Bed rest in hospital can be bad for you. Here’s what nurses say would help get patients moving

Shutterstock

Danny Hills, Federation University Australia; Breanne Kunstler, Monash University; Christina Ekegren, Monash University; Nicole Freene, University of Canberra; Tracy Robinson, Charles Sturt University, and Virginia Plummer, Federation University AustraliaIf you or a loved one is unlucky enough to be in hospital, you might think the best thing to do is rest in bed as much as possible. But while rest is important, lying or sitting in bed too much can actually make many conditions worse.

Researchers have developed mobility recommendations for some hospital settings but in practice, most patients still aren’t active enough.

To find out more, we asked 138 nurses from five Australian states about the challenges they face trying to to get patients moving more, and what changes would help. We also did some in-depth interviews with a sample of nurses involved in the study.

Our results, published in the Journal of Clinical Nursing, showed there is much we can do. Managers and team leaders have an important role in empowering nurses because our study found nurses do not always feel able to reduce sedentary behaviour in their patients.

---

Read more:
For older people and those with chronic health conditions, staying active at home is extra important – here’s how

---

The dangers of sedentary behaviour in hospital

Lying or sitting too much while in hospital can lead to deconditioning (such as loss of strength, joint function and mobility), pressure injuries, blood clots, infections, prolonged hospital stays and unplanned hospital re-admissions.

In rehabilitation settings, where a person is recovering from conditions such as stroke, amputation or arthritis, older adults spend as little as 5% of the day
upright.

In acute settings — where a patient in hospital may require surgery or treatments to repair a fracture, remove a tumour or relieve nerve pain — it can be much worse. Older adults spend a median of just 3% of their day standing or walking.

These are staggering figures but the good news is even small increases in activity and movement can help prevent the rapid loss of muscle mass and strength that comes from lying down or sitting too long in hospital.

Our study found nurses have a key role in supporting patients’ mobility and in reducing their sedentary behaviour.

Nurses in this study told us that workload and lack of time were significant barriers to encouraging reduced sedentary behaviour.
Shutterstock

What are the barriers?

Perhaps unsurprisingly, nurses in this study told us workload and lack of time to encourage reduced sedentary behaviour were significant barriers.

However, they also told us there was a perception among family and sometimes patients themselves that they needed to rest and that older people had earned the right to sit back and relax.

This was especially the case when people were unwell or had complex needs. As one nurse said:

For example, ‘Dad’s in his 80s, does he need to do this?’ It is a common mindset of the family of an older person.

So how much exercise should you get while in hospital? There’s no “one size fits all” answer. For some patients, it might just mean getting out of bed and walking to the bathroom, getting dressed or moving around a room. For others, it might mean walking around hospital hallways or doing more specialised movement programs such as My Therapy.

What would help?

Nurses told us that help from family in getting patients up and moving would be a huge bonus.

Families can also help by providing really comfortable shoes and clothing. We know patients are less likely to participate if they are not comfortable.

Another said:

We involved family members at mealtimes [by walking to] the lounge and it has improved nutritional intake by bringing in [special] food and contributing to the social aspects. One brought Italian food and they loved it.

Some patients, however, have only family members or visitors who are, themselves, older and unable to assist the patient with walking. Or, a patient may have no visitors at all.

Working closely with other members of the care team yields results, with one saying:

Going to a team meeting is good […] they say to the patient, this is what we are aiming for, do you agree that you will sit up for lunch every day […] it’s a team effort.

Another told us:

I like to read the physio notes every day and then just have an idea what their actual functional goals and actual functional levels are like. Encouraging people to achieve those tiny little goals like ‘oh, we walked to the toilet’, ‘oh, we brushed our teeth at the sink’.

Nurses told us that help from family in getting patients up and moving would be a huge bonus.
Shutterstock

One nurse spoke of the value of interventions aimed at getting patients more active, such as the UK’s End PJ Paralysis program.

[…] although not very well promoted, [it] was a great help. Many resources went
into it. With our model of care, there was a social aspect that was a great success, they started friendship groups, lots of activities, we had the Melbourne Cup down in the lounge, and they watched the tennis together. It’s been so positive. We used to really encourage them to go just once, now they want to go all the time. But some nurses still need to learn it’s not about wheeling people down there.

In other words, it’s about walking, not wheeling.

A nurse leader said:

It’s staggering how much time they [patients] spend alone. There’s a potential connection here. Isolation and boredom is one thing. If we tackle the boredom, we tackle the sedentary behaviour, there is a link, and we will solve the social isolation. Enabling nurses to be the coach for getting people up, and there’s definitely an educational aspect.

Creative and sustainable solutions

Our study shows that reducing sedentary behaviour in hospitals is often complex and there are important roles for nurse leaders and organisations in working together on creative and sustainable solutions.

