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Tkatschenko D, Hansen S, Koch J, Ames C, Fehlings MG, Berven S, Sekhon L, Shaffrey C, Smith JS, Hart R, Kim HJ, Wang J, Ha Y, Kwan K, Hai Y, Valacco M, Falavigna A, Taboada N, Guiroy A, Emmerich J, Meyer B, Kandziora F, Thomé C, Loibl M, Peul W, Gasbarrini A, Obeid I, Gehrchen M, Trampuz A, Vajkoczy P, Onken J. Prevention of Surgical Site Infections in Spine Surgery: An International Survey of Clinical Practices Among Expert Spine Surgeons. Global Spine J 2023; 13:2007-2015. [PMID: 35216540 PMCID: PMC10556889 DOI: 10.1177/21925682211068414] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
STUDY DESIGN Questionnaire-based survey. OBJECTIVES Surgical site infection (SSI) is a common complication in spine surgery but universal guidelines for SSI prevention are lacking. The objectives of this study are to depict a global status quo on implemented prevention strategies in spine surgery, common themes of practice and determine key areas for future research. METHODS An 80-item survey was distributed among spine surgeons worldwide via email. The questionnaire was designed and approved by an International Consensus Group on spine SSI. Consensus was defined as more than 60% of participants agreeing to a specific prevention strategy. RESULTS Four hundred seventy-two surgeons participated in the survey. Screening for Staphylococcus aureus (SA) is not common, whereas preoperative decolonization is performed in almost half of all hospitals. Body mass index (BMI) was not important for surgery planning. In contrast, elevated HbA1c level and hypoalbuminemia were often considered as reasons to postpone surgery. Cefazoline is the common drug for antimicrobial prophylaxis. Alcohol-based chlorhexidine is mainly used for skin disinfection. Double-gloving, wound irrigation, and tissue-conserving surgical techniques are routine in the operating room (OR). Local antibiotic administration is not common. Wound closure techniques and postoperative wound dressing routines vary greatly between the participating institutions. CONCLUSIONS With this study we provide an international overview on the heterogeneity of SSI prevention strategies in spine surgery. We demonstrated a large heterogeneity for pre-, peri- and postoperative measures to prevent SSI. Our data illustrated the need for developing universal guidelines and for testing areas of controversy in prospective clinical trials.
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Affiliation(s)
- Dimitri Tkatschenko
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sonja Hansen
- Department of Hygiene and Environmental Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Julia Koch
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christopher Ames
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Michael G. Fehlings
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Sigurd Berven
- Orthopedic Surgery, UCSF Spine Center, San Francisco, CA, USA
| | | | - Christopher Shaffrey
- Departments of Neurosurgery and Orthopaedic Surgery, Duke Medical Center, Durham, NC, USA
| | - Justin S. Smith
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Robert Hart
- Department of Orthopaedic Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Han Jo Kim
- Hospital for Special Surgery, New York, NY, USA
| | | | - Yoon Ha
- Department of Neurosurgery, Spine, and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kenny Kwan
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Yong Hai
- Department of Orthopedics, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Marcelo Valacco
- Department of Orthopaedics, Churruca Hospital de Buenos Aires, Buenos Aires, Argentina
| | - Asdrubal Falavigna
- Department of Neurosurgery, University of Caxias do Sul, Caxias do Sul, Brazil
| | | | - Alfredo Guiroy
- Spine Unit, Orthopedic Department, Hospital Español, Mendoza, Argentina
| | - Juan Emmerich
- Department of Neurological Surgery, Children’s Hospital, La Plata, Argentina
| | - Bernhard Meyer
- Department of Neurosurgery, Technische Universität München, Munich, Germany
| | - Frank Kandziora
- Centre for Spinal Surgery and Neurotraumatology, BG Unfallklinik, Frankfurt am Main, Germany
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Tyrol, Austria
| | - Markus Loibl
- Department of Spine Surgery, Schulthess Klinik Zürich Switzerland and Department of Trauma Surgery, University Medical Center, Regensburg, Germany
| | - Wilco Peul
- University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center & Haga Teaching Hospital, Leiden and The Hague, The Netherlands
| | - Alessandro Gasbarrini
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Ibrahim Obeid
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
| | - Martin Gehrchen
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Andrej Trampuz
- Center for Musculoskeletal Surgery (CMSC), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Julia Onken
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Alfarhan A, Al-Swailem S, Alobaid M, Ahmad K, Khan R. Needle-Stick Injuries in Ophthalmic Practice. Risk Manag Healthc Policy 2023; 16:1667-1677. [PMID: 37641780 PMCID: PMC10460596 DOI: 10.2147/rmhp.s409326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/04/2023] [Indexed: 08/31/2023] Open
Abstract
Purpose Needle-stick injuries (NSI) are a prominent route by which blood-borne infections are transmitted. The unique microsurgical nature of ophthalmic practice constitutes an additional risk to sustain injury. This study aimed to identify the epidemiological profile of needle-stick injuries in a tertiary eye center and to evaluate the implemented safety policy in preventing sharp injuries. Methods This was a retrospective cross-sectional study of all sharp injuries that occurred at King Khalid Eye Specialist Hospital (KKESH). Data on all reported sharp injury incidents from 2013 to 2021 were collected. The mechanisms of injury, context, location, and type of prick were collected and analyzed. Also, this study involved an institution-based survey for all ophthalmic staff. Results Two hundred and one sharp injury incidents were reported over 9 years. Physicians sustained 46.8% (n=94) of injuries, followed by nurses and ophthalmic technicians, 40.8% (n=82) and 7% (14); respectively. Operating and treatment rooms were the locations of 60.7% of incidents, whereas outpatient clinics and emergency rooms accounted for 19.4% and 13.4% of injuries, respectively. Conclusion The current findings add to the growing body of literature on the importance of NSI prevention and reporting strategies. In the present study, sharp injuries were most commonly encountered by ophthalmic staff in the operating rooms. Continuous staff education on handling sharp instruments, encouraging anonymous reporting, and up-to-date revisions of guidelines and policies are of paramount importance to lessen the burden of sharp injuries.
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Affiliation(s)
- Abdulrahman Alfarhan
- Fellowship and Residency Training Program, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Samar Al-Swailem
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Mohannad Alobaid
- Department of Ophthalmology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Khabir Ahmad
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Ruhi Khan
- Medicine Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Prada C, Bengoa F, Bhandari M. The management of fracture related infections: What practices can be supported by high-level evidence? J Orthop Surg (Hong Kong) 2022; 30:10225536221119580. [PMID: 36545907 DOI: 10.1177/10225536221119580] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Fracture related infections (FRIs) are a disabling condition causing significant concern within the orthopaedic community. FRIs have a huge societal and economic burden leading to prolonged recovery times and the potential for becoming chronic conditions or being life-threatening. Despite its importance in our field, the surgical community has just recently agreed on a definition which, added to the lack of surgical trials assessing preventive and treatment interventions have limited our understanding and precipitated wide variations in surgeons' practice. This article aims to review the current practices that can be supported with high-quality evidence. Currently, we have a limited body of high-quality evidence on FRI prevention and treatment. A handful of measures have proven effective, such as the use of prophylactic antibiotics, the use of saline and low pressure as the preferred irrigation solution and the safety of delaying initial surgical débridement more than 6 hours without impacting infection rates for open fracture wounds débridement. Future multicentre trials, properly powered, will shed light on current areas of controversy regarding the benefit of different preoperative and perioperative factors for the prevention and treatment of FRIs. Higher quality evidence is needed to guide surgeons to offer an evidence-based approach to prevent FRI occurrence and to treat patients suffering from them.
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Affiliation(s)
- Carlos Prada
- Division of Orthopaedic Surgery, Department of Surgery, 3710McMaster University, Hamilton, Ontario, Canada
| | - Francisco Bengoa
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohit Bhandari
- Division of Orthopaedic Surgery, Department of Surgery, 3710McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Ontario, Canada
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Guanche Garcell H, Gonzalez Valdés A, Gonzalez Alvarez L, Fresneda Septiem G, Cardenás Goulet K, Matos Figueroa Y, Gutiérrez García F. Glove perforation in selected surgical procedures in a general hospital in La Habana, Cuba. Infect Prev Pract 2022; 4:100238. [PMID: 36052310 PMCID: PMC9424954 DOI: 10.1016/j.infpip.2022.100238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background Surgical glove perforation constitutes a risk for the maintenance of aseptic technique and the risk of surgical site infection and occupational exposure to blood borne infections for healthcare workers. Aim To identify the frequency of glove perforation in selected surgical procedures. Methods A cross-sectional descriptive observational study was carried out in the surgical unit of the Joaquin Albarrán Hospital (La Habana, Cuba) during the period September–December 2019. Gloves used by surgeons in major urgent or elective surgical procedures were collected and tested for perforations. Findings 757 gloves from 149 surgeons and 8 surgical specialties were tested and 95 (25.8%) had perforations. The highest frequencies of glove perforations were reported in vascular surgery (50.0%), proctology (37.9%), urology (28.0%) and general surgery (26.1%). The selected surgical procedures with the highest frequencies were open radical nephrectomy (87.5%), splenectomy (57.1%), open adenomectomy (55.6%), limb amputation (46.2%) and hysterectomy (41.7%). Glove perforation occurred more frequently in consultant surgeons (28.8%) than in residents (20.9%) (P = 0.021), in surgeons with more years of surgical experience (P = 0.003) and longer procedure duration (P = <0.001). Most glove perforations were identified in the left hand (64.1%), while 23.1% were in the right hand and 12.8% in both hands. 51.2% occurred in thumb and index finger. Differences in the patterns of glove perforation were observed among the different surgical procedures. Conclusions Our findings provide insights into the risk of glove perforation during selected surgical procedures and the need for prevention strategies to reduce adverse consequences of glove perforation in patients and healthcare workers.
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Eto S, Yoshikawa K, Takehara Y, Yoshimoto T, Takasu C, Kashihara H, Nishi M, Tokunaga T, Nakao T, Higashijima J, Iwata T, Shimada M. Usefulness of a multidisciplinary surgical site infection team in colorectal surgery. THE JOURNAL OF MEDICAL INVESTIGATION 2021; 68:256-259. [PMID: 34759140 DOI: 10.2152/jmi.68.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background : Surgical site infection (SSI) is an adverse event that places a major burden on patients and staff. In this study, we examined the occurrence of SSI and the characteristics of patients referred to the SSI team after colorectal surgery. Methods : In total, 955 patients underwent colorectal surgery at our hospital from 2014 to 2019. Of these 955 patients, 516 received therapeutic support by the SSI team from 2017 to 2019. All patients were evaluated using an SSI surveillance sheet, and we checked for reports of SSI once a month. Each attending physician performed SSI prophylaxis (use of new instruments before wound irrigation and closure). Results : SSI occurred in 80 (8.4%) patients. The incidence of SSI and the incidence of surface SSI were higher in the patients who did not receive intervention by the SSI team than in the patients who did. Organ / space SSI occurred in 18 patients. Among patients with surface SSI, Enterococcus was the most commonly detected bacteria. Among the 18 patients with organ / space SSI, 5 developed anastomotic leakage and 4 developed intra-abdominal abscesses. Conclusions : An SSI team for prevention and treatment of infection may contribute to reduction of SSI. J. Med. Invest. 68 : 256-259, August, 2021.
