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1
Njenje, Charles Chukwuemeka. „Improving Hand Hygiene in an Intensive Care Unit“. ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5914.
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Health-care-associated infections (HCAIs) affect hundreds of millions of people worldwide, causing morbidity and mortality among hospitalized patients. About 2 million patients suffer from HCAIs in the United States, and it is estimated that 99,000 of them die each year. Studies have indicated that transmission of health-care-associated microorganisms occurs through contaminated hands of health care workers. Hand hygiene (HH) is the single most effective way to prevent health-care-associated infections, yet health care workers' hand hygiene compliance remains low. One factor responsible for poor compliance with hand hygiene guide-lines are lack of knowledge of good hand hygiene and lack of hand hygiene techniques. This project evaluated the effect of educational program on hand hygiene for intensive care unit (ICU) healthcare workers. The Health Belief Model was applied as the framework in this project. Key components of the model are perceived susceptibility, perceived severity, perceived benefit, and perceived barriers. A convenience sample of 25 ICU healthcare workers participated in the educational program. Pre- and post- education surveys and tests were assessed using descriptive statistics. Results were consistent with existing findings indicating that education is needed to improve HH compliance and that effective HH reduces infections. The findings from this project may contribute to positive social change by promoting increased HH knowledge and infection prevention while decreasing complications of treatments, costs, morbidity, and mortality, thereby promoting a healthy and safe community.
2
Magner, MaryBeth. „The Effects of Managed Care on the Quality of Dental Hygiene Care“. TopSCHOLAR®, 1998. http://digitalcommons.wku.edu/theses/344.
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Managed care has become a prominent mechanism for insuring dental care. Empirical research suggests that managed dental plans provide lower quality care to patients. However, few studies have specifically addressed the effects of managed care on the quality of dental hygiene care. Thus, in this study the researcher examines whether dental hygienists deliver a lower level of treatment to managed care patients than to those who are not subject to managed care. Questionnaire data were gathered from 193 members of the American Dental Hygienists' Association residing in the Chicago area. The primary independent variable, managed care, was measured with an item that asked the respondents to indicate the percentage of patients they treat that are insured by a managed dental plan. The questionnaire also contained items that measured the frequency in which the respondents perform 23 tasks that are indicators of quality of dental hygiene care. Principal components factor analysis of these 23 items yielded the study's two dependent variables: periodontal procedures and appointment time. Regression analysis of the data revealed a significant negative relationship between managed care and appointment time. This relationship may be attributable to an economic incentive on the part of dentist-employers who control the amount of time scheduled for dental hygienists' patients. Dentist-employers may reduce the time available for managed care patients in order to allow longer appointments for more profitable fee-for-service patients. The study results did not support the notion that managed care affects the extent to which dental hygienists perform periodontal procedures. These mixed results suggest that future research should examine the relationships between managed care and other aspects of quality of dental hygiene care not addressed in the current study.
3
Lungui, Ilona. „Hand Hygiene and Compliance Rates in an Acute Care Setting“. ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6454.
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Hospital-acquired infections (HAIs) are a significant problem faced by healthcare organizations globally. The Centers for Disease Control reported that in 2014, 722,000 patients acquired an HAI, and of those, 75,000 died as a result. This project focused on reeducating healthcare staff on hand hygiene practices to prevent HAIs. Preintervention hand hygiene compliance rates were compared to postintervention hand hygiene compliance rates on 2 units in an acute care setting to evaluate if reeducation of healthcare staff on hand hygiene protocols and practices would increase hand hygiene compliance rates. The evidence-based practice model used for this project was Nightingale's environmental theory. The research question for the study examined the effectiveness of hand hygiene reeducation on hand hygiene compliance rates. Participants included 97 nurses and ancillary staff. Hand hygiene compliance rates were compared 1 month before and 1 month after healthcare staff reeducation. Results showed an 18% increase in compliance rates following reeducation. These results might effect positive social change by reinforcing that reeducation has an impact on compliance rates for hand hygiene among nursing and ancillary staff in acute care settings.
4
Lisauckis, Lisa Elena. „Herbal supplement education in dental hygiene curricula“. Morgantown, W. Va. : [West Virginia University Libraries], 2002. http://etd.wvu.edu/templates/showETD.cfm?recnum=2326.
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Thesis (M.S.)--West Virginia University, 2002.Title from document title page. Document formatted into pages; contains viii, 63 p. : ill. (some col.). Vita. Includes abstract. Includes bibliographical references (p. 48-50).
5
Griffiths, John H. „Verbal regulation of behaviour in children : establishing effective dental care“. Thesis, Bangor University, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.357889.
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6
Henry, Rachel K. „A Comparison of Millennial and Non-Millennial Dental Hygiene Student and Faculty Classroom Expectations“. The Ohio State University, 2007. http://rave.ohiolink.edu/etdc/view?acc_num=osu1419262693.
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Cravens, Cedric A. „Tr?-Vigil, LLC, a hand hygiene company for health care organizations“. Thesis, California State University, Long Beach, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10167528.
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Nosocomial infections are a significant medical burden to every health care setting in the United States. Also known as health-associated infections or hospital-acquired infections (HAIs), they are infections that people acquire while they are receiving treatment for another condition in a health care setting. To decrease rates of HAIs, Tr?-Vigil, LLC will provide health care facilities with point-of-care hand hygiene capability in the form of portable hand sanitizers that clip onto lab coats or scrubs, along with a monitoring system that tracks medical staff usage of the sanitizers. This business plan will demonstrate how Tr?-Vigil intends to deliver a vital health care service, while being a sustainable and profitable company.
8
Chang, Nai-Chung Nelson. „Identifying factors influencing hand hygiene compliance during the patient care sequence“. Diss., University of Iowa, 2018. https://ir.uiowa.edu/etd/6390.
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Healthcare-associated infections (HAI) are a significant issue in healthcare facilities worldwide. Hand hygiene (HH) remains the most effective method for preventing the incidence of HAI in routine patient care. Past and current interventions focused on the overall improvement of HH compliance, but studies found that the amount of time required to achieve full HH compliance with the existing guidelines may not be practical. Improving HH compliance at critical moments during patient care may be more effective than improving HH compliance at all opportunities. However, there are little to no studies on healthcare workers’ (HCWs) behavior regarding HH during the patient care process.
Secondary data analysis on a prospective dataset from the STAR-ICU trial was completed to identify HCWs’ behavior patterns regarding HH during the patient care process. Multiple logistic regression for transitions with random effects using repeated measures and transition modeling was used to identify possible associations between HH compliance and patient care tasks, the order of tasks, and workload. The models adjusted for the effects of HCW type, glove use, and isolation precautions.
The study identified 28,826 task sequences and 42,349 HH opportunities. HCWs were slightly less likely to do HH before critical tasks compared with other tasks (OR: 0.97, 95% CI: 0.96-0.99), but more likely to do HH after contaminating tasks compared with other tasks (OR: 1.12, 95% CI: 1.10-1.13). HCWs are also more likely to move from task sequences that have a relatively lower risk to patients to task sequences that have a relatively higher risk to patients than vice versa (65.4% versus 34.7%). HCWs are also less likely to do HH after moving from tasks that have a relatively lower risk to patients to tasks that have a relatively higher risk to patients than vice versa (OR: 0.93, 95% CI:0.92-0.95). HCWs’ HH compliance rates decreased as the workload level increased (OR: 0.93, 95% CI: 0.89-0.98). Workload did not appear to affect HH compliance before critical tasks or after contaminating tasks and did not affect the order in which HCWs perform patient care tasks. Increase in workload was associated with an increase in the odds of critical tasks occurring (OR: 1.55, 95% CI: 1.45-1.65).
In conclusion, HCWs are more likely to perform HH after contaminating tasks to prevent contaminating themselves and to reduce the risk of transmission in subsequent task sequences. However, they do not perform tasks in an order that minimizes risk to the patient; instead, it appears that they perform tasks as they come up in routine care. Furthermore, HH is not being performed at critical moments during patient care. Lastly, workload did not affect the order in which HCWs perform patient care tasks, suggesting that HCWs behavior patterns contribute significantly to how they care for patients and perform HH. Interventions targeting the order in which HCWs perform patient care tasks and improving HH compliance before critical tasks may be more effective than those designed to improve HH compliance at all HH opportunities for reducing HAI rates.
9
Lau, Chun-ling, und 劉俊玲. „Factors affecting hand hygiene compliance in intensive care units: a systematic review“. Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48423890.
