Reducing extent of stay with early ...

Reducing extent of stay with early oral intake

American Journal of Obstetrics and Gynecology May 2002

The project of this study was to determine whether early oral intake after major gynecologic oncology and urogynecology processs resulted in reduced inpatient detail of stay (LOS). (1) Patients were assigned randomly to either the experimental or check group. Patients in the experimental cluster (ie, early oral intake) were given clear fluids onward the first postoperative day. After they tolerated a minimum of 500 mL of clear fluids, they resum a regular diet. Patients in the ascendency group followed a traditional plan of care, which included nothing by way of mouth until the return of bowel vigorouss passage of flatus or stool, and get back of hunger.

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

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

Risk factors for venous thromboembolism

Archives of Internal Medicine, June 10 2002

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

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

* hospitalization or nursing household 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 allude to that although causation is a difficult universal to prove, the results of this cogitation strongly suggest direct cause and result Further, they suggest that 75% of all venous thromboembolisms might be obstructed 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 gown in preventing the penetration of bacteria during surgery (3) This is important because the majority of patient infections are caused by dint of bacteria that contaminate wounds during surgery and surgical team members are the chiefly important source of bacteria-causing infection. Using a simple, of recent origin method to measure bacterial penetration, this quasi-experiment examined the differences in penetration between reusable and disposable gown in the axilla, back, groin, and perianal regions. After surgical team members gown and glov petri dishes were placed divest of coveringed on a sterile incise drape, adhesive side up The incise drape and petri dish then were compressed onto the gown so that the growing media was in contact with the gown material. The petri dish was incubated before examination.

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

Clinical implications. This close attention demonstrated that disposable gowns have a greater resistance to bacterial penetration than reusable gown especially in areas of highest bacterial load. although there is no evidence directly linking bacterial penetration of surgical gown to surgical site infection, it is reasonable to bring to an end that this is a viable course of bacterial contamination. The authors recommend that disposable gowns be worn for operations involving orthopedic implants. The application of mind method provides a unique and inexpensive approach to this adumbration of testing.