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Sample records for antisepsis

  1. Alcoholic versus aqueous chlorhexidine for skin antisepsis: the AVALANCHE trial.

    Science.gov (United States)

    Charles, Daniel; Heal, Clare F; Delpachitra, Meth; Wohlfahrt, Michael; Kimber, Debbie; Sullivan, Julie; Browning, Sheldon; Saednia, Sabine; Hardy, Alexandra; Banks, Jennifer; Buttner, Petra

    2017-08-08

    Preoperative skin antisepsis is routine practice. We compared alcoholic chlorhexidine with aqueous chlorhexidine for skin antisepsis to prevent surgical site infection after minor skin excisions in general practice. We conducted this prospective, multicentre, randomized controlled trial in 4 private general practices in North Queensland, Australia, from October 2015 to August 2016. Consecutive adult patients presenting for minor skin excisions were randomly assigned to undergo preoperative skin antisepsis with 0.5% chlorhexidine in 70% ethanol (intervention) or 0.5% chlorhexidine aqueous solution (control). Our primary outcome was surgical site infection within 30 days of excision. We also measured the incidence of adverse reactions. A total of 916 patients were included in the study: 454 underwent antisepsis with alcoholic chlorhexidine and 462 with aqueous chlorhexidine. Of these, 909 completed follow-up. In the intention-to-treat analysis of cases available at follow-up, there was no significant difference in the incidence of surgical site infection between the alcoholic chlorhexidine arm (5.8%, 95% confidence interval [CI] 3.6% to 7.9%) and the aqueous chlorhexidine arm (6.8%, 95% CI 4.5% to 9.1%). The attributable risk reduction was 0.010 (95% CI -0.021 to 0.042), the relative risk was 0.85 (95% CI 0.51 to 1.41), and the number needed to treat to benefit was 100. Per protocol and sensitivity analyses produced similar results. The incidence of adverse reactions was low, with no difference between groups ( p = 0.6). There was no significant difference in efficacy between alcoholic and aqueous chlorhexidine for the prevention of surgical site infection after minor skin excisions in general practice. Trial registration: https://www.anzctr.org.au, no. ACTRN12615001045505. © 2017 Canadian Medical Association or its licensors.

  2. Laser antisepsis of Phorphyromonas gingivalis in vitro with dental lasers

    Science.gov (United States)

    Harris, David M.

    2004-05-01

    It has been shown that both pulsed Nd:YAG (1064nm) and continuous diode (810nm) dental lasers kill pathogenic bacteria (laser antisepsis), but a quantitative method for determining clinical dosimetry does not exist. The purpose of this study was to develop a method to quantify the efficacy of ablation of Porphyromonas gingivalis (Pg) in vitro for two different lasers. The ablation thresholds for the two lasers were compared in the following manner. The energy density was measured as a function of distance from the output of the fiber-optic delivery system. Pg cultures were grown on blood agar plates under standard anaerobic conditions. Blood agar provides an approximation of gingival tissue for the wavelengths tested in having hemoglobin as a primary absorber. Single pulses (Nd:YAG: 100- Œs diode: 100-msec) of laser energy were delivered to Pg colonies and the energy density was increased until the appearance of a small plume was observed coincident with a laser pulse. The energy density at this point defines the ablation threshold. Ablation thresholds to a single pulse were determined for both Pg and for blood agar alone. The large difference in ablation thresholds between the pigmented pathogen and the host matrix for pulsed-Nd:YAG represented a significant therapeutic ratio and Pg was ablated without visible effect on the blood agar. Near threshold the 810-nm diode laser destroyed both the pathogen and the gel. Clinically, the pulsed Nd:YAG may selectively destroy pigmented pathogens leaving the surrounding tissue intact. The 810-nm diode laser may not demonstrate this selectivity due to its longer pulse length and greater absorption by hemoglobin.

  3. Can we reduce the surgical site infection rate in cesarean sections using a chlorhexidine-based antisepsis protocol?

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    Amer-Alshiek, Jonia; Alshiek, Tahani; Almog, Benny; Lessing, Joseph B; Satel, Abed; Many, Ariel; Levin, Ishai

    2013-11-01

    To determine whether chlorhexidine-based antisepsis reduces the rate of surgical site infections (SSIs) in elective and non-elective cesarean sections (CS) compared with povidone-iodine protocol. This was a retrospective study. Women undergoing elective and non-elective CS during two periods of time who were treated with two different antisepsis protocols were included. The protocols for antisepsis were povidone-iodine 10% scrub followed by 10% povidone-iodine in 65% alcohol (n = 163) and chlorhexidine 2% followed by 70% alcohol (n = 163). The rate of SSIs and the risk factors for their occurrence were calculated and compared between the two groups. Antisepsis with chlorhexidine and alcohol was associated with a lower rate of SSIs, 10.43% versus 3.07% with povidone-iodine (p = 0.08). The two groups of patients were similar in baseline characteristics. Risk factors associated with SSIs were body mass index, urgent CS, and the use of the povidone-iodine protocol. Antisepsis with Chlorhexidine-based regimen was associated with a significant reduction in the rate of SSIs compared to povidone-iodine antisepsis in women undergoing elective and non-elective CS. This is of extreme clinical importance, as a change in antisepsis protocol can significantly reduce the morbidity and healthcare costs regarding cesarean sections.

  4. Gangrene therapy and antisepsis before lister: the civil war contributions of Middleton Goldsmith of Louisville.

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    Trombold, John M

    2011-09-01

    It is commonly accepted that Louis Pasteur is the father of microbiology and Joseph Lister is the father of antisepsis. Middleton Goldsmith, a surgeon in the Union Army during the American Civil War, meticulously studied hospital gangrene and developed a revolutionary treatment regimen. The cumulative Civil War hospital gangrene mortality was 45 per cent. Goldsmith's method, which he applied to over 330 cases, yielded a mortality under 3 per cent. His innovative work predated Pasteur and Lister, making his success truly remarkable and worthy of historical and surgical note.

  5. A retrospective analysis of surgical site infections after chlorhexidine-alcohol versus iodine-alcohol for pre-operative antisepsis.

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    Charehbili, Ayoub; Swijnenburg, Rutger-Jan; van de Velde, Cornelis; van den Bremer, Jephta; van Gijn, Willem

    2014-06-01

    Surgical site infection (SSI) is the most common hospital-acquired infection in the Netherlands. There is little evidence in regard to differences in the efficacy of pre-operative topical antisepsis with iodine-alcohol as compared with chlorhexidine-alcohol for preventing SSI. We conducted a retrospective analysis at a single center, involving all patients who underwent breast, colon, or vascular surgery in 2010 and 2011, in which pre-operative disinfection of the skin was done with iodine-alcohol in 2010 and with chlorhexidine-alcohol in 2011. Demographic characteristics, surgical parameters, and rates of SSI were compared in the two groups of patients. Subgroup analyses were done for wound classification, wound type, and type of surgery performed. Associations of patient characteristics with SSI were also investigated. Data were analyzed with χ(2) tests, Student t-tests, and logistic regression analysis. No statistically significant difference was found in the rates of SSI in the two study groups, at 6.1% for the patients who underwent antisepsis with iodine-alcohol and 3.8% for those who underwent disinfection with chlorhexidine-alcohol (p=0.20). After multivariable analysis, an odds ratio (OR) of 0.68 (95% confidence interval [CI] 0.30-1.47) in favor of chlorhexidine-alcohol was found. Male gender, acute surgery, absence of antibiotic prophylaxis, and longer hospital length of stay (LOS) were all associated with SSI after pre-operative topical antisepsis. In this single-center study conducted over a course of one year with each of the preparations investigated, no difference in the rate of SSI was found after an instantaneous protocol change from iodine-alcohol to chlorhexidine-alcohol for pre-operative topical antisepsis.

  6. Aqueous Chlorhexidine for Intravitreal Injection Antisepsis: A Case Series and Review of the Literature.

    Science.gov (United States)

    Merani, Rohan; McPherson, Zachary E; Luckie, Alan P; Gilhotra, Jagjit S; Runciman, Jim; Durkin, Shane; Muecke, James; Donaldson, Mark; Aralar, Albert; Rao, Anupam; Davies, Peter E

    2016-12-01

    To determine the incidence of endophthalmitis in a large clinical series using aqueous chlorhexidine for antisepsis before intravitreal injection and to review the ophthalmic literature regarding chlorhexidine efficacy and safety. Multicenter retrospective case series. All patients receiving intravitreal injections from 7 retinal specialists. An audit of intravitreal injections performed by retinal specialists who exclusively used aqueous chlorhexidine 0.05% or 0.1% for prophylaxis of infective endophthalmitis was undertaken. The incidence of endophthalmitis was determined from August 1, 2011, to February 28, 2015. A literature review was performed to critically appraise the ocular safety and efficacy of aqueous chlorhexidine. Incidence of endophthalmitis after intravitreal injections. A total of 40 535 intravitreal injections were performed by 7 retinal specialists across 3 centers. Chlorhexidine was well tolerated, and only 1 patient with a suspected allergic reaction was noted. Three cases of endophthalmitis were identified with 1 culture-positive case. The 0.0074% (1 in 13 512) per-injection rate of endophthalmitis in this series compares favorably with previous series in which povidone-iodine has been used. Aqueous chlorhexidine was associated with a low rate of postinjection endophthalmitis and was well tolerated by patients. Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  7. Systematic Review and Cost Analysis Comparing Use of Chlorhexidine with Use of Iodine for Preoperative Skin Antisepsis to Prevent Surgical Site Infection

    Science.gov (United States)

    Lee, Ingi; Agarwal, Rajender K.; Lee, Bruce Y.; Fishman, Neil O.; Umscheid, Craig A.

    2013-01-01

    Objective To compare use of chlorhexidine with use of iodine for preoperative skin antisepsis with respect to effectiveness in preventing surgical site infections (SSIs) and cost. Methods We searched the Agency for Healthcare Research and Quality website, the Cochrane Library, Medline, and EMBASE up to January 2010 for eligible studies. Included studies were systematic reviews, meta-analyses, or randomized controlled trials (RCTs) comparing preoperative skin antisepsis with chlorhexidine and with iodine and assessing for the outcomes of SSI or positive skin culture result after application. One reviewer extracted data and assessed individual study quality, quality of evidence for each outcome, and publication bias. Meta-analyses were performed using a fixed-effects model. Using results from the meta-analysis and cost data from the Hospital of the University of Pennsylvania, we developed a decision analytic cost-benefit model to compare the economic value, from the hospital perspective, of antisepsis with iodine versus antisepsis with 2 preparations of chlorhexidine (ie, 4% chlorhexidine bottle and single-use applicators of a 2% chlorhexidine gluconate [CHG] and 70% isopropyl alcohol [IPA] solution), and also performed sensitivity analyses. Results Nine RCTs with a total of 3,614 patients were included in the meta-analysis. Meta-analysis revealed that chlorhexidine antisepsis was associated with significantly fewer SSIs (adjusted risk ratio, 0.64 [95% confidence interval, [0.51–0.80]) and positive skin culture results (adjusted risk ratio, 0.44 [95% confidence interval, 0.35–0.56]) than was iodine antisepsis. In the cost-benefit model baseline scenario, switching from iodine to chlorhexidine resulted in a net cost savings of $16–$26 per surgical case and $349,904–$568,594 per year for the Hospital of the University of Pennsylvania. Sensitivity analyses showed that net cost savings persisted under most circumstances. Conclusions Preoperative skin antisepsis

  8. Absorption and Tolerability of Aqueous Chlorhexidine Gluconate Used for Skin Antisepsis Prior to Catheter Insertion in Preterm Neonates

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    Chapman, Alison K.; Aucott, Susan W.; Gilmore, Maureen M.; Advani, Sonali; Clarke, William; Milstone, Aaron M.

    2013-01-01

    Objective To assess chlorhexidine absorption and skin tolerability in premature infants following skin antisepsis with 2% aqueous chlorhexidine gluconate (CHG) prior to peripherally inserted central catheter (PICC) placement. Study Design Neonates less than 32 weeks gestation had skin cleansed with CHG prior to PICC placement. CHG concentrations were measured on serial blood samples. Skin integrity was evaluated for 2 weeks after CHG exposure. Results Twenty infants were enrolled; median gestational age 28 2/7 weeks (range 24 3/7–31 4/7). Ten infants had detectable serum chlorhexidine concentrations (range 1.6–206 ng/ml). Seven of these infants had their highest serum concentration 2 to 3 days following exposure. No CHG-related skin irritation occurred in any infant. Conclusion CHG was detected in the blood of preterm infants receiving CHG skin antisepsis for PICC insertion. Highest serum concentrations occurred 2 to 3 days after exposure. Further investigation is needed to determine the clinical relevance of CHG absorption in preterm infants. PMID:23702618

  9. Chlorhexidine-Alcohol Compared With Povidone-Iodine for Preoperative Topical Antisepsis for Abdominal Hysterectomy.

    Science.gov (United States)

    Uppal, Shitanshu; Bazzi, Ali; Reynolds, R Kevin; Harris, John; Pearlman, Mark D; Campbell, Darrell A; Morgan, Daniel M

    2017-08-01

    (Pchlorhexidine-alcohol-based skin antisepsis is associated with overall lower odds of surgical site infection compared with povidone-iodine.

  10. Beyond antisepsis: Examining the relevance of the works of Joseph Baron Lister to the contemporary surgeon-scientist

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    Graeme E Glass

    2014-01-01

    Full Text Available As the father of antispesis, the legacy of Joseph Baron Lister is assured and his influence on the development of contemporary surgical practice is recognised in the context of his achievement of predictable, infection-free surgery. However, looking beyond Lister′s finest achievement and examining this work in the context of his whole career as a surgeon-scientist reveals important lessons pertinent to aspiring peers in how, by replacing surgical dogma with observation, deductive reasoning and scientific verification, by pursuing good ideas in the face of resistance and by making research directly relevant and patient-focused, lasting changes can be accomplished. This short paper aims to put Lister′s developments in antisepsis in the context of his whole career, to evaluate his legacy and to commend his approach to contemporary surgeon-scientists.

  11. Beyond antisepsis: Examining the relevance of the works of Joseph Baron Lister to the contemporary surgeon-scientist.

    Science.gov (United States)

    Glass, Graeme E

    2014-01-01

    As the father of antispesis, the legacy of Joseph Baron Lister is assured and his influence on the development of contemporary surgical practice is recognised in the context of his achievement of predictable, infection-free surgery. However, looking beyond Lister's finest achievement and examining this work in the context of his whole career as a surgeon-scientist reveals important lessons pertinent to aspiring peers in how, by replacing surgical dogma with observation, deductive reasoning and scientific verification, by pursuing good ideas in the face of resistance and by making research directly relevant and patient-focused, lasting changes can be accomplished. This short paper aims to put Lister's developments in antisepsis in the context of his whole career, to evaluate his legacy and to commend his approach to contemporary surgeon-scientists.

  12. Ethanol and ethyl glucuronide urine concentrations after ethanol-based hand antisepsis with and without permitted alcohol consumption.

    Science.gov (United States)

    Gessner, Stephan; Below, Elke; Diedrich, Stephan; Wegner, Christian; Gessner, Wiebke; Kohlmann, Thomas; Heidecke, Claus-Dieter; Bockholdt, Britta; Kramer, Axel; Assadian, Ojan; Below, Harald

    2016-09-01

    During hand antisepsis, health care workers (HCWs) are exposed to alcohol by dermal contact and by inhalation. Concerns have been raised that high alcohol absorptions may adversely affect HCWs, particularly certain vulnerable individuals such as pregnant women or individuals with genetic deficiencies of aldehyde dehydrogenase. We investigated the kinetics of HCWs' urinary concentrations of ethanol and its metabolite ethyl glucuronide (EtG) during clinical work with and without previous consumption of alcoholic beverages by HCWs. The median ethanol concentration was 0.7 mg/L (interquartile range [IQR], 0.5-1.9 mg/L; maximum, 9.2 mg/L) during abstinence and 12.2 mg/L (IQR, 1.5-139.6 mg/L; maximum, 1,020.1 mg/L) during alcohol consumption. During abstinence, EtG reached concentrations of up to 958 ng/mL. When alcohol consumption was permitted, the median EtG concentration of all samples was 2,593 ng/mL (IQR, 890.8-3,576 ng/mL; maximum, 5,043 ng/mL). Although alcohol consumption was strongly correlated with both EtG and ethanol in urine, no significant correlation for the frequency of alcoholic hand antisepsis was observed in the linear mixed models. The use of ethanol-based handrub induces measurable ethanol and EtG concentrations in urine. Compared with consumption of alcoholic beverages or use of consumer products containing ethanol, the amount of ethanol absorption resulting from handrub applications is negligible. In practice, there is no evidence of any harmful effect of using ethanol-based handrubs as much as it is clinically necessary. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  13. USE OF HYDROALCOHOLIC EXTRACT OF Schinus terebinthifolius Raddi IN PRE- AND POST-MILKING ANTISEPSIS OF THE TEAT IN DAIRY COWS

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    Ângela Faccin

    2016-01-01

    Full Text Available Medicinal plants have been used for centuries as an alternative treatment for health problems. Schinus terebinthifolius Raddi is a median tree that belongs to the Anacardiaceae family. The antibacterial effect of leaves extract of this plant has already been demonstrated. The objective of this study was to test a substance derived from this plant to be used in pre- and post-milking teat antisepsis. The hydroalcoholic extract of Brazilian pepper tree was used in opposite quarters for twelve consecutive weeks, and commercial iodine was used as control. None of the indices analyzed – black background mug, CMT, intramammary infections, skin health, and teat health – showed a statistical difference between the treatments, suggesting that the plant extract can be used in pre- and post-milking teat antisepsis, as a substitute for conventional products for herds in an agroecological production system.

  14. Antimicrobial efficacy of preoperative skin antisepsis and clonal relationship to postantiseptic skin-and-wound flora in patients undergoing clean orthopedic surgery.

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    Daeschlein, G; Napp, M; Layer, F; von Podewils, S; Haase, H; Spitzmueller, R; Assadian, O; Kasch, R; Werner, G; Jünger, M; Hinz, P; Ekkernkamp, A

    2015-11-01

    Nosocomial surgical site infections (SSI) are still important complications in surgery. The underlying mechanisms are not fully understood. The aim of this study was to elucidate the possible role of skin flora surviving preoperative antisepsis as a possible cause of SSI. We conducted a two-phase prospective clinical trial in patients undergoing clean orthopedic surgery at a university trauma center in northern Germany. Quantitative swab samples were taken from pre- and postantiseptic skin and, additionally, from the wound base, wound margin, and the suture of 137 patients. Seventy-four patients during phase I and 63 during phase II were investigated. Microbial growth, species spectrum, and antibiotic susceptibility were analyzed. In phase two, the clonal relationship of strains was additionally analyzed. 18.0 % of the swab samples were positive for bacterial growth in the wound base, 24.5 % in the margin, and 27.3 % in the suture. Only 65.5 % of patients showed a 100 % reduction of the skin flora after antisepsis. The microbial spectrum in all postantiseptic samples was dominated by coagulase-negative staphylococci (CoNS). Clonally related staphylococci were detected in ten patients [nine CoNS, one methicillin-susceptible Staphylococcus aureus (MSSA)]. Six of ten patients were suspected of having transmitted identical clones from skin flora into the wound. Ethanol-based antisepsis results in unexpected high levels of skin flora, which can be transmitted into the wound during surgery causing yet unexplained SSI. Keeping with the concept of zero tolerance, further studies are needed in order to understand the origin of this flora to allow further reduction of SSI.

  15. A randomized open-label controlled trial of chlorhexidine-alcohol vs povidone-iodine for cesarean antisepsis: the CAPICA trial.

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    Springel, Edward H; Wang, Xiao-Yu; Sarfoh, Vanessa M; Stetzer, Bradley P; Weight, Steven A; Mercer, Brian M

    2017-10-01

    Identification of optimal surgical site antisepsis preparations may reduce cesarean-related surgical site infections. Two recently published investigations examined efficacy of chlorhexidine-alcohol and iodine-alcohol preparations. No previous randomized controlled trial has compared chlorhexidine-alcohol to povidone-iodine aqueous scrub and paint in reduction of cesarean-related surgical site infection. The purpose of the study was to determine if chlorhexidine-alcohol would result in fewer surgical site infections than povidone-iodine when used as skin antisepsis preparation prior to cesarean delivery. This study was a single-center pragmatic randomized controlled trial at an urban tertiary care institution to compare chlorhexidine-alcohol 26-mL single-step applicator to povidone-iodine aqueous scrub and paint 236-mL wet skin tray as preoperative skin antiseptic preparation for women undergoing cesarean delivery. Patients were eligible for study participation if they could provide informed consent in English or Spanish, were ≥18 years of age, did not have clinical chorioamnionitis, were unlikely to be lost to follow-up, and had no sensitivities to chlorhexidine, betadine, or iodine. Treatment was assigned by computer-generated simple 1:1 randomization immediately before skin preparation. The primary outcome was surgical site infection occurring within 30 days of cesarean delivery including ≥1 of: superficial or deep surgical site infection, or endometritis, according to Centers for Disease Control and Prevention definitions. Analysis was by intent to treat. Categorical outcomes were compared using Fisher exact test. The Wilcoxon rank-sum test was performed for continuous outcomes. This trial was institutional review board approved and registered at ClinicalTrials.gov (NCT02202577). In all, 932 subjects (461 assigned to chlorhexidine-alcohol, 471 assigned to povidone-iodine) were randomized from February 2013 through May 2016. Rate of follow-up evaluation

  16. Skin antisepsis with 0.05% sodium hypochlorite before central venous catheter insertion in neonates: A 2-year single-center experience.

