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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.
The rapid development of early cities at different dates in many regions of the world affected their hinterlands profoundly. Ancient Egypt, in many periods a territorial state unlike the typical city-state configuration of the other regions in most periods, presents some of the largest monuments and the longest timespan for investigation, but its urbanism is imperfectly understood. Classic Maya performances were strongly sonic, with anticipation fortified by blasts of trumpet or conch, the pounding of large drums or tapping of smaller ones under the arm, whistles and maracas, singing, and the musical collisions of shells on the king's body. Secular performances in Southeast Asia could involve hundreds or thousands of urban residents as participants and as spectators. Public movement was generally toward a restricted space: ceremonies within a royal court could only ever have small numbers of participants and be observed by relatively few.
Chemical contaminants—such as explosives from unexploded
ordnance and impact—found within cratered areas on military firing
ranges are subject to environmental fate and transport processes.
Depending on the solubility and charge of the pollutant, soils with higher
fractions of organic carbon and/or higher cation exchange capacities
may inhibit movement of contaminants and provide time for contaminant
transformation and degradation to take place before resources such as
groundwater are impacted. Cation exchange capacity should allow the use of
the retardation factor approach in determining the relative risk for
organic contaminant releases to soils. A soil property investigation,
involving the collection of soil samples from an active impact area and
subsequent mathematical modeling and statistical analysis of soil
laboratory results, was used to determine the soil properties that best
predict soil cation exchange capacity and describe crater disturbance, in
terms of the resulting loss of organic matter. Organic matter content of
the soil, in this study, proved to be a good predictor of cation exchange
capacity and also a good descriptor of munitions disturbance. Because soil
organic matter has an influence on contaminant fate and transport through
the environment, and because its availability is affected by munitions
disturbance, resource managers should be concerned with the effect of
munitions use on soil organic matter dynamics.
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