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Search results for "Nosocomial Infections"
Journal Article > Study
Fry DE, Pine M, Jones BL, Meimban RJ. Arch Surg. 2010;145:148-151.
The term never event was originally coined to describe rare, devastating, and preventable events like wrong-site surgery or fatal medication errors. This definition has expanded over time to include a variety of serious adverse events; for some of them (i.e., certain health care–associated infections), the Centers for Medicare and Medicaid Services denies additional reimbursement. This article sought to determine if eight never events (mostly infectious complications of surgery) are truly preventable, by examining whether baseline patient characteristics could predict which patients would experience a never event. The authors found that incidence of most of these complications could be predicted on the basis of preexisting conditions or the specific surgical procedure performed, calling into question whether these events are truly preventable. This study exemplifies research into the "basic science" of patient safety; a prior commentary called for studies focusing on identifying truly preventable harm and developing accurate, reliable measurement standards.
Journal Article > Study
Randomized crossover study evaluating the effect of a hand sanitizer dispenser on the frequency of hand hygiene among anesthesiology staff in the operating room.
Munoz-Price LS, Patel Z, Banks S, et al. Infect Control Hosp Epidemiol. 2014;35:717-720.
Hand hygiene rates remain disappointingly low among physicians and nurses, despite appropriate handwashing being an essential factor in preventing health care–associated infections. In this study, installing a hand sanitizer dispenser on the anesthesia machine resulted in only a limited increase in the frequency of hand sanitization by anesthesiologists.
Journal Article > Commentary
Unintended transplantation of three organs from an HIV-positive donor: report of the analysis of an adverse event in a regional health care service in Italy.
Bellandi T, Albolino S, Tartaglia R, Filipponi F. Transplant Proc. 2010;42:2187-2189.
This case study discusses errors that contributed to transplantation of infected organs and provides recommendations to improve test result communication and organizational safety culture.