Thinking About Banning Skullcaps? Read This First
TAKE COVER Banning skullcaps in favor of bouffant-style caps did not have a statistically significant effect on SSI rates.

All this uproar over banning skullcaps from the OR in favor of bouffant-style caps because of infection risk, and now comes research that suggests a surgeon's choice of headwear might not impact SSIs.

The Association of periOperative Registered Nurses opts for hoods or bouffant-style coverings over skullcaps, because the skullcap may not effectively contain the hair and minimize microbial dispersal. But using bouffant caps in the OR in place of other types of head covers does not appear to offer any additional protection against surgical site infections, say the researchers from the University at Buffalo (N.Y.) who authored a new study in Neurosurgery.

The authors reviewed monthly infection-control summary reports from a single, 25-OR site that mandated the use of bouffant caps in February 2015. The data, pulled from January 2014 to March 2016, was categorized into 2 groups: a non-bouffant group, which included the period before February 2015, when OR personnel could use headwear of their choice; and a bouffant group, which included the post-implementation period, when all OR personnel were required to wear a bouffant cap. In both groups, personnel with beards were required to use a hood-style hat to cover the hair on the face and scalp.

"Our results comparing the use of bouffant caps with other choices of headwear indicate that for class I OR cases, the use of bouffant caps instead of other types of head covers does not influence the rate of SSI," the authors write. "In fact, for all class I OR cases and for all spinal procedures, the rate of SSI had a non-statistically significant increase after the use of bouffant caps in the OR became mandatory in accordance with hospital policy."

The mean monthly rate of SSI in all Class I OR cases was 0.79 ± 0.44% before the implementation of the bouffant-only policy; this increased to 0.85 ± 0.42% in the year following the mandate.

The authors say bouffant caps are often donned improperly, meaning the hair could fall from the cap when a surgical headlight or neurosurgery loupe is applied, removed and otherwise maneuvered around the surgeon's headwear. In addition, some surgeons who wear bouffant caps complain of experiencing hearing difficulties and discomfort. For others, the skullcap is simply a style preference, even something of a status symbol.

Bill Donahue

What Caused 40 Patients to Develop Septic Arthritis of the Knee?
KNEE DEEP Forty patients developed septic arthritis of the knee after being given hyaluronic acid injections at a New Jersey pain clinic.

From not washing their hands between treating patients to reusing single-use vials of an injectable contrast agent, doctors at a New Jersey pain clinic routinely failed to follow basic infection-related protocols while administering hyaluronic acid injections for knee pain, says a scathing report from the state's Department of Health.

The Osteo Relief Institute of Jersey Shore in Wall Twp., which had been treating up to 85 patients a day, voluntarily closed for 2 weeks in March, according to news reports, but has since reopened. Forty patients developed septic arthritis of the knee after being given knee injections; 29 of the 40 later required surgery. All 40 patients received injections of lidocaine 1% and Omnipaque 300 contrast agent. At least 35 of 40 patients received injections of viscosupplement (various types). The various viscosupplements in pre-filled sterile syringes were no longer outside of sterile packaging but were taken out of their boxes and placed in clear plastic bins in advance of treatment, thereby exposing the medications to light, according to the report.

Among the findings detailed in the health department report: A single-dose vial of the contrast agent Omnipaque 300 was used for up to 50 knee injections; sterile needles and syringes were opened in advance and stored in bins; multiple-dose vials weren't labeled or dated; and an exam table that was cleaned no more than once a day was used as the surface for medication preparation.

Additionally, one physician, Mariam Rubbani, MD, reportedly told investigators that she rarely checked patients' vital signs, and that she didn't wash her hands between patients, because she wore non-sterile gloves while administering injections. Staff told investigators that they used hand sanitizer, but none was available in the clinic, according to the report.

Dr. Rubbani, who has since resigned from the clinic, could not be reached for comment. The clinic did not return a call from Outpatient Surgery.

Jim Burger

Consumer Reports for Surgery Centers
LINES OF COMMUNICATION Keep patients informed about what to expect during pre- and post-op phone calls.

Cars, appliances, electronics and … surgery? Consumer Reports has revealed what patients should ask about to ensure they receive the best possible care at surgery centers. Capitalize on the insights from the product ratings authority and boost your center's satisfaction scores by addressing these key concerns with patients before they arrive for surgery.

  • Safety scores. Discuss the surgeon's and center's rates of infection and complications, and how many patients have been hospitalized following surgery with post-op infections.
  • CMS certification. Tell patients your facility meets the government's standards related to anesthesia administration, operating and recovery rooms, medical staff, and nursing services, as well as statistics on patient burns and burns, and hospital transfers.
  • Surgeon experience. Patients will want to ensure their surgeons have performed the procedure they're scheduled to undergo at least 50 times within the last year.
  • Anesthesia information. Inform patients about what kind of anesthesia will be used, who will administer and whether or not your providers are board-certified and have hospital-admitting privileges.
  • Life-saving measures. Note the emergency medications and equipment you have on site and discuss which members of the care team are certified in advanced resuscitation techniques. Also inform patients of your hospital transfer plan, should it be needed.
  • Post-op protocols. Assure patients that their blood pressure and temperature will be normal and their pain and PONV will be well managed before they're allowed to be discharged. Also explain that you'll call patients in the days following surgery to check on their condition and address any concerns they might have.
  • Follow-up care. Provide written discharge instructions that touch on proper post-op diet, permitted physical activities, required follow-up appointments and contacts to call if complications arise at home.

Daniel Cook

InstaPoll: Reusable or Disposable Blood Pressure Cuffs?

Does your facility use wipeable, reusable blood pressure cuffs or disposable cuffs? Tell us in this week's InstaPoll if same-gender care is an option at your facility.

Slightly more than half (56%) of the 190 respondents to last week's InstaPoll offer same-gender physician care to patients, meaning a physician who shared their gender. The results:

Is same-gender care an option at your facility?

  • yes 56%
  • no 44%

Dan O'Connor

News & Notes
  • Intraoperative methadone Patients treated with methadone during spinal fusion surgery required less hydromorphone and reported improved satisfaction with pain management, according to a study published in the May issue Anesthesiology.
  • Arthroscopy doesn't relieve knee pain Arthroscopic knee surgery does not effectively relieve pain or improve joint function in patients with arthritis or meniscal tears, according to a new clinical guideline published in BMJ. A panel of international surgeons made the recommendation after reviewing 13 studies involving nearly 1,700 patients with damaged knees who underwent surgery, received physical therapy or simply exercised. The panel says knee arthroscopies cost the U.S. healthcare system $3 billion each year. Knee replacement is "the only definitive therapy," the panel determined, but it is reserved for patients with severe disease after non-operative management has been unsuccessful.
  • N.Y. anesthesiologists oppose CRNA bill The New York State Society of Anesthesiologists is denouncing a proposal that would certify CRNAs to administer anesthesia, saying that it "fails to establish even the most basic parameters of acceptable practice" and creates ambiguity in anesthesia standards.