Elimination of Routine Contact Precautions for Endemic Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus: A Retrospective Quasi-Experimental Study.

OBJECTIVE To evaluate the impact of discontinuation of contact precautions (CP) for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) and expansion of chlorhexidine gluconate (CHG) use on the health system. DESIGN Retrospective, nonrandomized, observational, quasi-experimental study. SETTING Two California hospitals. PARTICIPANTS Inpatients. METHODS We compared hospital-wide laboratory-identified clinical culture rates (as a marker of healthcare-associated infections) 1 year before and after routine CP for endemic MRSA and VRE were discontinued and CHG bathing was expanded to all units. Culture data from patients and cost data on material utilization were collected. Nursing time spent donning personal protective equipment was assessed and quantified using time-driven activity-based costing. RESULTS Average positive culture rates before and after discontinuing CP were 0.40 and 0.32 cultures/100 admissions for MRSA (P=.09), and 0.48 and 0.40 cultures/100 admissions for VRE (P=.14). When combining isolation gown and CHG costs, the health system saved $643,776 in 1 year. Before the change, 28.5% intensive care unit and 19% medicine/surgery beds were on CP for MRSA/VRE. On the basis of average room entries and donning time, estimated nursing time spent donning personal protective equipment for MRSA/VRE before the change was 45,277 hours/year (estimated cost, $4.6 million). CONCLUSION Discontinuing routine CP for endemic MRSA and VRE did not result in increased rates of MRSA or VRE after 1 year. With cost savings on materials, decreased healthcare worker time, and no concomitant increase in possible infections, elimination of routine CP may add substantial value to inpatient care delivery. Infect Control Hosp Epidemiol 2016;1-8.

Value of extended warming in patients undergoing elective surgery.

Perioperative temperature management is imperative for positive surgical outcomes. This study assessed the clinical and wellbeing benefits of extending normothermia by using a portable warming gown. A total of 94 patients undergoing elective surgery were enrolled. They were randomized pre-operatively to either a portable warming gown or the standard warming procedure. The warming gown stayed with patients from pre-op to operating room to postrecovery room discharge. Core temperature was tracked throughout the study. Patients also provided responses to a satisfaction and comfort status survey. The change in average core temperature did not differ significantly between groups (P = 0.23). A nonsignificant 48% relative decrease in hypothermic events was observed for the extended warming group (P = 0.12). Patients receiving the warming gown were more likely to report always having their temperature controlled (P = 0.04) and significantly less likely to request additional blankets for comfort (P = 0.006). Clinical outcomes and satisfaction were improved for patients with extended warming.

Costs of reusable and disposable aprons in a public teaching hospital / Costos de delantales de tejido reutilizables y de desechables en hospital universitario público / Custos de aventais de tecido reutilizáveis e de descartáveis em hospital universitário público

Objective To analyze the direct cost of reusable and disposable aprons in a public teaching hospital. Method Cross-sectional study of quantitative approach, focusing on the direct cost of reusable and disposable aprons at a teaching hospital in northern Paraná. The study population consisted of secondary data collected in reports of the cost of services, laundry, materials and supplies division of the institution for the year 2012 Results We identified a lower average cost of using disposable apron when compared to the reusable apron. The direct cost of reusable apron was R$ 3.06, and the steps of preparation and washing were mainly responsible for the high cost, and disposable apron cost was R$ 0.94. Conclusion The results presented are important for hospital managers properly allocate resources and manage costs in hospitals
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Objetivo Analizar el costo directo de delantales de tejido reutilizables y de desechables en hospital universitario público. Método Estudio transversal de abordaje cuantitativo, con énfasis en el costo directo de los delantales de tejido reutilizables y desechables, realizado en hospital universitario del norte de Paraná. La población de estudio estuvo compuesta de datos secundarios recogidos en informes de los servicios de costo, lavandería, división de material y provisiones de la institución, referentes al año de 2012. Resultados Se identificó un menor costo medio de utilización del delantal desechable cuando comparado con el costo del delantal de tejido reutilizable. El costo directo de utilización del delantal de tejido fue de R$3,06, siendo las etapas de confección y lavado las principales responsables de la elevación del costo, y el delantal desechable costó R$0,94. Conclusión Los resultados presentados constituyen herramientas para que los gestores hospitalarios puedan destinar adecuadamente los recursos y gestionar los costos en instituciones hospitalarias. .

Objetivo Analisar o custo direto de aventais de tecido reutilizáveis e de descartáveis em hospital universitário público. Método Estudo transversal de abordagem quantitativa, com enfoque no custo direto de aventais de tecido reutilizáveis e de descartáveis, realizado em hospital universitário do norte do Paraná. A população de estudo foi composta por dados secundários coletados em relatórios dos serviços de custo, lavanderia, divisão de material e suprimentos da instituição, referentes ao ano de 2012. Resultados Identificou-se um menor custo médio de utilização do avental descartável quando comparado ao do avental de tecido reutilizável. O custo direto de utilização do avental de tecido foi de R$ 3,06, sendo as etapas de confecção e lavagem as principais responsáveis pela elevação do custo, e o avental descartável custou R$ 0,94. Conclusão Os resultados apresentados constituem ferramentas para que os gestores hospitalares possam alocar adequadamente os recursos e gerenciar custos em instituições hospitalares.


