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PubMed1985

Legionella pneumophila and water temperatures in Australian hospitals.

Thirty-four samples of warm waters from 12 psychiatric centres in Victoria and New South Wales were examined for legionellae by guinea-pig inoculation. Legionella pneumophila was isolated from 20 of the samples collected from ten of the establishments investigated. The detected prevalence proportion of L. pneumophila in waters of temperatures 36 to 43 degrees C was 0.9 (18/20), whereas the prevalence in waters of temperatures 45 to 54.2 degrees C was 0.14 (2/14). The two 'positive' waters within the latter range showed evidence of low numbers of L. pneumophila. No significant antibody titres to relevant serogroups were detected in the 112 exposed residents tested from seven psychiatric hospitals in New South Wales. The findings show that the temperature range with the greatest prevalence of L. pneumophila in warm waters is 36 to 43 degrees C. The presence of legionellae in these warm water-distribution systems contrasts with their absence from the water-distribution systems of Victorian hospitals in an earlier survey and underlines the value and simplicity of the usual Australian practice of maintaining hospital hot water temperatures at about 70 degrees C in the control of L. pneumophila.

Animals↗
PubMed1983

Pharmacy-based controlled substances distribution for a university campus.

A university-wide pharmacy-based controlled substances distribution system is described. The purchasing and control of controlled substances for the entire university campus is centralized in the hospital pharmacy department. The distribution system uses the concept of restricted versus nonrestricted drugs, where restricted drugs are all Schedule II controlled substances and other drugs needing restrictive control. The restricted or nonrestricted status of a drug is based upon suspected or observed abuse potential. After receipt by the pharmacy, all controlled substances and restricted drugs are stored in a vault. A 24-hour audit-disposition record system is used to control the inpatient distribution of restricted drugs, which are stored in locked cabinets on each nursing unit. In the outpatient pharmacy, a small supply of restricted drugs is stored in a locked cabinet; the inventory is reconciled weekly. Nonrestricted controlled substances, such as phenobarbital and chloral hydrate, are distributed to the inpatient satellite pharmacies and the outpatient pharmacy in the same manner as other prescription drugs. Campus practitioners and researchers order all controlled substances from the pharmacy using the appropriate order forms; each individual is responsible for maintaining a record and control system. A quality assurance program was established to review and improve the quality of service. The centralized pharmacy-based system improved the control, monitoring, and efficiency of controlled substances distribution for the entire university campus.

Academic Medical Centers↗
PubMed1998

Nosocomial legionnaires' disease discovered in community hospitals following cultures of the water system: seek and ye shall find.

BACKGROUND: The reservoir for hospital-acquired legionnaires' disease is the water distribution system. The Allegheny County (Pa.) Health Department recommended environmental cultures for all health care facilities for the prevention of hospital-acquired Legionella infection including facilities with no known cases of legionnaires' disease. METHODS: Environmental cultures of hot water tanks, faucets, and showerheads were performed in six health care facilities according to health department guidelines. If hot water tanks, faucets, or showerheads yielded Legionella, monitoring with Legionella culture and urinary antigen was performed for all cases of nosocomial pneumonia. RESULTS: Legionella was isolated from the water distribution system in 83% (five of six) of facilities. Three facilities dropped out of the study; two decided to disinfect the water and one had no Legionella in the water system. The other three facilities all discovered cases of legionnaires' disease during the 1-year study period after introduction of Legionella testing. L. pneumophilia, serogroups 1, 3, and 5, caused 12 cases of hospital-acquired legionnaires' disease. Positive diagnostic tests included: 10 of 12 (83%) urinary antigen, 6 of 8 (75%) respiratory cultures, and 2 of 5 (40%) serology. Molecular typing confirmed that the source of infection was the water supply in two hospitals. CONCLUSION: Routine environmental cultures for Legionella in the water distribution system are recommended even if the hospital had not previously recognized cases of hospital acquired legionnaires' disease. The Allegheny County Health Department guidelines were inexpensive to implement and resulted in the discovery of cases that would have otherwise been undiagnosed.

Cross Infection↗
PubMed2001

Fusariosis associated with pathogenic fusarium species colonization of a hospital water system: a new paradigm for the epidemiology of opportunistic mold infections.

