Resistive Warming Mattress, Forced-Air Warming System, or a Combination of the Two in the Prevention of Intraoperative Inadvertent Hypothermia: A Randomized Trial.

PURPOSE: To prevent intraoperative inadvertent hypothermia (IIH), resistive products and forced-air warming systems are often used simultaneously. There is insufficient evidence to show whether this application is clinically more effective than a single active warming device. The aim of this study is to compare the efficacy a single intraoperative active warming method with combined methods in IIH prevention. DESIGN: A randomized, prospective, experimental study. METHODS: This study was conducted between June and October 2021 in the operating room of a training and research hospital. The study sample consisted of 123 patients who underwent scheduled orthopedic surgery under spinal anesthesia, were young (18-64), and had an ASA risk score of I to III. The patients were divided into three groups preoperatively according to the stratified randomization technique. To prevent IIH, a resistive warming mattress was used in group 1; a forced-air warming system was used in group 2; and a combination of the two methods were used in group 3. The body temperatures of the patients were measured and recorded every 15 minutes from admission to the operating room until the end of surgery. FINDINGS: The mean intraoperative body temperature of the patients was 36.6±0.15˚C for group 1; 36.6±0.1˚C for Group 2 and 36.6 ± 0.15˚C for Group 3. There was no difference between the groups in terms of body temperature. The overall incidence of IIH was 8.1%; 9.8% in group 1, 9.8% in group 2 and 4.9% in group 3. There was no statistically significant difference between the groups in terms of IIH (p < .05). CONCLUSIONS: This study supports the efficacy of using resistive warming mattress and forced-air warming systems in preventing IIH. The use of both methods together made no difference in terms of IIH development.

Forensic Cases in the Operating Room: Knowledge and Practices of Physicians and Nurses.

PURPOSE: The purpose of this study was to investigate physicians' and nurses' knowledge and practices regarding forensic cases in the operating room. DESIGN: This is a descriptive study. METHODS: The sample consisted of 139 physicians and 59 nurses working in the operating rooms of a university hospital. Data were collected via a question form prepared by the researchers. FINDINGS: Approximately half of the physicians and nurses did not know whether a patient brought to the operating room was a forensic case. Most of the physicians and nurses working in the operating room felt their knowledge and practice regarding the preservation and storage of evidence in forensic cases was inadequate. CONCLUSIONS: The results of this study highlight the necessity of an increased focus on forensic case process.

Effect of patient position on endotracheal cuff pressure in mechanically ventilated critically ill patients.

BACKGROUND: Endotracheal tube cuff pressure must be maintained within 20-30mH2O to prevent complications. There is limited literature reporting the impact of nursing care on endotracheal cuff pressure. However, few studies have reported the effect of nursing care on endotracheal cuff pressure. OBJECTIVES: This study was performed to investigate the effects of body position on endotracheal cuff pressure. METHODS: Twenty-five patients receiving mechanical ventilatory therapy were placed in a baseline position (semirecumbent position with the head of the bed elevated at 30° and head in a neutral position) with endotracheal tube cuff was adjusted to 25cmH2O. The patients were moved into 16 different positions: anteflexion of the head; hyperextension of the head; left lateral flexion of the head; right lateral flexion of the head; rotation of the head to the left; rotation of the head to the right; semirecumbent position with 45° elevation of the head of the bed; recumbent position with 10° elevation of the head of the bed; supine position; trendelenburg position 10°; left lateral position at 30°, 45°, and 90°; and right lateral position at 30°, 45°, and 90°. The endotracheal tube cuff pressure was measured and recorded after each position change. RESULTS: Among the 400 endotracheal tube cuff pressure measurements (25 patients×16 positions) 10 (2.5%) were lower than 20cmH2O; 201 (50.3%) were between 20-30cmH2O and 189 (47.3%) were higher than 30cmH2O. Mean endotracheal tube cuff pressure increased from 25 to 32.59±4.08cmH2O after changing the patients' position. Friedman test indicated a statistically significant deviation in the ETCP across the 16 positions (X2: 122.019, p: 0.0001). CONCLUSIONS: Body positioning during daily nursing care effected the endotracheal tube cuff pressure, suggesting that endotracheal tube cuff pressure should be measured after changing a patient's position and adjusted within the recommended range.

Prevention of ventilator-associated pneumonia: Use of the care bundle approach.

BACKGROUND: The ventilator-associated pneumonia (VAP) care bundle consists of evidence-based practices to improve the outcomes of patients receiving mechanical ventilatory therapy. This study aimed to investigate the implementation of the care bundle on VAP rates in this quasiexperimental study. METHODS: The protocol of this study consisted of 3 phases. In the initial phase, observations were made to determine the VAP care bundle adherence of intensive care unit (ICU) nurses. In the second phase, education was provided to ICU nurses on the subject of the VAP care bundle. For the third phase, the effect of VAP care bundle adherence on the VAP rates after education was investigated. RESULTS: The nurses' VAP care bundle adherence improved after education from 10.8% (n = 152) to 89.8% (n = 1,324) and showed statistically significant improvement (P = .0001 and P < .05). In this study, the VAP rates were determined as 15.91/103 ventilator-days before education and 8.50/103 ventilator days after education. It was found that the VAP rates after the education period were significantly lower than the VAP rates before education. CONCLUSION: VAP care bundle implementation with education prepared according to evidence-based guidelines decreased VAP rates. Thus, implementation of the VAP care bundle on mechanically ventilated patients care is recommended.

Comparison of the efficiency of nail pick and brush used for nail cleaning during surgical scrub on reducing bacterial counts.

BACKGROUND: Although the surgical scrub is a mandatory and routine procedure, there is no standard recommendation for nail cleaning during the scrub. This study compared the efficacy of nail picks and brushes used for nail cleaning during the surgical scrub in reducing bacterial counts. METHODS: Sixty circulatory nurses were included in the survey. The nurses were randomized to undertake 1 of 3 surgical hand scrub protocols: using surgical scrub alone (control group), using a nail pick during the surgical scrub, or using a brush during the surgical scrub. Bacterial counts were measured on the dominant hand immediately before the scrub and 1 hour after the scrub using the glove juice method. RESULTS: The bacterial counts at 1 hour after the surgical scrub were lower in the control group than in the 2 intervention groups, and there was no significant difference between the 2 intervention groups (F = 2.063; P = .136; P > .05). CONCLUSION: Using nail picks and brushes on nails during the surgical scrub does not provide additional decontamination.