Compliance assessment regarding the PVC management on normal wards of a university hospital.

Objective: The risk of peripheral venous catheter (PVC) infections in inpatients is often underestimated, even if it is lower than that for central venous catheters. Guidelines for the prevention of PVC-associated infections describe the evidence-based management of PVCs. The aims of this study were the development of standardized methods for compliance assessment regarding PVC management and the evaluation of self-reported knowledge and implementations among healthcare providers regarding PVC care. Method: We developed a checklist based on the recommendation of the Commission of Hospital Hygiene and Infection Prevention at the Robert Koch Institute (KRINKO) Berlin for the standardized evaluation of PVC management. The following parameters were collected and evaluated: condition of the puncture site, condition of the bandage, presence of an extension set, presence of a plug, and documentation. The checklist was applied in 14 normal wards in 2019. After feedback of the ward staff on the results, it was applied again in 2020 in the same wards. For retrospective data analysis, we used a newly developed PVC-quality index. After the second evaluation in 2020, we carried out an anonymous survey among the healthcare providers. Results: The evaluation of 627 indwelling PVCs showed a significant increase in compliance related to the presence of an extension set (p=0.049) and documentation (p<0.001) in the 2nd year. The quality index increased in 12 out of 14 wards. The participants of the survey were aware of the in-house standard "Prevention of vascular catheter-associated infections", with a mean score of 4.98 on a Likert scale (1=not aware, 7=completely aware). The main barrier to implementation of the preventive measures was the time factor. Survey participants were more aware of PVC placement than PVC care. Conclusion: The PVC quality index is a valuable tool for the assessment of compliance regarding PVC management in daily practice. Feedback from the ward staff on the results of compliance assessment improves PVC management, but the outcome is very heterogeneous.

COTPA implementation status: An observational study in South Indian city.

Background & objectives: The World Health Organization (WHO) document released on the World No Tobacco Day, 2020, mentions that tobacco kills over 22,000 people worldwide every day either from its use or second-hand smoke exposure, which is one person every 4 sec. In 2003, the Cigarettes and Other Tobacco Products Act (COTPA) was enacted by the Indian government to control/regulate use of tobacco and tobacco products. Despite various amendments to this law, there has not been any appreciable decrease in tobacco use. The objective of this study was to assess the compliance level with sections 4-10 of COTPA in urban Puducherry in South India. Methods: Random sample survey of 13 wards was carried out in selected parts of the city of Puducherry. The estimated sample size was minimum 160 public places and point of sales (PoS) each. A pre-tested checklist was used to obtain information on compliance with COTPA. Statistical and spatial analysis was performed using STATA v12.0 and QGIS v2.14.21, respectively. Results: Eight per cent of public places, 0 per cent of PoS, 1.7 per cent of educational institutions and 48 per cent of tobacco packages were found compliant with COTPA specifications. The compliance in public places varied from 0 (bus stops) to 55 per cent (religious places). Interpretation & conclusions: The overall compliance with COTPA was found to be very low in urban Puducherry. In order to ensure proper implementation of the laws, effective enforcement with periodic monitoring of various sections of COTPA are needed.

[The evaluation of compliance of medical activity to established requirements: organizational and technological support].

The ongoing process of reforming national health care system determines associated search for systems of adequate decision-making based on comprehensive and objective analysis of activities of sector objects. The results of many years research demonstrate that one of the most effective such systems is system of assessing compliance of medical activities with established requirements. It is a methodology that permits to implement systematic comprehensive analysis of health care objects and make necessary decisions on its basis. This approach is extremely important for improving control and authorization-based mechanisms, justifying necessary resource support and developing comprehensive programs of development of isolated institutions, services and industry as whole. The term "conformity assessment" was introduced for the first time in the Federal Law № 184 of 27.12.2002 "On Technical Regulation". The given law defines concept of conformity assessment as direct or indirect compliance with requirements imposed on the object. The concept presented in this law regulates industrial activity to objects and subjects of technical regulation. It is this ideology that became a basis of actual study, in which methodology and organizational technology was developed and experimentally tested to assess compliance of medical organizations and individual health services with requirements established by current legislation. Within study framework, development and experimental testing of system of assessing compliance of medical activities with requirements of regulatory documents was carried out. The object of the study was medical organizations and their structural divisions.The significant increase was established in specially developed integral compliance coefficients for studied objects for 2016-2020: from 76.5% to 82.0% for a number of medical profiles selected for the study and from 72.0% to 78.0% for medical organizations. The data obtained indicate that on the basis of a set of balanced indices, administration of monitoring objects made adequate management decisions.

