Hospital Management Course Materials PDF

iC:\\Users\\Admin\\AppData\\Local\\Temp\\ksohtml16964\\wps1.png **UNIVERSITY OF JUBA** **School of PUBLIC HEALTH** **Masters of Public Health** **Course: Course Title: Hospital Management Course Code: PHM533** **2 Credit hours** **Lecturer: Dr. Apal Toby** **BSc, MBBS, MPH- Tropical Diseases*...

iC:\\Users\\Admin\\AppData\\Local\\Temp\\ksohtml16964\\wps1.png **UNIVERSITY OF JUBA** **School of PUBLIC HEALTH** **Masters of Public Health** **Course: Course Title: Hospital Management Course Code: PHM533** **2 Credit hours** **Lecturer: Dr. Apal Toby** **BSc, MBBS, MPH- Tropical Diseases** **[Hospital Management ]** +-----------------------------------------------------------------------+ | **Course content** | +=======================================================================+ | **Hospital System and its Role, Components of a Hospital System & | | Role of Hospitals in PHC Vision, Mission, Goals and Values of a | | Hospital Role and Functions of Hospital Managers Hospital | | Services Management: Nursing Management Change Management | | Infrastructure Management Inventory Management Drugs Management in | | Hospitals (1, 2). Human Resource Management o Human Resource | | Development: current status and future challenges Financial | | Management: o Accounting rules and practices in a public & Private | | Hospital o Financial Management o Hospital Financing for | | Sustainabilityo Cost Containment, cost effectiveness and | | profitability o Costing and Cost implications of Hospital Services | | Risk Assessment and Programming (RAP Tool):o Introduction to Rapid | | Appraisal Tool for assessment of Emergency of a Hospital o Data | | Collection in Hospitals using RAP Tool Preparing a Hospital Budget | | Hospital Waste Management and infection control o Hospital | | Environment & Hospital Waste Management o Hospital | | Environment-related issues: lighting, ventilation, Cleanliness and | | tidiness, horticulture and greenery, Clean, regular and safe water | | supply, standards of personal hygiene, Control measures for hospital | | associated infections Accident & Emergency /Trauma Management | | Services** | | | | ** Infrastructure Management o Hospital Planning and Design o TQM | | and Medical Audit of the Hospital. o Total Quality Management: key | | concepts and Introduction to some basic tools of TQMo Hospital | | Purchasing Process o Hospital Purchase, Tendering and Processing | | Hospital Ethical Concerns** | +-----------------------------------------------------------------------+ **Background: The name Hospital derived from a Latin word hopes, which means a guest or a host, hospital means lodging. Its connected to words like hostel, hotel, and host.A hospital is a building or an institution that is built, equipped and staffed for the purpose of diagnosis of diseases, treatment, and management of various complications. It offers both medical and surgical interventions including rehabilitation in some cases of sick and injured patients. In modern era hospitals serve as centers for investigations, teaching and research.** **Hospital Management** - **Is a process of where the healthcare providers administer everything from the time the patients enter the hospital at the reception where personal information are documented, registration, triage till the last stage of obtaining the treatment in an efficient and effective manner. The management aspect is what integrate various departments and units of the hospital in order to operate together for the overall purpose of offering a comprehensive preventive, curative and rehabilitative services for the patients. Good hospital management is described by ensuring availability, accessibility and quality services for all patients. The system enables hospitals, healthcare centers, and staff to function in a systematic manner while managing the information and integrate the data related to patients, providers, staff and the department effectively.** **Hospital Management System** **All hospitals and clinics strive to provide the best services but it is a challenging task because of the multiple departments, specialties, teams, data therefore establishing proper procedures and systems in place is vital. Developed countries have long switched to digital health records for a better hospital management. Management of a hospital or a medical facility requires a good hospital management system (HMS). It's predicted that in years to come the positive impact of the HMS software will be remarkable. HMS could come in different product types: cloud based, free, on premise, paid, and open-source HMS.** **[Modules of HMS]** **Appointment Scheduling System Radiology Information Management System Insurance Claims Management System Healthcare billing and accounting system Inventory and Procurement Management System** **Information Management System Laboratory Information Management System Electronic Medical/Health Records (EMR & EHR)Human Resource Management System Immunization Tracking System Data Analysis and Reporting System Pharmaceutical Information [Components of HMS]** **Appointments Management Staff Management Billing recordsClaims management Supply Chain Management Laboratory Management** **[Systems Theory of HMS]** **Systems Theory:** It depend on the concept that systems do not exist in isolation but they are interdependent between their parts. Many healthcare agencies adopted a culture of safety based on systems theory which encourages employees to report errors so that Systemic causes of problems are identified, addressed to improve patient's safety. **Culture of Safety includes:Just Culture:** where individuals feel safe when raising questions and concerns and report safety events in a specific context. The manager then draws line between human error, at risk, and a reckless employee behavior for an illustration of just culture. **Reporting Culture:** Realization that errors are inevitable therefore nurses are encouraged to report errors and near misses to ensure patient's safety. Example when a nurse writes an incident report when a medication error occurs leading to severe reaction or in the case of an incident of a client falling. The report will help the agency manage the risk or reduce potential liabilities.