Seemingly unaffected patients who were injected with contaminated methylprednisolone acetate (MPA) from the New England Compounding Center in Framingham, Mass., may be developing localized spinal or paraspinal infections, according to new information from the CDC based on diagnostic imaging. As a result, the CDC has issued a health alert with the following updates:

• Preliminary MRI data shows that among patients who had spinal or paraspinal injections with the contaminated MPA, but who have been so far asymptomatic, 50% show evidence of new or worsening localized spinal or paraspinal infections, including epidural abscess, phlegmon, arachnoiditis, discitis, or vertebral osteomyelitis.
• It may be likely that patients who are suffering infections from the contaminated doses have not yet been diagnosed.
• The CDC recommends that clinicians remain vigilant and consider obtaining MRIs with contrast images of the injection site "in patients with persistent but baseline symptoms because the presentation of these spinal or paraspinal infections can be subtle and difficult to distinguish from a patient's baseline chronic pain."

Since the outbreak emerged in September, 656 patients have been infected and 39 have died.

Stephanie Wasek

Surgical team members who undergo structured communication training and use safety checklists are less likely to commit errors in the OR, according to a study in the December 2012 issue of the Journal of the American College of Surgeons.

In a review of more than more than 300 procedures performed at St. Francis Hospital and Medical Center in Hartford, Conn., lead author Lindsay Bliss, MD, general surgery resident at the University of Connecticut Health Center in Farmington, discovered 30-day complication rates dropped from 16% to 8% when surgical team members underwent communication training and used safety checklists.

That checklists help avoid adverse events isn't new, but this is the first study to discover checklists used in conjunction with communication training curbed such complications as SSIs, blood clots and UTIs, says Dr. Bliss.

Requiring pre-op nurses, circulators, surgical techs, OR nurses and recovery room RNs to undergo classes on improving communication skills helps them have productive conversations with other team members when things don't go according to plan, says Scott Ellner, DO, FACS, assistant professor of surgery at the UConn School of Medicine and director of surgical quality at St. Francis. The communication training involved in this study included sessions on, for example, how to effectively interact with introverts and extroverts on surgical teams.

"Improving patient safety and outcomes using a cost-effective tool was the main motivation for this work," says Dr. Bliss. "Surgeons alter practice patterns based on data, and this study provides concrete evidence of the impact team communication training and a safety checklist can have on patient outcomes."

Daniel Cook

A thin film of hydrogen peroxide dispersed over clinical surfaces demonstrates a significantly greater reduction in multi-drug resistant organisms (MDROs) than manual mopping and scrubbing, says a team of infection preventionists from Johns Hopkins Hospital in Baltimore.

The researchers studied the effectiveness of "robot-like devices" that disinfect patient rooms through vaporizing action. Their findings have been published in the Jan. 1 issue of the journal Clinical Infectious Diseases.

Here's how the devices work: after routine room cleaning, two devices about the size of washing machines are moved in. The vents are covered and the room is sealed. One machine disperses the hydrogen peroxide onto the floors, walls and equipment surfaces. The other machine, working in tandem, breaks down the bleaching chemical into its harmless water and oxygen components. The entire process takes about 90 minutes.

Observing the process — and comparing it to the results of manual cleaning — in 180 single-patient rooms that hosted 6,350 patients over the course of 2.5 years, the researchers saw 64% fewer patients who staye in the hydrogen peroxide rooms contaminated with MDROs, even when the previous occupant had been infected.

They plan to next study whether the technology's effectiveness in decontaminating the packaging of unused but potentially MDRO-exposed supplies which would otherwise be discarded.

David Bernard

Nothing is more damaging to your facility's bottom line than not billing for and collecting all the reimbursement that's due to you. Tell us in this week's Outpatient Surgery Magazine InstaPoll if you're leaving money on the table because you don't maximize your reimbursements.

Seeing as how propofol might soon be classified as a controlled substance, we wanted to know if your facility is already in the habit of counting it daily as well as witnessing any waste. A little more than one-third (34%) are, according to 716 responses:

• Yes: 34%
• No: 26%
• No, but we are planning on starting a count sheet in the near future: 4%
• No, but we keep it locked up: 36%

Dan O'Connor

• Zimmer Spine recalls implant instrument Manufacturer Zimmer Spine has announced a voluntary global recall of its PEEK Ardis Inserter, a device used during surgery to place the PEEK Ardis Interbody Spacer. The company is reporting that, in rare instances, the implant has broken when manipulated by the inserter, though it reports no incidents of post-op complications from fractured implants or retained fragments. Zimmer's recall alert includes a list of affected products and recall instructions.
• Anti-emetic dosages studied Dexamethasone, a staple of post-op nausea and vomiting prevention, appears to be similarly effective for its purpose at a lower dosage. In a paper published in the journal Anesthesia & Analgesia, researchers wrote that 4mg to 5mg doses of dexamethasone had "similar clinical effects in the reduction of PONV" to 8mg to 10mg doses when used as a single drug or combination therapy. "These findings support the current recommendation of the [Society for Ambulatory Anesthesia's] guidelines for PONV," write the authors.
• Spinal anesthesia for total knees Patients with multiple co-morbidities who receive spinal sedation instead of general anesthesia while undergoing total knee arthroscopy are less likely to suffer complications at 30 days post-op, according to a study published online in the Dec. 26 issue of the Journal of Bone & Joint Surgery. The study's authors note that spinal anesthesia is associated with lower rates of deep-vein thrombosis, shorter operative times and less blood loss when compared to general anesthesia.
• Quill power Researchers at MIT and Boston's Brigham and Women's Hospital recently studied porcupines' quills — specifically, the forces needed for them to enter and exit the skin — and found that their unique barbed properties made entry easier and exit 30% more difficult than non-barbed sharps. They hope to create medical devices with the same mechanical features as the quills, such as less painful needles, or adhesives that bind internal tissues more securely. If made from biodegradable materials, such adhesives could break down inside the body after they're no longer needed.