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Ito Y, Nojiri S, Iwanaga N, Kawano S, Noro T, Machida M, Watanobe I, Sugo H. Incisional surgical site infections by subcutaneous soaking of wound with aqueous 0.05% chlorhexidine gluconate in gastroenterological surgery: A randomized controlled trial. Surgery 2024:S0039-6060(24)00314-3. [PMID: 38876900 DOI: 10.1016/j.surg.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/22/2024] [Accepted: 05/08/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Chlorhexidine gluconate solution is superior to povidone-iodine for prevention of surgical site infection. However, the overall efficacy of chlorhexidine gluconate for surgical site infection prevention in various types of gastroenterological surgery, as well as the optimal concentration of chlorhexidine gluconate, remain unclear. The aim of the present study was to clarify whether subcutaneous wound soaking with chlorhexidine gluconate would reduce the incidence of surgical site infection associated with gastroenterological surgery in patients with wound classes Ⅱ to Ⅳ. METHODS Patients were randomly assigned (1:1) to either wound soaking with chlorhexidine gluconate (chlorhexidine gluconate group) or no chlorhexidine gluconate soaking (control group). After closure of the abdominal fascia, gentle subcutaneous soaking of the wound was performed using gauze fully soaked in aqueous 0.05% chlorhexidine gluconate before skin closure. Incisional surgical site infection was diagnosed using the Centers for Disease Control and Prevention criteria. The primary end point was the occurrence of incisional surgical site infection. RESULTS Among 363 patients, 245 (67%) underwent laparoscopic surgery. All 363 patients were included-181 in the chlorhexidine gluconate group (49.9%) and 182 (50.1%) in the control group. There were no significant inter-group differences in patient background, the type of procedure, or wound classification. The incidence proportion of incisional surgical site infection was significantly lower in the chlorhexidine gluconate group than in the control group (9.4% vs 19.2%; P = .008). CONCLUSION Subcutaneous wound soaking with chlorhexidine gluconate reduces the incidence of incisional surgical site infection in patients undergoing gastroenterological surgery.
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Affiliation(s)
- Yuzuru Ito
- Department of General Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
| | - Naoki Iwanaga
- Department of General Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Shingo Kawano
- Department of General Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Takuji Noro
- Department of General Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Michio Machida
- Department of General Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Ikuo Watanobe
- Department of General Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Hiroyuki Sugo
- Department of General Surgery, Juntendo University Nerima Hospital, Tokyo, Japan.
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Nye AK, Thieman Mankin KM. Small animal patient preoperative preparation: a review of common antiseptics, comparison studies, and resistance. Front Vet Sci 2024; 11:1374826. [PMID: 38605919 PMCID: PMC11007076 DOI: 10.3389/fvets.2024.1374826] [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: 01/22/2024] [Accepted: 03/19/2024] [Indexed: 04/13/2024] Open
Abstract
This review aims to describe commonly used antiseptics in veterinary medicine including their mechanism of action, spectrum of activity, potential adverse effects, and application techniques. Additionally, it provides a review of the veterinary literature comparing antiseptics, a discussion of effectiveness and efficacy studies, and the potential for increased resistance to biocides and antimicrobials. This review concludes that appropriate selection and use is necessary to prevent the occurrence of surgical site infections, adverse effects, and potential for increasing resistance to antimicrobials. Continued research is needed to fill gaps in the current knowledge such as optimal preparation procedures for various surgical sites, standardization of efficacy and effectiveness testing, and the clinical impact of decreased susceptibility to chlorhexidine and other antiseptics.
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Affiliation(s)
| | - Kelley M. Thieman Mankin
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, United States
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3
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Price L, Gozdzielewska L, Alejandre JC, Jorgenson A, Stewart E, Pittet D, Reilly J. Systematic review on factors influencing the effectiveness of alcohol-based hand rubbing in healthcare. Antimicrob Resist Infect Control 2022; 11:16. [PMID: 35073993 PMCID: PMC8785453 DOI: 10.1186/s13756-021-01049-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/29/2021] [Indexed: 11/29/2022] Open
Abstract
Background The effectiveness of hand rubbing with alcohol-based handrub (ABHR) is impacted by several factors. To investigate these, World Health Organization (WHO) commissioned a systematic review. Aim To evaluate the impact of ABHR volume, application time, rubbing friction and hand size on microbiological load reduction, hand surface coverage or drying time.
Methods Medline, CINAHL, Web of Science and ScienceDirect databases were searched for healthcare or laboratory-based primary studies, published in English, (1980- February 2021), investigating the impact of ABHR volume, application time, rubbing friction or hand size on bacterial load reduction, hand coverage or drying time. Two reviewers independently performed data extraction and quality assessment. The results are presented narratively. Findings Twenty studies were included in the review. Categories included: ABHR volume, application time and rubbing friction. Sub-categories: bacterial load reduction, hand size, drying time or hand surface coverage. All used experimental or quasi-experimental designs. Findings showed as ABHR volume increased, bacterial load reduced, and drying times increased. Furthermore, one study showed that the application of sprayed ABHR without hand rubbing resulted in significantly lower bacterial load reduction than poured or sprayed ABHR with hand rubbing (− 0.70; 95%CI: − 1.13 to − 0.28). Evidence was heterogeneous in application time, volume, technique, and product. All studies were assessed as high risk of bias. Conclusions There is insufficient evidence to change WHO recommendation of a palmful of ABHR in a cupped hand applied for 20–30 s or manufacturer-recommended volume applied for about 20 s (Centers for Disease Control and Prevention). Future hand hygiene research should standardise volume, application time, and consider hand size. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-021-01049-9.
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Chatterjee S, Roy MN, Banerjee K, Mojumdar S, Osbert N. Understanding the gap between knowledge and practice of handwashing in rural India: evidence from a cross-sectional study. JOURNAL OF WATER AND HEALTH 2022; 20:1701-1720. [PMID: 36573674 DOI: 10.2166/wh.2022.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Limited studies in India had captured the gap in knowledge and practice of handwashing in the community. This study assesses the gap in knowledge and practice of handwashing in rural India. The study was conducted across 10 districts in five states of India - Andhra Pradesh, Assam, Maharashtra, Odisha and West Bengal from December 2021 to January 2022 by the SIGMA Foundation, Kolkata in collaboration with UNICEF India. Descriptive statistics, bivariate analysis, creation of indices and multinomial logistic regression were employed. Findings demonstrated that both knowledge of different aspects of hand hygiene and practice of handwashing with soap and water (HWWS) at critical times varied by socio-economic groups and also across the districts/states. Half of the respondents used only water to wash their hands after taking meals, before serving food, whenever their hands seemed dirty and before eating or cooking. Overall, the 'HWWS knowledge index' was 0.46, whereas the 'HWWS practice index' was 0.36. The correlation coefficient between the two was 0.36. The HWWS practice index was lower than the HWWS knowledge index for 50% of the sampled households. Both HWWS knowledge and practice indices were higher among females, higher educated and younger population. The gap between handwashing practice and knowledge was also higher among females and higher educated.
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Chirani MR, Kowsari E, Teymourian T, Ramakrishna S. Environmental impact of increased soap consumption during COVID-19 pandemic: Biodegradable soap production and sustainable packaging. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 796:149013. [PMID: 34271380 PMCID: PMC8272010 DOI: 10.1016/j.scitotenv.2021.149013] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 05/11/2023]
Abstract
A year into the coronavirus disease 2019 pandemic, the role of washing hands with soap and hand disinfectants is unavoidable as a primary way to control the infection spread in communities and healthcare facilities. The extraordinary surge in demand for handwashing products has led to environmental concerns. Since soaps are complex mixtures of toxic and persistent active ingredients, the prudent option is to promote eco-friendly replacements for the current products. On the other hand, with the increase in soap packaging waste production, soap packaging waste management and recycling become essential to reduce environmental impact. This systematic review aimed to collect some recent methods for identifying biodegradable and sustainable raw materials to produce and package cleaning agents, especially soap.
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Affiliation(s)
- Mahboobeh Rafieepoor Chirani
- Department of Chemistry, Amirkabir University of Technology (Tehran Polytechnic), No. 424, Hafez Avenue, 1591634311 Tehran, Iran
| | - Elaheh Kowsari
- Department of Chemistry, Amirkabir University of Technology (Tehran Polytechnic), No. 424, Hafez Avenue, 1591634311 Tehran, Iran.
| | - Targol Teymourian
- Department of Civil and Environmental Engineering, Amirkabir University of Technology (Tehran Polytechnic), Hafez Avenue, 158754413 Tehran, Iran
| | - Seeram Ramakrishna
- Department of Mechanical Engineering, Center for Nanofibers and Nanotechnology, National University of Singapore, 119260, Singapore.
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Prezzavento GE, Mas CR, Achaval Rodríguez J, Juárez Calvi RN, Piskulic L, Angelini J, Allasia MB, Smania AM, Moyano AJ. Comparison of Efficacy of Povidone-Iodine, Ethanol, and an Aerosol Formulation of Silver Sulfadiazine in Controlling Microbial Burden on Sutures From Clean Surgeries. J Burn Care Res 2021; 42:975-980. [PMID: 33515461 DOI: 10.1093/jbcr/irab022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In the surgical suture, the implanted thread can be a source of microbial contamination. Implanted materials are frequently described as being substrates prone for biofilm development provoking surgical site infections. Treatment of postsurgical wounds with different topical antimicrobial agents is a current practice applied to every patient. However, to date, there is little evidence on the efficacy of different antiseptic treatments on suture materials in preventing environmental or skin bacterial adhesion and further infection. Here, the authors compared the ability of an aerosol formulation of silver sulfadiazine, vitamin A, and lidocaine (AF-SSD) and of two of the most frequently used topical treatments, povidone-iodine and ethanol, in eradicating or controlling the microbial contamination of suture threads in patients who have undergone clean surgeries. Postsurgical suture threads treated with AF-SSD showed a significantly reduced proportion of contaminated samples containing viable microbial cells compared with those treated with povidone-iodine or ethanol. Furthermore, those samples that were positive for bacterial growth showed a lesser number of viable cells in AF-SSD-treated sutures than those treated with povidone-iodine or ethanol. Confocal laser scanning microscopy showed that AF-SSD-treated postsurgical sutures presented significantly less attached microbial cells than povidone-iodine and ethanol, with scarce observable microbial cells on the surface of the suture. Taken together, the results suggest that treatment with AF-SSD is more effective than the other two antiseptics, and there is a potential for improvement in reducing the microbial burden of implanted materials such as the suture thread.
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Affiliation(s)
- Gustavo E Prezzavento
- Servicio Cirugía Plástica y Reconstructiva, Hospital Alemán, Buenos Aires, Argentina
| | - Carlos R Mas
- Universidad Nacional de Córdoba, Facultad de Ciencias Químicas, Departamento de Química Biológica Ranwel Caputto, Córdoba, Argentina.,CONICET, Centro de Investigaciones en Química Biológica de Córdoba (CIQUIBIC), Universidad Nacional de Córdoba, Argentina
| | | | | | - Laura Piskulic
- Área Estadística y Procesamiento de Datos, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Argentina
| | - Julia Angelini
- Área Estadística y Procesamiento de Datos, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Argentina
| | - María B Allasia
- Área Estadística y Procesamiento de Datos, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Argentina
| | - Andrea M Smania
- Universidad Nacional de Córdoba, Facultad de Ciencias Químicas, Departamento de Química Biológica Ranwel Caputto, Córdoba, Argentina.,CONICET, Centro de Investigaciones en Química Biológica de Córdoba (CIQUIBIC), Universidad Nacional de Córdoba, Argentina
| | - Alejandro J Moyano
- Universidad Nacional de Córdoba, Facultad de Ciencias Químicas, Departamento de Química Biológica Ranwel Caputto, Córdoba, Argentina.,CONICET, Centro de Investigaciones en Química Biológica de Córdoba (CIQUIBIC), Universidad Nacional de Córdoba, Argentina
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7
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Novel moisturized and antimicrobial hand gel based on zinc-aminoclay and Opuntia humifusa extract. Sci Rep 2021; 11:17821. [PMID: 34497316 PMCID: PMC8426495 DOI: 10.1038/s41598-021-97363-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/23/2021] [Indexed: 11/09/2022] Open
Abstract
The high antimicrobial ability and low toxicity of zinc-aminoclay (ZnAC) are claimed in our previous reports. In this study, we formulate a novel hand gel based on ZnAC and Opuntia humifusa (O. humifusa) extract, which is a high moisturizing agent. The antimicrobial activity, cytotoxicity, moisturizing effect, and clinical skin irritation of the hand gel are evaluated. The hand gel with 0.5 wt.% ZnAC and 1.0 v/v% O. humifusa extract can kill more than 99% Escherichia coli (gram-negative bacteria) and Staphylococcus aureus (gram-positive bacteria) after 24 h. Toxicity evaluation shows that, the hand gel does not affect the viability of mammalian HaCaT cells. Additionally, skin moisture is increased by applying the hand gel while its viscosity is at the standard level of commercial products. The hand gel has a skin irritation index of 0.0 and is classified as a non-irritating product. We successfully formulated hand gel from ZnAC, glucomannan, glycerol, and O. humifusa extract. Owing to the high antimicrobial activity and skin protection of hand gels, they are suitable to be used as hand sanitizers in restaurants, hospitals, and homes effectively.
