OBJECTIVETo investigate the hand hygiene (HH) compliance and its influencing factors in order to improve the HH of healthcare workers (HCWs).

METHODSHH compliance of HCWs in randomly sampled departments in our hospital was observed and recorded single-blindly by specially-trained staffs using a uniform method.

RESULTSThe total compliance rate of HH of HCWs was 30.2%, which varied among different departments and posts, and working areas. It was significantly higher in ward doctors than in outpatient physicians (P < 0.01). However, the compliance was not significantly different among nurses in different departments (P > 0.05). The compliance of HH of HCWs after surgical procedures (40.4%) was significantly higher than that before procedures (19.6%) (P < 0.01).

CONCLUSIONThe compliance of HH of HCWs remains low, which is somehow affected by factors such as departments, posts, and treatment modes.

Female ; Guideline Adherence ; statistics & numerical data ; Hand Disinfection ; Humans ; Hygiene ; Male ; Personnel, Hospital ; statistics & numerical data

INTRODUCTIONAntimicrobial stewardship programmes (ASP) can reduce antibiotic use but patient safety concerns exist. We evaluated the safety of prospective carbapenem review and feedback and its impact on carbapenem use and patient outcomes.

MATERIALS AND METHODSAfter 3 months implementation of our ASP, we compared patients with and without acceptance of ASP recommendations on the use of carbapenems. Primary outcome was 30-day mortality. Secondary outcomes included duration of carbapenem use, length of hospitalisation, clinical response, microbiological clearance, 30-day readmission and mortality at discharge.

RESULTSOf 226 recommendations for 183 patients, 59.3% was accepted. De-escalation, switching to oral antibiotics and antibiotic cessation comprised 72% of recommendations. Patients with acceptance of ASP recommendations had lower 30-day mortality and higher end-of-therapy clinical response despite shorter carbapenem duration (P <0.05). Predictors of 30-day mortality were Pitt bacteraemia score (adjusted odds ratio [aOR] 1.39, 95% confidence interval [CI], 1.11 to 1.74; P = 0.004) and non-acceptance of ASP recommendations (aOR 2.84, 95% CI, 1.21 to 6.64; P = 0.016).

CONCLUSIONOur prospective carbapenem review and feedback mainly comprising of reducing carbapenem use is safe.

Carbapenems ; therapeutic use ; Drug Utilization ; standards ; Feedback ; Guideline Adherence ; statistics & numerical data ; Humans ; Patient Safety ; Pharmaceutical Services ; Treatment Outcome

Nephrectomy is the cornerstone therapy for renal cell carcinoma (RCC) and continued refinement of the procedure through research may enhance patient outcomes. A national nephrectomy registry may provide the key information needed to assess the procedure at a national level. The aim of this study was to review nephrectomy data available at a population-based level in Australia and to benchmark these data against data from the rest of the world as an examination of the national nephrectomy registry model. A PubMed search identified records pertaining to RCC nephrectomy in Australia. A similar search identified records relating to established nephrectomy registries internationally and other surgical registries of clinical importance. These records were reviewed to address the stated aims of this article. Population-based data within Australia for nephrectomy were lacking. Key issues identified were the difficulty in benchmarking outcomes and no ongoing monitoring of trends. The care centralization debate, which questions whether small-volume centers provide comparable outcomes to high-volume centers, is ongoing. Patterns of adherence and the effectiveness of existing protocols are uncertain. A review of established international registries demonstrated that the registry model can effectively address issues comparable to those identified in the Australian literature. A national nephrectomy registry could address deficiencies identified in a given nation's nephrectomy field. The model is supported by evidence from international examples and will provide the population-based data needed for studies. Scope exists for possible integration with other registries to develop a more encompassing urological or surgical registry. Need remains for further exploration of the feasibility and practicalities of initiating such a registry including a minimum data set, outcome indicators, and auditing of data.
Australia ; Benchmarking ; Carcinoma, Renal Cell/*surgery ; Guideline Adherence ; Humans ; Kidney Neoplasms/*surgery ; Models, Theoretical ; Nephrectomy/*standards/*statistics & numerical data ; Practice Guidelines as Topic ; *Registries ; Treatment Outcome

