Managerial Epidemiology

The healthcare sector has distinguished itself as one of the most
fundamental sectors in the contemporary human society. It is primarily
concerned with enhancing the health of the population, which has a
bearing on the economies of countries especially considering that only
healthy individuals have the ability to engage in wealth creation. Like
other sectors, the healthcare sector needs to undergo reform on a
regular basis still with the aim of improving the health of the
population that it serves. This underlines the fact that the focus of
health services management and clinical practice lays on the health of
the population that they serve rather than on their institutions’
fiscal health. This also underlines the importance of managerial
epidemiology as an evaluation tool. Managerial epidemiology underlines a
branch of epidemiology that makes use of the conventional causal and
quantitative reasoning techniques, while also incorporating business
elements of healthcare that monitors demand, clinical outcome
measurement, delivery, resource allocation, program planning and
strategic analysis, as well as managed care. Underlining the importance
of managerial epidemiology is the fact that it has the capacity to
evaluate the implications or effects of healthcare reform and determine
how effective a reformed health care system is in enhancing human
condition. This is the case in the Good Health Hospital case study.
Recent nosocomial infections: Data
Recent data shows increased prevalence of nosocomial infections in the
healthcare facility. Of particular note is the fact that the infections
are not limited to specific gender, race, or age group.
Nosocomial infections prevalence
Phneumonia affected 22 individuals including 13 children, 6 women and 3
Infections of the bloodstream affected 14 individuals including 9
children, 3 adult women and 2 adult men.
Stomach infections and diarrhea affected 24 individuals including 14
children, 6 adult women and four adult men.
Questions for the health care administrator at Good Health Hospital,
regarding potential litigation issues with infections from the
nosocomial diseases
Needless to say, the spread of the nosocomial infections to the patients
is bound to have legal consequences on the hospital at large. This is
especially considering that the spread of the infection touched on the
safety of patients, with studies showing that the outbreak had been
caused by spoiled food from the cafeteria. Nevertheless, the healthcare
administrator must ask varied questions with regard to the possibility.
First, did the healthcare provider exercise due care and skill with
regard to the outbreak? This question emanates from the legal
requirement that the healthcare providers have to exercise a degree of
skill and care that would be reasonably expected from prudent and normal
Second, did the hospital provide a safe environment for the protection
of the patients from harm as they receive care? Not only do hospitals
have a legal obligation to put in place the necessary protocols and
systems that promote patient safety but they also have to take
reasonable measures to ensure that the staff follows the protocol
(Hugonnet et al, 2007).
Third, did the healthcare provider inform the patients about the
infection? Healthcare providers are under an obligation to contact the
patients so exposed to an infection so as to warn them of the risk
posed, as well as advice them on the appropriate follow-up care and
Fourth, did the healthcare provider engage in a timely review so as to
identify patients that may have been put at risk? As Pittman Estate vs.
Bain (1994) showed, healthcare providers have to notify the recipients
at risk in a time and manner that is commensurate with the risk posed to
their health.
Fifth, did the healthcare provider inform patients on any potential
risks that they face in the course of receiving treatment? This is an
extension of the duty to inform a patient who may have been exposed to
harm or who may have been harmed.
Lastly, did the healthcare provider report risks to government agencies
and regulatory officials among others? As much as healthcare providers
are independent and may have to maintain confidentiality, they operate
within a framework that requires then to make incident reports
pertaining to certain incidents especially in the case of an outbreak
(Hugonnet et al, 2007). This will allow government agencies and
regulatory bodies to monitor the outbreak and take precautionary
measures to safeguard patient safety.
Final Implementation Plan
The final implementation plan requires the full cooperation of the staff
at the hospital, as well as all stakeholders in the healthcare
institution (Chen & Chiang, 2007). This is especially considering that
the patients are in the dark as to the appropriate measures that should
be taken in case of an outbreak or even the manner in which the
infection spreads from one individual to another (Chen & Chiang, 2007).
The final implementation plan would have varied measures.
First, the food source has been identified as the genesis of the
outbreak, in which case it has to undergo a complete overhaul (Hugonnet
et al, 2007). This means that proper measures must be taken to prevent
further contamination or spoilage of the food items that are provided to
the patients.
Second, patients whose infection has been confirmed must be catered for
and taken through the appropriate healthcare procedures to control the
infections and regain their health. This must be done with
considerations on the treatment procedures required (Chen & Chiang,
Third, the remaining but at-risk-of-infection patients have to be placed
under surveillance and monitoring to ensure that they are provided with
the appropriate healthcare before their situation worsens.
