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Implementation of an Enhanced Safety-Engineered Sharp Device Oversight and Bloodborne Pathogen Protection Program at a Large Academic Medical Center
- Thomas R. Talbot, Deede Wang, Melanie Swift, Paul St. Jacques, Susan Johnson, Vicki Brinsko, Valerie Thayer, Teresa Dail, Nancye Feistritzer, Shea Polancich
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 35 / Issue 11 / November 2014
- Published online by Cambridge University Press:
- 10 May 2016, pp. 1383-1390
- Print publication:
- November 2014
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Objective.
Exposure of healthcare personnel to bloodborne pathogens (BBPs) can be prevented in part by using safety-engineered sharp devices (SESDs) and other safe practices, such as double gloving. In some instances, however, safer devices and practices cannot be utilized because of procedural factors or the lack of a manufactured safety device for the specific clinical use. In these situations, a standardized system to examine requests for waiver from expected practices is necessary
Design.Before-after program analysis.
Setting.Large academic medical center.
Interventions.Vanderbilt University Medical Center developed a formalized system for an improved waiver process, including an online submission and tracking site, and standards surrounding implementation of core safe practices. The program’s impact on sharp device injuries and utilization of double gloving and blunt sutures was examined.
Results.Following implementation of the enhanced program, there was an increase in the amount of undergloves and blunt sutures purchased for surgical procedures, suggesting larger utilization of these practices. The rate of sharp device injuries of all at-risk employees decreased from 2.32% to 2.12%, but this decline was not statistically significant (P = .14). The proportion of reported injuries that were deemed preventable significantly decreased from 72.7% (386/531) before implementation to 63.9% (334/523; P = .002) after implementation of the enhanced program.
Conclusions.An enhanced BBP protection program was successful at providing guidance to increase safe practices and at improving the management of SESD waiver requests and was associated with a reduction in preventable sharp device injuries.
Effect of a low-glycaemic index–low-fat–high protein diet on the atherogenic metabolic risk profile of abdominally obese men
- Jean G. Dumesnil, Jacques Turgeon, Angelo Tremblay, Paul Poirier, Marcel Gilbert, Louise Gagnon, Sylvie St-Pierra, Caroline Garneau, Isabelle Lemieux, Agnés Pascot, Jean Bergeron, Jean-Pierre Deapés
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- Journal:
- British Journal of Nutrition / Volume 86 / Issue 5 / November 2001
- Published online by Cambridge University Press:
- 09 March 2007, pp. 557-568
- Print publication:
- November 2001
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- Article
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It has been suggested that the current dietary recommendations (low-fat–high-carbohydrate diet) may promote the intake of sugar and highly refined starches which could have adverse effects on the metabolic risk profile. We have investigated the short-term (6-d) nutritional and metabolic effects of an ad libitum low-glycaemic index–low-fat–high-protein diet (prepared according to the Montignac method) compared with the American Heart Association (AHA) phase I diet consumed ad libitum as well as with a pair-fed session consisting of the same daily energy intake as the former but with the same macronutrient composition as the AHA phase I diet. Twelve overweight men (BMI 33·0 (SD 3·5) KG/M2) WITHOUT OTHER DISEASES WERE INVOLVED IN THREE EXPERIMENTAL CONDITIONS WITH A MINIMAL WASHOUT PERIOD OF 2 WEEKS SEPARATING EACH INTERVENTION. BY PROTOCOL DESIGN, THE FIRST TWO CONDITIONS WERE ADMINISTERED RANDOMLY WHEREAS THE PAIR-FED SESSION HAD TO BE ADMINISTERED LAST. DURING THE AD LIBITUM VERSION OF THE AHA DIET, SUBJECTS CONSUMED 11695·0 (sd 1163·0) kJ/d and this diet induced a 28 % increase in plasma triacylglycerol levels (1·77 (sd 0·79) v. 2·27 (sd 0·92) mmol/l, P<0·05) and a 10 % reduction in plasma HDL-cholesterol concentrations (0·92 (sd 0·16) v. 0·83 (sd 0·09) mmol/l, P<0·01) which contributed to a significant increase in cholesterol:HDL-cholesterol ratio (P<0·05), this lipid index being commonly used to assess the risk of coronary heart disease. In contrast, the low-glycaemic index–low-fat–high-protein diet consumed ad libitum resulted in a spontaneous 25 % decrease (P<0·001) in total energy intake which averaged 8815·0 (sd 738·0) kJ/d. As opposed to the AHA diet, the low-glycaemic index–low-fat–high-protein diet produced a substantial decrease (-35 %) in plasma triacylglycerol levels (2·00 (sd 0·83) v. 1·31 (sd 0·38) mmol/l, P<0·0005), a significant increase (+1·6 %) in LDL peak particle diameter (251 (sd 5) v. 255 (sd 5) Å, P<0·02) and marked decreases in plasma insulin levels measured either in the fasting state, over daytime and following a 75 g oral glucose load. During the pair-fed session, in which subjects were exposed to a diet with the same macronutrient composition as the AHA diet but restricted to the same energy intake as during the low-glycaemic index–low-fat–high-protein diet, there was a trend for a decrease in plasma HDL-cholesterol levels which contributed to the significant increase in cholesterol:HDL-cholesterol ratio noted with this condition. Furthermore, a marked increase in hunger (P<0·0002) and a significant decrease in satiety (P<0·007) were also noted with this energy-restricted diet. Finally, favourable changes in the metabolic risk profile noted with the ad libitum consumption of the low-glycaemic index–low-fat–high-protein diet (decreases in triacyglycerols, lack of increase in cholesterol:HDL-cholesterol ratio, increase in LDL particle size) were significantly different from the response of these variables to the AHA phase I diet. Thus, a low-glycaemic index–low-fat–high-protein content diet may have unique beneficial effects compared with the conventional AHA diet for the treatment of the atherogenic metabolic risk profile of abdominally obese patients. However, the present study was a short-term intervention and additional trials are clearly needed to document the long-term efficacy of this dietary approach with regard to compliance and effects on the metabolic risk profile.
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