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Macedo CE, Ferreira AM, Barcelos LDS, Alvim ALS, Carneiro LM, Martins SR, de Andrade D, Rigotti MA, Gasques RP, da Silva VA, de Oliveira LB, de Carvalho HEF, de Sousa AFL. Contamination of equipment and surfaces in the operating room anesthesia workspace: a cross-sectional study. SAO PAULO MED J 2024; 142:e2023177. [PMID: 38422242 PMCID: PMC10885631 DOI: 10.1590/1516-3180.2023.0177.r1.291123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/24/2023] [Accepted: 11/29/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Contamination of the breathing circuit and medication preparation surface of an anesthesia machine can increase the risk of cross-infection. OBJECTIVE To evaluate the contamination of the anesthetic medication preparation surface, respiratory circuits, and devices used in general anesthesia with assisted mechanical ventilation. DESIGN AND SETTING Cross-sectional, quantitative study conducted at the surgical center of a philanthropic hospital, of medium complexity located in the municipality of Três Lagoas, in the eastern region of the State of Mato Grosso do Sul. METHODS Eighty-two microbiological samples were collected from the breathing circuits. After repeating the samples in different culture media, 328 analyses were performed. RESULTS A higher occurrence of E. coli, Enterobacter spp., Pseudomonas spp., Staphylococcus aureus, and Streptococcus pneumoniae (P < 0.001) were observed. Variations were observed depending on the culture medium and sample collection site. CONCLUSION The study findings underscore the inadequate disinfection of the inspiratory and expiratory branches, highlighting the importance of stringent cleaning and disinfection of high-touch surfaces.
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Affiliation(s)
- Carlos Eduardo Macedo
- MD. Physician, Postgraduate Program in Nursing, Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande (MS), Brazil
| | - Adriano Menis Ferreira
- PhD. Nurse, Full Professor, Postgraduate Program in Nursing, Universidade Federal de Mato Grosso do Sul (UFMS), Três Lagoas (MS), Brazil
| | - Larissa da Silva Barcelos
- PhD. Associate Professor, Postgraduate Program in Nursing, Universidade Federal de Mato Grosso do Sul (UFMS), Três Lagoas (MS), Brazil
| | - André Luiz Silva Alvim
- PhD. Associate Professor, Graduate Program in Nursing, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora (MG), Brazil
| | - Liliane Moretti Carneiro
- MSc, Nurse, Doctoral Student, Postgraduate Program in Nursing, Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande (MS), Brazil
| | | | - Denise de Andrade
- PhD. Nurse, Full Professor, Ribeirão Preto College of Nursing, Universidade de São Paulo (USP), Ribeirão Preto, São Paulo (SP), Brazil
| | - Marcelo Alessandro Rigotti
- PhD. Nurse, Associate Professor, Postgraduate Program in Nursing, Universidade Federal de Mato Grosso do Sul (UFMS), Três Lagoas (MS), Brazil
| | - Ruberval Peres Gasques
- Nurse. Master Student, Postgraduate Program in Nursing, Universidade Federal de Mato Grosso do Sul (UFMS), Três Lagoas (MS), Brazil
| | - Vanderlei Amaro da Silva
- BS. Biomedic, Postgraduate Program in Nursing, Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande (MS), Brazil
| | - Layze Braz de Oliveira
- PhD, Nurse, Ribeirão Preto College of Nursing, Universidade de São Paulo (USP), Ribeirão Preto, São Paulo (SP), Brazil
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Dexter F, Loftus RW. Estimation of the contribution to intraoperative pathogen transmission from bacterial contamination of patient nose, patient groin and axilla, anesthesia practitioners' hands, anesthesia machine, and intravenous lumen. J Clin Anesth 2024; 92:111303. [PMID: 37875062 DOI: 10.1016/j.jclinane.2023.111303] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/30/2023] [Accepted: 10/18/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Earlier studies showed net cost saving from anesthesia practitioners' use of a bundle of infection prevention products, with feedback on monitored Staphylococcus aureus intraoperative transmission. ESKAPE pathogens also include Enterococcus and gram-negative pathogens: Klebsiella, Acinetobacter, Pseudomonas, and Enterobacter. We evaluated whether bacterial contamination of patient nose, patient groin and axilla, anesthesia practitioners' hands, anesthesia machine, and intravenous lumen all contribute meaningfully to ESKAPE pathogen transmission within anesthesia work areas. METHODS The retrospective cohort study used bacterial count data from nine hospitals, 43 months, and 448 ESKAPE pathogen transmission events within anesthesia areas of 86 operating rooms. Transmission was measured within and between pairs of successive surgical cases performed in the same operating room on the same day. RESULTS There were 203 transmission events with S. aureus, 72 with Enterococcus, and 173 with gram negatives. ESKAPE pathogens in the nose contributed to transmission for 50% (99% confidence limit ≥45%) of case pairs, on the groin or axilla for 54% (≥49%), on the hands for 53% (≥47%), on the anesthesia machine for 21% (≥17%), and in the intravenous lumen for 24% (≥20%). ESKAPE pathogens in the nose started a transmission pathway for 27% (≥22%) of case pairs, on the groin or axilla for 24% (≥19%), on the hands for 38% (≥33%), on the anesthesia machine for 11% (≥7.6%), and in the intravenous lumen for 8.0% (≥5.3%). All P ≤ 0.0022 compared with 5%. CONCLUSIONS To prevent intraoperative ESKAPE pathogen transmission, anesthesia practitioners would need to address all five categories of infection control approaches: nasal antisepsis (e.g., povidone-iodine applied the morning of surgery), skin antisepsis (e.g., chlorhexidine wipes), hand antisepsis with dispensers next to the patient, decontamination of the anesthesia machine before and during anesthetics, and disinfecting caps for needleless connectors, disinfecting port protectors, and disinfecting caps for open female Luer type connectors.
