Evaluating use of flash sterilization in the OR with regard to postoperative infections.

This article describes a quality improvement project that examined postoperative infection rates for 100 surgical procedures in which a total of 121 flash sterilizations were performed and determined the costs of treating the postoperative infections compared to the cost of purchasing additional instruments. The post operative infection rate on physical examination was 3%, and the overall cost of diagnosing and treating the postoperative infections was found to be lower than the cost of purchasing additional instruments. To minimize use of flash sterilization, the hospital has added additional surgical instrument inventory and expanded flash sterilization education requirements for staff members.

Influenza vaccination: incidence of symptoms and resulting absenteeism in hospital employees.

A convenience sample of hospital workers, those receiving influenza vaccine and those not receiving vaccine, were asked to complete questionnaires delineating the occurrence of symptoms (e.g., fever, headache, extreme tiredness, dry cough, sore throat, runny nose, stuffy nose, muscle aches) and absenteeism in the 7-day period post-vaccination if vaccinated. Those unvaccinated completed the questionnaire in a self-selected 7 consecutive day period during the study conducted from November 2004 to February 2005. Those receiving either Fluzone or FluMist reported significantly fewer symptoms and related absenteeism than the unvaccinated group (p < .05). Administration of influenza vaccine did not result in higher rates of post-vaccination symptoms as compared to an unvaccinated group. Further, vaccinated employees did not experience higher absenteeism rates as a result of receiving either influenza vaccine. However, for those reporting absenteeism as a result of symptoms, mean absenteeism days were highest in the FluMist group (4.5 days) compared to the unvaccinated group (2.1 days) and the Fluzone group (1.9 days).

Factors affecting hemolysis rates in blood samples drawn from newly placed IV sites in the emergency department.

INTRODUCTION: To decrease the number of hemolyzed samples in the emergency department, performance improvement activities were implemented, including phlebotomy classes for staff, evaluation of blood draw equipment, and a study to evaluate factors attributed to hemolysis of blood samples when drawn at the time a new intravenous catheter is inserted. METHODS: In a study with an observational design conducted in June and July 2004, researchers examined the cases of 100 randomly chosen patients who had blood drawn through newly placed peripheral intravenous access. RESULTS: In this study, the blood draw collection factors with the highest hemolysis rates included blood samples drawn between 12:00 am to 5:59 am; samples drawn by patient care technicians; right-hand site; 22-gauge intravenous catheters; syringe draws; blue tubes; 6.0 mL tubes; difficulty drawing blood; 2 tries for intravenous placement; resistance when aspirating blood using a syringe; and respiratory discharge diagnoses. Statistically significant (P < .05) blood draw factors included intravenous placement sites of right hand/forearm and antecubital; intravenous catheter size 22 gauge; blood drawing categorized as difficult; number of tries for intravenous placement; blood tube size 1.8 mL; and discharge diagnoses of respiratory, gastrointestinal, reproductive, dermatologic, and endocrine. DISCUSSION: Clinically meaningful factors associated with hemolysis rates included the use of a 22-gauge intravenous catheter size, which resulted in a hemolysis rate of 60%; in addition, intravenous placement sites on the right side had statistically significant higher hemolysis rates than the left side, a finding that merits further research. As a result of the study we modified our standard operating procedure to discontinue the use of a 22-gauge or smaller intravenous catheter in adults. If required for small vein sticks, the use of a straight needle stick to obtain blood samples should be considered. The results of this study underscore the importance of education and training and the consideration for regular competency testing for staff with phlebotomy responsibilities.

Evaluation of demographic, behavioral, and procedural factors on pain perception by patients undergoing colonoscopy and moderate sedation.

This prospective study collected demographic, behavioral, and procedural factors data on the pain perception of 100 patients as they were undergoing colonoscopy and moderate sedation. Patients were asked to rate pain on a 4-point categorical scale (no, slight, moderate, or severe pain) before the colonoscopy, every 5 minutes during, and after the colonoscopy. Before discharge, patients recorded overall pain control satisfaction on a 100-mm visual analog scale (0=not satisfied and 100=satisfied). The average patient age was 54.3 years, and 56% were male. A total of 59 subjects reported an averaged "no pain" or "slight pain" rating, and 41 reported moderate or severe pain. The median visual analog scale score was 92.5, demonstrating a high level of overall pain-control satisfaction. Patient reports of pain during the colonoscopy procedure may not be recalled by the moderately sedated patient, as evidenced from the high level of satisfaction of overall pain control demonstrated by the visual analog scale finding. Compared with women and non-Whites, a larger proportion (P<.05) of men and Whites reported "no" or "slight pain"; moreover, a larger proportion (P<.05) of patients experiencing no preprocedure anxiety reported "no" or "slight pain" compared with those experiencing anxiety before their procedure. Compared with other sedation groups, a larger proportion (P<.05) of patients receiving Versed + Fentanyl reported "no" or "slight pain" during their procedures. Other factors that were analyzed, including age, body mass index, history of alcohol consumption, smoking, narcotic use, length of procedure, and medical or nursing intervention, did not appear to influence the level of pain perceived by patients observed in this study.