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Hospital-acquired, or nosocomial infections (HAIs) are the major source of mortality and morbidity for hospitalized patients. It is estimated that 7-10% patients developed HAIs during their hospital stays, with most patients got infected from intensive care units (ICU) [1,2]. Hand hygiene (HH) is recognized as the most easy and effective way to prevent HAIs. However, the observed hand hygiene compliance rates among healthcare workers (HCWs) have been regarded as unacceptably low, especially in ICU [3]. This literature review is to discuss the factors influencing the hand hygiene compliance among HCWs in ICU, in both the individual and institutional level, and suggest which factor was important in both levels. Recommendations in comprehensive approach on hand hygiene practices will also be included.published_or_final_version
Public Health
Master
Master of Public Health
10
Bauchmoyer, Susan Marie. „Predicting Academic and National Board Dental Hygiene Examination Performance Based on Academic Factors“. The Ohio State University, 2002. http://rave.ohiolink.edu/etdc/view?acc_num=osu1418401625.
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Yip, Shuaih-yee Bethia, und 葉率意. „Oral care practice in cancer nursing“. Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2006. http://hub.hku.hk/bib/B45011990.
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Wang, Jennifer. „Health care behaviour of Hmong refugees in Sydney“. Thesis, The University of Sydney, 1998. https://hdl.handle.net/2123/27572.
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The Hmong, a minority group from Laos, began arriving in Australia in 1976, having fled their country after the Pathet Lao (Lao communists) came into power in May, 1975. Little has been written on the Hmong in Australia but one survey
conducted in 1987 on the Hmong community in Sydney identified it as socioeconomically disadvantaged (Lee 1987). At the same time, studies from the United States were discovering a significant problem of poor health status and
unsatisfactory health care behaviour within various Hmong refugee communities in that country (Bliatout 1988a; Deinard and Dunnigan 1987; Scott 1982; Strand and Jones 1983). This study aims to examine the health care behaviour of Hmong in Sydney, and related socio-economic issues, in part to discover whether Hmong in Sydney exhibit similar health care behaviour and health status to Hmong in the United States. It will therefore both provide basic information on the Hmong in Australia, and specifically focus on the health care behaviour of Hmong in Sydney and, secondly, compare this with situations in the United States.
13
Jose, Babu. „Dental caries and oral hygiene practices of children and caregivers inKerala, India“. Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2001. http://hub.hku.hk/bib/B31954224.
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14
Dean, Lesa. „Dental Care in Long-Term Care Facilities of Warren County, Kentucky“. TopSCHOLAR®, 1986. https://digitalcommons.wku.edu/theses/2252.
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Many physical changes occur as one ages, including changes associated with the oral cavity. A review of the literature suggests that the provision of dental care to institutionalized elderly patients presents problems due to a variety of factors. The purpose of this study is to assess the level or dental care provided to residents of long-term care facilities located in Warren County, Kentucky. In addition, secondary objectives Include the ascertainment of who provides dental care to residents and the amount or in-service dental training made available to staff members of the facility.
Each administrator of the long term care facilities located in Warren County participated in an *interview conducted by the author. During the interview, information was obtained for a 21 item questionnaire concerning the facility, the number and age range or the residents, and types of dental services provided within the facility.
Results obtained from the questionnaire indicated that 77 percent or the residents in long-tern care facilities in Warren County are 70 years of age or older. No significant differences were noted in the types or dental services provided to residents. However, the dental services provided ranged from those that were obtained in a private dental office via transportation or the resident to outside dental facilities to routine oral hygiene measures carried out by staff members employed by the facility.
The findings revealed significant differences in the dental status of the MRDD residents when compared to the nursing home residents. Other findings indicated that none of the long-term care facilities had dental operatories or dental radiographic equipment on the premises.
Additional research would be required in order to address uncertainties discovered in the study. A followup to the questionnaire Interview with the consulting dentists may be included to determine to what capacity and to what extent they are utilized by the facilities. Other recommendations include the utilization of entrance dental examinations to determine if services offered do meet the needs of the residents and periodic dental examinations to aid in detection and thus reduce the prevalence of dental diseases in this population.
15
Travis, Shirley S. „Self-care dependency among elders in long-term care settings“. Diss., Virginia Polytechnic Institute and State University, 1985. http://hdl.handle.net/10919/49945.
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General acceptance of a pattern of activities of daily living (ADL) dependency has led to the use of an additive method of determining self-care dependency and need for long-term care. This traditional method of determining ADL levels is convenient, and it is practical to the extent that individuals in a long-term care population do fit a scaled pattern of dependency. This research was based on 3611 cases from the Preadmission Screening Program of the Virginia Medical Assistance Program. Tabular and staged logistic regression analyses examined: 1) characteristics of this group of long-term care elders, 2) the extent of ADL divergence in various recommended care settings, 3) the relationship between rehabilitation status and ADL divergence, 4) other factors influencing divergence from the ADL dependency hierarchy.
The results of this study demonstrated that a large proportion of those screened did not match the original Index of ADL. Therefore, the justification for counting ADL dependency, based on an underlying hierarchy of ADL, was not upheld. Further research was indicated for improving eligibility and placement criteria that would reflect a fluid rather than a static system of long-term care. For example, rehabilitative trajectory could serve as an indicator of projected changes in assistance for self-care.Ph. D.
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16
Rooshenas, Leila. „Managing common infections in Day Care settings : Day Care providers' sickness exclusion beliefs, advice, and their consequences for parents“. Thesis, Cardiff University, 2012. http://orca.cf.ac.uk/38020/.
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Background and Aims: Judicial antibiotic prescribing and appropriate use of healthcare resources are public health priorities. Preschool-aged children that attend day care frequently consult general practitioners (GPs) and receive antibiotics, despite experiencing mainly self-limiting and/or viral infections. North-American surveys indicate that day care providers unnecessarily exclude children with infections, and make exceptions to exclusion on the basis of antibiotic treatment. Commentators suggest that this may lead to unnecessary consultations and inappropriate antibiotic requests. This study’s main aim was to explore whether UK-based day care providers’ management of infections encourages parents to unnecessarily consult GPs, and inappropriately seek antibiotics. A secondary aim was to describe the content and nature of written day care sickness exclusion policies. Questionnaire Methods and Results: Questionnaires were distributed to 329 day care providers in three socio-demographically contrasting areas of South-East Wales, to gather descriptive data regarding sickness exclusion policies. 216 (66%) responses were received. Policies were mostly self-written, diverse in content and detail, and often non-evidence-based. Qualitative Methods and Results: Day care providers’ management of infections, and the influence this had on parents’ consulting and antibiotic-seeking behaviours, were explored through semi-structured interviews with 24 purposefully selected day care providers, and 28 opportunistically-selected parents that used their services. Interviews underwent inductive thematic analysis. All day care providers encouraged parents to consult GPs for self-limiting infections, and often inappropriately advised antibiotic treatment through written policies and verbal communication. Some parents felt that day care attendance increased their tendency to consult for symptoms they would usually manage themselves. The purpose of consultation was often to expedite return to day care, rather than alleviate concern. Parents understood that antibiotics were unlikely to be beneficial, but still sought and received treatment in order to appease day care providers’ requirements. Conclusion: Day care providers’ inappropriate advice to parents, together with non-evidence-based exclusion policies, contribute to unnecessary GP consultations and inappropriate antibiotic-seeking behaviour.
17
Darr, Robert Edward. „Barriers To Men Entering Undergraduate Dental Hygiene Programs“. The Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1471863587.
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18
Cousineau, Lisa Marie. „Pharmaceutical and personal care product concentrations in the upper Susquehanna River“. Diss., Online access via UMI:, 2008.
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19
Price, Tabitha. „How to Care for Patients with Diabetes“. Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/2533.
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Excerpt: More than 25.8 million people in the United States have diabetes. This metabolic disorder is associated with many health complications that result from microvascular and macrovascular diseases.
20
Ramírez, Montoya María Fernanda, Simón Farley Fareld Chacaliaza, Pariasca Jose Herrera, Barrantes Alessandra Ventosilla und Yabar Stephany Gisella Gonzales. „Spartan Men Care“. Bachelor's thesis, Universidad Peruana de Ciencias Aplicadas (UPC), 2020. http://hdl.handle.net/10757/652796.
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Hoy en día, no solo las mujeres se preocupan por el cuidado de la piel sino también los hombres. Sumado a esta nueva tendencia, se puede observar el ascenso de la preferencia en productos de origen natural que contribuyen al aporte de beneficios a la piel y a la reducción del daño ocasionado por los químicos.
En este sentido, se ha encontrado un mercado potencial, los hombres específicamente del estilo de vida sofisticado, una parte de la población, definida por Arellano Marketing, como preocupados por el status, la moda y la imagen. Partiendo de la imagen, es sabido que en la actualidad el mercado de productos estéticos para hombres se encuentra en crecimiento desde hace algunos años habiendo generado hasta S/1,000 millones en el año 2018.
