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PSBH and CBH News
On October 30th, a follow-up workshop for Stara Zagora Initiative projects was held. Amongst the projects reported, were several very successful ones:
· Increasing the number of families with disabled children attending the day-care centre in Stara Zagora (Mrs. Maria Milousheva)
· Early detection and remedial gymnastics for spinal deformities in primary school children (Dr. Antoaneta Todorova)
· Early detection and rehabilitation for flat foot deformities in children aged 18 months – 3 years (Mrs. Rositza Cherneva, Kazanlak)
· Training asthma and diabetes patients to avoid complications and reduce rehospitalizations rates (Mrs. Mima Nikolova)
· Training nurses to place peripheral intravenous cannule (Mrs. Slava Rouseva)
· Training amateur hunters to avoid incidents and give first aid (Mr. Lazar Lazarov)
All these projects had been completed and reported as such at a previous follow-up workshop. What these projects shared was that they all had been continued to become routine programs, or were now run on a larger scale.
At the follow-up workshop in Sofia on October 31st, the following projects from the PSBH workshop in 2001were reported:
· A program to help newly admitted students (14 years old) of the National School of Classical Languages and Culture in Sofia (Mrs. Bozhidara Racheva)
· Increasing the level of knowledge of school children aged 10-11 on the harmful effect of drugs (Mrs. Budinka Lilyanova)
· A program to ensure social re-integration of 15 addicts who underwent treatment in community of former addicts (Mrs. Galina Dyankova)
· A program to improve on the adaptation skills of 20 children aged with problems at school (Mrs. Daniela Borisova)
· An educational program to increase the level of knowledge to preserve reproductive health in 100 children aged 12-16, attending a middle school in Sofia (Mrs. Elena Vassileva)
· An educational program for children aged 8-11 and their parents on the harmful effects of alcohol, nicotine and drugs (Mrs. Elena Spridonova)
· An educational program for children aged 10 - 11 in four schools in Sofia, their teachers and parents to reduce the quantity of carbohydrate intake (Dr. Emilia Dimitrova)
· A health educational program to raise the level of knowledge on sexually transmitted infections (STI) among 25 boys at a technical high school in Sofia (Dr. Irina Haralanova)
· An antismoking program for children age 12-13 in Neophit Rilski Comprehensive School in Pernik (Dr. Yordanka Dimitrova)
· An educational program on the harmful effect of psychoactive substances among 150 children aged 14, attending two schools in Sofia (Mrs. Laura Moskova)
A social program to reduce tuberculosis and morbidity and death rates among homeless young people in Sofia (Mrs. Margarita Dimitrova)
· Reducing the rates of smoking among medical students (Dr. Mariyana Vakarelova)
· Improving the school yard environment to prevent accidents and exposure to drugs (Mrs. Penka Rashkova)
· A program for children aged 12 to reduce violence and aggressive behavior (Mrs. Rositza Vergova)
· Providing temporary employment for schizophrenic patients (Mrs. Roumyana Stoyanova)
· A health educational program to reduce alcohol consumption rates among 150 high-school students aged 17 in a tourism vocational school in Bankya (Mrs. Svetla Kirilova)
· Teaching basic hygiene to 500 primary school children aged 7-11 (Mrs. Tzveta Baleva)
All project leaders reported that a year after the workshop, they continue working, either on the same project with different target groups, or with the same groups, adding new activities and working on new problems. Most of them had raised additional funding to complete their projects.
One of the projects – this of Mrs. Rashkova got additional funding from Children’s Help Net Foundation Co., and after improving on the schoolyard of Graf Ignatiev Elementary School in Sofia, the yard had become a more attractive for the children - they do not run to play in the street during the breaks, and no car accidents have occurred.
At the follow-up workshop in Gabrovo on November 16th, three months after the workshop in June, 45 out of 46 projects prepared during the June 2002 PSBH workshop were reported as implemented, some of them completed. Progress reports on these will be in the January – April 2003 issue of the Digest.
