Examining the Effect of Haptic Factors for Vascular Palpation Skill Assessment Using an Affordable Simulator

Goal: Simulators that incorporate haptic feedback for clinical skills training are increasingly used in medical education. This study addresses the neglected aspect of rendering simulated feedback for vascular palpation skills training by systematically examining the effect of haptic factors on performance. Methods: A simulator-based approach to examine palpation skill is presented. Novice participants with and without minimal previous palpation training performed a palpation task on a simulator that rendered controlled vibratory feedback under various conditions. Results: Five objective metrics were employed to analyze participants’ performance that yielded key findings in quantifying palpation performance. Participants’ palpation accuracy was influenced by all three haptic factors, ranging from moderate to statistically significant. Duration, Total Path Length and Ratio of Correct Movement also demonstrated utility for quantifying performance. Conclusions: We demonstrate that our affordable simulator is capable of rendering controlled haptic feedback suitable for skills training. Further, metrics presented in this study can be used for structured palpation skills assessment and training, potentially improving healthcare delivery.

Protected Clinical Indication of Peripheral Intravenous Lines: Successful Implementation

Background: A large, urban community hospital developed an insertion bundle to support the safe implementation of a policy of extended dwell time (clinical indication) for inpatient peripheral intravenous lines (PIVs).

Methods: Internal evaluation of practices through direct observations as well as evidence-based guidelines and historic data on PIV-related bloodstream infections helped drive the bundle elements. A surveillance plan was in place to continue measurement of these outcomes during the postimplementation period.

Results: At 12 months following implementation, the organization documented a 37% reduction (P = .03) in primary bacteremias (combining PIV and central line-associated bloodstream [CLABSI] infections) and a 19% percent reduction in PIV bloodstream infections. CLABSI rates were also reviewed, as 20% of CLABSI were noted to also have peripheral access present during the year prior to implementation. CLABSI standardized infection ratios for the publicly reported intensive care units decreased from 1.3 to 0.32 (P = .02). In addition, intravenous line start kit use decreased 48% during the year following bundle implementation.

Conclusions: Careful planning and development of an education bundle and an insertion bundle in a community hospital setting allowed for longer dwell times and a trend of decreased bloodstream infections.

Addressing the need for an infection prevention and control framework that incorporates the role of surveillance: a discussion paper

AIM

To present a discussion on theoretical frameworks in infection prevention and control.

BACKGROUND

Infection prevention and control programmes have been in place for several years in response to the incidence of healthcare-associated infections and their associated morbidity and mortality. Theoretical frameworks play an important role in formalizing the understanding of infection prevention activities.

DESIGN

Discussion paper.

DATA SOURCES

A literature search using electronic databases was conducted for published articles in English addressing theoretical frameworks in infection prevention and control between 1980-2012.

RESULTS

Nineteen papers that included a reference to frameworks were identified in the review. A narrative analysis of these papers was completed. Two models were identified and neither included the role of surveillance.

DISCUSSION

To reduce the risk of acquiring a healthcare-associated infection, a multifaceted approach to infection prevention is required. One key component in this approach is surveillance. The review identified two infection prevention and control frameworks, yet these are rarely applied in infection prevention and control programmes. Only one framework considered the multifaceted approach required for infection prevention. It did not, however, incorporate the role of surveillance. We present a framework that incorporates the role of surveillance into a biopsychosocial approach to infection prevention and control.

CONCLUSION

Infection prevention and control programmes and associated research are led primarily by nurses. There is a need for an explicit infection prevention and control framework incorporating the important role that surveillance has in infection prevention activities. This study presents one framework for further critique and discussion.

Simulated infusion of paclitaxel with in-line filters

BACKGROUND

Paclitaxel is one of the most effective anticancer drugs ever developed. To prevent hazards associated with intravenous (IV) administration which include the formation of microbubbles, microbiological contamination and particulate matter, the suppliers recommend that an in-line IV filter should be used during the infusion of the chemotherapeutic agent.

METHODS

To rule out the possibility that polyethersulfone (PES) membranes retain the paclitaxel during filtration, we carried out specific tests. Paclitaxel retention by PES in-line IV filters was evaluated by a simulated-drug IV infusion and high-performance liquid chromatography analysis.

RESULTS

In our model of study, no variation of paclitaxel concentration was revealed before and after filtration using two different filter devices.

CONCLUSIONS

The results suggest that, under our experimental conditions, paclitaxel concentration in saline solution remains constant before and after filtration. Indeed, our study indicates that the filters analyzed herein, other than preventing hazards associated with IV administration, do not retain paclitaxel, thus avoiding the reduction of the drug concentration and potency during filtration.