**Learning Culture:** Systemic data collection and information sharing for evidence base to improve processes and improve patients outcomes. **Role of Hospital in PHC** Health for ALL concept: "attainment of a level of health that will enable every individual lead a socially and economically productive life"Level of Cares are: Primary Health CareSecondary Health CareTertiary Health Care **Primary Health Care** PHC became WHO core policy in 1978 with Alma- Ata Declaration for the aim of reduction the gaps between the haves and have-nots giving birth to Health for all by 2000 programs. PHC could be different in each community or catchment area depend on: The health needs of the residents', availability of health workforce, the geographic location of the communities as well as their distance from other health care services The first level of contact between the individual and the health system. Where the Essential Health Care Package (PHC) is provided Where most of the prevailing health care problems and complaints are managedNearest to the people and communities Services are provided by the health care centers **PHC Key Elements** Prevention & Control of outbreaks & Endemic Diseases Education and Information sharing on specific health problemsImmunization of preventable infectious diseasesMaternal and Child health including FPAdequate supply of safe water and basic sanitation Promotion of food supply and proper nutrition Provision of Essential drugs Appropriate treatment of common diseases **Secondary Health Care** Complex problems are addressedIncludes Curative ServicesProvided by the district/counties hospitalsFirst referral level **Tertiary Health Care** Offers advanced specialist care Services Provided by the regional/central level institutions Provide teaching and training programs Support studies and operational researches **Hospital** Vision - Mission -- and Values of a hospital are considered the core description and expression of the hospital's culture. **Role of the Hospital Manager** Healthcare managers focus on the broader prospective in the healthcare industry encompasses: financial, and administrative policies. Hospital managers concentrate on:staff management & capacity building interpersonal communication among staffEnsure optima patient's care and patient's satisfaction. Often referred to as a Medical Director Chief Executive Officer (CEO)Chief Operation officer (COO)Chief Medical Officers (CMO)Chief Resident, Senior Resident **Hospital Service Management** **Inventory Management** It encompasses ordering, storing, selling and management of goods and services. The products could include raw materials.Packaging process and shipment of goods ordered by customers.Inventory theory deals with the stock's levels and stocks at hand so that the demands for these goods are met between the buyer and the seller. When the demands are not met leading to the shortage. Medical Inventory is when medical supplies, equipment\'s, medicines, and other medical consumables are managed in the healthcare setting. To streamline medical inventory management utilization of digital solutions including internet and used of AI is recommended if there is an infrastructure. **Types of Medical Inventory Management** Establishing an inventory management system ensure efficiency, reduce costs, improve patient care as well as patient outcome. Some systems used are below: RFID- Radio frequency technology Barcode scanning systems- using of barcode labels and scanners for inventory trackingCloud based inventory systems- centralized platforms to track and manage inventory timely Assessment of each system and forecasting challenges that are related to each system may lead to a selection of an appropriate system. **4 steps on Inventory Management** Step 1: Forecasting -- predicting the quantities that will be needed Step 2: Inventory Tracking Step 3: Recording and Replenishment Step 4: Inventory Optimization **Methods of Managing Inventory** First in, first out (FIFO)Last in, first out (LIFO)Just in time (JIT)Average Costing -- average stock-takes Perpetual Inventory System- computerized live recording of sales, purchasing ABC analysis (high values items, medium values items, low values items)Economic Order quantity (EOQ) Hospital Inventory Items Includes: PPEs (Masks, surgical gowns, gloves)Medical supplies ( Band- aids, cotton, bandages, syringes)Health & wellness products **South Sudan Health Services Structure** In S.Sudan, hospital care is provided through a network of county, state and teaching hospitals spread across South Sudan. Currently there are 3 operational Teaching Hospitals, 7 State Hospitals, and 27 County Hospitals operational distributed across the ten states and 79 counties in South Sudan. However most of these facilities do not provide services as expected of their