The Impact on Midwives of Undertaking Screening for Domestic Violence: Focus Group Findings

Objective: To investigate the impact mandatory screening for domestic violence has had upon registered midwives. Design: Three phase study – Phase one involved focus group interviews. Setting: Hospitals in South-East Queensland undertaking mandatory domestic violence screening. Participants: Registered midwives undertaking screening for domestic violence. Results: Several barriers were identified that directly impacted upon the midwives' potential to screen effectively. Barriers identified were classified as intrinsic (intrapersonal and perception) and extrinsic (interpersonal, environmental and organisational infrastructure). Principle, conclusions and implications for practice: Although midwives have strong beliefs about the value of domestic violence screening, there is a negative perception about it's efficacy and an assumption of failure due to the barriers identified by the registered midwives

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

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

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

Preoperative bathing or showering with skin antiseptics to prevent surgical site infection (Review)

Surgical site infection is a serious complication of surgery and is usually associated with increased length of hospital stay for the patient, and also higher hospital costs. The use of an antiseptic solution for preoperative bathing or showering is widely practiced in the belief that it will help to prevent surgical site infections from developing. This review identified seven trials, with over 10,000 patients, that tested skin antiseptics (chlorhexidine solution) against normal soap or no presurgical washing. The review of these trials did not show clear evidence that the use of chlorhexidine solution before surgery was better than other wash products at preventing surgical site infections from developing after surgery

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

Development and validation of a pregnancy symptoms inventory

Background: Physical symptoms are common in pregnancy and are predominantly associated with normal physiological changes. These symptoms have a social and economic cost, leading to absenteeism from work and additional medical interventions. There is currently no simple method for identifying common pregnancy related problems in the antenatal period. A validated tool, for use by pregnancy care providers would be useful. The aim of this study was to develop and validate a Pregnancy Symptoms Inventory for use by health professionals. Methods: A list of symptoms was generated via expert consultation with health professionals. Focus groups were conducted with pregnant women. The inventory was tested for face validity and piloted for readability and comprehension. For test-re-test reliability, the tool was administered to the same women 2 to 3 days apart. Finally, midwives trialled the inventory for 1 month and rated its usefulness on a 10cm visual analogue scale (VAS). Results: A 41-item Likert inventory assessing how often symptoms occurred and what effect they had, was developed. Individual item test re-test reliability was between .51 to 1, the majority (34 items) scoring ≥0.70. The top four " often" reported symptoms were urinary frequency (52.2%), tiredness (45.5%), poor sleep (27.5%) and back pain (19.5%). Among the women surveyed, 16.2% claimed to sometimes or often be incontinent. Referrals to the incontinence nurse increased > 8 fold during the study period. Conclusions: The PSI provides a comprehensive inventory of pregnancy related symptoms, with a mechanism for assessing their effect on function. It was robustly developed, with good test re-test reliability, face validity, comprehension and readability. This provides a validated tool for assessing the impact of interventions in pregnancy

Dressings and topical agents for preventing pressure ulcers (Review)

Background: Pressure ulcers, which are localised injury to the skin, or underlying tissue or both, occur when people are unable to reposition themselves to relieve pressure on bony prominences. Pressure ulcers are often difficult to heal, painful and impact negatively on the individual's quality of life. The cost implications of pressure ulcer treatment are considerable, compounding the challenges in providing cost effective, efficient health services. Efforts to prevent the development of pressure ulcers have focused on nutritional support, pressure redistributing devices, turning regimes and the application of various topical agents and dressings designed to maintain healthy skin, relieve pressure and prevent shearing forces. Although products aimed at preventing pressure ulcers are widely used, it remains unclear which, if any, of these approaches are effective in preventing the development of pressure ulcers. Objectives: To evaluate the effects of dressings and topical agents on the prevention of pressure ulcers, in people of any age without existing pressure ulcers, but considered to be at risk of developing a pressure ulcer, in any healthcare setting. Search methods: In February 2013 we searched the following electronic databases to identify reports of relevant randomised clinical trials (RCTs): the Cochrane Wounds Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Database of Abstracts of Reviews of Effects (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. Selection criteria: We included RCTs evaluating the use of dressings, topical agents, or topical agents with dressings, compared with a different dressing, topical agent, or combined topical agent and dressing, or no intervention or standard care, with the aim of preventing the development of a pressure ulcer. Data collection and analysis: We assessed trials for their appropriateness for inclusion and for their risk of bias. This was done by two review authors working independently, using pre-determined inclusion and quality criteria. Main results: Five trials (940 participants) of unclear or high risk of bias compared a topical agent with a placebo. Four of these trials randomised by individual and one by cluster. When results from the five trials were combined, the risk ratio (RR) was 0.78 (95% CI 0.47 to 1.31; P value 0.35) indicating no overall beneficial effect of the topical agents. When the cluster randomised trial was omitted from the analysis, use of topical agents reduced the pressure ulcer incidence by 36%; RR 0.64 (95% CI 0.49 to 0.83; P value 0.0008). Four trials (561 participants), all of which were of high or unclear risk of bias, showed that dressings applied over bony prominences reduced pressure ulcer incidence; RR 0.21 (95% CI 0.09 to 0.51; P value 0.0006). Authors' conclusions: There is insufficient evidence from RCTs to support or refute the use of topical agents applied over bony prominences to prevent pressure ulcers. Although the incidence of pressure ulcers was reduced when dressings were used to protect the skin, results were compromised by the low quality of the included trials. These trials contained substantial risk of bias and clinical heterogeneity (variations in populations and interventions); consequently, results should be interpreted as inconclusive. Further well designed trials addressing important clinical, quality of life and economic outcomes are justified, based on the incidence of the problem and the high costs associated with pressure ulcer management

Routine care of peripheral intravenous catheters versus clinically indicated replacement: randomised controlled trial

Objective To compare routine replacement of intravenous peripheral catheters with replacement only when clinically indicated