epic2: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England.

National evidence-based guidelines for preventing healthcare-associated infections (HCAI) in National Health Service (NHS) hospitals in England were commissioned by the Department of Health (DH) and developed during 1998-2000 by a nurse-led multi-professional team of researchers and specialist clinicians. Following extensive consultation, they were published in January 2001. These guidelines describe the precautions healthcare workers should take in three areas: standard principles for preventing HCAI, which include hospital environmental hygiene, hand hygiene, the use of personal protective equipment, and the safe use and disposal of sharps; preventing infections associated with the use of short-term indwelling urethral catheters; and preventing infections associated with central venous catheters. The evidence for these guidelines was identified by multiple systematic reviews of experimental and non-experimental research and expert opinion as reflected in systematically identified professional, national and international guidelines, which were formally assessed by a validated appraisal process. In 2003, we developed complementary national guidelines for preventing HCAI in primary and community care on behalf of the National Collaborating Centre for Nursing and Supportive Care (National Institute for Healthand Clinical Excellence). A cardinal feature of evidence-based guidelines is that they are subject to timely review in order that new research evidence and technological advances can be identified, appraised and, if shown to be effective in preventing HCAI, incorporated into amended guidelines. Periodically updating the evidence base and guideline recommendations is essential in order to maintain their validity and authority. Consequently, the DH commissioned a review of new evidence published following the last systematic reviews. We have now updated the evidence base for making infection prevention and control recommendations. A critical assessment of the updated evidence indicated that the original epic guidelines published in 2001 remain robust, relevant and appropriate but that adjustments need to be made to some guideline recommendations following a synopsis of the evidence underpinning the guidelines. These updated national guidelines (epic2) provide comprehensive recommendations for preventing HCAI in hospitals and other acute care settings based on the best currently available evidence. Because this is not always the best possible evidence, we have included a suggested agenda for further research in each section of the guidelines. National evidence-based guidelines are broad principles of best practice which need to be integrated into local practice guidelines. To monitor implementation, we have suggested key audit criteria for each section of recommendations. Clinically effective infection prevention and control practice is an essential feature of protecting patients. By incorporating these guidelines into routine daily clinical practice, patient safety can be enhanced and the risk of patients acquiring an infection during episodes of healthcare in NHS hospitals in England can be minimised.

The placebo effect and the hidden benefits of oral medications.

The effectiveness of any drug involves many factors not just the pharmacological ingredients. The hidden benefits of a drug are termed the 'placebo effect', but because many of these factors cannot be explained scientifically they are often dismissed as irrelevant. However, factors including the attributes of the drug itself (shape, colour, taste), the relationship between the nurse dispensing the drug and the patient receiving it, the route of administration, the setting in which the drug is given and wider sociocultural beliefs surrounding the ingestion of medicines can all have a major influence on a drug's efficacy. This article explains the term 'placebo' and explores some of the factors contributing to the placebo effect in relation to oral medications. Nurses need to appreciate the influence of such factors in order to provide appropriate and holistic care to patients with different social and cultural beliefs and expectations.

The "unrecognized" spigelian hernia.

The appearance at a community hospital of four cases of spigelian hernia within a 16-month period lends support to the supposition that this lesion is more common than reports would indicate. Main points to consider in establishing the likelihood of this condition primarily include an awareness of its existence and its multiple symptomatology, the anatomic schema of the lateral rectus border, careful abdominal examination and use of radiographic aids.