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Given the growing support for establishing a just patient safety culture in health-care settings, a valid tool is needed to assess and improve just patient safety culture. The purpose of this study was to develop a measure of individual perceptions of just culture for a hospital setting.The 27-item survey was administered to 998 members of a health-care staff in a pediatric research hospital as part of the hospital's ongoing patient safety culture assessment process. Subscales included balancing a blame-free approach with accountability, feedback and communication, openness of communication, quality of the event reporting process, continuous improvement, and trust. The final sample of 404 participants (40% response rate) included nurses, physicians, pharmacists, and other hospital staff members involved in patient care. Confirmatory factor analysis was used to test the internal structure of the measure and reliability analyses were conducted on the subscales.Moderate support for the factor structure was established with confirmatory factor analysis. After modifications were made to improve statistical fit, the final version of the measure included 6 subscales loading onto one higher-order dimension. Additionally, Cronbach α reliability scores for the subscales were positive, with each dimension being above 0.7 with the exception of one.The instrument designed and tested in this study demonstrated adequate structure and reliability. Given the uniqueness of the current sample, further verification of the JCAT is needed from hospitals that serve broader populations. A validated tool could also be used to evaluate the relation between just culture and patient safety outcomes.

To evaluate the process of survivorship care plan (SCP) completion and to survey oncology staff and primary care physicians (PCPs) regarding challenges of implementing SCPs.Descriptive pilot study.Two facilities in Vermont, an urban academic medical center and a rural community academic cancer center.17 oncology clinical staff created SCPs, 39 PCPs completed surveys, and 58 patients (breast or colorectal cancer) participated in a telephone survey.Using Journey Forward tools, SCPs were created and presented to patients. PCPs received the SCP with a survey assessing its usefulness and barriers to delivery. Oncology staff were interviewed to assess perceived challenges and benefits of SCPs. Qualitative and quantitative data were used to identify challenges to the development and implementation process as well as patient perceptions of the SCP visit.SCP, healthcare provider perception of barriers to completion and implementation, and patient perception of SCP visit.Oncology staff cited the time required to obtain information for SCPs as a challenge. Completing SCPs 3-6 months after treatment ended was optimal. All participants felt advanced practice professionals should complete and review SCPs with patients. The most common challenge for PCPs to implement SCP recommendations was insufficient knowledge of cancer survivor issues. Most patients found the care plan visit very useful, particularly within six months of diagnosis.Creation time may be a barrier to widespread SCP implementation. Cancer survivors find SCPs useful, but PCPs feel insufficient knowledge of cancer survivor issues is a barrier to providing best follow-up care. Incorporating SCPs in electronic medical records may facilitate patient identification, appropriate staff scheduling, and timely SCP creation.Oncology nurse practitioners are well positioned to create and deliver SCPs, transitioning patients from oncology care to a PCP in a shared-care model of optimal wellness. Institution support for the time needed for SCP creation and review is imperative for sustaining this initiative.Accessing complete medical records is an obstacle for completing SCPs. A 3-6 month window to develop and deliver SCPs may be ideal. PCPs perceive insufficient knowledge of cancer survivor issues as a barrier to providing appropriate follow-up care.

El registro informatizado de los datos clínicos abre nuevas perspectivas sobre el uso de la información y el ejercicio de preservar el secreto profesional. La definición más ampliamente aceptada de la confidencialidad es la propuesta por Joseph y Oneck: «[ ] confiar información a otra persona con la expectativa de que se mantendrá en secreto». Los colegios profesionales son en quienes se ha delegado la potestad normativa acerca del cuidado del secreto profesional y sus alcances, a través de los códigos deontológicos de cada profesión. Por otra parte, disposiciones legales, como la Constitución Española, y leyes específicas, como la Ley Orgánica de Protección Civil del Derecho al Honor, la Ley Orgánica de Protección de Datos de Carácter Personal o la Ley Básica Reguladora de la Autonomía del Paciente y de Derechos y Obligaciones en Materia de Información y Documentación Clínica también regulan sobre la extensión de esta preservación de la información. También definen en qué circunstancias los profesionales deberían, o no, ofrecer la información relativa a sus pacientes, que inicialmente fue aceptada bajo criterios asistenciales y, por tanto, está sometida a la protección de su confidencialidad.

During the global outbreak of severe acute respiratory syndrome (SARS) in 2003, treatment was empiric. We report the case history of the index patient in a hospital outbreak of SARS in Hong Kong. The patient recovered after conventional antimicrobial therapy. Further studies are needed to address treatment of SARS, which has high attack and death rates.