The follow-up workshop in Varna on November 23rd showed that 35 projects had been started. Reports on the projects are in this issue. The local coordinator for the PSBH projects – Mrs. Gergana Momova was very supportive, so was the Association of Varna NGOs for Drug Abuse prevention. Most of the school nurses sought and received help from Health Promotion Department of the Varna Hygiene and Epidemiology Station.
On October 30th, facilitators visited the day care centre for disabled persons in Stara Zagora. At the moment, 58 children with different disabilities spend the day at the center, with rehabilitation and therapy provided. The center provides 250 consultations a month, and works in close collaboration with the general practitioners, the social services, and the health insurance fund. Its main goal is help the families keep the disabled children in the family, provide psychological help and training for them, and give them time to go to work. The staff is highly qualified, and has participated in projects funded by foundations from the UK and the Netherlands, and its program has been presented in Turkey and Macedonia.
The two projects that were visited at the University Hospital in Stara Zagora were those of Mrs. Katya Stancheva and Mrs. Mima Nikolova were both aimed to educate patients so that no complications occur after tonsillectomy (Mrs. Stancheva), or rehospitalization rates would be lower in asthma and diabetic patients (Mrs. Nikolova).
· Projects from the May 2003 PSBH workshop will be presented at the follow-up, which is to take place in January 2003.
· This issue of the digest may be also found at www. livebg.net/psbh-digest, where you can see photos illustrating projects.
· Anybody interested in publishing materials that can be related to problems approached by PSBH projects, please contact us at firstname.lastname@example.org, or at the address of the Communication for Better Health Program.
Author(s): Turrini RN
Title: [Perception of nurses about risk factors for nosocomial infection]
Source: Rev Esc Enferm USP, 2000 Jun, Vol. 34(2). pp. 174-84.
Abstract: A study was undertaken in a pediatric teaching hospital to evaluate the nurses understanding about risk factors for nosocomial infections. The data were obtained in interviews with nurses of the emergency room, intensive and semi-intensive units. The analysis of the meaning of the conversation permitted the identification of the following risk factors: inadequacy of the hospital design and construction, deficiency of care equipment and supplies, understaffing, lack of education and training to the healthcare workers and orientation to the patients family.
Author(s): Smith PW; Seip CW; Schaefer SC; Bell-Dixon C
Title: Microbiologic survey of long-term care facilities.
Source: Am J Infect Control, 2000 Feb, Vol. 28(1). pp. 8-13.
Abstract: BACKGROUND: We undertook a microbiologic survey of long-term care facilities to categorize bacteria found in cultures of residents. Culture and sensitivity data were collected on 566 samples from indwelling bladder catheters, percutaneous gastrostomy tubes, snares, stool, wounds, pressure ulcers, and tracheostomies in 25 Nebraska and Iowa facilities. Information was also collected on resident factors (eg, presence of indwelling urinary catheter, prior antibiotic administration) and institutional variables (eg, number of beds, nosocomial infection rates). RESULTS: There were 478 gram- negative isolates, the leading organisms being Pseudomonas aeruginosa, Proteus mirabilis, Escherichia coli, and Klebsiella pneumoniae. There were 221 gram-positive isolates, the most frequently seen of which were enterococci and Staphylococcus aureus. Of the 442 residents sampled in the study, 168 (38%) were taking, or had within the previous month been taking, a systemic antibiotic. Quinolones were the most frequently prescribed antibiotic class. The institutional prevalence of urinary catheterization averaged 6.7%. CONCLUSIONS: Significant antibiotic pressure exists in long- term care facilities, a fact that is reflected in antibiotic resistance patterns. A variety of gram-positive and gram-negative bacteria were found in nursing home culture specimens.
Author(s): Robert J; Fridkin SK; Blumberg HM; Anderson B; White N; Ray SM; Chan J; Jarvis WR
Title: The influence of the composition of the nursing staff on primary bloodstream infection rates in a surgical intensive care unit.
Source: Infect Control Hosp Epidemiol, 2000 Jan, Vol. 21(1). pp. 12-7.
