Diagnóstico y diseño del sistema de gestión de seguridad y salud en el trabajo de la IPS MEDICINA 2000 S.A.S

Este trabajo está basado en el diagnóstico y diseño del sistema de gestión de seguridad y salud en el trabajo (SG-SST) de la IPS Medicina 2000 S.A.S, ubicada en el área metropolitana de la ciudad de Medellín, la cual es una empresa prestadora de servicios de apoyo diagnóstico y terapéutico en la especialidad de urología. Inicialmente se realiza un diagnóstico previo sobre el sistema de gestión de la empresa y su grado de implementación, con el propósito de identificar oportunidades de mejora, y con base en ello realizar un replanteamiento del mismo, mediante la identificación de los peligros y riesgos asociados a su actividad económica, determinando sus respectivos controles en pro de encaminar acciones hacia la prevención de incidentes, accidentes y enfermedades laborales a causa del trabajo que desarrolla el talento humano de la empresa; se establece la política de SST, el plan de trabajo anual basado en el ciclo PHVA y los respectivos indicadores del SG-SST. Posteriormente se realiza una auditoría interna mediante la aplicación de una lista de verificación, con la cual se evidencia un cumplimiento satisfactorio, según los criterios establecidos en el decreto 1072 de 2015. Sin embargo se determinan ciertas desviaciones en el SG-SST, como lo son: La no actualización del curso virtual de 20 horas del SG-SST, falta de ejecución de capacitaciones del Copasst, en ello se evidencian reuniones del Copasst; pero no hay evidencias específicas de capacitaciones realizadas en el año en curso, falta de actualización de la matriz legal, insuficiente implementación de los programas p y p, falta de actualización del diagnóstico de condiciones de salud del personal, no hay evidencias de las mediciones ambientales que se deben realizar, falta de capacitación de la brigada de emergencias, sólo han sido realizadas dos capacitaciones en lo que va corrido del año, lo cual no genera ningún impacto en el entrenamiento de la brigada. De igual manera se identifican muchas fortalezas, respecto a lo cual se establecen oportunidades de mejora, encaminadas al fortalecimiento de la gestión de la seguridad y salud en el trabajo en la IPS, generando gran impacto en los procesos que se llevan a cabo en la empresa.This work is based on the diagnosis and design of the occupational health and safety management systems (OHSMS) of IPS Medicina 2000 SAS in the metropolitan area of Medellin city. This company provides diagnostic and therapeutic support services in the specialty of urology. First, a preliminary diagnosis is held on the company's management system and its implementation in order to identify opportunities for improvement. Afterwards, based on the diagnosis, the system is replanned by identifying the dangers and risks associated with its economic activity, determining its controls aiming at directing actions towards the prevention of incidents, accidents and occupational diseases caused by the work carried out by the company's human talent employees; the OSH policy, the annual work plan based on the PHVA cycle, and the SG-OSH indicators are established. Consequently, an internal audit is carried out through the application of a checklist, which shows how the criteria established in Decree 1072 of 2015 is satisfactory achieved. However, certain deviations in the SG-SST are determined, such as the lack of update of the 20-hour SG-SST online course, absence of execution of Copasst trainings, in which Copasst meetings are evidenced; but there is no detailed evidence of the training developed in the current year. There is also a lack of updating of the legal matrix, insufficient implementation of the p and p programs, lack of update in the diagnosis of employees’ health conditions, there is no evidence of the environmental measurements to be accomplished, lack of training of the emergency brigade, only two trainings have been done so far this year, which does not have any impact on the brigades training. Likewise, many strengths are identified, regarding the opportunities for improvement that have been established, aimed at strengthening the management of health and safety in the IPS, therefore generating a great impact on the processes carried out in the company

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a −$11 (95$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Use of Telemedicine for Post-discharge Assessment of the Surgical Wound: International Cohort Study, and Systematic Review with Meta-analysis

Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardised assessment tools are needed. Summary background data: Surgical site infection is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was surgical site infection reported up to 30-days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analysed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30-days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs. 11.1%, P<0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval 0.63-0.84, P<0.001). This association was consistent across sensitivity and subgroup analyses, including a propensity-score matched model. In nine eligible non-randomised studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47-0.94) than in-person (reference) follow-up (I2=0.45, P=0.12), although there a high risk of bias in included studies. Conclusions: Use of telemedicine to assess the surgical wound post-discharge is feasible, but risks underreporting of SSI. Standardised tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally