Safety and Health at Work

Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency (산업안전보건연구원)
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Repeat Auditing of Primary Health-care Facilities Against Standards for Occupational Health and Infection Control: A Study of Compliance and Reliability

  • Cloete, Brynt (School of Public Health and Family Medicine, University of Cape Town) ;
  • Yassi, Annalee (School of Population and Public Health, University of British Columbia) ;
  • Ehrlich, Rodney (School of Public Health and Family Medicine, University of Cape Town)
  • Received : 2019.07.10
  • Accepted : 2019.12.04
  • Published : 2020.03.30
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Abstract

Background: The elevated risk of occupational infection such as tuberculosis among health workers in many countries raises the question of whether the quality of occupational health and safety (OHS) and infection prevention and control (IPC) can be improved by auditing. The objectives of this study were to measure (1) audited compliance of primary health-care facilities in South Africa with national standards for OHS and IPC, (2) change in compliance at reaudit three years after baseline, and (3) the inter-rater reliability of the audit. Methods: The study analyzed audits of 60 primary health-care facilities in the Western Cape Province of South Africa. Baseline external audits in the time period 2011-2012 were compared with follow-up internal audits in 2014-2015. Audits at 25 facilities that had both internal and external audits conducted in 2014/2015 were used to measure reliability. Results: At baseline, 25% of 60 facilities were "noncompliant" (audit score<50%), 48% "conditionally compliant" (score >50 < 80%), and only 27% "compliant" (score >80%). Overall, there was no significant improvement in compliance three years after baseline. Percentage agreement on specific items between internal and external audits ranged from 28% to 92% and kappa from -0.8 to 0.41 (poor to moderate). Conclusion: Low baseline compliance with OHS-IPC measures and lack of improvement over three years reflect the difficulties of quality improvement in these domains. Low inter-rater reliability of the audit instrument undermines the audit process. Evidence-based investment of effort is required if repeat auditing is to contribute to occupational risk reduction for health workers.