Updated several times a week with posts by a wide variety of authors, AJN's blog Off the Charts allows us to provide more timely-and often more personal-perspectives on professional, policy, and clinical issues. Best of the Blog will be a regular column to bring AJN readers recent posts that we think deserve a wider audience. To read more, please visit: www.ajnoffthecharts.com.

In this Viewpoint, Medicare administrators describe the intended role and proper use of its Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey as a measure of patients' hospital-based experience.

A junior doctor who cited her senior colleagues without their knowledge as coauthors in papers that were later retracted for faulty or fabricated data has been suspended for 12 months by the Medical Practitioners Tribunal Service in Manchester. Gemina Doolub was working in cardiology for Oxford University Hospitals NHS Trust in 2013 when she submitted a research paper to ISRN Cardiology 1 and a research abstract to the Journal of the American College of Cardiology .2 In the research paper, submitted in or around February 2013, she cited Erica Dall’Armellina, a clinical research fellow at the John Radcliffe Hospital, as a coauthor, fabricating an email address for her. Neither Dall’Armellina nor …

Health Education England (HEE) has told hospital trusts that they could lose funding for training posts if they decide not to impose a new contract on their junior doctors. In a letter sent to the chief executives of all hospital trusts in England, Ian Cumming, HEE’s chief executive, said, “Implementation of the national contract will be a key criterion for HEE in making its decisions on our investment in training posts.” Last week the health …

University Hospitals of Leicester NHS Trust has appointed a humanist pastoral carer to provide support to patients, families, and staff who don’t have religious beliefs from 4 January. The hospital group is thought to be …

Textiles are a common material in healthcare facilities; therefore it is important that they do not pose as a vehicle for the transfer of pathogens to patients or hospital workers. During the course of use hospital textiles become contaminated and laundering is necessary. Laundering of healthcare textiles is most commonly adequate, but in some instances, due to inappropriate disinfection or subsequent recontamination, the textiles may become a contaminated inanimate surface with the possibility to transfer pathogens. In this review we searched the published literature in order to answer four review questions: (1) Are there any reports on the survival of microorganisms on hospital textiles after laundering? (2) Are there any reports that indicate the presence of microorganisms on hospital textiles during use? (3) Are there any reports that microorganisms on textiles are a possible source infection of patients? (4) Are there any reports that microorganisms on textiles are a possible source infection for healthcare workers?

Background The cancellation of planned surgeries causes prolonged wait times, harm to patients, and is a waste of scarce resources. To reduce high cancellation rates in a Norwegian general hospital, the pathway for elective surgery was redesigned. The changes included earlier clinical assessment of patients, better planning and documentation systems, and increased involvement of patients in the scheduling of surgeries. This study evaluated the outcomes of this new pathway for elective surgery and explored which factors affected the outcomes. Methods We collected the number of planned operations, performed operations, and cancellations per month from the hospital’s patient administrative system. We then used Student's t-test to analyze differences in cancellation rates (CRs) before and after interventions and a u-chart to analyze whether the improvements were sustained. We also conducted semi-structured interviews with employees of the hospital to explore the changes in the surgical pathway and the factors that facilitated these changes. Results The mean CR was reduced from 8.5% to 4.9% (95% CI for mean reduction 2.6-4.5, p p = 0.04). A clear improvement strategy, involvement of frontline clinicians, introduction of an electronic scheduling system, and engagement of middle managers were important factors for the success of the interventions. Conclusion The redesign of the old clinical pathway contributed to a sustained reduction in cancellations and an increased number of performed operations.

Medical X-ray technicians are exposed to low-level ionizing radiation in their occupational field. There are very few data on low-dose radiation effects. The present study was designed to estimate a few vital trace metals (Zn, Cu, Fe) in indicator tissues (blood and hair) of X-ray technicians and non-X-ray technicians (hospital employees were used as controls) by Atomic Absorption Spectrometry (AAS). This analysis noted a significant increase in Zn, Cu, and Fe concentrations in X-ray technicians' hair. But in blood, Zn and Cu were depleted, whereas Fe was increased. Such changes in trace metal concentrations among X-ray technicians were noted where occupational exposure to radiation was for longer than three years. Through composite risk analysis, by using Zn:Fe as an indicator, it was noted that blood gave a stronger indication than hair in analyzing and estimating risk.

This article presents the results of a survey designed to assess current Biomedical/Clinical Engineering attitudes. Issues discussed include separating biomedical/clinical services from engineering/maintenance services; certification; factors affecting salary levels; and whether technicians should use the "engineer" title. The opinions presented are meant to stimulate discussion among individual BMETs and CEs, and within clinical engineering departments.