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Takahashi S, Arakawa S, Ishikawa K, Kamei J, Kobayashi K, Shigemura K, Takahashi S, Hiyama Y, Hamasuna R, Hayami H, Yazawa S, Yasuda M, Togo Y, Yamamoto S, Wada K, Watanabe T. Guidelines for Infection Control in the Urological Field, including Urinary Tract Management (revised second edition). Int J Urol 2021; 28:1198-1211. [PMID: 34480379 DOI: 10.1111/iju.14684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/17/2021] [Indexed: 01/08/2023]
Abstract
The Committee for the Development of Guidelines for Infection Control in the Urological Field, including Urinary Tract Management of the Japanese Urological Association, together with its systematic review team and external reviewers, have prepared a set of practice guidelines, an abridged version of which is published herein. These guidelines cover the following topics: (i) foundations of infection control, standard precautions, route-specific precautions, and occupational infection control (including vaccines); (ii) the relationship between urologists and infection control; (iii) infection control in urological wards and outpatient clinics; (iv) response to hepatitis B virus reactivation; (v) infection control in urological procedures and examinations; (vi) prevention of infections occurring in conjunction with medical procedures and examinations; (vii) responses to urinary tract tuberculosis and bacillus Calmette-Guérin; (viii) aseptic handling, cleaning, disinfection, and sterilization of urinary tract endoscopes (principles of endoscope manipulation, endoscope lumen cleaning, and disinfection); (ix) infection control in the operating room (principles of hand washing, preoperative rubbing methods, etc.); (x) prevention of needlestick and blood/bodily fluid exposure and response to accidental exposure; (xi) urinary catheter-associated urinary tract infection and purple urinary bag syndrome; and (xii) urinary catheter-associated urinary tract infections in conjunction with home care. In addressing these topics, the relevant medical literature was searched to the extent possible, and content was prepared for the purpose of providing useful information for clinical practice.
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Affiliation(s)
- Satoshi Takahashi
- Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Soichi Arakawa
- Department of Urology, Sanda City Hospital, Sanda, Hyogo, Japan
| | - Kiyohito Ishikawa
- Department of Quality and Safety in Healthcare, Division of Infection Control and Prevention, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Jun Kamei
- Department of Urology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kanao Kobayashi
- Department of Urology, Japan Organization of Occupational Health and Safety, Chugoku Rosai Hospital, Kure, Hiroshima, Japan
| | | | - Satoru Takahashi
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshiki Hiyama
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Ryoichi Hamasuna
- Department of Urology, Federation of National Public Service and Affiliated Personal Mutual Aid Association, Shin-Kokura Hospital, Kitakyushu, Fukuoka, Japan
| | - Hiroshi Hayami
- Blood Purification Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Satoshi Yazawa
- Yazawa Clinic, Tokyo, Japan.,Keio University School of Medicine, Tokyo, Japan
| | - Mitsuru Yasuda
- Center for Nutrition Support and Infection Control, Gifu University Hospital, Gifu, Japan
| | - Yoshikazu Togo
- Department of Urology, Kyowakai Medical Corporation Kyoritsu Hospital, Kawanishi, Hyogo, Japan
| | - Shingo Yamamoto
- Urology and Kidney Transplant Center, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Koichiro Wada
- Department of Urology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Toyohiko Watanabe
- Department of Urology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
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Chong CY, Catahan MA, Lim SH, Jais T, Kaur G, Yin S, de Korne D, Thoon KC, Ng KC. Patient, staff empowerment and hand hygiene bundle improved and sustained hand hygiene in hospital wards. J Paediatr Child Health 2021; 57:1460-1466. [PMID: 33908109 DOI: 10.1111/jpc.15526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/10/2021] [Accepted: 04/14/2021] [Indexed: 11/29/2022]
Abstract
AIM We piloted a hand hygiene (HH) project in a ward, focusing on World Health Organization moments 1 and 4. Our aim was to design highly reliable interventions to achieve >90% compliance. METHODS Baseline HH compliance was 57 and 67% for moments 1, 4, respectively, in 2015. After the pilot ward showed sustained improvement, we launched the 'HH bundle' throughout the hospital. This included: (i) appointment of HH champions; (ii) verbal/visual bedside reminders; (iii) patient empowerment; (iv) hand moisturisers; (v) tagging near-empty handrub (HR) bottles. Other hospital-wide initiatives included: (vi) Smartphone application for auditing; (vii) 'Speak up for Patient Safety' Campaign in 2017 for staff empowerment; (viii) making HH a key performance indicator. RESULTS Overall HH compliance increased from a baseline median of 79.6-92.6% in end-2019. Moments 1 and 4 improved from 71 to 92.7% and from 77.6 to 93.2%, respectively. Combined HR and hand wash consumption increased from a baseline median of 82.6 ml/patient day (PD) to 109.2 mL/PD. Health-care-associated rotavirus infections decreased from a baseline median of 4.5 per 10 000 PDs to 1.5 per 10 000 PDs over time. CONCLUSIONS The 'HH Bundle' of appointing HH champions, active reminders and feedback, patient education and empowerment, availability of hand moisturisers, tagging near-empty hand rub bottles together with hospital-wide initiatives including financial incentives and the 'Speak Up for Patient Safety' campaign successfully improved the overall HH compliance to >90%. These interventions were highly reliable, sustained over 4 years and also reduced health-care-associated rotavirus infection rates.
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Affiliation(s)
- Chia Yin Chong
- Infectious Diseases, Paediatrics, KK Women's and Children's Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Paediatrics, Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | - Siok Hong Lim
- Infection Control, Division of Nursing, KK Women's and Children's Hospital, Singapore
| | - Thuraiya Jais
- Ward 55, Urgent Obstetric and Gynecology Centre, Division of Nursing, KK Women's and Children's Hospital, Singapore
| | - Gian Kaur
- Specialty and Ambulatory Services, KK Women's and Children's Hospital, Singapore
| | - Shanqing Yin
- Chairman Medical Board Office, KK Women's and Children's Hospital, Singapore
| | - Dirk de Korne
- Medical Innovation & Care Transformation, KK Women's & Children's Hospital, Singapore.,Department of Care and Welfare, SVRZ Cares in Zeeland, Middelburg, Netherlands.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Koh Cheng Thoon
- Infectious Diseases, Paediatrics, KK Women's and Children's Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Paediatrics, Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Kee Chong Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Paediatrics, Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Chairman Medical Board Office, KK Women's and Children's Hospital, Singapore
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11
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Hand Hygiene Compliance at a Canadian provincial cancer centre - the complementary roles of nurse auditor-driven and patient auditor-driven audit processes and impact upon practice in ambulatory cancer care. Am J Infect Control 2021; 49:571-575. [PMID: 33096127 DOI: 10.1016/j.ajic.2020.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND We examined the patterns of hand hygiene compliance (HHC) among health care providers (HCP) as observed by trained nurse and patient auditors over time in an ambulatory care Canadian provincial cancer agency. METHODS Nurse and volunteer patient auditors completed separate standardized forms documenting hand-cleansing opportunities during clinic visits. HHC rates were compared over time by HCP group and by specialty teams. Observations from 10 calendar quarters were analyzed from April 2015 to September 2019. RESULTS Nurse audit HHC rates ranged from 84% to 96%, encompassing 7,213 opportunities with no significant time-dependent trends by linear regression (R2 = 2.3E-005, P = .9895). The patient audit HHC rates ranged from 57% to 82%, encompassing 23,402 opportunities, were lower overall compared to the nurse audit (73.6% vs 89.2%, respectively, P < .0001), but displayed an increasing trend (R2 = 0.5374, P = .0159) over the same 10 time periods. The relative risk ratio for the differences decreased over time (R2 = .5101, P = .0203). Patients acknowledged the importance of HHC and the audit process, but were reticent to remind HCP to comply. CONCLUSIONS The nurse audit measuring HCP HHC before entering and after exiting patient examination rooms showed persistently high compliance over time whereas the patient-driven audit measuring HHC within the examination room increased over time suggesting a training effect upon practice. These measures appeared complementary.
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12
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Schmidt JS, Hartnack S, Schuller S, Kuster SP, Willi B. Hand hygiene compliance in companion animal clinics and practices in Switzerland: An observational study. Vet Rec 2021; 189:e307. [PMID: 33870536 PMCID: PMC8250537 DOI: 10.1002/vetr.307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 01/08/2021] [Accepted: 03/07/2021] [Indexed: 12/17/2022]
Abstract
Background: Hand hygiene (HH) is one of the most important measures to prevent healthcare‐associated infections. Data on HH compliance in companion animal veterinary institutions in Europe are sparse. Methods: This observational study assessed HH according to WHO standards in three large and two medium‐sized clinics and two primary care practices in Switzerland. Associations with HH indication, professional group, clinical area and institution were determined using a generalized linear mixed effects model. Results: Based on 2056 observations, overall HH compliance [95% confidence interval] was 32% [30%‐34%]. HH compliance was highest in the consultation area (41% [38%‐45%]) and after contact to body fluids (45% [40%‐50%]), and lowest in the pre‐OR area (20% [15%‐24%]) and before clean/aseptic procedures (12% [9%‐15%]). Veterinarians showed a higher HH compliance (37% [34%‐40%]) than veterinary nurses (25% [22%‐28%]). HH compliance was lower before clean/aseptic procedures compared to all other indications (all p < 0.015 except ‘before touching a patient’ in medium‐sized clinics/practices, p = 0.095) and higher in the consultation area compared to all other areas in large clinics (all p < 0.04). Conclusion: Effective HH training should urgently be promoted for all veterinary personnel with special emphasis on the importance of HH before clean/aseptic procedures.
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Affiliation(s)
- Janne S Schmidt
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Sonja Hartnack
- Section of Epidemiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Simone Schuller
- Division of Small Animal Internal Medicine, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Stefan P Kuster
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Barbara Willi
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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13
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Alharbi AS, Yousef AA, Alharbi SA, Al-Shamrani A, Alqwaiee MM, Almeziny M, Said YS, Alshehri SA, Alotaibi FN, Mosalli R, Alawam KA, Alsaadi MM. Application of aerosol therapy in respiratory diseases in children: A Saudi expert consensus. Ann Thorac Med 2021; 16:188-218. [PMID: 34012486 PMCID: PMC8109687 DOI: 10.4103/atm.atm_74_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 02/14/2021] [Indexed: 11/27/2022] Open
Abstract
The Saudi Pediatric Pulmonology Association (SPPA) is a subsidiary of the Saudi Thoracic Society (STS), which consists of a group of Saudi experts with well-respected academic and clinical backgrounds in the fields of asthma and other respiratory diseases. The SPPA Expert Panel realized the need to draw up a clear, simple to understand, and easy to use guidance regarding the application of different aerosol therapies in respiratory diseases in children, due to the high prevalence and high economic burden of these diseases in Saudi Arabia. This statement was developed based on the available literature, new evidence, and experts' practice to come up with such consensuses about the usage of different aerosol therapies for the management of respiratory diseases in children (asthma and nonasthma) in different patient settings, including outpatient, emergency room, intensive care unit, and inpatient settings. For this purpose, SPPA has initiated and formed a national committee which consists of experts from concerned specialties (pediatric pulmonology, pediatric emergency, clinical pharmacology, pediatric respiratory therapy, as well as pediatric and neonatal intensive care). These committee members are from different healthcare sectors in Saudi Arabia (Ministry of Health, Ministry of Defence, Ministry of Education, and private healthcare sector). In addition to that, this committee is representing different regions in Saudi Arabia (Eastern, Central, and Western region). The subject was divided into several topics which were then assigned to at least two experts. The authors searched the literature according to their own strategies without central literature review. To achieve consensus, draft reports and recommendations were reviewed and voted on by the whole panel.