Delta9-THC determination by the EU official method: evaluation of measurement uncertainty and compliance assessment of hemp samples.

Hemp cultivation is living a period of renewed interest worldwide after long years of opposition and abandonment. The European Union (EU) allows and subsidizes the growing of fiber and oilseed cultivars of Cannabis sativa L. with respect to the THC content limit of 0.2%. The EU method for the quantitative determination of Δ9-tetrahydrocannabinol (THC) content in hemp varieties provides to apply a tolerance of 0.03 g of THC per 100 g of sample concerning compliance assessment to that limit. However, the method does not report any precision data, especially useful as a function of THC content to evaluate measurement uncertainty and therefore to establish the conformity of hemp at different THC legal limits. Measurement uncertainty of the method by both bottom-up and top-down approach, besides repeatability and reproducibility, was investigated and estimated in the THC concentration range 0.2-1.0%, which includes the different legal limits set out for hemp around the world. We proposed Decision Rules for conformity of hemp showing that a non-compliant declaration beyond reasonable doubt should be stated when the THC content, as a mean result on a duplicate analysis, exceeds the limit by at least 11-15%, depending on THC limit. We highlighted other issues concerning practical aspects of hemp analysis, from sampling to evaluation of results, as well as the need to carry out collaborative studies on the EU method.

Assessing Compliance of European Fresh Waters for Copper: Accounting for Bioavailability.

This study determines the levels of compliance of European fresh waters with a bioavailability-based copper Environmental Quality Standard (EQS). A tiered approach for compliance assessment is used at which the first tier compares the dissolved metal concentration to a threshold, estimated using either regional or continental water chemistry data. At the second tier, the bioavailable metal concentration is calculated using the chemistry of the water body, and compared to the EQSbioavailable for copper. The thresholds at Tier 1 must be set at a level to ensure adequate protection of sensitive environments and to ensure efficient use of regulatory resources. Compliance of 99.3% is observed where bioavailability-based thresholds are used for the implementation derived from regionally relevant water chemistry data. Sites where elevated ambient background levels of copper are combined with high bioavailability (waters with low dissolved organic carbon) are those most likely to be at risk from copper exposures.

Index-based and compliance assessment of water quality for a Brazilian subtropical reservoir / Avaliação da qualidade da água baseada em índices e da conformidade ao enquadramento de um reservatório subtropical brasileiro

ABSTRACT The Passaúna catchment is part of the Upper Iguaçu watershed and includes a water supply reservoir for over 500,000 inhabitants of Curitiba metropolitan region. The aim of this study was to establish the state of reservoir water quality, and whether it has undergone any recent medium- and long-term variations. A physical-chemical-biological assessment was undertaken using nine indicators and three indexes: Water Quality Index (WQI), Trophic State Index (TSI) and Shannon-Weaver Index (H') for macroinvertebrate diversity. Compliance with the prescribed quality standards for the water body was verified using frequency curves. Two WQI calculation approaches were contrasted to test for conditions of partial data unavailability. Temporal trends in key parameters were assessed using Spearman's rank correlation coefficient. WQI results from 1991-2014 indicated that the water quality may be classified as good and improved in the final decade of such period, while most TSI results were in the oligotrophic/mesotrophic range, but with no significant temporal trend. The biodiversity result of H'=1.6 obtained with data acquired in 2014 indicated a moderately degraded ecosystem that is typically associated with flow regulation and a degree of water quality impairment. Such a multi-indicator integrated physical-chemical-biological monitoring approach comprised a robust framework for assessments of medium-long term aquatic health.

