Do surgical helmet systems affect intraoperative wound contamination? A randomised controlled trial.

BACKGROUND: Deep infection following arthroplasty remains a devastating complication. Some registry data suggests that modern positive-pressure surgical helmet systems (SHS) are associated with a paradoxical increase in infection rates, and as such their role in arthroplasty remains unclear. The aim of this study was to investigate whether SHS increase wound contamination in total knee arthroplasty (TKA) and if this contamination can be reduced by placing tape around the gown/glove interface. METHODS: Seventy-five patients were randomised into three groups: scrubbed theatre staff wore standard surgical gowns (SG), SHS without tape at the gown/glove interface, or SHS with tape. All TKA operations were carried out by the same surgeon. Wound contamination was assessed using a wound culture technique. Blinded laboratory analysis was performed. RESULTS: There were 5/50 culture positive cases when a SHS was used compared to 0/25 when a SG was used; but this difference was not statistically significant (p = 0.16). There were 4/24 culture positive cases when SHS with tape was used compared to 1/26 when SHS without tape was used; but this difference was not statistical significant p = 0.18. CONCLUSION: We found no difference in wound contamination between SG and SHS. Addition of tape at the gown/glove interface did not alter the contamination rate. The choice of surgical gown should take into account cost, comfort and personal protection; as this study found no evidence that wound contamination rates will be altered.

Neuraxial Anesthesia and the Use of Sterile Gowning.

Epidural or spinal anesthesia-related infections cause serious and devastating morbidity and mortality. The possible infectious complications of neuraxial anesthesia have become better understood in the past 10 years. We assessed information from published case series, studies, randomized controlled trials, and retrospective cohort studies to determine the rate of neuraxial infection and to evaluate iatrogenic causes of infection. The use of sterile gowning appears to be a factor associated with the decreased infection rates noted in some studies. A review of the literature demonstrated that personnel in interdisciplinary specialties use gowns for invasive procedures to prevent infection, and national and international multidisciplinary health care professionals appear to be increasing their use of sterile gowning to prevent infections. We undertook this literature review to explore the incidence of neuraxial infection, provide additional insight into multidisciplinary standards, and evaluate whether the use of sterile gowns while performing neuraxial anesthesia decreases infection rates.

Current perioperative practice patterns for minimizing surgical site infection during rhinologic procedures.

BACKGROUND: There is a paucity of information in the literature regarding the best practices to reduce surgical site infections associated with rhinologic surgery. METHODS: We surveyed the American Rhinologic Society (ARS) membership to assess current perioperative infection control measures performed for rhinologic procedures, with the goal of establishing a baseline of current practice. RESULTS: Results revealed that for most rhinologic procedures performed in the operating room (OR) setting, the majority of physicians gown and drape in a sterile fashion and perform a complete surgical scrub of their hands and forearms but do not prep the facial skin with an antimicrobial agent. For rhinologic procedures performed in the office setting, the majority of physicians do not perform any of the aforementioned perioperative measures for any of the office procedures. Interestingly, for physicians that perform inferior turbinate reductions in both settings, 45% gown and drape in a sterile fashion and 28% perform a complete surgical scrub of their hands in the OR setting but not in the office setting. The most stringent measures were performed for endoscopic skull-base procedures, with over 90% of responders administering perioperative antibiotics, gowning and draping in a sterile fashion, and performing a complete surgical scrub of their hands. Despite lack of demonstrated benefit, antibiotics were used variably for the other procedures. CONCLUSION: This survey demonstrates that there is great variability in the perioperative measures rhinologists perform to reduce surgical site infection, which differs by the practice site. These data serve as a baseline for future studies.

Intervention to reduce transmission of resistant bacteria in intensive care.

BACKGROUND: Intensive care units (ICUs) are high-risk settings for the transmission of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE). METHODS: In a cluster-randomized trial, we evaluated the effect of surveillance for MRSA and VRE colonization and of the expanded use of barrier precautions (intervention) as compared with existing practice (control) on the incidence of MRSA or VRE colonization or infection in adult ICUs. Surveillance cultures were obtained from patients in all participating ICUs; the results were reported only to ICUs assigned to the intervention. In intervention ICUs, patients who were colonized or infected with MRSA or VRE were assigned to care with contact precautions; all the other patients were assigned to care with universal gloving until their discharge or until surveillance cultures obtained at admission were reported to be negative. RESULTS: During a 6-month intervention period, there were 5434 admissions to 10 intervention ICUs, and 3705 admissions to 8 control ICUs. Patients who were colonized or infected with MRSA or VRE were assigned to barrier precautions more frequently in intervention ICUs than in control ICUs (a median of 92% of ICU days with either contact precautions or universal gloving [51% with contact precautions and 43% with universal gloving] in intervention ICUs vs. a median of 38% of ICU days with contact precautions in control ICUs, P<0.001). In intervention ICUs, health care providers used clean gloves, gowns, and hand hygiene less frequently than required for contacts with patients assigned to barrier precautions; when contact precautions were specified, gloves were used for a median of 82% of contacts, gowns for 77% of contacts, and hand hygiene after 69% of contacts, and when universal gloving was specified, gloves were used for a median of 72% of contacts and hand hygiene after 62% of contacts. The mean (±SE) ICU-level incidence of events of colonization or infection with MRSA or VRE per 1000 patient-days at risk, adjusted for baseline incidence, did not differ significantly between the intervention and control ICUs (40.4±3.3 and 35.6±3.7 in the two groups, respectively; P=0.35). CONCLUSIONS: The intervention was not effective in reducing the transmission of MRSA or VRE, although the use of barrier precautions by providers was less than what was required. (Funded by the National Institute of Allergy and Infectious Diseases and others; STAR*ICU ClinicalTrials.gov number, NCT00100386.).