DNA Methylation Patterns in Peripheral Blood of Pregnant Women With Group B Streptococcus Colonization.

The primary risk factor for neonatal Group B streptococcus (GBS) infection, which is the leading cause of infectious neonatal morbidity and mortality, is maternal colonization. However, no definitive maternal risk factors for GBS colonization have been identified and no systematic efforts have been made to prevent maternal colonization. The purpose of this exploratory secondary analysis was to evaluate genome-wide DNA methylation patterns in maternal peripheral blood early in pregnancy for association with GBS colonization status in the third trimester. Genome-wide DNA methylation was analyzed from 18 nulliparous GBS-positive and -negative women (n = 9/group) recruited for a previous study. No statistically significant differences in baseline characteristics or DNA methylation in peripheral blood were identified between GBS-positive and -negative women in early pregnancy. The results suggest that DNA methylation patterns in peripheral blood are not associated with risk for GBS colonization.

Determination of the effectiveness of electronic health records to document pressure ulcers.

The purpose of this pilot project was to track the electronic health record documentation of pressure ulcers on a medical-surgical unit and compare the electronic health record with the written medical record.

Evaluation of the incidence of pressure ulcers using hill-rom versacare surfaces.

OBJECTIVE: This study was conducted to: (1) determine the clinical effectiveness of a low-air-loss surface, VersaCare P500, in the prevention of pressure ulcers in surgical patients; (2) determine differences in the adjusted Braden scores between those using VersaCare and VersaCare P500 mattress surfaces; and (3) explore the demographic and therapeutic factors associated with the risk of skin breakdown as measured by Braden score. DESIGN: An open label quasi-experimental clinical trial was conducted. SETTING: A 540-bed acute care hospital. PATIENTS: A sample of 127 surgical patients admitted for elective orthopedic or neurologic surgery participated in the study. MAIN OUTCOME MEASURES: Decreased pressure ulcers. RESULTS: The sample was composed of 51 (51.5%) Hispanics, 38 (38.4%) Blacks, and 10 (10.1%) Whites. Both groups were not different in their demographic and therapeutic characteristics except with regard to their total number of bed-confinement days (t = -2.225; P = .028). Multivariate analysis demonstrated that only Black race (ß = -.225; P = .03), days of bed confinement (ß = -.257; P = .016), and bed type (ß = .257; P = .013) were independently associated with skin integrity. CONCLUSION: The authors' findings suggest that the use of mircroclimate performance mattresses is associated with higher Braden scores, indicating a possible benefit with regard to protecting skin integrity and decreasing the risk of skin breakdown. Blacks were more likely to have lower Braden scores and "days of bed confinement" were negatively associated with the Braden score.

A descriptive study exploring the principles of asepsis techniques among perioperative personnel during surgery.

BACKGROUND: Perioperative nurses are expected to demonstrate strict adherence with asepsis principles to prevent surgical site infections (SSIs) as breaching of these principles poses a serious risk of infection to surgical patients. METHODS: A descriptive survey was conducted with a convenience sample of 87 perioperative personnel to describe self-reported compliance with the principles of asepsis during surgery. PURPOSE: The purpose of this study was to examine the practices of perioperative scrub personnel with surgical asepsis. RESULTS: A sizable percentage of participants indicated that they never or rarely observe breaches in the sterile field during surgery with regards to open suction drain systems (46.6%; n = 41), closed suction drain systems (46.6%; n = 41), suture material (39.7%; n = 35), use of surgical instruments (37.5%; n = 33), and prosthetic implants (56.8%; n = 50). Perioperative scrub RNs were less likely to wear shoe covers during surgical procedures than ORTs (M = 3.42 and 4.17; mdn = 3.00 and 5.00 respectively; p = .026). CONCLUSIONS: The findings showed areas of compliance and noncompliance with the principles of asepsis. Given that the role of the perioperative nurse is paramount in maintaining surgical integrity, and enhancing positive patient outcomes, strict adherence to surgical asepsis is vital to prevent SSIs and other complications.

