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Antisepsis in surgery

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https://www.readbyqxmd.com/read/27838164/skin-antisepsis-with-chlorhexidine-versus-iodine-for-the-prevention-of-surgical-site-infection-a-systematic-review-and-meta-analysis
#1
REVIEW
Gaetano Pierpaolo Privitera, Anna Laura Costa, Silvio Brusaferro, Piero Chirletti, Paola Crosasso, Gabriele Massimetti, Angelo Nespoli, Nicola Petrosillo, Mauro Pittiruti, Giancarlo Scoppettuolo, Fabio Tumietto, Pierluigi Viale
BACKGROUND: Surgical site infection (SSI) is one of the most frequent health care-associated infections. One of the practices to reduce their incidence is preoperative skin antisepsis. Two of the most commonly active components used are chlorhexidine gluconate and povidone iodine. Of 3 reviews conducted between 2010 and 2012 comparing antiseptics, 2 were in favor of chlorhexidine; however, the latest was unable to draw conclusions. PURPOSE: To verify whether recent evidence supports the hypothesis that chlorhexidine in preoperative antisepsis is more efficient than other antiseptics in reducing SSI rates...
November 9, 2016: American Journal of Infection Control
https://www.readbyqxmd.com/read/27817826/the-impact-of-surgical-hand-antisepsis-technique-on-surgical-site-infection
#2
Brad S Oriel, Qi Chen, Kamal M F Itani
BACKGROUND: Limited evidence exists regarding the effect on superficial and deep incisional surgical site infections (SDSSIs) of alcohol-based hand rubs (ABR) versus traditional aqueous surgical scrubs (TSS). User preferences and practice are unknown. METHODS: A retrospective cohort study examining SDSSIs using VA Surgical Quality Improvement Program cases before ABR implementation (2007-2009, TSS group) and after (2013-2014, ABR group). A descriptive survey. RESULTS: SDSSI rates were 1...
October 8, 2016: American Journal of Surgery
https://www.readbyqxmd.com/read/27671220/acquired-resistance-to-chlorhexidine-is-it-time-to-establish-an-antiseptic-stewardship-initiative
#3
G Kampf
Chlorhexidine digluconate (CHG) is an antimicrobial agent used for different types of applications in hand hygiene, skin antisepsis, oral care, and patient washing. Increasing use raises concern regarding development of acquired bacterial resistance. Published data from clinical isolates with CHG minimum inhibitory concentrations (MICs) were reviewed and compared to epidemiological cut-off values to determine resistance. CHG resistance is rarely found in Escherichia coli, Salmonella spp., Staphylococcus aureus or coagulase-negative staphylococci...
August 26, 2016: Journal of Hospital Infection
https://www.readbyqxmd.com/read/27131128/disinfection-sterilization-and-antisepsis-an-overview
#4
William A Rutala, David J Weber
All invasive procedures involve contact by a medical device or surgical instrument with a patient's sterile tissue or mucous membranes. The level of disinfection or sterilization is dependent on the intended use of the object: critical (items that contact sterile tissue such as surgical instruments), semicritical (items that contact mucous membrane such as endoscopes), and noncritical (devices that contact only intact skin such as stethoscopes) items require sterilization, high-level disinfection and low-level disinfection, respectively...
May 2, 2016: American Journal of Infection Control
https://www.readbyqxmd.com/read/26781394/single-vs-repeat-surgical-skin-preparations-for-reducing-surgical-site-infection-after-total-joint-arthroplasty-a-prospective-randomized-double-blinded-study
#5
Tiffany N Morrison, Antonia F Chen, Mayank Taneja, Fatih Küçükdurmaz, Richard H Rothman, Javad Parvizi
BACKGROUND: Preventing surgical site infection (SSI) after total joint arthroplasty (TJA) is a high priority and is partly linked to the efficacy of surgical site preparation solutions (SPSs) in reducing the number of pathogens on the skin before incision. The aim of this study is to investigate the effectiveness of SRS reapplication after draping to reduce the incidence of SSI after TJA. METHODS: Six hundred patients undergoing primary TJA between 2010 and 2011 at a single institution were recruited and randomly assigned to one of 2 groups...
June 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/26012179/the-right-skin-preparation-technique-a-literature-review
#6
REVIEW
Pedro Silva
Recent debates and guidelines are suggesting back and forth motion to be the optimal preoperative technique for skin preparation. There is a lack of conclusive evidence showing this to be the case, but it may be reasonable to follow this technique, in preference to the widely used concentric circles motion, as the antiseptic agent will reach deeper cell layers of the skin where most of the microbes are found.
