scholarly journals Status of Tuberculosis Infection Control Programs in Canadian Acute Care Hospitals, 1989 to 1993 – Part 1

1997 ◽  
Vol 8 (4) ◽  
pp. 188-194 ◽  
Author(s):  
Donna Holton ◽  
Shirley Paton ◽  
Helen Gibson ◽  
Geoffrey Taylor ◽  
Carol Whyman ◽  
...  
Keyword(s):  
Infection Control ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Acute Care Hospitals ◽  
Respiratory Protection ◽  
Care Hospital ◽  
Screening Programs ◽  
Control Programs ◽  
Environmental Controls ◽  
Hospital Infection Control

OBJECTIVE: To document tuberculosis (TB) prevention and control activities in Canadian acute care hospitals from 1989 to 1993.DESIGN: Retrospective questionnaire.PARTICIPANTS: All members of the Community and Hospital Infection Control Association-Canada and l’Association des professionnels pour la prévention des infections who lived in Canada and worked in an acute care hospital received a questionnaire. One questionnaire per hospital was completed.OUTCOME: The study documented the number of respiratory TB cases admitted to the hospital, the type of engineering and environmental controls available, and the type of occupational tuberculin skin test (TST) screening programs offered by the hospital.RESULTS: Questionnaires were received from 319 hospitals. Ninety-nine (32%) hospitals did not admit a respiratory TB case during the study. Thirty-one (10%) hospitals averaged six or more TB cases per year. TST results were reported for 47,181 health care workers, and 819 (1.7%) were reported as TST converters; physicians had a significantly higher TST conversion rate than other occupational groups. Most hospitals did not have isolation rooms with air exhausted outside the building, negative air pressure and six or more air changes per hour. Surgical masks were used as respiratory protection by 74% of staff.CONCLUSIONS: Canadian hospitals can expect to admit TB patients. Participating hospitals did not meet TB engineering or environmental recommendations published in 1990 and 1991. In addition, occupational TB screening programs in 1989 to 1993 did not meet Canadian recommendations published in 1988.

scholarly journals Comparison of Tuberculosis Infection Control Programs in Canadian Hospitals Categorized by Size and Risk of Exposure to Tuberculosis Patients, 1989 to 1993 – Part 2

1997 ◽  
Vol 8 (4) ◽  
pp. 195-201
Author(s):  
Donna Holton ◽  
Shirley Paton ◽  
Helen Gibson ◽  
Geoffrey Taylor ◽  
Carol Whyman ◽  
...  
Keyword(s):  
High Risk ◽  
Infection Control ◽  
Low Risk ◽  
Respiratory Protection ◽  
Hospital Size ◽  
Screening Programs ◽  
Environmental Controls ◽  
Hospital Infection Control ◽  
Mdr Tb ◽  
Risk Of Exposure

OBJECTIVE: To analyze tuberculosis (TB) programs in acute care hospitals (hospitals) categorized by size and risk of exposure to TB patients from 1989 to 1993.DESIGN: Retrospective survey.PARTICIPANTS: Members of the Community and Hospital Infection Control Association-Canada and l’Association des professionnels pour la prévention des infections who worked in Canadian hospitals received questionnaires. One questionnaire per hospital was completed.OUTCOME: Hospitals reported the number of respiratory TB and human immunodeficiency virus (HIV) cases admitted, the engineering and environmental controls available, and the type of occupational TB screening programs available. Data were stratified by hospital size and risk of exposure to TB patients.RESULTS: Thirty-four (10.9%) hospitals with at least 500 beds admitted more than 50% of the TB cases, more than 40% of the multidrug-resistant TB (MDR-TB) cases and more than 65% of the HIV cases. Thirty-six (11.6%) facilities classified as high risk hospitals reported more than 70% of the TB cases, more than 58% of the MDR-TB cases and more than 75% of the HIV cases. A significantly higher pooled average tuberculin test conversion rate was found in individuals working in high risk (4.4%) than in low risk hospitals (1.5%). Significantly more high risk than low risk hospitals had an isolation room with air exhausted outside, negative air pressure and at least six air changes per hour. Only 13 high risk hospitals had all three engineering characteristics. Surgical masks were used for respiratory protection in 18 (50%) high risk and 186 (77.8%) low risk hospitals.CONCLUSIONS: Nosocomial transmission ofMycobacterium tuberculosismay have occurred because TB programs available in many Canadian hospitals were inadequate.

scholarly journals Communication behavior of cognitively impaired older inpatients

