Is a surgical facility with a 95 percent compliance rate for hand hygiene safer than one with 75 percent compliance? Not necessarily, says the Joint Commission. The 2 facilities may not be measuring the same criteria.

"While most would agree that hand hygiene is of critical importance, many have found that measuring adherence to hand hygiene guidelines is not a simple task," write the authors of "Measuring Hand Hygiene Adherence: Overcoming the Challenges," a 202-page monograph issued last week by the Joint Commission and available for free download.

Before setting out to benchmark hand hygiene, the report says, you need to ask yourself the following questions, which will help determine the best way to measure compliance.

Researchers at Children's Hospital Boston have developed a single-injection nerve block that lasts for days and possibly months, a discovery they say might dramatically improve patient care in surgical and pain management facilities.

In lab experiments conducted on rats, they discovered that packaging the potent local anesthetic saxitoxin with fat-based particles called liposomes released the drug slowly, blocking nerve transmission of pain without damaging surrounding nerves or muscle. Blocks comprised of liposomes and saxitoxin alone lasted 2 days; adding the steroid dexamethasone extended the block's duration to 7 days.

"The idea was to have a single injection that could produce a nerve block lasting days, weeks, maybe even months," says Daniel Kohane, MD, PhD, of the division of critical care medicine in the department of anesthesiology at Children's Hospital and the senior author of the study, which appears in the April 13 online edition of the journal Proceedings of the National Academy of Sciences.

If the slow-release delivery method proves effective in humans, "it would be useful for conditions like chronic pain where, rather than use narcotics, which are systemic and pose a risk of addiction, you could just put that piece of the body to sleep, so to speak," adds Dr. Kohane. He is continuing to enhance the drug-delivery's formulation with the aim of beginning clinical trials soon.

Daniel Cook

A perioperative nurse at an outpatient clinic in Madison, Wisc., was called out of surgery last week to receive the news that she was being laid off. The notification left the OR without an RN for part of the procedure, observers note.

In a prepared statement, Dean Health System confirmed the nurse's removal and acknowledged that "while there were other clinical staff present including a physician, the absence of an RN goes against established patient care procedures at Dean Health System."

The layoff occurred at Dean's West Clinic & Urgent Care, an outpatient facility that hosts a wide range of services. Spokesman Paul Pitas called the incident "an error in judgment on the part of the manager conducting the layoff."

Dean Health officials have declined to comment on the specifics of the case, including exactly what procedure was being performed at the time, but say they are "looking into this and appropriate action will be taken." The physician who performed the procedure reported that it "went as expected" and the patient is "doing fine," according to Mr. Pitas.

Dean Health recently announced it would "immediately" lay off 90 employees, creating a stressful situation among some staff. For instance, medical assistant Cheryl Koerwitz told the Wisconsin State Journal that she felt "threatened and scared" after she and other employees at St. Mary's Hospital were warned to expect layoffs if they saw a company representative at the facility.

Irene Tsikitas