Leadership in Surgery for Public Sector Hospitals in Jamaica: Strategies for the Operating Room

Abstract

Surgical operations provide opportunities for the transmission of infection between patients and healthcare workers (HCWs) and between patients. This risk may increase in under-developed and developing countries by low compliance with infection control (IC) policies and precautions. This study investigated HCWs attitude and compliance with infection control practices in the operating department (OD) of a Jamaican teaching hospital, with the objective of obtaining data to design evidence-based interventions. A single-centre, cross-sectional, descriptive study, using a self-administered questionnaire, was conducted between March and May 2009. Ninety doctors and forty-two nurses, representing 73% and 75% respectively of their total OD population, participated in the study. Reported compliance was low: only 17% of all participants were compliant with all of the seven infection control policies inquired into. The results also showed that HCWs were selective in what practices they adhered to: reported rates of compliance were high for hand-washing (100%), use of gloves (98%), use of gowns (83%) and facemasks (87%); but low for use of eye protection mask (56%), not re-sheathing needles (46%) and changing clothes when exiting and re-entering the OD (55%). Discrepancies were observed between attitude and compliance rates in such cases as 'use of facemasks'-low favourableattitude (68%) but high compliance; 'use of eye protection masks'-high favourable-attitude (100%) but low Corresponding Author

Impact of a medical university on laparoscopic surgery in a service-oriented public hospital in the Caribbean

“…There are numerous obstacles to the advancement of laparoscopy in the Caribbean, including negative attitudes toward laparoscopy,2,5,16 equipment deficiencies,2 financial constraints,2,17 ineffective leadership,5,18 and high demand for operating time and lists 3. The POSGH was a typical Caribbean hospital where these factors were in play, limiting laparoscopic surgical practice.…”

“…There were also many “self-imposed obstacles” such as deficiencies in surgical leadership,5 lack of prioritization by policy makers,2,5 and the “sole practitioner culture”6 that prevailed in the Caribbean. This led to high rates of emigration of skilled health care workers,7 compounding the deficiencies.…”

Evolution of SILS Cholecystectomy in the Caribbean: The Direct Transfascial Puncture Technique Using Conventional Instruments without Working Ports

“…The first SILC in the Caribbean was performed in Jamaica in 2009 [ 2 ]. There are several challenges preventing minimally invasive surgery from being established in this environment [ 18 – 20 ]. At the forefront is the fact that this is a developing nation with an underfunded health care system [ 18 ].…”

“…There are several challenges preventing minimally invasive surgery from being established in this environment [ 18 – 20 ]. At the forefront is the fact that this is a developing nation with an underfunded health care system [ 18 ]. The public health care system cannot afford to procure access platforms, flexible scopes, or curved instruments.…”

An Audit of Clinician Compliance with Best Practice Recommendations to Repair Severe Obstetric Anal Sphincter Injuries

“…This is 1 of 2 tertiary referral hospitals that serve an estimated catchment population of 826,880 persons in and around Kingston, the capital of Jamaica. 10 This hospital facilitates 1696 vaginal deliveries each year. 1 The new practice guidelines were introduced at this institution in 2007 8 and rolled out in four stages.…”