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Affiliation(s)
- Shohei Eto
- Department of Surgery, Graduate School of Medical Sciences, Tokushima University, Tokushima, Japan
| | - Kozo Yoshikawa
- Department of Surgery, Graduate School of Medical Sciences, Tokushima University, Tokushima, Japan
| | - Yukako Takehara
- Department of Surgery, Graduate School of Medical Sciences, Tokushima University, Tokushima, Japan
| | - Toshiaki Yoshimoto
- Department of Surgery, Graduate School of Medical Sciences, Tokushima University, Tokushima, Japan
| | - Chie Takasu
- Department of Surgery, Graduate School of Medical Sciences, Tokushima University, Tokushima, Japan
| | - Hideya Kashihara
- Department of Surgery, Graduate School of Medical Sciences, Tokushima University, Tokushima, Japan
| | - Masaaki Nishi
- Department of Surgery, Graduate School of Medical Sciences, Tokushima University, Tokushima, Japan
| | - Takuya Tokunaga
- Department of Surgery, Graduate School of Medical Sciences, Tokushima University, Tokushima, Japan
| | - Toshihiro Nakao
- Department of Surgery, Graduate School of Medical Sciences, Tokushima University, Tokushima, Japan
| | - Jun Higashijima
- Department of Surgery, Graduate School of Medical Sciences, Tokushima University, Tokushima, Japan
| | - Takashi Iwata
- Department of Surgery, Graduate School of Medical Sciences, Tokushima University, Tokushima, Japan
| | - Mitsuo Shimada
- Department of Surgery, Graduate School of Medical Sciences, Tokushima University, Tokushima, Japan
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Cayetano-Alcaraz AA, Yassin M, Desai A, Tharakan T, Tsampoukas G, Zurli M, Minhas S. Penile implant surgery-managing complications. Fac Rev 2021; 10:73. [PMID: 34632459 PMCID: PMC8483239 DOI: 10.12703/r/10-73] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Penile prosthesis surgery represents the end-stage treatment for erectile dysfunction. It is conventionally used only in cases of erectile dysfunction refractory to pharmacological treatments or vacuum constriction devices. Contemporary literature suggests that penile prothesis surgery is associated with a high satisfaction rate and a low complication profile. However, it must be appreciated that the complications of surgery can have devastating consequences on a patient’s quality of life and satisfaction and include infection, prosthesis malfunction, penile corporal perforation and penile length loss. Several factors – such as appropriate patient selection, methodical preoperative assessment and patient optimization, specific intraoperative protocols and postoperative recommendations – can reduce the risk of surgical complications. This narrative review discusses the diagnosis and management of both intraoperative and postoperative complications of penile prosthesis surgery.
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Affiliation(s)
| | - Musaab Yassin
- Andrology Department, Imperial College Healthcare NHS Trust, Charing Cross, London, UK
| | - Ankit Desai
- Andrology Department, Imperial College Healthcare NHS Trust, Charing Cross, London, UK
| | - Tharu Tharakan
- Andrology Department, Imperial College Healthcare NHS Trust, Charing Cross, London, UK
| | | | - Martina Zurli
- Andrology Department, Imperial College Healthcare NHS Trust, Charing Cross, London, UK
| | - Suks Minhas
- Andrology Department, Imperial College Healthcare NHS Trust, Charing Cross, London, UK
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Stanberry B, Bothma G, Harrison K. Using the MEAT VBP Framework to analyse and understand the value of surgical gloves: an explanatory case study. HEALTH ECONOMICS REVIEW 2021; 11:23. [PMID: 34228279 PMCID: PMC8259099 DOI: 10.1186/s13561-021-00325-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/21/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Value-based healthcare is being extensively piloted, scaled and implemented by healthcare providers and systems around the world. However, the ability of the healthcare supply chain function to strategically contribute to the improvement of value has been held back by a lack of practical tools for turning value-based procurement from concept into action. Two recently developed conceptual models - the American CQO Movement and the European MEAT VBP Framework - have been developed to support the implementation of value-based procurement in healthcare. We demonstrate how the latter of these models can be adapted and applied pragmatically to generate insights into the value of a specific medical device, technology or consumable. METHODS We undertook an explanatory, qualitative, single-case study focused on a specific consumable - surgical gloves - that provide a critical example of a type of medical device usually procured in high volumes but at risk of commoditisation due to a widespread lack of understanding of their value. Since the global Covid-19 pandemic prevented fieldwork, structured interviews were conducted via Zoom and corroborated by a literature review. RESULTS We identified ten cost criteria and eight outcome criteria with which the value of surgical gloves can be analysed and understood. For each of these criteria we propose definitions and value impact metrics that decision-makers can use during a procurement exercise to describe, quantify and compare glove value. CONCLUSION The MEAT VBP Framework provides a highly practical and adaptable means of imposing both structure and rigour on a value analysis process and of qualitatively describing the potential value impact of surgical gloves for patients, professionals, providers and health systems.
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Affiliation(s)
| | - Gerhard Bothma
- Mölnlycke Health Care AB, Gamlestadsvägan 3C, 411 36, Gothenburg, Sweden
| | - Katie Harrison
- Mölnlycke Health Care AB, Gamlestadsvägan 3C, 411 36, Gothenburg, Sweden
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de Barros MPM, Godoi TTF, Ferretti Filho M, Fernandes HJA, Dos Reis FB. Surgical Gloves in Orthopedic Trauma Procedures: How Many Lose Their Integrity? Rev Bras Ortop 2021; 56:379-383. [PMID: 34239206 PMCID: PMC8249058 DOI: 10.1055/s-0040-1722591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/16/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction
The possibility of perforation of gloves during orthopedic surgeries can reach 56.8%, and it mainly related to the manipulation of blunt instruments. Surgeries for the treatment of fractures and trauma present additional risk due to contact with bone spires.
Objective
Analysis of the prevalence of loss of integrity of surgical gloves in orthopedic trauma procedures, especially fractures, and evaluation of the surgeon's exposure and contact with secretions from the patient.
Methods
Macroscopic inspection of the gloves of two surgeons specialized in trauma, over a period of 4 months. Both used two gloves for all procedures and, at the end of the surgery, analyzed the presence or absence of blood stains on the internal gloves and/or fingers. The procedures were categorized according to the time and type of surgery. The intercurrence investigated was the perforation of one or two gloves; if the tear was perceived immediately or only at the end of the surgery, and the location of and reason for the tear, if identified.
Results
A total of 210 surgeries were included, 87 of which presented perforations, with 17 cases occurring in both gloves and 70 only in the outer glove. Finally, there was a more significant relationship with open focus surgeries and duration > 60 minutes.
Conclusion
Our results suggest that greater care and inspection of gloves to look for damage are needed in prolonged surgeries with an open focus.
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Affiliation(s)
| | - Thales Thiago Ferreira Godoi
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Mario Ferretti Filho
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Helio Jorge Alchavian Fernandes
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Fernando Baldy Dos Reis
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
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Current concepts in the prevention, diagnosis and treatment of fracture-related infection (FRI). EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:957-966. [PMID: 33778904 DOI: 10.1007/s00590-021-02956-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/21/2021] [Indexed: 12/24/2022]
Abstract
Fracture-related infection (FRI) is one of the most challenging complications following operative management of fractures. It can have profound implications for the patient, can be associated with considerable morbidity and often lead to impaired outcomes. There are significant healthcare-related costs. In recent years, there has been significant progress towards developing preventative strategies. Furthermore, diagnostic algorithms and management protocols have recently been reported. Lack of a strong evidence base has previously hindered efforts to implement these and develop established standards of care. There are multiple aspects of care that need to be considered and a multi-disciplinary approach is recommended. In this narrative review, we present the most up-to-date recommendations in the prevention, diagnosis and management of FRI.
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Ryu RC, Behrens PH, Malik AT, Lester JD, Ahmad CS. Are we putting ourselves in danger? Occupational hazards and job safety for orthopaedic surgeons. J Orthop 2021; 24:96-101. [PMID: 33716416 DOI: 10.1016/j.jor.2021.02.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 02/14/2021] [Indexed: 10/22/2022] Open
Abstract
As physicians, we strive to meet the needs of our patients. In doing so, we are often exposed to hazards that have the potential to not only compromise our health, but also our ability to deliver the best possible healthcare. Occupational hazards specific to the field of orthopaedics include infectious organisms, radiation, surgical smoke, chemicals, hazardous noise, musculoskeletal injury, and psychosocial stressors. Even though orthopaedic surgeons acknowledge the risk, most lack in-depth knowledge of the associated long-term harm associated with these hazards and ways of reducing risk of exposure. Orthopaedic surgeons should increase awareness, follow established guidelines, and integrate preventative measures to create the safest possible work environment. It is our hope that by improving our own health, we will be better equipped to address the health concerns of those we serve-our patients.
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Affiliation(s)
- Robert C Ryu
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Phillip H Behrens
- Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Azeem T Malik
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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DODAMANI ARUNSURESH, JADHAV HARISHCHAITRAM, KHAIRNAR MAHESHRAVINDRA, NAIK RAHULGAYBARO. Dental professionals' knowledge and behavior towards utilization of gloves: a cross-sectional survey. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 61:E636-E641. [PMID: 33628971 PMCID: PMC7888390 DOI: 10.15167/2421-4248/jpmh2020.61.4.1291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 10/30/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Dental practitioners are at risk of developing infections due to nature of their occupation which can be prevented by following proper infection control protocols, including proper use of gloves. Hence, the purpose of this study was to assess the perception and beliefs of dental healthcare providers towards usage of different type of gloves. METHODS A self-administered questionnaire was distributed among a total of 241 participants out of which 198 participants (77 interns, 58 dental post-graduate students (PG) and 63 dental faculty members) returned completed questionnaire (response rate of 82.15%). The questionnaire comprised of questions on dental professionals' preferences for certain types of gloves and the reasons for these preferences, as well as determining their knowledge, beliefs and behavior concerning the use of dental gloves as a means of barrier protection. Data obtained was analyzed using chi-square test. RESULTS Dental faculty members had a better knowledge regarding use of gloves as compared to dental PG students and interns. Most of the study participants preferred certain types of gloves for the purpose of better protection followed by comfort. Most of the participants believed that gloves provide full protection as long as there is no visible tear (interns 70.1%; PG students 50%; faculty members 60.3%). Most of the interns (42.9%) and PG students (41.4%) did not know about the fact that petroleum based products affect the integrity of the gloves. 2.6% interns, 29.3% PG students and 20.6% faculty members reported that they would not change gloves during an uninterrupted three-hour long procedure. CONCLUSION Most of the interns and PG students had poor knowledge regarding usage of gloves which calls for an action on the part of educators to educate and train dental professionals regarding proper infection control practices.
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Affiliation(s)
- ARUN SURESH DODAMANI
- Department of Public Health Dentistry, ACPM Dental College & Hospital, Dhule, Maharashtra, India
| | - HARISH CHAITRAM JADHAV
- Department of Public Health Dentistry, ACPM Dental College & Hospital, Dhule, Maharashtra, India
| | - MAHESH RAVINDRA KHAIRNAR
- Public Health Dentistry, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
- Correspondence: Mahesh R. Khairnar, Public Health Dentistry, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India - Tel. +91 7045653288 - E-mail:
| | - RAHUL GAYBARO NAIK
- Department of Public Health Dentistry, ACPM Dental College & Hospital, Dhule, Maharashtra, India
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Svetanoff WJ, Dekonenko C, Briggs KB, Sujka JA, Osuchukwu O, Dorman RM, Oyetunji TA, St Peter SD. Debunking the Myth: What You Really Need to Know about Clothing, Electronic Devices, and Surgical Site Infection. J Am Coll Surg 2021; 232:320-331.e7. [PMID: 33453379 DOI: 10.1016/j.jamcollsurg.2020.11.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Wendy Jo Svetanoff
- Department of General and Thoracic Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Charlene Dekonenko
- Department of General and Thoracic Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Kayla B Briggs
- Department of General and Thoracic Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Joseph A Sujka
- Department of General Surgery, Tampa General Hospital, Tampa, FL
| | - Obiyo Osuchukwu
- Department of General and Thoracic Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Robert M Dorman
- Department of General and Thoracic Surgery, Children's Mercy Hospital, Kansas City, MO; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Tolulope A Oyetunji
- Department of General and Thoracic Surgery, Children's Mercy Hospital, Kansas City, MO; University of Missouri-Kansas City (UMKC) School of Medicine, Kansas City, MO
| | - Shawn D St Peter
- Department of General and Thoracic Surgery, Children's Mercy Hospital, Kansas City, MO; University of Missouri-Kansas City (UMKC) School of Medicine, Kansas City, MO.
