The RN first assistant: an expert resource for surgical site infection prevention.

The role of the RN first assistant (RNFA) has expanded and evolved during the past three decades. Studies that have examined patient care outcomes relative to RNFAs substituting for surgeons as first assistants have noted no resulting adverse consequences, and the use of RNFAs in surgery may improve patient outcomes. This article reports on an intervention to improve surgical outcomes in patients undergoing cardiac surgery that involved replacing surgical residents with RNFAs for the harvesting of saphenous vein grafts.

Epidemics of diarrhea caused by a clindamycin-resistant strain of Clostridium difficile in four hospitals.

Background: Large outbreaks of diarrhea caused by a newly recognized strain of Clostridium difficile occurred in four hospitals located in different parts of the United States between 1989 and 1992. Since frequent use of clindamycin was associated with the outbreak in one of the hospitals, we examined the resistance genes of the epidemic-strain isolates and studied the role of clindamycin use in these outbreaks.

Methods: Case-control studies were performed at three of the four hospitals to assess the relation of the use of clindamycin to C.

Identification and voluntary reduction of vancomycin use for perioperative antibiotic prophylaxis during coronary artery bypass graft surgery.

Vancomycin prophylaxis for coronary artery bypass graft surgery without prosthetic valve implantation voluntarily decreased from 94% to 18% in one medical center. Median hospital stay (10 vs 9 days, P = .30) and number of postoperative infections (17.

The role of understaffing in central venous catheter-associated bloodstream infections.

Objective: To determine risk factors for central venous catheter-associated bloodstream infections (CVC-BSI) during a protracted outbreak.

Design: Case-control and cohort studies of surgical intensive care unit (SICU) patients.

Setting: A university-affiliated Veterans Affairs medical center.