Aseptic versus clean technique during wound management? Systematic review with meta-analysis.

The management of wounds by health professionals usually involves aseptic technique. An alternative is the use of clean techniques where the risk of infection is minimised but use of non-sterile materials is considered permissible. This systematic review and meta-analysis compares these two approaches. Nine studies met the inclusion criteria. Overall risk of bias was judged to be low. The random-effects relative risk of infection for clean dressings rather than aseptic dressings was 0.86 (95% CI 0.67, 1.12). There was little evidence of statistical heterogeneity, although the small number of infections in either group resulted in wide confidence intervals. The 95% prediction interval for future studies was 0.63, 1.18. There was therefore no evidence showing inferiority of clean techniques compared to aseptic methods. Before clinical studies are undertaken with higher risk procedures, laboratory simulations should explore safety by investigating the potential for pathogen transmission at each stage in the dressing procedure.

Impact of a training strategy on improving compliance of hand hygiene and gloving during the placement of a short peripheral venous catheter: the multicentre study CleanHand4.

BACKGROUND: Patients who have short peripheral venous catheters (PVC) face an elevated risk of developing bloodstream infections. Preventing catheter-related infections relies on implementing multiple measures, including practicing proper hand hygiene (HH) during catheter placement. METHODS: We conducted a four-part study: (1) an evaluation of HH practices through direct observation of PVC placements, coupled with the study of the microbial flora of the HCWs fingers just before the placement; (2) the development of an educational tool based on the collected observational and microbiological data; (3) the training to the HCWs observed during the first part, using this tool; and (4) the subsequent observation of the trained HCWs to measure the impact of the training on practice improvement. RESULTS: Compliant HH was observed in 23.5% of the 647 HCWs observed during PVC placement before training. The microbiological study revealed fewer pathogens on the fingertips of the HCWs practicing compliant HH compared other HCWs (2.6 vs 11,7%; p = 0.003). The comparison of practices before and after training, assessed among 180 HCWs, showed an increase in the proportion of HCWs performing compliant HH (25.0 vs 63.2%; p < 0.001). CONCLUSIONS: Training HCWs using our educational tool, which combines reminders of best practices and risk factors associated with PVC-related infections, engaging HCWs (presentation of practice evaluation), identifying professionals deviating from best practices (simulation videos), and objectively assessing fingertip contamination (microbiological study), significantly improved compliance with HH gestures and glove usage. We encourage infection control teams to utilize this tool to raise awareness among HCWs responsible for PVC placement about the risk of infection associated inadequate hand hygiene.

Endodontic operative field asepsis: a comparison between general dentists and specialists.

OBJECTIVE: The aim was to evaluate the establishment of an aseptic endodontic operative field in general dentistry by assessing general dentists' ability to reduce the amount of contamination to a non-cultivable level, and to compare the operative field asepsis at a general dentistry clinic with that at an endodontic specialist clinic. MATERIALS AND METHODS: A total of 353 teeth were included in the study (153 in general dentistry, 200 at the specialist clinic). After isolation, control samples were taken, the operative fields disinfected with 30% hydrogen peroxide (1 min) followed by 5% iodine tincture or .5% chlorhexidine solution. Samples were collected from the access cavity area and buccal area, placed in a fluid thioglycolate medium, incubated (37°, 7 d), evaluated for growth/non-growth. RESULTS: Significantly more contamination was observed at the general dentistry clinic (31.6%, 95/301), than at the endodontic specialist clinic (7.0%, 27/386) (p <.001). In general dentistry, significantly more positive samples were collected in the buccal area than in the occlusal area. Significantly more positive samples were collected when the chlorhexidine protocol had been used, both in general dentistry (p <.001) and at the specialist clinic (p =.028). CONCLUSIONS: The result from this study shows insufficient endodontic aseptic control in general dentistry. At the specialist clinic, both disinfection protocols were able to reduce the amount of microorganisms to a non-cultivable level. The observed difference between the protocols may not reflect a true difference in the effectiveness of the antimicrobial solutions, as confounding factors may have contributed to the result.

Comparison of Honey & Povidone Iodine dressings in Post-Cesarean Surgical Site Wound Infection Healing.

