Category: Hospitals

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South Africa’s Palliative Care Standards Earn Global Recognition

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Photo by Pexels on Pixabay

The 5th edition of the Standards for Palliative Healthcare Services has achieved a major milestone: it has secured accreditation from the International Society for Quality in Health Care’s External Evaluation Association (IEEA).

This international endorsement reaffirms the commitment of the Association of Palliative Care Centres (APCC) to deliver world-class palliative care.

As the only internationally accredited framework guiding palliative care institutions in South Africa, these Standards play a crucial role in ensuring quality, safety, and compassionate service delivery. Developed through a long-standing partnership between the Association of Palliative Care Centres (APCC) and COHSASA, the Standards have been shaping palliative care excellence since 2005.

The 5th edition—available for free at APCC’s website—features:

 ✔A refined presentation structure for easier navigation

 ✔Removal of outdated or duplicated criteria to streamline compliance

✔Changes in terms of new legislation, particularly as it relates to the POPI act

✔ New essential elements to enhance care quality

Why accreditation matters

According to Warren Oxford-Huggett, National Accreditation Manager for the APCC, earning accreditation requires time, energy and commitment, but the rewards are far-reaching.

He highlights three key benefits:

·       Optimal Community Engagement – Accredited palliative service providers gain increased community trust and support, strengthening relationships between institutions, families, and caregivers. “From a patient perspective, knowing that the organisation that is providing care is accredited puts your mind at ease.” 

·       Better Organisational Performance – Self assessments and internal peer reviews drive higher efficiency, sustainability, credibility and overall service quality. It revolves around the framework that COHSASA sets up.

·       A Culture of Excellence – Accreditation fosters a mindset of continuous improvement, embedding best practices within healthcare teams.

Oxford-Huggett also has a role to encourage more palliative care organisations to join APCC’s current 68-member network, particularly as demand grows for structured palliative care in elderly care facilities. Of the five latest institutions that are currently in the process of joining the APCC, four of them are facilities for the aged.

“The market for new APCC members is increasingly swinging to more aged care facilities. What that will mean in terms of cost of care remains to be seen”, says Oxford-Huggett. “Many elderly care institutions advertise or market palliative care, but seldom is anyone adequately trained. It’s early days but we are looking at developing a collaborative model to help these frail care facilities implement structured, high-quality care at an affordable cost. With rising living expenses and an aging population, we must ensure end-of-life care remains accessible without imposing financial strain.”

Mentorship for success

To assist APCC members in meeting these high standards, APCC offers a structured mentorship programme, led by Oxford-Huggett. This initiative guides members through the compliance process, preparing them for COHSASA’s external review and international accreditation.

APCC member, Helderberg Hospice, based in Somerset West, has just achieved their 6th accreditation, with their first accreditation achieved in May 2006.  Robert de Wet, the CEO of Helderberg Hospice comments: “In addition to focusing on clinical compliance, the accreditation process assesses criteria across the entire organisation, including areas relating to governance, fundraising, administration, and human resources. Subjecting your organisation to an intensive external accreditation process is important as it serves to both affirm the positive aspects of the work we do and simultaneously makes us aware of areas in which we require more focus.” They achieved a 97% score.

Setting the Standard for Palliative Care

Since 2005, 95 APCC members have undergone COHSASA accreditation, with 117 accreditation decisions issued—ranging from full accreditation to graded recognition.

Palliative care focuses on improving quality of life for patients with serious illnesses such as cancer, HIV/AIDS and TB as well as conditions such as COPD, heart and organ failure.  The APCC philosophy of palliative care is the activeholistic care of patients who have received a life-threatening diagnosis. The control of pain, of other symptoms and support for psychosocial and spiritual needs is paramount.

APCC members report that around 90% of palliative care efforts take place in patients’ homes, extending support to loved ones, from diagnosis to after bereavement.

Jacqui Stewart, CEO of COHSASA, affirms:“The international accreditation of this 5th edition confirms that the APCC standards align with global best practices. For over 20 years, the APCC and COHSASA have collaborated to ensure that South Africa’s palliative care remains internationally recognised. COHSASA is committed to driving ongoing improvements in palliative care services.”

The 5th Edition of the Standards for Palliative Healthcare Services is available free of charge from the APCC website: https://apcc.org.za/standards-for-palliative-healthcare-services/

For mentorship details, contact warren@apcc.org.za.

For membership details, visit: Become a Member.

