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Litofsky NS, Cohen D, Schlesselman C, Vallabhaneni A, Warner T, Herbert JP. No Link Between Inadvertent Surgical Glove Contamination and Surgical Site Infection in Patients Undergoing Elective Neurosurgical Operations. World Neurosurg 2023; 175:e1025-e1031. [PMID: 37087035 DOI: 10.1016/j.wneu.2023.04.065] [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: 03/19/2023] [Revised: 04/13/2023] [Accepted: 04/15/2023] [Indexed: 04/24/2023]
Abstract
INTRODUCTION Controllable factors associated with surgical site infections (SSIs) have focused on reducing contamination of the surgical field with potential pathogens. The aim of this prospective study is to determine the incidence of glove contamination in a series of elective neurosurgical operations and determine the relationship of such glove contamination to subsequent SSI. We hypothesize that contamination of surgical gloves is associated with subsequent SSI. METHODS In this prospective quality improvement study, gloves of the surgical team were swabbed for standard culture just prior to wound closure of elective neurosurgical operations. Patient characteristics, surgical details, and occurrence of subsequent SSIs were collected retrospectively from the electronic medical records. Data were analyzed with χ2 with Fisher's exact test and Student's t test. RESULTS Surgical glove contamination occurred in 10 of 96 elective neurosurgical cases (10.4%). SSIs occurred in 6 cases (6.2%), but no SSI occurred in a case in which surgical glove contamination occurred (P = 1). SSI was associated with younger patient age (P = 0.0448), and surgical glove contamination was associated with less resident experience (P = 0.0354). CONCLUSIONS Surgical glove contamination identified at the time of wound closure does not correlate with the development of subsequent SSI in elective neurosurgical operations.
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Affiliation(s)
- N Scott Litofsky
- Department of Neurological Surgery, University of Missouri School of Medicine, Columbia, Missouri.
| | - David Cohen
- Department of Neurology, University of Missouri School of Medicine, Columbia, Missouri
| | - Chase Schlesselman
- Office of Medical Research, University of Missouri School of Medicine, Columbia, Missouri
| | - Ahdarsh Vallabhaneni
- Department of Neurological Surgery, University of Missouri School of Medicine, Columbia, Missouri
| | - Tyler Warner
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joseph P Herbert
- Department of Neurological Surgery, University of Missouri School of Medicine, Columbia, Missouri
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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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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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Li X, Li M, Li J, Gong W, Sun Y, Tang J, Yao X, Wang X. Glove perforation and contamination in fracture fixation surgeries. Am J Infect Control 2017; 45:458-460. [PMID: 27769705 DOI: 10.1016/j.ajic.2016.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 07/06/2016] [Accepted: 07/06/2016] [Indexed: 11/25/2022]
Abstract
The aim of the present study was to investigate glove contamination and perforation rate during traumatic orthopedic surgeries and evaluate the factors affecting glove contamination and perforation. There were significant differences in glove contamination among different surgery stages. In terms of contamination and perforation, there were significant differences between surgeons and assistants (ie, scrub-nurses).
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Andrade N, Schmiedt CW, Cornell K, Radlinsky MG, Heidingsfelder L, Clarke K, Hurley DJ, Hinson WD. Survey of Intraoperative Bacterial Contamination in Dogs Undergoing Elective Orthopedic Surgery. Vet Surg 2016; 45:214-22. [PMID: 26757033 DOI: 10.1111/vsu.12438] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To investigate the frequency, source, and risk factors of intraoperative (IO) surgeon and patient bacterial contamination during clean orthopedic surgeries, and to investigate the relationship between IO contamination and surgical site infection (SSI) in dogs. STUDY DESIGN Prospective clinical study. SAMPLE POPULATION Client-owned dogs undergoing stifle surgery (n = 100). METHODS IO cultures were taken in each case from surgical foot wrap, peri-incisional skin, surgical gloves, and the surgical team's hands. The environment (operating room [OR] lights, computers, scrub sink faucet, anesthesia gurney, and radiology table) was sampled every 5 months. Bacteria were identified and the contamination of each case was categorized. All gloves from the surgical team were collected and tested for perforations using a water infusion test. Cases were followed for at least 8 weeks to determine the presence or absence of SSI. Perioperative variables were evaluated for association with IO contamination and SSI. RESULTS Bacterial isolates were yielded from 81% of procedures from 1 or more sources; 58% had positive hand cultures, 46% had positive glove cultures, 23% had positive patient skin cultures, and 12% had positive foot wrap cultures. Staphylococcus spp. was the most commonly recovered bacteria. There was no apparent association between IO contamination and SSI. The highest level of environmental contamination was associated with the scrub sink faucet, followed by the radiology table, anesthesia gurney, and OR computers. The IO glove perforation rate was 18%. CONCLUSION Clean orthopedic procedures commonly had clinically insignificant bacterial contamination. In our study, bacteria responsible for SSI did not appear to colonize the patient in the OR.