Exploring the factors associated with hand hygiene compliance of nurses during routine clinical practice.

BACKGROUND: Nurses and other health care providers (HCPs) continue to be noncompliant with the guidelines of proper hand hygiene practices. PURPOSE: The purpose of this study was to explore the factors associated with hand hygiene compliance among HCPs during routine clinical. METHODS: An observational study was conducted at an oncology hospital to examine hand hygiene practices observed during 612 procedures that were performed by 67 HCPs. RESULTS: Hand hygiene compliance was 41.7% (n = 255) before procedure and 72.1% (n = 441) after the procedure. The overall compliance was only 34.3% (n = 210). Compliance with the standards of hand hygiene was higher in high-risk procedures (odds ratio [OR] = 1.77; 95% confidence interval [CI], 1.18-2.65) and when HCPs were exposed to blood (OR = 1.40; 95% CI, 1.07-1.73). CONCLUSION: The findings highlight the need to continue to push compliance with hand hygiene using innovative approaches that go beyond teaching and in-service training.

A national online survey on the effectiveness of clinical alarms.

PURPOSE: To develop a national online survey to be administered by the American College of Clinical Engineers Healthcare Technology Foundation to hospitals and healthcare workers to determine the problems associated with alarms in hospitals. METHODS: An online survey was developed by a 16-member task force representing professionals from clinical engineering, nursing, and technology to evaluate the reasons health-care workers do not respond to clinical alarms. RESULTS: A total of 1327 persons responded to the survey; most (94%) worked in acute care hospitals. About half of the respondents were registered nurses (51%), and one-third of respondents (31%) worked in a critical care unit. Most respondents (>90%) agreed or strongly agreed with the statements covering the purpose of clinical alarms and the need for prioritized and easily differentiated audible and visual alarms. Likewise, many respondents identified nuisance alarms as problematic; most agreed or strongly agreed that the alarms occur frequently (81%), disrupt patient care (77%), and can reduce trust in alarms and cause caregivers to disable them (78%). CONCLUSIONS: Effective clinical alarm management relies on (1) equipment designs that promote appropriate use, (2) clinicians who take an active role in learning how to use equipment safely over its full range of capabilities, and (3) hospitals that recognize the complexities of managing clinical alarms and devote the necessary resources to develop effective management schemes.

Keeping patients safe: an interventional hand hygiene study at an oncology center.

Healthcare-associated infections (HCIs) continue to affect patient morbidity and mortality and contribute to the rising cost of health care. Factors associated with the rise of HCIs in patients with cancer may include an increase in antimicrobial resistance and treatment effects of radiation and chemotherapeutic agents. Infection control and prevention practices can decrease infection rates among patients with cancer. In an effort to reduce HCIs and increase awareness, an interventional study was conducted at an oncology center to investigate hand hygiene compliance of healthcare professionals before and after the introduction of a handheld sanitizer spray. Although healthcare professionals had a positive response to the spray, it did not improve compliance rates.

Effect of aloe-vera impregnated gloves on hand hygiene attitudes of health care workers.

Following standard precautions and hand hygiene guidelines is important to health care workers and the patients they serve. The purpose of this study was to determine the effect of aloe-vera impregnated gloves on attitudes about hand hygiene among many health care workers and perceived sense of skin condition.

Conversion to low-protein, powder-free surgical gloves: is it worth the cost?

This study was conducted to determine changes in overall costs associated with conversion to powder-free gloves including cost of workers' compensation cases for natural rubber latex (NRL)-related symptoms and health care workers' glove satisfaction. The study, a 2-year, longitudinal design with retrospective and prospective aspects, was developed to determine health care worker use of powder-free, low-protein NRL gloves, sensitization, cost, and glove satisfaction. Informed consent was obtained from 103 health care workers. Prior to glove conversion, nearly one-half (44%, 36 of 82) of the operating room staff reported symptoms related to NRL exposure. At the end of the 14-month data collection period, only 27% (22 of 82, McNemar test = .007) reported symptoms related to NRL exposure. Additionally, a cost savings of 10,000 dollars per year for gloves was evident with reports of increased user satisfaction. This study demonstrated that conversion to the use of powder-free, low-protein NRL gloves not only reduces health care worker NRL symptoms, but also positively affects the costs of glove purchases and workers' compensation.

