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3 results

  • Frequency of Hand Decontamination of Intraoperative Providers and Reduction of Postoperative Healthcare-Associated Infections: A Randomized Clinical Trial of a Novel Hand Hygiene System

  • Matthew D. Koff, Jeremiah R. Brown, Emily J. Marshall, A. James O’Malley, Jens T. Jensen, Stephen O. Heard, Karen Longtine, Melissa O’Neill, Jaclyn Longtine, Donna Houston, Cindy Robison, Eric Moulton, Hetal M. Patel, Randy W. Loftus
  • Journal:
    Infection Control & Hospital Epidemiology / Volume 37 / Issue 8 / August 2016
    Published online by Cambridge University Press:
    07 June 2016, pp. 888-895
    Print publication:
    August 2016
  • BACKGROUND

    Healthcare provider hands are an important source of intraoperative bacterial transmission events associated with postoperative infection development.

    OBJECTIVE

    To explore the efficacy of a novel hand hygiene improvement system leveraging provider proximity and individual and group performance feedback in reducing 30-day postoperative healthcare-associated infections via increased provider hourly hand decontamination events.

    DESIGN

    Randomized, prospective study.

    SETTING

    Dartmouth-Hitchcock Medical Center in New Hampshire and UMass Memorial Medical Center in Massachusetts.

    PATIENTS

    Patients undergoing surgery.

    METHODS

    Operating room environments were randomly assigned to usual intraoperative hand hygiene or to a personalized, body-worn hand hygiene system. Anesthesia and circulating nurse provider hourly hand decontamination events were continuously monitored and reported. All patients were followed prospectively for the development of 30-day postoperative healthcare-associated infections.

    RESULTS

    A total of 3,256 operating room environments and patients (1,620 control and 1,636 treatment) were enrolled. The mean (SD) provider hand decontamination event rate achieved was 4.3 (2.9) events per hour, an approximate 8-fold increase in hand decontamination events above that of conventional wall-mounted devices (0.57 events/hour); P<.001. Use of the hand hygiene system was not associated with a reduction in healthcare-associated infections (odds ratio, 1.07 [95% CI, 0.82–1.40], P=.626).

    CONCLUSIONS

    The hand hygiene system evaluated in this study increased the frequency of hand decontamination events without reducing 30-day postoperative healthcare-associated infections. Future work is indicated to optimize the efficacy of this hand hygiene improvement strategy.

    Infect Control Hosp Epidemiol 2016;37:888–895

  • 42 - Upper tract dilation

  • from Part V - Urology
  • Edited by Mark D. Stringer, Keith T. Oldham, Pierre D. E. Mouriquand
  • Book:
    Pediatric Surgery and Urology
    Published online:
    08 January 2010
    Print publication:
    09 November 2006, pp 533-539

  • Summary

    Introduction

    In former years, the clinical management of upper tract dilation was simple. Because most children with hydronephrosis presented with a mass or a clinical problem such as infection or pain, it was assumed that the cause was an obstruction. Surgical treatment was performed and the outcome was usually satisfactory. The advent of prenatal ultrasonography and the resultant identification of large numbers of asymptomatic upper tract dilation has forced physicians to alter their understanding of the significance of hydronephrosis and to better define obstruction. This is largely because dilation often improves or resolves spontaneously, which questions the necessity of surgical treatment. Whereas in the past only few natural history studies were available, a greater appreciation of the spontaneous resolution of prenatally detected hydronephrosis has been gleaned from multiple studies from various centers around the world.

    Any analysis of long-term outcomes of upper tract dilation management must of necessity deal separately with the symptomatic and asymptomatic varieties and must also recognize that dilation involving the kidney alone is different from dilation affecting kidney and ureter together. Accordingly, this chapter will be divided into two sections. The first will deal with pure hydronephrosis and consider the child with dilated renal collecting systems without ureteral dilation. The second portion will examine hydroureteronephrosis and dilation of both the renal collecting system and ureter.

    Dilation of the renal collecting system is easily diagnosed on radiographic imaging studies. However, not all upper tract dilation is caused by obstruction.