A Novel Technique of Aseptic Manufacture of Autologous Serum Eye Drops (ASEDs) and Sterility Analysis of the Bottled Ophtioles.

PURPOSE: To introduce a novel technique of the aseptic manufacture of autologous serum eye drops (ASEDs) with a prefiltered closed system and to analyze the sterility of the produced ophtioles between 2018 and 2022. METHODS: This is a prospective single-center study conducted at the Department of Ophthalmology at a Swiss University Hospital between 2018 and 2022. For regulatory reasons, closed systems for manufacturing ASEDs are strongly recommended. We attached an upstream sterile filter (Sterivex PES0.22 µm Burlington, USA) to a commercially available closed system (COL System Modena, Italy) for manufacturing ASEDs. The goal of this novel approach was to reduce the microbiological contamination of the donated autologous blood. Using the presented manufacturing method, we are able to produce, on average, 56 ophtioles per batch, containing either 1.45 mL or 2.5 mL of autologous serum per ophtiole. For each batch of ASEDs, we performed a microbiological analysis by automated blood culture testing (BACTEC). This system examines the presence of bacteria and fungi. RESULTS: We analyzed all manufactured batches between 2018 and 2022. None of the 2297 batches and the resulting 129 060 ophtioles showed bacterial or mycotic contamination. During the analyzed period, two batches were discarded: one due to fibrin-lipid aggregations, further microbiological and histological work-up excluded any contamination; another due to false-positive HIV in serological testing. Overall, the contamination rate was 0%, and the batch discharge rate was 0.09%. CONCLUSIONS: The combination of upstream sterile filtration with a commercial closed system for manufacturing ASEDs proved to be effective in ensuring sterility without any contamination over the past 4 years. This is becoming crucial, as the demand for autologous blood products for treating ocular surface disorders, such as refractory dry eyes or nonhealing defects of the corneal epithelium, is on the rise.

Reutilización de barrera de tela de algodón estéril en la práctica clínica: estudio observacional longitudinal / Reusing sterile cotton fabric barriers in the clinical practice: an observational and longitudinal study / Reuso de barreira estéril de tecido de algodão na prática clínica: estudo longitudinal observacional

Objetivo: analizar las características de barrera física y biológica de los campos de algodón utilizados como sistema de barrera estéril después de ser sometidos a múltiples usos y procesos en la práctica clínica. Método: estudio observacional longitudinal de seguimiento y evaluación de tela 100% algodón, utilizada como sistema de barrera estéril en un hospital de mediano porte. Se recolectaron muestras antes del uso (después de tres lavados) y después de tres, seis, nueve, 12 y 15 meses de uso y se evaluaron el número, grosor e integridad de los hilos, peso, absorción de agua y penetración húmeda de microorganismos. Resultados: después de 85 lavados, no cambió el número de hilos, aumentó el número de fibras deshilachadas y el volumen de agua absorbida. La prueba microbiológica mediante la metodología estándar alemana obtuvo un resultado negativo y la de penetración húmeda de microorganismos no mostró cambios significativos con el tiempo, a pesar de que una fracción de células microbianas pasó a través de las muestras de doble capa. Conclusión: las propiedades físicas de la tela 100% algodón utilizada como sistema de barrera estéril cambiaron con el uso/procesamiento; sin embargo, no interfirieron significativamente con los resultados obtenidos en las pruebas realizadas a la barrera microbiológica hasta los 85 lavados.

Objective: to analyze the physical and biological barrier characteristics of cotton fields used as a sterile barrier system after multiple use and processing cycles in the clinical practice. Method: an observational and longitudinal study to monitor and evaluate 100% cotton fabric used as a sterile barrier system in a medium-sized hospital. Samples were collected before use (after three washes) and at three, six, nine, 12 and 15 months of use and evaluated for the number, thickness and integrity of threads, weight, water absorption and wet penetration by microorganisms. Results: after 85 washes, the number of threads remained unchanged, and the shredded fibers and the water volume absorbed were increased. The microbiological test using the German standard methodology obtained a negative result and wet penetration by microorganisms did not show significant changes over time, although a percentage of the microbial cells passed through the double-layer samples. Conclusion: the physical properties of 100% cotton used as a sterile barrier system changed with use/processing cycles; however, these alterations did not significantly interfere with the results obtained by the tests performed on the microbiological barrier up to 85 washes.

