The hand hygiene compliance of student nurses during clinical placements.

AIMS AND OBJECTIVES: To observe student nurses' overall and moment-specific hand hygiene compliance during clinical placement. BACKGROUND: Hand hygiene is the single most important measure to prevent healthcare-associated infections. However, research has shown low compliance among healthcare workers. During clinical placements, student nurses perform various nursing tasks and procedures to a large number of patients, requiring extensive patient contact. It is crucial that they practice correct hand hygiene to prevent healthcare-associated infections. DESIGN: Open, standardised and nonparticipating observations. METHODS: Twenty-nine student nurses were observed three times for 20 ± 10 min during clinical placement in a Norwegian university hospital. To measure compliance, we used WHO's Hand Hygiene Observation tool, based on the model "My five moments for hand hygiene". RESULTS: Overall hand hygiene compliance in the student group was 83.5%. Highest moment-specific compliance was after touching patient surroundings, after touching patients and after body fluid exposure risk. Lowest moment-specific compliance was recorded before touching patients or patient surroundings, and before clean/aseptic procedures. CONCLUSIONS: Nurse education needs to be improved both theoretically and during clinical placements in order to advance and sustain compliance among student nurses. RELEVANCE TO CLINICAL PRACTICE: Increasing healthcare workers' compliance with hand hygiene guidelines remains a challenge to the clinical community. In order to reduce healthcare-associated infections, it is important to educate student nurses to comply with the guidelines during clinical placements. Identifying student nurses' hand hygiene performance is the first step towards developing teaching methods to improve and sustain their overall and moment-specific compliance. As a measure to ensure student compliance during clinical placements, mentors should be aware of their influence on students' performance, act as hand hygiene ambassadors, encourage students to comply with established guidelines and provide regular feedback.

Development of a multimodal tumor model for porcine liver.

In our efforts to develop a guidance system for laparoscopic liver surgery, we are working towards a live animal tumor model. The objective of this study was to establish the tumor model for live porcine liver, visible on both computed tomography (CT) and ultrasound images. The tumor model was created by injecting a mixture of agarose, sephadex, and glycerol. Together with water, the mixture was heated to bring its components into solution. Once heating was complete, methylthionine chloride and CT contrast were added. Using laparoscopic ultrasound guidance, the tumor model mixture was injected into in vivo porcine liver. The resulting model tumors were radiolucent, visible on both CT and conventional X-ray. They appeared as hyperechoic lesions on ultrasound images. Compared to the CT images, the model tumors in the ultrasound images showed good correspondence in size. We conclude that our tumor model, due to its clearly identifiable nature on multiple imaging modalities, is a valuable tool for further studies on laparoscopic ultrasound (2D and 3D) and navigated ultrasound in laparoscopic surgery of the liver and other organs in a pre-clinical set-up.

Strain estimation in abdominal aortic aneurysms from 2-D ultrasound.

The rupture risk of abdominal aortic aneurysms (AAAs) is routinely inferred from the maximum diameter of the AAA. However, clinical experience indicates that this criterion has poor accuracy and that noninvasive assessment of the elastic properties of the vessel might give better correspondence with the rupture risk. We have developed a method for analysis of circumferential strain in AAAs from sequences of cross-sectional ultrasound B-mode images. The algorithm is fast, semiautomatic and well-suited for real-time applications. The method was developed and evaluated using data from 10 AAA patients. The preliminary results demonstrate that the method is sufficiently accurate and robust for clinically acquired data. An important finding is that local strain values may exceed the circumferential average strain significantly. Furthermore, the calculated strain shows no apparent covariation with the diagnosed diameter. This implies that the method may give new and essential information on the clinical condition of the AAA.

[Teleradiologic follow up of patients treated with aortic stent grafting]. / Teleradiologisk oppfølging av pasienter behandlet med stentgraft i aorta.

BACKGROUND: A study has confirmed the possibility of follow up in the local hospital of patients who have undergone endovascular repair. We present a cost analysis of such a regimen compared to follow up at a university hospital. MATERIAL AND METHODS: By using discharge data from the Norwegian Patient Register we identified a group of patients which could have been followed up at their local hospital for their stent-grafted abdominal aortic aneurysm and estimated the cost effects of performing follow ups locally. RESULTS: The cost analysis showed a potential for cost savings from local follow ups, especially from moving from inpatient care at the university hospital to outpatient care locally. The result of this cost analysis differs from other Norwegian studies of teleradiology by identifying a possibility for more cost-effective treatment. INTERPRETATION: Using teleradiology to follow up these patients will free up capacity in the university hospital. Most probably, other groups of patients can also be followed up by teleradiology. The university hospitals can use this freed-up capacity for new patients. Teleradiology could lead to more efficient use of health care facilities, which should be in the interest of the health authorities.