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Affiliation(s)
- Adel S. Alharbi
- Department of Pediatrics, Prince Sultan Military City, Ministry of Defence, Riyadh, Saudi Arabia
| | - Abdullah A. Yousef
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- Department of Pediatrics, King Fahd Hospital of the University, Khobar, Saudi Arabia
| | - Saleh A. Alharbi
- Department of Pediatrics, Umm Al-Qura University, Mecca, Saudi Arabia
- Department of Pediatrics, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia
| | - Abdullah Al-Shamrani
- Department of Pediatrics, Prince Sultan Military City, Ministry of Defence, Riyadh, Saudi Arabia
| | - Mansour M. Alqwaiee
- Department of Pediatrics, Prince Sultan Military City, Ministry of Defence, Riyadh, Saudi Arabia
| | - Mohammed Almeziny
- Department of Pharmacy, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Yazan S. Said
- Department of Pediatrics, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Saleh Ali Alshehri
- Department of Emergency, Pediatric Emergency Division, Prince Sultan Medical Military City, Riyadh, Saudi Arabia
| | - Faisal N. Alotaibi
- Department of Pediatrics, Prince Sultan Military City, Ministry of Defence, Riyadh, Saudi Arabia
| | - Rafat Mosalli
- Department of Pediatrics, Umm Al Qura University, Makkah, Saudi Arabia
- Department of Pediatrics, International Medical Center, Jeddah, Saudi Arabia
| | - Khaled Ali Alawam
- Department of Respiratory Therapy Sciences, Inaya Medical College, Riyadh, Saudi Arabia
| | - Muslim M. Alsaadi
- Department of Pediatrics, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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Scaggs Huang F, Schaffzin JK. Rewriting the playbook: infection prevention practices to mitigate nosocomial severe acute respiratory syndrome coronavirus 2 transmission. Curr Opin Pediatr 2021; 33:136-143. [PMID: 33315687 DOI: 10.1097/mop.0000000000000973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Given the limited evidence and experience with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), this novel pathogen has challenged the field of infection prevention. Despite uncertainty, infection prevention principles and experience with similar diseases have helped guide how to best protect providers and patients against disease acquisition. RECENT FINDINGS Guidance to date has relied on data from SARS-CoV-1 and MERS-CoV to guide practices on patient isolation and personal protective equipment (PPE) use. Although a face mask and eye protection are likely adequate for most clinical scenarios, published guidelines for PPE can be confusing and conflicting. Consensus for what constitutes a high-risk aerosol-generating procedure (AGP) is lacking, but most agree providers performing procedures such as bronchoscopy, intubation, and cardiopulmonary resuscitation would likely benefit from the use of an N95 respirator and eye protection. SUMMARY Needed research to elucidate the predominant SARS-CoV-2 mode of transmission is not likely to be completed in the immediate future. Recommendations for PPE to mitigate procedure-associated risk remain controversial. Nonetheless, implementation of existing measures based on basic infection prevention principles is likely to prevent transmission significantly.
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Affiliation(s)
- Felicia Scaggs Huang
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Joshua K Schaffzin
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
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Torondel B, Khan R, Larsen TH, White S. Evaluating the Efficacy of the Supertowel™ as a Handwashing Product: A Simulation of Real-World Use Conditions. Am J Trop Med Hyg 2021; 104:1554-1561. [PMID: 33534745 PMCID: PMC8045667 DOI: 10.4269/ajtmh.20-1284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/02/2020] [Indexed: 11/18/2022] Open
Abstract
The Supertowel is a fabric treated with a permanent antimicrobial bonding and has been designed as a soap alternative in emergency situations. The Supertowel has been shown to be as efficacious as handwashing with soap and water when tested under controlled laboratory conditions. It has also been shown to be a practical, acceptable, and desirable product among crisis-affected populations. The aim of this study was to test whether the Supertowel remains as efficacious when used under conditions which mimic real-world hand cleaning in challenging settings. Two rounds of laboratory tests, with 16 volunteers in each, were conducted to test the efficacy of the Supertowel when used for a shorter duration, when less wet, when used with contaminated water, when visibly dirty, and when dry. Volunteers pre-contaminated their hands with nonpathogenic Escherichia coli. Comparisons were made between hand cleaning with the Supertowel and the reference condition (normally handwashing with soap), using a crossover design. The Supertowel was marginally less efficacious than handwashing with soap when used for 15 seconds (P = 0.04) but as efficacious at 30 and 60 seconds durations. All the other Supertowel conditions were as efficient as their reference comparisons meaning that the Supertowel can effectively remove pathogens from hands when it is wet, damp, or completely dry, when it is used with contaminated water, when visibly dirty with mud and/or oil.
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Affiliation(s)
- Belen Torondel
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rummana Khan
- Department of Microbiology, KET’s Scientific Research Centre, Mumbai, India
| | | | - Sian White
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Mann M, Wright CH, Jella T, Labak CM, Shammassian B, Srivatsa S, Wright J, Engineer L, Sajatovic M, Selman W. Cranial Surgical Site Infection Interventions and Prevention Bundles: A Systematic Review of the Literature. World Neurosurg 2021; 148:206-219.e4. [PMID: 33412319 DOI: 10.1016/j.wneu.2020.12.137] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 12/27/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cranial surgical site infections (cSSIs) are associated with significant morbidity. Measures to reduce cSSI are necessary to reduce patient morbidity as well as hospital costs and resource utilization. OBJECTIVE To identify and characterize interventions or bundled interventions aimed at reduction of the incidence of cranial surgical site infections. METHODS A systematic review of the literature was conducted according to the PRISMA guidelines. The search strategy included randomized trials, quasi-experimental studies, cohort studies, and case series published between 2000 and 2020 that evaluated interventions implemented to reduce cSSI. Bias assessments and data extraction were performed on included studies. RESULTS The initial search generated 1249 studies. Application of inclusion and exclusion criteria and review of references yielded 15 single-intervention and 6 bundled-intervention studies. The single interventions included handwashing protocols, use of vancomycin powder, hair washing and clipping practices, and incision closure techniques. Bundled interventions addressed a variety of preoperative, intraoperative, and postoperative changes. Despite a lack of strong evidence to support the adoption of statistically significant interventions, the use of vancomycin powder may be effective in reducing cSSI. In addition, bundled interventions that involved cultural changes, such as increased teaching/education, personal accountability, direct observation, and feedback, showed some success in decreasing SSI rates. CONCLUSIONS The strength of the conclusions is limited by small sample sizes, study heterogeneity, relatively low cSSI incidence, and high case variability. Some evidence supports the use of intraoperative vancomycin powder in adult noncranioplasty cases and the application of accountability, teaching, and surveillance of faculty, particularly those early in training.
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Affiliation(s)
- Michael Mann
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Christina Huang Wright
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
| | - Tarun Jella
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Collin M Labak
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Berje Shammassian
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Shaarada Srivatsa
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - James Wright
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Lilly Engineer
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Martha Sajatovic
- Department of Neurology, and Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Neurological and Behavioral Outcomes Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Warren Selman
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Ifversen M, Meisel R, Sedlacek P, Kalwak K, Sisinni L, Hutt D, Lehrnbecher T, Balduzzi A, Diesch T, Jarisch A, Güngör T, Stein J, Yaniv I, Bonig H, Kuhlen M, Ansari M, Nava T, Dalle JH, Diaz-de-Heredia C, Trigoso E, Falkenberg U, Hartmann M, Deiana M, Canesi M, Broggi C, Bertaina A, Gibson B, Krivan G, Vettenranta K, Matic T, Buechner J, Lawitschka A, Peters C, Yesilipek A, Yalçin K, Lucchini G, Bakhtiar S, Turkiewicz D, Niinimäki R, Wachowiak J, Cesaro S, Dalissier A, Corbacioglu S, Willasch AM, Bader P. Supportive Care During Pediatric Hematopoietic Stem Cell Transplantation: Prevention of Infections. A Report From Workshops on Supportive Care of the Paediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT). Front Pediatr 2021; 9:705179. [PMID: 34395344 PMCID: PMC8358428 DOI: 10.3389/fped.2021.705179] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/25/2021] [Indexed: 02/02/2023] Open
Abstract
Specific protocols define eligibility, conditioning, donor selection, graft composition and prophylaxis of graft vs. host disease for children and young adults undergoing hematopoietic stem cell transplant (HSCT). However, international protocols rarely, if ever, detail supportive care, including pharmaceutical infection prophylaxis, physical protection with face masks and cohort isolation or food restrictions. Supportive care suffers from a lack of scientific evidence and implementation of practices in the transplant centers brings extensive restrictions to the child's and family's daily life after HSCT. Therefore, the Board of the Pediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT) held a series of dedicated workshops since 2017 with the aim of initiating the production of a set of minimal recommendations. The present paper describes the consensus reached within the field of infection prophylaxis.