We sought the reservoir of Fusarium species in a hospital with cases of known fusarial infections. Cultures of samples from patients and the environment were performed and evaluated for relatedness by use of molecular methods. Fusarium species was recovered from 162 (57%) of 283 water system samples. Of 92 sink drains tested, 72 (88%) yielded Fusarium solani; 12 (16%) of 71 sink faucet aerators and 2 (8%) of 26 shower heads yielded Fusarium oxysporum. Fusarium solani was isolated from the hospital water tank. Aerosolization of Fusarium species was documented after running the showers. Molecular biotyping revealed multiple distinct genotypes among the isolates from the environment and patients. Eight of 20 patients with F. solani infections had isolates with a molecular match with either an environmental isolate (n=2) or another patient isolate (n=6). The time interval between the 2 matched patient-environment isolates pairs was 5 and 11 months, and 2, 4, and 5.5 years for the 3 patient-patient isolate pairs. The water distribution system of a hospital was identified as a reservoir of Fusarium species.

Air Microbiology↗
PubMed1978

Computer system for unit dose drug distribution.

A computerized unit dose drug distribution system, part of an online hospital information system, is described. Differences between manual and computerized pharmacy distribution, and the advantages and deficiencies of the automated system are discussed. The system seems to improve pharmacy's efficiency, accuracy, control of drugs and capabilities for patient monitoring and drug use review. If mechanical failure occurs, back-up procedures keep the distribution system operational. The computer system is believed to decrease the time spent by pharmacists on routine distribution tasks, leaving time for other necessary pharmacy functions.

Computers↗
PubMed2003

The equine antitoxins supply system for biological poisons in Japan.

Recently, the equine antitoxin supply in Japan has sharply decreased; then it is apparent that a stable supply produced solely by private industry cannot be relied upon. The Ministry of Health, Labor and Welfare (MHLW), therefore, purchases vaccines and equine antitoxins from manufacturers who could not otherwise independently provide an adequate antitoxin supply to hospitals. This supply system is called the 'Kokuyu vaccine system.' Under this system, MHLW purchases, stores and distributes vaccines and antitoxins to hospitals. This system has worked efficiently and effectively so far and may be a good model for establishing a stable antitoxin supply system in other countries.

Animals↗
PubMedDate not supplied

[Prevention and control of Legionella infection in the hospital environment].

An outbreak of nosocomial legionnaires' disease in a hospital of Northern Italy is described, together with the epidemiological survey and the control measures adopted. Two patients developed Legionella pneumophila (serogroup 1) pneumonia, one (immunodepressed) died. The Task Group organised by the Health Service excluded other previous nosocomial infections, and made controls on patients and personnel of at risk units (all negative). An intensive programme of environmental sampling and educational activities on personnel have been carried out. The environmental surveillance revealed that the centralised hot water distribution system of the hospital was colonised with Legionella. Shock heating and hyperchlorination of water were applied, which reduced the number of contaminated sites short term, but recolonisation took place two months later. We underline the difficulties encountered to control Legionella by active surveillance of water quality; once the system is contamined, Legionella eradication may be difficult and expensive, and cases of hospital-acquired legionnaieres' disease are likely to occur.

Adult↗
PubMed2005

The impacts of smart cards on hospital information systems--an investigation of the first phase of the national health insurance smart card project in Taiwan.

PURPOSE: To investigate the impacts of the first phase of Taiwan's Bureau of National Health Insurance (TBNHI) smart card project on existing hospital information systems. SETTING: TBNHI has launched a nationwide project for replacement of its paper-based health insurance cards by smart cards (or NHI-IC cards) since November 1999. The NHI-IC cards have been used since 1 July 2003, and they have fully replaced the paper-based cards since 1 January 2004. Hospitals must support the cards in order to provide medical services for insured patients. METHODS: We made a comprehensive study of the current phase of the NHI-IC card system, and conducted a questionnaire survey (from 1 October to 30 November, 2003) to investigate the impacts of NHI-IC cards on the existing hospital information systems. A questionnaire was distributed by mail to 479 hospitals, including 23 medical centers, 71 regional hospitals, and 355 district hospitals. The returned questionnaires were also collected by prepaid mail. RESULTS: The questionnaire return rates of the medical centers, regional hospitals and district hospitals were 39.1, 29.6 and 20.9%, respectively. In phase 1 of the project, the average number of card readers purchased per medical center, regional hospital, and district hospital were 202, 45 and 10, respectively. The average person-days for the enhancement of existing information systems of a medical center, regional hospital and district hospital were 175, 74 and 58, respectively. Three months after using the NHI-IC cards most hospitals (60.6%) experienced prolonged service time for their patients due to more interruptions caused mainly by: (1) impairment of the NHI-IC cards (31.2%), (2) failure in authentication of the SAMs (17.0%), (3) malfunction in card readers (15.3%) and (4) problems with interfaces between the card readers and hospital information systems (15.8%). The overall hospital satisfaction on the 5-point Likert scale was 2.86. Although most hospitals were OK with the project, there was about 22% dissatisfied and strongly dissatisfied, that is twice as many hospitals with satisfied (about 10%). CONCLUSIONS: Our recommendations for those who are planning to implement similar projects are: (1) provide public-awareness programs or campaigns across the country for elucidating the smart card policy and educate the public on the proper usage and storage of the cards, (2) improve the quality of the NHI-IC cards, (3) conduct comprehensive tests in software and hardware components associated with NHI-IC cards before operating the systems and (4) perform further investigations in authentication approaches and develop tools that can quickly identify where and what the problems are.