Three-dimensional teleradiology for surveillance following endovascular aortic aneurysm repair: a feasibility study.

PURPOSE: To study the feasibility of 3-dimensional (3D) teleradiology in surveillance of patients treated with stent-grafts for abdominal aortic aneurysm (AAA). METHODS: Between April 2002 and November 2003, 8 AAA patients (7 men; median age 73 years, range 62-84) with stent-grafts had follow-up computed tomograms (CT) performed at their local hospital and transmitted without loss across a broadband connection to the university hospital. On both monitors, the radiologists were presented with the complete CT axial dataset, sagittal and coronal reformatted slices, and a 3D volume-rendered reconstruction. The two radiologists were then able to simultaneously perform measurements and real-time manipulations of the axial and 3D pictures, which were discussed over the telephone or using a videoconferencing unit. Patient satisfaction, the radiologists' evaluation of the method, and the potential cost savings were explored. RESULTS: Twelve follow-up CT scans were performed on the 8 patients. The time for transmission over the teleradiological network averaged 5 minutes, and the evaluation required 15 minutes at the university hospital. The overall technical quality of the images was rated as good by the university radiologist. In 11 studies, the stent-grafts were satisfactory, but a type III endoleak was detected in one 5.5-year-old stent-graft. Neither radiologist had a problem identifying the endoleak. Patients had confidence that the examination at the local hospital was of good quality; they all felt that they received good care and were pleased with avoiding travel to the university hospital. From the economic analysis, an annual savings of 40,000 Euros (USD 52,304) was projected, mostly due to avoiding hospital stays and outpatient consultations at the university hospital. CONCLUSIONS: The experiences from this study are encouraging, but a larger series will be necessary for a thorough evaluation of 3D teleradiology as a surveillance method for aortic stent-graft patients.

[Nine years' experience with endovascular treatment of abdominal aortic aneurysms]. / Ni års erfaring med endovaskulaer behandling av abdominale aortaaneurismer.

BACKGROUND: Endovascular repair of abdominal aortic aneurysm was started nine years ago at our institution. Our purpose was to evaluate the results over this period. MATERIAL AND METHODS: From 1995 to 2003, a total of 148 patients were treated for infrarenal abdominal aortic aneurysms by endovascular repair. The material includes 31 patients (21%) who were unfit for open surgery because of comorbidity or poor general condition. The patients have been followed up at regular intervals with clinical investigation, plain abdominal X-ray, and CT scans. Regional anaesthesia was used for 143 procedures; 5 were carried out under general anaesthesia. RESULTS: 30-day mortality following elective procedures was 2.3%. 31 endo-leaks were observed, 16 early and 15 late. Furthermore, 22 graft limb occlusions were diagnosed and thirteen of them repaired with femoro-femoral bypass. Secondary procedures were necessary in 42 (28.4%) of the patients, including 7 late conversions to open surgery. Some patients had more than one secondary procedure. With better stent grafts, the incidence of complications and secondary procedures has decreased significantly. During the last 4.5 years, only 4 secondary procedures (5.8%) have been necessary in 69 patients. In the total material the accumulated five-year survival rate was about 60%. INTERPRETATION: Results from endovascular repair of abdominal aortic aneurysm have improved in recent years. Ongoing prospective randomised studies could give us the information we need in order to establish what role this treatment should have.

Combined open and endovascular treatment of complex aortic disease.

The purpose of this article is to report whether combined open and endovascular treatment could be applied in patients with complex aortic disease. A retrospective study including four patients with complex aortic disease was undertaken. In all patients, extra-anatomic bypass to the visceral arteries was made through a laparotomy while the aortic lesion was repaired by stent grafting. One patient died on the first postoperative day and another died 3 months after treatment from a myocardial infarction. The other two patients were alive 13 and 34 months after treatment, respectively. However, a patient treated for a ruptured thoracoabdominal type 2 aneurysm on the basis of a dissection suffers from postoperative paraplegia. The combination of open surgery with extra-anatomic bypass to visceral arteries and stent grafting could be an option for the treatment of patients with complex aortic disease, especially in high-risk cases in which more extensive open surgery is contraindicated.