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Affiliation(s)
- Marianne Ifversen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Roland Meisel
- Division of Pediatric Stem Cell Therapy, Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Petr Sedlacek
- Department of Pediatric Hematology and Oncology, Hospital Motol, Charles University, Prague, Czechia
| | - Krzysztof Kalwak
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Luisa Sisinni
- Pediatric Hematology, Oncology and Hematopoietic Stem Cell Transplantation Unit, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Daphna Hutt
- Division of Pediatric Hematology, Oncology and Bone Marrow Transplantation, The Edmond and Lily Safra Children's Hospital, Tel Aviv, Israel
| | - Thomas Lehrnbecher
- Division for Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Adriana Balduzzi
- Clinica Pediatrica Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy
| | - Tamara Diesch
- Division of Pediatric Hematology-Oncology, University Children's Hospital of Basel, Basel, Switzerland
| | - Andrea Jarisch
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Hospital for Children and Adolescents, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Tayfun Güngör
- Department of Hematology, Immunology, Oncology and Stem Cell Transplantation, University Children's Hospital Zürich, Zurich, Switzerland
| | - Jerry Stein
- Division of Pediatric Hematoloy-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Isaac Yaniv
- Division of Pediatric Hematoloy-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Halvard Bonig
- Institute for Transfusion Medicine and Immunohematology of Goethe University, German Red Cross Blood Service Baden-Württemberg-Hessen, Frankfurt am Main, Germany
| | - Michaela Kuhlen
- Paediatrics and Adolescent Medicine, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Marc Ansari
- Division of Pediatric Hematology-Oncology, University Hospital of Geneva, Geneva, Switzerland.,Cansearch Research Platform in Paediatric Oncology and Haematology, Department of Paediatrics, Gynaecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Tiago Nava
- Division of Pediatric Hematology-Oncology, University Hospital of Geneva, Geneva, Switzerland.,Cansearch Research Platform in Paediatric Oncology and Haematology, Department of Paediatrics, Gynaecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jean-Hugues Dalle
- Hematology and Immunology Department, Robert-Debre Hospital, Assistance Publique-Hopitaux de Paris and University of Paris, Paris, France
| | - Cristina Diaz-de-Heredia
- Department of Pediatric Oncology and Hematology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Eugenia Trigoso
- Paediatric Transplant Unit, Hospital University and Polytechnic, Hospital LA FE, Valencia, Spain
| | - Ulrike Falkenberg
- Stem Cell Transplantation-Unit, Department of Pediatrics, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Mihaela Hartmann
- Stem Cell Transplantation-Unit, Department of Pediatrics, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Marco Deiana
- Paediatric Haematology-Oncology Department, Istituto di Ricovero e Cura a Carattere Scientifico G Gaslini, Genova, Italy
| | - Marta Canesi
- Clinica Pediatrica Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy
| | - Chiara Broggi
- Clinica Pediatrica Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy
| | - Alice Bertaina
- Department of Pediatric Hematology-Oncology and Cell and Gene Therapy, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Bambino Gesù, Rome, Italy.,Division of Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, United States
| | - Brenda Gibson
- Department of Paediatric Haematology-Oncology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Gergely Krivan
- Central Hospital of Southern Pest, National Institute of Hematology and Infectious Disease, Budapest, Hungary
| | - Kim Vettenranta
- Children's Hospital and Pediatric Research Center, University of Helsinki, Helsinki, Finland
| | - Toni Matic
- Department of Pediatrics, University Hospital Center Zagreb, Zagreb, Croatia
| | - Jochen Buechner
- Department of Pediatric Hematology and Oncology, Oslo University Hospital, Oslo, Norway
| | - Anita Lawitschka
- Stem Cell Transplantation-Unit, Department of Pediatrics, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Christina Peters
- Stem Cell Transplantation-Unit, Department of Pediatrics, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Akif Yesilipek
- Department of Pediatric Hematology and Pediatric Stem Cell Transplantation Unit, Antalya and Göztepe Medicalpark Hospitals, Antalya, Turkey
| | - Koray Yalçin
- Department of Pediatric Bone Marrow Transplantation Unit, Medicalpark Göztepe Hospital, Istanbul, Turkey
| | - Giovanna Lucchini
- Department of Bone Marrow Transplantation, Great Ormond Street Hospital for Children, National Health Service Foundation Trust, London, United Kingdom
| | - Shahrzad Bakhtiar
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Hospital for Children and Adolescents, University Hospital, Goethe University, Frankfurt am Main, Germany
| | | | - Riitta Niinimäki
- Department of Pediatrics, Oulu University Hospital, Oulu, Finland
| | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology and Hematopoietic Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Simone Cesaro
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Arnaud Dalissier
- European Society for Blood and Marrow Transplantation Paris Office, Hôpital Saint Antoine, Paris, France
| | - Selim Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Hospital of Regensburg, Regensburg, Germany
| | - Andre Manfred Willasch
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Hospital for Children and Adolescents, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Peter Bader
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Hospital for Children and Adolescents, University Hospital, Goethe University, Frankfurt am Main, Germany
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Kato H, Takeda R, Ideno Y, Suzuki T, Sano K, Nakamura K. Physicians' compliance for hand hygiene in medical outpatient clinics: automated hand-hygiene monitoring with touch sensor and wireless internet. Am J Infect Control 2021; 49:50-54. [PMID: 32512079 DOI: 10.1016/j.ajic.2020.05.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/29/2020] [Accepted: 05/29/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Outpatient clinics are reservoirs for significant pathogens. Hand hygiene with alcohol-based hand rubs are measures currently in use to prevent horizontal transmission of infections. The extent of compliance with hand hygiene regulations is unclear and difficult to monitor. METHODS We built an automated monitoring system with a pressure sensor attached to the alcohol-based hand rubs containers. Wireless fidelity (WIFI)-assisted data collection took place over 9 weeks. Interventions included posters, email reminders and newsletters. Hand hygiene compliance before and after these interventions was evaluated. RESULTS Overall compliance with hand hygiene regulations was 6.48%; half of the physicians participating in our study performed hand hygiene at only 3.08% of patient visits. Twenty-four (17.9%) physicians performed hand hygiene with high compliance (≥10%), while 11.2% performed no hand hygiene at all. Physicians in academic positions and those with ≥20 years of experience performed hand hygiene less frequently than did other physicians. Compliance with hand hygiene regulations improved from 6.08% to 6.73% (P < .001) after intervention. DISCUSSION Compliance with hand hygiene among physicians in our outpatient clinics was very low and needs to improve. CONCLUSIONS Interventions improved the compliance somewhat, although additional interventions including education, training and feedback were suggested.
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Affiliation(s)
- Hideaki Kato
- Infection Prevention and Control Department, Yokohama City University Hospital, Kanazawa-ku, Yokohama Japan.
| | - Rie Takeda
- Infection Prevention and Control Department, Yokohama City University Hospital, Kanazawa-ku, Yokohama Japan; Nursing Department, Yokohama City University Hospital, Kanazawa-ku, Yokohama, Japan
| | | | - Tomoyo Suzuki
- Infection Prevention and Control Department, Yokohama City University Hospital, Kanazawa-ku, Yokohama Japan
| | - Kayoko Sano
- Infection Prevention and Control Department, Yokohama City University Hospital, Kanazawa-ku, Yokohama Japan
| | - Kana Nakamura
- Infection Prevention and Control Department, Yokohama City University Hospital, Kanazawa-ku, Yokohama Japan; Nursing Department, Yokohama City University Hospital, Kanazawa-ku, Yokohama, Japan
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Castagnetti F, Bertani C, Foroni M, Falco G, Cenini E, De Bonis F, Ferrari G. The Bovine Pericardium Matrix in Immediate Implant-Based Breast Reconstruction. Aesthetic Plast Surg 2020; 44:2051-2060. [PMID: 32112193 DOI: 10.1007/s00266-020-01651-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 02/13/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Acellular dermal matrices have been introduced to optimize direct-to-implant breast reconstruction. We selected a bovine pericardium noncross-linked matrix. METHODS The study consists in the retrospective analysis of 123 patients (141 breasts) who underwent conservative mastectomy and immediate implant-based breast reconstruction with bovine pericardium matrix Veritas® from March 2012 to October 2017. RESULTS The overall rates of early and late complications, after a median follow-up of 51.84 months, were, respectively, 37.6% and 24.1%. The most noticeable early complications were flap ischemia [n = 39 (27.7%)], hematoma [n = 5 (3.6%)], marginal skin flap necrosis [n = 5 (3.6%)] and dehiscence of the surgical wound [n = 2 (1.4%)]. The most common late complications were rippling [n = 18 (12.7%)] and seroma [n = 4 (2.8%)]. The rate of clinically relevant capsular contracture was low: 12.1% (n = 17) presented grade II and only 2.1%% (n = 3) grade III. Implant substitution became necessary for five patients (3.6%). Early complications occurred more frequently in patients undergoing therapeutic mastectomy (p = 0.031). Patients undergoing preoperative radiotherapy more frequently developed late complications (p = 0.012). A clinically relevant capsular contracture (grade II-III) was found in higher average patients age (p = 0.0019). The left side developed less frequently late complications except for rippling (p = 0.002). Rippling occurred more frequently in patients who sustained a nipple skin-sparing mastectomy (p = 0.035). CONCLUSION Our results further support the safety of Veritas® in immediate implant-based breast reconstruction. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Fabio Castagnetti
- Breast Surgery Unit, AZIENDA USL-IRCCS Reggio Emilia, Viale Risorgimento no. 80, 42123, Reggio Emilia, Italy.
| | - Chiara Bertani
- Breast Surgery Unit, AZIENDA USL-IRCCS Reggio Emilia, Viale Risorgimento no. 80, 42123, Reggio Emilia, Italy
| | - Monica Foroni
- Breast Surgery Unit, AZIENDA USL-IRCCS Reggio Emilia, Viale Risorgimento no. 80, 42123, Reggio Emilia, Italy
| | - Giuseppe Falco
- Breast Surgery Unit, AZIENDA USL-IRCCS Reggio Emilia, Viale Risorgimento no. 80, 42123, Reggio Emilia, Italy
| | - Eugenio Cenini
- Breast Surgery Unit, AZIENDA USL-IRCCS Reggio Emilia, Viale Risorgimento no. 80, 42123, Reggio Emilia, Italy
| | - Filomena De Bonis
- Breast Surgery Unit, AZIENDA USL-IRCCS Reggio Emilia, Viale Risorgimento no. 80, 42123, Reggio Emilia, Italy
| | - Guglielmo Ferrari
- Breast Surgery Unit, AZIENDA USL-IRCCS Reggio Emilia, Viale Risorgimento no. 80, 42123, Reggio Emilia, Italy
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Abuosi AA, Akoriyea SK, Ntow-Kummi G, Akanuwe J, Abor PA, Daniels AA, Alhassan RK. Hand hygiene compliance among healthcare workers in Ghana’s health care institutions: An observational study. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2020. [DOI: 10.1177/2516043520958579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To assess hand hygiene compliance in selected primary hospitals in Ghana. Design A cross-sectional health facility-based observational study was conducted in primary health care facilities in five regions in Ghana. A total of 546 healthcare workers including doctors, nurses, midwives and laboratory personnel from 106 health facilities participated in the study. Main outcome measures The main outcome measures included availability of hand hygiene materials and alcohol job aids; compliance with moments of hand hygiene; and compliance with steps in hygienic hand washing. These were assessed using descriptive statistics. Results The mean availability of hand hygiene material and alcohol job aids was 75% and 71% respectively. This was described as moderately high, but less desirable. The mean hand hygiene compliance with moments of hand hygiene was 51%, which was also described asmoderately high, but less desirable. It was observed that, generally, hand hygiene was performed after procedures than before. However, the mean compliance with steps in hygienic hand washing was 86%, which was described as high and desirable. Conclusion Healthcare workers are generally competent in performance of hygienic hand washing. However, this does not seem to influence compliance with moments of hand hygiene. Efforts must therefore be made to translate the competence of healthcare workers in hygienic hand washing into willingness to comply with moments of hand hygiene, especially contact with patients.
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Affiliation(s)
- Aaron Asibi Abuosi
- Department of Public Administration and Health Services Management, University of Ghana, Accra, Ghana
| | | | | | - Joseph Akanuwe
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Patience Aseweh Abor
- Department of Public Administration and Health Services Management, University of Ghana, Accra, Ghana
| | - Anita Anima Daniels
- Department of Public Administration and Health Services Management, University of Ghana, Accra, Ghana
| | - Robert Kaba Alhassan
- Department of Public Health Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
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Horstmann Risso N, Ottonelli Stopiglia CD, Oliveira MT, Haas SE, Ramos Maciel T, Reginatto Lazzari N, Kelmer EL, Pinto Vilela JA, Beckmann DV. Chlorhexidine Nanoemulsion: A New Antiseptic Formulation. Int J Nanomedicine 2020; 15:6935-6944. [PMID: 33061360 PMCID: PMC7519836 DOI: 10.2147/ijn.s228280] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/30/2020] [Indexed: 01/10/2023] Open
Abstract
Introduction Nanoparticle solutions have been studied to improve antimicrobial effect. The aim of this study was to develop, characterize, and evaluate the in vitro and in vivo antiseptic efficacy of 0.25% aqueous-based chlorhexidine nanoemulsion (NM-Cl 0.25% w/v). Methods The NM-Cl 0.25% w/v (2.5mg/mL) and free chlorhexidine nanoemulsion (FCN; same composition of NM-Cl without the molecule of chlorhexidine) were synthetized by the spontaneous emulsification method. Characterization analyses of physical and chemical properties were performed. The NM-Cl 0.25% w/v was compared with chlorhexidine 0.5% alcohol base (CS-Cl 0.5%) in vitro studies (microdilution study and kill curve study), and in vivo study (antisepsis of rats dorsum). Kruskal–Wallis test was used between groups and inside the same group, at different sample times and the Mann–Whitney test was performed when difference was detected. Results The NM-Cl 0.25% w/v presented adequate physicochemical characteristics for a nanoemulsion, revealing a more basic pH than FCN and difference between zeta potential of NM-Cl 0.25% w/v and FCN. The NM-Cl 0.25% w/v and CS-Cl 0.5% solutions were more effective on Gram-positive than on Gram-negative bacteria (p≤0.05). NM-Cl 0.25% w/v presented upper antiseptic effect in the microdilution study and residual antiseptic effect was maintained for a longer time when compared to CS-Cl 0.5% (kill curve study). The four-fold (minimal inhibitory concentration) of NM-Cl 0.25% were the formulations with most durable effect within those tested, presenting residual effect until T6 for both bacteria. In the in vivo study, both formulations (NM-Cl 0.25% w/v and CS-Cl 0.5%) had a reduction of the microorganisms in the skin of the rats (p<0.0001) not revealing any difference between the formulations at different times, showing the antiseptic effect of NM-Cl (p≤0.05). Conclusion Both in vitro and in vivo experiments demonstrated that NM-Cl showed promising future as an antiseptic for cutaneous microbiota.
