Comparing human to electronic observers to monitor hand hygiene compliance in an intensive care unit.

Objective: We sought to determine whether an electronic hand hygiene (HH) system could monitor HH compliance at similar rates to direct human observation. Methods: This 4-year proof-of-concept study was conducted in an intensive care unit (ICU) of a private tertiary-care hospital in São Paulo, Brazil, where electronic HH systems were installed in 2 rooms. HH compliance was reported respectively using direct observation and electronic counter devices with an infrared system for detecting HH opportunities. Results: In phase 1, HH compliance by human observers was 56.3% (564 of 1,001 opportunities), while HH compliance detected by the electronic observer was 51.0% (515 of 1,010 opportunities). In phase 2, human observers registered 484 HH opportunities with a HH compliance rate of 64.7% (313 of 484) versus 70.6% (346 of 490) simultaneously detected by the electronic system. In addition, an enhanced HH electronic system monitored activity 24 hours per day and HH compliance without the presence of a human observer was 40.3% (10,642 of 26,421 opportunities), providing evidence for the Hawthorne effect. Conclusions: The electronic HH monitoring system had good correlation with human HH observation, but compliance was remarkably lower when human observers were not present due to the Hawthorne effect (25%-30% absolute difference). Electronic monitoring systems can replace direct observation and can markedly reduce the Hawthorne effect.

Comparison of two electronic hand hygiene systems using real-time feedback via wireless technology to improve hand hygiene compliance in an intensive care unit.

Background: Most hand hygiene (HH) intervention studies use a quasi-experimental design, are primarily uncontrolled before-and-after studies, or are controlled before-and-after studies with a nonequivalent control group. Well-funded studies with improved designs and HH interventions are needed. Objectives: To evaluate healthcare worker (HCW) HH compliance with alcohol-based hand rub (ABHR) through direct observation (human observer), 2 electronic technologies, a radio frequency identification (RFID) badge system, and an invasive device sensor. Methods: In our controlled experimental study, 2,269 observations were made over a 6-month period from July 1 to December 30, 2020, in a 4-bed intensive care unit. We compared HH compliance between a basic feedback loop system with RFID badges and an enhanced feedback loop system that utilized sensors on invasive devices. Results: Real-time feedback by wireless technology connected to a patient's invasive device (enhanced feedback loop) resulted in a significant increase in HH compliance (69.5% in the enhanced group vs 59.1% in the basic group; P = .0001). Conclusion: An enhanced feedback loop system connected to invasive devices, providing real-time alerts to HCWs, is effective in improving HH compliance.

Sevoflurane Sparing Effect of Morphine in Tegus (Salvator merianae) - A Preliminary Study.

This study aimed to determine the minimum anesthetic concentration (MAC) of sevoflurane in tegus (Salvator merianae) and the morphine-sparing effect on this variable. In a prospective, non-blinded, crossover study, MAC was first determined in 6 tegus under sevoflurane anesthesia alone (MACSEVO) and then following intramuscular administration of morphine (10 mg/kg), administered 3 hour before sevoflurane anesthesia (MACSEVO+MOR). A standard bracketing technique was applied to determine the MAC by an electrical supramaximal noxious stimulus (50 Hz, 30 mA) delivered at the base of the tail of the tegus. The end-tidal sevoflurane fraction was reduced or increased by 10% in any evidence of negative or positive motor responses, respectively. The MAC was calculated as the mean of the 2 highest successive sevoflurane concentrations that permitted positive responses and the 2 lowest that prevented positive responses. Heart rate, esophageal temperature, and noninvasive mean arterial blood pressure were assessed every 10 minutes. The MAC was significantly different between MACSEVO (2.41 ± 0.06%) and MACSEVO+MORF (1.88 ± 0.43%) (P = .007), with a mean ± SD morphine-induced reduction in the sevoflurane MAC of 22 ± 18% (P = .0158). Heart rate, mean arterial blood pressure, and esophageal temperature did not differ between groups or within groups over time. Results showed that intramuscular premedication with 10 mg/kg morphine produced a sevoflurane sparing effect in tegus with no significant impact on cardiovascular variables.

Hand hygiene performance in an intensive care unit before and during the COVID-19 pandemic.