Objective: To compare the healing of post-cesarean infected wounds by a combination of honey and povidone iodine & povidone-iodine alone dressings using ASEPSIS Score. Method: This prospective randomised cohort study was carried out at at OBGYN Department Jinnah Postgraduate Medical Center from 1st August 2022 till 31st December 2022. Patients were randomly allocated into groups A and B. Group-A was dressed with honey povidone-iodine, while Group-B only had povidone-iodine. The ASEPSIS score was calculated in both groups on day fifth, 7th, 9th, and 10th day. Patients were followed till full recovery of the wound. Results: A total of 70 women were included and equally allocated into two groups A & B (35 each). On day five mean ASEPSIS score in Group-A was 36.14 and that in Group- B was 37.74. No significant difference in scores were noted on day five [t (68) = -.753, p = .454] & day seven Group-A 28.63 vs Group-B 32.11 [t (68) = -1.302, p = .197]. Significant improvements in ASEPSIS scores were noted on days ninth & tenth. On day nine ASEPSIS score of Group-A was 21.54 and that of Group-B was 27.14 [t (68) = -2.056, p = .044]. On day tenth the mean ASEPSIS score of Group-A was 18.26, while that of Group-B was 23.86 [t (68) = -2.021, p = .047]. The mean time required for the wound to heal in Group-A and Group-B was eighteen & twenty-one days respectively. Conclusion: Significant improvements in ASEPSIS score occurred with the use of honey with povidone-iodine combination.

Prospective evaluation of the prevalence of conjunctival and intraocular bacteria in dogs undergoing phacoemulsification following a standardized aseptic preparation with 0.5% povidone iodine.

PURPOSE: To evaluate bacterial contamination of conjunctiva and aqueous humor in dogs undergoing phacoemulsification following asepsis with 0.5% povidone iodine and determine the influence of intravenous antibiotics on outcome of contamination. METHODS: Client-owned dogs were prospectively enrolled and randomly assigned to a control group, receiving 22 mg/kg intravenous cefazolin at induction prior to sampling, or experimental group receiving no antibiotic prior to sampling, masked to the surgeon. Dogs receiving antimicrobials in the pre-operative period were excluded. Asepsis was performed on all operated eyes using 0.5% iodine with minimum 3 min contact time at induction of anesthesia and repeated before surgery. A conjunctival swab and aqueous humor sample were collected prior to incision and following incision closure, respectively. Samples were submitted for aerobic and anaerobic bacterial culture and susceptibility. RESULTS: Seventy-one eyes of 42 dogs were included. Median age was 9 years. Thirty-nine and 32/71 eyes received intravenous cefazolin and no antibiotic, respectively. Median procedure time was 40 min per eye. Conjunctival cultures were positive in 6 eyes (8.5%): Serratia marcescens (5 eyes) and Cutibacterium acnes (1 eye). Aqueous humor cultures were positive in 5 eyes (7.0%): S. marcescens (2 eyes), Pseudomonas aeruginosa (2 eyes), Staphylococcus pseudointermedius (1 eye). Prevalence of positive culture did not differ between groups (p = .74), order of eyes for bilateral procedures (p = .74) and diabetic status (p = 1). CONCLUSIONS: Bacterial contamination of the conjunctiva and aqueous humor was present in 8.5% and 7.0% of dogs undergoing phacoemulsification after asepsis. Lack of IV cefazolin was not significantly associated with positive culture.

The Revolutionary Gustav Adolf Neuber: A Tribute to the Father of Aseptic Surgery.