Abstract: OBJECTIVES: To determine the risk factors for acquisition of nosocomial primary bloodstream infections (BSIs), including the effect of nursing-staff levels, in surgical intensive care unit (SICU) patients. DESIGN: A nested case-control study. SETTING: A 20-bed SICU in a 1,000-bed inner-city public hospital. PATIENTS: 28 patients with BSI (case-patients) were compared to 99 randomly selected patients ( controls) hospitalized > or =3 days in the same unit. RESULTS: Case- and control-patients were similar in age, severity of illness, and type of central venous catheter (CVC) used. Case- patients were significantly more likely than controls to be hospitalized during a 5-month period that had lower regular-nurse-to-patient and higher pool-nurse-to-patient ratios than during an 8-month reference period; to be in the SICU for a longer period of time; to be mechanically ventilated longer; to receive more antimicrobials and total parenteral nutrition; to have more CVC days; or to die. Case-patients had significantly lower regular-nurse-to- patient and higher pool-nurse-to-patient ratios for the 3 days before BSI than controls. In multivariate analyses, admission during a period of higher pool-nurse-to-patient ratio (odds ratio [OR]=3.8), total parenteral nutrition (OR=1.3), and CVC days (OR=1.1) remained independent BSI risk factors. CONCLUSIONS: Our data suggest that, in addition to other factors, nurse staffing composition (ie, pool-nurse-to-patient ratio) may be related to primary BSI risk. Patterns in intensive care unit nurse staffing should be monitored to assess their impact on nosocomial infection rates. This may be particularly important in an era of cost containment and healthcare reform.
Author(s): Pittet D; Hugonnet S; Harbarth S; Mourouga P; Sauvan V; Touveneau S; Perneger TV
Title: Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme.
Source: Lancet, 2000 Oct 14, Vol. 356(9238). pp. 1307-12.
Abstract: BACKGROUND: Hand hygiene prevents cross infection in hospitals, but compliance with recommended instructions is commonly poor. We attempted to promote hand hygiene by implementing a hospital-wide programme, with special emphasis on bedside, alcohol-based hand disinfection. We measured nosocomial infections in parallel. METHODS: We monitored the overall compliance with hand hygiene during routine patient care in a teaching hospital in Geneva, Switzerland, before and during implementation of a hand-hygiene campaign. Seven hospital-wide observational surveys were done twice yearly from December, 1994, to December, 1997. Secondary outcome measures were nosocomial infection rates, attack rates of methicillin- resistant Staphylococcus aureus (MRSA), and consumption of handrub disinfectant. FINDINGS: We observed more than 20,000 opportunities for hand hygiene. Compliance improved progressively from 48% in 1994, to 66% in 1997 (p<0.001). Although recourse to handwashing with soap and water remained stable, frequency of hand disinfection substantially increased during the study period (p<0.001). This result was unchanged after adjustment for known risk factors of poor adherence. Hand hygiene improved significantly among nurses and nursing assistants, but remained poor among doctors. During the same period, overall nosocomial infection decreased (prevalence of 16.9% in 1994 to 9.9% in 1998; p=0.04), MRSA transmission rates decreased (2.16 to 0.93 episodes per 10,000 patient-days; p<0.001), and the consumption of alcohol-based handrub solution increased from 3.5 to 15.4 L per 1000 patient-days between 1993 and 1998 (p<0.001). INTERPRETATION: The campaign produced a sustained improvement in compliance with hand hygiene, coinciding with a reduction of nosocomial infections and MRSA transmission. The promotion of bedside, antiseptic handrubs largely contributed to the increase in compliance.
Author(s): Winnefeld M; Richard MA; Drancourt M; Grob JJ
Title: Skin tolerance and effectiveness of two hand decontamination procedures in everyday hospital use.
Source: Br J Dermatol, 2000 Sep, Vol. 143(3). pp. 546- 50.