The current COVID-19 pandemic has heightened the focus on infection prevention in hospitals. We evaluated hand hygiene compliance with alcohol-based hand rub via electronic observation among healthcare workers in an intensive care unit from 2017 to 2020. The COVID-19 pandemic was not associated with an increase in hand hygiene compliance.

Intranasal oxygen reverses hypoxaemia in immobilised free-ranging capybaras (Hydrochoerus hydrochaeris).

Capybara (Hydrochoerus hydrochaeris) is the main host of tick-borne pathogens causing Brazilian spotted fever; therefore, controlling its population is essential, and this may require chemical restraint. We assessed the impact of chemical restraint protocols on the partial pressure of arterial oxygen (PaO2) and other blood variables in 36 capybaras and the effect of different flows of nasal oxygen (O2) supplementation. The capybaras were hand-injected with dexmedetomidine (5 µg/kg) and midazolam (0.1 mg/kg) and butorphanol (0.2 mg/kg) (DMB, n = 18) or methadone (0.1 mg/kg) (DMM, n = 18). One-third of the animals were maintained in ambient air throughout the procedure, and one-third were administered intranasal 2 L/min O2 after 30 min whereas the other third were administered 5 L/min O2. Arterial blood gases, acid-base status, and electrolytes were assessed 30 and 60 min after drug injection. The DMB and DMM groups did not vary based on any of the evaluated variables. All animals developed hypoxaemia (PaO2 44 [30; 73] mmHg, SaO2 81 [62; 93] %) 30 min before O2 supplementation. Intranasal O2 at 2 L/min improved PaO2 (63 [49; 97] mmHg and SaO2 [92 [85; 98] %), but 9 of 12 capybaras remained hypoxaemic. A higher O2 flow of 5 L/min was efficient in treating hypoxaemia (PaO2 188 [146; 414] mmHg, SaO2 100 [99; 100] %) in all the 12 animals that received it. Both drug protocols induced hypoxaemia, which could be treated with intranasal oxygen supplementation.

Evaluation of totally implantable catheters in healthy horses.

BACKGROUND: For horses requiring prolonged daily cephalic intravenous regional limb perfusion (IVRLP), the use of a totally implantable catheter (TIC) could be indicated to reduce complications associated with frequent venipuncture or external catheterization. This study aims to evaluate the implantation technique of the TIC in the cephalic vein of horses for IVRLP, describe the complications associated with the device's placement and use, and assess its viability up to 60 days after implantation. Totally implantable catheters, cut to 15 cm (n = 5) and 46 cm (n = 5) in length, were implanted into one cephalic vein in ten adult horses (n = 10). Twenty-four hours following placement, IVRLP with contrast was performed via the TIC and evaluated with radiography. Physical examinations, lameness evaluation, hematologic assessment, and the catheter patency tests were performed at scheduled intervals for the duration of catheterization (7-60 days). RESULTS: Catheters were implanted without difficulty and allowed for IVRLP 24 h post implantation. Complications resulted in removal of the catheters, with four maintained for 7 days, three in place for 15 days, and three catheters maintained for 60 days. Complications included lameness, limb swelling, catheter kinking, and venous thrombosis. CONCLUSIONS: The implantation technique of the TIC in the cephalic vein of horses is feasible and requires minimal technical effort. Although TIC allows venous access without the need for repeated venipuncture, its long-term use presents complications. For horses requiring prolonged daily cephalic IVRLP, the use of a TIC could be indicated. However, the high incidence of venous thrombosis may limit clinical application.

Pharmacopuncture Analgesia Using Flunixin Meglumine Injection into the Acupoint GV1 (Ho Hai) After Elective Castration in Horses.