Gustav Adolf Neuber was a celebrated multifaceted German surgeon, who significantly contributed to the establishment of modern surgical Antisepsis techniques as well as the modification and questioning of the use of wound drainage systems. In addition, he reformed architectural and structural concepts regrading operating rooms. In the field of plastic surgery, Gustav Adolf Neuber established a procedure for autologous fat-grafting. The lack and inadequacy of literature sources regarding Neuber´s contribution to common surgical practices and antisepsis vastly disregards the importance of his work. Aim of the current work is not only to restore his reputation as the Father of Antisepsis and autologous fat-grafting but also to make amends for the lack of relevant sources in the current literature. To the best of our knowledge there is no concrete and adequate biographical work regarding G.A. Neuber´s immense contribution in the outstanding English literature. References can only be found in writings or speeches of German Surgeons originating in the mid of the 20th century. The current work is mainly based on the opening speech delivered by Professor Dr Konjentzny (1880-1957) in a sitting ceremony of the "Deutsche Gesellschaft der Chirurgie" on the first of June in 1950 which was dedicated to commemorating Neuber as a tribute for his 100th Birthday and a historical article entitled: "Neuber und die Asepsis".

The strange history of surgical gloves in orthopaedic surgery (part I): from no gloves and no hand washing to the introduction of cotton gloves in orthopaedic surgery.

PURPOSE: The goal was to evaluate the advent of surgical gloves during the eighteenth century, nineteenth century, and the beginning of the twentieth century. MATERIAL AND METHODS: We used first drawings and paintings, then historical photographs identified in books after 1830 (date of discovery of the photography) or in medical reports of surgery and anesthesiologists. The pictures determined the presence or absence of gloves in the period corresponding to the changing understanding of aseptic and antiseptic techniques proposed by Lister and Pasteur. RESULTS: There was an evolution of the material of gloves, but surgeons throughout time remained significantly opposed to gloves for a long period. Concerning materials, the caecum of a sheep, cotton, silk, leather, and crude rubber were used before the introduction of latex by Goodyear. For surgeons, gloves were introduced initially to protect theatre staff's and surgeon hands from infection and not to protect the patient. Many surgeons contributed to the evolution of surgical gloves, and the use of gloves was an evolutionary process rather than a discovery. The probability that a surgeon had gloves on photographs was 0% in 1860-1870 (period of Lister and Pasteur), 5% in 1890, 28% in 1900, 42% in 1910, 48% in 1920, 58% in 1930, and 75% during the World Word II and reached 100% only in 1950. CONCLUSION: While some reports suggest that by 1920, the use of gloves in surgery became routine practice, in reality, around 30% of trauma surgeons were not wearing gloves until 1939.

Pre-surgical hand preparation in veterinary practice.

The objective of this paper is to review the evidence for different methods of surgical hand preparation applicable to veterinary practice. Surgical hand preparation is an essential step in performing surgery as a veterinarian. Recommended protocols and products for surgical hand preparation have varied since its inception in the late 1800s. Many factors must be considered when assessing the efficacy, safety, and users' compliance with any available product. Traditional scrub methods employing chlorhexidine gluconate or povidone-iodine have been compared to alcohol-based rub protocols with respect to immediate and prolonged efficacy, safety, compliance, requirements for theatre furniture, cost and water usage. Although much of the comparative data has been generated in human medical facilities, extrapolation of the data to veterinary surgery is appropriate. Considerations for veterinary practice are specifically discussed. Overall, the benefits of alcohol-based rubs indicate that this should be the preferred method of pre-surgical hand preparation for veterinarians in all types of practice.

Foot and Ankle Surgical Incision Closure With Three Different Materials.

There is no clear recommendation for wound closure material in foot and ankle surgery. Thus, we hypothesized that there was no difference in clinical outcomes among 3 suture materials, namely, absorbable sutures, nonabsorbable sutures, and metallic staples. This study compared the 3 materials for wound closure in foot and ankle surgery. In this prospective randomized study, 124 patients were randomly divided into the nonabsorbable suture group, absorbable suture group, and staple group. ASEPSIS score, Hollander Wound Evaluation Scale, and numerical rating scale (regarding pain and satisfaction) were collected at first dressing changes, suture removal, and 6 weeks after surgery. Suture time and incision length were recorded. No significant differences were detected for the ASEPSIS and Hollander Wound Evaluation Scale scores. There was significantly more pain after 6 weeks in the nonabsorbable suture group. The closure time (13 s/cm) with staples was significantly lower in the nonabsorbable suture group than in the other groups. Regardless of wound closure material, male sex and obesity appeared to be associated with a higher risk for the occurrence of wound complications. The 3 suture materials showed no significant differences regarding the frequency of wound complications. Staples and absorbable sutures should therefore be considered in the repertoire of suture materials used in foot and ankle surgery.

