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Okishio Y, Ueda K, Nasu T, Kawashima S, Kunitatsu K, Masuda M, Ichimiya M, Uyama S, Kato S. Intraoperative techniques to prevent deep incisional or organ-space surgical site infection after emergency surgery for nonappendiceal perforation peritonitis: a prospective two-center observational study. Eur J Trauma Emerg Surg 2023; 49:2215-2224. [PMID: 37300696 DOI: 10.1007/s00068-023-02301-0] [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: 03/12/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE The rate of surgical site infection (SSI) after surgery for secondary peritonitis is very high. This study investigated the relationship between intraoperative procedures of emergency surgery for nonappendiceal perforation peritonitis and deep incisional or organ-space SSI. METHODS This prospective, two-center observational study included patients aged ≥ 20 years who underwent emergency surgery for perforation peritonitis between April 2017 and March 2020. We compared patients with deep incisional or organ-space SSI (Group S) to patients without SSIs or with superficial incisional SSIs (Group C). Thereafter, we evaluated the association between intraoperative technical variables and deep incisional or organ-space SSI using a multivariate logistic regression model. All multivariate analyses were adjusted for potentially relevant risk factors (e.g., age, body mass index, diabetes, smoking habit, and National Nosocomial Infection Surveillance risk index). RESULTS Of the 75 participants, 14 were in Group S and 61 were in Group C. The use of a wound protector device was significantly associated with decreased odds of deep incisional or organ-space SSI (adjusted odds ratios [AOR], 0.017; 95% confidence intervals [CI] 0.0014-0.19, p = 0.0011). A 1000 ml increase in intra-abdominal lavage with normal saline was significantly associated with increased odds of deep incisional or organ-space SSI (AOR: 1.28, 95% CI 1.02-1.61, p = 0.033). CONCLUSION Wound protector devices should be used in emergency surgery for nonappendiceal perforation peritonitis. Excessive intra-abdominal lavage with normal saline for peritonitis may have unsatisfactory benefits and increases the incidence of deep incisional or organ-space SSI.
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Affiliation(s)
- Yuko Okishio
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan.
| | - Kentaro Ueda
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Toru Nasu
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
- Department of Emergency Medicine, Katsuragi Hospital, Kishiwada, Japan
| | - Shuji Kawashima
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Kosei Kunitatsu
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Mitsuru Masuda
- Department of Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Masato Ichimiya
- Department of Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Shiro Uyama
- Department of Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Seiya Kato
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
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Schlosser KA, Warren JA. Hernia Mesh Complications: Management of Mesh Infections and Enteroprosthetic Fistula. Surg Clin North Am 2023; 103:1029-1042. [PMID: 37709388 DOI: 10.1016/j.suc.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
The potential consequences of mesh infection mandate careful consideration of surgical approach, mesh selection, and preoperative patient optimization when planning for ventral hernia repair. Intraperitoneal mesh, microporous or laminar mesh, and multifilament mesh typically require explantation, whereas macroporous, monofilament mesh in an extraperitoneal position is often salvageable. Delayed presentation of mesh infection should raise the suspicion for enteroprosthetic fistula when intraperitoneal mesh is present. When mesh excision is necessary, the surgeon must carefully consider both the risk of recurrent infection as well as hernia recurrence when deciding on single-stage definitive reconstruction versus primary closure with delayed reconstruction.
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Affiliation(s)
- Kathryn A Schlosser
- Department of Surgery, Prisma Health, 701 Grove Road, Support Tower 3, Greenville, SC 29605, USA. https://twitter.com/KT_Schlosser
| | - Jeremy A Warren
- Department of Surgery, Division of Minimal Access Surgery, University of South Carolina School of Medicine Greenville, Prisma Health, 701 Grove Road, Support Tower 3, Greenville, SC 29605, USA.
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Reducing ventriculoperitoneal shunt infection with intraoperative glove removal. Infect Control Hosp Epidemiol 2023; 44:234-237. [PMID: 35438070 PMCID: PMC9929712 DOI: 10.1017/ice.2022.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Contamination of ventriculoperitoneal shunts (VPS) by cutaneous flora, particularly coagulase-negative staphylococci, is a common cause of shunt infection and failure, leading to prolonged hospital stay, higher costs of care, and poor outcomes. Glove contamination may occur during VPS insertion, increasing risk of such infections. METHODS We performed a systematic search of the PubMed database for studies published January 1, 1970, through August 31, 2021 that documented VPS infection rates before and after implementing a practice of double gloving with change or removal of the outer glove immediately prior to shunt insertion. RESULTS Among 272 reports screened, 4 were eligible for review based on our inclusion criteria. The incidence of VPS infection was reduced in all 4 quasi-experimental studies with an aggregate incidence of VPS infection of 11.8% before the change in intraoperative protocol and 4.9% after protocol change. One study documented reduced hospital stay with this change in protocol. CONCLUSION The risk of VPS infection is reduced by removal or replacement of the outer surgical gloves immediately prior to intraoperative insertion of a VPS as part of an infection control bundle.
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Brand KJ, Malek S, Ruple A, Hendrix GK. Evaluation of Surgical Gown Cuff Contamination During Orthopaedic Surgery in a Veterinary Teaching Hospital. Vet Comp Orthop Traumatol 2023; 36:21-28. [PMID: 36150696 DOI: 10.1055/s-0042-1756621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The objective of this study was to determine the frequency of positive cultures of the surgical gown cuffs among scrubbed personnel prior to and immediately after orthopaedic surgical procedures performed on client-owned dogs. STUDY DESIGN In this cross-sectional study, the left and right surgical gown cuffs of three scrubbed persons in 10 orthopaedic surgical procedures were individually sampled using a sterile wipe prior to and immediately after surgery in order to determine the frequency of and risk factors associated with positive bacterial cultures. RESULTS Fifty of 120 (41.6%) cultures were positive with an even distribution before and after surgery. The three most common genera were Staphylococcus, Corynebacterium and Streptococcus. Using multivariable logistic regression models, humidity in the operating room (odds ratio: 1.04, 95% confidence interval: 1.00-1.08; p = 0.038) and the number of individuals scrubbed into surgery (odds ratio: 0.59, 95% confidence interval: 0.39-0.91; p = 0.016) had a significant effect on the likelihood of positive culture after surgery. Of the nine patients available for follow-up, one dog developed osteomyelitis. CONCLUSIONS Maintaining the humidity in the operating room to the lowest comfortable level may reduce contamination of the surgical gown cuffs. Confirmation of bacterial contamination of surgical gown cuffs warrants adherence to operative guidelines to minimize the risk of surgical gown cuffs' contact with sterile attire, equipment and the surgical field during surgical procedures.