Es por ello que “Spartan Man Care” busca abordar el negocio de los productos naturales especializados en hombres que se preocupan por su aspecto físico. Además, es importante resaltar que hoy en día a pesar del mercado potencial existente en los hombres, no existe una variedad de productos dirigidos a ellos, por lo que hay una oportunidad de negocio latente para trabajar. Actualmente, el total de hombres considerados sofisticados en Lima dentro del rango de 25 a 39 años es de 121, 392. De este total el 14% compra productos de higiene con regularidad, representado por 16,995 habitantes y S/3, 976,830 en soles. Finalmente, se determinó que la ganancia del proyecto, calculada a través del VAN, será de S/126, 316 de retorno sobre la inversión.Today, not only women care about skin care but also men. In addition to this new trend, you can see the rise in preference in products of natural origin that contribute to providing benefits to the skin and reducing the damage caused by chemicals. In this sense, a potential market has been found, men specifically for the sophisticated lifestyle, a part of the population, defined by Arellano Marketing, as concerned about status, fashion and image. Based on the image, it is known that currently the market for men's cosmetic products has been growing for some years, having generated up to S / 1,000 million in 2018. That is why "Spartan Man Care" seeks to address the business of natural products specialized in men who care about their physical appearance. Furthermore, it is important to note that today despite the potential market for men, there is no variety of products for them, so there is a latent business opportunity to work. Currently, the total of men considered sophisticated in Lima within the range of 25 to 39 years is 121, 392. Of this total, 14% purchase hygiene products regularly, represented by 16,995 inhabitants and S / 3,976,830 in soles. Finally, it was determined that the project's profit, calculated through the NPV, will be S / 126, 316 of return on investment.
Trabajo de investigación
21
Johnson, Cassandra Jean. „Perceptions of Pre-doctoral and Dental Hygiene Students Regarding Intraprofessional Education“. The Ohio State University, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=osu1492611975616089.
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22
Rosenberg, Anna. „Hand Hygiene Barriers faced byHealth Care Workers in The Gambia: : A Health Belief Model Approach“. Thesis, Södertörns högskola, Miljövetenskap, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:sh:diva-32255.
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Health care associated infections cause major challenges to the provision of health care. This isdue to the burden placed on individuals, their families, and health services. Hand hygiene actions are cost effective measures towards reducing the spread of health care associated infections and have proven very effective in preventing microbial transmission during patient care. It has beenproven that health care workers hands are the main routes of transmission of health care associated infections. Despite this, hand hygiene is still frequently overlooked by health careworkers especially in settings with limited resources. This paper therefore explores hand hygieneknowledge and behaviours of public and private health care workers in The Gambia with focuson the health belief model. The required information has been gathered from 4 public and 2 private health care facilities through the use of a questionnaire based on the WHO evaluation toolkit. Hand hygiene knowledge of health care workers corresponded with their hand hygiene behaviour. Inadequate hand hygiene performance was noted in many health care workers as wellas limited availability of hand hygiene resources from health care facilities. Private health care facilities provided better hand hygiene opportunities for their health care workers yet neither private nor public health care facilities offered adequate hand hygiene training and feedback on hand hygiene performances to their health care workers.
23
Johansson, Isabelle. „Dental- and nursing care collaborations in Sweden – A way to support nursing staff in oral hygiene care for older people“. Licentiate thesis, Hälsohögskolan, Högskolan i Jönköping, HHJ. ARN-J (Aging Research Network - Jönköping), 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-43631.
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Background: Oral health is an integral part of the general health and quality of life. Yet oral health among older people requiring nursing care is often poor. Despite this group’s frequent contact with health care services, they tend to lose contact with dental care. In nursing care, nursing staff are tasked to assist with oral hygiene care, but this has become more demanding as many older people retain more teeth or have advanced prosthetic constructions. Previous research in the field emphasised the need of collaboration between dental- and nursing care to support the nursing staff in this task. However, there is a lack of evidence regarding the effects of these collaborations. Aim: The overall aim of the thesis is to examine two oral health programmes used within nursing care with different design regarding support from and collaboration with dental care. Methods: Quantitative research methods was used. The data in Study I comes from an oral health assessments guide (ROAG-J) performed by nursing staff in a national health register. Oral health, assessed at two occasions from older people with nursing care, were used. Study II was a controlled intervention study performed at a nursing home. The intervention involved individual coaching of nursing staff in oral hygiene care by dental hygienist for four hours per week at the ward for a period of three months. Oral assessments of older people were performed by dental hygienists and questionnaires to nursing home staff were used. Result: In Study I, 667 individuals aged 65 years or older, receiving nursing care services and assessed using ROAG-J between November 2011 and March 2014 were included. No statistically significant difference in any of the oral health variables was found between the first and subsequent assessments. At the first assessments, less than one third of participants had oral health problems. At the first assessment, status of the tongue differed in men and women (p < .01); at the subsequent assessment, gender differences were found in voice (p < .05), mucous membranes (p < .003), tongue (p < .01), and saliva (p < .006). In Study II, 33 nursing staff and 48 residents participated at the baseline measurement and 22 and 32 respectively at the 9-month follow-up. The nursing staff changed in knowledge and attitudes related to gum disease, approximal cleaning, usage of fluoride and the likelihood that older persons would express the need for oral health support. The most frequently reported oral health problems among the residents pertained to teeth and gums. The residents relatively high level of oral health was stable during the study period. Conclusions: The participants in the oral health programmes were able to maintain an acceptable level of oral health during the study periods although health was likely to decline. The nursing staff maintained a high level of knowledge and attitudes about oral health. However, there seems to be a discrepancy regarding the prevalence of oral health problems among older people. A collaboration between dental- and nursing care providers indicates a positive influence on providing oral hygiene care.
24
Knowlton, Samantha Dawn. „Measuring bioaerosol concentrations generated from toilet flushes during hospital-based patient care“. Thesis, University of Iowa, 2017. https://ir.uiowa.edu/etd/5539.
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Infectious diseases account for over 15 million deaths worldwide. Those who are at greatest risk of contracting an infectious disease are immunocompromised. These individuals may be admitted to a healthcare-based setting where they may become infected. In the United States, 1.7 million immunocompromised individuals contract a healthcare-associated infection which lengthens stay, increases medical costs, and puts lives at stake. The transmission routes for these infections occur from direct contact with healthcare staff and contaminated surfaces. Indirect contact methods, such as bioaerosols suggest, but are not a well-examined route of infection. One possible bioaerosol generator includes the flushing of loose stools in toilets from infected patients. To date, no study has investigated the particle or bioaerosol changes in the air resulting from toilet flushing loose fecal wastes in a healthcare setting. The purpose of this study was to investigate changes in the air before and after a toilet flush to support hypotheses that toilets can produce an aerosol containing viable microorganisms, potentially spreading infectious disease.
Particle and bioaerosol concentrations were measured in hospital bathrooms across 3 sampling conditions; no waste no flush, no waste with flush, and fecal waste with flush. Particle concentrations were measured with a particle counter 3 minutes before a flushing event and throughout the bioaerosol collection period. Bioaerosol concentrations were measured with BioStage impactors fixed on a sampling cart at distances of 0.15, 0.5, and 1 m that was placed in front of a toilet. For each sampling trial, 3 time measurements were recorded after a flushing event (i.e., 5, 10, 15 minutes).
Particle concentrations measured before and after the flush were found to be significantly different in 0.3 (p-values= 0.002, 0.002, 0.015), 0.5 (p-values= 0.002, 0.002, 0.018), 1 (p-values= 0.003, 0.003, 0.027), and 3 µm (p-values= 0.016, 0.032) size bins of the no waste with flush and 0.3 (p-values= 0.009, 0.007, 0.007), 0.5 (p-values= 0.018, 0.006, 0.004), 1 µm (p-values= 0.023, 0.013,) size bins of the fecal waste with flush conditions. Bioaerosol concentrations measured in the no waste no flush and fecal waste with flush were found to be significantly different (p-value= 0.005). However, the bioaerosol concentrations measured were not significantly different across time (p-value= 0.977) or distance (p-value= 0.911).
From the study, we concluded that toilets in this unit produce particles when flushed. The particles aerosolized include microorganisms remaining from previous use or from loose fecal wastes. Differences in bioaerosol concentrations across conditions also suggest that toilets flushed containing wastes may be a likely source of bioaerosols that could allow transmission of infectious microorganisms. No observed differences across time and distance of bioaerosol concentrations suggests that generated aerosols quickly diffuse in the air. Since this study is the first to quantify particles and bioaerosols produced from flushing a hospital toilet, future studies are needed for comparison and for intervention development.
25
嚴蕙怡 und Wai-yi Yim. „Evidence-based eye care protocol for ICU patients with altered level of consciousness“. Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B43251778.
