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JAMA Ophthalmol ; 138(4): 382-386, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32105297


Importance: Alcohol-based surgical scrub is recommended for presurgical antisepsis by leading health organizations. Despite this recommendation, water-based scrub techniques remain common practice at many institutions. Objective: To calculate the potential financial savings that a large, subspecialty ophthalmic surgical center can achieve with a conversion to waterless surgical hand preparation. Design, Setting, and Participants: A review of accounting records associated with the purchase of scrubbing materials and water company invoices was conducted to assess direct costs attributable to water consumption and scrub materials for brushless, alcohol-based surgical scrub and water-based presurgical scrub. The flow rate of scrub sinks to estimate water consumption per year was tested. Savings associated with operating room (OR) and personnel time were calculated based on the prescribed scrub times for waterless techniques vs traditional running-water techniques. The study was conducted from January 5 to March 1, 2019. Main Outcomes and Measures: The primary outcomes for this study were the quantity of water consumed by aqueous scrubbing procedures as well as the cost differences between alcohol-based surgical scrub and water-based scrub procedures per OR per year. Results: Scrub sinks consumed 15.9 L of water in a 2-minute period, projecting a savings of 61 631 L and $277 in water and sewer cost per operating room per year. Alcohol-based surgical scrub cost $1083 less than aqueous soap applied from wall-mounted soap dispensers and $271 less than preimpregnated scrub brushes per OR per year in supply costs. The decrease in scrub time from adopting waterless scrub technique could save between approximately $280 000 and $348 000 per OR per year. Conclusions and Relevance: Adopting waterless scrub techniques has the potential for economic savings attributable to water. Savings may be larger for surgical facilities performing more personnel-intensive procedures.

Anti-Infecciosos Locais/administração & dosagem , Antissepsia/métodos , Clorexidina/análogos & derivados , Etanol/administração & dosagem , Desinfecção das Mãos/economia , Desinfecção das Mãos/métodos , Procedimentos Cirúrgicos Oftalmológicos , Água , Anti-Infecciosos Locais/economia , Clorexidina/administração & dosagem , Clorexidina/economia , Desinfetantes , Etanol/economia , Feminino , Humanos , Masculino , Salas Cirúrgicas , Procedimentos Cirúrgicos Oftalmológicos/economia , Cuidados Pré-Operatórios
J Hosp Infect ; 103(3): 311-320, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31449919


BACKGROUND: Cardiac implantable electronic device (CIED) infection, a major complication of a CIED implant procedure, can prolong hospitalization and cause mortality. AIM: To evaluate the efficacy of a bundled skin antiseptic preparation for preventing infection after implantation of a complex CIED. METHODS: This study analysed 1163 consecutive patients who had received a bundled skin antiseptic preparation before CIED implantation from July 2012 to December 2017. According to the complexity of the CIED implant procedure, the patients were divided into a complex CIED group (N = 370) and a non-complex CIED group (N = 793). A complex procedure was defined as a pacemaker replacement, implantation of implantable cardioverter defibrillator and cardiac resynchronization therapy, device upgrade, or lead revision. FINDINGS: During a mean follow-up of 2.9 ± 1.7 years, CIED infection developed in 15 patients (1.3%), and the incidence of minor and major infection was 1.1% and 0.2%, respectively. The incidence of CIED infection did not significantly differ between the complex CIED group and the non-complex CIED group (1.1% vs 1.4%, respectively; non-significant). Multivariate analysis indicated that procedural complexity was not an independent predictor of CIED infection. After 2:1 propensity score matching, the matched non-complex CIED group and the matched complex CIED group still showed no significant difference in the incidence of CIED infection. CONCLUSION: Bundled skin antiseptic preparation is an effective and widely applicable strategy for decreasing infection risk after a complex CIED implantation.

Antissepsia/métodos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Pacotes de Assistência ao Paciente/métodos , Cuidados Pré-Operatórios/métodos , Implantação de Prótese/efeitos adversos , Infecção da Ferida Cirúrgica/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
Pediatr Int ; 61(7): 647-651, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31172642


