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PubMed2000

Waterborne Nosocomial Infections.

Waterborne pathogens cause infections in health-care facilities. Despite guidelines addressing these pathogens, outbreaks and pseudo-outbreaks continue to occur. We reviewed recent reports of infections caused by Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Chryseobacterium species, nontuberculous mycobacteria, and Legionella species. Mycobacterium avium complex (MAC) infection in HIV patients has been linked to hospital water distribution systems; molecular subtyping showed that MAC isolates in patients and hospital water were identical. In immunosuppressed patients, Fusarium infection has been linked to the hospital water distribution system; again molecular subtyping showed that isolates from patients and the water supply were identical. Parasites, especially Cryptosporidium, and viruses have also been implicated in nosocomial infection. Transmission occurs via contact, ingestion, aspiration, or aerosolization of potable water, or via the hands of health-care workers. Interventions designed to interrupt transmission of waterborne pathogens have included the use of antimicrobial handwashes, targeted disinfection of the water supply, and, in high-risk populations, restricting the use of tap water.

Journal Article↗
PubMed1986

A practical application of just-in-time.

During the 1950s, the Japanese recognized that they would have to upgrade their manufacturing operations significantly if they were going to make inroads into world markets. One of the targets they set for themselves was to eliminate waste, particularly, excess inventory. The Toyota Company originated a concept called kanban hoshiki, which, when translated, means "card system". The name refers to the use of tags (cards) to track the flow of work-in-progress inventory. On this side of the Pacific, the kanban hoshiki inventory management system has been renamed Just-in-Time. The basic premise of JIT is that inventory is an evil presence that drains company cash flow, contributes to wast and misuse of company assets, takes up valuable space, and undermines company profitability. The principal goal of JIT, then, is to get as close to zero inventory as possible. JIT has been applied with success in large manufacturing industries and recently has found a home in small business as well. A growing number of hospitals are also experimenting with the JIT concept, sometimes under the name of stockless purchasing.

Cost-Benefit Analysis↗
PubMed2006

Key facilitators and best practices of hotel-style room service in hospitals.

This qualitative study sought to identify the features, advantages, and disadvantages of hotel-style room service; the barriers to, and facilitators for, implementing the process; and "best practices." The study took place in four heterogeneous hospitals. Participants included hospital administrators, managers, and room-service employees. Data-collection methods included semi-structured interviews, observations, and document analysis. Common features of hotel-style room service were meal delivery within 30 to 45 minutes, a restaurant-style menu, procedures to feed ineligible patients, tray assembly on demand, scripting, and waitstaff uniforms for room-service employees. The major barrier to implementing room service was obtaining nursing support. The key facilitators were the hospital's service-oriented culture, using a multidisciplinary planning team, engaging nursing departments early in the planning stages, and intense customer-service training of room-service employees. The overwhelming advantage was patients' control over their food choices. The main disadvantage was cost. Initial best practices in hotel-style room service include: (a) taking a multidisciplinary team approach for developing and implementing the process, (b) customer-service training, (c) using a customer-driven menu, (d) wearing waitstaff uniforms, and (e) using carts with airpots for dispensing hot beverages.

Adolescent↗
PubMed1987

Legionnaires' disease: an emerging surgical problem.

Legionnaires' disease is an important, although often overlooked, complication in the patient postoperatively. Up to 50% of all nosocomial legionellosis in the hospitals reviewed was found in surgical patients. Patients undergoing a transplant procedure are at highest risk, but occurrence is common in the surgical patient undergoing general anesthesia, endotracheal intubation, or both. Aerosolization, aspiration, and direct instillation of contaminated water during manipulation of the respiratory tract are likely mechanisms of transmission. The usual clinical presentation is that of a nonspecific pneumonia. Specialized laboratory techniques including selective culture media, direct fluorescent antibody stains, and serological detection of antibodies are necessary for accurate diagnosis. If these tests are not routinely available, Legionnaires' disease may remain undiagnosed. Environmental surveillance of the hospital water distribution system is advisable for hospitals with a large surgical case load. If transplantation is performed, such surveillance is mandatory.

Cross Infection↗
PubMed1990

Off-site storage--move it!

The planning and implementation of the onsite proposal required the devotion and creativity of many individuals, including administrative, clerical, and line workers, and has been accomplished through the completion of a series of objectives. While the plan took three years to be realized, cost containment efforts of this magnitude signify the important contribution a material management department can make in the healthcare industry. Departmental credibility and support from customers are the foundation for implementing such a plan in any medical center. Materiel management departments continue to incorporate creative and innovative programs into their daily operations, which contributes to the institution's bottom-line. This on-site project has brought The University of Michigan Hospitals one step closer to its ultimate cost containment goal of a total stockless purchasing/supply program.

Cost Control↗
PubMed1993

Customer satisfaction planning and industrial engineering move hospital towards in-house stockless program.

By integrating customer satisfaction planning and industrial engineering techniques when examining internal costs and efficiencies, materiel managers are able to better realize what concepts will best meet their customers' needs. Defining your customer(s), applying industrial engineering techniques, completing work sampling studies, itemizing recommendations and benefits to each alternative, performing feasibility and cost-analysis matrixes and utilizing resources through productivity monitoring will get you on the right path toward selecting concepts to use. This article reviews the above procedures as they applied to one hospital's decision-making process to determine whether to incorporate a stockless inventory program. Through an analysis of customer demand, the hospital realized that stockless was the way to go, but not by outsourcing the function--the hospital incorporated an in-house stockless inventory program.

Consumer Behavior↗