The study assessed the self-reported frequency and quality of use of the Paediatric Standard Treatment Book by staff in urban clinics and rural health centres. 61 of the 88 nursing officers and 44 of the 89 community health workers in 9 urban and 4 rural health settings completed written questionnaires on their use of the Standard Treatment Book. The survey participants were also assessed on the management of three case scenarios of common clinical conditions. Whilst 69% of the participants reported daily use of the book, only 51% indicated that they always followed the guidelines. Performance in the case scenarios was poor. Although 87% made a correct diagnosis in the most straightforward case, only 38% indicated complete treatment and only 36% indicated complete and correct advice. In two more complex scenarios less than 30% of the participants made correct diagnoses and less than 10% indicated complete treatment and advice. 75% of the study group wanted inservice training on the use of the book; the majority of these said that doctors should give this training. 79% thought that the book could be improved. Many of the participants felt that more topics and more flow charts should be included. Whilst nursing officers and community health workers regard the Standard Treatment Book (STB) as important, many do not make optimal use of it. Knowledge of appropriate advice to give parents regarding their child's illness was particularly poor. Given the low scores of health workers on case scenarios involving children with more than one presenting problem, the use of the STB appears to be essential for management of most severely ill children presenting to health facilities in Papua New Guinea. Doctors, especially paediatricians, have an important role to play in stressing the importance of the book, in teaching health workers to use it correctly and in emphasizing an integrated approach to the management of sick children. The study incorporated an assessment of health facility infrastructure and equipment. All facilities needed maintenance work, and more than half had significant deficiencies in equipment and drug availability. Medical staff supervision and support of primary health staff is important and should include increasing and improving the use of the Standard Treatment Book. Such support should also aim to improve the working environment and health facility resources. This would substantially improve the service provided.
Child ; Child Health Services - standards ; Clinical Protocols ; Community Health Services ; Community Health Workers Delivery of Health Care / standards* Guideline Adherence - statistics & ; numerical data ; Papua New Guinea

OBJECTIVES: Although vaccination rates have increased, problems still remain in the storage and handling of vaccines. This study focused on inspecting actual vaccine storage status and awareness, and comparing them before and after education was provided. METHODS: In the primary inspection, a status survey checklist was completed by visual inspection. A questionnaire on the awareness of proper vaccine storage and handling was also administered to vaccine administrators in private medical institutions in 4 regions in Gyeongsangbuk-province. One-on-one education was then carried out, and our self-produced manual on safe vaccine storage and management methods was provided. In the secondary inspection, the investigators visited the same medical institutions and used the same questionnaire and checklist used during the primary inspection. The results before and after education were compared, by treating each appropriate answer as 1 point. RESULTS: The average checklists score was 9.74 (out of 15 points), which increased significantly after education was provided (by 0.84, p<0.001). The participants demonstrated improved practices in recording storage temperatures (p=0.016), storing vaccines in the center of the refrigerator (p=0.004), storing vaccines with other medication and non-medical items (p=0.031) after education. The average score calculated from the questionnaires was 10.48 (out of 14 points), which increased after education (by 1.03, p<0.001). CONCLUSIONS: This study suggests that vaccine storage practices and awareness are inadequate, but can be partially improved by providing relevant education. Repetitive education and policy-making are required to store vaccines safely because one-off education and unenforced guidelines offer limited efficacy.
Adult ; Drug Storage/*standards/statistics & numerical data ; Female ; Guideline Adherence/statistics & numerical data ; Health Facilities, Proprietary/*standards/statistics & numerical data ; *Health Knowledge, Attitudes, Practice ; Health Personnel/*education ; Humans ; Inservice Training ; Male ; Middle Aged ; Questionnaires ; Republic of Korea ; Vaccines/*standards ; Young Adult

The treatment preferences of 109 general practitioners (GPs) for childhood asthma were determined. Availability and adherence to clinical practice guidelines (CPG) for the treatment of childhood asthma was also assessed. Ninety eight (90%), 60 (55%) and 33 (30%) GPs considered nocturnal symptoms > 2 times/week, exercise induced wheeze and cough respectively as indications for preventer therapy. An oral preparation was preferred for relief medication [72 (66%) for 2-5 years, 60 (55%) for > 5 years]. An inhaled preparation was however preferred for preventer medication [60 (55%) for 2-5 years, 85 (78%) for > 5 years]. The oral form was more likely prescribed for asthmatic children 2-5 years (p < 0.001). Corticosteroids and ketotifen were the commonest inhaled and oral preventer treatment prescribed respectively. Only 36(33%) GPs have a CPG copy for reference. Children with asthma symptoms that require preventer therapy may not always be identified in general practice. The oral route remains important for asthma medication especially in young children. The accessibility to the CPG among GPs is disappointing.
Anti-Asthmatic Agents/*therapeutic use ; Asthma/*drug therapy ; Chi-Square Distribution ; Family Practice/*statistics & numerical data ; Guideline Adherence ; Pediatrics/*statistics & numerical data ; Physician's Practice Patterns/*statistics & numerical data ; Practice Guidelines ; Questionnaires

BACKGROUNDElevating the head of bed (HOB) 30° - 45° has been widely supported as a means of ventilator associated pneumonia (VAP) prevention. However, it was poorly adhered in clinical practice. This observational study aimed to investigate the factors impeding this simple practice at the bedside.

METHODSThis prospective study was conducted in 33 Chinese academic hospital intensive care units (ICUs). HOB angle was measured four times daily at 5 - 7 hour intervals. The predefined HOB elevation goal was an angle ≥ 30°.

RESULTSThe overall rate of achieving the HOB goal was 27.8% of the 8647 measurements in 314 patients during 2842 ventilation days. The HOB goal of ≥ 3 times/d was consistently achieved only in 15.9% of the cases. Almost 60% of patients had at least one 24 hours period during which the HOB goal was never documented. This low rate of protocol compliance was not associated with acute physiology and chronic health evaluation (APACHE) II score or dependence on vasopressors. In a survey, "nurse workload" was identified as the most important factor for non-compliance with the HOB goal. In addition, the rates of compliance were significantly different (P < 0.001) between physicians self-reporting that they either did or did not know the Institutes of Healthcare Improvement (IHI) ventilator bundle.