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Affiliation(s)
- Franklin Dexter
- University of Iowa, Iowa City, IA, United States of America.
| | - Randy W Loftus
- University of Iowa, Iowa City, IA, United States of America.
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Yoon J, Nwadike BA, Bijanki VN, Kaar SG. Cleanliness of Lead Garments in the Operating Room. Am J Med Qual 2023; 38:107-109. [PMID: 36762853 DOI: 10.1097/jmq.0000000000000103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Jane Yoon
- Department of Orthopaedic Surgery, Saint Louis University School of Medicine, Saint Louis, MO
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Murphy LW. Preventing Surgical Site Infections. AORN J 2023; 117:126-130. [PMID: 36705458 DOI: 10.1002/aorn.13868] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 01/28/2023]
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Hospital-Based Air-Borne and Surface-Borne Bacterial Pathogens and Their Antimicrobial Profiles in Wolaita Sodo, Southern Ethiopia. Int J Microbiol 2022; 2022:5718341. [DOI: 10.1155/2022/5718341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/30/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
Background. It is well documented that hospital environments are the niche/reservoir of many clinically important microorganisms, including multidrug-resistant air-borne and surface-borne pathogens. This problem is the most pressing public health concern, particularly in developing countries like Ethiopia, due to its poor infection management system. This study was planned to detect air-borne and surface-borne bacterial pathogens and their antimicrobial resistance patterns in Wolaita Sodo University Comprehensive Hospital, Southern Ethiopia. Method. A laboratory-based cross-sectional study was conducted from May to July 2021. Swabbing and open-plate sample collection methods were used to collect specimens. Standard bacteriological techniques were used to isolate and identify bacterial pathogens. The Mueller-Hinton agar was used to detect the drug susceptibility pattern of bacteria by using the Kirby-Bauer disc diffusion method. Result. From a total of 323 samples tested, 118 (36.5%) showed the growth of bacteria. The detection rate of bacterial pathogens in the intensive care unit (35.4%) was higher than in operation theater. From the total of 118 bacterial isolates, 39.8%, 27.9%, 20.3%, and 11.5% of S. aureus, P. aeruginosa, Klebsiella pneumoniae, and E. coli, respectively, were surface-borne. Whereas 37%, 25%, 20.83, and 16.6% of S. aureus, P. aeruginosa, Klebsiella species, and E. coli, respectively, were air-borne. S. aureus showed a 19.04 to 80.9% range of antimicrobial resistance to different classes of antibiotics from surface specimens. A 12.5–100% range of antibiotic resistance levels was detected for all Gram-negative surface-borne bacterial pathogens. P. aeruginosa was 66.7%, 73.3%, and 73.3% resistant to gentamicin, chloramphenicol, and ceftriaxone, respectively. K. pneumoniae showed 75% and 87.5% resistance to ceftriaxone and ciprofloxacin, respectively, and a completely ampicillin-resistant E. coli was detected. From a total of 48 bacterial pathogens identified from surfaces in the intensive care unit, 34 (70.8%) developed multidrug resistance. Conclusion. A significant prevalence of surface-borne bacterial pathogens was detected. This study revealed that S. aureus, P. aeruginosa, K. pneumoniae, and E. coli were nosocomial infection concerns of the hospital, and this could be the reason for different types of hospital acquired infections in the study area. A high prevalence of MDR was detected in the most surface-borne bacterial isolates.