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Affiliation(s)
- Kenneth J Brand
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, United States
| | - Sarah Malek
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, United States
| | - Audrey Ruple
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, United States
| | - G Kenitra Hendrix
- Indiana Animal Disease Diagnostic Laboratory, West Lafayette, Indiana, United States
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Sundet A, Nelms NJ, Michelson JD. Donning Gloves Before Surgical Gown Cross-contaminates the Assistant. Arthroplast Today 2022; 17:142-144. [PMID: 36158460 PMCID: PMC9493291 DOI: 10.1016/j.artd.2022.08.009] [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: 11/30/2021] [Revised: 05/13/2022] [Accepted: 08/09/2022] [Indexed: 11/24/2022] Open
Abstract
Background Maintaining a sterile surgical environment is of the upmost importance in total joint arthroplasty. The surgical gown-glove interface is a frequent and known cause of bacterial contamination. A variation of the traditional staff-assisted open-gloving technique has been developed in an attempt to address this. In this method, the surgeon dons their undergloves before their gown. Although this has demonstrated improved sterility for the surgeon, no studies have considered the effects of this technique on the person assisting the surgeon. The present study was designed to investigate this. We hypothesize that the process of donning undergloves before the surgical gown leads to higher rates of contamination for the assistant. Methods We performed a comparative study between the traditional and a gloves-first scrubbing technique. We assessed the differences in gown and glove contamination of the surgical assistant following each scrubbing event. Two surgeons applied ultraviolet light-disclosing lotion to their upper extremities and then performed each method in a randomized order with 40 surgical technologists/nurses. Blinded evaluators then quantified the amount of contamination on the surgical assistant's gown and gloves. Results The gloves-first technique resulted in increased contamination of the surgical assistant's gloves (P = .002). There was no difference in contamination of the surgical gown (P =.982). Conclusions Although the staff-assisted open-gloving technique may improve the sterility of the surgeon, it does so at the expense of the surgical assistant. Surgeons adopting this technique should consider donning their own undergloves or having the assistant rescrub before any further contact with the sterile environment.
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Changes in the properties of pure cotton surgical gowns and drapes with clinical use and reprocessing. Infect Control Hosp Epidemiol 2022:1-4. [DOI: 10.1017/ice.2022.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
The impact of repeated in-hospital reprocessing on 100% cotton fabric continues to be debated. We analyzed the properties of surgical gowns and drapes over 15 months of clinical use. The amount of linting fibers and the water absorption rate increased significantly, but microbial and blood penetration was preserved.
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Thomson I, Krysa N, McGuire A, Mann S. Recognition of intraoperative surgical glove perforation: a comparison by surgical role and level of training. Can J Surg 2022; 65:E82-E88. [PMID: 35135784 PMCID: PMC8834241 DOI: 10.1503/cjs.016720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 11/19/2022] Open
Abstract
Background: The aim of this study was to characterize the risk of glove perforation among surgical team members performing a typical set of trauma procedures, as well as to identify the rate at which these people recognize potential perforations. Methods: Gloves used in orthopedic trauma room procedures were collected from all participating team members over 2 weeks and were subsequently examined for perforations. Perforation rates based on glove position, type, wearer and procedure were assessed. Results: Perforations were found in 5.9% of gloves; 4.3% of the perforations were found in outer gloves and 1.6% in inner gloves. Among the outer gloves, 30.7% of the perforations were recognized by the wearer at the time of perforation; none of the inner glove perforations were recognized, even when they were associated with an accompanying outer glove perforation. Significantly more perforations were identified in the gloves of attending staff than in those of other team members. Attending staff experienced more perforations than other wearers, regardless of whether they were acting as the primary surgeon or as an assistant. Perforations were more common in open reduction internal fixation and amputation procedures. For open reduction internal fixation procedures, longer operative times were associated with more frequent glove perforations. Conclusion: The rates of glove perforation are high in orthopedic trauma surgeries, and often these perforations are not recognized by the wearer. Attending staff are at an elevated risk of glove perforation. It is recommended that all members of the surgical team change both pairs of gloves whenever an outer glove perforation is observed.
