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A novel, multi-dimensional protocol named GENIE has been in use for intensive insulin therapy (IIT, target glucose

When the South Carolina legislature created the anti-NAACP oath in 1956, teachers across the state lost their positions. But it was the dismissal of twenty-one teachers at the Elloree Training School that captured the attention of the NAACP and Black media outlets. In the years following Brown v. Board of Education, South Carolina's Black and White communities went head-to-head in the battle over White supremacy versus expanded civil rights. The desegregation movement in 1955 and 1956 placed Black teachers’ activism in the spotlight—activism that mirrored what was happening in their community. This largely unknown episode of civil rights activism demonstrates that Black teachers were willing to serve not only as behind-the-scenes supporters in the equal education struggle but as frontline activists. Furthermore, it shows that South Carolina was an integral site of the long civil rights movement.

Objective.To identify characteristics of encounters between healthcare workers (HCWs) and patients that correlated with hand hygiene adherence among HCWs.Design.Observational study.Setting.Intensive care unit in a Veterans Affairs hospital.Participants.HCWs.Results.There were 767 patient encounters observed (48.6% involved nurses, 20.6% involved physicians, and 30.8% involved other HCWs); 39.8% of encounters involved patients placed under contact precautions. HCW contact with either the patient or surfaces in the patient's environment occurred during all encounters; direct patient contact occurred during 439 encounters (57.4%), and contact with environmental surfaces occurred during 710 encounters (92.6%). The median duration of encounters was 2 minutes (range, 1 to ≤2 minutes, 51.1% after encounters of >3 to ≤5 minutes, and 64.9% after encounters of >5 minutes (P < .001 by the x2 for trend). In multivariate analyses, longer encounter duration, contact precautions status, patient contact, and nursing occupation were independently associated with adherence to hand hygiene recommendations.Conclusions.In this study, adherence to hand hygiene practices was lowest after brief patient encounters (ie

I t’s a reality that no part of a healthcare system exists as an island; inpatient and outpatient settings overlap. This became apparent at VA Pittsburgh Healthcare System (VAPHS), an integrated three-division system with a medical center consisting of 583 operational beds, servicing a veteran population of over 360,000 patients. VAPHS had made an organizational commitment to reduce methicillin-resistant Staphylococcus aureus (MRSA) infections, even though in national comparisons its MRSA rates were less than the national average. Of particular concern at VAPHS was the relationship between MRSA and surgical site infections (SSIs).1 Although MRSA prevention efforts were concentrated on inpatient areas and there were no immediate plans to expand into other areas, the outpatient staff recognized the efficacy of a proactive approach and also began working toward MRSA prevention.

Objective.To measure the effectiveness of an industrial systems-engineering approach to a methicillin-resistantStaphylococcus aureus(MRSA) prevention program.Design.Before-after intervention studySetting.An intensive care unit (ICU) and a surgical unit that was not an ICU in the Pittsburgh Veterans Administration hospitalPatients.Allpatientsadmittedtothe study unitsIntervention.We implemented an MRSA infection control program that consisted of the following 4 elements: (1) the use of standard precautions for all patient contact, with emphasis on hand hygiene; (2) the use of contact precautions for interactions with patients known to be infected or colonized with MRSA; (3) the use of active surveillance cultures to identify patients who were asymptomatically colonized with MRSA; and (4) use of an industrial systems-engineering approach, the Toyota Production System, to facilitate consistent and reliable adherence to the infection control program.Results.The rate of healthcare-associated MRSA infection in the surgical unit decreased from 1.56 infections per 1,000 patient-days in the 2 years before the intervention to 0.63 infections per 1,000 patient-days in the 4 years after the intervention (a 60% reduction;P= .003). The rate of healthcare-associated MRSA infection in the ICU decreased from 5.45 infections per 1,000 patient-days in the 2 years before to the intervention to 1.35 infections per 1,000 patient-days in the 3 years after the intervention (a 75% reduction;P= .001). The combined estimate for reduction in the incidence of infection after the intervention in the 2 units was 68% (95% confidence interval, 50%-79%;P< .001).Conclusions.Sustained reduction in the incidence of MRSA infection is possible in a setting where this pathogen is endemic. An industrial systems-engineering approach can be adapted to facilitate consistent and reliable adherence to MRSA infection prevention practices in healthcare facilities.