RESUMO A bacia do rio Passaúna situa-se na parte superior da Bacia do Rio Iguaçu e inclui um reservatório de águas de abastecimento público para mais de 500 mil habitantes da região metropolitana de Curitiba. O objetivo deste estudo foi avaliar a qualidade das águas desse reservatório e identificar eventuais ocorrências de tendência temporal de variação. O estudo de características físicas, químicas e biológicas do corpo de água envolveu dados históricos e recém-adquiridos de nove indicadores e três índices: Índice de Qualidade das Águas (WQI), Índice de Estado Trófico (TSI) e Índice de Diversidade de Shannon-Weaver (H') para diversidade de macroinvertebrados. A conformidade aos padrões de qualidade prescritos foi analisada com base em curvas de permanência de qualidade de água. Duas formas de cálculo do WQI foram contrastadas para averiguar o efeito de disponibilidade incompleta de dados. Tendências temporais em parâmetros-chave foram buscadas com o teste de correlação de Spearman. Os resultados do WQI, entre 1991 e 2014, indicaram que a qualidade da água do reservatório pode ser classificada como "boa", apresentando tendência estatisticamente significativa de melhoria na última década de tal período. Os resultados obtidos para o TSI ficaram na faixa oligotrófico/mesotrófico e sem tendência significativa de variação temporal. O resultado de biodiversidade do H'=1,6, obtido com dados adquiridos em 2014, indicou um ecossistema aquático moderadamente degradado, tipicamente associado com o represamento de cursos de água e com um certo grau de comprometimento da qualidade da água. A abordagem integradora multi-indicadores de aspectos físicos, químicos e biológicos adotada neste estudo conferiu robustez à avaliação realizada da qualidade de água do corpo de água no médio-longo prazo.

Compliance Assessment of Cigarette and Other Tobacco Products Act in Public Places in Delhi Government Hospitals

Objective: Tobacco-free policies in hospital campus reduce exposure to tobacco smoke; change the demeanour of the professionals, patients and people visiting hospitals towards tobacco use. Section-4, 5 and 6 of COTPA (Cigarettes and Other Tobacco Products Act) necessitates the need for implementation of the prohibition on smoking in public places. Against this background, the present work was designed to evaluate the status of compliance Section 4, 5 and 6 of COTPA in Delhi Government hospitals Methods: A cross-sectional observational study was conducted within Government hospitals. Multistage random sampling was used to select 18 hospitals out of 39 hospitals from 5 zones. Standard assessment Proforma developed by John Hopkins School of Public Health for assessing compliance to Tobacco-Free Law was used and modified to address certain aspects of Section-4, 5 and 6 of COTPA. Hospital campuses were assessed by dividing them into zones like hospital buildings, office buildings, public places outside the hospital and residential areas. Result: Signs of active tobacco use observed in 40.6% of hospital buildings, 35.3% in office buildings, and 75.4% in public places outside the buildings. 'No smoking signage was not as per the COTPA guidelines in 21.4% of the hospitals and 72% were not tobacco free outdoors in these positions. Conclusion: The study highlighted a lower compliance rate than expected which raises questions on law enforcement concerning tobacco. Hence necessary measures have to be used up for sustained awareness campaigns, backed by enforcement drives. Periodic compliance surveys will strengthen the implementation of tobacco free legislation in health care institutions.

On Abandoning Hypothesis Testing in Environmental Standard Compliance Assessment.

We use basic characteristics of statistical significance test to argue the abandonment of hypothesis testing in environmental standard (or criterion) compliance assessment. The typical sample size used for environmental assessment is small, and the natural variation of many water quality constituent concentrations is high. These conditions lead to low statistical power of the hypothesis tests used in the assessment process. As a result, using hypothesis testing is often inefficient in detecting noncompliance. When a noncompliance is detected, it is frequently due to sampling or other types of error. We illustrate the problems using two examples, through which we argue that these problems cannot be resolved under the current practice of assessing compliance one water at a time. We recommend that the hypothesis testing framework be replaced by a statistical estimation approach, which can more effectively leverage information from assessments on similar waters using a probabilistic assessment approach.

Are Lead Exposures a Risk in European Fresh Waters? A Regulatory Assessment Accounting for Bioavailability.

An indicative compliance assessment of the Europe-wide bioavailable lead Environmental Quality Standard of 1.2 µg L-1 (EQS) was undertaken against regulatory freshwater monitoring data from six European member states and FOREGS database. Bio-met, a user-friendly tool based upon Biotic Ligand Models (BLMs) was used to account for bioavailability, along with the current European Water Framework Directive lead dissolved organic carbon correction approach. The outputs from both approaches were compared to the BLM. Of the 9054 freshwater samples assessed only 0.6% exceeded the EQS of 1.2 µg L-1 after accounting for bioavailability. The data showed that ambient background concentrations of lead across Europe are unlikely to influence general compliance with the EQS, although there may be isolated local issues. The waters showing the greatest sensitivity to potential lead exposures are characterized by relatively low DOC (< 0.5 mg L-1), regardless of the pH and calcium concentrations.

Influence of measurement uncertainty on the world health organization recommended regulation for mainstream cigarette smoke constituents.