level. The South Sudan health system therefore envisages a three-tier structure of primary, secondary and tertiary health-care facilities to bring health-care services within the reach of the population. Under the primary tier, a PHCU serves a population of at least 10,000 people and PHCC serves a population of 50,000. The county and state level hospitals serve as a secondary tier for rural health care and are the first level referral point from the community serving populations of at least 300,000 and 500,000 people respectively. Tertiary health care is provided by teaching hospitals, often located in urban areas, providing comprehensive specialist services in addition to their main role of teaching and research. **Global Milestone** 1. All countries have inclusive institutional mechanisms in place to coordinate an inter-sectoral health workforce.2) All countries have a HRH unit with responsibility for development and monitoring of policies and plans. 3) All countries have regulatory mechanisms to promote, patient safety and adequate oversight of the private sector. 4) All countries have established accreditation mechanisms for health training institutions. 5) Making progress on health workforce registries to track health workforce. All counties are making progress on sharing data on HRH through National Health Workforce Accounts and submit core indicators to the WHO Secretariat annually. All Bilateral and Multilateral agencies are strengthening health workforce assessment and information exchange. ** Risk Assessment and Programming (RAP Tool):** **The RAP toolkit has categorized the Emergency Medical Services into three component:** 1. **Educational Public health Initiative Service:** **- Training of Emergency Medical Teams (EMTs) and Paramedics on specific packages such as for opiod use disorder and the path to recovery.** **- If there is an increase in domestic violence in certain area, ems agencies educates the workers on how to recognize any domestic violence, reporting policies and resource for the victims** 2. **Integrated:** **During an outbreak of infectious disease, fire department transmits alerts in the ePCR system for early identification and coordinate with local health departments on a collaborative response** 3. **Expanded:** **- A multidisciplinary task-forces and other teams will be set to operate during an emergency or an outbreak** **- During an outbreak a regional vaccination team will be deployed to address the outbreak**   **o A Rapid Appraisal Tool for assessment of Emergency of a Hospital** **Is used in an emergency departments for a quick assessment of patients to identify the appropriate investigation and treatment they need. o Data Collection in Hospitals using RAP Tool** **Used to evaluate the quality and safety of medical services by gathering, analyzing and interpreting the data for a quick decision and action. It uses both qualitative and quantitative methods.** - **Hospital waste or Medical waste** The waste material could be trash or disposable by-products from health care activities which may include:Contaminated medical devices  needles, syringes, and other sharp instrumentsSoiled dressingsBody partsDiagnostic samples like blood, sputum, CSF, urine, or stoolChemicals used in treatments or testsPharmaceutical wasteRadioactive materials - **Hospital Waste Management** waste management guidance for all health and care settings including waste classification, segregation, storage, packaging, transport, treatment and disposal.In reference to UK, Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 outline the regulatory requirements for employers and contractors in the healthcare sector in relation to the safe disposal of sharps. **Waste disposal:**dispose immediately and as close to the point of use as possible; andinto the correct segregated colour coded rigid container or sharps box if a sharpLiquid waste, e.g suction canisters, must be rendered safe by adding a polymer gel or compound to the container prior to placing in an orange lidded leak proof bin or yellow lidded leak proof bin if contaminated by pharmaceuticals.waste bags must be no more than 2/3 full and no more than the UN approved weight and must be securely tied using a plastic tie or secure knot using a 'swan neck' to close. Waste must be traceable back to ward/care area or department, this may be achieved by writing on bags (prior to use), attaching sticky labels or uniquely numbered tags with the post code on them.**Regulations of Waste** store all waste in a designated, safe, lockable area while awaiting collection. Collection schedules must be acceptable to the care area and there should be no build-up of waste receptacles.Local guidance on management of waste at care level, eg, domiciliary settings should be followed Sharps containers must:have a handle (small community boxes do not require a handle) and temporary closure mechanism, employed when box is not in usebe disposed of when the manufacturers' fill line is reached be labeled with point of origin and date of assembly and disposal. Where re-usable sharps containers are used, organization must have a protocol in place to assure themselves of safe use and reprocessing. **Biological (Infectious)** **Chemical risks ** **Low risks** ------------------------------------------------------ --------------------------------------------------- ------------------ sharps Pharmaceutical  Non hazardous (Needles , blades, Broken glasses) Expired drugs, Vaccines, Cytotoxic waste Infectious  Chemicals Recyclable (Contaminated with