Is sterile exposure in perianal procedures necessary? A single-institution experience and results from a national survey.

BACKGROUND: Surgical site infections (SSI) are the most common postoperative complications. To minimize the risk of SSI, there is a strict asepsis policy in the operating theatre. The aim of this study was to evaluate the risk and cost-saving benefit of performing perianal surgery in a non-sterile setting. METHODS: All patients who had perianal surgery at our institution between January 2014 and December 2017 in a sterile (S) or non-sterile (NS) setting for an infectious or non-infectious cause were included. The primary outcome was the 30-day SSI rate. The secondary outcome was the reintervention rate. A questionnaire was sent to surgeons in the Netherlands to assess current policy with regard to asepsis in perianal procedures. Finally, a cost analysis was performed. RESULTS: In total, 376 patients were included. The rate of SSI in infectious procedures was 13% (S) versus 14% (NS, p = 0.853) and 5.1% (S) versus 0.9% (NS) in non-infectious procedures (p = 0.071). Reintervention rates in infectious procedures were 3.4% (S) versus 8.6% (NS, p = 0.187) and 1.3% (S) versus 0.0% (NS) in non-infectious procedures (p = 0.227). The questionnaire revealed that most surgeons perform perianal surgery in a sterile setting although they did not consider this useful. The potential national cost-saving benefit of a non-sterile setting is €124.61 per patient. CONCLUSIONS: This study suggests that it is safe to perform perianal surgery in a non-sterile setting with regard to the SSI and reintervention rate. Adjustment of the current practice will contribute to a reduction in healthcare expenses.

Impact of timing on wound dressing removal after caesarean delivery: a multicentre, randomised controlled trial.

We compared wound dressing removal at 24 hours versus 48 hours following low-risk caesarean deliveries. This multicentre, randomised, controlled study included patients 18-44 years of age with low-risk term, singleton pregnancies. The randomisation was done weekly. Scheduled caesarean deliveries without labour were included. For comparison, the Additional treatment, Serous discharge, Erythema, Purulent exudate, Separation of deep tissues, Isolation of bacteria, Stay in hospital > 14 days (ASEPSIS) score for wound healing assessment was modified. The absolute scores were obtained based on a one-day reading rather than the five-day reading used in ASEPSIS. Zero ("0") was assigned as a complete healing. Higher scores were associated with more severe disruption of healing. The patients were enrolled between March 2015 and February 2017. The demographics were not statistically different. The wound scoring was similar in the groups at discharge and first-week evaluation. At the six weeks post-surgery, the wound scoring was significantly less in the 48-hour (3.9%) versus the 24-hour group (9%; p = .002). Dressing removal at 48 hours had a lower scoring in the low-risk population with scheduled caesarean deliveries.IMPACT STATEMENTWhat is already known on this subject? Surgical dressings are used to provide suitable conditions to heal caesarean incisions. There has been a limited number of studies on the evaluation of ideal timing on wound dressing removal after a caesarean delivery. These studies concluded there are no increased wound complications with removal at six hours versus 24 hours or within or beyond 48 hours after surgery.What do the results of this study add? The postoperative removal of the wound dressing at 48 hours had a lower wound score at six weeks than the removal at 24 hours for women with uncomplicated scheduled caesarean deliveries.What are the implications of these findings for clinical practice and/or further research? Early discharge after caesarean delivery is becoming more common. Dressing removal at 24 hours versus 48 hours becomes more crucial and needs to be clarified. Besides, high-risk populations, different skin closure techniques, and patients in labour should be addressed separately.

Necrotizing soft tissue infection of both ear lobules occurring concomitantly in a set of twins following non-aseptic ear piercing: a case report.

