Use of plastic adhesive drapes during surgery for preventing surgical site infection (Review)

Background: Surgical site infection has been estimated to occur in about 15% of clean surgery and 30% of contaminated surgery cases. Using plastic adhesive drapes to protect the wound from organisms that may be present on the surrounding skin during surgery is one strategy used to prevent surgical site infection. Results from non-randomised studies have produced conflicting results about the efficacy of this approach. A systematic review was required to guide clinical practice. Objectives: To assess the effect of adhesive drapes used during surgery on surgical site infection, cost, mortality and morbidity. Search methods: For this fourth update we searched the Cochrane Wounds Group Specialised Register (searched 4th March 2015); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015, Issue 2); Ovid MEDLINE (2012 to 3rd March 2015); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, 2012 to 3rd March 2015); Ovid EMBASE (2012 to 3rd March 2015); and EBSCO CINAHL (2012 to 4th March 2015). Selection criteria: Randomised controlled trials comparing any plastic adhesive drape with no plastic adhesive drape, used alone or in combination with woven (material) drapes or disposable (paper) drapes, in patients undergoing any type of surgery. Ring drapes were excluded. Data collection and analysis: Two review authors independently selected and assessed studies for trial quality and both independently extracted data. We contacted study authors for additional information. Main results: We identified no new studies for this fourth update. The review includes five studies involving 3082 participants comparing plastic adhesive drapes with no drapes and two studies involving 1113 participants comparing iodine-impregnated adhesive drapes with no drapes. A significantly higher proportion of patients in the adhesive drape group developed a surgical site infection when compared with no drapes (risk ratio (RR) 1.23, 95% confidence interval (CI) 1.02 to 1.48, P = 0.03). Iodine-impregnated adhesive drapes had no effect on the surgical site infection rate (RR 1.03, 95% CI 0.06 to 1.66, P = 0.89). Length of hospital stay was similar in the adhesive drape and non-adhesive drape groups. Authors' conclusions: There was no evidence from the seven trials that plastic adhesive drapes reduce surgical site infection rates, and some evidence that they increase infection rates. Further trials may be justified, using blinded outcome assessment to examine the effect of adhesive drapes on surgical site infection, based on different wound classifications

Skin preparation with alcohol versus alcohol followed by any antiseptic for preventing bacteraemia or contamination of blood for transfusion (Review)

Background: Blood for transfusion may become contaminated at any point between collection and transfusion and may result in bacteraemia (the presence of bacteria in the blood), severe illness or even death for the blood recipient. Donor arm skin is one potential source of blood contamination, so it is usual to cleanse the skin with an antiseptic before blood donation. One-step and two-step alcohol based antiseptic regimens are both commonly advocated but there is uncertainty as to which is most effective. Objectives: To assess the effects of cleansing the skin of blood donors with alcohol in a one-step compared with alcohol in a two-step procedure to prevent contamination of collected blood or bacteraemia in the recipient. Search methods: In December 2014, for this third update, we searched the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library; Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. Selection criteria: All randomised trials (RCTs) comparing alcohol based donor skin cleansing in a one-step versus a two-step process that includes alcohol and any other antiseptic for pre-venepuncture skin cleansing were considered. Quasi randomised trials were to have been considered in the absence of RCTs. Data collection and analysis: Two review authors independently assessed studies for inclusion. Main results: No studies (RCTs or quasi RCTs) met the inclusion criteria. Authors' conclusions: We did not identify any eligible studies for inclusion in this review. It is therefore unclear whether a two-step, alcohol followed by antiseptic skin cleansing process prior to blood donation confers any reduction in the risk of blood contamination or bacteraemia in blood recipients, or conversely whether a one-step process increases risk above that associated with a two-step process

Rethinking Sterilization Practices: Evidence for Event‐Related Outdating

A prospective study was conducted during a 2‐year period to evaluate the effectiveness of event‐related outdating. Hospitalprepared sterilized items (n = 152) were shelved in wards and every 3 months, several articles were retrieved and microbiologically tested. During the 2‐year period, all of the items tested were sterile

Reflections on equality, diversity and gender at the end of a media studies headship

