Medical Intensive Care Unit Nurses Research Articles

A Usability Survey of a Quality Improvement Data Visualization Tool among Medical Intensive Care Unit Nurses

Abstract Background Cognitive overload is prevalent among intensive care unit (ICU) clinicians. Data visualization may decrease cognitive load by assisting with data interpretation and task prioritization. We developed the Bundle Board to display real-time data from the electronic medical record (EMR), highlighting opportunities for action in standardized ICU patient care. This study evaluates the practical usability of this data visualization tool among nurses in the ICU. Methods The tool is offered as an application separate from the EMR and was available in the medical ICU for 8 months before we surveyed unit nursing staff. To evaluate usability of the tool, we adapted the Health-Information Technology Usability Scale and included an option to provide open-ended feedback. Survey data were analyzed using quantitative and qualitative methods. Results ICU nurses were invited to participate through email and verbal announcements. Of the potential participants, 38% (N = 47) responded. The survey demonstrated that the tool was perceived as usable. For each subscale, mean scores were as follows: Perceived Ease of Use 4.40, Impact 4.14, User Control 4.07, and Perceived Usefulness 3.61. There were no significant differences between core and contracted nurses or after stratifying by duration of Bundle Board use. Fifteen respondents completed the optional free-text portion of the survey. Qualitative analysis revealed six subthemes focusing on perceived impacts on quality and safety, cognitive burden and workload, and emotional impact of the Bundle Board. Conclusion The Bundle Board demonstrated good usability among ICU nurses, who provided substantive feedback for its improvement. These observations may be generalizable to other comparable interventions. Iterative feedback from end users is vital to developing and implementing a digital health intervention. Our study provides a framework for performing a usability analysis within a specific clinician population and environment.

Delirium Care by Intensive Care Unit Nurses: Focus Group Studies in a Medical Center of Southern Taiwan.

Studies have identified many nursing interventions that can prevent delirium and fall accidents in clinical patients, detect and treat delirium early to prevent functional decline in the patient, shorten hospitalization duration, and lower the death rate. This study aimed to explore delirium care by intensive care unit (ICU) nurses in a medical center of southern Taiwan. This study conducted 3 semistructured focus group interviews, each for a single medical ICU, involving groups of 6 to 8 nurses each. The nurses were recruited through purposive sampling. This research was approved by an institutional review board in the medical center of southern Taiwan from March 31, 2020, to January 30, 2021. The co-principal investigator described the purpose and process of this study to the participants before they provided their written informed consents. The interviews were conducted in the meeting room and were audiotape recorded. The recordings were transcribed and subject to content analysis to identify the themes of delirium care. For nursing interventions of delirium, satisfying the patient's physical needs: comfort care, massages, and early rehabilitation; and psychological care: being presence, communication, and ensuring familial support were included. In terms of environmental interventions for delirium, providing reorientation, music, light, belongings with sentimental value, and audiovisual equipment were included. However, according to the recruited medical ICU nurses, these nonpharmacological interventions, although effective, do not have long-lasting effects. Finally, nurses reported themselves as having been attacked by patients with delirium. Thus, they all agreed that restraining patients with delirium may be necessary, but restraining is a double-edged sword for ICU delirium patients. Research team suggests for future studies to extend their evidence-based findings of physical, psychological, and environmental care for ICU delirium patients toward integrating the efforts of various health care professionals.

Increasing the Accuracy of Extracorporeal Membrane Oxygenation Critical Event Management in the Medical Intensive Care Unit

