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Mastracci JC, Bonvillain KW, Gaston RG. Surgical Hand Antisepsis: Environmental and Cost Impact in Hand Surgery. J Hand Surg Am 2024:S0363-5023(24)00171-0. [PMID: 38795103 DOI: 10.1016/j.jhsa.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/31/2024] [Accepted: 04/13/2024] [Indexed: 05/27/2024]
Abstract
Health care systems, including operating rooms, are a considerable contributor to environmental waste. Given ongoing concerns regarding water scarcity in the United States and worldwide, action to reduce water utilization should be taken. Traditional water-based hand scrubbing wastes an estimated 11 L of water per scrub. Waterless hand rubbing with an alcohol-based solution has been shown to be as effective as traditional water-based hand scrubbing in surgical hand antisepsis and in preventing surgical site infections. Furthermore, alcohol-based rubbing results in less waste and reduced costs when compared with water-based hand scrubbing. The hand surgery operating room, including minor procedure rooms, serves as an opportunity to decrease water use and reduce the environmental impact of our field. Waterless alcohol-based hand rubbing for antisepsis may also be an opportunity to save money and provide value-based care to our patients.
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Affiliation(s)
- Julia C Mastracci
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC
| | - Kirby W Bonvillain
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC
| | - R Glenn Gaston
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC; OrthoCarolina Hand Center, Charlotte, NC.
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Saleh JR, Mitchell A, Kha ST, Outterson R, Choi A, Allen L, Chang T, Ladd AL, Goodman SB, Fox P, Chou L. The Environmental Impact of Orthopaedic Surgery. J Bone Joint Surg Am 2023; 105:74-82. [PMID: 36574633 DOI: 10.2106/jbjs.22.00548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
➤ There are a growing number of opportunities within the field of orthopaedic surgery to address climate change and investigate ways to promote sustainability. ➤ Orthopaedic surgeons can take a proactive role in addressing climate change and its impacts within the areas of operating-room waste, carbon emissions from transportation and implant manufacturing, anesthetic gases, and water usage. ➤ Future studies are needed to further these initiatives on quantifying and decreasing environmental impact and furthering sustainable use of our resources.
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Affiliation(s)
- Jason R Saleh
- VA Palo Alto Health Care System, Palo Alto, California
| | - Allison Mitchell
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Stephanie T Kha
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Rachel Outterson
- Department of Anesthesia, Perioperative and Pain Medicine, Stanford University, Redwood City, California
| | - Aiden Choi
- Stanford University, Stanford, California
| | | | - Tony Chang
- Stanford University, Stanford, California
| | - Amy L Ladd
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Stuart B Goodman
- Departments of Orthopaedic Surgery and Bioengineering, Stanford University, Redwood City, California
| | - Paige Fox
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Stanford, California
| | - Loretta Chou
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
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Akita S, Fujioka M, Akita T, Tanaka J, Masunaga A, Kawahara T. Effects of Hand Hygiene Using 4% Chlorhexidine Gluconate or Natural Soap During Hand Rubbing Followed by Alcohol-Based 1% Chlorhexidine Gluconate Sanitizer Lotion in the Operating Room. Adv Wound Care (New Rochelle) 2022; 11:1-9. [PMID: 33563102 PMCID: PMC9831244 DOI: 10.1089/wound.2020.1352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Objective: Hand hygiene using either 4% chlorhexidine gluconate (CHG) or natural soap during hand rubbing, followed by alcohol-based 1% CHG sanitizer lotion in the operating room was compared to assess bacterial reduction, skin moisture, skin texture, and hand hygiene using qualitative questionnaires. Approach: A crossover study with 36 professional scrub nurses at two medical centers was performed to compare 4% CHG followed by alcohol-based 1% CHG sanitizer lotion, the Two-stage method with handwashing using natural soap followed by alcohol-based 1% CHG sanitizer lotion, and the Waterless method, after a period of 10 days of use. The study completely followed CONSORT, www.consort-statement.org. Results: There was no significant difference in bacterial reduction based on the bacterial colony-forming units between the two methods. The skin moisture and skin roughness scores were not significantly different between the two methods. The Waterless method was significantly better than the Two-stage method regarding "foaming," "quality," "longevity" (p < 0.0001, p < 0.0001, and p < 0.0001, respectively), but "disappearance" was significantly better by the Two-stage method (p = 0.0095) during washing and rubbing. Immediately after washing and rubbing, the Waterless method was significantly better regarding "tightness" and "moisture," whereas the Two-stage method was significantly better regarding "stickiness" (p = 0.0114, p = <0.0001, and 0.0059, respectively) Innovation: The Waterless method using natural soap during handwashing followed by alcohol-based 1% CHG sanitizer lotion was as effective as the Two-stage method of 4% CHG followed by alcohol-based 1% CHG sanitizer lotion. Conclusion: Handwashing using natural soap is simple and superior to hand scrubbing in several aspects.