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Affiliation(s)
- Ian Thomson
- From the Division of Orthopaedic Surgery, Queen's University, Kingston, Ont. (Thomson, McGuire, Mann); and the Queen's School of Medicine, Kingston, Ont. (Krysa)
| | - Nicole Krysa
- From the Division of Orthopaedic Surgery, Queen's University, Kingston, Ont. (Thomson, McGuire, Mann); and the Queen's School of Medicine, Kingston, Ont. (Krysa)
| | - Andrew McGuire
- From the Division of Orthopaedic Surgery, Queen's University, Kingston, Ont. (Thomson, McGuire, Mann); and the Queen's School of Medicine, Kingston, Ont. (Krysa)
| | - Steve Mann
- From the Division of Orthopaedic Surgery, Queen's University, Kingston, Ont. (Thomson, McGuire, Mann); and the Queen's School of Medicine, Kingston, Ont. (Krysa)
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Do Gloves Provide Adequate Protection Against Infection? Aesthetic Plast Surg 2021; 45:3045-3047. [PMID: 34491413 DOI: 10.1007/s00266-021-02553-4] [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: 08/17/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
In the early 1800s gloves were a foreign concept to surgeons, as a result, patient care suffered, and mortality was high due to poor sanitary conditions in the operating room. This all changed in 1889, where the introduction of the surgical glove completely revolutionized surgical aseptic ideals. Through the work of William Halsted and his desire to help his nurse, Caroline Hampton, who was from suffering contact dermatitis, the first pair of rubber gloves were created. Since this invention, there have been significant advancements in glove technology including the use of latex and non-latex gloves. However, significant problems remain including, perioperative contamination in longer procedures, a false sense of sterility, and no consensus in optimal glove donning procedures. Additional measures including patient preparation, limited handling of tissue specimens, minimal coagulation, and in particular a no-touch strategy need to be continued and optimized to minimize iatrogenic infection and sequelae. LEVEL OF EVIDENCE V: 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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9
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Sidhu DS, Gull T, Skinner OT. Influence of intraoperative closed glove exchange on glove contamination during clean soft tissue surgeries. Vet Surg 2021; 50:1510-1517. [PMID: 34286868 DOI: 10.1111/vsu.13688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 05/10/2021] [Accepted: 07/07/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the influence of intraoperative glove exchange on glove contamination during clean soft tissue surgery. STUDY DESIGN Prospective clinical study. SAMPLE POPULATION Two hundred pairs of gloves and gowns from 50 clean soft tissue surgeries. METHODS Gloves and gown cuffs were cultured from the primary surgeon and first assistant using a standardized protocol. Cultures were taken from outer surface of both gown cuffs prior to surgery and after gloves were removed at the end of surgery; gloves were cultured prior to surgery, at end of surgery and after a new pair was donned after closed glove exchange. Cultures were evaluated for colony-forming units after 72 h of inoculation. RESULTS Bacterial contamination was documented in 41 of the 50 surgeries (82%). The most common species cultured was Streptocococcus spp. There was no difference (p = .719) in the bacterial contamination rate of gown cuffs prior to surgery (10%; 20/200) compared to after surgery (9.5%; 19/200). The bacterial contamination rate for gloves was 10.5% (21/200) prior to surgery, 19.5% (39/196) after surgery, and 11% (22/200) after regloving. Gloves cultured following surgery were significantly more contaminated than gloves cultured preoperatively (p = .010) or gloves cultured following regloving (p = .018). CONCLUSION Glove exchange did not increase bacterial contamination of gloves during the clean soft tissue surgeries tested here. CLINICAL SIGNIFICANCE The outside of the gown cuff does not seem to represent a major source of contamination during clean procedures. This study does not provide evidence to support a change in current practices for intraoperative closed glove exchange.
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Affiliation(s)
- Deepinder S Sidhu
- Department of Veterinary Medicine and Surgery, University of Missouri College of Veterinary Medicine, Columbia, Missouri, USA
| | - Tamara Gull
- Veterinary Medical Diagnostic Lab, University of Missouri, Columbia, Missouri, USA
| | - Owen T Skinner
- Department of Veterinary Medicine and Surgery, University of Missouri College of Veterinary Medicine, Columbia, Missouri, USA
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Li L, Zeng M, Chen X, Cai S, Xu C, Xia W, Jiang L, Zou X, Chen P, Rong M. Optimizing Safe Dental Practice During the COVID-19 Pandemic: Recommendations Based on a Guide Developed for Dental Practices in China. Front Med (Lausanne) 2021; 8:619357. [PMID: 34124084 PMCID: PMC8187590 DOI: 10.3389/fmed.2021.619357] [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: 10/20/2020] [Accepted: 04/09/2021] [Indexed: 12/18/2022] Open
Abstract
The current global coronavirus disease 2019 (COVID-19) outbreak is still exerting severe global implications, and its development in various regions is complex and variable. The high risk of cross-infection poses a great challenge to the dental practice environment; it is therefore urgent to develop a set of pandemic prevention measures to ensure dental practice safety during the COVID-19 outbreak. Therefore, we combined the epidemiological characteristics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), public emergency measures for COVID-19, characteristics of dental practice, and relevant literature reports to develop a set of dynamic practice measures for dental practices in high-, medium-, and low-risk areas affected by COVID-19. This will help dental practices to achieve standard prevention and ensure their safe and smooth operation during the pandemic. It is hoped that these measures will provide a reference basis for dental hospitals and dental clinics in their care and pandemic prevention work.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Pei Chen
- Department of Periodontology and Oral Implantology, Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Mingdeng Rong
- Department of Periodontology and Oral Implantology, Stomatological Hospital, Southern Medical University, Guangzhou, China
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Explanatory Factors for Periprosthetic Infection in Total Knee Arthroplasty. J Clin Med 2021; 10:jcm10112315. [PMID: 34073171 PMCID: PMC8198388 DOI: 10.3390/jcm10112315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 12/01/2022] Open
Abstract
There are many studies whose results reveal possible risk factors for developing an infection after a total knee arthroplasty (TKA). The objective of this study is to analyse the risk factors that depend on the hospital and, especially, if the patellar replacement influences the appearance of periprosthetic infection. A retrospective study was performed, where data from the electronic registry of patients of people over 18 and who had undergone TKA, between the years 2015 and 2018, were reviewed. Dependent variables on the patients and the health care system were collected. The possible associations between the factors and the appearance of infection after TKA were studied using univariate and multivariate regression analyses. A total of 907 primary knee arthroplasties were included in the study. Those patients who had their patella replaced had a significantly higher risk of developing an infection (OR 2.07; 95% confidence interval 1.01–6.31). Likewise, patients who underwent surgery by surgeons with more than 10 years of experience were more than twice as likely to become infected than those operated on by younger surgeons (OR 2.64; 95%CI 1.01–6.97). Male patients were also found to be three times more likely to be infected than women (OR 2.99; 95%CI 1.32–5.74). Those interventions that were longer had a higher risk of infection. The same happened with patients who stayed in the hospital for a longer period of time. The rest of the variables did not show statistically significant results. In this study, it was found that the replacement of the patella may be a factor of infection, but it should be corroborated with randomized clinical trials. Furthermore, patients who underwent longer surgeries or those with prolonged hospital stays should be closely monitored to detect infection as soon as possible and establish the most appropriate treatment.
