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When should pharmacists visit their wards? An application of simulation to planning hospital pharmacy services.

This paper reports a pilot study of the use of simulation in planning hospital pharmacy services. The objectives were to create a simulation model of the hospital drug distribution system, to use the model to investigate a simple problem and to assess the potential for simulation to aid decision making in hospital pharmacy management. The problem chosen for investigation focused on the UK ward pharmacy system, where a pharmacist visits each ward daily to initiate the supply of newly prescribed non-stock medication. A simulation model was used to investigate how changing the time of the ward pharmacist's visit could affect the mean time delay between the prescription of a non-stock drug and the arrival of that drug on the ward. The simulation results suggest that the time of day at which pharmacists visit their wards can have a major impact on delay times, and that the relative benefit of different visit times is likely to vary between wards. Simulation was found to be a useful approach to investigating different service alternatives without the expense and disruption of assessing each in practice.

Computer Simulation↗

Established and emerging waterborne nosocomial infections.

PURPOSE OF REVIEW: To assess the recent advances in the field of waterborne nosocomial infections. RECENT FINDINGS: In the last year, many publications have confirmed the importance of well known nosocomial waterborne pathogens such as Legionella spp. or other Gram-negative bacteria, especially non-fermentative bacilli. There have also been numerous reports of outbreaks or pseudo-outbreaks caused by Mycobacteria spp. The most intriguing information relates to the possibility that some fungi causing nosocomial infections may originate from the hospital water distribution system. SUMMARY: Despite progress in understanding the pathogenesis of nosocomial waterborne infections, outbreaks, pseudo-outbreaks and sporadic infections still occur. Targeted quality control of hospital water, updated procedures for the appropriate use of sterile and non-sterile water, coupled with surveillance constitute the cornerstones of prevention of these infections.

Communicable Diseases, Emerging↗

A proactive approach to prevention of health care-acquired Legionnaires' disease: the Allegheny County (Pittsburgh) experience.

BACKGROUND: The Allegheny County Health Department (ACHD) in Pennsylvania distributed the first guidelines for prevention and control of health care-acquired Legionnaires' disease (LD) by 1995. The proactive approach advocated in the guidelines differed notably from that of the Centers for Disease Control and Prevention (CDC) by recommending routine environmental testing of the hospital water distribution system even when cases of health care-acquired Legionnaires' disease had never been identified. OBJECTIVES: Our purpose was to (1) evaluate the impact of the ACHD guidelines on the Legionella diagnostic and preventive practices of health care facilities in Allegheny and surrounding counties and (2) compare the incidence of health care-acquired LD before and after issuance of the ACHD guidelines. METHODS: CDC case reports of LD from 1991 to 2001 were tabulated and compiled by the ACHD Infectious Disease Unit and the Association for Professionals in Infection Control and Epidemiology, Inc, Three Rivers Chapter. A survey was distributed to 110 hospitals and long-term care facilities in the region. The results were analyzed as occurring either in the preguideline period (1991-1994) or postguideline period (1995-2001). RESULTS: A significant decrease in the number of health care-acquired cases was demonstrated between the preguideline (33%) and postguideline (9%) periods (P=.0001). In contrast, community-acquired cases increased from 67% pre guideline to 91% post guideline. A total of 71% of the facilities were colonized with Legionella. Disinfection of the water distribution system was initiated by 44% of facilities. Use of urinary antigen testing significantly increased from 40% pre guideline to 79% post guideline (P=.0001). CONCLUSIONS: Health care-acquired LD declined significantly after the issuance of guidelines for prevention and control of health care-acquired LD. The decline was associated with health care facilities performing routine environmental monitoring of their water distribution systems followed by the initiation of disinfection methods if indicated. Two unanticipated benefits were (1) cases of LD in the community and long-term care facilities were uncovered as a result of increased availability of Legionella tests and (2) litigation and unfavorable publicity involving ACHD hospitals ceased.

Cross Infection↗

[Relation between colonization of hospital water supply by Legionella and risk of infection in patients].

The aim of the study was risk assessment for exposure to legionellae measured by seroreactivity of in-patients and infection in colonized hospitals. Sampling of water from distribution systems of two hospitals (A, B) revealed legionella contamination in 30.7% and 28.3% in the ranges of 10(4)-10(7) CFU/l. The most common isolates were of Legionella pneumophila sp. (L.p.) serotypes L.p.10 and 5 in hospital A, in hospital B L.p.1 (non-Pontiac group) and L.p. 3 (some of tested strains were virulent for guinea pigs). Paired sera of 64 patients from hospital A in the ages of 56 +/- 16.0 taken in the range of 18.4 +/- 8.6 days reacted mostly with low titers (up to 1:32) with standard antigens (15 patients) and endemic antigens (6 patients). Sera (time span 25.0 +/- 8.1 days) of 64 patients with oncological diseases (from hospital B) aged 56.2 +/- 7.3 years reacted only with standard antigens in lower titres in 4 cases. Despite of low seroreactivity of in-patients and no nosocomial cases in colonized hospitals, both facilities (especially hospital B) must be considered as risk sites for susceptible patients, active surveillance using urinary legionella antigen detection must be introduced.

Adult↗