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Background Children 0–4 years attending childcare are more prone to acquire infections than home-cared children. Childcare illness absenteeism due to fever is mostly driven by fear towards fever in childcare staff and parents. This may cause high childcare absenteeism, healthcare service use, and work absenteeism in parents. This study evaluates a multicomponent intervention targeting determinants of decision-making among childcare staff on illness absenteeism due to fever and common infections. Methods The multicomponent intervention was developed based on the Intervention Mapping approach and consisted of (i) an educational session, (ii) a decision tool, (iii) an information booklet and (iv) an online video. The intervention was evaluated in a cluster randomized controlled trial in Southern Netherlands. Nine centres received the intervention and nine provided childcare-as-usual. Primary outcome measure was the percentage of illness absenteeism on cluster level, defined as number of childcare days absent due to illness on total of registered childcare contract days in a 12-week period. Secondary outcome measures included intended behaviour, attitude, risk perception, knowledge and self-efficacy of childcare staff. Outcomes were analyzed using linear mixed models accounting for clustering. Knowledge was descriptively analysed. Results Overall illness absenteeism was comparable in intervention (2.95%) and control group (2.52%). Secondary outcomes showed significant improvements in intervention group regarding intended behaviour, two of three attitude dimensions. Knowledge increased compared with control but no differences regarding self-efficacy. Conclusion The intervention was not effective in reducing illness absenteeism. However, the intervention improved determinants of decision-making such as intended behaviour, attitude, and knowledge on fever. Trial registration NTR6402 (registered on 21 April 2017). [ABSTRACT FROM AUTHOR]

Background: Evidence has shown that children 0-4 year-old attending childcare are prone to acquire infections compared to children cared for at home, with fever being the most common symptom. Illness absenteeism due to fever and common infections is substantial and mostly driven by unrealistic concerns and negative attitude towards fever of both childcare staff and parents, resulting in illness absenteeism from childcare, work absenteeism among parents and healthcare service use. The objective of this study is to optimise decision making among childcare staff on illness absenteeism due to fever and common infections in childcare. Underlying determinants of behavioural change were targeted by means of a multicomponent intervention.Methods: A multicomponent intervention was developed to improve decision making, using the stepwise approach of Intervention Mapping, and in close collaboration with stakeholders and experts. The intervention consisted of 1) a two-hour educational session on fever among childcare staff; 2) an online video for childcare staff and parents emphasising key information of the educational session; 3) a decision tool for childcare staff and parents in the format of a traffic light system to estimate the severity of illness and corresponding advices for childcare staff and parents; 4) an information booklet regarding childhood fever, common infections, and self-management strategies for childcare staff and parents. The multicomponent intervention will be evaluated in a cluster randomised trial with a 12-week follow-up period and absenteeism due to illness (defined as the percentage of childcare days absent due to illness on the total of childcare days during a 12-week period) as primary outcome measure. Secondary outcome measures are: incidence rate and duration of illness episodes, knowledge, attitude, self-efficacy, and risk perception on fever and common infections of childcare staff and parents, healthcare service use in general and paracetamol use, and work absenteeism of parents.Discussion: This study aims to develop a multicomponent intervention and to evaluate to what extent illness absenteeism due to fever and common infections can be affected by implementing a multicomponent intervention addressing decision making and underlying determinants among childcare staff and parents of children attending daycare.Trial Registration: NTR6402 (registered on 21-apr-2017). [ABSTRACT FROM AUTHOR]

