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PubMed1999

Deterioration of theatre discipline during total joint replacement--have theatre protocols been abandoned?

The results of the Medical Research Council trial by Lidwell et al. in 1982 [Lidwell OM, Lowbury EJ, Whyte W et al. Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomised study. BMJ 1982; 285: 10-4] showed a decrease in infection rates following joint replacements carried out in ultraclean air theatres. Since then, the orthopaedic community in the UK has relied to a large extent on laminar airflow theatres to control infection following arthroplasty. At the same time, there has been a decline in the emphasis on basic principles and practices of antisepsis based on scientific evidence. We undertook this audit to establish whether published recommendations on theatre discipline were being followed in operating theatres where joint replacements are carried out, in England, Scotland and Wales. Our results show that with improvement in technology involved in clean air theatres, and availability in practice, slackness has crept into theatre protocol. In view of the fact that infection following arthroplasty has not been eliminated or indeed in some cases, maintained at the levels of the Medical Research Council study, we feel that traditional practices should be reintroduced. This study shows that there is pressing need for a set of recommendations on theatre practice for all staff in operating theatres that carry out joint replacements.

Air Microbiology↗
PubMed1999

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

OBJECTIVE: To investigate the susceptibility of clinical isolates of gram-negative bacteria to chlorhexidine gluconate. DESIGN: Prospective laboratory study. SETTING: Tikur Anbessa Hospital, Addis Ababa, Ethiopia. SUBJECTS: Clinical specimens from 443 hospital patients. MAIN OUTCOME MEASURES: Significant number of gram negative bacteria were not inhibited by chlorhexidine gluconate (0.02-0.05%) used for antisepsis. RESULTS: 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 = 0.01%. Twenty nine per cent of Acinetobacter, 28% of K. pneumoniae and Enterobacter species and 19-25% of Pseudomonas, Proteus and Providencia species were only inhibited at high concentrations of CHG (> or = 0.1%). CONCLUSION: 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.

Anti-Bacterial Agents↗
PubMed2000

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

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.

Facility Design and Construction↗
PubMed2000

The snake as the symbol of medicine, toxicology and toxinology.

We investigated the meaning and the roots of the snake's usage as a symbol of medicine, the medical profession, toxicology and toxinology by examining mythological, archeological data and a variety of texts from the ancient Greek world. The snake figure was associated with Asclepios, the ancient Greek God of medicine, and possessed benevolent properties. It was believed to be able to cure a patient or a wounded person just by touch. The snake is also connected with pharmacology and antisepsis, as snakes possess an antivenom against their own poison. The snake is related to sciences associated with poison and death, such as toxicology and toxinology, and it also implies a metaphysical idea. It is connected with the underworld, not only because it crawls on the ground, but because it can bring death, connecting the upper with the underground world. The ability of the snake to shed its skin has been associated with the circle of life, and the renaissance spirit also, ever since early Hellenic antiquity. Consequently, as a symbol of the modern medical profession, toxicology and toxinology, the snake twisted around a stick or the snake beside a pharmapeutic cup, which also implies the use of medicines or even poison, has its roots in the ancient Mediterranean area as proven by the archeological data combined with literary references. Its benevolent as well as its poisonous properties could be paralleled by the similar properties of medicines.

Animals↗
PubMed2000

Pasteur, Koch and American bacteriology.

This study traces American awareness of the work of Louis Pasteur and Robert Koch from the 1860s to the 1890s. In the years before the Civil War, American interest in germ theories had appeared at times of epidemics and persisted to a limited extent among physician-microscopists. Discussions of Pasteur's work occurred primarily in the context of spontaneous generation and antisepsis. Few Americans imitated his work on immunology or studied with Pasteur, but his work on immunity influenced their faith in the potential of bacteriology as a solution to problems of infectious disease. Koch's discoveries of the bacterial agents of tuberculosis and cholera stimulated American medical and public health interest in bacteriology in a more practical way. Americans learned Koch's methods by taking his courses and imported them directly into their own laboratories. A context of enthusiasm for science, educational reform, and problems of infectious disease associated with urbanization and changes in agriculture aided the growth of bacteriology in the American context.

Bacteriology↗
PubMed2001

Office management of minor wounds.