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何穎恩 und Wing-yan Vivian Ho. „An evidence-based guideline on emollient therapy for skin care in premature infants“. Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193052.
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Skin is the major protective barrier in a human body. In premature infants, the immature skin barrier reduces the protection against germs. Emollient therapy is an effective prophylactic measure to improve premature infants’ skin condition so as to protect the premature infants against infection. A systematic review of studies shows that emollient therapy is a simple, safe and cost effective intervention for premature infants to improve skin condition. Evidence shows that emollient therapy can also decrease transdermal water loss, conserve heat and energy, stabilize fluid and electrolytes and prevent nosocomial sepsis. The potential of implementing the proposed evidence-based guideline is explored. It will be carried out in a clinical setting. The transferability of the findings, feasibility and cost-benefit ratio of the emollient therapy will be discussed. In order to ensure the evidence-based guideline will be carried out smoothly, a communication plan is necessary to be made in consultation with the stakeholders. A pilot study will also be conducted before the innovation is implemented to ensure frontline staff members to be familiar with the emollient therapy. At the end, the effectiveness of the emollient therapy will be evaluated in terms of skin score. Patients’ outcome and healthcare provider’s outcome will also be evaluated.published_or_final_version
Nursing Studies
Master
Master of Nursing
27
Guzzi, Johnna M. „Impact of early childhood perceptions and experiences on oral health practices in later life“. Morgantown, W. Va. : [West Virginia University Libraries], 2002. http://etd.wvu.edu/templates/showETD.cfm?recnum=2651.
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Thesis (M.S.)--West Virginia University, 2002.Title from document title page. Document formatted into pages; contains ix, 83 p. : ill. (some col.). Vita. Includes abstract. Includes bibliographical references (p. 64-66).
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Slater, Karen. „Improving Care of Peripheral Intravenous Needleless Connectors“. Thesis, Griffith University, 2022. http://hdl.handle.net/10072/412414.
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Background: Most hospitalised patients have a peripheral intravenous catheter (PIVC) at some point during hospitalisation. Although the rate of bloodstream infection (BSI) for PIVCs is low, the sheer number of devices inserted makes them a device of interest, since cumulatively many infections occur worldwide each year. Access to intravenous (IV) lines for the administration of medication and fluids in most of the developed world is through the needleless connector (NC) component of a PIVC. NCs were introduced several decades ago to reduce the risk of needlestick injuries amongst healthcare workers. Although they have been successful in reducing needlestick injuries, there has been an unintended consequence of NCs being associated with increased patient BSI. Patient BSI leads to prolonged length of hospital stay and higher costs, as well as significant morbidity and mortality. About half of all BSIs are attributed to the insertion process and half to on-going maintenance care. One of the most important aspects of maintenance care is NC disinfection, which should take place prior to each access of the NC. When disinfection does not occur, or is inadequate, there is a risk of microorganisms gaining access to the patient’s bloodstream. The optimal cleaning duration and disinfectant agent for NC disinfection have not been established. There have been many laboratory-based studies of NC disinfection but few in the clinical environment. Establishment of the optimal disinfectant agent and disinfection duration is vital to prevent patient BSI and improve patient outcomes. It is also important to establish current practice and identify how this compares to best practice guidelines and what factors influence clinicians’ practice behaviours, since providing evidence-based practice is vital to improve patient outcomes and decrease the risk of patient BSI.Aims and Objectives The aim of this PhD was to establish the most effective method for disinfection of PIVC NCs in the clinical environment and to examine current local infection prevention practices to improve NC care. The research findings will inform healthcare worker practice in the care of PIVC NCs to prevent BSIs. Four objectives guided the three phases of the research: 1. To determine the most effective active disinfectant agent and scrub time to disinfect NCs; 2. To establish adequate NC drying times after disinfection; 3. To evaluate current local practice of PIVC NC care; and 4. To identify nurses’ self-reported practice and attitudes regarding NC care and identify factors that influence their behaviour. Design: This PhD had a multi-method research design. It was underpinned by the Mitchell and Gardiner Infection Prevention and Control conceptual framework. This framework entails a multi-faceted approach to infection prevention. There were three phases to this research: a factorial randomised controlled trial (RCT) comparing disinfectant solutions and disinfectant times, with an associated NC drying time experimental study; an observational study to establish local PIVC care; and finally, a survey of nurses’ practice and attitudes about NC care. Phase 1, Part 1: Research questions: 1. What disinfection agent, 70% isopropyl alcohol (IPA) or 2% chlorhexidine in 70% alcohol (CHG-IPA), is more effective in eliminating microorganisms on PIVC NCs? 2. What disinfection time (5, 10, or 15 seconds) is most effective in eliminating microorganisms on PIVC NCs? Setting: Tertiary adult hospital in Brisbane, Australia. Sample: 300 NCs on PIVCs of adult in-patients located on the internal medical units. Main findings: There was no statistical difference between 70% IPA and 2% CHG in 70% IPA (p = .62) in disinfecting the external surface of NCs in the clinical environment; both were effective, but neither removed all microorganisms. There was no statistical difference in the effectiveness of 5, 10, or 15 (p = .21) second scrub times. Phase 1, Part 2 Research questions: 1. What is the effective drying time of 70% IPA, 2% CHG in 70% IPA, and 10% povidone iodine for NC disinfection? 2. Does the drying time of the three recommended disinfectants differ? Setting: Non-clinical area of tertiary adult hospital in Brisbane, Australia Sample: Three commonly available disinfectant preparation pads/wipes were compared. Main findings: The drying time of the three tested disinfectants differed substantially. After a 15-second scrub, 70% IPA was consistently dry after 5 seconds and 2% CHG in 70% IPA was consistently dry after 20 seconds. Drying time for povidone iodine 10% was not established, as it remained wet at 6 minutes, making its use clinically unfeasible. Phase 2 Research questions: 1. How often do nurses decontaminate their hands prior to accessing PIVC NCs (Moment 2 of the 5 Moments of Hand Hygiene)? 2. How often do nurses disinfect PIVC NCS prior to accessing them? 3. What is the length of time that nurses spend disinfecting PIVC NCs prior to accessing them? 4. What is the length of time that nurses let NCs dry after disinfection, prior to accessing them? Setting: Tertiary adult hospital in Brisbane, Australia Sample: 108 observations of nurses working in the emergency department, two medical wards, and two surgical wards. Main findings: Compliance with disinfection of NCs was high (99%), although disinfection time was a much shorter duration than that recommended in the hospital policy (average 6.1 seconds vs 15 seconds). Compliance with hand hygiene prior to drawing up medication (33%) and immediately prior to medication administration (43%) was suboptimal. The most common duration that nurses allowed NCs to dry was 6–10 seconds. Working in the emergency department setting and use f gloves were associated with poorer compliance with hand hygiene.Phase 3: Research questions: 1. What are nurses’ self-reported practices of NC care? 2. How do self-reported practices of NC care compare to current clinical guidelines and results from previous studies? 3. What influences nurses’ behaviour in relation to NC care and how does this compare to previous studies? Setting: Tertiary adult hospital in Brisbane, Australia Sample: Registered and Enrolled nurses working within the clinical divisions. Main findings Most nurses (89%) stated that they always disinfect NCs prior to access. Nurses’ ability to recognise and undertake the correct sequencing for clamping and line/syringe disconnection was low; 79% of nurses identified the correct clamping and disconnection for negative pressure NCs, and 34% identified the correct sequencing for positive pressure devices. Nurses’ behaviour was most influenced by other senior nurses. The risk of introducing bacteria into the patient’s bloodstream was of great concern to most nurses. Conclusion: PIVC-associated BSI, reflecting suboptimal PIVC maintenance care, remains a serious problem. The results of this PhD focusing on NC disinfection highlight that NCs in the clinical environment are frequently contaminated with microorganisms found on the skin. The RCT—the first on this topic undertaken in a clinical environment—determined that the disinfectants and timeframes tested were very effective in removing most microorganisms from NCs in the clinical environment, but there was no difference between the disinfectants or application durations trialled. The drying time study—the first to examine drying time for commonly used disinfectant preparation pads/wipes on NCs—determined that IPA had the shortest drying time. The observational study established that most nurses disinfect NCs prior to access, but for a shorter duration than is currently recommended. Hand hygiene associated with NC care was suboptimal. The survey—the first comprehensive Australian study—established significant nursing knowledge gaps in NC care and identified opportunities for improvement (particularly the sequencing of disconnecting and clamping NCs and lines), which has the potential to reduce BSIs; it also established that local senior nurses were most likely to influence behaviour. Maintenance care of PIVC NCs has previously been minimally researched and is likely the missing link in infection prevention strategies. This PhD has provided comprehensive new evidence and attention now needs to be directed toward improving the maintenance care of NCs to reduce patient BSI and improve patient safety.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Nursing & Midwifery
Griffith Health
Full Text
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Shiao, Judith Shu-Chu School of Health Services Management UNSW. „Needlestick injury in health care workers in Taiwan“. Awarded by:University of New South Wales. School of Health Services Management, 2000. http://handle.unsw.edu.au/1959.4/17829.