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Affiliation(s)
| | | | | | | | | | | | - David J Hurley
- Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, Georgia
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Yaldiz C, Yaldiz M, Ceylan N, Kacira OK, Ceylan D, Kacira T, Kizilcay G, Tanriverdi T. Retrospective, Demographic, and Clinical Investigation of the Causes of Postoperative Infection in Patients With Lumbar Spinal Stenosis Who Underwent Posterior Stabilization. Medicine (Baltimore) 2015. [PMID: 26200620 PMCID: PMC4602987 DOI: 10.1097/md.0000000000001177] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Owing to the increasing population of elderly patients, a large number of patients with degenerative spondylosis are currently being surgically treated. Although basic measures for decreasing postoperative surgical infections (PSIs) are considered, it still remains among the leading causes of morbidity and mortality. The aim of this retrospective analysis is to present possible causes leading to PSI in patients who underwent surgery for lumbar degenerative spondylosis and highlight how it can be avoided to decrease morbidity and mortality. The study included 540 patients who underwent posterior stabilization due to degenerative lumbar stenosis between January 2013 and January 2014. The data before and after surgery was retrieved from the hospital charts. Patients with degenerative lumbar stenosis who were operated upon in this study had >2 levels of laminectomy and facetectomy. For this reason, posterior stabilization was performed for all the patients included in this study. Determining the causes of postoperative infection (PI) following spinal surgeries performed with instrumentation is a struggle. Seventeen different parameters that may be related to PI were evaluated in this study. The presence of systemic diseases, unknown glove perforations, and perioperative blood transfusions were among the parameters that increased the prevalence of PI. Alternatively, prolene sutures, double-layered gloves, and the use of rifampicin Sv (RIS) decreased the incidence of PI. Although the presence of systemic diseases, unnoticed glove perforations, and perioperative blood transfusions increased PIs, prolene suture material, double-layered gloves, and the use of RIS decreased PIs.
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Affiliation(s)
- Can Yaldiz
- From the Departmant of Neurosurgery (CY, DC, TK, GK); Departmant of Dermatology (MY); Departmant of Internal Medicine (NC); Departmant of Radiology (OKK), Sakarya University Training and Research Hospital, Sakarya; and Department of Neurosurgery (TT), Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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Beldame J, Lagrave B, Lievain L, Lefebvre B, Frebourg N, Dujardin F. Surgical glove bacterial contamination and perforation during total hip arthroplasty implantation: when gloves should be changed. Orthop Traumatol Surg Res 2012; 98:432-40. [PMID: 22578871 DOI: 10.1016/j.otsr.2011.10.015] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Revised: 10/21/2011] [Accepted: 10/25/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Double gloving is recommended in orthopedic surgery, notably in total hip arthroplasties (THA) to prevent contamination of the surgical site. HYPOTHESIS Systematic glove changes during the key phases of hip prosthesis implantation reduce the frequency of occult perforations and bacterial loading of glove surfaces. PATIENTS AND METHODS During 29 THA implantation procedures, we evaluated the bacterial contamination of the outer glove surface and its perforation rate. Contaminations were sought by placing the gloved fingertips on blood geloses (incubation, 48 h at 37°C), and perforations were sought using a water test (NF EN 455-1). RESULTS One intervention was excluded from the study because an initial contamination was detected, leaving 28 cases analyzed. Fifteen interventions (53.6%) presented contaminated geloses (26 contaminated glove changes for 3.38% of the gloves used). These contaminations were found on the gloves of all of the gloved personnel, with no distinction as to the right or left side. Thirty-eight percent of the contaminations occurred during joint