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Affiliation(s)
- Sadanori Akita
- Department of Plastic Surgery, Wound Repair and Regeneration, School of Medicine, Fukuoka University, Fukuoka, Japan.,Correspondence: Department of Plastic Surgery, Wound Repair and Regeneration, School of Medicine, Fukuoka University, Fukuoka 8140180, Japan
| | - Masaki Fujioka
- Department of Plastic and Reconstructive Surgery, National Hospital Organization, Nagasaki Medical Center, Nagasaki, Japan
| | - Tomoyuki Akita
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical & Health Science, Hiroshima University, Hiroshima, Japan
| | - Junko Tanaka
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical & Health Science, Hiroshima University, Hiroshima, Japan
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Baird BA, Parikh K, Broderick G. Penile implant infection factors: a contemporary narrative review of literature. Transl Androl Urol 2021; 10:3873-3884. [PMID: 34804829 PMCID: PMC8575569 DOI: 10.21037/tau-21-568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/27/2021] [Indexed: 11/20/2022] Open
Abstract
Objective We aim to review and summarize published literature that features implanted penile devices and details infection of these devices as a complication. In particular, we will detail the factors that influence infection of penile implants. Background Types of penile prostheses (PP) include inflatable implants and semirigid implants; these are utilized for treatment of erectile dysfunction. Likely the most feared complication of penile implants is infection. There are a handful of factors that are implicated in device infection. Methods Searches were performed using MEDLINE and PubMed databases using keywords and phrases ‘penile implant AND infection’; ‘penile prosthesis AND infection’; ‘penile implant infection’. We have presented results from our literature search. We divided these into ‘Surgical Elements’ and ‘Patient Selection and Factors.’ Each topic is discussed in its own section. Conclusions Strides have been made since the initial penile prosthesis (IPP) surgeries to improve infection rates including diabetes control, antibiotic coating of devices, and antibiotic implementation. Going forward, more studies, especially randomized control trials, need to focus on defining levels of diabetic control (sugar control and A1C control), determining the role of metabolic syndrome in infection promotion and determining laboratory values which could be predictive of infection. We present a discussion of important factors to consider in the realm of PP infections. In addition, we include studies which discuss topics for future directions in decreasing the number of infections seen with PP.
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Parlak EA, Iyigun E, Albay A, Bedir O. Impact of methods and duration of surgical hand scrub on bacterial count: A randomized controlled trial. Am J Infect Control 2021; 49:1376-1383. [PMID: 34029650 DOI: 10.1016/j.ajic.2021.05.006] [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: 03/11/2021] [Revised: 05/12/2021] [Accepted: 05/15/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is no standard protocol for surgical scrubbing. This study aims to compare the effectiveness of surgical hand scrub duration and method by analyzing their effects on bacterial count. METHODS The study was conducted on 180 surgical nurses and surgeons. While the duration of surgical hand scrub in Groups I and II was one minute, participants in Group I used a nail brush, whereas Group II did not. Similarly, the duration of surgical hand scrub in Groups III and IV was two minutes, but Group III used a nail brush, whereas Group IV did not. Bacterial count on the hands of all participants was measured before and after the surgical hand scrub and after the surgery by using the glove juice method. RESULTS Bacterial count on the hands of the participants in Group III after surgical hand scrub was significantly higher than Group IV (P < .001). We did not find any statistically significant difference between Group II and Group IV in terms of bacterial count on the hands immediately after surgical hand scrub and after the surgery (P = .401, P =.658, respectively). CONCLUSIONS This study found that brushing during surgical hand scrub increased the number of bacteria on the hand. Besides, one-minute surgical hand scrub was equally effective as two-minute scrub to reduce the number of bacteria on the hand.
