Disinfection of Blood Pressure Cuffs and Electrocardiographic Telemetry Leads With 0.5% Hydrogen Peroxide Wipes.

BACKGROUND: Disinfection of frequently touched surfaces in the hospital is critical for providing safe care. Because of their complex intricate surfaces, blood pressure cuffs and electrocardiographic telemetry leads may be harder than other equipment to disinfect. OBJECTIVE: To determine the effectiveness of 0.5% hydrogen peroxide wipes in cleaning and disinfecting inpatient hospital surfaces, including hook and loop (Velcro) fasteners of blood pressure cuffs and electrocardiographic telemetry leads. METHODS: A prospective study of an inpatient telemetry unit was designed to measure the persistence of a UV indicator and the presence of bacterial colonization on electrocardiographic telemetry leads and blood pressure cuffs. Call buttons and patient trays were used as control surfaces, because they are often touched but are easy to disinfect via standard practices. RESULTS: A total of 392 samples were collected between July 11 and August 3, 2016, and cultured for microorganisms. Among the cultures, 247 (63%) had at least 1 colony-forming unit. After adjustments in a multivariable analysis, odds of a contaminated surface (≥ 10 colony-forming units) after final cleaning with 0.5% hydrogen peroxide wipes were 3.70 times greater for patient trays than for blood pressure cuffs (P = .03) and 3.80 times greater for telemetry leads than for blood pressure cuffs (P = .04). The UV indicator persisted longer on blood pressure cuffs and telemetry leads than on patient trays or call buttons (P < .001). CONCLUSION: Wipes with 0.5% hydrogen peroxide adequately disinfect blood pressure cuffs but not telemetry leads.

Door openings in the operating room are associated with increased environmental contamination.

Door openings in the operating room (OR) have been hypothesized to increase OR environmental contamination. This study measured average colony-forming units (CFU) in the OR as a function of door openings and other potentially important variables. Bacterial settle plates were placed inside and outside of laminar airflow (LAF) by both exit doors, on the instrument table, and on the back instrument table (if applicable) for 48 orthopedic and general surgery procedures. CFU data were paired to Staphylococcus aureus colonization status, door openings, surgery duration, time of day, OR location, number of staff, use of warming devices, temperature, and humidity. The number of door openings in the OR and surgery duration were significantly associated with increased CFU in the OR overall and outside of LAF. However, under LAF conditions, only the number of OR personnel was significantly associated with increased CFU.

Low dose compared to variable dose Warfarin and to Fondaparinux as prophylaxis for thromboembolism after elective hip or knee replacement surgery; a randomized, prospective study.

BACKGROUND: Deep vein thrombosis (DVT) and pulmonary emboli (PE), known together as venous thromboembolic (VTE) disease remain major complications following elective hip and knee surgery. This study compares three chemoprophylactic regimens for VTE following elective primary unilateral hip or knee replacement, one of which was designed to minimize risk of post-operative bleeding. METHODS: Patients were randomized and stratified for hip vs. knee to receive A: variable dose warfarin (first dose on the night preceding surgery with subsequent target INR 2.0-2.5), B: 2.5 mg fondaparinux daily starting 6-18 h postoperatively, or C: fixed 1.0 mg dose warfarin daily starting 7 days preoperatively. All treatments continued until bilateral leg venous ultrasound day 28 ± 2 or earlier upon a VTE event. The study examined primary endpoints including leg DVT, PE or death due to VTE and secondary endpoints including effects on D-dimer, estimated blood loss (EBL) at surgery and hemorrhagic complications. RESULTS: Three hundred fifty-five patients were randomized. None was lost to follow-up. Taking 1.0 mg warfarin for seven days preoperatively did not prolong the prothrombin time (PT). Two patients in Arm C had asymptomatic distal DVT. One major bleed occurred in Arm B and one in Arm C (ischemic colitis). Elevated d-dimer did not predict delayed VTE for one year. CONCLUSIONS: Fixed low dose warfarin started preoperatively is equivalent to two other standards of care under study (95 % CI: -0.0428, 0.0067 for both) as VTE prophylaxis for the patients having elective major joint replacement surgery. TRIAL REGISTRATION: ClinicalTrials.gov identifier # NCT00767559 FDA IND: 103,716.

Institutional prescreening for detection and eradication of methicillin-resistant Staphylococcus aureus in patients undergoing elective orthopaedic surgery.

BACKGROUND: Surgical site infection has been identified as one of the most important preventable sources of morbidity and mortality associated with medical treatment. The purpose of the present study was to evaluate the feasibility and efficacy of an institutional prescreening program for the preoperative detection and eradication of both methicillin-resistant and methicillin-sensitive Staphylococcus aureus in patients undergoing elective orthopaedic surgery. METHODS: Data were collected prospectively during a single-center study. A universal prescreening program, employing rapid polymerase chain reaction analysis of nasal swabs followed by an eradication protocol of intranasal mupirocin and chlorhexidine showers for identified carriers, was implemented. Surgical site infection rates were calculated and compared with a historical control period immediately preceding the start of the screening program. RESULTS: During the study period, 7019 of 7338 patients underwent preoperative screening before elective surgery, for a successful screening rate of 95.7%. One thousand five hundred and eighty-eight (22.6%) of the patients were identified as Staphylococcus aureus carriers, and 309 (4.4%) were identified as methicillin-resistant Staphylococcus aureus carriers. A significantly higher rate of surgical site infection was observed among methicillin-resistant Staphylococcus aureus carriers (0.97%; three of 309) compared with noncarriers (0.14%; seven of 5122) (p = 0.0162). Although a higher rate of surgical site infection was also observed among methicillin-sensitive Staphylococcus aureus carriers (0.19%; three of 1588) compared with noncarriers, this difference did not achieve significance (p = 0.709). Overall, thirteen cases of surgical site infection were identified during the study period, for an institutional infection rate of 0.19%. This rate was significantly lower than that observed during the control period (0.45%; twenty-four cases of surgical site infection among 5293 patients) (p = 0.0093). CONCLUSIONS: Implementation of an institution-wide prescreening program for the identification and eradication of methicillin-resistant and methicillin-sensitive Staphylococcus aureus carrier status among patients undergoing elective orthopaedic surgery is feasible and can lead to significant reductions in postoperative rates of surgical site infection. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.