Gardam, Gitterman and Reason. HAIs: new initiatives and continuing challenges. Healthca... - 0 views
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need for local solutions, engagement and empowerment of those who are deeply connected to the problem
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Irene Jansen on 20 Sep 12hard to do when services are contracted-out (team is fragmented, workers have less job security and power, worse training, working conditions and oversight)
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public reporting in Ontario has helped improvement processes by drawing much broader attention to the issues at hand and by enabling facilities at the higher end of the infection spectrum to realize that they might have a bigger problem than they thought.
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caveats. Because public reporting data rarely control for known factors that influence infection rates, with the exception of hospital type and size, it is very difficult to meaningfully compare infection rates between facilities; yet the public and the media do exactly that.
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process measures such as hand hygiene can be quite problematic as public accountability measures because current auditing processes can introduce substantial biases into rates, making it appear that hand hygiene compliance is excellent when it may not be (Muller and Detsky 2010).
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NS has started its public reporting with hand compliance. I wonder if their auditing processes have this flaw.
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hand hygiene compliance measurement involving human auditors is both costly and subject to substantial bias
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there are some examples of settings where these individuals are becoming more involved (Bittle and LaMarche 2009)
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Despite considerable, robust evidence that healthcare design has a large role to play in preventing the spread of communicable agents, Canada has been slow to adopt single-patient room design standards that have been accepted in other countries such as the United States (American Institute of Architects 2006).
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having roommates is a very potent risk factor for acquiring a communicable organism (Hamel et al. 2010)
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single-patient rooms have been shown to have multiple other patient safety and comfort benefits that ultimately result in decreased lengths of stay and better outcomes (Ulrich et al. 2008)
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the upfront capital costs are rapidly recouped over the lifetime of the facility (Ulrich et al. 2008)
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the Canadian Standards Association has recently released new guidelines that support the use of single-patient rooms (Canadian Standards Association 2011)
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Reason, P., L. Rykert, B. Zimmerman, L. Gitterman, J. Christian, N. Crowcroft et al. 2012. "Decreasing Healthcare-Associated Infections through Enabling the Front-Line." Manuscript in Preparation.
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Marra, A., L. Guastelli, C. de Araujo, J. Santos, L. Lamblet, M. Silva et al. 2010. "Positive Deviance: A New Strategy for Improving Hand Hygiene Compliance." Infection Control and Hospital Epidemiology 31(1): 12–20.
