Are Your Skin Preps Contaminated?

Could surgical skin preps be causing rather than preventing infections? Researchers believe the answer is yes.

Nosocomial infections associated with contaminated antiseptic products may be more common than indicated by manufacturers' reports and medical literature, according to an article by 2 FDA researchers published in the New England Journal of Medicine. Because preps aren't sterile products, produced under sterile conditions and stored as such, they're open to contamination by microbial organisms during manufacture or use.

"Users should … be aware that microbial contamination can occur when they are opening containers or diluting and storing solutions under nonsterile conditions," write the authors. "The period during which a container, once opened, can remain safe from extrinsic contamination is unknown. Awareness on the part of users may reduce the likelihood that multidose antiseptic products will become contaminated."

Although it's difficult to assess the extent of infections associated with contaminated skin preps, outbreaks that have been reported in the literature and to the CDC have resulted in adverse outcomes ranging from localized infections at injection sites to systemic infections and death. The reports have implicated alcohol, iodophor, chlorhexidine gluconate and quaternary ammonium products, according to the authors.

In 2009, an FDA advisory committee considered whether to mandate sterile manufacturing conditions for topical antiseptic products intended for use on non-intact skin, but it didn't reach a conclusion. The agency has scheduled a public hearing for Dec. 12, and is inviting input.

Stephanie Wasek

Regional Anesthesia Safe in Children

Regional anesthesia is a safe option for pain control in pediatric patients, according to a study published in the December issue of the journal Anesthesia & Analgesia.

Researchers at Children's Hospital Colorado in Aurora mined a national database of more than 15,000 pediatric cases involving regional anesthesia for serious block-related complications that occurred during or after surgery. They report no patient deaths or serious complications leading to permanent injury.

Continuous blocks did, however, have a higher overall complication rate than single-injection blocks, with most adverse events related to difficulties with catheter placement or dislodgement. Single-injection caudal blocks (in the pelvis area for lower-body procedures), were the most frequently performed blocks, followed by peripheral nerve blocks for surgeries on upper and lower extremities.

The study's authors say the large number of peripheral nerve blocks performed could be linked to the increased popularity of ultrasound guidance, which was used in more than 80% of upper-limb blocks and nearly 70% of lower-limb blocks.

Large database studies are needed to determine the true risks of regional anesthesia because overall complication rates are extremely low, note the authors, who say their findings coincide with a similar European study that found blocks placed in children to be a largely safe practice.

Daniel Cook

Study Backs Contract Nursing

It's common practice for hospitals and surgery centers to hire temporary and per diem nurses to combat staffing shortages. Perhaps they've questioned whether this solution is productive or simply mathematical. Researchers at the University of Pennsylvania's School of Nursing, however, report that the hiring of supplemental nurses seems to have a positive effect on the quality of care and patient outcomes.

"Our study showed these nurses could be lifesavers," says Linda H. Aiken, PhD, RN, a professor at the school and director of its Center for Health Outcomes and Policy Research (CHOPR). "Hiring temporary nurses can alleviate shortages that could produce higher patient mortality."

Her team of researchers reviewed data collected from more than 1.3 million patient cases, 40,000 nurses and 600 hospitals in Pennsylvania, New Jersey, Florida and California, to conclude that the anecdotal association of temporary nurses and poor outcomes may be more a reflection of shortfalls in the facility in which they're working.

"Hospital executives and managers who employ large numbers of supplemental nurses should evaluate whether deficiencies in work environments in their institutions are adversely impacting the success in attracting and retaining qualified permanent nurses, as well as possibly adversely affecting patient outcomes," says Dr. Aiken.

CHOPR researchers have also recently reported on the possibility that nurses who work longer shifts are more prone to burnout and more likely to spark patient dissatisfaction, as well as a potential connection between burned-out nurses and higher infection rates.

David Bernard

InstaPoll: Is the Patient Always No. 1?

What do you do when the best interests of your facility or your surgeons are at odds with what's best for the patient on the table? Tell us in this week's Outpatient Surgery Magazine InstaPoll.

Last week we asked at what age you require patients to have an EKG, even if they have no history of heart disease. The responses from 708 facility managers were interesting and across the board, with no real consensus:

  • 40 plus: 17%
  • 50 plus: 32%
  • 55 plus: 8%
  • 60 plus: 17%
  • Never: 26%
Does pre-anesthesia testing without a demonstrated risk help to detect heart disease and prevent poor surgical outcomes, or is it a waste of healthcare dollars? "All of the literature I have read from the American Society of Anesthesiologists on pre-anesthesia testing says over 50 years [for EKGs], but even the ASA members do not agree on this topic," says Beverly Kirchner, RN, BSN, CNOR, CASC, president of Genesee Associates in Southlake, Texas.

Dan O'Connor

News & Notes
  • MedPAC proposes slight increases ASCs should receive a 0.5% payment rate increase in 2014, says the Medicare Payment Advisory Commission (MedPAC). The independent legislative agency, which advises Congress on Medicare issues, also recommended that surgery centers be required to report cost data, and proposed a 1.0% increase in hospitals' 2014 payment rates. MedPAC's board will vote on the proposals in January.
  • Videolaryngoscope blades recalled Medical device manufacturer Verathon has announced a voluntary recall of some GlideScope GVL reusable videolaryngoscope blades. The blades at issue, manufactured between December 2010 and August 2011, are reported to develop stress cracks across the tip. Such structural failures present the risk that pieces will break off in patients' mouths, obstructing airways or being swallowed. No patient injuries have yet been reported, says Verathon. The affected blade model and serial numbers are available on an FDA announcement. Users of the specified blades are asked to contact the company at (800) 331-2313 or for replacements.

  • New sterile compounding guidelines The Institute for Safe Medication Practices (ISMP) has issued recommendations for practitioners on the safe preparation of sterile compounds. They're compiled in the proceedings of ISMP's sterile preparation compounding safety summit, which took place in October 2011 and addressed the frequent reports of critical intravenous compounding errors to national reporting programs, scientific literature and the lay media.
  • IV lidocaine limits opioid use Intravenous lidocaine improves the quality of patients' recoveries following outpatient laparoscopic surgery by limiting opioid consumption, notes a study in the journal Anesthesia & Analgesia. Lidocaine is a safe, inexpensive and effective pain control option, note the study's authors. Gildasio De Oliveira Jr., MD, assistant professor of anesthesiology at Northwestern University Feinberg School of Medicine in Evanston, Ill., and one of the study's authors, told Anesthesia News that the drug should be used routinely in outpatient procedures.