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Objectives: Risk associated with needlestick injuries (NSI) in health care workers (HCWs) in Taiwan has not been characterized. We conducted this investigation to study 1) the prevalence and yearly incidence of NSI in HCWs in Taiwan, and the risk factors associated with NSIs; 2) reporting behavior when a NSI was sustained; and 3) seroprevalence of blood-borne pathogens among inpatients. Combination of the above information allowed for risk estimation for contracting hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) in HCWs. Methodology: A cross-sectional questionnaire survey for life-time experience and frequency of NSI was conducted in a random sample from four strata of accredited hospitals according to the number of employees, from July 1996 to June 1997 in Taiwan. All full time employees, including physicians, nurses, technicians, and supporting personnel were recruited. Seroprevalence was examined for HBV, HCV and HIV among inpatients six years in age or older in one teaching hospital during July 1997 to June 1998. Results: A total of 10,469 health care workers were recruited from 16 out of 132 accredited hospitals and 82.6% (8,645) completed the survey, including nurses (61.0%), physicians (16.1%), medical technicians (14.9%), supporting personnel (7.9%). The prevalence of NSI were 93.1%, 86.6%, 78.3%, 61.0% in nurses, physicians, technicians, and supporting personnel respectively. The reported incidence of needlestick and other sharps injuries was 1.30 and 1.21 times per person in the past 12 months. Of the most recent episodes of NSIs, ordinary syringe needles accounted for 80.3% (95% CI, 79.4% - 81.2%) of hollow-bore needles associated incidents, and 74.1% (95% CI, 72.8% - 75.4%) of them were contaminated. The most frequently reported circumstance was the "Breakdown of Universal Precautions", recapping-related behaviors (81.6%, 95% CI 80.3% - 82.9%) of HCWs. More than a quarter (27.8%, 2,399) of HCWs were unprotected (either not vaccinated or having an unknown serological status) against HBV. Seroconversion in stuck HCWs was reported 1.8% for HBV (135), 0.2% (18) for HCV, 0.2% (15) for both HBV and HCV, 0.1% (5) for syphilis and less than 0.1% (2) for HIV. ^M A total of 81.8% of NSIs were unreported. Similarly, high incidence of NSI and low reporting rate were also found in student nurses. Seroprevalence of HBV, HCV, and HIV among inpatients were found higher than the reported rate in source patients of this survey. Seroprevalence of HBsAg was 16.7% in hospitalized patients, 1.7% positive for HBeAg, 12.7% for Anti-HCV, and 0.8% for Anti-HIV. Different seroprevalence rates of HBsAb (+), HBsAg (+), Anti-HCV (+), Anti-HIV (+) in different seasons were also found significant (p<0.001). The risk of seroconversion to HBV was thus estimated to be 0.003 ~ 0.008 time per person-year, HCV 0.003 ~ 0.007 per person-year, and HIV 0.4 ~ 1.2 /100, 000 person-year. Considering the number of HCWs in Taiwan, a total of 330 ~ 917 HCWs will seroconvert to HBV (+) in a year, 330 ~ 880 HCWs seroconvert to HCV (+), and less than one to two HCWs seroconvert to HIV (+). Conclusions: Needlestick and sharps injuries were highly prevalent among Taiwanese HCW and across job categories. Risk of seroconversion is real and significant. Preventive measures are warranted for reduction of contracting blood-borne pathogens in HCWs in Taiwan.
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Youssef, Sarah Jane. „Implant Maintenance Curriculum Among U.S. Dental Hygiene Programs“. The Ohio State University, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=osu1586814568072554.
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Ahlström, Mandy, und Valles Carmelle Fajutrao. „Hand hygiene compliance among nursing staff in a Philippine private hospital“. Thesis, Sophiahemmet Högskola, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-1585.
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Background Healthcare-associated infections constitute a threat to patient safety and an economic burden on health systems worldwide. The most effective way to prevent healthcare-associated infections is through proper hand hygiene practice, but studies show that compliance is low. In 2009, the World Health Organization released hand hygiene guidelines and tools to address the issue. Aim The aim of the study was to measure the compliance to the WHO Guidelines on Hand Hygiene in Health Care among nursing staff in a private hospital in the Philippines using the evaluation framework of the World Health Organization. Method The method used to assess compliance was structured direct observations using the World Health Organization’s observation form. Data was collected in 15 days, during full shifts, and analyzed quantitatively based on overall compliance, according to indication, ward, week day/weekend and shift. Results A total of 1920 opportunities were recorded, of which 336 were hand rub performances, 168 hand wash and 1416 missed opportunities, giving an overall compliance of 26.25 percent. The ward with the highest compliance rate was the Neonatal Intensive Care Unit (45.40 percent) and the lowest was Nursing Station 1 (22.26 percent). Conclusion The overall compliance rate of 26.25 percent is lower compared to most published studies and healthcare workers were more compliant to indications that protect themselves than to indications that protect patients. The results can be useful in improving quality of care and patient safety.
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Daugherty-Wood, Heather Nichole. „Measuring the Impact of Cultural Competence Training for Dental Hygiene Students“. The Ohio State University, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=osu1429889900.
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Tucker, Helen Jean. „Integrated care : the presence, nature and development of integrated care in community health services in England and Ireland“. Thesis, University of Warwick, 2012. http://wrap.warwick.ac.uk/56879/.
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Background: Integrated care is a policy imperative in health and social care services globally, and yet there are reported difficulties in defining, developing and sustaining this way of working. Research Question: This research explores staff views and experiences of the presence, nature and development of integrated care in two programmes of community services. Method: A case study approach was adopted using secondary analysis of qualitative data from staff questionnaires using themed content analysis and pattern matching, with findings triangulated with documentary sources. The study considers the presence and nature of integrated care using the conceptual framework “to what extent integrated care is for everyone (inclusive) and not just for some (exclusive)” as interpreted from the literature. The development of integrated care was explored using systems theory for the management of change in a complex environment. Findings: A meta-analysis of the two case studies demonstrated that integration was present in all 66 services within the two programmes. The nature of integrated care varied and was demonstrated as multiple types (in community hospitals) and processes (in community services). The most frequently reported type was multidisciplinary working. The processes most teams chose to develop were information sharing systems. The development of integration within the case studies was affected by a number of factors, such as commitment and staffing. Conclusion: This study provides new evidence of the presence, nature and development of integration within a wide range of established services spanning all ages. From this and other measures, the extent to which integrated care is presented as “exclusive” can be questioned. These findings have informed the development of a framework of five principles, reflecting whether integrated care is: for everyone, extensive, enduring, can be enabled and essential. The implications and application of this research for policy, service development and training are discussed, and proposals for further research include testing the applicability of this framework and widening this study.
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Delport, S. V. „Health and health care of the preschool child in Hout Bay“. Master's thesis, University of Cape Town, 1987. http://hdl.handle.net/11427/27215.
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At present not enough is known about the health of preschool children in the poorer communities of Cape Town. This study, was undertaken to assess the health and health care of preschool children in one such community: that of the Hout Bay harbour township. A clinic and community-based surveillance programme was devised to make this assessment. Data were obtained by monitoring the records at the Community Health Centre in the township. A study sample of 214 children from the community was also selected by random stratified cluster sampling. This sample was assessed by means of a questionnaire and a full physical examination. Analysis of data was performed on the IBM main-frame computer. A large number of medical problems were identified on screening the community sample. Most of these problems were minor ones and could be managed appropriately at the Health Centre. On the basis of the referral patterns and the small number of newly diagnosed functionally important health problems, the provision of health care in-the area was considered to be adequate. The high immunisation rate in the preschool children and the excellent attendance figures at the child health clinics indicates that the services provided are well utilised by the population. Dental caries was found to be a major health problem in the area. A strong case for the introduction of a dental health educational programme and for the fluoridisation of drinking water can made on the basis of these findings. An ongoing health screening programme would be beneficial. It could be accomplished by utilising appropriately trained nursing personnel.
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Moore, Christian. „A qualitative case study of nurse, physician, and allied clinicians perceptions on hand hygiene compliance“. Thesis, University of Phoenix, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=3746426.
