Healthcare Failure Mode and Effect Analysis (HFMEA) as an Effective Mechanism in Preventing Infection Caused by Accompanying Caregivers During COVID-19-Experience of a City Medical Center in Taiwan.

BACKGROUND AND OBJECTIVES: In response to the COVID-19 pandemic outbreak and to ensure the safety of epidemic prevention in the hospital, the hospital has established mitigation strategies in advance including risk assessment and effect analysis to control hospital visitors and accompanying persons. The study aims to assess the effectiveness of mitigation strategies implemented to effectively prevent the invasion and spread of the virus. METHOD: Conduct a status analysis in accordance with the Healthcare Failure Mode and Effect Analysis (HFMEA) 4-step model, construct a response workflow, confirm the failure mode and potential causes, perform hazard matrix analysis and decision tree analysis, and formulate risk control management measures. RESULTS: For the 4 main processes and 9 subprocesses of the accompanying carers and contract caregivers entering the hospital, 26 potential failure modes and 42 potential causes of failure were analyzed. Following implementing improvement measures including strategies targeting the accompanying person, mitigation workflow failure rates decreased from 42 to 13 items, the pass rate for the maximum body temperature cutoff increased from 53.1% to 90.8%, and the compliance rate of hand washing increased from 89.5% to 100%. CONCLUSION: The HFMEA model can effectively implement preventive risk assessment and workflow management of high-risk medical procedures. The model can adjudicate the health of hospital visitors during the epidemic/pandemic, provide epidemic/pandemic education training and preventive measure health education guidance for hospital visits, and improve their epidemic prevention cognition. When combined, these strategies can prevent nosocomial infection to achieve the best anti-epidemic effect.

Percutaneous CT-guided chemical thoracic sympathectomy for patients with palmar hyperhidrosis after transthoracic endoscopic sympathectomy.

BACKGROUND: Palmar hyperhidrosis is a common functional disorder in the Asians. Currently, transthoracic endoscopic sympathectomy (TES) is considered to be the treatment of choice for this entity because of its high initial success rate and minimal morbidity. However, primary failure and recurrence of hyperhidrosis occurred in some patients, even with a very low incidence. We present our experience in the treatment of primary failure and recurrence of hyperhidrosis after TES by means of percutaneous computer tomography (CT) guided ethanol thoracic sympathectomy. METHODS: From July 1999 to July 2001, 11 patients (2 males and 9 females with a mean age of 25.9 years, range: 19-44 years) of this subgroup underwent percutaneous CT-guided chemical thoracic sympathectomy. Failure of the first sympathectomy was caused by severe pleural adhesion (from the previous operative findings) in 7 patients. The remaining 4 patients were recurrent palmar hyperhidrosis. All patients underwent unilateral procedures (3 on the right and 8 on the left). RESULTS: All patients were followed for at least 2 years after the treatment. Needle puncture was possible without difficulty in all patients. All patients had satisfactory results with minimal complication. No recurrence was noted at follow-up. CONCLUSION: In summary, percutaneous CT-guided ethanol thoracic sympathectomy could be an easy, safe, and alternative strategy to treat patients with palmar hyperhidrosis after failure or recurrence after TES.

External subdural drainage in the treatment of infantile chronic subdural hematoma.

BACKGROUND: The management of chronic subdural hematoma (CSDH) in infants remains controversial. The purpose of this study was to analyze the clinical characteristics of CSDH in infancy and evaluate the efficacy of continuous external subdural drainage in the treatment of infantile CSDH. METHODS: We prospectively collected 36 consecutive infants with CSDH, to receive continuous external subdural drainage as the initial management. Medical records were reviewed for comparison of age, gender, cause of injury, clinical presentation, surgical management, and outcome. Diagnosis was made by computed tomography and/or magnetic resonance imaging. RESULTS: There were 20 boys and 16 girls, with ages ranging from 1 to 11 months (average, 5.9 months). The most common cause of CSDH was head injury (44.5%), followed by shaken baby syndrome (36.1%). The most common clinical presentations were seizure, bulging fontanel, and consciousness disturbance. Continuous external subdural drainage was the definite treatment in 34 patients (94.4%). The drains were left in place for no more than 9 days. Only two (5.6%) patients needed permanent subduroperitoneal shunting. No obvious complication was found. At follow-up (17-160 months; mean, 86.6 months), 23 (63.9%) had good recovery, 5 (13.9%) had moderate disability, 3 (8.3%) had severe disability, 4 (11.1%) were in a vegetative state, and 1 (2.8%) died. CONCLUSION: Continuous external subdural drainage was an effective treatment in infantile CSDH, with a low complication rate and good clinical outcome. It might be considered as a strategy before subduroperitoneal shunting in the treatment of CSDH in infants.