Sustained improvement in hand hygiene compliance using a multi-modal improvement programme at a Swiss multi-site regional hospital.

BACKGROUND: Evidence of sustained improvement in hand hygiene compliance at the institutional level is scarce. AIM: To assess the impact and sustainability of a hospital-wide improvement programme on hand hygiene compliance of staff. METHODS: Analysis of trends of hand hygiene compliance for all clinical staff, measured through direct observation by trained observers, within a 450-bed multi-centre teaching hospital in the county of Neuchâtel, Switzerland. INTERVENTION: Implementation of a multi-modal improvement programme based on the World Health Organization (WHO) strategy, with the goal of reaching overall compliance of at least 80%. The strategy content included increasing access to alcohol hand rub; healthcare worker education; two-month interval compliance measurement; and hospital-wide open communication about ward-level results, point-of-care reminders, communication via a dedicated in-house newsletter and leadership engagement. The implementation phase was followed by a consolidation phase. FINDINGS: In total, 33,476 observations were collected from September 2012 to March 2014 (mean >3000 opportunities per audit). Overall compliance improved from 61.4% at baseline to 83.6% after the 18-month improvement programme (P<0.001), and was sustained at 85.3% 18 months later (i.e. 18 months after the programme finished) (P=0.08). The same trend (significant and clinically relevant improvement during the intervention, sustained after 18 months) was measured for all professional categories. CONCLUSIONS: This WHO-inspired improvement programme was associated with a significant improvement in hand hygiene compliance, globally and for each professional category. The results were sustained over an 18-month period.

Can remifentanil use in obstetrics be improved by optimal patient-controlled analgesia bolus timing?

BACKGROUND: The safety of patient-controlled i.v. analgesia (PCA) with remifentanil for obstetrical analgesia remains a matter of concern. The efficacy of remifentanil bolus application, that is, the coincidence between pain and remifentanil effect-site concentration, may be improved by forecasting contractions, but it is not known whether such a technique would also improve safety. METHODS: We recorded pain intensity during labour continuously using a handheld dynamometer in 43 parturients. Using these data, we compared different models in their ability to predict future contractions. In addition, we modelled remifentanil effect-site concentration using three simulated modes of bolus administration, with and without prediction of future contractions. RESULTS: The average duration of pain during contractions recorded by the dynamometer was 45 [14 standard deviation (sd)] s. The time interval between painful contractions was highly variable, with a mean of 151 (31 sd) s during the first and 154 (52 sd) s during the second recording. Using a simple algorithm (three-point moving average), the sd of the difference between predicted and observed inter-contraction intervals can be reduced from 0.95 to 0.79 min. However, the coincidence between remifentanil concentration and pain during contraction is not substantially improved when using these models to guide remifentanil bolus application. CONCLUSIONS: Because of the large variability of inter-contraction intervals, the use of prediction models will not influence the mean remifentanil concentration in-between contractions. Using models predicting future contractions to improve the timing of remifentanil PCA bolus administration will not diminish the need of continuous clinical surveillance and other safety measures.

[Nutritional deficiency after gastric bypass surgery: a review of the literature and guidelines for follow-up]. / Carence nutritionnelle apràs bypass gastrique: revue de la littérature, recommandations et suivi.

Roux-en-Y gastric bypass (RYGB) is the most frequently performed bariatric surgical procedure in Switzerland. The incidence of postoperative nutritional deficiencies is high. Therefore, guidelines have been established for patient follow-up and prophylactic treatment of such complications. This article makes use of a case report and a review of the literature to emphasize the importance of such measures.