Biomedical subjects
H K Geiss
Publications and source records attributed to H K Geiss.
Reduction of aseptic measures in gynecologic endoscopy: a comparative clinical trial.
OBJECTIVE: A prospective comparative clinical study was conducted on 200 patients to evaluate the consequences of minimizing the following standard hygienic measures in gynecologic laparoscopy: surgical scrub, patient draping, surgical gowns. STUDY DESIGN: A group of 100 patients treated according to maximum hygienic protocol was compared to a group of 100 patients undergoing laparoscopic procedures with only limited aseptic precautions. Clinical control parameters were perioperative temperature and white blood cell count up to the 4th postoperative day. Furthermore, patients and their gynecologists were interviewed 2-4 weeks after surgery to rule out any delayed manifestation of an infection. RESULTS: Perioperative infection was low in both groups. CONCLUSION: As we found no significant difference between the two collectives' control parameters, we conclude that a reduction in perioperative hygiene seems feasible for certain laparoscopic procedures. However, a larger collective should be studied in order to confirm this action.
Prevalence of vancomycin-resistant enterococci among children with end-stage renal failure. Mid-European Pediatric Peritoneal Dialysis Study Group.
To evaluate the prevalence of colonization with vancomycin-resistant enterococcus (VRE) in end-stage renal failure (ESRF), we screened the intestinal flora from 338 pediatric ESRF patients treated in 13 pediatric nephrology units in mid-Europe. Eighty-one patients were undergoing hemodialysis, 66 were undergoing chronic peritoneal dialysis, and 191 were transplant recipients. A total of 363 enterococcal strains were recovered from 232 patients. Twenty-seven enterococcal strains from 24 patients (7.1%) had reduced susceptibility to vancomycin (minimal inhibitory concentration [MIC], >4 microg/mL). Although two patients (0.6%) carried enterococci with high-level resistance to vancomycin (MIC, >32 microg/mL; i.e., VRE), strains of enterococcus with reduced susceptibility to vancomycin (ERSV) were recovered from the other 22 subjects. Past use of vancomycin (P = .05) and tacrolimus therapy (P = .011) were independent risk factors for ERSV or VRE carriage. Enterococcal infections occurred with a similar frequency among enterococcal carriers and noncarriers; no infections with VRE or ERSV were reported. In conclusion, the prevalence of ERSV carriage and the rate of VRE colonization among mid-European children and adolescents with ESRF currently are moderate and low, respectively.
Comparative study on the in vitro antibacterial activity of Australian tea tree oil, cajuput oil, niaouli oil, manuka oil, kanuka oil, and eucalyptus oil.
To compare the antibacterial activity of the Australian tea tree oil (TTO) with various other medicinally and commercially important essential myrtaceous oils (cajuput oil, niaouli oil, kanuka oil, manuka oil, and eucalyptus oil) the essential oils were first analysed by GC-MS and then tested against various bacteria using a broth microdilution method. The highest activity was obtained by TTO, with MIC values of 0.25% for Enterobacter aerogenes, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Salmonella choleraesuis, Shigella flexneri, Bacillus subtilis, Listeria monocytogenes, Staphylococcus aureus, S. saprophyticus, and S. xylosus. It is noteworthy that manuka oil exhibited a higher activity than TTO against gram-positive bacteria, with MIC values of 0.12%. Both TTO and manuka oil also demonstrated a very good antimicrobial efficacy against various antibiotic-resistant Staphylococcus species. Pseudomonas aeruginosa was resistant to all essential oils tested, even at the highest concentration of 4%.
[Recommendations for surgical therapy planning and interventions in patients with AIDS].
No other disease has exhibited such a significant influence on the behaviour of health care workers (HCW) as the AIDS pandemic. Numerous epidemiological data, however, have proven that the overall risk of transmission of the human deficiency virus (HIV) during surgical interventions is low; it is 0.3% for all types of percutaneous exposures. Nevertheless, there still is a need for wider adoption of safer surgical techniques to reduce the chances of HIV transmission in the operation theatre, which additionally minimize the risk of transmission of other blood-borne pathogens. In the case of occupational exposure to HIV-contaminated blood or body secretions post-exposure prophylaxis should be recommended stratified by the type of exposure and source material.
[Hygiene in ENT. What is necessary, what is possible?].
Explore the source record for details and available documents.
Comparative evaluation of a commercial system for identification of gram-positive cocci.
The performance of a new commercial system for the identification of different groups of gram-positive cocci [BBL Crystal Gram-Positive (GP) Identification System; Becton Dickinson Microbiology Systems, Germany] was evaluated in comparison with two currently used commercial systems, the API Staph and the API Strep (bioMérieux Diagnostic, Germany). A total of 191 strains from seven different gram-positive genera comprising 32 different species were tested. For the BBL Crystal GP system, the correct identification rate without additional tests was 89.5% at the species level and 97.9% at the genus level. The findings suggest that the newly introduced BBL Crystal GP ID system provides an accurate method for the identification of gram-positive cocci, with an overall rate of correct species identification of about 90%, similar to that of the established API systems. Its major advantage is the extended spectrum of taxa included in a single test panel in contrast to the two different API test kits. Furthermore, the simplicity of use and the safe and rapid handling in a closed system conveniently accommodate existing laboratory workflow.
Comparative in vitro activity of meropenem versus other routinely used antimicrobials against 18632 aerobic bacteria tested in 92 German centers.