The study evaluated the effect of a 1/10 dose of flunixin meglumine administered into the governing vessel 1 (GV1) acupoint in horses that underwent castration. Twenty animals received 0.02 mg/kg detomidine intravenously, followed by 2.2 mg/kg ketamine and 0.1 mg/kg diazepam by the same route, and also a local anesthesia with 30 mL lidocaine. As postoperative analgesia, the animals received 1.1 mg/kg flunixin meglumine IV (FIV) or 0.11 mg/kg flunixin meglumine into the GV1 acupoint (FGV). Behavioral parameters were assessed 12 hours before the procedure (baseline) and at 4, 6, 12, and 24 hours after surgery; physiological parameters were measured at baseline and at 2, 4, 6, 8, 10, 12, 16, and 24 hours after surgery. The groups did not differ regarding pain scores. Heart rate was higher in the FIV group than in the FGV group 2 hours after surgery (46 ± 5.2 bpm vs. 37 ± 8.2 bpm); gut sounds decreased at 2, 4, and 6 hours in both groups. The temperature showed a decrease after 2 hours compared with baseline in the FGV group, and the systolic blood pressure was higher in the FGV group than in the FIV group at 8 hours (158 ± 18.1 mmHg vs. 134 ± 14.5 mmHg), 10 hours (157 ± 15.5 mm Hg vs. 130 ± 11.5 mmHg), and 12 hours (151 ± 18.7 mmHg vs. 134 ± 15.8 mmHg). Pharmacopuncture was as effective as conventional dose and route of flunixin meglumine in horses that underwent elective castration under those conditions.

Azaperone and xylazine: A pharmacological combination to facilitate captive deer management for red brocket deer (Mazama americana).

The care and management of deer in captivity is challenging, especially in the case of red brocket deer (Mazama americana), whose routine management using physical restraint is difficult. Our study evaluated the effects of azaperone and xylazine combination for immobilizing red brocket deer and allow for the standard capture and handling protocols (e.g., biological material, horn cutting, and trimming) to be conducted safely. Six adult, captive, red brocket deer received an intramuscular injection of either 1 mg/kg azaperone and 0.5 mg/kg xylazine (AX0.5) or 1 mg/kg azaperone and 1 mg/kg xylazine (AX1.0). Sedation latency, sternal recumbency, safe handling, and quality of the sedation were evaluated to provide an overview of how the immobilizing drugs affected managing the species in captivity. Additionally, heart rate, respiratory rate, mean arterial pressure, rectal temperature, pH, PaO2, PaCO2, SaO2, HCO3-, BE, Na+, K+ and serum lactate were also measured. The latency period of the animals in the AX0.5 group was greater than that of the animals in the AX1.0 group (7 ± 6.6 min vs. 5 ± 2.0 min), as was the time for them to assume sternal recumbency (12 ± 9.7 min vs. 6 ± 3.1 min). However, the time after the initial dose at which the animals could safely be handled (14 ± 4.5 min vs. 12 ± 5.2 min), and the time until the end of the safe handling period (75 ± 12.3 min vs. 85 ± 6.8 min) were similar for both groups. Animals in both groups showed physiological stability during all evaluations, but hypoxemia was observed in one animal in each group. We conclude that both drug combinations are safe and effective at sedating red brocket deer in captivity and suggest that the procedure be performed with oxygen supplementation to reduce the potential for hypoxia.

Hyaluronidase administered with xylazine-tiletamine-zolazepam into adipose tissue shortens recovery from anesthesia in pigs.

OBJECTIVE: To evaluate the effect of hyaluronidase on uptake, duration and speed of elimination of xylazine-tiletamine-zolazepam administered in the subcutaneous fat over the dorsal lumbar region of swine. STUDY DESIGN: Blinded, randomized, crossover study. ANIMALS: Six healthy Landrace/Large White pigs weighing 132±24 kg (mean±standard deviation). METHODS: Animals were administered xylazine (1 mg kg-1) and tiletamine-zolazepam (8 mg kg-1) (control treatment, CON), or xylazine-tiletamine-zolazepam at the same doses with hyaluronidase (400 IU) (treatment HYA). The treatments were administered into the dorsal lumbar adipose tissue, 2.5-3.0 cm laterally from the spinous process of the second lumbar vertebra. The latency, anesthesia and recovery periods were measured. Heart rate, noninvasive systolic, diastolic, and mean arterial pressures, respiratory rate, hemoglobin oxygen saturation and rectal temperature were recorded every 10 minutes for up to 50 minutes. RESULTS: One animal in CON and one animal in HYA were responsive to stimulation and did not allow safe handling. No significant difference was found between treatments for latency (CON 11.3±5.9 minutes, HYA 7.4±5.1 minutes) and anesthesia (CON 53±53 minutes, HYA 49±38 minutes) periods. Recovery period was shorter in HYA (9±6 minutes) than in CON (32±16 minutes) (p < 0.05). Physiological variables were not significantly changed over time and were within accepted normal clinical limits for the species in both treatments. CONCLUSION AND CLINICAL RELEVANCE: Hyaluronidase (400 IU) administered into adipose tissue in pigs did not reduce the latency and duration of dissociative anesthesia, but was associated with faster recovery.