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Khalifa MMM, Kolta ML, Tawfik M, Khaled S, Fakhry EE. Preventive infection control in cardiac device implantation. Herzschrittmacherther Elektrophysiol 2020; 32:54-61. [PMID: 33108510 DOI: 10.1007/s00399-020-00727-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiac implantable electronic devices have been increasingly used in recent years; as a result, there has been a rise in device-related complications. Pacemaker-associated infection is challenging to manage, including system removal, antimicrobial therapy and reimplantation at another site. The aim of this study was to evaluate adherence to the steps in an infection control protocol in cardiac device implantation. RESULTS A total of 100 patients referred for cardiac device implantation were enrolled in the study. They were evaluated with regard to the application of infection control measures during device implantation and followed-up for 6 months to detect clinical signs of device-related infection (DRI). A significant correlation was found between the development of postoperative DRI and the presence or absence of the following factors: increasing patient age (p = 0.010), diabetes mellitus (p = 0.024), number of operators ≥4 (p = 0.001), implantation of a biventricular system (p = 0.025), duration of sterilization (p = 0.001), wearing double gloves (p < 0.001) and postoperative hematoma (p = 0.021). CONCLUSIONS The study identified the following risk factors for DRI: age, diabetes mellitus and cardiac resynchronization therapy system implantation (p = 0.025). Antiseptic measures such as double-glove technique and duration of skin disinfection prior to the procedure, as well as environmental factors, also influenced device infection, as did the number of operators/staff and pocket hematoma.
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Affiliation(s)
| | - Michel Lotfy Kolta
- Department of cardiology, Ain Shams University Hospital, 11312, Cairo, Egypt
| | - Mazen Tawfik
- Department of cardiology, Ain Shams University Hospital, 11312, Cairo, Egypt
| | - Said Khaled
- Department of cardiology, Ain Shams University Hospital, 11312, Cairo, Egypt
| | - Emad Effat Fakhry
- Department of cardiology, Ain Shams University Hospital, 11312, Cairo, Egypt
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Isguven S, Chung PH, Machado P, Delaney LJ, Chen AF, Forsberg F, Hickok NJ. Minimizing Penile Prosthesis Implant Infection: What Can We Learn From Orthopedic Surgery? Urology 2020; 146:6-14. [PMID: 32991908 DOI: 10.1016/j.urology.2020.08.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/15/2020] [Accepted: 08/17/2020] [Indexed: 11/18/2022]
Abstract
The implantation of penile protheses for the surgical treatment of erectile dysfunction has risen in popularity over the past several decades. Considerable advances have been made in surgical protocol and device design, specifically targeting infection prevention. Despite these efforts, device infection remains a critical problem, which causes significant physical and emotional burden to the patient. The aim of this review is to broaden the discussion of best practices by not only examining practices in urology, but additionally delving into the field of orthopedic surgery to identify techniques and approaches that may be applied to penile prothesis surgery.
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Affiliation(s)
- Selin Isguven
- Department of Orthopaedic Surgery, Thomas Jefferson University Philadelphia, Philadelphia, PA; Department of Radiology, Thomas Jefferson University Philadelphia, Philadelphia, PA
| | - Paul H Chung
- Department of Urology, Thomas Jefferson University Philadelphia, Philadelphia, PA.
| | - Priscilla Machado
- Department of Radiology, Thomas Jefferson University Philadelphia, Philadelphia, PA
| | - Lauren J Delaney
- Department of Radiology, Thomas Jefferson University Philadelphia, Philadelphia, PA
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham & Women's Hospital, Boston, MA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University Philadelphia, Philadelphia, PA
| | - Noreen J Hickok
- Department of Orthopaedic Surgery, Thomas Jefferson University Philadelphia, Philadelphia, PA
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Schömig F, Perka C, Pumberger M, Ascherl R. Implant contamination as a cause of surgical site infection in spinal surgery: are single-use implants a reasonable solution? - a systematic review. BMC Musculoskelet Disord 2020; 21:634. [PMID: 32977778 PMCID: PMC7519515 DOI: 10.1186/s12891-020-03653-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/16/2020] [Indexed: 01/03/2023] Open
Abstract
Background In spine surgery, surgical site infection (SSI) is one of the main perioperative complications and is associated with a higher patient morbidity and longer patient hospitalization. Most factors associated with SSI are connected with asepsis during the surgical procedure and thus with contamination of implants and instruments used which can be caused by pre- and intraoperative factors. In this systematic review we evaluate the current literature on these causes and discuss possible solutions to avoid implant and instrument contamination. Methods A systematic literature search of PubMed addressing implant, instrument and tray contamination in orthopaedic and spinal surgery from 2001 to 2019 was conducted following the PRISMA guidelines. All studies regarding implant and instrument contamination in orthopaedic surgery published in English language were included. Results Thirty-five studies were eligible for inclusion and were divided into pre- and intraoperative causes for implant and instrument contamination. Multiple studies showed that reprocessing of medical devices for surgery may be insufficient and lead to surgical site contamination. Regarding intraoperative causes, contamination of gloves and gowns as well as contamination via air are the most striking factors contributing to microbial contamination. Conclusions Our systematic literature review shows that multiple factors can lead to instrument or implant contamination. Intraoperative causes of contamination can be avoided by implementing behavior such as changing gloves right before handling an implant and reducing the instruments’ intraoperative exposure to air. In avoidance of preoperative contamination, there still is a lack of convincing evidence for the use of single-use implants in orthopaedic surgery.
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Affiliation(s)
- Friederike Schömig
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Carsten Perka
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Rudolf Ascherl
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
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15
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Kobayashi M, Tsujimoto H, Takahata R, Einama T, Okamoto K, Kajiwara Y, Shinto E, Kishi Y, Hase K, Ueno H. Association Between the Frequency of Glove Change and the Risk of Blood and Body Fluid Exposure in Gastrointestinal Surgery. World J Surg 2020; 44:3695-3701. [PMID: 32661693 DOI: 10.1007/s00268-020-05681-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Surgical gloves are used to prevent the transmission of microorganisms from the surgeon's hands to the patient and vice versa. Little is known on the optimal frequency of glove changing. Therefore, we aimed to examine the optimal frequency of glove change during surgery by assessing the glove perforation rate in gastrointestinal surgery. METHODS In this observational prospective cohort study, we investigated the incidence of perforation of 5,267 gloves during gastrointestinal surgeries. RESULTS The overall glove perforation rate was 10.1%. There was no significant difference between single gloving (10.2%) and double gloving (10.0%; p = 0.8491). However, the perforation rate of the inner glove (5.7%) was found to be significantly lower than that of the outer glove (11.6%) (p < 0.0001). A significant difference in perforation rate was observed after wearing inner gloves for 240 min (< 240 min, 4.4%; ≤ 240 min, 7.2%; p = 0.0314), and outer gloves for 60 min (< 60 min, 7.1%; ≤ 60 min, 12.6%; p < 0.0001). We found cumulative perforation rate to rapidly increase until the wear time was 90 min. CONCLUSION The inner gloves and outer gloves have a higher perforation rate as the wear time increased. To reduce the risk of intraoperative blood and fluid exposure and prevent healthcare-associated infection, gloves should be changed for approximately every 60-90 min for outer gloves and approximately every 240 min for inner gloves.
