Evaluation of a thermoregulatory intravascular catheter in critically ill burns patients.

Patients with severe burns are at high risk of thermoregulatory failure. Yet, there is a lack of consensus regarding the optimum approach to temperature dysregulation in patients with severe burns. Intravascular temperature management catheters may offer a superior method of temperature control, but robust data are lacking. In this article, we describe our experience in using a thermoregulatory catheter for temperature management in a tertiary referral burns center. We conducted a single-center, prospective evaluation of the use of a thermoregulatory intravenous catheter system (Thermogard XP®) in critically injured burns patients admitted to our intensive care unit over an 18-month period. Ten patients had a total of 12 catheters inserted. Patient temperatures were maintained between a median low of 36.9 °C and a median high of 38.4 °C while in the intensive care unit. If patients were transferred to theater, the median temperature change was -0.15 °C (interquartile range [IQR] -0.3, 0) if TBSA was ≤50% and -1.45 °C (IQR -2.05, -0.975) if >50%. No surgical procedures were terminated due to intraoperative hypothermia. On return from theater, 72.2% of patients were normothermic with a median temperature of 36.8 °C. Thirty percent of patients developed a thrombotic complication. Overall, the device appeared reliable in achieving and maintaining normothermia for critically ill burns patients manifesting temperature dysregulation. It may also be of benefit to patients expected to show temperature fluctuations during operative procedures. Further research is needed to define whether this represents an improvement over current practice and investigate the thrombus risk associated with such devices.

Improving the inspection and manual cleaning of dental instruments in a dental hospital.

Within the dental hospital setting, it is a frequent occurrence to find residual cement contaminating instruments in a newly opened kit having undergone the decontamination cycle. Any instrument found to be contaminated then cannot be used, as the area underneath the cement is not sterile. This in itself has several repercussions. These include: cross-contamination, since there is a chance that the cement will be removed and the contaminated instrument used; cost, as each new kit that will be opened due to contaminated instruments will incur decontamination costs; and finally time, which most importantly has an impact on patient experience. Our baseline data recording focussed on finding out the severity of the problem, which instruments were most affected, and how this affected patient treatment, using a questionnaire. Within the paediatric department, 27% of examination kits contained a contaminated instrument, almost one third of all kits used. This quality improvement project utilized a poster and team huddle discussions to raise awareness of the problem and successfully reduced the number of contaminated instrument kits to 7% over a period of four weeks.