Occupational Hazards of Hospital Person- nel: Assessment of a Safe Alternative to Formalde- hyde: Fabio BERTON, et al. Department of Public Policies and Public Choice, University of Eastern Piedmont, Italy—Objectives: Formaldehyde — a chemical widely used to preserve organic tissues in hospitals — is known to be carcinogenic in the long term and to cause breathing-related symptoms in the short term. We have taken advantage of an experiment to quantify this second effect among hospital workers in terms of probability of showing respiratory symptoms with respect to a benchmark in which tissues are preserved using a procedure with arguably no impact, i.e., under-vacuum sealing. Methods: This paper exploits an experimental situation with controls for potential confounding effects to estimate a logistic regression of the probability that formalin (a solution of formaldehyde and water) causes respiratory symptoms. Results: The probability for formalin users was found to be eight to ten times higher than for personnel testing under-vacuum sealing. Conclusions: The substitution of formaldehyde with under-vacuum sealing would markedly improve the health of personnel. (J Occup Health 2012; 54: 74-78)

One of the limitations of anatomical based imaging approaches is its relative inability to identify whether specific brain functions may be compromised by the location of brain lesions or contemplated brain surgeries. For this reason, methods for identifying the regions of eloquent brain that should not be disturbed are absolutely critical to the surgeon. By accurately identifying these regions preoperatively, virtually every pre-surgical decision from the surgical approach, operative goals (biopsy, sub-total vs. gross-total resection), and the potential need for awake craniotomy with intraoperative cortical-mapping is affected. Of the many techniques available to the surgeon, functional magnetic resonance imaging (fMRI) has become the primary modality of choice due to the ability of MRI to serve as a “one-stop shop” for assessing both anatomy and functionality of the brain. Given their prevalence, brain tumors serve as the model pathology for the included discussion; however, a similar case can be made for the use of fMRI in other neurological conditions, most notably epilepsy. The value of fMRI was validated in 2007 when the Centers for Medicare and Medicaid Services (CMS) established three new current procedural terminology (CPT) codes for clinical fMRI based upon its use for pre-therapeutic planning. In this article we will discuss the specific requirements for establishing an fMRI program, including specific software and hardware requirements. In addition, the nature of the fMRI CPT codes will be discussed.

Objetivo Estimar los costos directos de varicela en una población pediátrica de Colombia.Método Se diseño un estudio de casos retrospectivo sobre todos los casos de varicela diagnosticados de 2005-2008 en el Hospital Infantil Napoleón Franco Pareja de Cartagena de Indias, Colombia. Fue utilizada la perspectiva del hospital. Se buscaron costos de atención, laboratorio, imagenología y medicamentos. El microcosteo se realizó en pesos colombianos del 2010. Se realizó un ajuste por inflación. Resultados La mediana de costos totales hospitalarios fue de $ 898 766 (Q1: $ 197 348; Q3: $ 1 195 262). La mediana de costo por día hospitalario fue de $ 221 777 (Q1: $ 97 027; Q3: $ 293 740). En menores de 1 año la mediana de costo fue de $ 980 742 (Q1: $ 905 708; Q3: $ 1 026 031). En pacientes de 5-12 años la mediana de costo fue de $ 105 833 (Q1: $ 39 568; Q3: $ 891 824).Conclusiones. Los resultados se asemejan con estudios previos sobre el tema (en Panamá, e incluso algunos países desarrollados), evidenciando un relativo alto costo de enfermedad por varicela en Colombia. Estos resultados aumentan la evidencia a favor de la vacunación, e invitan a decisores en salud en Colombia a considerar la introducción de la vacunación contra varicela.

SUMMARYGenotyping was used to analysePseudomonas aeruginosaisolates from sink drains and 15 intubated patients as part of a 3-month prospective study of strain transmission in a medical-surgical intensive care unit. Ninety percent of all washbasin drains were persistently contaminated with severalP. aeruginosagenotypes. In 60% (9/15) of the patients,P. aeruginosacolonization or infection was hospital-acquired:P. aeruginosastrains isolated from these patients were present in hospital sinks or in other patients before their admission. Since all patients were immobile, personnel were the probable route of transmission ofP. aeruginosain the hospital. The mechanism of strain transmission from sinks to hands during hand washing was investigated in a children's hospital. WhenP. aeruginosawas present at densities of > 105/c.f.u. per ml in sink drains, hand washing resulted in hand contamination withP. aeruginosavia aerosol generation in the majority of experiments orP. aeruginosawas detected using an air sampler above the washing basin. HighP. aeruginosacfu were present at 4.30 h in the eight sinks (5.4 × 105−7.0 × 1010c.f.u./ml), whereas at 13.00 hP. aeruginosac.f.u. were significantly lower (3.1 × 102−8.0 × 105c.f.u. / ml). These data reveal that the danger of bacterial contamination of hands during hand washing is highest in the morning. The identified transmission routes demand more effective hygienic measures in hospital settings particularly concerning personnel hands and sink drains.