As influential British doctor, Richard Asher, put it in his oft-quoted poem about the danger of sedentary behaviour in hospitals:

Teach us to live that we may dread;

unnecessary time in bed.

Get people up and we may save;

patients from an early grave.

---

Read more:
Sitting for too long could increase your risk of dying – even if you exercise

---

Danny Hills, Associate Professor, Deputy Dean, Federation University Australia; Breanne Kunstler, Research Fellow, BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University; Christina Ekegren, Senior Research Fellow, Monash University; Nicole Freene, Associate Professor, Physiotherapy, University of Canberra; Tracy Robinson, Senior Lecturer in Nursing, Charles Sturt University, and Virginia Plummer, Professor, Federation University Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

A ‘deep clean’ has been ordered for a Brisbane hospital ward. What does that actually involve

Brett Mitchell, University of Newcastle and Philip Russo, Monash UniversityThe Australian public’s infection control literacy continues to expand. We know what PPE is, what “flattening the curve” means, and we are growing increasingly familiar with the term “deep clean”. But what does a deep clean involve, and when is it necessary?

This week, media reported that a ward at Brisbane’s Princess Alexandra Hospital was to undergo further “deep cleaning” after testing found a “COVID-19 related virus” in the ward. This was to be combined with further engineering reviews, although the ward’s isolation rooms were deemed to be functioning as expected.

What role does environmental cleaning play?

SARS-CoV-2, the virus that causes COVID-19, can survive on surfaces. This means if a surface is contaminated by someone with COVID-19, it is theoretically possible for other people to become infected if they touch those surfaces and then touch their nose, mouth, or eyes.

It is not clear how many cases of COVID-19 are acquired through surface transmission, although the risk from this transmission route is thought to be lower than other routes, such as droplets, aerosols and direct contact.

The other good news is that SARS-CoV-2 is easily broken down and can degrade quickly upon contact with particular cleaning agents and under certain environmental conditions.

---

Read more:
How worried should I be about news the coronavirus survives on surfaces for up to 28 days?

---

Nonetheless, because SARS-CoV-2 can survive on surfaces and there is a theoretical risk, it is important that measures to reduce subsequent transmission include cleaning. This is on top of other, potentially more important measures such as increasing appropriate ventilation, waiting as long as possible before entering the space (at least several hours), and using personal protective equipment (PPE).

So, what is a deep clean?

There is no nationally agreed definition of what constitutes a “deep clean”. The term seems to have originated during disease outbreaks in hospitals in the 1990s and 2000s.

Cleaning is a complex and skilled process involving many facets. Evidence has shown that improving routine cleaning in hospitals can reduce infection risk, and that this is cost-effective. But what is the difference between a routine cleaning and deep cleaning?

There’s no agreed definition of a deep clean, but it goes a long way beyond mopping the floor.
Masanori Inagaki/AP

In the absence of detailed guidelines, institutions and companies have developed their own approach to deep cleaning. In Victoria, there is some limited guidance of what a deep clean involves.

Broadly speaking, a deep clean should pay particular attention to cleaning objects or surfaces that may not be cleaned as part of a routine clean. These could include walls, ventilation ducts, curtains, and harder-to-reach surfaces that are touched less frequently. In contrast, routine cleaning focuses on surfaces that are frequently touched.

Deep cleaning typically involves the use of a disinfectant, as well as a detergent. Typically detergents are used to remove organic matter. Disinfectant can kill bacteria and viruses (depending on the type of disinfectant). Products or surfaces that are more difficult to clean, such as carpets, soft furnishings or certain equipment, may also be included in a more thorough clean, noting that care has to be taken not to damage such items in the process.

Training and auditing are also crucial for effective cleaning. Cleaners need to be properly trained, including in the correct use of PPE to ensure they are protected.

Regular auditing of cleaning can be done in various ways, including direct observation or by using fluorescent markers. Fluorescent markers are invisible to the naked eye, but are removed when a surface is cleaned. They can be applied before cleaning a surface and checked again after, to determine whether it has been effectively cleaned.

What about ‘fogging’?

Media footage often shows workers “fogging” rooms and facilities as part of a deep clean. This involves spraying the area with very fine droplets of disinfectant, and it certainly makes for compelling television.

But several Australian organisations have recommended against fogging, including the Victorian Department of Health and Human Services, New South Wales’ Clinical Excellence Commission and Safe Work Australia.

The US Environmental Protection Agency does not recommend fogging or fumigation, unless the product label specifically includes disinfection directions. Australia’s Therapeutical Goods Administration has also noted that testing of disinfectants may not apply to techniques such as fogging.

Where to from here?

Like all things COVID-19, our understanding of the role of surface transmission and the benefits of deep cleaning continues to evolve. Any unusual transmission events or “mystery” cases, particularly in a health-care setting, need to be thoroughly investigated.

