Microbiological assessment of indoor air quality at different hospital sites

Poor hospital indoor air quality (IAQ) may lead to hospital-acquired infections, sick hospital syndrome and various occupational hazards. Air-control measures are crucial for reducing dissemination of airborne biological particles in hospitals. The objective of this study was to perform a survey of bioaerosol quality in different sites in a Portuguese Hospital, namely the operating theater (OT), the emergency service (ES) and the surgical ward (SW). Aerobic mesophilic bacterial counts (BCs) and fungal load (FL) were assessed by impaction directly onto tryptic soy agar and malt extract agar supplemented with antibiotic chloramphenicol (0.05%) plates, respectively using a MAS-100 air sampler. The ES revealed the highest airborne microbial concentrations (BC range 240-736 CFU/m(3) CFU/m(3); FL range 27-933 CFU/m(3)), exceeding, at several sampling sites, conformity criteria defined in national legislation [6]. Bacterial concentrations in the SW (BC range 99-495 CFU/m(3)) and the OT (BC range 12-170 CFU/m(3)) were under recommended criteria. While fungal levels were below 1 CFU/m(3) in the OT, in the SW (range 1-32 CFU/m(3)), there existed a site with fungal indoor concentrations higher than those detected outdoors. Airborne Gram-positive cocci were the most frequent phenotype (88%) detected from the measured bacterial population in all indoor environments. Staphylococcus (51%) and Micrococcus (37%) were dominant among the bacterial genera identified in the present study. Concerning indoor fungal characterization, the prevalent genera were Penicillium (41%) and Aspergillus (24%). Regular monitoring is essential for assessing air control efficiency and for detecting irregular introduction of airborne particles via clothing of visitors and medical staff or carriage by personal and medical materials. Furthermore, microbiological survey data should be used to clearly define specific air quality guidelines for controlled environments in hospital settings.

Balanced Scorecard para o serviço de urgência geral

Mestrado em Contabilidade

Motivos de recurso ao Serviço de Urgência Pediátrica

Introdução: O recurso ao serviço de urgência (SU) hospitalar motivado por situações não urgentes é frequente e conduz a pior prestação de cuidados, insatisfação dos utentes e profissionais e aumento dos custos. Objectivos: Determinar os motivos para recurso a SU pediátrica hospitalar. Material e métodos: Estudo descritivo, transversal, entre 10/10 e 31/12/2013 em SU pediátrico hospitalar, através de análises de inquéritos preenchidos de forma anónima pelos acompanhantes e complementados com informação clínica pelo médico. Resultados: Foram analisados 481 questionários. O recurso ao SU ocorreu nas primeiras 24 horas de doença em 48% dos casos. Os principais motivos foram: noção de doença grave e urgente (33%), local de atendimento mais próximo (17%), preferência por avaliação por pediatra (17%). A maioria teve alta sem realização de exames complementares de diagnóstico ou tratamento (89%) e os principais diagnósticos de alta foram nasofaringite e gastroenterite agudas. Apenas 19,7% das idas ao SU poderiam ser consideradas como “justificadas” pelo cumprimento dos critérios de OMS para urgência hospitalar ou por orientação prévia por outra entidade de saúde. Não existem diferenças estatisticamente significativas entre as características das crianças que recorreram ao SU de forma “justificada” e “não justificada”. Discussão e conclusão: O reconhecimento de situações clínicas que justifiquem o recurso ao SU hospitalar não parece relacionado com habilitações literárias parentais ou atribuição de médico de família. A percepção de doença grave em situação benigna com recurso precoce e injustificado ao atendimento em contexto de serviço de urgência denota falta de educação para a saúde na população geral.