The Occupational Safety and Health Administration (OSHA) revised the Bloodborne Pathogen Standard and, on July 17, 2001, began enforcing the use of appropriate and effective sharps devices with engineered sharps-injury protection. OSHA requires employers to maintain a sharps-injury log that records, among other items, the type and brand of contaminated sharps device involved in each injury. Federal OSHA does not require needlestick injury rates to be calculated by brand or type of device. A sufficient sample size to show a valid comparison of safety devices, based on injury rates, is rarely feasible in a single facility outside of a formal research trial. Thus, calculations of injury rates should not be used by employers for product evaluations to compare the effectiveness of safety devices. This article provides examples of sample-size requirements for statistically valid comparisons, ranging from 100,000 to 4.5 million of each device, depending on study design, and expected reductions in needlestick injury rates.

During the last 20 years, the number of infants evaluated for permanent hearing loss at birth has increased dramatically with universal newborn hearing screening and intervention (UNHSI) programs operating in all US states and many territories. One of the most urgent challenges of UNHSI programs involves loss to follow-up among families whose infants screen positive for hearing loss. We surveyed 55 state and territorial UNHSI programs and conducted site visits with 8 state programs to evaluate progress in reaching program goals and to identify barriers to successful follow-up. We conclude that programs have made great strides in screening infants for hearing loss, but barriers to linking families of infants who do not pass the screening to further follow-up remain. We identified 4 areas in which there were barriers to follow-up (lack of service-system capacity, lack of provider knowledge, challenges to families in obtaining services, and information gaps), as well as successful strategies used by some states to address barriers within each of these areas. We also identified 5 key areas for future program improvements: (1) improving data systems to support surveillance and follow-up activities; (2) ensuring that all infants have a medical home; (3) building capacity beyond identified providers; (4) developing family support services; and (5) promoting the importance of early detection.

The use of patient hotels for ambulatory care of women with uncomplicated deliveries has become a routine in Sweden. This report describes a minor outbreak of a group A Streptococcus strain in 2 newly delivered mothers and their newborn babies at a patient hotel.

Background Most midwives in the Netherlands work in primary care where they are the lead professionals providing care to women with 'normal' or uncomplicated pregnancies, while some midwives work in hospitals ("clinical midwives"). The actual involvement of midwives in maternity care in hospitals is unknown, because in all statistics births in secondary care are registered as births assisted by gynaecologists. The aim of this study is to gain insight in the involvement of midwives with births in secondary care, under supervision of a gynaecologist. This is done using data from the PRN (The Netherlands Perinatal Registry), a voluntary registration of births in the Netherlands. The PRN covers 97% to 99% of all births taking place under responsibility of a gynaecologist. Methods All births registered in secondary care in the period 1998-2007 (1,102,676, on average 61% of all births) were selected. We analyzed trends in socio-demographic, obstetric and organisational characteristics, associated with the involvement of midwives, using frequency tables and uni- and multivariate logistic regression analyses. As main outcome measure the percentage of births in secondary care with a midwife 'catching' the baby was used. Results The proportion of births attended by a midwife in secondary care increased from 8.3% in 1998 to 26.06% in 2007, the largest increase involving spontaneous births of a second or later child, on weekdays during day shifts (8.00-20.00 hr) from younger mothers with a gestational age (almost) at term. After 2002, parallel to the growing numbers of midwives working in hospitals, the percentage of instrumental births decreased. Conclusions In 2007 more midwives are assisting with more births in secondary care than in 1998. Hospital-based midwives are primarily involved with uncomplicated births of women with relatively low risk demographical and obstetrical characteristics. However, they are still only involved with half of the less complicated births, indicating that there may be room for more midwives in hospitals to care for women with relatively uncomplicated births. Whether an association exists between the growing involvement of midwives and the decreasing percentage of instrumental births needs further investigation.

In spite of the growing recognition of the influence of interactions with health care providers on how patients and family members respond to illness, more research providing data-based conceptualizations of these interactions is needed. This paper contributes to the growing body of research on the nature of relationships between health care providers and consumers. Drawing on data from interviews with 102 parents (51 couples) of children with chronic illness, the authors explore provider behaviors that promote and sustain a positive working relationship with family members.

