Quality management in healthcare: challenging healthcare-associated infections

ABSTRAC - Healthcare-associated infections (HAI) are a worldwide problem with devastating effects, with both economic and public health impacts in the medium and long term, and its high prevalence and incidence rates contributing strongly for mortality and morbidity rates. A study was performed with the main objective to analyse HAI prevention and control systems, to identify what are the barriers for Structures, Processes and Results at hospital level and to determine how quality management models and tools can help to improve of these systems. An exhaustive literature review related with HAI prevention and control issues and quality management in healthcare issues was accomplished and, from this, several international projects to promote HAI prevention and control systems were identified, as well as a set of barriers at international level. A multi-case study was also performed, aiming to analyse HAI prevention and control systems from three hospitals with different quality management models. From this study barriers were identified, as well as management tools used to promote HAI prevention and control system, best practices and improvement suggestions. As the main result a HAI prevention and control management system model was developed, based on ISO 9001 model and supported in the process-approach model, incorporating all the suggestions obtained from the literature review and from the multi-case study. This study also provides an extensive analysis on HAI prevention and control management issues and on quality management issues, at national and international level. The result is innovative and highlights several possibilities of improvement as well as valuable information to health authorities.Resumo As infeções associadas aos cuidados de Saúde (IACS) são considerados atualmente um problema mundial com efeitos devastadores, quer ao nível económico quer ao nível da saúde pública a curto e a longo prazo, cujas taxas de prevalência e incidência estão a dar um forte contributo nas taxas de mortalidade em morbilidade. Foi realizado um estudo com o objectivo de analisar os sistemas de prevenção e controlo das IACS, quais as barreiras identificadas para as Estruturas, Processos e Resultados, ao nível hospitalar e como os modelos e ferramentas de gestão da qualidade poderão promover a melhoria destes sistemas. Foi efetuada uma revisão exaustiva da literatura sobre os sistemas de gestão de IACS e sobre os modelos de gestão da qualidade aplicados à saúde e foram identificados diversos projetos internacionais assim como diversas barreiras identificadas a nível internacional. No sentido de melhor entender a realidade nacional foi efetuado um estudo multi-caso para analisar os sistemas de gestão da prevenção e controlo das IACS de três hospitais com modelos de gestão da qualidade diferentes. Com este estudo conseguiu-se identificar as barreiras, as ferramentas de gestão da qualidade e as melhores práticas utilizadas para promover a efetividade dos sistemas prevenção e controlo de IACS assim como sugestões de melhoria. Como resultado foi desenvolvido um modelo de gestão da prevenção e controlo das IACS, suportado no modelo da ISO 9001 e no modelo de abordagem por processos, onde foram incorporadas as sugestões, as melhores práticas identificadas na literatura e no estudo multicaso. Este estudo proporciona também uma análise exaustiva de questões relacionadas com a gestão dos sistemas de prevenção e controlo da infeção e questões relacionadas com a gestão da qualidade na saúde, ao nível nacional e internacional. O resultado, que poderá ser analisado como uma plataforma para futuros trabalhos nesta área, é inovador e assinala possibilidades de melhoria assim como informação de relevo para as autoridades de saúde

Healthcare-associated infections – on developing effective control systems under a renewed healthcare management debate

Purpose The development of control systems to sustain the level of healthcare-associated infections (HAIs) is an emerging issue for healthcare management. This is partly due to the perception that HAI became a serious negative impact factor on the performance of healthcare organizations and on related public health dimensions. Throughout the decade of 1990 a significant number of international programmes were developed to understand and to promote effective HAIs prevention and control systems: Patient Safety and the quality improvement of healthcare organizations became common concepts in healthcare management. However, regardless of advances in infection control systems, the rates of incidence of HAIs remained relatively unchanged in the last decades. The purpose of this study is to point out barriers that recent international literature has identified as factors hindering the successful development of control systems to prevent HAIs. The international debate on possible alternatives to strengthen this common healthcare management issue, benefits form one such update. Methods A literature review was conducted in a 3-month period by two investigators. The BioMed Central, Pubmed, Emerald, and B-on databases were searched for articles published between January 2006 and September 2011. A standard form was created for data extraction. Findings A total of 49 articles met inclusion criteria. Within the analysed articles, 26 were developed in Europe, 15 were developed in North America; 6 were developed in Asia, and 2 in Australia. Thirty (30) different barriers to effective HAIs control systems were identified. The barriers were clustered by dimensions and sub-dimensions. The largest number of barriers clustered, are associated with structures and processes and also barriers associated with healthcare management processes.info:eu-repo/semantics/publishedVersio

Exploring the real costs of healthcare-associated infections: an international review

