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Biomedical subjects

L M Harkavy

Publications and source records attributed to L M Harkavy.

9 recordsLinked to original sources
PubMed1989

Lobbying: everyone's responsibility.

Health legislation is increasingly important to us as citizens and infection control professionals. The clearest need for influencing policymakers is in cost-cutting activities and the resulting impact on health care delivery. Health care professionals (HCPs) can highlight for lawmakers those health systems that are cost-effective and beneficial to the public. HCPs can help explain to constituents the costs and the scientific reasons for proposed changes. Additionally, HCPs are aware of nonmonetary costs, including emotional and social deficits, or indirect costs, of health-related programs. These should be addressed in the discussion of costs with government officials. Infection control personnel have shown effective means of reducing the cost of health care. ICPs must publicize their role in cost saving at the government level, as well as within individual institutions. Protecting the patient's welfare and cost control do not often go in tandem in this country's multibillion dollar health care industry. Infection control is almost unique in this respect. It is crucial to our patients, the employers for whom we work, and to ourselves that we share this information with those who decide public policy.

Communicable Disease Control↗
PubMed1989

Surgical wound infections.

At the last meeting of the SURGIKOS Operating Room/Infection Control Combined Advisory Panel, guest speakers reviewed current thinking and practices that have an impact on surgical wound infections. Presentation topics included the role of the CDC, nursing and classification systems in controlling wound infections; cost effective epidemiologic methods of reducing infections; and outcomes of surgical wound infection prevention practices deemed critical by the Joint Commission on Accreditation of Healthcare Organizations. The following is a brief overview of the presentations that guided panel discussions on these topics.

Antisepsis↗
PubMed1988

Description of case-mix adjusters by the Severity of Illness Working Group of the Society of Hospital Epidemiologists of America (SHEA).

Hospitals, insurance companies, and federal and state governments are increasingly concerned about reducing patient cost expenditures while maintaining high quality patient care. One method of reducing expenditures has been to tie hospital reimbursement with a prospective payment system based on diagnosis-related groups (DRGs). However, reimbursement under the DRG system is not acceptable for all patients in all hospitals because it is neither an accurate predictor of costs nor of clinical outcome. This deficiency poses significant problems for hospitals because DRGs are used nationwide as the prospective payment system for inpatients covered by Medicare. Several case-mix adjusters have been proposed to modify DRGs to improve their accuracy in predicting costs and outcome. We reviewed five of the most widely available indices: Acute Physiologic and Chronic Health Evaluation (APACHE II), Coded Disease Staging, Computerized Severity Index (CSI), Medical Illness Severity Group System (MEDISGROUPS), and Patient Management Categories (PMC). Recommendations for the use of a single case-mix adjuster cannot be made at this time because all indices have not been compared in sufficiently diverse settings and because some are better predictors of costs while others are better predictors of clinical outcome. Hospital epidemiologists and other infection control practitioners should be informed about these indices and their potential applications as they expand their role beyond infection control problems to issues concerning cost containment, quality assurance, and reimbursement.

Cost Control↗
PubMed1978

Surveillance for postoperative wound infections: practical aspects.

Intensive surveillance for postoperative wound infections was conducted for one month on three separate occasions at the Veterans Administration Hospital, West Haven, Connecticut. The mean wound infection rates for clean, clean-contaminated, contaminated, and dirty wounds were 6, 11, 17 and 18%, respectively. During the second survey, the clean-contaminated rate was 25% and was significantly higher than at other periods (p less than 0.05). Most of these infections occurred on a single surgical subspecialty service. The methods used to conduct intensive wound surveillance and the need for close liaison between the infection control team and the surgical service is emphasized. Current problems with wound surveillance are reviewed.

Connecticut↗
PubMedDate not supplied

The epidemiology of nosocomial enterococcal urinary tract infection.

Enterococci are the most frequent cause of urinary tract infections (UTIs) in our hospital, which is comprised primarily of elderly male patients. Thirty of 34 UTLs, associated with enterococci in a three-month study, were preceded by urinary tract instrumentation and not related to antecedent antibiotic therapy. Although most UTLs were polymicrobic and clinically asymptomatic, monomicrobic septicemia with enterococci did occur and in one patient polymicrobic bacteremia was observed. Extensive epidemiologic studies demonstrated that the mode of spread did not involve passive carriage by personnel or other exogenous sources. Rather endogenous infection with the patient's fecal flora serving as the reservoir was probably responsible for the UTLs. This route of spread was demonstrated prospectively in two patients. Proper and frequent cleansing of the perineal area after catheter insertion should decrease UTIs resulting from this endogenous route.

Adult↗