This article reflects, from a feminist perspective, on a five-year period as Head of a School of Media. It considers the position of media studies within the new academic capitalism, and the re-masculinisation of the university that this has produced. It considers strategies employed by the field to stake its own claim to that masculinisation, in particular the embrace of ‘the digital’. Finally it describes the challenges this posed for the author, and tactics employed in dealing with them

Befriending the Boogeyman: Using Improvisation Methods to Motivate Employees and Mitigate Fear of Failure

This project combines improvisation principles with design thinking concepts to create new exercises which can be used in the workplace to mitigate the impacts of fear of failure within an organization. The main research question for this project is as follows: How might we combine design thinking and improvisation principles to mitigate the negative impacts of fear of failure in an organization? Fear of failure is a pervasive feeling which impacts organizations of all sizes, sectors, and maturities, and can have devastating impacts on organizational culture. These impacts include cynicism, lack of motivation, high employee turnover, and low self esteem. This project study uses evidence from academic literature as well as primary research to pinpoint the most pressing impacts of fear of failure and define points of intervention where improvisation principles would be most beneficial. This project culminates in several new exercises which can be used by teams within an organization to mitigate these main impacts, giving way for higher levels of employee communication, creative thinking, and innovation potential

A One Health overview, facilitating advances in comparative medicine and translational research.

Table of contentsA1 One health advances and successes in comparative medicine and translational researchCheryl StroudA2 Dendritic cell-targeted gorilla adenoviral vector for cancer vaccination for canine melanomaIgor Dmitriev, Elena Kashentseva, Jeffrey N. Bryan, David T. CurielA3 Viroimmunotherapy for malignant melanoma in the companion dog modelJeffrey N. Bryan, David Curiel, Igor Dmitriev, Elena Kashentseva, Hans Rindt, Carol Reinero, Carolyn J. HenryA4 Of mice and men (and dogs!): development of a commercially licensed xenogeneic DNA vaccine for companion animals with malignant melanomaPhilip J. BergmanA5 Successful immunotherapy with a recombinant HER2-expressing Listeria monocytogenes in dogs with spontaneous osteosarcoma paves the way for advances in pediatric osteosarcomaNicola J. Mason, Josephine S. Gnanandarajah, Julie B. Engiles, Falon Gray, Danielle Laughlin, Anita Gaurnier-Hausser, Anu Wallecha, Margie Huebner, Yvonne PatersonA6 Human clinical development of ADXS-HER2Daniel O'ConnorA7 Leveraging use of data for both human and veterinary benefitLaura S. TremlA8 Biologic replacement of the knee: innovations and early clinical resultsJames P. StannardA9 Mizzou BioJoint Center: a translational success storyJames L. CookA10 University and industry translational partnership: from the lab to commercializationMarc JacobsA11 Beyond docking: an evolutionarily guided OneHealth approach to drug discoveryGerald J. Wyckoff, Lee Likins, Ubadah Sabbagh, Andrew SkaffA12 Challenges and opportunities for data applications in animal health: from precision medicine to precision husbandryAmado S. GuloyA13 A cloud-based programmable platform for healthHarlen D. HaysA14 Comparative oncology: One Health in actionAmy K. LeBlancA15 Companion animal diseases bridge the translational gap for human neurodegenerative diseaseJoan R. Coates, Martin L. Katz, Leslie A. Lyons, Gayle C. Johnson, Gary S. Johnson, Dennis P. O'BrienA16 Duchenne muscular dystrophy gene therapyDongsheng DuanA17 Polycystic kidney disease: cellular mechanisms to emerging therapiesJames P. CalvetA18 The domestic cat as a large animal model for polycystic kidney diseaseLeslie A. Lyons, Barbara GandolfiA19 The support of basic and clinical research by the Polycystic Kidney Disease FoundationDavid A. BaronA20 Using naturally occurring large animal models of human disease to enable clinical translation: treatment of arthritis using autologous stromal vascular fraction in dogsMark L. WeissA21 Regulatory requirements regarding clinical use of human cells, tissues, and tissue-based productsDebra A. WebsterA22 Regenerative medicine approaches to Type 1 diabetes treatmentFrancis N. KaranuA23 The zoobiquity of canine diabetes mellitus, man's best friend is a friend indeed-islet transplantationEdward J. RobbA24 One Medicine: a development model for cellular therapy of diabetesRobert J. Harman