OBJECTIVE: To review office interventions for minor wounds not requiring sutures, such as abrasions, bites, and lacerations. QUALITY OF EVIDENCE: Most information on minor wound management comes from descriptive studies. Few comparative studies examine the effectiveness of topical antisepsis for minor wounds. Several clinical trials have demonstrated that tissue adhesives produce short- and long-term cosmetic results equivalent to those achieved with suture materials. MAIN MESSAGE: Sterile saline is the least toxic solution for wound irrigation. Chlorhexidine (2%) and povidone iodine (10%) have been the most investigated antiseptic solutions. Systemic antibiotics are unnecessary for wounds unlikely to be infected. All bite wounds require special attention. Primary closure of bite wounds is indicated in certain circumstances: less than 12-hour-old nonpuncture wounds, uninfected wounds, and low-risk lesions (such as on the face). In spite of their many advantages, skin tapes should be used for low-tension wounds only. The popularity of tissue adhesives has greatly increased. Since the advent of newer products (with increased bonding strength and flexibility), adhesives are used to manage most lacerations except those in areas of high tension (e.g., joints) and on mucosal surfaces. CONCLUSION: Minor wounds not requiring sutures can be managed easily in the office.

Anti-Bacterial Agents↗
PubMed2000

[Spanish disinfectants for the 21st century].

There are two chemical disinfectants patents from Spain that permit to obtain advantageous products on other disinfectants: Nduopropenide (two iodures of quaternary ammonium) and "Peroxidine" (hydrogen peroxide that active to lactic acid and a surfactant mixture). The first product is used as an antiseptic or disinfectant, but the second, only act as disinfectant. DISINFECTION: It is studied (by germ-carrier methods), the microbicide effect on different microorganisms (Gram positive cocci, Gram negative bacilli, fungus, Mycobacteria and B subtilis spores), comparing these two products with different disinfectants as 2% glutaraldehyde, 1/8 phenate-glutaraldehyde, peracetic acid compounds, 11% oxygen peroxide and 2% sodium hypoclorite. It is obtained that 1/4 Peroxidine in 5 minutes or 1/6 Peroxidine in 10 minutes, are the most effective disinfectant on all microorganisms used (includes the most resistant) since it produces destruction of 4 log-10 of spores and 5 log-10 of Mycobacteria. Moreover, it can destroy, completely, the inoculum of commercial spores, routinely used for sterilization process evaluation, in 20 minutes, when 2% glutaraldehyd needs 3-10 hours. ANTISEPSIE: It is studied the "hygienization" and surgical handwashing with Nduopropenide solution, in comparison with classical washing methods (neutral soap in routinely handwashing and 5% chlorhexidine or 10% iodine-povidone in surgical washing): 1) Nduopropenide and alcohol solution is more effective that routinely handwashing. 2) This product is more effective and persistent, after surgical washing that chlorhexidine or iodine-povidone. Moreover, it does not must be applied with brush. 3) The mixture Nduopropenide and chlorhexidine makes a synergy, then it can be used in hand or skin washing, on heath personnel or patient people, being advantageous on the other products.

Anti-Infective Agents, Local↗
PubMed1970

[Not Available].

Based on hardly accessible archive documents as well as other original sources and literature data, the author traces the life of the Russian physician K. Yuriev, and more particularly the years of his sojourn in Bulgaria. The emigrant-populist has merits towards Bulgarian surgery in the period of antisepsis. Dr. Yuriev was in contact with the leftists of the liberal party, led by Zahari Stoyanov, he was in charge of the Russe revolutionary circle "1st March", a good friend to the well known Bulgarian populist Spiro Gulabchev and to the outstanding Bulgarian physician Dr. Paraskev Stoyanov.

Bulgaria↗
PubMed1994

[Léopold Ollier (1830-1900)].

Born in a small village of Ardèche, Ollier became, still in his youth, chief surgeon at the Hôtel Dieu of Lyons and later professor of surgical clinic at the Faculty. His experimental works carried on during his lifetime showed the role played by the periosteum in bone regeneration and established the rules of the success or failure of homo and heterografts. Utilizing clinically the periosteum capacities, he codified the osteo-articular resections in many traumatic and inflammatory diseases of the members, ensuring the superiority of the resections on the amputations and desarticulations. Taking profit of the innovations of his time: anaesthesia, antisepsis and radiography, he must be considered as one of the founders of French orthopedics.