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Munday J, Higgins N, Mathew S, Dalgleish L, Batterbury AS, Burgess L, Campbell J, Delaney LJ, Griffin BR, Hughes JA, Ingleman J, Keogh S, Coyer F. Nurse-Led Randomized Controlled Trials in the Perioperative Setting: A Scoping Review. J Multidiscip Healthc 2020; 13:647-660. [PMID: 32821111 PMCID: PMC7419608 DOI: 10.2147/jmdh.s255785] [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: 03/27/2020] [Accepted: 05/28/2020] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Nurses provide care at each phase of the complex, perioperative pathway and are well placed to identify areas of care requiring investigation in randomized controlled trials. Yet, currently, the scope of nurse-led randomized controlled trials conducted within the perioperative setting are unknown. This scoping review aims to identify areas of perioperative care in which nurse-led randomized controlled trials have been conducted, to identify issues impacting upon the quality of these trials and identify gaps for future investigation. METHODS This scoping review was conducted in reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Searches were conducted in PubMed, Embase, Cumulative Index for Nursing and Allied Health Literature and the Cochrane Central Register of Controlled Trials, with a date range of 2014-19. Sources of unpublished literature included Open Grey, and ProQuest Dissertation and Theses, Clinical Trials.gov and the Australian and New Zealand Clinical Trials Registry. After title and abstract checking, full-text retrieval and data extraction, studies were appraised using the Joanna Briggs Institute Critical Appraisal Checklists for randomized controlled trials. Data were synthesized according to the main objectives. Key information was tabulated. RESULTS From the 86 included studies, key areas where nurses have led randomized controlled trials include patient or caregiver anxiety; postoperative pain relief; surgical site infection prevention: patient and caregiver knowledge; perioperative hypothermia prevention; postoperative nausea and vomiting; in addition to other diverse outcomes. Issues impacting upon quality (including poorly reported randomization), and gaps for future investigation (including a focus on vulnerable populations), are evident. CONCLUSION Nurse-led randomized controlled trials in the perioperative setting have focused on key areas of perioperative care. Yet, opportunities exist for nurses to lead experimental research in other perioperative priority areas and within different populations that have been neglected, such as in the population of older adults undergoing surgery.
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Affiliation(s)
- Judy Munday
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Department of Health and Nursing Science, University of Agder, Grimstad, 4879, Norway
- Mater Research Institute-UQ, South Brisbane, QLD4101, Australia
| | - Niall Higgins
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Royal Brisbane and Women’s Hospital, Herston, QLD4029, Australia
| | - Saira Mathew
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Lizanne Dalgleish
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Royal Brisbane and Women’s Hospital, Herston, QLD4029, Australia
| | - Anthony S Batterbury
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Royal Brisbane and Women’s Hospital, Herston, QLD4029, Australia
| | - Luke Burgess
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Mater Research Institute-UQ, South Brisbane, QLD4101, Australia
| | - Jill Campbell
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Royal Brisbane and Women’s Hospital, Herston, QLD4029, Australia
| | - Lori J Delaney
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Colleges of Health and Medicine, Australian National University, Acton, ACT2601, Australia
| | - Bronwyn R Griffin
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - James A Hughes
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Royal Brisbane and Women’s Hospital, Herston, QLD4029, Australia
| | - Jessica Ingleman
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Samantha Keogh
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Royal Brisbane and Women’s Hospital, Herston, QLD4029, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, QLD, 4111, Australia
| | - Fiona Coyer
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Royal Brisbane and Women’s Hospital, Herston, QLD4029, Australia
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Feng W, Lin S, Huang D, Huang J, Chen L, Wu W, Hu S, Wei Z, Wang X. Surgical hand rubbing versus surgical hand scrubbing: Systematic review and meta-analysis of efficacy. Injury 2020; 51:1250-1257. [PMID: 32331847 DOI: 10.1016/j.injury.2020.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/01/2020] [Accepted: 03/03/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Surgical hand rubbing (SHR) and surgical hand scrubbing (SHS) are two common methods used by surgeons to reduce surgical site infections. To date, the optimal method that can effectively reduce these infections remains unknown. In this study, we performed a comprehensive statistical analysis to compare the efficacy of these two methods in effectively controlling surgical site infections. METHODS A systemic review and meta-analysis was performed by mining literature from major databases, including Pubmed, Embase, Cochrane library, Ovid and Google Scholar, and recruiting studies published between 1980 and 1st April 2019. Analysis was performed using Revman, version 5.3, software, and focused on primary outcomes that included colony-forming unit (CFU) counts and logarithmic reduction of CFU after hand antisepsis and after surgery. RESULTS Seven clinical trials met our inclusion criteria, with a total of 764 healthcare workers analyzed. We found no statistically significant differences between the two methods with regards to CFU counts and logarithmic reduction of CFU after hand antisepsis and surgery, as well as antisepsis and surgery times. CONCLUSION From the literature, it was evident that SHR had similar efficacy to SHS, without necessarily increasing costs. Owing to advantages such as ease of application, exposure to less dermal irritation, and less time consumption, SHR is recommended as a cost-effective alternative for management of surgical site infections.