Diffusion of Innovation↗
PubMed2004

An information system for drug prescription and distribution in a public hospital.

With 773 beds and 3696 employees, the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (HCFMRP)-Universidade de São Paulo, is one of the largest medical institutions in Latin America. The complete process of prescribing and distributing medication at HCFMRP involves the following stages: prescribing (physicians); ordering (infirmary); separating and dispensing (main drugstore); verifying and administering (infirmary). This was a manual process, normally taking place in the morning. Bottlenecks were inevitable and the risk of errors was elevated. An information system (IS) was devised and implemented with a view to controlling such problems. This article addresses the construction of this system and reports on a survey in which different groups of users have evaluated the project.

Brazil↗
PubMed2004

[Remote access to a web-based image distribution system].

PURPOSE: To assess different network and security technologies for remote access to a web-based image distribution system of a hospital intranet. MATERIALS AND METHODS: Following preparatory testing, the time-to-display (TTD) was measured for three image types (CR, CT, MR). The evaluation included two remote access technologies consisting of direct ISDN-Dial-Up or VPN connection (Virtual Private Network), with three different connection speeds of 64, 128 (ISDN) and 768 Kbit/s (ADSL-Asymmetric Digital Subscriber Line), as well as with lossless and lossy compression. RESULTS: Depending on the image type, the TTD with lossless compression for 64 Kbit/s varied from 1 : 00 to 2 : 40 minutes, for 128 Kbit/s from 0 : 35 to 1 : 15 minutes and for ADSL from 0 : 15 to 0 : 45 minutes. The ISDN-Dial-Up connection was superior to VPN technology at 64 Kbit/s but did not allow higher connection speeds. Lossy compression reduced the TTD by half for all measurements. CONCLUSIONS: VPN technology is preferable to direct Dial-Up connections since it offers higher connection speeds and advantages in usage and security. For occasional usage, 128 Kbit/s (ISDN) can be considered sufficient, especially in conjunction with lossy compression. ADSL should be chosen when a more frequent usage is anticipated, whereby lossy compression may be omitted. Due to higher bandwidths and improved usability, the web-based approach appears superior to conventional teleradiology systems.

Internet↗
PubMed2002

Cleaning patient shower facilities: a novel approach to reducing patient exposure to aerosolized Aspergillus species and other opportunistic molds.

We previously have demonstrated that the hospital water-distribution system could be a reservoir for airborne molds that leads to secondary aerosolization of these molds in patient shower facilities. In this report, we show that cleaning the floors of patient shower facilities in a bone marrow transplantation unit reduced the mean air concentrations of molds, including Aspergillus species (from 12 cfu/m3 to 4 cfu/m3; P=.0047).

Aspergillosis↗
PubMed2000

Legionnaires' disease in a newly constructed long-term care facility.

OBJECTIVES: To determine whether a newly-constructed long-term care facility would become colonized with Legionella and whether Legionnaires' disease would occur in residents of this new facility. DESIGN: Prospective environmental surveillance of the hospital's water distribution system for the presence of Legionella pneumophila during construction. Utilization of diagnostic tests for Legionnaires' disease in cases of nosocomial pneumonia. SETTING: The Pittsburgh VA Health Care System, Aspinwall Division, a two-building 400-bed complex. PARTICIPANTS: Six patients who acquired Legionnaires' disease while in the facility. INTERVENTION: Installation of copper-silver ionization systems. MEASUREMENTS: Isolation of L. pneumophila from potable water and the occurrence of Legionnaires' disease. RESULTS: L. pneumophila serogroup 1 was recovered from the water distribution system within 1 month of operation; 74% (61/82) of distal sites were positive during construction. In the first 2 years of occupancy, six cases of legionellosis were diagnosed. Both clinical isolates of L. pneumophila were identical to environmental isolates by pulsed field gel electrophoresis (PFGE). Copper-silver ionization systems were installed to control Legionella in the water system. CONCLUSIONS: We conclude that long-term care residents are at risk for acquiring nosocomial Legionnaires' disease in the presence of a colonized water system, even in a newly constructed building.

Aged↗
PubMed1979

The health impact of restricting public funds for abortion. October 10, 1977--June 10, 1978.

