Veterinary hygiene : A guideline for veterinary practices

This guide has been drafted as a concrete protocol of the National Action Plan on Antimicrobial Resistance in order to provide practical assistance for the development of hygiene practices at veterinary receptions and prevent the spread of antimicrobial resistance. Increasing antimicrobial resistance is one of the biggest national health threats in the world. The antimicrobial resistance of pathogenic bacteria in animals is also increasing at an alarming rate. Reducing the use of antimicrobials mitigates the development of resistance and improving the level of hygiene at veterinary receptions can also effectively prevent infections and the spread of antimicrobial resistance. Daily hygiene procedures and taking standard precautions form the basis for preventing infections. These precautions must be taken with each and every patient by all reception personnel. Proper hand hygiene is the foundation of hygiene protocols. In addition to proper hand hygiene, hygiene protocols and standard precautions include aseptic technique, the proper use of personal protection equipment, the immediate cleaning of secretions, the prevention of needle stick and cutting injuries, and maintaining reception tidiness and cleanliness. Furthermore, special attention must be given to the treatment and handling of risk patients, i.e. potential carriers of resistant bacteria and animals with contagious diseases. The identification of risk patients, choosing the right treatment room and treatment planning at the reception are crucial to avoiding contamination of the facility and the spread of infection transmitted by the hands of personnel, the environment and the equipment used. This guide will help point out essential factors in the planning of hygiene protocols at different veterinary receptions

Veterinary hygiene : A guideline for veterinary practices

This guide has been drafted as a concrete protocol of the National Action Plan on Antimicrobial Resistance in order to provide practical assistance for the development of hygiene practices at veterinary receptions and prevent the spread of antimicrobial resistance. Increasing antimicrobial resistance is one of the biggest national health threats in the world. The antimicrobial resistance of pathogenic bacteria in animals is also increasing at an alarming rate. Reducing the use of antimicrobials mitigates the development of resistance and improving the level of hygiene at veterinary receptions can also effectively prevent infections and the spread of antimicrobial resistance. Daily hygiene procedures and taking standard precautions form the basis for preventing infections. These precautions must be taken with each and every patient by all reception personnel. Proper hand hygiene is the foundation of hygiene protocols. In addition to proper hand hygiene, hygiene protocols and standard precautions include aseptic technique, the proper use of personal protection equipment, the immediate cleaning of secretions, the prevention of needle stick and cutting injuries, and maintaining reception tidiness and cleanliness. Furthermore, special attention must be given to the treatment and handling of risk patients, i.e. potential carriers of resistant bacteria and animals with contagious diseases. The identification of risk patients, choosing the right treatment room and treatment planning at the reception are crucial to avoiding contamination of the facility and the spread of infection transmitted by the hands of personnel, the environment and the equipment used. This guide will help point out essential factors in the planning of hygiene protocols at different veterinary receptions