The in vitro antibacterial activity of meropenem and up to 26 other antibiotics was compared under routine conditions at 92 German centers from March to June 1995 with use of the agar diffusion method against 18632 recent isolates from ICU--hemato-oncology--and pediatric patients. Overall, meropenem was the most active drug exhibiting a higher activity against gram-negative aerobes than imipenem, but somewhat less active against staphylococci and enterocooci. The overall resistance rates of most antibiotics tested was higher compared to the recently published surveillance data of the Paul-Ehrlich-Society in Germany. The main reason for this discrepancy is the higher percentage of test strains which were recovered from intensive care unit patients in the present study. These data confirm similar results from the USA and underscore the pressing need for the implementation of a nationwide antimicrobial surveillance system which is risk-stratified by hospital size, ICU- versus non-ICU-patients, and body site from which the isolates are recovered.
Acridine-orange leucocyte cytospin (AOLC) test as an in-situ method for the diagnosis of central venous catheter (CVC)-related sepsis in adult risk patients.
The AOLC method for the in-situ diagnosis of catheter-associated septicemia was evaluated in adult intensive care patients. 55 blood samples and corresponding CVC tips were examined using the AOLC method, the semiquantitative roll plate method and the broth immersion method. In 4 patients (7.3%), a CVC-related septicemia was diagnosed, 10 patients (18.2%) showed a colonisation of their central venous access. The AOLC method was positive in 50% of the cases with CVC-related septicemia and in 20% of the colonized patients. Thus, we do not recommend the AOLC test as a routine method for the diagnosis of suspected CVC-related infection but as a facultative additional diagnostic measure for certain risk patients.
[How dangerous are high-resistance bacteria in intensive care units?].
Explore the source record for details and available documents.
[The presence of the mother during induction of anesthesia--from the standpoint of hygiene].
Explore the source record for details and available documents.
DNA fingerprinting of Mycobacterium tuberculosis complex culture isolates collected in Brazil and spotted onto filter paper.
The usefulness of filter paper for preservation of bacterial cells was shown by mixed-linker DNA fingerprint analysis of Mycobacterium tuberculosis isolates from 77 Brazilian patients. DNA fingerprints of samples spotted onto filter paper and conventional culture material were identical. Thus, filter paper specimens analyzed by an amplification-based typing method provide a new resource for epidemiological studies of infectious diseases.
Bleeding after cardiovascular surgery caused by detergent residues in laparotomy sponges.
On 2 successive days in July 1994, six patients who underwent coronary artery bypass grafting developed postoperative bleeding requiring reexploration. The cause was the use of reprocessed laparotomy sponges with retained detergents, inducing a bleeding disorder.
[Perioperative antibiotic prophylaxis from the microbiological viewpoint].
The practice of using antibiotic prophylaxis before surgery has evolved greatly in the past 20 years and is regarded as the third cornerstone in the prevention of postoperative wound infections. In contrast to asepsis and antisepsis, which have been standard techniques for almost a century, perioperative antibiotic prophylaxis is all too frequently administered in a suboptimal fashion. During the last few years, improvements in the timing of initial administration, the appropriate choice of antibiotic agents in each clinical setting, and the limitation of the duration of administration have defined more clearly the value of this technique in reducing postoperative wound infections. Implementation of these guidelines must be regarded as major issues in improving the quality of care in surgery.
[From GIGO (garbage in, garbage out) to KABA (correct disease-relevant consultation, treatment-relevant response)--principles for effective diagnosis of infection].
In the era of cost containment in health care, medical microbiology also faces the challenge of cost-effective use of microbiological diagnostics. However, problems do not arise primarily within the laboratory during analysis of clinical specimens, but also during the pre-analytical stage, i.e. indication, sampling, storing and transporting of microbiological samples. This situation is emphasized drastically by the acronym GIGO, "Garbage In, Garbage Out". To overcome this unsatisfactory situation both clinicians and microbiologists have to improve communication and collaboration which is the basis for the rational diagnosis of infection and therapy. Examples of inadequate microbiological investigations together with the correct use of blood cultures are given.
Propofol and postoperative infections.
Explore the source record for details and available documents.
Reprocessing of anaesthetic and ventilatory equipment.
Uniform and standardized recommendations for reprocessing of anaesthetic and ventilatory equipment are still lacking. The uncertainty in this field is underscored by the various methods which are described in the literature which include pasteurization, immersion baths, formaldehyde cabinets, automated washers/disinfectors and sterilization procedures like autoclaving, ethylene oxide and gaseous formaldehyde. Based on the classification of anaesthetic and ventilatory equipment as semi-critical items, high level disinfection must be regarded as the appropriate decontamination procedure. In contrast to automated washers the other above-mentioned disinfection procedures lack an integrated and all inclusive reprocessing cycle which consists of cleaning, disinfection, rinsing and drying. In view of the increasing demands of employee safety, environmental suitability, cost-effectiveness and quality assurance in hospital hygiene, only automated washers/disinfectors--either based on hot water disinfection or chemothermic processing--fulfil the basic requirements for safe and standardized reprocessing of anaesthetic and ventilatory equipment.
Diagnosis of catheter-related infections.
Catheter-related infections (CRI) are a major cause of febrile episodes in hospitalized patients. Additionally, approximately 40% of primary infections in intensive care patients are directly related to central venous catheters. Despite the clinical significance of CRI diagnostic procedures are still under debate. Clinical diagnosis which includes systemic signs of infection and suppuration at the catheter entry site is altogether a rare event. Therefore, most cases are still diagnosed by laboratory methods. Although the semiquantitative roll-plate technique is widely used and frequently regarded as gold standard, the disadvantages of a post-hoc diagnosis are obvious. In-situ techniques which leave the suspected catheter in place include differential blood cultures, skin and hub cultures and a new method of microscopic screening of blood drawn through the inflicted catheter. However, until now the true value of all these methods still lack unanimous acceptance. Further research is necessary to close the gap between clinical expectations and laboratory results.