CONCLUSIONSLow adherence to a HOB angle of ≥ 30° was found in this nationwide survey. Nursing workload and lack of knowledge on VAP prevention were important barriers to changing this practice.

Adult ; Aged ; China ; Female ; Guideline Adherence ; statistics & numerical data ; Humans ; Intensive Care Units ; statistics & numerical data ; Male ; Middle Aged ; Pneumonia, Ventilator-Associated ; prevention & control ; Respiration, Artificial ; statistics & numerical data

Clinical practice guidelines (CPG) are one of the most effective ways to translate evidence of medical improvement into everyday practice. This study evaluated the dissemination and implementation of the Sexually Transmitted Infections-Korean Guidelines (STIKG) by applying the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework. A survey questionnaire was administered to clinicians via the internet. Among the 332 respondents, 190 (57.2%) stated that they were aware of STIKG and 107 (33.2%) implemented STIKG in their practice. The odds that a physician was exposed to STIKG (dissemination) were 2.61 times greater among physicians with previous training or education for any CPG than those who did not. Clinicians who indicated that STIKG were easy to understand were 4.88 times more likely to implement STIKG in their practice than those who found them not so easy. When a clinician's workplace had a supporting system for CPG use, the odds of implementation was 3.76 times higher. Perceived level of effectiveness of STIKG did not significantly influence their implementation. The findings of this study suggest that, ultimately, knowing how to engage clinicians in CPG implementation is as important as how to disseminate such guidelines; moreover, easy-to-use guidelines and institutional support are key factors.
Adult ; Female ; Guideline Adherence/*statistics & numerical data ; *Health Knowledge, Attitudes, Practice ; *Health Plan Implementation ; Humans ; *Information Dissemination ; Male ; Middle Aged ; Physicians ; Practice Patterns, Physicians' ; Public Health Surveillance ; Quality of Health Care ; Sexually Transmitted Diseases/*therapy ; Surveys and Questionnaires

In order to increase inhaled corticosteroid (ICS) use and to reduce hospitalization, emergency department visits and ultimately the economic burden of asthma, "Korean Asthma Management Guideline for Adults 2007" was developed. To assess the guideline effects on physician's ICS prescription for asthma, we conducted segmented regression and multilevel logistic regression using National Health Insurance claims database of outpatient visits from 2003 to 2010. We set each quarter of a year as a time unit and compared ICS prescription between before and after guideline dissemination. A total of 624,309 quarterly visits for asthma was observed. The ICS prescription rate before and after guideline dissemination was 13.3% and 16.4% respectively (P < 0.001). In the segmented regression, there was no significant guideline effect on overall ICS prescription rate. In multilevel logistic regression analyses, the effect of guideline on overall ICS prescription was not significant (odds ratio, 1.03; 95% CI, 1.00-1.06). In subgroup analysis, ICS prescription increased in secondary care hospitals (odds ratio, 1.15; 95% CI, 1.02-1.30) and in general hospitals (odds ratio, 1.10; 95% CI, 1.04-1.16). However, in primary clinics, which covered 81.7% of asthma cases, there was no significant change (odds ratio, 0.98; 95% CI, 0.94-1.02). From the in-depth interview, we could identify that the reimbursement criteria of the Health Insurance Review and Assessment Service and patient's preference for oral drug were barriers for the ICS prescription. The domestic asthma clinical guideline have no significant effect on ICS prescription, especially in primary clinics.
Administration, Inhalation ; Adrenal Cortex Hormones/*administration & dosage ; Allergy and Immunology/standards ; Anti-Inflammatory Agents/administration & dosage ; Asthma/*drug therapy/*epidemiology ; Drug Prescriptions/*statistics & numerical data ; Guideline Adherence/*utilization ; Humans ; *Practice Guidelines as Topic ; Prevalence ; Pulmonary Medicine/standards ; Republic of Korea/epidemiology ; Treatment Outcome

The standardized hypertension management provided by primary health care workers is an important part of China's recent health care reform efforts. Investigating 5,116 hypertensive patients from a cross-sectional survey conducted by the Chinese Center for Disease Control and Prevention in 2012, this study found that adherence to standardized hypertension management is associated with positive effects on hypertension- related knowledge, healthy lifestyle behavior, antihypertensive medical treatments, and blood pressure control. It will be necessary to provide primary health care workers with sufficient training and reasonable incentives to ensure the implementation and effectiveness of hypertension management.
Adult ; Aged ; Aged, 80 and over ; China ; Cross-Sectional Studies ; Female ; Guideline Adherence ; statistics & numerical data ; Health Care Reform ; legislation & jurisprudence ; Health Care Surveys ; Health Knowledge, Attitudes, Practice ; Healthy Lifestyle ; Humans ; Hypertension ; psychology ; therapy ; Male ; Middle Aged ; Patient Compliance ; psychology ; statistics & numerical data