Objetivo: analisar as características de barreira física e biológica de campos de algodão, que são utilizados como sistema de barreira estéril, após múltiplos usos e processamentos na prática clínica. Método: estudo longitudinal observacional de acompanhamento e de avaliação de tecido 100% algodão que foi utilizado como sistema de barreira estéril em um hospital de médio porte. Amostras foram coletadas antes do uso (após três lavagens) e com três, seis, nove, 12 e 15 meses de uso e avaliadas quanto ao número, à espessura e à integridade dos fios, peso, absorção de água e penetração úmida de micro-organismos. Resultados: após 85 lavagens, o número de fios permaneceu inalterado, porém aumentaram-se as fibras desfiadas e o volume de água absorvido. O teste microbiológico utilizando metodologia padrão alemão obteve resultado negativo; já o de penetração de úmida de micro-organismos não apresentou mudanças significativas ao longo do tempo, embora uma fração das células microbianas tenham passado pelas amostras de dupla camada. Conclusão: as propriedades físicas do tecido 100% algodão, utilizado como sistema de barreira estéril, alteraram com usos/processamentos; entretanto essas não interferiram significativamente nos resultados obtidos pelos testes realizados na barreira microbiológica até 85 lavagens.

[Assessment of the prevention of healthcare-associated infections in the dental practice in Rabat]. / Évaluation de la prévention des infections associées aux soins dans des cabinets dentaires à Rabat.

Introduction: in dentistry, many treatments are invasive and can lead to infections. The purpose of this study was to evaluate the prevention of healthcare-associated infections in the dental practice in Rabat. Methods: a survey on the prevention of healthcare-associated infections in Rabat dental practices was conducted among 324 practitioners. A self-administered questionnaire was used to assess their training, hygiene, protection, organization of premises, asepsis, antisepsis and use of medical devices. Data were collected using JAMOVI version 1.8.4, the χ2 and Fisher tests were used to compare the variables, the significance level was set at P<0.05. Results: only 80 subjects took part in the study. All the dentists had protective equipment, but 68 (85%) did not have instructions on what to do in case of accidental exposure to blood; 41 (62.1%) operators had qualified assistants, 36.4% had a team vaccinated against hepatitis B and 61.3% of operators and assistants had been trained to handle reusable medical devices. Seventy-six studies had isolated examination rooms, 41 had a steam steriliser and a sorting area with sharps collector. However, 35.1% had a contract for the collection of waste generated by health-care activities, posing a significant risk of infection. Conclusion: the results of this study show that most practitioners in Rabat comply with the majority of the aseptic and hygienic standards in dentistry. However, more needs to be done to ensure that staff are vaccinated.

What techniques are recommended to undertake procedures that require asepsis? Content and cluster analysis of information supplied in international guidance.

BACKGROUND: Health professionals frequently conduct procedures requiring asepsis but there is no definitive evidence-based guidance on how aseptic technique should be undertaken. OBJECTIVE: To undertake content and cluster analysis to compare and contrast information relating to the conduct of aseptic technique in national and international guidance. METHODS: Content and hierarchical cluster analysis. RESULTS: We identified 16 sources of information from: organizations that generate infection prevention guidelines, provide advice about infection prevention in addition to other topics, generate guidance for procedures (e.g., wound care); practice manuals; MeSH and Wikipedia. Content related to: theory underpinning aseptic technique; terminology used; how and when it should be undertaken; and equipment. The nature and amount of information varied widely. Most frequently stated information related to: environment or equipment (N = 13), followed by the absolute nature of asepsis and the importance of hand hygiene (N = 10); general personal protective equipment, the significance of pathogens, and no-touch techniques (N = 8); that it is risk-based (N = 7); the existence of key parts or sites, and that there are different types of aseptic technique (N = 6). The most comprehensive sources were a wound care organization in the USA, and a British internationally used textbook. Least information was provided in some general infection prevention guidelines. CONCLUSION: Progress with research and practice in relation to aseptic technique suffers through lack of common goals and understanding. This study is one step towards establishing what constitutes aseptic technique, how and when it should be conducted, and the equipment necessary. This is required to support practice, policy and education, and may improve sustainability of healthcare resources.

Nurses' assessed self-efficacy levels to medical asepsis and their relation to structural empowerment, work engagement and work-related stress.

