No abstract

This is the accepted version of the paper.This version of the publication may differ from the final published version. Background: Monitoring of hand hygiene compliance (HHC) by observation has been used in health care for more than a decade to provide assurance of infection control practice. The validity of this information is rarely tested. Permanent

N. (2013). The efficacy of saline washout technique in the management of exfoliant and vesicant chemotherapy extravasation: a historical case series report. European Journal Of Cancer Care, 22(2), pp. 169-178. doi: 10.1111/ecc.12023 This is the unspecified version of the paper.This version of the publication may differ from the final published version. This report presents the results from an historical case series of cytotoxic drug extravasations managed by saline washout; its purpose is to assess the efficacy of the procedure based on patient outcome. 89 patients were identified as having experienced a vesicant or exfoliant extravasation from incident reports filed over a 10 year period, from 1 st April 2001 -31 st March 2011. Outcome was measured against the need for further surgical treatment being required. Of the 89 cases assessed for efficacy of saline washout one patient experienced a wound infection which was treated effectively with oral antibiotics. There were no other complications reported and no patients required further treatment with surgical debridement. The majority of patients had no deferral of treatment as chemotherapy could be continued in their unaffected arm immediately following saline washout procedure. For patients where cannulation in their opposite arm for continuation of treatment was not advisable chemotherapy was delayed between 3 to 7 days. Hospitalisation as a result of the extravasation or subsequent treatment was not required in any of the 89 cases. Results indicate that saline washout technique is a safe and effective management strategy for the treatment of both vesicant and exfoliant chemotherapy extravasation. Permanent

Background: Electronic hand hygiene monitoring overcomes limitations associated with manual audit but acceptability to health workers varies and may depend on culture of the ward and the nature of the system. Objectives: Evaluate the acceptability of a new fifth type electronic monitoring system to frontline health workers in a National Health Service trust in the UK. Methods: Qualitative interviews with 11 informants following 12 months experience using an electronic monitoring system. Results: Informants recognised the importance of hand hygiene and embraced technology to improve adherence. Barriers to hand hygiene adherence included heavy workload, dealing with emergencies and ergonomic factors related to placement of alcohol dispensers. Opinions about the validity of the automated readings were conflicting. Some health workers thought they were accurate. Others reported problems associated with differences in the intelligence of the system and their own clinical decisions. Opinions about feedback were diverse. Some health workers thought the system increased personal accountability for hand hygiene. Others ignored feedback on suboptimal performance or ignored the data altogether. It was hard for health workers to understand why the system registered some instances of poor performance because feedback did not allow omissions in hand hygiene to be related to the context of care. Conclusion: Electronic monitoring can be very well tolerated despite some limitations. Further research needs to explore different reactions to feedback and how often clinical emergencies arise. Electronic and manual audit have complementary strengths.