Assessing a Novel Method to Reduce Anesthesia Machine Contamination: A Prospective, Observational Trial.

BACKGROUND: Anesthesia machines are known reservoirs of bacterial species, potentially contributing to healthcare associated infections (HAIs). An inexpensive, disposable, nonpermeable, transparent anesthesia machine wrap (AMW) may reduce microbial contamination of the anesthesia machine. This study quantified the density and diversity of bacterial species found on anesthesia machines after terminal cleaning and between cases during actual anesthesia care to assess the impact of the AMW. We hypothesized reduced bioburden with the use of the AMW. METHODS: In a prospective, experimental research design, the AMW was used in 11 surgical cases (intervention group) and not used in 11 control surgical cases. Cases were consecutively assigned to general surgical operating rooms. Seven frequently touched and difficult to disinfect "hot spots" were cultured on each machine preceding and following each case. The density and diversity of cultured colony forming units (CFUs) between the covered and uncovered machines were compared using Wilcoxon signed-rank test and Student's t-tests. RESULTS: There was a statistically significant reduction in CFU density and diversity when the AMW was employed. CONCLUSION: The protective effect of the AMW during regular anesthetic care provides a reliable and low-cost method to minimize the transmission of pathogens across patients and potentially reduces HAIs.

Barriers and Facilitators to Implementing Holistic Admission Review in Graduate Advanced Nursing Programs.

BACKGROUND: There are strong recommendations and high demand for the use of holistic admission review (HAR). However, there is no study exploring and identifying barriers and facilitators to implementing HAR in health care education programs. METHOD: This qualitative descriptive study aimed to understand the key determinants influencing the integration of HAR in graduate advanced nursing programs. Two online focus groups with content analysis were used to identify barriers and facilitators. RESULTS: The findings highlight 39 key determinants of HAR implementation in the graduate advanced nursing program; the determinants included four neutral influencing factors, 18 barriers, and 17 facilitators. These influencing factors aligned with all four domains in the Consolidated Framework for Implementation Research (CFIR) and with 20 of the 39 CFIR constructs. CONCLUSION: By taking into account the facilitators and barriers, graduate advanced nursing programs may use effective implementation strategies to integrate HAR changes and guide their evolving admissions processes. [J Nurs Educ. 2023;62(10):570-574.].

A High-Fidelity Simulation Study of Intraoperative Latent Hazards and Their Impact on Anesthesia Care-Related Handoff Outcomes.

The "handoff" phase of patient care is frequently associated with the genesis of adverse events. Patient handoffs in anesthesia care remain poorly studied. By reviewing archived video of anesthesia handoffs taking place in a simulated environment, we aimed to identify latent conditions and their impact on the quality and nature of handoffs occurring during surgical anesthesia care. Four trained coders assessed 58 handoffs occurring in 58 different simulated cases, for the presence or absence of 4 latent conditions: distractions, production pressure, noninteractive communication, and inappropriately timed handoff. Latent hazards frequently jeopardized handoff quality. Distractions and interruptions were conditions observed in 82% of cases; independently these did not appear to degrade handoff quality. The latent condition noninteractive communication was the greatest predictor of poor handoff scores (P < .001). Handoffs were often good or excellent with 0, 1, or 2 latent conditions present, but with 3 or more latent conditions, the quality invariably degraded. When handoff scores were high, the handoffs were always interactive. This is the first study to relate specific latent conditions to handoff quality, providing a foundation for future research, as well as for the education and training of anesthesia providers.

Application of the Synergy Model with the surgical care of smokers.

The Synergy Model for Patient Care, developed by the American Association of Critical-Care Nurses (AACN), demonstrates that positive patient outcomes are achieved when patient characteristics are matched with nurse competencies. This article describes how effective nursing practice, whether providing smoking cessation counseling or evaluating preoperative laboratory tests, must be centered around the needs and characteristics of patients. Smokers requiring surgical intervention have unique needs and require nurses with competent skills to help promote optimal pulmonary, cardiovascular, and wound healing outcomes.

Understanding the complete blood count with differential.

The complete blood count (CBC) with differential is one of the most common laboratory tests performed today. It gives information about the production of all blood cells and identifies the patient's oxygen-carrying capacity through the evaluation of red blood cell (RBC) indices, hemoglobin, and hematocrit. It also provides information about the immune system through the evaluation of the white blood cell (WBC) count with differential. These tests are helpful in diagnosing anemia, certain cancers, infection, acute hemorrhagic states, allergies, and immunodeficiencies as well as monitoring for side effects of certain drugs that cause blood dyscrasias. Nurses in the perianesthesia arena are frequently challenged to obtain and evaluate all or parts of the CBC as a part of the patient's preoperative, intraoperative, and postoperative assessments. An enhanced understanding of this laboratory test is essential to providing quality care.