Categories : General Interest HospitalsTags :

My Five-hour Wait for Treatment at Mamelodi Hospital

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Gauteng Health MEC has said Mamelodi Regional Hospital meets National Health Insurance standards, but my experience was not good

The writer waited five hours for treatment for a broken wrist and head injuries at Mamelodi Regional Hospital in Tshwane. Photo: Warren Mabona.

By Warren Mabona

I waited five hours to get medical treatment at Mamelodi Regional Hospital in Tshwane, with a broken wrist and an injured head.

On 19 February 2025 at about 4pm I was walking in Mamelodi West. I was on a journalism assignment, heading to informal settlements that are prone to flooding.

The street was quiet, but I felt safe because I had walked there before. Suddenly, a car stopped in front of me, and two men got out of it and tried to rob me. I ran away and jumped into the stormwater passage, but slipped and fell, hitting my face against the concrete.

When I managed to stand up, I was dizzy and my vision was blurred. I was drenched in dirty water and my belongings — my cell phone, my wallet and my camera bag — were wet.

The men who attacked me were no longer on the street. My right wrist was swollen and painful, an injury above my eye was bleeding profusely, and my head was aching. But I was relieved that I was still alive and I still had all my belongings.

I decided not to call an ambulance, but to walk about 800 metres to Mamelodi Regional Hospital.

I went to the casualty unit, expecting that I would receive treatment quickly. At the front desk, a clerk took more than 20 minutes to fill in my file. He said the hospital’s computer system was offline and he had to fill in the file with a pen. I then went to sit at the reception area. My head was aching and I repeatedly requested headache tablets from the nurses, who gave me two tablets after 30 minutes. But my pain lingered.

The wound on my face was still bleeding and my wrist was swollen and bent. About 40 minutes after my arrival, a nurse cleaned my wound and wrapped it with a bandage, stopping the bleeding.

At about 8pm, a man sitting next to me said he had arrived at the hospital at 2pm after falling from scaffolding at a construction site. He was still waiting for his X-ray results.

I went for X-rays and long afterwards, at about 10pm, I had a cast put on my wrist. I was given injections which helped with the pain. I was discharged at 11pm and went home.

In September last year, the Gauteng MEC for Health Nomantu Nkomo-Ralehoko said that Mamelodi Regional Hospital was the first hospital in Gauteng ready to meet National Health Insurance (NHI) standards.

In response to GroundUp’s questions, Gauteng Department of Health spokesperson Motalatale Modiba said a triage priority system is followed at the hospital, meaning that four patients with critical wounds that required life-saving emergencies were attended to first. He said this affected my waiting time for wound care and the application of a cast.

“You were classified as Orange P2, that is a person who is in a stable condition and is not in any immediate danger, but requires observation,” said Modiba.

“At the time of your arrival, the casualty unit had 31 other patients to be seen. These include four critical cases in the resuscitation unit, ten trauma cases, 16 medical cases and four pediatric cases,” he said.

Modiba confirmed that the hospital’s computer system was offline when I arrived.

I asked Modiba whether the Gauteng Department of Health can still confidently regard this hospital as NHI-ready despite the slow delivery of medical services I experienced. Modiba said: “Mamelodi Regional Hospital remains committed to provide best healthcare services.”

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Read the original article.

Categories : HospitalsTags :

Substituting NHS Doctors with Physician Associates is not Necessarily Safe

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Source: Pixabay CC0

Researchers say they can find no convincing evidence that physician associates add value in UK primary care or that anaesthetic associates add value in anaesthetics, and some evidence suggested that they do not.

In a special paper published by The BMJ, Professors Trisha Greenhalgh and Martin McKee say the absence of safety incidents in a handful of small studies “should not be taken as evidence that deployment of physician associates and anaesthetic associates is safe.”

New research is urgently needed “to explore staff concerns, examine safety incidents, and inform a national scope of practice for these relatively new and contested staff roles,” they add.

Physician associates and anaesthetic associates are being introduced in the UK to work alongside doctors and nurses. They are graduates – usually with a health or life sciences degree – who complete two years of extra training, but there has been much debate about the effectiveness and safety of these new roles.

As a result, the UK government has commissioned an independent review into the scope and safety of these roles in the NHS and their place in providing care to patients.

To inform this review, the researchers trawled three electronic research databases (PubMed, CINAHL, Cochrane Library) for any studies of physician associates and anaesthetic associates in UK healthcare published between 2015 and January 2025.