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The purpose of this qualitative exploratory case study was to explore the perceptions held by physicians, nurses, and other allied clinicians regarding hand-hygiene practices in order to understand what causes non-compliance with those practices. The conceptual framework guiding the research study was based on the social behavioral theories Rosenstocks Health Belief Model, The theory of reasoned action (TRA), introduced by Ajzen and Fishbein (1975) and The social cognitive theory which suggests that an individual’s behavior is determined by his or her own personal intention and that this intention is a function that also determines the individual’s attitude toward the subjective norm or behavior. This research study employed a telephone interview with open-ended questions to explore physician, nurse, and allied clinician perceptions about the hand washing and the factors for non-compliance. The content of the transcribed interviews were analyzed using NVivo 10 software to explore the hand hygiene perspective of a purposeful sample of 3 nurse, 3 physicians and 4 allied clinicians with at least two years of direct patient care experience. Interview data collected from the study resulted in 5 major themes encompassing the need for healthcare institutions to consider when developing hand hygiene initiatives. The descriptive patterns that emerged were: (a) lack of reoccurring formal education/training, (b) staff shortages, (c) sink placement, (d) skin breakdown and sensitivity to hand hygiene products, (e) educational differences among the three groups (physician, nurse, and allied clinician staff). Specifically the results of the case study showed demographic and generational variability with participants of different ages, educational backgrounds, and patient care experience. Results from the study led to recommendations for healthcare leaders that may strengthen hand hygiene compliance enforcement. Study results were also used to make suggestions for future research.
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Crawford, Kathryn J. „Assessment of noise in a medical intensive care unit“. Thesis, University of Iowa, 2016. https://ir.uiowa.edu/etd/2061.
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Exposure to noise in hospital intensive care units (ICUs) can disrupt patients’ sleep and delay their recovery. In this intervention study, noise levels were measured in eight patient rooms of a medical ICU (MICU) every minute with sound level meters for eight weeks before and after an intervention. Implemented over six weeks, the intervention was designed to educate nurses and other staff members to reduce noise levels through behavior modification, including instituting a “quiet time” in the afternoons, encouraging patients to keep televisions off or at lower volumes, and speaking more quietly during conversations. Sound equivalent levels (Leq) were calculated from one-minute measurements for each hour in each room. These hourly Leq (Leq-H) values were compared by pod (group of rooms within the MICU), room position (in proximity to a central nurses’ station), occupancy status, and time of day. Days with more than ten hours of one-minute noise levels above 60 dBA were flagged as the loudest time periods and compared to MICU activity logs. The intervention was ineffective with Leq-H values always above World Health Organization guidelines for ICUs (35 dBA in day; 30 dBA at night) before and after the intervention. Leq-H values frequently exceeded more modest project goals during the day regardless of the intervention (50% of Leq-H > 55 dBA both pre- and post-intervention) and at night (68% and 62% of Leq-H > 50 dBA pre- and post-intervention). Statistical analysis of the Leq-H suggests a general source is contributing to the high baseline noise in the MICU, most likely the heating, ventilation, and air-conditioning (HVAC) system. Our analysis of one-minute data indicated that high noise was often associated with high-volume respiratory-support devices. We concluded that our intervention focusing on administrative controls (e.g., education and training) was not enough to reduce noise in the MICU but that an intervention designed with engineering controls (e.g., shielding, substitution) would be more effective.
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Cole, Mark. „Social construction of hand hygiene as a simple measure to prevent health care associated infection“. Thesis, University of Nottingham, 2014. http://eprints.nottingham.ac.uk/14426/.
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The incidence of Heath Care Associated Infection is a major patient safety concern in the United Kingdom and reducing the morbidity and mortality associated with this has become a National Health Service priority. It is generally accepted that this objective will require a multi-factorial approach where infection prevention and control is seen as everybody’s business. However, some strategies receive greater exposure than others and hand hygiene is widely touted as a common sense solution to a complex problem. This discourse based study combined the techniques of Corpus Linguistics with Critical Discourse Analysis to explore the Textual, Discursive and Sociocultural features of hand hygiene discourse. This took place across three language domains, the Academy, the Newspaper Media and Organisational Policy Makers. These three cultural elites take a consistent account of the problem and the solution. Broadly hand hygiene is portrayed as effective, compliance is basic, performance is poor and Health Care Workers should be held to account through zero tolerance policies and if necessary disciplinary action. However, not only does this background the messy, contextual factors of implementing a hand hygiene policy it imposes a one size fits all approach and measurement programme on compliance that hides the true nature of performance and this ultimately impacts on patient care. This study calls for junior clinicians for whom policy has the greatest impact to become more engaged in the policy making process. In a spirit of openness trusts should adopt linguistic devices that recognise the dynamic nature of practice and a more educational, sophisticated approach to audit.
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Bronson-Lowe, Daniel. „Impact of an Environmental Hygiene Intervention on Illness and Microbial Levels in Child Care Centers“. Diss., The University of Arizona, 2006. http://hdl.handle.net/10150/195257.
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Pathogens on surfaces in child care centers can contribute to illness among attendees and may thereby contribute to medical visits as well. This intervention study was conducted to assess the effect of using specific sanitizing products and cleaning protocols in child care centers on the incidences of lower respiratory infections, diarrheal illness, antibiotic use, and medical visits among children attending the centers and on the levels and antibiotic resistance of indicator bacteria in those centers. During the ten-week study period, children from twelve centers were observed. Six of the centers were randomly assigned to the intervention. The other six were controls. Intervention centers were given cleaning protocols and sanitizing products. Control centers were asked to retain their original procedures and products.Acute illness was determined from records kept by the center directors and telephone calls made to parents of ill children. A call was also made to one randomly selected healthy child's parents for every two ill children recorded. Parents were given a questionnaire requesting information including bedroom sharing status, environmental tobacco smoke exposure, and chronic illnesses.After controlling for within-center clustering and zero-inflation, statistically non-significant trends of reduction were seen in the weeks of lower respiratory infections, diarrheal illness, and medical visits. Multivariable zero-inflated Poisson regression revealed that the number of weeks intervention center children were using antibiotics was 32% lower than among the control center children. This was a statistically significant reduction (95% CI = 0.54-0.86; p = 0.001).Bacterial samples were collected from ten sites within each center at the beginning and the end of the study period to determine the effect of the intervention on the microbial population. The study determined the heterotrophic plate count bacteria numbers and the rates of resistance to ampicillin and cephalothin. Neither heterotrophic bacterial concentrations nor antibiotic resistance rates significantly changed over the course of the study.
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Mok, Anthony, und 莫彤. „Effectiveness of hand hygiene programs that improve compliance rate among healthcare workers: a systematic review“. Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48424985.
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Introduction:
Hand hygiene, the most effective and economical way to prevent the transmission of many bacteria and viruses in healthcare settings, yet, its compliance rate remained unacceptably poor in many countries. Compliance with hand hygiene among healthcare workers increased substantially during outbreak of serious acute respiratory symptoms (SARS) in 2003 but decreased to the baseline after SARS, to improve compliance rate sustainable, many hand hygiene intervention programs have been established since 2003. However, the effectiveness of these programs were in big variations. The objectives of this review were to identify the effectiveness of these hand hygiene intervention programs.
Methods:
This review was conducted using the search engines – PubMed. The key words “hand hygiene”, “hand-washing”, “compliance”, “healthcare personnel”, and “program*” were used for searching literature published from 2003 to July 2012.. Forty-Seven articles were initially obtained. After screening and reviewing of these articles,9 articles met the requirements for inclusion and exclusion criteria were included in this review. The outcome measure was set as the differences and relative ratios in the observed hand hygiene compliance rate before and after intervention.
Results:
Results showed that 8 hand hygiene programs were effective while 1 programme was ineffective in improving hand hygiene compliance rates. Of the eight studies that reported improvement in compliance with hand hygiene, improvement in compliance rate after the interventions was ranged from (24% to 50%) while the relative ratio of compliance (after vs. before intervention) was ranged from 1.78 to 4. The study that reported no improvement in compliance with hand hygiene had a relative high naseline hand hygiene compliance rate of 61%
Conclusion:
Hand hygiene programs that improve compliance rate among healthcare workers were effective overall. The effectiveness of hand hygiene programs seemed to be positively associated with the numbers of intervention types involved. Research on non-compliance and intrapersonal behavior on hand hygiene was suggested for future investigation.published_or_final_version
Public Health
Master
Master of Public Health
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Snyman, J. S. „Effectiveness of the basic antenatal care package in primary health care clinics“. Thesis, Nelson Mandela Metropolitan University, 2007. http://hdl.handle.net/10948/728.
