Delay in performing operating procedures is one of the key factors that hinders optimal flow of patients and also has a significant impact on the economic outcome of the hospital. These delays could arise at various points due to multiple personnel involved in the process of performing a surgery. The main aim of the study was to identify possible causes for delay in performing operating procedures on time and instituting effective interventions which would prevent such delays. Positive reinforcement was used to encourage the surgical teams to perform the procedures on time and avoid the delays. The mean number of cases starting on time has improved from about 10% in March 2009 to about 80% in March 2011. With the use of effective intervention strategies delay in performing operating procedures can be reduced which ultimately improves overall patient satisfaction along with improving hospital costs.

To determine whether a slime-producing strain of Staphylococcus epUlermUlis was capable of producing acute infection of a prosthetic vascular graft, 5 cm segments of knitted Dacron were implanted in the infrarenal aortic position ofdogs in three groups ofanimals. 'These included a control group (no graft contaminati~n), a contaminated group that received a graft soaked in an S. epidermidis solution (untreated group), and a contaminated group in which pe~operative antibiotics (three doses of ce(amandole, 100 mg/kg) were administered (prophylaxis group). In all the animals reexploration and graft removal were performed at 10 days, with replacement of the defect being achieved with a new uncontaminated graft. 'These animals underwent explorati~n a third time after an additional 10-day period.. S. epidermidis was not grown from the control animals (n = 7) but was cultured in 44% of the prophylaxis group (n = 9) and 88% of the untreated group (n = 16) during at least one of the• operative procedures (X 2 = 15.859; P < 0.001). 'The pathologic features ofacute S. epUlermidis. infectio~were best seen in the untreated animals and included anastomotic dismption (56%), periaortic hematoma, and lymphadenopathy (94%). Microscopic examination ofthe ,aortic tissues revealed extensive infiltrates ofleukoeytes, macrophages, and foreign body giant cells with aortic necrosis. These features were less prominent" in the prophylaxis animals. We conclude that S. epidermidis is capable of producing acute graft infection with perigraft inflammation and anastomotic dismption. 1he administration of perioperative antibiotics reduced but did not abolish these effects of bacterial con~ation of prosthetic vascular grafts. (J VAse SURG 1989;9:464-71.) Two percent to 5% of patients in w:hom a prosthetic vascwar graft is placed develop graft infection. 1 Since 1984 several reports have documented that coagulase-n~gativestaphylococci are now the most common organisms infecting vas~ular prosthetic grafts. 2 -4 Staphylococcus epidertnidis has also been identified as the most frequent cause of infection in ar-, tificial joints, prosthetic heart valves, and cerebral peritoneal shunt devices.~'Research concerping the pathogenesis of S. epiderm.idis infection and clinical recognition ofthe magnitude of the problem have been hampered by the lack of a reproducible animal model. We developed a model of S. epidertnidis prosthetic graft infections

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