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Jennings JM, Johnson RM, Brady AC, Stuckey WP, Pollet AK, Dennis DA. Effectiveness of Manual Terminal Cleaning Varies on High-Touch Surfaces Near the Operative Field. Arthroplast Today 2022; 17:53-57. [PMID: 36032796 PMCID: PMC9399380 DOI: 10.1016/j.artd.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/16/2022] [Accepted: 07/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background Periprosthetic joint infection may result from pathogen to patient transmission within the environment. The purpose of this study is to evaluate the contamination level of selected high-touch surfaces in the operating room (OR) using a blacklight fluorescent marking system after a manual terminal clean. Methods Prior to the manual terminal clean, 16 high-touch surfaces were marked using a blacklight fluorescent gel. The marked areas were assessed the next morning for thoroughness of cleaning. Surfaces were categorized based on the average percent of the marks removed as “clean” (>75%), “partially clean” (26%-74%), or poorly cleaned (<25%). This process was repeated randomly 12 times. Terminal cleaning was done in the standard fashion, and the perioperative team was unaware of the initiation of this study. Results A total of 936 marks were analyzed. There was a significant difference in the number of marks completely clean (29.1%, 272/936) vs marks that were not touched (40.8%, 382/936), P < .001. Only the OR back table (75%) had a rating of clean. Partially clean areas included Mayfield table (72%), overhead lights (70.1%), infusion pump (61.1%), clock reset button (58.3%), table remote control (50%), tourniquet machine (50%), and the OR table (33.3%). Poorly cleaned surfaces included anesthesia medication cart (21.8%), door handles (20.8%), phone (16.7%), electrocautery unit (16.7%), foot pedal (16.7%), anesthesia cart (16.2%), nurses’ station (14.1%), and supply cabinet doors (6%). Conclusions Effectiveness of manual terminal cleaning varied greatly across surfaces. In general, surfaces further from the operative field were less likely to have markings removed.
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Affiliation(s)
- Jason M. Jennings
- Colorado Joint Replacement, Denver, CO, USA
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USA
- Corresponding author. Colorado Joint Replacement, 2535 S. Downing St Suite 100, Denver, CO 80210, USA. Tel.: +1 720 524 1367.
| | | | | | | | | | - Douglas A. Dennis
- Colorado Joint Replacement, Denver, CO, USA
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USA
- Department of Orthopaedics, University of Colorado School of Medicine, Denver, CO, USA
- Department of Biomedical Engineering, University of Tennessee, Knoxville, TN, USA
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Cahn J. Environmental Cleaning. AORN J 2022; 115:264-271. [PMID: 35213053 DOI: 10.1002/aorn.13623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 11/08/2022]
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Meunier O, Fersing T, Burger S, Santasouk J. Biocleaning in operating theatres: validation of cleaning techniques by revealing residual traces of blood. J Hosp Infect 2021; 121:32-38. [PMID: 34921911 DOI: 10.1016/j.jhin.2021.11.023] [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: 08/27/2021] [Revised: 11/05/2021] [Accepted: 11/26/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND In the operating theatre the biocleaning process is essential after each passage to guarantee the non-transmission of potentially pathogenic microbial agents from patients to patient. AIM To evaluate the quality of this biocleaning, the Operational Hygiene Team used a very sensitive method to detect residual traces of blood : luminol (3-aminophthalhydrazide) on the basis of methods used by the police. METHOS Luminol was used after conventional one-step biocleaning with the usual detergent/disinfectant ; after bleach disinfection before biocleaning ; and after biocleaning with a steam cleaner. FINDINGS Lunimol revealed extended traces of blood corresponding to the passage of the strip on the floor, in the corners of the room and on certain pieces of furniture which are difficult to clean. However, no luminescence was detected on the surfaces cleaned by a single passage of the steam cleaner. CONCLUSION In all cases, the rooms appeared visually clean and traces of blood only became visible when revealed by luminol. We also showed that usual detergents or disinfectants do not remove blood and instead actually spread it over surfaces that may seem visually clean. These results led us to modify our procedure and also confirmed our wish to generalize the use of the steam cleaning technique for immediate cleaning. Much more our tests show the relevance of luminol as a validation tool for the quality and method of biocleaning.