Healthcare-associated infections acquired a high degree of dissemination, being considered a serious public health problem and assumed as one of the most common adverse events associated with healthcare. They have a significant impact on health systems by increasing hospital expenses, and compromising the healthcare quality and effectiveness. Surgical site infections (SSI) are considered one of the most serious complications that can occur after an orthopaedic surgery. The aim of this study is to contribute to the development of a framework to analyse the costs of infections related to hip and knee arthroplasties. A literature review was conducted on databases, and articles published between January 2005 and April 2016 were searched. A total of 14 articles met the inclusion criteria. Costs were grouped in hospitalization and treatment dimensions. For hospitalization, the indicators were the length of stay (LOS) and/or monetary costs; For treatment, the indicators were number of surgeries and LOS, or monetary costs. We observed that LOS is the most commonly used to estimate SSI direct costs. Patients who developed hip or knee arthroplasty infections remained in hospital 2.5–3 times longer and incurred hospital costs almost three times higher, when compared with an uninfected patient.info:eu-repo/semantics/publishedVersio

Health promotion conceptual evolution and program development: a literature Review

The World Health Organization defends prevention and health promotion among communities as a driver of economic and social development, where the individual level of health literacy determines health choices such as adopting healthy lifestyles, managing individual healthcare and preventing chronic diseases. Currently, health promotion is guided by a set of values, being these principles essential for identifying needs and priorities, planning, implementing, evaluating and determining the health promotion programs, that can be defined as a set of programmed, integrated and interrelated strategies and actions that aim to promote health, prevent risks, reduce years of life lost due to disability and increase quality of life. There are several models for planning health promotion programs, such as the Precede-Proceed Model, the Multivariate Approach to community Health (MATCH) Model, the Mapped Intervention Model and the Social Marketing Model. A good planning of a health promotion program can effectively reduce the health costs.info:eu-repo/semantics/publishedVersio

Underestimated prediabetic biomarkers: are we blind to their strategy?

Type 2 Diabetes (T2D) is currently one of the fastest growing health challenging, a non-communicable disease result of the XXI century lifestyle. Given its growing incidence and prevalence, it became increasingly imperative to develop new technologies and implement new biomarkers for early diagnosis in order to promote lifestyle changes and thus cause a setback of the disease. Promising biomarkers have been identified as predictive of T2D development; however, none of them have yet been implemented in clinical practice routine. Moreover, many prediabetic biomarkers can also represent potential therapeutical targets in disease management. Previous studies have identified the most popular biomarkers, which are being thoroughly investigated. However, there are some biomarkers with promising preliminary results with limited associated studies; hence there is still much to be understood about its mechanisms and associations in T2D pathophysiology. This work identifies and discusses the promising results of Galectin-3, Ophthalmate and Fetuin-A.info:eu-repo/semantics/publishedVersio

Healthcare workers’ mental health in pandemic times: the predict role of psychosocial risks

Healthcare workers perform an emotionally exhausting daily work activity, making them prone to occupational hazards, namely psychosocial ones. This study aims to assess the impact of psy chosocial risk factors on healthcare workers’ mental health. A cross-sectional study was developed between May and June of 2021 with 479 healthcare workers from Portuguese hospitals. The Depression, Anxiety and Stress Scale was used to assess mental health, and psychosocial risks were assessed through the Health and Work Survey e INSAT. Statistical analysis was performed to identify the psychosocial risk factors related to anxiety, depression, and stress. Subsequently, a multiple linear regression was performed to identify the models that better explained psychosocial risk factors’ relationship with anxiety, depression, and stress. Data showed a strong exposure to psychosocial risks. Work pace and intensity, work relation ships, and emotional demands stood out with higher global average percentages for yes answers to “exposure and discomfort.” The analysis of the b values and p-values from the multiple linear regression shows that some cross-sectional psychosocial risks are predictors of anxiety and stress dimensions, and other psychosocial risks differ in the two mental health dimensions. However, it is important to highlight that healthcare workers still showed great joy and pleasure in performing their work activities. Support network development in the work environment is needed to prevent healthcare workers’ emotional stress and promote their psychological well-being. Therefore, new research is essential to understand the psychosocial risks that affect healthcare workers and assess the less visible effects of workehealth relationshipsinfo:eu-repo/semantics/publishedVersio

Development and validation of a health and work survey based on the rasch model among portuguese Workers

The purpose of this study was to develop the Health and Work Survey (INSAT) and examine the validity of the discomfort rating scale. Data were collected from 706 Portuguese workers from six economic sectors with the support of the Health and Work Survey (INSAT - Inquérito Saúde e Trabalho). The INSAT is a self-administered questionnaire to assessing working conditions, health and wellbeing, and to provide information to the occupational health systems in the organisations. For the survey instrument validation, the Rasch Partial Credit Model (PCM) was used to analyse item fit statistics. From the application of PCM, Person Separation Reliability was obtained (0.8761) and the value can be considered very good (>0.8). From the statistical analysis, the Overall Model fit information, given by Outfit Mean square/Infit Mean square, is between 0.5 and 1.5, meaning "Productive for measurement" and "acceptable fit overall". The INSAT items can generate predictable response patterns. We recommend that the INSAT discomfort rating scale and some other items should be reviewed in future works. In any event, this tool proves to be useful in assessing the relationship between work and health and in evaluating key main risk factors, helping to prevent problems and improving occupational health systems.info:eu-repo/semantics/publishedVersio

