Enhancement of landfill leachate treatment using extracellular polymeric substances as bio-flocculants.

Fermentation of Klebsiella pneumoniae was conducted using crude glycerol fortified with secondary paper mill sludge as a carbon source in 5 L fermenter. After 96 hours of fermentation, the fermented broth contained mostly microbial cells surrounded by extracellular polymeric substances (EPS) and other particulate residues from paper mill sludge and glycerol. When this fermented broth is used as it is, it is called broth EPS (B-EPS). When the fermented broth is centrifuged, the supernatant solution is separated from the rest of the microbial cells and from sludge residues. This supernatant is called Slime-EPS (S-EPS). Both types of EPS were used for treatment of landfill leachate. S-EPS showed better flocculation activity (85%) than B-EPS (70%). EPS was also used in combination of Al2(SO4)3 or FeSO4. The removal efficiency of COD with use of S-EPS combined with FeSO4 (more than 80% of COD removal) was higher than with S-EPS alone (48% of COD removal). Better results were recorded when S-EPS (0.015 g/L) was combined with FeSO4 (2 g/L) at pH 8. A remarkable reduction of the following parameters was recorded: COD (82%), total nitrogen (44%), phosphorus (50%) and removal of metals such as Ca (64.3%) and Mg (62.4%).

Healthcare technologies, quality improvement programs and hospital organizational culture in Canadian hospitals.

BACKGROUND: Healthcare technology and quality improvement programs have been identified as a means to influence healthcare costs and healthcare quality in Canada. This study seeks to identify whether the ability to implement healthcare technology by a hospital was related to usage of quality improvement programs within the hospital and whether the culture within a hospital plays a role in the adoption of quality improvement programs. METHODS: A cross-sectional study of Canadian hospitals was conducted in 2010. The sample consisted of hospital administrators that were selected by provincial review boards. The questionnaire consisted of 3 sections: 20 healthcare technology items, 16 quality improvement program items and 63 culture items. RESULTS: Rasch model analysis revealed that a hierarchy existed among the healthcare technologies based upon the difficulty of implementation. The results also showed a significant relationship existed between the ability to implement healthcare technologies and the number of quality improvement programs adopted. In addition, culture within a hospital served a mediating role in quality improvement programs adoption. CONCLUSIONS: Healthcare technologies each have different levels of difficulty. As a consequence, hospitals need to understand their current level of capability before selecting a particular technology in order to assess the level of resources needed. Further the usage of quality improvement programs is related to the ability to implement technology and the culture within a hospital.

Simple standardized patient handoff system that increases accuracy and completeness.

PURPOSE: The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) defines a "handoff" as a contemporaneous, interactive process of passing patient-specific information from one caregiver to another for the purpose of ensuring the continuity and safety of patient care. The purpose of this study was to conduct a comprehensive investigation on the determinants of an effective handoff management system. Specifically, we sought to address the following null hypotheses: There is no difference before and after implementation of a new, low-cost, low-tech process for surgery patient handoffs in accuracy of information, completeness, clarity of exact time of patient transfer, and number of tasks appropriately handed off. METHODS: Baseline description of the handoff process was mapped from 3 direct observation sessions by an efficiency operations team. A focus group with residents, nurses, hospital administrators, and surgeons was held to identify concerns with the baseline process and to identify important features of a handoff system. These data were used to create an electronic survey for residents to indicate level of agreement with importance of various features and qualities of a handoff system. Longitudinal telephone surveys were performed with residents throughout and after the development period to determine the residents' perceptions of the completeness, accuracy, clarity of handoff time, and method of information transfer, as well as the frequency with which residents were expected to perform tasks that should have been performed by outgoing residents. An online survey was sent to residents before and after the new handoff system was implemented to study perceptions of information quality, process operations, clarity of responsibility, and satisfaction with the handoff process. Perceptions were rated on operationally defined scales. All instruments underwent expert review for content validity and clarity of instructions and scale definition appropriateness. A standardized, and partially automated, handoff form was then developed. After a 2-week pilot study, telephone surveys were repeated. Data were analyzed using descriptive statistics, the Student t-test, and multivariate analysis. RESULTS: Compared with baseline, residents reported increased accuracy, as measured by the perceived number of inaccuracies found on sign-out sheets (p = 0.003). Completeness of the information on sign-out sheets also was improved (p = 0.015). Clarity as to the time of transfer of care from outgoing (day team) to incoming (night float) improved (p = 0.0001). The type of rotation (intensive care unit vs non-intensive care unit) did lead to an improvement (confidence interval< 99%). Across both shifts, the perceived number of inappropriate tasks transferred decreased significantly. Experience (months of training) and type of rotation did not affect these measures. CONCLUSIONS: By simplifying and standardizing the handoff instrument, we demonstrated improvements in resident perceptions of accuracy, completeness, and number of tasks transferred. This low-cost, low-tech paradigm may be useful to others.