Though widely reported, Hair-thread Tourniquet Syndrome (HTTS) is poorly recognized. It refers to external, mechanical, circumferential constriction of an appendage, typically with an end-artery such as a digit, resulting in a “compartment syndrome-like” situation. HTTS is illustrated using the case of an infant. Children presenting with irritability should have their digits examined for signs of strangulation, with the awareness that numerous strands may be involved, with some buried in the skin. Early surgical-release must be performed if unwinding or simple cutting is unsuccessful.

ObjectivesTo assess the awareness and voluntary usage of the World Health Organization's Surgical Safety Checklist (WHO SSC), just prior to its mandatory implementation.DesignQuestionnaire-based, prospective, telephone survey.SettingPatients are exposed to systematic risks and principles of surgical safety are inconsistently applied even in sophisticated settings. The evidence-based WHO SSC addresses shortfalls to promote patient safety. It was formally introduced in the United Kingdom in January 2009 and became a mandatory preoperative requirement in all hospitals from February 2010.ParticipantsTwo hundred and thirty-eight hospitals, both private and government-run, in the UK.Main outcome measuresAppreciation among senior theatre personnel as to the existence, implementation and usage of the WHO SSC concept.ResultsAlmost all had heard of the SSC, but in only two-thirds of hospitals was its use mandatory. Where the SSC was not compulsory, 80% were using it informally or sporadically. One-quarter of senior theatre personnel in hospitals without compulsory use indicated they did not know or that their department did not plan on using the checklist in the next six months, despite the deadline for implementation.ConclusionsIf the SSC is to optimize safety, then greater education and awareness is required.

Chlorhexidine is an effective cleansing skin-preparation agent and has many user benefits. It has, however, been associated with a number of complications which are highlighted in this paper. All users of chlorhexidine must be aware of these risks and employ insightful use of this chemical.