In all, 52 papers were eligible (48 on physician associates, 4 on anaesthetic associates), of which 29 (all from England) met their inclusion criteria of trustworthiness, generalisability, and relevance to current UK policy.

They found that the total number of physician associates studied was very small, especially in primary care, and no studies reported direct assessment of anaesthetic associates.

Only one study, of four physician associates, involved any assessment by a doctor of their clinical competence by direct observation, and no studies examined safety incidents.

Some studies among the 29 suggested that physician associates could support the work of ward based teams and work in emergency departments when appropriately deployed and supervised in low risk clinical settings, but the number of individuals and settings studied was small, so these findings should be considered preliminary.

However, studies reported that physician associates seemed to struggle in primary care because the role was more autonomous, the case mix was more diverse, decisions were more uncertain, institutional support was more limited, and supervision arrangements were more challenging.

Patients’ views of physician associates were mostly positive or neutral, whereas staff expressed concern about physician associates’ and anaesthetic associates’ competence to manage undifferentiated, clinically complex, or high dependency patients; order scans; or prescribe. Physician associates reported a range of experiences and desired a clear role within the team.

Overall, the researchers found no evidence that physician associates add value in primary care or that anaesthetic associates add value in anaesthetics and some evidence suggested that they do not.

They acknowledge some limitations, such as not including evidence on similar roles in other countries, and stress that their findings should be interpreted in the context of the wider international evidence base. But say their focus on UK based research, detailed search and analysis of the most influential papers, and identification of gaps in existing research, provide robust conclusions to help inform this policy review.

“Very few UK studies have assessed the clinical competence and safety of physician associates or anaesthetic associates,” they write. “Findings of apparent non-inferiority in non-randomised studies may obscure important unmeasured differences in quality of care.”

In a linked editorial, Professor Kieran Walshe at the University of Manchester, asks how did the NHS end up in this mess, and what should we do about it?

He points to massive underinvestment in research on the healthcare workforce, ambiguous and largely uncosted future plans for workforce expansion, and statutory arrangements for regulating the health professions that are not fit for purpose.

“It seems likely that a messy compromise will be found to resolve the debacle over physician associates and anaesthetic associates,” he writes. But says “we need to do these kinds of workforce reforms much better in the future—both for the safety of patients and for the wellbeing of staff.”

Source: The BMJ

Categories : HospitalsTags :

Six out of Ten People Globally Lack Access to Medical Oxygen

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Photo by Samuel Ramos on Unsplash

Six out of every ten people globally lack access to safe medical oxygen, resulting in hundreds of thousands of preventable deaths each year and reducing quality of life for millions more, an international report co-authored by the University of Auckland has found.

Associate Professor Stephen Howie from the University’s Faculty of Medical and Health Sciences (FMHS) was an adviser to the Lancet Global Health Commission on Medical Oxygen Security and co-author of its report Reducing global inequities in medical oxygen access released 18 February.

A key finding shows global access to medical oxygen is highly inequitable. Five billion people, mostly from low and middle-income countries don’t have access to safe, quality, affordable medical oxygen.

Associate Professor Howie, child health researcher and a specialist paediatrician says he hopes further lives will be saved because of this work, and that children and adults will not only survive but thrive.

The Auckland University team are leading the field to improve access to medical oxygen. Howie recently gave a plenary address  at the World Lung Health Conference in Bali, spelling out the challenges and opportunities to tackle the global issue.

“I have been working in the area of oxygen treatment for oxygen-starved (hypoxic) illnesses for two decades, particularly in Africa and the Pacific. My first priority was children (naturally, as a paediatrician) but we learnt soon enough that solving the problem has to involve catering for all ages.

“It is such an obvious need. I saw it at the hospitals I worked at in Africa where needless death from diseases like pneumonia happened because oxygen supplies were short, and this hit families and staff very hard. It was at that time that we made it our goal that ‘no child should die for lack of oxygen’ and this applies to adults too.” 

Fiji was particularly hard hit when the first waves of the COVID-19 pandemic arrived, at one point it had the highest rate of COVID-19 in the world. A close partnership between the Fiji Ministry of Health, the University of Auckland, Cure Kids and Fiji National University, funded by New Zealand MFAT and other donors, played an important role in supporting the pandemic response says Howie. 