blood, cultures, isolated wastes) (Chemical solvents, mercury, cleaners, batteries) Pathological waste Radioactive  Non - recyclable (Body parts, tissues, animal carcasses) (Radio nuclides, vials, radioactive residues) settings should be followed **WHO Classification of Waste** **Category** **Segregation** **Treatment/disposal** -------------------------------------------------------------------------------- ------------------------------------------------------------- ---------------------------------------------------------- Offensive (non-infectious) Yellow bag with black stripe (tiger) bag Energy from waste, landfill or other permitted processes Clinical waste (infectious only) UN approved orange bag, UN approved box or sharps container For alternative treatment Healthcare waste contaminated with non-hazardous pharmaceuticals or chemicals) UN approved yellow bag, UN approved box or sharps container For incineration or other permitted process Waste contaminated with cytotoxic or cytostatic medication UN approved purple bag, UN approved box or sharps container For incineration Non-hazardous pharmaceuticals (no sharps) Blue box/container For incineration or other permitted process Anatomical waste/full blood bag and blood preserves UN approved red lidded container For incineration only Domestic Black/clear bags Energy from waste, recovery or landfill Recycling Clear, green or other colour bag Recycling **Infection, Prevention and Control** **Infection prevention and control (IPC) is a practical, evidence-based approach preventing patients and health workers from being harmed by avoidable infections (WHO).IPC uses a risk management approach to minimize or prevent thetransmission of infection. The two-tiered approach of standard and transmission-basedprecautions provides a high level of protection to patients, healthcare workers and others in healthcare settings** **WHO recommend 8 key components in provision of IPC** Core component 1: IPC programme (andall relevant programme linkages) Core component 2: I PC guidelines Core component 3: I PC education andtraining Core component 4: Surveillance Core component 5: Multimodal strategies Core component 6: Monitoring/audit of IPCpractices and feedback Core component 7: Workload, staffing andbed occupancy. Core component 8: Built environment,materials and equipment for IPC at thefacility level **Standard infection control precautions (SICPs)** are to be used by all staff, in all care settings, at all times, for all patients whether infection is known to be present or not, to ensure the safety of those being cared for, staff and visitors in the care environment.SICPs are the basic infection prevention and control measures necessary to reduce the risk of transmitting infectious agents from both recognized/ unrecognized sources of infection.Sources of (potential) infection include blood and other body fluids, secretions or excretions (excluding sweat), non-intact skin or mucous membranes and any equipment or items in the care environment that could have become contaminated The application of SICPs during care delivery is determined by assessing risk to and from individuals. This includes the task, level of interaction and/or the anticipated level of exposure to blood and/or other body fluids.To protect effectively against infection risks, SICPs must be used consistently by all staff. SICPs implementation monitoring must also be ongoing to ensure compliance with safe practices and to demonstrate ongoing commitment to patient, staff and visitor safety as required by the Health and Safety Executive and the care regulators, the Care Quality Commission. **10 Elements of SICPs** patient placement/assessment of infection riskhand hygienerespiratory and cough hygienepersonal protective equipmentsafe management of the care environmentsafe management of care equipmentsafe management of healthcare linensafe management of blood and body fluidssafe disposal of waste (including sharps)occupational safety/managing prevention of exposure (including sharps) **Patient placement/assessment for infection risk** Thorough assessment of Patients on arrival for infection risk at the clinic is important, eg inpatient/outpatient/care home, (if possible, prior to accepting a patient from another care area) in addition to throughout their stay.This assessment should influence placement decisions in accordance with clinical/care need(s).Patients who may present a cross-infection risk include those:with diarrhea, vomiting, an unexplained rash, fever or respiratory symptomspreviously positive with a multi-drug resistant organism (MDRO), eg MRSA, inpatient in any hospital in country or abroad or are a known epidemiological link **Hand Hygiene** - Hand hygiene is considered one of the most important ways to reduce the transmission of infectious agents that cause healthcare associated infections (HCAIs).Clinical hand-wash basins must:be used for that purpose only and not used for the disposal of other liquidshave mixer taps, no overflow or plug and be in a good state of repairhave wall mounted liquid soap and paper towel dispensers.Hand hygiene facilities should include instructional posters.Before performing hand hygiene:expose forearms (bare below the elbow). If disposable over-sleeves are worn for religious reasons, these must be removed and disposed of before performing hand hygiene, then replaced with a new pair​\*remove all hand and wrist jewellery. The wearing of a single, plain metal finger ring, eg a wedding band, is permitted but should be removed (or moved up) during hand hygiene. A religious bangle can be worn but should be moved up the forearm during hand hygiene and secured during patient care activitiesensure fingernails are clean and short, and do not wear artificial nails or nail productscover all cuts or abrasions with a waterproof dressing. ABHRs must be available for staff as near to the point of care as possible where running water is unavailable, or hand hygiene facilities are lacking, staff may use hand wipes followed by ABHR and should wash their hands at the first opportunity.