AORN journal
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Review Meta Analysis
Risk Factors of Postoperative Delirium in Older Adult Spine Surgery Patients: A Meta-Analysis.
This literature review identifies factors that may place older adult patients at risk for developing delirium after spine surgery. We conducted a meta-analysis according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Using a variety of electronic databases, we identified five studies for inclusion that represent 645 patients who were 65 years or older. ⋯ Factors associated with developing postoperative delirium included preoperative opioid use, cervical spine surgery versus lumbar or thoracic spine surgery, spine fusion versus simple spine surgery, hypertension, cerebrovascular disease, pulmonary disease, duration of surgery, and infused IV fluid volume. Nurses who provide perioperative care for older adult patients undergoing spine surgery should be aware of the potential risk factors of delirium to ensure patient safety. Further research is required to clearly delineate the risk factors for postoperative delirium in older adults.
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This article reviews current literature about the contamination of laryngoscope blades and handles, disinfection practices for laryngoscope blades and handles, and environmental effects and costs of reusable and single-use laryngoscopes. This review shows that inadequately processed rigid laryngoscopes may have the ability to transmit infections to patients and health care personnel. ⋯ Laryngoscope costs are lower for processing reusable laryngoscope handles and blades by HLD and highest for single-use laryngoscopes. Evidence-based guidelines are needed to specify and standardize best practices for processing rigid laryngoscopes.
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Meta Analysis
Systematic Review and Meta-Analysis of Cricoid Pressure Training and Education Efficacy.
We examined the evidence on the effectiveness of education and training on cricoid pressure (ie, Sellick maneuver) application. Cricoid pressure is used during rapid sequence induction and intubation to reduce the risk of pulmonary aspiration. We searched seven databases for studies on the education and training of health care personnel expected to apply cricoid pressure as a part of their regular clinical responsibilities. ⋯ The success rate for intubation increased after training according to the random effect model (95% CI = 0.157 to 0.452). Fisher's method combined probability test rejected the null hypothesis for patients (P = 4.93e-6), indicating that the application of cricoid pressure significantly improved after educational interventions. Regularly scheduled training in the application of cricoid pressure could sustain health care personnel's ability to apply effective cricoid pressure.
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Sterile technique is an essential patient safety principle that reduces the risk of microbial transmission to patients during surgery. The ability to establish and maintain a sterile environment is an important skill for all perioperative team members. Understanding the principles of sterile technique is crucial for anyone entering the perioperative environment. This Back to Basics article reviews sterile technique and the importance of all perioperative team members adhering to aseptic principles.
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Epidural or spinal anesthesia-related infections cause serious and devastating morbidity and mortality. The possible infectious complications of neuraxial anesthesia have become better understood in the past 10 years. ⋯ A review of the literature demonstrated that personnel in interdisciplinary specialties use gowns for invasive procedures to prevent infection, and national and international multidisciplinary health care professionals appear to be increasing their use of sterile gowning to prevent infections. We undertook this literature review to explore the incidence of neuraxial infection, provide additional insight into multidisciplinary standards, and evaluate whether the use of sterile gowns while performing neuraxial anesthesia decreases infection rates.