Abstract Aims Nurses’ hand temperature may affect patient comfort but has not been investigated. This study aimed to determine female hospital nurses' hand skin temperature and clarify the effects of measurement site, time, nursing procedures, and environment. Design An observational study. Methods The middle finger, thenar eminence, hypothenar eminence, and medial forearm skin temperature of 29 female hospital nurses was measured at four time points during a day shift and before and after nursing procedures (hand disinfection, hand washing, taking vital signs, hygiene care, and positioning). Results Mean hand skin temperature was in the range of 29–32°C with interpersonal variations. Mean skin temperature at the medial forearm was 31.94–32.35°C (SD 0.87–1.52°C) and at the middle finger, 29.73–31.07°C (SD > 3°C). Time‐dependent skin temperature fluctuations were confirmed on the middle finger ( p = .022), and thenar ( p = .005) and hypothenar eminence ( p = .001). There were weak correlations between skin temperature and environmental factors, including ambient temperature (ρ = .194–.266), humidity (ρ = −.309 to −.319), and hospital room wind speed (ρ = .253–.314). The skin temperature dropped significantly after hand disinfection and handwashing at all measurement sites (middle finger: −1.30 and −3.56°C, respectively; thenar eminence: −1.19 and −3.32°C; hypothenar eminence: −0.80 and −3.39°C; medial forearm: −0.21 and −1.60°C). Conclusion These findings may raise nurses' awareness of their skin temperature. Moreover, our study highlights the need to develop countermeasures to ensure optimal nurses' skin temperature and patient comfort.
BACKGROUND: Electrolyzed strongly acidic aqueous solution which is produced by electrolysis of a sodium chloride solution has been used in Japan for the irrigation of wounds or body cavities even in the absence of particular evidence. OBJECTIVE: The purpose of this study is to investigate the efficacy or harmful effects of the disinfectant when applied before wound closure in colorectal surgery. DESIGN: We performed a prospective, randomized study. SETTING: The study was conducted at Surgical Department of Hyogo College of Medicine PATIENTS: Patients who underwent elective colorectal surgery were randomly assigned to 2 groups. The surgical wound was irrigated with >500 mL of the disinfectant or saline solution after the completion of fascia closure. Patients with dirty/infected wounds were excluded from the study. MAIN OUTCOME MEASURES: The primary end point of this study was comparison of the frequency of incisional surgical site infection. The secondary end point was the occurrence of wound dehiscence or wound hernia. RESULTS: One hundred eighty patients in the disinfectant group and 183 patients in the saline solution group were analyzed. In multivariate analysis, IBD and contaminated wounds were independent risk factors for incisional surgical site infection. Application of the disinfectant tended to lower the risk of the infection (OR 0.457, 95% CI 0.206–1.013). In the analysis of poor wound healing, preoperative hospital stay of >2 weeks, stoma creation, and use of the disinfectant (OR 2.28, 95% CI 1.03–5.04) were independent risk factors. LIMITATION: This study was not a double-blind trial. CONCLUSIONS: Application of electrolyzed strongly acidic aqueous solution to the wound impaired wound healing. Routine use of electrolyzed strongly acidic aqueous solution is not recommended in patients undergoing elective colorectal surgery. As for the contribution of the disinfectant to preventing wound infections, further study is needed to make a definitive conclusion.
Abstract Background: A trough concentration (C min ) ≥20 μg/mL of teicoplanin is recommended for the treatment of serious methicillin-resistant Staphylococcus aureus (MRSA) infections. However available data are limited because it is difficult to attain this target C min . Methods: Pharmacokinetics and adverse events were evaluated in all eligible patients. For clinical efficacy, patients who had bacteremia/complicated MRSA infections were analyzed. The primary endpoint for clinical efficacy was an early clinical response at 72–96 h after the start of therapy. Five dosed of 12 mg/kg or 10 mg/kg was administered as an enhanced or conventional high loading dose regimen, respectively. The C min was obtained at 72 h after the first dose. Results: Overall, 512 patients were eligible, and 76 patients were analyzed for treatment efficacy. The proportion of patients achieving the target C min range (20–40 μg/mL) by the enhanced regimen was significantly higher than for the conventional regimen (75.2% versus 41.0%, p < 0.001). In multivariate analysis, C min ≥20 μg/mL was an independent factor for an early clinical response (odds ratio 3.95, 95% confidence interval 1.25–12.53). There was no significant difference in the occurrence of adverse events between patients who did or did not achieve a C min ≥20 μg/mL. Conclusion: A target C min ≥20 μg/mL might improve early clinical responses during the treatment of difficult MRSA infections using 12 mg/kg teicoplanin for five doses within the initial 3 days.
Abstract Background Acute kidney injury (AKI) and hypokalaemia are common adverse events after treatment with liposomal amphotericin B (L‐AMB). Objectives Because excess potassium (K) leakage occurs during renal tubular injury caused by L‐AMB, measuring the decrease in rate of serum K concentration might be more useful to assess the renal impact of L‐AMB than hypokalaemia identified from a one‐point measurement. The effects of a decrease in K concentration and duration of hypokalaemia on AKI were investigated. Methods A ≥ 10% decrease in K concentration from the reference concentration within a 7‐day timeframe was evaluated. The hypokalaemia index, which combines the duration of K concentration lower than the reference and a marked low K concentration, was calculated from the area over the concentration curve. Results Eighty‐six patients were included in the study. The incidences of AKI and decrease in K concentration were 36.0% and 63.9%, respectively. Of patients who developed both adverse events, a decrease in K concentration occurred first in 22 of 26 patients, followed by AKI 7 days later. Hypokalaemia did not increase AKI risk whereas a decrease in K concentration was an independent risk factor for AKI. The hypokalaemia index in patients with AKI was significantly higher than those without AKI (5.35 vs. 2.50 points, p = 0.002), and ≥3.45 points was a significant predictor for AKI. Conclusion A ≥ 10% decrease in the K concentration was a significant factor for AKI in patients receiving L‐AMB therapy. In such patients, dose reduction or alternative antifungals could be considered based on the hypokalaemia index.