The Center for Disease Control (CDC), Atlanta, Georgia implemented an eight-month prospective surveillance system in 24 hospitals distributed among states with and without public funding for abortion. Out of 3,157 visits for abortion-related complications, only 10 women gave a history of non-physician or self-induced abortion and none were Medicaid recipients. The small number of hospitals located in non-funded states and the smaller numbers of women served in these hospitals than in the funded states limited the power of out study. Women living along the Texas-Mexico border appeared more likely to have complications after illegal abortions than women from other areas of the country.

Abortion, Illegal↗
PubMed1992

Use of an automated medication storage and distribution system.

The effects of an automated medication storage and distribution system in a hospital setting were evaluated. The Pyxis Medstation system was implemented on two nursing units at a 1000-bed tertiary-care referral hospital. The system, which is designed like an automated bank teller, dispenses items to authorized users and records all transactions. Floor-stock controlled substances and noncontrolled medications, large-volume i.v. solutions, and i.v. administration sets were stocked in the system. The system was evaluated (1) by comparing the mean patient charge capture rates for six months before and for three months after implementation, (2) by measuring nurse and pharmacy technician time required for various tasks before and after implementation, and (3) through questionnaires filled out by nurses and technicians. After the system was installed, nursing personnel spent less time on medication-related activities, charting, and documentation and more time interacting with patients. Pharmacy technicians spent more time on floor-stock activities and less time on billing activities. Nurses indicated positive attitudes toward the system features. Both nurses and pharmacy technicians indicated that the system should remain in use. After implementation, the charge capture rate for noncontrolled medications, i.v. solutions, and i.v. sets increased from 63% to 97%. This increase, extrapolated to the entire hospital, reflects $35,000 in additional revenue over the total costs of implementation of the system. Implementation of an automated medication storage and dispensing system is expected to increase hospital revenue and enable nurses to spend more time interacting with patients at this institution.

Attitude of Health Personnel↗
PubMed1987

Nosocomial Legionnaires' disease following renal transplantation.

A cluster of five cases of Legionnaires' disease in renal transplant patients is described. They were treated with erythromycin and rifampicin, and all five survived. Two of them had rejected their grafts prior to their Legionella pneumonia; two rejected their transplants after reduction of immunosuppressive therapy to combat the infection. L pneumophila was present in the water distribution system of the hospital. Eradication measures included flushing the water pipes to the transplantation ward with hot and hyperchlorinated water, raising the warm water temperature to 60 degrees C, and installing ultraviolet (UV) irradiation units on the warm and cold water pipes to the ward. These measures were successful in that no new cases of legionellosis occurred after wards. L pneumophila could subsequently not be demonstrated by culture in plastic shower hoses supplied with UV-irradiated water. L pneumophila could be demonstrated by direct fluorescent antibody technique, but nonspecific reactions cannot be excluded. A higher prevalence of elevated L pneumophila antibody titers was observed in patients nursed for more than four weeks in the hospital than in patients with a shorter hospital stay, in hospital staff members, or in the general population. It seems that, with appropriate control measures, transplantation activities need not be discontinued in the presence of a minor cluster of Legionnaires' disease in renal transplant patients.

Adult↗
PubMed1978

Decentralized pharmacist concept solves unit dose problems.

In order to solve problems associated with the unit dose drug distribution system at LDS Hospital, the decentralized pharmacist concept was tried. The pharmacist uses a master medication cart to fill new drug orders at the nursing station and a computer video terminal at the nursing station to check patient profiles. The reactions of nurses and members of the medical staff to the decentralized pharmacist are described.

Hospital Bed Capacity, 500 and over↗
PubMed1986

A drug distribution system to supply a detached ambulatory surgery center from the main hospital's central pharmacy.

Ambulatory surgery centers (ASCs) and other outpatient service facilities are becoming more prevalent throughout the country. The development and implementation of a drug distribution system to supply a detached ambulatory surgery center is described. The method proposed to provide all the medication needed for the ASC uses a unit-dose cart with lockable doors. The cart is delivered to the ASC each morning by nonpharmacy hospital transportation personnel. A locked case method similar to the system described by McClure-Zola et al. is employed for schedule II controlled substances. Specific formularies were developed for the anesthesia and the operating/recovery rooms. Medications for both areas are arranged separately in the cart. The cart is returned to the pharmacy at the end of each ASC day to be replenished on the night shift by the pharmacy staff. Additional full-time equivalents are not required in the pharmacy budget to provide this service. The system described provides a simple method for efficiently and effectively meeting the medications needs of a free-standing satellite of the hospital.

Centralized Hospital Services↗