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Affiliation(s)
- Olivier Meunier
- Service d'hygiène hospitalière, Centre hospitalier de Haguenau, Haguenau, France.
| | - Tania Fersing
- Service d'hygiène hospitalière, Centre hospitalier de Haguenau, Haguenau, France
| | - Sandrine Burger
- Service d'hygiène hospitalière, Centre hospitalier de Haguenau, Haguenau, France
| | - Jérôme Santasouk
- Service d'hygiène hospitalière, Centre hospitalier de Haguenau, Haguenau, France
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Assessing Risks Awareness in Operating Rooms among Post-Graduate Students: A Pilot Study. SUSTAINABILITY 2021. [DOI: 10.3390/su13073860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: In this study, we promote a global approach to occupational risk perception in order to improve occupational health and safety training programs. The study investigates the occupational risk perception of operating room healthcare workers using an Analytic Hierarchy Process approach. Methods: A pilot study was carried out through a cross-sectional survey in a university hospital in Southern Italy. An ad hoc questionnaire was administered to enrolled medical post-graduate students working in the operating room. Results: Fifty medical specialists from seven fields (anaesthetists, digestive system surgeons, general surgeons, maxillofacial surgeons, thoracic surgeons, urologists, and gynaecologists) were questioned about perceived occupational risk by themselves. Biological, ionizing radiation, and chemical risks were the most commonly perceived in order of priority (w = 0.300, 0.219, 0.210). Concerning the biological risk, gynaecologists unexpected perceived this risk as less critical (w = 0.2820) than anaesthesiologists (w = 0.3354), which have the lowest perception of the risk of ionizing radiation (w = 0.1657). Conclusions: Prioritization methods could improve risk perception in healthcare settings and help detect training needs and perform sustainable training programs.
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Misha G, Chelkeba L, Melaku T. Incidence, risk factors and outcomes of surgical site infections among patients admitted to Jimma Medical Center, South West Ethiopia: Prospective cohort study. Ann Med Surg (Lond) 2021; 65:102247. [PMID: 33898031 PMCID: PMC8058519 DOI: 10.1016/j.amsu.2021.102247] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 11/17/2022] Open
Abstract
Background Surgical site infections are one of the leading health care–associated infections in developing countries. Despite improvements in surgical technique and the use of best infection prevention strategies, surgical site infections remained the major cause of hospital acquired infections. Therefore, this study aimed to determine incidence, risk factors, and outcomes of surgical site infections among patients admitted to Jimma Medical Center, South West Ethiopia. Methods A hospital based prospective cohort study design was employed to follow adult patients admitted to general surgery ward, orthopaedic ward and gynaecologic/obstetrics ward of Jimma Medical Centre, from April 20 to August 20, 2019. All patients were followed daily before, during and after operation for 30 days to determine the incidence of surgical site infection and other outcomes. Data was entered using EpiData version 4.2 and analyzed using statistical software package for social science version 20.0. To identify the independent predictors of outcome, multiple stepwise backward cox regression analysis was done. Statistical significance was considered at p-value <0.05. Results Of total of 251 participants included to the study, about 126 (50.2%) of them were females. The mean ± SD age of patients was 38 ± 16.30 years. Considerable number of patients 53(21.1%) developed surgical site infections. American Society of Anaesthesiologists score ≥3 [ Adjusted Hazard Ratio (AHR) = 2.26; 95%CI = (1.03–4.93)], postoperative antibiotic prescription [AHR = 3.2; 95%CI = (1.71–6.01)], contaminated-wound [AHR = 7.9; 95%CI = (4.3–14.60)], emergency surgery [AHR = 2.8; 95% CI = (1.16–6.80)], duration of operation ≥ 2 h [AHR = 4; 95% CI = (2.17–7.50)] and comorbidity [AHR = 2.52; 95%CI = (1.28–4.94)] were independent predictors for surgical site infections. Twenty nine (11.6%) patients returned to operation room. The result of the multivariate cox regression analysis showed that SSI [AHR (95% CI) = 7(3.16–15.72)], and incision site [AHR (95% CI) = 2.5(1.14–5.42)] had statistically significant association with re-operation Conclusion The incidence of surgical site infection was high in the study setting. There were significant numbers of contributing factors for the occurrence of surgical site infections. Although no mortality observed during the study period, significant number of patients re-operated. Large multicenter study is urgently needed to confirm the outcome of this study. Surgical site infections are one of the leading health care–associated infections in developing countries. Considerable number of risk factors are associated with the occurrence of surgical site infection. Surgical site infection is associated with increased length of hospital stay and number of patients re-operated.
