of scabies has decreased dramatically since the late 1980s in Korea. However, recent outbreaks in nursing homes or hospitals have been raising public health concerns. OBJECTIVE: We intended to evaluate the epidemiological and clinical aspects of patients diagnosed with scabies in Korea. In particular, we tried to investigate the changing trend of contact sources in our society. METHODS: A multi-center cross sectional study was performed at 25 hospitals in Korea. We included 1,539 patients who were diagnosed with scabies. These patients showed scabies mites or eggs under microscopic examination, or clinical improvement after treatment. Their medical records with information of contact sources were reviewed. RESULTS: Six hundred and ninety-three patients were males and 826 were females. Patients' age from 70 to 79 was the most common followed by patients below 10 years of age. More patients were found in the fall and winter months. 66.7% of patients were thought to be infected at their homes which were situated next to nursing homes or hospitals (23.1%). Place of infection could not be verified in 39.3% of patients. 25.8% of patients were suggested to be infected through contact with medical staff or patients from hospitals or nursing homes. CONCLUSION: We confirmed that the contact sources of scabies are changing in our society; nursing homes and hospitals are emerging sources of infection. The majority of patients are old or very young who are vulnerable to many diseases. Therefore, dermatologists should pay attention to new contact sources and appropriate care of patients.

A reorientação do ensino e da prática em enfermagem: implantação do Pró-Saúde em Mossoró, Brasil / La reorientación de la enseñanza y práctica de la enfermería: implantación del Pró-Saúde en Mossoró, Brasil / Teaching and nursing practices reorientation: Pro-Health implantation in Mossoró Brasil

A Faculdade de Enfermagem da Universidade do Estado do Rio Grande do Norte, através do Programa Nacional de Reorientação da Formação Profissional em Saúde (Pró-Saúde) visa articular ensino/serviço contribuindo na reflexão da formação em enfermagem em Mossoró, Rio Grande do Norte. Esta pesquisa objetivou conhecer a implantação e inserção do Pró-Saúde nas Unidades Básicas de Saúde do município de Mossoró, para entender como os enfermeiros se posicionam diante da articulação ensino/serviço. Foram realizadas entrevistas com seis profissionais que atuam nas Unidades de Saúde parceiras neste projeto. Os resultados demonstraram que estes trabalhadores detinham poucos conhecimentos acerca do Pró-Saúde. Essa falta de conhecimento, associada às dificuldades na integração ensino/serviço, não contribuía para a reflexão e reorientação das práticas de enfermagem. Portanto, é necessário repensar saberes e práticas, pactuando mudanças que contribuam com uma formação em saúde que estabeleça um cuidado de qualidade, baseado nos princípios estabelecidos pelo Sistema Único de Saúde.

La Facultad de Enfermería de la Universidad del Estado del Rio Grande do Norte, a través del Programa Nacional de Reorientación de la Formación Profesional en Salud (Pró-Saúde) articula enseñanza/servicio contribuyendo en la reflexión de la formación en enfermería en Mossoró, Rio Grande do Norte, Brasil. Esta pesquisa buscó conocer la implantación e inserción del Pró-Saúde en las Unidades Básicas de Salud del municipio de Mossoró, para entender el posicionamiento de los enfermeros en la articulación enseñanza/servicio. Fueron realizadas entrevistas con seis profesionales que actúan en las Unidades de Salud colaboradoras en este proyecto. Los resultados demuestran que estos trabajadores poco conocían el Pró-Saúde. Este factor, asociado a dificultades en la integración enseñanza/servicio, dificuldaba la reflexión y reorientación de las prácticas de enfermería. Así, hay que repensar conocimientos y prácticas, pactando cambios que contribuyan con una formación en salud que establezca un cuidado de calidad, basado en los principios del Sistema Único de Salud.

The Nursing School of Universidade do Estado do Rio Grande do Norte through the Programa Nacional de Reorientação da Formação Profissional em Saúde (Pro-Health) seeks to articulate the teaching / service, contributing to develop the concept of nursing education in Mossoró, Rio Grande do Norte, Brazil. This research aimed to investigate the implementation of Pro Health in the Basic Units of Health in Mossoró understanding the position of nursing workers in the teach/service link. Thus, interviews were conducted with six nurses who work in health clinics partners of this project. The results demonstrated that these workers had a lack of knowledge about the Pro-Health. Therefore, this lack of knowledge associated with difficulties in integrating teaching and service did not contribute to the nursing practice reflection and reorientation. Thus it is necessary to rethink the knowledge and nursing practices for a gradual change, contributing to improve the health care quality, based on the norms established by the Unified Health System in Brazil.

Reducing Use of Injections Through Interactional Group Discussions: A Randomized Controlled Trial.

Objective: To determine whether “interactional group discussions” could reduce prescriptions of injections by physicians. Study design: Randomized controlled trial. Setting: Rural public health care facilities, North 24 Parganas district, West Bengal, India. Subjects: 72 medical officers, 36 each in intervention and control groups. Intervention: Interactional group discussions. Outcome measure: Proportion of prescriptions including at least one injection. Results: In the intervention group, 249 of 1,080 prescriptions (23%) included at least one injection compared with 79 of 1,080 prescriptions (7%) before and after the intervention, respectively. (RR: 0.32, 95% CI: 0.25-0.40). In the control group, 231 of 1,080 prescriptions (21%) included at least one injection before the intervention vs 178 of 1,080 prescriptions (16%) after the intervention (RR 0.77, 95% CI: 0.65-0.92). Conclusion: Interactional group discussions reduce prescription of injections.