Extracorporeal membrane oxygenation (ECMO) is an intervention that replaces cardiopulmonary function temporarily to reduce injury to vital organs. As important members of the ECMO medical team, intensive care unit nurses must be well trained and alert to possible critical events. Failure to troubleshoot and manage ECMO promptly and correctly significantly increases the risk of mortality. A previous ECMO critical event in our unit resulted in lingering concerns and stress among nurses related to implementing this intervention. A survey conducted among our medical intensive care unit (MICU) nurses identified an implementation accuracy level for ECMO critical event management of only 59.1%. This poor result was attributed to a lack of technical assessment standards, in-service training, clinical experience, and instruction materials and the failure to offer online courses. This study was designed to increase the accuracy of ECMO critical event management implementation among intensive care unit nurses to >86%. We conducted a problem-based training project to improve ECMO critical event management that: introduced a technical assessment sheet and technical simulation exercise, organized in-service training, implemented irregular simulation exercises, and produced multiple different instructional materials. The accuracy of ECMO critical event management implementation among the intensive care unit nurses increased from 59.1% pretest to 95.9% posttest. This project improved the ECMO care ability of MICU nurses in our hospital significantly, resulting in increased ECMO critical event management implementation accuracy, better patient care, higher nursing staff confidence, and lower perceived stress among nursing staff.

Utility of a "Lavender Lounge" to Reduce Stress Among Critical Care Registered Nurses: A Cross-Sectional Study.

Work-related stressors are present in almost every profession, but many believe nurses caring for critically ill patients experience additional and unique stresses. Results of previous studies have demonstrated the potential benefits of various interventions to reduce stress among intensive care nurses. However, the practicality of nurses taking time out from a busy unit to meet their own needs remains in question. To assess intensive care nurses' perceptions of the usability of a lounge designed to support them in refreshing and renewing themselves after stressful clinical situations. This study used a descriptive, cross-sectional design and survey methodology with a convenience sample of registered nurses from a medical intensive care unit. Of 250 registered nurses eligible for participation, 54 (21.6%) completed surveys, and of those, 31 (57%) reported having used the lounge within the past month. Nurses reported having coverage provided by colleagues, visiting during their lunch break, and having low unit acuity were facilitators of lounge use. Barriers included high unit acuity, high unit census, and high patient care demands with no one available to cover patient assignments. The variables that lead to stress and burnout among medical intensive care unit nurses also prevent nurses from using a "relaxation room." A more effective approach may be organizational change that supports reduction of workload through increased staffing, prearranged breaks during shifts, and increased recovery time between shifts by limiting work to no more than 40 hours per week.

Reducing Central Line Utilization by Peripherally Infusing Vasopressors.

Central line-associated bloodstream infection is a preventable contributor to excess death and excess cost in the health care system. Vasopressor infusion is one of the primary reasons for central line placement. In the medical intensive care unit (MICU) at an academic medical center, there was no standard practice for peripheral versus central infusion of vasopressors. The objective of this quality improvement project was to implement an evidence-based, nurse-driven protocol to guide the peripheral infusion of vasopressors. The goal was to reduce central line utilization by 10%. Education on the protocol was provided to the MICU nurses, MICU residents, and crisis nurses, followed by a 16-week implementation period. Nursing staff were also surveyed preimplementation and postimplementation of the protocol. Central line utilization was reduced by 37.9%, and there were no central line-associated bloodstream infections recorded during project implementation. Most of the nursing staff indicated that use of the protocol increased their confidence in administering vasopressors without a central line. No significant extravasation events occurred. Although a causal link between implementation of this protocol and reduction of central line utilization cannot be established, the reduction is clinically meaningful given the known risks of central lines. Increased nursing staff confidence also provides support for continued use of the protocol. A nurse-driven protocol to guide the peripheral infusion of vasopressors can be effectively implemented into nursing practice.

Time Spent by Intensive Care Unit Nurses on the Electronic Health Record.

The amount of time spent on the electronic health record is often cited as a contributing factor to burnout and work-related stress in nurses. Increased electronic health record use also reduces the time nurses have for direct contact with patients and families. There has been minimal investigation into the amount of time intensive care unit nurses spend on the electronic health record. To quantify the amount of time spent by intensive care unit nurses on the electronic health record. In this observational study, active electronic health record use time was analyzed for 317 intensive care unit nurses in a single institution from January 2019 through July 2020. Monthly data on electronic health record use by nurses in the medical, neurosurgical, and surgical-trauma intensive care units were evaluated. Full-time intensive care unit nurses spent 28.9 hours per month on the electronic health record, about 17.5% of their clinical shift, for a total of 346.3 hours per year. Part-time nurses and those working as needed spent 20.5 hours per month (17.6%) and 7.4 hours per month (14.2%) on the electronic health record, respectively. Neurosurgical and medical intensive care unit nurses spent 25.0 hours and 19.9 hours per month, respectively. Nurses averaged 23 clicks per minute during use. Most time was spent on the task of documentation at 12.3 hours per month, which was followed by medical record review at 2.6 hours per month. Intensive care unit nurses spend at least 17% of their shift on the electronic health record, primarily on documentation. Future interventions are necessary to reduce time spent on the electronic health record and to improve nurse and patient satisfaction.