Abstract: BACKGROUND: Hand decontamination is crucial to control nosocomial infections. The utility of hand decontamination is related not only to its antimicrobial effectiveness, but also to its acceptability by hospital staff. OBJECTIVES: We aimed to assess skin tolerance and antimicrobial effects of two widely accepted hand hygiene measures under in-use conditions. METHODS: Fifty-two nurses were randomly assigned for an 8-day period to either an alcohol-based disinfectant or a hand wash with a non-antiseptic soap. At baseline and at the end of the test period, microbiological hand samples were obtained both before and after a hand hygiene procedure, and skin tolerance was assessed using clinical scores and measurement of transepidermal water loss. RESULTS: Self- assessment of skin condition and grade of skin damage worsened significantly more in the group using soap than in the group using alcoholic disinfectant (P = 0.004 and P = 0.01, respectively). The alcohol-based rinse was significantly more effective than liquid soap in removing transient contaminant micro- organisms (P = 0.016). Twenty of 50 hand washes with non-antiseptic soap apparently resulted in bacterial contamination of the hands. At the end of the study, the total bacterial count increased with the increasing number of hand washes in the soap group (P = 0.003), and with the degree of skin damage (P = 0.005) in the antiseptic group. CONCLUSIONS: In everyday hospital practice, alcohol-based disinfectant is more effective and better tolerated than non- antiseptic soap; soap is at risk of spreading contamination; and skin comfort strongly influences the number and the quality of hand hygiene procedures.
Author(s): Bucher A
Title: [Hand hygiene--is hand disinfection the best solution?]
Source: Tidsskr Nor Laegeforen, 2000 Feb 10, Vol. 120( 4). pp. 472-5.
Abstract: Nosocomial infections have been recognized as a critical problem in modern medicine and are associated with the quality of health care provided in hospitals. On average, 7-10% of hospitalized patients acquire an infection after hospital admission. A substantial proportion of these result from cross- contamination. Transmission of microorganisms by the hands of health care workers is the main cause for spreading. Prevention of bacterial contamination and infection to the patients requires good hand washing or disinfection, and a series of guidelines have been proposed. However, health care workers show poor compliance with such rules. At a time when costs for patient care are increasing and hospitals are threatened by bacterial resistance, prevention of nosocomial infections is an important issue. Thus, many international publications at present discuss the general problems of hand hygiene, still is the most cost effective method in prevention of nosocomial infections. Factors that contribute to poor compliance in hand hygiene have been targeted, and practical solutions in order to improve hand cleansing practices have been suggested. Increased use of the quicker methods of hand disinfection instead of hand washing is one of them.
Author(s): Markovic-Denic L; Quenon JL; Broden M
Title: [Organization of the program for prevention and control of nosocomial infections in France]
Source: Srp Arh Celok Lek, 1999 Nov-Dec, Vol. 127(11- 12). pp. 383-6.
Abstract: Nosocomial infections (NI) are infections acquired in hospitals. The aim of this paper is to describe the organization of NI control program in France. The organization of this program started in 1988 by the formation of the Infection Control Committees in hospitals. Their role has been to organize the surveillance of NI, to verify basic measures of hygiene, safety of invasive procedures, disinfection and sterilization procedures, occupational safety, and to organize the continued education of health staff members. Operational teams have also been established in hospitals. At the national and regional levels, the National and Regional Infection Control Committees were established in 1992 in order to define the national policy for the treatment of actual infection problems in hospitals and to organize the co-operation between hospitals. In addition, many research projects concerning NI have been conducted and a number of international scientific meetings regarding this subject have taken place in France. According to the two surveys conducted at the national level, in 1990 and 1996, the prevalence rate of NI was found to be 7.4 and 7. 6%, respectively. The infection control program could probably be integrated, in the future, into the Hospital Risk Management Program.
Author(s): de Andrade D; Angerami EL; Padovani CR
Title: A bacteriological study of hospital beds before and after disinfection with phenolic disinfectant.
Source: Rev Panam Salud Publica, 2000 Mar, Vol. 7(3). pp. 179-84.