**Perform hand hygiene:**before touching a patient.before clean or aseptic procedures.after body fluid exposure riskafter touching a patient; andafter touching a patient's immediate surroundings.dry hands thoroughly after hand washing, using disposable paper towelsuse an emollient hand cream regularly e.g during breaks and when off dutystaff with skin problems should seek advice from occupational health or their GP and depending on their skin condition and the severity may require extra precautions. **Respiratory and Cough Hygiene** Respiratory and cough hygiene is designed to minimize the risk of cross transmission of known or suspected respiratory illness (pathogens):cover the nose and mouth with a disposable tissue when sneezing, coughing, wiping and blowing the nose; if unavailable use the crook of the armdispose of all used tissues promptly into a waste binwash hands with liquid soap and warm water after coughing, sneezing, using tissues, or after contact with respiratory secretions or objects contaminated by these secretionswhere there is no running water available or hand hygiene facilities are lacking, staff may use hand wipes followed by sanitizer and should wash their hands at the first available opportunitykeep contaminated hands away from the eyes nose and mouth.Staff should promote respiratory and cough hygiene helping those (eg, elderly, children) who need assistance with this, eg providing patients with tissues, a dedicated receptacle i.e. waste bag for used tissues and hand hygiene facilities as necessary **PPEs** Before undertaking any procedure, staff should assess any likely exposure to blood and/or other body fluids, non-intact skin or mucous membranes and wear personal protective equipment (PPE) that protects adequately against the risks associated with the procedure. The principles of PPE use set out below are important to ensure that PPE is used correctly to ensure patient and staff safety. Avoiding overuse or inappropriate use of PPE Where appropriate, consideration should be given to the environmental impact of sustainable or reusable PPE options versus single-use PPE while adhering to the principles below Gloves ( Single use medical gloves could be sterile or non sterile) (Protective work gloves)Mask ( Surgical or Respirator and it depends to the level of protection required )Aprons (single used or reusable)GownsGoggles /Eye protectorsFluid resistant surgical face maskFoot wear/ shoe covers Headwear **Environmental Care** the environment should be routinely cleaned in accordance with the Standards. use of detergent wipes is acceptable for cleaning surfaces/frequently touched sites within the care areaa fresh solution of general-purpose neutral detergent in warm water is recommended for routine cleaning. This should be changed when dirty or when changing tasksroutine disinfection of the environment is not recommended however, 1,000ppm available chlorine should be used routinely on sanitary fittingsstaff groups should be aware of their environmental cleaning schedules for their area and clear on their specific responsibilitiescleaning protocols should include responsibility for, frequency of, and method of environmental decontamination. **Equipment** Equipment\'s are easily contaminated with blood, other body fluids, secretions, excretions and infectious agents. Consequently, it is easy to transfer infectious agents from communal care equipment during care deliveryBefore using any sterile equipment check that:the packaging is intactthere are no obvious signs of packaging contaminationthe expiry date remains validany sterility indicators are consistent with the process being completed successfully.Decontamination of reusable non-invasive care equipment must be undertaken:between each use/between patientsafter blood and/or body fluid contaminationat regular as part of an equipment cleaning protocolbefore inspection, servicing or repair. **Linens** Clean linen -- linen washed and ready to be used.Used (soiled and fouled) linen -- used linen, irrespective of state, which on occasion may be contaminated by blood or body fluids, andInfectious linen -- linen that has been used by a patient who is known or suspected to be infectious.Storage and handling of clean linen:Hand hygiene should be performed prior to handling clean linen.Clean linen should be removed from plastic bags before storage to prevent the growth of Bacillus cereus.Clean linen should be stored above floor level in a designated area, preferably an enclosed cupboard that is clean, dry and cool.If clean linen is not stored in a cupboard, then the trolley used for storage must be designated for this purpose and completely covered with an impervious covering/or door that is able to withstand decontamination.Clean linen storage areas should be dedicated for the purpose and appropriately designed to prevent damage to linen and to allow for the rotation of stocks.Clean linen should be physically separated from used/infectious linen when in storage and during transport.Storage