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Shah VI, Upadhyay S, Shah K, Singh V. COVID-19 pandemic and total knee arthroplasty: the concept of a containment sheet-a frugal innovation. ARTHROPLASTY 2020; 2:23. [PMID: 34977464 PMCID: PMC7449786 DOI: 10.1186/s42836-020-00042-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The primary purpose of the present study was to assess whether use of proposed containment sheet (so called "a frugal innovation") minimizes the aerosol and splatter dispersion during total knee arthroplasty (TKA). MATERIAL AND METHOD A total of 32 patients with knee osteoarthritis who were scheduled to undergo primary and unilateral TKA reported during the COVID-19 pandemic were enrolled into this prospective single-institution cohort study. Demographic and epidemiological data, travel and contact history were collected. Eligible cohort was randomly assigned to a study (TKA using containment sheet) group and a control group (TKA without containment sheet). Radiological and functional outcomes before operation and at the final follow-up were assessed using Western Ontario and Mc-master Universities Osteoarthritis Index score (WOMAC) and the visual analog scale (VAS). The primary outcome was the postoperative effectiveness of containment sheet and face shield, defined as the numbers of countable macroscopic aerosols and/or splatters to naked eyes. The level of significance was set at p < 0.05 levels. RESULTS Present cohort was comprised of 14 men (43.75%) and 18 women (56.25%) with an average age of 65.45 ± 4.07 years (range, 62-75 years). There were no statistically significant differences with regard to baseline parameters and perioperative demographics. Functional outcomes for knee function at the last follow-up showed significant improvement in both the groups (p < 0.05). Face shield showed significant number of aerosols/splatters in control group. Highest number/concentration of aerosols/splatters was contained within the sheet. CONCLUSION The proposed containment sheet can minimize the dispersion of aerosols and splatters generated during TKA and provide a safe healthcare environment in a cost-effective manner.
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Affiliation(s)
- Vikram Indrajit Shah
- Department of Knee and Hip Arthroplasty, Shalby Hospitals, Ahmedabad, Gujarat India
| | - Sachin Upadhyay
- Department of Orthopaedics, NSCB Medical College, Jabalpur, MP India
- Department of Trauma and Knee and Hip Arthroplasty, Shalby Hospitals Jabalpur, Jabalpur, Madhya Pradesh India
| | - Kalpesh Shah
- Department of Knee and Hip Arthroplasty, Shalby Hospitals, Ahmedabad, Gujarat India
| | - Vipin Singh
- Department of Knee and Hip Arthroplasty, Shalby Hospitals, Ahmedabad, Gujarat India
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Lee JT, Gaertner WB. Workplace Exposures. Clin Colon Rectal Surg 2019; 32:435-441. [PMID: 31686995 DOI: 10.1055/s-0039-1693010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Workplace exposure in colorectal surgery is unique compared with other surgical specialties and generally underreported. Although the most common device-associated exposure in surgery is suture needle injury, colorectal surgeons are increasingly exposed to gastrointestinal-related infectious agents, radiation, and other hazards in multiple different clinical settings. Highlighting the unique workplace exposures in colorectal surgery may help increase awareness, improve education, and identify possible targets for early intervention in order to minimize these risks.
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Affiliation(s)
- Janet T Lee
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Wolfgang B Gaertner
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
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Moszkowicz D, Hobeika C, Collard M, Bruzzi M, Beghdadi N, Catry J, Duchalais E, Manceau G, Voron T, Lakkis Z, Allard MA, Cauchy F, Maggiori L. Operating room hygiene: Clinical practice recommendations. J Visc Surg 2019; 156:413-422. [DOI: 10.1016/j.jviscsurg.2019.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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[Infections after reconstructive spinal interventions : How do I deal with them?]. DER ORTHOPADE 2019; 47:288-295. [PMID: 29556679 DOI: 10.1007/s00132-018-3557-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BASICS Postoperative surgical site infections of the spine have been described in up to 20% of patients and can result in serious consequences for the patient and substantial treatment costs. Typical bacteria often arise from skin or fecal flora. Various risk factors for infection have been described, including obesity, diabetes, high ASA scores, as well as intraoperative factors such as heavy blood loss, dural tears, or several revision procedures. Consequently, the prophylaxis with pre- and postoperative risk minimization is of particular importance. TREATMENT When an infection has developed, it is important to carry out early operative revision involving tissue debridement, lavage and acquiring microbiological samples for culture. If the infection presents early, the instrumentation can often be retained. Adjuvant measures such as negative pressure wound treatment may improve the outcome. In late-onset infections, due to the biofilm production on the instrument surface or in cases of implant loosening, one should attempt to remove the instrumentation, and in cases of instability replace it. This article deals with the current literature on the subject and provides an overview of the data with regard to peri- and postoperative infections.
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Jain S, Rajfer RA, Melton-Kreft R, Nistico L, Miller MC, Stoodley P, Altman DT, Altman GT. Evaluation of bacterial presence on lead X-ray aprons utilised in the operating room via IBIS and standard culture methods. J Infect Prev 2019; 20:191-196. [PMID: 31428200 DOI: 10.1177/1757177419833163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 11/04/2018] [Indexed: 11/17/2022] Open
Abstract
Background Despite precautions, surgical procedures carry risk of infection. Radiation-protective lead aprons worn by operating personnel are a potential source of bacterial contamination and have not been fully evaluated. Aim/objective To evaluate lead aprons as a source of bacterial contamination, identify organisms most commonly found on this source, and devise a method with which to lower the risk of contamination. Methods In this basic science study, 20 randomly selected lead X-ray aprons were swabbed at three time points. The experimental treatment was with a hospital-grade disinfectant wipe. The samples were assessed for bacterial growth via traditional plating methods and mass spectrometry. Plates were graded on a scale of 0 to 4+ based on the number of quadrants with growth. Growth on one quadrant or more was considered contaminated. Findings/results Bacteria were initially detected via IBIS on a majority of the aprons (32/40), most commonly Staphylococcus epidermidis and Propionibacterium acnes. Virulent organisms cultured were Methicillin-resistant Staphylococcus epidermidis (MRSE), Neisseria, Streptococcus viridans and pseudomonas. MRSE were detected on 5/20 of the samples. Immediately after treatment, the majority of aprons showed less bacterial contamination (0/20 standard culture positive; 13/20 IBIS positive) with some recurrence at the 6-h time point (2/20 standard culture positive, 16/20 IBIS positive). All MRSE detected initially was eradicated. Discussion Lead X-ray aprons worn in the operating room harbour bacteria. Disinfecting before use may prevent the introduction of virulent organisms to patients. Our proposed method of sanitising with a disinfectant wipe is quick and effective.
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Affiliation(s)
- Sameer Jain
- Department of Orthopaedic Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | - Rebecca A Rajfer
- Department of Orthopaedic Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | - Rachel Melton-Kreft
- Center of Excellence in Biofilm Research, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | - Laura Nistico
- Center of Excellence in Biofilm Research, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | - Mark C Miller
- Biomechanics Laboratory, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | - Paul Stoodley
- Departments of Microbial Infection and Immunity and Orthopaedics, Infectious Diseases Institute, Ohio State University, Columbus, OH, USA.,National Centre for Advanced Tribology at Southampton (nCATS), Department of Mechanical Engineering, University of Southampton, Southampton, UK
| | - Daniel T Altman
- Department of Orthopaedic Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | - Gregory T Altman
- Department of Orthopaedic Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
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Alsaigh SY, Alasmari AA, Hakeem AH, Aloushan AF, Saleh FSB, Althubaiti A, Yousef Z. Gender differences in practicing standard precautions against blood-borne pathogens among surgeons at a tertiary care center: A cross-sectional study. Avicenna J Med 2019; 9:15-22. [PMID: 30697521 PMCID: PMC6335877 DOI: 10.4103/ajm.ajm_146_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Surgeons are at an increased risk of contracting blood-borne pathogens. The aim of this study was to evaluate gender difference, surgical position, surgical experience, and subspecialty regarding surgeons' compliance to standard precautions. METHODS A cross-sectional questionnaire-based study was performed using a purposive sampling. A total of 241 surgeons were surveyed from June 2017 to January 2018. RESULTS In total, 179 (74.3%) males and 62 (25.7%) females completed the questionnaire. The gender difference was evident when the type of surgery was extremely important in influencing the decision on wearing double gloves (DGs); 108 (60.3%) male surgeons versus 27 (43.5%) female surgeons (P = 0.022). Although a total of 17 (30.3%) surgeons reported being extremely and very concerned about contracting human immunodeficiency virus through their work, they had never tried DG (P = 0.027). CONCLUSION This study revealed that the decision of wearing DG was affected by several factors. Surgeons' decision to wear DG was influenced by the type of surgery. This study showed that most surgeons reported lack of adherence to barrier precaution measures.
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Affiliation(s)
- Shahad Yousef Alsaigh
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Amal Aboud Alasmari
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Anadel Hassan Hakeem
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Amairah Fahad Aloushan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Fatemah Saleh Bin Saleh
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Alaa Althubaiti
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Zeyad Yousef
- Department of Surgery, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
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Spina NT, Aleem IS, Nassr A, Lawrence BD. Surgical Site Infections in Spine Surgery: Preoperative Prevention Strategies to Minimize Risk. Global Spine J 2018; 8:31S-36S. [PMID: 30574435 PMCID: PMC6295818 DOI: 10.1177/2192568217752130] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
STUDY DESIGN Literature review. OBJECTIVES A review of the literature identifying preoperative risk factors for developing surgical site infections after spine surgery and discussion of the preventive strategies to minimize risks. METHODS A review of the literature and synthesis of the data to provide an updated review on the preoperative management of surgical site infection. RESULTS Preoperative prevention strategies of reducing surgical site infections in spine surgery remains a challenging problem. Careful mitigation of modifiable patient comorbidities, blood glucose control, smoking, obesity, and screening for pathologic microorganisms is paramount to reduce this risk. Individualized antibiotic regimens, skin preparation, and hand hygiene also play a critical role in surgical site infection prevention. CONCLUSIONS This review of the literature discusses the preoperative preventive strategies and risk management techniques of surgical site infections in spine surgery. Significant decreases in surgical site infections after spine surgery have been noted over the past decade due to increased awareness and implementation of the prevention strategies described in this article. However, it is important to recognize that prevention of surgical site infection requires a system-wide approach that includes the hospital system, the surgeon, and the patient. Continued efforts should focus on system-wide implementation programs including careful patient selection, individualized antibiotic treatment algorithms, identification of pathologic organisms, and preoperative decolonization programs to further prevent surgical site infections and optimize patient outcomes.
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Tubre DJ, Schroeder AD, Estes J, Eisenga J, Fitzgibbons RJ. Surgical site infection: the "Achilles Heel" of all types of abdominal wall hernia reconstruction. Hernia 2018; 22:1003-1013. [PMID: 30276561 DOI: 10.1007/s10029-018-1826-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/14/2018] [Indexed: 01/12/2023]
Abstract
PURPOSE Surgical site infection is the most common hospital-acquired infection in surgical patients. Recently, public health organizations have updated prevention guidelines. This review discusses surgical site infections as a complication of abdominal wall reconstruction. METHODS The authors reviewed guidelines on prevention of surgical site infections from the Center for Disease Control and Prevention, World Health Organization, and National Institute for Health and Care Excellence and put them into context with the relevant abdominal wall reconstruction literature. This was the subject of the Nyhus-Wantz lecture given at The International Hernia Congress on March 14, 2018 in Miami, FL and is summarized here. RESULTS Routine use of preoperative antibiotics in prosthetic groin hernia repair is not supported by the available literature. High-quality data on antibiotic prophylaxis in ventral (both primary and incisional) hernia repair is lacking, but it is widely utilized and may reduce SSIs. Recommended preventative strategies discussed in this manuscript include: treatment of remote site infections, perioperative normothermia and normoglycemia, avoidance of hypoxemia, antiseptic preparation of surgical team hands and patient skin, treatment of obesity, smoking cessation, correction of malnutrition, and physical conditioning. CONCLUSION Surgical site infections lead to significant morbidity and mortality, hernia recurrences, prolonged hospital stay, and increased hospital costs. This makes surgical site infections the "Achilles Heel" of abdominal wall reconstruction. Strict adherence to standardized guidelines and preoperative optimization of patients' risk profiles are crucial to decrease the incidence of surgical site infections.