Acreditação da idoneidade formativa do contexto de prática clínica no S. de Urgência do CHMT – Abrantes

Num contexto de mudança dos estatutos da Ordem dos Enfermeiros, reconhece-se a importância de renovar um Sistema de Certificação de Competências, que é contemplado por um período de Exercício Profissional Tutelado, para a obtenção do título de Enfermeiro, e um período de Desenvolvimento Profissional Tutelado, para a atribuição do título de Enfermeiro Especialista. O Conselho de Enfermagem reconhece que para a obtenção destes títulos, esta Prática Tutelada deve acontecer num contexto de prática clinica de Idoneidade Formativa, reconhecida e acreditada pela Ordem dos Enfermeiros, e sob a supervisão de um Enfermeiro com certificação de competências, com a designação de Enfermeiro Supervisor. Serve então o presente relatório para verificar se, se encontram reunidas as condições para um eventual processo de candidatura a Acreditação de Idoneidade Formativa do Contexto de Prática Clinica, no Serviço de Urgência – Unidade de Abrantes – Centro Hospitalar Médio Tejo. Ao longo do relatório são descritas as fases de implementação e feito o levantamento das condições necessárias à candidatura para o processo de Acreditação

Prevalencia de trauma encéfalo craneal en niños de 0 a 5 años y factores asociados, en el servicio de emergencia pediátrica del HVCM febrero- julio 2014

ANTECEDENTES: El trauma encéfalo craneal (TEC), es una de las principales causas de atención en emergencia pediátrica del país y el mundo. Representa una carga en morbilidad y mortalidad, constituyendo una causa importante de internamiento, complicaciones y muerte en pediatría. OBJETIVOS: Determinar la prevalencia de TEC y factores asociados en niños de 0 a 5 años atendidos en emergencia del Hospital Vicente Corral Moscoso, Febrero- Julio 2014. MÉTODO Y TÉCNICAS Se realizó un estudio transversal en niños de 0 a 5 años con TEC, atendidos en emergencia del HVCM, de febrero a julio del 2014, determinando la prevalencia y factores asociados a TEC; previa firma de consentimiento informado por los representantes. Tras recolectarse los datos, estos fueron codificados y tabulados mediante SPSS versión 20, obteniendo las variables demográficas de estudio. RESULTADOS Se estudiaron 1681 niños, con un promedio en edad de 26,2 meses (DS 20,76). La prevalencia de TEC fue del 10,4%. El TEC leve representó el 8,6% del total de niños. Los factores positivos asociados fueron: estar a cuidado de terceros o sin cuidador (RP: 3,91; IC: 2,94-5,20); pertenecer a un grupo minoritario, indígena o negro (RP: 3,64; IC: 2,46-5,39); siendo el maltrato infantil la variable que más se relacionó con TEC. (RP: 6,11; IC: 3,61-10,65). CONCLUSIONES: La prevalencia de TEC en el HVCM en niños de 0 a 5 años, fue de 10,4%. Asociándose positivamente con etnia indígena o negra, encontrarse sin cuidador o a cargo de terceros y el maltrato infantil.

Contributos psicológicos para a compreensão da utilização inapropiada dos serviços de saúde: Estudo exploratório num serviço de urgência

O sobrelotamento dos Serviços de Urgência Pediátrica é uma realidade da sociedade atual, verificando-se uma crescente progressão de atendimentos, principalmente de falsas urgências. Tendo como objetivo identificar fatores psicológicos que possam contribuir para a compreensão da utilização inapropriada destes serviços, foi desenvolvido este estudo exploratório-descritivo. A amostra foi constituída por 115 crianças, observadas sem critérios de urgência num Serviço de Urgência Pediátrica, e respetivos acompanhantes, dos quais 26.1% são emocionalmente perturbados. Os dados, recolhidos através da ficha de urgência, da entrevista e de um questionário, revelaram que a recorrência frequente ao Serviço de Urgência está relacionada com as crenças dos acompanhantes acerca do serviço, com a perceção de criança mais frágil, mais difícil e com mais problemas de comportamento. Conhecidos os efeitos da hospitalização infantil, pretende-se que este estudo abra portas à exploração de novos horizontes, na tentativa de encontrar soluções para a racionalização da utilização dos recursos de saúde. ABSTRACT: The overflow of the Pediatrics Emergencies is a reality in today's society. There has been an increasing attendance, primarily of false emergencies. The objective of this exploratory-descriptive study is to identify the psychological factors that might contribute to the understanding of the inappropriate use of these services. The sample was composed of 115 children, observed without any emergency criterion of the Pediatric Emergency, and respective escorts, of which 26.1% of them are emotionally disturbed. The data gathered through the emergency file, the interview and a questionnaire, revealed that the frequent use of the Emergency Service is related with the beliefs of the escorts, with the perception of a more fragile child, more difficult and with more behavioral problems child. The effects of child hospitalization known, this study intends to open the doors to new horizons, in an attempt to find solutions to the rationalization of the use of health resources.

