OR Manager - April 2020 - 32

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At a Glance
Endoscope disinfection
In this review article, Cori L. Ofstead,
MSPH, and associates discuss reasons
for ineffective endoscope reprocessing
after high-level disinfection.
Among the reasons:
* non-adherence to guidelines
* use of damaged endoscopes
* use of insoluble products
during endoscopy
* insufficient cleaning
* contaminated rinse water
* inadequate drying before storage.
They found that reusable high-level
disinfectants commonly failed tests for
minimum effective concentration before
their maximum use periods. Minimum
effective concentration tests also found
failures linked to single-use high-level
disinfectants that did not fully deploy.
Infection preventionists should collaborate
with manufacturers, endoscopists,
and reprocessing personnel to
improve high-level disinfection effectiveness,
the researchers say.
-Ofstead C L, Hopkins K M, Buro
B L, et al. Am J Infect Control.
2020;48(3):309-315.
Effect of total joint bundled
payments on patient selection
In this study, researchers found little to
no significant change in the characteristics
of patients having total hip and
knee replacement surgery after the Cen32
OR
Manager | April 2020
ters for Medicare & Medicaid Services
introduced mandatory bundled payment
programs in selected metropolitan statistical
areas.
The analysis included a matched set
of more than 12,000 episodes of hip and
knee replacement and follow-up care for
patients in bundled payment areas and
20,000 episodes in other areas.
Earlier analyses showed cost savings
but also a trend toward the selection
of healthier patients for total hips
and knees performed under Medicare's
Comprehensive Care for Joint Replacement
program.
-Humbyrd C J, Wu S S, Trujillo A J. J
Bone Joint Surg. Published online
December 18, 2019.
Internationally educated nurses
in US hospitals
US hospitals with more internationally
trained nurses have more stable, educated
nursing workforces, and collaboration
among healthcare professionals
is not hindered, this study finds.
Researchers analyzed 2013 survey
data from the National Database of
Nursing Quality Indicators that included
responses from 24,045 nurses (2,156
were trained outside the US) working on
958 units in 160 US acute care hospitals.
Collaboration was measured using
a nurse-nurse interaction scale and a
nurse-physician interaction scale.
Units with higher proportions of internationally
educated nurses had no
decrease in collaboration among nurses
and between nurses and physicians,
and there was less turnover. However,
these hospitals also had worse nurse
staffing levels or higher patient-to-nurse
ratios.
Given the nursing workforce shortage,
healthcare leaders should not be
reluctant to hire qualified internationally
educated nurses, the authors say.
-http://www.nursingeconomics.net/
necfiles/2020/JF20/33.pdf.
Inadequate precleaning of
surgical tools
This study by William A. Rutala, PhD,
MPH, and colleagues at the University
of North Carolina at Chapel Hill, which
compared three low-temperature sterilization
technologies to steam sterilization
of simulated inadequately precleaned
surgical tools, found steam
sterilization to be the most effective
and with the largest margin of safety.
Vaporized hydrogen peroxide
failed to completely sterilize the tools
76.3% of the time. Ethylene oxide and
hydrogen peroxide gas plasma both had
failure rates of 1.9%.
-Rutala W A, Gergen M F, SickbertBennet
E E, et al. Infect Control Hosp
Epidemiol. Published online February
26, 2020.
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OR Manager - April 2020

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