This article reviews perioperative antibacterial prophylaxis, a discrete in-hospital intervention that prevents surgical site infections and reduces the costs of complications and adverse effects of care. Clinical trials have shown that, when used appropriately, prophylactic antibacterial agents are effective and cost effective. Appropriate use requires targeting micro-organisms that are expected to contaminate the operative field; attaining effective drug concentrations in operative site tissues at the time of bacterial contamination; using safe and inexpensive agents; and basing the choice of agents on the results of randomised trials and local patterns of drug resistance. Prophylaxis is indicated for operations in which bacterial contamination is encountered or expected. These include hysterectomy, primary Caesarean sections, Caesarean sections following prolonged rupture of the membranes, abdominal trauma and all operative procedures in which the gastrointestinal tract is opened. Gastrointestinal operations that require prophylaxis are head and neck operations in which the oropharynx is opened and procedures in which the oesophagus, stomach, duodenum, small or large intestine, appendix or biliary tract are opened. For ‘clean’ operations in which no epithelium-lined lumen is opened and no infection or gross contamination is encountered, antibacterial prophylaxis is indicated for insertion of cerebrospinal fluid shunts, prosthetic vascular grafts and orthopaedic hardware. For other ‘clean’ implant operations, such as insertion of prosthetic material in hernia repair, antibacterial prophylaxis is controversial. For ‘clean’, non-implant operations, prophylaxis is indicated for craniotomy incisions, vascular operations that use a groin incision and cardiac procedures that use a median sternotomy. For other ‘clean’, non-implant procedures, such as hernia and breast operations, antibacterial prophylaxis is used commonly, but the results from clinical trials have been equivocal. [ABSTRACT FROM AUTHOR]

In May 1997, a panel of surgeon-investigators met to discuss the clinical importance and research implications of controlling the source of abdominal infections. It was concluded that source control is critical to therapeutic success and that antimicrobial therapy and other adjunctive interventions will fail if the source of infection is not controlled by resection, exteriorization or other means. The panelists presented different definitions of source control, depending on the scientific purpose of the definition. All participants agreed that failure to consider the adequacy of source control of infection has limited the value of most clinical trials of therapeutic anti-infective agents. Besides recognizing source control as an essential goal of patient care, the panelists emphasized the need for further investigative work to define, record and stratify the adequacy of source control in clinical trials of therapeutic agents for abdominal infections. [ABSTRACT FROM AUTHOR]

Operating room (OR) delays due to inefficiency can result from a chain of intraoperative events including technical factors, equipment failures or unavailability, and non-technical human factors. The newly developed Operating Room Black Box (ORBB) technology can be used to capture information during surgery which can be analyzed to potentially identify the root causes of delays and inefficiencies. We aimed to develop a procedural framework for total laparoscopic hysterectomy (TLH) in order to accurately and consistently capture the essential time points that occur during this complex laparoscopic procedure. Multi-disciplinary collaborative working group. Canadian tertiary care academic hospital. Team consisted of gynecologic surgeons, an anesthetist, an OR nurse and systems analysts. Multi-disciplinary working group collaborated to develop a procedural framework encompassing the critical steps and check points occurring during the course of a TLH. All phases of the operation were considered including pre-operative, intra-operative, and post-operative steps. The completed framework consists of a series of procedural steps divided into three time phases: pre-operative, intraoperative and post-operative. Consensus from the group led to the identification of 7 discrete steps during the pre-operative phase, 11 intra-operative steps and 6 post-operative steps. The development of a standardized procedural framework for TLH is the first step towards capturing data with the ORBB technology. The analysis of the captured data will allow us to analyze the non-technical skills and team performance in the OR, and ultimately develop a multi-disciplinary operating room "playbook" that can be utilized to minimize time delays and maximize OR utilization. [ABSTRACT FROM AUTHOR]

Abstract Background The timing of prophylactic antibiotic administration is a patient safety outcome that is recurrently tracked and reported. The interpretation of these data has important implications for patient safety practices. However, diverse data collection methods and approaches to analysis impede knowledge building in this field. This paper makes explicit several challenges to quantifying the timing of prophylactic antibiotics that we encountered during a recent study and offers a suggested protocol for resolving these challenges. Challenges Two clear challenges manifested during the data extraction process: the actual classification of antibiotic timing, and the additional complication of multiple antibiotic regimens with different timing classifications in a single case. A formalized protocol was developed for dealing with incomplete, ambiguous and unclear documentation. A hierarchical coding system was implemented for managing cases with multiple antibiotic regimens. Interpretation Researchers who are tracking prophylactic antibiotic timing as an outcome measure should be aware that documentation of antibiotic timing in the patient chart is frequently incomplete and unclear, and these inconsistencies should be accounted for in analyses. We have developed a systematic method for dealing with specific problematic patterns encountered in the data. We propose that the general adoption of a systematic approach to analysis of this type of data will allow for cross-study comparisons and ensure that interpretation of results is on the basis of timing practices rather than documentation practices.