I've Got the Power: Nurses' Moral Distress and Perceptions of Empowerment.

Nurses experience moral distress when they feel disempowered or impeded in taking the ethically right course of action. Research suggests an inverse relationship between moral distress and empowerment. In the intensive care unit, providing palliative care services may reduce moral distress because palliative care is often provided in situations that give rise to moral distress. To evaluate the effect of nurses' use of a palliative care screening tool on their moral distress and perceptions of empowerment. A pretest-posttest pilot study was conducted involving day-shift medical intensive care unit nurses. The nurses administered a palliative care screening tool to their assigned patients daily for 8 weeks and communicated the results to an attending physician or fellow. Demographic information was collected, along with data on nurses' moral distress and perceptions of structural and workplace empowerment before and after the intervention. Moral distress was evaluated using the Moral Distress Scale-Revised. Perceptions of structural and workplace empowerment were quantified using the Conditions for Work Effectiveness Questionnaire-II and the Global Empowerment Scale, respectively. Preintervention and postintervention surveys were completed by 17 nurses. Paired-sample t tests revealed a significant decrease in the frequency of moral distress (t16 = -2.22, P = .04) and a significant increase in workplace empowerment (t16 = -2.75, P = .01). No significant changes in moral distress intensity or structural empowerment were found. Nurses' sense of empowerment and the frequency of moral distress are favorably affected by active participation in assessing and communicating patients' palliative care needs.

Facilitators and Barriers to Nursing Implementation of Continuous Glucose Monitoring (CGM) in Critically Ill Patients With COVID-19

ObjectiveWe describe our implementation of a continuous glucose monitoring (CGM) guideline to support intravenous insulin administration and reduce point of care (POC) glucose monitoring frequency in the coronavirus disease 2019 medical intensive care unit (MICU) and evaluate nurses’ experience with implementation of CGM and hybrid POC + CGM protocol using the Promoting Action on Research in Health Services framework. MethodsA multidisciplinary team created a guideline providing criteria for establishing initial sensor-meter agreement within each individual patient followed by hybrid use of CGM and POC. POC measures were obtained hourly during initial validation, then every 6 hours. We conducted a focus group among MICU nurses to evaluate initial implementation efforts with content areas focused on initial assessment of evidence, context, and facilitation to identify barriers and facilitators. The focus group was analyzed using a qualitative descriptive approach. ResultsThe protocol was integrated through a rapid cycle review process and ultimately disseminated nationally. The Diabetes Consult Service performed device set-up and nurses received just-in-time training. The majority of barriers centered on contextual factors, including limitations of the physical environment, complex device set-up, hospital firewalls, need for training, and CGM documentation. Nurses’ perceived device accuracy and utility were exceptionally high. Solutions were devised to maximize facilitation and sustainability for nurses while maintaining patient safety. ConclusionOutpatient CGM systems can be implemented in the MICU using a hybrid protocol implementation science approach. These efforts hold tremendous potential to reduce healthcare worker exposure while maintaining glucose control during the COVID-19 pandemic.