I saw it at the hospitals I worked at in Africa where needless death from diseases like pneumonia happened because oxygen supplies were short, and this hit families and staff very hard. It was at that time that we made it our goal that ‘no child should die for lack of oxygen’ and this applies to adults too.

Associate Professor Stephen Howie Waipapa Taumata Rau, University of Auckland, Faculty of Medicine and Health Sciences

Dr Sainimere Boladuadua is Lancet Commission’s Western Pacific Region ambassador 

On the ground during that time was Dr Sainimere Boladuadua, a public health medicine specialist, now a doctoral student at the University of Auckland and currently undertaking a Fulbright fellowship at Johns Hopkins University in Baltimore. 

Boladuadua (Somosomo, Cakaudrove, vasu i Levuka-i-Yale, Kadavu/Fiji) also has the honour of being the Lancet Commission’s Western Pacific Region ambassador and will spearhead advocacy for improving access to medical oxygen in the region. 

“I remember those days, the adrenalin was pumping and it was scary. It was very difficult before the vaccine arrived. We had very little sleep trying to get everything set up,” she says recalling the period of the country organising itself and the national response which included setting up field hospitals. 

Boladuadua met Howie in Fiji where he helped to lead the Fiji Oxygen Project, supporting the vital work of health leaders like Dr Luke Nasedra and Dr Eric Rafai. 

“The project was just doing exactly this, trying to improve and ensure that all the health facilities had access to medical oxygen, facilities to deliver them. That no child or adult should die for lack of oxygen, and it’s such a simple medical therapy that you expect to be available but often it isn’t, says Boladuadua. 

“The reality was rural health facilities sometimes had to ration the oxygen. You have a limited supply, the cylinders that come in every month you have your quota, and if you run out then sometimes you have to prioritize who gets it, who doesn’t. Which is just so heartbreaking.” 

The Fiji Ministry of Health, supported by the project, was in the midst of covering those gaps when COVID hit, and Boladuadua says the one silver lining was that it shone a light on the gaps, putting the issue on the radar. 

“You saw the images around the world, hospitals running out of oxygen in India, family members hauling oxygen cylinders on motorcycles. I guess that made it really come up to the forefront.” 

This was the entry point for Boladudua to start work on her doctoral studies at the University with Howie as her primary academic supervisor, and unsurprisingly her PhD has a focus closely related to her previous work. 

“My research question is how to improve access to care for children with acute respiratory infections in Fiji and obviously links to the supply of oxygen as well.” 

She says respiratory conditions are rising and pneumonia is still one of the leading causes of death and disease particularly in under five year-olds across the Pacific and even in New Zealand. 

“Within New Zealand, our Pacific children experience a larger acute respiratory burden than children of any other ethnic group.” 

Boladuadua says she’s grateful to Professor Cameron Grant, Head of Paediatrics, Child & Youth Health at FMHS who encouraged her to apply for the Fulbright Scholarship. As well as support from her friends, doctoral candidates Alehandrea Manuel (who has since completed her PhD) and Ashlea Gillon. 

“Professor Grant was a Fulbright scholar 30 years ago and he said it would be life changing, and it has been in so many ways,” she says of working closely with the team at Johns Hopkins and the opportunities presented such as the lecture she’s been asked to present next month at the School of Public Health: ‘Decolonising Global Health – a Pacific perspective’.

“What appealed to me was they had a Centre for Indigenous Health that worked very closely with Native American communities. And although Johns Hopkins is in Baltimore, their work is very much within the communities themselves, in the tribal lands of the Navajo and White Mountain Apache peoples in the Southwest of the US. 

“They’ve got sites in all these communities and the staff – data collectors, researchers, the research nurses and everyone in those teams, the majority are Native American. So it’s about responding to their health needs and also building local capacity.” 

Learning how the Indian Health System has accommodated traditional medicine has inspired Boladuadua and she’s brimming with ideas that she’s eager to bring back to Aotearoa later this year when she returns. 

“I wanted to see how you can use traditional knowledge and practices with western knowledge, I wanted to learn how that happened. They’re just doing it so beautifully here. I am learning so much and it has been life changing with all the different perspectives, exposure and the incredible people I’m able to work with.”  

Source: University of Auckland

Categories : HospitalsTags :

New Study Reveals the Burden of Critical Illness in African Hospitals

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One in eight patients in hospitals in Africa is critically ill, and one in five of the critically ill die within a week, according to a new study in The Lancet. The researchers behind the largest study of critical illness in Africa to date conclude that many of these lives could have been saved with access to cheap life-saving treatments.