Hiljaisen raportoinnin käyttöönotto sisätautiosastolla

Kehittämisprojektin taustalla oli toiminnan ja rakenteiden kehittäminen Tyks Vakka-Suomen sairaalassa. Strategiaan kuuluvat potilaslähtöiset palvelut ja potilasturvallisuudesta huolehtiminen. Tyks Vakka-Suomen sairaalassa potilaslähtöisten palvelujen laadun varmistamiseksi sairaala käynnisti SHQS-laautjärjestelmän, jossa tehtiin itsearviointi ja sisäinen auditointi vuonna 2013 sekä uudelleen vuonna 2014. Tehdyssä sisäisen auditoinnin raportissa yhtenä kehittämissuosituksena oli hoitotyön suunnitelmien päivittäminen vastaamaan nykytilannetta. Lisäksi osaston toiminnasta oli pyritty tunnistamaan kohdat, joista voisi vapautua resurssia hoitotyöhön. Aikaa koettiin kuluvan liikaa raportointiin. Kehittämisprojektin tarkoituksena oli tukea ja kehittää Tyks Vakka-Suomen sairaalan sisätautiosaston moniammatillisia työkäytänteitä osaston sisäisen tiedonkulun osalta. Kehittämisprojektin tavoitteena oli raportointikäytänteiden kehittäminen kohti hiljaista raportointia. Tutkimusaineisto kerättiin mittaamalla suulliseen raportointiin kuluvaa aikaa ennen hiljaiseen raportointiin siirtymistä ja hiljaiseen raportointiin kuluvaa aikaa hiljaisen raportoinnin kokeilussa. Tulokseksi saatiin, että hiljaiseen raportointiin käytetty aika per potilas oli lyhyempi kuin suulli-sen raportointiin käytetty aika; toisaalta osastolla oli hiljaisen raportoinnin mittausaikana vähemmän potilaita ja potilaiden hoitoisuus oli pienempi. Hiljaisen raportoinnin kokeilun jälkeen kartoitettiin hoitajien mielipiteitä kokeilusta avokysymyksiä sisältävällä kyselylomakkeella. Kyselyssä osallistujiksi tavoiteltiin kaikkia (N=25) sisätautiosaston hoitotyöntekijöitä. Kyselystä saatiin 23 vastausta ja vastausprosentiksi saatiin 92 %. Kaikki kyselyyn vastanneista halusivat ottaa hiljaisen raportoinnin käyttöön. Hoitajat kokivat, että hiljaisen raportoinnin kokeilun aikana jäi enemmän aikaa potilastyöhön, työn kiireellisyys ja ylityöt vähenivät. Toisaalta kirjaaminen lisääntyi, mutta se myös parani kokeilun aikana. Suullista tiedonantoa hiljaisen raportoinnin lisäksi pidettiin tärkeänä erityisesti pitkien vapaiden jälkeen ja perehdytettäessä uusia työntekijöitä ja opiskelijoita. Hiljaisen raportoinnin onnistumisen edellytyksenä pidettiin hyvää kirjaamista sekä sitä, että tietokoneita on riittävästi ja että on rauhallinen tila hiljaisen raportoinnin toteuttamiseksi. Projektissa saatiin luotua malli, jonka mukaan hiljaista raportointia on mahdollista toteuttaa. Hiljainen raportointi on luodun mallin mukaan käytössä kohdeorganisaatiossa.The background for this development project was the development of the operations and structure in the Tyks Vakka-Suomi hospital (Turku University Hospital). Parts of the strategy include patient oriented services and taking care of patient safety. To ensure the quality of patient oriented services, the Vakka-Suomi Hospital of Tyks launched the SHQS quality system. A self-assessment and an internal audit were conducted in 2013 and in 2014 using the SHQS quality system. One of the recommendations for development in the internal audit report was to update the strategy of nursing in response to the current situation. Another goal was to identify the parts of the department that could work more effectively to release more resources to nursing. Reporting was seen as taking too much time. The development project was made to support and develop the multiprofessional working practices of the Tyks internal medicine inpatient ward for the part of its internal communications. The objective of the development project was to develop the reporting practices towards silent reporting. The data was gathered by measuring the time spent on oral reporting before moving into silent reporting, and the time spent on silent reporting while conducting the silent reporting experiment. The result was that the time per patient spent on silent reporting was shorter than when using oral reporting; on the other hand, during the measurements of the silent reporting there were less patients in the department, and also patients requiring less care. After the silent reporting experiment a survey was conducted among the nurses about the experiment with an open questionnaire, which was aimed at all care workers of the internal medicine inpatient ward (N=25). A total of 23 responses 25 were gathered, with a response percentage of 92 %. Everyone responding to the survey wanted to bring silent reporting into use. The nurses felt that during the silent reporting experiment they had more time left for nursing, work schedules were less busy and they had to do less overtime. On the other hand there was an increase in recording, but that also improved during the experiment. Oral reporting in addition to silent reporting was held important especially after long vacations, and in the induction of new workers and students. According to the survey the prerequisites for a successful reporting were good record keeping, adequate amount of computers and a calm and quiet space to carry out the silent reporting. The project succeeded in creating a model in which it is possible to implement silent reporting. Silent reporting in accordance with the model is in use in the target organization

