Surgical Site Infections and Hand Hygiene Discharge Teaching

Problem: During the span of a nine-month period, the PACU of a perioperative unit in an acute care hospital in the East Bay Area saw an incidence of 13 surgical site infections (SSIs). SSIs have been associated with negative patient health outcomes, diminished quality of life, and increasing healthcare costs. Context: The PACU consisted of 20 beds and a competent staff of registered nurses, medical assistants, patient care technicians (PCTs), and management staff. It served mostly adults from diverse backgrounds receiving elective and emergent surgeries. Intervention: A Standardized 3-Step Hand Hygiene Discharge Teaching model with nurse self-audits for every surgical patient with a surgical incision aims to improve the consistency of hand hygiene education provided during discharge for the patient to be able to care for their surgical incision at home. The anticipated outcome is a decrease in SSIs. Measures: The outcome measure for this project is the rate of SSI occurrences per 1000 patient days. The process measure is the percentage of PACU nurses completing the nurse self-audit sheet. The balancing measure includes the change of adding the nurse self-audit sheet and whether it is indirectly causing negative implications on other processes within the microsystem Results: After implementing the proposed intervention, it is anticipated that this acute care hospital will experience a significant decrease in SSIs with a 70% compliance rate of self-audit completion by the PACU nurses. Conclusion: Practicing proper hand hygiene is the simplest, least expensive and most important intervention patients can do to reduce infection. However, an inconsistency on hand hygiene education during the discharge process was observed within the PACU. Because of the organization’s policies and the short time frame allotted for this project, an actual intervention was not feasible. Therefore, future direction includes implementing the Standardized 3-Step Hand Hygiene Discharge Teaching model, performing periodic audits to further explore the influence of consistent hand hygiene discharge teaching over SSIs, and conducting observations on other days and shifts to further explore the validity of the observation results

ALMA 690 GHz observations of IRAS 16293-2422B: Infall in a highly optically-thick disk

We present sensitive, high angular resolution ($\sim$ 0.2 arcsec) submillimeter continuum and line observations of IRAS 16293-2422B made with the Atacama Large Millimeter/Submillimeter Array (ALMA). The 0.45 mm continuum observations reveal a single and very compact source associated with IRAS 16293-2422B. This submillimeter source has a deconvolved angular size of about 400 {\it milli-arcseconds} (50 AU), and does not show any inner structure inside of this diameter. The H$^{13}$CN, HC$^{15}$N, and CH$_{3}$OH line emission regions are about twice as large as the continuum emission and reveal a pronounced inner depression or "hole" with a size comparable to that estimated for the submillimeter continuum. We suggest that the presence of this inner depression and the fact that we do not see inner structure (or a flat structure) in the continuum is produced by very optically thick dust located in the innermost parts of IRAS 16293-2422B. All three lines also show pronounced inverse P-Cygni profiles with infall and dispersion velocities larger than those recently reported from observations at lower frequencies, suggesting that we are detecting faster, and more turbulent gas located closer to the central object. Finally, we report a small east-west velocity gradient in IRAS 16293-2422B that suggests that its disk plane is likely located very close to the plane of the sky.Comment: Accepted to ApJ