Recommendations regarding the implementation plan
As much as the outbreak of the infection may be blamed on issues
pertaining to sanitation in the kitchen, it is evident that the
phenomenon is indicative of a deep-sited problem in the entire
healthcare institution (Creedon, 2005). This means that the problem
extends not only in the kitchen but also in other sectors of the
healthcare institution. In this case, it is imperative that fundamental
steps are taken to enhance the safety of the patients in the institution
in the future.
First, it is imperative that a proper audit of the suppliers of the food
items is carried out. Indeed, officials of the healthcare facility must
undertake an inspection of the facilities in which the suppliers
manufacture or produce the food items delivered to the healthcare
facility to ensure that proper sanitation and safety measures are taken
(Hugonnet et al, 2007).
Second, it is imperative that every food item is subjected to a random
inspection to ensure that it is up to standard before being admitted
into the healthcare facility.
Third, it is imperative that the healthcare facility requires all
suppliers to have certification from a health officer (Creedon, 2005).
This should be complemented with a requirement that all food items be
certified by a healthcare officer and bear a mark or stamp to ascertain
the same before being admitted to the healthcare facility.
Fourth, the healthcare facility must undertake a regular inspection of
its own storage and food preparation to ensure that proper sanitation
and safety measures are taken with regard to any food that is admitted
and stored (Chen & Chiang, 2007).
Lastly, only authorized individuals should be admitted to the food
preparation unit. This will prevent any possibility of an infection
emanating from external sources and contaminating the food items.
Safety protocol Itinerary
The main aim of the safety protocol itinerary is to bring the current
outbreak under control through interrupting its transmission chain, as
well as prevent the occurrence of similar outbreaks in the future. The
choice of control measures is determined by the results pertaining to
the initial analysis in conjunction or consultation with the appropriate
professionals such as microbiologists, nurses, clinicians
epidemiologists and infection control staff. On the same note, this
provides an opportunity for the initiation or improvement of a
surveillance system that would facilitate the assessment of the efficacy
of the varied control measures that were established (Chen & Chiang,
2007). Nevertheless, the proper control of the infection both in the
present and the future is dependent on the capacity of the institution
to put in place varied measures that would ensure the highest
cleanliness levels even in the public areas. Varied measures in this
case can be taken.
The institution should ensure that proper hand decontamination
procedures are undertaken as it has been proved that hands play an
immense role in the transmission of hospital infections. Hand-washing
facilities have to be established in varied public spaces and especially
in the lavatories (Chen & Chiang, 2007). For hand-washing, it is
imperative that there exists running water with large basins that
require little maintenance, antisplash devices, as well as hands-free
control. On the same note, products such as soap and antiseptic have to
be placed in these locations (Chen & Chiang, 2007). In addition, it is
imperative that facilities that allow for drying without any
contamination should be placed in these locations. If possible, the
facility should put disposable towels to minimize any possibility of
In the case of hand disinfection, it is imperative that specific hand
disinfectants are placed in public areas within the facility to minimize
the infection rates. These can be alcoholic rubs with emollient gels and
antiseptics that can be applied on physically clean hands.
In addition, it is imperative that proper disposal facilities are put in
place in the public areas within the hospital. In this case, the
hospital should have numerous waste disposal cans that have an automatic
lid to not only allow for proper disposal of items but also reduce the
possibility that flies and other insects reach the cans (Creedon, 2005).
These cans should not only be clean but also emptied on a regular basis
to allow for enhanced cleanliness and safety within the healthcare
facility. Of particular note is the importance of ensuring that an
inspection of the facility to ensure that any garbage is properly
disposed. Indeed, janitors and other garbage collection workers must
regularly comb public areas to ensure no garbage is in the public spaces
(Creedon, 2005). On the same note, the waste disposal cans should be
placed in strategic places so as to give the public an incentive to take
charge and dispose their waste in an appropriate manner.
Jackson, M., Chiarello, L.A., Gaynes, R.P., & Gerberding, J.L. (2002).
Nurse staffing and healthcare-associated infections: Proceedings from a
working group meeting. Journal of Nursing Administration, 32(6),
Chen, Y.C., & Chiang, L.C. (2007). Effectiveness of hand-washing
teaching programs for families of children in pediatric intensive care
units. Journal of Clinical Nursing, 16(6), 1173-1179.
Creedon, S.A. (2005). Healthcare workers’ hand decontamination
practices: Compliance with recommended guidelines. Journal of Advanced
Nursing, 51(3), 208-216.
Hugonnet, S., Uckay, I., & Pittet, D. (2007). Staffing level: A
determinant of late-onset ventilator-associated pneumonia. Critical
Care, 11(4), 1-7.