BACKGROUND: Necrotizing soft tissue infection of the ear following ear piercing is a very rare condition. It is easily misdiagnosed leading to reconstructive morbidities and mortality in neonates. High clinical suspicion is important for early diagnosis. Our knowledge, this is the first case reported in the literature in this unique initial presentation. We hope to heighten the awareness of necrotizing soft tissue infection of the ear following ear piercing to ensure early aggressive intervention. CASE PRESENTATION: We report a set of 19-day-old female twin neonates who developed bilateral ear sores following ear piercing in a primary healthcentre without adherence to surgical asepsis. Examination findings showed features consistent with necrotizing soft tissue infections of the ears. They were successfully managed with antibiotics and wound care. CONCLUSION: Necrotizing soft tissue infections is a very rare complication of neonatal ear piercing. It may occur following suboptimal aseptic procedure and a high index of suspicion is necessary to make this diagnosis to ensure early intervention and to forestall the potential reconstructive morbidities and mortality associated with late recognition. Adherence to basic aseptic surgical principles is the key to prevention of necrotizing soft tissue infections.

Touchless interaction with medical images based on 3D hand cursors supported by single-foot input: A case study in dentistry.

Feet input can support mid-air hand gestures for touchless medical image manipulation to prevent unintended activations, especially in sterile contexts. However, foot interaction has yet to be investigated in dental settings. In this paper, we conducted a mixed methods research study with medical dentistry professionals. To this end, we developed a touchless medical image system in either sitting or standing configurations. Clinicians could use both hands as 3D cursors and a minimalist single-foot gesture vocabulary to activate manipulations. First, we performed a qualitative evaluation with 18 medical dentists to assess the utility and usability of our system. Second, we used quantitative methods to compare pedal foot-supported hand interaction and hands-only conditions next to 22 medical dentists. We expand on previous work by characterizing a range of potential limitations of foot-supported touchless 3D interaction in the dental domain. Our findings suggest that clinicians are open to use their foot for simple, fast and easy access to image data during surgical procedures, such as dental implant placement. Furthermore, 3D hand cursors, supported by foot gestures for activation events, were considered useful and easy to employ for medical image manipulation. Even though most clinicians preferred hands-only manipulation for pragmatic purposes, feet-supported interaction was found to provide more precise control and, most importantly, to decrease the number of unintended activations during manipulation. Finally, we provide design considerations for future work exploring foot-supported touchless interfaces for sterile settings in Dental Medicine, regarding: interaction design, foot input devices, the learning process and camera occlusions.

[Clinicopathological and ALVAL score analysis of pseudotumor-like tissue around aseptic joint arthroplasty].

Objective: To analyze the clinicopathological features of pseudotumor-like tissue around aseptic joint arthroplasty and aseptic lymphocytic vasculitis-associated lesions (ALVAL) scores. The characters of wear granules were observed. Methods: Total 122 cases were retrieved from the surgical pathology files between May 2015 and August 2018 in the department of pathology in Beijing Jishuitan Hospital, which included the knee joint arthroplasty (10 cases) and hip arthroplasty (112 cases). There were 62 females and 60 males. Patients' age ranged from 29 to 86 years (mean 56 years). The pseudotumor-like tissue around aseptic joint arthroplasty were stained with HE and analyzed by two ALVAL score systems. The characters of wear granules were observed by light microscope and polarized light. Results: The cohort included 62 females and 60 males. Patients' age ranged from 29 to 86 years (mean 56 years). Compbell-ALVAL system includes synovial lining,inflammatory infiltrate and tissue organization. The scores were: low (0-4): 18cases; moderate (5-8): 101 cases; high (9-10): 3 cases. Oxford-ALVAL system only evaluated the inflammatory infiltrate,and the scores were:0 grade:56 cases; 1 grade:51 cases; 2 grade: 12 cases; 3 grade:3 cases. Cases with high score in the Compbell-ALVAL system were concordant with the 3 grade of the Oxford-ALVAL system. Under light microscope,the metal particles were small black granules; the polyethylene fibers were needle-like and easily visible in polarized light. The polymethylmethacrylate showed clear spaces because of particle melting. Conclusions: The Compbell-ALVAL scoring system is based on the histologic analysis of pseudotumor-like tissue around aseptic joint arthroplasty, and the Oxford-ALVAL scoring systems is based on lymphocytic response. The wear particles could be differentiated by the features in the light microscope.