and handling of used (previously known as soiled/fouled linen) and infectious linen:Staff handling used and/or infectious linen must wear appropriate PPE (see section 1.4).Hand hygiene must be performed after handling used and/or infectious linen.Ensure a laundry receptacle is available as close as possible to the point of use for immediate linen deposit.Used items of linen should be removed one by one and placed in the used linen hamper/stream. Infrastructural Issues could arise and they have direct impact on overall health services and individual's health outcomes of a patient, below are few: \- Lighting - Ventilation- Cleanliness - horticulture and greenery **Safe and Regular Water Supply** Access to running water: All of the critical areas (operating rooms, outpatient consultation rooms, patient care units, wound dressing rooms, etc.) and service areas (sterilization, laboratory, kitchen, laundry, showers, toilets, waste storage area and morgue) should be equipped with a water tap for hand washing. Hand washing stations must be located as close as possible to where care is performed and, in accordance with WHO minimum requirements, the overall ratio should be one wash basin for every ten patients. **Standards of Personal Hygiene** Hygiene should not be considered as set of rules that must be followed but rather recognize its impact in reduction of spread of infections. Requires everyone's participation therefore we must be organized and descriptive of everyone's task.Hygiene practices rely not on habit or routine but on prioritizing Quality of care and infection control. All personnel, both medical and non-medical have to practice how to follow best hygiene practices in their activities in order to limit the spread of infection in health care facilities and/or reduce the sources of infection. **Blood and Body Fluid** Spillages of blood and other body fluids may transmit blood borne viruses Spillages must be treated immediately by staff trained to undertake this safelyResponsibilities for the management of blood/body fluid spills must be clear within each area/care setting. **Occupation Safety** The Health and Safety (Sharp Instruments in Healthcare) regulatory requirements for employers and contractors in the healthcare sector in relation to: the safe use and disposal of sharps; provision of information and training to employees; investigations and actions required in response to work related sharps injuries. There is a potential risk of transmission of a (Blood Born viruses) from a significant occupational exposure.Staff must understand the actions they should take when a significant occupational exposure incident takes place. There is a legal requirement to report all sharps injuries and near misses to line managers/employers. **Key Definitions** **Aseptic: free of contamination and without transmission of any microorganisms. Example of** Aseptic technique Use of personal protective equipment (PPE) Respiratory hygiene and cough etiquette Safe use of sharps Environmental cleaning Reprocessing of medical equipment Appropriate handling of linen and waste management.**Antiseptic: A chemical substance use to remove bacteria from skin surfaces which is different from disinfectant should never be put on skin surface. Anti-microbial Resistance (AMR):Biohazard: Bio fluids: Carrier: A person or an animal that has an infectious agent but does not show any symptoms (asymptomatic carrier), hence serve as a potential source of infection. It could also be a convalescent carrier who has recovered from an illness, not showing any symptoms anymore but still continue to shed the micro-organisims. It could also be during the Incubation period, while the carrier state could be temprory, transient or chronic. A carrier Colonisation:Contamination: Presence of an infectious agent in a living and non-living surface often invisible to the naked eye. Disinfection/Disinfectant Endogenous Flora: Bacteria that resides within human bodyFomites: An article who was in contact with a patient that may transmit infectious micro-organisms Hand hygiene: is used for hand cleaning. It may be hand washing with soap or hand rubbing with alcohol based for removing or reducing any microbes. HAIs: Healthcare associated infections always do not manifest themselves before 48 hours after contact with healthcare services. Some surgical site infections may appear after 30 to 90 days post-operatively. Occupational and iaetrogenic infection are also considered HAIs. Healthcare risk waste: hazardous solid or liquid portions of waste generated from health establishments of treatment, prevention and diagnosis of infections in humans, infectious waste,infectious sharps and pharmaceutical waste.** **High risk settings: They include operating theatres, Neonatal units, ICUs, Maternity, Dialysis units. Incubation period: Is an average time taken from the time the infectious agent enters the human body till the time the sign and symptoms started to show. Infectious Linen: linens used in care of patients infected with communicable diseases, colonized or infected with multi-drug resistance (patients nursed with isolation precautions)** **Infested Linen: linens used in patients with parasites like scabies, lies , fleas and bedbugs** **Used Linen: Linen that has been used in patient care but not visibly soiledIPC Practitioner** **Isolation: Patients placement in a separate room to prevent transmission usually in a single room, or a cohort of patients with similar infection in a ward or designated areas with transmission based - precautions applied. Medical Surveillance: Is a planned program or a a periodic examination services for employees which may include clinical examination, biological monitoring, or medical tests.Multi-modal Improvement Strategies: Comprises of many models which are implemented in an integrated fashion with an aim of improving outcome and change behaviors. It includes tools such as checklist, bundles developed by multidisciplinary team. Negative vs. Positive Pressure: Negative pressure is used in areas where it is necessary to prevent the escape of of contaminated air from isolation room so that the infectious droplet nuclei are contained within a room which has lower pressure than the area around it. Negative air pressure keeps pathogens in and positive air pressure keep pathogens out. In hospitals negative pressure rooms are called isolations rooms as well, they are designed to prevent airborne micro-organism in the room from escaping the room and entering the hallways, corridors and other areas. Point of Care: Signifies a place where a patient seeking care, a health care provider rendering services and the environment all exist.** **Quality Control**: is a process by which entities review the quality of all factors involved in production. ISO 9000 defines quality control as part of the quality management. Inspection is applied. **Quality Assurance**: ensures the safety, quality and efficacy of health products procured. **Total Quality Management**: is a management approach for the purpose of improving services, products and processes through a collective efforts of all the employees. The purpose is to ensure continous improvement. **Hospital Acquired Infection (HAI)** Hospital Acquired infection is an infection that was contracted during the time when the patient was staying at the hospital or in any medical facility while undergoing treatment according to WHO definition in which it was not present at the time of admission. It is also referred to as healthcare associated infection such as or nosocomial infection. The infection can occur at many settings for example at a hospital, a surgical center, a dialysis center, or any other healthcare facility. It could also include an infection that appears after discharge on a patient, an occupational infection among staff. -Hospitals must dedicate resources for IPC program - Establishing a multidisciplinary Infection Control Committee - Review, approve, and implement policies approved by the Infection Control Committee - Dedicate resources for IPC - Educate, train and supervise all staff including support staff on the prevention of infection in disinfection and sterilization techniques - Delegate technical aspects of hospital hygiene to appropriate staff, such as: --- nursing --- housekeeping --- maintenance --- clinical microbiology laboratory - Periodic review of the status of nosocomial infections and effectiveness of interventions for containment - ensuring the infection control team has authority to facilitate appropriate programme function - participating in outbreak investigation **Accidents and Emergency** Accident and Emergency Department (A &E) is also referred to as an emergency department (ED).Communication is important at every healthcare environment and even more critical at the ER, with the patinet, staff, and the co-patients because it informs decision making and timely response when saving lives. Good number of studies links poor treatment outcome and poor patients safety to poor staff communication either among themselves or with their supervisors at the ED for example failing to communicate changes in patient's vital signs to the physician, also delayed treatment between shifts and poor communication with the co-patients to provide prescribed medicines from the pharmacy all. Need to establish an easy communication system at ER and deployment of communication tools and methods to share important information,Triaging is as well important at the ED, so that critical cases are given the priority. Strategy to strengthen team work and improve communication at the ER **Trauma Management in Hospital** Trauma management is sets of efforts done to support an individual after experiencing any traumatic event or incident. There are 3 principal phases that an individual could go through (Pre-hospital, in hospital and rehabilitation phase).Immediate management will include stabilization, resuscitation from a trauma or injury. **Infastructure Management** Is investing in planning and organizing the hospital and the services provided are efficient and effective. It encompasses the physical structures of the facility, the equipment installed at various units and the systems established as well as integrated technologies and innovations. E.g: Electrical SystemsPlumbing and sewage systemsEntrances, exits and accessibility to the building Audio insullation **Hospital Planning and Design o TQM and Medical Audit of the Hospital** Hospital Major facility zones: Accident and Emergency Ambulatory Care also known as Outpatient deptDiagnostic and Therapeutic Facility In-Patient & Nursing careAdministration Dept.Hospital Engineering or Maintenance Unit **Hospital Purchasing Process:** Known as health care procurement Goods and Services procured Equipment and Furniture **Quality in Health care** Quality refer to standard of something that could be measured against other things that are similar but with highest standard and excelence. Quality could differ among individuals due to their experience, education, and environment.Quality has evolved