BACKGROUND: Nurses' working conditions are important for their well-being at work and for their ability to provide patients with safe care. Self-efficacy can influence employees' behaviour at work. Therefore, it is valuable to study self-efficacy levels to medical asepsis in relation to working conditions. OBJECTIVE: To investigate the relationship between nurses' assessed self-efficacy levels to medical asepsis in care situations and structural empowerment, work engagement and work-related stress. METHODS: A cross-sectional study with a correlational design was conducted. A total of 417 registered nurses and licensed practical nurses at surgical and orthopaedic units responded to a questionnaire containing: the Infection Prevention Appraisal Scale, the Conditions of Work Effectiveness Questionnaire-II, the Utrecht Work Engagement Scale-9 and the Health & Safety Executive Management Standards Indicator Tool. Correlational analyses and group comparisons were performed. RESULTS: The nurses rated high levels of self-efficacy to medical asepsis in care situations. The correlational analyses revealed that correlation coefficients between structural empowerment, work engagement, work-related stress and self-efficacy to medical asepsis were 0.254-0.268. Significant differences in self-efficacy were found in the grouped working conditions. CONCLUSIONS: This study revealed that nurses rated high self-efficacy levels to medical asepsis and, to some extent, this seemed related to structural empowerment, work engagement and work-related stress. This valuable knowledge could enable improvements at the managerial and organisational levels, benefiting both nurses and patients in the long run.

Challenges undertaking procedures requiring asepsis: a qualitative interview study with nurses.

BACKGROUND: Invasive devices and breaches to skin and mucous membranes increase susceptibility to infection. Nurses frequently undertake procedures requiring asepsis (PRAs), but report challenges and unwarranted variations in practice. OBJECTIVE: To explore nurses' experiences, perceived gaps in information and support needed to conduct PRAs. METHODS: Qualitative interviews were undertaken with 20 nurses in the UK National Health Service between September 2021 and January 2022 employing approaches to sampling and data collection adopted in grounded theory. RESULTS: Informants were employed in diverse clinical settings. They thought that outside operating theatres, attempts to maintain asepsis would inevitably be compromised, but that much could still be done to contain the risk of contaminating susceptible sites irrespective of circumstances. Suboptimal practice was reported, and informants were unclear whether asepsis was needed to perform routine procedures (e.g. dressing chronic wounds, manipulating indwelling intravascular lines). Problems were attributed to inadequacies in nursing education, poor access to continuing professional development, and carelessness of junior nurses and medical staff. Informants wanted more detailed guidelines to conduct PRAs. Senior nurses wanted procedures to be conducted in the same way regardless of circumstance. Nurses who undertook PRAs regularly suggested that guidelines should be flexible. CONCLUSION: There is a need for detailed guidelines to inform PRAs, better access to clinical updating, and improvements in pre-registration nursing education. To meet contemporary standards, guideline generation should adopt recognized methodology. Student nurses should be introduced to the knowledge and skills required to undertake and adjust PRAs according to circumstance during simulated practice before contact with real patients.

Avaliação da efetividade da esterilização por luz ultravioleta em aerossóis contaminados por Sars-Cov-2 / Evaluation of the effectiveness of ultraviolet light sterilization in aerosols contaminated by Sars-Cov-2 / Evaluación de la eficacia de la esterilización por luz ultravioleta en aerosoles contaminados por Sars-Cov-2

O contato direto e a disseminação aérea são os principais mecanismos de transmissão do SARS-CoV-2. Uma abordagem direta para limitar as transmissões virais no ar é inativá-las dentro de um curto período de tempo após sua produção é a luz ultravioleta C (UVC). Neste sentido, o objetivo do presente estudo foi de avaliar a efetividade do uso de luz ultravioleta na esterilização de aerossóis contaminados pelo SARS-CoV-2. Para o estudo foram analisados todos os pacientes que estavam internados na enfermaria COVID com resultados dos swabs positivos. O paciente escolhido para o estudo encontrava-se com resultado positivo e com 8 dias de sintomas. As medições de contaminação da deposição de aerossol na mesa de tomografia foram realizadas em triplicatas, utilizando swabs estéreis com meio de transporte viral. O paciente foi mantido sozinho dentro desta sala por 30 minutos produzindo aerossóis para que pudesse ocorrer contaminação do ar. Após, foram realizadas as medições utilizando a exposição à luz ultravioleta C, coletada nos minutos 0, 5, 10, 15, 30, 60, 120 e 180, após o paciente ter deixado a sala de tomografia. Esta sequência de medições foi realizada por 6 dias, sendo o primeiro dia sem a exposição da luz UVC e 5 dias com a exposição da luz UVC. Após a coleta dos dados, foi realizada a análise dos swabs para os resultados através do método RT-PCR. Os resultados encontrados das coletas desde o tempo 0 até 180 minutos foram negativos para os 6 dias de estudo. Os resultados dos swabs do paciente seguiram positivos do primeiro até o último dia de estudo. Sendo assim, conclui-se a efetividade da utilização da luz ultravioleta como uma forma de descontaminação, juntamente com a ação antimicrobiana do desinfetante, pois a ausência do vírus vivo evidencia a importância de cuidados de higienização para evitar a reincidência da contaminação após a limpeza.

