Urinary incontinence management costs are reduced following Burch or sling surgery for stress incontinence.

OBJECTIVE: The objective of the study was to estimate the effect of Burch and fascial sling surgery on out-of-pocket urinary incontinence (UI) management costs at 24 months postoperatively and identify predictors of change in cost among women enrolled in a randomized trial comparing these procedures. STUDY DESIGN: Resources used for UI management (supplies, laundry, dry cleaning) were self-reported by 491 women at baseline and 24 months after surgery, and total out-of-pocket costs for UI management (in 2012 US dollars) were estimated. Data from the 2 surgical groups were combined to examine the change in cost for UI management over 24 months. Univariate and bivariate changes in cost were analyzed using the Wilcoxon signed rank test. Predictors of change in cost were examined using multivariate mixed models. RESULTS: At baseline mean (±SD) age of participants was 53 ± 10 years, and the frequency of weekly UI episodes was 23 ± 21. Weekly UI episodes decreased by 86% at 24 months (P < .001). The mean weekly cost was $16.60 ± $27.00 (median $9.39) at baseline and $4.57 ± $15.00 (median $0.10) at 24 months (P < .001), a decrease of 72%. In multivariate analyses, cost decreased by $3.38 ± $0.77 per week for each decrease of 1 UI episode per day (P < .001) and was strongly associated with greater improvement in Urogenital Distress Inventory and Incontinence Impact Questionnaire scores (P < .001) and decreased 24-hour pad weight (P < .02). CONCLUSION: Following Burch or fascial sling surgery, the UI management cost at 24 months decreased by 72% ($625 per woman per year) and was strongly associated with decreasing UI frequency. Reduced out-of-pocket expenses may be a benefit of these established urinary incontinence procedures.

Financial and environmental modelling of water hardness--implications for utilising harvested rainwater in washing machines.

A study was conducted to determine the financial and environmental effects of water quality on rainwater harvesting systems. The potential for replacing tap water used in washing machines with rainwater was studied, and then analysis presented in this paper is valid for applications that include washing machines where tap water hardness may be important. A wide range of weather conditions, such as rainfall (284-1,794 mm/year); water hardness (14-315 mg/L CaCO3); tap water prices (0.85-2.65 Euros/m(3)) in different Spanish urban areas (from individual buildings to whole neighbourhoods); and other scenarios (including materials and water storage capacity) were analysed. Rainfall was essential for rainwater harvesting, but the tap water prices and the water hardness were the main factors for consideration in the financial and the environmental analyses, respectively. The local tap water hardness and prices can cause greater financial and environmental impacts than the type of material used for the water storage tank or the volume of the tank. The use of rainwater as a substitute for hard water in washing machines favours financial analysis. Although tap water hardness significantly affects the financial analysis, the greatest effect was found in the environmental analysis. When hard tap water needed to be replaced, it was found that a water price of 1 Euro/m(3) could render the use of rainwater financially feasible when using large-scale rainwater harvesting systems. When the water hardness was greater than 300 mg/L CaCO3, a financial analysis revealed that an net present value greater than 270 Euros/dwelling could be obtained at the neighbourhood scale, and there could be a reduction in the Global Warming Potential (100 years) ranging between 35 and 101 kg CO2 eq./dwelling/year.

Laundering of theatre scrubs at home.

Infections, particularly those caused by antibiotic-resistant gram-positive bacteria, such as methicillin-resistant staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), are a growing concern, particularly in units in which patients are immunosuppressed either intentionally (as for transplantation) or as a result of trauma (severe burns) or disease (such as acquired immunodeficiency disease) (Steinstraesser et al 2009). As more bacteria become resistant to antibiotics, our ability to control the spread of these bacteria with antibiotic treatments decreases (Steinstraesser et al 2009).

Clinical utility and economic impact of introducing a bowel management system.

PURPOSE: The primary objective of this study was to compare rates of urinary tract and soft tissue infections in critically ill burn patients before and following introduction of a Bowel Management System (BMS). We also analyzed the economic impact of the BMS as compared to reactive management of fecal soiling via cleansing and dressing changes. METHODS AND MATERIALS: A retrospective case-matched before-after study was completed. Critically ill burn patients using a BMS were matched with similar patients managed before introduction of the device based on gender, total body surface area burned, burn location, ventilation days, and hospital length of stay. RESULTS: Reductions in hospital-acquired urinary tract infections and skin and soft tissue infections were observed after introduction of the BMS. Despite its initial cost, it proved more cost effective than a reactive bowel management strategy based on cleansing and dressing changes when fecal soiling occurs. CONCLUSIONS: Proactive use of a bowel management device appears to reduce some infectious sequelae in a complicated burn care population and proved cost-effective for our facility.