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Affiliation(s)
- D J Tubre
- Department of Surgery, Creighton University Medical Center, Bergan Mercy, 7710 Mercy Road, Suite 501, Omaha, NE, 68124, USA
| | - A D Schroeder
- Department of Surgery, Creighton University Medical Center, Bergan Mercy, 7710 Mercy Road, Suite 501, Omaha, NE, 68124, USA
| | - J Estes
- Creighton University School of Medicine, 2500 California Plaza, Omaha, NE, 68178, USA
| | - J Eisenga
- Creighton University School of Medicine, 2500 California Plaza, Omaha, NE, 68178, USA
| | - R J Fitzgibbons
- Department of Surgery, Creighton University Medical Center, Bergan Mercy, 7710 Mercy Road, Suite 501, Omaha, NE, 68124, USA.
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Wistrand C, Söderquist B, Falk-Brynhildsen K, Nilsson U. Exploring bacterial growth and recolonization after preoperative hand disinfection and surgery between operating room nurses and non-health care workers: a pilot study. BMC Infect Dis 2018; 18:466. [PMID: 30223772 PMCID: PMC6142708 DOI: 10.1186/s12879-018-3375-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/05/2018] [Indexed: 12/01/2022] Open
Abstract
Background To prevent cross infection the surgical team perform preoperative hand disinfection before dressed in surgical gowns and gloves. Preoperative hand disinfection does not make hands sterile and the surgical glove cuff end has been regarded as a weak link, since it is not a liquid-proof interface. The aims were to investigate if there were differences in bacterial growth and recolonization of hands between operating room nurses and non-health care workers as well as to investigate if bacterial growth existed at the surgical glove cuff end during surgery. Methods This pilot project was conducted as an exploratory comparative clinical trial. Bacterial cultures were taken from the glove and gown interface and at three sites of the hands of 12 operating room nurses and 13 non-health care workers controls directly after preoperative hand disinfection and again after wearing surgical gloves and gowns. Colony forming units were analysed with Mann-Whitney U test and Wilcoxon Sign Ranks test comparing repeated measurements. Categorical variables were evaluated with chi-square test or Fisher’s exact test. Results Operating room nurses compared to non-health care workers had significant higher bacterial growth at two of three culture sites after surgical hand disinfection. Both groups had higher recolonization at one of the three culture sites after wearing surgical gloves. There were no differences between the groups in total colony forming units, that is, all sampling sites. Five out of 12 of the operating room nurses had bacterial growth at the glove cuff end and of those, four had the same bacteria at the glove cuff end as found in the cultures from the hands. Bacteria isolated from the glove cuff were P. acnes, S. warneri, S. epidermidis and Micrococcus species, the CFU/mL ranged from 10 to 40. Conclusions There were differences in bacterial growth and re-colonization between the groups but this was inconclusive. However, bacterial growth exists at the glove cuff and gown interface, further investigation in larger study is needed, to build on these promising, but preliminary, findings. Trial registration Trial registration was performed prospectively at Research web (FOU in Sweden, 117,971) 14/01/2013, and retrospectively at ClinicalTrials.gov (NCT02359708). 01/27/2015.
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Affiliation(s)
- Camilla Wistrand
- Department of Cardiothoracic Surgery and Vascular Surgery, University Hospital in Örebro, Örebro, Sweden. .,School of Health Sciences, Faculty of Medicine and Health, Örebro University, SE 701 82, Örebro, Sweden.
| | - Bo Söderquist
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, SE 701 82, Örebro, Sweden.,Departments of Laboratory Medicine, Clinical Microbiology, and Infectious diseases, Örebro University Hospital, 701 85, Örebro, Sweden
| | - Karin Falk-Brynhildsen
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, SE 701 82, Örebro, Sweden
| | - Ulrica Nilsson
- Division of Nursing,DepartmentofNeurobiology,Care Sciences,and Society,Karolinska Institute and Perioperative Medicine, Karolinska University Hospital, SE 14183, Stockholm, Sweden
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Itatsu K, Yokoyama Y, Sugawara G, Kamiya S, Terasaki M, Morioka A, Iyomasa S, Shirai K, Ando M, Nagino M. The Benefits of a Wound Protector in Preventing Incisional Surgical Site Infection in Elective Open Digestive Surgery: A Large-Scale Cohort Study. World J Surg 2018; 41:2715-2722. [PMID: 28608019 DOI: 10.1007/s00268-017-4082-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the benefits of wound protectors (WPs) in preventing incisional surgical site infection (I-SSI) in open elective digestive surgery using data from a large-scale, multi-institutional cohort study. METHODS Patients who had elective digestive surgery for malignant neoplasms between November 2009 and February 2011 were included. The protective value of WPs against I-SSI was evaluated. RESULTS A total of 3201 patients were analyzed. A WP was used in 1022 patients (32%). The incident rate of I-SSI (not including organ/space SSI) was 9%. In the univariate and the multivariate analyses for perioperative risk factors for I-SSI, the use of WP was an independent favorable factor that reduced the incidence of I-SSI (odds ratio 0.73, 95% confidence interval 0.55-0.98. P = 0.038). The subgroup forest plot analyses revealed that WP reduced the risk of I-SSI only in patients aged 74 years or younger, males, non-obese patients (body mass index <25 kg/m2), patients with an American Society of Anesthesiologists score of 1/2, patients with a previous history of laparotomy, non-smokers, and patients who underwent colon and rectum operations. In patients who underwent colorectal surgery, the postoperative hospital stay was significantly shorter in patients with WP than those without WP (median 13 vs. 15 days, P = 0.040). In terms of the depth of SSI, WP only prevented superficial I-SSI and did not reduce the incidence of deep I-SSI. CONCLUSIONS WP is a useful device for preventing superficial I-SSI in open elective digestive surgery. TRIAL REGISTRATION NUMBER UMIN000004723.
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Affiliation(s)
- Keita Itatsu
- The Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.,Department of Surgery, Kamiiida Daiichi General Hospital, Nagoya, Japan
| | - Yukihiro Yokoyama
- The Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Gen Sugawara
- The Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Satoaki Kamiya
- Department of Surgery, Tsushima Municipal Hospital, Tsushima, Japan
| | - Masaki Terasaki
- Department of Surgery, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Atsushi Morioka
- Department of Surgery, Kumiai Kosei Hospital, Takayama, Japan
| | | | - Kazuhisa Shirai
- Department of Surgery, Yamashita Hospital, Ichinomiya, Japan
| | - Masahiko Ando
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Masato Nagino
- The Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
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The Effect of Operating Room Temperature on the Performance of Clinical and Cognitive Tasks. Pediatr Qual Saf 2018; 3:e069. [PMID: 30280125 PMCID: PMC6132757 DOI: 10.1097/pq9.0000000000000069] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 02/12/2018] [Indexed: 12/26/2022] Open
Abstract
Introduction: Operating room (OR) temperature may impact the performance of health care providers. This study assesses whether hot or cold room temperature diminishes the performance of OR personnel measured by psychomotor vigilance testing (PVT) and self-report scales. Methods: This prospective observational study enrolled surgical/anesthesia trainees, student registered nurse anesthetists, and certified registered nurse anesthetists. Each provider participated in a test of psychomotor function and a questionnaire using a self-report scale of personal comfort and well-being. The PVT and questionnaires were completed after 30 minutes of exposure to 3 different conditions (temperature of 21°C, 23°C, and 26°C). Results: The cohort of 22 personnel included 9 certified registered nurse anesthetists, 7 anesthesia/surgical trainees, and 6 student registered nurse anesthetists. Mean reaction time on the PVT was comparable among baseline (280 ± 47 ms), hot (286 ± 55 ms; P = 0.171), and cold (303 ± 114 ms; P = 0.378) conditions. On the self-report score (range, 1–21), there was no difference in the self-rated subjective performance between baseline and cold conditions. However, the self-rated subjective performance scale was lower (12 ± 6, P = 0.003) during hot conditions. Discussion: No difference was noted in reaction time depending on the temperature; however, excessive heat in the OR environment was associated with worse self-rated subjective performance among health care providers. Particularly, self-rated subjective physical demand and frustration were greater under hot condition.
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Liu Z, Dumville JC, Norman G, Westby MJ, Blazeby J, McFarlane E, Welton NJ, O'Connor L, Cawthorne J, George RP, Crosbie EJ, Rithalia AD, Cheng H. Intraoperative interventions for preventing surgical site infection: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2018; 2:CD012653. [PMID: 29406579 PMCID: PMC6491077 DOI: 10.1002/14651858.cd012653.pub2] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Surgical site infection (SSI) rates vary from 1% to 5% in the month following surgery. Due to the large number of surgical procedures conducted annually, the costs of these SSIs can be considerable in financial and social terms. Many interventions are used with the aim of reducing the risk of SSI in people undergoing surgery. These interventions can be broadly delivered at three stages: preoperatively, intraoperatively and postoperatively. The intraoperative interventions are largely focused on decontamination of skin using soap and antiseptics; the use of barriers to prevent movement of micro-organisms into incisions; and optimising the patient's own bodily functions to promote best recovery. Both decontamination and barrier methods can be aimed at people undergoing surgery and operating staff. Other interventions focused on SSI prevention may be aimed at the surgical environment and include methods of theatre cleansing and approaches to managing theatre traffic. OBJECTIVES To present an overview of Cochrane Reviews of the effectiveness and safety of interventions, delivered during the intraoperative period, aimed at preventing SSIs in all populations undergoing surgery in an operating theatre. METHODS Published Cochrane systematic reviews reporting the effectiveness of interventions delivered during the intraoperative period in terms of SSI prevention were eligible for inclusion in this overview. We also identified Cochrane protocols and title registrations for future inclusion into the overview. We searched the Cochrane Library on 01 July 2017. Two review authors independently screened search results and undertook data extraction and 'Risk of bias' and certainty assessment. We used the ROBIS (risk of bias in systematic reviews) tool to assess the quality of included reviews, and we used GRADE methods to assess the certainty of the evidence for each outcome. We summarised the characteristics of included reviews in the text and in additional tables. MAIN RESULTS We included 32 Cochrane Reviews in this overview: we judged 30 reviews as being at low risk of bias and two at unclear risk of bias. Thirteen reviews had not been updated in the past three years. Two reviews had no relevant data to extract. We extracted data from 30 reviews with 349 included trials, totaling 73,053 participants. Interventions assessed included gloving, use of disposable face masks, patient oxygenation protocols, use of skin antiseptics for hand washing and patient skin preparation, vaginal preparation, microbial sealants, methods of surgical incision, antibiotic prophylaxis and methods of skin closure. Overall, the GRADE certainty of evidence for outcomes was low or very low. Of the 77 comparisons providing evidence for the outcome of SSI, seven provided high- or moderate-certainty evidence, 39 provided low-certainty evidence and 31 very low-certainty evidence. Of the nine comparisons that provided evidence for the outcome of mortality, five provided low-certainty evidence and four very low-certainty evidence.There is high- or moderate-certainty evidence for the following outcomes for these intraoperative interventions. (1) Prophylactic intravenous antibiotics administered before caesarean incision reduce SSI risk compared with administration after cord clamping (10 trials, 5041 participants; risk ratio (RR) 0.59, 95% confidence interval (CI) 0.44 to 0.81; high-certainty evidence - assessed by review authors). (2) Preoperative antibiotics reduce SSI risk compared with placebo after breast cancer surgery (6 trials, 1708 participants; RR 0.74, 95% CI 0.56 to 0.98; high-certainty evidence - assessed by overview authors). (3) Antibiotic prophylaxis probably reduce SSI risk in caesarean sections compared with no antibiotics (82 relevant trials, 14,407 participants; RR 0.40, 95% CI 0.35 to 0.46; moderate-certainty evidence; downgraded once for risk of bias - assessed by review authors). (4) Antibiotic prophylaxis probably reduces SSI risk for hernia repair compared with placebo or no treatment (17 trials, 7843 participants; RR 0.67, 95% CI 0.54 to 0.84; moderate-certainty evidence; downgraded once for risk of bias - assessed by overview authors); (5) There is currently no clear difference in the risk of SSI between iodine-impregnated adhesive drapes compared with no adhesive drapes (2 trials, 1113 participants; RR 1.03, 95% CI 0.66 to 1.60; moderate-certainty evidence; downgraded once for imprecision - assessed by review authors); (6) There is currently no clear difference in SSI risk between short-term compared with long-term duration antibiotics in colorectal surgery (7 trials; 1484 participants; RR 1.05 95% CI 0.78 to 1.40; moderate-certainty evidence; downgraded once for imprecision - assessed by overview authors). There was only one comparison showing negative effects associated with the intervention: adhesive drapes increase the risk of SSI compared with no drapes (5 trials; 3082 participants; RR 1.23, 95% CI 1.02 to 1.48; high-certainty evidence - rated by review authors). AUTHORS' CONCLUSIONS This overview provides the most up-to-date evidence on use of intraoperative treatments for the prevention of SSIs from all currently published Cochrane Reviews. There is evidence that some interventions are useful in reducing SSI risk for people undergoing surgery, such as antibiotic prophylaxis for caesarean section and hernia repair, and also the timing of prophylactic intravenous antibiotics administered before caesarean incision. Also, there is evidence that adhesive drapes increase SSI risk. Evidence for the many other treatment choices is largely of low or very low certainty and no quality-of-life or cost-effectiveness data were reported. Future trials should elucidate the relative effects of some treatments. These studies should focus on increasing participant numbers, using robust methodology and being of sufficient duration to adequately assess SSI. Assessment of other outcomes such as mortality might also be investigated as part of non-experimental prospective follow-up of people with SSI of different severity, so the risk of death for different subgroups can be better understood.
