paywalled: Cochrane Review - Removal of nail polish and finger rings to prevent surgical infection.

Cochrane Database Syst Rev. 2012 May 16;5:CD003325.

Removal of nail polish and finger rings to prevent surgical infection.

Abstract

BACKGROUND:

Surgical wound infections may be caused by the transfer of bacteria from the hands of surgical teams to patients during operations. Surgical scrubbing prior to surgery reduces the number of bacteria on the skin, but wearing rings and nail polish on the fingers may reduce the efficacy of scrubbing, as bacteria may remain in microscopic imperfections of nail polish and on the skin beneath rings.

OBJECTIVES:

To assess the effect of the presence or absence of rings and nail polish on the hands of the surgical scrub team on postoperative wound infection rates.

MAIN RESULTS:

We identified: no new trials; no RCTs that compared wearing of rings with the removal of rings; and no trials of nail polish versus no nail polish that measured surgical infection rates. We found one small RCT (102 scrub nurses) that evaluated the effect of nail polish on the number of bacterial colony forming units left on hands after pre-operative surgical scrubbing. Nurses had either unpolished nails, freshly-applied nail polish (less than two days old), or old nail polish (more than four days old). There were no significant differences in the number of bacteria on hands between the groups before and after surgical scrubbing.

AUTHORS' CONCLUSIONS:

No trials have investigated whether wearing nail polish or finger rings affects the rate of surgical wound infection. There is insufficient evidence to determine whether wearing nail polish affects the number of bacteria on the skin post-scrub.

Characteristics and Outcomes of Methicillin-Resistant Staphylococcus aureus Bloodstream Infections in Patients with Cancer Treated with Vancomycin: 9-Year Experience at a Comprehensive Cancer Center - The Oncologist

Abstract

Abstract Background. Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs) can cause significant morbidity and mortality in patients with cancer. However, data on outcomes of patients treated with vancomycin are lacking.

Methods. We identified 223 patients with cancer who developed MRSA BSIs between January 2001 and June 2009 and were treated with vancomycin. Treatment failure was defined as death within 60 days of infection, persistent bacteremia ≥5 days, fever ≥4 days, recurrence or relapse, and secondary MRSA infection.

Results. The treatment failure rate was 52% (116 of 223 patients). These patients were more likely to have been hospitalized, been treated with steroids within the previous 3 months, developed acute respiratory distress syndrome, required mechanical ventilation, required intensive care unit care, and community-onset infections (all p < .05). Risk factors for MRSA-associated mortality (27 of 223 patients; 12%) included hematologic malignancy and hematopoietic stem cell transplantation, community-onset infection, secondary BSI, MRSA with minimum inhibitory concentration (MIC) ≥2.0 μg/mL, mechanical ventilation, and a late switch to an alternative therapy (≥4 days after treatment failure; all p < .05). On multivariate analysis, mechanical ventilation and recent hospitalization were identified as independent predictors of vancomycin failure, and community-onset infection, secondary BSIs, and MIC ≥2 μg/mL were identified as significant predictors of MRSA-associated mortality.

Conclusions. We found a high treatment failure rate for vancomycin in patients with cancer and MRSA BSIs, as well as a higher mortality. A vancomycin MIC ≥2 μg/mL was an independent predictor of MRSA-associated mortality. An early switch to an alternative therapy at the earliest sign of failure may improve outcome.

Imperfect measure of hospital safety - CIHI

Imperfect measure of hospital safety

Imperfect measure of hospital safety

1. CMAJ

The failure to include hospital-acquired infections or medication errors as a performance indicator limits the utility of the Canadian Institute for Health Information’s (CIHI) new hospital benchmarking tool, critics say....