749. Wide Variation in the Use of External Cooling Blankets Among Adult Intensive Care Unit Nurses for Fever

BackgroundThere are limited data on whether external cooling blankets (ECBs) are beneficial in the treatment of fever that is not related to malignant hyperthermia (MH). There are no established national guidelines for the use of ECBs for fevers other than for MH. Thus, there may be a wide variation in nursing practice related to their use.MethodsWe performed a cross-sectional survey of adult intensive care unit (ICU) nurses at our hospital, using SurveyMonkeyTM, to evaluate nursing practices related to the use of ECBs in febrile patients other than MH. Data collected from the survey included years of experience as an ICU nurse, type of ICU, when ECBs are used and temperature of initiation and discontinuation. Continuous variables were compared using Student’s t-test and categorical variables were described as frequency distributions. Data were analyzed using SPSS v. 25.0 and a P-value of 0.05 or less was considered to indicate statistical significance.ResultsWe invited 150 nurses to participate in the survey, 61 responded (40.7%). The mean number of years worked in an ICU was 8.6 ± 9.4 years (range: 1–34), 14 (23%) worked in a cardiovascular ICU (CVICU), 22 (36%) worked in a medical ICU (MICU), and 25 (41%) in a surgical ICU (SICU). A total of 58 (95.1%) of nurses reported using ECBs for fever, with 50 (82%) of nurses using ECBs only when other methods failed. MICU nurses (31.8%) were more likely to report using ECBs prior to failed attempt of other anti-pyrexia methods than SICU (16%) and CVICU (0.0%) nurses. There was no association between initiation and termination of ECB use by ICU type, years of nursing experience or a given range of temperature values.ConclusionThere was a wide variation of practice among ICU nurses as it relates to the use of ECBs in patients with fevers. Medical ICU nurses tended to use ECBs before failure of other methods compared with other ICU nurses. Standardized protocols should be developed for their use based on existing medical literature. Further studies should be performed to confirm our findings.Disclosures All authors: No reported disclosures.

Factors Influencing How Intensive Care Unit Nurses Allocate Their Time.

Spending time with the patient is essential for intensive care unit (ICU) nurses to detect clinical change. This article reports on an examination of factors influencing nurses' activity time allocation. Data were analyzed from a prospective time and motion study of medical ICU nurses. Nurse demographic data and observation, electronic locator technology, and electronic medical record log data were collected over 12 days from 11 registered nurses. Charlson Co-Morbidity Index and Sequential Organ Failure Assessment scores were calculated for patient assignments. Nurses averaged 78.04 (SD = 47.85) min per patient on activities in the patient room. Years of ICU nursing experience and the patient's Charlson Co-Morbidity Index was significantly associated with time spent in the patient's room. Neither nursing education nor specialty certification was found to influence time spent in a patient's room. Using technology can advance understanding of nurses' time allocation leading to interventions optimizing time spent with the patient.

Knowledge and practice patterns of Intensive Care Unit nurses towards eye care in Chhattisgarh state.

Purpose:The aim of the study was to present the level of knowledge and practice patterns regarding exposure keratopathy in mechanically ventilated patients among Intensive Care Unit (ICU) nurses in Chhattisgarh state.Methods:A previously validated semi-structured questionnaire was administered in the ICU of six multispecialty hospitals in Chhattisgarh in 2014–2015. Demography included age, gender, level of education, and months of working in ICU. Most of the questions dealt with frequency of eyelid closure assessment, frequency of cleaning of eyes with saline gauze, using a protocol-based approach for eye care, and documentation of ophthalmic complications. Common barriers to delivery of eye care such as shortage of time and too much writing tasks were also inquired.Results:Our study included 120 nurses. They worked for mean 22.9 ± 17.8 months in ICU. Knowledge about high risk of exposure keratopathy in ventilated patient was present in 93% (78%; 95% confidence interval [CI]) nurses. Only six nurses (5%) followed a strict protocol for eye care, 52 nurses (43%) checked for eyelid closure in the ventilated patients, and 58 (48%) cleaned the eyes frequently. Those who were aware of exposure keratopathy checked eyelid closure (73% vs. 48%) and cleaned eyes with saline gauze more frequently (24% vs. 4%). Nurses in cardiac ICU were significantly lesser aware of exposure complications compared to medical ICU nurses (40% reduction in awareness, 95% CI = 0.37–0.98, P = 0.04).Conclusion:Although there is high awareness, practice patterns of ICU nurses were less than desired. Educational initiatives should focus on weaknesses in knowledge and practice noted to improve eye care of patients in ICU.