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Pregnancy challenges the health care system in a unique way in that it involves at least two individuals – the woman and the fetus. The death rates of both pregnant women (maternal mortality) and newborns (perinatal mortality) are often used to indicate the quality of care the health system is providing. In terms of maternal and perinatal outcomes South Africa scores poorly compared to other upper-middle income countries (Penn-Kekana & Blaauw, 2002:14). The high stillbirth rate compared to the neonatal death rate reflects poor quality of antenatal care. Maternal and perinatal mortality is recognised as a problem and as a priority for action in the Millennium Development Goals (Thieren & Beusenberg, 2005:11). The Saving Mothers (Pattinson, 2002: 37-135) and Saving Babies (Pattinson, 2004:4-35) reports describe the causes and avoidable factors of these deaths with recommendations on how to improve care. The quality of care during the antenatal period may impact on the health of the pregnant woman and the outcome of the pregnancy, in particular on the still birth rate. In primary health care services there are many factors which may impact on and influence the quality of antenatal care. For example with the implementation of the comprehensive primary health care services package (Department of Health, 2001a:21-35) changes at clinic level resulted in a large number of primary health care professional nurses having to provide antenatal care, who previously may only have worked with one aspect of the primary health care package such as minor ailments or childcare. Because skills of midwifery or antenatal care, had not been practiced by some of these professional nurses, perhaps since completion of basic training, their level of competence has declined, and they have not been exposed to new developments in the field of midwifery. The practice of primary health care nurses is also influenced by the impact of diseases not specifically related to pregnancy like HIV/AIDS and tuberculosis. The principles of quality antenatal care are known (Chalmers et al. 2001:203) but despite the knowledge about these principles the maternal and perinatal mortality remains high. The Basic Antenatal Care quality improvement package is designed to assist clinical management and decision making in antenatal care. The implementation of the BANC package may influence the quality of antenatal care positively, which in turn may impact on the outcome of pregnancy for the mother and her baby. The aim of this study was to evaluate the effectiveness of the Basic antenatal care (BANC) package to improve the quality of antenatal care at primary health care clinics.
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McLean, Christopher Duncan. „Thinking about patients and talking about persons in critical care nursing“. Thesis, University of Southampton, 2012. https://eprints.soton.ac.uk/349086/.
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Nursing scholarship and healthcare policy set an expectation that nurses should think about patients as persons. Nevertheless, the literature reveals that critical care nurses can struggle to perceive patients as persons, and thus suggests they may think about patients in different ways. This thesis presents the findings of an ethnographic study undertaken within one critical care unit in the United Kingdom which examined how critical care nurses do think about patients. A purposive sampling strategy recruited 7 participants representing both experienced and inexperienced critical care nurses. Data were collected over a period of 8 months during 2006 to 2007, and primarily comprised the field notes from 92 hours of participant observation supplemented by 13 tape recorded interviews. Data analysis was influenced by Foucault and Goffman and adopted the perspective of linguistic ethnography. Analysis revealed that all participants thought about patients in seven distinct ways: as ‘social beings’, as ‘valued individuals’, as ‘routine work’, as a ‘set of needs’, as a ‘body’, as ‘(un)stable’ or as a ‘medical case’. Accounts of participants’ practice revealed that they had a tacit understanding that these different ways of thinking related to aspects of one coherent whole, but no one way of thinking could be characterised as thinking about this ‘whole person’. Nurses could only think about one aspect of the patient at a time. Nurses’ practice was not guided or explained by their thinking about patients as persons, but rather expert practice was characterised by nurses’ fluid and appropriate movement between different ways of thinking about patients. When participants talked about their practice it was evident that these nurses could only legitimately talk about themselves as giving care to persons. Participants characterised some of the ways in which they had to think about patients as impersonal, and this actively hindered these nurses from describing or reflecting upon elements of their practice. There is therefore conflict and dissonance between nurses’ expectation that they should think about patients as persons, and the fact that delivering nursing care requires them to think about patients in different ways. The development of future critical care nurses will require practitioners and educators to recognise that nurses think about patients in different ways, and that expert practice is characterised by the clinical wisdom which enables nurses to think about patients in ways which are appropriate to the moment. Nurse scholars and educationalists should therefore avoid claims to a unique professional knowledge base which suggest to nurses that some ways of thinking are always inappropriate or inherently reductionist. Instead, there is a need for scholars and policy makers to articulate a vision of person centred care clearly, and in ways which avoid constructing dissonance between nurses’ ideals, and the ways in which they do and must think about patients.
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McGuire, Margaret Maher. „Community postnatal care provision in Scotland : the development and evaluation of a template for the provision of woman centred community postnatal care“. Thesis, University of Glasgow, 2001. http://theses.gla.ac.uk/1184/.
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The specific objectives of the study were to: 1. Investigate women's perceptions and experiences of postnatal care; 2. Examine the current pattern of postnatal care provision in terms of clinical outcomes (maternal and neonatal) and maternal satisfaction; 3. Evaluate the new model in terms of clinical outcomes (maternal and neonatal) and maternal satisfaction; 4. Compare the outcomes of both models; and 5. Evaluate midwives' perceptions of both models of care. There were no difference between the two Phases in terms of clinical outcomes (maternal and neonatal) midwifery and maternal satisfaction. In both stages of the study, the average day of postnatal discharge was day three, the mean number of postnatal visits was 4.2, and the average number of midwives to visit a woman was two. Women were very satisfied with the community postnatal care provided by midwives, although concerns were expressed about hospital postnatal care. All women agreed that community postnatal care was an important service and would choose to have the midwife visit her in their own home rather than attend health or drop in centres. Midwives applied aspects of the new template of postnatal visiting and were more likely to visit low risk women three times following introduction of the ne template. There was not change in community of carer. Findings of focus group discussions highlighted that women were not prepared for motherhood and the postnatal period. Women stated that the educational support antenatally and in the postnatal ward did not meet their expectations and needs.
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Dalgarno, Elizabeth Louise. „'Through the looking glass' : primary care consultations, work and health : a qualitative study“. Thesis, Keele University, 2018. http://eprints.keele.ac.uk/5580/.
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Musculoskeletal conditions are believed to cost UK society approximately £7.4 billion per year, with 30 million working days lost each year due to musculoskeletal conditions. Currently, within the UK, sickness certification can be self-certified for a period of seven days after which time a General Practitioner is required to authorise any further period of absence from work for patients. In April 2010 the Sickness Certificate was replaced with the Fit Note. The existing literature has offered little ‘in-vivo’ insight into the primary care consultation in relation to the management of patient musculoskeletal work-related concerns since the introduction of the Fit Note, and there is a paucity of research exploring the patient experience of these consultations. The research questions in this thesis broadly ask: How are musculoskeletal work-related concerns discussed and managed within the primary care consultation? How do patients experience these consultations? Mixed qualitative methodology is used within this study. Interpretative methods are used to thematically analyse 100 video-recorded consultations and 19 semi-structured interviews to answer these research questions and provide insight into this area. Findings reveal that the management of musculoskeletal work-related concerns within the primary care consultation is sub-optimal. Accessing work-related support for these people is complicated and contingent upon how they come to identify themselves as candidates for work-related support. The theoretical framework of candidacy is offered as a useful device for understanding and conceptualising the patient experience of these consultations. Interactions with healthcare, in combination with sociocultural factors, mediate how people come to understand their candidacy to seek musculoskeletal work-related support. Directions for further research in this area are provided.
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Tang, Pui-kwan, und 鄧佩君. „Voice problems of secondary school teachers and the need for preventative education“. Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/206591.
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Voice problems are common among teachers due to their job characteristics. Thus, the quality of teaching, daily communication, emotion would be adversely affected. However, the past studies mainly focused on primary school and preschool teachers. There is lack of investigation on voice problems of secondary school teachers. Moreover, the need for voice use training for secondary school teachers was not addressed in the past.
This study investigated the prevalence of voice problems in secondary school teachers in Hong Kong and the need for preventive education. A questionnaire was decided with domains in demographics, job natures, impact on voice disorders, risk factors, history of seeking help because of voice problems, view on different treatment options and opinion towards the need of voice protection training. Subjects were recruited from four local secondary schools in Hong Kong.
85 questionnaires were collected and analyzed. The results showed a high prevalence of voice disorders (75%) among secondary school teachers. Also it revealed different levels of impact on work performance, emotion and daily communication. Laryngitis was the only risk factor found to be significantly correlated with the voice disorder. On the other hand, the rate of seeking professional help and their knowledge about voice rehabilitation were low. Most of the respondents realized the need for voice protection training. It suggested that the voice problems of secondary school teachers should be highlighted and more voice protection information and voice training should be provided.published_or_final_version
Surgery
Master
Master of Medical Sciences
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Morgan, Trina J. „Minority College Students’ Attitudes and Beliefs Regarding the Profession of Dental Hygiene in Comparison to their Oral Health and Dental Knowledge“. Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etd/2564.
