Dipping Titan implants in Irrisept solution (0.05% chlorhexidine gluconate) and exposure to various aerobic, anaerobic, and fungal species.

BACKGROUND: The organisms causing penile implant infections are changing from predominantly indolent gram-positive infections to more aggressive gram-negative and fungal infections because of antibiotic selection pressures based on novel next-generation sequencing DNA data. AIM: To evaluate the effectiveness of Irrisept solution (0.05% chlorhexidine gluconate) in decreasing isolate colony counts from a Titan implant by using a novel kill time washout methodology to mirror real-world usage. METHODS: Sterilized Titan discs were dipped in Irrisept or saline. An inoculum of 109 organisms of a single bacterial or fungal species was placed on the discs. Bacterial and fungal strains were tested: Bacteroides fragilis, Candida albicans, Enterococcus faecalis, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, and Staphylococcus epidermidis. The discs were then irrigated 3 times with Irrisept or saline. Microorganisms were sonicated off the discs and placed on appropriate agar and conditions for each species. The plates were incubated for 48 to 72 hours at the temperature and under the conditions appropriate for each species. Colonies on the plates were hand counted. OUTCOMES: Irrisept effectively decreased microbial colony counts in all the species tested. RESULTS: Irrisept was shown to effectively decrease microbial colony counts from 3 to 6 log10 in all species tested. A 3-log10 reduction is considered the target level of performance that would indicate that a compound or product has effective killing activity against an organism of interest. The saline control with bulb syringe irrigation did not demonstrate reduction of microbial colony counts in any of the species tested. CLINICAL IMPLICATIONS: Irrisept is effective against all of the organisms causing modern-day infections with penile implant surgery and may decrease clinical infection rates to lower levels. STRENGTHS AND LIMITATIONS: The strength of this study is that we used quantitative microbial reduction counting and the largest array of bacterial and fungal species causing modern-day penile implant infections. The limitation is that this is an in vitro study and the clinical implications of our findings are not yet known. CONCLUSION: Quantitative microbial reduction counting shows that Irrisept is effective against the most commonly known modern-day organisms causing penile implant infections.

Effect of 0.05% chlorhexidine gluconate in water on the hydrophilic inflatable penile prosthesis: biocompatibility, adherence, and dip time.

BACKGROUND: Rates of infection after inflatable penile prosthesis range from 1% to 3%; however, a new surgical irrigation solution is Food and Drug Administration cleared as antimicrobial wound lavage and appears to be safe for patients and noncaustic during hydrophilic inflatable penile prosthesis (hIPP) dipping and irrigation. AIM: To evaluate if 0.05% chlorhexidine (CHG) lavage is caustic to the hIPP coating and if dip adherence is dependent on time. METHODS: Preconnected hIPP devices were tested at a Coloplast research and development laboratory. The devices were soaked in the 0.05% CHG lavage solution or normal saline for 1, 15, 30, and 60 minutes. Subsequently, all parts were dried for 15 minutes in a 35 °C oven. A Congo red dye test was performed following a Coloplast-validated and Food and Drug Administration-cleared test method to ensure product reliability. Implants were then visually inspected for deleterious effects as well as dip coverage. In addition, we evaluated 0.05% CHG lavage solution vs previously published hIPP dipping solutions. OUTCOMES: 0.05% CHG lavage does not appear to damage the hIPP coating, and adherence of this solution is not dependent on dip time. RESULTS: All components of the preconnected hydrophilic IPPs were tested for coating adherence and defects. All tested IPPs achieved a "satisfactory" coating, meaning a uniform coat without flaking or clumping. Furthermore, there were no noticeable caustic effects or differences in coating adherence between the normal saline-soaked control and 0.05% CHG-coated arms with increasing dip time. A review of the literature for 0.05% CHG lavage solutions vs previously published hIPP dipping solutions revealed that it may have some advantages over previously reported antibiotic solutions. CLINICAL IMPLICATIONS: This study serves as a foundation to introduce 0.05% CHG lavage to the urologic literature as a potentially new "magic bullet" irrigation. STRENGTHS AND LIMITATIONS: Major strengths of the study are that it is the first study of its kind to address the question of what dip duration should be used and whether it is scientifically reproducible. A limitation is the in vitro model, thus needing validation in a clinical setting. CONCLUSION: 0.05% CHG does not appear to negatively affect the hIPP coating or differ in adherence with increasing dip time; however, long-term device performance has not been verified.