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A survey of surgical draping practices in small-animal practice in the UK.

Veterinary practices in the United Kingdom were surveyed to compare their surgical draping practices with Royal College of Veterinary Surgeons (RCVS) accreditation tier and other surgery-related factors. Using descriptive statistics and logistic or ordinal regression analysis (where appropriate), the relationships between draping material and accreditation tier and other surgery-related factors were assessed. Procedures were categorised as short or long. Two hundred and sixty-nine surveys were completed. Reusable drapes were used in 66 per cent of practices. Antibiotics were administered routinely in 38 per cent of short and 93 per cent of long procedures. Practices accredited as a Veterinary Hospital (VH) were 6.3-7.2 (short and long surgeries, respectively) times more likely to use disposable drapes, when compared with non-accredited practices. Use of dedicated surgical attire, draping the whole animal/table, and routine antibiotic usage were also positively correlated with disposable drape usage. Fifty-one per cent of practices rated infection rate as most important when choosing drape material. 'Best practice' techniques are associated with lower importance given to infection rate, and higher importance given to financial cost, when choosing drape material. Disposable drape use correlates with RCVS accreditation and with other aspects of surgical technique. Importance ratings awarded correlate with best practice procedures. Clinical relevance 'Best practice' draping procedures, that are not governed by RCVS accreditation scheme, are also more frequently performed in accredited VHs.

Is prophylactic fixation a cost-effective method to prevent a future contralateral fragility hip fracture?

OBJECTIVE: : A previous hip fracture more than doubles the risk of a contralateral hip fracture. Pharmacologic and environmental interventions to prevent hip fracture have documented poor compliance. The purpose of this study was to examine the cost-effectiveness of prophylactic fixation of the uninjured hip to prevent contralateral hip fracture. METHODS: : A Markov state-transition model was used to evaluate the cost and quality-adjusted life-years (QALYs) for unilateral fixation of hip fracture alone (including internal fixation or arthroplasty) compared with unilateral fixation and contralateral prophylactic hip fixation performed at the time of hip fracture or unilateral fixation and bilateral hip pad protection. Prophylactic fixation involved placement of a cephalomedullary nail in the uninjured hip and was initially assumed to have a relative risk of a contralateral fracture of 1%. Health states included good health, surgery-related complications requiring a second operation (infection, osteonecrosis, nonunion, and malunion), fracture of the uninjured hip, and death. The primary outcome measure was the incremental cost-effectiveness ratio estimated as cost per QALY gained in 2006 US dollars with incremental cost-effectiveness ratios below $50,000 per QALY gained considered cost-effective. Sensitivity analyses evaluated the impact of patient age, annual mortality and complication rates, intervention effectiveness, utilities, and costs on the value of prophylactic fixation. RESULTS: : In the baseline analysis, in a 79-year-old woman, prophylactic fixation was not found to be cost-effective (incremental cost-effectiveness ratio = $142,795/QALY). However, prophylactic fixation was found to be a cost-effective method to prevent contralateral hip fracture in: 1) women 71 to 75 years old who had 30% greater relative risk for a contralateral fracture; and 2) women younger than age 70 years. Cost-effectiveness was greater when the additional costs of prophylaxis were less than $6000. However, for most analyses, the success of prophylactic fixation was highly sensitive to the effectiveness and the relative morbidity and mortality of the additional procedure. CONCLUSION: : Prophylactic fixation with a cephalomedullary nail was not found to be cost-effective for the average older woman who sustained a hip fracture. However, it may be appropriate for select patient populations. The study supports the need for basic science and clinical trials investigating the effectiveness of prophylactic fixation for patient populations at higher lifetime risk for contralateral hip fracture.

Planning for a brighter future: a review of sun protection and barriers to behavioral change in children and adolescents.

Skin cancer is one of the most preventable groups of malignancies; however, skin cancer incidence continues to rise in the United States. The relationship between skin cancer and ultraviolet (UV) radiation is well known. Many interventions to prevent skin cancer by reducing exposure to UV radiation have been employed throughout the United States. Studies show an increase in knowledge and awareness regarding sun exposure and skin cancer. Unfortunately, sun protection interventions are slow at effecting behavioral change. In this review, we examine current barriers facing youth today in regards to sun protection practices, appropriate age groups to target for intervention, proposed methods of sun protection, the influence of role models in changing sun protective behavior, the stages of behavioral change, and characteristics and techniques of sun protection programs that can not only increase knowledge but actually elicit changes in sun protection behavior.

The European standard for sun-protective clothing: EN 13758.