2019 ◽  
Vol 52 (S4) ◽  
pp. 264-272
Author(s):  
Eva-Luisa Schnabel ◽  
Hans-Werner Wahl ◽  
Susanne Penger ◽  
Julia Haberstroh
Keyword(s):  
Cognitive Impairment ◽  
Psychometric Properties ◽  
Acute Care ◽  
Older Patients ◽  
Hospital Setting ◽  
Acute Care Hospital ◽  
Acute Care Hospitals ◽  
Well Being ◽  
Communication Behavior ◽  
Care Hospital

Abstract Background and objective Acutely ill older patients with cognitive impairment represent a major subgroup in acute care hospitals. In this context, communication plays a crucial role for patients’ well-being, healthcare decisions, and medical outcomes. As validated measures are lacking, we tested the psychometric properties of an observational instrument to assess Communication Behavior in Dementia (CODEM) in the acute care hospital setting. As a novel feature, we were also able to incorporate linguistic and social-contextual measures. Material and methods Data were drawn from a cross-sectional mixed methods study that focused on the occurrence of elderspeak during care interactions in two German acute care hospitals. A total of 43 acutely ill older patients with severe cognitive impairment (CI group, Mage ± SD = 83.6 ± 5.7 years) and 50 without cognitive impairment (CU group, Mage ± SD = 82.1 ± 6.3 years) were observed by trained research assistants during a standardized interview situation and rated afterwards by use of CODEM. Results Factor analysis supported the expected two-factor solution for the CI group, i.e., a verbal content and a nonverbal relationship aspect. Findings of the current study indicated sound psychometric properties of the CODEM instrument including internal consistency, convergent, divergent, and criterion validity. Conclusion CODEM represents a reliable and valid tool to examine the communication behavior of older patients with CI in the acute care hospital setting. Thus, CODEM might serve as an important instrument for researcher and healthcare professionals to describe and improve communication patterns in this environment.

Estimated Annual Number of US Acute-Care Hospital Inpatients Meeting ACCP Criteria for Venous Thromboembolism (VTE) Prophylaxis.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 903-903 ◽  
Author(s):  
Frederick A. Anderson ◽  
Max Zayaruzny ◽  
John A. Heit ◽  
Alexander T. Cohen ◽  
Keyword(s):  
Acute Care ◽  
Operative Procedure ◽  
Acute Care Hospital ◽  
Acute Care Hospitals ◽  
Care Quality ◽  
Major Surgery ◽  
Medical Illness ◽  
Care Hospital ◽  
Vte Prophylaxis ◽  
Hospital Inpatients

Abstract Background While consensus guidelines regarding VTE prophylaxis for hospital inpatients have been available for more than 15 years, the number of US inpatients who are potentially eligible for prophylaxis is unknown. Such data are required for estimating the potential costs and benefits of prophylaxis in reducing VTE incidence. Objective To estimate the number of Y2002 US acute-care hospital inpatients who are potentially eligible for VTE prophylaxis. Methods We applied the 7th (2004) American College of Chest Physician (ACCP) Consensus Conference VTE prophylaxis guidelines (Geerts et al. Chest2004;126:338S–400S) to inpatients with hospital discharge International Classification of Disease (ICD-9) codes for major surgery or medical illness identified from the Healthcare Utilization and Cost Database (HCUP), a national acute-care hospital database supported by the US Agency for Health Care Quality Research. Results Of a total of 37.8 million inpatients discharged from US acute-care hospitals in Y2002, 13.4 million (35%) met ACCP guideline criteria for VTE prophylaxis (Table). Table. Inpatients Discharged from US Acute-Care Hospitals with ACCP Guideline Defined Risk of VTE in Y2002 Surgical VTE Risk N Highest risk surgery 744,465 High risk surgery 3,031,318 Moderate risk surgery 2,019,696 Surgical subtotal 5,795,479 Medical VTE Risk N Heart failure 1,867,576 Cancer 1,017,356 Stroke 515,370 Other medical conditions 4,196,343 Medical subtotal 7,596,645 Grand Total 13,392,124 Among the 37.8 million Y2002 discharged inpatinets, 7.7 million were defined by HCUP criteria as having had a major operative procedure. When ACCP surgical risk criteria were applied to this population, 1.9 (25%) were at low VTE risk, while 5.8 million (75%) were at moderate (26%), high (39%) or highest (10%) VTE risk. Among the patients without a major operative procedure, 7.6 million met the ACCP criteria for VTE prophylaxis based on medical illness risk factors. Conclusions In total, 13.4 million US residents meet ACCP criteria for VTE prophylaxis annually due to hospitalization for either major surgery or medical illness. Given that almost 60% of all VTE events occurring in the community are related to recent acute-care hospitalization, providing universal, safe and effective VTE prophylaxis to this population affords an important opportunity to significantly reduce the incidence of VTE. These data provide support for developing and monitoring compliance with hospital-wide guidelines for VTE prevention.