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Affiliation(s)
- Natalia Horstmann Risso
- Postgraduate Program in Animal Sciences, Federal University of Pampa (UNIPAMPA), Uruguaiana, Brazil
| | | | - Marília Teresa Oliveira
- Postgraduate Program in Animal Sciences, Federal University of Pampa (UNIPAMPA), Uruguaiana, Brazil
| | - Sandra Elisa Haas
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Pampa (UNIPAMPA), Uruguaiana, RS, Brazil
| | - Tamara Ramos Maciel
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Pampa (UNIPAMPA), Uruguaiana, RS, Brazil
| | | | - Edilson Luis Kelmer
- Veterinary Medicine Course, Federal University of Pampa (UNIPAMPA), Uruguaiana, Brazil
| | | | - Diego Vilibaldo Beckmann
- Postgraduate Program in Animal Sciences, Federal University of Pampa (UNIPAMPA), Uruguaiana, Brazil
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Hilt N, Lokate M, OldeLoohuis A, Hulscher MEJL, Friedrich AW, Voss A. Hand hygiene compliance in Dutch general practice offices. Arch Public Health 2020; 78:79. [PMID: 32939264 PMCID: PMC7486593 DOI: 10.1186/s13690-020-00464-5] [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: 05/06/2020] [Accepted: 09/02/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Hand hygiene (HH) is considered one of the most important measures to prevent healthcare-associated infections (HAI). Most studies focus on HH compliance within the hospital setting, whereas little is known for the outpatient setting. The aim of this study was to evaluate compliance with HH recommendations in general practitioners (GPs) office, based on World Health Organization (WHO) guideline. METHODS An observational study was conducted at five Dutch GPs-practices in September 2017. We measured HH compliance through direct observation using WHO's 'five moments of hand hygiene' observation tool. All observations were done by one trained professional. RESULTS We monitored a total of 285 HH opportunities for 30 health care workers (HCWs). The overall compliance was 37%. Hand hygiene compliance was 34, 51 and 16% for general practitioners, practice assistants, and nurses, respectively. It varies between 63% after body fluid exposure and no HH performance before-, during and after home visit of a patient (defined as moment 5). The preferred method of HH was soap and water (63%) versus 37% for alcohol-based hand rub (ABHR). The median time of disinfecting hands was 8 s (range 6-11 s) for HCWs in our study. CONCLUSIONS HH compliance among HCWs in Dutch GPs was found to be low, especially with regard to home visits. The WHO recommended switch from hand wash to ABHR was not implemented by the majority of HCWs in 5 observed GPs offices.
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Affiliation(s)
- Nataliya Hilt
- Radboudumc, Department of Medical Microbiology, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Mariëtte Lokate
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Alfons OldeLoohuis
- Radboudumc, Department of Primary and Community Care, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - Marlies E. J. L. Hulscher
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - Alex W. Friedrich
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Andreas Voss
- Radboudumc, Department of Medical Microbiology, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Department of Clinical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital (CWZ), Weg door Jonkerbos 100, 6532 SZ Nijmegen, the Netherlands
- Radboudumc, REshape Center for Innovation, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
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Santoro E, Fiore M, Leone S, Masucci A, Manente R, Guida M, Libralato G, Russo M, Di Onofrio V, Capunzo M, Boccia G. Correlation between Antibiotic Consumption and Hand Hygiene Compliance Among Anesthesia and Intensive Care Healthcare Professionals. THE OPEN ANESTHESIA JOURNAL 2020. [DOI: 10.2174/2589645802014010042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Aims:
The aim of this study was to investigate the correct use of gloves and alcohol-based products for hand hygiene and identify opportunities for hand hygiene replacement with gloves among healthcare professionals working in the Department of Anesthesia and Intensive Care of a tertiary care University Hospital.
Background:
Two centuries have passed since the discovery of Semmelweis that the “puerperal fever” was due to an infection transmitted by the hands. Currently the hand hygiene is still not well performed, rather it is often replaced by the improper use of gloves. Microbial transmission is estimated to occur in one-fifth of all contact cases.
Objective:
To investigate the correct use of gloves and alcohol-based products for hand hygiene and identify opportunities for hand hygiene replacement with gloves among healthcare professionals. Furthermore, to correlate the consumption data of the hydroalcoholic solution and the amount of antibiotics used for the treatment of hospital-acquired infections.
Method:
The study was conducted over six months period (from January to June 2018); during this period, 20 monitoring sessions were performed. The following indicators were evaluated: a) Non-adherence to hand hygiene with concomitant use of gloves; b) Adhesion to alcoholic friction of hands; c) Hand-washing adhesion. Instead, the consumption data, provided by the hospital ward itself, were used for the evaluation of d) The antibiotics used in the treatment of hospital-acquired infections; e) The hydro-alcoholic solution used by the healthcare professionals for hand hygiene.
Results:
The frequency of non-adherence to hand hygiene was very high at the beginning of the study, subsequently it decreased to about a half percent to that at the initial stage. The adhesion to alcoholic friction of hands increased during the study period. Otherwise, the hand-washing adhesion slightly reduced, especially in March probably due to the recruitment of new inadequately trained nursing staff. The trend of antibiotic consumption was similar to handwashing. The consumption of hydro-alcoholic solution was very low, however over time, it increased considerably until the end of the study.
Conclusion:
In light of the findings from this work, it is necessary to make the hospital staff increasingly aware of the correct practice of hand hygiene and to organize training and informative sessions to promote the health of the individual and the community.
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Ding BTK, Soh T, Tan BY, Oh JYL, Mohd Fadhil MFB, Rasappan K, Lee KT. Operating in a Pandemic: Lessons and Strategies from an Orthopaedic Unit at the Epicenter of COVID-19 in Singapore. J Bone Joint Surg Am 2020; 102:e67. [PMID: 32618915 PMCID: PMC7396219 DOI: 10.2106/jbjs.20.00568] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤With severe limitations in manpower, facilities, and equipment, and the concern for nosocomial transmission, operating in a pandemic is fraught with danger from multiple fronts. ➤Strategies to mitigate nosocomial spread include prioritization of existing patients, triaging and treatment of new patient encounters, infection control protocols, perioperative considerations, manpower management, and novel strategies for interdisciplinary interaction and education. ➤The decision to proceed with or postpone surgery should be based on the urgency of the surgical procedure and the physiological health of the patient. ➤When performing an operation on a patient who has suspected or confirmed infection with novel coronavirus disease 2019 (COVID-19), personal protection equipment should include hair covers, face shields or goggles, N95 respirator masks, a blood-borne pathogen-resistant surgical gown, shoe covers, and double-gloving with single-use gloves. ➤Loose-fitting, powered air-purifying respirators should be considered for prolonged surgeries. ➤An astutely formulated and comprehensive business continuity plan is an orthopaedic unit’s best strategy for maintaining critical standards, discipline, and morale in severe and prolonged outbreaks.
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Affiliation(s)
| | - Tamara Soh
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Bryan Yijia Tan
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | | | | | - Kumaran Rasappan
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Keng Thiam Lee
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
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Molecular Docking and Chemical Analysis of Alcohol Compounds (C16-C20) Bound to InhA Receptors as Mycobactericidal Candidates. JURNAL KIMIA SAINS DAN APLIKASI 2020. [DOI: 10.14710/jksa.23.5.135-141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Tuberculosis (TB) is an infectious disease caused by a bacterium called Mycobacterium tuberculosis. TB infection spreads through the air and is more likely when using inappropriate disinfectants in medical and laboratory equipment related to TB research. Appropriate disinfectants used for laboratory equipment can reduce the risk of TB disease transmission. Alcohol compound is a common disinfectant with broad-spectrum activity against microbes, viruses, and fungi. Molecular Docking can be applied to support virtual receptor-ligand screening in finding the right mycobactericidal agent as a disinfectant candidate from the alcohol group. Based on docking analysis, octadecanol (C18) has potential as a mycobactericidal agent with InhA as its specific receptor. Gibbs (ΔG) free energy obtained by octadecanol (C18) and InhA is -4.9 kcal/mol.
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Hand hygiene as an incomplete challenge for developing countries: discussions based on knowledge and perceptions of nurses in North Cyprus example and published studies. MARMARA MEDICAL JOURNAL 2020. [DOI: 10.5472/marumj.737740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Jing JLJ, Pei Yi T, Bose RJC, McCarthy JR, Tharmalingam N, Madheswaran T. Hand Sanitizers: A Review on Formulation Aspects, Adverse Effects, and Regulations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3326. [PMID: 32403261 PMCID: PMC7246736 DOI: 10.3390/ijerph17093326] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 12/14/2022]
Abstract
Hand hygiene is of utmost importance as it may be contaminated easily from direct contact with airborne microorganism droplets from coughs and sneezes. Particularly in situations like pandemic outbreak, it is crucial to interrupt the transmission chain of the virus by the practice of proper hand sanitization. It can be achieved with contact isolation and strict infection control tool like maintaining good hand hygiene in hospital settings and in public. The success of the hand sanitization solely depends on the use of effective hand disinfecting agents formulated in various types and forms such as antimicrobial soaps, water-based or alcohol-based hand sanitizer, with the latter being widely used in hospital settings. To date, most of the effective hand sanitizer products are alcohol-based formulations containing 62%-95% of alcohol as it can denature the proteins of microbes and the ability to inactivate viruses. This systematic review correlated with the data available in Pubmed, and it will investigate the range of available hand sanitizers and their effectiveness as well as the formulation aspects, adverse effects, and recommendations to enhance the formulation efficiency and safety. Further, this article highlights the efficacy of alcohol-based hand sanitizer against the coronavirus.
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Affiliation(s)
- Jane Lee Jia Jing
- School of Pharmacy, International Medical University, No. 126 Jalan Jalil Perkasa 19, Bukit Jalil, Kuala Lumpur 57000, Malaysia; (J.L.J.J.); (T.P.Y.)
| | - Thong Pei Yi
- School of Pharmacy, International Medical University, No. 126 Jalan Jalil Perkasa 19, Bukit Jalil, Kuala Lumpur 57000, Malaysia; (J.L.J.J.); (T.P.Y.)
| | - Rajendran J. C. Bose
- Masonic Medical Research Institute, 2150 Bleecker St, Utica, NY 13501, USA; (R.J.C.B.); (J.R.M.)
| | - Jason R. McCarthy
- Masonic Medical Research Institute, 2150 Bleecker St, Utica, NY 13501, USA; (R.J.C.B.); (J.R.M.)
| | - Nagendran Tharmalingam
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI 02903, USA;
| | - Thiagarajan Madheswaran
- Department of Pharmaceutical Technology, International Medical University, No. 126 Jalan Jalil Perkasa 19, Bukit Jalil, Kuala Lumpur 57000, Malaysia
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DelMauro MA, Kalberer DC, Rodgers IR. Infection prophylaxis in periorbital Mohs surgery and reconstruction: a review and update to recommendations. Surv Ophthalmol 2020; 65:323-347. [DOI: 10.1016/j.survophthal.2019.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 11/27/2019] [Accepted: 12/02/2019] [Indexed: 01/04/2023]
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Saitoh A, Sato K, Magara Y, Osaki K, Narita K, Shioiri K, Fowler KE, Ratz D, Saint S. Improving Hand Hygiene Adherence in Healthcare Workers Before Patient Contact: A Multimodal Intervention in Four Tertiary Care Hospitals in Japan. J Hosp Med 2020; 15:262-267. [PMID: 32379022 DOI: 10.12788/jhm.3446] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/12/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Hand hygiene is key to preventing healthcare-associated infection and the spread of respiratory viruses like the novel coronavirus that causes COVID-19. Unfortunately, hand hygiene adherence of healthcare workers (HCWs) in Japan is suboptimal according to previous studies. OBJECTIVES Our objectives were to evaluate hand hygiene adherence among physicians and nurses before touching hospitalized patients and to evaluate changes in hand hygiene adherence after a multimodal intervention was implemented. DESIGN, SETTING, AND PARTICIPANTS We conducted a pre- and postintervention study with HCWs at four tertiary hospitals in Niigata, Japan. Hand hygiene observations were conducted from June to August 2018 (preintervention) and February to March 2019 (postintervention). INTERVENTION The multimodal hand hygiene intervention recommended by the World Health Organization was tailored to each hospital and implemented from September 2018 to February 2019. MAIN OUTCOMES AND MEASURES We observed hand hygiene adherence before touching patients in each hospital and compared rates before and after intervention. Intervention components were also evaluated. RESULTS There were 2,018 patient observations preintervention and 1,630 postintervention. Overall, hand hygiene adherence improved from 453 of 2,018 preintervention observations (22.4%) to 548 of 1,630 postintervention observations (33.6%; P < .001). Rates improved more among nurses (13.9 percentage points) than among doctors (5.7 percentage points). Improvement varied among the hospitals: Hospital B (18.4 percentage points) was highest, followed by Hospitals D (11.4 percentage points), C (11.3 percentage points), and Hospital A (6.5 percentage points). CONCLUSIONS A multimodal intervention improved hand hygiene adherence rates in physicians and nurses in Niigata, Japan; however, further improvement is necessary. Given the current suboptimal hand hygiene adherence rates in Japanese hospitals, the spread of COVID-19 within the hospital setting is a concern.