Abstract: In hospitals, one of the ways to control microbial contamination is by disinfecting the furniture used by patients. This study's main objective was to evaluate the microbiological condition of hospital mattresses before and after such disinfection, in order to identify bacteria that are epidemiologically important in nosocomial infection, such as Staphylococcus aureus and Pseudomonas aeruginosa. RODAC plates with two different culture media were used to collect specimens. Patient beds were selected according to previously established criteria, and surface areas on the mattresses were chosen at random. From the total of 1,040 plate cultures from 52 mattresses, positive results were obtained from 500 of them (48.1%), 263 before disinfection and 237 after disinfection. Considering the selectivity of the culture media, the positivity rate was high. There were high prevalences of S. aureus both before and after mattress disinfection. The study results suggest that the usual disinfection procedures, instead of diminishing the number of microbes, merely displace them from one part of the mattress to another, and the number of microorganisms remains the same.
Author(s): Larson EL; Aiello AE; Bastyr J; Lyle C; Stahl J; Cronquist A; Lai L; Della-Latta P
Title: Assessment of two hand hygiene regimens for intensive care unit personnel.
Source: Crit Care Med, 2001 May, Vol. 29(5). pp. 944-51.
Abstract: OBJECTIVE: To compare skin condition and skin microbiology among intensive care unit personnel using one of two randomly assigned hand hygiene regimens: a 2% chlorhexidine gluconate (CHG)-containing traditional antiseptic wash and a waterless handrub containing 61% ethanol with emollients (ALC). DESIGN: Prospective, randomized clinical trial. SETTING: Two critical care units (medical and surgical) in a large, metropolitan academic health center in Manhattan. SUBJECTS: Fifty staff members (physicians, nurses, housekeepers, respiratory therapists) working full time in the intensive care unit. INTERVENTIONS: One of two hand hygiene regimens randomly assigned for four consecutive weeks. MEASUREMENTS AND MAIN RESULTS: The two outcomes were skin condition (measured by two tools: Hand Skin Assessment form and Visual Skin Scaling form) and skin microbiology. Samples were obtained at baseline, on day 1, and at the end of wks 2 and 4. Participants in the ALC group had significant improvements in the Hand Skin Assessment scores at wk 4 (p = 0.04) and in Visual Skin Scaling scores at wks 3 (p = 0. 01) and 4 (p = 0.0005). There were no significant differences in numbers of colony- forming units between participants in the CHG or ALC group at any time period. The ALC regimen required significantly less time than the CHG regimen (mean: 12.7 secs and 21.1 secs, respectively; p = 0.000) and resulted in a 50% reduction in material costs. CONCLUSIONS: Changes in hand hygiene practices in acute care settings from the traditional antiseptic wash to use of plain, mild soap and an alcohol-based product should be considered. Further research is needed to examine the association between use of antiseptic products for hand hygiene of staff and reductions in nosocomial infection rates among patients.
Author(s): Saloojee H; Steenhoff A
Title: The health professional's role in preventing nosocomial infections.
Source: Postgrad Med J, 2001 Jan, Vol. 77(903). pp. 16- 9.
Abstract: Despite their best intentions, health professionals sometimes act as vectors of disease, disseminating new infections among their unsuspecting clients. Attention to simple preventive strategies may significantly reduce disease transmission rates. Frequent hand washing remains the single most important intervention in infection control. However, identifying mechanisms to ensure compliance by health professionals remains a perplexing problem. Gloves, gowns, and masks have a role in preventing infections, but are often used inappropriately, increasing service costs unnecessarily. While virulent microorganisms can be cultured from stethoscopes and white coats, their role in disease transmission remains undefined. There is greater consensus about sterile insertion techniques for intravascular catheters-a common source of infections-and their care. By following a few simple rules identified in this review, health professionals may prevent much unnecessary medical and financial distress to their patients.
Author(s): Hugonnet S; Pittet D
Title: Hand hygiene-beliefs or science?
Source: Clin Microbiol Infect, 2000 Jul, Vol. 6(7). pp. 348-54.
