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PubMed2004

The presence of a specific genotype of Legionella pneumophila serogroup 1 in a hospital and municipal water distribution system over a 12-year period.

The genotypic distribution of Legionella pneumophila serogroup 1 was investigated in the water distribution system of a 450-bed Swedish hospital and the surrounding community. A single genotype identified by amplified fragment length polymorphism (AFLP) analysis, was found in all 34 hospital isolates and in 18 out of 20 community isolates over a 12-y surveillance period. All isolates were either monoclonal antibody subtypes Benidorm or Bellingham. In a geographical comparison, the hospital genotype was also identified in 2 out of 6 Swedish hospitals, both located within 100 km of the studied community. In all, 70 isolates originating from 7 Swedish communities clustered in 4 groups, each also containing 1 AFLP type as defined by the European Working Group on Legionella Infections (EWGLI). It was concluded that a single Legionella pneumophila serogroup 1 genotype may colonize a large water distribution system over a long period of time, and that certain clones seem to be widely spread in the environment. Results from molecular typing of isolates originating from a limited geographical area must, therefore, be interpreted cautiously in epidemiological investigations of Legionnaires' disease.

Bacterial Typing Techniques↗
PubMed2003

ASHP national survey of pharmacy practice in hospital settings: dispensing and administration--2002.

Results of the 2002 ASHP national survey of pharmacy practice in hospital settings that pertain to dispensing and administration are presented. A stratified random sample of pharmacy directors at 1101 general and children's medical-surgical hospitals in the United States were surveyed by mail. SMG Marketing Group, Inc., supplied data on hospital characteristics; the survey sample was drawn from SMG's hospital database. The response rate was 46.7%. During 2002, both inpatient and outpatient hours of service increased compared with 2001. Paradoxically, there was an 8.5% decrease in pharmacy staffing and a 7% vacancy rate, suggesting that pharmacists are busier. Most hospitals (80%) had a centralized inpatient dispensing system, but 44% were planning to become more decentralized. Automated dispensing cabinets were used by 58% of hospitals with decentralized drug distribution systems. Most hospitals (81.4%) dispensed more than three quarters of oral doses as unit doses and 63.3% of injectable doses to non-critical care patients, increases from 1999. A large percentage of hospitals (89%) repackaged both oral and injectable medications. More hospitals were repackaging medications than three years ago, primarily because of lack of commercial availability. Approximately 20% of pharmacies either partially or completely outsourced drug preparation activities. Nurses administered medications in virtually all hospitals (99.7%). Despite widespread recommendations to use bar-code technology to check and document doses administered, only 1.5% of hospitals used this technology, an increase from 1.1% in 1999. Nearly two thirds of hospitals used computer-generated medication administration records. While pharmaceutical services are expanding, workforce issues continue to challenge pharmacists trying to maintain and enhance safe medication systems. Safe systems continue to be in place in most hospitals, but the adoption of new technology to improve safety is slow.

Documentation↗
PubMed1999

Redesigning medication distribution systems in the OR.

Detroit Riverview Hospital's surgery suite recently converted to an automated medication distribution system. Focusing on control, access, documentation, and charging, the redesign has benefited pharmacists, nurse anesthetists, and OR nurses. Automation reduced nursing labor associated with ordering and restocking medications, counting narcotics, and investigating discrepancies. Storage and dispensing options, including innovative anesthesia trays, facilitate caregiver productivity, quality initiatives, and clinical pathways. System documentation pinpoints questionable events and patterns to ensure that all medications dispensed were administered to patients. Charges are captured and posted automatically. Overall, automated medication distribution has helped the OR improve clinical care quality and patient service.

Automation↗
PubMed1993

Empirical comparison of just-in-time and stockless materiel management systems in the health care industry.

Despite the limitations, this study is the first comparative empirical investigation of two relatively new materiel management systems applied in hospitals. The results show that hospital managers have significantly rated the possibility that more effective use of some materiel management resources can be achieved by adopting either a JIT or stockless system over conventional materiel management systems.

Cost Savings↗
PubMed2001

Computerized controlled-substance surveillance: application involving automated storage and distribution cabinets.

A secondary data-reporting system used to scan the archives of a hospital's automated storage and distribution cabinets (ASDCs) for indications of controlled-substance diversion is described. ASDCs, which allow access to multiple doses of the same medication at one time, use drug count verification to ensure complete audits and disposition tracking. Because an ASDC may interpret inappropriate removal of a medication as a normal transaction, users of ASDCs should have a comprehensive plan for detecting and investigating controlled-substance diversion. Monitoring for and detecting diversion can be difficult and time-consuming, given the limited report-generating features of many ASDCs. Managers at an 800-bed hospital used report-writing software to address these problems. This application interfaces with the hospital's computer system and generates customized reports. The monthly activity recapitulation report lists each user of the ASDCs and gives a summary of all the controlled-substance transactions for those users for the time period specified. The monthly summary report provides the backbone of the surveillance system and identifies situations that require further audit and review. This report provides a summary of each user's activity for a specific medication for the time period specified. The detailed summary report allows for efficient review of specific transactions before there is a decision to conduct a chart review. This report identifies all ASDC controlled-substance transactions associated with a user. A computerized report-generating system identifies instances of inappropriate removal of controlled substances from a hospital's ASDCs.

Analgesics, Opioid↗
PubMed1987

Comparative assessment of chlorine, heat, ozone, and UV light for killing Legionella pneumophila within a model plumbing system.

Nosocomial Legionnaires disease can be acquired by exposure to the organism from the hospital water distribution system. As a result, many hospitals have instituted eradication procedures, including hypercholorination and thermal eradication. We compared the efficacy of ozonation, UV light, hyperchlorination, and heat eradication using a model plumbing system constructed of copper piping, brass spigots, Plexiglas reservoir, electric hot water tank, and a pump. Legionella pneumophila was added to the system at 10(7) CFU/ml. Each method was tested under three conditions; (i) nonturbid water at 25 degrees C, (ii) turbid water at 25 degrees C, and (iii) nonturbid water at 43 degrees C. UV light and heat killed L. pneumophila most rapidly and required minimal maintenance. Both UV light and heat (60 degrees C) produced a 5 log kill in less than 1 h. In contrast, both chlorine and ozone required 5 h of exposure to produce a 5 log decrease. Neither turbidity nor the higher temperature of 43 degrees C impaired the efficacy of any of the disinfectant methods. Surprisingly, higher temperature enhanced the disinfecting efficacy of chlorine. However, higher temperature accelerated the decomposition of the chlorine residual such that an additional 120% volume of chlorine was required. All four methods proved efficacious in eradicating L. pneumophila from a model plumbing system.

Chlorine↗