Information for managers in hospitals: representing maternity unit statistics graphically.

Staff who organise and run maternity units contribute many statistics to their health authority but do not find it easy to obtain information about their unit from these statistics. Data that are collected routinely, however, can be used to provide each unit with a graphical profile of its activity and resources. The method described here was derived from the personality profiles used by psychologists and allows staff in one unit to assess the outcome, activity, and use of resources in their unit in relation to similar units, to explain some of the differences when these occur, or to highlight potential problems. Examples are taken from a study of maternity units in the West Midlands. It is concluded that the technique can indicate potential problems and usefully be adopted by those who monitor maternity care in districts or hospitals.     

Methodological aspects of the evaluation of epidemiological safety in maternity hospitals

The distribution of morbidity and mortality in newborns, as well as morbidity of parturient women, in maternity hospitals of Moscow official have been analyzed according to statistical data for 1996-1999. The methods of cluster analysis (k-medium and tree classification by the method of the next door neighbours) were used. The evaluation of the stability of the distribution of morbidity and mortality in maternity hospitals was made with the use of chi 2 criterion. The specific features of the distribution of morbidity and mortality of newborns, as well as morbidity of parturient women, in the hospitals under study were detected. The methodological approach to the evaluation of epidemiological safety in maternity hospitals was proposed.     

Ecology of serogroup B streptococci in maternity hospitals (preliminary report)

Materials on the study of the colonization of newborns, their mothers and the medical staff of a maternity hospital by group B streptococci are presented. These streptococci were isolated from 26.3% of newborns, 19.6% of puerperae and 14.7% of the staff members. Group B streptococci were found to colonize different loci in newborns (the fauces, the nose, the umbilical cord, the ears, feces) and their mothers (the fauces, the vagina, the perianal fold, milk, the skin around the nipples, amniotic fluid, the umbilical cord). The serological typing of streptococci, isolated simultaneously from newborns and their mothers, suggested the presence of two possibilities of infecting the newborns with these microorganisms: (1) from their mothers and (2) from other newborns or members of the hospital staff during the stay in the maternity hospital.     

Risk factors of development of nosocomial pyogenic and septic infections in maternity hospitals

During prospective epidemiological surveillance cases of pyogenic and septic infections (PSI) in mothers and newborns in two maternity hospitals were studied using standard case definition and leading risk factors of their development were revealed. These factors differed in two hospitals and were connected mainly with high level of patients colonization, contamination of the environment by nosocomial strains of microorganisms, and degree of participation of mother's relatives in delivery. It was shown that permission to relatives for presence on delivery did not influence on the rate of PSI. Specificity of risk factors of PSI in mothers and newborns dictates necessity to determine them in each maternity hospital.     

A system for the operative management of hospital infections in maternity hospitals]

A system for controlling the epidemic process of hospital infections in maternity hospitals and departments of infant pathology has been created. The specific feature of the proposed method is the prospective character of epidemiological surveillance: from the cause to the effect, and not vice versa. This is achieved by using the results of follow-up of the preconditions of the epidemic process activation (preterm delivery, gestosis, dry labor, birth injuries in mothers and infants) and the precursors of the beginning aggravation of the epidemic situation (the level of the contamination of infants with hospital microflora). Early information in this respect will help foresee the possible activation of the epidemic process of hospital infections and take necessary measures when infant infection rate is just elevated.     

Plasmid analysis of cadmium- and penicillin-resistant strains of staphylococci isolated in maternity hospitals]

The plasmid analysis of a collection of the staphylococci isolated was made in the obstetric hospitals of Nizhny Novgorod and Arzamas in 1986-1989. It revealed the presence of large complex plasmids with a molecular weight of 22 MD carrying the determinants of resistance to penicillins and cadmium and mercury ions in polyresistant strains. Conjugation transfer of the plasmid even between the staphylococci of different species was performed under experimental conditions. It was suggested that occurrence of the strains carrying the complex cadmium-penicillinase plasmid was due to violation of the sanitary or ecological requirements.     

Measures of prophylaxis of nosocomial infections in somatic hospitals

Data are presented on the complex of measures for the prophylaxis of infections at the obstetrical and surgical clinics; also information on the efficacy of new disinfectants made in the USSR for the disinfection of objects of external environment, hands of medical personnel and air in somatic hospitals is given.     

Improved method for sanitary bacteriological control in the epidemiological surveillance of suppurative-inflammatory diseases in maternity hospitals

To increase the information content of sanitary bacteriological control, the methods of planning laboratory investigations and their organization have been developed and the scheme of the bacteriological analysis of washings has been improved. On the basis of the improved method of bacteriological control, greatly varying data indicating the contamination of environmental objects in children's wards with indicator microorganisms (12.0-64.0%) have been obtained. The qualitative and quantitative characteristics of the microflora existing in the biotope of infants' skin have been studied on a new methodological level, and close correlation between the degrees of the microbial contamination of the skin and the incidence of purulent inflammatory diseases in newborn infants has been established. For the dynamic surveillance of the bacteriological situation in maternity hospitals a signal test, viz. the determination of the microbial contamination of the inner surface of swaddling clothes, has been proposed. This "swaddling clothes test" has made it possible to establish, for the first time, the microbiological characteristics indicating the degree of epidemic well-being in obstetric institutions.     

Head injuries in three Scottish neurosurgical units. Scottish head injury management study.

The organisation of care for patients with head injuries in Scotland was investigated by studying retrospectively 785 patients admitted in 1974 and 1975 to neurosurgical units in Glasgow, Aberdeen, and Dundee. The reasons for the injuries and the patients'' clinical conditions were similar in each unit. The referral practices at the hospitals containing the units were compared and found to be different from that of the unit in Edinburgh. It is concluded that patients in the Glasgow, Aberdeen, and Dundee units, which operate a similar policy for head-injured patients, are in general similar. Transferring to a neurosurgical unit only selected patients rather than all patients with head injuries is safe practice only if policies are agreed with primary surgeons and patients can be transferred without delay.     

Reports by anaesthetists to procurators-fiscal: analysis of "anaesthetic deaths" over 10 years in four Scottish teaching hospitals.

Review of 489 "anaesthetic deaths" reported to procurators-fiscal over 10 years disclosed only 30 that were thought to justify such reporting. Most of the remainder occurred in patients so desperately ill at the time of operation that death was expected. Postmortem examinations ordered by the Crown authorities in nearly all cases were probably largely unrewarding and mostly unnecessary. The results suggest that the present regulation on reporting should be revised to focus more attention on the few deaths that occur in patients who have no apparent contraindication to anaesthesia or operation.