Falls, muscle strength, and functional abilities in community-dwelling elderly women / Quedas, força muscular e habilidades funcionais em idosas na comunidade

Abstract Introduction: Falls are among the most common and serious problems facing elderly women. Falling is associated with increased mortality, morbidity, reduced functioning, loss of independence and hospitalization. Objective: The aim of this study was to investigate the association among fear of falling, muscle strength, and functional abilities in community-dwelling elderly women. Methods: Forty-nine elderly women (70.57 ± 5.59 years) participated in this study. Records of falls, self-efficacy associated with falls (FES-I Brazil), functional abilities (the Timed Up and Down Stairs test [TUDS] and the Timed Up and Go test [TUG]), lower limb muscle strength (knee extensors and ankle plantar flexors), and hand grip strength were investigated as variables of interest. Descriptive statistics, the one-way ANOVA, and linear regression tests were used to analyze the association between fear of falling and falls with other variables (α = 0.05). Results: Elderly women who presented records of falls within the last year had lesser strength of knee extensors and plantar flexors (p ≤. 05). Those who had low self-efficacy associated with falls presented lower strength of knee extensors (p ≤. 01). Variables associated with functional abilities (r = 0.70) and lower limb strength (r = 0.53) showed a positive correlation (p ≤. 01). Conclusion: The concern with the fear of falling and falls may be negative effects caused by lower limb muscle weakness.

Resumo Introdução: As quedas representam um dos problemas mais comuns e graves enfrentadas por idosas. A queda está associada com o aumento da mortalidade, morbidade, limitação funcional, perda de independência e hospitalização. Objetivo: investigar a associação entre a preocupação com o medo de cair, a força muscular e as habilidades funcionais em idosas residentes na comunidade. Métodos: Participaram deste estudo 49 idosas (70,57 ± 5,59 anos). Como variáveis de interesse foram investigadas: história de quedas, auto eficácia relacionada às quedas (FES-I Brasil), habilidades funcionais (teste cronometrado de subir e descer escadas-TCSDE e Timed Up and Go-TUG), força muscular de membros inferiores (extensores do joelho e flexores plantares do tornozelo) e medida de preensão manual. Estatísticas descritivas, ANOVA One Way e testes de Regressão Linear foram utilizados para analisar as relações entre a preocupação com o medo de cair e quedas com outras variáveis (α = 0,05). Resultados: As idosas que apresentaram histórico de quedas no último ano tinham menor força de extensores do joelho e flexores plantares (p ≤ ,05). E aquelas que tinham uma baixa auto eficácia relacionada com quedas apresentavam força inferior dos extensores do joelho (p ≤ ,01). As variáveis relacionadas com habilidades funcionais (r = ,70) e força de membros inferiores (r = ,53) apresentaram uma relação positiva (p ≤ ,01). Conclusão: A preocupação com o medo de cair e as quedas podem ser efeitos negativos decorrentes de fraqueza muscular de membros inferiores.

Inconsistency of allometric scaling for dissociative anesthesia of wild felids.