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Affiliation(s)
- Zhenmi Liu
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Jo C Dumville
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Gill Norman
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Maggie J Westby
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Jane Blazeby
- University of BristolNIHR Bristol Biomedical Research Centre, School of Social and Community Medicine, Bristol Medical SchoolBristolUK
| | - Emma McFarlane
- National Institute for Health and Care ExcellenceCentre for GuidelinesLevel 1A, City TowerPiccadilly PlazaManchesterUKM1 4BD
| | - Nicky J Welton
- University of BristolNIHR Bristol Biomedical Research Centre, School of Social and Community Medicine, Bristol Medical SchoolBristolUK
| | - Louise O'Connor
- Central Manchester University Hospitals NHS Foundation TrustInfection Prevention and Control / Tissue Viability TeamCobbett HouseOxford RoadManchesterUKM13 9WL
| | - Julie Cawthorne
- Central Manchester University Hospitals NHS Foundation TrustInfection Prevention and Control / Tissue Viability TeamCobbett HouseOxford RoadManchesterUKM13 9WL
| | - Ryan P George
- Central Manchester University Hospitals NHS Foundation TrustInfection Prevention and Control / Tissue Viability TeamCobbett HouseOxford RoadManchesterUKM13 9WL
| | - Emma J Crosbie
- Faculty of Biology, Medicine and Health, University of ManchesterDivision of Cancer Sciences5th Floor ‐ ResearchSt Mary's HospitalManchesterUKM13 9WL
| | - Amber D Rithalia
- Independent Researcher7 Victoria Terrace, KirkstallLeedsUKLS5 3HX
| | - Hung‐Yuan Cheng
- University of BristolBristol Centre for Surgical Research, Bristol Medical SchoolOffice 2.01Canynge Hall, 39 Whatley RoadBristolUKBS8 2PS
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Kozon I, Riahi S, Lundbye-Christensen S, Thøgersen AM, Ejlertsen T, Aaen D, Paulsen KI, Hjortshøj S. Risk factors of cardiac device infection: Glove contamination during device procedures. Am J Infect Control 2017; 45:866-871. [PMID: 28526307 DOI: 10.1016/j.ajic.2017.03.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 03/19/2017] [Accepted: 03/20/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Infections in cardiac implantable electronic devices (CIEDs) constitute a serious complication. We sought to identify contamination of gloves before handling the device in primary and replacement CIED procedures. METHODS Two groups of 30 patients underwent primary CIED implantation or replacement. Before the device entered the surgical field, surgeon and assistant imprinted their outer gloves on aerobe and anaerobe agar plates, and a wound swab was performed. Samples were cultured, and the presence of bacteria was identified, counted as the number of colony forming units, and characterized to the level of genus and species. RESULTS Samples from 40 (67%) procedures revealed bacteria on surgeons' or assistants' gloves. Contamination occurred in 80% of replacements and 67% of primary implantations (risk difference, 13%; 95% confidence interval [CI], -8.8 to 35.5). Contamination of surgeons' and assistants' gloves occurred in 55% and 44% of procedures, respectively. Coagulase-negative Staphylococcus (CNS) occurred in 52%, and Propionibacterium spp (PS) occurred in 84% of positive cases. For every 15 minutes of procedure time, colony levels increased by 7.4% (95% CI, 1.4%-13.4%). CONCLUSIONS Contamination of gloves is common during CIED procedures before handling the device. Therefore, devices are often handled with contaminated gloves. The most prevalent bacteria were PS and CNS, which are associated with clinical CIED infections. Changing outer gloves before handling the device might improve sterile state and lower infection risk.
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Affiliation(s)
- Isabella Kozon
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | | | - Tove Ejlertsen
- Department of Microbiology, Aalborg University Hospital, Aalborg, Denmark
| | - Dorthe Aaen
- Department of Microbiology, Aalborg University Hospital, Aalborg, Denmark
| | - Kirsten I Paulsen
- Department of Microbiology, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Hjortshøj
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
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Bekele A, Makonnen N, Tesfaye L, Taye M. Incidence and patterns of surgical glove perforations: experience from Addis Ababa, Ethiopia. BMC Surg 2017; 17:26. [PMID: 28320370 PMCID: PMC5359816 DOI: 10.1186/s12893-017-0228-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 03/16/2017] [Indexed: 11/17/2022] Open
Abstract
Background Surgical glove perforation is a common event. The operating staff is not aware of the perforation until the procedure is complete, sometimes in as high as 70% of the incidences. Data from Ethiopia indicates that the surgical workforce suffers from a very surgery related accidents, however there is paucity of data regarding surgical glove perforation. The main objective is to describe the incidence and patterns of surgical glove perforation during surgical procedures and to compare the rates between emergency and elective surgeries at one of the main hospitals in Addis Ababa Ethiopia. Methods This is a prospective study, performed at the Minilik II referral hospital, Addis Ababa. All surgical gloves worn during all major surgical procedures (Emergency and Elective) from June 1-July 20, 2016 were collected and used for the study. Standardised visual and hydro insufflation techniques were used to test the gloves for perforations. Parameters recorded included type of procedure performed, number of perforations, localisation of perforation and the roles of the surgical team. Results A total of 2634 gloves were tested, 1588 from elective and 1026 from emergency procedures. The total rate of perforation in emergency procedures was 41.4%, while perforation in elective surgeries was 30.0%. A statistically significant difference (P < 0.05) was found in between emergency and elective surgeries. There were a very high rate of perforations of gloves among first surgeons 40.6% and scrub nurses 38.8% during elective procedures and among first surgeons (60.14%), and second assistants (53.0%) during emergency surgeries. Only 0.4% of inner gloves were perforated. The left hand, the left index finger and thumb were the most commonly perforated parts of the glove. Glove perforation rate was low among consultant surgeons than residents. Conclusions Our reported perforation rate is higher than most publications, and this shows that the surgical workforce in Ethiopia is under a clear and present threat. Measures such as double gloving seems to have effectively prevented cutaneous blood exposure and thus should become a routine for all surgical procedures. Manufacturing related defects and faults in glove quality may also be contributing factors.
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Affiliation(s)
- Abebe Bekele
- School of Medicine, Addis Ababa University, PO BOX 3560, Addis Ababa, Ethiopia.
| | | | - Lidya Tesfaye
- School of Medicine, Addis Ababa University, PO BOX 3560, Addis Ababa, Ethiopia
| | - Mulat Taye
- School of Medicine, Addis Ababa University, PO BOX 3560, Addis Ababa, Ethiopia
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Ratto N, Arrigoni C, Rosso F, Bruzzone M, Dettoni F, Bonasia DE, Rossi R. Total knee arthroplasty and infection: how surgeons can reduce the risks. EFORT Open Rev 2017; 1:339-344. [PMID: 28461965 PMCID: PMC5367521 DOI: 10.1302/2058-5241.1.000032] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Total joint arthroplasty (TJA) is one of the most common orthopaedic procedures. Nevertheless, several complications can lead to implant failure. Peri-prosthetic joint infections (PJI) certainly represent a significant challenge in TJA, constituting a major cause of prosthetic revision. The surgeon may have an important role in reducing the PJI rate by limiting the impact of significant risk factors associated to either the patient, the operative environment or the post-operative care. In the pre-operative period, several preventive measures may be adopted to manage reversible medical comorbidities. Other recognised pre-operative risk factors are urinary tract infections, intra-articular corticosteroid injections and nasal colonisation with Staphylococcus (S.) aureus, particularly the methicillin-resistant strain (MRSA). In the intra-operative setting, protective measures for PJI include antibiotic prophylaxis, surgical-site antisepsis and use of pre-admission chlorhexidine washing and pulsed lavage during surgery. In this setting, the use of plastic adhesive drapes and sterile stockinette, as well as using personal protection systems, do not clearly reduce the risk of infection. On the contrary, using sterile theatre light handles and splash basins as well as an increased traffic in the operating room are all associated with an increased risk for PJI. In the post-operative period, other infections causing transient bacteraemia, blood transfusion and poor wound care are considered as risk factors for PJI.
Cite this article: Ratto N, Arrigoni C, Rosso F, Bruzzone M, Dettoni F, Bonasia DE, Rossi R. Total knee arthroplasty and infection: how surgeons can reduce the risks. EFORT Open Rev 2016;1: 339-344 DOI: 10.1302/2058-5241.1.000032.
