Use of the Oucher Numeric and the Word Graphic Scale in children aged 9–14 years with post‐operative pain

? The construct validity and clinical applicability of two self‐report scales, the Oucher Numeric and the Word Graphic Scales, were examined in this study. Construct validity was tested on the assumption that pain declines following the administration of analgesia. ? Eighty‐one children aged between nine and 14 years with post‐operative pain used the two scales before and for each of the 4 hours following the administration of analgesia, to report their intensity of pain. The method used for testing construct validity was a replication of the study conducted by 3 ; Children’s pain perception before and after analgesia: a study of instrument construct validity and related issues. Journal of Pediatric Nursing 3 (1), 11–23) to test the construct validity of the Oucher Scale. Construct validity was supported for both the scales. ? Twenty‐eight nurses who administered the scales and the parents of 45 children who had observed their children use the scales, commented on the usefulness of the scales in assessment of pain during hospitalization. ? A majority of children and nurses preferred the Oucher Numeric, whereas the Word Graphic Scale was preferred by a majority of the parents. ? Preference of scale was based on its ease of use and whether the child preferred to use numbers or words to describe the intensity of pain. ? A majority of the children and nurses and all parents believed that a self‐report scale was useful for assessment and communication of children’s pain following surgery.     

Effect of healthcare-acquired infection on length of hospital stay and cost.

OBJECTIVE: To estimate the independent effect of a single lower respiratory tract infection, urinary tract infection, or other healthcare-acquired infection on length-of-stay and variable costs and to demonstrate the bias from omitted variables that is present in previous estimates. DESIGN: Prospective cohort study.Setting. A tertiary care referral hospital and regional district hospital in southeast Queensland, Australia. PATIENTS: Adults aged 18 years or older with a minimum inpatient stay of 1 night who were admitted to selected clinical specialities. RESULTS: Urinary tract infection was not associated with an increase in length of hospital stay or variable costs. Lower respiratory tract infection was associated with an increase of 2.58 days in the hospital and variable costs of AU $24, whereas other types of infection were associated with an increased length of stay of 2.61 days but not with variable costs. Many other factors were found to be associated with increased length of stay and variable costs alongside healthcare-acquired infection. The exclusion of these variables caused a positive bias in the estimates of the costs of healthcare-acquired infection. CONCLUSIONS: The existing literature may overstate the costs of healthcare-acquired infection because of bias, and the existing estimates of excess costs may not make intuitive sense to clinicians and policy makers. Accurate estimates of the costs of healthcare-acquired infection should be made and used in appropriately designed decision-analytic economic models (ie, cost-effectiveness models) that will make valid and believable predictions of the economic value of increased infection control.     

Catheter-related bloodstream infections in intensive care units: a systematic review with meta-analysis

Title. Catheter‐related bloodstream infections in intensive care units: a systematic review with meta‐analysis Aim. This paper is a report of a systematic review and meta‐analysis of strategies, other than antimicrobial coated catheters, hypothesized to reduce risk of catheter‐related bloodstream infections and catheter colonization in the intensive care unit setting. Background. Catheter‐related bloodstream infections occur at a rate of 5 per 1000 catheter days in the intensive care unit setting and cause substantial mortality and excess cost. Reducing risk of catheter‐related bloodstream infections among intensive care unit patients will save costs, reduce length of stay, and improve outcomes. Methods. A systematic review of studies published between January 1985 and February 2007 was carried out using the keywords ‘catheterization – central venous’ with combinations of infection*, prevention* and bloodstream*. All included studies were screened by two reviewers, a validated data extraction instrument was used and data collection was completed by two blinded independent reviewers. Risk ratios for catheter‐related bloodstream infections and catheter colonization were estimated with 95% confidence intervals for each study. Results from studies of similar interventions were pooled using meta‐analyses. Results. Twenty‐three studies were included in the review. The strategies that reduced catheter colonization included insertion of central venous catheters in the subclavian vein rather than other sites, use of alternate skin disinfection solutions before catheter insertion and use of Vitacuff in combination with polymyxin, neomycin and bacitracin ointment. Strategies to reduce catheter‐related bloodstream infection included staff education multifaceted infection control programmes and performance feedback. Conclusion. A range of interventions may reduce risks of catheter‐related bloodstream infection, in addition to antimicrobial catheters.     

Performance of urinary catheterisation by mothers of children with spina bifida.

This paper describes a review of the practices related to the performance of catheterisation for obtaining residual volume of urine by mothers of children with spina bifida. Mothers of children, up to five years of age and attending an outpatient Specialist Clinic were requested to perform catheterisation once a month to obtain urine residuals. The procedure for catheterisation was taught to mothers in the Outpatient's Clinic. A review of clinical practice resulted in discontinuation of this procedure. Mothers (n = 16) reported varied reasons for feeling relieved that the procedure was discontinued.