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Background Surgical-site infection (SSI) is associated with significant healthcare costs. To reduce the high rate of SSI among patients undergoing colorectal surgery at a cancer centre, a comprehensive care bundle was implemented and its efficacy tested. Methods A pragmatic study involving three phases (baseline, implementation and sustainability) was conducted on patients treated consecutively between 2013 and 2016. The intervention included 13 components related to: bowel preparation; oral and intravenous antibiotic selection and administration; skin preparation, disinfection and hygiene; maintenance of normothermia during surgery; and use of clean instruments for closure. SSI risk was evaluated by means of a preoperative calculator, and effectiveness was assessed using interrupted time-series regression. Results In a population with a mean BMI of 30 kg/m2, diabetes mellitus in 17·5 per cent, and smoking history in 49·3 per cent, SSI rates declined from 11·0 to 4·1 per cent following implementation of the intervention bundle (P = 0·001). The greatest reductions in SSI rates occurred in patients at intermediate or high risk of SSI: from 10·3 to 4·7 per cent (P = 0·006) and from 19 to 2 per cent (P < 0·001) respectively. Wound care modifications were very different in the implementation phase (43·2 versus 24·9 per cent baseline), including use of an overlying surface vacuum dressing (17·2 from 1·4 per cent baseline) or leaving wounds partially open (13·2 from 6·7 per cent baseline). As a result, the biggest difference was in wound-related rather than organ-space SSI. The median length of hospital stay decreased from 7 (i.q.r. 5–10) to 6 (5–9) days (P = 0·002). The greatest reduction in hospital stay was seen in patients at high risk of SSI: from 8 to 6 days (P < 0·001). SSI rates remained low (4·5 per cent) in the sustainability phase. Conclusion Meaningful reductions in SSI can be achieved by implementing a multidisciplinary care bundle at a hospital-wide level.

Prosthetic rehabilitation of the patient with a cleft soft palate has three main objectives. Foremost is the need to improve the function of speech and comfortable swallowing, that are impaired by the potency of the soft palate, which allows the escape of air or fluid into the nasopharynx and nasal cavity. Unrepaired clefts of the soft palate produce a deficient velar-pharyngeal seal and require the construction of an obturator toward the speech bulb. Measurement of the nasality of a patient wearing a speech bulb for 18 years is described in this paper. This was done by means of Nasal View System, Tiger Electronics Inc. (Seattle, WA), which developed this system based on the work of Awan (1996, 1997). The Nasal View system is a PC/Windows based system, which enables the recording of high-resolution speech signals using Windows compatible sound cards (sampling at up to 44100 Hz at 8 or 16 bits of resolution). The hardware components included in the Nasal View system include headgear and a portable custom dual-channel pre-amplification unit.The key component of the headgear is a rigid plate, constructed of 5 mm thick styrene, which is used to separate an oral from a nasal microphone. The special sentence was used for our assessment. In this sentence 5 sounds out of 28 are nasal sounds (17.86%). The results are as follows: With the obturator in place the values of nasality were: Ave 19.32% SD 14.31%, Max 66.53% Min 1.28% Median 15.04% Mode 12.70%. The measurements of nasality without the obturator were: Ave 41.31% SD 24.39% Max 97.03% Min 7.61% Median 30.02% Mode 23.26%. Nasality measurement is displayed in the histogram of the nasality distribution, in the real-time analysis, power spectrum, LPC spectrum power and LPC spectrum, and in spectrograms.