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Affiliation(s)
- Weili Feng
- First Department of Orthopaedics, Affiliated Xiaolan Hospital, Southern Medical University, No. 65, Jucheng Rd. Xiaolan Dist. 528415. Zhongshan, Guangdong Prov. P.R. China
| | - Shiyuan Lin
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Guangzhou 510515, Guangdong Prov. P.R. China
| | - Daoqiang Huang
- First Department of Orthopaedics, Affiliated Xiaolan Hospital, Southern Medical University, No. 65, Jucheng Rd. Xiaolan Dist. 528415. Zhongshan, Guangdong Prov. P.R. China; The Second School of Clinical Medicine, Southern Medical University
| | - Jian Huang
- First Department of Orthopaedics, Affiliated Xiaolan Hospital, Southern Medical University, No. 65, Jucheng Rd. Xiaolan Dist. 528415. Zhongshan, Guangdong Prov. P.R. China
| | - Luyao Chen
- First Department of Orthopaedics, Affiliated Xiaolan Hospital, Southern Medical University, No. 65, Jucheng Rd. Xiaolan Dist. 528415. Zhongshan, Guangdong Prov. P.R. China
| | - Weiwei Wu
- First Department of Orthopaedics, Affiliated Xiaolan Hospital, Southern Medical University, No. 65, Jucheng Rd. Xiaolan Dist. 528415. Zhongshan, Guangdong Prov. P.R. China
| | - Shiqiang Hu
- First Department of Orthopaedics, Affiliated Xiaolan Hospital, Southern Medical University, No. 65, Jucheng Rd. Xiaolan Dist. 528415. Zhongshan, Guangdong Prov. P.R. China
| | - Zhantu Wei
- First Department of Orthopaedics, Affiliated Xiaolan Hospital, Southern Medical University, No. 65, Jucheng Rd. Xiaolan Dist. 528415. Zhongshan, Guangdong Prov. P.R. China
| | - Xiaoping Wang
- First Department of Orthopaedics, Affiliated Xiaolan Hospital, Southern Medical University, No. 65, Jucheng Rd. Xiaolan Dist. 528415. Zhongshan, Guangdong Prov. P.R. China.
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Ergani B, Çetin T, Yalçın MY, Özbilen MH, Bildirici Ç, Karaca E, Boyacıoğlu H, Koç G, İlbey YÖ. Effect of rectal mucosa cleansing on acute prostatitis during prostate biopsy: A randomized prospective study. Turk J Urol 2020; 46:159-164. [PMID: 31922485 DOI: 10.5152/tud.2019.19172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/26/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Infectious complications after transrectal ultrasound-guided prostate biopsy (TRUS-PB) can range from asymptomatic bacteriuria and febrile or non-febrile urinary tract infection (UTI) to sepsis. Cleaning of rectal mucosa with topical antiseptics such as povidone iodine or chlorhexidine before the procedure are alternative prophylaxis methods. We aimed to investigate the effects of these two different topical antiseptic agents on infectious complications and their superiority to each other. MATERIAL AND METHODS The study was conducted with 200 patients. Rectal mucosa cleansings were performed in 50 patients with povidone iodine and 49 patients with chlorhexidine. The remaining 101 patients did not receive any antiseptic treatment. The results were examined according to the hospital admissions or hospitalization for the first 30 days after the procedure due to UTI, body temperature >38.5°C, sepsis, hematuria, rectal bleeding, and urinary retention. RESULTS The mean age of study population was 63.3±7.26 years, and the mean prostate specific antigen value was 13.96±29.5 ng/mL. Acute prostatitis occurred in 14 patients (7%), 9 of whom were hospitalized due to sepsis after TRUS-PB. Statistically significant less acute prostatitis was observed in those patients who were treated with topical rectal antisepsis (topical rectal antisepsis 2% vs. no rectal antisepsis 12.1%, p=0.01). Chlorhexidine and povidone iodine were not superior to each other in terms of inhibiting the development of acute prostatitis (chlorhexidine 2% vs. povidone iodine 2%, p=1.00). CONCLUSION Rectal mucosal cleansing with chlorhexidine or povidone iodine before TRUS-PB prevented the development of sepsis due to acute prostatitis. We recommend that this effective method, which is easy to apply, cheap, reliable, easily tolerated should be used in all prostate biopsy practice.