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Affiliation(s)
| | | | - Federica Rosso
- AO Mauriziano Umberto I, Department of Orthopedics and Traumatology, Torino, Italy
| | - Matteo Bruzzone
- AO Mauriziano Umberto I, Department of Orthopedics and Traumatology, Torino, Italy
| | - Federico Dettoni
- AO Mauriziano Umberto I, Department of Orthopedics and Traumatology, Torino, Italy
| | | | - Roberto Rossi
- AO Mauriziano Umberto I, Department of Orthopedics and Traumatology, Torino, Italy
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Sprowson AP, Jensen C, Chambers S, Parsons NR, Aradhyula NM, Carluke I, Inman D, Reed MR. The use of high-dose dual-impregnated antibiotic-laden cement with hemiarthroplasty for the treatment of a fracture of the hip: The Fractured Hip Infection trial. Bone Joint J 2017; 98-B:1534-1541. [PMID: 27803231 PMCID: PMC5102031 DOI: 10.1302/0301-620x.98b11.34693] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 07/06/2016] [Indexed: 12/27/2022]
Abstract
Aims A fracture of the hip is the most common serious orthopaedic
injury, and surgical site infection (SSI) is one of the most significant
complications, resulting in increased mortality, prolonged hospital
stay and often the need for further surgery. Our aim was to determine
whether high dose dual antibiotic impregnated bone cement decreases the
rate of infection. Patients and Methods A quasi-randomised study of 848 patients with an intracapsular
fracture of the hip was conducted in one large teaching hospital
on two sites. All were treated with a hemiarthroplasty. A total
of 448 patients received low dose single-antibiotic impregnated
cement (control group) and 400 patients received high dose dual-antibiotic impregnated
cement (intervention group). The primary outcome measure was deep
SSI at one year after surgery. Results The rate of deep SSI was 3.5% in the control group and 1.1% in
the intervention group
(p = 0.041; logistic regression adjusting for age and gender). The
overall rate of non-infective surgical complications did not differ
between the two groups (unadjusted chi-squared test; p > 0.999). Conclusion The use of high dose dual-antibiotic impregnated cement in these
patients significantly reduces the rate of SSI compared with standard
low dose single antibiotic loaded bone cement. Cite this article: Bone Joint J 2016;98-B:1534–1541.
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Affiliation(s)
| | - C Jensen
- Northumbria Healthcare NHS Foundation Trust, Wansbeck General Hospital, Woodhorn Lane, Ashington, NE63 9JJ, UK
| | - S Chambers
- Northern Deanery Training Programme, Waterfront 4, Goldcrest Way, Newburn Riverside, Newcastle-upon-Tyne, NE15 8NY, UK
| | - N R Parsons
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - N M Aradhyula
- Northumbria Healthcare NHS Foundation Trust, Wansbeck General Hospital, Woodhorn Lane, Ashington, NE63 9JJ, UK
| | - I Carluke
- Northumbria Healthcare NHS Foundation Trust, Wansbeck General Hospital, Woodhorn Lane, Ashington, NE63 9JJ, UK
| | - D Inman
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, North Shields, NE29 8NH, UK
| | - M R Reed
- Northumbria Healthcare NHS Foundation Trust, Wansbeck General Hospital, Woodhorn Lane, Ashington, NE63 9JJ, UK
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Kumar D, Shantanu K, Kumar M, Kumar A, Sharma V. A Cross-sectional Analysis of Glove Perforation in Primary and Revision Total Hip Arthroplasty. Malays Orthop J 2016; 10:31-35. [PMID: 28553445 PMCID: PMC5333681 DOI: 10.5704/moj.1611.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The number of total hip arthroplasties is ever increasing. Literature about glove perforation rates in arthroplasties in India is very scarce. The purpose of our study was to determine the incidence of glove perforation and increasing the awareness of possible glove perforations to decrease the risk of infection. We performed a prospective study in which we tested gloves worn by all scrubbed personnel. A total of 1408 gloves were collected from 42 primary total hip and 13 revision total hip arthroplasties. Incidence of glove perforation was found to be more in revision total hip arthroplasty. We found a greater outer glove perforation rate of about 38.33% as compared to 25 % inner glove perforation rate. Outer glove perforation was recognized 100% of time intraoperatively but inner glove perforation was noted only 17% of time. First assistant recorded highest rate of glove perforation.
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Affiliation(s)
- D Kumar
- Department of Orthopaedics, King George's Medical University, Lucknow, India
| | - K Shantanu
- Department of Orthopaedics, King George's Medical University, Lucknow, India
| | - M Kumar
- Department of Orthopaedics, King George's Medical University, Lucknow, India
| | - A Kumar
- Department of Orthopaedics, King George's Medical University, Lucknow, India
| | - V Sharma
- Department of Orthopaedics, King George's Medical University, Lucknow, India
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High Risk of Surgical Glove Perforation From Surgical Rotatory Instruments. Clin Orthop Relat Res 2016; 474:2513-2517. [PMID: 27339122 PMCID: PMC5052191 DOI: 10.1007/s11999-016-4948-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 06/14/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgical gloves can be damaged during the course of a procedure, which can place the surgeon and patient at risk. Glove perforation may not always be readily apparent, and determining the risk factors for glove perforation can aid the surgeon in deciding when a glove change is advisable. Time of wear and needle sticks have been well studied; however, other mechanisms including mechanical stress from surgical equipment have had limited evaluation to date. QUESTIONS/PURPOSES We evaluated the risk of glove perforation in gloves that were caught in a surgical rotatory device (such as drills and reamers). The aims of our study were (1) to determine the percentage of undetected microperforations after entanglement on a rotatory tool during orthopaedic procedures, (2) to determine which kinds of rotatory devices most commonly cause such microperforations, and (3) to assess whether time of wear had an effect on the risk of perforation. METHODS From July 2014 to September 2015, 33 gloves were obtained from all orthopaedic subspecialties at our Level I trauma center if they were caught in a rotatory device greater than one revolution. Time of glove wear and location of the glove that was caught in a rotatory device were recorded. After an evaluation for macroperforations (≥ 5 mm), the gloves were evaluated for microperforations (< 5 mm) via the American Society for Testing and Materials (ASTM) one-liter load test. Time of wear was compared among gloves with macroperforations, microperforations, and no perforations. RESULTS The 33 gloves obtained came from 33 procedures. Seventeen of 33 (52 %) gloves had perforations. Seven of the 17 perforated gloves had macroperforations while 10 had microperforations. Eleven of 33 entanglements were caught by drills, nine by reamers, eight by K-wires, and the remaining five gloves were caught by various other instruments. Eight of 17 perforations were caused by drills, three by reamers, three by K-wires, and three by various other instruments. The average time of wear was 58 minutes which did not differ with pattern of glove damage. CONCLUSION Surgical gloves caught in a rotatory power instrument are likely to have been perforated, regardless of the amount of time that they had been worn. Visual inspection appears to be an inadequate test of glove integrity. When a glove becomes entangled in a rotary instrument such as a drill, pin, or reamer, a surgeon should change the gloves regardless of whether he or she believes a perforation is present. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Meakin LB, Gilman OP, Parsons KJ, Burton NJ, Langley-Hobbs SJ. Colored Indicator Undergloves Increase the Detection of Glove Perforations by Surgeons During Small Animal Orthopedic Surgery: A Randomized Controlled Trial. Vet Surg 2016; 45:709-14. [PMID: 27412490 PMCID: PMC4973670 DOI: 10.1111/vsu.12519] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 04/22/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether use of colored indicator gloves affects perforation detection rate and to identify risk factors for glove perforation during veterinary orthopedic surgery. STUDY DESIGN Prospective randomized controlled trial. SAMPLE POPULATION 574 double pairs of gloves worn during 300 orthopedic surgical procedures (2,296 gloves). METHODS Primary and assistant surgeons double-gloved for all orthopedic surgical procedures. Type of inner glove (standard or colored indicator) was randomized for the first 360 double pairs of gloves worn by surgeons during 180 procedures. Perforations detected by surgeons were recorded and gloves changed if requested. For a further 120 procedures, indicator gloves were used exclusively. All gloves were leak-tested after surgery to identify perforations. Association between potential risk factors and perforation was explored using multivariate logistical regression analysis. RESULTS Glove perforations occurred during 43% of surgeries with a mean of 2.3 holes/surgery. Inner gloves were intact in 63% of glove pairs where an outer perforation occurred. Intraoperative perforation detection was improved when colored indicator gloves were worn (83% sensitivity) vs. standard gloves (34% sensitivity; P<.001). Independent risk factors for perforation were placement of plates and/or screws (P=.001; OR=2.4; 95% CI, 1.4-4.0), placement of an external skeletal fixator (P=.002; OR=7.0; 95% CI, 2.1-23.8), use of orthopedic wire (P=.011; OR=2.4; 95% CI, 1.2-4.7), and primary surgeon being board-certified (P=.016; OR=1.9; 95% CI, 1.1-3.1). CONCLUSION Increased surgeon recognition of glove perforations through use of colored indicator gloves enables prompt change of gloves if perforation occurs and may reduce potential contamination of the surgical site.
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Affiliation(s)
- Lee B Meakin
- School of Veterinary Science, University of Bristol, Bristol, United Kingdom
| | - Oliver P Gilman
- School of Veterinary Science, University of Bristol, Bristol, United Kingdom
| | - Kevin J Parsons
- School of Veterinary Science, University of Bristol, Bristol, United Kingdom
| | - Neil J Burton
- School of Veterinary Science, University of Bristol, Bristol, United Kingdom
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Provenzano DA, Deer T, Luginbuhl Phelps A, Drennen ZC, Thomson S, Hayek SM, Narouze S, Rana MV, Watson TW, Buvanendran A. An International Survey to Understand Infection Control Practices for Spinal Cord Stimulation. Neuromodulation 2015; 19:71-84. [DOI: 10.1111/ner.12356] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 08/08/2015] [Accepted: 09/01/2015] [Indexed: 11/28/2022]
Affiliation(s)
| | - Timothy Deer
- The Center for Pain Relief, Inc.; Charleston WV USA
| | - Amy Luginbuhl Phelps
- Economic and Finance Department at the AJ Palumbo Donahue School of Business; Duquesne University; Pittsburgh PA USA
| | | | - Simon Thomson
- Basildon and Thurrock University Hospitals; Grays Essex UK
| | - Salim M. Hayek
- University Hospitals Case Medical Center; Cleveland OH USA
| | - Samer Narouze
- Center for Pain Medicine at Western Reserve Hospital; Cuyahoga Falls OH USA
| | - Maunak V. Rana
- Advocate Illinois Masonic Medical Center; Chicago IL USA
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López‐Alcalde J, Mateos‐Mazón M, Guevara M, Conterno LO, Solà I, Cabir Nunes S, Bonfill Cosp X. Gloves, gowns and masks for reducing the transmission of meticillin-resistant Staphylococcus aureus (MRSA) in the hospital setting. Cochrane Database Syst Rev 2015; 2015:CD007087. [PMID: 26184396 PMCID: PMC7026606 DOI: 10.1002/14651858.cd007087.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Meticillin-resistant Staphylococcus aureus (MRSA; also known as methicillin-resistant S aureus) is a common hospital-acquired pathogen that increases morbidity, mortality, and healthcare costs. Its control continues to be an unresolved issue in many hospitals worldwide. The evidence base for the effects of the use of gloves, gowns or masks as control measures for MRSA is unclear. OBJECTIVES To assess the effectiveness of wearing gloves, a gown or a mask when contact is anticipated with a hospitalised patient colonised or infected with MRSA, or with the patient's immediate environment. SEARCH METHODS We searched the Specialised Registers of three Cochrane Groups (Wounds Group on 5 June 2015; Effective Practice and Organisation of Care (EPOC) Group on 9 July 2013; and Infectious Diseases Group on 5 January 2009); CENTRAL (The Cochrane Library 2015, Issue 6); DARE, HTA, NHS EED, and the Methodology Register (The Cochrane Library 2015, Issue 6); MEDLINE and MEDLINE In-Process & Other Non-Indexed Citations (1946 to June week 1 2015); EMBASE (1974 to 4 June 2015); Web of Science (WOS) Core Collection (from inception to 7 June 2015); CINAHL (1982 to 5 June 2015); British Nursing Index (1985 to 6 July 2010); and ProQuest Dissertations & Theses Database (1639 to 11 June 2015). We also searched three trials registers (on 6 June 2015), references list of articles, and conference proceedings. We finally contacted relevant individuals for additional studies. SELECTION CRITERIA Studies assessing the effects on MRSA transmission of the use of gloves, gowns or masks by any person in the hospital setting when contact is anticipated with a hospitalised patient colonised or infected with MRSA, or with the patient's immediate environment. We did not assess adverse effects or economic issues associated with these interventions.We considered any comparator to be eligible. With regard to study design, only randomised controlled trials (clustered or not) and the following non-randomised experimental studies were eligible: quasi-randomised controlled trials (clustered or not), non-randomised controlled trials (clustered or not), controlled before-and-after studies, controlled cohort before-after studies, interrupted time series studies (controlled or not), and repeated measures studies. We did not exclude any study on the basis of language or date of publication. DATA COLLECTION AND ANALYSIS Two review authors independently decided on eligibility of the studies. Had any study having been included, two review authors would have extracted data (at least for outcome data) and assessed the risk of bias independently. We would have followed the standard methodological procedures suggested by Cochrane and the Cochrane EPOC Group for assessing risk of bias and analysing the data. MAIN RESULTS We identified no eligible studies for this review, either completed or ongoing. AUTHORS' CONCLUSIONS We found no studies assessing the effects of wearing gloves, gowns or masks for contact with MRSA hospitalised patients, or with their immediate environment, on the transmission of MRSA to patients, hospital staff, patients' caregivers or visitors. This absence of evidence should not be interpreted as evidence of no effect for these interventions. The effects of gloves, gowns and masks in these circumstances have yet to be determined by rigorous experimental studies, such as cluster-randomised trials involving multiple wards or hospitals, or interrupted time series studies.
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Affiliation(s)
- Jesús López‐Alcalde
- CIBER Epidemiología y Salud Pública (CIBERESP) ‐ Universitat Autònoma de BarcelonaIberoamerican Cochrane Centre ‐ Biomedical Research Institute Sant Pau (IIB Sant Pau)BarcelonaCatalunyaSpain08041
| | - Marta Mateos‐Mazón
- University Hospital Central de AsturiasDepartment of Preventive MedicineAvenida de Roma s/nOviedoOviedoSpain33006
| | - Marcela Guevara
- Public Health Institute of Navarre, CIBER Epidemiología y Salud Pública (CIBERESP), IdiSNAC/ Leyre 15PamplonaNavarreSpainE‐31003
| | - Lucieni O Conterno
- Marilia Medical SchoolDepartment of General Internal Medicine and Clinical Epidemiology UnitAvenida Monte Carmelo 800FragataMariliaSão PauloBrazil17519‐030
| | - Ivan Solà
- CIBER Epidemiología y Salud Pública (CIBERESP) ‐ Universitat Autònoma de BarcelonaIberoamerican Cochrane Centre ‐ Biomedical Research Institute Sant Pau (IIB Sant Pau)BarcelonaCatalunyaSpain08041
| | | | - Xavier Bonfill Cosp
- CIBER Epidemiología y Salud Pública (CIBERESP) ‐ Universitat Autònoma de BarcelonaIberoamerican Cochrane Centre ‐ Biomedical Research Institute Sant Pau (IIB Sant Pau)BarcelonaCatalunyaSpain08041
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Verwilghen D, Singh A. Fighting surgical site infections in small animals: are we getting anywhere? Vet Clin North Am Small Anim Pract 2014; 45:243-76, v. [PMID: 25542615 DOI: 10.1016/j.cvsm.2014.11.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A diverse array of pathogen-related, patient-related, and caretaker-related issues influence risk and prevention of surgical site infections (SSIs). The entire surgical team involved in health care settings in which surgical procedures are performed play a pivotal role in the prevention of SSIs. In this article, current knowledge of SSI risk factors and prevention methods is reviewed. Although new avenues that can be explored in the prevention of SSIs in veterinary medicine are described, the main conclusion drawn is that the best method for prevention of SSI is to adhere to what we already know.
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Affiliation(s)
- Denis Verwilghen
- Department of Large Animal Sciences, University of Copenhagen, Hojbakkegaerd Allé 5, Taatsrup 2630, Denmark.
| | - Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada
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Makki D, Deierl K, Pandit A, Trakru S. A prospective study on the risk of glove fingertip contamination during draping in joint replacement surgery. Ann R Coll Surg Engl 2014; 96:434-6. [PMID: 25198974 DOI: 10.1308/003588414x13946184902046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of this prospective study was to investigate the risk of contamination of surgical gloves during preparation and draping in joint replacement surgery. METHODS During 46 hip and knee replacement procedures, the gloves of orthopaedic consultants (n=5) and registrars (n=3) were assessed for contamination immediately after draping by impression of gloved fingers on blood agar. Contamination was evaluated by the surgeon's grade, the type of procedure, the role of the assistant and the dominance of the hand. RESULTS A total of 125 pairs of top gloves were examined (79 pairs from registrars and 46 pairs from consultants). Bacterial contamination was isolated on 19 pairs (15.2%) (16 pairs from registrars and 3 pairs from consultants, p=0.04). Coagulase negative staphylococci were the main isolates and contamination was considered low in all cases (1-5 colonies). Contamination was seen more on the dominant hand (16 gloves from dominant hands and 6 from non-dominant hands, p=0.04), on the index finger and thumb. More contaminated gloves were seen in hip arthroplasty procedures (16 pairs from total hip replacements vs 3 pairs from total knee replacements, p=0.02). CONCLUSIONS Contamination of glove fingertips during draping in joint replacement procedures is more likely to occur among junior surgeons, in hip rather than knee arthroplasty procedures and on the dominant hand. It is therefore essential that surgeons of different grades replace gloves used in draping to avoid exposing patients to the risk of infection.
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Affiliation(s)
- D Makki
- North Middlesex University Hospital NHS Trust, UK
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Hayes GM, Reynolds D, Moens NM, Singh A, Oblak M, Gibson TW, Brisson BA, Nazarali A, Dewey C. Investigation of Incidence and Risk Factors for Surgical Glove Perforation in Small Animal Surgery. Vet Surg 2014; 43:400-4. [DOI: 10.1111/j.1532-950x.2014.12159.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 03/30/2012] [Indexed: 10/25/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Cate Dewey
- University of Guelph; Guelph Ontario Canada
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Mischke C, Verbeek JH, Saarto A, Lavoie M, Pahwa M, Ijaz S. Gloves, extra gloves or special types of gloves for preventing percutaneous exposure injuries in healthcare personnel. Cochrane Database Syst Rev 2014; 2014:CD009573. [PMID: 24610769 PMCID: PMC10766138 DOI: 10.1002/14651858.cd009573.pub2] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Healthcare workers are at risk of acquiring viral diseases such as hepatitis B, hepatitis C and HIV through exposure to contaminated blood and body fluids at work. Most often infection occurs when a healthcare worker inadvertently punctures the skin of their hand with a sharp implement that has been used in the treatment of an infected patient, thus bringing the patient's blood into contact with their own. Such occurrences are commonly known as percutaneous exposure incidents. OBJECTIVES To determine the benefits and harms of extra gloves for preventing percutaneous exposure incidents among healthcare workers versus no intervention or alternative interventions. SEARCH METHODS We searched CENTRAL, MEDLINE, EMBASE, NHSEED, Science Citation Index Expanded, CINAHL, NIOSHTIC, CISDOC, PsycINFO and LILACS until 26 June 2013. SELECTION CRITERIA Randomised controlled trials (RCTs) with healthcare workers as the majority of participants, extra gloves or special types of gloves as the intervention, and exposure to blood or bodily fluids as the outcome. DATA COLLECTION AND ANALYSIS Two authors independently assessed study eligibility and risk of bias, and extracted data. We performed meta-analyses for seven different comparisons. MAIN RESULTS We found 34 RCTs that included 6890 person-operations as participating units and reported on 46 intervention-control group comparisons. We grouped interventions as follows: increased layers of standard gloves, gloves manufactured with special protective materials or thicker gloves, and gloves with puncture indicator systems. Indicator gloves show a coloured spot when they are perforated. Participants were surgeons in all studies and they used at least one pair of standard gloves as the control intervention. Twenty-seven studies also included other surgical staff (e.g. nurses). All but one study used perforations in gloves as an indication of exposure. The median control group rate was 18.5 perforations per 100 person-operations. Seven studies reported blood stains on the skin and two studies reported self reported needlestick injuries. Six studies reported dexterity as visual analogue scale scores for the comparison double versus single gloves, 13 studies reported outer glove perforations. We judged the included studies to have a moderate to high risk of bias.We found moderate-quality evidence that double gloves compared to single gloves reduce the risk of glove perforation (rate ratio (RR) 0.29, 95% confidence interval (CI) 0.23 to 0.37) and the risk of blood stains on the skin (RR 0.35, 95% CI 0.17 to 0.70). Two studies with a high risk of bias also reported the effect of double compared to single gloves on needlestick injuries (RR 0.58, 95% CI 0.21 to 1.62).We found low-quality evidence in one small study that the use of three gloves compared to two gloves reduces the risk of perforation further (RR 0.03, 95% CI 0.00 to 0.52). There was similar low-quality evidence that the use of one fabric glove over one normal glove reduces perforations compared to two normal gloves (RR 0.24, 95% CI 0.06 to 0.93). There was moderate-quality evidence that this effect was similar for the use of one special material glove between two normal material gloves. Thicker gloves did not perform better than thinner gloves.There was moderate to low-quality evidence in two studies that an indicator system does not reduce the total number of perforations during an operation even though it reduces the number of perforations per glove used.There was moderate-quality evidence that double gloves have a similar number of outer glove perforations as single gloves, indicating that there is no loss of dexterity with double gloves (RR 1.10, 95% CI 0.93 to 1.31). AUTHORS' CONCLUSIONS There is moderate-quality evidence that double gloving compared to single gloving during surgery reduces perforations and blood stains on the skin, indicating a decrease in percutaneous exposure incidents. There is low-quality evidence that triple gloving and the use of special gloves can further reduce the risk of glove perforations compared to double gloving with normal material gloves. The preventive effect of double gloves on percutaneous exposure incidents in surgery does not need further research. Further studies are needed to evaluate the effectiveness and cost-effectiveness of special material gloves and triple gloves, and of gloves in other occupational groups.
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Affiliation(s)
| | - Jos H Verbeek
- Finnish Institute of Occupational HealthCochrane Occupational Safety and Health Review GroupPO Box 310KuopioFinland70101
| | - Annika Saarto
- Finnish Institute of Occupational HealthLemminkäisenkatu 14‐18 BTurkuFinland20520
| | - Marie‐Claude Lavoie
- University of Maryland Baltimore110 South Paca StreetRm 4‐S‐100BaltimoreMarylandUSA21201
| | - Manisha Pahwa
- University of TorontoDalla Lana School of Public Health155 College Street, 6th floorTorontoOntarioCanadaM5T 3M7
| | - Sharea Ijaz
- Finnish Institute of Occupational HealthCochrane Occupational Safety and Health Review GroupPO Box 310KuopioFinland70101
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Study of Glove Perforation during Hip Replacement Arthroplasty: Its Frequency, Location, and Timing. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:129561. [PMID: 27350965 PMCID: PMC4897540 DOI: 10.1155/2014/129561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 09/01/2014] [Indexed: 11/17/2022]
Abstract
Objective. The aim of the study was to evaluate the location, timing, and frequency of glove perforation during hip replacement arthroplasty. Methods. Gloves worn by surgical team members in 19 primary hip replacement arthroplasties were assessed. The study was of a single gloving system. All the used gloves were collected at the end of the surgery and assessed visually and by using water inflation technique. Relevant data were collected at the time of surgery. Results. A total of one hundred and ninety-one surgical gloves were evaluated. Twenty-three glove perforations were noted in nineteen of the operations. Of these perforations 14 belonged to gloves worn by surgeon and first assistant (60.1%). Glove perforation in thumb, index finger, and palm was more common. More perforation occurred in the gloves worn in nondominant hand (52%) but was insignificant. Conclusion. Glove perforation in surgeries such as total hip arthroplasty is not uncommon. In this study of single gloving system glove perforation rate was 12.04%, whereas literature reports of glove perforation rate as low as 3.3% in elective orthopedic surgeries with double gloving system. As such emphasis should be given to wear double pair of gloves wherever this practice is uncommon.