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Affiliation(s)
- Minako Kobayashi
- Department of Medical Risk Management and Infection Control, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama, Japan.
| | - Hironori Tsujimoto
- Department of Medical Risk Management and Infection Control, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama, Japan
| | - Risa Takahata
- Department of Medical Risk Management and Infection Control, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama, Japan
| | - Takahiro Einama
- Department of Surgery, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama, Japan
| | - Koichi Okamoto
- Department of Surgery, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama, Japan
| | - Yoshiki Kajiwara
- Department of Surgery, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama, Japan
| | - Eiji Shinto
- Department of Surgery, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama, Japan
| | - Yoji Kishi
- Department of Surgery, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama, Japan
| | - Kazuo Hase
- Department of Surgery, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama, Japan
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Guo XM, Runge M, Miller D, Aaby D, Milad M. A bundled intervention lowers surgical site infection in hysterectomy for benign and malignant indications. Int J Gynaecol Obstet 2020; 150:392-397. [DOI: 10.1002/ijgo.13257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 01/22/2020] [Accepted: 06/01/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Xiaoyue Mona Guo
- Department of Obstetrics and Gynecology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Megan Runge
- Department of Obstetrics and Gynecology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Deborah Miller
- Department of Obstetrics and Gynecology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - David Aaby
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Magdy Milad
- Department of Obstetrics and Gynecology Northwestern University Feinberg School of Medicine Chicago IL USA
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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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Holst DC, Angerame MR, Dennis DA, Jennings JM. Does the Method of Sterile Glove-Opening Influence Back Table Contamination? A Fluorescent Particle Study. J Arthroplasty 2019; 34:2075-2079. [PMID: 31208911 DOI: 10.1016/j.arth.2019.05.004] [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: 03/08/2019] [Revised: 04/23/2019] [Accepted: 05/02/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Surgical site infections (SSI) may result from inadvertent intraoperative contamination events. This study investigated the method of opening surgical gloves onto the operative field (OF) and potential contamination rates. METHODS Twenty surgical glove packets were coated with a commercially available fluorescent particle powder. Two methods of glove openings (10 surgical glove packets in each cohort) were investigated: direct drop (DD) onto the OF vs opening and direct hand-off (DH) to a sterile intermediary (SI). Ultraviolet black light was used to quantify fluorescent particles for dispensed glove packets and the OF in both cohorts. The gloves of the SI were inspected in the DH cohort. A previously used contamination scale for fluorescent particle model contamination was employed: 0: no detectable fluorescent particle specks, 1: 1-5 specks, 2: 5-10 specks, 3: 11-100 specks, 4: >100 specks. RESULTS The DD cohort had a median OF contamination of 4 (range, 3-4) vs 3 for the DH trials (range, 1-3; P = .001). Likewise, the median glove contamination was higher in the DD cohort, 3 (range, 2-4) vs 1 for DH (range, 0-3; P = .007). Minimal contamination was found on the hands of the SI. Total fluorescent contamination rates, including the gloves of SI in the DH cohort, revealed greater overall contamination in DD (median, 3.5; range, 2-4) vs DH cohort (median, 1; range, 0-3); (P < .001). CONCLUSION Using a fluorescent particle model, there is a greater burden of potential contamination from dispensed glove packets and OF with DD vs DH. The DH method did not show significant fluorescent particle contamination on the SI gloves. These data support the use of the opening of gloves via DH over the DD method in total joint arthroplasty to decrease the risk of potential contamination.
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Affiliation(s)
- David C Holst
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| | - Marc R Angerame
- Department of Orthopaedic Surgery, Illinois Bone and Joint Institute, Barrington, IL
| | - Douglas A Dennis
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO; Department of Mechanical and Materials Engineering, Denver University, Denver, CO; Department of Orthopaedics, University of Colorado School of Medicine, Denver, CO; Department of Biomedical Engineering, University of Tennessee, Knoxville, TN
| | - Jason M Jennings
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO; Department of Mechanical and Materials Engineering, Denver University, Denver, CO
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Byrd WA, Kavolus JJ, Penrose CT, Wellman SS. Donning Gloves Before Surgical Gown Eliminates Sleeve Contamination. J Arthroplasty 2019; 34:1184-1188. [PMID: 30878507 DOI: 10.1016/j.arth.2019.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/21/2018] [Accepted: 01/07/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There are numerous studies in the literature that have recognized the importance of the glove-gown interface as a potential source of intraoperative bacterial contamination. It has been demonstrated that the methods with which one dons their surgical gown and gloves can alter the level of gown contamination. We hypothesize that donning undergloves before the surgical gown will decrease if not eliminate sleeve contamination. METHODS We performed a comparative study to assess the differences in gown contamination between three different gown and glove donning techniques. Participants ranged in experience level from intern to attending. Each participant covered their hands with ultraviolet light disclosing lotion and then donned surgical gown and gloves with their preferred technique and with the proposed technique in a randomly assigned order. The gowns were then removed and analyzed under ultraviolet light for distance and quantity of sleeve contamination. RESULTS The gloves-first technique demonstrated zero contamination in all samples. This is significantly less than both closed and open staff-assisted techniques (P < .0001). All samples of closed and open techniques demonstrated some level of contamination. The distance of contamination on the right sleeve is significantly greater than the left sleeve (P < .0001). DISCUSSION The gloves-first technique demonstrates zero sleeve contamination throughout all samples, regardless of the experience level. We strongly recommend considering the use of this glove and gown donning technique as opposed to the currently accepted closed and open techniques in an effort to reduce gown contamination.
