Increasing face-mask compliance among healthcare personnel during the coronavirus disease 2019 (COVID-19) pandemic.

OBJECTIVE: Prior studies of universal masking have not measured face-mask compliance. We performed a quality improvement study to monitor and improve face-mask compliance among healthcare personnel (HCP) during the coronavirus disease 2019 (COVID-19) pandemic. DESIGN: Mixed-methods study. SETTING: Tertiary-care center in West Haven, Connecticut. PATIENTS: HCP including physicians, nurses, and ancillary staff. METHODS: Face-mask compliance was measured through direct observations during a 4-week baseline period after universal masking was mandated. Frontline and management HCP completed semistructured interviews from which a multimodal intervention was developed. Direct observations were repeated during a 14-week period following implementation of the multimodal intervention. Differences between units were evaluated with χ2 testing using the Bonferroni correction. Face-mask compliance between baseline and intervention periods was compared using time-series regression. RESULTS: Among 1,561 observations during the baseline period, median weekly face-mask compliance was 82.2% (range, 80.8%-84.4%). Semistructured interviews were performed with 16 HCP. Qualitative analysis informed the development of a multimodal intervention consisting of audit and passive feedback, active discussion, and increased communication from leadership. Among 2,651 observations during the intervention period, median weekly face-mask compliance was 92.6% (range, 84.6%-97.9%). There was no difference in weekly face-mask compliance between COVID-19 and non-COVID-19 units. The multimodal intervention was associated with an increase in face-mask compliance (ß = 0.023; P = .002). CONCLUSIONS: Face-mask compliance remained suboptimal among HCP despite a facility-wide mandate for universal masking. A multimodal intervention consisting of audit and passive feedback, active discussion, and increased communication from leadership was effective in increasing face-mask compliance among HCP.

Transforaminal lumbar interbody fusion: the effect of various instrumentation techniques on the flexibility of the lumbar spine.

STUDY DESIGN: In vitro comparison of four reconstruction techniques following transforaminal lumbar interbody fusion in a human cadaveric model. INTRODUCTION: Transforaminal lumbar interbody fusion (TLIF) is a relatively new technique that avoids the morbidity of an anterior approach and the nerve root manipulation of a posterior interbody fusion. This study measured the effects of a TLIF on the overall and segmental flexibility of the lumbar spine using four different spinal implant configurations. SUMMARY OF BACKGROUND DATA: Anterior lumbar interbody fusion, posterior lumbar interbody fusion, and combined anterior-posterior spinal procedures are gaining wide acceptance for the treatment of selected patients with segmental spinal instability and spondylolisthesis with associated degenerative changes. Each fusion technique may have different effects on the overall flexibility of the lumbar spine. The unilateral TLIF procedure with adjunctive pedicular fixation is one variation of an interbody fusion technique that requires less bony and soft tissue dissection and minimizes nerve root manipulation compared with other interbody fusion methods. METHODS: Five fresh-frozen, human lumbar spines were nondestructively subjected to flexion, extension, lateral bending, and axial rotation moments using a previously validated spine flexibility tester, and displacements were measured. Testing the intact lumbar spine was followed by testing of a unilateral L4-L5 TLIF using a single ramp carbon fiber cage without adjunctive internal fixation. The single carbon fiber (Brantigan) cage was inserted obliquely in a posterolateral to anteromedial position in the L4-L5 disc space. Following testing of the cage alone, three different adjunctive stabilization techniques were tested. Posterior stabilization involved one of the following: a contralateral translaminar facet screw, single side/ipsilateral nonsegmental pedicle screw fixation, and bilateral nonsegmental pedicle screw fixation. The overall flexibility of each lumbar spine was calculated from load-displacement curves for each axis of rotation. The flexibility of the L4-L5 segment of each spine was computed from kinematic motion data acquired via attached LED sensors to the L4 and L5 vertebral bodies. Statistical testing was performed with paired t tests. RESULTS: The flexibility of the entire (T12-S1) destabilized spine after TLIF with interbody cage alone and with all three reconstructive techniques was comparable with the intact spine. However, the motion at the L4-L5 segment was significantly increased for the TLIF with interbody cage alone in axial rotation (299% of intact, P < 0.01), with no significant change in flexion-extension (79% of intact, P = 0.22) or lateral bending (87% of intact, P = 0.39). With the addition of a contralateral translaminar facet screw, the motion at the L4-L5 segment remained significantly more flexible in axial rotation (250% of intact, P = 0.06) although less than with the cage alone. With the unilateral pedicle screw construct, the L4-L5 segment remained more flexible in axial rotation (182% of intact, P = 0.07) although significantly less than with the facet screw construct (P < 0.05). The addition of bilateral pedicle screws most closely reapproximated the flexibility of the intact spine with no significant difference in axial rotation (91% of intact, P = 0.30), flexion-extension (93% of intact, P = 0.19), or lateral bending (99% of intact, P = 0.47). The motion at the L4-L5 segment with bilateral pedicle screws was not significantly different than for the intact specimen in axial rotation (144% of intact, P = 0.17), flexion-extension (81% of intact, P = 0.21), or lateral bending (86% of intact, P = 0.27). CONCLUSIONS: TLIF reconstruction with a solitary cage did not increase overall spine flexibility from the intact condition but significantly increased segmental flexibility at L4-L5 in axial rotation. A unilateral translaminar facet screw had minimal stabilizing effect at L4-L5. Unilateral pedicle screws frews further increased stiffness at the L4-L5 segment. However, TLIF with bilateral pedicle screws most closely approximated the L4-L5 segmental flexibility of the intact spine.