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Affiliation(s)
- Gemedo Misha
- Department of Pharmacy, Arsi University, Assella, Oromia, Ethiopia
| | - Legese Chelkeba
- Department of Pharmacology and Therapeutics, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tsegaye Melaku
- Department of Clinical Pharmacy, School of Pharmacy, Jimma University, Jimma, Oromia, Ethiopia
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One-Pot Reducing Agent-Free Synthesis of Silver Nanoparticles/Nitrocellulose Composite Surface Coating with Antimicrobial and Antibiofilm Activities. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6666642. [PMID: 33855077 PMCID: PMC8019633 DOI: 10.1155/2021/6666642] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/17/2021] [Accepted: 03/07/2021] [Indexed: 12/24/2022]
Abstract
Nitrocellulose with silver nanoparticle (AgNP/NC) composite was prepared in situ using Ag(CH3CO2) and nitrocellulose without any reducing agent. The composite materials synthesized were spray coated onto glass substrates to obtain thin films. The AgNPs/NC composites were characterized by ultraviolet-visible, Fourier transform infrared, X-ray photoelectron spectroscopy, scanning electron microscopy, and transmission electron microscopy. The antimicrobial activity of AgNPs/NC composite was investigated by tube method and time-kill kinetic studies against three microbial species, including Pseudomonas aeruginosa (ATCC 27853), Staphylococcus aureus (ATCC 25923), and Candida albicans (ATCC 10231). The antibiofilm activities were qualitatively determined against all three organisms. Prepared AgNPs/NC films exhibited good antimicrobial activity and significant inhibition of biofilm development against all three microbial species. The effective dispersion of AgNPs/NC in biofilm was responsible for the significant antibiofilm activity of the prepared material. The reported AgNPs/NC composite can be used as coating additive in bacteriocidal paint which can be applied onto surfaces such as in healthcare environments.
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Zorrilla-Vaca A, Marmolejo-Posso D, Caballero-Lozada AF, Miño-Bernal JF. Sterility and Infection Prevention Standards for Anesthesiologists in LMICs: Preventing Infections and Antimicrobial Resistance. CURRENT ANESTHESIOLOGY REPORTS 2021. [DOI: 10.1007/s40140-021-00441-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Tostes LCS, Loyola ABAT, Fraga ADEO, Gazzi LA, Paiva LFDE, Juliano Y, Veiga DF. Alcohol (70%) versus alcoholic chlorhexidine solution (0.5%) in skin antisepsis for neuraxial blocks: a randomized clinical trial. Rev Col Bras Cir 2021; 48:e20202633. [PMID: 33470369 PMCID: PMC10683467 DOI: 10.1590/0100-6991e-20202633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/02/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to compare the use of 0.5% alcoholic chlorhexidine and 70% alcohol in skin antisepsis for neuraxial blocks. METHOD this is a non-inferiority randomized clinical trial, with two parallel arms. Seventy patients who were candidates for neuraxial block were randomly allocated to group A (n = 35), in whom antisepsis was performed with 0.5% alcoholic chlorhexidine, or to group B (n = 35), in whom we used 70% hydrated ethyl alcohol. Swabs were harvested for culture at three times: before antisepsis, two minutes after application of the antiseptic, and immediately after puncture. The samples were sown in three culture media and the number of colony forming units (CFU) per cm² was counted. RESULTS there was no difference between the groups regarding age, sex, body mass index, time to perform the block or type of block. There were no differences between groups in the CFU/cm² counts before antisepsis. There was less bacterial growth in group B two minutes after application of the antiseptic (p = 0.048), but there was no difference between the groups regarding the number of CFU/cm² at the end of the puncture. CONCLUSION 70% alcohol was more effective in reducing the number of CFU/cm² after two minutes, and there was no difference between the two groups regarding skin colonization at the end of the procedure. These results suggest that 70% alcohol may be an option for skin antisepsis before neuraxial blocks. Trial registration: ClinicalTrials.gov, NCT02833376.
