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Aims: Increasing focus on
improvement and optimisation of the treatment in primary care and reduction of
healthcare costs emphasize the need to understand which factors determines
adherence and non-adherence to clinical guidelines. In the present study, we
examined attitudes towards clinical guidelines in Danish general
practitioners (GPs). Methods: We conducted a survey among Danish GPs from all
five regions of Denmark. In total, 443 GPs answered the web-based questionnaire
that contained questions about attitudes and barriers to clinical guidelines. Results:
More than 90% of the GPs reported that they have good knowledge of the
guidelines and in general follows the guidelines. A majority of the GPs (81%)
found it acceptable that economic considerations are part of the guidelines.
The most important factors for non- adherence to guidelines were “need of
adjustment to clinical practice” and “lack of confidence in guidelines”.
The attitudes to clinical guidelines were not significantly associated with
practice characteristics such as gender, years of experience, practice
organisation and localisation. Conclusions: Our findings show that clinical
guidelines are an integrated or internalised part of everyday practice among
GPs in Denmark. Furthermore, the findings indicate that Danish GPs are positive
towards applying priority setting in their practice. This is decisive in the
light of rising healthcare costs due to development of new expensive
technologies and ageing populations that puts pressure on the healthcare system
in general and primary healthcare in particular.
Floor drains in processing environments harbor Listeria spp. due to continuous presence of humidity and organic substrates. Cleaning and washing activities in food-processing facilities can translocate the bacterial cells from the drain to the surrounding environment, thus contaminating food products still in production. This study evaluated the potential for translocation of Listeria monocytogenes from drains to food contact surfaces in the surrounding environment using Listeria innocua as a surrogate. A 7 × 7 × 8-foot polycarbonate flexi-glass chamber with a 10-inch-diameter drain mounted on an aluminum cabinet was used. Stainless steel coupons (6.4 × 1.9 × 0.1 cm, 12 per height) were hung at 1, 3, and 5 feet inside the chamber. Four treatment sets; non-inoculated, non-treated; non-inoculated, treated; inoculated, treated; inoculated non-treated; and two subtreatments of 8 h and 48 h were performed. For the inoculated sets, meat slurry (10 gof ground beef in 900 mL water) and a four-strain cocktail of Listeria innocua at 7 - 8 log CFU/mL were used. For the treated sets, in addition, a commercial cleaner and sanitizer was applied. The drain was cleaned using a pressure hose (40 - 50 psi) after 8 h and 48 h. Coupons were then removed and enriched in listeria enrichment broth to establish if any cell translocated from the drain onto the stainless steel coupons via aerosols generated during washing. Confirmation was done using VIP Listeria rapid test kits. Results indicated translocation at all three heights ranging from 2% - 25%. Significantly higher translocation (p < 0.05) was found at 1 foot (up to 25%), followed by 3 feet (up to 11%) and 5 feet (up to 2.7%). This research indicated that translocation of Listeria spp. from drains to food contact surfaces does occur and increases with increased proximity to the drain.