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At least 829 records · Page 46Linked to original sources
PubMed1990

Effect of chlorhexidine scrub on postoperative bacterial counts.

Chlorhexidine surgical scrub was left on the surgeon's hands in 50 orthopedic and vascular surgical procedures to determine whether the number of bacteria on the hands could be decreased postoperatively. After a standard 5-minute scrub, one hand was randomly rinsed prior to gloving; the other was lightly patted with a sterile towel, leaving some foam on the hand. The surgeon then gloved and performed the procedure in the usual manner. After the operation, both hands were immersed in a tryptic soy broth for 30 seconds. The broth was then cultured for bacterial species and number. Cases in which glove puncture occurred were not cultured. The results were analyzed using the Wilcoxon signed-rank test. There were fewer bacterial colonies isolated from the hand coated with chlorhexidine scrub versus the other; this difference was statistically significant (p less than 0.005). There also seemed to be a trend towards higher bacterial counts after longer operations; however, the difference was not significant. Neither surgeon noted any evidence of dermatitis during the study. These results suggest that leaving chlorhexidine scrub on the hands during surgery can lead to lower bacterial counts on the surgeon's hands and less chance of wound contamination should glove puncture occur.

Antisepsis↗
PubMed1986

Reduction of infection after cardiac surgery: a clinical trial.

Between January 1, 1975, and June 1, 1984, 3,275 patients underwent cardiac operations with cardiopulmonary bypass. No operations were performed in 1978. In Phase I of the study, general operating rooms were used for cardiac operations, and standard methods of antisepsis and asepsis were used. Phase II began in January, 1979, with the opening of two specially constructed operating rooms with complete separation of incoming and outgoing personnel and supplies, and with a laminar airflow system. All personnel scrubbed 3 minutes and changed into autoclaved clothing before entering the operating suite, and scrubbed again for 5 minutes before putting on gowns. By Phase III, which began in July, 1982, all additional protocols against infection were in place including strict techniques in the intensive care unit and a continuous antiinfection surveillance program. In Phase I, 7.3% (70% confidence limits [CL] 6.4 to 8.2%) of patients had an infectious complication; in Phase II, 2.7% (CL 2.3 to 3.2%), and in Phase III, 0.8% (CL 0.5 to 1.2%). The reductions were similar in the four subtypes of infection (superficial presternal infection, mediastinitis, endocarditis, and septicemia). The study indicates that improving the surgical environment, improving the surgical and operating room protocols, and increasing the awareness of the dangers of infection among the personnel can strikingly reduce the incidence of infections after cardiac operations.

Bacterial Infections↗
PubMed1978

Is skin preparation necessary before insulin injection?

The effect of routine skin preparation on skin bacterial flora was measured in thirteen insulin-dependent diabetic patients. 5 seconds of skin cleansing of sites on the leg, arm, and abdomen with 70% isopropyl alcohol reduced bacterial counts by 82-91%. During a 3-5 month observation period the subjects omitted skin preparation before insulin injection every other week. More than 1700 insulin injections were given without skin preparation. No signs of local or systemic infection were observed. These results indicate that routine skin preparation with alcohol before insulin injection markedly reduces skin bacterial-counts but may not be necessary to prevent infection at the injection sites.

1-Propanol↗
PubMed1983

Effect of catheter tunnelling and a nutrition nurse on catheter sepsis during parenteral nutrition. A controlled trial.

In a three-year controlled trial of subcutaneous catheter tunnelling as a method of reducing total parenteral nutrition (TPN) catheter sepsis 99 silicone catheters (52 tunnelled, 47 untunnelled) were inserted into the subclavian (94%) or jugular (6%) veins under aseptic conditions. The influence of a nutrition nurse, who joined the nutrition team after 18 months, on catheter sepsis rate was also documented. Catheter sepsis was confirmed in 13 of 47 (28%) untunnelled catheters and only 6 of 52 (11.5%) tunnelled catheters (p less than 0.05). A nutrition nurse reduced sepsis rate from 33% (tunnelled 6, untunnelled 11) to 4% (0 tunnelled; 2 untunnelled) (p less than 0.001). There was no significant difference between tunnelled and untunnelled catheters in sepsis rates after the arrival of the nutrition nurse. Although 85% patients had concurrent internal sepsis, the pathogens implicated in catheter sepsis came from superficial sites in 16 of 19 cases (p less than 0.01). Rigorous aseptic nursing care is thus the most significant factor in the reduction of TPN catheter sepsis, but tunnelling can reduce sepsis rate when nursing care is suboptimum.