Impact of converting to powder-free gloves. Decreasing the symptoms of latex exposure in operating room personnel.

This study examined health care worker satisfaction with the use of non-powdered natural rubber latex (NRL) surgical gloves to determine the impact of non-powdered NRL gloves on the NRL sensitization of operating room personnel. The study used a 1-year longitudinal design to obtain recall information from employees about their NRL exposure. Additionally, a survey was completed by participants related to their satisfaction with non-powdered NRL gloves. Informed consent was obtained from 103 employees. After conversion to an operating room using non-powdered NRL, there was a significant decrease in reported symptoms with NRL exposure (42% pre- and 29% post-conversion, Fisher's exact, two-tailed, p = .0001). This study demonstrated that the conversion to non-powdered low-protein NRL gloves resulted in decreased symptoms because of NRL exposure.

Predictors of nosocomial bloodstream infections among critically ill adult trauma patients.

OBJECTIVE: To identify the independent predictors of nosocomial bloodstream infections (BSIs) among critically ill adult trauma patients. DESIGN: A prospective, cohort design was used to study patients who met predetermined inclusion criteria. Basic descriptive and univariate statistical analyses were performed to identify unadjusted predictors. A forward stepwise multivariate logistic regression analysis was then conducted to identify independent predictors of nosocomial BSI. SETTING: Level I university-affiliated shock trauma center. PATIENTS: Three hundred sixty-one critically ill adult trauma patients, 55 of whom developed nosocomial BSIs (15.2%). RESULTS: Data analysis of 45 variables indicated that only 9 were independent predictors of nosocomial BSI: presence of a chest tube, use of immunosuppressive agents, presence of microbial resistance, length of stay, presence of preexisting infection, percentage change of serum albumin levels, patient disposition, transfusion of 10 or more units of blood, and number of central venous catheters (CVCs) for patients who had 4 or more. The classification index of the final regression model at a cut-off point of 0.5 had a specificity of 97.4%, a sensitivity of 60%, a positive predictive value of 76.7%, a negative predictive value of 93%, and an overall precision of 91%. CONCLUSION: In this study, only 9 variables were independent predictors of nosocomial BSI. Our findings are specific to critically ill adult trauma patients and should be interpreted within the context of this particular population.

Failure rates in nonlatex surgical gloves.

BACKGROUND: The purpose of this study was to compare the frequency of glove defects for nonlatex surgical gloves while surgeons performed routine surgery and to evaluate surgeons' satisfaction with nonlatex sterile gloves. METHODS: Two brands of latex gloves and 6 brands of nonlatex gloves were tested. Gloves were collected at the end of each surgical procedure and tested for visual defects and barrier integrity using an automated calibrated water test machine consistent with FDA's recommended standards. A total of 6386 gloves used by 101 surgeons and 164 residents representing 15 surgical services were included in the analysis. RESULTS: Higher after-use defect rates occurred in nonlatex surgical gloves than in latex gloves. Higher times of use were related to higher defect rates for some surgical specialties, and both surgeons and residents were less satisfied with nonlatex surgical gloves. CONCLUSION: Intact latex and nonlatex surgical gloves provide adequate barrier protection. Nonlatex surgical gloves have higher failure rates and lower user satisfaction than latex gloves do. Both nonlatex and latex gloves should be changed after 2 to 3 hours of use because the barrier of either type of glove becomes compromised with extended use.

Health care workers: risk factors for nonlatex and latex gloves during surgery.