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    Ciccia, Matilde; Chakrokh, Roksana; Molinazzi, Dario; Zanni, Angela; Farruggia, Patrizia; Sandri, Fabrizio

    2018-02-01

    The study reports a 2-year single-center experience of the practice of skin antisepsis using a 0.05% sodium hypochlorite solution before central venous catheter placement in neonates. Eligible subjects included any hospitalized neonate who needed a central line for at least 48 hours. Infants were excluded if they had a generalized or localized skin disorder. An ad hoc Excel (Microsoft Corp, Redmond, WA) file was used to record the data from each patient. The catheter sites were monitored daily for the presence of contact dermatitis. Central line-associated bloodstream infection was diagnosed according to Centers for Disease Control and Prevention definition. One hundred five infants underwent central venous catheter placement and were enrolled. A total of 198 central lines were inserted. The median gestational age was 31 weeks (range, 23-41 weeks) and median birth weight was 1,420 g (range, 500-5,170 g). There were no signs of 0.05% sodium hypochlorite-related skin toxicity in any infant. Of 198 catheters (1,652 catheter-days) prospectively studied, 9 were associated with bloodstream infections (5.4 per 1,000 catheter-days). During the observation period, no local adverse effects were observed suggesting that 0.05% sodium hypochlorite may be a safe choice in this context. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  17. La desinfección-antisepsia y esterilización en la atención primaria de salud: Laboratorios Desinfection-antisepsis and sterilization in primay health care: Laboratories

    OpenAIRE

    Abilio Ubaldo Rodríguez Pérez

    2006-01-01

    La desinfección-antisepsia y esterilización son procedimientos que se utilizan como elementos de ruptura de la cadena de transmisión de microorganismos, evitando posibles contaminaciones a nivel de laboratorios para el nivel primario de asistencia médica, por lo que es nuestro objetivo describirlos en el presente trabajo y establecer una política en este sentido.Desinfection-antisepsis and sterilization are procedures that are used as elements to break up the microorganisms transmission chain...

  18. La desinfección-antisepsia y esterilización en la atención primaria de salud: Laboratorios Desinfection-antisepsis and sterilization in primay health care: Laboratories

    Directory of Open Access Journals (Sweden)

    Abilio Ubaldo Rodríguez Pérez

    2006-09-01

    Full Text Available La desinfección-antisepsia y esterilización son procedimientos que se utilizan como elementos de ruptura de la cadena de transmisión de microorganismos, evitando posibles contaminaciones a nivel de laboratorios para el nivel primario de asistencia médica, por lo que es nuestro objetivo describirlos en el presente trabajo y establecer una política en este sentido.Desinfection-antisepsis and sterilization are procedures that are used as elements to break up the microorganisms transmission chain, preventing possible contaminations in the laboratories at the primary health care level. It is our objective to describe them and to establish a policy in this sense.

  19. The role of heat-tolerant endotoxin-retentive ultrafilters (UFs) for the remediation of reverse osmosis (RO) plants employed for surgical hand antisepsis using periodic thermal disinfection -A ten-year longitudinal experience study in the operating theater.

    Science.gov (United States)

    Uetera, Yushi; Yasuhara, Hiroshi; Kumada, Naohito; Misawa, Yoshiki; Terada, Yoshiyuki; Satou, Yoshio; Suhara, Tamaki; Kawamura, Kunio

    2018-03-15

    Recently, the use of filters has come into light for sanitizing water plants. This study investigated the role of heat-tolerant ultrafilters (UFs) for the remediation of reverse osmosis (RO) plants using periodic thermal disinfection. Two completely identical RO plants (RO plants A & B) were installed in 2006 for surgical hand antisepsis in the operating theater. RO water was stored in the 300-liter storage tank and re-circulated in the 190 meter-long loop delivering water to 12 faucets in each RO plant. Periodic thermal disinfection has come into practice since a UF module was retrofitted to the recirculation loop of each RO plant in 2010. Endotoxin was monitored closely before and after thermal disinfection. Before UF modules were retrofitted, endotoxin increased to a maximum of 0.301 EU/ml in the RO plant A and 1.446 EU/ml in the RO plant B after thermal disinfection, respectively. Since a UF module was retrofitted to each RO plant in 2010, endotoxin has been continuously below 0.025 EU/ml in the RO plant A and exceeded this level five times in the RO plant B. On one occasion, endotoxin increased in all samples collected simultaneously after solenoid valves were replaced in the recirculation loop near the air conditioner outlet. At this time, the inside of pipework was exposed to the ventilation airflow. After the valves were replaced again with the work place isolated using a curing sheet, endotoxin decreased. On the other occasions, endotoxin increased only in one sample and decreased after thermal disinfection. Annually replaced UF modules were examined twice for estimating the amounts of immobilized endotoxin. The estimated amounts decreased in 2013 by the order of 10-3 in comparison with those in 2011 in both RO plants. The present study suggested that UFs acted synergistically with periodic thermal disinfection for the remediation of RO plants. Copyright © 2018, Parenteral Drug Association.

  20. Polivinilpirrolidona-iodo (PVP-I em base aquosa na antissepsia de campo operatório oftálmico de cães Water-soluble polyvinylpyrrolidone-iodine (PVP-I on concentrations of 0.1% and 0.5% in antisepsis of dogs ophthalmic surgery

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    Priscilla Santos Bagbed Pithon

    2010-12-01

    Full Text Available Com o presente trabalho, objetivou-se comparar o efeito bactericida do polivinilpirrolidona-iodo nas concentrações a 0,1% e 0,5% sobre a antissepsia do campo operatório oftálmico de cães. Foram utilizados 20 cães e soluções em concentrações diferentes para cada olho. No olho direito, utilizou-se solução de polivinilpirrolidona-iodo a 0,1% e no olho esquerdo a 0,5%. A colheita da amostra conjuntival de ambos os grupos foi realizada antes da antissepsia (0, após 30 minutos (1, 1,5 horas (2 e 2,5 horas (3 da irrigação e limpeza. Foi identificado crescimento bacteriano em 70% das amostras oculares colhidas antes da antissepsia. Os agentes bacterianos encontrados nos diferentes tempos de colheita foram Staphylococcus intermedis, Staphylococcus aureus, Staphylococcus sp., Staphylococcus epidermidis, Bacillus sp., Difteróide, Enterobacter sp., Micrococcus sp. A solução de polivinilpirrolidona-iodo a 0,1% diminuiu em 64% e 50% o crescimento de bactérias após 30min (1 e 90min da antissepsia (2, respectivamente. Enquanto a concentração 0,5% reduziu em 86%, houve crescimento bacteriano de 71%, o que indicou um maior poder inibitório sobre o crescimento bacteriano. Dessa maneira, a solução de polivinilpirrolidona-iodo a 0,5%, em relação à solução a 0,1%, mostrou-se mais eficaz na redução da microbiota conjuntival até 90min após a antissepsia.The objective of this study was to compare the bactericide effect of polyvinylpyrrolidone-iodine at concentrations of 0.1% and 0.5% on antisepsis of dog ophthalmic region. Solutions with different concentrations were used on each eye of twenty dogs. On the right eye, the 0.1% solution was administered and, on the left eye, the 0.5% solution. Conjunctival sampling of both groups was performed before antisepsis (0, after 30 minutes (1, 1.5h (2 and 2.5h (3 of irrigation and cleaning. Bacterial growth was identified in 70% of ocular sample collected before the antisepsis. The bacterial

  1. Revisão sistemática sobre antissepsia cirúrgica das mãos com preparação alcoólica em comparação aos produtos tradicionais Revisión sistemática sobre antisepsia quirúrgica de manos con preparación alcohólica comparada a productos tradicionales A systematic review of surgical hand antisepsis utilizing an alcohol preparation compared to traditional products

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    Karen de Jesus Gonçalves

    2012-12-01

    soporte a la seguridad de las preparaciones alcohólicas para la antisepsia quirúrgica de las manos.Surgical hand antisepsis aims at preventing surgical site infections, an important cause of postoperative morbidity and mortality and escalating hospital costs. The objectives of this study were to compare the efficacy of alcohol preparations with traditional surgical hand antisepsis products by means of a systematic review of the literature. Primary and secondary studies were included, considering the microbial count or surgical site infection rates as outcomes. The search was performed on the BVS Portal, PubMed, Ask and MEDLINE. Twenty-five studies were selected (two systematic reviews, nineteen experimental and four cohort studies. The alcohol preparations promoted a microbial reduction equal to and/or greater than traditional products in 17 studies, and a lesser reduction in four studies; similar surgical site infection rates were identified. Therefore, there is scientific evidence that support the safety of alcohol preparations for surgical hand antisepsis.

  2. Effect of biomechanical preparation and calcium hydroxide pastes on the antisepsis of root canal systems in dogs Ação do preparo biomecânico e de pastas à base de hidróxido de cálcio na anti-sepsia do sistema de canais radiculares de cães

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    Janir Alves Soares

    2005-03-01

    Full Text Available In the endodontic treatment of root canals with necrotic pulps associated with periapical radiolucent areas, one of the main objectives of treatment consists in eliminating the microorganisms spread throughout the ramifications of the root canal system. The scope of this study was to evaluate the antiseptic efficacy of biomechanical preparation and two calcium hydroxide-based pastes, in dogs' teeth with experimentally induced chronic periapical lesions. After initial microbiological sampling, instrumentation of the root canals was undertaken using the conventional technique, using K type files used in conjunction with a solution of 5.25% sodium hypochlorite. After ninety-six hours, further microbiological sampling was undertaken and Calen/CPMC or Calasept pastes were applied for 15 and 30 days. Ninety six hours after the removal of the medication, the third microbiological sampling was undertaken and finally histomicrobiological analysis followed using Brown & Brenn staining. The results were analyzed using the Kruskall-Wallis test, with a level of significance established at 5% (p0.05, characterized by an elevated incidence of cocci, bacilli and filaments, predominantly gram-positive, in root canals, secondary canals and accessories, apical cementoplasts and dentinal tubules, but with a low incidence of microorganisms in areas of cementum resorption and the periapical lesion. The biomechanical preparation and intracanal dressing based on calcium hydroxide were important in the antisepsis of the root canal; however, both procedures did not produce significant changes in the microbiological aspects of the root canal system.No tratamento endodôntico dos canais radiculares com polpa necrótica associados à áreas radiolúcidas periapicais, um dos principais objetivos consiste em eliminar os microrganismos situados em todo o sistema de ramificações. Por conseguinte, o objetivo deste estudo foi avaliar a eficácia anti-séptica do preparo

  3. Effect of rotary instrumentation and of the association of calcium hydroxide and chlorhexidine on the antisepsis of the root canal system in dogs Efeito da instrumentação automatizada e da associação hidróxido de cálcio e clorexidina na anti-sepsia de canais radiculares de cães

    Directory of Open Access Journals (Sweden)

    Janir Alves Soares

    2006-04-01

    Full Text Available This study aimed at evaluating the antisepsis of the root canal system (RCS and periapical region (PR provided by rotary instrumentation associated with chlorhexidine + calcium hydroxide as intracanal medicament. Chronic periapical lesions were induced in 26 pre-molar roots in two dogs. After microbiological sampling, automatic instrumentation using the Profile system and irrigation with 5.25% sodium hypochlorite solution, with a final rinse of 14.3% EDTA followed by profuse irrigation with physiological saline were carried out in 18 root canals. After drying the canals, a paste based on calcium hydroxide associated with a 2% chlorhexidine digluconate solution was placed inside them. After 21 days, the medication was removed, leaving the root canals empty and coronally sealed. After 96 hours, a final microbiological sample was obtained, followed by histomicrobiological processing by the Brown & Brenn method. Eight untreated root canals represented the control group (C-G. Based on the Mann-Whitney test at a confidence level of 5% (p Este estudo objetivou avaliar a anti-sepsia do sistema de canais radiculares (SCR e da região periapical (RP proporcionada pela instrumentação automatizada associada a medicação intracanal à base de hidróxido de cálcio + clorexidina. Lesões periapicais crônicas foram induzidas em 26 raízes de pré-molares de dois cães. Após amostragem microbiológica, procedeu-se à instrumentação automatizada de 18 canais radiculares (CR utilizando-se o sistema Profile e a solução de hipoclorito de sódio a 5,25%, com irrigação final com EDTA a 14,3%, seguida de irrigação profusa com soro fisiológico. Após se secarem os canais, foi colocada em seu interior uma pasta à base de hidróxido de cálcio P.A. associada à solução de digluconato de clorexidina a 2%. Transcorridos 21 dias, removeu-se a medicação, deixando-se os CR vazios e selados coronariamente. Após 96 horas, obteve-se a amostra microbiol

  4. Antisepsis with Argyrol, acrimony and advocacy for African art ...

    African Journals Online (AJOL)

    Despite lack of evidence regarding its antiseptic superiority over silver nitrate for preventing ophthalmia neonatorum, Argyrol was promoted so savvily by Albert Coombs Barnes that the revenues enabled him to amass a unique art collection reflecting his early appreciation of the African influence on European painters.

  5. Antisepsis with argyrol, acrimony and advocacy for African art.

    Science.gov (United States)

    Edouard, Lindsay

    2011-09-01

    Despite lack of evidence regarding its antiseptic superiority over silver nitrate for preventing ophthalmia neonatorum, Argyrol was promoted so savvily by Albert Coombs Barnes that the revenues enabled him to amass a unique art collection reflecting his early appreciation of the African influence on European painters. He addressed social disparities specially through access for disadvantaged individuals to his iconoclastic foundation and collaboration with a local African-American university. Legal wrangling over complex management issues and distinctive display arrangements, led to fiscal anguish, cultural torment and local affliction over that trove which is currently relocating to downtown Philadelphia.

  6. Antisepsis with Argyrol, Acrimony and Advocacy for African Art

    African Journals Online (AJOL)

    Erah

    Despite lack of evidence regarding its antiseptic superiority over silver nitrate for preventing ophthalmia neonatorum, Argyrol was promoted so savvily by Albert Coombs Barnes that the revenues enabled him to amass a unique art collection reflecting his early appreciation of the African influence on European painters.

  7. Antisepsis with Argyrol, Acrimony and Advocacy for African Art

    African Journals Online (AJOL)

    Erah

    most unconventionally, (c) investing his resulting substantial profits, as a bold and innovative collector, in impressionism art though it was not well appreciated at the time and (d) selling his pharmaceutical company to the Zonite Products. Corporation in July 1929 when the stock market was at a record high. When the stock ...

  8. Bundled preparation of skin antisepsis decreases the risk of cardiac implantable electronic device-related infection.

    Science.gov (United States)

    Chen, Huang-Chung; Chen, Mien-Cheng; Chen, Yung-Lung; Tsai, Tzu-Hsien; Pan, Kuo-Li; Lin, Yu-Sheng

    2016-06-01

    To evaluate the efficacy of bundled skin antiseptic preparation to prevent cardiac implantable electronic device (CIED) infections. From January 2010 to November 2013, 665 consecutive patients were divided into two groups according to the strategy of skin preparation. In Period 1 (January 2010 to June 2012), 395 patients received the standard skin antiseptic preparation. In Period 2 (July 2012 to November 2013), 270 patients received a triple-step skin antiseptic preparation, 'bundled skin antiseptic preparation', consisting of applying 75% alcohol over anterior chest on the night before the index day, povidone-iodine 10 min before operation, and the standard skin antiseptic preparation before incision. During follow-up, the occurrence of CIED infection was recorded. Multiple logistic regression analysis was used to determinate the risk factors of CIED infection. During a mean follow-up of 26.9 ± 16.2 months, 20 episodes of CIED infection developed in 19 patients (2.9%), and the incidence of minor and major infection episodes was 2.2% and 0.8%, respectively. Patients with the bundled skin antiseptic preparation had a significantly lower incidence of CIED infection, compared with patients with the standard preparation (0.7 vs. 4.3%, P = 0.007). In multivariate analysis, pocket haematoma (P = 0.020), atrial fibrillation (P = 0.033), and complex procedures (P = 0.047) were independent predictors for CIED infection. In contrast, the bundled skin antiseptic preparation was a significant predictor against CIED infection (P = 0.014). Pocket haematoma was the most important risk factor for CIED infection. The bundled skin antiseptic preparation strategy significantly reduced the risk of minor CIED infection. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  9. Cohort study of adherence to correct hand antisepsis before and after performance of clinical procedures

    DEFF Research Database (Denmark)

    Laustsen, Sussie; Lund, Elisabeth; Bibby, Bo Martin

    2009-01-01

    -based hand rub before performance (odds ratio [OR] 1.51 [95% confidence interval {CI}, 1.09-2.10]) and after performance (OR, 1.73 [95% CI, 1.27-2.36]) of clinical procedures. In general, the rate of adherence was significantly higher after the performance of clinical procedures, compared with before (OR, 1......OBJECTIVE: To investigate the rate of adherence by hospital staff members to the correct use of alcohol-based hand rub before and after performance of clinical procedures. DESIGN: A cohort study conducted during the period from 2006 through 2007 and 2 cross-sectional studies conducted in 2006...... and after performance of a clinical procedure. RESULTS: A total of 496 participants were observed during 22,906 opportunities for hand hygiene (ie, 11,177 before and 11,729 after clinical procedures) that required the use of alcohol-based hand rub. The overall rates of adherence to the correct use...

  10. Chlorhexidine-alcohol compared with povidone-iodine for surgical-site antisepsis in cesarean deliveries.

    Science.gov (United States)

    Menderes, Gulden; Athar Ali, Nishath; Aagaard, Kjersti; Sangi-Haghpeykar, Haleh

    2012-11-01

    To estimate the incidence of surgical-site infection with use of chlorhexidine-alcohol compared with povidone-iodine among women undergoing cesarean deliveries. This was a retrospective cohort review of 1,000 consecutive cases in women who underwent cesarean delivery over a 1-year interval. The primary outcome was any surgical-site infection within 30 days (Centers for Disease Control and Prevention criterion). Mean age and parity were equivalent (29.8±5.9 years; 2.6±1.4). Women were similar regarding baseline characteristics, including acknowledged surgical-site infection comorbidities (body mass index [BMI, calculated as weight (kg)/[height (m)]2], gestational diabetes, smoking; P>.05). Method of skin incision closure was different, with 91% among povidine-iodine compared with 81% among chlorhexidine-alcohol using staples (Pcesarean delivery (29% compared with 46%; Pinfection, the overall rate was similar between the two groups (5% [n=25] chlorhexidine and 5.8% [n=29] povidone-iodine; P=.58). In multivariable analysis and after control for potential confounders, odds for surgical-site infection remained similar between the two groups (adjusted odds ratio 0.74, 95% confidence interval 0.41-1.33; P=.32). The only significant predictor of surgical-site infection was duration of cesarean delivery, in which every 1-minute increase in duration increased the odds for infection by 1.3% (adjusted odds ratio 1.013, 95% CI 1.004-1.022; P=.004). The single significant predictor of surgical-site infection is operative time. Cleansing with povidone-iodine may be a cost-effective and equally efficacious alternative to chlorhexidine-alcohol among women undergoing cesarean deliveries. II.

  11. Pre-Operative Skin Antisepsis with Chlorhexidine Gluconate and Povidone-Iodine to Prevent Port-Site Infection in Laparoscopic Cholecystectomy: A Prospective Study.

    Science.gov (United States)

    Spaziani, Erasmo; Di Filippo, Annalisa; Orelli, Simone; Fiorini, Flavia; Spaziani, Martina; Tintisona, Orlando; Torcasio, Angelo; De Cesare, Alessandro; Picchio, Marcello

    2018-04-01

    Skin preparation with antiseptic agents is commonly recommended for incisional site cleansing before surgery. We present the result of a prospective case series submitted to a scheduled pre-operative antiseptic procedure combining chlorhexidine gluconate and povidone-iodine before elective laparoscopic cholecystectomy. Consecutive patients underwent pre-operative standardized cleansing of the operation site combining chlorhexidine gluconate and povidone-iodine. Patients were reviewed one week and four weeks post-operatively. Post-operative infection was observed in seven patients (4.3%). All observed infections were port-site infections, always located at the level of the umbilical incision. In all cases infections involved skin and subcutaneous tissue. Staphylococcus aureus was isolated in five patients (71.4%) and miscellaneous aerobic gram-positive bacteria in two subjects (28.6%). Post-operative hospital stay was the only factor significantly associated with the development of port-site infections. Port-site infections are a common complication after elective laparoscopic cholecystectomy. The proposed pre-operative disinfection procedure is effective in reducing port-site infections. Reducing hospital stay may contribute to limiting the occurrence of this complication.

  12. Improved methods for thermal rearrangement of alicyclic α-hydroxyimines to α-aminoketones: synthesis of ketamine analogues as antisepsis candidates.

    Science.gov (United States)

    Elhawi, Hagit; Eini, Hadar; Douvdevani, Amos; Byk, Gerardo

    2012-06-04

    Ketamine is an analgesic/anesthetic drug, which, in combination with other drugs, has been used as anesthetic for over 40 years. Ketamine induces its analgesic activities by blocking the N-methyl-D-aspartate (NMDA) receptor in the central nervous system (CNS). We have reported that low doses of ketamine administrated to patients before incision significantly reduced post-operative inflammation as reflected by reduced interleukin-6 (IL-6) sera-levels. Our data demonstrated in a rat model of Gram-negative bacterial-sepsis that if we inject a low dose of ketamine following bacterial inoculation we reduce mortality from approximately 75% to 25%. Similar to what we have observed in operated patients, the levels of TNF-α and IL-6 in ketamine-treated rats were significantly lower than in septic animals not treated with ketamine. On the base of these results, we have designed and synthesized series of new analogues of ketamine applying a thermal rearrangement of alicyclic α-hydroxyimines to a-aminoketones in parallel arrays. One of the analogues (compound 6e) displayed high activity in down-regulating the levels of IL-6 and TNF-α in vivo as compared to ketamine.

  13. Improved Methods for Thermal Rearrangement of Alicyclic α-Hydroxyimines to α-Aminoketones: Synthesis of Ketamine Analogues as Antisepsis Candidates

    Directory of Open Access Journals (Sweden)

    Gerardo Byk

    2012-06-01

    Full Text Available Ketamine is an analgesic/anesthetic drug, which, in combination with other drugs, has been used as anesthetic for over 40 years. Ketamine induces its analgesic activities by blocking the N-methyl-D-aspartate (NMDA receptor in the central nervous system (CNS. We have reported that low doses of ketamine administrated to patients before incision significantly reduced post-operative inflammation as reflected by reduced interleukin-6 (IL-6 sera-levels. Our data demonstrated in a rat model of Gram-negative bacterial-sepsis that if we inject a low dose of ketamine following bacterial inoculation we reduce mortality from approximately 75% to 25%. Similar to what we have observed in operated patients, the levels of TNF-α and IL-6 in ketamine-treated rats were significantly lower than in septic animals not treated with ketamine. On the base of these results, we have designed and synthesized series of new analogues of ketamine applying a thermal rearrangement of alicyclic α-hydroxyimines to a-aminoketones in parallel arrays. One of the analogues (compound 6e displayed high activity in down-regulating the levels of IL-6 and TNF-α in vivo as compared to ketamine.