Gowning by Attendant and Visitors in Newborn Nurseries for Prevention of Neonatal Morbidity and Mortality [protocol]

Background: Overgowns are widely used in newborn nurseries and neonatal intensive care units. It is thought that gowns may help to prevent the spread of nosocomial infection and serve as a reminder to staff and visitors to wash their hands before contact with the infant. Objectives: The objective of this review is to assess the effects of the wearing of an overgown by attendants and visitors on the incidence of infection and death in infants in newborn nurseries. Search methods: The standard methods of the Cochrane Collaboration and its Neonatal Review Group were used. We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2009), MEDLINE (1950 - January 2009), Embase (1950 - January 2009) and CINAHL (1982 - January 2009). This search was updated in December 2010. Selection criteria: The review includes all published trials using random or quasi-random patient allocation, in which overgowns worn by attendants or visitors were compared with no overgowns worn by attendants or visitors. Data collection and analysis: The standard methods of the Cochrane Collaboration and its Neonatal Review Group were used. Data extraction and study quality were independently assessed by the two review authors. Missing information was sought from three authors, but only one responded. Results are expressed as relative risk or mean difference with 95% confidence intervals . Main results: Eight trials were included, reporting outcomes for 3,811 infants. Trial quality varied, with only two assessed as being of good quality. Not wearing overgowns was associated with a trend to reduction in the death rate (typical RR 0.84, 95% CI 0.70 to 1.02) compared to wearing overgowns, but these results did not reach statistical significance. There was no statistically significant effect of gowning policy on incidence of systemic nosocomial infection, (typical RR 1.24, 95% CI 0.90 to 1.71). The overall analysis showed no significant effects of gowning policy on the incidence of colonisation, length of hospital stay or handwashing frequency. No trials of visitor gowning were found. Authors' conclusions: There is no evidence from this systematic review and meta-analysis to demonstrate that overgowns are effective in limiting death, infection or bacterial colonisation in infants admitted to newborn nurseries

The cost-effectiveness of a patient centred pressure ulcer prevention care bundle: findings from the INTACT cluster randomised trial

Background: Pressure ulcers are serious, avoidable, costly and common adverse outcomes of healthcare. Objectives: To evaluate the cost-effectiveness of a patient-centred pressure ulcer prevention care bundle compared to standard care. Design: Cost-effectiveness and cost-benefit analyses of pressure ulcer prevention performed from the health system perspective using data collected alongside a cluster-randomised trial. Settings: Eight tertiary hospitals in Australia. Participants: Adult patients receiving either a patient-centred pressure ulcer prevention care bundle (n = 799) or standard care (n = 799). Methods: Direct costs related to the intervention and preventative strategies were collected from trial data and supplemented by micro-costing data on patient turning and skin care from a 4-week substudy (n = 317). The time horizon for the economic evaluation matched the trial duration, with the endpoint being diagnosis of a new pressure ulcer, hospital discharge/transfer or 28 days; whichever occurred first. For the cost-effectiveness analysis, the primary outcome was the incremental costs of prevention per additional hospital acquired pressure ulcer case avoided, estimated using a two-stage cluster-adjusted non-parametric bootstrap method. The cost-benefit analysis estimated net monetary benefit, which considered both the costs of prevention and any difference in length of stay. All costs are reported in AU$(2015). Results: The care bundle cost AU$144.91 (95%CI: $74.96 to$246.08) more per patient than standard care. The largest contributors to cost were clinical nurse time for repositioning and skin inspection. In the cost-effectiveness analysis, the care bundle was estimated to cost an additional $3,296 (95$144,525) per pressure ulcer avoided. This estimate is highly uncertain. Length of stay was unexpectedly higher in the care bundle group. In a cost-benefit analysis which considered length of stay, the net monetary benefit for the care bundle was estimated to be −$2,320 (95$3,900, −$1,175) per patient, suggesting the care bundle was not a cost-effective use of resources. Conclusions: A pressure ulcer prevention care bundle consisting of multicomponent nurse training and patient education may promote best practice nursing care but may not be cost-effective in preventing hospital acquired pressure ulcer