The study is the first large-scale mapping of critically ill patients in Africa. Nearly 20 000 patients in 180 hospitals in 22 African countries were surveyed in the study.

Being critically ill means having severely affected vital functions, such as extremely low blood pressure or low levels of oxygen in the blood. In the new study, researchers show that one in eight patients in African hospitals, 12.5%, is in this condition. Of these, one in five, 21%, die within a week, compared to 2.7% of those who are not critically ill.

A large proportion of critically ill patients, 69%, are treated in general wards rather than intensive care units. More than half of critically ill patients, 56%, do not receive even the basic critical care they need, such as oxygen therapy, intravenous fluids or simple airway management.

“Our study shows that there is a large and often neglected group of patients with critical illness in Africa,” says first author Tim Baker, Associate Professor at the Department of Global Public Health at Karolinska Institutet.

The researchers behind the study emphasise that these are basic but crucial health interventions that can make a big difference.

“If all patients had access to essential emergency and critical care, we could significantly reduce mortality. Moreover, these interventions are inexpensive and can be provided in general wards,” says Carl Otto Schell, researcher at the Department of Global Public Health at Karolinska Institutet and one of the initiators of the study.

Source: EurekAlert!

Categories : Hospitals Mental HealthTags :

Simple Ways to Improve the Wellbeing of Paediatric Critical Care Staff

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Photo by RDNE Stock project

Paediatric critical care (PCC) staff are known to experience high levels of moral distress, symptoms of post-traumatic stress disorder (PTSD) and burnout, but often feel little is offered to help them with their mental health. The SWell team at Aston University, led by Professor Rachel Shaw from the Institute of Health and Neurodevelopment, realised following a literature review that there are no existing, evidence-based interventions specifically designed to improve PCC staff wellbeing. Initial work by SWell identified the ‘active ingredients’ likely to create successful intervention designs.

Together with a team from NHS England, the Aston University researchers set up the SWell Collaborative Project: Interventions for Staff Wellbeing in Paediatric Critical Care, in PCC units across England and Scotland. The aim of the project was to determine the feasibility and acceptability of implementing wellbeing interventions for staff working in PCC in UK hospitals. In total, 14 of the 28 UK PCC units were involved. One hundred and four intervention sessions were run, attended by 573 individuals.

Professor Shaw said: “The significance of healthcare staff wellbeing was brought to the surface during the COVID-19 pandemic, but it’s a problem that has existed far longer than that. As far as we could see researchers had focused on measuring the extent of the problem rather than coming up with possible solutions. The SWell project was initiated to understand the challenges to wellbeing when working in paediatric critical care, to determine what staff in that high-pressure environment need, and what could actually work day-to-day to make a difference. Seeing PCC staff across half the paediatric critical care units in the UK show such enthusiasm and commitment to make the SWell interventions a success has been one of the proudest experiences in my academic career to date.”

The two wellbeing sessions tested are low-resource and low-intensity, and can be delivered by staff for staff without any specialist qualifications.

In the session ‘Wellbeing Images’, a small group of staff is shown images representing wellbeing, with a facilitated discussion using appreciative inquiry – a way of structuring discussions to create positive change in a system or situation by focusing on what works well, rather than what is wrong.

In the ‘Mad-Sad-Glad’ session, another small group reflective session, participants explore what makes them feel mad, sad and glad, and identify positive actions to resolve any issues raised.

The key ingredients in both sessions are social support – providing a psychologically safe space where staff can share their sensitive experiences and emotions without judgement, providing support for each other; self-belief – boosting staff’s self-confidence and ability to identify and express their emotions in response to work; and feedback and monitoring – encouraging staff to monitor what increases their stress, when they experience challenging emotions, and what might help boost their wellbeing in those scenarios.

Feedback from staff both running and participating in the SWell interventions was very positive, with high satisfaction and feasibility ratings. Participants like that the session facilitated open and honest discussions, provided opportunities to connect with colleagues and offered opportunities for generating solutions and support.

One hospital staff member responsible for delivering the sessions said:

“Our staff engaged really well, and it created a buzz around the unit with members of the team asking if they could be ‘swelled’ on shift. A really positive experience and we are keeping it as part of our staff wellbeing package.”

The team concluded that even on busy PCC units, it is feasible to deliver SWell sessions. In addition, following the sessions, staff wellbeing and depression scores improved, indicating their likely positive impact on staff. Further evaluations are needed to determine whether positive changes can be sustained over time following the SWell sessions.

