What's new in the prevention of healthcare-associated infections using chlorhexidine gluconate-impregnated washcloths

Intraoperative Wound Lavage System for Deep Neck Infection: A Retrospective Cohort Study

Introduction  Multiple solutions are currently used to cleanse a deep neck infection (DNI), and a variety of devices are available to deliver wound irrigation solutions. An essential difference between these devices is the pressure that the irrigation solution exerts over the wound tissue. Objective  To compare low-pressure and high-pressure irrigation delivery systems for wound cleansing in DNI. Methods  we designed a retrospective cohort study and reviewed the medical records of patients operated on due to DNI from June 2016 to December 2017 at our institution. One cohort included patients treated with an intraoperative irrigation method that exerts low pressure over the irrigated tissue, and the other cohort, to a system capable of generating higher pressure. The Pearson Chi-squared test was used to analyze the data. Results  A total of 42 patients whose ages ranged from 16 months to 72 years were included. The low-pressure irrigation system was used in 18 patients, and the high-pressure system was used in 24 patients. No statistical differences were observed regarding the irrigation methods, the complexity of the DNI, and the overall outcomes. Conclusions  The present is the first study in which low- and high-pressure systems for wound lavage were evaluated in the treatment of DNI. When comparing these methods, we did not find one to be superior to the other; however, the additional cost associated with the high-pressure devices may not justify their in head and neck procedures.

Healthcare-associated infections in adult intensive care unit patients: Changes in epidemiology, diagnosis, prevention and contributions of new technologies

Patients in intensive care units (ICUs) are at high risk for healthcare-acquired infections (HAI) due to the high prevalence of invasive procedures and devices, induced immunosuppression, comorbidity, frailty and increased age. Over the past decade we have seen a successful reduction in the incidence of HAI related to invasive procedures and devices. However, the rate of ICU-acquired infections remains high. Within this context, the ongoing emergence of new pathogens, further complicates treatment and threatens patient outcomes. Additionally, the SARS-CoV-2 (COVID-19) pandemic highlighted the challenge that an emerging pathogen provides in adapting prevention measures regarding both the risk of exposure to caregivers and the need to maintain quality of care. ICU nurses hold a special place in the prevention and management of HAI as they are involved in basic hygienic care, steering and implementing quality improvement initiatives, correct microbiological sampling, and aspects antibiotic stewardship. The emergence of more sensitive microbiological techniques and our increased knowledge about interactions between critically ill patients and their microbiota are leading us to rethink how we define HAIs and best strategies to diagnose, treat and prevent these infections in the ICU. This multidisciplinary expert review, focused on the ICU setting, will summarise the recent epidemiology of ICU-HAI, discuss the place of modern microbiological techniques in their diagnosis, review operational and epidemiological definitions and redefine the place of several controversial preventive measures including antimicrobial-impregnated medical devices, chlorhexidine-impregnated washcloths, catheter dressings and chlorhexidine-based mouthwashes. Finally, general guidance is suggested that may reduce HAI incidence and especially outbreaks in ICUs.