Assessing hand hygiene attitudes of inpatient nursing personnel in a US military hospital.

Between 10% and 40% of hospital-acquired infections have been attributed to cross-contamination of healthcare personnel hands. This study described frequency of hand hygiene within a fixed US military facility, in participants wearing a military uniform and hospital-provided scrubs. The median frequency of hand hygiene reported in both uniforms was 10 per hour. However, two-thirds of staff indicated that the military uniform decreased their ability to perform hand hygiene. Stakeholders should re-evaluate policies requiring wear of long-sleeved military uniforms by nursing staff to facilitate hand hygiene. Non-military facilities may also consider the impact of long-sleeved garments on hand hygiene.

A nationwide assessment comparing nonelective open with minimally invasive complex colorectal procedures.

AIM: The use of minimally invasive colorectal surgery has increased greatly for both benign and malignant disease. Studies evaluating complex procedures have been largely limited to elective indications. We aimed to compare the outcome of a laparoscopic with an open transverse (TC) and total abdominal colectomy (TAC) in the nonelective setting. METHOD: Comparative analysis was made using the Nationwide Inpatient Sample (2008-11) of patients undergoing a nonelective TC or TAC identified by ICD-9-CM procedure codes. The risk-adjusted 30-day outcome was assessed using regression modelling accounting for patient characteristics, comorbidity and surgical procedure. RESULTS: We identified 7261 admissions including 818 laparoscopic and 6443 open procedures. The mean age of the population was 65 ± 17 years and patients in the laparoscopic group were younger (56 ± 20 vs. 66 ± 17 years; P < 0.05). The rate of a single complication was lower in the laparoscopic group (26% vs. 38%; P < 0.01), but this did not remain significant following a logistic regression analysis. Mortality was significantly lower in the laparoscopic group (3.1% vs. 17%; P < 0.01) and this remained true after adjusting for covariates (OR = 0.62; P < 0.05). Laparoscopic cases were associated with a shorter median length of stay (10 vs. 13 days; P < 0.01) and hospital charge ($75,758 vs. $98,833; P < 0.01). CONCLUSION: A nonelective laparoscopic TC or TAC is associated with an equivalent complication rate and lower mortality compared with an open operation. The results should encourage surgeons with the appropriate skills to consider a laparoscopic approach for nonelective pathology requiring a complex colectomy.

Comparison of outcomes after TURP versus photoselective vaporization of the prostate with respect to trainee involvement utilizing ACS NSQIP.

BACKGROUND: Large multicenter studies comparing outcomes between TURP and photoselective vaporization of the prostate (PVP) are sparse, with no studies having compared the influence of trainee involvement on these outcomes. Our objectives were to assess 30-day outcomes after TURP and PVP with respect to trainee involvement using an independent national surgical database. METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data (2005-2011), 7893 men were identified who underwent TURP or PVP. Regression models were constructed to assess associations between surgical approach, risk-adjusted morbidity and individual complications. Relationships between operative approach, operative duration and duration of stay were also examined and subdivided based upon trainee level. RESULTS: Of 7893 patients, 4950 (62.7%) underwent TURP and 2943 (37.3%) underwent PVP. TURP patients were older, more likely to have diabetes, cancer, history of steroid use and preoperative transfusion compared with PVP patients, who were more likely to have coronary artery disease or bleeding disorders. Risk-adjusted overall morbidity was similar; however, PVP was associated with less pneumonia (0.2% vs 0.5%, P<0.015), bleeding requiring transfusion (0.5% vs 1.8%, P<0.001) and return to the operating room (1.5% vs 2.2%, P<0.022). PVP patients also had shorter length of stay (0.8 vs 2.1 days, P<0.001). There were no significant differences in outcomes when a trainee was involved. Operative duration was similar for TURP and PVP when performed by an attending alone (52 vs 52 min, P<0.001), but was longer with trainee involvement, regardless of post-graduate year (PGY) level (P<0.001). Comparison of operative duration among trainee subgroups demonstrated longer operative times for the PGY 6-9 subgroup performing PVP when compared with other subgroups (P<0.003). CONCLUSIONS: Within ACS NSQIP hospitals, TURP and PVP demonstrated similar risk-adjusted overall morbidity. Despite longer operative times for TURP and PVP with trainee involvement, there were no significant differences in outcomes.

Health status of Air Force veterans occupationally exposed to herbicides in Vietnam. I. Physical health.

The Air Force Health Study is a 20-year comprehensive assessment of the health of Air Force veterans of Operation Ranch Hand, the unit responsible for aerial spraying of herbicides in Vietnam. The study compares the health and noncombat mortality of Ranch Hand veterans with a comparison group of Air Force veterans primarily involved with cargo missions in Southeast Asia but who were not exposed to herbicides. This report summarizes the health of these veterans as determined at the third in a series of physical examinations. Nine hundred ninety-five Ranch Hands and 1299 comparison subjects attended the second follow-up examination in 1987. The two groups were similar in reported health problems, diagnosed skin conditions, and hepatic, cardiovascular, and immune profiles. Ranch Hands have experienced significantly more basal cell carcinomas than comparison subjects. The two groups were not different with respect to melanoma and systemic cancer.