Donna Austin, an advanced critical care practitioner at University Hospital Southampton paediatric intensive care unit, said: “We were relatively new to implementing wellbeing initiatives, but we recognised the need for measures to be put in place for an improvement in staff wellbeing, as staff had described burnout, stress and poor mood. SWell has enabled our unit to become more acutely aware of the needs of the workforce and adapt what we deliver to suit the needs of the staff where possible. Staff morale and retention has been the greatest outcomes from us participating in the SWell study and ongoing SWell related interventions.”

Read the paper about the SWell interventions in the journal Nursing in Critical Care.

Source: Aston University

Categories : Hospitals Respiratory DiseasesTags :

Global Action Needed to Solve the Medical Oxygen Crisis

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Photo by engin akyurt on Unsplash

Targets for universal access, national roadmaps and more affordable and accessible care are vital to help fill the medical oxygen gap affecting more than half of the world’s population, according to a new global report.

The Lancet Global Health Commission report details for the first time how future investment in strengthening medical oxygen systems could have a huge impact by saving millions of lives and improving pandemic preparedness.

Almost 400 million children and adults require medical oxygen every year. More than five billion people, 60 per cent of the world’s population, don’t have access to safe and affordable medical oxygen services.

The Commission, co-chaired by Makerere University in Uganda, the International Centre for Diarrheal Disease Research (icddr,b) in Bangladesh, Murdoch Children’s Research Institute (MCRI) in Australia, Karolinska Institute in Sweden and the Every Breath Counts Coalition in the US was launched in 2022 against the backdrop of the COVID-19 pandemic. The Commission was tasked with submitting actionable recommendations for governments, industry, global health agencies, donors and the healthcare workforce.

MCRI Dr Hamish Graham said the COVID-19 pandemic had put a spotlight on the longstanding global inequities in accessing medical oxygen.

“Oxygen is required at every level of the healthcare system for children and adults with a wide range of acute and chronic conditions,” he said. Previous efforts, including the major investments in response to the COVID-19 pandemic, largely focused on the delivery of equipment to produce more oxygen, neglecting the supporting systems and people required to ensure it was distributed, maintained, and used safely and effectively.”

Dr Graham said channelling investments into national oxygen plans and bolstering health systems, including wider use of pulse oximeters (a small device that measures how much oxygen is in the blood), would help solve the medical oxygen crisis.

“We urgently need to make high-quality, pulse oximeters more affordable and widely accessible,” he said. Pulse oximeters are available in 54 per cent of general and 83 per cent of tertiary hospitals in low- and middle-income countries, with frequent shortages and equipment breakdowns.

“Concerningly, in these countries the devices are performed for only 20 per cent of patients presenting to general hospitals and almost never for those at primary healthcare facilities. We see the greatest inequities in small and rural government health facilities and across Sub-Saharan Africa.”

Dr Graham said the importance of medical oxygen must also be recognised and integrated into broader national strategies and pandemic preparedness and response planning.

“Governments should bring together public and private sector partners with a stake in medical oxygen delivery, including health, education, industry, energy and transport to design a system and set up a governance structure that supports the new Global Oxygen Alliance (GO₂AL) and replenishing The Global Fund with a strong oxygen access mandate,” he said.

Source: Murdoch Childrens Research Institute

Categories : HospitalsTags :

Ventilation in Hospitals could Actually Spread Viruses Further

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Photo by Pixabay: https://www.pexels.com/photo/view-of-operating-room-247786/

Increased use of ventilation and air cleaners, designed to mitigate the spread of viral infections in hospitals, is likely to have unpredictable effects and may cause viral particles to move around more, according to a new study from researchers at UCL and UCLH.

In the study, published in Aerosol Science & Technology, researchers investigated the effect of using built-in mechanical ventilation and portable air cleaners (PACs)1 upon the spread of airborne particles, which are similar to those breathed out by a person with a viral respiratory infection such as SARS-CoV-2 or influenza.

The team tracked the movement of airborne particles around a typical hospital outpatients’ clinic at UCLH in central London using an aerosol generator and particle counters2. A variety of scenarios were simulated, including particle movement to a neighbouring room, throughout the whole clinic, and from one room to another room at the far side of the clinic.

They also tested whether factors such as closing doors, or the position of ventilation and PACs within a room, had an effect on the spread of particles.