Experience of maternal and paternal adversities in childhood as determinants of self-harm in adolescence and young adulthood

Introduction Previous studies suggest that childhood experience of parental adversities increases the risk of subsequent offspring self-harm, but studies on distinct paternal and maternal characteristics are few and it remains unclear how these interact with childhood social position. The study aims to assess whether paternal and maternal adversities have different associations with offspring self-harm in adolescence and young adulthood. Interaction by offspring gender and childhood income are investigated, as well as cumulative effects of multiple adversities. Methods The study uses administrative register data on a 20% random sample of Finnish households with children aged 0–14 years in 2000. We follow children born in 1986–1998 (n=155 855) from their 13th birthday until 2011. Parental substance abuse, psychiatric disorders, criminality and hospitalisations due to interpersonal violence or self-harm are used to predict offspring self-harm with Cox proportional hazards models. Results The results show a clear increase in the risk of self-harm among those exposed to maternal or paternal adversities with HRs between 1.5 and 5.4 among boys and 1.7 and 3.9 among girls. The excess risks hold for every measure of maternal and paternal adversities after adjusting for childhood income and parental education. Evidence was found suggesting that low income, accumulation of adversity and female gender may exacerbate the consequences of adversities. Conclusions Our findings suggest that both parents’ adversities increase the risk of self-harm and that multiple experiences of parental adversities in childhood are especially harmful, regardless of parent gender. Higher levels of childhood income can protect from the negative consequences of adverse experiences.Peer reviewe

Socioeconomic differences in psychiatric treatment before and after self-harm : an observational study of 4,280 adolescents and young adults

Background: Individuals in higher socioeconomic positions tend to utilise more mental health care, especially specialist services, than those in lower positions. Whether these disparities in treatment exist among adolescents and young adults who self-harm is currently unknown. Methods: The study is based on Finnish administrative register data on all individuals born 1986–1994. Adolescents and young adults with an episode of self-harm treated in specialised healthcare at ages 16–21 in 2002–2015 (n=4280, 64% female) were identified and followed 2 years before and after the episode. Probabilities of specialised psychiatric inpatient admissions and outpatient visits and purchases of psychotropic medication at different time points relative to self-harm were estimated using generalised estimation equations, multinomial models and cumulative averages. Socioeconomic differences were assessed based on parental education, controlling for income. Results: An educational gradient in specialised treatment and prescription medication was observed, with the highest probabilities of treatment among the adolescents and young adults with the highest educated parents and low- est probabilities among those whose parents had basic education. These differences emerged mostly after self-harm. The probability to not receive any treatment, either in specialised healthcare or psychotropic medication, was highest among youth whose parents had a basic level of education (before self-harm 0.39, 95% CI 0.34–0.43, and after 0.29, 95% CI 0.25–0.33 after) and lowest among youth with higher tertiary educated parents (before self-harm: 0.22, 95% CI 0.18–0.26, and after 0.18, 95% CI 0.14–0.22). The largest differences were observed in inpatient care. Conclusions: The results suggest that specialised psychiatric care and psychotropic medication use are common among youth who self-harm, but a considerable proportion have no prior or subsequent specialised treatment. The children of parents with lower levels of education are likely to benefit from additional support in initiating and adhering to treatment after an episode of self-harm. Further research on the mechanisms underlying the educational gradient in psychiatric treatment is needed.Peer reviewe