Exploring direct costs of primary hip and knee arthroplasties healthcare-associated infections: A retrospective study

Hip or knee arthroplasty healthcare-associated infections (HAI) are a public health problem that induces the increase of morbidity and mortality rates and poses an economic problem with significant impact on hospitals budget. The infection rate in primary hip and knee arthroplasties range between 1.5% and 2.5%, and is considered one of the main reasons for surgeries non-effectiveness. A retrospective study was carried out in S. João Hospital Center, EPE (CHSJ) to calculate HAI rate in primary hip and knee arthroplasties, and to analyse their direct costs, for a better understanding of their economic impact. Four hundred and eighty seven arthroplasties were studied and infection was noticed in 11 cases: 3 after hip and 8 after knee arthroplasties. Data collected from infected patients-related costs were compared with the average cost of non-infected patients (standard). An incidence rate of 2.17% for hip arthroplasties and 2.25% for knee arthroplasties was found. Results showed that patients with infection remained in hospital 7.45 times longer than uninfected patients and incurred hospital costs almost 3.8 times higher. This work shows how important is the quantification of additional HAI costs to allow hospital managers to weigh the cost/benefit ratio and better justify investments in HAI prevention and control programmes.info:eu-repo/semantics/publishedVersio

Clinical and metabolic implications of obesity in prostate cancer: is testosterone a missing link?

Objectives: To assess sex hormones in men with obesity and prostate cancer (PCa) and to study association between androgens and the pathogenesis biology of PCa in vitro. Subjects and methods: One hundred and eighty-one men older than 45 years selected from of a population attending to Urology departments screening for PCa, (78 participants without PCa and 103 patients with PCa). All participants were assessed for body mass index (BMI), age, Gleason score, and PSA. Endocrine profile was determined for LH, total testosterone (TT), 17β-estradiol (E2), prolactin and leptin. Biochemical profile (HbA1c, triacylglycerols and lipoproteins) was also determined. In vitro experiments were also performed, involving the study of 5α-dihydrotestosterone (DHT) and E2 in the presence of adipocyte-conditioned medium (aCM). Results: All variables were continuous and described a Gaussian distribution unless mentioned. To determine the relation of aggressiveness, variable were transformed into categories. Thus, PCa aggressiveness is associated with the increase of age and BMI (p < .0001) but with is decreased with TT and E2 (p < .05). Moreover, adipocyte-secreted molecules increase aggressiveness of PCa cells in vitro. Lastly, DTH but not E2 enables invasiveness in vitro. Conclusions: It was observed a coexistence of hormone axis profile alteration with sex hormones and BMI in PCa patients, in accordance with the new perspective of PCa pathogenesis.info:eu-repo/semantics/publishedVersio

Management system certification benefits: where do we stand?

The implementation and certification of Management Systems International Standards, such as ISO 9001 and ISO 14001, achieved a high international recognition, with more than 1 million organizations with their Quality Management Systems certified worldwide. Researchers have been paying considerable attention to this theme and the number of published articles has robustly grown. Although on an overall basis, the research results support the existence of positive impacts on the adoption and certification of these International Standards, there are various inconsistencies and contradictory results, leading to some controversy over its impacts for organizations. This study aims to bring a longitudinal time perspective to this area of research, analyzing the articles published since 1996, on the benefits of Management Systems Certification. A longitudinal perspective of countries of authors origin, keywords and journals is presented, complemented with an evaluation of the research results. The results evidence a steep increase in the number of publications addressing Management Systems Certification benefits, that mainly originate from Europe (48%) and East Asia and Pacific (23%), with Spain as the leading country (accounting for 14% of the total number of articles published between 1996 and April 2017). Journal of Cleaner Production (Environmental Management System Certification) and Total Quality Management and Business Excellence journal (Quality Management Systems Certification) are the leading journals for disseminating the research and the most used keywords are “Quality/Environment”, “ISO 9001/14001”, “Performance”, “Management Systems” and “Certification”. There are also insights that the research is now open to other Management Systems either than Quality and Environment. The systematic review of the selected papers shows that the Management Systems adoption and certification brings fairly positive benefits (average 2,34 in a 1 to 5 Likert type scale) for the certified organizations, although some variations are observed. Some avenues for future research should consider the reliability and validation of measures; sampling and biases errors; the identification of control, moderating and mediating variables; the consideration of time and situational contingencies; and the search for explanations for cause and effect relationships.info:eu-repo/semantics/publishedVersio