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Biomedical subjects

C Oxley

Publications and source records attributed to C Oxley.

8 recordsLinked to original sources
PubMed2001

HeatBalance, a computer program to determine optimum incubator air temperature and humidity. A comparison against nurse settings for infants less than 29 weeks gestation.

BACKGROUND: Very immature newborn infants need close control of their thermal environment. Decisions on incubator temperature and humidity settings can be difficult and available charts are not readily applicable to these babies. A computer program (HeatBalance) using basic principles to calculate heat gains and losses has been developed. The program recommends incubator temperature and humidity settings to keep babies in thermal balance. AIM: The aim of this study was to compare the effect of the program on temperature control of infants <29 weeks gestation with that achieved by experienced nurses. METHOD: Twenty consecutive babies were studied over the first 5 days of life, all nursed in incubators using air mode control. The first 10 had temperature and humidity set by the nurses while the next 10 had incubator settings determined by the program. Nurses could alter the parameters if the babies were too hot or cold. Incubator temperature and humidity data along with central and peripheral temperatures from the babies were collected autonomicallly onto a cotside computer system. RESULTS: There were no differences between the groups in mean central temperatures or the periods of time the babies were either too hot (central temperature T(c)>37.5) or too cold (T(c)<36.5). In the control group, the nurses often altered incubator temperature because of changes in the infant's temperature on the monitors. On each day of the study, the nurses deviated from the HeatBalance recommendations between 11% and 22% of the time. CONCLUSIONS: The HeatBalance program and the nurses achieved similar results in temperature stability for these immature infants. Whichever method was used to determine the initial incubator settings, this study highlighted the importance of continuous monitoring of central and peripheral temperatures in these infants.

Body Temperature Regulation↗
PubMed1997

Total purchasing. Tracking down care.

Purchasers have a duty to monitor the quality of services purchased on patients' behalf; a purchasing general practice is best placed to do this effectively, especially by means of a tracker nurse. The tracker nurse should be diplomatic and experienced to earn the respect of professional staff in provider units, some of whom may see the process as threatening. The purchaser must introduce the concept of care monitoring gently but firmly, agreeing terms of confidentiality. Good practice should be highlighted and used as an example to others. Monitoring must follow the whole pathway of care, at the time and place it is given.

Budgets↗
PubMed1996

Elimination of an outbreak of gram-negative bacteremia in a hemodialysis unit.

BACKGROUND: The purpose of this study was to identify the cause of an unusual outbreak of gram-negative bacteremia in patients undergoing long-term hemodialysis. METHODS: We performed direct observation and investigation of current dialysis techniques and facilities including microbiologic sampling in a long-term hemodialysis unit in a tertiary care center. We also performed a retrospective review of medical charts and laboratory data of 10 patients undergoing long-term hemodialysis who experienced 11 episodes of gram-negative bacteremia between March 4 and June 28, 1993. RESULTS: All of these patients underwent dialysis by jugular venous access. Containers used to collect flush solution after priming of dialysis tubing remained unemptied for extended periods of time, and quantitative culture revealed more than 200 colony-forming units/ml gram-negative bacilli, including species isolated in blood cultures. Dialysis tubing and connector were left submerged in flush solution collection containers during priming, and the process of disinfecting tubing before patient connection had recently been discontinued. Control measures included emptying of flush containers after each use and daily decontamination. All dialysis tubing was to be disinfected before patient connection. CONCLUSION: Outbreak was due to contamination during dialysis setup. After institution of appropriate control measures, no new cases have occurred.

Aged↗
PubMed1996

Three-year outbreak of pseudobacteremia with Burkholderia cepacia traced to a contaminated blood gas analyzer.

Between November 1990 and June 1993, Burkholderia cepacia was isolated from the blood cultures of 13 neonates born at the Ottawa General Hospital. Eight of the 13 neonates appeared symptomatic, and only 4 were treated with appropriate antimicrobial therapy, but all improved clinically. In August 1993, the blood gas analyzer in the neonatal intensive-care unit was found to be contaminated heavily with B cepacia. Eight available patient isolates were identical to the isolates recovered from the blood gas analyzer by ribotyping analysis. Infection control measures were implemented to prevent future contamination of the analyzer, and no further cases have been identified.

Bacteremia↗
PubMed1995

Underestimation of surgical site infection rates in obstetrics and gynecology.

BACKGROUND: With the increasing volume of same-day operations and shortened hospital stays, it becomes more likely that a significant percentage of surgical site infections will occur after these patients' discharges. METHODS: To document the true incidence of postdischarge surgical site infection, surveillance was undertaken in a group of obstetric and gynecologic patients. The study consisted of two parts. (1) A questionnaire was mailed to each surgeon, inquiring about clinical evidence of infection. The infection control service continued to do surveillance of wound infection in the usual manner, and the results of the two methods were compared. (2) A questionnaire was provided to patients undergoing operation, inquiring about signs and symptoms of wound infection. RESULTS: A total of 469 surgical procedures were included, with a total of 24 infections detected (5.2%). Of these, 14 infections (58.3%) were detected by the usual surveillance method. An additional 10 infections (41.7%) were detected after patient discharge by the physician questionnaire. Only two of the 24 infections were detected by the patient questionnaire. CONCLUSIONS: Failure to include postdischarge surgical site surveillance results in a substantial underestimation of the true surgical site infection rate. Physician input and strong support have prompted a regular biannual postdischarge surgical site surveillance program in this patient population.

Female↗
PubMed1992

Plumbing system shock absorbers as a source of Legionella pneumophila.

BACKGROUND: Water distribution systems have been demonstrated to be a major source of nosocomial legionellosis. We describe an outbreak in our institution in which a novel source of Legionella pneumophila was identified in the plumbing system. METHODS: After an outbreak of 10 cases of legionellosis in our hospital, recommended measures including superheating of the hot water to 80 degrees C, hyperchlorination to 2 ppm, and flushing resulted in no new cases in the following 5 years. Recently, despite these control measures, three new cases occurred. Surveillance cultures of shower heads and water tanks were negative; cultures of tap water samples remained positive. This prompted a search for another reservoir. Shock absorbers installed within water pipes to decrease noise were suspected. RESULTS: One hundred twenty-five shock absorbers were removed and cultured. A total of 13 (10%) yielded heavy growth of L. pneumophila (serogroup 1). Since their removal, no new cases have been found and the percentage of positive results of random tap water culture has dropped from 20% to 5%. CONCLUSIONS: This is the first report that identifies shock absorbers as a possible reservoir for L. pneumophila. We recommend that institutions with endemic legionellosis assess the water system for possible removal of shock absorbers.

Cross Infection↗
PubMed1985

Colonization of intravascular catheters in the intensive care unit.

A prospective study of intravascular catheters (arterial, Swan-Ganz, and central venous) in two hospitals with similar intensive care units revealed an overall 25 percent colonization rate (more than 15 colony counts). Arterial catheters had the lowest colonization rate and central venous catheters had the highest. Arterial, Swan-Ganz, and central venous catheters are possible sources of nosocomial infections and septicemia. They should be inserted only when necessary. A critical review of our data and the literature suggests that future studies should examine the potential benefits of assiduous insertion technique, improved dressing care, intravascular delivery systems, and the choice of catheter.

Candida albicans↗