  14. La desinfección-antisepsia y esterilización en instituciones de salud: Atención primaria Disinfection-antisepsis and sterilization in health centers: Primary health care

    OpenAIRE

    Abilio Ubaldo Rodríguez Pérez

    2006-01-01

    La infección como enfermedad de interés clínico-epidemiológico a nivel primario de salud trae como consecuencia un impacto humano-económico-social por la morbimortalidad que condiciona, por lo que se hace necesario un sistema de vigilancia para su prevención y control. En el presente trabajo se describen los procedimientos de desinfección-antisepsia y esterilización para este nivel de asistencia médica, como elementos de ruptura de la cadena de transmisión, haciéndose recomendaciones para est...

  15. Mammalian Toxicology Testing: Problem Definition Study, Global Army Toxicology Requirements.

    Science.gov (United States)

    1981-03-01

    antisepsis, anesthesia properties) Artifical Skin and Contouring Material Esophageal/Tracheal Transplant Materials Microencapsulated Antibiotics...Devices Dental Devices Dental Diseases Dental Materiels Biocompatible Tooth Implants Artificial Bone Implant Materials Beryliumin Castings Beryliumin...biocompatible, with nemostasis, antisepsis, anesthesia properties) Artifical Skin and Contouring Material Esophageal/Tracheal Transplant Materials

  16. Antimycobacterial activity assessment of three ethnobotanical plants against Mycobacterium Tuberculosis: An In Vitro study

    Directory of Open Access Journals (Sweden)

    Mohammad Arjomandzadegan

    2016-01-01

    Conclusion: The results give some scientific basis to the use of plant extracts for growth control of MTB cells. Clinical trials are recommended for assessment of the extract as complementary medicine, as well as for antisepsis.

  17. 杨梅叶水溶性提取物的抗氧化、抗菌活性与防腐应用

    Czech Academy of Sciences Publication Activity Database

    君酸, 杨.; 云酸, 朱.; 清酸, 吴.; 洁酸, 尹.; Langhansová, Lenka; Vaněk, Tomáš; 生酸, 高.

    2014-01-01

    Roč. 28, č. 2 (2014), s. 198-202 ISSN 1006-2513 Institutional support: RVO:61389030 Keywords : Myrica rubra leaf * antioxidation * antisepsis Subject RIV: EF - Botanics http://d.g.wanfangdata.com.cn/Periodical_zgsptjj201402029.aspx

  18. Prospective evaluation of 2% (w/v alcoholic chlorhexidine gluconate as an antiseptic agent for blood donor arm preparation

    Directory of Open Access Journals (Sweden)

    Sweta Shah

    2014-01-01

    Full Text Available Aim: A prospective study was undertaken to evaluate the use of 2% (w/v alcoholic chlorhexidine gluconate (2% AlcCHG in donor arm preparation, to monitor the contamination rate of blood products after the collection and to find incidence of transfusion associated bacteremia. Settings and Design: Optimal skin antisepsis of the phlebotomy site is essential to minimize the risk of contamination. Food and Drug Administration (FDA in India has recommended antisepsis with three-step regimen of spirit-10% povidone iodine-spirit for donor arm antisepsis, but not with chlorhexidine, which is recommended by many other authors. Material and Methods: A total of 795 donors were studied from July 2011 to January 2012. Spirit-10% povidone iodine-spirit was used for 398 donors and 2% AlcCHG was used for 397 donors with the two-step method for arm antisepsis. Swabs were collected before and after use of antiseptic agents for all the donors. All the blood products collected from donors with growth in post-antisepsis swabs were cultured. A total of 123 various blood products were cultured irrespective of the method and result of antisepsis was observed. A total of seven patients had mild transfusion reaction. The transfused blood products, blood and urine specimen of the patients who had transfusion reaction were also cultured. Results: Seven donors out of 398 donors had growth in post-antisepsis swab with spirit-10% povidone iodine-spirit protocol and three donors out of 397 donors had growth in post-antisepsis swab with 2% AlcCHG protocol. All blood products collected from donors who had growth in post-antisepsis swabs when cultured had no growth. There was no contamination of blood products. Conclusions: Two percent (w/v alcoholic chlorhexidine gluconate with two-step protocol can be used as an antiseptic agent for donor arm preparation without considerable cost difference. It is at par with spirit 10% povidone iodine spirit protocol as suggested by FDA in India

  19. Optimal skin antiseptic agents for prevention of surgical site infection in cesarean section: a meta-analysis with trial sequential analysis.

    Science.gov (United States)

    Huang, Huaping; Li, Guirong; Wang, Haiyan; He, Mei

    2017-08-30

    The best choice of antiseptic agent for skin preparation at cesarean section remains controversial. We performed this meta-analysis to assess whether chlorhexidine (CH)-based skin antisepsis was more effective than povidone iodine (PI)-based antisepsis for the prevention of surgical site infection (SSI) after cesarean section. PubMed, EMBASE, and the Cochrane Library were systematically searched to identify English publications that compared chlorhexidine gluconate (CH) as a skin preparation agent with PI in cesarean section. The primary outcome was SSI rate. Review Manager 5.3 was used to analyze the collected data and trial sequential analysis (TSA) Software 0.9 (Cochrane Collaboration, Oxford, UK) beta was applied to estimate whether the overall pooled outcome was conclusive. Six articles involving 4385 participants were included in this study. The outcomes showed that CH-based skin antisepsis, compared with PI-based antisepsis, was not associated with a decreased overall rate of SSI (risk ratio [RR], 0.74; 95% confidence interval [CI], 0.54-1.02; p = .07). TSA indicated that the current available evidence was inconclusive. There were no differences in adverse skin reactions in the two groups. This study provides evidence that CH-based antisepsis for skin preparation does not show an additional advantage in reducing risk of SSI after cesarean section. However, additional high-quality, randomized clinical trials are needed to confirm these findings.

  20. How European centres diagnose, treat, and prevent CIED infections

    DEFF Research Database (Denmark)

    Bongiorni, Maria Grazia; Marinskis, Germanas; Lip, Gregory Y H

    2012-01-01

    kind of skin antisepsis, but only 42.2% use chlorhexidine. In case of local infection, 43.5% of centres perform lead extraction as first approach. In the case of systemic infection or evidence of lead or valvular endocarditis, 95% of centres treat these conditions by extracting the leads, which...

  1. Inspections of Hand Washing Supplies and Hand Sanitizer in Public Schools

    Science.gov (United States)

    Ramos, Mary M.; Blea, Mary; Trujillo, Rebecca; Greenberg, Cynthia

    2010-01-01

    Hand washing and hand antisepsis are proven infection control measures in the school setting, yet barriers such as lack of soap, paper towels, and hand sanitizer can hinder compliance. This pilot study measured the prevalence of hand cleaning supplies in public schools. Ten school districts (93 schools) participated in school nurse inspections. In…

  2. Prevention of perioperative wound infections | Buteera | East and ...

    African Journals Online (AJOL)

    Aiming at short preoperative stay in hospital, and pre-washing of the area concerned before cleaning with antiseptic are also imperative in reducing SSI. Preoperative skin preparation is an important element in prevention of infection, but removes only up to 80% of skin flora. Standard surgical antisepsis is an accepted ...

  3. Comparison of an alcohol-based hand sanitation product with a traditional chlorhexidine hand scrub technique for hand hygiene preparation in an equine hospital

    NARCIS (Netherlands)

    Edwards, R A; Riley, C B; Howe, L; Burrows, E A; Riley, K T; Frellstedt, L

    AIMS: To investigate the efficacy of an alcohol gel-based hand antisepsis protocol compared with a traditional chlorhexidine-based protocol under conditions of routine clinical contamination, and following heavy faecal contamination. METHODS: Twelve adult participants were recruited and on four

  4. Joseph Lister and his 1876 tour of America.

    Science.gov (United States)

    Rutkow, Ira

    2013-06-01

    To explore the events and people that shaped Joseph Lister's 1876 tour of America and how the journey became a landmark episode in the history of surgery. In a little known chapter in American medical history, Joseph Lister toured the United States in 1876 in an attempt to convince physicians that they should accept his ideas about surgical antisepsis. His 2 month-long visit, which included a transcontinental railroad trip across the North American continent, sparked controversy as doctors struggled to understand the relationship between bacteria and disease. An analysis of the published medical and lay literature and unpublished documents pertaining to Lister and antisepsis for the 15-year period, from 1865 to 1880. Joseph Lister's 1876 tour of America proved a turning point in the slow process of accepting the principles of antisepsis by the nation's doctors. This visit laid the foundation for the blossoming of medical care in America and the remarkable advances that followed. Among the most debated topics in the American medical world of 1876 was whether to accept Joseph Lister's principles of surgical antisepsis. He was invited to address the issue and gave a series of lectures in Philadelphia, Boston, and New York. The presentations marked the beginning of a significant change in American physicians' awareness of the correlation between wounds, germs, and pus. Lister's visit is a crucial milestone in the history of medicine.

  5. The role of Joseph Lister in developing the absorbable ligature.

    Science.gov (United States)

    Hall, M J

    2001-08-01

    Joseph Lister is associated with pioneering work on antisepsis. However an important but less well-known contribution to surgical progress was his work on the absorbable suture. This article details the problems Lister faced in operative surgery, his observations and experiments that lead to his development of an absorbable suture.

  6. Effect of Corynoline Isolated from Corydalis bungeana Turcz on ...

    African Journals Online (AJOL)

    Purpose: To investigate the protective effect of corynoline isolated from Corydalis bungeana Turcz on lipopolysaccharides (LPS)-induced sepsis, and determine the possible mechanism of anti-sepsis effect of the isolated corynoline. Methods: Corynoline was extracted by column chromatography. LPS (100 ng/mL) was used ...

  7. 杨梅叶水溶性提取物的抗氧化、抗菌活性 与防腐应用

    Czech Academy of Sciences Publication Activity Database

    Jun, Y.; Li-yun, Z.; Jun-qing, W.; Jie, Y.; Langhansová, Lenka; Vaněk, Tomáš; Yong-sheng, G.; Ji-dong, L.

    -, č. 2 (2014), s. 198-202 ISSN 1006-2513 R&D Projects: GA MŠk LH12165 Institutional support: RVO:61389030 Keywords : Myrica rubra leaf * antioxidation * antimicrobial Subject RIV: FR - Pharmacology ; Medidal Chemistry http://caod.oriprobe.com/articles/42399762/Antioxidant_antimicrobial_and_antisepsis_properties_of_the_water_solub.htm

  8. Cascade Wittig reaction-double Claisen and Cope rearrangements: one-pot synthesis of diprenylated coumarins gravelliferone, balsamiferone, and 6,8-diprenylumbelliferone

    Digital Repository Service at National Institute of Oceanography (India)

    Patre, R.E.; Shet, J.B.; Parameswaran, P.S.; Tilve, S.G.

    -arrhythmia, anti- osteoporosis, pain relief, antisepsis as well as prevention of asthma. Several of these coumarins have prenyl side chains in their skeleton either intact or in a modified form as a furan or pyran ring.7 Gravelliferone 1 [3-(1,1’-dimethylallyl)-6...

  9. Cuan Chaitriona Nursing Home, The Lawn, Castlebar, Mayo

    LENUS (Irish Health Repository)

    O’ Hanlon, M

    2016-09-01

    Surgical site infection (SSI) rates are used extensively by hospitals as a basis for quality improvement. A 30-day post-discharge SSI programme for Caesarean section operations has been implemented in Our Lady of Lourdes Hospital since 2011. It has been shown that skin antisepsis and antibiotic prophylaxis are key factors in the prevention of SSI. Using quality improvement methodology, an infection prevention bundle was introduced to address these two factors. Skin antisepsis was changed from povidone-iodine to chlorhexidine-alcohol. Compliance with choice of antibiotic prophylaxis increased from 89.6% in 2014 to 98.5% in 2015. Compliance with timing also improved. The SSI rate of 7.5% was the lowest recorded to date, with the majority of SSIs (64%) diagnosed after hospital discharge. The level of variation was also reduced. However, the continued presence of variation and possibility of lower infection rates from the literature imply that further improvements are required.

  10. A Quality Improvement Approach to Reducing the Caesarean section Surgical Site Infection Rate in a Regional Hospital

    LENUS (Irish Health Repository)

    O’ Hanlon, M

    2016-09-01

    Surgical site infection (SSI) rates are used extensively by hospitals as a basis for quality improvement. A 30-day post-discharge SSI programme for Caesarean section operations has been implemented in Our Lady of Lourdes Hospital since 2011. It has been shown that skin antisepsis and antibiotic prophylaxis are key factors in the prevention of SSI. Using quality improvement methodology, an infection prevention bundle was introduced to address these two factors. Skin antisepsis was changed from povidone-iodine to chlorhexidine-alcohol. Compliance with choice of antibiotic prophylaxis increased from 89.6% in 2014 to 98.5% in 2015. Compliance with timing also improved. The SSI rate of 7.5% was the lowest recorded to date, with the majority of SSIs (64%) diagnosed after hospital discharge. The level of variation was also reduced. However, the continued presence of variation and possibility of lower infection rates from the literature imply that further improvements are required.

  11. A Quality Improvement Approach to Reducing the Caesarean section Surgical Site Infection Rate in a Regional Hospital.

    Science.gov (United States)

    O'Hanlon, M; McKenna, C; Carton, E; Diviney, D; Costello, M R; O'Sullivan, L; Fitzsimons, J; Toland, L; Dornikova, G; Curran, R; McCann, C; O'Sullivan, L; Doherty, T; Crowley, C; O'Coigligh, S

    2016-09-09

    Surgical site infection (SSI) rates are used extensively by hospitals as a basis for quality improvement. A 30-day post-discharge SSI programme for Caesarean section operations has been implemented in Our Lady of Lourdes Hospital since 2011. It has been shown that skin antisepsis and antibiotic prophylaxis are key factors in the prevention of SSI. Using quality improvement methodology, an infection prevention bundle was introduced to address these two factors. Skin antisepsis was changed from povidone-iodine to chlorhexidine-alcohol. Compliance with choice of antibiotic prophylaxis increased from 89.6% in 2014 to 98.5% in 2015. Compliance with timing also improved. The SSI rate of 7.5% was the lowest recorded to date, with the majority of SSIs (64%) diagnosed after hospital discharge. The level of variation was also reduced. However, the continued presence of variation and possibility of lower infection rates from the literature imply that further improvements are required.

  12. Application of physics technology in the preservation of food and fresh fruits and vegetables

    International Nuclear Information System (INIS)

    Bai Yaxiang; Hu Yucai; Xu Jianping

    2003-01-01

    Physics provides a new way for food storage and preservation. Experiments show that application of radiation, electrostatic fields, high voltage pulsed electric fields and microwaves to food, fruits and vegetables plays the part of insecticide, pasteurization and antisepsis without damaging nutritional structure and original flavor. Recent advances in the application of physics technology in food pasteurization and preservation are summarized, and prospects for future developments presented

  13. A review of current strategies to reduce intraoperative bacterial contamination of surgical wounds

    OpenAIRE

    Dohmen, Pascal M.; Konertz, Wolfgang

    2007-01-01

    Surgical site infections are a mean topic in cardiac surgery, leading to a prolonged hospitalization, and substantially increased morbidity and mortality. One source of pathogens is the endogenous flora of the patient?s skin, which can contaminate the surgical site. A number of preoperative skin care strategies are performed to reduce bacterial contamination like preoperative antiseptic showering, hair removal, antisepsis of the skin, adhesive barrier drapes, and antimicrobial prophylaxis. Fu...

  14. La rage

    OpenAIRE

    Ribadeau-Dumas, Florence; Dacheux, Laurent; Bourhy, Hervé

    2013-01-01

    International audience; Rabies virus, a neurotropic lyssavirus responsible for unavoidable fatal encephalitis, is transmitted by saliva of infected animals through bite, scratch or licking of broken skin or a mucous membrane. Infection can be prevented by timely prevention (wash for several minutes, antisepsis and vaccination completed by antirabies immunoglobulins [Ig] according to the severity of exposure). The 55,000 human deaths estimated annually worldwide result mainly from uncontrolled...

  15. Optimum Operating Room Environment for the Prevention of Surgical Site Infections.

    Science.gov (United States)

    Gaines, Sara; Luo, James N; Gilbert, Jack; Zaborina, Olga; Alverdy, John C

    Surgical site infections (SSI), whether they be incisional or deep, can entail major morbidity and death to patients and additional cost to the healthcare system. A significant amount of effort has gone into optimizing the surgical patient and the operating room environment to reduce SSI. Relevant guidelines and literature were reviewed. The modern practice of surgical antisepsis involves the employment of strict sterile techniques inside the operating room. Extensive guidelines are available regarding the proper operating room antisepsis as well as pre-operative preparation. The use of pre-operative antimicrobial prophylaxis has become increasingly prevalent, which also presents the challenge of opportunistic and nosocomial infections. Ongoing investigative efforts have brought about a greater appreciation of the surgical patient's endogenous microflora, use of non-bactericidal small molecules, and pre-operative microbial screening. Systematic protocols exist for optimizing the surgical sterility of the operating room to prevent SSIs. Ongoing research efforts aim to improve the precision of peri-operative antisepsis measures and personalize these measures to tailor the patient's unique microbial environment.

  16. The gut microbiota and gastrointestinal surgery.

    Science.gov (United States)

    Guyton, Kristina; Alverdy, John C

    2017-01-01

    Surgery involving the gastrointestinal tract continues to prove challenging because of the persistence of unpredictable complications such as anastomotic leakage and life-threatening infections. Removal of diseased intestinal segments results in substantial catabolic stress and might require complex reconstructive surgery to maintain the functional continuity of the intestinal tract. As gastrointestinal surgery necessarily involves a breach of an epithelial barrier colonized by microorganisms, preoperative intestinal antisepsis is used to reduce infection-related complications. The current approach to intestinal antisepsis varies widely across institutions and countries with little understanding of its mechanism of action, effect on the gut microbiota and overall efficacy. Many of the current approaches to intestinal antisepsis before gastrointestinal surgery run counter to emerging concepts of intestinal microbiota contributing to immune function and recovery from injury. Here, we review evidence outlining the role of gut microbiota in recovery from gastrointestinal surgery, particularly in the development of infections and anastomotic leak. To make surgery safer and further reduce complications, a molecular, genetic and functional understanding of the response of the gastrointestinal tract to alterations in its microbiota is needed. Methods can then be developed to preserve the health-promoting functions of the microbiota while at the same time suppressing their harmful effects.

  17. Intervention of Dietary Dipeptide Gamma-l-Glutamyl-l-Valine (γ-EV) Ameliorates Inflammatory Response in a Mouse Model of LPS-Induced Sepsis.

    Science.gov (United States)

    Chee, MacKenzie E; Majumder, Kaustav; Mine, Yoshinori

    2017-07-26

    Sepsis, the systemic inflammatory response syndrome (SIRS) with infection is one of the leading causes of death in critically ill patients in the developed world due to the lack of effective antisepsis treatments. This study examined the efficacy of dietary dipeptide gamma-l-glutamyl-l-valine (γ-EV), which was characterized previously as an anti-inflammatory peptide, in an LPS-induced mouse model of sepsis. BALB/c mice were administered γ-EV via oral gavage followed by an intraperitoneal injection of LPS to induce sepsis. The γ-EV exhibited antisepsis activity by reducing the expression of pro-inflammatory cytokines TNF-α, IL-6, and IL-1β in plasma and small intestine. γ-EV also reduced the phosphorylation of the signaling proteins JNK and IκBα. We concluded that γ-EV could possess an antisepsis effect against bacterial infection in intestine. This study proposes a signaling mechanism whereby the calcium-sensing receptor (CaSR) allosterically activated by γ-EV stimulates the interaction of β-arrestin2 with the TIR(TLR/IL-1R) signaling proteins TRAF6, TAB1, and IκBα to suppress inflammatory signaling.

  18. A Randomized Trial Comparing Skin Antiseptic Agents at Cesarean Delivery.

    Science.gov (United States)

    Tuuli, Methodius G; Liu, Jingxia; Stout, Molly J; Martin, Shannon; Cahill, Alison G; Odibo, Anthony O; Colditz, Graham A; Macones, George A

    2016-02-18

    Preoperative skin antisepsis has the potential to decrease the risk of surgical-site infection. However, evidence is limited to guide the choice of antiseptic agent at cesarean delivery, which is the most common major surgical procedure among women in the United States. In this single-center, randomized, controlled trial, we evaluated whether the use of chlorhexidine-alcohol for preoperative skin antisepsis was superior to the use of iodine-alcohol for the prevention of surgical-site infection after cesarean delivery. We randomly assigned patients undergoing cesarean delivery to skin preparation with either chlorhexidine-alcohol or iodine-alcohol. The primary outcome was superficial or deep surgical-site infection within 30 days after cesarean delivery, on the basis of definitions from the Centers for Disease Control and Prevention. From September 2011 through June 2015, a total of 1147 patients were enrolled; 572 patients were assigned to chlorhexidine-alcohol and 575 to iodine-alcohol. In an intention-to-treat analysis, surgical-site infection was diagnosed in 23 patients (4.0%) in the chlorhexidine-alcohol group and in 42 (7.3%) in the iodine-alcohol group (relative risk, 0.55; 95% confidence interval, 0.34 to 0.90; P=0.02). The rate of superficial surgical-site infection was 3.0% in the chlorhexidine-alcohol group and 4.9% in the iodine-alcohol group (P=0.10); the rate of deep infection was 1.0% and 2.4%, respectively (P=0.07). The frequency of adverse skin reactions was similar in the two groups. The use of chlorhexidine-alcohol for preoperative skin antisepsis resulted in a significantly lower risk of surgical-site infection after cesarean delivery than did the use of iodine-alcohol. (Funded by the National Institutes of Health and Washington University School of Medicine in St. Louis; ClinicalTrials.gov number, NCT01472549.).

  19. Joseph Lister (1827-1912): a pioneer of antiseptic surgery remembered a century after his death.

    Science.gov (United States)

    Jessney, Benn

    2012-08-01

    Joseph Lister was a remarkable British surgeon who pioneered principles of antisepsis. He died 100 years ago after devoting his life to developing and promoting safe, antiseptic surgery. In the 1800 s as many as 80% of all operations resulted in infection but many people refused to accept the true nature of infection, believing instead that the deaths were coincidental. Lister became familiar with the work of Pasteur while working in Glasgow. He recognized the truth in Pasteur's work and in 1867 Lister published his landmark paper 'On the Antiseptic Principle in the Practice of Surgery' in the British Medical Journal. It proved to be a turning point in healthcare.

