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PubMed1975

Role of hand contamination of personnel in the epidemiology of gram-negative nosocomial infections.

Gram-negative organisms, responsible for a high rate of colonization and infection in an intensive care nursery, were recovered frequently from hands of personnel, despite regular hand antisepsis. In sequential hand cultures contamination of hands by gram-negative organisms was transient in some nurses, but active multiplication of the organisms occurred on the hands of others and in a few nurses a temporary carrier state appeared to exist. The results of this study suggest that the hands of hospital personnel may serve not only as a passive vehicle in the nosocomial transmission of gran-negative bacteria, but also may constitute a reservoir of nosocomial organisms.

Animals↗
PubMed2003

Antiseptic wound ventilation with a gas diffuser: a new intraoperative method to prevent surgical wound infection?

Postoperative wound infections are often a result of peri-operative contamination by Staphylococcus aureus. With a new insufflation device, a gas diffuser, it has become possible to establish a local micro-environment of almost 100% carbon dioxide in an open surgical wound. The device enables ventilation of the wound with an antiseptic agent, which in gaseous form can be delivered as a low uniform dose to all parts of the wound. The use of carbon dioxide (CO2) as a carrier gas eliminates possible inflammability of an antiseptic agent and helps to concentrate it to the site of interest by gravity. Using the above delivery system we have demonstrated the antibacterial effect of gaseous ethanol on S. aureus inoculated on sterile filter disks and blood agar plates, respectively. Ethanol is a very potent antiseptic agent with known properties, which makes it suitable for testing the maximal decontamination level. On filter disks, CO2 carrying vapour from a 95% ethanol solution decreased the number of colony-forming units after 5 min of exposure (P=0.04), and killed all bacteria within 10-15 min (P<0.001). In the presence of organic material, i.e. on exposed blood agar plates, the colony size decreased with exposure time, and no colonies were detected after 60 min of exposure (P<0.001). Antiseptic gas derived from 70% ethanol solution was less effective than that from 95% ethanol (P<0.001). CO2 humidified with water did not have a significant effect on number or size of the colonies. Our findings suggest that intraoperative wound antisepsis with a gas mixture of CO2 and an antiseptic agent delivered with a gas diffuser, may be a simple method to reduce the risk of postoperative wound infection.

Administration, Cutaneous↗
PubMed1986

Surgical infections--the general surgeon's perspective. Defining the problem, seeking solutions.

Infection has been historically the greatest threat to patients undergoing surgery, but with effective surveillance programs, the risk of surgical infection can be markedly reduced. An effective approach to infection control involves attention to the triad complex of infection--asepsis (keeping bacteria below the "critical inoculum"), antisepsis (disciplined use of antibiotics), and host defense mechanisms (altering factors that reduce immunity). Several large studies indicate a national trend toward decreased wound infection rates. This trend is probably attributable to a wide acceptance of surveillance programs, shorter length of hospitalization, and better use of antibiotic therapy.

Anti-Bacterial Agents↗
PubMed2005

Why is it that internists do not follow guidelines for preventing intravascular catheter infections?

BACKGROUND AND OBJECTIVE: High morbidity of CVC-related infections has led to national guidelines for their prevention. Despite recommendations for the use of maximal barrier precautions (mask, sterile gloves, gown, and large drape) and skin antisepsis with 2% chlorhexidine gluconate during CVC insertion, internists in the United States are not implementing these practices frequently. This study sought to identify and characterize the obstacles to and potential opportunities for improving adherence. DESIGN: Cross-sectional survey. PARTICIPANTS: One thousand randomly selected physician-members of the American College of Physicians-American Society of Internal Medicine. METHODS: Several potential determinants of adherence to maximal barrier precautions were assessed, including awareness of, agreement with, and ability to implement the recommendation, as well as the practice and training characteristics of the respondents. Factors influencing antiseptic selection were also recorded. RESULTS: Of 526 respondents, 178 (34%) had recently inserted CVCs. Clinician experience and subspecialty, awareness of CDC guidelines, and external influences (eg, time to collect equipment) did not affect maximal barrier precautions adherence. The only independent predictor of adherence was high outcome expectancy for the use of large sterile drapes (OR, 5.3; CI95, 2.2-12.6). Availability had the greatest influence on internists' selection of specific antiseptic agents, whereas cost was the least important determinant. CONCLUSIONS: Despite established efficacy, use of maximal barrier precautions and chlorhexidine gluconate is low among internists. Because improved adherence to these practices will require increased outcome expectancy for maximal barrier precautions and availability of chlorhexidine gluconate, targeting these areas through focused education and systems modifications is essential.