Technologies such as genomic testing, which provide detailed information about specific chains of transmission between people, could provide rich data to help us understand the role of the environment and inform future strategies.

Importantly, any findings from investigating these unusual events need to be made publicly available so the wider community can better understand how to combat the spread of COVID-19.

---

Read more:
Catching COVID from surfaces is very unlikely. So perhaps we can ease up on the disinfecting

---

Brett Mitchell, Professor of Nursing, University of Newcastle and Philip Russo, Associate Professor, Director Cabrini Monash University Department of Nursing Research, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The ‘hospital in the home’ revolution has been stalled by COVID-19. But it’s still a good idea

Shutterstock

Martin Hensher, Deakin University; Bodil Rasmussen, Deakin University, and Maxine Duke, Deakin University

Growing numbers of Australians are choosing to receive their hospital care at home, according to figures published today in the Medical Journal of Australia. In 2017-18, more than half a million days of publicly funded hospital care were delivered at patients’ homes rather than in hospital.

“Hospital in the home” is just what it sounds like – an acute care service that provides care in the home that would otherwise need to be received as an inpatient.

It provides an alternative to hospital admission, or an opportunity for earlier discharge than would otherwise be possible. The research found it is also associated with a lower likelihood of readmission within 28 days (2.3% vs 3.6%) and lower rates of patient deaths (0.3% vs 1.4%), compared with being an inpatient.

While federal government plans to boost hospital in the home have been hampered by COVID-19, home service models may be even more valuable in a post-pandemic world.

---

Read more:
Private health insurers should start paying for hospital-type care at home

---

A push from government

In November last year, federal health minister Greg Hunt called for a “hospital in the home revolution”.

He told state and territory governments and private health insurers he wanted more care delivered in patients’ homes rather than hospitals, and pledged to make it easier for these services to qualify for funding.

Hunt said his aim was to offer more choice and better clinical outcomes for patients, as well as better efficiency for state and territory health departments and private health funds. He explicitly linked this plan to efforts to curb the spiralling increases in private health insurance premiums, which threaten that industry’s future.

Hospital in the home was on the federal government’s agenda late last year.
Shuttershock

The promised revolution has inevitably been stalled by the COVID-19 pandemic. But the new research provides a timely reminder of the importance and potential of hospital in the home.

How is hospital in the home delivered?

Hospital in the home is already a widespread practice in Australia. Nationwide, more than 595,000 days of hospital in the home care were delivered in 2017-18 for public patients, accounting for more than 5% of acute-care bed days.

Yet in the private sector, fewer than 1% of acute bed days were delivered at home.

In Victoria, hospital in the home services have been funded by the public health system since 1994, and have consistently been affirmed as being safe and appropriate for patients.

Victoria’s hospital in the home program delivered more than 242,000 patient bed days in 2017-18. Monash Health’s hospital in the home service provided care for some 14% of the whole health service’s overnight admissions in June 2019.

---

Read more:
From triage to discharge: a user’s guide to navigating hospitals

---

There is considerable variation between states and territories, and between individual health services, in how these services are delivered.

Generally, they are staffed by a multidisciplinary mix of nursing, medical and allied health staff. Patients admitted to the program remain under the care of their hospital doctor, and the hospital’s full resources are available to each patient should they need them.

Some of the main activities of hospital in the home include:

• administration of intravenous antibiotics for short- and long-term infections

• administration of anticoagulants to help prevent blood clots

• post-surgical care

• complex wound care and management

• chemotherapy.

Western Health’s hospital in the home program provides support for people with chronic conditions like heart failure, chronic obstructive pulmonary disease and cancer. Monash Health provides a wide range of care throughout life, from premature babies to aged care.

Why is it a good thing?

For patients, the benefits include increased comfort, less noise, freedom of movement, more palatable food and, crucially, reduced exposure to hospital-acquired infections.

Treating patients in their homes can also improve responsiveness to cultural and socioeconomic needs, and provide support for carers.

Patients and carers alike appreciate the ability to choose an alternative to hospital admission and feel more in control when care is delivered in their own home.

---

Read more:
Here’s how many people get infections in Australian hospitals every year

---

Based on international evidence, it is less clear whether discharging patients early from hospital and treating them at home actually reduces costs. A 2012 meta-analysis suggested it does, but more recent Cochrane reviews concluded the cost benefits are “uncertain”.

Many people prefer to be at home.
Shutterstock

Hospital in the home and COVID-19

Despite having pushed hospital in the home reforms onto the back burner, COVID-19 might paradoxically provide even greater impetus for this type of care model.

In the short term, home treatment can relieve pressure on the acute hospital system. One example is the Victorian government’s support for mental health care delivered to young people via hospital in the home during the pandemic.

Longer term, the rapid boost to telehealth and remote monitoring technology driven by COVID-19 will greatly benefit hospital in the home.

