1
|
Zhang B, Huang S, Zhou C, Zhu J, Chen T, Feng S, Huang C, Wang Z, Wu S, Liu C, Zhan X. Prediction of additional hospital days in patients undergoing cervical spine surgery with machine learning methods. Comput Assist Surg (Abingdon) 2024; 29:2345066. [PMID: 38860617 DOI: 10.1080/24699322.2024.2345066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Machine learning (ML), a subset of artificial intelligence (AI), uses algorithms to analyze data and predict outcomes without extensive human intervention. In healthcare, ML is gaining attention for enhancing patient outcomes. This study focuses on predicting additional hospital days (AHD) for patients with cervical spondylosis (CS), a condition affecting the cervical spine. The research aims to develop an ML-based nomogram model analyzing clinical and demographic factors to estimate hospital length of stay (LOS). Accurate AHD predictions enable efficient resource allocation, improved patient care, and potential cost reduction in healthcare. METHODS The study selected CS patients undergoing cervical spine surgery and investigated their medical data. A total of 945 patients were recruited, with 570 males and 375 females. The mean number of LOS calculated for the total sample was 8.64 ± 3.7 days. A LOS equal to or <8.64 days was categorized as the AHD-negative group (n = 539), and a LOS > 8.64 days comprised the AHD-positive group (n = 406). The collected data was randomly divided into training and validation cohorts using a 7:3 ratio. The parameters included their general conditions, chronic diseases, preoperative clinical scores, and preoperative radiographic data including ossification of the anterior longitudinal ligament (OALL), ossification of the posterior longitudinal ligament (OPLL), cervical instability and magnetic resonance imaging T2-weighted imaging high signal (MRI T2WIHS), operative indicators and complications. ML-based models like Lasso regression, random forest (RF), and support vector machine (SVM) recursive feature elimination (SVM-RFE) were developed for predicting AHD-related risk factors. The intersections of the variables screened by the aforementioned algorithms were utilized to construct a nomogram model for predicting AHD in patients. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve and C-index were used to evaluate the performance of the nomogram. Calibration curve and decision curve analysis (DCA) were performed to test the calibration performance and clinical utility. RESULTS For these participants, 25 statistically significant parameters were identified as risk factors for AHD. Among these, nine factors were obtained as the intersection factors of these three ML algorithms and were used to develop a nomogram model. These factors were gender, age, body mass index (BMI), American Spinal Injury Association (ASIA) scores, magnetic resonance imaging T2-weighted imaging high signal (MRI T2WIHS), operated segment, intraoperative bleeding volume, the volume of drainage, and diabetes. After model validation, the AUC was 0.753 in the training cohort and 0.777 in the validation cohort. The calibration curve exhibited a satisfactory agreement between the nomogram predictions and actual probabilities. The C-index was 0.788 (95% confidence interval: 0.73214-0.84386). On the decision curve analysis (DCA), the threshold probability of the nomogram ranged from 1 to 99% (training cohort) and 1 to 75% (validation cohort). CONCLUSION We successfully developed an ML model for predicting AHD in patients undergoing cervical spine surgery, showcasing its potential to support clinicians in AHD identification and enhance perioperative treatment strategies.
Collapse
Affiliation(s)
- Bin Zhang
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Department of Orthopaedics, The Guizhou Hospital of Beijing Jishuitan Hospital, Guiyang, China
| | - Shengsheng Huang
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chenxing Zhou
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jichong Zhu
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Tianyou Chen
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Sitan Feng
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chengqian Huang
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zequn Wang
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shaofeng Wu
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chong Liu
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xinli Zhan
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| |
Collapse
|
2
|
Olzowy B, Müller S, Cidlinsky NA, Guderian D. [Antiseptics in otorhinolaryngology-a substance overview]. HNO 2024; 72:452-460. [PMID: 38592477 DOI: 10.1007/s00106-024-01456-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/10/2024]
Abstract
For preoperative skin antisepsis, alcohol-containing iodine solutions and octenidine are suitable. For wound antisepsis, polyhexanide and hypochlorous acid (HOCL) are also available, but only PVP-iodine and HOCL can be applied to cartilage. Chlorhexidine should only be used as mouth- and bodywash for Staphylococcus aureus (MRSA) decolonization. For the many other throat antiseptics, evidence of clinical efficacy is lacking. For decolonization of the nares, polyhexanide and octenidine are available as nasal gels, but these are inferior to mupirocin for MRSA decolonization. PVP-iodine and HOCL are safe to use for nasal irrigation, but only HOCL has proven effective to improve symptoms of chronic rhinosinusitis. All antiseptics exhibit a certain ototoxicity. With an intact eardrum, acetic acid-containing eardrops can be used to prevent and treat external otitis and myringitis. When the eardrum is perforated, only alcohol-free PVP-iodine and HOCL may be used.
Collapse
Affiliation(s)
- Bernhard Olzowy
- HNO-Zentrum Landsberg, Ahornallee 2a, 86899, Landsberg, Deutschland.
| | - Sarina Müller
- Hals-Nasen-Ohrenklinik, Kopf- und Halschirurgie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | | | - Daniela Guderian
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt a.M., Goethe-Universität, Frankfurt am Main, Deutschland
| |
Collapse
|
3
|
Tucker J, Eberly HW, Lighthall JG. Impact of a History of COVID-19 Infection on Postoperative Outcomes for Free Flap Patients. EAR, NOSE & THROAT JOURNAL 2024:1455613241255995. [PMID: 38804526 DOI: 10.1177/01455613241255995] [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: 05/29/2024] Open
Abstract
Objectives: This study examines the impact of a history of coronavirus disease 2019 (COVID-19) infection on patients' outcomes after microvascular free flap surgery and to examine the recommendations on when to perform microvascular surgery after a COVID-19 infection. Methods: A retrospective chart review using the TriNetX database was completed on March 5, 2023. Two cohorts were created: (1) patients who had a positive COVID-19 diagnosis within 1 year before microvascular free flap surgery, and (2) patients with no history of COVID-19 who underwent free flap surgery. Current Procedural Terminology codes were used to identify procedures and International Classification of Diseases-10 codes were used to identify outcomes. Results: There was a total of 31,505 patients who underwent microvascular free flap surgery, 500 of whom had a diagnosis of COVID-19 within 1 year of free flap surgery and 31,005 without history of COVID-19. There was increased risk of sepsis, surgical site infection (SSI), generalized infection, gangrene, dehiscence, hematoma, seroma, intensive care unit admission, and death in patients who underwent free flap surgery within a year of COVID-19 infection. After propensity score matching, there were 498 patients in both groups. Increased risk remained for SSI and gangrene in patients with a history of COVID-19 after matching. When comparing surgical timing between 0 to 2 months after COVID-19 infection and 2 to 12 months after COVID-19 infection, there were no significant differences between groups. Conclusions: After propensity score matching, patients with a history of COVID-19 infection were at increased risk for SSI and gangrene. However, many flap surgeries cannot be delayed. This study may help counsel patients regarding the possible complications after surgery and provide a heightened awareness in the surgical team of a possible increase in infectious complications in this population. Additional studies should investigate optimal timing of free flap surgery after COVID-19 infection and ways to mitigate the risk of infectious complications.
Collapse
Affiliation(s)
| | - Hänel W Eberly
- Department of Otolaryngology-Head and Neck Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jessyka G Lighthall
- College of Medicine, Surgery, The Pennsylvania State University, Hershey, PA, USA
| |
Collapse
|
4
|
Egerci OF, Yapar A, Dogruoz F, Selcuk H, Kose O. Preventive strategies to reduce the rate of periprosthetic infections in total joint arthroplasty; a comprehensive review. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05301-w. [PMID: 38635048 DOI: 10.1007/s00402-024-05301-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/24/2024] [Indexed: 04/19/2024]
Abstract
The increasing frequency of total hip (THA) and knee arthroplasties (TKA) is marred by the rise in periprosthetic joint infections (PJIs) and surgical site infections (SSIs), with PJIs incurring costs over $1.62 billion as of 2020 and individual case management averaging $90,000. SSIs additionally burden the U.S. healthcare economy with billions in expenses annually. PJI prevalence in primary THA and TKA ranges from 0.5% to 2.4%, spiking to 20% in revisions and representing 25% of TKA revision causes. Projections estimate up to 270,000 annual PJI cases by 2030. Often caused by gram-positive bacteria, particularly methicillin-resistant staphylococci, these infections demand preventive measures. This review dissects PJI prevention across preoperative, intraoperative, and perioperative phases, aligning with evidence-based CDC and WHO guidelines. Preoperative measures include managing diabetes, obesity, tobacco use, Staphylococcus aureus screening and nasal decolonization, nutritional optimization, and management of inflammatory arthropathies. Intraoperatively, antibiotic prophylaxis, skin preparation, operative room environmental controls, surgical technique precision, and irrigation options are scrutinized. Perioperative concerns focus on anticoagulation, blood management, and infection risk mitigation. Integrating these strategies promotes a patient-centric care model, aiming to reduce PJI incidence, improve patient outcomes, and increase care cost-effectiveness in joint arthroplasty.
Collapse
Affiliation(s)
- Omer Faruk Egerci
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Aliekber Yapar
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Fırat Dogruoz
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Huseyin Selcuk
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Ozkan Kose
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey.
| |
Collapse
|
5
|
Ali NS, Fitzpatrick Iv TH, Islam AS, Nord RS. Mitigating Infection Risk in Upper Airway Stimulation. Ann Otol Rhinol Laryngol 2024; 133:277-283. [PMID: 37927122 DOI: 10.1177/00034894231209540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
OBJECTIVE This study aims to define the incidence of infection with upper airway stimulation (UAS) devices requiring explantation in a single academic center and identify factors that may influence the risk of infection. METHODS A database of patients who underwent UAS at a single tertiary referral academic center from 2017 to 2021 was retrospectively reviewed to identify patients who developed surgical site infections, with and without subsequent explantation. Additional data for cases complicated by infection was extracted from the electronic medical record (EMR) and included: demographic information, medical history, complications and management, and overall outcomes. In March 2021, 2 modifications to infection control protocols were implemented: double skin preparation with Betadine and chlorhexidine, and MRSA decolonization. Statistical analysis was performed to compare infectious risk before and after these protocol changes. RESULTS In the study period, 215 patients underwent UAS in the specified time period and 3 cases (1.4%) of postoperative infections were identified, all of which required explantation. The infection rate did not significantly change after modifications to the surgical prep protocol (P = .52). CONCLUSIONS While no significant difference in infection risk was noted after modifying infection control protocols, additional longer-term study is warranted to elucidate effective infection reduction strategies.
Collapse
Affiliation(s)
- Naushin S Ali
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Thomas H Fitzpatrick Iv
- Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Albina S Islam
- Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Ryan S Nord
- Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
6
|
Deeming S, Dolja-Gore X, Gani J, Carroll R, Lott N, Attia J, Reeves P, Smith SR. Optimal antiseptic skin preparation agents for minimizing surgical site infection following surgery: cost and cost-effectiveness analysis. BJS Open 2024; 8:zrad160. [PMID: 38364056 PMCID: PMC10872689 DOI: 10.1093/bjsopen/zrad160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 09/14/2023] [Accepted: 11/02/2023] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND The application of antiseptic skin agents prior to incision minimizes the rate of surgical site infection. Despite their ubiquity, the optimal skin preparation agent remains uncertain. A retrospective economic analysis was conducted to complement the results from the NEWSkin Prep trial which prospectively compared three preparation agents. METHODS A cost and cost-effectiveness analysis was performed from a healthcare service perspective to compare chlorhexidine with 70% ethanol, and aqueous povidone-iodine, against povidone-iodine with 70% ethanol. Resource use estimates accounted for hospital admissions, readmissions associated with surgical site infection, outpatient and general practitioner attendances, visits from community nurses and therapeutic consumables. The measure of effectiveness comprised the net difference in number of patients with surgical site infections per 1000 patients. Costs were compared using a two-sample Welch's t-test. Deterministic and probabilistic sensitivity analyses were performed to evaluate the incremental cost-effectiveness ratio. RESULTS The null hypothesis that the mean costs for the trial arms were significantly different was not rejected (Welch's t-test P value: 0.771 for chlorhexidine with 70% ethanol against povidone-iodine with 70% ethanol; and 0.955 for aqueous povidone-iodine against povidone-iodine with 70% ethanol). Based on bootstrap averages, the chlorhexidine with 70% ethanol intervention generated 8.0 fewer surgical site infections per 1000 patients and net cost savings of €151,698 (Euros) per 1000 patients compared with povidone-iodine with 70% ethanol, and aqueous povidone-iodine produced a net cost saving of €37,494 per 1000 patients but generated an additional 11.6 surgical site infections per 1000 patients compared with povidone-iodine with 70% ethanol. The comparison of chlorhexidine with 70% ethanol to povidone-iodine with 70% ethanol was sensitive to the inclusion of cost outliers, while the comparison of aqueous povidone-iodine to povidone-iodine with 70% ethanol was sensitive to the estimated cost per surgical site infection. CONCLUSION Based on the outcomes from the NEWSkin Prep study, this economic analysis found no definitive evidence in favour of any one of the study comparators. Future model-based economic analyses of alternative skin preparations should critically address the quality of evidence and integrate the results from the NEWSkin Prep study.