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Affiliation(s)
- Luiz Carlos Souza Tostes
- - Universidade do Vale do Sapucaí (UNIVÁS), Mestrado Profissional em Ciências Aplicadas à Saúde - Pouso Alegre - MG - Brasil
| | - Ana Beatriz Alkmim Teixeira Loyola
- - Universidade do Vale do Sapucaí (UNIVÁS), Mestrado Profissional em Ciências Aplicadas à Saúde - Pouso Alegre - MG - Brasil
- - Universidade do Vale do Sapucaí (UNIVÁS), Departamento de Farmácia - Pouso Alegre - MG - Brasil
- - Universidade do Vale do Sapucaí (UNIVÁS), Disciplina de Microbiologia - Pouso Alegre - MG - Brasil
| | - Adilson DE Oliveira Fraga
- - Universidade do Vale do Sapucaí (UNIVÁS), Mestrado Profissional em Ciências Aplicadas à Saúde - Pouso Alegre - MG - Brasil
- - Hospital e Maternidade Santa Paula, Programa de Residência Médica em Anestesiologia - Pouso Alegre - MG - Brasil
| | - LetÍcia Azevedo Gazzi
- - Universidade do Vale do Sapucaí (UNIVÁS), Faculdade de Medicina - Pouso Alegre - MG - Brasil
| | - Luiz Francisley DE Paiva
- - Universidade do Vale do Sapucaí (UNIVÁS), Mestrado Profissional em Ciências Aplicadas à Saúde - Pouso Alegre - MG - Brasil
- - Universidade do Vale do Sapucaí (UNIVÁS), Disciplina de Microbiologia - Pouso Alegre - MG - Brasil
| | - Yara Juliano
- - Universidade do Vale do Sapucaí (UNIVÁS), Mestrado Profissional em Ciências Aplicadas à Saúde - Pouso Alegre - MG - Brasil
- - Universidade Santo Amaro (UNISA), Disciplina de Bioestatística - Santo Amaro - SP - Brasil
- - Universidade do Vale do Sapucaí (UNIVÁS), Disciplina de Bioestatística - Pouso Alegre - MG - Brasil
| | - Daniela Francescato Veiga
- - Universidade do Vale do Sapucaí (UNIVÁS), Mestrado Profissional em Ciências Aplicadas à Saúde - Pouso Alegre - MG - Brasil
- - Universidade Federal de São Paulo (UNIFESP), Programa de Pós-graduação em Cirurgia Translacional - São Paulo - SP - Brasil
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Synergistic effect of carboxypterin and methylene blue applied to antimicrobial photodynamic therapy against mature biofilm of Klebsiella pneumoniae. Heliyon 2020; 6:e03522. [PMID: 32195387 PMCID: PMC7075992 DOI: 10.1016/j.heliyon.2020.e03522] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/22/2019] [Accepted: 02/28/2020] [Indexed: 12/19/2022] Open
Abstract
The control of multidrug-resistant (MDR) bacteria is a growing public health problem, and new strategies are urgently needed for the control of the infections caused by these microorganisms. Notoriously, some MDR microorganisms generate complex structures or biofilms, which adhere to surfaces and confer extraordinary resistance properties that are fundamental challenges to control infections. One of the promising strategies for the control of MDR bacteria is antimicrobial photodynamic therapy (aPDT), which takes advantage of suitable photosensitizers (PS), oxygen and radiation to eradicate microorganisms by the generation of highly reactive species, including reactive oxygen species (ROS) that cause cytotoxic damage and cell death. Habitual aPDT treatments use only methylene blue (MB), but MDR microorganism eradication is not completely achieved. The key result of this study revealed that a combination of two known PSs, 6-carboxypterin (Cap, 100 μM) and MB (2.5–10 μM) exposed to ultraviolet and visible radiation, presents a synergistic effect on the eradication of a MDR Klebsiella pneumoniae strain. Similar effect was observed when the treatment was performed either with planktonic or biofilm growing cells. Moreover, it was found that after treatment the killing action continues in the absence of irradiation leading to the eradication of the microorganisms growing in biofilm. Therefore, the combined aPDT represents a promising strategy for the management of clinical contact surfaces, disinfection of surgical instruments, biofouling and even antimicrobial wastewater treatment.