Direct contact and aerial dissemination are the main transmission mechanisms of SARS-CoV-2. A direct approach to limiting airborne viral transmissions is to inactivate them within a short period of time after their production is ultraviolet C (UVC) light. In this sense, the objective of the present study was to evaluate the effectiveness of using ultraviolet light in the sterilization of aerosols contaminated by SARS-CoV-2. For the study, all patients who were admitted to the COVID ward with positive swab results were analyzed. The patient chosen for the study had a positive result and had had 8 days of symptoms. Measurements of contamination from aerosol deposition on the CT table were performed in triplicate, using sterile swabs with viral transport medium. The patient was kept alone inside this room for 30 minutes, producing aerosols so that air contamination could occur. Afterwards, measurements were performed using exposure to ultraviolet C light, collected at 0, 5, 10, 15, 30, 60, 120 and 180 minutes, after the patient had left the tomography room. This sequence of measurements was carried out in 6 days, the first day being without exposure to UVC light and 5 days with exposure to UVC light. After data collection, swab analysis was performed for the results using the RT-PCR method. The results found for collections from time 0 to 180 minutes were negative for the 6 days of study. The patient's swab results were positive from the first to the last day of the study. Thus, the effectiveness of using ultraviolet light as a form of decontamination is concluded, along with the antimicrobial action of the disinfectant, as the absence of the live virus highlights the importance of hygiene care to prevent the recurrence of contamination after cleaning.

El contacto directo y el contagio por vía aérea son los principales mecanismos de transmisión del SRAS-CoV-2. Un enfoque directo para limitar las transmisiones virales en el aire es inactivarlas en un corto período de tiempo después de su producción es la luz ultravioleta C (UVC). En este sentido, el objetivo del presente estudio fue evaluar la eficacia del uso de la luz ultravioleta en la esterilización de aerosoles contaminados con el SARS-CoV-2. Se analizaron todos los pacientes ingresados en la sala COVID con resultados positivos de los hisopos. El paciente elegido para el estudio era positivo y llevaba 8 días con síntomas. Las mediciones de la contaminación por deposición de aerosoles en la mesa de TC se realizaron por triplicado utilizando hisopos estériles con medio de transporte viral. El paciente se mantuvo solo dentro de esta habitación durante 30 minutos produciendo aerosoles para que se produjera la contaminación del aire. A continuación, se realizaron mediciones mediante la exposición a la luz ultravioleta C, recogidas a los 0, 5, 10, 15, 30, 60, 120 y 180 minutos después de que el paciente saliera de la sala de tomografía. Esta secuencia de mediciones se realizó durante 6 días, el primer día sin exposición a la luz UVC y 5 días con exposición a la luz UVC. Tras la recogida de datos, se realizó el análisis de los hisopos para obtener los resultados mediante el método RT-PCR. Los resultados encontrados en las recolecciones desde el tiempo 0 hasta los 180 minutos fueron negativos para los 6 días de estudio. Los resultados de los hisopos de los pacientes siguieron siendo positivos desde el primer hasta el último día del estudio. Así, se concluye la eficacia del uso de la luz ultravioleta como forma de descontaminación, junto con la acción antimicrobiana del desinfectante, ya que la ausencia de virus vivos pone de manifiesto la importancia de los cuidados higiénicos para evitar la reaparición de la contaminación tras la limpieza.