  20. Bed capacities and disinfection practices in hospitals in Istanbul are correlated.

    Science.gov (United States)

    Teker, Bahri; Ogutlu, Aziz; Yilmaz, Mesut; Gencer, Serap; Karabay, Oguz

    2015-03-19

    Disinfection, antisepsis and sterilization (DAS) practices are of critical importance in hospital practice. This study aims to investigate the daily DAS practices of private hospitals in Istanbul, Turkey. The DAS practices of 155 private hospitals in Istanbul province were investigated using a questionnaire including 26 questions. The questionnaire forms were faxed to all private hospitals located in Istanbul. A p value Istanbul need in-service training towards sterilization and disinfection issues. It is concluded that private hospitals need policies and educational activities for DAS practices.

  1. Antiseptic Effect of Conventional Povidone-Iodine Scrub, Chlorhexidine Scrub, and Waterless Hand Rub in a Surgical Room: A Randomized Controlled Trial.

    Science.gov (United States)

    Tsai, Jui-Chen; Lin, Yen-Kuang; Huang, Yen-Jung; Loh, El-Wui; Wen, Hsiao-Yun; Wang, Chia-Hui; Tsai, Yin-Tai; Hsieh, Wen-Shyang; Tam, Ka-Wai

    2017-04-01

    OBJECTIVE Effective perioperative hand antisepsis is crucial for the safety of patients and medical staff in surgical rooms. The antimicrobial effectiveness of different antiseptic methods, including conventional hand scrubs and waterless hand rubs, has not been well evaluated. DESIGN, SETTING, AND PARTICIPANTS A randomized controlled trial was conducted to investigate the effectiveness of the 3 antiseptic methods among surgical staff of Taipei Medical University-Shuang Ho Hospital. For each method used, a group of 80 participants was enrolled. INTERVENTION Surgical hand cleansing with conventional 10% povidone-iodine scrub, conventional 4% chlorhexidine scrub, or waterless hand rub (1% chlorhexidine gluconate and 61% ethyl alcohol). RESULTS Colony-forming unit (CFU) counts were collected using the hand imprinting method before and after disinfection and after surgery. After surgical hand disinfection, the mean CFU counts of the conventional chlorhexidine (0.5±0.2, Pantiseptic method (P=.0036), but not other variables, predicted the mean CFU count. CONCLUSIONS Conventional chlorhexidine scrub and waterless hand rub were superior to a conventional povidone-iodine product in bacterial inhibition. We recommend using conventional chlorhexidine scrub as a standard method for perioperative hand antisepsis. Waterless hand rub may be used if the higher cost is affordable. Infect Control Hosp Epidemiol 2017;38:417-422.

  2. Treating Parents to Reduce NICU Transmission of Staphylococcus aureus (TREAT PARENTS) trial: protocol of a multisite randomised, double-blind, placebo-controlled trial.

    Science.gov (United States)

    Milstone, Aaron M; Koontz, Danielle W; Voskertchian, Annie; Popoola, Victor O; Harrelson, Kathleen; Ross, Tracy; Aucott, Susan W; Gilmore, Maureen M; Carroll, Karen C; Colantuoni, Elizabeth

    2015-09-09

    More than 33,000 healthcare-associated infections occur in neonatal intensive care units (NICUs) each year in the USA. Parents, rather than healthcare workers, may be a reservoir from which neonates acquire Staphylococcus aureus (S. aureus) colonisation in the NICU. This study looks to measure the effect of treating parents with short course intranasal mupirocin and topical chlorhexidine antisepsis on acquisition of S. aureus colonisation and infection in neonates. The TREAT PARENTS trial (Treating Parents to Reduce Neonatal Transmission of S. aureus) is a multicentre randomised, masked, placebo-controlled trial. Shortly after a neonate is admitted to the NICU, parents will be tested for S. aureus colonisation. If either parent screens positive for S. aureus, then both parents as a pair will be enrolled and randomised to one of the two possible masked treatment arms. Arm 1 will include assignment to intranasal 2% mupirocin plus topical antisepsis with chlorhexidine gluconate impregnated cloths for 5 days. Arm 2 will include assignment to placebo ointment and placebo cloths for skin antisepsis for 5 days. The primary outcome will be neonatal acquisition of an S. aureus strain that is concordant to the parental baseline S. aureus strain as determined by periodic surveillance cultures or a culture collected during routine clinical care that grows S. aureus. Secondary outcomes will include neonatal acquisition of S. aureus, neonatal S. aureus infection, eradication of S. aureus colonisation in parents, natural history of S. aureus colonisation in parents receiving placebo, adverse reactions to treatment, feasibility of intervention, and attitudes and behaviour in consented parents. Four hundred neonate-parent pairs will be enrolled. The study was approved by Johns Hopkins University IRB in June 2014 (IRB number 00092982). Protocol V.7 was approved in November 2014. Findings will be published in peer-reviewed journals. NCT02223520. Published by the BMJ Publishing

  3. Dimethyl Sulfoxide Enhances Effectiveness of Skin Antiseptics and Reduces Contamination Rates of Blood Cultures

    Science.gov (United States)

    LaSala, Paul R.; Han, Xiang-Yang; Rolston, Kenneth V.; Kontoyiannis, Dimitrios P.

    2012-01-01

    Effective skin antisepsis is of central importance in the prevention of wound infections, colonization of medical devices, and nosocomial transmission of microorganisms. Current antiseptics have a suboptimal efficacy resulting in substantial infectious morbidity, mortality, and increased health care costs. Here, we introduce an in vitro method for antiseptic testing and a novel alcohol-based antiseptic containing 4 to 5% of the polar aprotic solvent dimethyl sulfoxide (DMSO). The DMSO-containing antiseptic resulted in a 1- to 2-log enhanced killing of Staphylococcus epidermidis and other microbes in vitro compared to the same antiseptic without DMSO. In a prospective clinical validation, blood culture contamination rates were reduced from 3.04% for 70% isopropanol–1% iodine (control antiseptic) to 1.04% for 70% isopropanol–1% iodine–5% DMSO (P antiseptics containing strongly polarized but nonionizing (polar aprotic) solvents. PMID:22378911

  4. Is 2% chlorhexidine gluconate in 70% isopropyl alcohol more effective at preventing central venous catheter-related infections than routinely used chlorhexidine gluconate solutions: A pilot multicenter randomized trial (ISRCTN2657745)?

    Science.gov (United States)

    McCann, Margaret; Fitzpatrick, Fidelma; Mellotte, George; Clarke, Michael

    2016-08-01

    A pilot randomized trial in 3 Irish outpatient hemodialysis units compared 2% chlorhexidine gluconate (CHG) in 70% isopropyl alcohol with routinely used CHG solutions for central venous catheter exit site antisepsis. We found no significant difference between the groups for the prevention of catheter-related bloodstream infections (1/53 vs 2/52; relative risk [RR], 0.49; 95% confidence interval [CI], 0.05-5.25; P = .55) and catheter-associated bloodstream infections (1/53 vs 4/52; RR, 0.25; 95% CI, 0.03-2.12; P = .16). Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  5. No need for preoperative antiseptics in elective outpatient plastic surgical operations: a prospective study.

    Science.gov (United States)

    Kalantar-Hormozi, A J; Davami, Babak

    2005-08-01

    The development of antisepsis in the late nineteenth and early twentieth centuries revolutionized health care. The time-honored technique of skin preparation is to scrub the entire operative area of the patient for 5 to 7 minutes with a germicidal detergent solution and then paint the region with an antimicrobial solution of either tincture of povidone-iodine (Betadine) or chlorhexidine. Although antiseptics result in lower colony counts on the skin, they have side effects and higher cost in relation to normal saline. The authors have prepared patients by showering the surgical site with soap and water and rinsing it with normal saline, in 905 cases of outpatient, clean-wound plastic surgery. In another 905 cases that served as the control group, the traditional method of preoperative shower and scrub with chlorhexidine or Betadine was used. In both groups, there was no incidence of wound infection.

  6. Positive deviance as a strategy to prevent and control bloodstream infections in intensive care

    Directory of Open Access Journals (Sweden)

    Francimar Tinoco de Oliveira

    Full Text Available Abstract OBJECTIVE To describe the application of positive deviance as a strategy to prevent and control bloodstream infections. METHOD An intervention study with nursing and medical team members working in an intensive care unit in a university hospital, between June and December 2014. The four steps of the positive defiance methodology were applied: to define, to determine, to discover and to design. RESULTS In 90 days, 188 actions were observed, of these, 36.70% (n=69 were related to catheter dressing. In 81.15% (n=56 of these dressings, the professionals most adhered to the use of flexible sterile cotton-tipped swabs to perform antisepsis at catheter entry sites and fixation dressing. CONCLUSION Positive deviance contributed to the implementation of proposals to improve work processes and team development related to problems identified in central venous catheter care.

  7. The self-healing composite anticorrosion coating

    Science.gov (United States)

    Yang, Zhao; Wei, Zhang; Le-ping, Liao; Hong-mei, Wang; Wu-jun, Li

    Self-healing coatings, which autonomically repair and prevent corrosion of the underlying substrate, are of particular interest for the researchers. In the article, effectiveness of epoxy resin filled microcapsules was investigated for healing of cracks generated in coatings. Microcapsules were prepared by in situ polymerization of urea-formaldehyde resin to form shell over epoxy resindroplets. Characteristics of these capsules were studied by scanning electron microscope (SEM), thermo gravimetric analyzer (TGA) and particle size analyzer. The model system of self-healing antisepsis coating consists of an epoxy resin matrix, 10 wt% microencapsulated healing agent, 2wt% catalyst solution. The self-healing function of this coating system is evaluated through corrosion testing of damaged and healed coated steel samples compared to control samples. Electrochemical testing provides further evidence of passivation of the substrate by self-healing coatings.

  8. Joseph Lister and the performance of antiseptic surgery.

    Science.gov (United States)

    Worboys, Michael

    2013-09-20

    This article highlights a neglected feature of Joseph Lister's work, namely how, in addition to promoting germ theories and the principles of the antiseptic system, he also devoted much time and effort to communicating the performative aspects of antisepsis and of the many other surgical innovations that he developed. Attention to 'detail' and striving for 'improvement' were crucial to Listerian practice, and he sought to convey his credo in three main ways: first, his publications aimed at 'bringing the subject out in the same sort of way as it had been worked out by himself'; second, he set out strict protocols and information on materials and methods, yet also encouraged surgeons to improvise; and third, he made himself an exemplar of a new form of professionalism, which made constancy and vigilance in practice a moral duty for surgeons.

  9. Analysis of YouTube videos about urinary catheterization technique of male delay.

    Science.gov (United States)

    Barreto Tavares Chiavone, Flávia; de Lima Ferreira, Larissa; Tuani Candido de Oliveira Salvador, Pétala; Filgueira Martins Rodrigues, Cláudia Cristiane; Yasmin Andrade Alves, Kisna; Pereira Santos, Viviane Euzébia

    2016-04-01

    To analyze the execution of urinary catheterization technique of male delay in YouTube videos. This is an exploratory research with a quantitative approach, performed using the YouTube sharing site. The search of the videos was conducted in September 2014, using the controlled descriptor "urinary catheterization". 32 videos were analyzed, none were in accordance with the standards established in the literature; among the main errors highlight the absence of hand washing (78.1%), the absence of the medical recording (71.8%), the absence of cleaning and drying of the patient at the end of the procedure (71.8%), the incorrect technique during antisepsis (62.5%) and the absence of gloves changes (59.3%). Although the YouTube sharing video site is currently a widespread tool, there is an absence of videos that reproduce the technique according to what is recommended in the literature.

  10. Impact of evidence-based interventions on wound complications after cesarean delivery.

    Science.gov (United States)

    Temming, Lorene A; Raghuraman, Nandini; Carter, Ebony B; Stout, Molly J; Rampersad, Roxane M; Macones, George A; Cahill, Alison G; Tuuli, Methodius G

    2017-10-01

    A number of evidence-based interventions have been proposed to reduce post-cesarean delivery wound complications. Examples of such interventions include appropriate timing of preoperative antibiotics, appropriate choice of skin antisepsis, closure of the subcutaneous layer if subcutaneous depth is ≥2 cm, and subcuticular skin closure with suture rather than staples. However, the collective impact of these measures is unclear. We sought to estimate the impact of a group of evidence-based surgical measures (prophylactic antibiotics administered before skin incision, chlorhexidine-alcohol for skin antisepsis, closure of subcutaneous layer, and subcuticular skin closure with suture) on wound complications after cesarean delivery and to estimate residual risk factors for wound complications. We conducted a secondary analysis of data from a randomized controlled trial of chlorhexidine-alcohol vs iodine-alcohol for skin antisepsis at cesarean delivery from 2011-2015. The primary outcome for this analysis was a composite of wound complications that included surgical site infection, cellulitis, seroma, hematoma, and separation within 30 days. Risk of wound complications in women who received all 4 evidence-based measures (prophylactic antibiotics within 60 minutes of cesarean delivery and before skin incision, chlorhexidine-alcohol for skin antisepsis with 3 minutes of drying time before incision, closure of subcutaneous layer if ≥2 cm of depth, and subcuticular skin closure with suture) were compared with those women who did not. We performed logistic regression analysis limited to patients who received all the evidence-based measures to estimate residual risk factors for wound complications and surgical site infection. Of 1082 patients with follow-up data, 349 (32.3%) received all the evidence-based measures, and 733 (67.7%) did not. The risk of wound complications was significantly lower in patients who received all the evidence-based measures compared with those who

  11. A family of helminth molecules that modulate innate cell responses via molecular mimicry of host antimicrobial peptides.

    Science.gov (United States)

    Robinson, Mark W; Donnelly, Sheila; Hutchinson, Andrew T; To, Joyce; Taylor, Nicole L; Norton, Raymond S; Perugini, Matthew A; Dalton, John P

    2011-05-01

    Over the last decade a significant number of studies have highlighted the central role of host antimicrobial (or defence) peptides in modulating the response of innate immune cells to pathogen-associated ligands. In humans, the most widely studied antimicrobial peptide is LL-37, a 37-residue peptide containing an amphipathic helix that is released via proteolytic cleavage of the precursor protein CAP18. Owing to its ability to protect against lethal endotoxaemia and clinically-relevant bacterial infections, LL-37 and its derivatives are seen as attractive candidates for anti-sepsis therapies. We have identified a novel family of molecules secreted by parasitic helminths (helminth defence molecules; HDMs) that exhibit similar biochemical and functional characteristics to human defence peptides, particularly CAP18. The HDM secreted by Fasciola hepatica (FhHDM-1) adopts a predominantly α-helical structure in solution. Processing of FhHDM-1 by F. hepatica cathepsin L1 releases a 34-residue C-terminal fragment containing a conserved amphipathic helix. This is analogous to the proteolytic processing of CAP18 to release LL-37, which modulates innate cell activation by classical toll-like receptor (TLR) ligands such as lipopolysaccharide (LPS). We show that full-length recombinant FhHDM-1 and a peptide analogue of the amphipathic C-terminus bind directly to LPS in a concentration-dependent manner, reducing its interaction with both LPS-binding protein (LBP) and the surface of macrophages. Furthermore, FhHDM-1 and the amphipathic C-terminal peptide protect mice against LPS-induced inflammation by significantly reducing the release of inflammatory mediators from macrophages. We propose that HDMs, by mimicking the function of host defence peptides, represent a novel family of innate cell modulators with therapeutic potential in anti-sepsis treatments and prevention of inflammation.

  12. A family of helminth molecules that modulate innate cell responses via molecular mimicry of host antimicrobial peptides.

    Directory of Open Access Journals (Sweden)

    Mark W Robinson

    2011-05-01

    Full Text Available Over the last decade a significant number of studies have highlighted the central role of host antimicrobial (or defence peptides in modulating the response of innate immune cells to pathogen-associated ligands. In humans, the most widely studied antimicrobial peptide is LL-37, a 37-residue peptide containing an amphipathic helix that is released via proteolytic cleavage of the precursor protein CAP18. Owing to its ability to protect against lethal endotoxaemia and clinically-relevant bacterial infections, LL-37 and its derivatives are seen as attractive candidates for anti-sepsis therapies. We have identified a novel family of molecules secreted by parasitic helminths (helminth defence molecules; HDMs that exhibit similar biochemical and functional characteristics to human defence peptides, particularly CAP18. The HDM secreted by Fasciola hepatica (FhHDM-1 adopts a predominantly α-helical structure in solution. Processing of FhHDM-1 by F. hepatica cathepsin L1 releases a 34-residue C-terminal fragment containing a conserved amphipathic helix. This is analogous to the proteolytic processing of CAP18 to release LL-37, which modulates innate cell activation by classical toll-like receptor (TLR ligands such as lipopolysaccharide (LPS. We show that full-length recombinant FhHDM-1 and a peptide analogue of the amphipathic C-terminus bind directly to LPS in a concentration-dependent manner, reducing its interaction with both LPS-binding protein (LBP and the surface of macrophages. Furthermore, FhHDM-1 and the amphipathic C-terminal peptide protect mice against LPS-induced inflammation by significantly reducing the release of inflammatory mediators from macrophages. We propose that HDMs, by mimicking the function of host defence peptides, represent a novel family of innate cell modulators with therapeutic potential in anti-sepsis treatments and prevention of inflammation.

  13. Antibacterial validation of electrogenerated hypochlorite using carbon-based electrodes.

    Science.gov (United States)

    Locker, J; Fitzgerald, P; Sharp, D

    2014-12-01

    This proof-of-concept study explores the novel use of carbon-based electrodes for the electrochemical generation of hypochlorite and compares the antimicrobial efficacy against commercial hypochlorite solution. Antimicrobial concentrations of hypochlorite were generated using pad-printed carbon and carbon fibre electrodes, yielding up to 0·027% hypochlorite in 60 min and 0·1% hypochlorite in 15 min, respectively, in a nondivided assembly. The minimum inhibitory concentration (MIC) of the electrogenerated hypochlorite produced using carbon fibre electrodes was established for four medically important bacteria (Pseudomonas aeruginosa and Staphylococcus aureus approx. 0·025%, Escherichia coli and Enterococcus faecalis approx. 0·012%) and found to be in agreement with those determined using commercial hypochlorite solution. Therefore, carbon-based electrodes, particularly carbon fibre, have proven effective for the generation of antimicrobial concentrations of hypochlorite. The similarity of the MIC values to commercial hypochlorite solutions suggests that the antimicrobial efficacy is derived from the quantified hypochlorite generated and not due to marked cogeneration of reactive oxygen species, as identified for other assemblies. As such, the application of carbon electrodes may be suitable for the local production of hypochlorite for healthcare antisepsis. Carbon fibre electrodes can rapidly generate antimicrobial concentrations of hypochlorite; as such, these cheap and commercially available electrodes are proposed for the local production of hypochlorite for healthcare antisepsis. Importantly, the antimicrobial properties of the electrochemically generated hypochlorite mirror those of commercial hypochlorite, suggesting this is not enhanced by the cogeneration of reactive oxygen species. This illustrates the potential use of disposable carbon electrodes for localized small-volume production of hypochlorite for surface and skin cleansing, and opens a broader

  14. Improving patient safety during insertion of peripheral venous catheters: an observational intervention study

    Directory of Open Access Journals (Sweden)

    Kampf, Günter

    2013-11-01

    Full Text Available [english] Background: Peripheral venous catheters are frequently used in hospitalized patients but increase the risk of nosocomial bloodstream infection. Evidence-based guidelines describe specific steps that are known to reduce infection risk. However, the degree of guideline implementation in clinical practice is not known. The aim of this study was to determine the use of specific steps for insertion of peripheral venous catheters in clinical practice and to implement a multimodal intervention aimed at improving both compliance and the optimum order of the steps.Methods: The study was conducted at University Hospital Hamburg. An optimum procedure for inserting a peripheral venous catheter was defined based on three evidence-based guidelines (WHO, CDC, RKI including five steps with 1A or 1B level of evidence: hand disinfection before patient contact, skin antisepsis of the puncture site, no palpation of treated puncture site, hand disinfection before aseptic procedure, and sterile dressing on the puncture site. A research nurse observed and recorded procedures for peripheral venous catheter insertion for healthcare workers in four different departments (endoscopy, central emergency admissions, pediatrics, and dermatology. A multimodal intervention with 5 elements was established (teaching session, dummy training, e-learning tool, tablet and poster, and direct feedback, followed by a second observation period. During the last observation week, participants evaluated the intervention.Results: In the control period, 207 insertions were observed, and 202 in the intervention period. Compliance improved significantly for four of five steps (e.g., from 11.6% to 57.9% for hand disinfection before patient contact; p<0.001, chi-square test. Compliance with skin antisepsis of the puncture site was high before and after intervention (99.5% before and 99.0% after. Performance of specific steps in the correct order also improved (e.g., from 7.7% to 68

  15. Pain reactivity in preterm neonates: examining the sex differences.

    Science.gov (United States)

    Valeri, B O; Gaspardo, C M; Martinez, F E; Linhares, M B M

    2014-11-01

    Early and repeated experiences of pain may have long-term effects on vulnerable newborns hospitalized in the Neonatal Intensive Care Unit (NICU), and neonatal pain responses may be affected by a variety of factors that neonates encounter. We tested the hypothesis that male preterm neonates exhibited greater pain sensitivity than females by assessing biobehavioural pain reactivity and recovery patterns to painful procedure. Fifty-three infants born preterm and low birthweight who were admitted to NICU were observed during five phases (baseline, antisepsis, puncture, recovery-dressing and recovery-resting). Behavioural pain reactivity was measured using the Neonatal Facial Coding System (NFCS) and the Sleep-Wake States Scale (SWS). The heart rate (HR) was continuously recorded. All measures were assessed based on scores and magnitude of responses. We found that male and female preterm neonates had similar patterns of behavioural pain reactivity and recovery; there were no statistical differences between groups in NFCS and SWS scores. However, male preterm infants presented higher HR immediately in the first minute of the puncture phase and also higher change in maximum HR between the baseline and puncture phases, than female preterm infants. Although we found that male infants showed higher physiological reactivity to painful stimulus in some HR parameters than female infants, the evidences were not sufficient to confirm the influence of sex on biobehavioural response to pain in vulnerable neonates. © 2014 European Pain Federation - EFIC®

  16. Changing pattern of causative factors in development of umbilical infections (omphalitis) in newborns

    International Nuclear Information System (INIS)

    Nadeem, A.Z.; Malik, R.