reduction, whereas the other surgical stages grouped 15-26% of the contaminations (P<0.05). Twenty-nine bacteria were identified: 62% coagulase-negative staphylococci (16% of which were methicillin-resistant). Twenty-eight perforations were identified (3.5% of the gloves used), 67.8% of which were located on the operator and 64.3% on the dominant side. Eighty percent of the perforations occurred during the "surgical incision" and the "cup and stem implantation" stages (respectively, 5.0% and 5.5% of the gloves used during the surgical time) (P<0.05), without being associated with an increased risk of bacterial contamination. At the 12-month clinical follow-up, no infectious complications were found. On the gloves worn by the 20 surgical team members contaminated during these 28 surgical procedures, replacing contaminated gloves with new sterile gloves rendered all the bacteriological samples of the subsequent surgical stages negative in 16 cases (80%). DISCUSSION Increasing the number of outer glove renewals, notably during certain surgical stages at risk for contamination (prosthesis reduction) or perforation (surgical incision/femoral cementing) can reduce the risk of contamination and perforation. The bacteria isolated suggest a cutaneous origin. Regularly changing gloves has resulted in a sterile state in 80% of cases. LEVEL OF EVIDENCE AND TYPE OF STUDY: Level III prospective diagnostic study.
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Affiliation(s)
- J Beldame
- Department of Orthopaedic Surgery, Rouen Teaching Hospital Center, 1, rue de Germont, 76031 Rouen cedex, France.
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Al-Maiyah M, Bajwa A, Mackenney P, Port A, Gregg PJ, Hill D, Finn P. Glove perforation and contamination in primary total hip arthroplasty. ACTA ACUST UNITED AC 2005; 87:556-9. [PMID: 15795210 DOI: 10.1302/0301-620x.87b4.15744] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We conducted a randomised, controlled trial to determine whether changing gloves at specified intervals can reduce the incidence of glove perforation and contamination in total hip arthroplasty. A total of 50 patients were included in the study. In the study group (25 patients), gloves were changed at 20-minute intervals or prior to cementation. In the control group (25 patients), gloves were changed prior to cementation. In addition, gloves were changed in both groups whenever there was a visible puncture. Only outer gloves were investigated. Contamination was tested by impression of gloved fingers on blood agar and culture plates were subsequently incubated at 37°C for 48 hours. The number of colonies and types of organisms were recorded. Glove perforation was assessed using the water test. The incidence of perforation and contamination was significantly lower in the study group compared with the control group. Changing gloves at regular intervals is an effective way to decrease the incidence of glove perforation and bacterial contamination during total hip arthroplasty.
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Affiliation(s)
- M Al-Maiyah
- Department of Orthopaedics, School of Health, University of Teeside, Middlesbrough TS1 3BA, UK.
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Dvilevicius AE, Machado S, do Rêgo JIM, Santos DS, Pietrowski F, Reis AD. Craniotomia sem tricotomia: avaliação de 640 casos. ARQUIVOS DE NEURO-PSIQUIATRIA 2004; 62:103-7. [PMID: 15122442 DOI: 10.1590/s0004-282x2004000100018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A remoção do cabelo para realização de craniotomia utilizada rotineiramente na maioria dos serviços de neurocirurgia para procedimentos cranianos diversos questionada em sua necessidade a partir da avaliação retrospectiva de 640 pacientes submetidos a cirurgias cranianas, em que foi observada uma porcentagem de infecção de ferida cirúrgica de 1,09 %, não superior àquelas com tricotomia revisadas na literatura. Nos 7 casos com infecção, 3 pacientes foram submetidos a derivações liquóricas, 3 pacientes eram vítimas de traumatismo crânio-encefálico e uma paciente substituida a craniotomia para tratamento de tumor cerebral. A técnica para preservação e manuseio do cabelo, suas vantagens e desvantagens são descritas e discutidas.