Factores que intervienen en la aparición de infecciones en heridas quirúrgicas de pacientes intervenidos en el hospital general milagro en el periodo de agosto 2020 a enero 2021 / Factors intervening in the appearance of infections in surgical wounds of patients operated at the milagro general hospital in the period from august 2020 to january 2021

El Ecuador mantiene una alta tasa de mortalidad derivada de las infecciones de heridas quirúrgicas, las post cesárea son las que se presentan comúnmente, donde las bacterias cada vez evolucionan mecanismos de resistencia a los antibióticos. Objetivo: analizar los factores que intervienen en la aparición de infección en herida quirúrgica. Materiales y Métodos: investigación tipo inductivo-deductiva al analizar variables cuantitativas; y la aplicación del razonamiento, con el que se obtuvieron generalizaciones del tema en estudio Resultados: Sexo el 35 % Mujeres y el 65% Varones, el 25 % tienen edad de 15 a 40 años, el 45 % tienen de 41 a 60 años, y el 30 % tienen de 61 años y más. Con respecto al nivel de educación, 50 % no tiene educación, 25% primaria, 15% secundaria y 10% superior, según la residencia el 75% vive en zona rural y 25 % en zona urbana. La mayoría de los procedimientos quirúrgicos involucrados en la complicación de infecciones de la herida fueron de emergencia en un 93,3%; mientras que las que se presentaron en electivas respondieron al 6,7%. Se observó que el 80% de las cirugías realizadas son clasificadas como cirugías limpias contaminadas, y un 20% cirugías contaminadas. Las mismas que tiene un alto riesgo de infectarse el SQ. Conclusiones: A pesar de que las acciones preventivas de preparación de piel y asepsia ­ antisepsia previa al acto quirúrgico se cumplen, las infecciones de la herida quirúrgica se siguen dando en una parte de pacientes intervenidos en el Hospital General Milagro(AU)

Ecuador maintains a high mortality rate derived from surgical wound infections, post-cesarean sections are the ones that commonly occur, where bacteria increasingly evolve mechanisms of resistance to antibiotics. Objective: to analyze the factors that intervene in the appearance of infection in surgical wounds. Materials and Methods: inductive-deductive type research when analyzing quantitative variables; and the application of reasoning, with which generalizations of the subject under study were obtained Results: Sex 35% Women and 65% Men, 25% are between 15 and 40 years old, 45% are between 41 and 60 years old, and 30% are 61 and older. Regarding the level of education, 50% have no education, 25% primary, 15% secondary and 10% higher, according to residence, 75% live in rural areas and 25% in urban areas. Most of the surgical procedures involved in the complication of wound infections were emergency in 93.3%; while those who attended electives responded to 6.7%. It was observed that 80% of the surgeries performed are classified as clean contaminated surgeries, and 20% contaminated surgeries. The same ones that have a high risk of becoming infected with SQ. Conclusions: Although the preventive actions of skin preparation and asepsis - antisepsis prior to the surgical act are fulfilled, infections of the surgical wound continue to occur in a part of patients operated on at the Hospital General Milagro(AU)

Preoperative skin asepsis protocols using chlorhexidine versus povidone-iodine in veterinary surgery: A systematic review and meta-analysis.

OBJECTIVE: To provide a systematic assessment of the efficacy of preoperative skin asepsis using chlorhexidine versus povidone-iodine based protocols for surgical site infection (SSI) prevention in veterinary surgery. STUDY DESIGN: Systematic meta-analytical review according to PRISMA-P guidelines. SAMPLE POPULATION: Studies comparing preoperative skin asepsis protocols using chlorhexidine versus povidone-iodine in veterinary surgery identified by systematic search between 1990 and 2020. METHODS: A search using MEDLINE/Pubmed, Web of Science and CAB Abstracts was performed, followed by secondary searches of Google Scholar, Proquest Dissertation and Theses, and relevant bibliographic articles. Primary and secondary outcome measures were the efficacy of skin asepsis protocols using chlorhexidine versus povidone-iodine on SSI incidence and skin bacterial colonization, respectively. A meta-analysis was performed with a random-effect model, with effect size calculated as risk ratio (RR) or mean standard deviation (MSD) with 95% CI. Statistical significance was set at P < .05. RESULTS: Among 1067 publications that met the initial search criteria, 9 relevant studies were eligible for analysis. No difference in the incidence of postoperative SSI or skin bacterial colonization between preoperative asepsis protocols using chlorhexidine versus povidone-iodine was found. Insufficient information and detail were frequent among studies and precluded a clear assessment of bias. CONCLUSION: This study showed that asepsis protocols using chlorhexidine were comparable to povidone-iodine in preventing postoperative SSI and reducing skin bacterial colonization. CLINICAL SIGNIFICANCE: Given the limitations of the studies that were included in terms of both quality and quantity, more high-quality randomized controlled trials are needed to confirm these conclusions.

Is ANTT Achievable in the Home Healthcare Setting?