Better integrated and coordinated hospital in the home care can be achieved via an e-enabled care model, supporting self-management activities, remote symptom monitoring, patient reminders and decision support. It’s likely we’ll see far less resistance to these measures following the COVID-19 pandemic.

Patients’ and carers’ perceptions of home hospital care are also likely to have improved as a byproduct of COVID-19, as people avoid visiting hospitals in person if possible. These attitudes may last well beyond the pandemic.

---

Read more:
Even in a pandemic, continue with routine health care and don’t ignore a medical emergency

---

While private health insurers are currently enjoying bumper profits as COVID-19 reduces the amount of member claims, the likely economic downturn in the wake of the pandemic may put insurers and private hospitals under great pressure as members cancel their policies due to unemployment or reduced income. Hospital in the home could prove a useful tool to drive down costs.

Hunt’s promised revolution will require big changes to the regulations that govern private health care, and to insurers’ willingness to demand change from private hospitals. But if we have learned anything from COVID-19, it’s that change can happen fast when it’s really needed.

---

The authors wish to acknowledge staff at Western Health (Micheal Perrone, Erin Webster, Aneta Lavcanski) and Monash Health (Jennine Harbrow, Helen Richards) for their contribution to this article.

Martin Hensher, Associate Professor of Health Systems Financing & Organisation, Deakin University; Bodil Rasmussen, Professor in Nursing, Deakin University, and Maxine Duke, Emeritus Professor Nursing and Midwifery, Deakin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Can I visit my loved one in hospital even if they don’t have coronavirus?

Shutterstock

Maximilian de Courten, Victoria University; Barbora de Courten, Monash University; Erwin Loh, Monash University, and Georgia Soldatos, Monash University

The number of people with suspected or confirmed COVID-19 who need to go to hospital is increasing.

So family members and friends will be asking whether they can visit their loved ones. People will also want to visit patients in hospital for another reason. Perhaps they’ve just given birth or are recovering after a heart attack.

Whether you can visit or not depends on a mix of policies put in place nationally, by the states, and by individual hospitals.

And as the situation can change daily, it’s best to check the hospital’s website or phone ahead to avoid being refused entry at the hospital gates.

---

Read more:
Banning visitors to aged care during coronavirus raises several ethical questions – with no simple answers

---

Why are more people in hospital?

The number of new cases diagnosed with the coronavirus each day in Australia is decreasing. But the number of people expected to be hospitalised with a suspected or confirmed case is still increasing.

This is due to the time lag, because whether there’s a need to hospitalise a patient for COVID-19 only becomes evident around the fifth day after diagnosis, sometimes even later. Further, patients with severe COVID-19 often have to remain in hospital for some time.

Initial estimates by the World Health Organisation predicted about 81% of COVID-19 infections to be mild or have no symptoms. But about 14% develop severe disease and require oxygen and 5% become critically unwell, requiring mechanical ventilation.

The latest data for Australia look a little better with 8% receiving hospital care, including 2% being in intensive care units (ICU).

---

Read more:
Why are older people more at risk of coronavirus?

---

People spend on average eight days in hospital with COVID-19. But if they develop serious complications and require a ventilator, the average length of stay might be double that.

This is much longer than the usual length of hospital stays which, for patients who spent at least one night in hospital, is 5.3 days overall.

How are hospital visits changing?

Before the coronavirus, hospitals encouraged family and friends to visit their loved ones as this can help reduce patients’ anxiety and stress, and may help them recover faster.

Visiting hours and hospital policies are set to limit traffic in and out of wards, allow treatment to take place and for patients to rest and recover.

Hospitals might also have asked visitors to clean their hands when they first arrived to avoid bringing infections in.

Visitors will be asked to clean their hands before and after seeing their loved one in hospital.
Shutterstock

In light of COVID-19, much tougher restrictions are now in place to protect the patient, hospital staff and the visitors.

For patients with COVID-19, rules about visiting them in hospital, and especially in the ICU, may be very restricted. Visiting may be prohibited or, if allowed, only for a very short amount of time under extra precautions.

For example, in New South Wales, visitors must wear a surgical mask and protective eyewear if they are visiting a person suspected or confirmed to have coronavirus.

These restrictions are set nationally and by individual states, and adapted into the visiting policies of individual hospitals.

---

Read more:
What does it mean to be immunocompromised? And why does this increase your risk of coronavirus?

---

Different states have different rules

The most recent rules for Victoria allow patients in public, private and denominational hospitals only one visit per day, a maximum of two visitors at a time and for up to two hours.

However, you will be prohibited from visiting if you have:

• been diagnosed with coronavirus and should be in isolation
• arrived in Australia within the last 14 days
• recently come into contact with a person confirmed to have the coronavirus
• a temperature over 37.5℃ or symptoms of a respiratory infection.