    2010-01-01

    Despite the drastic decrease in the incidence of neonatal tetanus due to better aseptic techniques in cutting and tying of umbilical cord at birth, an increase in the prevalence of umbilical infections has been noticed. Objectives The objectives were to assess the ongoing practices in umbilical care, detect the prevailing causative factors responsible for umbilical infections in newborns and suggest measures for minimizing these infections. Design setting This descriptive study was a collaborative effort at CMH Nowshera, Mardan and Lahore from January 2007 through 2009. Patients and Methods Three hundred consecutive cases of umbilical sepsis ( omphalitis), infants less than 20 days old were included irrespective of place of delivery and severity of infection. Those with congenital anomalies of umbilicus were excluded. A detailed questionnaire was filled for every patient covering related aspects. Results Antisepsis (mainly spirit) was used in 91 % cases irrespective of place of delivery. Major tool for cutting the cord was surgical or new common blade (277 cases). Clamp was used in 138 cases. Cord was intentionally attended in subsequent weeks after birth in only 48 cases. Hand washing practice was found in only 62 parents in subsequent weeks after birth. Diapers were used in 261 cases, majority of these were found covering the umbilicus or umbilical stump when initially examined (81 %). 48% of infected unshed cords were more than 3 inches long. Use of unwarranted substances applied on cord was found in only 16 cases. (author)

  17. Classification of wounds at risk and their antimicrobial treatment with polihexanide: a practice-oriented expert recommendation.

    Science.gov (United States)

    Dissemond, J; Assadian, O; Gerber, V; Kingsley, A; Kramer, A; Leaper, D J; Mosti, G; Piatkowski de Grzymala, A; Riepe, G; Risse, A; Romanelli, M; Strohal, R; Traber, J; Vasel-Biergans, A; Wild, T; Eberlein, T

    2011-01-01

    Currently, there are no generally accepted definitions for wounds at risk of infection. In clinical practice, too many chronic wounds are regarded as being at risk of infection, and therefore many topical antimicrobials - in terms of frequency and duration of use - are applied to wounds. Based on expert discussion and current knowledge, a clinical assessment score was developed. The objective of this wounds at risk (W.A.R.) score is to allow decision-making on the indication for the use of antiseptics on the basis of polihexanide. The proposed clinical classification of W.A.R. shall facilitate the decision for wound antisepsis and allow an appropriate general treatment regimen with the focus on the prevention of wound infection. The W.A.R. score is based on a clinically oriented risk assessment using concrete patient circumstances. The indication for the use of antiseptics results from the addition of differently weighted risk causes, for which points are assigned. Antimicrobial treatment is justified in the case of 3 or more points. Copyright © 2011 S. Karger AG, Basel.

  18. Catheter Related Blood Stream Infections In Patients Of The Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Ana Carolina Coimbra de Castro

    2017-07-01

    Full Text Available Objective: To identify the prevalence of bloodstream infection associated with the Catheter related Blood stream infections in patients of the Intensive Care Unit, and the characteristics of its use and handling. Methods: Descriptive and transversal study with a sample of 88 participants. Data were collected through the observational method and the records in the medical records. The absolute and relative frequencies were used for data analysis. Results: 73.86% of the patients had central venous access in the subclavian vein, 100% used double lumen Catheter related Blood stream infections, 0.5% chlorhexidine solution for skin antisepsis, dressing coverage is performed mostly with Sterile gauze and tape, with a daily exchange. The rate of infection related to the use of the Catheter related Blood stream infections was (6.81%. The most infused pharmacological drugs were antimicrobials (69.32%. Conclusion: The study showed that care with central venous accesses is performed according to recommendations for prevention of bloodstream infection related to the use of these devices. The infection rate is close to the standards found in the literature. Key words: Central Venous Catheterization. Hospital Infection. Intensive care unit. Risk factors. Catheter-Related Infection..

  19. In vitro susceptibility of gram-negative bacterial isolates to chlorhexidine gluconate.

    Science.gov (United States)

    Mengistu, Y; Erge, W; Bellete, B

    1999-05-01

    To investigate the susceptibility of clinical isolates of gram-negative bacteria to chlorhexidine gluconate. Prospective laboratory study. Tikur Anbessa Hospital, Addis Ababa, Ethiopia. Clinical specimens from 443 hospital patients. Significant number of gram negative bacteria were not inhibited by chlorhexidine gluconate (0.02-0.05%) used for antisepsis. Four hundred and forty three strains of gram-negative bacteria were isolated from Tikur Anbessa Hospital patients. Escherichia coli (31.6%) and Klebsiella pneumoniae (23%) were the most frequently isolated bacteria followed by Proteus species (13.3%), Pseudomonas species (9.2%), and Citrobacter species (6.1%). Each organism was tested to chlorhexidine gluconate (CHG), minimum inhibitory concentration (MIC) ranging from 0.0001% to 1%w/v. All Salmonella species and E. coli were inhibited by CHG, MIC or = 0.1%). Our results showed that a significant number of the gram-negative bacterial isolates were not inhibited by CHG at the concentration used for disinfection of wounds or instruments (MIC 0.02-0.05% w/v). It is therefore important to select appropriate concentration of this disinfectant and rationally use it for disinfection and hospital hygiene. Continuing follow up and surveillance is also needed to detect resistant bacteria to chlorhexidine or other disinfectants in time.

  20. Protective Effects of Polydatin on Septic Lung Injury in Mice via Upregulation of HO-1

    Directory of Open Access Journals (Sweden)

    Xiao-hui Li

    2013-01-01

    Full Text Available The present study was carried out to investigate the effects and mechanisms of polydatin (PD in septic mice. The model of cecal ligation and puncture (CLP-induced sepsis was employed. Pretreatment of mice with PD (15, 45, and 100 mg/kg dose-dependently reduced sepsis-induced mortality and lung injury, as indicated by alleviated lung pathological changes and infiltration of proteins and leukocytes. In addition, PD inhibited CLP-induced serum tumor necrosis factor-α (TNF-α and interleukin-6 (IL-6 production, lung cyclooxygenase-2 (COX-2 and inducible nitric oxide synthase isoform (iNOS protein expressions and NF-κB activation. Notably, PD upregulated the expression and activity of heme oxygenase (HO-1 in lung tissue of septic mice. Further, the protective effects of PD on sepsis were abrogated by ZnPP IX, a specific HO-1 inhibitor. These findings indicated that PD might be an effective antisepsis drug.

  1. Etiology, antimicrobial susceptibility profile of Staphylococcus spp. and risk factors associated with bovine mastitis in the states of Bahia and Pernambuco

    Directory of Open Access Journals (Sweden)

    Carina C. Krewer

    2013-05-01

    Full Text Available The purpose of this paper was to study the etiology of mastitis, determine the antimicrobial susceptibility profile of Staphylococcus spp. and to identify the risk factors associated with infection in dairy cows in the states of Bahia and Pernambuco, Brazil. From the 2,064 milk samples analyzed, 2.6% were associated with cases of clinical mastitis and 28.2% with subclinical mastitis. In the microbiological culture, Staphylococcus spp. (49.1% and Corynebacterium spp. (35.3% were the main agents found, followed by Prototheca spp. (4.6% and Gram negative bacilli (3.6%. In the antimicrobial susceptibility testing, all 218 Staphylococcus spp. were susceptible to rifampicin and the least effective drug was amoxicillin (32.6%. Multidrug resistance to three or more drugs was observed in 65.6% of Staphylococcus spp. The risk factors identified for mastitis were the extensive production system, not providing feed supplements, teat drying process, not disinfecting the teats before and after milking, and inadequate hygiene habits of the milking workers. The presence of multiresistant isolates in bovine milk demonstrates the importance of the choice and appropriate use of antimicrobial agents. Prophylactic and control measures, including teat antisepsis and best practices for achieving hygienic milking should be established in order to prevent new cases of the disease in herds.

  2. A study of the effects of different disinfectants used in Riyadh hospitals and their efficacy against Methicillin Resistant Staphylococcus Aureus (MRSA)

    International Nuclear Information System (INIS)

    Baddour, Manal M.

    2008-01-01

    Methicillin resistant Staphylococcus aureus (MRSA) and the means of controlling it, continue to be of major interest to the healthcare community. The bactericidal activity of some disinfectants which are in common use in seven major tertiary care hospitals in Riyadh was tested against two control strains of S.aureus, namely MRSA ATCC 33591 and Methicillin sensitive Staphylococcus aureus (MSSA) ATCC 29213. The disinfectants tested in this study were a group used for hand antisepsis (Purell, EZ-clean, Cida stat and Manorapid Synergy) and another group used for environmental disinfection (Combi spray, Tristel fusion, Alphadine, Isopropanol, Presept and Diesin). Presept, diesin and tristel fusion had a remarkable effect on the tested strains, both methicillin sensitive and methicillin resistant. There was hardly any noticeable difference between the effects on either (P>0.05). On the other hand, Purell and EZ-clean and Manorapid Synergy hand rubs had a relatively weak action after 15 and 30 minutes while their effect was better after 1 and 2 hours. There was no observable differences between their effects on MRSA or MSSA, P>0.05. Cita stat had a remarkably pronounced effect against both MRSA and MSSA. Contrary to some previous reports, this study has proven also that chlorhexidine and quaternary ammonium compounds show comparable efficacy against both MRSA and MSSA. (author)

  3. MODULATING LPS SIGNAL TRANSDUCTION AT THE LPS RECEPTOR COMPLEX WITH SYNTHETIC LIPID A ANALOGUES

    Science.gov (United States)

    White, Aileen F. B.; Demchenko, Alexei V.

    2015-01-01

    Sepsis, defined as a clinical syndrome brought about by an amplified and dysregulated inflammatory response to infections, is one of the leading causes of death worldwide. Despite persistent attempts to develop treatment strategies to manage sepsis in the clinical setting, the basic elements of treatment have not changed since the 1960s. As such, the development of effective therapies for reducing inflammatory reactions and end-organ dysfunction in critically ill patients with sepsis remains a global priority. Advances in understanding of the immune response to sepsis provide the opportunity to develop more effective pharmaceuticals. This article details current information on the modulation of the lipopolysaccharide (LPS) receptor complex with synthetic Lipid A mimetics. As the initial and most critical event in sepsis pathophysiology, the LPS receptor provides an attractive target for antisepsis agents. One of the well-studied approaches to sepsis therapy involves the use of derivatives of Lipid A, the membrane-anchor portion of an LPS, which is largely responsible for its endotoxic activity. This article describes the structural and conformational requirements influencing the ability of Lipid A analogues to compete with LPS for binding to the LPS receptor complex and to inhibit the induction of the signal transduction pathway by impairing LPS-initiated receptor dimerization. PMID:25480508

  4. Efficacy and dermal tolerance of a novel alcohol-based skin antiseptic in horses.

    Science.gov (United States)

    Tannahill, Victoria J; Cogan, Tristan; Allen, Kate; Acutt, Elizabeth; Busschers, Evita

    2018-04-14

    To determine the efficacy and dermal tolerance of a novel alcohol-based skin antiseptic (ABSA) in horses. Experimental study. Systemically healthy horses (n = 25) with no history or clinical signs of skin disease. Four clipped sites on the abdomen were randomly assigned to a skin preparation protocol: saline (negative control; NC), chlorhexidine gluconate followed by isopropyl alcohol (positive control; PC), saline followed by the ABSA (ABSA A), or a commercially available horse shampoo followed by the ABSA (ABSA B). Microbiological swabs were obtained from each site and cultured on MacConkey and mannitol salt agar plates. Colony-forming units were counted 18-24 hours later. All sites were scored for signs of skin reaction before, immediately after, 1 hour after, and 24 hours after skin preparation. The PC, ABSA A, and ABSA B methods reduced skin microbial burden compared with the NC method (P horses required veterinary treatment. The ABSA preparations tested in this study were as effective and well tolerated as a chlorhexidine gluconate-based method, but required less time in healthy horses. The ABSA tested here provides an efficacious, fast-acting, and well-tolerated alternative to achieve skin antisepsis in healthy horses. These results justify further investigation in clinical cases. © 2018 The American College of Veterinary Surgeons.

  5. Infection control in physicians' offices. Academy of Pediatrics. The American Occupational Safety and Health Administration (OSHA).

    Science.gov (United States)

    2000-06-01

    Infection control is an integral part of pediatric practice in outpatient settings as well as in hospitals. All employees should be educated regarding the routes of transmission and techniques used to prevent transmission of infectious agents. Policies for infection control and prevention should be written, readily available, updated annually, and enforced. The Centers for Disease Control and Prevention standard precautions for hospitalized patients with modifications from the American Academy of Pediatrics are appropriate for most patient encounters. As employers, pediatricians are required by the Occupational Safety and Health Administration (OSHA) to take precautions to protect staff likely to be exposed to blood or other potentially infectious materials while on the job. Key principles of infection control include the following: hand-washing before and after every patient contact, separation of infected, contagious children from uninfected children, safe handling and disposal of needles and other sharp medical devices, appropriate use of personal protection equipment such as gloves, appropriate sterilization, disinfection and antisepsis, and judicious use of antibiotics.

  6. Preoperative skin antiseptic preparations for preventing surgical site infections: a systematic review.

    Science.gov (United States)

    Kamel, Chris; McGahan, Lynda; Polisena, Julie; Mierzwinski-Urban, Monika; Embil, John M

    2012-06-01

    To evaluate the clinical effectiveness of preoperative skin antiseptic preparations and application techniques for the prevention of surgical site infections (SSIs). Systematic review of the literature using Medline, EMBASE, and other databases, for the period January 2001 to June 2011. Comparative studies (including randomized and nonrandomized trials) of preoperative skin antisepsis preparations and application techniques were included. Two researchers reviewed each study and extracted data using standardized tables developed before the study. Studies were reviewed for their methodological quality and clinical findings. Twenty studies (n = 9,520 patients) were included in the review. The results indicated that presurgical antiseptic showering is effective for reducing skin flora and may reduce SSI rates. Given the heterogeneity of the studies and the results, conclusions about which antiseptic is more effective at reducing SSIs cannot be drawn. The evidence suggests that preoperative antiseptic showers reduce bacterial colonization and may be effective at preventing SSIs. The antiseptic application method is inconsequential, and data are lacking to suggest which antiseptic solution is the most effective. Disinfectant products are often mixed with alcohol or water, which makes it difficult to form overall conclusions regarding an active ingredient. Large, well-conducted randomized controlled trials with consistent protocols comparing agents in the same bases are needed to provide unequivocal evidence on the effectiveness of one antiseptic preparation over another for the prevention of SSIs.

  7. Evaluation of the antiseptic efficacy and local tolerability of a polihexanide-based antiseptic on resident skin flora.

    Science.gov (United States)

    Egli-Gany, Dianne; Brill, Florian H H; Hintzpeter, Matthias; Andrée, Simone; Pavel, Viktoria

    2012-09-01

    The primary objective of this study was to compare the antimicrobial efficacy of polihexanide 0.02% and 0.04% with chlorhexidine 0.05% after 30 minutes of topical treatment on healthy intact skin. This study was performed as a double-blind, randomized, comparator-controlled, 3-arm, crossover study. : A phase I dermatological study unit. Twenty healthy volunteers with intact skin. : Test areas of 5 cm on the subjects' arms were treated with the investigational products using a polyurethane swab. Skin swabs were taken before and after treatment for quantitative microbial evaluation. The main outcome measure was the log reduction factor of colony-forming units on the skin after 30 minutes of treatment. No statistically significant difference was seen between both of the polihexanide test products (mean lgRF polihexanide 0.02%, 1.2251 [SD, 0.9399]; mean lgRF polihexanide 0.04%, 1.8991 [SD, 0.88]) and the comparator, chlorhexidine 0.05% (P > .1). The results of this study indicate that polihexanide is a suitable alternative to chlorhexidine for skin and wound antisepsis.

  8. Comparison of an alcohol-based hand sanitation product with a traditional chlorhexidine hand scrub technique for hand hygiene preparation in an equine hospital.

    Science.gov (United States)

    Edwards, R A; Riley, C B; Howe, L; Burrows, E A; Riley, K T; Frellstedt, L

    2017-09-01

    To investigate the efficacy of an alcohol gel-based hand antisepsis protocol compared with a traditional chlorhexidine-based protocol under conditions of routine clinical contamination, and following heavy faecal contamination. Twelve adult participants were recruited and on four separate days completed a hand sanitation protocol using a chlorhexidine scrub or an alcohol-based gel, with hands that were grossly clean but contaminated or with faecal contamination. Bacterial samples were obtained from participants' hands before sanitation, immediately after and then 2 hours later. All samples were cultured on blood and MacConkey agar and bacterial colonies counted after 48 hours. for clean contaminated hands, the percentage reduction in bacterial colonies on blood agar immediately after hand sanitation was similar for both protocols (p=0.3), but was greater for the alcohol gel than chlorhexidine after 2 hours (p=0.005). For hands with faecal contamination, the percentage reduction in bacterial colonies on blood agar was similar for both protocols immediately and 2 hours after sanitation (p>0.2), but positive cultures were obtained on blood agar from samples collected after both protocols, for almost all participants. The results indicate equivalent efficacy of the alcohol-based gel and the pre-surgical chlorhexidine protocol. The alcohol-based gel protocol is an effective hand asepsis technique for grossly clean contaminated hands and those following faecal contamination, with comparable efficacy to chlorhexidine based scrub.

  9. Low temperature plasma biomedicine: A tutorial review

    International Nuclear Information System (INIS)

    Graves, David B.

    2014-01-01

    Gas discharge plasmas formed at atmospheric pressure and near room temperature have recently been shown to be potentially useful for surface and wound sterilization, antisepsis, bleeding cessation, wound healing, and cancer treatment, among other biomedical applications. This tutorial review summarizes the field, stressing the likely role of reactive oxygen and nitrogen species created in these plasmas as the biologically and therapeutically active agents. Reactive species, including radicals and non-radical compounds, are generated naturally within the body and are now understood to be essential for normal biological functions. These species are known to be active agents in existing therapies for wound healing, infection control, and cancer treatment. But they are also observed at elevated levels in persons with many diseases and are associated with aging. The physical and chemical complexity of plasma medical devices and their associated biochemical effects makes the development of safe, effective plasma medical devices and procedures a challenge, but encouragingly rapid progress has been reported around the world in the last several years

  10. Scientific Knowledge and Technology, Animal Experimentation, and Pharmaceutical Development.

    Science.gov (United States)

    Kinter, Lewis B; DeGeorge, Joseph J

    2016-12-01

    Human discovery of pharmacologically active substances is arguably the oldest of the biomedical sciences with origins >3500 years ago. Since ancient times, four major transformations have dramatically impacted pharmaceutical development, each driven by advances in scientific knowledge, technology, and/or regulation: (1) anesthesia, analgesia, and antisepsis; (2) medicinal chemistry; (3) regulatory toxicology; and (4) targeted drug discovery. Animal experimentation in pharmaceutical development is a modern phenomenon dating from the 20th century and enabling several of the four transformations. While each transformation resulted in more effective and/or safer pharmaceuticals, overall attrition, cycle time, cost, numbers of animals used, and low probability of success for new products remain concerns, and pharmaceutical development remains a very high risk business proposition. In this manuscript we review pharmaceutical development since ancient times, describe its coevolution with animal experimentation, and attempt to predict the characteristics of future transformations. © The Author 2016. Published by Oxford University Press on behalf of the Institute for Laboratory Animal Research. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  11. Surveillance of Environmental and Procedural Measures of Infection Control in the Operating Theatre Setting.

    Science.gov (United States)

    Dallolio, Laura; Raggi, Alessandra; Sanna, Tiziana; Mazzetti, Magda; Orsi, Alessandra; Zanni, Angela; Farruggia, Patrizia; Leoni, Erica

    2017-12-28

    The microbiological contamination of operating theatres and the lack of adherence to best practices by surgical staff represent some of the factors affecting Surgical Site Infections (SSIs). The aim of the present study was to assess the microbiological quality of operating settings and the staff compliance to the SSI evidence-based control measures. Ten operating rooms were examined for microbiological contamination of air and surfaces, after cleaning procedures, in "at rest" conditions. Furthermore, 10 surgical operations were monitored to assess staff compliance to the recommended practices. None of the air samples exceeded microbiological reference standards and only six of the 200 surface samples (3.0%) were slightly above recommended levels. Potentially pathogenic bacteria and moulds were never detected. Staff compliance to best practices varied depending on the type of behaviour investigated and the role of the operator. The major not compliant behaviours were: pre-operative skin antisepsis, crowding of the operating room and hand hygiene of the anaesthetist. The good environmental microbiological quality observed is indicative of the efficacy of the cleaning-sanitization procedures adopted. The major critical point was staff compliance to recommended practices. Awareness campaigns are therefore necessary, aimed at improving the organisation of work so as to facilitate compliance to operative protocols.

  12. Low temperature plasma biomedicine: A tutorial review

    Energy Technology Data Exchange (ETDEWEB)

    Graves, David B., E-mail: graves@berkeley.edu [University of California at Berkeley, Berkeley, California 94720 (United States)

    2014-08-15

    Gas discharge plasmas formed at atmospheric pressure and near room temperature have recently been shown to be potentially useful for surface and wound sterilization, antisepsis, bleeding cessation, wound healing, and cancer treatment, among other biomedical applications. This tutorial review summarizes the field, stressing the likely role of reactive oxygen and nitrogen species created in these plasmas as the biologically and therapeutically active agents. Reactive species, including radicals and non-radical compounds, are generated naturally within the body and are now understood to be essential for normal biological functions. These species are known to be active agents in existing therapies for wound healing, infection control, and cancer treatment. But they are also observed at elevated levels in persons with many diseases and are associated with aging. The physical and chemical complexity of plasma medical devices and their associated biochemical effects makes the development of safe, effective plasma medical devices and procedures a challenge, but encouragingly rapid progress has been reported around the world in the last several years.