France↗
PubMed2001

[Modern methods of treatment of diabetic foot syndrome].

Method of complex treatment of the diabetic foot syndrome (DFS), which included combined application of intravascular laser irradiation of blood, ultraviolet irradiation of blood, indirect electrochemical detoxication of organism, endolymphatic therapy, abacterial environment, modern methods of physical antisepsis was elaborated and introduced in practice.

Diabetic Foot↗
PubMed2001

Financing North American medical libraries in the nineteenth century.

Culture not only justifies the existence of libraries but also determines the level of funding libraries receive for development. Cultural appreciation of the importance of libraries encourages their funding; lack of such appreciation discourages it. Medical library development is driven by culture in general and the culture of physicians in particular. Nineteenth-century North American medical library funding reflected the impact of physician culture in three phases: (1) Before the dawn of anesthesia (1840s) and antisepsis (1860s), when the wisdom of elders contained in books was venerated, libraries were well supported. (2) In the last third of the nineteenth century, as modern medicine grew and as physicians emphasized the practical and the present, rather than books, support for medical libraries declined. (3) By the 1890s, this attitude had changed because physicians had come to realize that, without both old and new medical literature readily available, they could not keep up with rapidly changing current clinical practice or research. Thus, "The Medical Library Movement" heralded the turn of the century.

Attitude of Health Personnel↗
PubMed1997

[TREATMENT AND PREVENTION OF BACTERIAL AND MYCOTICINFECTION IN ACUTE LIVER FAILURE]

Patients with acute liver failure (ALF) have increased susceptibility to nosocomial and opportunistic infections as a result of various immune defects and the need for invasive monitoring procedures. Bacteriologically proven infection was recorded in up to 80% of these patients and, fungal infection in 32%. Clinical signs such as high temperature and high WBC are absent in 30% of the cases. These patients are prone to develop multiple and concomitant infections. The most common infection in ALF patients is pneumonia, accounting for 50% of episodes. These infections occurs early in the course of the disease. Selective parenteral and enteral antisepsis regimens (SPEAR) were evaluated in prospective controlled studies. Although in a initial study there was an overall reduction of infection episodes. A recent study has shown that the administration of oral non-absorbable antibacterials did not confer any additional benefit over prophylactic systemic antibacterials. In conclusion it is clear that antimicrobial prophylaxis does dramatically reduce the risk of infectious complications and contribute to the improvement in mortality from ALF.

Journal Article↗
PubMedDate not supplied

[Absence of bacteremia after dental extractions].

A study was made on 100 subjects of both sexes between the ages of 3 and 15 years to detect the presence of bacteria in the circulation after performing dental extractions. Two groups were formed of 42 and 57 subjects respectively. One of these groups was subjected to preoperative antisepsis of the region to be operated on, the rest of the conditions were similar for both groups. All the patients were submitted to a preoperative gingival smear and 5 c.c. of blood taken for cultures. Two postoperative blood cultures, one immediately after the operations and another 24 hrs. later were also done in all patients. All the extracted teeth presented severe infections at the root level and some showed complicated infection such as osteomyelitis. All blood cultures performed 24, 48, 72 hrs. and 21 days after the operation, were negative; therefore, there is no justification based on the study, to assume the existance of focal infection related to the presence of bacteremia.

Adolescent↗
PubMed1997

[Pharmacological actions of different species form genus Pyrola].

This paper reporst the pharmacological actions and toxicities of the water extracts from Pyrola calliantha, Pyrola decorta and P. forrestiana. The results show that the actions of P. forrestiana on antiventricular fibrillation, strengthening cardiac musicular contraction and antihypoxia abitity are more stronger, but on antiinflammation and antipyretic, effects of P. decorta and P. calliantha are significantly better than that of P. forrestiana. The effects of the three species on immunization and antisepsis are similar.

Animals↗
PubMed2002

New concepts in etiology, clinic and management of postoperative endophthalmitis.