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Segal S, Harris HM, Gunawan A, Schumann R. A Simple Method for Estimating Hand Hygiene Use Among Anesthesia Personnel: Development, Validation, and Use in a Quality Improvement Project. Anesth Analg 2019; 129:1549-1556. [PMID: 31743174 DOI: 10.1213/ane.0000000000004106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Frequent hand hygiene by anesthesia personnel may be an important factor in reducing contamination of IV lines and medication access ports and may reduce hospital-acquired infections. Measurement of hand hygiene frequency at the individual clinician level by direct observation or electronic devices is cumbersome and expensive. We developed and validated a simple method for estimating hand hygiene frequency by individual anesthesia providers and utilized it in a quality improvement initiative to increase hand hygiene use. METHODS Pump-style, alcohol-based hand hygiene container weight at the anesthesia work station was measured before and after each surgical operation and converted to estimated number of accesses (pumps) per hour. Video observation was used to validate the estimated hand hygiene use. A quality improvement initiative utilized periodic measurement of hand hygiene frequency via the validated method, and incorporated individual provider feedback, email reminders, monthly departmental performance reports, and reminders in the electronic anesthesia record. Segmented linear regression was used to evaluate the effect of the intervention on hand hygiene use. RESULTS Delivered product per pump was consistent for containers at least half-full and averaged (mean ± SD) 0.92 ± 0.13 g per pump. Video observation in 26 cases showed a strong correlation between observed hand hygiene episodes and estimated hand hygiene use frequency based on weight change of the container (linear regression, R = 0.97, P < .0001). Median hand hygiene frequency was near 0 at baseline but increased progressively throughout the intervention period (segmented linear regression, overall R = 0.76, P < .0001; change of intercept or mean hand hygiene after initiation of intervention [parameter estimate ± SE] [0.970 ± 0.29], P = .0008). CONCLUSIONS A low-cost, simple method for measuring individual anesthesia clinician use of hand hygiene intraoperatively based on container weight change is feasible and sufficiently accurate to support a quality improvement initiative to increase its use.
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Affiliation(s)
- Scott Segal
- From the Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Hannah M Harris
- From the Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Antonius Gunawan
- From the Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Roman Schumann
- Department of Anesthesiology, Tufts University School of Medicine, Boston, Massachusetts
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Influence of a visible-light continuous environmental disinfection system on microbial contamination and surgical site infections in an orthopedic operating room. Am J Infect Control 2019; 47:804-810. [PMID: 30638672 DOI: 10.1016/j.ajic.2018.12.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/30/2018] [Accepted: 12/01/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND A growing body of research has demonstrated that manual cleaning and disinfection of the operating room (OR) is suboptimal. Residual environmental contamination may pose an infection risk to the surgical wound. This study evaluates the impact of a visible-light continuous environmental disinfection (CED) system on microbial surface contamination and surgical site infections (SSI) in an OR. METHODS Samples from 25 surfaces within 2 contiguous ORs sharing an air supply were obtained after manual cleaning on multiple days before and after a visible-light CED system installation in 1 of the ORs. Samples were incubated and enumerated as total colony-forming units. SSIs in both ORs, and a distant OR, were tracked for 1 year prior to and 1 year after the visible-light CED system installation. RESULTS There was an 81% (P = .017) and 49% (P = .015) reduction in total colony-forming units after the visible-light CED system installation in the OR in which the system was installed, and in the contiguous OR, respectively. In the OR with the visible-light CED system, SSIs decreased from 1.4% in the year prior to installation to 0.4% following installation (P = .029). CONCLUSIONS A visible-light CED system, used in conjunction with manual cleaning, resulted in significant reductions in both microbial surface contamination and SSIs in the OR.
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17
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Sen CK. Human Wounds and Its Burden: An Updated Compendium of Estimates. Adv Wound Care (New Rochelle) 2019; 8:39-48. [PMID: 30809421 PMCID: PMC6389759 DOI: 10.1089/wound.2019.0946] [Citation(s) in RCA: 534] [Impact Index Per Article: 106.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 01/15/2019] [Indexed: 12/11/2022] Open
Abstract
Significance: A 2018 retrospective analysis of Medicare beneficiaries identified that ∼8.2 million people had wounds with or without infections. Medicare cost estimates for acute and chronic wound treatments ranged from $28.1 billion to $96.8 billion. Highest expenses were for surgical wounds followed by diabetic foot ulcers, with a higher trend toward costs associated with outpatient wound care compared with inpatient. Increasing costs of health care, an aging population, recognition of difficult-to-treat infection threats such as biofilms, and the continued threat of diabetes and obesity worldwide make chronic wounds a substantial clinical, social, and economic challenge. Recent Advances: Chronic wounds are not a problem in an otherwise healthy population. Underlying conditions ranging from malnutrition, to stress, to metabolic syndrome, predispose patients to chronic, nonhealing wounds. From an economic point of view, the annual wound care products market is expected to reach $15-22 billion by 2024. The National Institutes of Health's (NIH) Research Portfolio Online Reporting Tool (RePORT) now lists wounds as a category. Future Directions: A continued rise in the economic, clinical, and social impact of wounds warrants a more structured approach and proportionate investment in wound care, education, and related research.