Acute Emergence of Elizabethkingia meningoseptica Infection among Mechanically Ventilated Patients in a Long-Term Acute Care Facility

2010 ◽  
Vol 31 (1) ◽  
pp. 54-58 ◽  
Author(s):  
Kingsley N. Weaver ◽  
Roderick C. Jones ◽  
Rosemary Albright ◽  
Yolanda Thomas ◽  
Carlos H. Zambrano ◽  
...  
Keyword(s):  
Acute Care ◽  
Acute Care Hospital ◽  
Care Facility ◽  
Acute Care Hospitals ◽  
Care Hospital ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Elizabethkingia Meningoseptica ◽  
Ventilated Patients

Objective.To describe an outbreak of infection associated with an infrequently implicated pathogen, Elizabethkingia meningoseptica, in an increasingly prominent setting for health care of severely ill patients, the long-term acute care hospital.Design.Outbreak investigation.Setting.Long-term acute care hospital with 55 patients, most of whom were mechanically ventilated.Methods.We defined a case as E. meningoseptica isolated from any patient specimen source from December 2007 through April 2008, conducted an investigation of case patients, obtained environmental specimens, and performed microbiologic testing.Results.Nineteen patients had E. meningoseptica infection, and 8 died. All case patients had been admitted with respiratory failure that required mechanical ventilation. Among the 8 individuals who died, the time from collection of the first specimen positive for E. meningoseptica to death ranged from 6 to 43 days (median, 16 days). Environmental sampling was performed on 106 surfaces; E. meningoseptica was isolated from only one swab. Three related pulsed-field gel electrophoresis patterns were identified in patient isolates; the environmental isolate yielded a fourth, unrelated pattern.Conclusion.Long-term acute care hospitals with mechanically ventilated patients could serve as an important transmission setting for E. meningoseptica. This multidrug-resistant bacterium could pose additional risk when patients are transferred between long-term acute care hospitals and acute care hospitals.

scholarly journals Long-term acute care hospitals and Georgia Medicaid: Utilization, outcomes, and cost

2016 ◽  
Vol 4 ◽  
pp. 205031211667092
Author(s):  
Evan S. Cole ◽  
Carla Willis ◽  
William C Rencher ◽  
Mei Zhou
Keyword(s):  
Acute Care ◽  
Diagnosis Related Groups ◽  
Acute Care Hospital ◽  
Acute Care Hospitals ◽  
Risk Scores ◽  
Average Risk ◽  
Care Hospital ◽  
Hospital Patients ◽  
Medicaid Population

Objectives: Because most research on long-term acute care hospitals has focused on Medicare, the objective of this research is to describe the Georgia Medicaid population who received care at a long-term acute care hospital, the type and volume of services provided by these long-term acute care hospitals, and the costs and outcomes of these services. For those with select respiratory conditions, we descriptively compare costs and outcomes to those of patients who received care for the same services in acute care hospitals. Methods: We describe Georgia Medicaid recipients admitted to a long-term acute care hospital between 2011 and 2012. We compare them to a population of Georgia Medicaid recipients admitted to an acute care hospital for one of five respiratory diagnosis-related groups. Measurements used include patient descriptive information, admissions, diagnosis-related groups, length of stay, place of discharge, 90-day episode costs, readmissions, and patient risk scores. Results: We found that long-term acute care hospital admissions for Medicaid patients were fairly low (470 90-day episodes) and restricted to complex cases. We also found that the majority of long-term acute care hospital patients were blind or disabled (71.2%). Compared to patients who stayed at an acute care hospital, long-term acute care hospital patients had higher average risk scores (13.1 versus 9.0), lengths of stay (61 versus 38 days), costs (US$143,898 versus US$115,056), but fewer discharges to the community (28.4% versus 51.8%). Conclusion: We found that the Medicaid population seeking care at long-term acute care hospitals is markedly different than the Medicare populations described in other long-term acute care hospital studies. In addition, our study revealed that Medicaid patients receiving select respiratory care at a long-term acute care hospital were distinct from Medicaid patients receiving similar care at an acute care hospital. Our findings suggest that state Medicaid programs should carefully consider reimbursement policies for long-term acute care hospitals, including bundled payments that cover both the original hospitalization and long-term acute care hospital admission.