The researchers found that while use of built-in ventilation and PACs can reduce particle spread in some scenarios, in some experiments the use of PACs increased aerosol spread by up to 29% between neighbouring rooms. Built-in ventilation potentially increased aerosol migration across the clinic by up to 5.5 times more than if no ventilation was used.

Professor Laurence Lovat, senior author of the study from UCL Surgery & Interventional Science and UCLH, said: “The COVID-19 pandemic really highlighted the risk of picking up airborne viral infections in hospitals, which naturally led to efforts to reduce this risk. In many hospitals, the use of ventilation systems and portable air cleaners has increased.

“While the urgency of the situation demanded a rapid response, since then we’ve been studying precisely how viral particles move around in real spaces and have been surprised by what we’ve found.

“Putting air cleaners in rooms led to unexpected increases in the circulation of aerosols in some cases, but it took months to understand what we were seeing. Each scenario produced different, unexpected results, depending on the spaces and airflow sources involved.

“Even at UCLH, a modern hospital built less than 20 years ago, airflow patterns were not predictable. In older hospitals, which often have natural draughts, the situation would likely be even more complex.”

Clinic airflow

The study concluded that using airflow devices in hospitals to try to limit the movement of airborne pathogens requires careful consideration of airflow dynamics and device placement to reduce the risk of exacerbating the problem.

The clinic where the experiments took place consisted of a large central waiting room (154 m3,split into A and B for the purpose of the study), eight surrounding consulting rooms and a nurses’ station (all approximately 35 m3). The clinic was connected via a permanently open passageway to a corridor leading to the rest of the hospital. Experiments took place at night and weekends when no staff or patients were present.

A number of experiments were conducted by placing aerosol generators dispersing saline solution in certain rooms, with particle detectors sited in other rooms to track the movement of particles around the clinic.

In one experiment, the researchers simulated particle spread from a medical professional or patient in one consulting room to a neighbouring room. A baseline measurement was taken in the consulting room with the aerosol source when all doors were open and no ventilation or PACs were in use.

Closing the room door that contained the source was found to reduce particle spread significantly and closing both room doors reduced it by 97%.

But when doors were opened and large PACs in the adjacent waiting room were turned on, the spread to the neighbouring consulting room increased by 29%. When small desktop PACs were added to both consulting rooms and the nurses’ station, the spread was lower than the baseline, but only slightly.

Dr Jacob Salmonsmith, first author of the study and an Honorary Research Fellow from UCL Mechanical Engineering, said: “The results of this experiment might seem counterintuitive if you take the view that changing the air in a room more often reduces the spread of viral particles.

“While it’s true that air cleaners do remove viral particles from the air and can reduce overall spread, they can also have unintended consequences. In particular, this experiment suggests that larger air cleaners, which have larger exhaust vents that introduce their own air currents, can cause particles that haven’t been filtered out to spread further than they would have if the cleaner wasn’t there.

“In any given space you have complex interactions between many different air currents, such as ventilation, doors closing and people’s movement. Our findings indicate that the whole picture needs to be considered when choosing when and where to introduce air cleaners.”

In another experiment, the team observed highly complex patterns of particle spread when all consulting room doors were open.

This included one scenario where the highest concentrations of particles were detected in rooms furthest away from an aerosol source situated in a consulting room where a PAC was in operation. Particle levels in the room furthest from this aerosol source were 184% higher than average, while in the room directly opposite the source they were 68% below average.

There were also 247% more particles in the waiting room furthest away from the consulting room, where a PAC was in operation, than in the waiting room right next door to it. The nurses’ station had a higher concentration of particles than any room on the same side of the clinic as the room where the aerosol generator was situated.

Professor Andrea Ducci, an author of the study from UCL Mechanical Engineering, said: “Our experiments demonstrated that high volume of particles can be corralled into particular areas as a result of airflow dynamics. This obviously isn’t ideal, particularly if that place is a key location, such as the nurses’ station that staff members who’re treating patients will likely visit often during their shift.

“The good news is that we’re rapidly expanding our knowledge of this phenomenon. The project that we are currently working on aims to simulate the entire airflow within a clinic and assess the efficacy of different devices positioned in different locations. This will allow us to identify relatively simple interventions, such as better positioning of ventilation devices to reduce the spread of particles, thus decreasing the risk of picking up an infection in hospital.”

