MELBOURNE - cbd, 11/29 & 12/01/10

What is the origin of the word "template"?

Search: template

Why: Uncle Hal is sending me some templates to work with. Hey, why don't you order some of his awesome name art? It makes a very nice Hanukkah or Christmas gift.

But is the root plate like Fashion Plates? Or temp like "time"? Or something else?

Wait, those make a nice Hanukkah or Christmas gift.

Answer: It's neither! It comes from a French word templet, "weaver's stretcher," from temple, which means the same thing. Those words are from Latin templum, "plank, rafter" and also "building for worship."

The meaning "pattern or gauge for shaping a piece of work" is first recorded 1819 in this form, earlier temple (1680s); the form was altered 1844, probably influenced by plate, but the pronunciation did not begin to shift until much more recently.

Plate, btw, originally meant "thin piece of metal," like a coin.

Source: EtymOnline

The More You Know: This has nothing to do with anything, but the guy who sits behind me at work sounds exactly like Peter Sarsgaard, so much so that it is jarring whenever I hear him talk (which is often. Get to work, buddy).

Two new NPSGs from the Joint Commission target VAP and CAUTI

University of Iowa, Class of 2013

The Joint Commission has just released new National Patient Safety Goals for 2012-13 for full implementation by January 1, 2013.  They cover VAP and CAUTI in hospitals and LTCF and are open for public comment until 1/27/2011.  The strategies were published in the October 2008 SHEA Compendium in ICHE. 

Two comments: (1) I thought the world was going to end in December 12, 2012, so probably not much to worry about, apart from the world ending and (2) VAP may be going away in NHSN to be replaced by process measures, so I wonder how VAP outcomes will be tracked, as required, when no one can decide on a definition? I'm sure you have comments and they want to hear from you.

Note: It looks like even if the Mayans were wrong about 2012, we may still not make it through 2013.

Example for VAP, NPSG.07.06.01 in Hospitals requires 7 steps:
1) A plan
2) Hand hygiene before/after caring for ventilated patients
3) Semirecumbent position of patient
4) Regular antiseptic oral care
5) Daily weaning assessment
6) Daily sedation interruption
7) Measure VAP process measures and outcomes

Hospital Program draft versions of NPSG.07.06.01 (VAP) and NPSG.07.07.01 (CAUTI) (PDF)
LTC Program versions (PDF)
JC page that provides links for submitting comments.

h/t Marc Wright

Marc Cohn Burnsville Performing Arts Center Tickets

American folk rock singer-songwriter and musician Marc Cohn is best known for his song "Walking in Memphis" from his 1991 album Marc Cohn.  Marc has released a total of six studio albums to date, with the most recent, Listening Booth: 1970, released in July of this year and is a collection of covers from the year 1970.  Marc has won two Grammy Awards, has been nominated for an American Music Award and was inducted into Beachwood High School Gallery of Success in 1994.  If you would like to see Marc Cohn LIVE at the Burnsville Performing Arts Center - Proscenium Stage on Saturday, January 29th, this is your chance!  Ticket King has Marc Cohn tickets in the front row and second row of the orchestra section!!  You won't find seats like this anywhere else so I would recommend grabbing them now before they're gone!  Tickets make excellent holiday gifts!

Sesame Street LIVE: Elmo's Healthy Heroes Target Center Tickets

When Super Grover loses his superness, Sesame Street needs a new hero!  That's when Elmo and his team of healthy heroes are here to teach lessons of healthy habits through song and dance.  Join Elmo, Abby Cadabby and your favorite Sesame Street friends as they explore exercise, nutrition, sleep, energy and hygiene - all in a quest to put the "super" back in Super Grover!  Elmo's Healthy Heroes to the rescue!!  Like myself, I'm sure many of you grew up watching Sesame Street and may even have children that watch it now.  I never had the chance to see the characters live but I think this is a super awesome idea to get children excited about living a healthy lifestyle.  If you would like to be a part of the magic at the Target Center in Minneapolis on January 19-23, check out our supply of Sesame Street LIVE tickets and get yours now while our selection is at it's best!

A surgical site infection enhancement bundle?

A new paper in the Archives of Surgery evaluated the implementation of a surgical site infection (SSI) prevention bundle for colon surgery (see free text of the paper here). The bundle contained the following components:

• Omission of mechanical bowel preparation
• Preoperative and intraoperative patient warming
• Increased concentration of inspired oxygen during and immediately after the surgical procedure
• Limiting intraoperative intravenous fluid volumes
• Use of wound barriers to protect the surgical wound from contamination during the procedure 

Each component of the bundle was supported by 1 or more randomized trials demonstrating reduction in SSIs. About 200 patients were randomized to receive either the bundle or standard care. SSIs were determined by IPs using CDC case definitions. The study was terminated after a planned interim analysis revealed a <1% chance of showing a positive effect of the bundle were the study to continue to the accrual goal.

The overall rate of infection was 35%. In the control group, 24% of patients developed an SSI vs. 45% in the intervention group (p .003). In multivariate analysis, the bundle was shown to an independent predictor for SSI (RR 2.49, CI95 1.36-4.56).

I was struck by the very high rate of infection in this study, so I looked at CDC's most recent surveillance report, which shows that the mean pooled infection rates for colon surgery depending on risk category ranges from 3.99% to 9.47%. The authors postulate that their case ascertainment may be greater since the study was performed at a VA hospital where outpatient follow-up of patients is much easier to track. However, even in light of that, the rate still seems quite high. But on the other hand, unless there is something very unique about these patients or the care provided at this hospital, you might think that an effective prevention bundle would have even more impact in a setting with exceedingly high infection rates. This raises more concern that the bundle was not just ineffective but actually increased the risk of post-operative infection.

This paper is another example of how immature implementation science remains. I think the authors of this paper are correct to conclude that bundles of evidence-based interventions need to be formally tested before there is wide spread implementation.

Needed: CLABSI tune-up

We have blogged before about problems with NHSN HAI case definitions. For central line associated bloodstream infections (CLABSI), a major problem is the lack of specicity of the definition, which many believe leads to an overestimation of the rate of these infections. In this month's Infection Control and Hospital Epidemiology there is a commentary on the CLABSI definition by Dan Sexton that is well worth reading. He proposes some simple changes to the definition that would make a big difference in improving specificity.