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The purpose of this study was to find out the attitudes and beliefs of minority college students enrolled at Missouri College in Brentwood, Missouri in reference to the dental hygiene profession. In particular, does their oral health and dental knowledge relate to their knowledge of profession of dental hygiene? One hundred and six students gave their consent to participate in the study via Survey Monkey. The study was conducted in May 2015 for a period of four weeks. Four statements were designed to gauge minority students’ knowledge of dental hygiene as a career. No differences were found based on gender, age, education and ethnicity. A difference was found based upon the respondent’s program of study. Further research is needed spread the word about dental hygiene programs and to explain the role of the dental hygienist.
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Pastakia, Sonak D. „Developing self-sustainable models of care for non-communicable diseases in Kenya“. Thesis, University of Warwick, 2016. http://wrap.warwick.ac.uk/91742/.
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Background (Kenya) Sub-Saharan Africa (SSA) is in the midst of experiencing an unprecedented increase in non-communicable diseases (NCD), specifically diabetes and hypertension. This shift has required public sector health systems, which have historically focused on managing acute diseases, to redesign their services to appropriately serve chronic disease needs. Issue Addressed In order to provide a description of our efforts to bring up comprehensive services for NCDs in rural Kenya within this thesis, I have specifically selected publications which target different aspects of the healthcare system. This includes our efforts related to clinical training for pharmacists, screening for NCDs, medication supply chains, remote phone-based care services, and care delivery based in the community. Prior to the implementation of the programs mentioned in these domains, access to these services was largely not available in western Kenya. Furthermore, the publication of our research from this western Kenyan cohort is designed to supplant the relatively limited research which emanates from rural sub-Saharan Africa. Research Questions For each of these selected publications, we defined a set of primary and, in some cases, secondary research questions focused on identifying the contextualized attributes of service delivery in this setting while also assessing the impact. For the first publication on training for clinical pharmacists, we assessed the impact of Kenyan Bachelor of Pharmacy interns and North American Doctor of Pharmacy interns while providing clinical care in an inpatient setting in Kenya. Our primary research question assessed whether there was a significant difference in the number of clinical interventions documented by interns from the two countries. In the second paper, we shifted our focus to outpatient care and wanted to address the uptake of different strategies of screening for diabetes and hypertension. Our primary research question assessed whether there were any significant differences in follow-up at the public sector clinic after screening positive via home-based screening (community health volunteer provides screening at your home) versus community-based screening (a community wide event is established where people voluntarily show up to receive screening) in a rural setting. In the third paper, we sought to continue to improve aspects of outpatient care by describing our model for improving access to medications. Our primary research question focused on descriptively assessing the change in availability of essential medications before and after implementation of this model. In the fourth paper, we described and assessed our model for providing intensive diabetes follow-up remotely. Our primary research question focused on whether patients experienced statistically significant improvements in blood glucose control after participating in this service for six months. In the fifth paper, we brought together various elements of our prior activities to design and evaluate the community-based model of care called BIGPIC - Bridging Income Generation through grouP Integrated Care. The primary research question for this investigation was to identify the frequency with which patients who screened positive for diabetes or hypertension linked to care. Secondary research questions compared the linkage frequency observed with this model compared to a historical control, along with a descriptive assessment of the loss to follow up, and an assessment of whether this model led to statistically significant reductions in blood pressure after 1 year of implementation. Short Summary of the Individual Papers with Results Linking Them Together Within our assessment of pharmacy training, we found that the Kenyan pharmacy interns provided statistically significantly more clinical interventions per day than their North American counterparts. This result highlighted the potential for Kenyan pharmacy providers to provide clinical services which were largely unavailable in western Kenya prior to this research. Despite the lack of the clinically focused Doctor of Pharmacy curriculum in Kenya, Kenyan pharmacy interns within the Bachelors in Pharmacy program were able to make an average of 16.7 consultations per day with the medical team compared to 12.0 per day for the North Americans. In the second paper we shifted our focus to the outpatient setting and were surprised to find that there weren’t any statistically significant differences in follow-up between home-based versus community-based screening for NCDs. This highlighted the reluctance of rural patients to travel to public sector facilities for care regardless of the screening method utilized. This realization led us to simultaneously focus on improving the reliability of services available in public sector while also trying to implement solutions to facilitate the provision of remote services for care. Within our efforts to improve medication access in paper 3, we were able to demonstrate how our revolving fund pharmacy model was able to improve access to medications from < 40% to > 90%. In paper 4, we were able to implement a self-monitored blood glucose program and demonstrate a dramatic improvement in the blood sugars of patients enrolled in the self-monitored blood glucose program with a statistically significant 31.6% absolute decline in HbA1c. The culmination of these efforts and learnings is described in paper 5, where we implemented the BIGPIC care delivery model which resulted in a statistically significant improvement in linkage to care for screened patients, a retention in care frequency of 70.3%, and a statistically significant mean decline in the systolic blood pressure of 21mmHg (95% CI 13.9-28.4, P < 0.01).
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McHattie, Lorna W. „The impact of interventions on food hygiene knowledge and behaviour of social care staff and managers“. Thesis, University of Aberdeen, 2005. http://digitool.abdn.ac.uk/R?func=search-advanced-go&find_code1=WSN&request1=AAIU199940.
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This was a multi-disciplinary thesis to examine the impact of current interventions (health education material, training, HACCP and inspection) on food hygiene knowledge and behaviour in social care organisations (SCOs), reviewing current practice and recommending the most effective food hygiene intervention. A systematic review identified and critically appraised the evidence for the effectiveness of current food hygiene interventions. Quantitative and qualitative methods of data collection were employed, such as structured and semi-structured postal questionnaires, focus groups of stakeholders and follow-up telephone interviews, to investigate the food hygiene knowledge and behaviour of SCO staff and managers. The systematic review found that many interventions are not based on epidemiological evidence of the main causative factors associated with food-borne disease, or designed to change behaviour and as a result their effect is limited. Although food hygiene training of managers in SCOs is of a lower level than staff, critical control points are recorded in over 80% of workplaces. Following a review of health promotion theories, no single intervention resulted in effective behavioural change to safer food safety practices. All interventions should be evidence and competence based. Improved teaching of theoretical models and closer collaboration between practitioners and academics is recommended to achieve more effective interventions, and research using robust study designs.
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McDowell, Joan Rachel Somerville. „Management of Type 2 diabetes mellitus in primary care“. Thesis, University of Glasgow, 2014. http://theses.gla.ac.uk/5139/.
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Background: The incidence and prevalence of diabetes mellitus (diabetes) is increasing globally. The majority of people have type 2 diabetes, initially managed by lifestyle changes and the gradual introduction of oral, followed by subcutaneous, medications. Due to the increasing numbers of people with type 2 diabetes, different models of care management have been utilised within the United Kingdom. One Health Board within Scotland received funding to undertake a service redesign whereby the responsibility of care for people with type 2 diabetes was transferred from secondary care to primary care, with referral to specialist services based on clinical need. Aim: The aim of this thesis is to present the body of published work on an evaluation research study on the change in service delivery for people with type 2 diabetes. The published works have arisen from two funded research studies resulting in one peer reviewed report and five peer-reviewed papers published in international journals.
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Feider, Laura Lee. „Survey of oral care practices for the orally intubated adult critically ill patient /“. Thesis, Connect to this title online; UW restricted, 2007. http://hdl.handle.net/1773/7305.
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Wilson, Caroline H. „The commodification of health care in Kerala, South India : science, consumerism and markets“. Thesis, University of Sussex, 2010. http://sro.sussex.ac.uk/id/eprint/2371/.
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In India, alongside Information Technology, health care has become a leading sector in the country‘s development as a 'knowledge economy' (World Bank 2005). One of the major achievements and beacons of economic reform is the growth of some of the most technologically advanced hospitals in the world. This thesis examines the social processes shaping the expansion of the private health care system in the state of Kerala, South India, where large corporate hospitals and 'super-speciality' medicine have spread throughout urban and many rural areas. It explores the intersections between the local and the global, as the health system becomes the major driver of industrial development, unevenly linking the local health care system to the global marketplace for technologies, health care professionals and patients. It examines the three faces of the health care system in Kerala - as a knowledge industry and route to social mobility for the middle classes, in particular doctors and nurses; secondly, as a consumer economy, as people prioritise spending on health care and shop for treatment in the urban marketplace; and finally as a moral economy, as people develop high levels of dependency on doctors, hospitals and technologies in the hope of receiving good health care. The ethnography is set in Malabar, Northern Kerala, where the expansion of private health care has been financed by remittances from migration to the Arabian Gulf countries. The thesis examines the influence of migration and economic reforms on local ecologies of health and health care; the impact of the globalisation of trade in health services in the developing world; the relationship between the private health care system and the middle classes in South Asia; and the role of markets in the delivery of health services. Based on 18 months of participant observation across the urban and rural health care market with local communities of doctors and patients, it examines how doctors and patients adjust to a changing ecology and economy of health care.