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Affiliation(s)
- William A Byrd
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Joseph J Kavolus
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Colin T Penrose
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Samuel S Wellman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
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Vautrin M, Moerenhout K, Udin G, Borens O. Perioperative Contamination of Orthopaedic Polyethylene Implants, Targeting Devices and Arthroscopes. Experts' Decision Tree and Literature Review. J Bone Jt Infect 2019; 4:65-71. [PMID: 31011510 PMCID: PMC6470652 DOI: 10.7150/jbji.30613] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 01/26/2019] [Indexed: 11/05/2022] Open
Abstract
Introduction Sterility errors during orthopaedic procedures can be stressful for the surgeon or scrub nurse and lead to devastating infectious complications and liability issues. This paper aims to review orthopaedic surgeon practices and propose possible attitudes to adopt. Methods Out of 1023 questionnaires sent, 170 orthopaedic surgeons answered a Volunteer Feedback Template (multiple-choice test) by SurveyMonkey® (San Mateo, CA, USA) anonymously. The survey questioned surgeon's response to a sterility mistake during a standard total knee joint replacement, trauma surgery and arthroscopic procedure. Those “sterility mistake” situations occurred when there was contamination of 1) a sterile polyethylene (PE) 2) a sterile targeting device, and 3) an arthroscope. Results When the definitive PE is contaminated, and if a new definitive PE will only be available 2 hours later, 52% of surgeons would wait for the new definitive PE (p<0.001). In the same situation, if a new PE will only be available in 4 hours, the results showed a significant difference favoring two other options: ”putting a definitive PE one size smaller or bigger with balance adjustment” (31%); and “leaving the provisional PE in the joint, closing the wound and re-operating the patient in the coming days when the definitive PE arrives” (29%) (p<0.001). When the new PE is only available 24 hours later results were 34% and 31%, respectively (p<0.001). In the case of a surgical procedure for a classic intertrochanteric fracture, if the carbon fiber targeting device is contaminated, most surgeons (50%) chose to put the nail without the targeting device and finish the surgery (p<0.001). When the arthroscope is desterilized, 39% of participants would wait until the arthroscope has been sterilized again (approximately 2 hours), while 24% would use another procedure (p<0.001). Sixty-two percent of surgeons would adapt their strategy. No clear trend could be identified in terms of antibiotic treatment following a sterility error. Conclusions There are no established guidelines on how to deal with sterility breaches during surgery and on the antibiotic strategy following the prolonged surgical time resulting from the delay for a new implant. The most common course of action chosen by participating surgeons is detailed in our expert decision tree - if another sterile component is not available within 2 hours - : insertion of another PE size, rescheduling the operation, adapting the surgical technique (for trauma procedures), or soaking the arthroscope in disinfectant solution. As instances of contamination cannot be avoided, it is recommended to have a minimum of two copies of sterile PE implants, arthroscopes or targeting devices readily available before surgery begins-.
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Affiliation(s)
- Matthias Vautrin
- Orthopaedic Trauma Surgery Unit, Department of the Locomotor Apparatus, Lausanne. University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Kevin Moerenhout
- Orthopaedic Trauma Surgery Unit, Department of the Locomotor Apparatus, Lausanne. University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Gilles Udin
- Orthopaedic Trauma Surgery Unit, Department of the Locomotor Apparatus, Lausanne. University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Olivier Borens
- Orthopaedic Trauma Surgery Unit, Department of the Locomotor Apparatus, Lausanne. University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
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Abstract
Current research suggests that for certain types of gastrointestinal endoscopes, longer shelf life (the interval of storage after which endoscopes should be reprocessed before their reuse) may not increase the likelihood of endoscope contamination. Scope contamination may, in fact, be related primarily to either inadequate disinfection processes or inadvertent contamination during storage, not to duration of storage. The purpose of this study evaluated the presence of bacteria and fungus following liquid chemical sterilization in colonoscopes and gastroscopes, after 12 weeks of shelf life during which time personal protective equipment was used during endoscope storage cabinet access. We stored four colonoscopes and two gastroscopes in a cabinet for 12 weeks after liquid chemical sterilization and the cabinet was only accessed during the 12-week period wearing personal protective equipment (gown and gloves). Scopes were tested for bacteria and fungus at the end of 12 weeks. No bacteria or fungus grew on any of the scopes. This study provides further support that contaminated endoscopes may be related to either inadequate disinfection or contamination during storage, not shelf life.
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General Assembly, Prevention, Operating Room - Surgical Attire: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S117-S125. [PMID: 30348561 DOI: 10.1016/j.arth.2018.09.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Abouljoud MM, Alvand A, Boscainos P, Chen AF, Garcia GA, Gehrke T, Granger J, Kheir M, Kinov P, Malo M, Manrique J, Meek D, Meheux C, Middleton R, Montilla F, Reed M, Reisener MJ, van der Rijt A, Rossmann M, Spangehl M, Stocks G, Young P, Young S, Zahar A, Zhang X. Hip and Knee Section, Prevention, Operating Room Environment: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S293-S300. [PMID: 30343970 DOI: 10.1016/j.arth.2018.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Kim K, Zhu M, Munro JT, Young SW. Glove change to reduce the risk of surgical site infection or prosthetic joint infection in arthroplasty surgeries: a systematic review. ANZ J Surg 2018; 89:1009-1015. [DOI: 10.1111/ans.14936] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 10/01/2018] [Accepted: 10/04/2018] [Indexed: 01/11/2023]
Affiliation(s)
- Katy Kim
- Department of OrthopaedicsNorth Shore Hospital Auckland New Zealand
| | - Mark Zhu
- Department of OrthopaedicsAuckland Hospital Auckland New Zealand
| | - Jacob T. Munro
- Department of OrthopaedicsAuckland Hospital Auckland New Zealand
| | - Simon W. Young
- Department of OrthopaedicsNorth Shore Hospital Auckland New Zealand
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Elgafy H, Raberding CJ, Mooney ML, Andrews KA, Duggan JM. Analysis of a ten step protocol to decrease postoperative spinal wound infections. World J Orthop 2018; 9:271-284. [PMID: 30479974 PMCID: PMC6242729 DOI: 10.5312/wjo.v9.i11.271] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 08/15/2018] [Accepted: 08/26/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To define a ten-step protocol that reduced the incidence of surgical site infection in the spine surgery practice of the senior author and evaluate the support for each step based on current literature.