December 2014: Journal of Perioperative Practice
https://www.readbyqxmd.com/read/26066854/operating-room-fire-should-we-mistrust-alcoholic-antiseptics
#7
A Bonnet, M Devienne, V De Broucker, V Duquennoy-Martinot, P Guerreschi
Surgical site infections are a challenge for public health. One of the keystones of prevention is the skin preparation of the patient. Alcoholic antiseptics are presented as the best solution. But the adverse effects attributed to them must not be overshadowed by the exclusive benefit of their microbiological performance. The authors report four cases of severe burn having occurred in the operating room after skin antisepsis performed with an alcoholic antiseptic. The mechanisms of these accidents and preventive measures are reviewed...
August 2015: Annales de Chirurgie Plastique et Esthétique
https://www.readbyqxmd.com/read/26388532/skin-antisepsis-with-chlorhexidine-alcohol-versus-povidone-iodine-alcohol-with-and-without-skin-scrubbing-for-prevention-of-intravascular-catheter-related-infection-clean-an-open-label-multicentre-randomised-controlled-two-by-two-factorial-trial
#8
RANDOMIZED CONTROLLED TRIAL
Olivier Mimoz, Jean-Christophe Lucet, Thomas Kerforne, Julien Pascal, Bertrand Souweine, Véronique Goudet, Alain Mercat, Lila Bouadma, Sigismond Lasocki, Serge Alfandari, Arnaud Friggeri, Florent Wallet, Nicolas Allou, Stéphane Ruckly, Dorothée Balayn, Alain Lepape, Jean-François Timsit
BACKGROUND: Intravascular-catheter-related infections are frequent life-threatening events in health care, but incidence can be decreased by improvements in the quality of care. Optimisation of skin antisepsis is essential to prevent short-term catheter-related infections. We hypothesised that chlorhexidine-alcohol would be more effective than povidone iodine-alcohol as a skin antiseptic to prevent intravascular-catheter-related infections. METHODS: In this open-label, randomised controlled trial with a two-by-two factorial design, we enrolled consecutive adults (age ≥18 years) admitted to one of 11 French intensive-care units and requiring at least one of central-venous, haemodialysis, or arterial catheters...
November 21, 2015: Lancet
https://www.readbyqxmd.com/read/26084075/susceptibility-of-selected-strains-used-for-evaluation-of-biocidal-efficiency-of-disinfectants-and-antibiotic-resistant-strains-to-didecyldimethylammonium-chloride-in-2-propanol
#9
Agnieszka Chojecka, Olga Wiercińska, Ewa Röhm-Rodowald, Krzysztof Kanclerski, Bożenna Jakimiak
INTRODUCTION: Didecyldimethylammonium chloride is an active substance which is part of variety of formulations used for the disinfection and antisepsis, both in the medical area as well as in the food, industrial and institutional area. Because of the widespread use of this substance and the development of bacterial resistance to quaternary ammonium compounds (QACs), the aim of this study was determination of the susceptibility of the standard strains used for the evaluation of the effectiveness of disinfectants and standard antibiotic-resistant strains to didecyldimethylammonium chloride in 2-propanol and its bactericidal activity...
2015: Medycyna Doświadczalna i Mikrobiologia
https://www.readbyqxmd.com/read/26308490/evidence-for-a-standardized-preadmission-showering-regimen-to-achieve-maximal-antiseptic-skin-surface-concentrations-of-chlorhexidine-gluconate-4-in-surgical-patients
#10
RANDOMIZED CONTROLLED TRIAL
Charles E Edmiston, Cheong J Lee, Candace J Krepel, Maureen Spencer, David Leaper, Kellie R Brown, Brian D Lewis, Peter J Rossi, Michael J Malinowski, Gary R Seabrook
IMPORTANCE: To reduce the amount of skin surface bacteria for patients undergoing elective surgery, selective health care facilities have instituted a preadmission antiseptic skin cleansing protocol using chlorhexidine gluconate. A Cochrane Collaborative review suggests that existing data do not justify preoperative skin cleansing as a strategy to reduce surgical site infection. OBJECTIVES: To develop and evaluate the efficacy of a standardized preadmission showering protocol that optimizes skin surface concentrations of chlorhexidine gluconate and to compare the findings with the design and methods of published studies on preoperative skin preparation...