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References

  1. National Institute for Clinical Excellence. Principles for best practice in clinical audit. Oxford (UK): Radcliffe Medical Press; 2002.
  2. French GL. Closing the loop: audit in infection control. J Hosp Infect 1993;24:301-8. https://doi.org/10.1016/0195-6701(93)90062-5
  3. Brubakk K, Vist GE, Bukholm G, Barach P, Tjomsland O. A systematic review of hospital accreditation: the challenges of measuring complex intervention effects. BMC Health Serv Res 2015;15:280. https://doi.org/10.1186/s12913-015-0933-x.
  4. Department: statistics SA (Stats SA). Public health care: how much per person?;Oct 2 2017.. http://www.statssa.gov.za/?p=10548. [Accessed 10 July 2019].
  5. National Department of Health. National strategic plan 2014/15-2018/19;2014. Pretoria (South Africa), https://www.health-e.org.za/wp-content/uploads/2014/08/SA-DoH-Strategic-Plan-2014-to-2019.pdf. [Accessed 30 May 2019].
  6. National Department of Health. National core standards for health establishments in South Africa; 2011. Tshwane (South Africa), http://www.rhap.org.za/wp-content/uploads/2014/05/National-Core-Standards-2011-1.pdf. [Accessed 10 July 2019].
  7. Republic of South Africa. National health Act (61/2003): procedural regulations pertaining to the functioning of the office of health standards compliance and handling of complaints by the ombud. Government Gazette. 2 November 2016. 40396, https://archive.opengazettes.org.za/archive/ZA/2016/government-gazette-ZA-vol-617-no-40396-dated-2016-11-02.pdf. [Accessed 5 June 2019].
  8. Uden L, Barber E, Ford N, Cooke GS. Risk of tuberculosis infection and disease for health care workers: an updated meta-analysis. Open Forum Infect Dis 2017;4:ofx137. https://doi.org/10.1093/ofid/ofx137 eCollection 2017 Summer.
  9. Yassi A, Zungu M, Spiegel JM, Kistnasamy B, Lockhart K, Jones D, et al. Protecting health workers from infectious disease transmission: an exploration of a Canadian-South African partnership of partnerships. Glob Health 2016;12:10. https://doi.org/10.1186/s12992-016-0145-0.
  10. Ehrlich R, Van der Water N, Yassi N. Tuberculosis as an occupational disease. Anthropol South Africa 2018;41:309-22. https://doi.org/10.1080/23323256.2018.1539624
  11. Republic of South Africa. Occupational health and safety Act no. 85 of 1993. https://www.gov.za/documents/occupational-health-and-safety-act (Accessed 9 January 2020).
  12. Health Systems Trust. The national health care facilities baseline audit: national summary report 2012 (revised 2013); 2013. Westville (South Africa), https://www.hst.org.za/publications/HST%20Publications/NHFA_webready_0.pdf#search=NHFA. [Accessed 9 October 2019].
  13. Cohen JA. Coefficient of agreement for nominal scales. Educ Psychol Meas 1960;20:37-46. https://doi.org/10.1177/001316446002000104
  14. Viera AJ, Garrett JM. Understanding interobserver agreement: the kappa statistic. Fam Med 2005;37:360-3.
  15. Whittaker S, Shaw C, Spieker N, Linegar A. Quality standards for healthcare establishments in South Africa. In: Padarath A, English R, editors. South African health review 2011. Durban (South Africa): Health Systems Trust. 2011. p. 59-67.. http://www.hst.org.za/publications/South%20African%20Health%20Reviews/sahr_2011.pdf. [Accessed 30 May 2019].
  16. Mphahlele MT, Tudor C, Van der Walt MML, Farley JE. Infection control audit in 10 primary health-care facilities in the Western Cape Province of South Africa. Int J Infect Control 2012;8:i3. https://doi.org/10.3396/ijic.v8i3.025.12.
  17. Adams S, Ehrlich R, Ismail N, Quail Z, Jeebhay MF. Occupational health challenges facing the Department of Health: protecting employees against tuberculosis and caring for former mineworkers with occupational health disease. In: Padarath A, English R, editors. South African health review 2012/2013. Durban (South Africa): Health Systems Trust. 2013. p. 67-82.. https://www.hst.org.za/publications/South%20African%20Health%20Reviews/HST%20SAHR%202017%20Web%20Version.pdf. [Accessed 10 July 2019].
  18. Robson LS, Bigelow PL. Measurement properties of occupational health and safety management audits: a systematic literature search and traditional literature synthesis. Can J Public Health 2010;101(Suppl. 1):S34-40. https://doi.org/10.1007/BF03403844
  19. Hermida J, Broughton EI, Miller Franco L. Validity of self-assessment in a quality improvement collaborative in Ecuador. Int J Qual Health Care 2011;23:690-6. https://doi.org/10.1093/intqhc/mzr057
  20. Katzenellenbogen J, Joubert G. In: Joubert G, Ehrlich R, editors. Epidemiology: a research manual for South Africa. 3rd ed. Cape Town (South Africa): Oxford University Press Southern Africa; 2014. p. 111-29.
  21. Bryce E, Copes R, Gamage B, Lockhart K, Yassi A. Staff perceptions and institutional reporting: two views of infection control compliance in British Columbia and Ontario three years after an outbreak of severe acute respiratory syndrome. J Hosp Infect 2008;69:169-76. https://doi.org/10.1016/j.jhin.2008.03.010
  22. Bryce EA, Scharf S, Walker M, Walsh A. The infection control audit: the standardized audit as a tool for change. Am J Infect Control 2007;35:271-83. https://doi.org/10.1016/j.ajic.2006.05.293
  23. Australian Council on Healthcare Standards. The ACHSNational report on health services AccreditationPerformance 2011 - 2012. Sydney NSW: ACHS. 2013.. https://www.achs.org.au/media/76734/nar_report_2013.pdf. [Accessed 10 July 2019].
  24. The Joint Commission. America's hospitals: improving quality and safety. The Joint Commission's Annual Report; 2015.. http://www.jointcommission.org/tjc_annual_report_2015/. [Accessed 10 July 2019].
  25. Hay A. Audit in infection control. J Hosp Infec 2006;62:270-7. https://doi.org/10.1016/j.jhin.2005.09.008
  26. Nouwens E, van Lieshout J, Wensing M. Determinants of impact of a practice accreditation program in primary care: a qualitative study. BMC Fam Pract 2015;16:78. https://doi.org/10.1186/s12875-015-0294-x.
  27. Sekimoto M, Imanaka Y, Kobayashi H, Okubo T, Kizu J, Kobuse H, et al. Factors affecting performance of hospital infection control in Japan. Am J Infect Control 2009;37:136-42. https://doi.org/10.1016/j.ajic.2008.03.005
  28. Griffiths P, Renz A, Hughes J, Rafferty AM. Impact of organisation and management factors on infection control in hospitals: a scoping review. J Hosp Infect 2009;73:1-14. https://doi.org/10.1016/j.jhin.2009.05.003
  29. Kelley E, Kelley AG, Simpara CHT, Sidibe O, Makinen M. The impact of selfassessment on provider performance in Mali. Int J Health Plann Manage 2003;18:41-8. https://doi.org/10.1002/hpm.688
  30. Shojaee J, Moosazadeh M. Determining the status quo of infection prevention and control standards in the hospitals of Iran: a case study in 23 hospitals. Iran Red Crescent Med J 2014;16:e14965. https://doi.org/10.5812/ircmj.14695.
  31. Jamtvedt G, Young JM, Kristoffersen DT, O'Brien MA, Oxman AD. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev Issue 2006;2. https://doi.org/10.1002/14651858.CD000259.pub2. Art. No.: CD000259.
  32. Liddy C, Wiens M, Hogg W. Methods to achieve high interrater reliability in data collection from primary care medical records. Ann Fam Med 2011;9:57-62. https://doi.org/10.1370/afm.1195

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