Hand hygiene and infection in hospitals: what do the public know; what should the public know?

M. Fletcher

Summary

Healthcare-associated infection (HCAI) is a topic of increasing public interest, particularly to users of health services. At the same time, there is a move towards greater openness and transparency across the whole healthcare sector. Thus we see public reporting of performance in relation to rates of HCAI and infection control practices is increasingly well established in the NHS in England. So does any of this make a difference? And how embedded is the ?public right to know?? In this paper it is argued that, although the public right to know about rates of HCAIs is well recognised, the evidence base about the impact of such information is limited. The paper suggests actions which can be taken by boards and senior leaders in healthcare organisations to increase impact. Furthermore the example of hand hygiene suggests that we have some way to go in creating an environment in which patients feel empowered to ask questions that may reduce their own vulnerability to infection.

Credit Journal of Hospital Infection Volume 73, Issue 4, December 2009, Pages 397-399

ขั้นตอนในการเก็บข้อมูลที่อังกฤษ ก็คงจะเหมือนกับที่เมืองไทย แต่ว่าคงจะพิถีพิถันและก็ค่อนข้างเข้มงวดกวดขันมากกว่า เพราะว่าที่นี่จะมีการร้องเรียน ฟ้องร้องกันเยอะถ้าขืนบุ่มบ่ามเก็บ เพราะคนที่นี่เขาไม่ใจดีแบบคนไทย ดังนั้นกว่าจะได้เข้าไปเก็บต้องผ่านขั้นตอนดังนี้คือ

1) ต้องผ่านกรรมการจริยธรรมของทางมหาวิทยาลัย หรือต้นสังกัดก่อน 2) เมื่อผ่านขั้นตอนแรก จึงสู่ขั้นการขอ ethical approval จาก คณะกรรมการจริยธรรมระดับประเทศ National Research Ethics Service (NRES) ซึ่งจะต้องกรอกเอกสารหรือ application form ผ่านเวบของเขา http://www.nres.npsa.nhs.uk/ มีประมาณห้าสิบกว่าหน้า กรอกกันตาลายค่ะ วันเดียวไม่เสร็จ ขอบอก และมีรายละเอียดมาก กรอกไปงงไป เกือบจะกรอกยานอนหลับตามกันเลย เฮ้อ ไม่รู้ว่าคิดผิดคิดถูกไงคะ ทำไมหาเรื่องให้กับตัวเองเยี่ยงนี้ เดือดร้อนต้องพึ่งซุป ก็จริงนะ ซุปที่นี่รับเงินจากค่าเทอมเราไปเยอะ ต้องพึ่งกันหน่อย กรอกเสร็จก็ submit ผ่านเวบเลย และก็ปริ้นตัวจริงออกมาให้ทางกรรมการจริยธรรมมหาวิทยาลัย และซุปเราเซ็นต์ด้วย จะต้องส่งเอกสารหลายอย่างแนบไปกับตัวจริง ได้แต่ proposal, CV ของผู้วิจัย ใบรับรองว่าผ่านกรรมการจริยธรรมของมหาลัย และพวกโปสเตอร์ หรือเครื่องมือต่างๆที่ใช้ในงานวิจัย

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Discourse analysis is a qualitative method that has been adopted and developed by social constructionists. It emerged between the sociology and scientific knowledge. It established a departure from realist accounts of scientists’ actions to a study of scientists’ accounting practices. It processes that language is used variably. Accounts are constructed from a range of descriptive possibilities, and are intimately tied to the context in which they are produced and functions they perform.

The analysis proceeds by trying to identify themes in what people say. By looking at each utterance, the researcher asks whether some theme can be abstracted about what is being said.