At the heart of infection prevention in the home care setting is aseptic technique, a generic term for the clinical competency of ensuring asepsis during invasive clinical procedures and the maintenance of invasive medical devices. Variable terminology has resulted in confused education and clinical practice. Ambiguity has played out in all care environments, but especially in the home, where the challenge of providing effective aseptic technique is complicated by unique environmental and logistical factors. This has led some to conclude that aseptic technique is not possible in the home, or that it is not required at all in certain situations. This article challenges these assumptions and outlines the Aseptic Non Touch Technique (ANTT®) Clinical Practice Framework, that is used widely internationally. Through a thematic analysis of focus group discussions with home care nurses (n = 107) in the United Kingdom and the United States, opinions about aseptic practice in the home care setting were examined. Three main polarizing themes were identified and used to discuss theory and practice applications of aseptic technique for home healthcare nurses. Specific challenges in performing aseptic technique in home-based settings are exacerbated by ambiguity between what constitutes "clean," "aseptic," or so-called "sterile" technique, and are perpetuated by a lack of competency-based training that doesn't reflect the critical importance of aseptic technique to patient safety. Rather than continuing an endless debate about the definition of aseptic technique, ANTT has redefined aseptic technique education and clinical practice, with a comprehensive clinical practice framework and associated clinical governance better supporting patient safety.

Asepsia, clínicas "particulares" y beneficencia pública / Asepsis, "private" clinics and public charity

Este trabajo se centra en el análisis de las primeras clínicas privadas de la ciudad de Valencia, una serie de pequeños hospitales quirúrgicos fundados a lo largo de las últimas décadas del siglo XIX y del primer tercio del XX en paralelo a un modelo de beneficencia insuficiente. Durante el período de estudio, coincidiendo con la introducción en Valencia de la antisepsia y la asepsia quirúrgicas, empezó a gestarse un modelo asistencial dual. Por una parte, el sistema sanitario heredado del Antiguo Régimen basado en un gran hospital general de beneficencia; por otra, una incipiente sanidad “particular” o privada basada en la progresiva habilitación de una serie de clínicas quirúrgicas, una estrategia asistencial que se inscribe en el complejo proceso de medicalización del conjunto de la población, no solo de la burguesía urbana, sino también de las clases populares, la menestralía y el obrerismo. El desarrollo de estas clínicas se vio truncado de raíz con el estallido de la Guerra Civil Española, dado que la mayoría fueron incautadas por los comités revolucionarios y transformados en hospitales de sangre, con el objetivo de satisfacer las necesidades asistenciales del estado de guerra (AU)

Coronavirus versus 70% Alcohol: Comments and Some Fundamental Definitions

Abstract The new coronavirus pandemic (COVID-19) is a global problem that is having severe impacts on health systems worldwide. One particular characteristic of this virus is its high transmission rate, which has led to a high demand for personal care materials such as masks, gloves, and alcohol for asepsis. Seventy percent is the ideal concentration for the ethanol used in hand sanitizers; however, this concentration can be expressed in different ways, and, consequently, the different solutions will have different antiseptic activity. In this manuscript we comment on some characteristics of alcohol-based preparations and the different ways of expressing the concentrations.

Reducing healthcare-associated infections by improving compliance to aseptic non-touch technique in intravenous line maintenance: a quality improvement approach.

BACKGROUND: Lack of standardisation and failure to maintain aseptic techniques during procedures contributes to healthcare-associated infections (HCAI). Although numerous procedures are performed in neonatal intensive care units (NICU), handling peripheral intravenous lines is one of the simple and common procedures performed daily. Despite evidence-based care bundle approach variability is higher, and compliance to asepsis is less in routine clinical practice. In this study, we aimed to standardise and improve compliance with Aseptic non-technique (ANTT) in intravenous line maintenance of neonates admitted to NICU to reduce HCAI by 50% over 6 months. METHODS: All nurses were subjects of assessment for compliance with intravenous line maintenance. All admitted neonates with intravenous lines were subjects for the HCAI data collection. At baseline, the current practices for intravenous line maintenance were observed on a generic ANTT audit proforma. Pictorial standard operating procedure (SOP) was developed based on ANTT. Implementation and sustenance were ensured by Plan-Do-Study-Act cycles. Audit data on compliance to ANTT and trends of HCAI rates were displayed using run charts monthly. Qualitative experience from the nursing staff was also recorded. RESULTS: Significant improvement was seen in compliance to various components-use of the aseptic field (0% to 100%), closed ports (0% to 100%), key part contamination reduction (80% to 0%), and intravenous hub scrubbing (0% to 72%). SOP of intravenous line maintenance based on ANTT could be implemented and sustained throughout for 9 months. There was a reduction of HCAI from 26 per 1000 patient days to 8 per 1000 patient days. Qualitative experience showed the main determinant of compliance to scrub the hub was the neonate's sickness level. CONCLUSIONS: Using a quality improvement model of improvement, ANTT in intravenous line maintenance was implemented stepwise. Improving compliance with ANTT principles in intravenous line maintenance reduced HCAI. Scrub the hub requires longer sustained efforts to become part of the practice.