Manejo del trauma de tórax y características demográficas, Hospital Vicente Corral Moscoso. Cuenca – Ecuador.

Objetivo: Analizar el manejo del trauma de tórax en el Hospital Vicente Corral Moscoso y describir las características demográficas de la población estudiada. Método: Estudio descriptivo retrospectivo, la muestra fue de 167 pacientes atendidos en el servicio de Emergencia del Hospital Vicente Corral Moscoso, con diagnóstico de trauma de tórax, durante el periodo enero de 2013 a junio de 2015; los datos se obtuvieron de las historias clínicas. Se analizaron las variables de datos demográficos y tratamiento, utilizando frecuencias, porcentajes y chi cuadrado. Se empleó el programa SPSS versión 18, Excel 2010. Resultados: La edad promedio fue de 37 años, con mayor frecuencia en varones con el 84.4%. Los diagnósticos fueron: hemotórax 36.53%, neumotórax 25.75%, hemoneumotórax 27.54%. El 4.8% de los pacientes recibió tratamiento no quirúrgico, el 82.6% avenamiento pleural; al 12.6% se practicó toracotomías al ingreso. Al 19.8% se realizó toracotomía durante la estancia hospitalaria debido a complicaciones como el hemotórax coagulado o residual. La mortalidad fue del 5.4% (9 pacientes), 7 presentaron lesiones extra torácicas. Conclusiones: El trauma de tórax se presentó en alto porcentaje en la tercera década de vida y se resolvió mayormente con avenamiento pleural. Las lesiones extra torácicas incrementan la mortalidad y necesitan un manejo multidisciplinario.

Hernia de Amyand, reporte de un caso: Hospital Vicente Corral Moscoso

La hernia de Amyand es una entidad rara que se caracteriza por la presencia del apéndice vermiforme en el saco herniario de una hernia inguinal. La prevalencia es de aproximadamente el 1% y, por lo general, se presenta en hernias ubicadas al lado derecho; su diagnóstico habitual se realiza durante la intervención quirúrgica. En el presente caso se describe a un paciente de 67 años que acude al servicio de emergencia del Hospital Vicente Corral Moscoso presentando esta patología y su correspondiente manejo.

Prevalencia de la luxación acromioclavicular y tratamientos en pacientes del Hospital José Carrasco Arteaga en el periodo enero 2010 a diciembre 2014

ANTECEDENTES: La luxación acromioclavicular es la lesión de hombro más prevalencia en quienes practican deportes de contacto, se relaciona con una alta tasa de accidentes de tránsito, por ello es importante conocer su prevalencia, factores de riesgo, para realizar un tratamiento adecuado. OBJETIVO GENERAL: Determinar la prevalencia de la luxación acromioclavicular y tratamientos en pacientes del Hospital José Carrasco Arteaga en el periodo enero 2010 a diciembre 2014. METODOLOGÍA: Se realizó un estudio descriptivo transversal, cuyo universo fueron las historias clínicas de pacientes que recibieron atención en el Hospital José Carrasco Arteaga entre enero del año 2010 hasta diciembre del 2014. Se recolectó la información de la base de datos (AS 400) en un formulario específico, el cual se analizó mediante el paquete estadístico SPSS 15.0 y Epi-Info 7, utilizando distribuciones de frecuencia y porcentajes. Los resultados se presentaron en gráficos, tablas simples y combinadas. USO DE RESULTADOS: De 120 pacientes con diagnóstico de luxación acromioclavicular se presentó una prevalencia de 3,7 casos por cada 1000 personas que se atendieron en emergencia del hospital José Carrasco Arteaga. Se incluyeron 86 casos en el estudio. Los hombres resultaron el grupo más afectado (91,9%). El tipo de luxación más frecuente fue el III (59,3%). La lesión que más asociada fue la fractura de clavícula (4,7%). El mecanismo de lesión directo (91,9%) fue el más prevalente. En 41.9 % de los casos la luxación se asoció con accidentes de tránsito