This study sought to determine the level of communication interference associated with commonly used disposable and reusable respirators and surgical masks worn by healthcare workers. Speech intelligibility was assessed using the modified rhyme test in an intensive care unit environment. Respirators decreased speech intelligibility by a range of 1% to 17%, although not all were statistically significant. Differences in speech intelligibility associated with surgical masks and disposable filtering facepiece respirators (without exhalation valves) were not statistically significant compared with controls. Wearing half-face elastomeric respirators with voice augmentation equipment was associated with higher speech intelligibility than models without this equipment (OR = 2.81). Hearing clarity while wearing a powered air-purifying respirator (PAPR) was 79% compared with 90% with no PAPR (OR = 0.40). While some respirators appear to have little or no effect on speech intelligibility, interference with speech intelligibility associated with certain types of respirators commonly worn by U.S. healthcare workers may be substantial.

Objetivo: Tipificar por metodos moleculares y fenotipicos, las cepas SAMR aisladas de pacientes y personal de enfermeria para establecer su posible origen clonal. Materiales y Metodos: Se analizaron 50 cepas SAMR aisladas en un Hospital Universitario de Maracaibo (Venezuela). La tipificacion se efectuo mediante electroforesis en gel de campo pulsado (EGCP) y antibiotipia. Resultados: Entre pacientes, se obtuvieron 19 antibiotipos y 12 grupos (I-XII); mientras que, en el personal de salud, por EGCP se detectaron seis grupos (I-VI) y dos antibiotipos. No se encontro asociacion estadisticamente significativa entre los antibiotipos y patrones de bandas obtenidos por EGCP (p > 0,05). Conclusiones: Por medio de la deteccion de marcadores de resistencia y mediante la EGCP, es factible diferenciar la naturaleza de las cepas SAMR de origen clinico. Los resultados obtenidos demuestran la posible transmision intrahospitalaria de cepas SAMR; asi como, su diseminacion clonal en los servicios del hospital, particularmente en la UCI, durante el periodo estudiado.

A study of the flow of information about organizational problems was conducted. We found that managers often avoided passing problems to formally designated problem solvers and used personal ties to forward information to problem solvers. The strength of ties between individuals had a weak effect on passing problems across professional boundaries.

Games can make learning fun and stimulating. This learning strategy is particularly useful in providing factual information to orientees. This article describes a game developed to orient staff nurses and unit clerks at the Calgary General Hospital in Calgary, Alberta, Canada, to agency policies and procedures.

Although case management programs attempt to reduce the use of psychiatric hospitalization for clients with long-term mental illness, inpatient treatment still is required for many individuals in even the best community support systems. Even when formal mechanisms for hospital-community liaison exist, there often is little effective collaboration between hospital and community treatment staffs. Depleted from struggling with relapsing patients, case managers often discontinue their efforts during hospitalization. At the same time, hospital staff often demonstrate little interest in community caregivers until discharge planning begins in earnest. Hospital staff and case managers .heve common barriers to effective collaboration, but they can work together toward the goal of achieving maximum benefit from hospitalization within the context of a long-term community plan.

Udgivelsesdato: 2009-Sep BACKGROUND: Since 2004, we have promoted alcohol-based hand rubbing (HR) with an e-learning program (ELP) among hospital staff. This study sought to determine whether an ELP improves adherence to correct HR. METHODS: This was a cohort study of staff members at Aarhus University Hospital, Skejby, Denmark who completed the ELP and were repeatedly observed for correct HR before and after clinical procedures in 2006 and/or 2007. RESULTS: Of the 496 participants, 13% completed the ELP in both 2006 and 2007, 29% completed the ELP only in 2006, 15% completed the ELP only in 2007, and 43% never completed the ELP. Compared with noncompleters, completers of the 2006 and 2007 ELP had a significantly higher adherence to correct HR both before clinical procedures (odds ratio [OR] = 1.54; 95% confidence interval [CI] = 1.11 to 2.13) and after clinical procedures (OR = 1.40; 95% CI = 1.03 to 1.89). Time since completing the ELP seemed to be inversely associated with adherence to correct HR. CONCLUSION: Completion of an ELP may have a positive impact on the performance of correct HR. The demands of lifelong education and training of hospital staff may call for the use of an ELP as a supplement to existing efforts aimed at improving HR to help prevent health care-related infections.

The extent to which the use of alcohol-based handrub for hand hygiene has been adopted by US hospitals is unknown. A survey of infection control coordinators (response rate, 516 [72%] of 719) revealed that most hospitals (436 [84%] of 516) have adopted alcohol-based handrub. Leadership support and staff receptivity play a significant role in its adoption. Infect Control Hosp Epidemiol 2008; 29:1177-1180

