JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org.. Cambridge University Press and ABSTRACTWe administered a web-based questionnaire to SHEA, APIC, and EIN members to assess the frequency of fires associated with alcohol-based hand rub (ABHR) dispensers in healthcare settings. None of the 798 responding facilities using ABHRs reported a dispenser-related fire; 766 facilities had accrued an estimated 1,430 hospital-years of ABHR use (Infect Control Hosp Epidemiol 2003;24:618-619).Alcohol-based hand rubs have been used routinely by healthcare workers (HCWs) in some parts of Europe for decades.1-3 Compared with soap and water hand washing, these products require less time to use, can be more accessible than sinks, cause less skin irritation and dryness, are more effective in reducing the bacterial count on hands, and when made widely available within an institution, have been shown to improve hand hygiene practices among HCWs. 4 In view of these advantages, the Healthcare Infection Control Practices Advisor y Committee of the Centers for Disease Control and Prevention recently recommended the routine use of alcohol-based hand rubs by HCWs, as long as their hands are not visibly soiled with blood or other proteinaceous material.5 To make these products readily accessible to HCWs, the new Guideline for Hand Hygiene in Healthcare Settings 5 recommends that alcohol-based hand rub dispensers be placed adjacent to patient beds, in hallways immediately outside patient rooms, and in other convenient locations. However, the implementation of alcoholbased hand rubs, particularly the placement of the dispensers in hallways, has been impeded in healthcare facilities in several states because of the concerns of local fire marshals that they may pose a fire hazard. METHODSTo obtain data on the frequency of fires related to alcohol-based hand rub dispensers, we administered a web-based questionnaire to members of the Society for Healthcare Epidemiology of America (SHEA), the Association of Professionals in Infection Control and Epidemiology (APIC), and the Emerging Infections Network (EIN) of the Infectious Diseases Society of America in March 2003. We obtained information regarding the routine use of alcohol-based hand rubs in facilities, the date (month and year) that the use began, the location of the dispensers within the facilities, and whether any fires had been attributed to the dispensers. We also asked whether they had been instructed by local fire marshals to remove or relocate the dispensers from hallways, change the size of the dispensers, or change the storage conditions of large stocks of alcohol-based hand rubs. Finally, we calculated the months of use of alcohol-based hand rubs for each facility and the cumulative months of use ...
Intensive insulin therapy (IIT) for the management of high blood glucose can reduce mortality and morbidity in the critically ill. However, there is little published literature on how to implement it successfully. The aim of this study is to chronicle the development and difficulties encountered in implementing an IIT protocol in a critical care unit in a district general hospital. A nurse-led protocol was developed. Qualitative audit was undertaken during development and implementation to identify potential problems with using the Bath Insulin Protocol. Regular feedback sessions were introduced to encourage change and further identify problem issues. Qualitative audit led to changes in practice for individual nurses and changes to other unit protocols. The main change for individual nurses was to measure blood glucose hourly using a bedside glucometer. The unit's feeding and drug dilution policies were identified as a potential cause of glucose instability and were modified. To implement IIT successfully, it is necessary to consider changing working practices and to identify other unit protocols which can cause glucose instability. The additional nursing workload must be considered and appropriate means of supporting staff identified.
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