No abstract

Abstract. While neglect, exploitation, denial of human rights and abuse of nursing home residents can be found in both non-profit and for-profit nursing homes, substantially higher non-compliance with the law is found among for-profits. A significant source of non-compliance is pressure on senior management from proprietors to reach financial goals that can only be attained by cutting corners on quality of care. This source of non-compliance is stronger among for-profits than nonprofits in a sample of 410 Australian nursing homes. These data therefore supply more systematic support for what has been a commonplace observation in the corporate crime literature: that pressure for lawbreaking comes from the top down and from profits.

Background. The rate of central-line-associated bloodstream infection (CLABSI) in South African (SA) public sector neonatal intensive care units (NICUs) is unknown. Tygerberg Children's Hospital (TCH), Cape Town, introduced a neonatal CLABSI surveillance and prevention programme in August 2012. Objectives. To describe CLABSI events and identify risk factors for development of CLABSI in a resource-limited NICU. Methods. A retrospective case-control study was conducted using prospectively collected NICU CLABSI events matched to four randomly selected controls, sampled from the NICU registry between 9 August 2012 and 31 July 2014. Clinical data and laboratory records were reviewed to identify possible risk factors, using stepwise forward logistic regression analysis. Results. A total of 706 central lines were inserted in 530 neonates during the study period. Nineteen CLABSI events were identified, with a CLABSI rate of 5.9/1 000 line days. CLABSI patients were of lower gestational age (28 v. 34 weeks; p=0.003), lower median birth weight (1 170 g v. 1 975 g; p=0.014), had longer catheter dwell times (>4 days) (odds ratio (OR) 5.1 (95% confidence interval (CI) 1.0 -25.4); p=0.04) and were more likely to have had surgery during their NICU stay (OR 3.5 (95% CI 1.26 -10); p=0.01). Significant risk factors for CLABSI were length of stay >30 days (OR 20.7 (95% CI 2.1 -203.2); p=0.009) and central-line insertion in the operating theatre (OR 8.1 (95% CI 1.2 -54.7); p=0.03). Gram-negative pathogens predominated (12/22; 54%), with most isolates (10/12; 83%) exhibiting multidrug resistance. Conclusion. The TCH NICU CLABSI rate is similar to that reported from resource-limited settings, but exceeds that of high-income countries. Prolonged NICU stay and central-line insertion in the operating theatre were important risk factors for CLABSI development. Intensified neonatal staff training regarding CLABSI maintenance bundle elements and hand hygiene are key to reducing CLABSI rates.

Bandura's (1986) social cognitive theory is proposed as an alternative theoretical framework from which to view the role of managerial cognitions in determining corporate compliance with the law. A first test is made of the usefulness of the construct of managerial self-efficacy in predicting compliance. Data were drawn from interviews with 410 chief executives of small organizations. The predictive utility of self-efficacy is tested with three compliance measures: a self-assessed compliance measure, a government-assessed compliance measure taken at the same time as the self-efficacy measure, and a government-assessed compliance measure taken after a 2-year time lapse. After taking into account a number of significant background variables and making a distinction between self-efficacy beliefs and control beliefs, self-efficacy was found to be significantly related to compliance in all cases. The implications of these results for the regulatory process are discussed.

No abstract