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PubMed2004

[From "wet caries" to controllable complication. History of post-traumatic and postoperative osteitis].

In former times treatment of osteomyelitis was based on very few surgical principles such as incision of the infected region, debridement with sequestrectomy, and continuous drainage to prevent superficial closing of the wound. There were no rules for asepsis, anesthesia, and microbiology in the treatment of bone infection. Therapy improved dramatically when J. Lister introduced and performed antisepsis. With the beginning of the twentieth century it became much more standardized and differentiated. In the 4th decade of the twentieth century, the development of antibiotics changed the regime of osteomyelitis therapy again. Especially systemic intravenous antibiotic therapy was very successful in the treatment of the hematogeneous osteomyelitis. Treatment failed in post-traumatic and postoperative osteitis. Local antibiotic therapy on a delivery system was the breakthrough for these cases. The application of PMMA cement as an antibiotic delivery system led to this new possibility for treating bone infections and is still in use nowadays.

Anti-Bacterial Agents↗
PubMed1991

Did suturing services at Alexandra Health Centre need upgrading?

Due to financial restrictions patients at the Alexandra Health Centre (AHC) were sutured under conditions of cleanliness but not complete asepsis. A study was undertaken in 1987 to determine the need and priority for upgrading suturing services at AHC by determining the rate of wound sepsis after suturing in 348 consecutive patients during 1 month. One hundred and thirty-nine (40%) returned for removal of sutures, of whom 31 (22.3%) were assessed as having septic wounds, 15 (10.8%) with mild sepsis (inflammation only) and 16 (11.5%) severe (pus present). Depending on whether one considers mild or only severe sepsis and how one takes account of the effect of non-responders, the overall sepsis rate is between 4.6% and 22.3%. The only factor found to be a predictor of sepsis was clinically evident wound contamination. A follow-up study, undertaken to investigate the reasons for so many patients not returning to the AHC for removal of sutures, found that most patients removed their sutures at home. The literature is reviewed and the problems in defining sepsis and handling poor response rates are discussed. In all, we recommended that the introduction of complete asepsis should not occur at the expense of other priorities at the AHC.

Adolescent↗
PubMed1982

[Our surgical heritage. History of modern surgery: a brief survey. I].

A short review is given that deals with modern surgery beginning from 1880. This amazing development began with general anaesthesia, anti- and asepsis. Its further progress till to the present time resulted mainly from research in bacteriology X-ray technique, endoscopy, chemotherapy, anaesthesiology, biochemistry, immunology and last not least from better knowledge of protein-, water- and elektrolyte metabolism. Thanks to microsurgery organ transplantation and replantation of severed limbs became possible: a new dimension of surgery.

Anesthesia, General↗
PubMed2002

A review of risk factors for catheter-related bloodstream infection caused by percutaneously inserted, noncuffed central venous catheters: implications for preventive strategies.

Strategies for preventing central venous catheter (CVC)-related bloodstream infection are most likely to be effective if guided by an understanding of the risk factors associated with these infections. In this critical review of published studies of risk factors for CVC-related bloodstream infection that were prospective and used multivariable techniques of data analysis or that were randomized trials of a preventive measure, a significantly increased risk of catheter-related bloodstream infection was associated with inexperience of the operator and nurse-to-patient ratio in the intensive care unit, catheter insertion with less than maximal sterile barriers, placement of a CVC in the internal jugular or femoral vein rather than subclavian vein, placement in an old site by guidewire exchange, heavy colonization of the insertion site or contamination of a catheter hub, and duration of CVC placement > 7 days. Prospective studies or randomized trials of control measures focusing on these risk factors have been shown to reduce risk significantly: formal training in CVC insertion and care, use of maximal sterile barriers at insertion, use of chlorhexidine rather than povidone-iodine for cutaneous antisepsis, applying a topical anti-infective cream or ointment or a chlorhexidine-impregnated dressing to the insertion site, and the use of novel catheters with an anti-infective surface or a contamination resistant hub. Better prospective studies of sufficient size to address all potential risk factors, including insertion site and hub colonization, insertion technique, and details of follow-up care, would enhance our understanding of the pathogenesis of CVC-related bloodstream infection and guide efforts to develop more effective strategies for prevention.

Asepsis↗
PubMed2001

[Prevention of infections transmitted by intravascular devices (catheters, implanted sites)].

Infection remains a major complication of central veinous catheters. A clinically or bacteriologically proven infection is identified in 5 to 10% of the cases although the actual risk varies from less than 1 to more than 30 episodes of infection per 1000 catheter-days. Systemic spread follows colonization of the catheter tip via the skin or the connectors, less frequently via hematogenous seeding from a distant focus of infection. Excepting emergency situations, search for proof of catheter-related infection or noninfection without removing the catheter now appears to be acceptable for selected intensive care patients if appropriate safety measures are taken; the reasonable choice is between maintaining the catheter while performing tests susceptible of determining the reality of catheter-related infection (in this case there remains a certain doubt concerning the respective performance of the different methods proposed for early diagnosis) and catheter exchange on a metal or plastic guide-wire. Rigorous application of the rules of hygiene, asepsis, and local care is crucial: systematic and repeated hand washing is by far the best antiinfectious prophylaxis. Three types of future developments susceptible of improving the current situation can be identified: better knowledge of host defense mechanisms against foreign bodies, reduction of hand-transmitted contamination by wider use of hydro-alcohol solutions for decontamination of the hands, and elaboration of new connectors, and most importantly, biomaterials capable of inhibiting colonization by the growing number of increasingly virulent strains. Discussions concerning the real clinical efficiency, ecological risk and the cost-effectiveness of catheters impregnated with antiseptics and/or antibiotics is a perfect illustration of the current debate.

Antibiotic Prophylaxis↗
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↗