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Digital Issues

Red Flashing Lights Improve Hand Hygiene Compliance

Hospital lobbies are full of distractions — signs, colors, frequent alarms and public address announcements. Is it any wonder visitors and staff, who might be carrying coffee or walking through staring at their smartphones, don't notice alcohol gel dispensers?

The authors of a new study in the American Journal of Infection Control assessed the effectiveness of placing blinking red lights — red because the color conventionally alerts individuals to stop or slow down — on alcohol gel dispensers located in the lobby of a large tertiary care academic hospital.

The researchers observed about 15,000 opportunities for hand hygiene on weekday mornings during 3 study periods conducted in January and April 2013. Compliance improved from approximately 13% without use of the blinking lights to 23.5% during cold weather (when individuals wearing gloves were presumably less likely to comply) and 27.1% during warm weather when the lights were activated.

"Red flashing lights make the gel dispensers the most conspicuous object at the front entrance, able to catch an individual's attention at a critical time, when they're entering the hospital," write the researchers. Attaching the lights on top of the dispensers positions them as close as possible to the necessary action, they add.

According to the study, a light's ideal flash rate is 2 to 5Hz, making them noticeable without reaching a seizure-inducing blinking rate. The brightness of the lights used in the study was 23 lumens — attention-grabbing, but not blinding. The rechargeable lights ($9.75) were attached with an organosiloxane polymer ($1.50) for a total system cost of $40.50.

The researchers say the inexpensive lights don't require education or training, can be installed in half a day, are easily replaced and effective immediately, making them a potentially useful way to increase short-term hand hygiene compliance.

Daniel Cook

Are Colonoscopies and Other Cancer Screenings Overused?

Two studies appearing in the latest edition of JAMA Internal Medicine suggest that colonoscopies and other types of cancer screenings are overprescribed in older patients who have limited life expectancies, driving up healthcare costs and potentially harming patients.

In one study, more than 27,000 patients 65 or older were grouped by risk of 9-year mortality from low (25% or less) to very high (75% or more). Screening rates in the very high mortality risk group were 55% for prostate cancer, 41% for colorectal cancer, 38% for breast cancer and 31% for cervical cancer.

These results, say the authors, "raise concerns about overscreening, which not only increases healthcare expenditure but can lead to patient net harm." Creating simple and reliable ways to assess life expectancy, they say, may benefit patients and substantially reduce costs.

A second study found that performing repeat colonoscopies every 5 years, instead of the recommended 10, on Medicare beneficiaries who'd had negative screenings at age 55 provided little benefit, was "inefficient from a societal (cost) perspective," and was often "unfavorable for those being screened," because of large increases in colonoscopy-related complications.

An accompanying commentary questions screening strategies for older patients, asserting that those with shorter life expectancies "have less time to develop clinically significant cancers after a screening test and are more likely to die from non-cancer health problems after a cancer diagnosis." Additionally, it adds, "Older persons face a higher risk of complications from procedures such as screening colonoscopy."

Jim Burger

Perioperative Arrhythmia Increases Patients' Stroke Risk

Perioperative atrial fibrillation (AF), often considered a fleeting condition brought on by the stresses of surgery, should be taken more seriously as a potential risk factor for stroke, warns a new study.

In the August 13 issue of JAMA, researchers from Weill Cornell Medical College in New York, N.Y., write that patients who suffer an episode of perioperative AF, especially those undergoing non-cardiac surgery, could be at increased risk of future stroke events.

The study followed more than 1.7 million patients undergoing inpatient surgery over a 2-year period who'd never previously exhibited AF. About 25,000 of them had an AF episode around the time of their operations. Compared to other patients, those who suffered AF while undergoing non-cardiac surgery nearly doubled their risk of a future stroke, while those receiving cardiac surgery increased their risk by 30%.

"Our results may have significant implications for the care of perioperative patients," the authors write. "The associations we found suggest that while many cases of perioperative AF after cardiac surgery may be an isolated response to the stress of surgery, perioperative AF after non-cardiac surgery may be similar to other etiologies of AF in regard to future thromboembolic risk."

Kendal Gapinski

InstaPoll: What's Your Disinfectant Dwell Time?

How long do you let your disinfectant cleaning solution stay on a surface before you turn the operating room over? Tell us in this week's InstaPoll, then check back next week for the results.

Most of the 518 respondents to last week's poll aren't struggling to convince their employees to get flu shots. The results:

What percentage of your staff get annual flu shots?

  • less than 25% 2%
  • 25% to 50% 6%
  • 50% to 75% 14%
  • more than 75% 76%
  • we don't monitor staff vaccinations 2%

Dan O'Connor

News & Notes

  • Last call for ORX pre-registration contest This Friday, August 22, is the deadline for participating in Outpatient Surgery Magazine's OR Excellence 2014 pre-registration contest. Reserve your place at our uniquely interactive educational and networking event now to lock in savings — including $100 off the full registration fee and discounted rooms at the New Orleans Marriott — and enter into a drawing for such prizes as dinners, accommodation upgrades and the grand prize, a free 4-night stay in the Mayor's Suite and complimentary airport transportation in a posh Town Car. Visit the OR Excellence website for more information and to register.
  • Nerve blocks effective in kids' knee surgeries Femoral nerve blocks may provide better pain management to pediatric patients undergoing knee surgery, according to a recent study. Researchers at Nationwide Children's Hospital in Columbus, Ohio, reviewed the cases of 376 arthroscopic knee surgery patients aged 7 to 18 years, about 30% of whom received a femoral nerve block in addition to general anesthesia. Those who received combined anesthesia reported less pain, shorter stays, and less opioid use after surgery, said researchers, including 98% of patients undergoing ACL reconstructions.
  • Beware the "doctor-shopping" ortho patient About 1 in 5 post-surgical ortho trauma patients go "doctor-shopping" to seek additional providers and obtain additional narcotics prescriptions, say researchers from Vanderbilt University Medical Center in Nashville, Tenn., in the August issue of the Journal of Bone & Joint Surgery. Reviewing a state-controlled substance-monitoring database, the researchers identified redundant prescriptions filled in the 6 months following patient discharges, which was convincing evidence of diversion and possible abuse.