Employee education found in cyberspace
Hospital’s Internet home page’ an important tool
A hospital newsletter that provides information on timely infection control issues educates not only the institution’s employees, but also anyone in the world with a computer, a modem, and access to the Internet’s World Wide Web.
Responses to the "home page" developed by Patrick S. Traynor, BS, infection control specialist at Barnes-Jewish Hospital of the Washington University Medical Center in St. Louis, have been received from as far away as France and Borneo, he says.
The home page recently was adapted from a hard-copy version of a quarterly newsletter initiated last year to improve communication and education related to infection control issues. Those include timely reminders such as the need for vaccinations, prevention of tuberculosis infection, isolation precaution standards, updates on infection control policies, portions of the infection control manual, reinforcement of employee inservices, and information on any hospital outbreaks.
He also can provide "hot links" to other relevant World Wide Web sites, such as federal Centers for Disease Control and Prevention publications. Plans are to provide information on new guidelines from regulatory agencies, articles by specialists at the 14-hospital system that includes Barnes-Jewish, and continuing education credits for reading the newsletter.
"Our primary mission is to facilitate the education of personnel throughout the system, and to do it in a more interesting way than has been traditional," he explains. "The Internet certainly contributes to that because it is so hot now. People like to have a reason to be on it."
Both the hard-copy and Web versions of the newsletter are geared toward the hospital’s infection control liaisons in nursing units and departments, which represents about 4,000 employees, Traynor says. Readers are mainly nursing personnel and physicians, although the information is available to anyone who either reads a hard copy posted on various bulletin boards or who has access to a computer equipped for the Internet. Hard-copy versions also are sent to all 14 hospitals’ head nurses, clinical service line directors, and infection control committee members.
Anyone can do it
Admittedly a computer whiz, Traynor says any employee health or infection control practitioner can accomplish similar feats in cyberspace with only basic computer knowledge and a good desktop publishing program.
Get started with just a hard-copy newsletter at first, he suggests. After establishing his hospital’s hard-copy newsletter, Traynor then began to transfer it electronically to the Internet home page he established. Initially, he spent about 40 hours over a month’s time setting up the home page, but now the entire process of converting the newsletter to home-page form requires only a couple of hours for each issue. Articles are edited separately by the chairman of the infection control committee.
Start-up costs are less than $100. Traynor uses the Microsoft Publisher desktop publishing software program (about $50), produces one hard copy, and has 500 copies printed by the hospital’s copy shop (about $50).
User access to the home page requires a computer equipped with a Web browser, such as Netscape Navigator (available free on line) or Mosaic, and a connection to the Internet.
"Many hospitals already have an Internet account. One reason it was so cheap for me to do [the newsletter] here was that I just took advantage of our already existing Internet access," Traynor says.
Internet access unbelievably cheap’
Any hospital affiliated with an educational institution also can use existing accounts, "but people at smaller hospitals that don’t have [access] can get it unbelievably cheap," he notes. Subscriptions to commercial on-line services such as America Online, CompuServe, and Prodigy are available for as little as $9.95 per month, which includes space for an Internet home page, as well as instructions on how to create one. Software needed to set up a home page is "shareware," programs that can be downloaded for free.
Traynor says response to the hospital’s educational information has been positive, both from employees and more distant cyberspace navigators.
"[Employees] think it’s very convenient and they’re glad to see those issues being addressed. I’m surprised at how many good comments I’ve gotten from doctors who are interested in infection control issues and feel that the information is good to have out there. It’s amazing how many responses I’ve had literally from all over the world now. People who are on the Internet looking for medical and infection control home pages can read our newsletter and send me mail with the click of a button," he says.
Although Traynor doesn’t foresee cyberspace education replacing periodic employee inservices, Internet use can provide valuable reinforcement.
"The Internet is an educational tool that is lying there waiting to be used if you know how to use it," he says. "Because the Internet makes the infection control home page available literally worldwide, the potential for far-reaching infection control education and public relations opportunities are limitless."
[Editor’s note: The Internet’s World Wide Web address for Barnes-Jewish Hospital’s infection control home page is: http://osler.wustl.edu/traynor/gjcicn. html.
For more information on setting up your own educational home page for employees and the world, contact Patrick S. Traynor, infection control specialist, Barnes-Jewish Hospital, Box 8150, 216 S. Kingshighway Blvd., St. Louis, MO 63110. Telephone (314) 454-5573.]