These restrictions are in place regardless of whether your loved one has COVID-19 or is in hospital for another reason.

In some cases, visitors can stay longer than two hours. These exemptions include parents or carers of people under 18, carers of people with a disability, the partner or support person of someone giving birth, a person accompanying a patient to the emergency department, or a person providing end-of-life support.

Different hospitals have imposed different restrictions on visitors during the coronavirus pandemic.
Shutterstock

While most states and territories have issued similar advice, Tasmania has closed all hospitals to visitors after the recent coronavirus outbreak in the North West Regional Hospital in Burnie.

Hospitals in Tasmania will make exceptions for people visiting their partners at the birth of a child, parents visiting dependent children and for “compassionate and end-of-life reasons”. But a person visiting under any of these exemptions still needs to check with the hospital.

Hospitals also have their own rules

Hospitals around the country have also restricted visiting hours and numbers beyond what the health departments are mandating.

For instance, at our hospital in Victoria, currently only one visitor per patient per day is allowed, and no children under 16. Visitors to our ICU are limited to a maximum of ten minutes whereas during labour one partner or support person can be there for 24 hours.

On entry, staff will screen you for symptoms and signs of COVID-19. This might be done by asking you a series of questions and/or checking your temperature.

---

Read more:
The coronavirus pandemic is forcing us to ask some very hard questions. But are we ready for the answers?

---

So as the rules vary across states, territories, individual hospitals – and even different wards within a single hospital – check the latest restrictions for your state and hospital before planning a visit.

Maximilian de Courten, Professor in Global Public Health, Victoria University; Barbora de Courten, Professor and Specialist Physcian, Monash University; Erwin Loh, Group Chief Medical Officer, St Vincent’s Health Australia & Clinical Professor, Monash University, Monash University, and Georgia Soldatos, Adjunct Clinical Associate Professor, School Public Health and Preventative Medicine, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Hospital beds and coronavirus test centres are needed fast. Here’s an Australian-designed solution

Deborah Ascher Barnstone, University of Technology Sydney

Two of the most pressing needs worldwide in the coronavirus pandemic are for more hospital beds and testing centres. No country in the world has enough hospital beds or intensive-care unit (ICU) beds for a pandemic. Even the best prepared, like Germany with 33.9 ICU beds per 100,000 citizens, does not have enough.

Most countries have locked down to buy time by flattening the infection curve so fewer patients will present to hospital at once. They hope to use the time to boost hospital capacity.

---

Read more:
What steps hospitals can take if coronavirus leads to a shortage of beds

---

But the design challenge is significant. We need structures that can be quickly and easily assembled, are inexpensive and meet technical requirements. Architects have always worked on such challenges – the Living Shelter is one recent example.

Here in Australia a consortium is working to develop two designs, one for hospital intensive care units and one for COVID-19 testing centres, that can be used across the country and overseas. By using recycled shipping containers as the core structure, the price of the buildings will be less than a third of the cost of conventional designs.

In both building types, the container doubles as structure and packaging. This means the designs are self-contained and easy to distribute anywhere in the world. All the building parts, technical equipment, cabinets and other fit-out materials pack into the container.

The design of the testing centre is based on a shipping container, which doubles as the packaging for transport.
Author provided

Douglas Abdiel, the director of charitable foundation P&G Purpose, and architect Robert Barnstone are working together on the design and delivery of these hospital units and testing centres.

Barnstone specialises in disaster relief architecture. He has developed designs for emergency housing for the International Red Cross and rapid deployment schools for countries afflicted by disaster. This experience gave Barnstone invaluable insights into the economics and potential construction systems for the hospital units and testing centres.

---

Read more:
Coronavirus will devastate Aboriginal communities if we don’t act now

---

What are the key requirements?

Any disaster relief architecture must consider several critical design aspects:

• buildings need to be as cheap as possible so limited funds can be stretched to help as many people as possible

• the structure should be lightweight and easy to assemble because professional builders might not be available for construction

• the structure needs to be weatherproof and insulated for variable climates

• medical functions require running water, electricity, air exchange to bring fresh air into the container, and air conditioning to control the temperature inside.

The mechanical services needed in a medical facility are highly specialised and expensive. This makes it particularly challenging to design. Ideally, the structure should be lasting, so money invested in relief efforts is not wasted.

Emergency structures should also be designed for easy packaging and shipping. Standard dimensions of shipping containers, freight costs and delivery logistics must be considered.

---

Read more:
Coronavirus an ‘existential threat’ to Africa and her crowded slums

---

So how do the two building designs work?

The two proposals for intensive care units and testing facilities use modified shipping containers as the supporting structure. You can see the full designs and specifications here.

The hospital structure is simply a large shed that houses ICU bays. A nurses’ station is located in the centre.

