The potential that forced-air warming systems may increase the risk of surgical site infections (SSIs) by acting as a vector or causing unwanted airflow disturbances is a concern to health care providers. To investigate this potential, we examined the literature to determine whether forced-air warming devices increase the risk of SSIs in patients undergoing general, vascular, or orthopedic surgical procedures. We examined 192 evidence sources, 15 of which met our inclusion criteria. Most sources we found indirectly addressed the issue of forced-air warming and only three studies followed patients who were warmed intraoperatively with forced-air warming devices to determine whether there was an increased incidence of SSIs. All of the sources we examined contained methodological concerns, and the evidence did not conclusively suggest that the use of forced-air warming systems increases the risk of SSIs. Given the efficacy of these devices in preventing inadvertent perioperative hypothermia, practitioners should continue to use and clean forced-air warming systems according to the manufacturer's instructions until well-conducted, large-scale trials can further examine the issue.
Lateral violence is a problem in nursing despite policies addressing the issue, which suggests that implementation of these policies may be ineffective. We used an evidence-based approach to locate and appraise evidence about effectively implementing lateral violence policies. Our search strategy emphasized preappraised evidence, and we found 12 sources that met our inclusion criteria. Most evidence was from low-level sources, which is not surprising due to the subjective and sensitive nature of this topic. The evidence did not indicate that there is consistent, effective implementation of lateral violence policies. The appraised evidence suggests the importance of collaboratively prepared implementation strategies. Administrator involvement and relationships with staff members and the presence of a commitment to positive behavior change before lateral violence incidents occur are factors that can lead to successful implementation of lateral violence policies.
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