Anti-Infective Agents, Local↗
PubMed1996

Current blood culture methods and systems: clinical concepts, technology, and interpretation of results.

Since the mid-1970s there has been a number of advances in blood culture practices and technology; these advances have been based largely on well-designed controlled clinical evaluations of blood culture systems and media. Thus, a sound scientific basis for the fundamental principles of blood culturing now exists. In this article. I will address issues of clinical and technical importance with regard to blood culturing; these issues include skin antisepsis, the number and timing of blood cultures, the appropriate volume of blood for culture, culture media and additives, length and atmosphere of incubation, and interpretation of positive blood culture results. Finally, I will discuss the currently available blood culture systems, with an emphasis on the newer continuous-monitoring blood culture systems.

Anti-Infective Agents↗
PubMed1977

Environmental air and airborne infections.

The results of a study on the epidemiology of airborne (aerobic) surgical infections are presented. The first phase of the study was carried out in a surgical suite which contained no environmental or traffic control systems. The second phase of the study took place within a modern "up to date" operating room suite containing multiple air screens as well as an elaborate ventilation system utilizing HEPA type filters which provided the operating room with clinically sterile air. One hundred and fifty-six patients were also studied. All patients underwent major procedures. The ratio of clean, clean-contaminated, and dirty cases was the same in both groups. Preoperatively, a nasal swab, clean voided urine (or vaginal swab) and a rectal swab were obtained on each patient. Daily nasal cultures and cultures of suspected sites of infection were obtained postoperatively. Daily nasal cultures and "glove sweat" cultures were obtained on all personnel attending the patient. Environmental cultures of the operating room, the operating room hallway, recovery room and patients' rooms were also taken. All samples were checked for the presence of staphylococci, streptococci, Escherichia coli, proteus species, enterobacter, klebsiella, and pseudomonas. In all, 15,000 cultures were taken during the study. The rate of infection was essentially the same in both phases of the study. Environmental air only occasionaly served as the source of infecting organisms. The results of the study support the conclusion that the most common source of infecting organisms in surgical infections is thepatient or those around him. The most common time of contamination is during the surgical procedure itself. Surgical infections can best be minimized by meticulous observation of fundamental principles of antisepsis rather than by dependence on elaborate and costly ventilation and air control systems.

Adolescent↗
PubMed1995

Comparison of 10% povidone-iodine and 0.5% chlorhexidine gluconate for the prevention of peripheral intravenous catheter colonization in neonates: a prospective trial.

The purpose of the study was to compare the efficacy of 10% povidone-iodine with that of 0.5% chlorhexidine gluconate in 70% isopropyl alcohol for the prevention of peripheral intravenous catheter colonization in neonates. This was a multicenter, nonrandomized prospective study in a tertiary neonatal intensive care setting in which povidone-iodine and chlorhexidine gluconate were each used as antiseptic skin preparations over sequential 6-month periods. During the first 6 months of the study when povidone-iodine was in use 9.3% (38 of 408) of catheters were colonized. During the second 6 months of the study when chlorhexidine gluconate was in use, catheter colonization occurred in 4.7% (20 of 418, P = 0.01). Catheter-related bacteremia occurred during only 0.2% (2 of 826) of all catheterizations. Heavy skin colonization before catheter insertion (relative risk, 3.6; 95% confidence interval, 1.9, 7.0), catheterization > or = 72 hours (relative risk. 2.0; 95% confidence interval, 1.01, 3.8) and gestational age < or = 32 weeks (relative risk, 1.8; 95% confidence interval, 1.02, 3.3) increased colonization risk. Ampicillin infusion (relative risk, 0.4; 95% confidence interval, 0.2, 0.7) and 0.5% chlorhexidine gluconate cutaneous antisepsis (relative risk, 0.4; 95% confidence interval, 0.2, 0.8) were factors associated with decreased colonization risk. We conclude that 0.5% chlorhexidine gluconate in 70% isopropyl alcohol appears to be more efficacious than 10% povidone-iodine for the prevention of peripheral intravenous catheter colonization in neonates.

Analysis of Variance↗
PubMed1990

Contamination of blood cultures during venepuncture: fact or myth?