scholarly journals The scope of a weekly infection control team rounding in an acute-care teaching hospital: a pilot study

2020 ◽  
Author(s):  
Yeon Su Jeong ◽  
Jin Hwa Kim ◽  
Seungju Lee ◽  
So Young Lee ◽  
Sun Mi Oh ◽  
...  
Keyword(s):  
Infection Control ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Essential Element ◽  
Surgical Site Infections ◽  
Control Program ◽  
Real Field ◽  
Care Hospital ◽  
Infection Control Program ◽  
Functional Coverage

Abstract Activities of infection control and prevention are diverse and complicated. Regular and well-organized inspection of infection control is essential element of infection control program. The aim of study was to identify strong points and limitations of weekly infection control rounding (ICTR) in an acute care hospital. We conducted infection control rounding weekly to improve the compliance of infection control in the real field at a 734-bed academic hospital in Republic of Korea between January, 18, 2018 to December, 26, 2018. We investigated the functional coverage of a weekly ICTR. The result of the rounding are categorized well maintained, improvement is needed, long-term support such as space or manpower is needed, not applicable and could not observed. ICTR visited median 7 times [interquartile range (IQR) 6–7 times] per department. When visiting a department, ICTR observed median 16 practices (IQR 12–22). There were 7452 results of practices. Of those results, 75% were monitored properly, 22% were not applicable, and 4% were difficult-to-observe. Among applicable practice results, the most common practices that were difficult to observe were strategies to prevent catheter-related surgical site infections and pneumonia, injection safety practices, and strategies to prevent occupationally-acquired infections. The ICTR was able to maintain regular visits to each department; however, additional observation is necessary to eliminate blind spots.* These authors contributed equally

scholarly journals Introducing virtual reality therapy for inpatients with dementia admitted to an acute care hospital: learnings from a pilot to pave the way to a randomized controlled trial

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Lora Appel ◽  
Erika Kisonas ◽  
Eva Appel ◽  
Jennifer Klein ◽  
Deanna Bartlett ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Virtual Reality ◽  
Acute Care ◽  
Controlled Trial ◽  
Acute Care Hospital ◽  
Acute Care Hospitals ◽  
Pharmacological Intervention ◽  
Care Hospital ◽  
Randomized Controlled ◽  
Prospective Longitudinal

Abstract Background Behavioural and psychological symptoms of dementia (BPSD) are difficult to manage, particularly in acute care settings. As virtual reality (VR) technology becomes increasingly accessible and affordable, there is growing interest among clinicians to evaluate VR therapy in hospitalized patients, as an alternative to administering antipsychotics/sedatives or using physical restraints associated with negative side effects. Objectives Validate and refine the proposed research protocol for a randomized controlled trial (RCT) that evaluates the impact of VR therapy on managing BPSD in acute care hospitals. Special attention was given to ascertain the processes of introducing non-pharmacological interventions in acute care hospitals. Methods Ten patients 65 years or older (mean = 87) previously diagnosed with dementia, admitted to an acute care hospital, were recruited over 3-month period into a prospective longitudinal pilot study. The intervention consisted of viewing 20-min of immersive 360° VR using a head-mounted display. Baseline and outcomes data were collected from the hospital electronic medical records, pre/post mood-state questionnaires, Neuropsychiatric Inventory (NPI) score, and standardized qualitative observations. Comprehensive process data and workflow were documented, including timestamps for each study task and detailed notes on personnel requirements and challenges encountered. Results Of 516 patients admitted during the study, 67 met the inclusion/exclusion criteria. In total, 234 calls were initiated to substitute decision makers (SDM) of the 67 patients for the consenting process. Nearly half (45.6%) of SDMs declined participation, and 40% could not be reached in time before patients being discharged, resulting in 57 eligible patients not being enrolled. Ten consented participants were enrolled and completed the study. The initial VR session averaged 53.6 min, largely due to the administration of NPI (mean = 19.5 min). Only four participants were able to respond reliably to questions. Seven participants opted for additional VR therapy sessions; of those providing feedback regarding the VR content, they wanted more varied scenery (animals, fields of flowers, holiday themes). Few sessions (4/18) encountered technical difficulties. Conclusion The pilot was instrumental in identifying issues and providing recommendations for the RCT. Screening, inclusion criteria, consenting, data collection, and interaction with SDMs and hospital staff were all processes requiring changes and optimizations. Overall, patients with dementia appear to tolerate immersive VR, and with suggested protocol alterations, it is feasible to evaluate this non-pharmacological intervention in acute care hospitals.

