Infection Control Dogma: Top 10 Suspects

As infection control evolved into an art and science through the years, many infection control practices have become infection control dogmas (principles, beliefs, ideas, or opinions). In this “Reality Check” session of the 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections, we assessed participants' perceptions of prevalent infection control dogmas. The majority of participants agreed with all dogmas having evidence of efficacy, except for the dogma on the frequency of changing mechanical-ventilator tubing. In contrast, the majority of participants disagreed with dogmas not having evidence of efficacy, except for the dogma on perineal care, umbilical cord care, and reminder signs for isolation precaution. As for controversial dogmas, many of the responses were almost evenly distributed between “agree” and “disagree.” Infection control professionals were knowledgeable about evidence-based infection control practices. However, many of the respondents still believe in some of the non–evidence-based dogmas.

MRI protocol for critically ill patients

BACKGROUND Ventilators compatible with magnetic resonance imaging machines are not universally available. However, the lack of such equipment should not preclude magnetic resonance imaging. We have developed a method by which a critically ill patient requiring mechanical ventilation can safely undergo such imaging without compatible equipment. METHOD By using extended ventilator tubing and calculating volume lost due to tubing compliance, safe and reliable mechanical ventilation can be achieved from a distance without impairing scan quality. RESULTS We devised a method to calculate volume lost due to mechanical compliance of the tubing with ventilator circuits employing 20, 30, and 50 feet of tubing. We added the estimated loss of volume to the set tidal volume of 700 mL to give a delivered volume of 700 mL. Twenty breaths were evaluated for each length of tubing. The evaluation of the 20- and 30-foot lengths of tubing demonstrated 10- and 52-mL discrepancies, respectively, between predicted and measured volumes. The 50-foot length showed a 121-mL discrepancy between predicted and measured volumes. CONCLUSIONS Our method appears to be clinically accurate for predicting volume lost due to tubing compliance for lengths of ventilator tubing less than or equal to 30 feet. We have found this technique to be a safe and effective way to ensure patient safety and scan quality in patients requiring mechanical ventilation during magnetic resonance imaging.