The development of a comprehensive infection prevention quality audit tool for operating room theatres in a private health care environment

A Dissertation submitted to the Faculty of Health Science, University of the Witwatersrand, in fulfillment of the requirements of the degree of Master of Science in Nursing Education Johannesburg, June 2017Multi-resistant organisms, the involvement of numerous stakeholders in the OR as well as the complex procedural and technical advancements, especially in the private healthcare environment, justifies an evidence based infection prevention quality audit tool for an OR that is comprehensive. The purpose of the study was to develop a comprehensive infection prevention quality audit tool for operating room within a private healthcare environment. A three phased, multi-method study was conducted whereby phase one included the identification of statements in existing audit tools, policies and published articles. This was used to compile concourse statements that were used during phase 2 in the Q-sort data collection method, which allowed stakeholders (scrub- and anaesthetic nurses, CSD Managers, IPC- and OHS Coordinators and surgeons) to indicate what they want to be included in the IPC Audit Tool for operating room. A statement verification was conducted to expand the concepts that enabled the researcher to compile an audit tool. Subject experts and the researcher tested the degree of validity of the audit tool in phase three of the study. A descriptive analysis revealed that the results of the Q-sort event was inconclusive. The subject experts were unable to determine the degree of validity of the audit tool, which forced the researcher to test the audit tool in an OR. A Comprehensive IPC Control Quality Audit Tool was developed. The utilisation of the audit tool in an OR should be a well-planned event. Specific education and training of the multidisciplinary team regarding IPC in the OR should be considered.MT201

The Translocal Event and the Polyrhythmic Diagram

This thesis identifies and analyses the key creative protocols in translocal performance practice, and ends with suggestions for new forms of transversal live and mediated performance practice, informed by theory. It argues that ontologies of emergence in dynamic systems nourish contemporary practice in the digital arts. Feedback in self-organised, recursive systems and organisms elicit change, and change transforms. The arguments trace concepts from chaos and complexity theory to virtual multiplicity, relationality, intuition and individuation (in the work of Bergson, Deleuze, Guattari, Simondon, Massumi, and other process theorists). It then examines the intersection of methodologies in philosophy, science and art and the radical contingencies implicit in the technicity of real-time, collaborative composition. Simultaneous forces or tendencies such as perception/memory, content/ expression and instinct/intellect produce composites (experience, meaning, and intuition- respectively) that affect the sensation of interplay. The translocal event is itself a diagram - an interstice between the forces of the local and the global, between the tendencies of the individual and the collective. The translocal is a point of reference for exploring the distribution of affect, parameters of control and emergent aesthetics. Translocal interplay, enabled by digital technologies and network protocols, is ontogenetic and autopoietic; diagrammatic and synaesthetic; intuitive and transductive. KeyWorx is a software application developed for realtime, distributed, multimodal media processing. As a technological tool created by artists, KeyWorx supports this intuitive type of creative experience: a real-time, translocal “jamming” that transduces the lived experience of a “biogram,” a synaesthetic hinge-dimension. The emerging aesthetics are processual – intuitive, diagrammatic and transversal

The ESSO core curriculum committee update on surgical oncology

Cancer care; Curriculum; Surgical oncologyCuidado del cancer; Plan de estudios; Oncología quirúrgicaCura del càncer; Pla d'estudis; Oncologia quirúrgicaIntroduction Surgical oncology is a defined specialty within the European Board of Surgery within the European Union of Medical Specialists (UEMS). Variation in training and specialization still occurs across Europe. There is a need to align the core knowledge needed to fulfil the criteria across subspecialities in surgical oncology. Material and methods The core curriculum, established in 2013, was developed with contributions from expert advisors from within the European Society of Surgical Oncology (ESSO), European Society for Radiotherapy and Oncology (ESTRO) and European Society of Medical Oncology (ESMO) and related subspeciality experts. Results The current version reiterates and updates the core curriculum structure needed for current and future candidates who plans to train for and eventually sit the European fellowship exam for the European Board of Surgery in Surgical Oncology. The content included is not intended to be exhaustive but, rather to give the candidate an idea of expectations and areas for in depth study, in addition to the practical requirements. The five elements included are: Basic principles of oncology; Disease site specific oncology; Generic clinical skills; Training recommendations, and, lastly; Eligibility for the EBSQ exam in Surgical Oncology. Conclusions As evidence-based care for cancer patients evolves through research into basic science, translational research and clinical trials, the core curriculum will evolve, mature and adapt to deliver continual improvements in cancer outcomes for patients