The Belgian national guidelines to prevent transmission of Clostridium difficile in hospitals state that it is justified to use a disinfectant containing 1,000 or 5,000 ppm free chlorine to disinfect the rooms of patients with C. difficile–associated disease (CDAD). Concern has risen about the occupational safety of the cleaning employees using the disinfectant at this concentration. We conducted a small test to evaluate the concentration of chlorine in the air while the cleaning employees disinfected a patient’s room according to our standard procedure (furniture, door, bathroom, and floor). The chlorine-containing disinfectant in our hospital is made from 3 tablets of sodium dichloroisocyanurate dihydrate dissolved in 1 L of water to obtain a concentration of 4,500 ppm free chlorine. During the test, the door and windows were closed. Air samples were taken in the neighborhood of the cleaning employees (distance, approximately 1 m) during the decontamination procedure. The samples were analyzed according to method P&CAM 209 in the NIOSH Manual of Analytical Methods. During an 18-minute decontamination with a solution containing 4,500 ppm free chlorine, we sampled 18.3 L of air and found traces of chlorine that were not quantifiable. During a 15-minute decontamination with a solution containing 1,500 ppm free chlorine, we sampled 15.2 L of air and could not detect chlorine at all. On the basis of these results, we concluded that there is no occupational hazard for the cleaning employees while performing a decontamination procedure with a solution containing 4,500 ppm free chlorine made from sodium dichloroisocyanurate dihydrate tablets.

Body packing is a common method of smuggling cocaine where individuals ingest several drug-filled parcels for transport. When identified by the authorities, body packers are usually taken to hospital for evaluation. There are several points during management of these patients when the health care team may be placed at risk. We explore the hazards encountered during the management of these patients in developing Caribbean nations.

Udgivelsesdato: 2008-Oct We evaluated hand antisepsis in clinical practice at Aarhus University Hospital in Skejby, Denmark. The rate of compliance with the correct use of alcohol-based hand rub exceeded 55% of all routine clinical procedures observed. With the correct use of alcohol-based hand rub by hospital staff, bacterial counts were reduced by 90% before and 82% after a clinical procedure; with incorrect use, the bacterial counts were reduced by 60% before and 54% after a clinical procedure.

