الفهرس 
Epidemoilogy Of ESRD
Ethical considerationsOnly 14 pages are availabe for public view
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Abstract
End Stage Renal Disease [ESRD] represents one of the major health problems in Egypt. The prevalence rate of ESRD is increasing in Egypt as it is increased from 225 per million population in 1996 to reach 264 in 1998 and up to 314 per million population in 2000.
Quality can be defined as compliance with or adherence to standards.
Quality can be measured once health care professionals define the standards under which they can comfortably practice. Acceptable compliance with standards is now the basis for health care organizations accreditation.
The national program of accreditation in Egypt has established some standards for certain clinical areas in hospital services including surgery and anaesthesia but the quality standards for haemodialysis units have not yet established in Egypt. So the aim of this Study is to develop a quality standards for haemodialysis units and measure the compliance for the developed set of quality standards in a sample of haemodialysis units then provide a preliminary quality standards ,for Ministry of Health and Population, as an initiative for national standards.
This study was conducted in Cairo and Giza governorates (There were 7 hospitals from Cairo and 9 hospitals from Giza). It was carried out in four phases. In phase one a preliminary quality standards were formulated through reviewing of literature and a meeting with an expert of nephrology. And so the preliminary quality standards were formulated. In phase two a panel of experts in the filed of nephrology and haemodialysis was selected and invited to participate to come up with the final version of quality standards through the Delphi technique which was applied to build up the consensus among the experts. This final version of standards and guidelines consists of 5 sections; Personnel, Patient care practice, Infection prevention and control, Facility and Documentation / Records. As regards personnel, it included consultant, medical director, haemodialysis physicians, nursing supervisor, dialysis nurse, and number of staff per patient. Regarding Patient care practices, this section included writing orders for haemodialysis , pre dialysis preparation, Dialysis (initiation, monitoring, termination of dialysis), post dialysis procedures and between dialysis As for infection prevention and control the following items were included; vaccination of patients, infectious diseases / occupation of health and immunization, general infection prevention measures, processing, sterilization and disinfection, and Housekeeping and waste management Regarding The facility. It included; Administrative standards General / physical standards, Nursing station and Dialysis treatment areas. As regards Documentation Records; Employee records, medical records, and storage and retention of records were included. In phase three description of each standard was written with its verification.
In phase four field visits to haemodialysis units were conducted to assess the compliance of these units. Seven Hospitals from Cairo and nine Hospitals from Giza were included in the study. 160 patients were observed during their sessions of haemodialysis and 160 patient records were assessed.
The results of this study showed that the overall mean percentage of compliance among all hospitals was 59.3 ± 11.2 and the range was 43.8 to 83.4 Regarding the different items of haemodialysis guidelines, it was clear that adherence of hamodialysis units to facility guidelines was the lowest being scored 51.5 ± 18.2 while the mean score of patient case practice was ranked the highest 68.5 ± 16. The comparison between the overall mean percentage of compliance between cairo and Giza revealed no significant difference while there were significant differences between the two governorates regarding certain items which were infection prevention and control, and facility guidelines The difference was in favor for Giza governorate and it may be attributed to the mix of hospitals in Giza as it included health insurance hospitals and police hospitals which were structured and equipped than most of the general hospitals in Cairo.
Regarding detailed analysis of the sub items in each section some were satisfactory while others were unsatisfactory. As regards the sub items of infection prevention and control the vaccination of patients against hepatitis B was very low with mean percentage of compliance = 13.75± 29.65.
The results also revealed the low vaccination coverage by hepatitis B vaccine among physicians as only 49% of them were vaccinated in Cairo hospitals compared too 55% in Giza hospitals. More over no one was vaccinated against tetanus toxoid
As for administration standards, only 3 haemodialysis units out of 16
study units have an organization chart with job description and responsibilities of all personnel working in the unit Also the results pointed out the availability of emergency lightening source in all haemodialysis units except one unit .Fire extinguishers were available in 13 units but there was no available eye station in all the units. Analysis of personnel section revealed that only two medical directors got certificate in BCLS. More over the majority of haemodialysis physicians and nurses do not have certificates in BCLS.
As regards, the compliance for documentation and records guidelines, the responses was very low as the mean percentage of compliance was 19.8±29 for employee records. In contrary to employee records, the compliance to medical records was much better as the mean percentage of compliance was 63.5 ±16.
Detailed analysis of the sub items of housekeeping and waste management guidelines showed that handling waste materials was in accordance with the national guidelines for infection control. Almost all haemodialysis centers in our study showed proper use and disposal of sharp devices .The mean percentage of compliance for washing hands between patients and after contact with a contaminated objects was 56.2 with a range between 30 to 90. More over the mean percentage of compliance of the appropriate disinfection of haemodialysis dialysis equipment including internal and external surfaces was 73.7.
Classification of the overall mean percent of compliance to the guidelines according to the level of acceptance revealed that four hemodialysis units out of 16 were below the minimal level of accreditation and all of them were located in Cairo.