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Health Care Industry

Oral intake; thromboembolism; bacterial penetration; nurse staffing levels

AORN Journal, Dec, 2002 by Ric Cuming

Reducing length of stay with early oral intake

American Journal of Obstetrics and Gynecology, May 2002

The purpose of this study was to determine whether early oral intake after major gynecologic oncology and urogynecology procedures resulted in reduced inpatient length of stay (LOS). (1) Patients were assigned randomly to either the experimental or control group. Patients in the experimental group (ie, early oral intake) were given clear fluids on the first postoperative day. After they tolerated a minimum of 500 mL of clear fluids, they resumed a regular diet. Patients in the control group followed a traditional plan of care, which included nothing by mouth until the return of bowel sounds, passage of flatus or stool, and return of hunger.

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Findings. Ninety-six patients were studied--47 in the experimental group and 49 in the control group. Patients in the experimental group had a shorter LOS by two days (P = .0001) with no significant difference in the number of episodes of emesis or incidence of postoperative ileus. More patients in the control group developed ileus than patients in the experimental group. Patients who received a preoperative bowel preparation, however, did not tolerate the early feeding protocol until postoperative day three. This suggests that patients who receive a bowel preparation before surgery may need 24 to 48 hours of rest after surgery before resuming a regular diet.

Clinical implications. This study shows that improved postoperative nutritional status contributes to increased wound healing and decreased risk of infection. Patients reported a greater sense of well being, potentially leading to a quicker recovery. Also, a shorter LOS should result in cost savings for these surgical patients.

Risk factors for venous thromboembolism

Archives of Internal Medicine, June 10, 2002

This population-based, nested, case control study examined the potential impact of controlling risk factors on the incidence of venous thromboembolism (ie, deep vein thrombosis and pulmonary embolism). (2) A lethal disease, venous thromboembolism has an average annual incidence of more than one per 1,000 people. Using a conditional logistic regression model appropriate to the matched case control study design, the researchers estimated individual and collective attributable risk factors. The study was conducted in a single community with 625 residents documented to have a definite first lifetime deep vein thrombosis or pulmonary embolism diagnosed from 1976 to 1990.

Findings. The final multivariate logistic regression model was used to isolate each risk factor and determine the percentage of attributable risk. These risk factors are

* hospitalization or nursing home residence, 59%;

* active malignant neoplasm, 18%;

* trauma, 12%;

* congestive heart failure, 10%;

* prior central venous catheter or pacemaker, 9%;

* neurological disease, 7%; and a prior superficial vein thrombosis, 5%.

Clinical implications. The authors suggest that although causation is a difficult concept to prove, the results of this study strongly suggest direct cause and effect. Further, they suggest that 75% of all venous thromboembolisms might be prevented if prophylaxis were universally prescribed and effective.

Bacterial penetration of surgical gowns

Journal of Hospital Infection, April 2002

Them is limited information available regarding the effectiveness of surgical gowns in preventing the penetration of bacteria during surgery. (3) This is important because the majority of patient infections are caused by bacteria that contaminate wounds during surgery, and surgical team members are the most important source of bacteria-causing infection. Using a simple, new method to measure bacterial penetration, this quasi-experiment examined the differences in penetration between reusable and disposable gowns in the axilla, back, groin, and perianal regions. After surgical team members gowned and gloved, petri dishes were placed uncovered on a sterile incise drape, adhesive side up. The incise drape and petri dish then were pressed onto the gown so that the growth media was in contact with the gown material. The petri dish was incubated before examination.

Findings. Twenty tests were performed in each region for each type of gown, and results were analyzed statistically. The only variable factor was the type of gown material (ie, reusable versus disposable). There were significant differences between the two types of gowns tested. Disposable gowns demonstrated a much greater resistance to bacterial penetration than reusable gowns. Disposable gowns virtually were impenetrable, and reusable gowns showed variability across the four tested regions and at the same site across the sample of gowns. This variability may be related to the number of times a gown has been reprocessed.

Clinical implications. This study demonstrated that disposable gowns have a greater resistance to bacterial penetration than reusable gowns, especially in areas of highest bacterial load. Though there is no evidence directly linking bacterial penetration of surgical gowns to surgical site infection, it is reasonable to conclude that this is a viable route of bacterial contamination. The authors suggest that disposable gowns be worn for procedures involving orthopedic implants. The study method provides a unique and inexpensive approach to this type of testing.

Health Care Industry

Oral intake; thromboembolism; bacterial penetration; nurse staffing levels

AORN Journal, Dec, 2002 by Ric Cuming

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