Factors Influencing Nurses' Use of Hazardous Drug Safe-Handling Precautions.

PURPOSE/OBJECTIVES: To identify factors associated with oncology nurses' use of hazardous drug (HD) safe-handling precautions in inpatient clinical research units.
. DESIGN: Descriptive, cross-sectional.
. SETTING: The National Institutes of Health Clinical Center in Bethesda, Maryland.
. SAMPLE: 115 RNs working on high-volume HD administration units. 
. METHODS: Survey data were collected online using the Hazardous Drug Handling Questionnaire. Data were analyzed using descriptive statistics and multiple regression analysis.
. MAIN RESEARCH VARIABLES: Exposure knowledge, self-efficacy, barriers to personal protective equipment use, perceived risk, conflict of interest, interpersonal influences, workplace safety climate, and total mean HD precaution use.
. FINDINGS: Participants demonstrated high exposure knowledge, self-efficacy, perceived risk, interpersonal influences, and workplace safety climate. Participants demonstrated moderate barriers and conflict of interest. Total mean HD precaution use proved highest during HD administration and lowest for handling excreta at 48 hours. Average patients per day significantly influenced total HD precaution. CONCLUSIONS: Despite high exposure knowledge, barriers to personal protective equipment use and conflict of interest may contribute to reduced adoption of personal protective practices among oncology nurses.
. IMPLICATIONS FOR NURSING: Hospital and unit-specific factors captured by the predictor variables could contribute to institutional HD policy.

Improving clinical communication through structured conversation.

Communication failure plays an important role in causing medical errors. Clinical communication is highly complex and prone to error especially during transitions of patient care and emergent situations. Standardized approaches and tools may provide potential solutions to improve the quality of communication and prevent subsequent patient harm. The National Patient Safety Foundation, through its Stand Up for Patient Safety Program, is committed to assisting organizations improve clinical communication.

Central venous catheter-associated bloodstream infections in pediatric oncology home care.

Fifty-two pediatric oncology patients with central venous catheters (CVCs) who received home care services were studied. Gram-negative organisms were responsible for a greater proportion of CVC-associated bloodstream infections in pediatric oncology patients receiving home care than in hospitalized pediatric oncology patients.

An outbreak of Serratia marcescens bacteremia after general anesthesia.

OBJECTIVE: To investigate an outbreak of Serratia marcescens bacteremia among patients after general anesthesia. DESIGN: A case-control study. SETTING: A 304-bed, pediatric teaching hospital. PATIENTS: Twenty-three pediatric patients who developed S. marcescens bacteremia within 2 weeks after general anesthesia between June 15 and September 22, 1999, were compared with 46 age-matched control-patients who had undergone procedures on the same clinical services of the hospital during the same period. RESULTS: Cases were distributed over a wide range of surgical services and were not correlated with exposure to any of the surgical, anesthesia, or nursing staff. Case-patients were significantly more likely than control-patients to have received cefazolin (odds ratio [OR], 11.1; 90% confidence interval [CI90], 1.9 to 24.3) or to have had perioperative placement of a central vascular catheter (OR, 4.2; CI90, 1.2 to 18.8). The timing of the procedures of patients who subsequently developed S. marcescens bacteremia was significantly associated with the shifts of one or more of five operating room technicians (OR, 2.9 to 6.8) who were responsible for preparing intravenous fluids used both to reconstitute perioperatively administered antibiotics and to prime central vascular catheter assemblies. CONCLUSIONS: Our findings are consistent with a pattern of intermittent contamination due to periodic breaches in sterile technique, rather than a point-source of contamination. The unique challenges that such a procedural breakdown presents to an epidemiologic investigation are discussed. This outbreak stresses the importance of providing comprehensive training in antisepsis when multifunctional personnel are incorporated into an operating room work environment.