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Definition

Conversation analysis is an approach to the study of natural conversation, especially with a view to determining the following:

Participants? methods of

• turn-taking
• constructing sequences of utterances across turns
• identifying and repairing problems, and
• employing gaze and movement

How conversation works in different conventional settings

Conversation analysis developed from Harver Sacks working. It examines language as social action. Talk-in-interaction is taken to be systematically organised and ordered. The primasy data research are audio recordings of naturally occuring interaction. Transcripts assist the analysis of audio material. The tracscription system provides a detailed characterisation of messiness of everyday interaction, focusing on speech production and turn-taking organisation.

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William T. Basco, Jr., MD, FAAP

Summary

This report represents an 18- to 21-month follow-up of a multicenter randomized controlled trial of caffeine given to premature infants. A previous report from this trial demonstrated that infants receiving caffeine had lower rates of bronchopulmonary dysplasia (BPD) than those who did not; however, potential neurodevelopmental adverse outcomes from use of methylxanthines in the developing brain necessitated longer-term developmental follow-up.

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Manon Ranger, PhD Student, MSc, RN; Marsha Campbell-Yeo, PhD Student, MN, NNP, RN

Abstract

Pain is a subjective and uniquely lived experience. Because reactions to pain vary so widely from one person to another, and better pain management remains a major issue in our attempt to resolve pain and suffering of varying populations, we need to generate interventions that better target interindividual variations. One research avenue could be the study of each person’s own biologic and psychologic makeup. Within this path, individual temperament is a rich and fascinating terrain to consider. The purpose of the present article is to describe the relationship between individual temperament and pain response (and pain perception) by searching the literature. Nursing implications regarding this theme are then discussed.

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Mary Puchalski, MS, RNC, APN/CNS

What is the preferred method of treating pediatric pain following minor surgery, such as an appendectomy?

Pain in pediatric patients has historically been undertreated. Study after study finds that we treat pain less aggressively in the pediatric patient because we are afraid of the side effects of medication, or we just do not believe that they are in pain because they do not “look like” they are in pain.

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Barbara Sattler, PhD, RN, FAAN; Allison Del Bene Davis, PhD, APRN, BC

Abstract

There is a growing body of evidence regarding the presence of toxic pollutants in the air, water, soil, food, and indoor environments, and the health effects of these pollutants on humans. Children have special vulnerabilities to environmental risks in their homes, schools, and communities. Children?s susceptibility to environmental risks stem from biological, behavioral, and socio-economic factors. Environmental standards are not always protective of children?s health, and in some instances, no standards exist. Addressing children?s vulnerabilities and decreasing their exposures require a multi-faceted and multi-disciplinary approach with clinical, public health, and policy interventions. Preventing exposure to hazardous levels of pollution is largely the role of the public health community, environmental protection agencies, and the policy makers who create the enabling laws. The Institute of Medicine (IOM) (1995) has recommended the integration of environmental health into nursing practice, education, research, and policy/advocacy work. This article identifies areas in each of these categories in which nurses can enhance their practice regarding children?s environmental health. In addressing children?s environmental health, nurses? expanded roles can include a range of activities, such as anticipatory guidance, health education, public health interface, improved health tracking, environmental health research, and legislative/regulatory engagement.

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James W. Gray

Abstract

Neonates are one of the highest risk groups of hospitalized patients for sepsis. There is a wide variation in the incidence and microbial causes of late-onset neonatal sepsis, owing to differences in both patient populations and standards of care in the individual neonatal units. Stratification according to risk factors is required to allow the meaningful comparison of infection rates between units. Knowledge of risk factors is also important in order to target interventions on high-risk aspects of neonatal care. Few independent risk factors for late-onset sepsis have been identified, the most common being birth gestational age and parenteral nutrition. Further work is required to validate that these observations can be generalized, and that they could, therefore, be used to stratify infection rates in multicenter surveillance schemes.

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Pain is the most common problem for health care, pain costs to society are exorbitant, and pain can have a widespread impact on all aspects of life (Stewart, Ricci, Chee, Morganstein, & Lipton, 2003), but pain in children particularly very young children is difficult to assess. This article discuss about peadiatric paon assessment that I think it might be useful for practitioner.

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