OBJECTIVE: To evaluate allometric scaling for ketamine-xylazine (KX) anesthesia in wild felids using domestic cats for reference. STUDY DESIGN: Prospective single-phase non-blinded study. ANIMALS: Six domestic cats and 13 wild felids (five Leopardus pardalis, five Puma concolor, one Panthera onca and two Panthera leo). METHODS: Six domestic cats (4.1 ± 0.8 kg, REF1) were anesthetized by intramuscular administration of ketamine (15 mg kg(-1) ) and xylazine (1 mg kg(-1) ). Wild cats were divided into three groups based on body weight: 12.9 ± 2.4 kg (G1; n = 7), 43.0 ± 15.7 kg (G2; n = 4) and 126.0 ± 7.8 kg (G3; n = 2). Ketamine and xylazine doses were calculated based on allometric scaling of the basal metabolic rate (BMR = 70 × body mass(0.75) ). Afterwards, the six domestic cats were administered mean KX doses calculated for G1 and G2 (REF2). The heart rate, systolic arterial pressure, respiratory frequency, pH, the venous partial pressure of carbon dioxide, bicarbonate and lactate concentrations were recorded for up to 60 minutes. RESULTS: Additional doses were required in 12 out of the 13 wild cats. Anesthesia was not achieved in G3. Latency periods in wild felids were longer than REF1 and REF2. Anesthesia duration in REF1 was longer than that in the other groups. Recovery from anesthesia in REF1 and REF2 was longer than G1 and G2. Physiological variables remained within the range limits for the species. G1 baseline lactate concentration was higher than in the other groups. CONCLUSION AND CLINICAL RELEVANCE: KX anesthesia established by allometric scaling of BMR from doses administered to domestic cats did not predict reliable anesthetic doses for wild cats. Dose rates calculated with this method must not be applied to these species.

Physiological and analgesic effects of continuous-rate infusion of morphine, butorphanol, tramadol or methadone in horses with lipopolysaccharide (LPS)-induced carpal synovitis.

BACKGROUND: Continuous-rate infusion (CRI) of drugs results in more stable plasma drug concentrations than administration of intermittent boluses, thus providing greater stability of physiological parameters. The aim of this study was to evaluate the physiologic and analgesic effects of the administration of morphine, butorphanol, tramadol or methadone by CRI in horses with induced synovitis of the radiocarpal joint. RESULTS: Increased values of cardiorespiratory parameters and body temperature were observed in all groups after initiation of opioid administration, and these increases were sustained throughout the CRI period. Morphine, butorphanol and methadone each caused a reduction in gut sounds, and this effect was greatest in animals that received morphine. Administration of morphine or methadone reduced the degree of lameness after the end of intravenous infusion. Administration of tramadol did not alter the degree of lameness in the animals. CONCLUSIONS: CRI of morphine or methadone, but not butorphanol or tramadol, provided analgesia in horses with carpal synovitis. All of these opioids increased cardiovascular and respiratory parameters and reduced gut sounds during CRI.

Principais erros na fase pré-analítica do laboratório prestador de serviço no Hospital Getúlio Vargas em Sapucaia do Sul

O laboratório de análises clínicas exerce um papel fundamental na promoção da saúde, pois auxilia nas decisões diagnósticas e terapêuticas. A fase pré-analítica se inicia com a solicitação do exame pelo médico, passando pela obtenção da amostra e finaliza quando se inicia a análise. Esta fase pré- analítica concentra a maior frequência de erros associados a exames laboratoriais, segundo estudos realizados na Itália e Índia. É importante que os profissionais envolvidos nesse processo entendam que esta fase é crucial para um exame de qualidade. O presente trabalho tem como objetivo compreender como ocorrem os principais erros na fase pré-analítica no laboratório prestador de serviço no Hospital Getúlio Vargas em Sapucaia do Sul. Para o desenvolvimento do trabalho serão analisados relatórios disponíveis no laboratório que contemplam informações sobre recoletas e sobre amostras rejeitadas. Os coletadores serão observados no momento da coleta com o objetivo de comparar a técnica aplicada com o POP da instituição. Os relatórios sobre nova coleta e materiais extra coletados disponíveis no laboratório serão analisados desde o mês de março de 2013, pois foi o mês de início desse controle até o mês de setembro. Os dados serão expostos em uma tabela no Excel, que constará os setores, o número total de recoletas, número de exames recoletados, motivo da recoleta e o funcionário responsável pela coleta. Isso permitirá avaliar qual o setor onde ocorre o maior número de recoletas. Para a análise dos dados proveniente das observações com os coletadores será realizada a estatística descritiva e os resultados serão expostos em forma de tabela, orientada pelo questionário da observação onde primeiramente será verificado a frequência das respostas. Para o campo dos comentários será realizada a análise textual discursiva.