This study examined glove failure and related factors in both nonlatex and latex surgical gloves after routine use. A federally funded research study was conducted to collect surgical gloves from those directly involved in surgical procedures. All gloves were examined in the laboratory for both visual defects and barrier integrity. A total of 11,118 usable surgical gloves were examined. The overall defect rate was 7.8%; nonlatex gloves were significantly more likely to fail (8.4%) than latex gloves (6.9%). The majority of defects in the latex gloves (90%) and nonlatex gloves (70%) were not detected by visual examination. Separate logistic regression models examined predictors of defects for the gloves. The only factor that increased the odds of a defect for a latex glove was duration of use over 6 hours. Factors increasing the odds of a defect in nonlatex gloves included gloves worn by a scrub person and gloves used in certain surgical services. Scrub persons had a higher defect rate despite wearing their gloves for a significantly shorter time than other health care workers. Latex and nonlatex gloves fail under different conditions. Latex gloves fail primarily due to length of use, whereas nonlatex gloves are more sensitive to conditions of us (e.g., type of health care worker and type of surgery). Providers can help guard against glove defects by double gloving and by changing gloves often, especially when using nonlatex gloves in higher-risk surgeries.

A laboratory-based study to assess the performance of surgical gloves.

The inherent tear resistance and elasticity of latex and the touch sensitivity it provides has made it the traditional material of choice for surgical gloves, protecting both health care workers and patients from the transmission of bloodborne infections. Although increased incidence of latex allergy has led to increased use of nonlatex surgical gloves, the effectiveness of these gloves as a barrier to infection has not been examined thoroughly. This laboratory-based study compared the performance of latex and nonlatex surgical gloves in a simulated stress protocol. The propensity of surgical gloves to fail was dependent on glove material, manufacturer, and stress. Nonlatex neoprene and nitrile gloves were comparable to latex and can provide a good alternative to latex for allergic patients and health care workers. In this study, isoprene was found to be inferior to latex and other nonlatex materials. The presence or absence of glove powder had no significant influence on the probability of glove failure.

Use of the injury severity score to predict nosocomial bloodstream infections among critically ill trauma patients.

Nosocomial bloodstream infections (NBSI) are associated with increased hospital length of stay (LOS), mortality, and costs. At this writing, no available reports describe the association between injury severity and NBSI among critically ill adult trauma patients. This study aimed to examine the use of the Injury Severity Score (ISS) as a predictor of NBSI among critically ill adult trauma patients. A case-control design was used to compare the mean ISS of 190 critically ill trauma patients equally divided between those with positive test results for NBSI and those with negative results. The mean hospital LOS (34.8 days versus 16.5 days) and the mean intensive care unit LOS (28.1 days versus 13 days) were significantly higher among the patients with NBSI than among the control subjects without such infection (P <.001 and P <.001, respectively). The mean LOS until the diagnosis of NBSI was significantly lower than the total LOS of the control subjects (odds ratio [OR], 0.959; 95% confidence interval [CI], 0.93-0.99). The ISS score and age were found to be independent predictors of NBSI. The findings provide a means for using the ISS score as a predictor of NBSI in the critically ill adult trauma population.

Awareness of surgical site infections for advanced practice nurses.

A primary concern in healthcare today is the prevention of infection. Surgical site infections (SSIs) are the leading type of infection among hospitalized patients. Advanced practice nurses play a vital role in patient care, and those who incorporate best practice standards can reduce the morbidity and mortality associated with SSIs. The Centers for Disease Control and Prevention have published recommendations for prevention of SSIs. This article reviews current literature regarding the prevention of SSIs and how critical care practitioners can incorporate these scientifically tested recommendations into their practice.

The opiate-dependent patient with endocarditis: addressing pain and substance abuse withdrawal.

Intravenous drug use is associated with infectious diseases such as endocarditis. Patients often require intensive medical and nursing management in the intensive care unit as well as simultaneous intensive pain, withdrawal, and psychosocial management for the tolerance and behavior issues commonly associated with this population. To provide comprehensive care, the advanced practice nurse needs to understand the relation between intravenous drug use and the development of infective endocarditis. Furthermore, the advanced practice nurse must have skill in making distinctions between pain and opiate withdrawal, selecting a strategy for treating these syndromes, and providing the intravenous drug-using patient with support and aftercare resources.