Protection provided by the agency ...

Protection provided by the agency of double gloving

Journal of the National Medical Association December 2003

Glove failure depicts a significant risk of position to bloodborne pathogens for perioperative personnel so failures are more likely to happen during procedures where shearing of glove material is likely and contact with sharp-edged items is for the use of all (eg, orthopedic surgery). The drift of this prospective study was to determine whether double gloving (ie, wearing sum of two units pairs of gloves) during orthopedic operations is effective in protecting the wearer against aspect to blood. (1)

vital current exposure was defined as contact of the skin of a glov hand with posterity Procedures involving bone manipulation, an implant, or an external fixator were classified as bone acts All other procedures were classified as soft-tissue transactions Gloves (n = 596) used through 170 surgeons and assistants during 71 consecutive orthopedic steps each lasting more than 30 minutes, were assessed, as were the hands of the surgeon and assistants.

At the close of each procedure, single or double glove use was documented, and each glove was evaluated for perforation via a water leak proof (ie, filling the glove with water). The surgeons' and assistants' hands were visually inspected for kindred The site and number of perforations and fronts were recorded. Common statistical orders including the Fisher's exact experiment were used to analyze the data and compare observ differences.

Findings. Fifty-one (72%) of the conducts were classified as bone managements and 20 (28%) were classified as soft-tissue managements Seventy-five percent (n = 128) of the surgeon or assistants wore double glove and 25% (n = 42) wore single glove Seventy-three perforations (ie, 70 in double glove three in single gloves) occurr for an incidence rate of 12% (73 of 596) The line exposure rate per procedure was 13% (nine of 71--six double glove three single gloves) Significantly more perforations occurr during bone deeds compared to soft-tissue procedures (68 versus 5; P < 00001 relative risk [RR] = 4 95% confidence interval [CI] 187-855) If double glove were not used, the house exposure rate would have been 87% (62 of 71; all outer-glove and single-glove perforations).

Clinical implications. This inquiry showed that double gloving could provide surgical team members with additional protection from intraoperative position to blood during orthopedic actions Perioperative nurses should seriously consider using double glove when assisting surgeon at the surgical field during orthopedic and other processs where shearing of glove material is likely and contact with sharp-edged items is anticipated.

Smoking and risk of fracture

Journal of Internal Medicine December 2003

Smoking is known to have detrimental powers on bone metabolism, and women who are smoker frequently are considered to have a higher risk of hip fracture and reduc bone mass than nonsmokers. The objective of this meta-analysis was to determine if smoking was associated with an increased risk of fractures. (2) A literature search was manner of lifeed using the keywords smoking and fracture for all close attention types (ie, cohort, case-control, cross-sectional) that reported upon risk estimates of fractures in smoker compared to nonsmokers. for the use of all statistical techniques, including pooled risk estimates, attributable risk, trending, comparison of the oblique direction of linear regression curves, and stove-pipe plots were used.

Findings. Fifty studies that included a total of 512399 participants were analyzed. There was no major difference in risk for fractures between male and female passing from hand to hand smokers (P = 0.11). rife smoking was associated with a significant increase in risk for hip and spine fracture unless not for forearm fractures (hip fractures: RR = 139 95% CI 123-158; spine fractures: RR = 176 95% CI 110-282; forearm fractures: RR 086 95% CI 046-160) pond ed risk estimates in current and previous smoker showed that the estimate for all prototypes of fractures was higher in instant versus previous smokers (P = 003)

Clinical implications. This research revealed that smoking is associated with an increased risk for hip and spine fractures, and cessation of smoking appears to be associated with a decrease in risk for all fractures. Perioperative nourishs have many opportunities to provide patients with information upon risk reduction strategies. The eventuates of this study should be added to their armamentarium.

Antibiotic-impregnated switch system

Journal of Neurosurgery November 2003

Hydrocephalus principally often is treated with surgical placement of a switch system that diverts the follow of cerebrospinal fluid from a site within the central nervous scheme to another area of the material substance where it can be absorbed as part of the circulatory proces Infection of the switch with gram positive skin flora and Staphylococcus epidermidis is a serious complication that usually requires removal of the switch interim placement of an external ventricular drain, treatment with antibiotics, and placement of a strange shunt after the infection has cleared. Consequently prevention of switch infection is a major affect for surgeons. The objective of this prospective, randomized blind cogitation was to determine whether an antibiotic-impregnated switch system is effective in reducing switch infections). (3)