Abstract: Over a century has passed since Ignaz P. Semmelweis demonstrated the association between hand hygiene and nosocomial infections, but this simple procedure is still not recognized by many healthcare workers as one of the most important measures to prevent cross- transmission of microorganisms. A relatively large amount of research has been done, in particular to try to understand why compliance remains so low, in order to implement successful promotion campaigns. This research has generated a fair amount of strong scientific data which are sometimes misunderstood and misused because of myths or certain beliefs. Observational or intervention studies have consistently shown a number of risk factors associated with non-compliance, such as high workload, professional category, or type of ward. Others are thought to be barriers to adequate compliance but have not yet been properly assessed. These include skin irritation due to hand hygiene agents, lack of knowledge of hand hygiene recommendations, or lack of institutional policy. Future interventions to promote hand hygiene will need to address these risk factors, and target the individual healthcare worker, as well as the group or institution if a significant degree of success is to be achieved.
Author(s): Hayashi Y; Shigemitsu M
Title: [Proper disposal(management) of medical wastes- infection prevention and waste management (Clean Hospital Project) at Hiroshima City, Asa Hospital]
Source: Rinsho Byori, 2000 May, Vol. Suppl 112pp. 26-31.
Abstract: Hospitals are socially obligated to maintain a clean environment and to dispose of medical waste, in order to prevent pollution and infection within and near the hospital. Since its establishment, Hiroshima City, Asa Hospital has been implementing a "Clean Hospital
Project", which has two goals: infection prevention and waste management. The nosocomial infection prevention committee and medical waste treatment and disposal examination committee lead these efforts.
Author(s): Sbutega-Milosevic G; Slepevic V; Marmut Z; Bujko M
Title: [Importance of disposable medical materials and instruments in the prevention of intrahospital infections]
Source: Vojnosanit Pregl, 2000 Jan-Feb, Vol. 57(1). pp. 55-8.
Abstract: Possibility for transmission of infectious diseases from patients to medical staff or vice versa is significant. Protective measures for patients as well as physicians must be applied and controlled. The aim was to investigate the microbiological status of disposable and reusable instruments and materials in order to establish the difference between them in protection from microorganisms. From the 122 samples of wet swab from reusables, 70.5% were bacteriologically negative and 29.5% positive. Seventy percent of isolated bacteria were pathogens, and 30% were pathogens. All 80 samples of wet swab from disposable products were sterile. The frequency of bacteriologically negative samples among disposable products is highly significant (p < 0.01). These results confirm that the level of protection is higher if disposable products are used. Reusables should be replaced by disposable materials to decrease the incidence of nosocomial infections.
Author(s): Rouget F; Chomienne F; Laurens E; Radet C; Seguin G.
Title: [Evaluation of a prevention program against nosocomial rotavirus infections in a pediatric ward]
Source: Arch Pediatr, 2000 Sep, Vol. 7(9). pp. 948-54.
Abstract: The incidence of nosocomial rotavirus infections was evaluated by a study made in the pediatric ward in Cholet during the winter of 1993-1994. A second study was performed three years later at the same place and in similar conditions in order to evaluate the efficacy of the prevention measures taken in between. PATIENTS AND METHODS: All children below three years of age and admitted to hospital between 1 December 1996 and 15 March 1997 were included in the prospective study (348 children). Fecal specimens were collected for each patient at admission in order to search for rotavirus. Then, a second stool analysis was performed if diarrhea occurred during hospitalization or within 48 hours of discharge. These last cases were detected by a phone call. RESULTS: Thirty percent of the children had diarrhea at admission to hospital (19.3% in 1993-1994). Rotavirus was present in 11.8% of the first stool analyses (8.6% in 1993-1994). The rotavirus nosocomial infection rate has decreased from 3.7% (13 cases) in 1993-1994 to 2.9% (ten cases). The mean length of hospitalization has also decreased from 2.7 to 1.6 days. CONCLUSION: The decrease in the rotavirus nosocomial infection rate leads to enforcing the prevention measures, among which the most important seems to us to be the short length of stay. However, the study also shows the limits of prevention that are linked to the virus characteristics and the conditions of hospitalization.