METHODS In response to unexplained increased infection rates at our institution following spine surgery, a ten-step protocol was implemented: (1) preoperative glycemic management based on hemoglobin A1c (HbA1c); (2) skin site preoperative preparation with 2% chlorhexidine gluconate disposable cloths; (3) limit operating room traffic; (4) cut the number of personnel in the room to the minimum required; (5) absolutely no flash sterilization of equipment; (6) double-gloving with frequent changing of outer gloves; (7) local application of vancomycin powder; (8) re-dosing antibiotic every 4 h for prolonged procedures and extending postoperative coverage to 72 h for high-risk patients; (9) irrigation of subcutaneous tissue with diluted povidone-iodine solution after deep fascial closure; and (10) use of DuraPrep skin preparation at the end of a case before skin closure. Through an extensive literature review, the current data available for each of the ten steps was evaluated.
RESULTS Use of vancomycin powder in surgical wounds, routine irrigation of surgical site, and frequent changing of surgical gloves are strongly supported by the literature. Preoperative skin preparation with chlorhexidine wipes is similarly supported. The majority of current literature supports control of HbA1c preoperatively to reduce risk of infection. Limiting the use of flash sterilization is supported, but has not been evaluated in spine-specific surgery. Limiting OR traffic and number of personnel in the OR are supported although without level 1 evidence. Prolonged use of antibiotics postoperatively is not supported by the literature. Intraoperative use of DuraPrep prior to skin closure is not yet explored.
CONCLUSION The ten-step protocol defined herein has significantly helped in decreasing surgical site infection rate. Several of the steps have already been shown in the literature to have significant effect on infection rates. As several measures are required to prevent infection, instituting a standard protocol for all the described steps appears beneficial.
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Affiliation(s)
- Hossein Elgafy
- Department of Orthopedics and Infectious Diseases, University of Toledo Medical Center, Toledo, OH 43614, United States
| | - Craig J Raberding
- Department of Orthopedics and Infectious Diseases, University of Toledo Medical Center, Toledo, OH 43614, United States
| | - Megan L Mooney
- Department of Orthopedics and Infectious Diseases, University of Toledo Medical Center, Toledo, OH 43614, United States
| | - Kyle A Andrews
- Department of Orthopedics and Infectious Diseases, University of Toledo Medical Center, Toledo, OH 43614, United States
| | - Joan M Duggan
- Department of Orthopedics and Infectious Diseases, University of Toledo Medical Center, Toledo, OH 43614, United States
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The art and science of surgery: Do the data support the banning of surgical skull caps? Surgery 2018; 164:921-925. [DOI: 10.1016/j.surg.2018.05.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/23/2018] [Accepted: 05/01/2018] [Indexed: 11/19/2022]
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Wistrand C, Falk-Brynhildsen K, Nilsson U. National Survey of Operating Room Nurses' Aseptic Techniques and Interventions for Patient Preparation to Reduce Surgical Site Infections. Surg Infect (Larchmt) 2018; 19:438-445. [PMID: 29672240 DOI: 10.1089/sur.2017.286] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Surgical site infection (SSI), the third most common type of nosocomial infection in Sweden, is a patient injury that should be prevented. Methods of reducing SSIs include, for instance, disinfecting the skin, maintaining body temperature, and ensuring an aseptic environment. Guidelines for most of these interventions exist, but there is a lack of studies describing to what extent the preventive interventions have been implemented in clinical practice. We describe the daily clinical interventions Swedish operating room (OR) nurses performed to prevent SSIs following national guidelines. METHODS A descriptive cross-sectional study using a Web-based questionnaire was conducted among Swedish OR nurses. The study-specific questionnaire included 32 items addressing aspects of the interventions performed to prevent SSI, such as preparation of the patient skin (n = 12), maintenance of patient temperature (n = 10), and choice of materials (n = 10). The response format included both closed and open-ended answers. RESULTS In total, 967 nurses (43% of the total) answered the questionnaire; of these, 77 were excluded for various reasons. The proportions of the OR nurses who complied with the preventive interventions recommended in the national guidelines were high: skin disinfection solution (93.5%), sterile drapes (97.4%) and gowns (83.8%) for single use, and the use of double gloves (73.0%). However, when guidelines were lacking, some interventions differed, such as the frequency of glove changes and the use of adhesive plastic drapes. CONCLUSION To standardize OR nurses' preventive interventions, implementing guidelines seems to be the key priority. Overall, OR nurses have high compliance with the national guidelines regarding interventions to prevent bacterial growth and SSIs in the surgical patient. However, when guidelines are lacking, the preventive interventions lose conformity.
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Affiliation(s)
- Camilla Wistrand
- 1 Department of Cardiothoracic and Vascular Surgery, University Hospital, Örebro University , Örebro, Sweden
| | - Karin Falk-Brynhildsen
- 2 School of Health Sciences, Faculty of Medicine and Health, Örebro University , Örebro, Sweden
| | - Ulrica Nilsson
- 1 Department of Cardiothoracic and Vascular Surgery, University Hospital, Örebro University , Örebro, Sweden .,3 Centre for Perioperative Nursing , Örebro University
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Horsnell J, Searle A, Harris P. Intra-operative techniques to reduce the risk of capsular contracture in patients undergoing aesthetic breast augmentation – A review. Surgeon 2017; 15:282-289. [DOI: 10.1016/j.surge.2017.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/13/2017] [Accepted: 03/22/2017] [Indexed: 10/19/2022]
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Deva AK. Response to "Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL): Why the Search for an Infectious Etiology May Be Irrelevant". Aesthet Surg J 2017; 37:NP122-NP128. [PMID: 29025239 DOI: 10.1093/asj/sjx133] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Anand K Deva
- Surgical Infection Research Group, Macquarie University, Sydney, Australia
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Scientific Article Review of "Glove and Gown Effects of Intraoperative Bacterial Contamination". Ann Surg 2017; 265:e33-e34. [PMID: 28266976 DOI: 10.1097/sla.0000000000001105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Deer TR, Provenzano DA, Hanes M, Pope JE, Thomson SJ, Russo MA, McJunkin T, Saulino M, Raso LJ, Lad SP, Narouze S, Falowski SM, Levy RM, Baranidharan G, Golovac S, Demesmin D, Witt WO, Simpson B, Krames E, Mekhail N. The Neurostimulation Appropriateness Consensus Committee (NACC) Recommendations for Infection Prevention and Management. Neuromodulation 2017; 20:31-50. [PMID: 28042909 DOI: 10.1111/ner.12565] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/13/2016] [Accepted: 10/24/2016] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The use of neurostimulation for pain has been an established therapy for many decades and is a major tool in the arsenal to treat neuropathic pain syndromes. Level I evidence has recently been presented to substantiate the therapy, but this is balanced against the risk of complications of an interventional technique. METHODS The Neurostimulation Appropriateness Consensus Committee (NACC) of the International Neuromodulation Society convened an international panel of well published and diverse physicians to examine the best practices for infection mitigation and management in patients undergoing neurostimulation. The NACC recommendations are based on evidence scoring and peer-reviewed literature. Where evidence is lacking the panel added expert opinion to establish recommendations. RESULTS The NACC has made recommendations to improve care by reducing infection and managing this complication when it occurs. These evidence-based recommendations should be considered best practices in the clinical implantation of neurostimulation devices. CONCLUSION Adhering to established standards can improve patient care and reduce the morbidity and mortality of infectious complications in patients receiving neurostimulation.