Una aportación al origen de las mascarillas / A contribution to the origin of masks

Las mascarillas, de demostrada eficacia a partir del siglo XIX (antisepsia-asepsia), se han visto reactualizadas debido a la pandemia COVID-19. En 1897, el cirujano Jan Mikulicz (1850-1905) fue el creador de las mascarillas quirúrgicas, al demostrar la teoría de la infección por las gotas de saliva (Flügge). No obstante, existen precedentes «pre-científicos» que conocemos fundamentalmente a través de grabados (s. XVII) y pinturas (s. XVIII). Presentamos una obra del pintor barroco Michel Serre (1658-1773), donde se observan personas utilizando mascarillas durante la gran peste de Marsella de 1720. (AU)

The masks, of proven efficacy from the 19th century (antisepsis-asepsis), have been updated due to the COVID-19 pandemic. In 1897, the surgeon Jan Mikulicz (1850-1905) was the creator of surgical masks, by demonstrating the theory of infection by drops of saliva (Flügge). However, there are «pre-scientific» precedents that we know mainly through engravings (17th century) and paintings (18th century). We present a work by the Baroque painter Michel Serre (1658-1773), where people are seen wearing masks during the great plague of Marseille in 1720. (AU)

Simulation training to improve aseptic non-touch technique and success during intravenous cannulation-effect on hospital-acquired blood stream infection and knowledge retention after 6 months: The snowball effect theory.

BACKGROUND: Intravenous cannulation is a common procedure and a valuable skill in the neonatal intensive care unit. Standardized procedure and personnel training are needed in the unit to prevent hospital-acquired blood stream infections. Hence, we evaluated the effect of training using a low-fidelity simulation on the improvement of the aseptic non-touch technique during intravenous cannulation and knowledge retention after 6 months. METHODS: The study was conducted in a tertiary care neonatal unit from June 2017 to July 2018. All the staff nurses and junior resident doctors posted in the neonatal intensive care were included in the study. A protocol and checklist score sheet was developed. The score sheet consisted of 23 items with a total score of 46. Participants were expected to obtain a minimum of 80%. A pre-test was conducted initially, followed by a formal training and then a post-test. The NITA newborn venous access mannequin was used to facilitate the training. A re-training for new nurses was conducted after 6 months. Data were analyzed using paired t-test. RESULTS: A total of 29 doctors and nurses were enrolled in the training. The mean pre-test score was 29.93 compared to 42.66 in the post-test scores (mean difference 12.24(95% confidence interval: 9.39-16.05), p < 0.01. The mean scores were higher when the simulation was conducted after 6 months. There was a significant decline in blood stream infection rates from 5.5 to 1.65 per 1000 patient days (p = 0.05). CONCLUSION: Simulation-based training of health care personnel is a good modality to improve aseptic non-touch technique during intravenous cannulation in the neonatal intensive care unit. Simulation-based training also helps in knowledge retention and standardization of training procedures.

Evaluation of the Sterility of Reynolds Wrap Aluminum Foil for Use During Rodent Surgery.

In biomedical research, surgeons are often responsible for simultaneously conducting rodent surgical procedures, monitoring anesthesia, and adjusting nonsterile equipment. Maintaining appropriate aseptic technique can be challenging when working under these conditions. Applying a sterile barrier material such as aluminum foil to nonsterile surfaces in these circumstances offers an innovative, inexpensive option to improve asepsis. The purpose of this study was to validate the sterility of foodgrade aluminum foil for use as a sterile barrier on nonsterile equipment during rodent surgery. In this investigation, 10 boxes of aluminum foil were assessed for sterility by using ATP swabs and replicate organism detection and counting (RODAC) plates at 0, 14, and 28 d and 6 mo. At 6 mo, foil was applied to surgical equipment, and sterility was assessed by using ATP swabs and RODAC plates. Results revealed no ATP-positive results at any time point. During assessment of samples obtained directly from boxes, RODAC plates yielded minimal bacterial growth (1 cfu per plate) in 2 of the 10 boxes at initial testing and in 1 box at the day 0, day 14, and 6 mo time points. No growth was observed at day 28 (tested directly from the box) or at 6-mo apparatus testing. Our data revealed minimal bacterial growth on tested samples and support the use of Reynolds Wrap aluminum foil as a sterile barrier on nonsterile surfaces during aseptic rodent surgery.