The testing centre is a drive-by place to conduct COVID-19 tests and either process them when a fast test is available or store them for shipping to laboratories.

Used shipping containers are cheap and easy to find. They are made from a steel frame with corrugated steel panelling, which makes them very strong.

Both schemes use prefabricated panels for exterior and interior walls. Window units will be integrated into panels. These come in standard sizes that easily pop into place.

The two design approaches do have differences, however.

The front entry of the rapid deployment hospital annexe.

The hospital uses a full-length 12-metre container. The shipping container acts as the structural and spatial core of the hospital building.

When unpacked, the container sits in the middle of the hospital and supports long-span steel trusses and the roof. It houses office and storage space.

Inside the hospital annexe the container houses the nurses’ annexe and supports the building trusses and roof.

The prefabricated panels form both the outside walls and interior partitions. End walls are made of transparent glass to allow natural light into the interior.

Interior bays for patients are also prefabricated. These line the exterior walls, leaving space for hospital staff to circulate between the ICU bays and central container.

In contrast, the testing centre is a single-unit building made from a half-length six-metre container. A large overhanging canopy covers the roof and front deck to protect against sun and rain.

A water storage tank rests on the roof underneath the canopy. A generator sits on one side. There is a scrub sink and changing area outside, with a curtain that allows for privacy and a bin to dispose of protective equipment.

The exterior of the testing centre has a changing area and sink.

The container doors support storage cabinets for test kits on their inside wall. These doors can swing open so they are flush with the front facade. In this position, the cabinets face the front deck for easy access by nurses and doctors.

The front deck of the testing centre showing storage cabinets.

The interior has ample storage and office furniture.

The testing centre office.

Construction of the prototype test centre was due to begin on April 15. To date, the team has raised A$30,000 to support the effort but needs $20,000 more. At A$3,125 per square metre, compared with about A$10,000 per square metre for usual construction, these solutions are affordable and can be produced and delivered very quickly.

Deborah Ascher Barnstone, Professor, Course Director Undergraduate Studies, School of Architecture, University of Technology Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

1 in 10 patients are infected in hospital, and it’s not always with what you think

Drips and other medical devices were potential sources of infection. But no-one expected to find hospital-acquired pneumonia and urinary tract infections.
from www.shutterstock.com

Philip Russo, Monash University and Brett Mitchell, University of Newcastle

Most people expect hospital treatment to make them better. But for some, a stay in hospital can actually make them sicker. Their wound might get infected after an operation or they might get a blood infection as a result of a medical procedure.

Our study, published today in the international journal Antimicrobial Resistance and Infection Control, found one in ten adult patients in hospital with an acute (short-term) condition had a health care associated infection.

In the first study of its kind in Australia for over 30 years, we also uncovered unexpected infections, like pneumonia and urinary tract infections, as well as high numbers of patients with multi-drug resistant organisms (superbugs).

---

Read more:
Infections, complications and safety breaches: why patients need better data on how hospitals compare

---

Why do we need to keep track of infections?

Most of these infections can be prevented. So it is important to know what type of infections they are, how common they are and which patients get them. Once we have this information, we can work out a way to prevent them.

Left unchecked, these infections can make already sick patients sicker, can divert hospital resources unnecessarily, and can kill.

Most hospitals in Australia have ongoing surveillance for specific infections, such as wound and bloodstream infections.

Some states have well coordinated programs like the Victorian program VICNISS, leading to detailed data on health care associated infections. This data is then used to inform hospital strategies on how to prevent infections. However, this type of surveillance method requires extensive resources and does not capture all infections that occur in a hospital.

Instead, we conducted a “point prevalence” survey, which takes a snapshot of the current situation on any given day. This is less resource intensive than ongoing surveillance and it provides valuable information on the distribution and occurrence of all infections in a hospital.

---

Read more:
Some private hospitals are safer than others, but we don’t know which

---

In Europe, the European Centre for Disease Prevention and Control co-ordinates national point prevalence studies every four years. These have provided valuable insight into the burden of health care associated infections. They have also been used to track the emergence of multi-drug resistant organisms in Europe. The US, Singapore and many other countries also run them.

Most hospital infections can be prevented.
Santypan/Shutterstock

Unlike most OECD countries, Australia does not have a national health care associated infection surveillance program and does not undertake national point prevalence studies.

The only national data routinely collected relates to bloodstream infections caused by the microorganism Staphylococcus aureus. These infections are serious but rare and only represent a tiny fraction of all infections in hospitals.

---

Read more:
Golden staph: the deadly bug that wreaks havoc in hospitals

---

To improve our understanding of health care associated infections across Australia, we used the same study method as the Europeans. Over a four month period in 2018, we visited 19 large hospitals across Australia and collected information on all infections in adult acute inpatients. Four of the hospitals were regional, the others major city hospitals.