Clothing is considered one of the most important tools for sun protection. Contrary to popular opinion, however, some summer fabrics provide insufficient ultraviolet (UV) protection. The European Committee for Standardization (CEN), has developed a new standard on requirements for test methods and labelling of sun-protective garments. This document has now been completed and is published. Within CEN, a working group, CEN/TC 248 WG14 'UV protective clothing', was set up with the mission to produce standards on the UV-protective properties of textile materials. This working group started its activities in 1998 and included 30 experts (dermatologists, physicists, textile technologists, fabric manufacturers and retailers of apparel textiles) from 11 European member states. Within this working group, all medical, ethical, technical and economical aspects of standardization of UV-protective clothing were discussed on the basis of the expertise of each member and in consideration of the relevant literature in this field. Decisions were made in consensus. The first part of the standard (EN 13758-1) deals with all details of test methods (e.g. spectrophotometric measurements) for textile materials and part 2 (EN 13758-2) covers classification and marking of apparel textiles. UV-protective cloths for which compliance with this standard is claimed must fulfill all stringent instructions of testing, classification and marking, including a UV protection factor (UPF) larger than 40 (UPF 40+), average UVA transmission lower than 5%, and design requirements as specified in part 2 of the standard. A pictogram, which is marked with the number of the standard EN 13758-2 and the UPF of 40+, shall be attached to the garment if it is in compliance with the standard. The dermatology community should take cognizance of this new standard document. Garment manufacturers and retailers may now follow these official guidelines for testing and labelling of UV-protective summer clothes, and the sun-aware consumer can easily recognize garments that definitely provide sufficient UV protection.

Effect of a school-based sun-protection intervention on the development of melanocytic nevi in children.

"Kidskin" was a 5-year (1995-1999), school-based intervention trial among first-grade children in Perth, Western Australia. It aimed to assess whether a sun-protection intervention could protect against nevus development on the trunk, face, and arms. Included were a control group, a "moderate intervention" group, and a "high intervention" group. Control schools taught the standard health curriculum, while intervention schools received a specially designed sun-protection curriculum over 4 years. The high intervention group also received program materials over summer vacations when sun exposure was likely to be highest and were offered low-cost sun-protective swimwear. After adjustment for baseline nevus counts and potential confounding, nevus counts on all body sites were slightly lower in both intervention groups relative to the control group at follow-up, although the differences were not statistically significant and the high intervention was no more protective. Children in the moderate and high intervention groups, respectively, had fewer nevi on the back (6%, 95% confidence interval (CI): 0, 12; 4%, 95% CI: -3, 11), chest (boys) (5%, 95% CI: -4, 13; 3%, 95% CI: -8, 14), face (11%, 95% CI: 0, 21; 9%, 95% CI: -6, 21), and arms (8%, 95% CI: -1, 17; 3%, 95% CI: -10, 14).

Inspection of lead aprons: criteria for rejection.

Lead aprons utilized by personnel performing fluoroscopy are routinely inspected for damage to comply with the requirements of hospital accrediting organizations. Fluoroscopic or radiographic examination of lead aprons may reveal imperfections ranging from small pinholes to large tears. Currently, there are no standards establishing a criteria for acceptance or rejection of lead aprons. As a consequence, many facilities have established arbitrary rejection criteria. Often lead aprons are discarded due to small imperfections, a practice that can become costly to these institutions. We have calculated increases in doses to the whole body for varying sizes of holes, including special consideration of the effects on effective dose equivalent when the hole is over the testes and thyroid. ALARA standards for cost per personsievert averted are used to establish a rational basis for criteria of acceptance or rejection of lead aprons.

Factors that influence the effectiveness of surgical gowns in the operating theatre.

OBJECTIVE: To compare the barrier function, comfort, and protection afforded by nine types of surgical gowns during use and to identify factors that may influence their effectiveness. DESIGN: Prospective randomised study. SETTING: Teaching hospital, Greece. MATERIAL: 4 Types of disposable single layer gowns, 1 reusable cloth gown, and 4 types of disposable reinforced gowns used during 250 major operations by the surgeon and first assistant (total n = 500). INTERVENTIONS: Direct observation by specially trained nurse and questionnaire to surgeons. MAIN OUTCOME MEASURES: Contamination of the outside of the gown, blood strike through, safety, and comfort. RESULTS: Half of all gowns became contaminated on the outside. The mean total rate of strike through was 90% in reusable gowns (528/586 areas contaminated), 11% in disposable single layer gowns (95/855 areas contaminated), and 3% in disposable reinforced gowns (42/1407 areas contaminated). There were differences in strike through among the disposable gowns depending on the material and design, the reinforced gowns consistently showing less strike through than the single layer ones. The areas most vulnerable to strike through were the cuff, forearm, thigh, chest, and abdomen. From 80% to 99% of surgeons felt comfortable and protected wearing disposable gowns, but only 0 to 4% of surgeons felt comfortable and safe with reusable gowns. CONCLUSIONS: Reusable cloth gowns have a high strike through rate and were rejected by most surgeons. Reinforced disposable gowns provided better protection. The highest strike through was at the cuffs, forearms, and thighs, and this requires new designs for surgical gowns.

Flexible protective gloves: the emperor's new clothes?

The risk of developing skin cancer is estimated for interventional radiologists who do and do not wear thin, flexible protective leaded gloves. The use of these gloves is extremely expensive in terms of dollars per potential cancer prevented. Good radiographic practice without the use of flexible protective gloves provides adequate protection.