Given the unpredictability of how aerosol particles move around spaces and the difficulty in measuring them, the team are currently building an AI system to help to do this and hope to start testing within the next 18 months.

The authors say the study holds great promise to inform governmental action on ensuring that NHS standards for ventilation and infection are fit for purpose, in line with efforts to prevent future pandemics.

1 Portable air cleaners, or purifiers, are devices that filter dust and fine particles out of the air. The devices used in this study all conformed to the HEPA standard, meaning they are designed to filter out almost all (99.7%) of the fine particles that pass through them. The PACs placed in the waiting room were large (around the size of a kitchen bin) and the ones used in smaller room were around the size of a desktop lamp.

2 The aerosol particles were created from a harmless saline solution and disbursed at a constant rate by an aerosol generator at roughly the face height of a seated person (1.2 metres). The particles were designed to mimic those breathed out by a person with an airborne respiratory infection, such as influenza.

Source: University College London

Categories : Ethics and Law HospitalsTags :

HASA Launches NHI Legal Challenge

On By ModernMedia
Photo by Bill Oxford on Unsplash

The Hospital Association of South Africa (HASA) remains unequivocally committed to working with all stakeholders to build a healthcare system that sustainably benefits all citizens of South Africa and urges all involved parties to engage in a solution-oriented approach.

HASA believes the National Health Insurance is neither sustainable nor affordable and that dialogue and collaboration between all stakeholders is critical to finding and developing solutions to achieve universal health coverage. 

HASA has thus far deferred filing a legal challenge to the NHI Act as it firmly believes that sustainable and affordable solutions, to achieve universal health coverage for all South Africans, are within reach. However, the government’s lack of response to several constructive and practical proposals, including those of Business Unity South Africa (BUSA), and the Minister of Health’s recent public statements concerning the NHI, including regarding the imminent publication of NHI regulations, have necessitated that HASA move forward with its legal challenge to the NHI legislation. 

Even though HASA has decided to proceed with legal action, it remains hopeful that the Presidency will respond positively to the constructive proposals that have been made. 

HASA remains open to engaging with the Government on the way forward in parallel to the legal process. Reiterating the time-critical nature of the matter, Melanie Da Costa, Chairperson of HASA, today said, “We remain firmly committed to participating constructively while the legal process unfolds. As an organisation, we have always preferred to resolve matters through dialogue, and we believe that effective healthcare solutions are urgently needed and achievable through a reasonable and collaborative approach.” 

Categories : HospitalsTags :

Windows in ICU Rooms Increase the Risk of Post-surgical Delirium

On By ModernMedia
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Delirium is a condition common in the post-surgical intensive care unit (ICU) setting, affecting up to 50-70% of those admitted, depending on individual risk profiles. ICU delirium can be associated with a multitude of factors including underlying and acute medical conditions, pharmacologic agents or treatment regimens like surgery. Currently there is no definitive consensus on drug interventions that aid in the prevention of delirium or its treatment.

While there has been some evidence that the ICU environment plays a role in delirium, more research is needed to understand this association. In a new study appearing in Critical Care Medicine, researchers found windowed patient rooms were associated with an increase in the odds of developing delirium, when compared to patient rooms without windows.

Using electronic medical records, researchers from Mass General Brigham and collaborators at Boston University Chobanian & Avedisian School of Medicine reviewed the association between patients being admitted to an ICU room with or without windows and the presence of delirium. Delirium was observed in 21% (460/2235) of patients in windowed rooms and 16% (206/1292) of patients in non-windowed rooms.

“While the findings of the study were ultimately unexpected due to prior research suggesting the importance of circadian rhythm while in the hospital, our results contribute to a growing body of evidence-based design literature around the importance of healthcare design to patient experience and outcomes,” explained corresponding author Diana Anderson, MD, FACHA, assistant professor of neurology at the school. She notes that because of the study design, these unexpected findings are not causative and may represent different patterns in which some patients – who are potentially at an increased risk of delirium – may be assigned to different room layouts by the clinical teams.

According to the authors, further research into the specific qualities of windows that may impact health is needed to better understand these results. “Although this study adds to our understanding of the relationship between delirium and characteristics of the built environment, it is clear that additional studies may provide further insight to understand these results. For example, it is possible that the window view toward adjacent landscapes or buildings may be important context to interpret these findings, or perhaps another feature of the room such as light or sound that we could consider in our next investigation,” Anderson says.

Source: Boston University School of Medicine