Dimensions in health service最新文献

There are only two ways to prevent infection: behaviour modification and technology. Infection control measures, including Universal Precautions, must be directed at these two areas if we are to provide the safest possible environment for patients and personnel. Administrators must make every effort to provide devices and systems that will promote and enhance a safer workplace. Personnel, on the other hand, are charged with altering their behaviours to utilize safe devices and practices. Finally, infection control personnel must make every effort to activate and sustain new behaviours in health care personnel and promote the design and use of new and safer devices at every opportunity.

There does not appear to be clear-cut evidence that reuse of catheters causes an increase in the incidence of side effects like infections. However, there is concern in the field that current cleaning and sterilizing techniques do not guarantee a safe product for reuse. If reuse is to occur, there must be written guidelines and procedures for cleaning/sterilizing, and appropriate documentation of these processes whenever they occur. The CCOHTA report focuses on the issues mentioned above. Three major studies concluded that, with rigorous cleaning and sterilizing, patients are not subjected to an increased risk of infection. However, the authors stated that further work needs to be done in this area before conclusive evidence can be presented. What is needed is a well-designed clinical trial; standardized guidelines and protocols for cleaning and sterilizing; criteria for determining numbers of reuses; and complete cost-benefit analyses.

There are four issues facing provincial GPO's, independent GPO's, health care organizations and vendors: co-operation; commitment; compliance; and competition. Co-operation: Hospitals have traditionally competed with each other for scarce resources and, as a result, have managed their operations in isolation. However, group purchasing provides hospitals willing to work together with an opportunity to significantly increase their purchasing power with vendors, thereby substantially reducing costs. Commitment: The success of GPO's depends on the commitment to contracts by the members. The American experience indicates that commitment of smaller, more focused organizations is easier to control and maintain. Some provincial GPO's have difficulties ensuring commitment from members; therefore, they have not achieved their full potential. Compliance: Hospital compliance with committed volumes negotiated in the corporate contract is essential to ensuring the continued strength of the group's purchasing power. GPO's require mechanisms for ensuring compliance. Smaller GPO's with a common vision and a mutual understanding of the benefits to be realized from compliance will be more successful. Competition: Independent, national GPO's, like Medbuy, may be perceived to pose a threat to provincial GPO's. However, this competition should be viewed positively because it encourages all GPO's to work harder to provide higher quality services that will ultimately benefit the hospital membership. The group purchasing concept is valuable to provide reduced costs to groups through higher volume purchases. Canadian GPO's are evolving and now offer Canadians provincial, interprovincial and independent GPO alternatives. Health care organizations must study these options and decide which alternative would be most beneficial for their particular situation.(ABSTRACT TRUNCATED AT 250 WORDS)