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| Clean Instruments May Help Prevent TASS
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A final report issued by the American Society of Cataract and Refractive Surgery says the improper cleaning and sterilization of instruments was a major factor in the early 2006 outbreak of Toxic Anterior Segment Syndrome, an eye injury that results when a noninfectious toxic agent enters the anterior segment during surgery and causes an inflammatory reaction.
The report, compiled by the ASCRS-sponsored TASS Task Force, focuses on instrument cleaning but admits the research failed to reveal a single cause of the recent outbreak. "There is no smoking gun," says Henry Edelhauser, PhD, a professor of ophthalmology and director of ophthalmic research at Emory University Eye Center in Atlanta, Ga., and a member of the ad hoc task force.
To reduce the likelihood of TASS, the report suggests allowing adequate time between cases for instrument cleaning, proper flushing of reusable cannulated instruments with deionized or distilled water and discarding of disposable instruments after one use.
Additional precautions identified by the report include the thorough rinsing of enzymes or detergents from instruments in centers where ophthalmic tools are washed with devices used in non-ophthalmologic cases, the emptying and proper cleaning of ultrasound water baths after each use or at the end of each day, and proper cleaning of the filters, water chambers and insides of autoclave units.
Dr. Edelhauser recommends facilities develop written protocols for instrument cleaning based on the manufacturer's directions for use and follow cleaning guidelines found in The Optometry Red Book, a reference work issued by the Association of Optometrists. Above all, he emphasizes the importance of looking beyond the OR to reduce instances of TASS. "Surgery is a team approach and the person cleaning the instruments plays a big role in case outcomes," he says.
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| Report: Pay for Performance Won't Fix Medicare
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A final report issued by the American Society of Cataract and Refractive Surgery says the improper cleaning and sterilization of instruments was a major factor in the early 2006 outbreak of Toxic Anterior Segment Syndrome, an eye injury that results when a noninfectious toxic agent enters the anterior segment during surgery and causes an inflammatory reaction.
The report, compiled by the ASCRS-sponsored TASS Task Force, focuses on instrument cleaning but admits the research failed to reveal a single cause of the recent outbreak. "There is no smoking gun," says Henry Edelhauser, PhD, a professor of ophthalmology and director of ophthalmic research at Emory University Eye Center in Atlanta, Ga., and a member of the ad hoc task force.
To reduce the likelihood of TASS, the report suggests allowing adequate time between cases for instrument cleaning, proper flushing of reusable cannulated instruments with deionized or distilled water and discarding of disposable instruments after one use.
Additional precautions identified by the report include the thorough rinsing of enzymes or detergents from instruments in centers where ophthalmic tools are washed with devices used in non-ophthalmologic cases, the emptying and proper cleaning of ultrasound water baths after each use or at the end of each day, and proper cleaning of the filters, water chambers and insides of autoclave units.
Dr. Edelhauser recommends facilities develop written protocols for instrument cleaning based on the manufacturer's directions for use and follow cleaning guidelines found in The Optometry Red Book, a reference work issued by the Association of Optometrists. Above all, he emphasizes the importance of looking beyond the OR to reduce instances of TASS. "Surgery is a team approach and the person cleaning the instruments plays a big role in case outcomes," he says.
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| Researchers Chart Nurses' Work-Life Conflicts
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One-half of the registered nurses responding to a recent survey reported suffering "chronic work interference" with their family or home life, while another 41 percent reported "episodic interference," according to a study published in the October issue of Research in Nursing & Health.
"Work-family conflict has significant implications for nurses in terms of personal health, their ability to provide quality care and for the nursing profession itself," says Joseph Grzywacz, PhD, associate professor of family and community medicine at the Wake Forest University School of Medicine in Winston-Salem, N.C., and the study's lead author, in a statement.
He notes that the physical and psychological impact may be exacerbating the nursing shortage by prompting some to change careers and discouraging others from entering the profession. Future studies, the researchers conclude, should examine the ability of more flexible work arrangements to reduce conflict.
The study, described by researchers as the first to gauge the incompatibility of the twin demands of healthcare careers and family roles, analyzed the views of 1,906 registered nurses nationwide. Sixty-three percent of the nurses worked in hospitals and 14 percent in ASCs; 64 percent were caregivers and 18.5 percent managers.
Researchers defined "chronic work interference" as incidents occurring one day a week or more, while "episodic" interference was one to three days a month or fewer. The study also addressed the opposite case, in which personal or family issues interfered with a nurse's work. Only 11 percent reported chronic interference of that situation and 52 percent admitted episodic interference.
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| News and Notes |
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THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS AND AMERICAN ASSOCIATION OF NURSE ANESTHETISTS have endorsed the evidence-based clinical practice consensus guideline for the prevention and management of PONV and PDNV. The guideline, which the American Society of PeriAnesthesia Nurses released three weeks ago, was the work of 18 multi-disciplinary, multi-specialty experts who reviewed and analyzed evidence related to the prevention and management of PONV and PDNV. The panel's guideline "should help improve health outcomes in adult surgical patients," forecasts ASPAN. Look for a special report on the guideline in the October issue of Outpatient Surgery Magazine.
THE CENTERS FOR DISEASE CONTROL AND PREVENTION is investigating a cluster of deep surgical site infections, caused by a single strain of Enterococcus galinarum or E. faecium (confirmatory species identification is still pending), in six out of 134 patients who've undergone total knee replacement procedures at the same Zanesville, Ohio hospital between April and June 2006. The CDC is seeking additional reports of recent infections or clusters of infections involving these Enterococcus species among total joint patients. You can e-mail the agency reports of any recent findings.
CMS HAS NAMED AN ACTING CHIEF to succeed Mark McClellan, MD, PhD, after he steps down later this month. Deputy administrator Leslie Norwalk is slated to fill the position as of Oct. 15. Norwalk, an attorney who has served in the Medicare agency's senior leadership for five years, previously worked for a Washington, D.C., law firm and in the White House Office of Presidential Personnel under George H. W. Bush. It is expected that Norwalk will oversee the next enrollment period for Medicare's prescription drug benefit, which begins Nov. 15. President George W. Bush has not yet announced a timetable for nominating a permanent replacement for Dr. McClellan, according to published reports. |
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