The World Health Organization Study Group on Tobacco Product Regulation (WHO TobReg) proposed mandated ceilings on 9 prioritized mainstream cigarette smoke constituents determined from the market-specific median of nicotine-normalized yield distributions. Considering the requirements for assessing and reporting of compliance with ceilings, it is of great importance to estimate the measurement uncertainty. To have a better understanding of influence of measurement uncertainty on the WHO recommended regulation for cigarette smoke constituents, in the present study, the measurement uncertainties were evaluated systematically based on series of collaborative studies reported by three different authorities over the years from 2012 to 2016, according to the approaches guided in ISO/TS 21748. Furthermore, the compliance assessment of 20 representative cigarette samples with proposed ceilings was conducted by taking measurement uncertainty into account. This work demonstrated that measurement uncertainty had great influence on the implementation of the regulated mandated lowering of toxic smoke constituents, both on the setting of ceilings and the compliance assessment as well.

Sunbeds' ultraviolet radiation measurements with different radiometers and criteria for compliance assessment set by the national competent authority in Greece.

In order to ground the credibility of the sunbeds' ultraviolet radiation compliance assessment with the 0.3W/m(2) erythema effective irradiance limit, it is highly important to use reliable measuring equipment and to justify reasonably the measurement's result. Recently, the first surveillance action of the artificial tanning sector in Greece has been finalised. The action consisted of in situ erythema effective irradiance measurements from sunbeds at commercial premises offering artificial tanning services at various cities throughout Greece. Four different broadband erythemal weighted radiometers were used in order to compare them during in situ sunbeds' radiation measurements, at commercial premises, and to choose the most suitable one for compliance inspections. Furthermore a rationale has been introduced in order to compare the measurement's result with the limit, and decide about compliance or not, taking into account the measurement's expanded uncertainty. According to this approach, compliance, probable compliance or non-compliance is verified when the measurement's result taking into account the measurement's expanded uncertainty does not, probably or does exceed the 0.3W/m(2) limit, respectively. Ultraviolet radiation exceeded the 0.3W/m(2) erythema effective irradiance limit in 63.5% (33 out of 52) of the sunbeds and probably exceeded the limit in 11.5% (6 out of 52) of the sunbeds, according to the measurements performed with the radiometer which was chosen as the most suitable one and the proposed rationale for compliance justification.

The Development and Piloting of a Mobile Data Collection Protocol to Assess Compliance With a National Tobacco Advertising, Promotion, and Product Display Ban at Retail Venues in the Russian Federation.

BACKGROUND: Tobacco control policies that lead to a significant reduction in tobacco industry marketing can improve public health by reducing consumption of tobacco and preventing initiation of tobacco use. Laws that ban or restrict advertising and promotion in point-of-sale (POS) environments, in the moment when consumers decide whether or not to purchase a tobacco product, must be correctly implemented to achieve the desired public health benefits. POS policy compliance assessments can support implementation; however, there are challenges to conducting evaluations that are rigorous, cost-effective, and timely. Data collection must be discreet, accurate, and systematic, and ideally collected both before and after policies take effect. The use of mobile phones and other mobile technology provide opportunities to efficiently collect data and support effective tobacco control policies. The Russian Federation (Russia) passed a comprehensive national tobacco control law that included a ban on most forms of tobacco advertising and promotion, effective November 15, 2013. The legislation further prohibited the display of tobacco products at retail trade sites and eliminated kiosks as a legal trade site, effective June 1, 2014. OBJECTIVE: The objective of the study was to develop and test a mobile data collection protocol including: (1) retailer sampling, (2) adaptation of survey instruments for mobile phones, and (3) data management protocols. METHODS: Two waves of observations were conducted; wave 1 took place during April-May 2014, after the advertising and promotion bans were effective, and again in August-September 2014, after the product display ban and elimination of tobacco sales in kiosks came into effect. Sampling took place in 5 Russian cities: Moscow, St. Petersburg, Novosibirsk, Yekaterinburg, and Kazan. Lack of access to a comprehensive list of licensed tobacco retailers necessitated a sampling approach that included the development of a walking protocol to identify tobacco retailers to observe. Observation instruments were optimized for use on mobile devices and included the collection of images/photos and the geographic location of retailers. Data were uploaded in real-time to a remote ("cloud-based") server accessible via Internet and verified with the use of a data management protocol that included submission of daily field notes from the research team for review by project managers. RESULTS: The walking protocol was a practical means of identifying 780 relevant retail venues in Russia, in the absence of reliable sampling resources. Mobile phones were convenient tools for completing observation checklists discretely and accurately. Daily field notes and meticulous oversight of collected data were critical to ensuring data quality. CONCLUSIONS: Mobile technology can support timely and accurate data collection and also help monitor data quality through the use of real-time uploads. These protocols can be adapted to assess compliance with other types of public health policies.

