Risk Factors and Best Practices for the Prevention of Post-Cardiac Surgery Surgical Site Infections in a Tertiary Care Centre.

BACKGROUND: Post-cardiac surgery surgical site infections (SSIs) pose devastating consequences in terms of morbidity and mortality to patients. OBJECTIVE: To examine current risk factors and best practice perioperative care for prevention of SSI following cardiac surgery through the lens of the demographic/clinical characteristics of patients who developed post-cardiac surgery SSIs at a major tertiary care institution, and to identify where documentation is lacking and could be improved to better serve clinical practice. METHODS: A literature review on post-cardiac surgery SSI prevention and risk factors was performed. These risk factors were examined through a retrospective chart review of the population of patients who developed SSIs during the study period. RESULTS: The study population was characterized by a high prevalence of riskfactors including age, diabetes, obesity, operative time, blood glucose control, surgical re-exploration, blood transfusions, and emergency context, as well as differences from best practice guidelines such as preoperative showering. Compared to other populations in the literature, several ofthese risk factors were more prevalent at the study site than in the other comparable populations. CONCLUSION: The patient population had a relatively high prevalence of riskfactors, and the care received by these patients varied in some ways from best practices. Using best practice guidelines, known risk factors, and the data specific to the institution can provide insightsfor analysis and practice improvement efforts in the form of identifying at-risk patients, improving adherence to best practice guidelines, targeting areas to focus care efforts, and improving clincal documentation.

Self-management support for peritoneal dialysis patients.

UNLABELLED: The increasing prevalence of chronic illnesses and kidney disease, in particular, makes it necessary to adopt new approaches towards their management (Wagner, 1998). Evidence suggests that promoting self-management improves the health status of peritoneal dialysis (PD) patients, as they manage upwards of 90% of their own care. Patients who are unable to self-manage suffer from various complications. This project proposes an intervention aimed at improving self-management skills among PD patients. GOAL: To promote self-management in peritoneal dialysis patients. This is achieved through the following objectives: (a) develop an algorithm that can improve patients' ability to solve the specific problem of fluid balance maintenance, (b) develop an educational session for patients on how to use the algorithm, and (c) develop an implementation strategy in collaboration with the PD nurse. METHOD AND RESULTS: Three measures evaluate the effectiveness of the intervention. First, a telephone call log shows that participating patients call the clinic less to inquire about fluid balance maintenance. Next, a pre- and post-intervention knowledge test measures definite knowledge increase. Finally, a Patient Satisfaction Questionnaire reveals overall satisfaction with the intervention. CONCLUSION: This project, which proved beneficial to our patient population, could be duplicated in other clinics. The algorithm "How do I choose a dialysis bag" and the slides of the educational sessions can be shared with PD nurses across the country for the benefit of PD patients.

A clinical nurse specialist intervention to facilitate safe transfer from ICU.

PURPOSE/OBJECTIVES: The purpose of this article was to describe an innovative quality initiative implemented by the clinical nurses specialist in medicine to facilitate the transition process between the intensive care unit and the medical wards. BACKGROUND/RATIONALE: Safely transferring patients with complex health conditions from an area of high technology and increased monitoring, like the intensive care unit, to an area with lower nurse-to-patient ratio is an intricate process. The care of these patients, once transferred, also requires varying levels of expertise. As indicated in the nursing literature, this type of transition is often associated with high stress levels for the patient and family, as well as for the healthcare providers. To maximize patient safety and ensure optimal care for this patient population, well-defined mechanisms must be put in place. DESCRIPTION OF THE PROJECT/INNOVATION: The introduction of a formal assessment, consultation, and follow-up process conducted by a clinical nurse specialist (CNS). OUTCOMES: On average, 150 patients are assessed each year by the CNS. Among these patients, 15% are considered at high risk for complications upon transfer to the unit. INTERPRETATION/CONCLUSION/IMPLICATIONS: A systematic evaluation of patients by the CNS, before their transfer from the ICU to a medical unit, has been proven beneficial in ensuring a comprehensive patient care plan. Patients and families have verbalized that this intervention is helpful. Staff members have indicated that this safety initiative is useful in planning patient transfers. The next step would be to formally measure patient, family, and staff satisfaction with this initiative.

Nuclear magnetic resonance and biochemical measurements of glucose utilization in the cone-dominant ground squirrel retina.

PURPOSE: To provide quantitative information on glucose utilization in cone-dominant ground squirrel retinas. METHODS: Ground squirrel eyecups were incubated in medium containing (14)C-glucose, and the production of (14)CO(2) was measured. Measurements were also made of lactic acid production (glycolysis). Nuclear magnetic resonance (NMR) was used to track metabolites generated from (13)C-1 glucose. RESULTS: Ground squirrel eyecups produced lactate at a high rate and exhibited normal histology. Light-adaptation reduced glycolysis by 20%. Ouabain decreased glycolysis by 25% and decreased (14)CO(2) production by 60%. Blockade of glutamate receptors had little effect on the glycolysis and (14)CO(2) produced. When metabolic responses were restricted to photoreceptors, light caused a 33% decrease in (14)CO(2) production. The rate of (14)CO(2) production was less than 10% of lactate production. Lactate was the major product formed from (13)C-glucose. Other (13)C-labeled compounds included glutamate, aspartate, glutamine, alanine, taurine, and GABA. Lactate was the only product detected in the medium bathing the ground squirrel retinas. The rod-dominant rat retina exhibited a similar pattern of metabolites formed from glucose. CONCLUSIONS: Lactate, not CO(2), is the major product of glucose metabolism in both ground squirrel and rat retinas. Active Na(+) transport, however, depends more on ATP produced by mitochondria than by glycolysis. A relatively high fraction of ATP production from glycolysis and glucose oxidation continues in the absence of active Na(+) pumping and glutamatergic transmission. Major neurotransmitters are synthesized from the aerobic metabolism of glucose; anoxia-induced impairment in retinal synaptic transmission may be due to depletion of neurotransmitters.