ABSTRACT
The standard of practice for perioperative hair removal is largely based on research that is outdated and underpowered. Although there is evidence to support the practice of clipping instead of shaving, current recommendations are to remove hair only when absolutely necessary. Human hair is bacteria-laden and challenging to disinfect, and clipping can be a safe method of hair removal that does not damage the skin. This article considers the removal of hair at the incision site with clippers, either before the patient enters the OR or in a manner that completely contains clipped hair, for every procedure, not just when absolutely necessary. There have been only two studies to date comparing clipping with no hair removal; more research is needed on this subject.
Subject(s)
Hair Removal/methods , Perioperative Care/methods , Disinfection/methods , Disinfection/trends , Hair Removal/instrumentation , Hair Removal/trends , Humans , Surgical Wound Infection/prevention & controlABSTRACT
Doernberg and colleagues describe the role and resourcing of the infectious disease (ID) physician for an effective hospital-based antibiotic stewardship program (ASP). There are similar resource requirements for the ID physician leader in an effective infection prevention (IP) program. This ID physician partnership is supported by professional organizations and predates the imperative of ID physician leadership in ASP. There are regulatory requirements for established IP programs, but they do not specify leadership structure to the same degree as ASP regulations. The Centers for Medicare and Medicaid and The Joint Commission have specified the inclusion of an ID-trained physician leader in ASP, and this has led to the development of curriculum to train more ASP physicians. More robust advocacy may ensure a similar regulatory mandate supporting the participation of ID-trained physicians in IP programs. This may encourage the development of a curriculum to meet the workforce.
Subject(s)
Antimicrobial Stewardship , Infections , Physicians , Aged , Health Resources , Humans , Medicare , United StatesABSTRACT
BACKGROUND: One position in integrated delivery networks (IDNs) that provides centralized oversight to optimize patient safety is the corporate-level infection prevention (IP) director. After noting variability in their roles, responsibilities, and IP programs, a national network of IDN IP directors planned a member survey to better understand common and variable elements. Nine network members volunteered to design a survey to describe the current role, responsibilities, and resourcing of all members of the corporate IP director group. METHODS: A 17-question survey was designed using the Survey Monkey multiple-choice format with a comment option. The questions were reviewed by the entire network to ensure content validity. The survey was delivered to all 72 network members by e-mail, and a 44% response rate was achieved. RESULTS: Survey responses revealed variation and commonalities relative to role structure, responsibilities, resourcing, and level of physician support for corporate IP directors. In addition, advantages of the position were described. CONCLUSIONS: The results of the survey will serve as a foundation on which to build, supporting standardization and reliable design for the role, responsibilities, and resourcing of corporate IP directors, with the ultimate goal of improving patient safety.
Subject(s)
Cross Infection/prevention & control , Disease Transmission, Infectious/prevention & control , Infection Control/organization & administration , Physician Executives , Professional Role , Health Facilities , Humans , Leadership , Patient Safety , Systems AnalysisABSTRACT
The current practice of perioperative hair removal reflects research-driven changes designed to minimize the risk of surgical wound infection. An aspect of the practice which has received less scrutiny is the clean-up of the clipped hair. This process is critical. The loose fibers represent a potential infection risk because of the micro-organisms they can carry, but their clean-up can pose a logistical problem because of the time required to remove them. Research has demonstrated that the most commonly employed means of clean-up, the use of adhesive tape or sticky mitts, can be both ineffective and time-consuming in addition to posing an infection risk from cross-contamination. Recently published research evaluating surgical clippers fitted with a vacuum-assisted hair collection device highlights the potential for significant practice improvement in the perioperative hair removal clean-up process. These improvements include not only further mitigation of potential infection risk but also substantial OR time and cost savings.
Subject(s)
Hair Removal/methods , Postoperative Care/methods , Practice Guidelines as Topic , Surgical Wound Infection/prevention & control , Female , Humans , Male , Prognosis , Risk Assessment , Treatment OutcomeABSTRACT
Accurate and rapid antimicrobial susceptibility testing with pathogen identification in bloodstream infections is critical to life results for early sepsis intervention. Advancements in rapid diagnostics have shortened the time to results from days to hours and have had positive effects on clinical outcomes and on efforts to combat antimicrobial resistance when paired with robust antimicrobial stewardship programs. This article provides infection preventionists with a working knowledge of available rapid diagnostics for bloodstream infections.
Subject(s)
Microbiological Techniques/methods , Sepsis/diagnosis , Anti-Bacterial Agents/administration & dosage , Humans , Sepsis/drug therapy , Time FactorsSubject(s)
Cross Infection/prevention & control , Infection Control/methods , Infection Control/standards , Clostridioides difficile/isolation & purification , Clostridium Infections/diagnosis , Clostridium Infections/prevention & control , Drug Resistance, Multiple, Bacterial , Enterobacteriaceae/isolation & purification , Enterobacteriaceae Infections/diagnosis , Enterobacteriaceae Infections/prevention & control , Hospitals , Humans , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Societies, Scientific , Staphylococcal Infections/diagnosis , Staphylococcal Infections/prevention & control , Universal Precautions/methods , Vancomycin-Resistant Enterococci/isolation & purificationABSTRACT
BACKGROUND: Whether contact precautions (CP) are required to control the endemic transmission of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) in acute care hospitals is controversial in light of improvements in hand hygiene, MRSA decolonization, environmental cleaning and disinfection, fomite elimination, and chlorhexidine bathing. OBJECTIVE: To provide a framework for decision making around use of CP for endemic MRSA and VRE based on a summary of evidence related to use of CP, including impact on patients and patient care processes, and current practices in use of CP for MRSA and VRE in US hospitals. DESIGN: A literature review, a survey of Society for Healthcare Epidemiology of America Research Network members on use of CP, and a detailed examination of the experience of a convenience sample of hospitals not using CP for MRSA or VRE. PARTICIPANTS: Hospital epidemiologists and infection prevention experts. RESULTS: No high quality data support or reject use of CP for endemic MRSA or VRE. Our survey found more than 90% of responding hospitals currently use CP for MRSA and VRE, but approximately 60% are interested in using CP in a different manner. More than 30 US hospitals do not use CP for control of endemic MRSA or VRE. CONCLUSIONS: Higher quality research on the benefits and harms of CP in the control of endemic MRSA and VRE is needed. Until more definitive data are available, the use of CP for endemic MRSA or VRE in acute care hospitals should be guided by local needs and resources.