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Affiliation(s)
| | - Taha Çetin
- Department of Urology, Health Sciences University Tepecik Training and Research Hospital, İzmir, Turkey
| | - Mehmet Yiğit Yalçın
- Department of Urology, Health Sciences University Tepecik Training and Research Hospital, İzmir, Turkey
| | - Mert Hamza Özbilen
- Department of Urology, Health Sciences University Tepecik Training and Research Hospital, İzmir, Turkey
| | - Çağdaş Bildirici
- Department of Urology, Health Sciences University Tepecik Training and Research Hospital, İzmir, Turkey
| | - Erkin Karaca
- Department of Urology, Health Sciences University Tepecik Training and Research Hospital, İzmir, Turkey
| | - Hayal Boyacıoğlu
- Department of Statistics, Ege University Faculty of Science, İzmir, Turkey
| | - Gökhan Koç
- Department of Urology, Health Sciences University Tepecik Training and Research Hospital, İzmir, Turkey
| | - Yusuf Özlem İlbey
- Department of Urology, Health Sciences University Tepecik Training and Research Hospital, İzmir, Turkey
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Widodo H, Sesaria TG, Maulana MR, Myint NMM. Effectiveness of Surgical hand Washing with Chlorhexidine, Providone iodine and Alcohol on Reducing the Microorganisms on the Hands: A Systematic Review. JURNAL NERS 2020. [DOI: 10.20473/jn.v14i3.17013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Postoperative infection is one of the causes of mortality and the hands of the surgical team are the most common cause. According to the The Center for Disease Control and Prevention (CDC), proper hand washing can reduce the occurrence of nosocomial infections by up to 30%. The aim of this study is to determine the effectiveness of surgical hand washing using chlorhexidine, providone iodine and alcohol in reducing the microorganisms on the hand.Method: The data was collected from the following electronic databases: Science Direct, Springer link, Scopus and ProQuest. The search obtained 11 articles in accordance with the inclusion criteria and we obtained the literature in full text form.Result: The results of the study found three articles that mentioned hand washing with an alcohol hand rub as being more effective than iodine and chlorhexidine providone. There was one article described that both alcohol hand rub and chlorhexidine are more effective than iodine providone, Another article mentioned that chlorhexidine, providone iodine and alcohol hand rub were equally effective at reducing microorganisms contaminating the hand.Conclusion: The conclusion of the study is that surgical hand washing using chlorhexidine, providone iodine and alcohol are all effective at reducing microorganisms.
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Moszkowicz D, Hobeika C, Collard M, Bruzzi M, Beghdadi N, Catry J, Duchalais E, Manceau G, Voron T, Lakkis Z, Allard MA, Cauchy F, Maggiori L. Operating room hygiene: Clinical practice recommendations. J Visc Surg 2019; 156:413-422. [DOI: 10.1016/j.jviscsurg.2019.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Antiseptic effect of conventional povidone–iodine scrub, chlorhexidine scrub, and waterless hand rub in a surgical room: a randomized controlled trial—ADDENDUM. Infect Control Hosp Epidemiol 2019; 40:267. [DOI: 10.1017/ice.2018.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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13
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Ho YH, Wang YC, Loh EW, Tam KW. Antiseptic efficacies of waterless hand rub, chlorhexidine scrub, and povidone-iodine scrub in surgical settings: a meta-analysis of randomized controlled trials. J Hosp Infect 2018; 101:370-379. [PMID: 30500384 DOI: 10.1016/j.jhin.2018.11.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 11/21/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Presurgical hand washing is crucial for preventing surgical site infections (SSIs). Chlorhexidine gluconate (CHG) and povidone-iodine (PI) products have been conventionally used as hand scrubs for presurgical hand preparation. However, waterless hand rub (WHR) products have been developed for operating room staff. AIM The aim of this study was to conduct a systematic review and meta-analysis to compare the antiseptic efficacies of WHR, CHG, and PI in surgical settings. METHODS PubMed, Embase, and Cochrane Library databases as well as the ClinicalTrials.gov registry were searched for studies published before October 2018. Randomized controlled trials (RCTs) comparing the clinical outcomes of the use of WHRs, CHG, or PI for presurgical hand washing were included. A random effects model was used for meta-analysis. Colony-forming unit (cfu) counts, SSI rates, and preference and compliance were determined to measure efficacies. FINDINGS Eleven RCTs involving 5135 participants were included. Residual cfu counts were significantly lower in the WHR and CHG groups than in the PI group. The differences in cfu counts between the WHR and CHG groups were non-significant. No significant differences were observed in the SSI rates between the WHR and traditional hand scrub groups. Moreover, WHRs were considered most favourable and were associated with higher compliance rates than the other products. CONCLUSION WHRs and CHG exhibited higher antiseptic efficacies than PI. However, additional studies with consistent outcome measurements and accurate grouping are required to obtain comprehensive results. Moreover, preference, compliance, and the cost determine the selection of hand wash products.