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Affiliation(s)
- Akihiko Saitoh
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata Japan
| | - Kiyomi Sato
- Department of Nursing, Niigata Saiseikai Daini Hospital, Niigata, Japan
| | - Yoko Magara
- Department of Nursing, Niigata Saiseikai Daini Hospital, Niigata, Japan
| | - Kakuei Osaki
- Department of Nursing, Niigata City General Hospital, Niigata, Japan
| | - Kiyoko Narita
- Department of Nursing, Naga-oka Red Cross Medical Center, Niigata, Japan
| | - Kumiko Shioiri
- Department of Nursing, Niigata Prefectural Shibata Hospital, Niigata, Japan
| | - Karen E Fowler
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - David Ratz
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Sanjay Saint
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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Osei Tutu B, Hushie C, Asante R, Egyakwa-Amusah JA. Food safety knowledge and self-reported practices among school children in the Ga West Municipality in Ghana. Food Control 2020. [DOI: 10.1016/j.foodcont.2019.107012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Taddese AA, Dagnew B, Dagne H, Andualem Z. Mother's Handwashing Practices and Health Outcomes of Under-Five Children in Northwest Ethiopia. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2020; 11:101-108. [PMID: 32210661 PMCID: PMC7073436 DOI: 10.2147/phmt.s238392] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/16/2020] [Indexed: 11/23/2022]
Abstract
Background Improving handwashing practices of mothers is important in developing countries to reduce child morbidity, mortality, and hygiene-related illnesses. This study aimed to assess mothers handwashing practice and the health effects on under-five children in northwest Ethiopia. Methods The study was an institution-based cross-sectional study conducted from November 2018 to January 2019 at the University of Gondar comprehensive specialized hospital. Four hundred and twenty two randomly selected mothers who have had under-five children were included in the study. Structured questioners were developed to assess handwashing practics and sociodemographic characterististics of mothers, and medical history related data of children were extracted from medical charts. Data entry and clearance were performed by Epi-infoTM version-7 software and exported for analysis to SPSS 22. Adjusted odds ratio with a 95% confidence interval was used to declare statistically significant variables on the basis of p-value < 0.05. Results The proportion of mothers who practiced good handwashing was 39.1% [95% CI: (34.8–43.9)]. More than half (54.3% and 53.6%) of the mothers indicated that they always remind their children to wash their hands before and after eating, respectively. However, 28% of under-five children were admitted to hospital with a diarrheal disease which may have been due to the poor hand washing practices of their mother. The odds of having good knowledge of handwashing practices were 0.26 times lower. Being married increased the handwashing practices of mothers by 2.62 times. Conclusion The majority of mothers who were knowledgable about handwashing were not executing it accuractely. Diarrheal admissions among under-five children have been influenced by their mother's poor hand washing practices. Therefore, it is imperitive to improve the understanding of proper handwashing practices of mothers at every level in the community.
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Affiliation(s)
- Asefa Adimasu Taddese
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Baye Dagnew
- Department of Human Physiology, School of Medicine, University of Gondar, Gonder, Ethiopia
| | - Henok Dagne
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Zewudu Andualem
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Kapanya A, Somsunan R, Molloy R, Jiranusornkul S, Leewattanapasuk W, Jongpaiboonkit L, Kong Y. Synthesis of polymeric hydrogels incorporating chlorhexidine gluconate as antibacterial wound dressings. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2020; 31:895-909. [DOI: 10.1080/09205063.2020.1725862] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Apichaya Kapanya
- Faculty of Science, Department of Chemistry, Chiang Mai University, Chiang Mai, Thailand
| | - Runglawan Somsunan
- Faculty of Science, Department of Chemistry, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Materials Science and Technology, Chiang Mai University, Chiang Mai, Thailand
| | - Robert Molloy
- Faculty of Science, Materials Science Research Center, Chiang Mai University, Chiang Mai, Thailand
| | - Supat Jiranusornkul
- Laboratory for Molecular Design and Simulation (LMDS), Department of Pharmaceutical Sciences, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | | | | | - Yen Kong
- AP Solutions LLC, Ypsilanti, MI, USA
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Torondel B, Khan R, Holm Larsen T, White S. Efficacy of the SuperTowel ®: An Alternative Hand-washing Product for Humanitarian Emergencies. Am J Trop Med Hyg 2020; 100:1278-1284. [PMID: 30860009 PMCID: PMC6493919 DOI: 10.4269/ajtmh.18-0860] [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: 12/12/2022] Open
Abstract
Handwashing with soap reduces the transmission of diarrheal pathogens, but access to hand-washing facilities, water, and soap in humanitarian emergencies is limited. The SuperTowel® (ST) is a fabric treated with permanent antimicrobial bonding and has been designed as a soap alternative in emergency situations. The aim of this study was to test the efficacy of the ST as a hand-cleaning product. Two sets of laboratory tests, with 16 volunteers in each, were conducted to test the efficacy of different prototypes of the ST. Volunteers pre-contaminated their hands with nonpathogenic Escherichia coli. Comparisons were made between hand cleaning with the ST and handwashing with the reference soap, using a crossover design. Participants also completed a questionnaire about product perceptions. Three of the prototypes of the ST were more efficacious at removing E. coli from pre-contaminated hands than handwashing with soap (mean log10 reduction of 4.11 ± 0.47 for ST1, 3.84 ± 0.61 for ST2, and 3.71 ± 0.67 for ST3 versus 3.01 ± 0.63 for soap [P < 0.001, P = 0.002, and P = 0.005, respectively]). The ST prototypes used less water than handwashing with soap, were well accepted, and were considered preferable in communal settings. The ST has the potential to be a suitable complementary hand-cleaning product for humanitarian emergencies.
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Affiliation(s)
- Belen Torondel
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rummana Khan
- Department of Microbiology, Kelkar Education Trust's Scientific Research Centre, Mumbai, India
| | | | - Sian White
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Osei-Asare C, Eshun Oppong E, Apenteng JA, Adi-Dako O, Kumadoh D, Akosua AA, Ohemeng KA. Managing Vibrio cholerae with a local beverage: preparation of an affordable ethanol based hand sanitizer. Heliyon 2020; 6:e03105. [PMID: 31956707 PMCID: PMC6956765 DOI: 10.1016/j.heliyon.2019.e03105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 11/06/2019] [Accepted: 12/19/2019] [Indexed: 11/18/2022] Open
Abstract
Research indicates an increased use of hand sanitizers globally, and in particular developing countries where bacterial epidemics such as cholera are common. While there is evidence of availability, high demand and use of hand sanitizers, the incidence of cholera in developing countries remains unabated. Several reasons have been put forward, and cost of hand sanitizers remains dominant. It is in response to this contradictory situation of availability but limited access, that this study was conducted to present an alternative option of formulating a high quality and cost effective ethanol-based sanitizer from a Ghanaian local beverage (akpeteshie). The concentration of ethanol in akpeteshie was determined using gas chromatography. An Ethanol based hand sanitizer (Sample C) was formulated with akpeteshie and tested against Vibrio cholerae using the microbial time -kill kinetics assay. Commercially available ethanol based Equi-Clean hand sanitizer (62%) (Sample D) was used as the standard. Results show that the akpeteshie contained 73.08% ethanol and formulated product (Sample C) contained 63.70% ethanol. Viscosity and pH of Sample C were; 89 rpm (1.48 cps) and 7.30 respectively whiles that of Sample D were; 80 rpm (1.33 cps) and 7.50 respectively. The formulated product (Sample C) was effective against Vibrio cholerae with a gradual reduction in microbial count upon exposure to the organisms at time intervals of 0, 5, 15, 30, 60 and 120 min.
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Affiliation(s)
- Christina Osei-Asare
- Department of Pharmaceutics, School of Pharmacy, Central University, Miotso, Ghana
| | - Esther Eshun Oppong
- Department of Pharmaceutics, School of Pharmacy, Central University, Miotso, Ghana
| | - John Antwi Apenteng
- Department of Pharmaceutics, School of Pharmacy, Central University, Miotso, Ghana
| | - Ofosua Adi-Dako
- Department of Pharmaceutics and Microbiology, University of Ghana School of Pharmacy, Legon, Accra, Ghana
| | - Doris Kumadoh
- Department of Pharmaceutics and Microbiology, University of Ghana School of Pharmacy, Legon, Accra, Ghana
| | | | - Kwasi Adomako Ohemeng
- Department of Medicinal Chemistry, School of Pharmacy, Central University, Miotso, Ghana
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Abstract
With reports of vancomycin-resistant enterococci recently emerging in hospital settings, renewed focus is turning to the importance of multifaceted infection prevention efforts. Careful compliance with established hygiene practices by healthcare workers together with effective antiseptic options is essential for the protection of patients from infectious agents. For over 60 years, povidone iodine (PVP-I) formulations have been shown to limit the impact and spread of infectious diseases with potent antiviral, antibacterial and antifungal effects. In addition to a lack of reported resistance, the benefits of PVP-I include an excellent safety profile and a broad spectrum of effect due to its multimodal action. Studies have shown that hand washing with PVP-I-based antiseptics is effective for the decontamination of skin, while PVP-I mouthwashes and gargles significantly reduce viral load in the oral cavity and the oropharynx. The importance of PVP-I has been emphasised by its inclusion in the World Health Organization's list of essential medicines, and high potency for virucidal activity has been observed against viruses of significant global concern, including hepatitis A and influenza, as well as the Middle-East Respiratory Syndrome and Sudden Acute Respiratory Syndrome coronaviruses. Together with its diverse applications in antimicrobial control, broad accessibility across the globe, and outstanding safety and tolerability profile, PVP-I offers an affordable, potent, and widely available antiseptic option.Funding Mundipharma Singapore Holding Pte Limited.
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Affiliation(s)
- Maren Eggers
- Labor Prof Gisela Enders MVZ GbR, Stuttgart, Germany.
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Mangold T, Hamilton EK, Johnson HB, Perez R. Standardising intraoperative irrigation with 0.05% chlorhexidine gluconate in caesarean delivery to reduce surgical site infections: A single institution experience. J Perioper Pract 2019; 30:24-33. [PMID: 31081734 DOI: 10.1177/1750458919850727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Surgical site infection is a significant cause of morbidity and mortality following caesarean delivery. Objective To determine whether standardising intraoperative irrigation with 0.05% chlorhexidine gluconate during caesarean delivery could decrease infection rates. Methods This was a process improvement project involving 742 women, 343 of whom received low-pressured 0.05% chlorhexidine gluconate irrigation during caesarean delivery over a one-year period. Infection rates were compared with a standard-of-care control group (399 women) undergoing caesarean delivery the preceding year. Results The treatment group infection rate met the study goal by achieving a lower infection rate than the control group, though this was not statistically significant. A significant interaction effect between irrigation with 0.05% chlorhexidine gluconate and antibiotic administration time existed, such that infection occurrence in the treatment group was not dependent on antibiotic timing, as opposed to the control group infection occurrence, which was dependent on antibiotic timing. Conclusion Intraoperative irrigation with 0.05% chlorhexidine gluconate during caesarean delivery did not statistically significantly reduce the rate of infections. It did render the impact of antibiotic administration timing irrelevant in prevention of surgical site infection. This suggests a role for 0.05% chlorhexidine gluconate irrigation in mitigating infection risk whether antibiotic prophylaxis timing is suboptimal or ideal.