  13. Antimicrobial and antiseptic strategies in wound management.

    Science.gov (United States)

    Daeschlein, Georg

    2013-12-01

    Wounds, especially chronic wounds, represent a global problem costing millions of dollars per year in developed countries and are characterised by microbial complications including local or overt infection, delayed healing and spread of multiresistant germs. Therefore, antimicrobial wound management is a major challenge that continues to require new solutions against microbes and their biofilms. As systemic antibiotics can barely penetrate into wound biofilms and topically applied ones can easily lead to sensitisation, antisepsis is the method of choice to treat germs in wounds. This brief review discusses the role of antiseptics in reducing bioburden in chronic wounds. Balancing antimicrobial potency and tolerability of antiseptic procedures is critical in wound therapy. However, antiseptics alone may not be able to achieve wound healing without addressing other factors regarding the patient's general health or the wound's physical environment. Although the precise role of bioburden in chronic wounds remains to be evaluated, planktonic as well as biofilm-bound microbes are indications for antiseptic intervention. Octenidine dihydrochloride and polyhexanide are the most effective, as well as best tolerated, antiseptics in wound management today, and new strategies to reduce bacterial wound burden and support the body's immune response are being developed. © 2013 The Author. International Wound Journal © 2013 John Wiley & Sons Ltd and Medicalhelplines.com Inc.

  14. Multi-drug-resistant Acinetobacter calcoaceticus-Acinetobacter baumannii complex infection outbreak in dogs and cats in a veterinary hospital.

    Science.gov (United States)

    Kuzi, S; Blum, S E; Kahane, N; Adler, A; Hussein, O; Segev, G; Aroch, I

    2016-11-01

    Members of the Acinetobacter calcoaceticus-Acinetobacter baumannii complex cause severe outbreaks in humans, and are increasingly reported in animals. A retrospective study, describing a severe outbreak in dogs and cats caused by a multidrug resistant member of the Acinetobacter calcoaceticus-Acinetobacter baumannii complex in a veterinary hospital, between July 2010 and November 2012. The study included 19 dogs and 4 cats. Acinetobacter calcoaceticus-Acinetobacter baumannii complex bacteria were isolated from urine (9 animals), respiratory tract (11), tissues (3) and blood (1). The most common infection-associated findings included fever, purulent discharge from endotracheal tubes, hypotension, and neutropaenia. Infections led to pneumonia, urinary tract infection, cellulitis and sepsis. Infection was transmitted in the intensive care unit, where 22 of 23 animals were initially hospitalised. The mortality rate was 70% (16 of 23 animals), and was higher in cases of respiratory infection compared to other infections. Aggressive environmental cleaning and disinfection, with staff education for personal hygiene and antisepsis, sharply decreased the infection incidence. Health care-associated outbreaks with multidrug resistant Acinetobacter calcoaceticus-Acinetobacter baumannii complex in dogs and cats are potentially highly fatal and difficult to eradicate, warranting monitoring, antiseptic techniques and judicious antibiotic use. © 2016 British Small Animal Veterinary Association.

  15. Surveillance of Environmental and Procedural Measures of Infection Control in the Operating Theatre Setting

    Directory of Open Access Journals (Sweden)

    Laura Dallolio

    2017-12-01

    Full Text Available The microbiological contamination of operating theatres and the lack of adherence to best practices by surgical staff represent some of the factors affecting Surgical Site Infections (SSIs. The aim of the present study was to assess the microbiological quality of operating settings and the staff compliance to the SSI evidence-based control measures. Ten operating rooms were examined for microbiological contamination of air and surfaces, after cleaning procedures, in “at rest” conditions. Furthermore, 10 surgical operations were monitored to assess staff compliance to the recommended practices. None of the air samples exceeded microbiological reference standards and only six of the 200 surface samples (3.0% were slightly above recommended levels. Potentially pathogenic bacteria and moulds were never detected. Staff compliance to best practices varied depending on the type of behaviour investigated and the role of the operator. The major not compliant behaviours were: pre-operative skin antisepsis, crowding of the operating room and hand hygiene of the anaesthetist. The good environmental microbiological quality observed is indicative of the efficacy of the cleaning-sanitization procedures adopted. The major critical point was staff compliance to recommended practices. Awareness campaigns are therefore necessary, aimed at improving the organisation of work so as to facilitate compliance to operative protocols.

  16. Anti-microbial efficiency of silver diamine fluoride as an endodontic medicament - An ex vivo study

    Directory of Open Access Journals (Sweden)

    Vinod B Mathew

    2012-01-01

    Full Text Available Context: Antisepsis achieved through appropriate use of irrigants is essential for endodontic success. Identification of newer anti-bacterial agents gives alternatives to clean the canal as eradication of the infection prior to obturation does affect prognosis. Objective: Comparison of the anti-bacterial action of 3.8% silver diamine fluoride and 2% chlorhexidine gluconate against Enterococcus faecalis in root canals. Materials and Methods: Forty-four single-rooted teeth were decoronated, and the root section was enlarged with peeso-reamer (No: 3 to standardize length and diameter. The samples were then autoclaved and divided into two study groups and two control groups. Enterococcus faecalis ATCC 29212 was inoculated into all test samples for 72 hours. The samples were enlarged with peeso-reamer (No: 5 after placement of respective medicament for 24 hours. Shavings were collected and inoculated on Brain Heart Infusion agar for 24 hrs to measure the colony forming units. Results: Both 3.8% silver diamine fluoride and 2% chlorhexidine showed a superior capacity to sterilize the root canals than control groups. Conclusion: The use of silver diamine fluoride as an endodontic irrigant is feasible as it can effectively remove the microbes present in the canal and circumpulpal dentin.

  17. Great Names in the History of Orthopaedics XIV: Joseph Lister (1827–1912 Part 1

    Directory of Open Access Journals (Sweden)

    Fu Kuo-Tai Louis

    2010-12-01

    Full Text Available Although the evolution of surgical practices cannot be the efforts of a single individual, Joseph almost single-handedly revolutionised modern surgery. Undoubtedly one of the greatest surgical benefactors of mankind, Joseph Lister was as great a scientist as he was a surgeon. His earliest research after graduation was on the muscles of the iris and coagulation of blood. He was one of the pioneers in bacteriology and the first to isolate bacteria in pure culture. While Professor of Surgery at Glasgow, he appreciated the significance of the antiseptic properties of certain phenolic compounds and applied them in clinical surgery. Although he was not the first person to apply antisepsis in surgery, he was the one who established the principles of antiseptic and later aseptic surgery and convinced the medical profession of his principles. In the world of science, credit goes to the person who developed and propagated the discovery, it first. Indeed, surgery is divided into its pre- and post-Listerian eras.

  18. Risk of cardiac pacemaker pocket infection in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Jaswinder Singh Gill

    2017-01-01

    Full Text Available Background: The risk of pacemaker pocket infections (PPIs is rare with good antisepsis techniques and use of advanced antibiotics. However, injudicious antibiotic usage leads to the rise of multidrug-resistant bacteria, which may cause PPI. Few reports exist about the microbial spectrum of the PPI from our country, prompting us to study the same. Methods: We conducted this retrospective observational study for 3 years (January 2013–February 2016 from all the patients with PPI. We collected the relevant clinical samples (blood and pus for the microbial culture using a standard protocol. We included 100 samples collected from the medical staff and the hospital environment as a control sample. The data were analyzed using appropriate statistical methods and a P< 0.05 was considered statistically significant. Results: Our data showed that 17 out of 160 (10.6% patients had PPI. Coagulase negative Staphylococcus sp. was isolated in 7 (41.2% patients, followed by Staphylococcus aureus in 4 patients (23.5%. Other isolated bacteria include multidrug-resistant Burkholderia cepacia (n = 3, Mycobacterium abscessus (n = 2 and polymicrobial infection in a single patient. One out of hundred surveillance samples grew B. cepacia. Conclusion: Our data revealed a high incidence of Gram-positive cocci causing PPI. Every hospital should formulate their antibiotic policy based on the pattern of the hospital flora and their drug sensitivity.

  19. Low temperature plasma biomedicine: A tutorial reviewa)

    Science.gov (United States)

    Graves, David B.

    2014-08-01

    Gas discharge plasmas formed at atmospheric pressure and near room temperature have recently been shown to be potentially useful for surface and wound sterilization, antisepsis, bleeding cessation, wound healing, and cancer treatment, among other biomedical applications. This tutorial review summarizes the field, stressing the likely role of reactive oxygen and nitrogen species created in these plasmas as the biologically and therapeutically active agents. Reactive species, including radicals and non-radical compounds, are generated naturally within the body and are now understood to be essential for normal biological functions. These species are known to be active agents in existing therapies for wound healing, infection control, and cancer treatment. But they are also observed at elevated levels in persons with many diseases and are associated with aging. The physical and chemical complexity of plasma medical devices and their associated biochemical effects makes the development of safe, effective plasma medical devices and procedures a challenge, but encouragingly rapid progress has been reported around the world in the last several years.

  20. [Modification of hybrid antimicrobial peptide CecA-mil gene and its over-secretion expression in Pichia pastoris].

    Science.gov (United States)

    Zhang, Su-fang; Cao, Rui-bing; Jia, Yun; Zhou, Bin; Chen, Pu-yan

    2005-04-01

    According to the partiality codon of Pichia pastoris, hybrid antimicrobial peptide CecA-mil gene was reconstructed, synthesized and cloned into pPICZalpha-A to construct the recombinant expression vector pPICZa-A-CM. The pPICZalpha-A-CM was transformed into yeast host strain X-33. Under the control of the promoter AOX1 (alcohol oxidase 1), a approximately 1.9 kD cecA-mil protein was expressed with the high level of 245 microg/mL after optimized the requirements for the flask-shaking culture fermentation of the Pichia pastoris rX-33/pPICZalpha-A-CM. The hybrid antibacterial peptide had a broad spectrum antibacterial activity on both gram-positive and gram-negative bacteria, especially showed potent antibacterial activity against ampicillin-resistant and kanamycin- resistant bacteria, such as Staphylococcus aureus (cowan I) and pathogenic E. coli (O1) from chicken. In addition, the hybrid antibacterial peptide showed an extreme heat-stable and acid-stable characteristic. Based on these characteristics, the recombinant antibacterial peptide CecA-mil display application foreground in the field of antisepsis of food, prevention of disease, additives of animal feedstuff and so on.

  1. Toothbrushing may reduce ventilator-associated pneumonia.

    Science.gov (United States)

    Yusuf, Huda

    2013-09-01

    The databases Embase, Medline, CINAHL, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, clinical trials.gov and controlled-trials.com were searched. Reference lists of reviewed articles and eligible trials were also searched, and toothpaste and toothbrush manufactures were contacted. Randomised controlled trials in adults over 18 years receiving mechanical ventilation were included where any kind of oral care involving toothbrushing was compared with any other kind of oral care or control with or without toothbrushing. Data were extracted in duplicate and quality assessed using the Cochrane risk of bias tool. The results were combined using a random effects model. The main outcome was VAP. Six trials involving a total of 1408 patients were included. The risk of bias was high in four trials, low in one and unclear in the other. In four trials, there was a trend toward lower ventilator-associated pneumonia rates (risk ratio, 0.77; 95% confidence interval, 0.50-1.21; p = 0.26). The only trial with low risk of bias suggested that toothbrushing significantly reduced ventilator-associated pneumonia (risk ratio, 0.26; 95% confidence interval, 0.10-0.67; p = 0.006). Use of chlorhexidine antisepsis seems to attenuate the effect of toothbrushing on ventilator-associated pneumonia (p for the interaction = 0.02). One trial comparing electric vs. manual toothbrushing showed no difference in ventilator-associated pneumonia rates (risk ratio, 0.96; 95% confidence interval, 0.47-1.96; p = 0.91). Toothbrushing did not impact on length of ICU stay, or ICU or hospital mortality. In summary, randomised trials to date show that toothbrushing is associated with a trend toward lower rates of VAP in intubated, mechanically ventilated critically ill patients. There is no clear difference between electric and manual toothbrushing. Toothbrushing has no effect on ICU mortality, hospital mortality, or ICU length of stay.

  2. Repair process of surgical defects filled with autogenous bone grafts in tibiae of diabetic rats

    Directory of Open Access Journals (Sweden)

    Jônatas Caldeira Esteves

    2008-10-01

    Full Text Available From a biological standpoint, the best material for reconstruction of bone defects is the autogenous bone graft. However, as tissue healing is affected under diabetic conditions, major changes might take place in the revascularization, incorporation, replacement and remodeling phases of the grafted area. The purpose of this study was to assess the bone healing process in surgical wounds prepared in tibiae of diabetic rats and filled with autogenous bone. Forty male rats (Rattus norvegicus albinus, Wistar were randomly assigned to receive an endovenous injection (penile vein of either citrate buffer solution (Group 1 - control; n=20 or streptozotocin dissolved in citrate buffer solution (35 mg/kg to induce diabetes (Group 2 - diabetic; n=20. After determination of glycemia, the animals were anesthetized and the anterolateral regions of the tibiae of both limbs were shaved, antisepsis was performed and longitudinal incisions were made in each limb. The tibiae were exposed and two 2mm-diameter surgical cavities were prepared: one in the right limb, filled with particulate autogenous bone and the other in the left limb, filled with blood clot. The animals were euthanized at 10 and 30 postoperative days. The anatomic pieces were obtained, submitted to laboratory processing and sections were stained by hematoxylin and eosin and Masson's Trichrome for histomorphologic and histometric analyses. In both groups, the wounds filled with autogenous bone graft showed better results than those filled with blood clot. The control group showed higher new bone formation in wounds filled with autogenous bone graft at 30 days than the diabetic group, but without statistical significance. It may be concluded that, in general, the new bone formation occurred with autogenous graft was quantitatively similar between control and diabetic groups and qualitatively better in the control group.

  3. [Rose necrosis: Necrotizing granulomatous reaction with infected node at red pigment of a tattoo].

    Science.gov (United States)

    Fray, J; Lekieffre, A; Parry, F; Huguier, V; Guillet, G

    2014-04-01

    Nowadays, necrotizing cutaneous reaction after a tattoo is rare especially with the sterile tattoo equipment and antisepsis rules. We report the rare case of a necrotizing reaction secondary to a granulomatous reaction after a red tattoo, with a satellite node. A 40-year-old patient suffering from a granulomatous reaction to red dye of a large pectoral tattoo, with cutaneous and sub-cutaneous necrosis, and an infected axillary node. This pectoral tattoo also triggered a necrotizing granulomatous reaction on red-pigmented areas of other older tattoos. Local treatments (dressings, antibiotics, repeated excisions of necrotizing tissues) did not stop the allergic reaction, and an infectious origin was eliminated. The patient asked for a complete excision of the pectoral tattoo. Black intramacrophagic pigment was found in the black lymph node analysed. We did not experience any complications and the patient is satisfied with the results. Very few examples of cutaneous necrotizing secondary to a tattoo have been found in the literature. The hypothesis of a primitive infection that had secondarily led to necrosis is refuted by the lack of infective structures found in the analysed node, and most of all by the same reaction on other older tattoos on red-pigmented areas. This rare complication must be known by plastic surgeons, who will probably be called upon to take care of more and more tattooed patients. Even if it's rare, necrosis with a granulomatous reaction to red pigment after a tattoo must be known. This case illustrates a very violent immune reaction where infection was not proved. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  4. The next generation of sepsis clinical trial designs: what is next after the demise of recombinant human activated protein C?*.

    Science.gov (United States)

    Opal, Steven M; Dellinger, R Phillip; Vincent, Jean-Louis; Masur, Henry; Angus, Derek C

    2014-07-01

    The developmental pipeline for novel therapeutics to treat sepsis has diminished to a trickle compared to previous years of sepsis research. While enormous strides have been made in understanding the basic molecular mechanisms that underlie the pathophysiology of sepsis, a long list of novel agents have now been tested in clinical trials without a single immunomodulating therapy showing consistent benefit. The only antisepsis agent to successfully complete a phase III clinical trial was human recumbent activated protein C. This drug was taken off the market after a follow-up placebo-controlled trial (human recombinant activated Protein C Worldwide Evaluation of Severe Sepsis and septic Shock [PROWESS SHOCK]) failed to replicate the favorable results of the initial registration trial performed ten years earlier. We must critically reevaluate our basic approach to the preclinical and clinical evaluation of new sepsis therapies. We selected the major clinical studies that investigated interventional trials with novel therapies to treat sepsis over the last 30 years. Phase II and phase III trials investigating new treatments for sepsis and editorials and critiques of these studies. Selected manuscripts and clinical study reports were analyzed from sepsis trials. Specific shortcomings and potential pit falls in preclinical evaluation and clinical study design and analysis were reviewed and synthesized. After review and discussion, a series of 12 recommendations were generated with suggestions to guide future studies with new treatments for sepsis. We need to improve our ability to define appropriate molecular targets for preclinical development and develop better methods to determine the clinical value of novel sepsis agents. Clinical trials must have realistic sample sizes and meaningful endpoints. Biomarker-driven studies should be considered to categorize specific "at risk" populations most likely to benefit from a new treatment. Innovations in clinical trial design

  5. Central venous access devices site care practices: an international survey of 34 countries.

    Science.gov (United States)

    Broadhurst, Daphne; Moureau, Nancy; Ullman, Amanda J

    2016-01-01

    Effective postinsertion management of central venous access devices (CVADs) is important to prevent CVAD-associated complications, including catheter-associated bloodstream infections. Although there is a wealth of evidence-based guidelines available to guide the care of CVADs, applying their recommendations to the clinical setting across variable patient groups, CVAD types and international healthcare settings is challenging. This may result in patients receiving suboptimal care. A cross-sectional descriptive study using an online survey was performed with an aim to determine current CVAD site care practices internationally. The CVAD site care domains included skin antisepsis, dressing selection, frequency of dressing change and device securement practices across impaired and unimpaired CVAD sites. Clinicians (n = 1044) residing in 34 countries reported diversity in their practice, with the majority of respondents practicing as nurses (89%) from North America (81%) as vascular access specialists (52%). The respondents' reported practice was variant, with differing inconsistency to guidelines throughout each of the domains. There was wide variance in the management of CVAD sites with impaired skin integrity, such as rash, skin stripping/adhesive-related injuries and drainage. Vascular access clinicians reported high levels of confidence in managing CVAD sites, including those with impaired skin. These inconsistencies are reflective of the complex and heterogeneous populations requiring CVADs, the evidence available to support practice in this area, the skills and knowledge of the clinicians caring for them and the resources of the healthcare setting. Further research and education is necessary to ensure that CVAD site care is undertaken effectively to minimise preventable complications.

  6. Effect of antiseptic irrigation on infection rates of traumatic soft tissue wounds: a longitudinal cohort study.

    Science.gov (United States)

    Roth, B; Neuenschwander, R; Brill, F; Wurmitzer, F; Wegner, C; Assadian, O; Kramer, A

    2017-03-02

    Acute traumatic wounds are contaminated with bacteria and therefore an infection risk. Antiseptic wound irrigation before surgical intervention is routinely performed for contaminated wounds. However, a broad variety of different irrigation solutions are in use. The aim of this retrospective, non-randomised, controlled longitudinal cohort study was to assess the preventive effect of four different irrigation solutions before surgical treatment, on wound infection in traumatic soft tissue wounds. Over a period of three decades, the prophylactic application of wound irrigation was studied in patients with contaminated traumatic wounds requiring surgical treatment, with or without primary wound closure. The main outcome measure was development of wound infection. From 1974-1983, either 0.04 % polihexanide (PHMB), 1 % povidone-iodine (PVP-I), 4 % hydrogen peroxide, or undiluted Ringer's solution were concurrently in use. From 1984-1996, only 0.04 % PHMB or 1 % PVP-I were applied. From 1997, 0.04 % PHMB was used until the end of the study period in 2005. The combined rate for superficial and deep wound infection was 1.7 % in the 0.04 % PHMB group (n=3264), 4.8 % in the 1 % PVP-I group (n=2552), 5.9 % in the Ringer's group (n=645), and 11.7 % in the 4 % hydrogen peroxide group (n=643). Compared with all other treatment arms, PHMB showed the highest efficacy in preventing infection in traumatic soft tissue wounds (p<0.001). However, compared with PVP-I, the difference was only significant for superficial infections. The large patient numbers in this study demonstrated a robust superiority of 0.04 % PHMB to prevent infection in traumatic soft tissue wounds. These retrospective results may further provide important information as the basis for power calculations for the urgently needed prospective clinical trials in the evolving field of wound antisepsis.

  7. Acquired resistance to chlorhexidine - is it time to establish an 'antiseptic stewardship' initiative?

    Science.gov (United States)

    Kampf, G

    2016-11-01

    Chlorhexidine digluconate (CHG) is an antimicrobial agent used for different types of applications in hand hygiene, skin antisepsis, oral care, and patient washing. Increasing use raises concern regarding development of acquired bacterial resistance. Published data from clinical isolates with CHG minimum inhibitory concentrations (MICs) were reviewed and compared to epidemiological cut-off values to determine resistance. CHG resistance is rarely found in Escherichia coli, Salmonella spp., Staphylococcus aureus or coagulase-negative staphylococci. In Enterobacter spp., Pseudomonas spp., Proteus spp., Providencia spp. and Enterococcus spp., however, isolates are more often CHG resistant. CHG resistance may be detected in multi-resistant isolates such as extremely drug-resistant Klebsiella pneumoniae. Isolates with a higher MIC are often less susceptible to CHG for disinfection. Although cross-resistance to antibiotics remains controversial, some studies indicate that the overall exposure to CHG increases the risk for resistance to some antibiotic agents. Resistance to CHG has resulted in numerous outbreaks and healthcare-associated infections. On an average intensive care unit, most of the CHG exposure would be explained by hand hygiene agents when liquid soaps or alcohol-based hand rubs contain CHG. Exposure to sub-lethal CHG concentration may enhance resistance in Acinetobacter spp., K. pneumoniae, and Pseudomonas spp., all species well known for emerging antibiotic resistance. In order to reduce additional selection pressure in nosocomial pathogens it seems to make sense to restrict the valuable agent CHG to those indications with a clear patient benefit and to eliminate it from applications without any benefit or with a doubtful benefit. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  8. Comparison of Four Antiseptic Preparations for Skin in the Prevention of Contamination of Percutaneously Drawn Blood Cultures: a Randomized Trial

    Science.gov (United States)

    Calfee, David P.; Farr, Barry M.