A new brochure presents a line of audiovisual and computer-based safety training programs for compliance with OSHA chemical hazard and biohazard regulations. In the chemical area, the brochure lists two 14- to 16-minute videotapes on right-to-know in English and Spanish. The biohazard line includes "Bloodborne Pathogens Annual Retraining" and "Guarding Against Tuberculosis." These programs, plus "A Model Exposure Control Plan for Laboratories," offer training that follows OSHA/CDC guidelines. Preview tapes are available for all videos.
A computer demo disk is available for "OSHA Bloodborne Pathogens Compliance," a self-paced interactive software program. To obtain the free brochure or to arrange for preview tapes or a demo disk, contact SAVANT Audiovisuals, P.O. Box 3670, Fullerton, CA 92834. Telephone: (800) 472-8268 or (714) 870-7880. Fax: (714) 526-7400.
The Wellness Councils of America (WELCOA) has produced Well-Informed: A Report to Management on Asthma. According to the report, if asthma is not controlled, one sufferer can cost employers about $600 per year in health care costs, $1,033 in lost productivity, and a day per month in absenteeism. The report discusses asthma as a chronic disease, outlines its costs for employers, and gives implications for employers under the Americans with Disabilities Act and the Family and Medical Leave Act. It also provides a fact sheet to be copied and distributed to employees. Cost is $9.95 for non-WELCOA members. Contact WELCOA, 7101 Newport Ave., Suite 311, Omaha, NE 68152. Telephone: (402) 572-3590.
Physicians’ Online (POL) with 115,000 members, the largest on-line information and communication network of physicians will provide its members five free hours of World Wide Web access each month. The service offers physicians access to National Library of Medicine databases such as Medline, and to hospital databases, drug databases, medical news, e-mail, discussion groups, and medical association forums. POL members also will be able to access medical Web site reviews and contribute feedback. Members must request and install POL software. Time in excess of five free hours per month costs $1.95 per hour. Contact Physicians’ Online, 560 White Plains Roads, Tarrytown, NY 10591. Telephone: (914) 332-6100. Fax: (914) 332-6445.
Camins BC, Bock N, Watkins DL, et al. Acceptance of isoniazid therapy by health care workers after tuberculin skin test conversion. JAMA 1996; 275:1,013-1,016.
Researchers who followed 125 health care workers (hospital employees, house staff, and medical students) who tested positive for tuberculosis exposure at Grady Memorial Hospital in Atlanta found that despite a high acceptance rate of isoniazid preventive therapy, a sizable proportion of workers, especially nonphysician HCWs, did not complete treatment.
"Adhering to the treatment regimen of daily doses of isoniazid for six months proved to be difficult for a number of HCWs," state the authors, who note that 98% (123) of the 125 HCWs saw physicians after their tests and were encouraged to begin isoniazid treatment to prevent active TB.
Pharmacy records show that 105 workers (84%) began treatment but only 69 (55%) completed it. Twenty-five of 34 physicians (74%) completed treatment, compared to 44 of the 91 nonphysician employees (48%).
At Grady, an inner-city public hospital, HCWs are required to undergo TB testing every six months or face dismissal. The researchers’ objective was to examine workers’ acceptance of and adherence to isoniazid preventive therapy in the setting of a comprehensive tuberculin skin-testing program.
The study included 119 HCWs who had a tuberculin skin test conversion during the study period, five HCWs with histories of Bacille Calmette-Guerin vaccination who had positive tuberculin skin tests during the study period, and one anergic HCW who also was offered preventive therapy. All 125 workers had chest radiographs performed. Radiographs were normal for 123 HCWs; the other two showed radiological evidence of prior TB.
For the nonphysician employee group, job classification was not associated with therapy completion. Of the HCWs who started treatment, physicians were more likely to complete it (25 of 30 [83%]) than were other employees (44 of 75 [59%]).
Thirty-six (34%) of the 105 HCWs who began therapy did not complete it. Their mean duration of treatment was 2.3 months. Twelve (33%) discontinued therapy due to an adverse effect (malaise, nausea and vomiting, numbness of toes or fingers, sedation or restlessness, rash, arthralgia or arthritis, abnormal liver function tests, leg and thigh muscle cramps, or diarrhea) attributed to the drug; 24 HCWs (67%) were noncompliant.
The authors note that compliance rates among physicians were higher than those previously reported in the literature. The high rates of acceptance of preventive therapy in both groups at Grady could be due to the high numbers seen by physicians and encouraged to begin treatment, they state.
As many HCWs chose not to complete the full treatment regimen, however, the authors suggest "adherence and compliance rates might be improved by providing a more convenient or simpler treatment regimen such as directly observed administration of isoniazid preventive therapy twice a week." Higher therapy completion rates also might be obtained with drugs having fewer side effects or multiple drugs given for much shorter periods of time, which currently are under investigation.
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