Surgical site infection prevention: a survey to identify the gap between evidence and practice in University of Toronto teaching hospitals - Can J Surg. 2012 Jun 1

Blogger's Note: surgical site infections safety checklist: WHO (World Health Organization) program in patient safety

Surgical site infection prevention: a survey to identifythe gap between evidence and practice in University of Toronto teaching hospitals

 "Surgical site infections (SSIs) are the most common
complication following surgery, with reported rates
ranging from 5% to 30%.1 The attributable morbidity
and mortality is significant, with patients who experience
SSIs being 60% more likely to spend time in the
intensive care unit, 5 times more likely to be readmitted to
hospital and twice as likely to die than patients without
SSIs.2 Whereas many risk factors for the development of
SSIs are related to patient characteristics that cannot be easily
modified, there are a variety of system or hospital factors
that can be manipulated. These include improper selection
and administration of antibiotic prophylaxis, intraoperative
hypothermia and intraoperative hyperglycemia.3
Despite clear evidence and guidelines to direct SSI prevention
strategies, compliance is uniformly poor......

abstract: Study: Vast Majority of C difficile Infections Occur in Medical Settings, April 4, 2012, Voelker 307 (13): 1356 — JAMA

Study: Vast Majority of C difficile Infections Occur in Medical Settings, April 4, 2012

Most Clostridium difficile infections, often assumed to be community acquired, actually occur in medical settings, according to recent data from the Centers for Disease Control and Prevention (CDC). 

In fact, 94% of the potentially fatal infections are in people who recently received care in facilities such as hospitals, nursing homes, physicians' offices, and outpatient surgical centers. To stem the rising tide of C difficile infections, CDC officials say hospitals and other health care settings need greater adherence to infection control practices and improved communication to notify each other whenever they transfer an infected patient. 

“These infections are now a patient safety concern everywhere medical care is given,” said Clifford McDonald, MD, a CDC medical epidemiologist and lead author of the study in the Morbidity and Mortality Weekly Report (http://tinyurl.com/7dh83hh). “About 25% of C difficile infections first show symptoms among patients in hospitals; 75% first show symptoms among patients in nursing …"

[Full Text of this Article] (requires paid subscription)

Evidence Updates: Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy. Cochrane Database Syst Rev includes professional commentaries

AUTHORS' CONCLUSIONS:

Antibiotic prophylaxis in afebrile neutropenic patients significantly reduced all-cause mortality.

In our review, the most significant reduction in mortality was observed in trials assessing prophylaxis with quinolones. The benefits of antibiotic prophylaxis outweighed the harm such as adverse effects and the development of resistance since all-cause mortality was reduced. As most trials in our review were of patients with haematologic cancer, we strongly recommend antibiotic prophylaxis for these patients, preferably with a quinolone.

Prophylaxis may also be considered for patients with solid tumours or lymphoma.

Alternate source/link

webinar notice: Best Practices for Decreasing Surgical Site Infections to be Discussed in Upcoming Patient Safety Webinar - Press Release - Digital Journal

Public, patients have right to know hospitals' infection rates | Op-Ed | Kentucky.com (C. difficile/MRSA)

ongoing media stories - Three more die in C. difficile outbreak - The Globe and Mail

Note:

irrespective of location, C. difficile is an ongoing and unresolved issue (both hospital/non-hospital acquired) and in particular for cancer patients;

it seems the SARS cases of the past have not impacted the 'lessons-not-learned' category and yet people continue to die due to lapses in policy amongst other issues/concerns, patient safety efforts (eg. handwashing...) still need to be addressed (obviously)

Healthcare-Associated Infection: Not on My Watch - Kimberly-Clark Health Care

Update on Paraneoplastic Neurologic Disorders

Note:  very complicated condition/conditions/subsets of conditions and requires specialist consultation/s.

"When patients with cancer develop neurologic symptoms, common causes include metastasis, infections, coagulopathy, metabolic or nutritional disturbances, and neurotoxicity from treatments. A thorough clinical history, temporal association with cancer therapies, and results of ancillary tests usually reveal one of these mechanisms as the etiology. When no etiology is identified, the diagnosis considered is often that of a paraneoplastic neurologic disorder (PND). With the recognition that PNDs are more frequent than previously thought, the availability of diagnostic tests, and the fact that, for some PNDs, treatment helps, PNDs should no longer be considered diagnostic zebras, and when appropriate should be included in the differential diagnosis early in the evaluation."

Surgical Quality Measures Not Associated with Infection Rates (U.S.)

Healthcare-Associated Infections: They Can Happen to You

patient safety news (U.S.): Infection checklist effort expands, but national rates unchanged