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Affiliation(s)
- Amylcar E Dvilevicius
- Serviço de Neurocirurgia e Neurologia, Hospital Regional Vale do Ribeira, Pariquera-Açu, SP, Brazil.
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Savitz MH, Malis LI, Savitz SI. Efficacy of prophylactic antibiotic therapy in spinal surgery: a meta-analysis. Neurosurgery 2003; 53:243-4; author reply 244-5. [PMID: 12879874 DOI: 10.1227/01.neu.0000072304.16102.2f] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abstract
Two regimens of antibiotic prophylaxis are in use at our institution. These protocols consist in perioperative administration of a single dose of amoxicillin-clavulanic acid of 2.2 g at induction and 8 h later and irrigation of the surgical wound with rifamycin before closure. In cases of dirty surgery, placement of external shunts or foreign bodies, we administer vancomycin 1.5 g/die and ceftazidime 6 g/die for 72 h. A retrospective study of all the clean operations we performed in the last 2 years yielded a total of 793 consecutive procedures with three postoperative wound infections. These results are in agreement with the majority of series reported in literature, although different prophylactic protocols are applied and in some cases no prophylactic antibiotics are administered at all. The use of these agents in clean neurosurgery remains, as a matter of fact, controversial. In order to further investigate this issue we took three or more intraoperative samples for culture in 40 clean cases. Only in 2% of these samples were cultures positive. Although lacking statistical significance, these results are interesting indications of the appropriateness of antimicrobial prophylaxis in clean neurosurgery and invite further investigation in that direction.
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Affiliation(s)
- F Cacciola
- Department of Neurosurgery, University of Florence, Italy.
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Savitz SI, Savitz MH, Goldstein HB, Mouracade CT, Malangone S. Topical irrigation with polymyxin and bacitracin for spinal surgery. SURGICAL NEUROLOGY 1998; 50:208-12. [PMID: 9736080 DOI: 10.1016/s0090-3019(97)00499-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The purpose of the present study was to evaluate constant irrigation with saline containing 50,000 units each of polymyxin and bacitracin in a regimen of antimicrobial prophylaxis for clean spinal surgery at two community hospitals with a zero infection rate. METHODS The focus was on the bactericidal effects of prophylactic topical antibiotics by assessing random contamination in neurosurgical wounds from: 1) the flora of the integument and nares of the operating team, 2) the surgical apparel, 3) the patient's skin, 4) air-borne organisms in the operating theater, and 5) the surgeon's gloves. RESULTS Based on individual biotyping of bacteria and antimicrobial sensitivity testing, no consistent source or pattern could be uncovered for the organisms recovered from the operative site. Relying on longitudinal data, the incidence of intraoperative bacterial growth with continuous saline lavage was reduced from 64 to 4% when the combination of topical polymyxin and bacitracin was added. CONCLUSIONS Although the virtual elimination of bacterial growth in the surgical site was accomplished, the efficacy of topical antibiotics in the prevention of wound infection remains unproven.
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Affiliation(s)
- S I Savitz
- Department of Surgery, Community Hospital, Dobbs Ferry, New York, USA
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Meta-analysis of Antibiotic Prophylaxis. Neurosurgery 1995. [DOI: 10.1097/00006123-199505000-00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Savitz MH, Malis LI. Meta-analysis of antibiotic prophylaxis. Neurosurgery 1995; 36:1057-8. [PMID: 7791975 DOI: 10.1097/00006123-199505000-00031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Barker FG. Meta-analysis of Antibiotic Prophylaxis. Neurosurgery 1995. [DOI: 10.1227/00006123-199505000-00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Savitz MH, Malis LI. Meta-analysis of Antibiotic Prophylaxis. Neurosurgery 1995. [DOI: 10.1227/00006123-199505000-00031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Gil-Salú J, Portillo E, Guridi J, Gallo-Ruiz A, Azcona J, Aguilera F, Uriz J, González M. Valoración de la profilaxis antibiótica en procedimientos neuroquirúrgicos. Neurocirugia (Astur) 1995. [DOI: 10.1016/s1130-1473(95)70780-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Investigations of the Bacteriological Factors in Clean Neurosurgical Cases. Neurosurgery 1994. [DOI: 10.1097/00006123-199404000-00047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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