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Affiliation(s)
- Chandan K. Sen
- Department of Surgery, Indiana University Health Comprehensive Wound Center, Indianapolis, Indiana
- Editor-in-Chief, Advances in Wound Care
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18
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A Simulation Study to Evaluate Improvements in Anesthesia Work Environment Contamination After Implementation of an Infection Prevention Bundle. Anesth Analg 2018; 127:662-670. [DOI: 10.1213/ane.0000000000002764] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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19
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Simmons S, Dale C, Holt J, Passey DG, Stibich M. Environmental effectiveness of pulsed-xenon light in the operating room. Am J Infect Control 2018; 46:1003-1008. [PMID: 29661632 DOI: 10.1016/j.ajic.2018.02.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 02/27/2018] [Accepted: 02/28/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Manual cleaning and disinfection of the operating room (OR) environment may be inadequate due to human error. No-touch technologies, such as pulsed-xenon ultraviolet light (PX-UV), can be used as an adjunct to manual cleaning processes to reduce surface contamination in the OR. This article reports the cumulative results from 23 hospitals across the United States that performed microbiologic validation of PX-UV disinfection after manual cleaning. METHODS We obtained samples from 732 high-touch surfaces in 136 ORs at 23 hospitals, after manual terminal cleaning, and again after PX-UV disinfection (n = 1464 surface samples). Samples were enumerated after incubation, and the results are reported as total colony-forming units (CFU). RESULTS The average CFU after manual cleaning ranged from 5.8 to 34.37, and after PX-UV, from 0.69 to 6.43. With manual cleaning alone, 67% of surfaces were still positive for CFUs; after PX-UV disinfection, that number decreased to 38% of all sampled surfaces-a 44% reduction. When comparing manual cleaning to PX-UV, the reduction in CFU count was statistically significant. CONCLUSION When used after the manual cleaning process, the PX-UV device significantly reduced contamination on high-touch surfaces in the OR.
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Affiliation(s)
| | - Charles Dale
- Xenex Disinfection Services, LLC, San Antonio, TX
| | - James Holt
- Xenex Disinfection Services, LLC, San Antonio, TX
| | | | - Mark Stibich
- Xenex Disinfection Services, LLC, San Antonio, TX; MD Anderson Cancer Center, Houston, TX
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20
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Stratton M. Designing a Culture of Safety in Perioperative Services. AORN J 2018; 107:617-620. [DOI: 10.1002/aorn.12142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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Prävention postoperativer Wundinfektionen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:448-473. [PMID: 29589090 DOI: 10.1007/s00103-018-2706-2] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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22
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Jagodzinski NA, Ibish S, Furniss D. Surgical site infection after hand surgery outside the operating theatre: a systematic review. J Hand Surg Eur Vol 2017; 42:289-294. [PMID: 28196439 DOI: 10.1177/1753193416676408] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED We carried out a systematic review to determine the incidence of infection for hand surgery done in settings other than the operating theatre. Databases were searched and a PRISMA chart created by three independent reviewers. From 1200 studies identified, 46 full text articles were reviewed and six were included (two Level 3 studies and four Level 4). In three studies there were no infections after surgery in an office, procedure room or emergency department. Two studies with a combined number of 1962 procedures reviewed carpal tunnel decompressions and reported identical infection rates of 0.4%. Although the current evidence is of poor quality, it suggests that some types of hand surgery may be done outside the operating theatre without increasing the risk of infection. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - S Ibish
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - D Furniss
- Oxford University Hospitals NHS Trust, Oxford, UK
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23
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Role of Ultraviolet Disinfection in the Prevention of Surgical Site Infections. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 996:255-266. [DOI: 10.1007/978-3-319-56017-5_21] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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24
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Armellino D. Optimal Infection Control Practices in the OR Environment. AORN J 2016; 104:516-522. [DOI: 10.1016/j.aorn.2016.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 09/29/2016] [Indexed: 12/19/2022]
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25
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Spencer M. Overview of Recent Issues and Advances in Infection Prevention. AORN J 2016; 104:502-505. [DOI: 10.1016/j.aorn.2016.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 09/29/2016] [Indexed: 11/25/2022]
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26
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Fornwalt L, Ennis D, Stibich M. Influence of a total joint infection control bundle on surgical site infection rates. Am J Infect Control 2016; 44:239-41. [PMID: 26521702 DOI: 10.1016/j.ajic.2015.09.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 09/08/2015] [Accepted: 09/10/2015] [Indexed: 10/22/2022]
Abstract
Quality improvement initiatives combined with pulsed xenon ultraviolet room disinfection were implemented to reduce surgical site infections (SSIs) in patients undergoing total joint procedures. After 12 months, knee SSIs were reduced from 4 to 0 (P = .03) and hip SSIs were reduced from 3 to 0 (P = .15) for a combined prevention of 7 SSIs (P = .01) and a savings of $290,990.
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