and changed with time.In early 1960s it was more on Quality Control In 1970s The focus was on Quality Assurance Comes 80s & 90s It was about Quality Managemet In 2000 its about Total Quality Management WHO supports countries develop, refine and implement National Quality policies and strategies. It promotes patent safety initiatives to reduce the harm to patients **Tendering and Processing** Is a process where the a buyer or an individual or institution in need of services invites a supplier in a Request for Tender (RFT) to suppliers. The supplier in return submit a proposal and in most cases there is more than one applicant therefore there will be competition for tender. Tendering goes through processes which include preparation, planning, document preparation , advertisement, bid submission, bid opening etc. There could be selected tender or negotiated tendering **Medical Ethics** Moral principles that guides all health professionals in making the right decisions that benefit the patient, without doing harm with respect to the patient's autonomy. Ethics in health promotes the consideration of values in the prioritization and justification of actions by the practitioners. One common medical ethic that always arise, is patient privacy and confidentiality. Protecting patient privacy and information is an ethical and legal obligation that is in the code of confidentiality and that is why medical doctors take the oath. **4 Basic Principles of Medical Ethics** 1. **Autonomy** in medical ethics is the right of patients to make decision about their own medical care. It is important for the health professional to respect patient's decision even if its contrary to the physicians recommendation as long as the patient is an adult with a capacity to make informed decision about his/her own health. The professional is obligated to provided an explanation consent to the patient about the investigation , procedure or a treatment before administration. **2) Justice:** Health is a human right and therefore it should be offered to anyone regardless of their ethnicity, age, race, class, political affiliation, religion or others. Patients are rendered health services equally. **3) Non-maleficence:** Do-no harm is a core principle of medical ethics Health professionals to avoid doing harm to patients. **4) Beneficence:** To act in the best interest of the patient. Physicians must secure the benefit of the patient first in order to ensure moral obligation to protect, preserve and promote patient's right. **Standard Precautions when seeking care: the services are expected to be effective, efficient, safe, timely and overall patient centered.** Effective: Beneficial, of valueEfficient: Avoiding wasteSafe: Avoid harmPatient Centered: Focus on the needs /preference of the patientTimely: reducing waiting time **Ethical Concerns** **Many issues arise while rendering services to patients therefore its important to consider how you will manage and maintain professionalism** Truth telling Disclosure of bad news,Patient's Privacy, conflicts of interest, Research on human subjects Access to care: How to ensure that everyone has access to the care they need when they need it. Patient-practitioner relationships: How to respond to a family\'s request to withhold information from a patient Professional differences: How to balance the quality and efficiency of patient care Reporting: Whether to report a patient to the driver\'s licensing authority or an impaired colleague to the appropriate authority Cultural practices: Whether to intervene when a patient is undergoing a cultural practice that may be harmful Patients\' Rights,Offering services and maintaining professional boundaries Equity of resources, Confidentiality of the patient Patient Safety Ethics of privatization Informed Consent Dealing with the opposite sex **Scenarios** 1\) A jehovah's witness patient refusing blood transfusion while severely anemic. Is it ethical to provide blood transfusion to rescue the woman and the fetus without her consent? What if the husband refuses as well ?2) Patient has a severe joint pain, a nurse wanted to administer pain medication to relief the pain, however the patient was very fairful of addiction thinking that getting use to pain-killer may lead to addiction. a nurse was concerned on how to convince her without interfering in her autonomy. What should she have done?3) Prioritzation of patients, who needs immediate and quick attention and who should wait?4) Organ donation, there are 2 patients who needs liver transplant. An older patient and a young patient? how will you determine who to be transplanted first?5) 2 critically ill patient are brought to ER with difficulty of breathing and a low oxygen saturation, you have only one oxygen cylinder. How will you decide which patient to prioritze firt for oxygen? **Readings** **Peter, M. Ginter, W. Jack Duncan, Linda, E. Swayne (2017). Strategic Management of Health Care Oragnziation. 8th Edition, Wiley.** **Gupta (2016). Hospital Administration and Management: A Comprehensive Guide. Jaypee Brothers Medical Publishers Pvt. Ltd.** **Elaine La Monica (2010). Management in Health Care. MacMillan Press Ltd** **Guidelines for County, State, and Teaching Hospitals in South Sudan 2013** **Human Resource for Health Policy 2006 -- 2011** **Strategic Plan for HRH 2007 - 2017** **South Sudan Health Sector Strategic Plan 2023 - 2027** **WHO- Global Strategy on HRH: Workforce 2030** **South Sudan National IPC Guidelines** **Gahara requirement on Quality** **Inspection Checklist**