THE AIM OF THE PAPER: In the last few years, as a result of the continuing changing of the ethiological, clinical and therapeutical aspects of the postoperative endophthalmitis, there are a lot of efforts to find the adequate means to prevent and to treat this severe complication of cataract surgery. So, the paper presents the most actual therapeutical approaches in the field. MATERIAL AND METHODS: The goals of treatment of postoperative endophthalmitis are: to regain vision and to save the bulb. From the prophylactic techniques, preoperative povidone-iodine antisepsis is the most recommended procedure for decreasing the risk of endophthalmitis related to surgery. The main elements of the modern treatment of endophthalmitis are medical treatment by intravitreal injections or by systemic drugs and surgical treatment with vitrectomy. CONCLUSIONS: Although endophthalmitis remains a potential cause of visual loss, both medical therapies and surgical techniques have evolved so that prognosis is not always as negative as it used to be.

Cataract Extraction↗
PubMedDate not supplied

Genes that permit or prevent infections.

In addition to heritable immunodeficiencies and polygenic susceptibility, acquisition genes and resistance genes are important genetic determinants of infectious diseases. Normal forms of acquisition genes permit entry of microorganisms into cells; mutations prevent entry. Normal forms of resistance genes prevent infections; mutations permit infections. The Genome Project has resulted in a growing list of each type. The current lists support important clinical principles. Many, if not most, pathogens readily enter cells unless prevented by antisepsis, blocking, and sterile techniques. Many, if not most, infections occur primarily in persons with heritable mutations of resistance genes.

Communicable Diseases↗
PubMed1992

[General rules of infection prevention in organ transplantation, bone marrow transplantation and prosthetic surgery].

General rules to prevent are categorized into four classes. The first one concern patient before operation: well-balanced nourishment latent infections treatment, digestive tract micro flora elimination, immunizations, antiseptic gargles, skin antisepsis. The second one concern operation: previous fumigation, very high efficiency filtration and laminar flow air, transplant care, antibioprophylaxis, operating theatre discipline. The third one concern post-operation days: cubicle initial fumigation, high efficiency filtration and positive pressure air, strict protective insulation, single-use things, controlled food, specific anti viral prevention, catheters and tubes removal or replacement. The fourth one concern going home patient: well-balanced nourishment, body hygiene and hands washing, infected people shunning, gardening and cleaning proscribing, medical follow-up and latent infections systematic detection.

Bone Marrow Transplantation↗
PubMed2003

[Structure and limitations of past and future functions of hospitals in Germany from the physicians's point of view].

The present paper describes the emergence of hospitals from the xenodochia of the early Christian period up to the hospitals founded in the middle of the 19th century. Based on this tradition the development of German hospitals up to the present day has been influenced by the increase in scientific medical knowledge (anaesthesia, asepsis, antisepsis, roentgenology). Also, the differentiation of the traditional medical specialties into additional special fields and branches will be illustrated. Here, a special role may be attributed to both the laws and regulations releasing hospitals from the care for the invalid and elderly and a change in the prerequisites for hospital financing, which finally led to today's German hospitals being "acute care hospitals". Especially after World War II, the organisation and management structure of German hospitals were also affected by socio-political changes; it will be emphasised that the pyramidal structure (hierarchy) of quality, experience and competence is an indispensable requirement, which particularly applies to the structure of the medical staff. When a human being falls ill he does so as an entire psychophysical unit; the medical care for the diseased person must therefore not regard this unit that forms man as arbitrarily divided individual sections. The development of modern health technologies (such as--to mention just a few--dialysis, ultrasound, endoscopy, cardiac catheterisation, computed tomography, magnetic resonance imaging) should not lead to a complete autonomy of process engineers and thus to the splitting up of medicine into individual allotments because such an approach would be based on an utterly erroneous perception of man. In German hospitals, measures of internal quality assurance have been known for ages, long before politicians also discovered the necessity of so-called external quality assurance in medicine. Quality assurance has always been a matter-of-factness with hospitals. The presentation of the quality of hospital care to the outside world is a necessity. Scientifically founded clinical guidelines will be welcome in hospitals if they identify the necessary lower limit on medical practices by summarising the world-wide knowledge about diagnosis and treatment and if they are regularly checked and updated. But guidelines determining an upper limit on medical practices serve economical purposes only, fixing the manoeuvring space for practising the art of medicine to the disadvantage of the patients and transforming medicine from an attention-giving into an allocation-oriented profession. The future of German hospitals will only partially depend on the progress achieved in the medical sciences; to a greater extent it will be restricted by political decisions and general economic conditions.

Germany↗