Novel Skin Prep Technique Reduces OR Preparation Times in a Randomized Trial for Podiatric and Orthopedic Procedures.

The primary objectives of any high-volume surgery department should be patient safety, block time utilization and operating room efficiency. Reducing preparation time in the OR prior to actual surgery can improve operating room efficiency and utilization, but only if patient safety can be maintained. With this goal, this study evaluated a novel skin preparation technique using a device named ULTRAPREP™, a sterile, medical-grade plastic bag that is applied to the upper or lower extremity in the pre-operative holding area which allows for skin disinfection outside the OR (referred to as "disinfection bag"). The study compared preparation times required in the OR and antiseptic efficiency (through Colony Forming Units (CFU) counts) for traditional methods versus using the disinfection bag on a total of 115 patients undergoing podiatric or orthopedic surgeries (upper and lower extremities) in one hospital. The disinfection bag reduced skin preparation time in the OR from 16.8±3.5min to 10.9±2.7min, which was a 35.2% reduction, and was statistically significant (p<0.01). Skin antisepsis met safety standards of <15 CFUs for all cases regardless of preparation type at 48h and 72h. There was no statistical difference in CFU levels between the traditional and disinfection bag methods at 48h or 72h (p>0.11). Therefore, ULTRAPREP™ has shown the ability to decrease operating room time while keeping surgical site infection rates to a minimum. Minimizing activities in the OR optimizes use of this costly resource and brings overall savings to the surgery department.

Community Paramedics' Perception of Frequent ED Users and the Community Paramedicine Program: A Mixed-Methods Study.

Community paramedicine (CP) model of care integrates existing emergency medical service (EMS) resources with primary care, public health, social services and community engagement. However, published studies about CP programs in the U.S. are sparse. To understand how paramedics perceive CP programs and patients in the program, we surveyed and interviewed 16 community paramedics (10 men and 6 women) who are currently delivering health care within a CP program. Our analyses highlighted that community paramedics: (1) defined CP patients in sympathetic terms; (2) reported patient and systemic factors contributing to ED overuse; and (3) expressed their frustrations and commendations for CP programs. Several suggestions were identified to improve CP program (all modifiable elements). Further, the frustrations expressed by paramedics highlight the barriers to health care access for underserved communities. We discuss the implications of this research for practice and recommend future qualitative studies on longer operating CP programs.

Drivers׳ merging behavior data in highway work zones.

There have been growing research interests in finding a suitable work zone layout to improve work zone safety and traffic efficiency. This paper contains data supporting the research article entitled: Effects of work zone configurations and traffic density on performance variables and subjective workload (Shakouri et al., 2014 [1]). A full factorial experiment was conducted to compare the efficiency of two work zone configurations by using a driving simulator with two levels of work zone configuration, two levels of traffic density and three levels of sign placement as fixed factors. Seven female and 23 male participants completed the experiment. In this paper we present the data relating to demographic information of participants, driving simulator data and subjective workload evaluation of participants for each work zone.

Effects of work zone configurations and traffic density on performance variables and subjective workload.

This paper investigates the effect of changing work zone configurations and traffic density on performance variables and subjective workload. Data regarding travel time, average speed, maximum percent braking force and location of lane changes were collected by using a full size driving simulator. The NASA-TLX was used to measure self-reported workload ratings during the driving task. Conventional lane merge (CLM) and joint lane merge (JLM) were modeled in a driving simulator, and thirty participants (seven female and 23 male), navigated through the two configurations with two levels of traffic density. The mean maximum braking forces was 34% lower in the JLM configuration, and drivers going through the JLM configuration remained in the closed lane longer. However, no significant differences in speed were found between the two merge configurations. The analysis of self-reported workload ratings show that participants reported 15.3% lower total workload when driving through the JLM. In conclusion, the implemented changes in the JLM make it a more favorable merge configuration in both high and low traffic densities in terms of optimizing traffic flow by increasing the time and distance cars use both lanes, and in terms of improving safety due to lower braking forces and lower reported workload.

Making safety an integral part of 5S in healthcare.

BACKGROUND: Healthcare faces major challenges with provider safety and rising costs, and many organizations are using Lean to instigate change. One Lean tool, 5S, is becoming popular for improving efficiency of physical work environments, and it can also improve safety. OBJECTIVE: This paper demonstrates that safety is an integral part of 5S by examining five specific 5S events in acute care facilities. We provide two arguments for how safety is linked to 5S:1. Safety is affected by 5S events, regardless of whether safety is a specific goal and 2. Safety can and should permeate all five S's as part of a comprehensive plan for system improvement. METHODS: Reports of 5S events from five departments in one health system were used to evaluate how changes made at each step of the 5S impacted safety. RESULTS: Safety was affected positively in each step of the 5S through initial safety goals and side effects of other changes. CONCLUSIONS: The case studies show that 5S can be a mechanism for improving safety. Practitioners may reap additional safety benefits by incorporating safety into 5S events through a safety analysis before the 5S, safety goals and considerations during the 5S, and follow-up safety analysis.

Neck disorders among construction workers: understanding the physical loads on the cervical spine during static lifting tasks.

In this study a common yet very strenuous construction work activity, was evaluated biomechanically by studying electromyography (EMG) of the major neck muscles. The muscles studied were the sternocleidomastoid and the upper trapezius. Fifteen healthy participants (10 males and 5 females) with no history of musculoskeletal abnormalities participated in this study. The participants lifted 25%, 50%, and 75% of their maximum shoulder height static strength at neutral, maximally flexed, and maximally extended neck postures. The weight lifted as well as the neck posture significantly affected the activities of the neck muscles. Increase in the weight increased the activation of the neck muscles. The sternocleidomastoid muscle was most active at the extended neck posture, while the upper trapezius muscle was most active at the flexed neck posture. The results of this study indicate that the neck muscles play an active role during lifting and holding tasks at shoulder height. Thus, such tasks could be probable risk factors associated with neck disorders prevalent among construction workers.

Experimental manipulation of psychosocial exposure and questionnaire sensitivity in a simulated manufacturing setting.

PURPOSE: The objectives of this study were to determine the efficacy of experimental manipulations of psychosocial exposures and to evaluate the sensitivity of a psychosocial questionnaire by determining the factors perceived. METHODS: A 50-item questionnaire was developed from the job content questionnaire (JCQ) and the quality of worklife survey (QWL). The experiment involved simulated work at different physical and psychosocial levels. Forty-eight participants were exposed to two levels of one psychosocial manipulation (job control, job demands, social support, or time pressure). RESULTS: Significantly different questionnaire responses supported the effectiveness of psychosocial manipulations. Exploratory factor analysis revealed five factors: skill discretion and decision authority, stress level and supervisor support, physical demands, quality of coworker support, and decision-making support. CONCLUSIONS: These results suggest that psychosocial factors can be manipulated experimentally, and that questionnaires can distinguish perceptions of these factors. These questionnaires may be used to assess perceptions of psychosocial factors in experimental settings.