Antisepsis↗
PubMed1985

Prevention of airborne infection during surgery.

Clinical trials carried out in Britain, Europe, and the United States have confirmed that between 80 and 90% of bacterial contaminants found in the wound after surgery come from colony forming units (cfu) present in the air of the operating theatre. When the numbers of cfu are reduced, there is a corresponding reduction in the incidence of would sepsis. The sources, concentration, and movement of airborne cfu during an operation are identified, and various ways of reducing their numbers are reviewed. Only reduction of cfu in the operating zone to less than 1/m3, by means of an exponentially curved flow of microbiologically clean air, together with a total body exhaust system worn by the members of the surgical team and the patient, provides aseptic conditions without imposing restrictions or changes in surgical procedure.

Air Microbiology↗
PubMed1981

Nosocomial infection control: scope and implications for health care--a historical view.

Knowing where we have come from helps to decide where we should be going. Many principles and practices of modern infection control were developed in the nineteenth and early twentieth century. The story is one of halting, yet relentless, progress. The history of these discoveries and their application to infection control, then and now, is described, such as principles of hygiene, antiseptic surgery, antimicrobial therapy, and improved hospital design. Many of the issues today are not new, nor are some of the fundamental solutions. An acceptance of this historical continuum may temper expectations and make us more accepting of change.

Antisepsis↗
PubMed1978

Prevention of postextraction bacteremia by local prophylaxis.

Four local prophylactic methods were studied in the prevention of postextraction bacteremia: 1) mouth rinsing with 1% iodine solution, postoperative bacteremia frequency 55%, 2) operative field isolation with cotton rolls and saliva ejector, bacteremia frequency 34%, 3) operative field isolation and disinfection with 10% iodine solution, bacteremia frequency 32%, 4) operative field isolation and disinfection with 0.5% chlorhexidine solution, bacteremia frequency 13%. The operative field isolation together with local disinfection with chlorhexidine was recommended for routine practice. However, when dealing with known or suspected risk group patients, a combined systemic and local prophylactic method was strongly recommended, as this was found in previous investigation to be the most effective method for reducing the frequency of bacteremia.

Adolescent↗
PubMed2002

David Murray Morton: father figure of surgery at St Vincent's Hospital, bush lawyer and thwarted reformer of the medico-legal system.

When the first Golden Age of surgery at St Vincent's Hospital Melbourne (a period covering the first 25 years of the twentieth century) is discussed, the names that spring to mind are usually those of Sir Thomas Dunhill, Sir Hugh Devine, Sir Douglas Shields and Julian Smith. A name which is often overlooked, and by now almost forgotten, is that of David Murray Morton. Murray -Morton's career both as a medical student, general practitioner, anaesthetist and surgeon coincided with a revolution in the practice of medicine. He witnessed the progression from Listerian antisepsis to asepsis in surgical practice, the improvements in anaesthesia, the introduction of antibiotics and, before he died in 1959, the beginnings of organ transplants and open heart surgery. Morton was fond of saying that he grew up with the hospital. From the time of his first appointment as an anaesthetist in l896 to the time of his retirement from St Vincent's as senior surgeon in 1931, Morton, admired by all as a highly competent surgeon and a man of incorruptible probity, can rightly be described as the father figure of surgery during the formative years of St Vincent's Hospital. His innate sense of justice and fair play formed the basis of his distinguished tenure of the Presidency of the Medical Defence Association of Victoria, where his constructive attempts at reform of the medico-legal system were only thwarted by the predictable opposition of the legal profession and politicians.

Australia↗
PubMed1990

Microbial challenge of a blood cell separator outside-seal bowl system.

