advertiser banner advertiser banner advertiser banner advertiser banner
Digital Issues

Hand Hygiene Declines Towards Workday's End

As the workday progresses, hand hygiene among hospital workers who deal directly with patients declines, according to behavioral researchers.

Their study, published online by the Journal of Applied Psychology, looked at 3 years of hand-washing data involving about 4,000 healthcare workers at 35 hospitals, including nurses (65%), patient care technicians (12%), therapists (7%) and physicians (4%), among others. It found that hand-washing compliance dropped an average of 8.7% between the beginning and the end of a typical 12-hour shift.

The study also suggested that the intensity of the work during a shift affects hand hygiene. Employees who worked more difficult shifts had a greater compliance decline, the researchers found. However, workers who had more time off between shifts followed hand-washing protocol more closely.

"Just as the repeated exercise of muscles leads to physical fatigue, repeated use of executive resources (cognitive resources that allow people to control their behaviors, desires and emotions) produces a decline in an individual's self-regulatory capacity," the researchers wrote.

Kendal Gapinski

Risk Factors for Delirium in the Elderly

Elderly patients who are depressed and in pain before surgery are more likely to suffer delirium in PACU, according to new research in the journal The Lancet Psychiatry.

The study showed that nearly a quarter of its 459 patients, who were aged 70 years or older and did not suffer from dementia when they underwent orthopedic surgery between June 2010 and August 2013, showed signs of post-op dementia.

Drilling down deeper into the findings, the researchers discovered patients with symptoms of depression were 21% more likely to suffer delirium with each single point increase in pre-op pain scores, as compared to 3% of non-depressed patients.

"Understanding the impact of pre-operative pain and depression on risk of delirium in older surgical patients is important," says study lead author Cyrus Kosar, a programmer analyst at the Harvard Medical School–affiliated Hebrew SeniorLife Institute for Aging Research in Boston. "By exploring the interaction between pain, depression, and delirium we may uncover potential targets for intervention."

He says surgical caregivers need to be aware of the factors that increase risk of post-op delirium, and facilities should include asking about signs of depression and pain levels during pre-op evaluation phone calls placed to the elderly.

Daniel Cook

Better Handoff Communication Cuts Errors

Implementing a structured handoff program for physicians to use during shift changes reduced medical errors by 23% and preventable adverse events by 30%, says a study in the New England Journal of Medicine.

The study, which involved nearly 11,000 patients at 9 hospitals, called for physicians to convey both oral and written instructions using an "IPASS" mnemonic: illness severity, patient summary, action list, situation awareness and contingency planning, and synthesis by receiver (asking questions, indicating understanding).

Additionally, the program didn't take a toll on the physicians' workflow, said lead author Amy J. Starmer, MD, MPH. "Not only do we see a dramatic reduction in medical errors, but we found that this method is adaptable to other hospitals and to other healthcare workers, such as nurses and surgeons."

Jim Burger

October 21st E-WEEKLY

InstaPoll: Is the Joan Rivers Case Bad for Business?

Has the fallout from the Joan Rivers case, the routine endoscopy that was anything but, impacted business at your surgical facility? Tell us in this week's InstaPoll, then check back next week for the results.

More than half (57%) of the 206 respondents to last week's poll say their surgeons don't support the use of safety devices in the OR. The results:

My surgeons are resistant to safety measures (double gloving, safety sharps, smoke evacuation).

  • Completely agree 18%
  • Mostly agree 39%
  • Neither agree nor disagree 7%
  • Mostly disagree 26%
  • Completely disagree 10%

Dan O'Connor

News & Notes

  • How do anesthetics work? Despite the everyday use of anesthetic drugs in surgery, no one is entirely clear on exactly how they work. Researchers at Weill Cornell Medical College in New York may have found a clue, however. Their recent study, published in the Journal of General Physiology, suggests that the application of anesthetics alters the proteins within nerve cells to disrupt cell-to-cell communication. In time, an understanding of the mechanism of anesthetic drugs may provide an opportunity to improve them, they note.
  • AORN will issue "guidelines," not "recommended practices" AORN's "Perioperative Recommended Practices" will, as of January publications, be known as "Guidelines for Perioperative Practice," the organization announced this week. "Our decision to retitle is primarily driven by the acceptance of our evidence-based recommended practices by the National Guidelines Clearinghouse as nationally recognized guidelines for perioperative practice," says CEO and Executive Director Linda Groah, MSN, RN, CNOR, NEA-BC FAAN.
  • There's an app for that The app Electronic Access to Surgical Events (EASE) keeps friends and family members informed about the progress of their loved ones' surgeries. Up to 10 registered recipients can download the free app onto their mobile devices and receive encrypted, HIPAA-compliant messages from the surgical team, which automatically disappear after 45 seconds to eliminate worry about deleting the sensitive information.