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Affiliation(s)
- Theresa Mangold
- Neonatal Services, Christus Santa Rosa Hospital-Westover Hills Women's Services Unit, San Antonio, USA
| | | | | | - Rene Perez
- Department of Obstetrics and Gynecology, Christus Santa Rosa Hospital-Westover Hills Women's Services Unit, San Antonio, USA
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Nazaroff WW. Embracing microbes in exposure science. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2019; 29:1-10. [PMID: 30254254 PMCID: PMC7100090 DOI: 10.1038/s41370-018-0075-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/26/2018] [Accepted: 09/06/2018] [Indexed: 05/03/2023]
Abstract
Although defined more broadly, exposure science has mainly focused on exposures to environmental chemicals and related stressors, such as airborne particulate matter. There is an opportunity for exposure science to contribute more substantially to improving public health by devoting more attention to microorganisms as key stressors and agents in exposure. The discovery that pathogenic microbes cause disease in humans precipitated a revolution in public health science and disease prevention. With a continued global urgency to address spread of pathogenic microbes, contributions of microorganisms to both infectious and noninfectious processes merit more attention from the exposure science community. Today, discoveries of the importance of the human microbiome as a determinant of health and disease are precipitating a second revolution. Emerging knowledge creates a major opportunity to expand the scope of exposure science to incorporate the human microbiome as a target and modulator of exposure. A study committee of the National Academies of Sciences, Engineering, and Medicine has defined a research strategy to address health risks that pertain to the interaction of environmental chemicals with the human microbiome. Some aspects of this strategy pose important challenges and opportunities for the exposure science community.
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Affiliation(s)
- William W Nazaroff
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA, 94720-1710, USA.
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Alsagher MR, Soudah SA, Khsheba AE, Fadel SM, Dadiesh MA, Houme MA, Eshagroni AS, Alosta FF, Almsalaty SM. Hand Washing Before and After Applying Different Hand Hygiene Techniques in Places of Public Concern in Tripoli-Libya. Open Microbiol J 2018. [DOI: 10.2174/1874285801812010364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:Hand hygiene has being considered as one of the primary measures to improve standards and practice for hospital care and to minimize the transmission of nosocomial pathogens. There is substantial evidence that incidence of hospital acquired infections is reduced by applying hand antisepsis. Regarding hand hygiene and public concern, hand washing has revealed that 85% of the observed adults wash their hands after using public toilets.Objective:To compare the efficacy of hand rubbing with an alcohol based solution versus conventional hand washing with antiseptic and non-antiseptic soaps in reducing bacterial counts using different hand hygiene techniques.Methods:Ninety-three volunteers took part in this study; 57 from Tripoli Medical Center (TMC); 16 from school; 11 from bank; and 9 from office. All volunteers performed six hand hygiene techniques, immediately before and after a volunteer practice activity: hand washing with non-antiseptic soap for 10 and 30 second (s); hand washing with antiseptic soap for 10, 30 or 60 s; and alcohol-based hand rub. A total of 864 specimens were taken: 432 before and 432 after volunteer's hand hygiene. The fingertips of the dominant hand for each volunteer were pressed on to agar for culture before and after each hand hygiene technique. Plates were incubated at 37oC, and colony-forming units were counted after 48 hours and pathogenic bacteria were identified.Results:Results showed that 617 specimens (71.41%) were positive for bacterial growth. 301 (48.78%) were from TMC, 118 (19.12%) were from office; 107 (14.34%) were from school and 91 (14.75%) were from bank.Conclusion:Both antiseptic and non–antiseptic soaps did not work properly in reducing bacterial counts of worker’s hands at all places of study, but significantly improved by an application of alcohol based gel.
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Tubre DJ, Schroeder AD, Estes J, Eisenga J, Fitzgibbons RJ. Surgical site infection: the "Achilles Heel" of all types of abdominal wall hernia reconstruction. Hernia 2018; 22:1003-1013. [PMID: 30276561 DOI: 10.1007/s10029-018-1826-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/14/2018] [Indexed: 01/12/2023]
Abstract
PURPOSE Surgical site infection is the most common hospital-acquired infection in surgical patients. Recently, public health organizations have updated prevention guidelines. This review discusses surgical site infections as a complication of abdominal wall reconstruction. METHODS The authors reviewed guidelines on prevention of surgical site infections from the Center for Disease Control and Prevention, World Health Organization, and National Institute for Health and Care Excellence and put them into context with the relevant abdominal wall reconstruction literature. This was the subject of the Nyhus-Wantz lecture given at The International Hernia Congress on March 14, 2018 in Miami, FL and is summarized here. RESULTS Routine use of preoperative antibiotics in prosthetic groin hernia repair is not supported by the available literature. High-quality data on antibiotic prophylaxis in ventral (both primary and incisional) hernia repair is lacking, but it is widely utilized and may reduce SSIs. Recommended preventative strategies discussed in this manuscript include: treatment of remote site infections, perioperative normothermia and normoglycemia, avoidance of hypoxemia, antiseptic preparation of surgical team hands and patient skin, treatment of obesity, smoking cessation, correction of malnutrition, and physical conditioning. CONCLUSION Surgical site infections lead to significant morbidity and mortality, hernia recurrences, prolonged hospital stay, and increased hospital costs. This makes surgical site infections the "Achilles Heel" of abdominal wall reconstruction. Strict adherence to standardized guidelines and preoperative optimization of patients' risk profiles are crucial to decrease the incidence of surgical site infections.
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Affiliation(s)
- D J Tubre
- Department of Surgery, Creighton University Medical Center, Bergan Mercy, 7710 Mercy Road, Suite 501, Omaha, NE, 68124, USA
| | - A D Schroeder
- Department of Surgery, Creighton University Medical Center, Bergan Mercy, 7710 Mercy Road, Suite 501, Omaha, NE, 68124, USA
| | - J Estes
- Creighton University School of Medicine, 2500 California Plaza, Omaha, NE, 68178, USA
| | - J Eisenga
- Creighton University School of Medicine, 2500 California Plaza, Omaha, NE, 68178, USA
| | - R J Fitzgibbons
- Department of Surgery, Creighton University Medical Center, Bergan Mercy, 7710 Mercy Road, Suite 501, Omaha, NE, 68124, USA.
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Yu JJ, Manus MB, Mueller O, Windsor SC, Horvath JE, Nunn CL. Antibacterial soap use impacts skin microbial communities in rural Madagascar. PLoS One 2018; 13:e0199899. [PMID: 30125279 PMCID: PMC6101359 DOI: 10.1371/journal.pone.0199899] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 06/15/2018] [Indexed: 11/18/2022] Open
Abstract
The skin harbors diverse communities of microorganisms, and alterations to these communities can impact the effectiveness of the skin as a barrier to infectious organisms or injury. As the global availability and adoption of antibacterial products increases, it is important to understand how these products affect skin microbial communities of people living in rural areas of developing countries, where risks of infection and injury often differ from urban populations in developed countries. We investigated the effect of antibacterial soap on skin microbial communities in a rural Malagasy population that practices subsistence agriculture in the absence of electricity and running water. We quantified the amount of soap used by each participant and obtained skin swab samples at three time points: prior to soap use, immediately after one week of soap use, and two weeks after soap use was discontinued. Soap use did not significantly impact ecological measures of diversity and richness (alpha diversity). However, the amount of soap used was a predictor of community-level change (beta diversity), with changes persisting for at least two weeks after subjects stopped using soap. Our results indicate that the overall species richness of skin microbial communities may be resistant to short-term use of antibacterial soap in settings characterized by regular contact with the natural environment, yet these communities may undergo shifts in microbial composition. Lifestyle changes associated with the use of antibacterial soap may therefore cause rapid alterations in skin microbial communities, with the potential for effects on skin health.
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Affiliation(s)
- James J. Yu
- Department of Evolutionary Anthropology, Duke University, Durham, North Carolina, United States of America
| | - Melissa B. Manus
- Department of Evolutionary Anthropology, Duke University, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Olaf Mueller
- Department of Molecular Genetics and Microbiology, Duke University, Durham, North Carolina, United States of America
- Center for the Genomics of Microbial Systems, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Sarah C. Windsor
- Genomics & Microbiology Research Lab, North Carolina Museum of Natural Sciences, Raleigh, North Carolina, United States of America
| | - Julie E. Horvath
- Department of Evolutionary Anthropology, Duke University, Durham, North Carolina, United States of America
- Genomics & Microbiology Research Lab, North Carolina Museum of Natural Sciences, Raleigh, North Carolina, United States of America
- Department of Biological and Biomedical Sciences, North Carolina Central University, Durham, North Carolina, United States of America
| | - Charles L. Nunn
- Department of Evolutionary Anthropology, Duke University, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
- * E-mail:
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Boucher C, Henton MM, Becker PJ, Kirberger RM, Hartman MJ. Comparative efficacy of three antiseptics as surgical skin preparations in dogs. Vet Surg 2018; 47:792-801. [PMID: 30004127 DOI: 10.1111/vsu.12913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 03/06/2018] [Accepted: 05/07/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the antimicrobial efficacy of a 2% chlorhexidine gluconate and 70% ethanol solution (CG+A) with that of F10 Skin Prep Solution (F10) and electrochemically activated water (EAW) when used as a surgical preparation in canine patients. STUDY DESIGN Prospective randomized clinical study. SAMPLE POPULATION One hundred sixteen dogs presented for ovariohysterectomy. METHODS Dogs were randomly divided into 1 of the 3 antiseptic groups (CG+A, F10, EAW). Skin samples with replicating organism detection and counting plates were taken at 4 different perioperative sites and time intervals (postskin preparation, postskin antisepsis, 2 hours after the second sample, and at the end of surgery) during ovariohysterectomies performed by students. The colony forming unit (CFU) counts from each sample were quantified according to the level of bacterial contamination. Zero CFU was defined as no contamination, 1-12 CFU was defined as low contamination, and greater than 12 CFU was defined as high contamination. The 3 antiseptics were compared with respect to the level of contamination. RESULTS There was no difference in the level of colonization between the antiseptics at the first sampling time (P = .454). However, the level of contamination for CG+A was lower compared with F10 and EAW at the second, third, and fourth sampling times (P = .001, P = .01, P = .02, respectively). CONCLUSION CG+A was more effective at achieving a zero CFU count and low levels of contamination compared with F10 and EAW for surgical preparation in dogs undergoing ovariohysterectomy. CLINICAL SIGNIFICANCE This study does not provide evidence to support the use of F10 and EAW instead of CG+A for the surgical skin preparation of dogs undergoing ovariohysterectomy.
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Affiliation(s)
- Charles Boucher
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | | | - Piet J Becker
- Research Office, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Robert M Kirberger
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Marthinus J Hartman
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
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Eggers M, Koburger-Janssen T, Ward LS, Newby C, Müller S. Bactericidal and Virucidal Activity of Povidone-Iodine and Chlorhexidine Gluconate Cleansers in an In Vivo Hand Hygiene Clinical Simulation Study. Infect Dis Ther 2018; 7:235-247. [PMID: 29761329 PMCID: PMC5986686 DOI: 10.1007/s40121-018-0202-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction Standard in vitro and in vivo tests help demonstrate efficacy of hand hygiene products; however, there is no standard in vivo test method for viruses. We investigated the bactericidal and virucidal efficacy of povidone-iodine (PVP-I) 7.5% scalp and skin cleanser, chlorhexidine gluconate (CHG) 4% hand cleanser and the reference hand wash (soft soap) in 15 healthy volunteers following European Standard EN1499 (hygienic hand wash test method for bacteria), which was adapted for virucidal testing. Methods Separate test series were performed for bactericidal (Escherichia coli) and virucidal [murine norovirus (MNV)] testing. After pre-washing and artificial contamination of hands with test organisms, volunteers underwent testing with 3 and 5 mL of each product for contact times of 15, 30 and 60 s according to a Latin-square randomization. The number of test organisms released from fingertips into sampling fluids was assessed before and after hand washing and mean log10 reduction factor (RF) was calculated. RFs (test-reference) were compared using a Wilcoxon–Wilcox multiple comparisons test per EN1499; efficacy was concluded if p ≤ 0.01. Results PVP-I 7.5% and CHG 4% cleansers both passed EN1499 requirements against E. coli, with statistically significantly greater (p ≤ 0.01) mean log10 RFs compared with reference soft soap across all tests (PVP-I: 4.09–5.27; CHG: 4.12–5.22; soap: 2.75–3.11). The experimental design using EN1499 was applicable to testing with MNV as discriminatory and reproducible results were generated. Mean log10 RFs of MNV were statistically significantly greater for PVP-I (1.57–2.57) compared with soft soap (1.24–1.62), while mean log10 RFs with CHG (0.90–1.34) were lower than for soft soap across all tests. Conclusion PVP-I 7.5% cleanser showed superior efficacy against MNV compared to soft soap and CHG 4% cleanser, while both PVP-I and CHG were superior to soft soap against E. coli. The experimental set-up may be applicable to future testing for antiviral hand washes. Funding Mundipharma Manufacturing Pte Ltd. Plain Language Summary Plain language summary available for this article.