The viability of professional wet cleaning as a pollution prevention alternative to perchloroethylene dry cleaning.

The vast majority of dry cleaners worldwide use the toxic chemical perchloroethylene (PCE), which is associated with a number of adverse health and environmental impacts. Professional wet cleaning was developed as a nontoxic alternative to PCE dry cleaning but has not been widely adopted as substitute technology. In the greater Los Angeles, CA, region, a demonstration project was set up to showcase this technology and evaluate its commercial viability by converting seven cleaners from PCE dry cleaning to professional wet cleaning. The demonstration site cleaners who switched to professional wet cleaning were able to maintain their level of service and customer base while lowering operating costs. The cleaners were able to transition to professional wet cleaning without a great degree of difficulty and expressed a high level of satisfaction with professional wet cleaning. Crucial to this success was the existence of the demonstration project, which helped to develop a supporting infrastructure for professional wet cleaning that had otherwise been lacking in the garment care industry.

Provision and decontamination of uniforms in the NHS.

AIM: To ascertain the provision and decontamination of uniforms within a cross-section of NHS trusts in the UK and to compare policies regarding their use. METHOD: A questionnaire was circulated to 170 NHS trust infection control teams in the UK. Eighty-six (51 per cent) responses were received, which represented 101 NHS trusts. RESULTS: Less than half of the trusts (47 per cent) provide adequate numbers of uniforms to allow a clean uniform per shift. Only 26 per cent had adequate on-site staff changing facilities and 65 per cent did not launder uniforms. The majority of nursing staff (91 per cent) were compelled, by a combination of these factors, to launder their uniforms at home. Few were provided with any guidance on how to do this safely. CONCLUSION: There is an urgent need for minimum standards to be set for the provision of uniforms, laundering and changing facilities, to minimise the potential for spread of healthcare-associated infections.

Home laundering of soiled surgical scrubs: surgical site infections and the home environment.

An increasing number of hospitals have implemented programs that permit their operating room (OR) personnel to launder their soiled "scrubs" at home. Not only have they not experienced an increase in the incidence of surgical site infections (SSIs), but they have also found the policy to be financially rewarding. Whereas the Association of periOperative Registered Nurses (AORN) opposes the practice, the Centers for Disease Control and Prevention (CDC) describes it as an unresolved issue. The variances in the positions taken by these two organizations obviously accounts for the differences in positions taken by the infection control community. In the absence of any evidence in the literature, the only alternative is to draw from knowledge and experience to determine whether the practice can be considered clinically effective and does not have a harmful effect on the home environment. On the basis of the results of that examination, it is concluded that the need for having soiled scrubs laundered by a facility-approved laundry is indefensible and simply predicated on the "that's the way we've always done it" syndrome.

Tracking perinatal infection: is it safe to launder your scrubs at home?

PURPOSE: This descriptive pilot study was conducted during 1991 and 1992 to determine the effect of wearing home-laundered scrub clothing in labor and delivery on the perinatal infection rate. METHOD: Unit meetings were conducted to instruct the 68 participating employees to launder their scrub clothing in an automatic washing machine, and to dry them in an automatic dryer on a hot setting. Statistics, including total births and cesarean births, were gathered, including all cesarean births during the years of 1991 and 1992 at the two study sites. Infection rates were monitored by the infection control department and reported frequently to the infection control committee and the medical and nursing staff. Employees were surveyed to assess their satisfaction after purchasing and wearing their own scrub clothing. The method for determining the perinatal infection rate in this study was based on the National Nosocomial Infections Surveillance System, which combines exogenous and endogenous factors when assessing the rate of wound infections(6). The method for monitoring the newborn infection rate in this study was outbreak surveillance. CONCLUSIONS: Home-laundered scrub clothing can be worn safely in labor and delivery units, including the operating rooms contained in those units. This practice can reduce costs without increasing surgical wound infection rates.