Hygieniaopas eläinlääkärin vastaanotolle

Tämä opas on laadittu Suomen mikrobilääkeresistenssin torjunnan kansallisen toimintaohjelman konkreettisena toimenpiteenä tuomaan käytännönläheistä apua eläinlääkärien vastaanottojen hygieenisen toiminnan kehittämiseksi ja mikrobilääkeresistenssin leviämisen ehkäisemiseksi. Kasvava mikrobilääkeresistenssi on yksi maailman suurimmista kansanterveyden uhista. Myös eläimille infektioita aiheuttavien bakteerien mikrobilääkeresistenssi lisääntyy huolestuttavasti. Mikrobilääkkeiden käytön vähentäminen hillitsee resistenssin kehittymistä ja sen lisäksi myös eläinlääkärien vastaanottojen hygieniaa parantamalla voidaan tehokkaasti ehkäistä infektioiden syntymistä ja mikrobilääkeresistenssin leviämistä. Päivittäinen hygieeninen toiminta ja tavanomaisten varotoimien noudattaminen on tartuntojen ja infektioiden ehkäisemisen perusta. Näitä varotoimia tulee toteuttaa jokaisen potilaan kohdalla kaikkien vastaanotolla työskentelevien toimesta. Hyvä käsihygienia on hygieenisen toiminnan perusta. Asianmukaisen käsihygienian lisäksi hygieeniseen toimintaan ja tavanomaisiin varotoimiin kuuluvat aseptinen työskentely, oikeaoppinen suojainten käyttö, eritetahrojen välitön siivoaminen, pisto- ja viiltotapaturmien ehkäisy sekä vastaanoton siisteyden ja puhtauden ylläpito. Lisäksi on kiinnitettävä erityistä huomiota riskipotilaiden, eli mahdollisten resistenttien bakteerien kantajien ja tarttuvaa tautia sairastavien eläinten käsittelyyn vastaanotolla. Riskipotilaan tunnistaminen, sopivan hoitotilan valitseminen ja hoidon suunnittelu vastaanotolla on tärkeää jotta vältetään tilojen kontaminoituminen ja tartunnan leviäminen niin henkilökunnan käsien, kuin ympäristön ja välineidenkin välityksellä. Tämä opas auttaa huomioimaan olennaiset tekijät erilaisten eläinlääkärivastaanottojen hygieenisten toimintatapojen suunnittelussa

Substance abuse in parents and subsequent risk of offspring psychiatric morbidity in late adolescence and early adulthood : A longitudinal analysis of siblings and their parents

The effects of substance abuse on other family members are not fully established. We estimate the contribution of parental substance abuse on offspring psychiatric morbidity in late adolescence and early adulthood, with emphasis on the timing and persistency of exposure. We used a nationally representative 20% sample of Finnish families with children born in 1986-1996 (n = 136,604) followed up in 1986-2011. We identified parental substance abuse and offspring psychiatric morbidity from hospital discharge records, death records and medication registers. The effects of parental substance abuse at ages 0-4, 5-9 and 10-14 on psychiatric morbidity after age 15 were estimated using population averaged and sibling fixed effects models; the latter controlling for unobserved factors shared by siblings. Parental substance abuse at ages 0-14 was associated with almost 2-fold increase in offspring psychiatric morbidity (HR = 1.86, 95% CI 1.78-1.95). Adjustment for childhood parental education, income, social class and family type reduced these effects by about 50%, with some further attenuation after adjustment for time-varying offspring characteristics. In the sibling fixed effects models those exposed at 0-4 or 5-9 years had 20% (HR = 1.20, 95% CI 0.90-1.60) and 33% (HR = 1.33, 95% CI 1.01-1.74) excess morbidity respectively. Also in sibling models those with early exposure at ages 0-4 combined with repeated exposure in later childhood had about 80-90% higher psychiatric morbidity as compared to never exposed siblings (e.g. for those exposed throughout childhood HR = 1.81, 95% CI 1.01-3.25). Childhood exposure to parental substance abuse is strongly associated with subsequent psychiatric morbidity. Although these effects are to a large extent due to other characteristics shared within the parental home, repeated exposure to parental substance abuse is independently associated with later psychiatric morbidity.Peer reviewe

The effect of low childhood income on self-harm in young adulthood : Mediation by adolescent mental health, behavioural factors and school performance