What infections did we find?

Of the 2,767 patients we surveyed, we found 363 infections in 273 patients, meaning some patients had more than one infection. The most common infections were wound infections after surgery (surgical site infections), pneumonia and urinary tract infections. These accounted for 64% of all the infections we found.

This is important as most hospitals do not normally look for pneumonia or urinary tract infections and there is no routine statewide or national surveillance for these.

Our findings mean these infections are commonly occurring but undetected. A potential source of information on these types of infections is hospital administrative coding data. However, these codes were mainly designed for billing purposes and have been shown to be unreliable when it comes to identifying infections.

---

Read more:
We know _why_ bacteria become resistant to antibiotics, but _how_ does this actually happen?

---

We also found patients with a medical device, such as a large intravenous drip, or urinary catheter (a flexible tube inserted into the bladder to empty it of urine), were more likely to have an infection than those who did not.

Intensive care units treat patients who are gravely unwell and at greater risk of infection. So it was unsurprising to find that 25% of patients in intensive care units had a health care associated infection.

The emergence of multi-drug resistant organisms (superbugs) is a concern worldwide. Previously unknown, our study revealed that 10% of the adult acute inpatients in our study had a multi-drug resistant organism.

What have other studies found?

For the first time in 34 years we have a glimpse of how common health care associated infections are in Australian hospitals. Although the only other previous study was larger, a major strength of our study is that we used the same two trained data collectors to collect the data from all hospitals.

This reduced the potential inconsistency in finding infections that might occur if hospital staff collected their own data. It also minimised the use of hospital resources to undertake the survey.

Importantly though, we did not survey all types of hospitals. It is possible that if the same survey was extended to include children, babies and cancer hospitals, higher rates of infection may be found given the vulnerability of these patients.

What can we do better?

As one of the authors has previously noted, a major gap in Australia’s effort to combat health care associated infections, and the emergence of multi-drug resistance organisms, is the lack of robust national data.

This means we cannot measure the effect of national policy or guidelines despite significant investment.

In the absence of a national surveillance program, we recommend that large-scale point prevalence surveys, including smaller hospitals, specialist hospitals and the private sector be undertaken regularly. Data generated from these studies could then be used to inform and drive national infection prevention initiatives.

Philip Russo, Associate Professor, Director Cabrini Monash University Department of Nursing Research, Monash University and Brett Mitchell, Professor of Nursing, University of Newcastle

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Are private patients in public hospitals a problem?

A new report has claimed public patients are worse off with increased numbers of private patients in public hospitals.
from http://www.shutterstock.com.au

Peter Sivey, RMIT University and Terence Cheng, University of Adelaide

Recently, hospital and aged care provider Catholic Health Australia (CHA) released a report sounding an alarm bell at recent increases in the number of patients in public hospitals being urged to “go private”.

Public hospitals may encourage their patients to “go private” because it allows them to bill the patient’s health insurance and Medicare for costs incurred, rather than having to dip into their own limited budgets. Patients may be persuaded to use their private health insurance after being assured by the public hospital of no out-of-pocket costs, or being promised added extras such as a private room.

The report argued this trend may harm the private hospital sector by affecting profitability and investment decisions. It may also harm the interests of public patients if public hospitals discriminate in favour of treating private patients.

While aspects of these concerns may be valid, there may also be some benefits to public hospitals treating more private patients.

A look at the figures

The report is correct that the numbers of private patients in public hospitals are increasing, at an average of 10.5% per year since 2011-12. Public patients in public hospitals and private patients in private hospitals have also been increasing, but at slower rates of only 2.7% and 4.5% per year respectively since 2011-12.

But percentage rates of change can be misleading. In raw numbers, the increase in public patients in public hospitals (527,467) and private patients in private hospitals (576,135) has actually outstripped the raw increase in private patients in public hospitals (287,473). This is because public patient numbers are increasing from a much larger base (over five million) than private patients in public hospitals (less than one million).

Concerns with this trend

The CHA report notes several concerns with the trend of increasing private patients in public hospitals. They note anecdotal evidence of public patients being pressured to “go private” with incentives including drinks vouchers, better food options and free parking. While these reports may seem concerning, it’s hard to base any change of policy on anecdotal reports.

More worrying is the suggestion that publicly-admitted patients in public hospitals are being discriminated against, for example by being made to wait longer for treatment. The CHA report cites data from an Australian Institute of Health and Welfare report, which shows waiting times on public hospital waiting lists for public patients (at 42 days) was more than twice that of private patients in public hospitals (20 days).

But this difference is hard to interpret. There may be many differences in diagnosis and disease severity between public and private patients, which may explain the waiting time gap. So we can’t conclude this is evidence of any form of “discrimination” against patients without private health insurance in the public hospital system from these figures.