Conocimiento sobre asepsia, antisepsia y su práctica durante el transoperatorio, Hospital Escuela Universitario / Knowledge of aseptic and antisepsis and their practice during intraoperative procedures at Hospital Escuela Universitario

Las medidas de asepsia y antisepsia, son procedimientos efectivos de bajo costo en la prevención de infecciones intrahospitalarias; prácticas inadecuadas del personal constituyen un problema de salud pública. Objetivo: determinar el nivel de conocimiento y práctica en asepsia y antisepsia en personal de Sala de Operaciones, Bloque Materno Infantil, Hospital Escuela Universitario. Material y Métodos: estudio descriptivo, observacional, transversal; universo 82 personas, muestra 38 sujetos; se aplicó instrumento de observación y entrevista estructurada. Resultados: 26(68%) femenino, 12(32%) masculino, edad promedio 38 años; 16(42%) personas obtuvieron débil conocimiento, 3(8%) muy buen conocimiento; conocimiento promedio (64%), puntaje mínimo (13%), máximo (93%). Práctica lavado de manos; calificación excelente 28(74%), 6(16%) no se lavaron las manos, 21(55%) al ingresar al área quirúrgica y 11(29%) entre procedimientos. 17(45%) realizaron buen uso de indumentaria quirúrgica, 23(92%) realizaron excelente lavado quirúrgico, 13(93%) instrumentistas excelente colocación de bata estéril. 19(76%) realizaron excelente manejo de asepsia y antisepsia durante transquirúrgico. 14(100%) circulantes realizaron excelente práctica postquirúrgica. Se comparó conocimiento contra práctica, excelente práctica de lavado de manos 10(26%), pero escaso conocimientos y buena práctica de indumentaria quirúrgica, 2(5%) muy buen conocimiento, pero práctica regular en uso de indumentaria quirúrgica (p ≤ 0.001). 3(12%) con conocimiento débil, realizó práctica excelente en transquirúrgico. 2(14%) obtuvieron 100% en práctica posquirúrgica (p ≤ 0.001). Se encontró factor protector 60% y 40% factor de riesgo durante la práctica transoperatoria, IC 95%, RR: 0.4 (-0.3, 0.5) y RR: 0.6 (- 05, 0.8). Conclusión: hubo diferencias entre categorías de profesionales afectando el nivel de conocimiento y práctica de la técnica aséptica, factor de riesgo 40%. Se encontró que los que no tienen conocimiento y no practican las técnicas de asepsia, tienen 2.9 veces más probabilidad de riesgo, en relación al grupo que tiene conocimiento y realiza medidas de asepsia en el transoperatorio...(AU)

How widely has ANTT been adopted in NHS hospitals and community care organisations in England and Scotland?

BACKGROUND: To the detriment of patient safety, the important clinical competency of aseptic technique has been notoriously variable in practice, and described ambiguously in the literature, internationally. From a UK perspective, attempts have been made to improve patient safety by reducing variability and improving education and practice through standardisation. The Welsh Government mandated Aseptic Non Touch Technique (ANTT®) as a specific national standard in 2015. All healthcare organisations in England are required by the Health and Social Care Act 2008 to have a single standard aseptic technique, demonstrable by the clinical governance indicators of education, training, competency assessment and compliance audit. In Scotland, an education-based initiative was launched by NHS Education for Scotland in 2012. To review the impact of these and other initiatives on the current status of aseptic technique, all NHS trusts in England and NHS health boards in Scotland were assessed under the Freedom of Information procedure. FINDINGS: 93% of NHS trusts in England use a single standard for aseptic technique. In 88% of these trusts the single standard was stipulated as being ANTT. In Scotland, 62% of NHS acute and community care hospitals within health boards use a single standard. In 56% of these, the single standard was ANTT. When including those that use ANTT in combination with other techniques ANTT usage is 73%. CONCLUSION: These data demonstrate significant progress in standardising aseptic technique education, assessment and governance, and confirms ANTT as the de facto aseptic technique used in NHS trusts in England and health boards in Scotland.