Occupational health and safety training of personnel from eleven Department of Health hospitals in Metro Manila

OBJECTIVE. This study was conducted to describe areas of concern with respect to occupational health and safety (OHS) program administration at eleven (11) Metro Manila hospitals, particularly: level of OHS knowledge and skill of personnel, the nature of occupational hazards perceived to exist in the hospitals, and how these relate to OHS program staffing and implementation.METHODS. Participants were surveyed on OHS knowledge and skills, as well as perceived occupational hazards, during the pilot of the "Occupational Health and Safety for Hospital Workers" training course held last April 2009.RESULTS AND DISCUSSION. The participants needed improvement in many of the OHS knowledge and ability items assessed. Familiarity and mastery of some items were demonstrated, but for effectiveness to be assured, it is necessary for other areas to be improved. Occupational hazards from all categories (chemical, ergonomic, physical, biological, and safety-related) are observed in the hospitals, with the most frequently cited being chemical and ergonomic in nature. Health and safety committees and OHS programs exist, but staff abilities limit their operation and effectiveness.CONCLUSION AND RECOMMENDATIONS. Improvement of certain OHS personnel abilities in the hospitals surveyed is suggested, and may help improve administration of OHS programs.

Job Performance Frequency and the Training Needs of Dieticians in Elderly Healthcare Facilities

The purpose of this study was to identify job frequency and the training needs of dieticians in elderly health care facilities. This study consisted of dieticians working in elderly health care facilities with a capacity of over 50 elderly. Survey questionnaires were distributed to 190 dieticians through the mail and 106 dieticians (55.8%) participated in this study. The results of the survey showed that dieticians in elderly health care facilities frequently performed the following job: work management, safety and sanitation management, purchase management, human resource management, finance management, nutrition management, and marketing management. The job frequency in safety and sanitation management (p<0.05) and nutrition management (p<0.01) areas were significantly different by the number of dieticians. Safety and sanitation management and menu management were considered job areas that needed further training and education. Dieticians in elderly health care facilities responded that the following jobs should require not only training but are also frequently performed: safety and sanitation management, menu management, work management, and human resource management. Thus, based on the results of this study, continuous training programs in these fields should be offered to satisfy the needs of dieticians.

Avaliação do ambiente eletromagnético em estabelecimentos assistenciais de saúde / Electromagnetic environment assessment in health care facilities

A crescente inserção de tecnologia eletroeletrônica em estabelecimentos assistenciais de saúde (EAS), seja como equipamentos terapêuticos, de diagnóstico ou até mesmo suporte vital, tem sido vista pela comunidade científica como a grande responsável pelo aumento dos níveis de energia eletromagnética emitidos ao ambiente hospitalar. Dessa forma, quando a energia eletromagnética presente no ambiente atinge um determinado nível crítico, fica estabelecida uma situação que é propícia ao aparecimento de dois fenômenos indesejados: a interferência eletromagnética (EMI) em equipamentos médicos, e os riscos biológicos (RBL) em seres vivos. Um importante recurso para gerenciar a compatibilidade eletromagnética e evitar o aparecimento destes fenômenos é o conhecimento das características eletromagnéticas presentes nestes ambientes. O objetivo deste trabalho é diagnosticar o comportamento eletromagnético estabelecido em ambientes de grande concentração de fontes emissoras como, por exemplo, o encontrado em centros cirúrgicos, através de uma série de medições in situ das grandezas eletromagnéticas envolvidas nestes meios (campos elétricos, campos magnéticos, ruídos conduzidos). Com base nestas medidas é realizada uma avaliação crítica de modo a comparar a situação estabelecida nos EAS e os limites de segurança preconizados por organismos competentes, tanto para EMI quanto para RBL. Como resultado desta análise, começa a existir maior discernimento quanto à real situação do ambiente eletromagnético encontrado em EAS nacionais, subsidiando informações para a definição de diretrizes mais eficientes para implementação de programas de gestão tecnológica que são direcionados às necessidades específicas destes hospitais.

Advances in technology and the increased use of electro-medical equipment (EME) to support medical procedures such as monitoring, diagnosis, therapeutic or even life support are considered as greatly responsible for the increase of electromagnetic energy within health care facilities (HCF) environments. In such circumstances, when electromagnetic energy reaches a certain critical level, a dangerous situation is established and two undesirable phenomena can take place, both electromagnetic interference (EMI) in medical equipment, and biological risks (BLR) in living beings. The knowledge of electromagneticcharacteristics shown by these environments can represent an important tool in order to promote electromagnetic compatibility and avoid the appearance of undesirable phenomena. Therefore, this work aims to diagnose the electromagnetic profile established in critical areas, such as operating rooms, through a number of “in situ” measurements concerning electromagnetic quantities present in this environment (electric field, magnetic field, conducted noise). Moreover, a critical evaluation follows in order to compare the establishedsituation within HCF and the safety levels prescribed by regulatory organizations regarding EMI and BLR. As a result of this assessment, a better understanding on the actual situation concerning the electromagnetic environment in HCF can be achieved, allowing clinical engineers to define better directives in order to implement an adequate management programs in these hospitals.