Surgical Smoke Evacuation Guidelines: Compliance Among Perioperative Nurses

Smoke (plume) is produced when tissue is cut or coagulated with lasers or electrosurgery devices during surgery. Research has documented that surgical smoke creates a serious workplace hazard for over 500,000 healthcare workers. Toxic gases create an offensive odor, small particulate matter causes respiratory complications, and pathogens may be transmitted within the surgical smoke to the surgical team. Previous research notes that smoke evacuation recommendations are not being consistently followed by perioperative nurses. The purpose of this study is to determine key indicators that are associated with compliance with smoke evacuation recommendations by perioperative nurses. The Diffusion of Innovation theory by Rogers serves as the model since it describes key indicators for the adoption of an innovation, including individual innovativeness, perceptions of the innovation attributes, and organizational innovativeness. A descriptive explanatory/exploratory study was conducted using a validated and piloted survey that consisted of both expert-generated questions and adaptations of previously proven measures. A population of AORN (Association of periOperative Registered Nurses) staff nurse members who have e-mail addresses (N=20,272) was targeted as the universe. A random sampling consisting of 4000 nurses were invited to respond to a web-based survey during a two-month period. There were 777 completed responses representing a 19.4 percent response rate. The SPSS statistical computer package was employed to analyze the data using frequency/descriptive statistical techniques and bivariate analyses to examine the relationship between the key indicators and compliance with smoke evacuation recommendations. Major findings reveal that specific key indicators influencing compliance include increased knowledge and training, positive perceptions about the complexity of the recommendations, and larger facilities with increased specialization, interconnectedness, and leadership support. The study outcomes are planned to be disseminated via lectures and articles. Promoting a safe surgical environment is a top priority for perioperative nurses. By identifying key predictors that influence compliance with smoke evacuation practices, a better understanding of the many factors that influence perioperative nurse practices is fostered. Nurse training programs can be developed that directly target and address these key predictors so that a safe and healthy surgical environment free from surgical smoke can be promoted

Body sensor networks: smart monitoring solutions after reconstructive surgery

Advances in reconstructive surgery are providing treatment options in the face of major trauma and cancer. Body Sensor Networks (BSN) have the potential to offer smart solutions to a range of clinical challenges. The aim of this thesis was to review the current state of the art devices, then develop and apply bespoke technologies developed by the Hamlyn Centre BSN engineering team supported by the EPSRC ESPRIT programme to deliver post-operative monitoring options for patients undergoing reconstructive surgery. A wireless optical sensor was developed to provide a continuous monitoring solution for free tissue transplants (free flaps). By recording backscattered light from 2 different source wavelengths, we were able to estimate the oxygenation of the superficial microvasculature. In a custom-made upper limb pressure cuff model, forearm deoxygenation measured by our sensor and gold standard equipment showed strong correlations, with incremental reductions in response to increased cuff inflation durations. Such a device might allow early detection of flap failure, optimising the likelihood of flap salvage. An ear-worn activity recognition sensor was utilised to provide a platform capable of facilitating objective assessment of functional mobility. This work evolved from an initial feasibility study in a knee replacement cohort, to a larger clinical trial designed to establish a novel mobility score in patients recovering from open tibial fractures (OTF). The Hamlyn Mobility Score (HMS) assesses mobility over 3 activities of daily living: walking, stair climbing, and standing from a chair. Sensor-derived parameters including variation in both temporal and force aspects of gait were validated to measure differences in performance in line with fracture severity, which also matched questionnaire-based assessments. Monitoring the OTF cohort over 12 months with the HMS allowed functional recovery to be profiled in great detail. Further, a novel finding of continued improvements in walking quality after a plateau in walking quantity was demonstrated objectively. The methods described in this thesis provide an opportunity to revamp the recovery paradigm through continuous, objective patient monitoring along with self-directed, personalised rehabilitation strategies, which has the potential to improve both the quality and cost-effectiveness of reconstructive surgery services.Open Acces

The Effects of Nursing Education on Decreasing Catheter Associated Urinary Tract Infection Rates

Catheter-associated urinary tract infections (CAUTIs) account for 40% of all nosocomial infections in the United States, affecting nearly 900,000 patients per year. The indwelling urinary catheter (IUC) is a widely utilized device in modern hospital environments, yet they are not always used appropriately in hospital settings and can result in prolonged use and improper management, increasing risk of infections and length of stay. Nurses are the primary champions to promote preventative measures, provide patient education, and evaluate evidence-based practice (EBP) strategies to decrease CAUTIs. The purpose of this study was to determine if nursing education on EBP guidelines could decrease CAUTI rates in hospitalized patients on a medical surgical unit. A quasi-experimental, one group, before-and-after design was used to evaluate changes in CAUTI rates before and after the educational intervention in a hospital in the southeastern United States among staff of 63 nurses. The baseline unidentified CAUTI rate of the selected population was provided by the organization prior to the educational intervention. There were 55 nurses who attended the educational session and the post-CAUTI rate was evaluated 1 month after the educational intervention. At the end of the study period, analysis of CAUTI rates were conducted using a chi square test to evaluate whether there was a significant difference in the CAUTI rates. A statistically significant difference was found in the pre-to post-CAUTI rate (p \u3c 0.05). The results of this study demonstrated that educating nurses on the CDC- recommended EBP guidelines and providing them with leadership supports significantly decreased CAUTI rates on a medical surgical unit. These findings suggest that using an effective approach to decrease CAUTI rates can create social change and initiate additional planning strategies for all healthcare settings