Intensive Care Nurses' Knowledge About Use of Neuromuscular Blocking Agents in Patients With Respiratory Failure.

The recent increase in use of neuromuscular blocking agents (NMBAs) in patients with acute respiratory distress syndrome is set against a backdrop of concerns about harm associated with use of these high-risk drugs. Bedside nurses play a pivotal role in the safe and effective use of these agents. To describe critical care nurses' knowledge of the therapeutic properties, adverse effects, and monitoring parameters associated with NMBAs. A prospective, multicenter survey of medical intensive care unit nurses between July 2012 and May 2013. The web-based survey instrument was designed, pretested, and administered under the direction of a multidisciplinary group of individuals. Responses from 160 nurses (22% of eligible nurses) were analyzed. Most respondents were able to identify NMBAs correctly as nonanalgesic (93%) and nonanxiolytic (83%). The perceived durations of action of NMBAs varied widely, and few nurses were familiar with patient-specific considerations related to drug elimination. Most (70%) recognized the independent associations between NMBAs and footdrop, muscle breakdown, and corneal ulceration. Pressure ulcers and a history of neuromuscular disease were the characteristics of patients perceived to most heighten the risk of NMBA use. Critical care nurses are knowledgeable about the importance of concurrent analgesia and sedation during use of NMBAs. Routes of elimination, duration of action, and adverse effects were less commonly known and represent areas for focused education and quality improvement surrounding use of NMBAs in the intensive care unit.

Multidisciplinary Decision Making Needed for Patient Transfers

I confess to some disappointment upon reading the Garland and Connors1 article in AJCC’s September issue.First, I noted that none of the references come from nursing journals or are about intensive care unit (ICU) nurses and transfers. When I access Ovid and search the combination of Intensive Care/Intensive Care Units/Critical Care plus patient transfer plus nurse, I find 86 references since 1995. Surely at least 1 would be relevant.Second, it appears that only physicians care for ICU patients, as the “team” described is only an intensivist, a fellow, and house officers. I demonstrated in 2 observational studies2–3 that when medical ICU nurses believed there had been collaboration in making the decision to transfer a patient out of the unit, patients were less likely to die or be readmitted.It is possible that rather than looking for an objective measure that would be applicable to all ICU patients being considered for transfer, regardless of diagnosis, physicians could collaborate with other care providers on the team to gather more information and make better decisions.

Physiologic and other effects and compliance with long-term respirator use among medical intensive care unit nurses

BackgroundLong-term use of respiratory protection may be necessary, but compliance may be low, and physiologic effects have not been well evaluated.MethodsTen nurses participated; physiologic effects, subjective symptoms, and compliance with wearing an N95 alone or with a surgical mask overlay were assessed. Longitudinal analysis based on multivariate linear regression models assessed changes in outcome variables (CO2, O2, heart rate, perceived comfort items, compliance measures, and others). Analyses compared changes over time, and compared wearing only an N95 to wearing an N95 with a surgical mask overlay.ResultsMost nurses (90%, n = 9) tolerated wearing respiratory protection for two 12-hour shifts. CO2 levels increased significantly compared with baseline measures, especially when comparing an N95 with a surgical mask to only an N95, but changes were not clinically relevant. Perceived exertion; perceived shortness of air; and complaints of headache, lightheadedness, and difficulty communicating also increased over time. Almost one-quarter (22%) of respirator removals were due to reported discomfort. N95 adjustments increased over time, but other compliance measures did not vary by time. Compliance increased on day 2, except for adjustments, touching under the N95, and eye touches.ConclusionLong-term use of respiratory protection did not result in any clinically relevant physiologic burden for health care personnel, although many subjective symptoms were reported. N95 compliance was fairly high.