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Affiliation(s)
| | | | | | | | - Simon J Thomson
- Pain Management and Neuromodulation Centre, Basildon & Thurrock University Hospitals, NHS, Trust, UK
| | | | | | | | | | - Shivanand P Lad
- Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Samer Narouze
- Summa Western Reserve Hospital, Cuyahoga Falls, OH, USA
| | | | | | | | | | - Didier Demesmin
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - William O Witt
- Cardinal Hill Pain Institute (emeritus), Lexington, KY, USA
| | - Brian Simpson
- Department of Neurosurgery, University Hospital of Wales, Cardiff, UK
| | - Elliot Krames
- Pacific Pain Treatment Center (ret.), San Francisco, CA, USA
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Barr SP, Topps AR, Barnes NLP, Henderson J, Hignett S, Teasdale RL, McKenna A, Harvey JR, Kirwan CC. Infection prevention in breast implant surgery - A review of the surgical evidence, guidelines and a checklist. Eur J Surg Oncol 2016; 42:591-603. [PMID: 27005885 DOI: 10.1016/j.ejso.2016.02.240] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 02/19/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION As a result of increasing use of implant-based breast reconstruction, complications such as infection are being encountered more frequently. Surgical Site Infections (SSIs) cause morbidity for the patient, can lead to capsular contracture or implant loss and are costly to healthcare systems. National Guidelines suggesting methods to reduce SSI related complications have been produced, but are limited in the scope of interventions covered and underlying evidence presented. METHODS We performed a literature review encompassing a wide variety of possible SSI prevention strategies. We aimed to present summaries of the available evidence and give pragmatic recommendations as to their validity to use as guidelines for infection prevention strategies for implant-based breast reconstruction. RESULTS A lack of high quality data relating to the benefit of SSI prevention strategies in implant-based breast reconstruction exists. Many papers relate to orthopaedic implant surgery, or clean surgery in general. Following review of the evidence, sufficient data exists to support use of perioperative antibiotics at implant-based breast reconstruction, with continuation for an extended period in "high risk" patients. Alcohol containing skin preparations should be used over aqueous solutions. Laminar air flow use is suggested. Theatre traffic should be kept to a minimum, as should duration of operative procedure. The implant pocket should be washed prior to implantation. Double gloving and conductive warming are also endorsed. CONCLUSIONS We have produced a perioperative "Theatre Implant Checklist" for SSI prevention in implant-based breast surgery, with a set of pragmatic up to date guidelines, which allows the reader to evaluate the evidence upon which our recommendations are based.
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Affiliation(s)
- S P Barr
- The North West Breast Research Collaborative, United Kingdom.
| | - A R Topps
- The North West Breast Research Collaborative, United Kingdom
| | - N L P Barnes
- The North West Breast Research Collaborative, United Kingdom
| | - J Henderson
- The North West Breast Research Collaborative, United Kingdom
| | - S Hignett
- The North West Breast Research Collaborative, United Kingdom
| | - R L Teasdale
- The North West Breast Research Collaborative, United Kingdom
| | - A McKenna
- The North West Breast Research Collaborative, United Kingdom
| | - J R Harvey
- The North West Breast Research Collaborative, United Kingdom
| | - C C Kirwan
- The North West Breast Research Collaborative, United Kingdom
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34
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Prkić A, van Bergen CJA, The B, Eygendaal D. Total elbow arthroplasty is moving forward: Review on past, present and future. World J Orthop 2016; 7:44-49. [PMID: 26807355 PMCID: PMC4716570 DOI: 10.5312/wjo.v7.i1.44] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/30/2015] [Accepted: 11/04/2015] [Indexed: 02/06/2023] Open
Abstract
The elbow joint is a complex joint, which, when impaired in function, leads to severe disability. In some cases however, an arthroplasty might be an appropriate treatment. In the past four decades, large steps have been taken to optimize this treatment in order to achieve better post-operative outcomes. To understand these progresses and to discover aspects for upcoming improvements, we present a review on the past developments, the present state of affairs and future developments which may improve patient care further.
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35
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Verwilghen D, Singh A. Fighting surgical site infections in small animals: are we getting anywhere? Vet Clin North Am Small Anim Pract 2014; 45:243-76, v. [PMID: 25542615 DOI: 10.1016/j.cvsm.2014.11.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A diverse array of pathogen-related, patient-related, and caretaker-related issues influence risk and prevention of surgical site infections (SSIs). The entire surgical team involved in health care settings in which surgical procedures are performed play a pivotal role in the prevention of SSIs. In this article, current knowledge of SSI risk factors and prevention methods is reviewed. Although new avenues that can be explored in the prevention of SSIs in veterinary medicine are described, the main conclusion drawn is that the best method for prevention of SSI is to adhere to what we already know.
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Affiliation(s)
- Denis Verwilghen
- Department of Large Animal Sciences, University of Copenhagen, Hojbakkegaerd Allé 5, Taatsrup 2630, Denmark.
| | - Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada
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