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Affiliation(s)
- Y-H Ho
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Y-C Wang
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - E-W Loh
- Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - K-W Tam
- Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
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Topical rectal antiseptic at time of prostate biopsy: how a resident patient safety project has evolved into institutional practice. Int Urol Nephrol 2018; 50:1563-1568. [PMID: 30019310 DOI: 10.1007/s11255-018-1937-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To report outcomes 5 years after a resident quality initiative incorporated topical rectal antiseptic into our ultrasound-guided prostate needle biopsy (TRUS PNB) protocol. METHODS A chart review was conducted on 1007 men who underwent TRUS PNB between 2010 and 2017. Comparison groups include those who received a topical rectal antiseptic (N = 437) compared to those who did not (N = 570). Povidone-iodine (N = 303) or 4% chlorhexidine solution without alcohol (N = 134) were topical agents. Outcomes of interest included post-biopsy infection (urinary tract infection and/or sepsis), hospital admission, and need for ICU monitoring. RESULTS Median age and PSA of men included in this study were 64 years and 12 ng/mL. Almost 90% of patients were Caucasian, 13% had diabetes, 3% were on immunosuppression, 32% had at least one prior biopsy, 14% received antibiotics, and 7% were hospitalized in the past 6 months. 22 patients (2.2%) developed a post-biopsy infection with a significant reduction in the group receiving topical rectal antiseptic (0.8 vs. 3.3%, p = 0.01). Post-biopsy UTI rates (p = 0.04) and hospital admission (p = 0.03) were also lower in the topical antiseptic group with trends to reduction in sepsis and need for ICU monitoring. CONCLUSIONS What started as a resident quality safety project 5 years ago has demonstrated a reduction in infections and hospital admissions following TRUS PNB. Our institutional practice now routinely uses povidone-iodine or chlorhexidine as an adjunct to oral quinolones for TRUS PNB perioperative prophylaxis.
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Izaguirre A, Govela A, Delgado I, Troncoso CM, Parra M, Viaña EÁ. Surgical hand antisepsis: experimental study. Ann Surg Treat Res 2018; 95:1-6. [PMID: 29963533 PMCID: PMC6024083 DOI: 10.4174/astr.2018.95.1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/20/2017] [Accepted: 11/10/2017] [Indexed: 11/30/2022] Open
Abstract
Purpose Nosocomial infections account for one of the most serious complications in hospitalized patients around the world. Surgical site infections have significant economic implications, and surgical antisepsis plays an important role in such processes. Methods With prior approval by the Institutional Review Board and informed consent, 10 volunteers were randomly assigned to 3 protocols on hand antisepsis: protocol A (chloroxylenol 3%), protocol B (benzalkonium chloride at 1%), and protocol C (ethyl alcohol 61%, 1% chlorhexidine gluconate). Smears from both hands were cultured after each hand pro tocol (t0) and at the end of suturing (t1). Colony forming units were counted (CFUs on blood agar dishes) with digital counting software (Open CFU). Friedman test was used to compare the mean values among the groups, and a Bonferroni correction was made to determine the dissimilar group, with a P = 0.015. Results At t0 for protocol A the CFU count was 82.8 ± 1.3; protocol B was 9.7 ± 30; protocol C was 0.1 ± 0.3 (P < 0.001). At t1 for protocol A the CFU was 80.7 ± 89.4; protocol B was 7.5 ± 32; protocol C was 0.0 ± 0.0 (P < 0.001). No adverse events were present among the subjects. Conclusion Ethyl alcohol at 61% with 1% chlorhexidine gluconate showed higher efficacy than the traditional washing antiseptics.
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Affiliation(s)
| | | | | | | | - María Parra
- Universidad Autónoma de Tamaulipas, Tampico, Mexico
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