Os hospitais públicos brasileiros têm mostrado descompassos, percebidos no seu gerenciamento e nas questões relativas aos trabalhadores da saúde, que influenciam a produção e organização do trabalho e a assistência prestada nestes espaços. Esta problemática catalisou a presente investigação, na emergência do entendimento destes fenômenos pela cultura organizacional. Também encaminhou os objetivos desta pesquisa, no sentido de traduzir/interpretar os significados acerca de aspectos hospitalares encontrados em estudos empíricos, que continham a temática cultura organizacional de hospitais, e compor um retrato da cultura destes hospitais, na forma de bricolagem. A tese sustentada foi de que a configuração estrutural dos hospitais, as relações dos trabalhadores da saúde com o trabalho nestes locais e a interface de ambos com o modelo público de gestão da saúde são aspectos que evidenciam significados, emergentes da interpretação dos autores, sobre significados construídos e incorporados pelos trabalhadores acerca dos mesmos. A re-interpretação do conjunto destes significados leva à compreensão de traços da cultura organizacional de hospitais públicos brasileiros. O referencial teórico e metodológico esteve assentado na perspectiva subjetivista da antropologia simbólico/interpretativa/hermenêutica defendida por Geertz. Os aspectos hospitalares, capturados de três teses e sete dissertações produzidas nos diversos programas de pós-graduações brasileiros entre 2002 e 2006, constituíram três estruturas de significação: “A cultura de hospitais públicos brasileiros na dimensão organizacional”; “A cultura de hospitais públicos brasileiros na dimensão dos sujeitos no trabalho”; e “A cultura de hospitais públicos brasileiros na dimensão ambiental”. A re-interpretação dos significados apontou que o arranjo funcional dos hospitais, formado pela natureza pública, a burocracia e os desdobramentos destas, contorna um conjunto de significados que traduzem a cultura em que o público e a burocracia são ineficientes, dificultam as demandas hospitalares, aumentam as distâncias entre os sujeitos, acirram conflitos e são instrumentos de discriminação e disputas profissionais. Afora este, outros desenhos de gerenciamentos materiais e humanos ainda são efetivados pelos hospitais, a fim de responder às exigências do modelo público de gestão da saúde, que busca empresariá-los, para a efetiva operacionalização e consolidação do SUS. As tensões resultantes destas transações impactam os significados que os trabalhadores da saúde constroem acerca do seu trabalho e desta lógica gestora. Assim, eles instituem e propagam, através da cultura organizacional, meios criativos de sobrevivência intra-hospitalares e de contra-reações à ingerência do modelo público de gestão da saúde nos hospitais, que se reproduzem nas relações de vínculo, subsistência e oposição processadas nestes ambientes. A expressão material da percepção/tradução/interpretação da cultura organizacional de hospitais públicos brasileiros pode ser exposta através do símbolo-significante de um retrato bricolado. Neste, o cenário é composto pela questão do público e da burocracia, as figuras centrais são os trabalhadores da saúde, em relações com seu trabalho, e a moldura constitui-se no modelo público de gestão da saúde, que dirige e ordena a realidade hospitalar. Esta investigação pretendeu fortalecer o estudo da cultura organizacional na especificidade dos hospitais, e, com isto, participar do processo de construção do conhecimento da Enfermagem, fornecendo subsídios para condução deste retrato, onde, sabidamente, os enfermeiros ocupam lugar de destaque. The public hospitals in Brazil have been showing a des-control, noticed in their administration and questions related to health workers, that influences the organization and production of work and the assistance given in this spaces. The catalysis problem of this present investigation, in the understanding emergency of this phenomenal by the organizational culture. Making the objectives of this study, in the direction of translating/interpreting the significant that surrounds the hospitals aspects encountered in this empirical study, that contains the organization culture theme of the hospitals, and compose a portrait of this hospitals culture, in the form of bricolage. The sustained theses is that the structural configuration of hospitals, as related to health workers that work in this locals and the interface of both public model of administration of health are aspects that are significant evidence, emergent of the authors interpretation, about the significant constructed and incorporated by workers surrounded by same. The re-interpretation of this significant links leads to the understanding of the characteristics of organizational culture of public hospitals in Brazil. The theoretical reference and methodology is placed in the subjectivity perspective of anthropology symbolic/interpretative/hermeneutical defended by Geertz. The hospitals aspects, captured in three theses and seven dissertation produced in diverse programs of Brazil courses of post-graduation between 2002 and 2006, constitute three significant structures: ´´The Brazilian public hospitals culture in organization dimension``; The culture of brazil public hospital in the dimension of workers at work and ´´ The Brazilian public hospitals culture in environmental organization``. The re-interpretation of the significant pointed out that the functional arrangements of hospitals, formed by public nature, the bureaucracy and the increase of this contains a link of significant that translate a culture in which the public and bureaucracy are inefficient, creates difficulty to hospitals demand, increases the distance between people, creates conflicts and they are instruments to discrimination and professional disputes. Apart from this, another portrait of administration materials and human are still not effected by the hospitals, in response to the exigency of public model of health administration, that search privatize them, to make them effective in operation and consolidation of SUS. The resultant tension of this transactions impact the significant of how the health workers construct as regards to their work and the logic of administration. In this manner, they institute and propagate, through the organizational culture, creative means of survival intrahospitals and the contra-reactions the interference of public model of administration of health in hospitals, that are produced as related to the link, subsistence and opposition processed in this environment. The material expression of perception/translation/interpretation of organizational culture of Brazil public hospitals can be exposed through the symbol-significant of a portrait of do it yourself. This situation is composed by public question and bureaucracy, the central figures are health workers, in relation to their work, this frame constitute the public model of administration of health, which run and give order in the hospital reality. This investigation pretends to make a strong case on the study of organizational culture in the specificity of hospitals, and , with this, participate in the process of knowledge construction in nursing, giving subsidies to the conduction of this portrait, where, knowing , that the nurses occupies a headline position. Los hospitales públicos brasileños han demostrado descompases que pueden ser percibidos en su administración y en las cuestiones relativas a los trabajadores del área de la salud, los cuales influyen en la producción y organización del trabajo, así como en la atención ofrecida en esos espacios. Esa problemática incentivó el desarrollo de la presente investigación, a partir de la comprensión de esos fenómenos por la cultura organizacional. También dirigió sus objetivos en el sentido de traducir/interpretar los significados acerca de aspectos hospitalarios encontrados en estudios empíricos que contienen el tema de la cultura organizacional de hospitales, además de permitir la elaboración de un retrato de la cultura de esos hospitales en la forma de bricolage. La tesis sustentada en este estudio es que la configuración estructural de los hospitales, asi como las relaciones de los trabajadores del área de la salud con el trabajo en esos lugares, y la interfaz de ambos con el modelo público de gestión de la salud son aspectos que manifiestan significados surgidos de la interpretación de los autores sobre los significados construidos e incorporados por los trabajadores acerca de los mismos. La interpretación del conjunto de esos significados conduce a la comprensión de aspectos de la cultura organizacional de los hospitales públicos brasileños. El marco teórico y metodológico de este estudio es basado en la perspectiva subjetivista de la antropología simbólica, interpretativa y hermenéutica defendida por Geertz. Los aspectos hospitalarios, extraidos de tres tesis y siete disertaciones hechas entre 2002 y 2006, en diversos programas de posgrado brasileños, constituyeron tres estructuras de significación: “La cultura de los hospitales públicos brasileños en la dimensión organizacional”; “La cultura de los hospitales públicos brasileños en la dimensión de los sujetos del trabajo”; y, “La cultura de los hospitales públicos brasileños en la dimensión ambiental”. La reinterpretación de los significados señaló que el orden funcional de los hospitales, formado por la naturaleza pública, la burocracia y los desdoblamientos que se producen a partir de ellas, producen un conjunto de significados que traducen la cultura en la cual lo público y la burocracia son ineficientes, dificultan las demandas hospitalarias, aumentan las distancias entre los sujetos, provocan conflictos y son instrumentos de discriminación y disputas profesionales. Además de ello, otros modelos de gerenciamiento materiales y humanos son realizados por los hospitales, con el objetivo de responder a las exigencias del modelo público de gestión de la salud, el cual busca convertir los hospitales en empresa, para la efectiva operacionalización y consolidación del SUS. Las tensiones resultantes de esas transacciones afectan los significados que los trabajadores de la salud construyen acerca de su trabajo y de esa lógica gestora. De esa forma, los trabajadores instituyen y propagan, a través de la cultura organizacional, medios creativos intrahospitalarios de supervivencia y de reacciones contra la intromisión del modelo público de gestión de la salud en los hospitales, los cuales se reproducen en las relaciones de vínculo, subsistencia y oposición producidas en esos ambientes. La expresión material de la percepción/traducción/interpretación de la cultura organizacional de los hospitales públicos brasileños puede ser expuesta a través del símbolo-significante de un cuadro bricolado. En esa imagen, el escenario es compuesto por la cuestión del público y de la burocracia, las figuras centrales son los trabajadores del área de la salud, en las relaciones con su trabajo, y el marco del cuadro lo constituye el modelo público de gestión de la salud que dirige y ordena la realidad hospitalaria. En la presente investigación se pretendió fortalecer el estudio de la cultura organizacional en la especificidad de los hospitales, y con ello, participar del proceso de construcción del conocimiento de la Enfermería, ofreciendo contribuciones para la conducción de ese cuadro, donde, como es sabido, los enfermeros ocupan un lugar destacado.