Skin asepsis protocols as a preventive measure of surgical site infections in dogs: chlorhexidine-alcohol versus povidone-iodine.

BACKGROUND: Most of surgical site infections (SSI) are caused by commensal and pathogenic agents from the patient's microbiota, which may include antibiotic resistant strains. Pre-surgical asepsis of the skin is one of the preventive measures performed to reduce SSI incidence and also antibiotic resistance dissemination. However, in veterinary medicine there is no agreement on which biocide is the most effective. The aim of this study was to evaluate the effectiveness of two pre-surgical skin asepsis protocols in dogs. A total of 46 animals were randomly assigned for an asepsis protocol with an aqueous solution of 7.5% povidone-iodine or with an alcoholic solution of 2% chlorhexidine. For each dog, two skin swab samples were collected at pre-asepsis and post-asepsis, for bacterial quantification by conventional techniques and isolation of methicillin-resistant species. RESULTS: Most samples collected at the post-asepsis did not present bacterial growth, both for the animals subjected to the povidone-iodine (74%) or to the chlorhexidine (70%) protocols. In only 9% of the cases a significant bacterial logarithmic reduction was not observed, indicating possible resistance to these agents. Also, the logarithmic reduction of the bacterial quantification from pre- and post-asepsis time, was not statistically different for povidone-iodine (6.51 ± 1.94 log10) and chlorhexidine (6.46 ± 2.62 log10) protocol. From the 39% pre-asepsis swabs which showed bacterial growth in MRSA modified chromogenic agar medium, only one isolate was identified as Staphylococcus aureus and one as S. epidermidis. False positives were mainly other staphylococci species, as well as Enterobacteriaceae. CONCLUSIONS: Pre-surgical skin asepsis protocols with povidone-iodine or chlorhexidine showed similar efficacy in the elimination of methicillin resistant bacteria and preventing surgical site infections in dogs undergoing surgery.

Postoperative wound management with negative pressure wound therapy in knee and hip surgery: a randomised control trial.

OBJECTIVE: To compare the effectiveness in wound healing of negative pressure wound therapy (NPWT) versus a standard dressing in patients who underwent hip or knee revision surgery. METHOD: Participating patients scheduled for hip and knee prosthetic revision were randomised into two groups: one receiving standard povidone-iodine gauze and patch wound dressing (control group) and the other NPWT over the sutured wound area (NPWT group). Patients were evaluated by means of ASEPSIS score, occurrence of blisters, visual analogue scale (VAS) and dressing changes seven days after surgery. We hypothesised a five-point difference in ASEPSIS scores as clinically relevant. RESULTS: A total of 110 patients were enrolled in the study. Mean ASEPSIS score was 5.1 for the control group and 3.0 for the NPWT group, with a significant difference in the ASEPSIS score between groups (p<0.001), although this was not clinically relevant. Considering patients with more than three risk factors for healing complication, a statistical difference of >5 points ASEPSIS score was recorded (p<0.0005). Blister occurrence, VAS score and number of dressing changes were significantly lower in the NPWT group. CONCLUSION: The results of this study do not support the routine use of NPWT after hip and knee revision. However, it could be beneficial for selected patients once specific risk factors for wound healing complications have been determined.

[Recollection of the great predecessor by a late successor leader]. / Semmelweis Ignác kései tanszékvezetoi utódjának megemlékezése.

Between 1990 and 2007, being the eighth successor leader following Ignác Semmelweis at the university department of obstetrics in Baross Street, what interested me mainly were the following: the lucky coincidences needed for the great discovery, the doctor's hopeless struggles, the circumstances of his death, his five burials and fourfold exhumations, the Hungarianization of his name and the deliberate or unintentional mistakes related to him. In the recollection, my impressions and experiences related to the great predecessor will be reviewed. Orv Hetil. 2018; 159(26): 1071-1078.

[Laudation to the midwives. Midwives and the puerperal fever]. / Laudáció a szülésznoknek. Bábák és a gyermekágyi láz.

Originally published in the Hungarian Postgraduate Journal of Gynecology and Obstetrics (2016; 18: 209-2013). Reprint with the contribution and permission of the Professional Publishing Hungary Kft., Budapest. Orv Hetil. 2018; 159(26): 1079-1083.