Contamination of blood cultures is believed to occur mainly during the venepuncture procedure. Consequently, meticulous preparation of the venepuncture site is widely recommended. To determine whether the contamination rate is indeed affected by the quality of the antiseptic procedure at the venepuncture site, 181 paired cultures were collected from 176 patients during a 6-month period after either strict antiseptic cleansing of skin with alcohol followed by povidone-iodine, or after brief disinfection with alcohol alone. The contamination rate was not influenced by the antiseptic procedure, and corresponded to the accepted percentage reported in most other studies. Eight false positive cultures (4.4%) were obtained after strict antisepsis of the skin and 6 (3.3%) after short simple cleansing with alcohol (P = 0.39). Our results suggest that contamination of blood cultures may not be related to the venepuncture procedure--regardless of the antiseptic technique used--but may be due to later stages of laboratory handling and processing of the specimens. Review of the literature has provided further indirect evidence to support this conclusion.

Antisepsis↗
PubMed1997

Effects of Betaisodona on parameters of host defense.

The numbers of patients in intensive care units, with immunosuppression, and of elderly people increase in parallel with antibiotic-resistant microorganisms. Therefore the demand for an effective antisepsis increases. Moreover, it became evident that the pathophysiology and the outcome of infection are dependent on the properties of the microorganisms, e.g. synthesis of endo- and exotoxins, and on the host defense, the immune system. In addition to the microbicidal action, we studied the effects of povidone-iodine (PVP-I, Betaisodona) on the generation, release and activity of exotoxins (alpha-hemolysin, phospholipase C, lipase), as well as on granulocyte-derived tissue-destructive enzymes (elastase, beta-glucuronidase) and microbial-induced cytokine generation from human neutrophils. Our results clearly show that PVP-I does not only kill a wide range of bacteria but also inhibits the generation and release of bacterial exotoxins; furthermore, it also inactivates bacterial exotoxins as well as granulocyte-derived tissue-destructive enzymes and cytokines. These data support the usefulness and efficacy of PVP-I as an effective therapeutic agent to combat infection.

Aged↗
PubMed2000

[From the history of wound care].

Wound care in ancient times was based on many techniques: Bandages soaked with antibiotics, Sutures continuous or in separate stitches, apply of poultices around the wounds, honey and propolis as antibiotics in the treatment of wounds, surgical drainage of pus with a piece of tin pipe etc. The oldest wound clamp is shown with the jaws of ants holding together the edges of a wound. Finally are discussed the cauterization and the principles of Antisepsis and Asepsis.

Anti-Bacterial Agents↗
PubMed1991

[Characteristics of surgeon's work with HIV-infected patients].

AIDS incidence is sharply growing in all countries. Doctors specialists in all fields of medicine may come in contact in the process of treatment with HIV carriers or patients suffering from AIDS, when the clinical picture is vividly manifested. The most frequently encountered HIV-dependent complex of symptoms includes persisting fever, lymphadenopathy, weight loss, diarrhoea. Blood test for HIV antibodies confirms the diagnosis. Treatment of surgical diseases in HIV-infected patients is justified in the latent period of the syndrome. In a marked clinical picture of AIDS and the presence of an opportunistic infection the patient survives no longer than 18 months. It is advisable in such cases, in the interest of the patient and the surgeon, to refrain from undertaking a planned operation because its mortality is very high. Only emergency interventions are indicated. During contact with a HIV-infected patient the medical staff must follow strictly the rules of hospital hygiene and antisepsis . The work must be carried out in gloves, protective glasses, and masks, and injure of the hands with sharp instruments must be avoided. The personnel must be trained and educated in working with HIV-infected patients.

Acquired Immunodeficiency Syndrome↗
PubMed1990

[Comparative study of 2 methods to determine the in vivo bactericidal activity of antiseptics].

In France in 1990, there is no standardized method to study the bactericidal activity in vivo of antiseptics. A comparative study of the Williamson-Kligmann techniques (on the epidermis of the forearm) and of the bag of Gaschen (on the hands) has been carried out by using 11 products and 10 volunteers for each of them. On the forearm, the rates of reduction of the number of bacterias numbered in decimal logarithms are significantly much higher to those measured on the hand. After having stated the advantages and drawbacks of each of these two techniques, an account fort the differences in the activity that have been observed is suggested. None of these two techniques is universal and one or the other has to be used according to the therapeutic prescription (antisepsy of the normal skin or of the hands) of the patent medicine.