Low childhood income is an established risk factor of self-harm in adolescence and young adulthood, and childhood income is additionally associated with various correlates of self-harm. How these correlates, such as psychiatric disorders, substance abuse, violent behaviour and school problems, mediate the effect of childhood income on self-harm, is less understood. The purpose of the current paper is to examine this mediation. The study is based on administrative register data on all Finnish children born in 1990-1995. An analytical sample of 384,121 children is followed from age 8 to 22. We apply the parametric g-formula to study the effect of childhood income on the risk of self-harm in young adulthood. Adolescent psychiatric disorders, substance abuse, prior self-harm, violent criminality and victimization, out-of-home placements, not being in education, employment or training and school performance are considered as potential mediators. We control for confounding factors related to childhood family characteristics. As a hypothetical intervention, we moved those in the lowest childhood income quintile to the second-lowest quintile, which resulted in a 7% reduction in hospital-presenting self-harm in young adulthood among those targeted by the intervention (2% reduction in the total population). 67% of the effect was mediated through the chosen mediators. The results indicate that increases in childhood material resources could protect from self-harm in young adulthood. Moreover, the large proportion of mediation suggests that targeted interventions for high-risk adolescents may be beneficial. To our knowledge, this is the first paper to use the parametric g-formula to study youth self-harm. Future applications are encouraged as the method offers several further opportunities for analysing the complex life course pathways to self-harm.Peer reviewe

Overstay and Readmission in Ear, Nose, and Throat Day Surgery—Factors Affecting Postanesthesia Course

Aims:Many procedures in ear, nose, and throat (ENT) day surgery are carried out under local anesthesia in Finland, whereas many other countries use general anesthesia. We investigated overstay and readmission rates in local and general anesthesia at Helsinki University Hospital.Material and Methods:We conducted a retrospective study on ENT (n = 1011) day surgery patients within a 3-month period using the hospital?s surgery database to collect data pertaining to anesthesia, overstays, readmissions, and contacts within 30 days of surgery.Objectives:We examined the effect of American Society of Anesthesiologists (ASA) class, age, sex, type of procedure, and anesthesia type on overstay, contact, and readmission rates.Results:A multivariable logistic regression model included ASA class, age, sex, type of procedure, and anesthesia (local vs general). Sex, age, and type of procedure had an effect on the outcomes of overstay, readmission, or contact. With general anesthesia, 3.2% (n = 23) had an overstay or readmission compared to 1.4% (n = 4) after local anesthesia. This was mainly explained by the number of study outcomes in tonsillar surgery that was performed only in general anesthesia.Conclusions:Day surgery could be done safely using local anesthesia, as the number of study outcomes was no greater than in general anesthesia. Sex, type of procedure, and age affected the rate of study outcomes, but ASA class and anesthesia form did not. Our overstay, contact, and readmission rates are on the same level, or lower, than in international studies.Peer reviewe

Long-term nationwide trends in the treatment of and outcomes among pancreatic cancer patients

Publisher Copyright: © 2021 The AuthorsWhilst treatment modalities for pancreatic cancer patients have evolved in recent years, their impact on outcomes remains relatively unexamined on a national scale. We aimed to analyse changes in overall survival and trends in surgical and oncological treatments in pancreatic cancer patients diagnosed in the periods 2000 through 2008 and 2009 through 2016 in Finland. We collected data for pancreatic cancer patients diagnosed between 2000 and 2016, gathering data from the Finnish national registries on surgeries, oncological treatments and time of death. Follow-up continued through the end of 2018. We compared patients diagnosed between 2000 and 2008 to those diagnosed between 2009 through 2016. Our study comprised 14 712 pancreatic cancer patients. There was no significant change in the national resection rate (8.1% vs 8.0%, p = 0.690). In radical surgery patients, median survival improved from 20 months (95% confidence interval (CI) 18–22) to 28 months (CI 25–31) (p < 0.001), with 1-year survival ranging from 70% to 81%. In the no-surgery group, median survival slightly improved from 3.1 months (CI 3.0–3.3) to 3.3 months (CI 3.1–3.4) (p < 0.001). The proportion of radical surgery patients receiving preoperative oncological treatment increased from 4% to 13% (p < 0.001) and only postoperative treatment from 25% to 47% (p < 0.001). Whilst the resection rate did not increase, the prognosis of pancreatic cancer patients improved, particularly amongst radical surgery patients resulting most likely from the fact that a larger proportion of patients receive more effective oncological treatments.Peer reviewe