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Affiliation(s)
- Maren Eggers
- Labor Prof Gisela Enders MVZ GbR, Stuttgart, Germany
| | | | - Lois S Ward
- Clinical Operations, Mundipharma Research Limited, Cambridge, UK
| | - Craig Newby
- R&D, Mundipharma Manufacturing Pte Ltd, Singapore, Singapore
| | - Stefan Müller
- Pharmacologicial and Translational Science, Mundipharma Research GmbH & Co KG, Limburg, Germany.
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Kurtz SL. Introduction of New Theory for Hand Hygiene Surveillance: Healthcare Environment Theory. Res Theory Nurs Pract 2018; 32:144-167. [PMID: 29792254 DOI: 10.1891/1541-6577.32.2.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this article is to introduce a theoretical foundation, the healthcare environment theory (HET), tested in a quantitative, cross-sectional, overt observational study measuring the association of demographic variables with consistent hand hygiene compliance of the ICU nurse. METHODS Six environments found in a hospital ICU setting (family, church, work, administration, community, and culture) work bi-directionally to influence and be influenced by the nurse, simultaneously influencing each of the other environments in a multidirectional manner. The HET was used as the theoretical foundation for a study, which included a convenience sample of registered nurses (RNs) from five ICUs (64 participating RNs) in four hospitals in Texas who were observed for a total of 18 days (144 hours). The desired sample size of 613 hand hygiene opportunities for each ICU was obtained in 3 days of observation at 3 ICUs, 4 days in one ICU, and 5 days in one ICU. The six environments were used to support the results observed. RESULTS Through the variables of age and having children, hand hygiene rates were influenced by the family environment. Community environment was associated with a change in hand hygiene behavior in hospital hand hygiene rates in regards to age of the nurse. Younger nurses had higher hand hygiene compliance rates than older nurses. IMPLICATIONS FOR PRACTICE The different hospital environments surrounding the nurse can be used to explain hand hygiene compliance rates in association with demographic variables.
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From Ignác Semmelweis to Primary Immunodeficiencies: a Bicentenary Commemoration. J Clin Immunol 2018; 38:247-250. [DOI: 10.1007/s10875-018-0495-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 03/29/2018] [Indexed: 10/17/2022]
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Liu Z, Dumville JC, Norman G, Westby MJ, Blazeby J, McFarlane E, Welton NJ, O'Connor L, Cawthorne J, George RP, Crosbie EJ, Rithalia AD, Cheng H. Intraoperative interventions for preventing surgical site infection: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2018; 2:CD012653. [PMID: 29406579 PMCID: PMC6491077 DOI: 10.1002/14651858.cd012653.pub2] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Surgical site infection (SSI) rates vary from 1% to 5% in the month following surgery. Due to the large number of surgical procedures conducted annually, the costs of these SSIs can be considerable in financial and social terms. Many interventions are used with the aim of reducing the risk of SSI in people undergoing surgery. These interventions can be broadly delivered at three stages: preoperatively, intraoperatively and postoperatively. The intraoperative interventions are largely focused on decontamination of skin using soap and antiseptics; the use of barriers to prevent movement of micro-organisms into incisions; and optimising the patient's own bodily functions to promote best recovery. Both decontamination and barrier methods can be aimed at people undergoing surgery and operating staff. Other interventions focused on SSI prevention may be aimed at the surgical environment and include methods of theatre cleansing and approaches to managing theatre traffic. OBJECTIVES To present an overview of Cochrane Reviews of the effectiveness and safety of interventions, delivered during the intraoperative period, aimed at preventing SSIs in all populations undergoing surgery in an operating theatre. METHODS Published Cochrane systematic reviews reporting the effectiveness of interventions delivered during the intraoperative period in terms of SSI prevention were eligible for inclusion in this overview. We also identified Cochrane protocols and title registrations for future inclusion into the overview. We searched the Cochrane Library on 01 July 2017. Two review authors independently screened search results and undertook data extraction and 'Risk of bias' and certainty assessment. We used the ROBIS (risk of bias in systematic reviews) tool to assess the quality of included reviews, and we used GRADE methods to assess the certainty of the evidence for each outcome. We summarised the characteristics of included reviews in the text and in additional tables. MAIN RESULTS We included 32 Cochrane Reviews in this overview: we judged 30 reviews as being at low risk of bias and two at unclear risk of bias. Thirteen reviews had not been updated in the past three years. Two reviews had no relevant data to extract. We extracted data from 30 reviews with 349 included trials, totaling 73,053 participants. Interventions assessed included gloving, use of disposable face masks, patient oxygenation protocols, use of skin antiseptics for hand washing and patient skin preparation, vaginal preparation, microbial sealants, methods of surgical incision, antibiotic prophylaxis and methods of skin closure. Overall, the GRADE certainty of evidence for outcomes was low or very low. Of the 77 comparisons providing evidence for the outcome of SSI, seven provided high- or moderate-certainty evidence, 39 provided low-certainty evidence and 31 very low-certainty evidence. Of the nine comparisons that provided evidence for the outcome of mortality, five provided low-certainty evidence and four very low-certainty evidence.There is high- or moderate-certainty evidence for the following outcomes for these intraoperative interventions. (1) Prophylactic intravenous antibiotics administered before caesarean incision reduce SSI risk compared with administration after cord clamping (10 trials, 5041 participants; risk ratio (RR) 0.59, 95% confidence interval (CI) 0.44 to 0.81; high-certainty evidence - assessed by review authors). (2) Preoperative antibiotics reduce SSI risk compared with placebo after breast cancer surgery (6 trials, 1708 participants; RR 0.74, 95% CI 0.56 to 0.98; high-certainty evidence - assessed by overview authors). (3) Antibiotic prophylaxis probably reduce SSI risk in caesarean sections compared with no antibiotics (82 relevant trials, 14,407 participants; RR 0.40, 95% CI 0.35 to 0.46; moderate-certainty evidence; downgraded once for risk of bias - assessed by review authors). (4) Antibiotic prophylaxis probably reduces SSI risk for hernia repair compared with placebo or no treatment (17 trials, 7843 participants; RR 0.67, 95% CI 0.54 to 0.84; moderate-certainty evidence; downgraded once for risk of bias - assessed by overview authors); (5) There is currently no clear difference in the risk of SSI between iodine-impregnated adhesive drapes compared with no adhesive drapes (2 trials, 1113 participants; RR 1.03, 95% CI 0.66 to 1.60; moderate-certainty evidence; downgraded once for imprecision - assessed by review authors); (6) There is currently no clear difference in SSI risk between short-term compared with long-term duration antibiotics in colorectal surgery (7 trials; 1484 participants; RR 1.05 95% CI 0.78 to 1.40; moderate-certainty evidence; downgraded once for imprecision - assessed by overview authors). There was only one comparison showing negative effects associated with the intervention: adhesive drapes increase the risk of SSI compared with no drapes (5 trials; 3082 participants; RR 1.23, 95% CI 1.02 to 1.48; high-certainty evidence - rated by review authors). AUTHORS' CONCLUSIONS This overview provides the most up-to-date evidence on use of intraoperative treatments for the prevention of SSIs from all currently published Cochrane Reviews. There is evidence that some interventions are useful in reducing SSI risk for people undergoing surgery, such as antibiotic prophylaxis for caesarean section and hernia repair, and also the timing of prophylactic intravenous antibiotics administered before caesarean incision. Also, there is evidence that adhesive drapes increase SSI risk. Evidence for the many other treatment choices is largely of low or very low certainty and no quality-of-life or cost-effectiveness data were reported. Future trials should elucidate the relative effects of some treatments. These studies should focus on increasing participant numbers, using robust methodology and being of sufficient duration to adequately assess SSI. Assessment of other outcomes such as mortality might also be investigated as part of non-experimental prospective follow-up of people with SSI of different severity, so the risk of death for different subgroups can be better understood.
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Affiliation(s)
- Zhenmi Liu
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Jo C Dumville
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Gill Norman
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Maggie J Westby
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Jane Blazeby
- University of BristolNIHR Bristol Biomedical Research Centre, School of Social and Community Medicine, Bristol Medical SchoolBristolUK
| | - Emma McFarlane
- National Institute for Health and Care ExcellenceCentre for GuidelinesLevel 1A, City TowerPiccadilly PlazaManchesterUKM1 4BD
| | - Nicky J Welton
- University of BristolNIHR Bristol Biomedical Research Centre, School of Social and Community Medicine, Bristol Medical SchoolBristolUK
| | - Louise O'Connor
- Central Manchester University Hospitals NHS Foundation TrustInfection Prevention and Control / Tissue Viability TeamCobbett HouseOxford RoadManchesterUKM13 9WL
| | - Julie Cawthorne
- Central Manchester University Hospitals NHS Foundation TrustInfection Prevention and Control / Tissue Viability TeamCobbett HouseOxford RoadManchesterUKM13 9WL
| | - Ryan P George
- Central Manchester University Hospitals NHS Foundation TrustInfection Prevention and Control / Tissue Viability TeamCobbett HouseOxford RoadManchesterUKM13 9WL
| | - Emma J Crosbie
- Faculty of Biology, Medicine and Health, University of ManchesterDivision of Cancer Sciences5th Floor ‐ ResearchSt Mary's HospitalManchesterUKM13 9WL
| | - Amber D Rithalia
- Independent Researcher7 Victoria Terrace, KirkstallLeedsUKLS5 3HX
| | - Hung‐Yuan Cheng
- University of BristolBristol Centre for Surgical Research, Bristol Medical SchoolOffice 2.01Canynge Hall, 39 Whatley RoadBristolUKBS8 2PS
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Clark J, Crandall PG, O’Bryan C. Climbing the Intervention Ladder to handwashing compliance: A review and directions for future research. Food Control 2018. [DOI: 10.1016/j.foodcont.2017.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- June Young Chun
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Wan KA, Ng MY, Wong YT. New Horizon on Community-Acquired Methicillin Resistant Staphylococcus Aureus (Ca-Mrsa) Skin and Soft Tissue Infection: Nanotechnology Antimicrobial Spray. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791101800611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in community and hospital is increasing. The development of drug resistance may be attributed to the extensive use of antibiotics. Nanotechnology antimicrobial spray (NTAS), a physical antibacterial agent, is an alternative to antibiotic treatment on wound management. We report a case of MRSA associated skin abscess using NTAS in the wound management. NTAS possesses potent, broad spectrum antibacterial effect while carrying no risk of resistance and minimal adverse effect. Moreover, NTAS facilitates home wound management, thus reducing dependency on public health resources. Further studies are indicated to explore the clinical role of NTAS in an attempt to reduce the use of antibiotics. (Hong Kong j.emerg.med. 2011;18:432-436)
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Masroor N, Doll M, Stevens M, Bearman G. Approaches to hand hygiene monitoring: From low to high technology approaches. Int J Infect Dis 2017; 65:101-104. [PMID: 29054442 DOI: 10.1016/j.ijid.2017.09.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/25/2017] [Accepted: 09/29/2017] [Indexed: 11/18/2022] Open
Abstract
Hand hygiene is a global and critical infection prevention practice across all healthcare settings. Approaches to monitoring hand hygiene compliance vary from simple methods such as direct observation and product usage to more advanced methods such as automated electronic monitoring systems. Current literature supports a multimodal approach, supplemented by education, to enhance hand hygiene performance.
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Affiliation(s)
- Nadia Masroor
- VCU Health Infection Prevention Program, P.O. Box 980019, Richmond, Virginia 23298, United States.
| | - Michelle Doll
- VCU Health Infection Prevention Program, P.O. Box 980019, Richmond, Virginia 23298, United States
| | - Michael Stevens
- VCU Health Infection Prevention Program, P.O. Box 980019, Richmond, Virginia 23298, United States
| | - Gonzalo Bearman
- VCU Health Infection Prevention Program, P.O. Box 980019, Richmond, Virginia 23298, United States
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Kashyap B, Gupta K, Gomber S, Gupta N, Bhardwaj A, Singh NP, Kumar A. Hand hygiene compliance among health care workers in pediatric oncology ward of a tertiary care hospital: A cross sectional observational study. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2017. [DOI: 10.1016/j.injms.2017.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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