Use of a validated delirium assessment tool improves the ability of physicians to identify delirium in medical intensive care unit patients

Although medical intensive care unit nurses at our institution routinely use the Intensive Care Delirium Screening Checklist (ICDSC) to identify delirium, physicians rely on traditional diagnostic methods. We sought to measure the effect of physicians' use of the ICDSC on their ability to detect delirium. Before-after study. Medical intensive care unit of an academic medical center. A total of 25 physicians with >or=1 month of clinical experience in the medical intensive care unit conducted 300 delirium assessments in 100 medical intensive care unit patients. Physicians sequentially evaluated two patients for delirium using whatever diagnostic method preferred. Following standardized education regarding ICDSC use, each physician evaluated two different patients for delirium using the ICDSC. Each physician assessment was preceded by consecutive, but independent, evaluations for delirium by the patient's nurse and then a validated judge using the ICDSC. Before (PRE) physician ICDSC use, the validated judge identified delirium in five patients; the physicians and nurses identified delirium in zero and four of these patients, respectively. The physicians incorrectly identified delirium in four additional patients. After (POST) physician ICDSC use, the validated judge identified delirium in 11 patients; the physicians and nurses identified delirium in eight and ten of these patients, respectively. The physicians incorrectly identified delirium in one patient. After physician ICDSC use, agreement improved between both the physicians and validated judge (PRE kappa = -0.14 [95% confidence interval {CI} = -0.27 to -0.02] to POST kappa = 0.67 [95% CI = 0.38 to 0.96]) and physicians and nurses (PRE kappa = -0.15 [95% CI = -0.29 to -0.02] to POST kappa = 0.58 [95% CI = 0.25 to 0.91]). Nurses vs. validated judge agreement was strong in both periods (PRE kappa = 0.65 [95% CI = 0.29 to 1.00] and POST kappa = 0.92 [95% CI = 0.76 to 1.00]). Use of the ICDSC, along with education supporting its use, improves the ability of physicians to detect delirium in the medical intensive care unit.

Moral Discord, Cognitive Coping Strategies, and Medical Intensive Care Unit Nurses

Moral discord occurs when contextual factors prevent nurses from implementing felt moral mandates. Medical intensive care unit (MICU) nurses frequently confront moral issues and hold themselves personally responsible for their moral actions. They use a variety of cognitive coping strategies to deal with moral discord. This article describes common moral dilemmas encountered by MICU nurses, explores patterns of both conscious and unconscious cognitive coping behaviors, and reviews steps that nurses can take to reduce the degree of moral discord they experience.

A descriptive study of coping strategies used by Medical Intensive Care Unit nurses during transitions from cure- to comfort-oriented care

The aim of this study was to describe Medical Intensive Care Unit (MICU) nurses' coping behaviors while caring for a patient whose medical treatment transitioned from cure- to comfort-oriented care. The use of a descriptive qualitative research design with brief selective participant observation and focus group interviews was used to explore the coping experiences of MICU nurses. The study took place in an 18-bed MICU that was part of a 719-bed acute care hospital located in the northeastern United States. Nineteen female and 5 male nurses participated in the study. MICU nurses used a variety of coping strategies including cognitive, affective, and behavioral techniques to cope with end-of-life care transitions. Being a MICU nurse in and of itself provided a sense of pride for staff. Most believed that their clinical opinions were valued and that they were respected as professionals. Providing futile care, the perception of "torturing the patient," and conflict with families caused the greatest distress to staff. MICU nurses are dynamic and resourceful when responding to challenging end-of-life patient care situations.

Implementation of a safe and effective insulin infusion protocol in a medical intensive care unit.