The ability to store platelets beyond 24 hours requires a functionally closed system. This study tested the ability of a cell separator bowl seal system to resist penetration of microbial contamination under normal running conditions and under extreme environmental stress. Three test organisms, Micrococcus luteus, Serratia marcescens, and Staphylococcus epidermidis, were applied directly to the bowl at the edge of the seal or aerosolized and passed through the centrifuge chamber while the cell separator was run through a simulated platelet collection. A sterile, bacteriologic nutrient medium was perfused through the tubing set, thus simulating the flow of blood fractions. Following the procedure, the medium was examined for microbial growth. The concentration of aerosolized bacteria ranged from 5.2 x 10(1) to 3.9 x 10(3) colony-forming units (CFU) per mL, and the concentration of bacteria applied to the edge of the seal ranged from 1.9 x 10(5) to 2.8 x 10(9) CFU per mL. The positive control, direct inoculation of S. marcescens into the circulating medium (50 CFU/500 mL), resulted in recovery of the identical organism after 24 hours' incubation. No contamination of the system was detected in 40 experiments with aerosolized bacteria or in 32 experiments in which bacteria were applied directly to the seal. This study demonstrates that this sealed-bowl system resists microbial contamination.

Aerosols↗
PubMed1984

Simple methods for direct antibiotic protection of synthetic vascular grafts.

Two simple methods for direct antibacterial protection of synthetic vascular grafts were investigated. In the first protocol the highly protein-bound antibiotics nafcillin (90% protein bound), cefazolin (80%), and cefamandole (70%) were added directly to preclotting blood. Knitted Dacron grafts preclotted in the presence of one of these drugs absorbed significant amounts. Although at high concentrations these antibiotics exhibited anticoagulant effects, significant antibacterial protection was obtained at lower antibiotic levels. Washing treated grafts for 6 hours failed to eliminate the antibacterial activity. Antibiotics remained on the grafts for at least 96 hours. In the second protocol knitted Dacron grafts were soaked in a suspension of silver-pefloxacin, a silver-nalidixic acid analogue with intense antistaphylococcic activity. Using 110Ag-labeled complexes, significant antibiotic activity was documented on the graft after 19 days of washing. Four nafcillin-treated prostheses, six silver-pefloxacin-coated grafts, and 11 control grafts were interposed in the infrarenal aorta of dogs and immediately challenged with an intravenous infusion of 1 X 10(7) Staphylococcus aureus. None of the four nafcillin-treated grafts was infected at 3 weeks. One of the six silver-pefloxacin-coated grafts grew staphylococci, and 9 of 11 controls had positive graft cultures for Staphylococcus when harvested. These studies suggest that prosthetic grafts can be simply coated at the time of implantation with antibiotics selected for appropriate binding and antibacterial characteristics to obtain an infection-resistant prosthesis.

Animals↗
PubMed2004

Localisation and William Macewen's early brain surgery Part I: the controversy.

Neurosurgery for the removal of brain tumours based on localising signs is usually dated from the 1884 operation by Bennett and Godlee. However, within weeks of that operation claims were made on behalf of William Macewen, the Glasgow surgeon, to have been the real pioneer of such surgery. According to Macewen's protagonists, he had conducted seven similar operations earlier than Bennett and Godlee and, in a notable 1888 address, Macewen described these seven pre-1884 cases and a number of others operated on after 1884. This paper, which is in two parts, contains an evaluation of the claims made for the priority of Macewen's pre-1884 operations. Part I deals mainly with Macewen's work in fields other than brain surgery that are relevant to it and sets out the facts of the controversy. It begins with a brief biography of Macewen, describes his pioneering work in antiseptic and aseptic surgery, his work on osteotomy and bone regeneration, and his use in brain surgery of the knowledge so gained. Part I concludes with an examination of the battle waged in the newspapers between Macewen's and Bennett's and Godlee's supporters, and of previously unpublished correspondence between Macewen himself, David Ferrier and Hughes Bennett. The primary records of the patients on whom Macewen operated, together with other materials relevant to the controversy, are examined in Part II.

Antisepsis↗