[Semmelweis - a contemplating human. Scientific historical lessons]. / Semmelweis ­ egy gondolkodó ember. Tudománytörténeti tanulságok.

In this article we examine why Semmelweis's seemingly simple, logical and practical discovery was categorically dismissed by the majority of his contemporaries, and why even many years after his death it was accepted with such reservation. We invoke wherever possible Semmelweis's own words citing from the series of articles appearing in the 'Orvosi Hetilap' [Hungarian Medical Weekly Journal] published in 1858 in Hungary, and also from the German language summary of the Journal published in 1860. We came to the conclusion that although Semmelweis did everything in his power to show the causal relationship between the development of puerperal fever (childbed fever) and some infectious substance on the hands of examining doctors and medical students, this was not convincing enough. The predominant theory at the time held that infection was caused by miasma transmitted in the air and therefore stubbornly precluded any notion of infectious matter physically transmitted on unclean hands. We also concluded that the causal sequence observed by Semmelweis was missing an essential empirical element: visual proof of the infectious agent he correctly postulated as physically transmitted. Visually demonstrating the presence of the infectious agent by means of a microscope would have made his case. This finally did occur but only two years after Semmelweis's death. Had the renowned Hungarian obstetrician realized the significance of taking advantage of the opportunity afforded by Dávid Gruby who was conducting experiments in the same town, a more convincing argument could have been made for his theory. In the 1840s and 1850s, Dávid Gruby was experimenting with various microscopic techniques and their application with success in Vienna before continuing his work in France. Gruby's work, especially that of microscopic observations of tissues, received international acceptance. Therefore, the involvement of Gruby and his work with microscopes to support Semmelweis's observations would most probably have forestalled much of the criticism and rejection his theory was initially awarded (among which perhaps Virchow's rejection proved the most damaging). Had Semmelweis utilized microscopic techniques, he would have been celebrated among the first to discover bacterial pathogens, contributing to the development of the currently predominant germ theory. Failure to utilize the microscope was the root cause leading to the tragedy of Semmelweis's rejection by the medical establishment of the time. Despite the increasing numbers of scientists utilizing the microscope at the University of Pest, offered to corroborate his daims with microscopic observations. Efforts have been made have since been to rehabilitate him as the key figure who not only discovered the method of transmission of infectious disease, but also implemented measures of prevention. Elevating him among the ranks of the ten greatest doctors who ever lived is certainly recognition due, but sadly denied to him in his lifetime. Orv Hetil. 2018; 159(26): 1055-1064.

Comparison of an alcohol-based hand sanitation product with a traditional chlorhexidine hand scrub technique for hand hygiene preparation in an equine hospital.

AIMS: To investigate the efficacy of an alcohol gel-based hand antisepsis protocol compared with a traditional chlorhexidine-based protocol under conditions of routine clinical contamination, and following heavy faecal contamination. METHODS: Twelve adult participants were recruited and on four separate days completed a hand sanitation protocol using a chlorhexidine scrub or an alcohol-based gel, with hands that were grossly clean but contaminated or with faecal contamination. Bacterial samples were obtained from participants' hands before sanitation, immediately after and then 2 hours later. All samples were cultured on blood and MacConkey agar and bacterial colonies counted after 48 hours. RESULTS: for clean contaminated hands, the percentage reduction in bacterial colonies on blood agar immediately after hand sanitation was similar for both protocols (p=0.3), but was greater for the alcohol gel than chlorhexidine after 2 hours (p=0.005). For hands with faecal contamination, the percentage reduction in bacterial colonies on blood agar was similar for both protocols immediately and 2 hours after sanitation (p>0.2), but positive cultures were obtained on blood agar from samples collected after both protocols, for almost all participants. CONCLUSIONS: The results indicate equivalent efficacy of the alcohol-based gel and the pre-surgical chlorhexidine protocol. CLINICAL RELEVANCE: The alcohol-based gel protocol is an effective hand asepsis technique for grossly clean contaminated hands and those following faecal contamination, with comparable efficacy to chlorhexidine based scrub.