November 2015: JAMA Surgery
https://www.readbyqxmd.com/read/26337434/antimicrobial-efficacy-of-preoperative-skin-antisepsis-and-clonal-relationship-to-postantiseptic-skin-and-wound-flora-in-patients-undergoing-clean-orthopedic-surgery
#11
G Daeschlein, M Napp, F Layer, S von Podewils, H Haase, R Spitzmueller, O Assadian, R Kasch, G Werner, M Jünger, P Hinz, A Ekkernkamp
Nosocomial surgical site infections (SSI) are still important complications in surgery. The underlying mechanisms are not fully understood. The aim of this study was to elucidate the possible role of skin flora surviving preoperative antisepsis as a possible cause of SSI. We conducted a two-phase prospective clinical trial in patients undergoing clean orthopedic surgery at a university trauma center in northern Germany. Quantitative swab samples were taken from pre- and postantiseptic skin and, additionally, from the wound base, wound margin, and the suture of 137 patients...
November 2015: European Journal of Clinical Microbiology & Infectious Diseases
https://www.readbyqxmd.com/read/21088455/characterization-of-skin-friction-coefficient-and-relationship-to-stratum-corneum-hydration-in-a-normal-chinese-population
#12
COMPARATIVE STUDY
Y H Zhu, S P Song, W Luo, P M Elias, M Q Man
BACKGROUND AND OBJECTIVES: Studies have demonstrated that some cutaneous biophysical properties vary with age, gender and body sites. However, the characteristics of the skin friction coefficient in different genders and age groups have not yet been well established. In the present study, we assess the skin friction coefficient in a larger Chinese population. METHODS: A total of 633 subjects (300 males and 333 females) aged 0.15-79 years were enrolled. A Frictiometer FR 770 and Corneometer CM 825 (C&K MPA 5) were used to measure the skin friction coefficient and stratum corneum hydration, respectively, on the dorsal surface of the hand, the forehead and the canthus...
2011: Skin Pharmacology and Physiology
https://www.readbyqxmd.com/read/25912596/chlorhexidine-pharmaco-biological-activity-and-application
#13
REVIEW
T M Karpiński, A K Szkaradkiewicz
OBJECTIVES: Chlorhexidine (CHX) is one of the most widely used antiseptic, especially in dentistry. At low concentrations CHX is bacteriostatic and at high concentrations acts bactericidal causing cell death by cytolysis. In this study, we performed a systematic review of pharmaco-biological activity and application of CHX. MATERIALS AND METHODS: Articles for inclusion in this review were retrieved from online databases PubMed/Medline. The selected papers were included in the present manuscript according to their relevance for the topic...
April 2015: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/25979197/a-comparison-of-the-efficacy-of-70-v-v-isopropyl-alcohol-with-either-0-5-w-v-or-2-w-v-chlorhexidine-gluconate-for-skin-preparation-before-harvest-of-the-long-saphenous-vein-used-in-coronary-artery-bypass-grafting
#14
RANDOMIZED CONTROLLED TRIAL
Anna Casey, Abdul Itrakjy, Chrissie Birkett, Alan Clethro, Robert Bonser, Tim Graham, Jorge Mascaro, Domenico Pagano, Stephen Rooney, Ian Wilson, Peter Nightingale, Cynthia Crosby, Thomas Elliott
BACKGROUND: Chlorhexidine gluconate (CHG) is often recommended for skin antisepsis; however, the most efficacious concentration is currently unclear. Our objective was to compare the efficacy of 70% isopropyl alcohol (IPA) containing either 0.5% or 2% CHG for antiseptic skin preparation in patients undergoing coronary artery bypass grafting. METHODS: One hundred patients were randomized to 1 of the 2 CHG concentrations. The designated antiseptic was applied to the skin of the operative site of patients before long saphenous vein harvest...
August 2015: American Journal of Infection Control
https://www.readbyqxmd.com/read/26056185/bundled-preparation-of-skin-antisepsis-decreases-the-risk-of-cardiac-implantable-electronic-device-related-infection
#15
Huang-Chung Chen, Mien-Cheng Chen, Yung-Lung Chen, Tzu-Hsien Tsai, Kuo-Li Pan, Yu-Sheng Lin
AIMS: To evaluate the efficacy of bundled skin antiseptic preparation to prevent cardiac implantable electronic device (CIED) infections. METHODS AND RESULTS: From January 2010 to November 2013, 665 consecutive patients were divided into two groups according to the strategy of skin preparation. In Period 1 (January 2010 to June 2012), 395 patients received the standard skin antiseptic preparation. In Period 2 (July 2012 to November 2013), 270 patients received a triple-step skin antiseptic preparation, 'bundled skin antiseptic preparation', consisting of applying 75% alcohol over anterior chest on the night before the index day, povidone-iodine 10 min before operation, and the standard skin antiseptic preparation before incision...