Design of evacuation plans for densely urbanised city centres

The high population density and tightly packed nature of some city centres make emergency planning for these urban spaces especially important, given the potential for human loss in case of disaster. Historic and recent events have made emergency service planners particularly conscious of the need for preparing evacuation plans in advance. This paper discusses a methodological approach for assisting decision-makers in designing urban evacuation plans. The approach aims at quickly and safely moving the population away from the danger zone into shelters. The plans include determining the number and location of rescue facilities, as well as the paths that people should take from their building to their assigned shelter in case of an occurrence requiring evacuation. The approach is thus of the location–allocation–routing type, through the existing streets network, and takes into account the trade-offs among different aspects of evacuation actions that inevitably come up during the planning stage. All the steps of the procedure are discussed and systematised, along with computational and practical implementation issues, in the context of a case study – the design of evacuation plans for the historical centre of an old European city.

Diez primeras causas de morbilidad en emergencia del Hospital Homero Castanier Crespo en el periodo de octubre a diciembre del 2014. Azogues-Ecuador

Antecedentes: Es preciso mencionar que en México en el 2005 estadísticas muestran que las principales causas de morbilidad en su servicio de emergencias las constituyen: Infecciones respiratorias agudas (19,4%), los traumatismos y envenenamientos (18,8%) y las enfermedades diarreicas (8%). (14). En Perú la principal causa de morbilidad se debió a traumatismos (12% del total), seguido en segundo lugar de asma (10%) y en tercer lugar por anormalidades y complicaciones del embarazo, parto o puerperio (8% del total). (5) Objetivo: Determinar las 10 primeras causas de morbilidad en emergencia del Hospital Homero Castanier Crespo en el período de octubre a diciembre 2014. Materiales y métodos: Se realizó un estudio observacional indirecto, mediante el registro de emergencia del total de pacientes que han acudido a emergencia en el Hospital Homero Castanier Crespo en período comprendido entre octubre – noviembre del 2014. El instrumento utilizado fue el formulario de recolección de datos (ver anexo 2). Resultados: la principal causa de morbilidad en la emergencia del Hospital Homero Castenier Crespo constituyen las enfermedades infecciosas: Enfermedades infecciosas intestinales, Amigdalitis aguda con un 10.86%. Gran parte de las morbilidades atendidas en la emergencia 20.85%, no son emergencias reales. En grupos edad pediátrica y adultos mayores, la principal causa fueron las Enfermedades infecciosas intestinales 14.52%, 6.96% respectivamente, que en este grupo si constituyen un verdadera emergencia. En ginecobstetricia: Falso trabajo de parto a las 37 y más semanas completas de gestación Conclusión: el estudio muestra las principales causas de morbilidad en el Hospital Homero Cartanier Crespo, revela una saturación del sistema por la cantidad de no emergencias que se atienden. Probablemente por la falta de un triage adecuado

Le sens de l’urgence à l’hôpital

Article

Le sens de l’urgence à l’hôpital

Article

How does ambulance service utilisation impact demand for Emergency Departments in Queensland, Australia?

Background: There are indications that pre-hospital emergency care and management of patients can help reduce the demand for hospital emergency departments (EDs). Ambulance services play a significant role at this stage of care. In 2003, the Queensland Government introduced a Community Ambulance Cover (CAC) levy in return for a free ambulance service at the point of access to all Queenslanders. This may have led to the impression in consumers of an entitlement to free ambulance services under any circumstances regardless of the urgency of the matter which may have in turn contributed to the crowding of EDs in Queensland. Objectives: This paper aims to answer the following questions: - How many patients arrive at hospital EDs by ambulance in Queensland, compared to other modes of arrival? - How has this changed over time, particularly after the CAC introduction in 2003? What percentage of ambulance arrivals are urgent ED patients? - Has the perceived free ambulance services created extra demand for EDs in Queensland, compared with other Australian jurisdictions that charge patients for ambulance services? Methods: We will secondary analyse the data from sources such as Queensland Ambulance Services, Department of Health and Australian Bureau of Statistics to answer the research questions. Findings and Conclusions Queensland has the highest utilization rate of ambulance services (about 18% in 2007-08) and the highest annual growth rate in demand for these services (7.7% on average since 2000-01), well above the population growth. On the other hand, the proportion of ED patients arriving by ambulance in Queensland has increased by about 4% annually. However, when compared with other states and territories with charge at the point of access, it seems that the growth in demand for EDs cannot be explained solely or mainly by CAC or ambulance utilisation in Queensland.