    2002-01-01

    A number of skin antiseptics have been used to prevent the contamination of blood cultures, but the comparative efficacies of these agents have not been extensively evaluated. We therefore sought to compare the efficacy of four skin antiseptics in preventing blood culture contamination in a randomized, crossover, investigator-blinded study conducted in an emergency department and the inpatient wards of a university hospital. The patient group included all patients from whom blood samples were obtained percutaneously for culture. Skin antisepsis was performed with 10% povidone-iodine, 70% isopropyl alcohol, tincture of iodine, or povidone-iodine with 70% ethyl alcohol (i.e., Persist). The blood culture contamination rate associated with each antiseptic was then determined. A total of 333 (2.62%) of 12,692 blood cultures were contaminated during the study period compared to 413 (3.21%) of 12,859 blood cultures obtained during the previous 12-month period (relative risk = 0.82; 95% confidence interval, 0.71 to 0.94; P = 0.006). During the study, the contamination rates were determined to be 2.93% with povidone-iodine, 2.58% with tincture of iodine, 2.50% with isopropyl alcohol, and 2.46% with Persist (P = 0.62). We detected no significant differences in the blood culture contamination rates among these four antiseptics, although there was some evidence suggesting greater efficacy among the alcohol-containing antiseptics. Among the evaluated antiseptics, isopropyl alcohol may be the optimal antiseptic for use prior to obtaining blood for culture, given its convenience, low cost, and tolerability. PMID:11980938

  9. Evaluation of antiseptic disinfectant activity with static light scattering technology

    Directory of Open Access Journals (Sweden)

    Gaia Ortalli

    2017-12-01

    Full Text Available Background and aims. Healthcare-associated infections (HAI are an increasingly important issue, for this reason disinfection and antisepsis practices acquire importance. The use of products with antiseptic activity and reports of resistance to these molecules, pose the need to test, in the local area, the sensitivity pattern. The aim of this study is to verify the ability of the analytical system Alfred 60AST (Alifax Spa Isola dell’Abbà, Polverara - PD - Italy in evaluating the antimicrobial effectiveness in vitro of different molecules in comparison to the membrane filtration reference method, in accordance with the procedure NF T72- 152 proposed by the Association Française de Normalisation (AFNOR. Materials and Methods. We used four antiseptic-disinfectant substances, commonly used in hospital practic: Iodopovidone, Ethanol, Chlorhexidine and DECS. ATCC strains were assessed both with clinical isolates. The eventual development occurs by means of microbial ALFRED AST60 was carried out in progressive times (30, 60 and 120 minutes with different dilutions for each of the disinfectant molecules tested. Results and Conclusions. Comparison tests carried out between membrane filtration method and instrumentation Alfred 60AST gave results almost totally concordant. The analyzer Alfred 60AST can then be appropriately adapted to the in vitro evaluation of antiseptics, representing a valuable aid in the periodic monitoring of their activities and the prior assessment of sensitivity for therapeutic use. Though preliminary, the study confirms the existence of bacteria resistant to alcohols and biguanides, and it emphasizes the opportunity to verify the in vitro sensitivity profile.

  10. Developing Process Maps as a Tool for a Surgical Infection Prevention Quality Improvement Initiative in Resource-Constrained Settings.

    Science.gov (United States)

    Forrester, Jared A; Koritsanszky, Luca A; Amenu, Demisew; Haynes, Alex B; Berry, William R; Alemu, Seifu; Jiru, Fekadu; Weiser, Thomas G

    2018-03-21

    Surgical infections cause substantial morbidity and mortality in low-and middle-income countries (LMICs). To improve adherence to critical perioperative infection prevention standards, we developed Clean Cut, a checklist-based quality improvement program to improve compliance with best practices. We hypothesized that process mapping infection prevention activities can help clinicians identify strategies for improving surgical safety. We introduced Clean Cut at a tertiary hospital in Ethiopia. Infection prevention standards included skin antisepsis, ensuring a sterile field, instrument decontamination/sterilization, prophylactic antibiotic administration, routine swab/gauze counting, and use of a surgical safety checklist. Processes were mapped by a visiting surgical fellow and local operating theater staff to facilitate the development of contextually-relevant solutions; processes were re-assessed for improvements. Process mapping helped identify barriers to using alcohol-based hand solution due to skin irritation, inconsistent administration of prophylactic antibiotics due to variable delivery outside of the operating theater, inefficiencies in assuring sterility of surgical instruments through lack of confirmatory measures, and occurrences of retained surgical items through inappropriate guidelines, staffing, and training in proper routine gauze counting. Compliance with most processes improved significantly following organizational changes to align tasks with specific process goals. Enumerating the steps involved in surgical infection prevention using a process mapping technique helped identify opportunities for improving adherence and plotting contextually relevant solutions, resulting in superior compliance with antiseptic standards. Simplifying these process maps into an adaptable tool could be a powerful strategy for improving safe surgery delivery in LMICs. Copyright © 2018. Published by Elsevier Inc.

  11. Profilaxis antibiótica en histerectomía abdominal y vaginal

    Directory of Open Access Journals (Sweden)

    Joaquín Hernández Torres

    1998-12-01

    Full Text Available Se estudiaron retrospectivamente los expedientes clínicos de 155 pacientes a las que se les realizó histerectomía por vía abdominal o vaginal, en el Servicio de Cirugía General durante un período de 30 meses. Las pacientes se dividieron en 3 grupos según: a recibieron antibioticoterapia perioperatoria, b recibieron antibioticoterapia en el posoperatorio inmediato y c no recibieron tratamiento antibiótico. Se analizó la tasa de infección de la herida quirúrgica, además de la relación de ésta con algunos factores, entre ellos el tiempo quirúrgico y la antisepsia vaginal. Se llevaron los resultados a tratamiento estadístico (chi cuadrado y test de Fisher y se concluyó en que existe diferencia significativa entre la tasa de infección de la herida cuando se utiliza profilaxis perioperatoria (4,7 % si se compara con las pacientes que no recibieron tratamiento antibióticoA retrospective study of the medical histories of 155 patients who underwent vaginal of abdominal hysterectomy at the General Surgery Service during 30 months was conducted. Patients were divided into 3 groups: a patients who received perioperative antibiotic therapy, b patients that were administered antibiotics theraphy in the immediate postoperative and c those under no antibiotics treatment. The surgical wound infection rate was analyzed as well as its relation with some factors, such as surgical time and vaginal antisepsis. The results were statistically treated (chi square and Fisher’s test and it was concluded that there is a significant difference between the wound infection rate of patients receiving perioperative prophylaxis (4.7 % and those without antibiotics treatment

  12. The proteolytically stable peptidomimetic Pam-(Lys-βNSpe)6-NH2 selectively inhibits human neutrophil activation via formyl peptide receptor 2.

    Science.gov (United States)

    Skovbakke, Sarah Line; Heegaard, Peter M H; Larsen, Camilla J; Franzyk, Henrik; Forsman, Huamei; Dahlgren, Claes

    2015-01-15

    Immunomodulatory host defense peptides (HDPs) are considered to be lead compounds for novel anti-sepsis and anti-inflammatory agents. However, development of drugs based on HDPs has been hampered by problems with toxicity and low bioavailability due to in vivo proteolysis. Here, a subclass of proteolytically stable HDP mimics consisting of lipidated α-peptide/β-peptoid oligomers was investigated for their effect on neutrophil function. The most promising compound, Pam-(Lys-βNSpe)6-NH2, was shown to inhibit formyl peptide receptor 2 (FPR2) agonist-induced neutrophil granule mobilization and release of reactive oxygen species. The potency of Pam-(Lys-βNSpe)6-NH2 was comparable to that of PBP10, the most potent FPR2-selective inhibitor known. The immunomodulatory effects of structural analogs of Pam-(Lys-βNSpe)6-NH2 emphasized the importance of both the lipid and peptidomimetic parts. By using imaging flow cytometry in primary neutrophils and FPR-transfected cell lines, we found that a fluorescently labeled analog of Pam-(Lys-βNSpe)6-NH2 interacted selectively with FPR2. Furthermore, the interaction between Pam-(Lys-βNSpe)6-NH2 and FPR2 was found to prevent binding of the FPR2-specific activating peptide agonist Cy5-WKYMWM, while the binding of an FPR1-selective agonist was not inhibited. To our knowledge, Pam-(Lys-βNSpe)6-NH2 is the first HDP mimic found to inhibit activation of human neutrophils via direct interaction with FPR2. Hence, we consider Pam-(Lys-βNSpe)6-NH2 to be a convenient tool in the further dissection of the role of FPR2 in inflammation and homeostasis as well as for investigation of the importance of neutrophil stimulation in anti-infective therapy involving HDPs. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Effect of Gamma Radiation on Antimicrobial Activity of Some Types of Egyptian Bees’ Products

    International Nuclear Information System (INIS)

    Aboul Magd, D.A.S.

    2014-01-01

    Api therapy (the medicinal use of honey bee products) has recently become the focus of attention as a form of folk and preventive medicine for treating certain conditions and diseases, as well as promoting overall health and well-being (Pyrzynska and Biesaga, 2009). Honeybees are master chemists and chemical engineers. Their success in the animal kingdom is greatly because of their unique chemistry and the application of their different products: honey, pollen, beeswax, propolis, royal jelly and bee venom. The first three products are chemically synthesized by the bees themselves while, the other three are derived from plants and are modified and engineered by the bees for their own use (Taha, 2004). Honey is the most important primary product of bee keeping from both a quantitative and an economic point of view (Adenekan et al., 2010). Honey is defined as the natural sweet substance, produced by the honeybees from the nectar, secretions of living parts or excretions of plant-sucking insects on the living parts of plants, which the bees collect, transform by combining with specific substances of their own, deposit, dehydrate, store and leave in honey combs to ripen and mature (Codex Alimentarius, 2001). Hippocrates, the great Greek scientist, prescribed a simple diet, favoring honey given as oxymel (vinegar and honey) for pain, hydromel (water and honey) for thirst, and a mixture of honey, water and various medical substances for acute fevers. Also, he utilized honey for baldness, contraception, wound healing, cough and sore throat, eye diseases, topical antisepsis, prevention and treatment of scars (Al-Jabri, 2005). During the biblical era, honey received a religious endorsement by both Islam and Christianity. Thus, the Holy Koran, the heritage of Islamic sciences, has time and again emphasized the medicinal virtue of honey (Sheikh et al., 1995). The last scripture enlisted it as a miraculous food in a separate Surah; ''Al-Nahl (The BEE).

  14. Use of Designated Nurse PICC Teams and CLABSI Prevention Practices Among U.S. Hospitals: A Survey-Based Study.

    Science.gov (United States)

    Krein, Sarah L; Kuhn, Latoya; Ratz, David; Chopra, Vineet

    2015-11-10

    The use of peripherally inserted central catheters (PICCs) has increased substantially within hospitals during the past several years. Yet, the prevalence and practices of designated nurse PICC teams (i.e., specially trained nurses who are responsible for PICC insertions at a hospital) are unknown. We, therefore, identified the prevalence of and factors associated with having a designated nurse PICC team among U.S. acute care hospitals. We conducted a survey of infection preventionists at a random sample of U.S. hospitals in May 2013, which asked about personnel who insert PICCs and the use of practices to prevent device-associated infections, including central line-associated bloodstream infection. We compared practice use between hospitals that have a designated nurse PICC team versus those that do not. Survey response rate was 70% (403/575). According to the respondents, nurse PICC teams inserted PICCs in more than 60% of U.S. hospitals in 2013. Moreover, certain practices to prevent central line-associated bloodstream infection, including maximum sterile barrier precautions (93% versus 88%, P = 0.06), chlorhexidine gluconate for insertion site antisepsis (96% versus 87%, P = .003) and facility-wide insertion checklists (95% versus 87%, P = 0.02) were regularly used by a higher percentage of hospitals with nurse PICC teams compared with those without. These data suggest that nurse PICC teams play an integral role in PICC use at many hospitals and that use of such teams may promote key practices to prevent complications. Better understanding of the role, composition, and practice of such teams is an important area for future study.

  15. Susceptibility of selected strains used for evaluation of biocidal efficiency of disinfectants and antibiotic-resistant strains to didecyldimethylammonium chloride in 2-propanol.

    Science.gov (United States)

    Chojecka, Agnieszka; Wiercińska, Olga; Röhm-Rodowald, Ewa; Kanclerski, Krzysztof; Jakimiak, Bożenna

    2015-01-01

    Didecyldimethylammonium chloride is an active substance which is part of variety of formulations used for the disinfection and antisepsis, both in the medical area as well as in the food, industrial and institutional area. Because of the widespread use of this substance and the development of bacterial resistance to quaternary ammonium compounds (QACs), the aim of this study was determination of the susceptibility of the standard strains used for the evaluation of the effectiveness of disinfectants and standard antibiotic-resistant strains to didecyldimethylammonium chloride in 2-propanol and its bactericidal activity. Susceptibility of standard strains used for the evaluation of the effectiveness of disinfectants (Staphylococcus aureus ATCC 6538-SA; Pseudomonas aeruginosa ATCC 15442-PA) and standard antibiotic-resistant strains (Staphylococcus aureus ATCC 43300-MRSA; Pseudomonas aeruginosa ATCC 47085-PAO-LAC) to CMAP was determined by minimum inhibitory concentrations (MICs) and minimum bactericidal concentration (MBCs). The bactericidal efficiency of CMAP against these strains was evaluated by using phenol coefficient (PC). Susceptibility of Gram-positive tested strains SA and MRSA to CMAP was similar (P>0,05). Significant difference in susceptibility of tested Gram-negative strains to CMAP was evaluated between PA and PAO-LAC strains (P<0,05). However,.higher resistance of PAO-LAC to CMAP was not significant when parameters such as concentration and contact time were applied in PC method. The correct determination and application of "in use" parameters (i.e. concentration, contact time, temperature and interfering substances) in disinfection process prevents the spread of resistant strains in.the environment.

  16. Therapeutical Administration of Peptide Pep19-2.5 and Ibuprofen Reduces Inflammation and Prevents Lethal Sepsis

    Science.gov (United States)

    Barcena Varela, Sergio; Ferrer-Espada, Raquel; Reiling, Norbert; Goldmann, Torsten; Gutsmann, Thomas; Mier, Walter; Schürholz, Tobias; Drömann, Daniel; Brandenburg, Klaus; Martinez de Tejada, Guillermo

    2015-01-01

    Sepsis is still a major cause of death and many efforts have been made to improve the physical condition of sepsis patients and to reduce the high mortality rate associated with this disease. While achievements were implemented in the intensive care treatment, all attempts within the field of novel therapeutics have failed. As a consequence new medications and improved patient stratification as well as a thoughtful management of the support therapies are urgently needed. In this study, we investigated the simultaneous administration of ibuprofen as a commonly used nonsteroidal anti-inflammatory drug (NSAID) and Pep19-2.5 (Aspidasept), a newly developed antimicrobial peptide. Here, we show a synergistic therapeutic effect of combined Pep19-2.5-ibuprofen treatment in an endotoxemia mouse model of sepsis. In vivo protection correlates with a reduction in plasma levels of both tumor necrosis factor α and prostaglandin E, as a likely consequence of Pep19-2.5 and ibuprofen-dependent blockade of TLR4 and COX pro-inflammatory cascades, respectively. This finding is further characterised and confirmed in a transcriptome analysis of LPS-stimulated human monocytes. The transcriptome analyses showed that Pep19-2.5 and ibuprofen exerted a synergistic global effect both on the number of regulated genes as well as on associated gene ontology and pathway expression. Overall, ibuprofen potentiated the anti-inflammatory activity of Pep19-2.5 both in vivo and in vitro, suggesting that NSAIDs could be useful to supplement future anti-sepsis therapies. PMID:26197109

  17. Toothbrushing for critically ill mechanically ventilated patients: a systematic review and meta-analysis of randomized trials evaluating ventilator-associated pneumonia.

    Science.gov (United States)

    Alhazzani, Waleed; Smith, Orla; Muscedere, John; Medd, James; Cook, Deborah

    2013-02-01

    Oral care may decrease ventilator-associated pneumonia in the ICU. The objective of this review was to summarize and critically appraise randomized trials in mechanically ventilated patients in the ICU testing the effect of oral care strategies involving toothbrushing on ventilator-associated pneumonia. We searched EMBASE, MEDLINE, and the Cochrane Controlled Trials Register and Database of Systematic Reviews from 1980 until March 2012, independently and in duplicate, as well as personal files and reference lists. In duplicate, articles were selected if they were randomized trials, enrolled adult critically ill patients, compared any kind of oral care involving toothbrushing with any other kind of oral care or control with or without toothbrushing, and examined ventilator-associated pneumonia. In duplicate, we abstracted trial characteristics and quality using the Cochrane risk of bias tool. The results were combined using a random effects model. We included six trials enrolling 1,408 patients, five of which compared toothbrushing to usual oral care and one of which compared electric with manual toothbrushing. In four trials, there was a trend toward lower ventilator-associated pneumonia rates (risk ratio, 0.77; 95% confidence interval, 0.50-1.21; p = 0.26). This trend was also observed in one trial reporting fewer cases of ventilator-associated pneumonia per 1,000 ventilator days (20.68 vs. 25.89; p = 0.53) in patients receiving toothbrushing vs. no toothbrushing. The only trial with low risk of bias suggested that toothbrushing significantly reduced ventilator-associated pneumonia (risk ratio, 0.26; 95% confidence interval, 0.10-0.67; p = 0.006). Use of chlorhexidine antisepsis seems to attenuate the effect of toothbrushing on ventilator-associated pneumonia (p for the interaction = 0.02). One trial comparing electric vs. manual toothbrushing showed no difference in ventilator-associated pneumonia rates (risk ratio, 0.96; 95% confidence interval, 0.47-1.96; p = 0

  18. Preoperative povidone-iodine vaginal gel in abdominal hysterectomy: a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Beigi A

    2007-09-01

    Full Text Available Background: Infectious complications of hysterectomy remain common despite the use of antibiotic. The usual existing methods of preoperative antisepsis do not control the vaginal bacteria that are the primary cause of contamination at the surgical site. Our goal was to assess whether febrile morbidity after total abdominal hysterectomy is decreased by the addition of povidone-iodine gel at the vaginal apex after the routine vaginal preparation with povidone-iodine solution.Methods: We carried out a prospective randomized trial on women admitted for elective abdominal hysterectomy. Inclusion criteria included planned abdominal hysterectomy for benign or malignant gynecologic conditions. Exclusion criteria consisted of emergency surgery, current treatment for pelvic infection, and known povidone-iodine allergy. A total of 168 patients were randomized to either the control group or the intervention group, who received 20 cc povidone-iodine gel placed at the vaginal apex immediately before the operation. Both groups received the routine preoperative preparation of antimicrobial prophylaxis, abdominal and vaginal scrubbing with povidone-iodine solution prior to the operation. The primary outcome was post-operative febrile morbidity. Other outcomes included abdominal wound infection, vaginal cuff cellulitis or pelvic abscess. Data was analyzed using Fisher's exact test. p<0.05 was considered statistically significant.Results: The overall rate of febrile morbidity was 20.5%. Febrile morbidity occurred in ten of 80 (12.5% women receiving the povidone-iodine gel preparation and 24 of 86 (27.9% women not receiving the gel (p<0.05. The rate of abdominal wound infection was 18.6% (16 in the control group, and 5% (4 in the gel group (p<0.05. Vaginal cuff cellulitis was seen in three patients from the control group versus one woman from the gel group (p>0.05. Pelvic abscess was diagnosed in one patient from the control group and in no patients from the

  19. Outlined history of the development of the world and Polish cardiac surgery.

    Science.gov (United States)

    Dziatkowiak, A J

    2006-04-01

    It was the dream of humanity to perform surgery on an open non-beating heart. Scientific and medical discoveries five thousand years ago in China, partially adopted by the Western civilization, laid, through ancient Egypt, Mesopotamia, Greece, Rome and, later on in the Renaissance, the foundations for the development of empirical medicine. The 19th and the 20th centuries shoved dynamic scientific and technical development in various fields including medicine and surgery whose importance grew with the necessity to help the patients wounded in the wars. A break-through event in the development of surgery was overcoming of pain and discovery of reasons of infections and the control thereof, and, in the case of cardiology and cardiac surgery, the discoveries in physiology of circulation and the diagnostics of cardiovascular system diseases. This review contains a brief description of medical science in the past centuries, emphasizing the most important discoveries. A focus has been placed on the contribution of general surgery and thoracic surgery to the development of Polish and World cardiac surgery. The I Congress of the Polish Surgeons was held in 1889 in the Austria occupied territory of Cracow, which celebrated its one hundredth anniversary. The main obstacles in the development of clinical cardiac surgery included intratracheal general anesthesia, antisepsis and aseptics, hypothermia, oxygenators, extracorporeal circulation, transfusions, blood clotting and thromboses and cardioplegia. The spectacular heart and aorta surgical operations performed for the first time in the world and in Poland as well as the names of cardiac surgeons employed by the important cardiac surgery centers in Poland have been mentioned. The Department of Heart, Vascular and Transplantology Surgery of Cracow, the role and the share of Fundacja Rozwoju Kardiochirurgii COR AEGRUM in Cracow (COR AEGRUM Foundation for the Development of Cardiac Surgery in Cracow) in the construction of the

  20. Perioperative management of neurosurgical patients with methicillin-resistant Staphylococcus aureus.

    Science.gov (United States)

    Akins, Paul T; Belko, John; Banerjee, Amit; Guppy, Kern; Herbert, David; Slipchenko, Tamara; DeLemos, Christi; Hawk, Mark

    2010-02-01

    patients who received MRSA-specific prophylactic antibiotic therapy (usually vancomycin) was 7.4% (27 procedures) compared with 32.1% (28 procedures) in patients who received the standard treatment (usually cefazolin) (p = 0.04). Wound care for ICU patients was standardized for postoperative Days 0-7 with chlorhexidine cleaning at bandage changes at 3-day intervals. Wound cultures from neurosurgical site infections in patients with prior MRSA colonization or infection grew MRSA in 7 of 11 patients. Neurosurgical patients identified with MRSA colonization or a prior history of MRSA infections benefit from specific perioperative care, including prophylactic antibiotics active against MRSA (such as vancomycin) and postoperative wound care with coverings and chlorhexidine antisepsis to reduce MRSA wound colonization.

  1. Infection Prevention and Control in Pediatric Ambulatory Settings.

    Science.gov (United States)

    Rathore, Mobeen H; Jackson, Mary Anne

    2017-11-01

    protective equipment, such as gloves, gowns, masks, and eye protection; and appropriate use of sterilization, disinfection, and antisepsis. Lastly, in this policy, we emphasize the importance of public health interventions, including vaccination for patients and health care personnel, and outline the responsibilities of the health care provider related to prompt public health notification for specific reportable diseases and communication with colleagues who may be providing subsequent care of an infected patient to optimize the use of isolation precautions and limit the spread of contagions. Copyright © 2017 by the American Academy of Pediatrics.

