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Using the same tools and techniques that they rely on to manage toxic chemical exposures, occupational safety and health professionals can successfully tackle the challenges of infectious agents in the […]

Thirty-two patients with severe mitral regurgitation underwent Carpentier mitral valvuloplasty. Postoperatively, three of these patients developed clinical and echocardiographic evidence of left ventricular outflow tract obstruction. None of these patients had asymmetric septal hypertrophy or preoperative echocardiography demonstration of systolic anterior motion of the mitral valve. Outflow obstruction postoperatively was caused by systolic anterior motion of the mitral valve. Because this potential complication of Carpentier mitral valvuloplasty produced significant hemodynamic effects in two patients, echocardiography should be routinely performed after this operation.

Echocardiography identified three patients with a mitral anular mass. Fluoroscopy demonstrated a faint, homogeneous intracardiac calcific density in each patient. Cardiac catheterization and angiography were performed and showed no left ventricular inflow or outflow obstruction. One patient died suddenly and two patients had cardiac surgery (one for mitral regurgitation and another for constrictive pericarditis). Examination demonstrated that each mass was nonencapsulated, sterile and acellular and contained cholesterol, calcium and fatty acids. The clinical significance and cause of these masses are unclear at present.

Nine patients with clinical and hemodynamic evidence of cardiac tamponade underwent M-mode and two-dimensional echocardiography. Pericardial effusion was documented in each patient. Four patients demonstrated respiratory variation in ventricular volumes in association with paradoxical pulse. Right ventricular compression was present in seven. In five patients, echocardiography demonstrated diastolic left atrial compression. In all nine patients, the apical four chamber view revealed diastolic right atrial compression. Drainage of 450 to 1,800 cc of pericardial fluid relieved the cardiac tamponade and eliminated the echocardiographic findings associated with this disorder. These observations suggest that the echocardiographic finding of atrial compression is a sensitive sign of cardiac tamponade.

Hospital-acquired infections with drug-resistant organisms, such as methicillin-resistant Staphylococcus aurcus, pose threats to healthcare workers and patient safety. Authors discuss the Centers for Disease Control and Prevention (CDC) guidelines that introduced “Standard Precautions.” Proposed in 1996, the Standard Precautions guidelines are a new, two-tiered approach to infection control. These CDC guidelines take a broader approach than Universal Precautions, offering infection control precautions that are standard for all patients and include bloodborne, airborne, and epide-miologically important pathogens. Specific applications of Standard Precautions and implications for IV therapy nurses are presented.