Collapse
Affiliation(s)
- Simon Deeming
- Health Economics and Impact, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Xenia Dolja-Gore
- Health Economics and Impact, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Jon Gani
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Surgical Clinical Research Unit, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Rosemary Carroll
- Hunter Surgical Clinical Research Unit, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Natalie Lott
- Hunter Surgical Clinical Research Unit, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - John Attia
- Center for Clinical Epidemiology and Biostatistics, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Penny Reeves
- Health Economics and Impact, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Stephen R Smith
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Surgical Clinical Research Unit, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| |
Collapse
|
7
|
Smith S, Abuhassanian I, Attia J, Carroll R, Lott N, Hampton J, Gani J. Antiseptic Skin Agents to Prevent Surgical Site Infection After Clean Implant Surgery: Subgroup Analysis of the NEWSkin Prep Trial. Surg Infect (Larchmt) 2023; 24:818-822. [PMID: 37944097 DOI: 10.1089/sur.2023.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
Background: There remains debate as to the ideal skin preparation agent to prevent surgical site infection (SSI) after clean implant surgery. This study is a subgroup analysis of all patients undergoing implant surgery in the NEWSkin prep trial. Patients and Methods: The NEWSkin prep trial is a randomized clinical trial (RCT; n = 3300) comparing the three antiseptic skin preparation agents commonly used prior to incisional surgery: chlorhexidine with alcohol (C-Alc), povidone iodine with alcohol (PI-Alc), and aqueous povidone iodine (PI-Aq). All participants who underwent clean incisional surgeries with implants from this trial were selected for analysis. The primary outcome was SSI rate; secondary outcomes were complication rates and re-admission rates. Results: A total of 712 patients in the NEWSkinPrep study underwent clean implant surgery between January 2015 and December 2018. Randomization resulted in the following distribution: C-Alc, 238; PI-Alc, 243; and PI-Aq, 231. Median age of participants was 63 years and 41% were female. Surgical site infection rates were: C-Alc, 10.13%; PI-Alc,11.52%; and PI-Aq, 11.26%. Povidone iodine with alcohol did not appear to be non-inferior to C-Alc (mean difference, 1.39%; 95% confidence interval [CI], -4.17 to 6.95) and PI-Alc was not superior to PI-Aq (mean difference, 0.27%; 95% CI, -5.45 to 5.99; p = 0.9271). There were no differences seen in secondary outcomes between groups. Conclusions: These results indicate a similarity between PI-Alc and C-Alc and that PI-Alc was not superior to PI-Aq. Because this study was not powered to assess these differences in clean cases with implants, additional studies are needed to assess these agents.
Collapse
Affiliation(s)
- Stephen Smith
- Hunter Surgical Clinical Research Unit, University of Newcastle, Newcastle, New South Wales, Australia
| | | | - John Attia
- Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Rosemary Carroll
- Hunter Surgical Clinical Research Unit, University of Newcastle, Newcastle, New South Wales, Australia
| | - Natalie Lott
- Hunter Surgical Clinical Research Unit, University of Newcastle, Newcastle, New South Wales, Australia
| | - Jacob Hampton
- John Hunter Division of Surgery, University of Newcastle, Newcastle, New South Wales, Australia
| | - Jon Gani
- Hunter Surgical Clinical Research Unit, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| |
Collapse
|
8
|
Bai D, Zhou F, Wu L. Comparing the efficacy of chlorhexidine and povidone-iodine in preventing surgical site infections: A systematic review and meta-analysis. Int Wound J 2023; 21:e14463. [PMID: 37885342 PMCID: PMC10828524 DOI: 10.1111/iwj.14463] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/15/2023] [Accepted: 10/15/2023] [Indexed: 10/28/2023] Open
Abstract
Surgical site infections (SSIs) post-surgery impact patient health and raise healthcare costs. This meta-analysis examines the efficacy of antiseptics, chlorhexidine and povidone-iodine, in reducing SSIs, including various types, to settle ongoing debates on their comparative effectiveness. A systematic literature search conforming to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines was executed on four established databases without temporal restrictions. Only randomized controlled trials (RCTs) including patients aged 18 years or older undergoing clean or potentially contaminated surgeries were included. Two independent evaluators carried out study selection, data extraction and quality assessment, adhering to Cochrane Collaboration's risk of bias tool. Statistical analyses were performed using chi-square tests and the I2 index to evaluate heterogeneity, and meta-analyses were conducted employing either fixed-effects or random-effects models as warranted by the heterogeneity assessments. A total of 16 RCTs were included after rigorous selection from an initial pool of 1742 articles. The studies demonstrated low levels of heterogeneity, supporting the use of a fixed-effects model. Chlorhexidine exhibited statistically lower rates of overall SSIs (RR 0.75; 95% CI 0.64-0.88; p < 0.001), superficial SSIs (RR 0.62; 95% CI 0.47-0.82; p < 0.001) and deep SSIs compared to povidone-iodine. The study furnishes compelling evidence in favour of chlorhexidine as a more efficacious antiseptic agent over povidone-iodine in minimizing the risk of various types of SSIs.
Collapse
Affiliation(s)
- Dunyao Bai
- Department of PharmacyPuren Hospital Affiliated to Wuhan University of Science and TechnologyWuhanChina
| | - Fan Zhou
- Laboratory of Molecular MedicinePuren Hospital Affiliated to Wuhan University of Science and TechnologyWuhanChina
| | - Liuting Wu
- Department of PharmacyPuren Hospital Affiliated to Wuhan University of Science and TechnologyWuhanChina
| |
Collapse
|
9
|
Ronghe V, Modak A, Gomase K, Mahakalkar MG. From Prevention to Management: Understanding Postoperative Infections in Gynaecology. Cureus 2023; 15:e46319. [PMID: 37916257 PMCID: PMC10617751 DOI: 10.7759/cureus.46319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/01/2023] [Indexed: 11/03/2023] Open
Abstract
This narrative review examines the multifaceted realm of postoperative infections in gynaecology, addressing their significance, types, risk factors, prevention, management, and emerging trends. Postoperative infections, encompassing surgical site infections, urinary tract infections, and pelvic inflammatory disease, pose considerable challenges in patient care, warranting comprehensive exploration. Strategies for prevention include preoperative patient assessment, antimicrobial prophylaxis, and aseptic techniques. Intraoperative measures encompass infection control and instrument sterilization, while postoperative care involves wound management and early infection detection. Diagnostic tools, including blood tests, imaging, and microbiological cultures, aid in timely identification. Management strategies encompass antibiotic therapy, surgical interventions, supportive care, and addressing complications. The review underscores the necessity of personalized approaches, multidisciplinary collaboration, and innovative technologies in future infection management. It calls for ongoing research, heightened awareness, and meticulous care to minimize the impact of postoperative infections and optimize patient outcomes.
Collapse
Affiliation(s)
- Vaishnavi Ronghe
- Obstetrics and Gynaecology, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Anushree Modak
- Obstetrics and Gynaecology, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Kavita Gomase
- Obstetrics and Gynaecology, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Manjusha G Mahakalkar
- Obstetrics and Gynaecology, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| |
Collapse
|
10
|
Wang P, Wang D, Zhang L. Effectiveness of chlorhexidine versus povidone-iodine for preventing surgical site wound infection: A meta-analysis. Int Wound J 2023; 21:e14394. [PMID: 37752735 PMCID: PMC10828122 DOI: 10.1111/iwj.14394] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/28/2023] Open
Abstract
A systematic evaluation was conducted to assess the efficacy of two disinfectants, chlorhexidine and povidone-iodine, as primary components in preventing surgical site infection (SSI). A comprehensive computerised search was performed in the PubMed, EMBASE, Web of Science, Cochrane Library, CNKI and Wanfang databases for randomised controlled trials (RCTs) on chlorhexidine and povidone-iodine disinfection for the prevention of SSI from inception until July 2023. Two independent researchers completed literature screening, data extraction and quality assessment of the included studies. The meta-analysis was conducted using RevMan 5.4 software. Ultimately, 20 RCTs were included, which included 13 133 patients, with 6460 patients in the chlorhexidine group and 6673 patients in the povidone-iodine group. The meta-analysis results revealed that the incidence rate of surgical site wound infections [odds ratio (OR): 0.67, 95% confidence interval (CI): 0.58-0.78, p < 0.001)], superficial SSI rate (OR: 0.59, 95% CI: 0.46-0.75, p < 0.001) and deep SSI rate (OR: 0.49, 95% CI: 0.31-0.79, p = 0.003) were all lower in patients subjected to chlorhexidine disinfection compared to those patients receiving povidone-iodine disinfection. Existing evidence suggests that chlorhexidine is more effective than povidone-iodine at preventing SSI. However, owing to the potential quality limitations of the included studies, further validation through high-quality large-scale RCTs is warranted.
Collapse
Affiliation(s)
- Panfeng Wang
- Department of PharmacyTaizhou First People's HospitalTaizhouChina
| | - Dandan Wang
- Department of PharmacyTaizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical UniversityTaizhouChina
| | - Lingqiao Zhang
- Department of PharmacyTaizhou First People's HospitalTaizhouChina
| |
Collapse
|
11
|
Tarabichi S, Parvizi J. Prevention of surgical site infection: a ten-step approach. ARTHROPLASTY 2023; 5:21. [PMID: 37029444 PMCID: PMC10082525 DOI: 10.1186/s42836-023-00174-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/20/2023] [Indexed: 04/09/2023] Open
Abstract
Surgical site infection (SSI) is a common cause of morbidity and mortality in patients undergoing surgery. Similarly, periprosthetic joint infection (PJI), is a major cause of failure after total joint arthroplasty (TJA). As the annual volume of TJA procedures is projected to rise, so will the rate of subsequent SSI and PJI. Currently, prevention has been identified as the single most important strategy for combating SSI/PJI. Hence, the present article will serve as a summary of an evidence-based ten-step approach for SSI/PJI prevention that may help orthopedic surgeons with their infection prevention strategies.
Collapse
Affiliation(s)
- Saad Tarabichi
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA.
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
| |
Collapse
|
12
|
Böhle S, Vogel AM, Matziolis G, Strube P, Rohe S, Brodt S, Mastrocola M, Eijer H, Rödel J, Lindemann C. Comparison of two different antiseptics regarding intracutaneous microbial load after preoperative skin cleansing in total knee and hip arthroplasties. Sci Rep 2022; 12:18246. [PMID: 36309598 PMCID: PMC9617848 DOI: 10.1038/s41598-022-23070-7] [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: 07/06/2022] [Accepted: 10/25/2022] [Indexed: 12/31/2022] Open
Abstract
Periprosthetic infections (PPIs) are a serious concern in total knee and hip arthroplasty, and they have an increasing incidence. To prevent PPI, preoperative skin disinfection, as a key element of antisepsis, represents an important part of infection prevention. However, no specific antiseptic agent is endorsed by the relevant guidelines. The purpose of this retrospective, not randomized study was to investigate the difference in the residual bacteria load between an approved antiseptic with an alcohol-based solution with additional benzalkonium chloride (BAC) and an alcohol-based solution with additional octenidine dihydrochloride (OCT) at two different time periods. In 200 consecutive patients with total knee or hip arthroplasty, skin samples from the surgical sites were collected after skin disinfection with BAC (100 g solution contain: propan-2-ol 63.0 g, benzalkonium chloride 0.025 g) or OCT (100 g solution contain: octenidine dihydrochloride 0.1 g, propan-1-ol, 30.0 g, propan-2-ol 45.0 g) (100 patients per group). Following the separation of cutis and subcutis and its processing, culture was performed on different agar plates in aerobic and anaerobic environments. In the case of bacteria detection, the microbial identification was determined by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), and the number of contaminated samples was compared between the groups. Additionally, multiple regression analysis was performed to examine the effect of the type of disinfectant, BMI, age, sex, rheumatoid arthritis, diabetes mellitus, skin disorders, smoking status, and localization of skin samples on positive bacteria detection. A total of 34 samples were positive for bacteria in the BAC group, while only 17 samples were positive in the OCT group (p = 0.005). Disinfectant type was the only significant parameter in the multiple regression analysis (p = 0.006). A significantly higher contamination rate of the subcutis was shown in the BAC group compared to the OCT group (19 vs. 9, p = 0,003). After the change from BAC to OCT in preoperative skin cleansing in the hip and knee areas, the number of positive cultures decreased by 50%, which might have been caused by a higher microbicidal activity of OCT. Therefore, the use of OCT in preoperative cleansing may reduce the risk of PPI in hip and knee surgery. Randomized controlled trials are required to confirm the effect and to evaluate if it reduces the risk of PPI.
Collapse
Affiliation(s)
- Sabrina Böhle
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607 Eisenberg, Germany
| | - Anna-Maria Vogel
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607 Eisenberg, Germany
| | - Georg Matziolis
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607 Eisenberg, Germany
| | - Patrick Strube
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607 Eisenberg, Germany
| | - Sebastian Rohe
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607 Eisenberg, Germany
| | - Steffen Brodt
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607 Eisenberg, Germany
| | - Mario Mastrocola
- Department of Orthopaedic Surgery, Spital Emmental, Oberburgstrasse 54, 3400 Burgdorf, Switzerland
| | - Henk Eijer
- Department of Orthopaedic Surgery, Spital Emmental, Oberburgstrasse 54, 3400 Burgdorf, Switzerland
| | - Jürgen Rödel
- grid.275559.90000 0000 8517 6224Institute of Medical Microbiology, Jena University Hospital, 07747 Jena, Germany
| | - Chris Lindemann
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607 Eisenberg, Germany
| |
Collapse
|
13
|
Thakuria D, Khangembam VC, Pant V, Bhat RAH, Tandel RS, C. S, Pande A, Pandey PK. Anti-oomycete Activity of Chlorhexidine Gluconate: Molecular Docking and in vitro Studies. Front Vet Sci 2022; 9:909570. [PMID: 35782554 PMCID: PMC9247576 DOI: 10.3389/fvets.2022.909570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/09/2022] [Indexed: 11/28/2022] Open
Abstract
Saprolegniosis is one of the most catastrophic oomycete diseases of freshwater fish caused by the members of the genus Saprolegnia. The disease is responsible for huge economic losses in the aquaculture industry worldwide. Until 2002, Saprolegnia infections were effectively controlled by using malachite green. However, the drug has been banned for use in aquaculture due to its harmful effect. Therefore, it has become important to find an alternate and safe anti-oomycete agent that is effective against Saprolegnia. In this study, we investigated the anti-oomycete activity of chlorhexidine gluconate (CHG) against Saprolegnia. Before in vitro evaluation, molecular docking was carried out to explore the binding of CHG with vital proteins of Saprolegnia, such as S. parasitica host-targeting protein 1 (SpHtp1), plasma membrane ATPase, and TKL protein kinase. In silico studies revealed that CHG binds with these proteins via hydrogen bonds and hydrophobic interactions. In an in vitro study, the minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) of CHG against S. parasitica were found to be 50 mg/L. Further, it was tested against S. australis, another species of Saprolegnia, and the MIC and MFC were found to be 100 and 200 mg/L, respectively. At 500 mg/L of CHG, there was complete inhibition of the radial growth of Saprolegnia hyphae. In propidium iodide (PI) uptake assay, CHG treated hyphae had bright red fluorescence of PI indicating the disruption of the cell membrane. The results of the present study indicated that CHG could effectively inhibit Saprolegnia and hence can be used for controlling Saprolegniasis in cultured fish.
Collapse
|
14
|
Fujita T, Okada N, Sato T, Sato K, Fujiwara H, Kojima T, Daiko H. Propensity-matched analysis of the efficacy of olanexidine gluconate versus chlorhexidine-alcohol as an antiseptic agent in thoracic esophagectomy. BMC Surg 2022; 22:20. [PMID: 35065644 PMCID: PMC8783436 DOI: 10.1186/s12893-022-01480-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 01/05/2022] [Indexed: 01/03/2023] Open
Abstract
Abstract
Background
In the present matched-cohort study, we investigated the efficacy of olanexidine gluconate in comparison with chlorhexidine-alcohol as an antiseptic agent in thoracic esophagectomy.
Methods
A total of 372 patients with esophageal cancer who were scheduled to undergo thoracic esophagectomy between 2016 and 2018 were assigned to one of two groups based on the preoperative antiseptic agent used in thoracic esophagectomy. We investigated the incidence of surgical site infectious complications in the propensity-matched cohort.
Results
Based on the propensity score, 116 patients prepared with 1.5% olanexidine gluconate and 114 patients prepared with 1.0% chlorhexidine-alcohol as surgical skin antisepsis were selected. No significant intergroup differences were observed with respect to incisional surgical site infection (0.8% in the olanexidine group versus 0.8% in the chlorhexidine group) and deep fascial/organ space surgical site infection (1.7%/10.3% in the olanexidine group versus 3.5%/15.7% in the chlorhexidine group, p = 0.39/p = 0.03). Notably, the respective incidences of surgical site infection except anastomotic leakage were 1.7% and 7.0% in the olanexidine and chlorhexidine groups (p = 0.04).
Conclusions
Olanexidine gluconate was well tolerated and significantly reduced incidence of surgical site infection except anastomotic leakage in comparison with chlorhexidine-alcohol as an antiseptic agent in thoracic esophagectomy with three-field lymph node dissection.
Collapse
|
15
|
Ulasi I, Michael A, Ayandipo O. PRE-INCISION SKIN ANTISEPSIS: PRACTICE PATTERNS AMONG SURGEONS IN NIGERIA. Ann Ib Postgrad Med 2021; 19:124-130. [PMID: 36177322 PMCID: PMC9484318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Background Although studies are rife on preoperative skin antisepsis, little is known about what surgeons in Nigeria practice. Objective To describe the pattern of practice of skin antisepsis prior to skin incision among surgeons in select tertiary hospitals in Nigeria. Methods This was a questionnaire-based descriptive cross-sectional survey involving surgeons and surgeons in training in the departments of surgery, obstetrics and gynaecology (O&G), otorhinolaryngology (ENT), and oral & maxillofacial surgery (OMS) of 26 select tertiary hospitals from all six geopolitical zones in Nigeria. Data was analysed using version 23 of the SPSS for Windows. Results A total of 200 surgeons participated in the study with a male-to-female ratio of 9:1. The mean age was 37.2 ± 5.2 years. Senior registrars constituted 60.5% (n=121), followed by registrars (24%; n= 48) and consultants (15.5%; n= 31). The respondents performed a mean volume of 4 surgeries per week. Their most common practice is to perform skin preparation with 3 antiseptic agents with skin scrubbing lasting for 3-4 minutes. Skin scrubbing was performed for longer duration amongst consultants compared with senior registrars and registrars. Of all the surgical wounds encountered in their practice, 57%were clean. The common complications associated with the use of these antiseptic agents include allergic dermatitis and blisters. Conclusion The practice of pre-incision skin antisepsis varies widely among Nigerian surgeons. The majority use 3 antiseptic agents for skin antisepsis although most of the procedures performed were clean surgeries. We recommend further studies to standardize our practice locally.
Collapse
Affiliation(s)
- I.B. Ulasi
- Department of Surgery, University College Hospital, Ibadan, Nigeria
| | - A.I. Michael
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, College of Medicine,
University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - O.O. Ayandipo
- Division of Oncological Surgery, Department of Surgery, College of Medicine, University of Ibadan/
University College Hospital, Ibadan, Nigeria
| |
Collapse
|
16
|
Wei J, He L, Weng F, Huang F, Teng P. Effectiveness of chlorhexidine in preventing infections among patients undergoing cardiac surgeries: a meta-analysis and systematic review. Antimicrob Resist Infect Control 2021; 10:140. [PMID: 34620240 PMCID: PMC8499511 DOI: 10.1186/s13756-021-01009-3] [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: 01/13/2021] [Accepted: 08/30/2021] [Indexed: 01/15/2023] Open
Abstract
Background Although several meta-analyses reported the impact of chlorhexidine (CHX) use in patients undergoing various types of surgery, no meta-analysis summarized the overall effectiveness of CHX specifically for cardiac surgery. This meta-analysis aimed to examine the impact of CHX on infections after cardiac surgery compared with other cleansers or antiseptics. Methods PubMed, Embase, and the Cochrane Library were searched from inception up to October 2020 for potentially eligible studies: (1) population: patients who underwent cardiac surgery; (2) intervention or exposure: any type of CHX use in the treatment or exposed group; (3) outcome: number of patients with infections; (4) comparison: placebo or other antiseptic agents; (5) English. The primary outcome was surgical site infection (SSI). Results Fourteen studies were included, with 8235 and 6901 patients in the CHX and control groups. CHX was not protective against SSI (OR = 0.77, 95% CI: 0.57–1.04, P = 0.090). CHX was protective for superficial wound infection (OR = 0.42, 95% CI: 0.26–0.70, P = 0.001), but not with deep wound infection (P = 0.509). CHX was not protective against urinary tract of infection (P = 0.415) but was protective for bloodstream infection (OR = 0.36, 95% CI: 0.16–0.80, P = 0.012), nosocomial infections (OR = 0.55, 95% CI: 0.44–0.69, P < 0.001), and pneumonia (OR = 0.26, 95% CI: 0.11–0.61, P = 0.002). Conclusions In patients undergoing cardiac surgery, CHX does not protect against SSI, deep wound infection, and urinary tract infections but might protect against superficial SSI, bloodstream infection, nosocomial infections, and pneumonia. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-021-01009-3.
Collapse
Affiliation(s)
- Jianhua Wei
- Surgical Intensive Care Unit, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China.
| | - Lingying He
- Surgical Intensive Care Unit, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Fengxia Weng
- Surgical Intensive Care Unit, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Fangfang Huang
- Surgical Intensive Care Unit, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Peng Teng
- Surgical Intensive Care Unit, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| |
Collapse
|
17
|
Mastrocola M, Matziolis G, Böhle S, Lindemann C, Schlattmann P, Eijer H. Meta-analysis of the efficacy of preoperative skin preparation with alcoholic chlorhexidine compared to povidone iodine in orthopedic surgery. Sci Rep 2021; 11:18634. [PMID: 34545135 PMCID: PMC8452611 DOI: 10.1038/s41598-021-97838-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/25/2021] [Indexed: 01/02/2023] Open
Abstract
Preoperative skin preparation is an effective method to prevent surgical site infections (SSI). Alcoholic chlorhexidine (CHG) and povidone iodine (PV-I) are the most widely used antiseptic agents. This meta-analysis aims to determine their efficacy in reducing natural bacterial skin flora in clean orthopedic surgery. A systematic search was conducted through current literature up to June 2021 to identify clinical randomized trials that compared the efficacy of alcoholic chlorhexidine and povidone iodine in reducing bacterial skin colonization after preoperative skin preparation. A meta-analysis was conducted. Of 235 screened articles, 8 randomized controlled trials were included. The results of the meta-analysis demonstrate a significantly lower positive culture rate in the chlorhexidine group than in the povidone iodine group (RR = 0.53, 95% Cl: 0.32-0.88). The present data show the superiority of chlorhexidine in reducing the normal bacterial flora compared to povidone iodine in clean orthopedic surgery.
Collapse
Affiliation(s)
- Mario Mastrocola
- Department of Orthopaedic Surgery, Spital Emmental, Oberburgstrasse 54, 3400, Burgdorf, Switzerland
| | - Georg Matziolis
- Orthopaedic Department, Campus Eisenberg, Jena University Hospital, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany.
| | - Sabrina Böhle
- Orthopaedic Department, Campus Eisenberg, Jena University Hospital, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Chris Lindemann
- Orthopaedic Department, Campus Eisenberg, Jena University Hospital, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Peter Schlattmann
- Department of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Bachstr. 18, 07743, Jena, Germany
| | - Henk Eijer
- Department of Orthopaedic Surgery, Spital Emmental, Oberburgstrasse 54, 3400, Burgdorf, Switzerland
| |
Collapse
|
18
|
Nagoba B, Gavkare A, Rayate A, Mumbre S, Rao A, Warad B, Nanaware N, Jamadar N. Role of an acidic environment in the treatment of diabetic foot infections: A review. World J Diabetes 2021; 12:1539-1549. [PMID: 34630906 PMCID: PMC8472499 DOI: 10.4239/wjd.v12.i9.1539] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/21/2021] [Accepted: 08/05/2021] [Indexed: 02/06/2023] Open
Abstract
Management of diabetic foot ulcers is the biggest challenge to the clinician, as conventional antibiotic therapies and local wound care have their own limitations. They are not effective for control of infections and promotion of healing because of cytotoxic effects. In view of cytotoxicity of routinely used topical antiseptic agents, this article focuses on the search of an ideal topical antiseptic agent that is safe and effective in controlling infectious agents and also in promoting the healing process. This review focuses on the use of various acids such as citric, acetic, hyaluronic, and hypochlorous acids as topical agents in diabetic foot infections. This article also focuses on the different roles of acids in the treatment of diabetic foot infections.
Collapse
Affiliation(s)
- Basavraj Nagoba
- Department of Microbiology, MIMSR Medical College, Latur 413512, Maharashtra, India
| | - Ajay Gavkare
- Department of Physiology, MIMSR Medical College, Latur 413512, Maharashtra, India
| | - Abhijit Rayate
- Department of Surgery, MIMSR Medical College, Latur 413512, Maharashtra, India
| | - Sachin Mumbre
- Department of Community Medicine, Ashwini Rural Medical College, Solapur 413001, Maharashtra, India
| | - Arunkumar Rao
- Department of Orthopedics, MIMSR Medical College, Latur 413512, India
| | - Basavraj Warad
- Department of Surgery, MIMSR Medical College, Latur 413512, Maharashtra, India
| | - Neeta Nanaware
- Department of Physiology, Government Medical College, Latur 413512, Maharashtra, India
| | - Nawab Jamadar
- Department of Anesthesiology, MIMSR Medical College, Latur 413512, Maharashtra, India
| |
Collapse
|
19
|
Mitchell B, Curryer C, Holliday E, Rickard CM, Fasugba O. Effectiveness of meatal cleaning in the prevention of catheter-associated urinary tract infections and bacteriuria: an updated systematic review and meta-analysis. BMJ Open 2021; 11:e046817. [PMID: 34103320 PMCID: PMC8190044 DOI: 10.1136/bmjopen-2020-046817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE A systematic review on meatal cleaning prior to urinary catheterisation and post catheterisation and reduces the risk catheter-associated urinary tract infections (CAUTIs) and bacteriuria was published in 2017, with further studies undertaken since this time. The objective of this paper is to present an updated systematic review on the effectiveness of antiseptic cleaning of the meatal area for the prevention of CAUTIs and bacteriuria in patients who receive a urinary catheter. DESIGN Systematic review. DATA SOURCES Electronic databases Cochrane Library, PubMed, Embase, The Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline and Academic Search Complete were searched from 1 January 2016 and 29 February 2020. ELIGIBILITY CRITERIA Randomised controlled trials (RCTs) and quasi-experimental studies evaluating the use of antiseptic, antibacterial or non-medicated agents for cleaning the meatal, periurethral or perineal areas before indwelling catheter insertion or intermittent catheterisation or during routine meatal care. DATA EXTRACTION AND SYNTHESIS Data were extracted using the Cochrane Collaboration's data collection form for RCTs and non-RCTs. Data were extracted by one researcher and then checked for accuracy by a second researcher. RESULTS A total of 18 studies were included. Some potential benefit of using antiseptics, compared with non-antiseptics for meatal cleaning to prevent bacteriuria and or CAUTI was identified (OR 0.84, 95% CI 0.69 to 1.02; p=0.071). Antiseptics (chlorhexidine or povidine-iodine) may be of value for meatal cleaning on the incidence of CAUTI, compared with comparator agents (saline, soap or antimicrobial cloths) (OR=0.65, 95% CI 0.42 to 0.99; p=0.047). CONCLUSION There is emerging evidence of the role of some specific antiseptics (chlorhexidine) prior to urinary catheterisation, in reducing CAUTIs, and some potential benefit to the role of antiseptics more generally in reducing bacteriuria. PROSPERO REGISTRATION NUMBER CRD42015023741.
Collapse
Affiliation(s)
- Brett Mitchell
- School of Nursing and Midwifery, The University of Newcastle-Central Coast Campus, Ourimbah, New South Wales, Australia
| | - Cassie Curryer
- School of Nursing and Midwifery, The University of Newcastle-Central Coast Campus, Ourimbah, New South Wales, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Claire M Rickard
- School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Herston Infectious Disease Institute, Metro North Hospitals and Health Service, Brisbane, Queensland, Australia
| | - Oyebola Fasugba
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Sydney, New South Wales, Australia
| |
Collapse
|
20
|
Peel TN, Watson E, Lee SJ. Randomised Controlled Trials of Alcohol-Based Surgical Site Skin Preparation for the Prevention of Surgical Site Infections: Systematic Review and Meta-Analysis. J Clin Med 2021; 10:663. [PMID: 33572218 PMCID: PMC7914441 DOI: 10.3390/jcm10040663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 01/27/2021] [Accepted: 02/04/2021] [Indexed: 12/16/2022] Open
Abstract
(1) Background: Surgical site skin preparation is an important approach to prevent postoperative wound infections. International guidelines recommend that alcohol-based combinations be used, however, the optimal combination remains uncertain. This study compares the effectiveness of alcohol-based chlorhexidine and alcohol-based iodophor for surgical site skin preparation for prevention of surgical site infections (SSIs). (2) Methods: Randomised controlled trials comparing alcohol-based interventions for surgical site skin preparation were included. The proportion of SSIs was compared using risk ratios (RR) with 95% confidence intervals (95% CI). The meta-analysis was performed with a fixed effect model using Mantel-Haenszel methods. As an a priori subgroup analysis SSI risk was examined according to different surgical procedural groups. (3) Results: Thirteen studies were included (n = 6023 participants). The use of chlorhexidine-alcohol was associated with a reduction in risk of SSIs compared with iodophor-alcohol (RR 0.790; 95% CI 0.669, 0.932). On sub-group analysis, chlorhexidine-alcohol was associated with a reduction in SSIs in caesarean surgery (RR 0.614; 95% CI 0.453, 0.831) however, chlorhexidine-alcohol was associated with an increased risk of SSI in bone and joint surgery (RR 2.667; 95% CI 1.051, 6.765). When excluding studies at high risk of bias on sensitivity analysis, this difference in alcohol-based combinations for bone and joint surgery was no longer observed (RR 2.636; 95% CI 0.995, 6.983). (4) Conclusions: The use of chlorhexidine-alcohol skin preparations was associated with a reduced risk of SSI compared to iodophor-alcohol agents. However, the efficacy of alcohol-based preparation agents may differ according to the surgical procedure group. This difference must be interpreted with caution given the low number of studies and potential for bias, however, it warrants further investigation into the potential biological and clinical validity of these findings.
Collapse
Affiliation(s)
- Trisha N. Peel
- Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, 85 Commercial Road, Melbourne, VIC 3004, Australia; (E.W.); (S.J.L.)
| | | | | |
Collapse
|
21
|
Maurer SM, Kursawe L, Rahm S, Prinz J, Zinkernagel AS, Moter A, Kuster SP, Zbinden R, Zingg PO, Achermann Y. Cutibacterium avidum resists surgical skin antisepsis in the groin-a potential risk factor for periprosthetic joint infection: a quality control study. Antimicrob Resist Infect Control 2021; 10:27. [PMID: 33522957 PMCID: PMC7852298 DOI: 10.1186/s13756-021-00883-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 01/05/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The skin commensal Cutibacterium avidum has been recognized as an emerging pathogen for periprosthetic joint infections (PJI). One currently assumes that the early occurring PJIs are a consequence of skin commensals contaminating the peri-implant tissue during surgery. We addressed whether standard skin antisepsis with povidone-iodine/alcohol before total hip arthroplasty (THA) is effective to eliminate colonizing bacteria with focus on C. avidum. METHODS In a single-center, prospective study, we screened all patients for skin colonizing C. avidum in the groin before THA. Only in the patients positive for C. avidum, we preoperatively repeated skin swabs after the first and third skin antisepsis and antibiotic prophylaxis. We also obtained dermis biopsies for microbiology and fluorescence in situ hybridization (FISH). RESULTS Fifty-one out of 60 patients (85%) were colonized on the skin with various bacteria, in particular with C. avidum in 12 out of 60. Skin antisepsis eliminated C. avidum in eight of ten (20%) colonized patients undergoing THA. Deeper skin (dermis) biopsies were all culture negative, but FISH detected single positive ribosome-rich C. avidum in one case near sweat glands. CONCLUSION Standard skin antisepsis was not effective to completely eliminate colonizing C. avidum on the skin in the groin of patients undergoing THA. Colonizing with C. avidum might pose an increased risk for PJI when considering a THA. Novel more effective antisepsis strategies are needed. Trial registration No clinical trial.
Collapse
Affiliation(s)
- Steven M Maurer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Laura Kursawe
- Institute of Microbiology, Infectious Diseases and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Rahm
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Julia Prinz
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Annelies S Zinkernagel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Annette Moter
- Institute of Microbiology, Infectious Diseases and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan P Kuster
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Reinhard Zbinden
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Yvonne Achermann
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| |
Collapse
|
22
|
Su WC, Lai YC, Lee CH, Shih CM, Chen CP, Hung LL, Wang SP. The Prevention of Periprosthetic Joint Infection in Primary Total Hip Arthroplasty Using Pre-Operative Chlorhexidine Bathing. J Clin Med 2021; 10:jcm10030434. [PMID: 33498636 PMCID: PMC7865798 DOI: 10.3390/jcm10030434] [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: 12/15/2020] [Revised: 01/13/2021] [Accepted: 01/20/2021] [Indexed: 11/26/2022] Open
Abstract
Periprosthetic joint infection (PJI) after total hip arthroplasty (THA) is a devastating complication. The aim of this study was to investigate whether preoperative bathing using chlorhexidine gluconate (CHG) before THA can effectively reduce the postoperative PJI rate. A total of 933 primary THA patients, with the majority being female (54.4%) were included in the study. Primary THA patients who performed preoperative chlorhexidine bathing were assigned to the CHG group (190 subjects), and those who did not have preoperative chlorhexidine bathing were in the control group (743 subjects). The effects of chlorhexidine bathing on the prevention of PJI incidence rates were investigated. Differences in age, sex, and the operated side between the two groups were not statistically significant. Postoperative PJI occurred in four subjects, indicating an infection rate of 0.43% (4/933). All four infected subjects belonged to the control group. Although the PJI cases were significantly more in the control group than in the CHG group, statistical analysis revealed no statistical significance in the risk of PJI occurrence between the two groups (p = 0.588). Preoperative skin preparation by bathing with a 2% chlorhexidine gluconate cleanser did not produce significant effects on the prevention of postoperative PJI in primary THA.
Collapse
Affiliation(s)
- Wen-Chi Su
- Department of Nursing, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (W.-C.S.); (Y.-C.L.); (L.-L.H.)
| | - Yu-Chin Lai
- Department of Nursing, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (W.-C.S.); (Y.-C.L.); (L.-L.H.)
| | - Cheng-Hung Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-H.L.); (C.-M.S.); (C.-P.C.)
- Department of Food Science and Technology, HungKuang University, Taichung 43302, Taiwan
| | - Cheng-Min Shih
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-H.L.); (C.-M.S.); (C.-P.C.)
- Department of Physical Therapy, HungKuang University, Taichung 43302, Taiwan
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu 30010, Taiwan
| | - Chao-Ping Chen
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-H.L.); (C.-M.S.); (C.-P.C.)
- Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli County 35664, Taiwan
| | - Li-Ling Hung
- Department of Nursing, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (W.-C.S.); (Y.-C.L.); (L.-L.H.)
- Department of Nursing, HungKuang University, Taichung 43302, Taiwan
| | - Shun-Ping Wang
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-H.L.); (C.-M.S.); (C.-P.C.)
- Sports Recreation and Health Management Continuing Studies-Bachelor’s Degree Completion Program, Tunghai University, Taichung 40704, Taiwan
- Correspondence:
| |
Collapse
|
23
|
Yamamoto M, Hara K, Sugezawa K, Uejima C, Tanio A, Tada Y, Shishido Y, Miyatani K, Hanaki T, Kihara K, Matsunaga T, Tokuyasu N, Takano S, Sakamoto T, Honjo S, Fujiwara Y. Disinfection with single or double usage of new antiseptic olanexidine gluconate in general surgery: a randomized study. Langenbecks Arch Surg 2020; 405:1183-1189. [PMID: 33057823 DOI: 10.1007/s00423-020-02007-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/01/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Olanexidine gluconate is a newly developed solution for skin disinfection that was recently approved in Japan. We aimed to compare single and double application of the solution in preventing surgical site infection (SSI) in patients undergoing general surgery. METHODS This randomized study was conducted at the Tottori University Hospital. Patients scheduled to undergo gastrointestinal or hernia surgery were randomly assigned to one of two groups using either one or two Olanedine applicators for skin disinfection. The primary endpoint was the difference in SSI incidence between the two groups. The secondary endpoint was all adverse events related to olanexidine gluconate. RESULTS A total of 393 patients qualified for the study protocol: 193 received a single application, and 200 received a double application of Olanedine. SSI occurred in 10 patients (2.5%) overall; nine were superficial incisional SSIs, and one patient had a deep incisional SSI. Of the 10 patients who developed SSI, six (3.1%) were in the group receiving a single application, and four (2.0%) were in the group receiving a double application; there was no statistically significant difference between the two groups (P = 0.537). Allergic reactions or skin disorders related to olanexidine gluconate were not observed. CONCLUSION There was no difference in the SSI incidence between the use of one or two Olanedine applicators for skin preparation in elective general surgery. Therefore, a single application of Olanedine is sufficient and is recommended for general surgery as a standard disinfection precaution. TRIAL REGISTRATION NUMBER UMIN000027319; 5/12/2017.
Collapse
Affiliation(s)
- Manabu Yamamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan.
| | - Kazushi Hara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Ken Sugezawa
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Chihiro Uejima
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Akimitsu Tanio
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Yoichiro Tada
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Yuji Shishido
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Kozo Miyatani
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Takehiko Hanaki
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Kyoichi Kihara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Tomoyuki Matsunaga
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Naruo Tokuyasu
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Shuichi Takano
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Teruhisa Sakamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Soichiro Honjo
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Yoshiyuki Fujiwara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| |
Collapse
|
24
|
Enhanced Recovery After Surgery (ERAS): Protocols in Post-Mastectomy Breast Reconstruction. CURRENT BREAST CANCER REPORTS 2020. [DOI: 10.1007/s12609-020-00378-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
25
|
Tipper GA, Chiwera L, Lucas J. Reducing Surgical Site Infection in Pediatric Scoliosis Surgery: A Multidisciplinary Improvement Program and Prospective 4-Year Audit. Global Spine J 2020; 10:633-639. [PMID: 32677570 PMCID: PMC7359689 DOI: 10.1177/2192568219868200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
STUDY DESIGN Single-center prospective cohort. OBJECTIVES To evaluate a multidisciplinary led, structured protocol for reducing surgical site infections (SSIs) in pediatric scoliosis surgery. METHODS Following a spike to 8.6% in local annual infection rate, a multidisciplinary team was convened to identify interventions. The team consisted of spinal surgeons, infectious diseases consultants, physiotherapists, specialist nurses, and theatre managers. A protocol was initiated, including preoperative skin decontamination; standardized operative site prepreparation; betadine-soaked swabs sutured to wound edges; blood loss minimization; 3 L0.9% saline pulsed-lavage; defined protocol of glove changes; antibiotic regime of preoperative gentamicin, intraoperative subfascial vancomycin powder, 48-hour cefuroxime; and intraoperative normothermia. A 4-year audit was initiated of all patients aged ≤18 years undergoing corrective spinal deformity surgery. Institutional board review was not required. RESULTS Between January 1, 2014 and January 1, 2018, 414 operations were performed on 355 patients: male:female = 1:2.2, mean age 13.7 years (range 2.5-17.9), 233 idiopathic (mean operated vertebral levels 12), 122 neuromuscular (mean operated vertebral levels 14), 66 growing rod procedures, 41 multistage procedures. The mean number of operated vertebral levels both overall and in infected cases was 13 (range 2-17). Nine SSIs occurred in 8 patients at 3 months (4 neuromuscular), resulting in an overall SSI per operation of 2.2%. CONCLUSION A multidisciplinary approach with standardized measures significantly reduced SSIs in the unit's pediatric scoliosis surgery.
Collapse
Affiliation(s)
- Geoffrey A. Tipper
- The National Hospital for Neurology and Neurosurgery, London, UK,Geoffrey A. Tipper, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK.
| | | | | |
Collapse
|
26
|
Azi LMTDA, Fonseca NM, Linard LG. SBA 2020: Regional anesthesia safety recommendations update. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2020. [PMID: 32636024 PMCID: PMC9373527 DOI: 10.1016/j.bjane.2020.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of the Brazilian Society of Anesthesiology (SBA)’s Regional Anesthesia Safety Recommendations Update is to provide new guidelines based on the current relevant clinical aspects related to safety in regional anesthesia and analgesia. The goal of the present article is to provide a broad overview of the current knowledge regarding pre-procedure asepsis and antisepsis, risk factors, diagnosis and treatment of infectious complications resulting from anesthetic techniques. It also aims to shed light on the use of reprocessed materials in regional anesthesia practice to establish the effects of aseptic handling of vials and ampoules, and to show cost-effectiveness in the preparation of solutions to be administered continuously in regional blockades. Electronic databases were searched between January 2011 (final date of the literature search for the past SBA recommendations for safety in regional anesthesia) and September 2019. A total of 712 publications were found, 201 of which were included for further analysis, and 82 new publications were added into the review. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to assess the quality of each study and to classify the strength of evidence. The present review was prepared by members of the SBA Technical Standards Committee.
Collapse
Affiliation(s)
- Liana Maria Tôrres de Araújo Azi
- Universidade Federal da Bahia (UFBA), Departamento de Anestesiologia e Cirurgia, Salvador, BA, Brazil; Hospital Universitário Professor Edgard Santos, Centro de Ensino e Treinamento em Anestesiologia, Salvador, BA, Brazil; Comissão de Norma Técnicas da Sociedade Brasileira de Anestesiologia (SBA), Salvador, BA, Brazil.
| | - Neuber Martins Fonseca
- Comissão de Norma Técnicas da Sociedade Brasileira de Anestesiologia (SBA), Salvador, BA, Brazil; Universidade Federal de Uberlândia (UFU), Faculdade de Medicina, Disciplina de Anestesiologia, Uberlândia, MG, Brazil; Universidade Federal de Uberlândia (UFU), Faculdade de Medicina, Centro de Ensino e Treinamento em Anestesiologia, Uberlândia, MG, Brazil; Coordinator of the Comitê de Estudo de Equipamentos Respiratórios e de Anestesiologia da ABNT, and Delegate and representative of the SBA Board at the Technical Committee 121/ISO - Anesthetic and Respiratory Equipment, Uberlândia, MG, Brazil
| | - Livia Gurgel Linard
- Hospital Geral do Estado 2 and of Hospital Roberto Santos, Salvador, BA, Brazil
| |
Collapse
|
27
|
Manka MG, Yang D, Andrews J, Chalmers B, Hebert K, Köhler TS, Trost L. Intraoperative Use of Betadine Irrigation is Associated With a 9-Fold Increased Likelihood of Penile Prosthesis Infection: Results From a Retrospective Case-Control Study. Sex Med 2020; 8:422-427. [PMID: 32601002 PMCID: PMC7471124 DOI: 10.1016/j.esxm.2020.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction Infection remains a persistent complication of penile prosthesis (PP) surgery. Despite popularity of Mulcahy’s PP washout protocol, Betadine has known tissue toxicity. Aim We evaluated PP infection rate based on the type of intraoperative irrigation used, ½ strength Betadine vs vancomycin/gentamicin. Methods We reviewed a prospective database of men undergoing primary, revision, and salvage PPs. No other changes to operative or perioperative techniques occurred after the change in irrigation solution. Univariate and logistic regression analyses were used to evaluate differences in infection rate with use of Betadine vs vancomycin/gentamicin irrigation. Potential confounders were reviewed. Main Outcome Measure The primary outcome was rate of PP infection before and after change of intraoperative irrigation. Results From 2014 to 2018, 217 patients underwent PP placement at our institution by a single surgeon; of whom, 21 (9.7%) experienced an infection (primary = 10 [7.1%], revision = 11 [17.19%], salvage = 0 [0%]). Overall, 152 (70%) received irrigation with Betadine and 65 (30%) with Vancomycin/Gentamicin. Univariate analysis demonstrated significantly increased infection rates with Betadine irrigation (odds ratio [OR]: 4.64, P = .006) and with revision surgery (OR: 2.68, P = .02). Significance of increased infection rate with Betadine was maintained (OR: 9.3; P = .025) after controlling for age, body mass index, Charlson comorbidity index, smoking, diabetes, primary vs revision/salvage, prior penile surgery, use of ectopic reservoir, and adjunctive glanulopexy. Conclusions Changing from intraoperative Betadine to vancomycin/gentamicin solution dramatically reduced infection rates among men undergoing PP placement in both primary and revision cases. We hypothesize that differences in infection rate may relate to the relative toxicity or non-sterile nature of Betadine. Manka MG, Yang D, Andrews J, et al. Intraoperative Use of Betadine Irrigation is Associated With a 9-Fold Increased Likelihood of Penile Prosthesis Infection: Results From a Retrospective Case-Control Study. Sex Med 2020;8:422–427.
Collapse
Affiliation(s)
- Madeleine G Manka
- Department of Urology, Mayo Clinic and Mayo Medical School, Rochester, MN, USA
| | - David Yang
- Department of Urology, Mayo Clinic and Mayo Medical School, Rochester, MN, USA
| | - Jack Andrews
- Department of Urology, Mayo Clinic and Mayo Medical School, Rochester, MN, USA
| | - Brian Chalmers
- Department of Orthopedics, Mayo Clinic and Mayo Medical School, Rochester, MN, USA
| | - Kevin Hebert
- Department of Urology, Mayo Clinic and Mayo Medical School, Rochester, MN, USA
| | - Tobias S Köhler
- Department of Urology, Mayo Clinic and Mayo Medical School, Rochester, MN, USA.
| | - Landon Trost
- Department of Urology, Mayo Clinic and Mayo Medical School, Rochester, MN, USA
| |
Collapse
|
28
|
Hadiati DR, Hakimi M, Nurdiati DS, Masuzawa Y, da Silva Lopes K, Ota E. Skin preparation for preventing infection following caesarean section. Cochrane Database Syst Rev 2020; 6:CD007462. [PMID: 32580252 PMCID: PMC7386833 DOI: 10.1002/14651858.cd007462.pub5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The risk of maternal mortality and morbidity is higher after caesarean section than for vaginal birth. With increasing rates of caesarean section, it is important to minimise risks to the mother as much as possible. This review focused on different skin preparations to prevent infection. This is an update of a review last published in 2018. OBJECTIVES To compare the effects of different antiseptic agents, different methods of application, or different forms of antiseptic used for preoperative skin preparation for preventing postcaesarean infection. SEARCH METHODS For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (9 July 2019), and reference lists of retrieved studies. SELECTION CRITERIA Randomised and quasi-randomised trials, evaluating any type of preoperative skin preparation (agents, methods or forms). We included studies presented only as abstracts, if there was enough information to assess risk of bias. Comparisons of interest in this review were between: different antiseptic agents (e.g. alcohol, povidone iodine), different methods of antiseptic application (e.g. scrub, paint, drape), different forms of antiseptic (e.g. powder, liquid), and also between different packages of skin preparation including a mix of agents and methods, such as a plastic incisional drape, which may or may not be impregnated with antiseptic agents. We mainly focused on the comparison between different agents, with and without the use of drapes. Only studies involving the preparation of the incision area were included. This review did not cover studies of preoperative handwashing by the surgical team or preoperative bathing. DATA COLLECTION AND ANALYSIS Three review authors independently assessed all potential studies for inclusion, assessed risk of bias, extracted the data and checked data for accuracy. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 13 individually-randomised controlled trials (RCTs), with a total of 6938 women who were undergoing caesarean section. Twelve trials (6916 women) contributed data to this review. The trial dates ranged from 1983 to 2016. Six trials were conducted in the USA, and the remainder in India, Egypt, Nigeria, South Africa, France, Denmark, and Indonesia. The included studies were broadly at low risk of bias for most domains, although high risk of detection bias raised some specific concerns in a number of studies. Length of stay was only reported in one comparison. Antiseptic agents Parachlorometaxylenol with iodine versus iodine alone We are uncertain whether parachlorometaxylenol with iodine made any difference to the incidence of surgical site infection (risk ratio (RR) 0.33, 95% confidence interval (CI) 0.04 to 2.99; 1 trial, 50 women), or endometritis (RR 0.88, 95% CI 0.56 to 1.38; 1 trial, 50 women) when compared with iodine alone, because the certainty of the evidence was very low. Adverse events (maternal or neonatal) were not reported. Chlorhexidine gluconate versus povidone iodine Moderate-certainty evidence suggested that chlorhexidine gluconate, when compared with povidone iodine, probably slightly reduces the incidence of surgical site infection (RR 0.72, 95% CI 0.58 to 0.91; 8 trials, 4323 women). This effect was still present in a sensitivity analysis after removing four trials at high risk of bias for outcome assessment (RR 0.87, 95% CI 0.62 to 1.23; 4 trials, 2037 women). Low-certainty evidence indicated that chlorhexidine gluconate, when compared with povidone iodine, may make little or no difference to the incidence of endometritis (RR 0.95, 95% CI 0.49 to 1.86; 3 trials, 2484 women). It is uncertain whether chlorhexidine gluconate reduces maternal skin irritation or allergic skin reaction (RR 0.64, 95% CI 0.28 to 1.46; 3 trials, 1926 women; very low certainty evidence). One small study (60 women) reported reduced bacterial growth at 18 hours after caesarean section for women who had chlorhexidine gluconate preparation compared with women who had povidone iodine preparation (RR 0.23, 95% CI 0.07 to 0.70). Methods Drape versus no drape This comparison investigated the use of drape versus no drape, following preparation of the skin with antiseptics. Low-certainty evidence suggested that using a drape before surgery compared with no drape, may make little or no difference to the incidence of surgical site infection (RR 1.29, 95% confidence interval (CI) 0.97 to 1.71; 3 trials, 1373 women), and probably makes little or no difference to the length of stay in the hospital (mean difference (MD) 0.10 days, 95% CI -0.27 to 0.46; 1 trial, 603 women; moderate-certainty evidence). One trial compared an alcohol scrub and iodophor drape with a five-minute iodophor scrub only, and reported no surgical site infection in either group (79 women, very-low certainty evidence). We were uncertain whether the combination of a one-minute alcohol scrub and a drape reduced the incidence of metritis when compared with a five-minute scrub, because the certainty of the evidence was very low (RR 1.62, 95% CI 0.29 to 9.16; 1 trial, 79 women). The studies did not report on adverse events (maternal or neonatal). AUTHORS' CONCLUSIONS Moderate-certainty evidence suggests that preparing the skin with chlorhexidine gluconate before caesarean section is probably slightly more effective at reducing the incidence of surgical site infection in comparison to povidone iodine. For other outcomes examined there was insufficient evidence available from the included RCTs. Most of the evidence in this review was deemed to be very low or low certainty. This means that for most findings, our confidence in any evidence of an intervention effect is limited, and indicates the need for more high-quality research. Therefore, it is not yet clear what sort of skin preparation may be most effective for preventing postcaesarean surgical site infection, or for reducing other undesirable outcomes for mother and baby. Well-designed RCTs, with larger sample sizes are needed. High-priority questions include comparing types of antiseptic (especially iodine versus chlorhexidine), and application methods (scrubbing, swabbing, or draping). We found two studies that are ongoing; we will incorporate the results of these studies in future updates of this review.
Collapse
Affiliation(s)
- Diah R Hadiati
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Mohammad Hakimi
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Detty S Nurdiati
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yuko Masuzawa
- Department of Health Informatics, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | | | - Erika Ota
- Global Health Nursing, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| |
Collapse
|
29
|
Philipp-Dormston WG, Goodman GJ, De Boulle K, Swift A, Delorenzi C, Jones D, Heydenrych I, Trindade De Almeida A, Batniji RK. Global Approaches to the Prevention and Management of Delayed-onset Adverse Reactions with Hyaluronic Acid-based Fillers. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2730. [PMID: 32440404 PMCID: PMC7209845 DOI: 10.1097/gox.0000000000002730] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/04/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Delayed-onset adverse reactions to hyaluronic acid (HA) fillers are uncommon but have received increased attention, particularly with regard to late-onset nodules. Globally, there is a need for comprehensive prevention and management strategies. METHODS Experts with clinical practices in diverse regions of the world and extensive experience in managing complications related to HA fillers convened to propose and evaluate approaches to prevent delayed-onset adverse reactions after HA filler administration and manage late-onset nodules. RESULTS The expert panel agreed to define delayed-onset adverse reactions as those presenting more than 4 weeks posttreatment, with swelling, induration, and nodulation being the most common clinical signs. The panel recommended 5 general key approaches for the prevention of delayed-onset reactions (patient selection, anatomic location of injection/product selection, aseptic technique, injection procedure/filler, and posttreatment care). Strategies recommended for managing late-onset nodules included oral antibiotics, oral steroids, nonsteroidal anti-inflammatory drugs if needed, hyaluronidase for noninflammatory nodules (recognizing the limitations and regional availability of this treatment), intralesional antibiotics, intralesional immunosuppressive drugs such as steroids and fluorouracil, and surgical excision as a last resort. The panel noted that late-onset nodules may vary in both clinical presentation and etiology, making them challenging to address or prevent, and stressed individualized treatment based on clinical presentation. Regional differences in aseptic protocols, antibiotic selection, and steroid formulations were described. CONCLUSION Insights from global experts on approaches to prevent and manage delayed-onset adverse reactions following HA filler administration, including late-onset nodules, support clinicians worldwide in optimizing patient outcomes and safety.
Collapse
Affiliation(s)
- Wolfgang G. Philipp-Dormston
- From the Department of Dermatology, Witten/Herdecke University, Witten, Germany
- Klinik Links vom Rhein, Cologne, Germany
| | - Greg J. Goodman
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
| | | | | | | | - Derek Jones
- Skin Care and Laser Physicians of Beverly Hills, Beverly Hills, Calif
| | - Izolda Heydenrych
- Cape Town Cosmetic Dermatology Centre, Cape Town, South Africa
- Stellenbosch University, Cape Town, South Africa
| | - Ada Trindade De Almeida
- Clinica de Dermatologia, Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil
| | | |
Collapse
|
30
|
Antiseptic efficacy of an innovative perioperative surgical skin preparation: A confirmatory FDA phase 3 analysis. Infect Control Hosp Epidemiol 2020; 41:653-659. [PMID: 32131912 PMCID: PMC7282856 DOI: 10.1017/ice.2020.27] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND An innovative approach to perioperative antiseptic skin preparation is warranted because of potential adverse skin irritation, rare risk of serious allergic reaction, and perceived diminished clinical efficacy of current perioperative antiseptic agents. The results of a confirmatory US Food and Drug Administration (FDA) phase 3 efficacy analysis of a recently approved innovative perioperative surgical skin antiseptic agent are discussed. METHODS The microbial skin flora on abdominal and groin sites in healthy volunteers were microbiologically sampled following randomization to either ZuraGard, a 2% chlorhexidine/70% isopropyl alcohol preparation (Chloraprep), or a control vehicle (alcohol-free ZuraGard). Mean log10 reduction of colony-forming units (CFU) was assessed at 30 seconds, 10 minutes, and 6 hours. RESULTS For combined groin sites (1,721 paired observations) at all time points, the mean log10 CFU reductions were significantly greater in the ZuraGard group than in the Chloraprep group (P < .02). Mean log10 CFU reductions across combined abdominal and groin sites at all time points (3,277 paired observations) were significantly greater in the ZuraGard group than in the Chloraprep group (P < .02). CONCLUSIONS A confirmatory FDA phase 3 efficacy analysis of skin antisepsis in human volunteers documented that ZuraGard was efficacious in significantly reducing the microbial burden on abdominal and groin test sites, exceeding that of Chloraprep. No significant adverse reactions were observed following the application of ZuraGard. TRIAL REGISTRATION ClinicalTrials.gov identifiers: NCT02831998 and NCT02831816.
Collapse
|
31
|
Atwan Y, Schemitsch EH. The top three unanswered questions in the management of open fractures. OTA Int 2020; 3:e072. [PMID: 33937691 PMCID: PMC8081489 DOI: 10.1097/oi9.0000000000000072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 12/23/2019] [Indexed: 11/26/2022]
Abstract
Despite improvements in treatment strategies and emphasis on preventative measures, the management of open fractures continues to be a challenging endeavor for orthopaedic surgeons. Deep infections, delayed healing, and nonunion continue to be problematic complications associated with these devastating injuries. There remain many unanswered clinical questions regarding the management of these injuries and how the various aspects of care can be further optimized. There continues to be a paucity of evidence regarding how infection can best be treated and prevented, how to reliability predict bone healing/nonunion, and how bone healing can be best augmented in the setting of open fractures and their potential nonunions. This review aims to assess the current literature on these top unanswered questions and discuss the gaps in evidence that may be filled with future studies.
Collapse
Affiliation(s)
- Yousif Atwan
- Division of Orthopaedic Surgery, Western University, London, ON, Canada
| | - Emil H Schemitsch
- Division of Orthopaedic Surgery, Western University, London, ON, Canada
| |
Collapse
|
32
|
Kawashita Y, Soutome S, Umeda M, Saito T. Oral management strategies for radiotherapy of head and neck cancer. JAPANESE DENTAL SCIENCE REVIEW 2020; 56:62-67. [PMID: 32123547 PMCID: PMC7037635 DOI: 10.1016/j.jdsr.2020.02.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 01/13/2020] [Accepted: 02/02/2020] [Indexed: 12/11/2022] Open
Abstract
Radiotherapy, often with concomitant chemotherapy, has a significant role in the management of head and neck cancer, however, radiotherapy induces adverse events include oral mucositis, hyposalivation, loss of taste, dental caries, osteoradionecrosis, and trismus, all of which have an impact on patients’ quality of life. Therefore, it is necessary to implement oral management strategies prior to the initiation of radiotherapy in patients with head and neck cancer. Since 2014, the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines) have enumerated the “Principles of Dental Evaluation and Management (DENT-A)” in the section on head and neck cancers, however, oral management was not explained in detail. Oral management has not been achieved a consensus protocol. The aim of this literature is to show that oral management strategy include removal infected teeth before the start of radiotherapy to prevent osteoradionecrosis, oral care for preventing severe oral mucositis to support patient complete radiotherapy during radiotherapy, and prevent of dental caries followed by osteoradionecrosis after radiotherapy.
Collapse
Affiliation(s)
- Yumiko Kawashita
- Department of Oral Management Center, Nagasaki University Hospital, Japan
- Corresponding author at: Department of Oral Management Center, Nagasaki University Hospital, 1-7-1, Sakamoto, Nagasaki-city, Nagasaki 852-8102, Japan.
| | - Sakiko Soutome
- Department of Oral Management Center, Nagasaki University Hospital, Japan
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Toshiyuki Saito
- Department of Oral Health, Nagasaki University Graduate School of Biomedical Sciences, Japan
| |
Collapse
|
33
|
Kumar A, Gautam A, Dey A, Saith R, Uttamacharya, Achyut P, Gautam V, Agarwal D, Chakraverty A, Mozumdar A, Aruldas K, Verma R, Nanda P, Krishnan S, Saggurti N. Infection prevention preparedness and practices for female sterilization services within primary care facilities in Northern India. BMC Health Serv Res 2019; 20:1. [PMID: 31888624 PMCID: PMC6937913 DOI: 10.1186/s12913-019-4778-6] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 11/25/2019] [Indexed: 11/10/2022] Open
Abstract
Background In 2014, 16 women died following female sterilization operations in Bilaspur, a district in central India. In addition to those 16 deaths, 70 women were hospitalized for critical conditions (Sharma, Lancet 384,2014). Although the government of India’s guidelines for female sterilization mandate infection prevention practices, little is known about the extent of infection prevention preparedness and practice during sterilization procedures that are part of the country’s primary health care services. This study assesses facility readiness for infection prevention and adherence to infection prevention practices during female sterilization procedures in rural northern India. Method The data for this study were collected in 2016–2017 as part of a family planning quality of care survey in selected public health facilities in Bihar (n = 100), and public (n = 120) and private health facilities (n = 97) in Uttar Pradesh. Descriptive analysis examined the extent of facility readiness for infection prevention (availability of handwashing facilities, new or sterilized gloves, antiseptic lotion, and equipment for sterilization). Correlation and multivariate statistical methods were used to examine the role of facility readiness and provider behaviors on infection prevention practices during female sterilization. Result Across the three health sectors, 62% of facilities featured all four infection prevention components. Sterilized equipment was lacking in all three health sectors. In facilities with all four components, provider adherence to infection prevention practices occurred in only 68% of female sterilization procedures. In Bihar, 76% of public health facilities evinced all four components of infection prevention, and in those facilities provider’s adherence to infection prevention practices was almost universal. In Uttar Pradesh, where only 55% of public health facilities had all four components, provider adherence to infection prevention practices occurred in only 43% of female sterilization procedures. Conclusion The findings suggest that facility preparedness for infection prevention does play an important role in provider adherence to infection prevention practices. This phenomenon is not universal, however. Not all doctors from facilities prepared for infection prevention adhere to the practices, highlighting the need to change provider attitudes. Unprepared facilities need to procure required equipment and supplies to ensure the universal practice of infection prevention.
Collapse
Affiliation(s)
- Abhishek Kumar
- Population Council, B 86, Defense Colony, New Delhi, 110024, India.
| | - Abhishek Gautam
- International Center for Research on Women, New Delhi, India
| | - Arnab Dey
- Sambodhi Research and Communications Private Limited, Noida, Uttar Pradesh, India
| | - Ruhi Saith
- Oxford Policy Management, New Delhi, India
| | - Uttamacharya
- International Center for Research on Women, New Delhi, India
| | - Pranita Achyut
- International Center for Research on Women, New Delhi, India
| | | | | | - Amit Chakraverty
- Sambodhi Research and Communications Private Limited, Noida, Uttar Pradesh, India
| | | | - Kumudha Aruldas
- Population Council, B 86, Defense Colony, New Delhi, 110024, India
| | - Ravi Verma
- International Center for Research on Women, New Delhi, India
| | - Priya Nanda
- Bill and Melinda Gates Foundation, New Delhi, India
| | | | | |
Collapse
|
34
|
Ling ML, Apisarnthanarak A, Abbas A, Morikane K, Lee KY, Warrier A, Yamada K. APSIC guidelines for the prevention of surgical site infections. Antimicrob Resist Infect Control 2019; 8:174. [PMID: 31749962 PMCID: PMC6852795 DOI: 10.1186/s13756-019-0638-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/31/2019] [Indexed: 01/25/2023] Open
Abstract
Background The Asia Pacific Society of Infection Control (APSIC) launched the APSIC Guidelines for the Prevention of Surgical Site Infections in 2018. This document describes the guidelines and recommendations for the setting prevention of surgical site infections (SSIs). It aims to highlight practical recommendations in a concise format designed to assist healthcare facilities at Asia Pacific region in achieving high standards in preoperative, perioperative and postoperative practices. Method The guidelines were developed by an appointed workgroup comprising experts in the Asia Pacific region, following reviews of previously published guidelines and recommendations relevant to each section. Results It recommends that healthcare facilities review specific risk factors and develop effective prevention strategies, which would be cost effective at local levels. Gaps identified are best closed using a quality improvement process. Surveillance of SSIs is recommended using accepted international methodology. The timely feedback of the data analysed would help in the monitoring of effective implementation of interventions. Conclusions Healthcare facilities should aim for excellence in safe surgery practices. The implementation of evidence-based practices using a quality improvement process helps towards achieving effective and sustainable results.
Collapse
Affiliation(s)
- Moi Lin Ling
- Infection Prevention & Epidemiology, Singapore General Hospital, Singapore, 169608 Singapore
| | - Anucha Apisarnthanarak
- Infectious Diseases, Division of Infectious Diseases, Thammasat University Hospital, Khlong Nueng, Thailand
| | - Azlina Abbas
- Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpor, Malaysia
| | - Keita Morikane
- Division of Clinical Laboratory and Infection Control Yamagata University Hospital, Yamagata, Japan
| | - Kil Yeon Lee
- Surgery, Medical College, Kyung Hee University Center, Gangdong-gu, South Korea
| | - Anup Warrier
- Infectious Diseases and Infection Control, Aster Medcity, Kochi, India
| | - Koji Yamada
- Orthopaedic Surgery, Kanto Rosai Hospital, Kawasaki, Japan
| |
Collapse
|
35
|
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]
|
36
|
|
37
|
Bruyere F, Pilatz A, Boehm A, Pradere B, Wagenlehner F, Vallee M. Associated measures to antibiotic prophylaxis in urology. World J Urol 2019; 38:9-15. [DOI: 10.1007/s00345-019-02854-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/15/2019] [Indexed: 01/20/2023] Open
|
38
|
Kyllo RL, Alam M. Risk, Prevention, Diagnosis, and Management of Post-Operative Cutaneous Infection. CURRENT DERMATOLOGY REPORTS 2019. [DOI: 10.1007/s13671-019-0257-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
39
|
Hegarty J, Howson V, Wills T, Creedon SA, Mc Cluskey P, Lane A, Connolly A, Walshe N, Noonan B, Guidera F, Gallagher AG, Murphy S. Acute surgical wound-dressing procedure: Description of the steps involved in the development and validation of an observational metric. Int Wound J 2019; 16:641-648. [PMID: 30932342 PMCID: PMC6850176 DOI: 10.1111/iwj.13072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/27/2018] [Accepted: 12/28/2018] [Indexed: 11/27/2022] Open
Abstract
The aim of this study was to develop an observational metric that could be used to assess the performance of a practitioner in completing an acute surgical wound-dressing procedure using aseptic non-touch technique (ANTT). A team of clinicians, academics, and researchers came together to develop an observational metric using an iterative six-stage process, culminating in a Delphi panel meeting. A scoping review of the literature provided a background empirical perspective relating to wound-dressing procedure performance. Video recordings of acute surgical wound-dressing procedures performed by nurses in clinical (n = 11) and simulated (n = 3) settings were viewed repeatedly and were iteratively deconstructed by the metric development group. This facilitated the identification of the discrete component steps, potential errors, and sentinel (serious) errors, which characterise a wound dressing procedure and formed part of the observational metric. The ANTT wound-dressing observational metric was stress tested for clarity, the ability to be scored, and interrater reliability, calculated during a further phase of video analysis. The metric was then subjected to a process of cyclical evaluation by a Delphi panel (n = 21) to obtain face and content validity of the metric. The Delphi panel deliberation verified the face and content validity of the metric. The final metric has three phases, 31 individual steps, 18 errors, and 27 sentinel errors. The metric is a tool that identifies the standard to be attained in the performance of acute surgical wound dressings. It can be used as both an adjunct to an educational programme and as a tool to assess a practitioner's performance of a wound-dressing procedure in both simulated and clinical practice contexts.
Collapse
Affiliation(s)
- Josephine Hegarty
- Catherine McAuley School of Nursing and MidwiferyUniversity College CorkIreland
| | - Victoria Howson
- Catherine McAuley School of Nursing and MidwiferyUniversity College CorkIreland
| | - Teresa Wills
- Catherine McAuley School of Nursing and MidwiferyUniversity College CorkIreland
| | - Sile A. Creedon
- Catherine McAuley School of Nursing and MidwiferyUniversity College CorkIreland
| | | | - Aoife Lane
- Catherine McAuley School of Nursing and MidwiferyUniversity College CorkIreland
| | - Aine Connolly
- Nursing Division, Cork University Hospital GroupIreland
| | - Nuala Walshe
- Catherine McAuley School of Nursing and MidwiferyUniversity College CorkIreland
| | - Brendan Noonan
- Catherine McAuley School of Nursing and MidwiferyUniversity College CorkIreland
| | - Fiona Guidera
- Nursing Division, Mercy University HospitalCorkIreland
| | - Anthony G Gallagher
- Application of Science to Simulation based Education and Research on Training Centre, College of Medicine and Health, University College Cork, Cork, Ireland & Faculty of Life and Health SciencesUlster University, Magee Campus, Northland Rd, Londonderry BT48 7JLUnited Kingdom
| | - Siobhan Murphy
- Catherine McAuley School of Nursing and MidwiferyUniversity College CorkIreland
| |
Collapse
|
40
|
Bobby S, Michael D J, Hiren P, Benjamin D. Current preoperative antisepsis in neurosurgery: an example of the challenges in implementing evidence-based medicine to surgical practice. Ann R Coll Surg Engl 2019; 101:279-284. [PMID: 30354177 PMCID: PMC6432964 DOI: 10.1308/rcsann.2018.0174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Surgical site infection is associated with significant morbidity and mortality. Effective preoperative skin decolonisation is an important preventative strategy. The National Institute for Health and Care Excellence clinical guidelines recommend decolonisation using chlorhexidine gluconate (CHG) or povidone iodine (PVI). Current evidence indicates that CHG is more effective, while the combination of CHG and PVI is greater still. This study describes current practice among neurosurgeons in the UK, including differences between trainees and consultants, to review compliance with the latest evidence. MATERIALS AND METHODS A Society of British Neurosurgical Surgeons approved national, multicentre questionnaire was circulated online. A total of 74 complete responses were obtained from 27 trainees and 47 consultants, representing 28 of 37 neurosurgical centres. RESULTS Of the total responding centres, 36 (49%) used a single agent and 38 (51%) used a dual-agent preparation. One respondent used Tisept®. Seventy (95%) used alcohol in some form and none used aqueous CHG. Trainees were more likely to use a dual-agent preparation (P = 0.025). Forty-seven (63%) prepared the skin three or more times, with trainees preparing the skin more times than consultants (P = 0.002). CONCLUSION Neurosurgical practice adheres to national clinical guidelines but not the latest evidence from the literature. Given the weighting placed on randomised controlled trials, such a trial may be required to standardise practice that is likely to reduce surgical site infection.
Collapse
Affiliation(s)
- Sachdev Bobby
- Department of Neurosurgery, King's College Hospital , London , UK
| | - Jenkinson Michael D
- Department of Neurosurgery, Walton Centre NHS Foundation Trust , Liverpool , UK
- Institute of Translational Medicine, University of Liverpool , Liverpool , UK
| | - Patel Hiren
- Department of Neurosurgery, Greater Manchester Neuroscience Centre, Salford Royal Foundation Trust , Salford , UK
| | - Davies Benjamin
- Department of Neurosurgery, Addenbrooke's Hospital , Cambridge , UK
| |
Collapse
|
41
|
Scholz R, Hönning A, Seifert J, Spranger N, Stengel D. Effectiveness of architectural separation of septic and aseptic operating theatres for improving process quality and patient outcomes: a systematic review. Syst Rev 2019; 8:16. [PMID: 30626433 PMCID: PMC6325836 DOI: 10.1186/s13643-018-0937-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 12/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Architectural division of aseptic and septic operating theatres is a distinct structural feature of surgical departments in Germany. Internationally, hygienists and microbiologists mainly recommend functional separation (i.e. aseptic procedures first) without calling for separate operating floors and rooms. However, patients with severe musculoskeletal infections (e.g. joint empyema, spondylodiscitis, deep implant-associated infections) may benefit from the permanent availability of septic operating capacities without delay caused by an ongoing aseptic surgical program. A systematic literature review on the influence of a structural separation of septic and aseptic operating theatres on process and/or outcome quality has not yet been conducted. METHODS Systematic literature search in PubMed MEDLINE, Ovid Embase, CINAHL and the Cochrane Library, screening of referenced citations, and assessment of grey literature. RESULTS A total of 572 articles were found through the systematic literature search. No head-to-head studies (neither randomised, quasi-randomised nor observational) were identified which examined the impact of structural separation of septic and aseptic operating theatres on process and/or outcome quality. CONCLUSIONS This review did not identify evidence in favour nor against architectural separation of septic or aseptic operating theatre. Specifically, there is no evidence of a harmful effect of architectural separation. Unless prospective studies, ideally randomised trials, will be available, it is unjustified to call for abolishing established hospital structures. Future investigations must address patient-centered endpoints, surgical site infections, process quality and hospital economy. SYSTEMATIC REVIEW REGISTRATION PROSPERO (International prospective register of systematic reviews): CRD42018086568.
Collapse
Affiliation(s)
- Romy Scholz
- Centre for Clinical Research, BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany
| | - Alexander Hönning
- Centre for Clinical Research, BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany
| | - Julia Seifert
- Department of Trauma and Orthopaedic Surgery, BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany
| | - Nikolai Spranger
- Department of Trauma and Orthopaedic Surgery, BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany
| | - Dirk Stengel
- Centre for Clinical Research, BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany
- Department of Trauma and Orthopaedic Surgery, BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany
- Hospital Group of the Statutory Accident Insurance, Berlin, Germany
| |
Collapse
|
42
|
Operation Department: Infection Control. PREVENTION AND CONTROL OF INFECTIONS IN HOSPITALS 2019. [PMCID: PMC7122724 DOI: 10.1007/978-3-319-99921-0_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Infection control in the operation department is the result of many single factors and routines, based on experience, documentation and expert panels through more than a hundred years. Many factors and routines in surgery are evidence-based, but most of them are still lacking evidence and can probably never be investigated because of ethical problems. Consequently, consensus and guidance are used to a great extent. Surgery opens into sterile tissues for hours, where there is massive tissue damage by knife, diathermy, clogging of vessels, pressure against and drying of tissues, decreased blood supply, impaired phagocytosis and impaired infection defence. Microbes deposited in this devitalized tissues may find a good basis for growth and proliferation if there is lack of infection control and sterility. For patients with ongoing infections and who need surgery, special routines are made to prevent the spread of infections in the operation department. This chapter is a practical description of many important preventive procedures that may protect the surgical patient against surgical site infection (SSI).
Collapse
|
43
|
Kick BL, Gumber S, Wang H, Moore RH, Taylor DK. Evaluation of 4 Presurgical Skin Preparation Methods in Mice. JOURNAL OF THE AMERICAN ASSOCIATION FOR LABORATORY ANIMAL SCIENCE : JAALAS 2019; 58:71-77. [PMID: 30609948 PMCID: PMC6351048 DOI: 10.30802/aalas-jaalas-18-000047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/31/2018] [Accepted: 07/02/2018] [Indexed: 11/05/2022]
Abstract
Mice routinely undergo surgical procedures for use in research; however, studies of skin preparation methods to achieve antisepsis are rare. The present study evaluated 4 skin preparation treatments: depilatory agent followed by povidone-iodine and alcohol scrub; depilatory agent followed by povidone-iodine and saline scrub; electric clippers followed by povidone-iodine and alcohol scrub; and electric clippers followed by povidone-iodine and saline scrub. Swabs for bacterial culture were obtained immediately after hair removal and after scrubbing to measure the reduction in bacterial load. Full-thickness incisions were assigned ASEPSIS wound scores and examined histologically on days 0, 1, and 7 after surgery. Neither bacterial load growth nor ASEPSIS wound scores differed among any of the treatments. Histopathology revealed statistically significant but biologically irrelevant differences. Overall all treatment methods achieved acceptable bacterial load reduction and surgical site healing.
Collapse
Affiliation(s)
- Brenda L Kick
- Division of Animal Resources, Emory University, Atlanta, Georgia;,
| | - Sanjeev Gumber
- Division of Pathology, Yerkes National Primate Research Center, Atlanta, Georgia, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Heqiong Wang
- Department of Biostatistics and Bioinformatics, Emory University School of Public Health, Emory University, Atlanta, Georgia
| | - Reneé H Moore
- Department of Biostatistics and Bioinformatics, Emory University School of Public Health, Emory University, Atlanta, Georgia
| | - Douglas K Taylor
- Division of Animal Resources, Emory University, Atlanta, Georgia, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
44
|
Merceron TK, Betarbet U, Hart A, Baker N, Carlson G, Losken A. Comparison of Complications Following Implant-Based Breast Reconstruction Using Triple Antibiotic Solution versus Low Concentration Chlorhexidine Gluconate Solution. ACTA ACUST UNITED AC 2019. [DOI: 10.4236/mps.2019.94010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
45
|
Jurado-Ruiz M, Slobogean GP, Bzovsky S, Garibaldi A, O'Hara NN, Howe A, Petrisor B, Sprague S. Large variations in the practice patterns of surgical antiseptic preparation solutions in patients with open and closed extremity fractures: a cross-sectional survey. Antimicrob Resist Infect Control 2018; 7:148. [PMID: 30519462 PMCID: PMC6267892 DOI: 10.1186/s13756-018-0440-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/20/2018] [Indexed: 02/05/2023] Open
Abstract
Background Surgically-managed fractures, particularly open fractures, are associated with high rates of surgical site infections (SSIs). To reduce the risk of an SSI, orthopaedic surgeons routinely clean open fracture wounds in the emergency department (ED) and then apply a bandage to the open wound. Prior to the surgical incision, it is standard practice to prepare the fracture region with an antiseptic skin solution as an additional SSI prevention strategy. Multiple antiseptic solutions are available. Objectives To explore the variation in practice patterns among orthopaedic surgeons regarding antiseptic solution use in the ED and antiseptic preparatory techniques for fracture surgery. Methods We developed a 27-item survey and surveyed members of several orthopaedic associations. Results Two hundred and-ten surveys were completed. 71.0% of respondents irrigate the open wound and skin in the ED, primarily with saline alone (59.7%) or iodine-based solutions (32.9%). 90.5% of responders indicated that they dress the open wound in the ED, with 41.0% applying a saline-soaked bandage and 33.7% applying an iodine-soaked dressing (33.7%). In their surgical preparation of open fractures, 41.0% of respondents used an iodine-based solution, 26.7% used a chlorhexidine gluconate (CHG)-based solution, and 31.4% used a combination of the two. In closed fractures, 43.8% of respondents used a CHG-based solution, 28.1% used an iodine-based solution, and 27.1% used a combination. Despite theoretical concerns about the use of alcohol in open wounds, 51.4% used alcohol-based solutions or alcohol alone during skin preparation of open fractures. Conclusions A lack of consensus exists regarding use of antiseptic surgical preparation solutions for fractures. High-quality clinical research is needed to assess the effectiveness of different surgical antiseptic preparation solutions on patient outcomes in fracture populations. Electronic supplementary material The online version of this article (10.1186/s13756-018-0440-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Maria Jurado-Ruiz
- 1Department of Trauma and Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Gerard P Slobogean
- 2R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD USA
| | - Sofia Bzovsky
- 3Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON Canada
| | - Alisha Garibaldi
- 3Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON Canada
| | - Nathan N O'Hara
- 2R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD USA
| | - Andrea Howe
- 2R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD USA
| | - Brad Petrisor
- 3Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON Canada
| | - Sheila Sprague
- 3Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON Canada.,4Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON Canada.,5McMaster University, 293 Wellington Street North, Suite 110, Ontario, Hamilton L8L 8E7 Canada
| |
Collapse
|
46
|
Hadiati DR, Hakimi M, Nurdiati DS, da Silva Lopes K, Ota E. Skin preparation for preventing infection following caesarean section. Cochrane Database Syst Rev 2018; 10:CD007462. [PMID: 30346040 PMCID: PMC6517158 DOI: 10.1002/14651858.cd007462.pub4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The risk of maternal mortality and morbidity (particularly postoperative infection) is higher for caesarean section (CS) than for vaginal birth. With the increasing rate of CS, it is important to minimise the risks to the mother as much as possible. This review focused on different forms and methods of preoperative skin preparation to prevent infection. This review is an update of a review that was first published in 2012, and updated in 2014. OBJECTIVES To compare the effects of different antiseptic agents, different methods of application, or different forms of antiseptic used for preoperative skin preparation for preventing postcaesarean infection. SEARCH METHODS For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (27 November 2017), and reference lists of retrieved studies. SELECTION CRITERIA Randomised and quasi-randomised trials, evaluating any type of preoperative skin preparation agents, forms, and methods of application for caesarean section.Comparisons of interest in this review were between different antiseptic agents used for CS skin preparation (e.g. alcohol, povidone iodine), different methods of antiseptic application (e.g. scrub, paint, drape), different forms of antiseptic (e.g. powder, liquid), and also between different skin preparations, such as a plastic incisional drape, which may or may not be impregnated with antiseptic agents.Only studies involving the preparation of the incision area were included. This review did not cover studies of preoperative handwashing by the surgical team or preoperative bathing. DATA COLLECTION AND ANALYSIS Three review authors independently assessed all potential studies for inclusion, assessed risk of bias, and extracted the data using a predesigned form. We checked data for accuracy. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS For this update, we included 11 randomised controlled trials (RCTs), with a total of 6237 women who were undergoing CS. Ten trials (6215 women) contributed data to this review. All included studies were individual RCTs. We did not identify any quasi- or cluster-RCTs. The trial dates ranged from 1983 to 2016. Six trials were conducted in the USA, and the remainder in Nigeria, South Africa, France, Denmark, and Indonesia.The included studies were broadly methodologically sound, but raised some specific concerns regarding risk of bias in a number of cases.Drape versus no drapeThis comparison investigated the use of a non-impregnated drape versus no drape, following preparation of the skin with antiseptics. For women undergoing CS, low-quality evidence suggested that using a drape before surgery compared with no drape, may make little or no difference to the incidence of surgical site infection (risk ratio (RR) 1.29, 95% confidence interval (CI) 0.97 to 1.71; 2 trials, 1294 women), or length of stay in the hospital (mean difference (MD) 0.10 day, 95% CI -0.27 to 0.46 1 trial, 603 women).One-minute alcohol scrub with iodophor drape versus five-minute iodophor scrub without drapeOne trial compared an alcohol scrub and iodophor drape with a five-minute iodophor scrub only, and reported no surgical site infection in either group (79 women, very-low quality evidence). We were uncertain whether the combination of a one-minute alcohol scrub and a drape reduced the incidence of endomyometritis when compared with a five-minute scrub, because the quality of the evidence was very low (RR 1.62, 95% CI 0.29 to 9.16; 1 trial, 79 women).Parachlorometaxylenol with iodine versus iodine aloneWe were uncertain whether parachlorometaxylenol with iodine before CS made any difference to the incidence of surgical site infection (RR 0.33, 95% CI 0.04 to 2.99; 1 trial, 50 women), or endometritis (RR 0.88, 95% CI 0.56 to 1.38; 1 trial, 50 women) when compared with iodine alone, because the quality of the evidence was very low.Chlorhexidine gluconate versus povidone iodineLow-quality evidence suggested that chlorhexidine gluconate before CS, when compared with povidone iodine, may make little or no difference to the incidence of surgical site infection (RR 0.80, 95% CI 0.62 to 1.02; 6 trials, 3607 women). However, surgical site infection appeared to be slightly reduced for women for whom chlorhexidine gluconate was used compared with povidone iodine after we removed four trials at high risk of bias for outcome assessment, in a sensitivity analysis (RR 0.59, 95% CI 0.37 to 0.95; 2 trials, 1321 women).Low-quality evidence indicated that chlorhexidine gluconate before CS, when compared with povidone iodine, may make little or no difference to the incidence of endometritis (RR 1.01, 95% CI 0.51 to 2.01; 2 trials, 2079 women), or to reducing maternal skin irritation or allergic skin reaction (RR 0.60, 95% CI 0.22 to 1.63; 2 trials, 1521 women).One small study (60 women) reported reduced bacterial growth at 18 hours after CS for women who had chlorhexidine gluconate preparation compared with women who had povidone iodine preparation (RR 0.23, 95% CI 0.07 to 0.70).None of the included trials reported on maternal mortality or repeat surgery.Chlorhexidine 0.5% versus 70% alcohol plus drapeOne trial, which was only available as an abstract, investigated the effect of skin preparation on neonatal adverse events, and found cord blood iodine concentration to be higher in the iodine group. AUTHORS' CONCLUSIONS There was insufficient evidence available from the included RCTs to fully evaluate different agents and methods of skin preparation for preventing infection following caesarean section. Therefore, it is not yet clear what sort of skin preparation may be most effective for preventing postcaesarean surgical site infection, or for reducing other undesirable outcomes for mother and baby.Most of the evidence in this review was deemed to be very low or low quality. This means that for most findings, our confidence in any evidence of an intervention effect is limited, and indicates the need for more high-quality research.This field needs high quality, well designed RCTs, with larger sample sizes. High priority questions include comparing types of antiseptic (especially iodine versus chlorhexidine), and application methods (scrubbing, swabbing, or draping). We found four studies that were ongoing; we will incorporate the results of these studies in future updates of this review.
Collapse
Affiliation(s)
- Diah R Hadiati
- Universitas Gadjah MadaFaculty of Medicine, Public Health and NursingDR.Sardjito HospitalJl. Kesehatan No.1, SekipYogyakartaDaerah Istimewa YogyakartaIndonesia55281
| | - Mohammad Hakimi
- Universitas Gadjah MadaFaculty of Medicine, Public Health and NursingDR.Sardjito HospitalJl. Kesehatan No.1, SekipYogyakartaDaerah Istimewa YogyakartaIndonesia55281
| | - Detty S Nurdiati
- Universitas Gadjah MadaDepartment of Obstetrics and Gynaecology, Faculty of MedicineJl. Farmako, SekipYogyakartaDaerah Istimewa YogyakartaIndonesia55281
| | - Katharina da Silva Lopes
- St. Luke's International UniversityGlobal Health Nursing, Graduate School of Nursing Sciences10‐1 Akashi‐choChuo‐KuTokyoMSJapan104‐0044
| | - Erika Ota
- St. Luke's International UniversityGlobal Health Nursing, Graduate School of Nursing Sciences10‐1 Akashi‐choChuo‐KuTokyoMSJapan104‐0044
| | | |
Collapse
|
47
|
Del Valle JM, Fisk EA, Noland EL, Pak D, Zhang J, Crim MJ, Lawrence FR, Hankenson FC. Comparison of Aqueous and Alcohol-based Agents for Presurgical Skin Preparation Methods in Mice. JOURNAL OF THE AMERICAN ASSOCIATION FOR LABORATORY ANIMAL SCIENCE 2018; 57:401-414. [PMID: 29970215 DOI: 10.30802/aalas-jaalas-17-000128] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Preparing the skin of rodents for surgery often involves multiple applications of antiseptic agents. However, fewer applications may achieve the same antiseptic outcome. We evaluated the antimicrobial efficacy and effects on intraoperative body temperature of various surgical scrub agents, including novel waterless alcohol-based (WAB) options. Prior to ventral laparotomy, female C57BL/6 mice were treated with 0.9% saline (control); 70% ethanol; 10% povidone-iodine alternated with saline or 70% ethanol; 2% chlorhexidine digluconate alternated with saline or 70% ethanol; or 1 of 3 WAB products-commercial surgical scrub A, commercial surgical scrub B, or a common commercial hand sanitizer. Core temperatures were recorded, and aerobic culture swabs were collected from the surgical site at multiple time points. Intraoperative temperature trajectories for animals treated with scrub B, 10% povidone-iodine with saline, or hand sanitizer did not differ from saline (control). Temperature trajectories of mice treated with other scrub agents did differ significantly from saline. Bacteria were not detected at the operative site after 3 scrubs of 70% ethanol or 10% povidone-iodine alternated with ethanol, 2 scrubs of scrub A or B, 1 scrub of hand sanitizer, and both 1 and 3 scrubs of 2% chlorhexidine alternated with ethanol. Scrub B and 2% chlorhexidine-ethanol demonstrated prolonged antibacterial efficacy. Histology of corresponding haired skin sections revealed no differences in postoperative healing between groups, and no postoperative infections occurred. These results indicate that various novel WAB disinfectants, particularly scrub B (61% ethanol and 1% chlorhexidine gluconate), mitigate intraoperative temperature effects associated with several traditional agents and combinations. Furthermore, reduction of skin bacterial load without adverse effects on healing was seen with fewer than triplicate applications of most tested agents. Ultimately effective skin preparation can be achieved by using only 1 or 2 applications of scrub, thus rendering the triplicate skin-prep method unnecessary in laboratory mice.
Collapse
Affiliation(s)
| | - Elizabeth A Fisk
- College of Veterinary Medicine, Michigan State University, Lansing, Michigan
| | - Erica L Noland
- Veterinary Diagnostic Laboratory, Michigan State University, Lansing, Michigan
| | - Daewoo Pak
- Center for Statistical Training and Consulting, Michigan State University, Lansing, Michigan
| | - Jingyi Zhang
- Center for Statistical Training and Consulting, Michigan State University, Lansing, Michigan
| | - Marcus J Crim
- Serology and Immunology, IDEXX BioResearch, Columbia, Missouri
| | - Frank R Lawrence
- Center for Statistical Training and Consulting, Michigan State University, Lansing, Michigan
| | - F Claire Hankenson
- Campus Animal Resources, College of Veterinary Medicine, Michigan State University, Lansing, Michigan
| |
Collapse
|
48
|
Antiseptic Agents Elicit Short-Term, Personalized, and Body Site-Specific Shifts in Resident Skin Bacterial Communities. J Invest Dermatol 2018; 138:2234-2243. [PMID: 29753031 DOI: 10.1016/j.jid.2018.04.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/09/2018] [Accepted: 04/23/2018] [Indexed: 01/19/2023]
Abstract
Despite critical functions in cutaneous health and disease, it is unclear how resident skin microbial communities are altered by topical antimicrobial interventions commonly used in personal and clinical settings. Here we show that acute exposure to antiseptic treatments elicits rapid but short-term depletion of microbial community diversity and membership. Thirteen subjects were enrolled in a longitudinal treatment study to analyze the effects of topical treatments (i.e., ethanol, povidone-iodine, chlorhexidine, and water) on the skin microbiome at two skin sites of disparate microenvironment: forearm and back. Treatment effects were highly dependent on personalized and body site-specific colonization signatures, which concealed community dynamics at the population level when not accounted for in this analysis. The magnitude of disruption was influenced by the identity and abundance of particular bacterial inhabitants. Lowly abundant members of the skin microbiota were more likely to be displaced, and subsequently replaced, by the most abundant taxa prior to treatment. Members of the skin commensal family Propionibactericeae were particularly resilient to treatment, suggesting a distinct competitive advantage in the face of disturbance. These results provide insight into the stability and resilience of the skin microbiome, while establishing the impact of topical antiseptic treatment on skin bacterial dynamics and community ecology.
Collapse
|
49
|
Trobos M, Johansson ML, Jonhede S, Peters H, Hoffman M, Omar O, Thomsen P, Hultcrantz M. The clinical outcome and microbiological profile of bone-anchored hearing systems (BAHS) with different abutment topographies: a prospective pilot study. Eur Arch Otorhinolaryngol 2018; 275:1395-1408. [PMID: 29623410 PMCID: PMC5951894 DOI: 10.1007/s00405-018-4946-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/20/2018] [Indexed: 02/07/2023]
Abstract
Purpose In this prospective clinical pilot study, abutments with different topologies (machined versus polished) were compared with respect to the clinical outcome and the microbiological profile. Furthermore, three different sampling methods (retrieval of abutment, collection of peri-abutment exudate using paper-points, and a small peri-abutment soft-tissue biopsy) were evaluated for the identification and quantification of colonising bacteria. Methods Twelve patients, seven with machined abutment and five with polished abutment, were included in the analysis. Three different sampling procedures were employed for the identification and quantification of colonising bacteria from baseline up to 12 months, using quantitative culturing. Clinical outcome measures (Holgers score, hygiene, pain, numbness and implant stability) were investigated. Results The clinical parameters, and total viable bacteria per abutment or in tissue biopsies did not differ significantly between the polished and machined abutments. The total CFU/mm2 abutment and CFU/peri-abutment fluid space of anaerobes, aerobes and staphylococci were significantly higher for the polished abutment. Anaerobic bacteria were detected in the tissue biopsies before BAHS implantation. Anaerobes and Staphylococcus spp. were detected in all three compartments after BAHS installation. For most patients (10/12), the same staphylococcal species were found in at least two of the three compartments at the same time-point. The common skin coloniser Staphylococcus epidermidis was identified in all patients but one (11/12), whereas the pathogen Staphylococcus aureus was isolated in five of the patients. Several associations between clinical and microbiological parameters were found. Conclusions There was no difference in the clinical outcome with the use of polished versus machined abutment at 3 and 12 months after implantation. The present pilot trial largely confirmed a suitable study design, sampling and analytical methodology to determine the effects of modified BAHS abutment properties. Level of evidence 2. Controlled prospective comparative study. Electronic supplementary material The online version of this article (10.1007/s00405-018-4946-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Margarita Trobos
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, P.O. Box 412, 405 30, Gothenburg, Sweden.
| | - Martin Lars Johansson
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, P.O. Box 412, 405 30, Gothenburg, Sweden
- Oticon Medical AB, Askim, Sweden
| | | | | | - Maria Hoffman
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, P.O. Box 412, 405 30, Gothenburg, Sweden
| | - Omar Omar
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, P.O. Box 412, 405 30, Gothenburg, Sweden
| | - Peter Thomsen
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, P.O. Box 412, 405 30, Gothenburg, Sweden
| | - Malou Hultcrantz
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
50
|
Özdemir Z, Şenol Çelik S. Wound care of the driveline exit site in patients with a ventricular assist device: A systematic review. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2018; 26:328-335. [PMID: 32082759 PMCID: PMC7024132 DOI: 10.5606/tgkdc.dergisi.2018.14982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 02/06/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND This study aims to systematically define and analyze the studies on driveline exit site care methods for patients with a ventricular assist device. METHODS The studies related to driveline exit site care of the patients with a ventricular assist device published in English and Turkish between 2008 and 2017 were reviewed from the international Science Direct, PubMed, Web of Science, Scopus, and the national databases. Of a total of 83 articles, a total of seven research articles which met the inclusion criteria were included in the study. RESULTS Findings related to the agents used in the cleaning of the driveline exit site, dressing closures, dressing change frequency, and use of driveline anchoring devices were obtained from studies included in the research. It was found that chlorhexidine solution for skin cleaning and sterile gauze sheets and transparent covering for dressing closure were the most preferred methods for the driveline exit site care. Dressing change frequency varied considerably from center to center and anchoring devices were used in all studies. CONCLUSION There is no gold standard method for the driveline exit site care of patients with a ventricular assist device and researches on the driveline exit site care seem to be limited. It is recommended that large-scale, randomized-controlled studies should be conducted which would provide a stronger proof of the driveline exit site care.
Collapse
Affiliation(s)
- Zeliha Özdemir
- Surgical Nursing Department, Hacettepe University Faculty of Nursing, Ankara, Turkey
| | - Sevilay Şenol Çelik
- Surgical Nursing Department, Hacettepe University Faculty of Nursing, Ankara, Turkey
| |
Collapse
|