Effectiveness of a surgical wound surveillance program.

A five-year surgical would surveillance program included the following features: (1) observations were made by a trained nurse-surveyor; (2) all surgical services, without exception, were surveyed; (3) the nurse-surveyor reported directly to the Chief, Surgical Service; (4) all infected wounds and all suspected of harboring an infection were observed daily by the nurse-surveyor; (5) all wounds were inspected on the third and seventh postoperative days, at hospital discharge, and at a follow-up clinic visit; and (6) cultures were obtained from all infected wounds. Data concerning infections for all surgical services were published each month at the mortality-morbidity conference. The number of wounds closed primarily and the number of infected wounds were recorded, together with calculations of wound infection rates by operation class, for each surgical service and for the whole hospital. During the study, the rate of wound infections progressively declined. The overall incidence decreased from 3.5% before the study began to less than 1% at its conclusion.

Hydrotherapy during labor. An example of developing a practice policy.

Warm water has been used for centuries to treat many painful ailments. In perinatal clinical practice, hydrotherapy is being used to increase relaxation and decrease pain during labor. This article summarizes clinical studies evaluating hydrotherapy during labor, describing the current evidence which supports hydrotherapy as an effective method for managing intrapartal pain. The article also describes the process by which an institution established an evidence-based practice policy for the use of hydrotherapy in labor.

Prevalence of human papillomavirus DNA in cholesteatomas.

Cholesteatomas show histomorphological features like papillary growth and koilocytosis, which are characteristic of lesions induced by human papillomaviruses (HPV). Two previous studies investigating the possible role of HPV in the development of cholesteatoma had detected HPV-6 and HPV-11 DNA with a prevalence differing from 3 to 36%. The aim of the presented study was to evaluate the prevalence of different HPV types in cholesteatomas using a sensitive detection system for HPV DNA. Twenty-nine biopsies from cholesteatomas were screened for HPV DNA with a 2-step broad-spectrum PCR (PCR and nested PCR). HPV-positive products were directly sequenced by means of a cycle sequencing approach. Sensitivity of the applied broad-spectrum PCR was 0.1 copy/genome. One out of 29 biopsies showed a positive signal on the nested PCR level. Considering the low prevalence (1/29 biopsies) of detected HPV DNA in cholesteatomas, infections with common HPV types are unlikely to be a causative factor.