More robust evidence from public hospitals in NSW in 2004-05 does show private patients were prioritised over public patients. In this study, waiting times for elective surgery were found to be considerably shorter for private patients, despite having similar clinical needs as public patients.

Differences in waiting times between public and private patients were found to be largest for patients assigned to the lowest two urgency levels. In these cases, waiting times for public patients were more than twice as long as for private patients.

There is further evidence, also from NSW public hospitals, that public and private patients may be treated differently when they are assigned to an urgency category for waiting lists for elective surgery. The study suggested private patients were more likely to be assigned into more urgent admission categories, which corresponds with a shorter maximum wait for admission into hospital.

This study also found private patients were likely to receive more medical procedures while in hospital, but found no difference for length of hospital stay or, importantly, for mortality rates.

Potential benefits

One claim of the CHA report is that there has been relatively “stagnant” growth of activity of private patients in private hospitals, potentially affecting their profitability and investment decisions.

First, the figures don’t seem to back this up. The increase in numbers of private patients in private hospitals is actually higher than the increase in numbers of private patients in public hospitals.

Second, even if private hospitals were losing business to public hospitals, it could be a welcome demonstration of competition in the health care market. The trend may be explained through public hospitals providing better amenities, higher quality, or lower costs than private hospitals.

There are some arguments to support continuing the practice of public hospitals admitting private patients. There can be efficiency gains to the health system given that the fees and charges for private patients in public hospitals are usually lower than those in private hospitals. So this form of competition could lower the costs in the health system as a whole.

Additional revenue raised by public hospitals could also support the continual provision of services and programs for public patients, which may have been curtailed due to budget cuts to the public hospital system.

The public hospital system is often seen as unfairly treated by the private sector in how it bears costs for training junior doctors (which takes place overwhelmingly in the public system), and treating the most severely ill patients. From this perspective, it seems only fair to allow public hospitals to take their “share” of the more profitable private patients.

Why we need better data

It’s important to figure out whether private patients are receiving preferential treatment at the expense of public patients. One study found abolishing preferential access for private patients and admitting patients according to when they were listed for an elective procedure would only lead to a small improvement in waiting times for public patients.

This is because long waiting times for public patients are primarily due to budget constraints in public hospitals, and not because private patients are skipping the queue.

The available robust evidence on the treatment of private patients in public hospitals is from more than a decade ago, and it’s unclear if the disparities between how public and private patients are treated have improved or worsened.

One reason for the lack of high quality research on this topic is the restriction on access to detailed hospital data in Australia, which we need for robust studies. If we had access to more detailed data, we could better understand what’s happening now, and ensure timely access to high quality hospital care for both public and private patients.

Peter Sivey, Associate Professor, School of Economics, Finance and Marketing, RMIT University and Terence Cheng, Senior Lecturer, School of Economics, University of Adelaide

This article was originally published on The Conversation. Read the original article.

Paris Jackson in Hospital after Suicide Attempt

Pakistan: Arrests Made for Shooting of 14-Year-Old Blogger

In recent days the world has been shocked yet again by Taliban thugs who shot a 14-year-old girl in the head because of her blogging posts which were critical of the Taliban and promoted the education of females. It would seem the Taliban were intent on proving the girl correct by their cowardly actions. There have now been some arrests over the shooting, while 14-year-old Malala Yousafzai fights for her life in hospital.

For more visit:
http://global.christianpost.com/news/arrests-made-in-taliban-ordered-shooting-of-14-year-old-activist-83164/

Latest Persecution News – 13 March 2012

Islamists in Egypt Use Rumors to Attack Christians

The following article reports on rioting Muslims attacking Christians in Meet Bahsar, Egypt.

http://www.compassdirect.org/english/country/egypt/article_1433598.html

 

Egyptian Court Sentences Priest from Attacked Church Building

The following article reports on the arrest and jailing of an Egyptian priest in Aswan, Egypt, over a building violation. The arrest occurred after the burning of his church by an Islamic mob.

http://www.compassdirect.org/english/country/egypt/article_1436277.html

 

Two Christian Hospital Workers Abducted in Karachi, Pakistan

The following article reports on the abduction of two Good Samaritan Hospital staff who are Christians in Karachi, Pakistan.

http://www.compassdirect.org/english/country/pakistan/article_1436466.html

 

Another Church in Jos, Nigeria Hit by Suicide Bombing

The following article reports on yet another suicide bombing of a church in Jos, Nigeria, by extremists linked to Boko Haram.

http://www.compassdirect.org/english/country/nigeria/article_1440491.html

 

The articles linked to above are by Compass Direct News and  relate to persecution of Christians around the world. Please keep in mind that the definition of ‘Christian’ used by Compass Direct News is inclusive of some that would not be included in a definition of Christian that I would use or would be used by other Reformed Christians. The articles do however present an indication of persecution being faced by Christians around the world.