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C J Alvarado

Publications and source records attributed to C J Alvarado.

9 recordsLinked to original sources
PubMed2006

Work system design for patient safety: the SEIPS model.

Models and methods of work system design need to be developed and implemented to advance research in and design for patient safety. In this paper we describe how the Systems Engineering Initiative for Patient Safety (SEIPS) model of work system and patient safety, which provides a framework for understanding the structures, processes and outcomes in health care and their relationships, can be used toward these ends. An application of the SEIPS model in one particular care setting (outpatient surgery) is presented and other practical and research applications of the model are described.

Ergonomics↗
PubMed1999

Sterilization vs. disinfection vs. clean.

The safe reuse of medical devices involves two distinct issues: the regulatory requirements of the FDA for devices intended for reprocessing and reuse by another patient and labeled as such by the manufacturer and the regulation of the off-label reuse of single-use medical devices that are neither designed nor labeled for reprocessing and reuse. This article discusses the risks, complications, and common discussions on the issue of reusing medical devices.

Disinfection↗
PubMed1991

Nosocomial infections from contaminated endoscopes: a flawed automated endoscope washer. An investigation using molecular epidemiology.

Approximately 1 year after purchase of one manufacturer's automated endoscope washing machine, we began to detect heavy contamination of upper gastrointestinal (UGI) endoscopes cultured after cleaning and disinfection in the washer. During the first 6 months of 1988, 77% of surveillance cultures (20-mL flush through the biopsy channel) were positive for gram-negative bacilli (median concentration, 10(5) cfu/mL), most frequently Pseudomonas aeruginosa serotype 10. During the first 19 months of use of the washer, nosocomial post-UGI endoscopy colonization or infections with P. aeruginosa increased 36%. Investigations show that endoscope contamination derives from a flaw in the design of the EW-10 washer: the detergent holding tank, inlet water hose, and air vents cannot be reliably disinfected and contain heavy biofilms that recontaminate the machine after it has been disinfected, as specified by the manufacturer, with glutaraldehyde. Only by rinsing machine-cleansed endoscopes with 70% alcohol followed by forced air drying has reliable disinfection been achieved. Since adaptation of terminal alcohol treatment and drying, post-UGI endoscopy colonization or infection by P. aeruginosa has declined threefold (p less than 0.001). Testing in other centers using the manufacturer's EW-10 or EW-20 washer has shown similar contamination. In three centers, including our own, postendoscopy infections by machine-associated type 10 P. aeruginosa have been confirmed by demonstrating concordance between isolates from contaminated machines or endoscopes and from infected patients by immunoblot of whole cell lysates and by pulsed-field electrophoresis of DraI endonuclease-digested genomic DNA. This problem reaffirms the vulnerability to microbial contamination of water-containing apparatus and equipment in patient care and points up the critical importance of engineering design to prevent contamination.

Cross Infection↗
PubMed1991

Prospective randomised trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters.

More than 90% of all intravascular device-related septicaemias are due to central venous or arterial catheters. To assess the efficacy of cutaneous antisepsis to prevent catheter-associated infection, we prospectively studied three antiseptics for disinfection of patients' central venous and arterial catheter insertion sites in a surgical intensive care unit. 668 catheters were randomised to 10% povidone-iodine, 70% alcohol, or 2% aqueous chlorhexidine disinfection of the site before insertion and for site care every other day thereafter. Chlorhexidine was associated with the lowest incidence of local catheter-related infection (2.3 per 100 catheters vs 7.1 and 9.3 for alcohol and povidone-iodine, respectively, p = 0.02) and catheter-related bacteraemia (0.5 vs 2.3 and 2.6). Of the 14 infusion-related bacteraemias (4 due to contaminated infusate or catheter hub, 10 due to infected catheters), 1 was in the chlorhexidine group and 13 were in the other two groups (odds ratio 0.16, p = 0.04). We conclude that use of 2% chlorhexidine, rather than 10% povidone-iodine or 70% alcohol, for cutaneous disinfection before insertion of an intravascular device and for post-insertion site care can substantially reduce the incidence of device-related infection.

1-Propanol↗
PubMed1991

Nosocomial Pseudomonas pickettii bacteremias traced to narcotic tampering. A case for selective drug screening of health care personnel.

Three patients in a university hospital developed nosocomial infusion-related Pseudomonas pickettii bacteremia. Investigation identified six additional patients who had received intravenous fluid contaminated by P pickettii but did not become ill. All nine patients had had surgery, and each of these patients but only nine of 19 operated-on control patients had received intravenous fentanyl citrate in the operating room; the mean dose given to the nine case patients was far greater than that given to control patients. Fentanyl in 20 (40%) of 50 predrawn 30-mL syringes was shown to be contaminated by P pickettii. Contamination was caused by theft of fentanyl from predrawn synringes and replacement by distilled water contaminated by P pickettii. Narcotic theft by health care personnel may cause patients to suffer pain needlessly and can also result in dire unanticipated consequences, such as nosocomial bacteremia. Whereas drug testing in the workplace is highly controversial, we believe that testing of health care personnel is indicated when drug abuse or theft is suspected.

Adult↗
PubMed1979

A semiquantitative culture technic for identifying infection due to steel needles used for intravenous therapy.

Using steel intravneous needles obtained from patients with hematologic malignancies, the authors evaluated the efficacy of a semiquantitative method for culturing vascular cannulas on solid medium, comparing it with conventional broth culture. Of 148 needles studied, 140 (95%) were negative on semiquantitative culture (less than 15 colonies on the plate) although 38 produced growth in broth or on the plate; none of these needles caused septicemia. Eight needles were positive on semiquantitative culture (greater than or equal to 15 colonies), and two of these caused septicemia (P = .002). Positive semiquantitative cultures were associated with local inflammation (P = .02). Semiquantitative culturing was equal to the broth method in sensitivity (100%) in the diagnosis of needle-related septicemia; specificity (96% vs. 92%) and the predictive value of a positive needle culture (25% vs. 14%) were both enhanced with the semiquantitative method. The semiquantitative technic differentiates infection from contamination and offers other major advantages compared with the broth method, and is recommended for culturing steel needles as well as plastic catheters.

Culture Media↗
PubMedDate not supplied

Patient safety in outpatient surgery: the viewpoint of the healthcare providers.

The objective of this study is to understand the viewpoint of healthcare providers with regard to patient safety in outpatient surgery settings. Two methods were used to gather data from the healthcare providers: (1) questionnaire with open-ended questions about six predefined stages of the patient care process; (2) survey with closed questions. With the first method, the main quality and safety of care issues concerned communication to patients, coordination of reports and forms, patient and staff time pressures and standards of care. The first two stages of the outpatient surgery process, i.e. patient work-up prior to day of surgery and patient admission and preparation on the day of surgery, yielded many more comments than the other four stages. The results of the structured questionnaire show that, overall, the healthcare providers report high quality of care provided by themselves (98%) and their surgery centre (96%). With regard to patient safety (i.e. cancellations of surgeries, patient safety problems and serious mistakes), there was a clear difference in perceptions reported by the physicians vs. the nurses and other staff. Nurses and other staff were more likely to report patient safety problems than physicians. The combination of qualitative data from the initial questionnaire and the quantitative data from the structured questionnaire provides a rather complete view of the outpatient surgery staff perceptions of quality and safety of care. This research highlights the importance of getting input from the healthcare providers regarding the quality and safety of care rather than relying only on traditional measures about patient outcomes.

Adult↗