Plasmid profiling was used as an epidemiological tool during a period of frequent Salmonella enteritidis infection in a hospital. S. enteritidis was isolated from 22 patients and employees. Isolates from 18 persons harbored one 29 and one 36 megadalton (MDa) plasmid. The 29 MDa plasmid has not been previously described in this species and was not found in 54 control strains of S. enteritidis from other sources. The respective restriction endonuclease digest fragments of the 36 and the 29 MDa plasmids were always identical. This plasmid pattern thus served as a marker for the isolates from the outbreak.

Health professionals often recommend that patients make lifestyle modifications to improve their health. Unhealthy lifestyle habits are well documented as complicating factors for such diseases as cancer and heart disease.[1][1] We conducted a survey to help determine whether health care workers

To date, chronic toxic encephalopathy (CTE) has never been described in operating room personnel. We report two cases of anaesthetists who developed this pathology. They have both used anaesthetic gases for many years in paediatric surgery. Air conditioning was deficient during three years in operating rooms and atmospheric anaesthetics concentration was high (N2O mean concentration: 311 ppm, peak levels 1,600 ppm; halogenated: 16 ppm, peak levels: 1,600 ppm). Mood troubles and non-specific neuropsychic deficits gradually evolved until they had to stop working. Neuropsychological assessment showed important deficits in attention, executive functioning, short-term memory and visuo-spatial organization. Blood tests, VEPs, MRI, neuroSPECT and cardiovascular exams were normal. Troubles had slowly improved after cessation of exposure and sequels still remain. These CTE cases seem to be the consequence of a long-term exposure to important levels of anaesthetic gases, and particularly nitrous oxide. It points out the importance of preventive measures in operating rooms, where occupational hazards are varied.

At 8:52 am on 8 October 2005 a massive earthquake wracked northern Pakistan and Kashmir. Various teams were sent to Islamabad and the disaster region from the UK. We discuss the types of injury patterns seen and recommend that a central register of volunteers should be created to deal with similar situations in the future.

In an Italian hospital, we observed that hand hygiene was performed in 638 (19.6%) of 3,253 opportunities, whereas gloves were worn in 538 (44.2%) 1,218 of opportunities. We observed an inverse correlation between the intensity of care and the rate of hand hygiene compliance (R2=0.057; P2 = 0.014; P = .078). Rates of compliance with hand hygiene and glove use recommendations follow different behavioral patterns.

In addition to concerns that “Members of the public will come in and use the free wi-fi, patients will be distracted and clinics will run even later, and inappropriate use would have to be controlled, with costs of filtering and legal liabilities,”1 I think hospital staff will be distracted from their healthcare duties …