Implementation of an external female urinary catheter strategy on prevention of skin breakdown in acute care: A quality improvement study.

AIM(S): To evaluate the incidence of skin-related complications attributable to incontinence-associated dermatitis (IAD) using an external female urinary catheter device strategy for urinary incontinent (UI) patients in acute care. DESIGN: Multicenter quality improvement study. METHODS: Randomized allocation of two commercially available external female urinary catheter devices was used in hospitalized UI female patients. Daily nursing skin assessments were documented in the electronic health record before, during and after external catheter device application. Methods and results were reported following SQUIRE guidelines. RESULTS: Three hundred and eighty-one patients from 57 inpatient care units were included in the analysis. Both catheter devices were associated with an overall low risk (5 %) of new or worsening skin breakdown. CONCLUSION: The overall benefit of external catheters is most persuasive for skin integrity, rather than infection prevention. IMPACT: Significant negative outcomes are associated with UI patients. External female urinary catheters are a non-invasive alternative strategy to reduce exposure of regional skin to urine contamination and IAD-related skin complications. Use of external female urinary catheters in hospitalized UI female patients offers low risk (5%) of new or worsening overall skin breakdown. PATIENT CONTRIBUTION: Hospitalized UI female patients were screened for external catheter device eligibility by the bedside nurse. The quality improvement review committee waved consent because the intervention was considered standard care.

Automated traffic monitoring of neurosurgical operating room.

BACKGROUND: Operating room (OR) traffic disrupts airflow and increases particle count, which predisposes patients to surgical site infections, particularly in longer surgeries with hardware placement. The aim of this study is to evaluate the rate of traffic during neurosurgical procedures, as well as reasons for and perceptions of OR traffic. METHODS: This is a single-center, multimethod study monitoring neurosurgical OR traffic through direct observation, automated monitoring, and interviews. Traffic was observed between the skin incision and closure. Personal interviews with OR teams including surgeons, anesthesia, and nurses were conducted to evaluate their perceptions of the frequency of OR traffic and reasons for OR traffic. RESULTS: Direct observation reported OR door opening an average of 18 times, with 20 people entering or exiting per hour. The exact reason for traffic was not verified in all traffic cases and was able to be confirmed in only a third of the cases. Automated monitoring resulted in an average of 31 people entering or exiting the OR per hour. The procedure length was significantly associated with the number of people entering or exiting the OR per hour (P < .0001). Interviews highlighted that OR teams reported traffic to be significantly lower than observed and automated monitoring results, with approximately <6 people entering or exiting per hour. CONCLUSIONS: OR traffic is higher than staff expected, and updated processes are required to reduce the number of times the OR door opens. Implementing automated observation of OR traffic could reduce the OR traffic and the risk for surgical site infection.

Group A Streptococcus outbreak among residents and employees of two skilled nursing facilities: North Carolina, 2017.

In this report, we summarize the results of surveillance, on-site assessments, and molecular analysis conducted as part of a group A Streptococcus outbreak investigation in 2 skilled nursing facilities. We identified cases in 24 individuals (6 deaths) and infection prevention deficiencies. Isolates from 14 individuals represented the globally emergent clade 3 emm89 strain. Molecular analysis suggests that the 2 outbreaks were related. Wound care practices and 1 symptomatic shared employee may have facilitated transmission. Strict adherence to infection prevention practices is needed to prevent group A Streptococcus transmission.