Forensic-metrological considerations on assessment of compliance (or non-compliance) in forensic blood alcohol content determinations: A case study with software application.

Blood alcohol concentration is the most frequent analytical determination carried out in forensic toxicology laboratories worldwide. It is usually required to assess if an offence has been committed by comparing blood alcohol levels with specified legal limits, which can vary widely among countries. Due to possible serious legal consequences associated with non-compliant alcohol levels, measurement uncertainty should be carefully evaluated, along with other metrological aspects which can influence the final result. The whole procedure can be time-consuming and error-generating in routine practice, increasing the risks for unreliable assessments. A software application named Ethanol WorkBook (EtWB) was developed at the author's laboratory by using Visual Basic for Application language and MS Excel(®), with the aim of providing help to forensic analysts involved in blood alcohol determinations. The program can (i) calculate measurement uncertainties and decision limits with different methodologies; (ii) assess compliance to specification limits with a guard-band approach; (iii) manage quality control (QC) data and create control charts for QC samples; (iv) create control maps from real cases data archives; (v) provide laboratory reports with graphical outputs for elaborated data and (vi) create comprehensive searchable case archives. A typical example of drink driving case is presented and discussed to illustrate the importance of a metrological approach for reliable compliance assessment and to demonstrate software application in routine practice. The tool is made freely available to the scientific community at request.

Variability of blood alcohol content (BAC) determinations: the role of measurement uncertainty, significant figures, and decision rules for compliance assessment in the frame of a multiple BAC threshold law.

The measurement of blood-alcohol content (BAC) is a crucial analytical determination required to assess if an offence (e.g. driving under the influence of alcohol) has been committed. For various reasons, results of forensic alcohol analysis are often challenged by the defence. As a consequence, measurement uncertainty becomes a critical topic when assessing compliance with specification limits for forensic purposes. The aims of this study were: (1) to investigate major sources of variability for BAC determinations; (2) to estimate measurement uncertainty for routine BAC determinations; (3) to discuss the role of measurement uncertainty in compliance assessment; (4) to set decision rules for a multiple BAC threshold law, as provided in the Italian Highway Code; (5) to address the topic of the zero-alcohol limit from the forensic toxicology point of view; and (6) to discuss the role of significant figures and rounding errors on measurement uncertainty and compliance assessment. Measurement variability was investigated by the analysis of data collected from real cases and internal quality control. The contribution of both pre-analytical and analytical processes to measurement variability was considered. The resulting expanded measurement uncertainty was 8.0%. Decision rules for the multiple BAC threshold Italian law were set by adopting a guard-banding approach. 0.1 g/L was chosen as cut-off level to assess compliance with the zero-alcohol limit. The role of significant figures and rounding errors in compliance assessment was discussed by providing examples which stressed the importance of these topics for forensic purposes.

Refining compliance surveys to measure the smokefree status of jurisdictions using the Delphi method.

SETTING: Compliance assessment surveys are cost-effective means of assessing smokefree status in a jurisdiction. Assigning weights to assessment criteria (indicators) can also inform law implementers and policy makers about the effectiveness of the enforcement of smokefree rules. OBJECTIVE: To develop a standardised measure for compliance surveys using the Delphi method in India. DESIGN: Tobacco control experts from India comprising different constituencies and jurisdictions met for a half-day workshop in August 2012 to deliberate on how weights can be assigned to criteria for smokefree status. Using the Delphi method, the relevance and ranking of criteria from an existing protocol for measuring compliance was evaluated. RESULTS: Consensus was reached on all five compliance survey indicators through three rigorous rounds of discussion. The highest priority was assigned to the absence of the act of smoking in public places (33%), followed by the display of no-smoking signage in public places (32%), absence of cigarette butts or bidi stubs (15%), absence of smoking aids (10%) and absence of tobacco smoke and ash (10%). CONCLUSION: Tobacco control advocates can effectively inform local policy makers using weights that prioritise directed enforcement and targeted interventions, which in turn will ensure stronger compliance and sustainable smokefree settings.