Analysis of Variance↗
PubMed1989

[Research in hospital health at the Institute of General and Community Health of the Greifswald Ernst-Moritz-Arndt University].

With a retrospect of the historical development of hygiene in Greifswald the essential tasks of research in hospital hygiene especially during the last two decades are shown. The problems of hospital hygiene have been treated already before the establishment of the Institute of Hygiene of the University. Friedrich Loeffler, who as a young researcher had already treated the problems of disinfection and antisepsis, has founded the systematic hygienic-microbiological-virological working direction in Greifswald. Out of this in the following years with different essential tasks and devotion the hospital hygiene has developed in Greifswald. During the process of differentiation and forming of the department and later the Institute of General and Communal Hygiene was the hospital hygiene an essential task of research work. As peculiarity to this a close research co-operation has been developed with the territorial Institute of Hygiene of District Hygiene Inspection Rostock.

Antisepsis↗
PubMed1969

The catheter. How to use and when not to use.

Catheterization should not be used without true indication. Careful control of hydration, sedation, anesthesia and use of anticholinergic agents before, during and after operation can do a great deal to prevent the need for catheterization. When the procedure is necessary, simple, inexpensive measures of care usually are sufficient. Prophylactic antisepsis before and after, with reexamination of the urine after discontinuance of antiseptic drugs to make sure there is no recrudescence, prevents acute and chronic infections. The catheter recommended for routine male and female catheterization is the 14-16 (French) olive tip coude (Tieman) catheter or the Tieman-Foley. Closed drainage systems are the best. Continuous irrigation is without value. Water is an excellent irrigant. Calcium deposits are prevented by Renacidin(R) instillation and acetic acid irrigation.

Antisepsis↗
PubMed1978

Symposium on intensive care: 2. Infection control in the surgical intensive care unit.

Control of infection in the surgical intensive care unit demands unfailing attention to three distinct areas: a) The bacteria responsible may be endogenous or exogenous. The effects of the former can be limited by careful surgical techniques and judicious use of antibiotics, of the latter by the practice of asepsis and antisepsis, essentially of scrupulous cleanliness. b) The environment of infection concerns the support of natural barriers to infection (notably the integrity of the skin and the adequate drainage of the pulmonary system), and the sterility and appropriate care and use of the many invasive devices currently available. c) The patient's natural defence mechanisms show considerable variation, and those at increased risk can be detected by skin-testing with a number of antigens as well as by recognized clinical features. It is in these patients with anergy and abnormal natural defences that total parenteral nutrition can be of the greatest value.

Aged↗
PubMed1978

[Postoperative complications of wound healing in orthopaedic surgery (author's transl)].

From 1. 1. 1971--30. 6. 1977 (6.5 years) 4,169 aseptic orthopaedic operations were performed in the Orthopädische Universitätsklinik Düsseldorf. 42 complications of wound healing have been observed (1%)9 Without an ultrasteril operationbox it is also possible to reduce the complications of wound healing in orthopaedic surgery. It is important to know the principles of asepsis and antisepsis, the method of our preoperative preparation of patients is described; the indication of prophylaxis of chemotherapeutic agents should be severe.

Antisepsis↗
PubMed1982

[Laminar flow in the operating room (author's transl)].

After twenty years of clean-air operating rooms, no uniform opinion about the efficiency in preventing infections has been achieved. The reason is that with an infection rate around 1% only very large series of homologous material are statistically significant. Vertical flow is more efficient than horizontal flow. Clean-air technique is only one of the many facets of antisepsis and asepsis; it should be used especially in implantation and transplantation surgery in spite of the fact that its efficiency is not yet clearly proven.

Air Movements↗
PubMedDate not supplied

Preparation of nonmedical personnel in the operating room environment.

The nonmedical visitor to the operating room often provides vital expertise in the effective care and treatment of the surgical patient using today's sophisticated technology. By becoming aware of the special environment in the operating room and following the guidelines set up by each institution, the biomedical equipment technician, clinical engineer, or manufacturer representative will enhance his or her effectiveness when the need for entering the operating room suite arises. Guidelines cover personal hygiene and clothing and antisepsis techniques (scrubbing, gowning, draping, patient preparation, and equipment cleaning) to prepare for the operating. The visitor in the OR must also observe rules of etiquette to guard against interference with the established procedure routine.

Antisepsis↗