Evaluating the effect of a patient education brochure on patients’ expectations and satisfaction with emergency department service

Introduction: The purpose of this study was to assess the capacity of a written intervention, in this case a patient information brochure, to improve patient satisfaction during an Emergency Department (ED) visit. For the purpose of measuring the effect of the intervention the ED journey was conceptualised as a series of distinct areas of service comprising waiting time, service by the triage nurse, care from doctors and nurses and information giving Background of study: Research into patient satisfaction has become a widespread activity endorsed by both governments and hospital administrations. The literature on ED patient satisfaction has consistently indicated three primary areas of patient dissatisfaction: waiting time, nursing care and communication. Recent developments in the literature on patient satisfaction studies however have highlighted the relationship between patients. expectations of a service encounter and their consequent assessment of the experience as dissatisfying or satisfying. Disconfirmation theory posits that the degree to which expectations are confirmed will affect subsequent levels of satisfaction. The conceptual framework utilised in this study is Coye.s (2004) model of disconfirmation. Coye while reiterating satisfaction is a consequence of the degree expectations are either confirmed or disconfirmed also posits that expectations can be modified by interventions. Coye.s work conceptualises these interventions as intra encounter experiences (cues) which function to adjust expectations. Coye suggests some cues are unintended and may have a negative impact which also reinforces the value of planned cues intended to meet or exceed consumer expectations. Consequently the brochure can be characterized as a potentially positive cue, encouraging the patient to understand processes and to orient them in what can be a confronting environment. Only a limited number of studies have examined the effect of written interventions within an ED. No studies could be located which have tested the effect of ED interventions using a conceptual framework which relates the effect of the degree to which expectations are confirmed or disconfirmed in terms of satisfaction with services. Method: Two studies were conducted. Study One used qualitative methods to explore patients. expectations of the ED from the perspective of both patients and health care professionals. Study One was used in part to direct the development of the intervention (brochure) in Study Two. The brochure was an intervention designed to modify patients. expectations thus increasing their satisfaction with the provision of ED service. As there was no existing tools to measure ED patients. expectations and satisfaction a new tool was also developed based on the findings and the literature of Study One. Study Two used a non-randomised, quasi-experimental approach using a non-equivalent post-test only comparison group design used to investigate the effect of the patient education brochure (Stommel and Wills, 2004). The brochure was disseminated to one of two study groups (the intervention group). The effect of the brochure was assessed by comparing the data obtained from both the intervention and control group. These two groups consisted of 150 participants each. It was expected that any differences in the relevant domains selected for examination would indicate the effect of the brochure both on expectation and potentially satisfaction. Results: Study One revealed several areas of common ground between patients and nurses in terms of relevant content for the written intervention, including the need for information on the triage system and waiting times. Areas of difference were also found with patients emphasizing communication issues, whereas focus group members expressed concern that patients were often unable to assimilate verbal information. The findings suggested the potential utility of written material to reinforce verbal communication particularly in terms of the triage process and other ED protocols. This material was synthesized within the final version of the written intervention. Overall the results of Study Two indicated no significant differences between the two groups. The intervention group did indicate a significant number of participants who viewed the brochure of having changed their expectations. The effect of the brochure may have been obscured by a lack of parity between the two groups as the control group presented with statistically significantly higher levels of acuity and experienced significantly shorter waiting times. In terms of disconfirmation theory this would suggest expectations that had been met or exceeded. The results confirmed the correlation of expectations with satisfaction. Several domains also indicated age as a significant predictor with older patients tending to score higher satisfaction results. Other significant predictors of satisfaction established were waiting time and care from nurses, reinforcing the combination of efficient service and positive interpersonal experiences as being valued by patients. Conclusions: Information presented in written form appears to benefit a significant number of ED users in terms of orientation and explaining systems and procedures. The degree to which these effects may interact with other dimensions of satisfaction however is likely to be limited. Waiting time and interpersonal behaviours from staff also provide influential cues in determining satisfaction. Written material is likely to be one element in a series of coordinated strategies to improve patient satisfaction during periods of peak demand.