scholarly journals Palliative care for cancer patients near end of life in acute-care hospitals across Canada: a look at the inpatient palliative care code

2019 ◽  
Vol 26 (1) ◽  
Author(s):  
J. Tung ◽  
J. Chadder ◽  
D. Dudgeon ◽  
C. Louzado ◽  
J. Niu ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Acute Care ◽  
Care Delivery ◽  
Acute Care Hospital ◽  
Acute Care Hospitals ◽  
Administrative Databases ◽  
Care Hospital ◽  
Care Needs ◽  
Patients With Cancer

Hospitals play an important role in the care of patients with advanced cancer: nearly half of all cancer deaths occur in acute-care settings. The need for increasing access to palliative care and related support services for patients with cancer in acute-care hospitals is therefore growing. Here, we examine how often and how early in their illness patients with cancer might be receiving palliative care services in the 2 years before their death in an acute-care hospital in Canada. The palliative care code from inpatient administrative databases was used as a proxy for receiving, or being referred for, palliative care. Currently, the palliative care code is the only data element routinely collected from patient charts that allows for the tracking of palliative care activity at a pan-Canadian level.     Our findings suggest that most patients with cancer who die in an acute-care hospital receive a palliative designation; however, many of those patients are identified as palliative only in their final admission before death. Of the patients who received a palliative designation before their final admission, nearly half were identified as palliative less than 2 months before death. Findings signal that delivery of services within and between jurisdictions is not consistent, that the palliative care needs of some patients are being missed by physicians, and that palliative care is still largely seen as end-of-life care and is not recognized as an integral component of cancer care.     Measuring the provision of system-wide palliative care remains a challenge because comprehensive national data about palliative care are not currently reported from all sectors. To advance measurement and reporting of palliative care in Canada, attention should be focused on collecting comparable data from regional and provincial palliative care programs that individually capture data about palliative care delivery in all health care sectors.

scholarly journals Antimicrobial use trends, Israel, 2012 to 2017

2019 ◽  
Vol 24 (34) ◽  
Author(s):  
Yaakov Dickstein ◽  
Elizabeth Temkin ◽  
Debby Ben-David ◽  
Yehuda Carmeli ◽  
Mitchell J Schwaber
Keyword(s):  
Acute Care ◽  
Acute Care Hospital ◽  
Acute Care Hospitals ◽  
Study Data ◽  
Antimicrobial Use ◽  
Care Hospital ◽  
Hospital Data ◽  
Surgical Intensive Care ◽  
Health Maintenance ◽  
Defined Daily Doses

Background In 2012, Israel’s National Center for Infection Control initiated a national stewardship programme that included mandatory annual reporting of antimicrobial use. Here we present nationwide Israeli data for the period 2012 to 2017. Aim The goal of this study was to detect trends in antimicrobial use in Israel following the introduction of the stewardship programme, as part of an assessment of the programme’s impact. Methods In this retrospective observational study, data were collected from Israel’s health maintenance organisations (HMOs), acute care hospitals and post-acute care hospitals (PACHs). Acute care hospital data were collected for general medical and surgical wards, and medical/surgical intensive care units (ICUs). Data were converted into defined daily doses (DDD), with use rates presented as DDD per 1,000 insured/day in the community and DDD per 100 patient-days in hospitals and PACHs. Trends were analysed using linear regression. Results Antimicrobial use decreased across sectors between 2012 and 2017. In the community, the decrease was modest, from 22.8 to 21.8 DDD per 1,000 insured per day (4.4%, p = 0.004). In acute care hospitals, antibiotic DDDs per 100 patient-days decreased from 100.0 to 84.0 (16.0%, p = 0.002) in medical wards, from 112.8 to 94.2 (16.5%, p = 0.004) in surgical wards and from 154.4 to 137.2 (11.1%, p = 0.04) in ICUs. Antimicrobial use decreased most markedly in PACHs, from 29.1 to 18.1 DDD per 100 patient-days (37.8%, p = 0.005). Conclusion Between 2012 and 2017, antimicrobial use decreased significantly in all types of healthcare institutions in Israel, following the introduction of the nationwide antimicrobial stewardship programme.

Sign in / Sign up

Export Citation Format

Share Document