June 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/26021139/-antisepsis-of-wounds-when-and-what
#16
Ryve Ramosaj Mulaj, Michael Mühlstädt, Neda Barouti
Bacterial colonisation of a wound is a normal process and usually not dangerous. The role of micro-organisms in the healing process is not fully elucidated, however it is well known that infection interrupts healing and even worse can severely threaten the organism. We present the different types of antiseptics that are used in treating wounds as well as their interactions. We would like to remind the reader that antiseptics are more effective than antibiotics with much fewer resistances. Finally, we provide a flow chart for a reasonable treatment of chronic wounds...
April 1, 2015: Revue Médicale Suisse
https://www.readbyqxmd.com/read/25984901/role-of-antiseptics-in-the-prevention-of-surgical-site-infections
#17
REVIEW
Kathryn Echols, Michael Graves, Keith G LeBlanc, Sean Marzolf, Avis Yount
BACKGROUND: Antiseptics are chemical agents used to reduce the microbial population on the surface of the skin and are used in nearly every surgical procedure today. Despite this, there are currently no definitive guidelines on surgical preoperative antisepsis that indicate a specific regimen based on demonstration of superior efficacy. OBJECTIVE: This review serves to examine preoperative antisepsis, including cutaneous bacteriology, preoperative hair removal, preoperative decolonization, surgical attire, and the antiseptic agents themselves...
June 2015: Dermatologic Surgery: Official Publication for American Society for Dermatologic Surgery [et Al.]
https://www.readbyqxmd.com/read/24655901/efficacy-of-1-0-chlorhexidine-gluconate-ethanol-compared-with-10-povidone-iodine-for-long-term-central-venous-catheter-care-in-hematology-departments-a-prospective-study
#18
RANDOMIZED CONTROLLED TRIAL
Natsuo Yamamoto, Hideo Kimura, Hanako Misao, Hayato Matsumoto, Yuji Imafuku, Akemi Watanabe, Hiroko Mori, Akiko Yoshida, Saori Miura, Yoshinobu Abe, Mamoru Toba, Hiromi Suzuki, Kazuei Ogawa, Keiji Kanemitsu
The efficacy of 1% chlorhexidine-gluconate ethanol and 10% povidone-iodine for skin antisepsis of central venous catheter (CVC) sites were compared among hematology patients. The CVC site colonization rates of those groups were 11.9% and 29.2%, respectively, and the catheter-associated blood stream infections were 0.75 and 3.62 per 1,000 catheter-days, respectively. One percent chlorhexidine-gluconate ethanol was superior to povidone-iodine to reduce skin colonizers at CVC sites even when catheters were used for long duration...
May 2014: American Journal of Infection Control
https://www.readbyqxmd.com/read/24833699/alcoholic-chlorhexidine-or-alcoholic-iodine-skin-antisepsis-acaisa-protocol-for-cluster-randomised-controlled-trial-of-surgical-skin-preparation-for-the-prevention-of-superficial-wound-complications-in-prosthetic-hip-and-knee-replacement-surgery
#19
RANDOMIZED CONTROLLED TRIAL
T N Peel, A C Cheng, K L Buising, M M Dowsey, P F M Choong
INTRODUCTION: Wound complications following arthroplasty are associated with significant impact on the patient and healthcare system. Skin cleansing prior to surgical incision is a simple and effective method to prevent wound complications however, the question of which agent is superior for surgical skin antisepsis is unresolved. METHODS AND ANALYSIS: This cluster randomised controlled trial aims to compare the incidence of superficial wound complications in patients undergoing elective prosthetic hip or knee replacement surgery receiving surgical skin antisepsis with either: 0...
2014: BMJ Open
https://www.readbyqxmd.com/read/24969555/new-strategies-for-preoperative-skin-antisepsis
#20
REVIEW
Miriam Ulmer, Juergen Lademann, Alexa Patzelt, Fanny Knorr, Axel Kramer, Torsten Koburger, Ojan Assadian, Georg Daeschlein, Bernhard Lange-Asschenfeldt
During the past decades, encouraging progress has been made in the prevention of surgical site infections (SSI). However, as SSI still occur today, strategic prevention measures such as standardized skin antisepsis must be implemented and rigorously promoted. Recent discoveries in skin physiology necessitate the development of novel antiseptic agents and procedures in order to ameliorate their efficacy. In particular, alternate target structures in the skin need to be taken into consideration for the development of the next generation of antiseptics...
2014: Skin Pharmacology and Physiology
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