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DeGirolamo KM, Courtemanche DJ, Hill WD, Kennedy A, Skarsgard ED. Use of safety scalpels and other safety practices to reduce sharps injury in the operating room: what is the evidence? Can J Surg 2013; 56:263-9. [PMID: 23883497 DOI: 10.1503/cjs.003812] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The occupational hazard associated with percutaneous injury in the operating room (OR) has encouraged harm reduction through behaviour change and the use of safety-engineered surgical sharps. Some Canadian regulatory agencies have mandated the use of "safety scalpels." Our primary objective was to determine whether safety scalpels reduce the risk of percutaneous injury in the OR, while a secondary objective was to evaluate risk reduction associated with other safety practices. METHODS We used evidence review methods described by the International Liaison Committee on Resuscitation and conducted a systematic, English-language search of Ovid, MEDLINE and EMBASE using the following search terms: "safety-engineered scalpel," "mistake proofing device," "retractable/removable blade/scalpel," "pass tray," "hands free passing," "neutral zone," "sharpless surgery," "double/cutproof gloving" and "blunt suture needles." Included articles were scored according to level of evidence; quality; and whether they were supportive, opposed or neutral to the study question(s). RESULTS Of 72 included citations, none was supportive of the use of safety scalpels. There was high-level/quality evidence (Cochrane reviews) in support of risk reduction through double-gloving and use of blunt suture needles, with additional evidence supporting a pass tray/neutral zone for sharps handling (4 of 5 articles supportive) and use of suturing adjuncts (1 article supportive). CONCLUSION There is insufficient evidence to support regulated use of safety scalpels. Injury-reduction strategies should emphasize proven methods, including double-gloving, blunt suture needles and use of hands-free sharps transfer.
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Shek KMY, Chau JPC. Surgical glove perforation among nurses in ophthalmic surgery: A case-control study. Int J Nurs Pract 2013; 20:179-186. [DOI: 10.1111/ijn.12136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Karen Mei-Yan Shek
- Eye and Refractive Surgery Center; St. Teresa's Hospital; Kowloon Hong Kong
| | - Janita Pak-Chun Chau
- The Nethersole School of Nursing; The Chinese University of Hong Kong; Shatin Hong Kong
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Uçkay I, Hoffmeyer P, Lew D, Pittet D. Prevention of surgical site infections in orthopaedic surgery and bone trauma: state-of-the-art update. J Hosp Infect 2013; 84:5-12. [DOI: 10.1016/j.jhin.2012.12.014] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 12/31/2012] [Indexed: 01/05/2023]
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Bonfill X, Roqué M, Aller MB, Osorio D, Foradada C, Vives À, Rigau D. Development of quality of care indicators from systematic reviews: the case of hospital delivery. Implement Sci 2013; 8:42. [PMID: 23574918 PMCID: PMC3626798 DOI: 10.1186/1748-5908-8-42] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 04/01/2013] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The objective of this research is to generate quality of care indicators from systematic reviews to assess the appropriateness of obstetric care in hospitals. METHODS A search for systematic reviews about hospital obstetric interventions, conducted in The Cochrane Library, clinical evidence and practice guidelines, identified 303 reviews. We selected 48 high-quality evidence reviews, which resulted in strong clinical recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The 255 remaining reviews were excluded, mainly due to a lack of strong evidence provided by the studies reviewed. RESULTS A total of 18 indicators were formulated from these clinical recommendations, on antepartum care (8), care during delivery and postpartum (9), and incomplete miscarriage (1). Authors of the systematic reviews and specialists in obstetrics were consulted to refine the formulation of indicators. CONCLUSIONS High-quality systematic reviews, whose conclusions clearly claim in favour or against an intervention, can be a source for generating quality indicators of delivery care. To make indicators coherent, the nuances of clinical practice should be considered. Any attempt made to evaluate the extent to which delivery care in hospitals is based on scientific evidence should take the generated indicators into account.
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Affiliation(s)
- Xavier Bonfill
- Service of Clinical Epidemiology, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), c/Sant Quintí 89, Barcelona, 08026, Spain
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
- Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine., Universitat Autònoma de Barcelona, Bellaterra, Spain
- CIBERESP (CIBER de Epidemiología y Salud Pública), Barcelona, Spain
| | - Marta Roqué
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
- CIBERESP (CIBER de Epidemiología y Salud Pública), Barcelona, Spain
| | - Marta Beatriz Aller
- Research Unit. Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - Dimelza Osorio
- Service of Clinical Epidemiology, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), c/Sant Quintí 89, Barcelona, 08026, Spain
| | - Carles Foradada
- Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine., Universitat Autònoma de Barcelona, Bellaterra, Spain
- Department of Gynaecology and Obstetrics, Corporació Sanitària Parc Taulí, Sabadell, Spain
| | - Àngels Vives
- Department of Gynaecology and Obstetrics, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - David Rigau
- Service of Clinical Epidemiology, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), c/Sant Quintí 89, Barcelona, 08026, Spain
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
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Johnson R, Jameson SS, Sanders RD, Sargant NJ, Muller SD, Meek RMD, Reed MR. Reducing surgical site infection in arthroplasty of the lower limb: A multi-disciplinary approach. Bone Joint Res 2013; 2:58-65. [PMID: 23610703 PMCID: PMC3626200 DOI: 10.1302/2046-3758.23.2000146] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 01/25/2013] [Indexed: 12/29/2022] Open
Abstract
Objectives To review the current best surgical practice and detail a multi-disciplinary
approach that could further reduce joint replacement infection. Methods Review of relevant literature indexed in PubMed. Results Surgical site infection is a major complication following arthroplasty.
Despite its rarity in contemporary orthopaedic practice, it remains
difficult to treat and is costly in terms of both patient morbidity
and long-term health care resources. Conclusions Emphasis on education of patients and all members of the health-care
team and raising awareness in how to participate in preventative
efforts is imperative.
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Affiliation(s)
- R Johnson
- Northumbria Healthcare NHS Foundation Trust, Department of Orthopaedics, Woodhorn Lane, Ashington, Northumberland NE63 9JJ, UK
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Hommelstad J, Madsø A, Eide PK. Significant reduction of shunt infection rate in children below 1 year of age after implementation of a perioperative protocol. Acta Neurochir (Wien) 2013; 155:523-31. [PMID: 23224578 DOI: 10.1007/s00701-012-1574-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 11/23/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Shunt infection markedly impairs the clinical result of shunt surgery. The infection rate can be reduced by dedicated protocols. This study was undertaken to determine the efficacy of introducing a perioperative protocol for control of shunt infections. METHOD The shunt infection rate and risk factors for shunt infection were determined for two periods, namely the period 2001-2002 (Patient Material A), and the period 2005-2008 (Patient Material B). The perioperative protocol was introduced in 2005 before the second period. RESULTS The total patient material includes 901 patients, in whom 1,404 shunt procedures were performed during the study periods. While the overall infection rate dropped nonsignificantly from 6.5 % to 4.3 %, infection rate dropped markedly and significantly from 18.4 % to 5.7 % among the children younger than 1 year (p = 0.016). The significant risk factors for shunt infection were in Patient Material A age below 1 year (p < .001), and in Patient Material B premature birth (p = 0.045), postoperative cerebrospinal fluid (CSF) leakage (p < .001) and high American Society of Anaesthesiologists (ASA) score (p = 0.039). Of the protocol steps, only the lack of preoperative wash with 4 % clorhexidine gluconate (Hibiscrub®) showed a tendency of influencing the shunt infection rate (p = 0.051). CONCLUSIONS This study showed that implementation of a perioperative protocol markedly and significantly reduced shunt infection rate in children younger than 1 year, even though no significant overall reduction in shunt infection rate was found.
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Bhat M, Ghali P, Deschenes M, Wong P. Hepatitis B and the infected health care worker: public safety at what cost? CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2012; 26:257-60. [PMID: 22590698 PMCID: PMC3352840 DOI: 10.1155/2012/348240] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 08/16/2011] [Indexed: 02/06/2023]
Abstract
Public safety and the right of the health care worker to practise without prejudice based on underlying illness may be at odds for those affected by the hepatitis B virus (HBV). Nevertheless, HBV does not preclude entry into a health care profession, and the risk of transmission from health care worker to patient is not uniform across the spectrum of health care fields. In the present article, the authors present an overview of the literature regarding transmission of HBV from the health care worker to the patient, and the current recommendations that vary from province to province within Canada. The establishment of national guidelines to standardize monitoring of HBV infection among health care workers would improve health care workplace safety and patient care.
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Affiliation(s)
- Mamatha Bhat
- Department of Gastroenterology & Hepatology, McGill University Health Centre, Montreal, Quebec, Canada.
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Korniewicz D, El-Masri M. Exploring the Benefits of Double Gloving During Surgery. AORN J 2012; 95:328-36. [DOI: 10.1016/j.aorn.2011.04.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 03/19/2011] [Accepted: 04/15/2011] [Indexed: 11/16/2022]
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Surgeon's garb and infection control: What's the evidence? J Am Acad Dermatol 2011; 64:960.e1-20. [DOI: 10.1016/j.jaad.2010.04.037] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 03/31/2010] [Accepted: 04/09/2010] [Indexed: 11/21/2022]
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Haines T, Stringer B, Herring J, Thoma A, Harris KA. Surgeons' and residents' double-gloving practices at 2 teaching hospitals in Ontario. Can J Surg 2011; 54:95-100. [PMID: 21251417 PMCID: PMC3116701 DOI: 10.1503/cjs.028409] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2009] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Surgeons and residents are at increased risk of exposure to blood-borne pathogens owing to percutaneous injury (PI) and contamination. One method known to reduce risk is double-gloving (DG) during surgery. METHODS All surgeons and residents affiliated with the University of Western Ontario (UWO) and McMaster University in 2005 were asked to participate in a Web-based survey. The survey asked respondents their specialty, the number of operations they participated in per week, their age and sex, the proportion of surgeries in which they double-gloved (DG in ≥75% surgeries was considered to be routine), and the average number of PIs they sustained per year and whether or not they reported them to an employee health service. RESULTS In total, 155 of 331 (47%) eligible surgeons and residents responded; response rates for UWO and McMaster surgeons were 50% and 39%, respectively, and for UWO and McMaster residents, they were 52% and 47%, respectively. A total of 43% of surgeons and residents reported routine DG; 50% from McMaster and 36% from UWO. Using logistic regression to simultaneously adjust for participant characteristics, we confirmed that DG was more frequent at McMaster than at UWO, with an odds ratio of 3.32 (95% confidence interval 1.35-8.17). Surgeons and residents reported an average of 3.3 surgical PIs per year (2.2 among McMaster participants and 4.5 among UWO participants). Of the 77% who reported at least 1 injury/year, 67% stated that they had not reported it to an employee health service. CONCLUSION Percutaneous injuries occur frequently during surgery, yet routine DG, an effective means of reducing risk, was carried out by less than half of the surgeons and residents participating in this study. This highlights the need for a more concerted and broad-based approach to increase the use of a measure that is effective, inexpensive and easily carried out.
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Affiliation(s)
- Ted Haines
- Departments of Clinical Epidemiology and Biostatistics and of Surgery, McMaster University, Hamilton, Ont
| | - Bernadette Stringer
- School of Environmental Health, University of British Columbia, Vancouver, BC
| | - Jeremy Herring
- Department of Epidemiology and Biostatistics, University of Western Ontario (at the time of writing), London, Ont
| | - Achilleas Thoma
- Departments of Clinical Epidemiology and Biostatistics and of Surgery, McMaster University, Hamilton, Ont
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