OR Air Quality: Is It Time to Consider Adjunctive Air Cleaning Technology?: 1.3 www.aornjournal.org/content/cme.

Patients undergoing surgery may be at risk for infection from airborne particles such as dust, skin scales, respiratory aerosols, and hair fibers emanating from multiple sources in the OR, including personnel, heater-cooler devices, and surgical smoke. This risk is increased in surgical patients undergoing procedures involving implanted devices. Surgical personnel also are at risk from exposure to surgical smoke, which can contain viable viral particles including human papillomavirus infection. Air quality in the OR is improved by engineering controls (eg, maintaining positive pressure). During the past decade, innovations in the field of adjunctive technology designed to improve OR air quality include using ultraviolet disinfection and mobile ultraviolet disinfection plus high-efficiency particulate air filtration. Some of these technologies additionally provide continuous monitoring of circulating air particle counts. Additional research regarding the benefits of adjunctive air-cleaning technology in the OR is warranted.

The changing face of hand protection.

Perioperative nurses are empowered to act as patient advocates. As such, it is their responsibility to critically evaluate all products used in the surgical environment, including gloves. A basic understanding of the history of surgical gloves, health issues associated with their use, glove materials, and the essential properties of hand scrubs can help perioperative nurses choose appropriate products. This article explores these issues so that nurses and other health care workers can develop a framework for making informed decisions based on clinical reasoning.

Influence of double-gloving on manual dexterity and tactile sensation of surgeons.

BACKGROUND: Double-gloving in the performance of surgical procedures has been demonstrated to reduce the frequency of blood contact with the hands of members of the surgical team. Concerns persist that double-gloving can compromise the dexterity and tactile sensitivity of the surgeon. STUDY DESIGN: Fifty-three surgeons and surgeons-in-training volunteered at the Clinical Congress of the American College of Surgeons and were studied using the Purdue Pegboard test and a standard 2-point discrimination test to compare no gloves, a single pair of gloves, and double-gloving on manual dexterity and tactile sensitivity. Categorical and continuous variables were identified, general linear prediction models were computed, and the influence of glove status was analyzed as an independent variable. Monte Carlo simulation was employed to validate conclusions. RESULTS: Gender, specialty, and handedness did not affect prediction models. Glove status did not affect dexterity performance scores (p = 0.57) after accounting for the influence of age on score variation (p < 0.001). Comparing ulnar and radial surfaces of the index finger for 2-point discrimination, no difference was detected between trials (p < 0.66), nor was an interaction effect detected with glove status (p = 0.40). Monte Carlo simulations validated the apparent absence of differences. CONCLUSIONS: Double-gloving does not have a substantial impact on manual dexterity or tactile sensitivity when compared with no gloves or single-gloving in this study.

Double gloving: a risk reduction strategy.

BACKGROUND: The use of sterile surgical gloves has become the international standard of care in the perioperative environment. Yet the potential for barrier failure exists, with the subsequent potential for the transfer of pathogens to both the patient and the surgical team. The practice of double gloving (wearing two pairs of sterile surgical gloves) is often considered a mechanism for managing the potential risk of exposure during surgery. LITERATURE ON DOUBLE GLOVING: In the 2002 Cochrane review of double gloving, findings were summarized from 18 studies. The review, which covers a variety of surgical environments and addresses several double gloving options, indicates that double gloving significantly reduced perforations to the innermost glove. Other studies report a risk reduction of 70%-78% attributed to double gloving. OVERCOMING PRACTITIONER OBJECTIONS: Practitioners, in voicing objections to double gloving, cite poor fit, loss of tactile sensitivity, and increased costs. An important issue is how the two gloves work together, especially when they are powder free. Several studies have reported good acceptance of double gloving without loss of tactile sensitivity, two-point discrimination, or loss of dexterity. Although double gloving increases the glove cost per practitioner, the reduction of bloodborne pathogen exposure and possible seroconversion of practitioners represents a significant savings. Strategies that may help to facilitate the process include sharing the data on double gloving to build justification for the implementation, enlisting the support of the champions of the change at hand, and providing a glove-fitting station. SUMMARY: The stresses placed on a surgical glove today--the length of cases, heavy and/or sharp instrumentation, and chemicals used in the surgical field--make it imperative that barrier protection be ensured.