In a recent randomized controlled trial, lowering blood glucose levels to 80-110 mg/dl improved clinical outcomes in critically ill patients. In that study, the insulin infusion protocol (IIP) used to normalize blood glucose levels provided valuable guidelines for adjusting insulin therapy. In our hands, however, ongoing expert supervision was required to effectively manage the insulin infusions. This work describes our early experience with a safe, effective, nurse-implemented IIP that provides detailed insulin dosing instructions and requires minimal physician input. We collected data from 52 medical intensive care unit (MICU) patients who were placed on the IIP. Blood glucose levels were the primary outcome measurement. Relevant clinical variables and insulin requirements were also recorded. MICU nurses were surveyed regarding their experience with the IIP. To date, our IIP has been employed 69 times in 52 patients admitted to an MICU. Using the IIP, the median time to reach target blood glucose levels (100-139 mg/dl) was 9 h. Once blood glucose levels fell below 140 mg/dl, 52% of 5,808 subsequent hourly blood glucose values fell within our narrow target range; 66% within a "clinically desirable" range of 80-139 mg/dl; and 93% within a "clinically acceptable" range of 80-199 mg/dl. Only 20 (0.3%) blood glucose values were <60 mg/dl, none of which resulted in clinically significant adverse events. In general, the IIP was readily accepted by our MICU nursing staff, most of whom rated the protocol as both clinically effective and easy to use. Our nurse-implemented IIP is safe and effective in improving glycemic control in critically ill patients.

Phase I collaborative pilot study: Waste anesthetic gas levels in the PACU

The National Institute of Occupational Safety and Health (NIOSH) recommends that exposure to waste anesthetic gas (WAG) be minimized to the greatest extent possible. Current recommendations include 2 parts per million (ppm) for 1 hour sample to halogenated agents level or 25 ppm based on nitrous oxide level or combination of 0.5 ppm for halogenated agents and 25 ppm nitrous oxide. The Occupational Safety Health Administration requires that work practices and engineering controls be implemented so that occupational exposure to WAG is controlled. This pilot study was conducted to (1) evaluate the level of WAG in the PACU, (2) analyze the relationship between nurse exposure and self-reported symptoms, and (3) test methods used to describe occupational exposure of PACU staff to WAG. Air sampling to measure levels of WAG in the patient and PACU nurse environment was performed with MIRAN SapphRE (Foxboro Company, Foxboro, MA), a nondispersive infrared spectrophotometer. A personal sampling method was used to measure the level of nurse exposure to WAG on 2 separate days. Self-report of 9 health symptoms using a 10-cm visual analogue scale was obtained before and after the shift from 6 (PACU) nurses. Three nurses from the Medical Intensive Care Unit (MICU) served as a control. Descriptive statistics summarized exhaled gas level and staff exposure. The highest concentrations of nitrous oxide were 283 to 295 ppm in the patient's breathing zone, whereas halogenated agents were below the limit of detection. Staff exposure to nitrous oxide ranged from 2.9 to 8.2 ppm, averaged over the work shift. T test of the pre- and postshift symptoms showed no significant difference in both PACU and MICU nurses. This pilot study identified the potential for staff exposure to WAG in the PACU setting. The methods to detect this exposure were also evaluated. It is recommended that further study be conducted to evaluate PACU staff exposure to WAG. Modifications in some of the measurement methods tested here are also suggested, including the use of procedures to measure the efficacy of air exchange and other engineering controls related to staff exposure. © 2002 by American Society of PeriAnesthesia Nurses.

Latex and vinyl examination gloves. Quality control procedures and implications for health care workers

In December 1987, we investigated an increased number of cases of herpetic whitlow in medical intensive care unit nurses who routinely gloved for secretion contact. One particular brand of vinyl examination glove had been used in the medical intensive care unit. Restriction endonuclease mapping established the similarity of employee isolates with one patient isolate of herpes simplex virus type I. When initial viral assay demonstrated 2.5% to 10% penetration of herpes simplex virus type I across unused gloves, an evaluation of glove quality was undertaken. In a 300-mL watertightness test, seven brands of vinyl gloves failed 4% to 28% (average, 11.1%; 132/1200), while seven brands of latex gloves failed 0% to 2.6% (average, 1.4%; 24/1750). The brand of vinyl glove that had been in use in the medical intensive care unit failed 28% of the time. Watertight gloves were then tested for permeability to herpes simplex virus type I. None of the latex gloves failed (n = 1726), while only 10 of the vinyl gloves failed (n = 1068, 0.95%). Extreme variability in glove quality was observed. However, gloves made from intact vinyl may provide similar protectiveness as those made from intact latex. As the demand for gloves increases, emphasis should be placed on the production of plentiful, better quality latex and vinyl gloves.