  2. Human Coronaviruses: Insights into Environmental Resistance and Its Influence on the Development of New Antiseptic Strategies

    Science.gov (United States)

    Geller, Chloé; Varbanov, Mihayl; Duval, Raphaël E.

    2012-01-01

    The Coronaviridae family, an enveloped RNA virus family, and, more particularly, human coronaviruses (HCoV), were historically known to be responsible for a large portion of common colds and other upper respiratory tract infections. HCoV are now known to be involved in more serious respiratory diseases, i.e. bronchitis, bronchiolitis or pneumonia, especially in young children and neonates, elderly people and immunosuppressed patients. They have also been involved in nosocomial viral infections. In 2002–2003, the outbreak of severe acute respiratory syndrome (SARS), due to a newly discovered coronavirus, the SARS-associated coronavirus (SARS-CoV); led to a new awareness of the medical importance of the Coronaviridae family. This pathogen, responsible for an emerging disease in humans, with high risk of fatal outcome; underline the pressing need for new approaches to the management of the infection, and primarily to its prevention. Another interesting feature of coronaviruses is their potential environmental resistance, despite the accepted fragility of enveloped viruses. Indeed, several studies have described the ability of HCoVs (i.e. HCoV 229E, HCoV OC43 (also known as betacoronavirus 1), NL63, HKU1 or SARS-CoV) to survive in different environmental conditions (e.g. temperature and humidity), on different supports found in hospital settings such as aluminum, sterile sponges or latex surgical gloves or in biological fluids. Finally, taking into account the persisting lack of specific antiviral treatments (there is, in fact, no specific treatment available to fight coronaviruses infections), the Coronaviridae specificities (i.e. pathogenicity, potential environmental resistance) make them a challenging model for the development of efficient means of prevention, as an adapted antisepsis-disinfection, to prevent the environmental spread of such infective agents. This review will summarize current knowledge on the capacity of human coronaviruses to survive in the

  3. Human coronaviruses: insights into environmental resistance and its influence on the development of new antiseptic strategies.

    Science.gov (United States)

    Geller, Chloé; Varbanov, Mihayl; Duval, Raphaël E

    2012-11-12

    The Coronaviridae family, an enveloped RNA virus family, and, more particularly, human coronaviruses (HCoV), were historically known to be responsible for a large portion of common colds and other upper respiratory tract infections. HCoV are now known to be involved in more serious respiratory diseases, i.e. bronchitis, bronchiolitis or pneumonia, especially in young children and neonates, elderly people and immunosuppressed patients. They have also been involved in nosocomial viral infections. In 2002-2003, the outbreak of severe acute respiratory syndrome (SARS), due to a newly discovered coronavirus, the SARS-associated coronavirus (SARS-CoV); led to a new awareness of the medical importance of the Coronaviridae family. This pathogen, responsible for an emerging disease in humans, with high risk of fatal outcome; underline the pressing need for new approaches to the management of the infection, and primarily to its prevention. Another interesting feature of coronaviruses is their potential environmental resistance, despite the accepted fragility of enveloped viruses. Indeed, several studies have described the ability of HCoVs (i.e. HCoV 229E, HCoV OC43 (also known as betacoronavirus 1), NL63, HKU1 or SARS-CoV) to survive in different environmental conditions (e.g. temperature and humidity), on different supports found in hospital settings such as aluminum, sterile sponges or latex surgical gloves or in biological fluids. Finally, taking into account the persisting lack of specific antiviral treatments (there is, in fact, no specific treatment available to fight coronaviruses infections), the Coronaviridae specificities (i.e. pathogenicity, potential environmental resistance) make them a challenging model for the development of efficient means of prevention, as an adapted antisepsis-disinfection, to prevent the environmental spread of such infective agents. This review will summarize current knowledge on the capacity of human coronaviruses to survive in the

  4. Análise bacteriológica da água de equipos odontológicos Bacteriological analysis of water in dental units

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    Maria Cristina Bronharo Tognim

    2000-05-01

    Full Text Available Nos últimos anos, grande esforço tem sido feito para conscientizar os profissionais da saúde sobre a importância dos processos de esterilização e anti-sepsia. Entretanto, pouca atenção tem sido dispensada pelos cirurgiões-dentistas à qualidade da água utilizada na prática odontológica. Neste trabalho, realizamos 72 análises bacteriológicas em amostras de água de 68 equipos odontológicos e de 4 torneiras, para verificar a qualidade microbiológica da água, através da contagem de bactérias heterotróficas e pesquisa de coliformes. As amostras coletadas das torneiras apresentaram valores compatíveis com os padrões de potabilidade. Das 68 amostras obtidas dos equipos 63 (92,7% estavam contaminadas e 5 (7,3% estavam dentro dos padrões de potabilidade. Observou-se que 42 equipos (61,8% continham água acentuadamente contaminada, 14 (20,6% apresentaram índice moderado de contaminação e 7 (10,3% estavam com a água levemente contaminada. Estes resultados apontam a necessidade de cuidados especiais, tais como a descontaminação e a desinfecção periódica dos sistemas de água dos equiposAlthough, in recent years, great efforts have been made to inform and make health professionals aware of the importance of sterilization, disinfection and antisepsis, little considerations have been shown in relation to the quality of the water of dental unit systems. In the present work 72 samples of water from 68 dental equipments and 4 faucets were submitted to bacteriological analysis, with the objective of detecting heterothrophic bacteria and coliform group. The samples collected from the faucets were compatible with the water potability patterns. In contrast, 63 (92.7% of the 68 samples obtained from the dental unit water systems were considered contaminated and only 5 (7.3% were in agreement with the potability patterns. It was observed that 42 water samples (61.8% were heavily contaminated, 14 (20.6% presented moderate index of

  5. A unique water optional health care personnel handwash provides antimicrobial persistence and residual effects while decreasing the need for additional products.

    Science.gov (United States)

    Seal, Lawton A; Rizer, Ronald L; Maas-Irslinger, Rainer

    2005-05-01

    , similar results were obtained as log 10 reductions of 2.5 were observed. The formulation is nonirritating, actually contributing to hand skin condition. The 61% alcohol-ZPT product exceeds all FDA criteria for the health care personnel handwash indication and is a significant advancement in the concept of skin antisepsis. It represents a single product suitable for use in all hand hygiene settings, demonstrating improved antimicrobial persistence and residual effects. The 61% alcohol-ZPT formulation contributes positively to overall hand conditioning, and a previously reported study has documented it to be virucidal for several DNA and RNA viruses.

  6. Fatores de risco para peritonites e internações Risk factors for peritonitis and hospitalizations

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    Sarah Silva Abrahão

    2010-03-01

    Full Text Available INTRODUÇÃO: Investigou-se um universo de 30 crianças e adolescentes portadores de doença renal crônica em tratamento dialítico, assistidos pelo Hospital das Clínicas da UFMG, a fim de determinar fatores de risco para a frequência de peritonites e de internações. MÉTODO: Estudo descritivo em que para a obtenção dos resultados utilizou-se o software SPSS (Statistical Package for Social Science versão 13.0. Testaram-se as variáveis: baixa escolaridade, baixa renda familiar, nível de informação inadequado, inadequação da antissepsia das mãos para a realização da diálise, ausência de pia no quarto da diálise como fator de risco para maior frequência de peritonites e internações. RESULTADOS: Os valores de Odds Ratio estiveram dentro dos limites dos intervalos de confiança (95% e em alguns casos foram INTRODUCTION: This study assessed 30 children and adolescents with chronic kidney disease on dialysis, cared for at the Hospital das Clínicas of UFMG, aiming at determining the risk factors for the frequency of peritonitis and hospitalizations. METHOD: Descriptive study using the SPSS (Statistical Package for Social Science software, version 13.0. The following variables were assessed as risk factors for a higher frequency of peritonitis and hospitalizations: low educational level; low family income; inadequate level of information; inadequate hand antisepsis during PD; and lack of a sink in the dialysis room. RESULTS: The odds ratio values were within the 95% confidence intervals, and, in some cases, were smaller than 1, indicating the possibility of a negative association between some independent variables and the variables studied, but with no statistically significant difference. CONCLUSION: No statistical significance was observed for the variables studied, despite the tendency towards that.

  7. Positive deviance as a strategy to prevent and control bloodstream infections in intensive care.

    Science.gov (United States)

    Oliveira, Francimar Tinoco de; Ferreira, Maria Manuela Frederico; Araújo, Silvia Teresa Carvalho de; Bessa, Amanda Trindade Teixeira de; Moraes, Advi Catarina Barbachan; Stipp, Marluci Andrade Conceição

    2017-04-03

    To describe the application of positive deviance as a strategy to prevent and control bloodstream infections. An intervention study with nursing and medical team members working in an intensive care unit in a university hospital, between June and December 2014. The four steps of the positive defiance methodology were applied: to define, to determine, to discover and to design. In 90 days, 188 actions were observed, of these, 36.70% (n=69) were related to catheter dressing. In 81.15% (n=56) of these dressings, the professionals most adhered to the use of flexible sterile cotton-tipped swabs to perform antisepsis at catheter entry sites and fixation dressing. Positive deviance contributed to the implementation of proposals to improve work processes and team development related to problems identified in central venous catheter care. Descrever a aplicação do Positive Deviance como estratégia na prevenção e no controle da infecção de corrente sanguínea. Estudo de intervenção realizado na Unidade de Terapia Intensiva de um hospital universitário, com os membros das equipes de enfermagem e médica, de junho a dezembro de 2014. Foram aplicados os quatro passos da metodologia Positive Deviance: Definir, Determinar, Descobrir e Desenhar. Em 90 dias 188 ações foram observadas, destas, 36,70% (n=69) estavam relacionadas aos curativos dos cateteres. Em 81,15% (n=56) desses curativos, o uso da haste flexível estéril para realização da antissepsia do local de inserção do cateter e de sua placa de fixação foi a ação de maior adesão. O Positive Deviance auxiliou na implementação de propostas de melhorias de processo de trabalho e no desenvolvimento da equipe para os problemas identificados no cuidado com o cateter venoso central.

  8. The effects of topical application of sunflower-seed oil on open wound healing in lambs Efeitos da aplicação tópica de óleo de semente de girassol em feridas cutâneas, em carneiros

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    Silvio Romero Marques

    2004-06-01

    Full Text Available PURPOSE: To demonstrate the effects of the use of sunflower seed oil on the treatment of skin wounds. METHODS: Eighteen male Saint Inês lambs were divided in 3 groups according to the pos-operative (7, 14 and 21 days. After antisepsis and local anestesia, two 4cm² wounds on each side of the thoracic region, close to the scapule were surgically produced. The experimental wounds were treated with sunflower seed oil, with high concentration of linoleic acid (LA, and the control ones with sterilized Vaseline. Biopsies of the pos-operative wounds tissue were performed on the 7th, 14th, 21st days and histologically evaluated. RESULTS: Topic application of sunflower seed oil accelerated healing process at the 7th and 21st days, reducing wound area and increasing wound contraction. Granulation tissue increased faster on treated wounds. The epidermis of the treated wounds was completely recovered when compared to control wounds. CONCLUSION: The topic use of sunflower seed oil accelerated the healing process, and it can be used as an alternative therapy on second intention wound healing.OBJETIVO: Demonstrar os efeitos do uso de óleo de semente de girassol no tratamento de feridas cutâneas. MÉTODOS: Dezoito carneiros da raça Santa Inês foram divididos em 3 grupos de acordo com o pós-cirúrgico (7, 14, e 21 dias. Após antisepsia e anestesia local foram produzidas cirurgicamente duas feridas de 4 cm² em cada lado da região torácica próxima escápula. As feridas experimentais foram tratadas com óleo de semente de girassol, com alta concentração de ácido linoléico (LA e as controles com vaselina esterilizada. Biopsias dos tecidos das feridas pós-cirúrgicas foram realizadas no 7º, 14º e 21º dias e avaliadas histologicamente. RESULTADOS: A aplicação tópica do óleo de semente de girassol acelerou o processo de cicatrização no 7ºe 21º dias, reduzindo a área e aumentando a contração das feridas. O tecido de granulação se

  9. Bacteriemia during endodontic treatment in relation to the technique of biomechanical preparation: randomized clinical trial Bacteriemia durante o tratamento endodôntico em função da técnica de preparo biomecânico: ensaio clínico randomizado

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    Adriane Tenório Dourado

    2005-12-01

    Full Text Available OBJECTIVE: The aim of this randomized clinical trial was to evaluate the frequency of bacteriemia during endodontic treatment, with comparison between two techniques for biomechanical preparation of the root canal system. MATERIALS AND METHODS: The sample comprised 50 patients aged 16 to 52 years, of both genders, which were divided into 2 groups with 25 patients each. Group I underwent biomechanical preparation by the step-back technique, and Group II was treated by the rotary technique with nickel-titanium instruments (K3. Patients were submitted to antisepsis of the oral cavity with chlorhexidine digluconate and three samples of blood were collected for blood culture: preoperatively, immediately after the biomechanical preparation and 10 minutes later. The significance level adopted was 5.0%, and analysis was performed by descriptive and inferential statistics by means of the Fisher's exact test, Fisher-Freeman-Halton test and Student's t test. Data were analyzed on the Statexact and SPSS softwares. RESULTS: All blood cultures achieved before and immediately after preparation were negative. On the other hand, with regard to the blood cultures collected 10 minutes after preparation, one (4% positive case was found for Group I. However, this difference was not statistically significant (p = 0.50. CONCLUSION: The frequency of bacteriemia was low and observed just for Group I.OBJETIVO: O objetivo deste ensaio clínico randomizado foi avaliar a freqüência de bacteriemia durante o tratamento endodôntico comparando duas técnicas de preparo biomecânico do sistema de canais radiculares. MATERIAIS E MÉTODOS: A amostra constou de 50 pacientes, com idade variando entre 16 e 52 anos e de ambos os sexos, sendo dividida em 2 grupos de 25 pacientes. No Grupo I, realizou-se o preparo biomecânico através da técnica escalonada com recuo progressivo programado, e, no Grupo II, por meio técnica rotatória, empregando instrumentos de níquel-titânio (K3

  10. Evidence for a Standardized Preadmission Showering Regimen to Achieve Maximal Antiseptic Skin Surface Concentrations of Chlorhexidine Gluconate, 4%, in Surgical Patients.

    Science.gov (United States)

    Edmiston, Charles E; Lee, Cheong J; Krepel, Candace J; Spencer, Maureen; Leaper, David; Brown, Kellie R; Lewis, Brian D; Rossi, Peter J; Malinowski, Michael J; Seabrook, Gary R

    2015-11-01

    To reduce the amount of skin surface bacteria for patients undergoing elective surgery, selective health care facilities have instituted a preadmission antiseptic skin cleansing protocol using chlorhexidine gluconate. A Cochrane Collaborative review suggests that existing data do not justify preoperative skin cleansing as a strategy to reduce surgical site infection. To develop and evaluate the efficacy of a standardized preadmission showering protocol that optimizes skin surface concentrations of chlorhexidine gluconate and to compare the findings with the design and methods of published studies on preoperative skin preparation. A randomized prospective analysis in 120 healthy volunteers was conducted at an academic tertiary care medical center from June 1, 2014, to September, 30, 2014. Data analysis was performed from October 13, 2014, to October 27, 2014. A standardized process of dose, duration, and timing was used to maximize antiseptic skin surface concentrations of chlorhexidine gluconate applied during preoperative showering. The volunteers were randomized to 2 chlorhexidine gluconate, 4%, showering groups (2 vs 3 showers), containing 60 participants each, and 3 subgroups (no pause, 1-minute pause, or 2-minute pause before rinsing), containing 20 participants each. Volunteers used 118 mL of chlorhexidine gluconate, 4%, for each shower. Skin surface concentrations of chlorhexidine gluconate were analyzed using colorimetric assay at 5 separate anatomic sites. Individual groups were analyzed using paired t test and analysis of variance. Preadmission showers using chlorhexidine gluconate, 4%. The primary outcome was to develop a standardized approach for administering the preadmission shower with chlorhexidine gluconate, 4%, resulting in maximal, persistent skin antisepsis by delineating a precise dose (volume) of chlorhexidine gluconate, 4%; duration (number of showers); and timing (pause) before rinsing. The mean (SD) composite chlorhexidine gluconate

  11. Cateter urinário: mitos e rituais presentes no preparo do paciente Catéter urinario: mitos y rituales presentes en la preparación del paciente Urinary catheter: myths and rituals present in preparation of patients

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    Alessandra Mazzo

    2012-01-01

    divergentes para la higiene y antisepsia del meato uretral, con presencia de mitos y rituales que se exceden a las evidencias científicas y destacam el modelo funcionalista en los procedimientos realizados por el equipo de enfermería. CONCLUSIÓN: Hay necesidad de reevaluar la intervención del cateterismo urinario, con discusiones interdisciplinarias, dando énfasis a la utilización de principios científicos.OBJECTIVE: This study aimed to identify and describe myths and rituals in preparing patients for urinary catheter insertion. METHODS: This was an observational, exploratory and descriptive study conducted in nine hospitals of a city in the interior of Brazil. Following ethical precepts, data were collected by interview, with the nurse designated by the institution, using a semistructured instrument. Among the 13 institutions of the municipality, nine participated in the study. RESULTS: All hospitals had a standardized, implemented procedure for urinary catheterization. During the preparation of patients, five participants (55.5% made no reference to orientation, privacy and humanization. All adopted divergent procedures for hygiene and antisepsis of the urethral meatus, with the presence of myths and rituals that exist outside the scientific evidence and highlight the functionalist model of the procedures performed by nursing staff. CONCLUSION: There is a need to reassess the intervention of urinary catheterization, with interdisciplinary discussions, emphasizing the use of scientific principles.

  12. Método bundle na redução de infecção de corrente sanguínea relacionada a cateteres centrais: revisão integrativa Método bundle en la redución de infecciones relacionadas a catéteres centrales: una revisión integrativa Care bundle to reduce central venous catheter-related bloodstream infection: an integrative review

    Directory of Open Access Journals (Sweden)

    Juliana Dane Pereira Brachine

    2012-12-01

    éter con su retirada inmediata cuando posible. La mayoría de los estudios analizados mostraron una reducción significante de infección sanguínea relacionadas o asociadas con catéteres intravenosos centrales.This is an integrative review of literature aimed to identify evidence-based interventions which make up care bundles to reduce central venous catheter-related or associated bloodstream infections. To collect data in Brazilian and international databases were used the key word bundle and the descriptors catheter-related infection, infection control and central venous catheterization, resulting in fifteen articles, after inclusion criteria application. This work showed five interventions as those commonly employed in the bundles methods: hand hygiene, chlorhexidine gluconate for skin antisepsis, use of maximal sterile barrier precaution during the catheter insertion, avoid the femoral access and daily review of catheter necessity with prompt removal as no longer essential. The majority of the studies showed a significant reduction in bloodstream infection related to or associated with central venous catheters.

  13. Correlação entre os métodos de concepção, ocorrência e formas de tratamento das onfalopatias em bovinos: estudo retrospectivo Correlation between conception methods, occurrence, and type o treatment of the umbilical diseases in cattle: a retrospective study

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    Celso A. Rodrigues

    2010-08-01

    ês foram tratados conservativamente. A análise dos diferentes métodos de concepção, correlacionados à ocorrência de onfalopatias, sugere que os animais provenientes de FIV, apresentam maior frequência de persistência de úraco (66,7%, e aqueles concebidos por IA, maior frequência de hérnia umbilical (58,4%, O tratamento cirúrgico foi mais eficiente que a terapia conservativa. Essa última apresentou melhores resultados nos casos descomplicados e precocemente diagnosticados.Some problems have been observed in bovine products of the in vitro fertilization technical, among these, the high umbilical diseases casuistry. From this observation, the aim of this work was to accomplish a retrospective study of the correlation between the conception methods and the occurrence of umbilical diseases in bovines and describe the results obtained from the conservative and surgical treatments. For this 44 animals attended at Veterinary Teaching Hospital of Unesp Araçatuba, with age varying from one day to 12 months among the years of 2003 and 2007 were used, twenty seven were from in vitro fertilization (IVF, twelve were from artificial insemination (AI, two were from natural mounts and three were from embryo transfer. The clinical-surgical diagnosis of the animals revealed that all of them presented umbilical disorders, being 22 cases of urachus patent, eight omphalophlebitis, eight umbilical hernia, five omphalitis and one umbilical fibrosis. Before and at the postoperative period was administered in all animals once a day for ten days 3mg/kg of ceftiofur sodium IV. In cases of serious infection or lack of response of the initial antimicrobial therapy a complementary treatment during seven days with 6.6 mg/kg of gentamicin sulfate IV was carried out. The antisepsis of the umbilicus with tincture of iodine to 2% was carried out twice daily in cases treated clinically, with out surgery, while the animals underwent surgery received 1.1mg/kg of flunixin meglumine IV once daily

  14. Citologia Hormonal do Trato Urinário Baixo e da Vagina de Mulheres na Pós-menopausa, antes e durante Estrogenioterapia Oral e Transdérmica Urinary and Vaginal Cytology of Postmenopausal Women with Oral and Transdermal Estrogen Replacement

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    Áurea Belas Lustosa

    2002-10-01

    . No entanto, quando se utiliza a via oral, nem sempre este resultado pode ser observado.Objective: to study the effects of oral or transdermal estrogen replacement on the lower urinary tract and vagina in postmenopausal women. Methods: we studied 25 postmenopausal women evaluating the oral or transdermic estrogen replacement effects on the vaginal cells and urinary sediment during 3 months. The patients were randomly distributed into 2 groups: Group I, n = 14, treated orally with 0.625 mg equine conjugated estrogen plus 5 mg medroxyprogesterone acetate, daily for 3 months; Group II, n = 11, treated transdermally with 50 mug 17-ß-estradiol, once a week, plus 5 mg medroxyprogesterone. Daily, for 3 months, urinary samples were collected from the first miction in the morning after urogenital antisepsis into sterile tubes. The sample was centrifuged and the sediment was smeared. Vaginal and urinary smears were then fixed in absoluted alcohol and stained by the method of Shorr. Results: the patients who used the oral route presented maturation of the vaginal cells (from 45.4 to 65.5% after 2 months of treatment, maintaing 62% afterwards but this did not occur with urinary cells (56.4 before treatment versus 60.4% at the end of the period. The transdermal route promoted maturation of vaginal and urinary cells. Conclusion: we have concluded that transdermal estrogens have satisfactory effects both on vaginal and urethral sites. However, with the oral route we did not find the expected results in the urinary tract in all cases.