BACKGROUND: In Japan, blood cultures for children are performed by pediatric residents, and povidone-iodine (PI) is the recommended solution for skin preparation. Given that PI needs to be applied for 1.5-2 min before venipuncture, skin preparation may be suboptimal if this is not followed. In this study, we investigated the blood culture contamination rate after skin preparation with only 70% isopropyl alcohol (IPA) or IPA plus PI. METHODS: We performed a retrospective study of patients aged ≤6 years who provided blood cultures in the emergency department or pediatric ward. Patients with indwelling central venous catheter were excluded. We evaluated the impact of changing the method of skin preparation, comparing the traditional method using IPA plus PI between 2008 and 2010 (IPA + PI group) with the simplified method using only IPA between 2015 and 2017 (IPA group). RESULTS: A total of 5,365 blood culture samples were eligible for this study. Of these, 171 (3.2%) had an organism identified in blood culture. Of the blood culture-positive samples, 68 (1.3%) were true positive and 103 (1.9%) were contaminated. Thirty-eight (1.6%) of 2,407 cultures in the IPA group were contaminated, whereas 65 (2.2%) of 2,958 cultures in the IPA + PI group were contaminated (OR, 0.72; 95%CI: 0.48-1.07; P = 0.1). Coagulase-negative Staphylococcus grew significantly less in the IPA group (1.7% vs 1.0%, P = 0.02). CONCLUSIONS: A single application of 70% IPA may be the optimal skin preparation method for obtaining peripheral blood cultures from children in Japan.

2-Propanol/administração & dosagem , Anti-Infecciosos Locais/administração & dosagem , Antissepsia/métodos , Bacteriemia/diagnóstico , Hemocultura , Flebotomia , Povidona-Iodo/administração & dosagem , Bacteriemia/sangue , Criança , Pré-Escolar , Estudos Transversais , Reações Falso-Positivas , Feminino , Infecções por Bactérias Gram-Negativas/sangue , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Positivas/sangue , Infecções por Bactérias Gram-Positivas/diagnóstico , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Manejo de Espécimes/métodos
J Mol Model ; 25(7): 186, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31187300


Faced with the worldwide spread of multidrug-resistant (MDR) bacterial strains, together with a lack of any appropriate treatment, urgent steps to combat infectious diseases should be taken. Usually, bacterial components are studied to understand, by analogy, the functioning of human proteins. However, molecular data from bacteria gathered over the past decades provide a sound basis for the search for novel approaches in medical care. With this current work, we want to direct attention to inhibition of the vSGLT glucose transporter from Vibrio parahaemolyticus belonging to the sodium solute symporter (SSS) family, to block sugar transport into the bacterial cell and, as a consequence, to limit its growth. Potential bacteriostatic properties can be drawn from commercially available drugs developed for human diseases. This goal can also be reached with natural components from traditional herbal medicine. The presented data from the numerical analysis of 44 known inhibitors of sodium glucose symporters shed light on potential novel approaches in fighting Gram-negative multidrug-resistant microorganisms. Graphical abstract Molecular view on vSGLT channel inhibition by gneyulin B, the compound of natural origin.

Modelos Moleculares , Relação Quantitativa Estrutura-Atividade , Proteínas de Transporte de Sódio-Glucose/química , Estilbenos/química , Antissepsia/métodos , Sítios de Ligação , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Bactérias Gram-Negativas/efeitos dos fármacos , Humanos , Ligantes , Ligação Proteica , Conformação Proteica , Proteínas de Transporte de Sódio-Glucose/antagonistas & inibidores , Estilbenos/farmacologia , Vibrio parahaemolyticus/metabolismo
BMJ Open ; 9(4): e028549, 2019 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-30944142


INTRODUCTION: Short peripheral intravenous catheters (PVCs) are the most frequently used invasive medical devices in hospitals. Unfortunately, PVCs often fail before the end of treatment due to the occurrence of mechanical, vascular or infectious complications, which prolongs hospitalisation and increases healthcare costs and mortality.Prevention of these complications is mainly based on the respect of hygiene rules and the use of biocompatible catheters. In critically ill patients, 2% chlorhexidine-alcohol is superior to 5% povidone iodine-alcohol for skin preparation before central venous and arterial catheters; whether this finding can be extended to PVC inserted in the wards remains speculative. Similarly, the use of new technologies such as catheters designed to minimise blood exposure, zero-reflux needleless connectors, disinfecting caps and flushing PVCs before and after each medication administration to maintain catheter patency are of theoretical interest to prevent PVC failure, but little scientific data support their routine use. METHODS AND ANALYSIS: The CLEAN 3 study is an open-label, single-centre, randomised, two-by-two factorial trial. One thousand patients visiting our emergency department and requiring hospital admission in the wards will be randomised to one of four strategies according to skin preparation and devices used. The two primary endpoints will be (1) the incidence of infectious complications related to the catheters (colonisation, local infection or bloodstream infection) and (2) the time between catheter insertion and catheter failure defined as any premature removal of PVC before end of treatment, other than for routine replacement. ETHICS AND DISSEMINATION: This protocol has been approved by an independent ethics committee and will be carried out according to the principles of the Declaration of Helsinki and the Good Clinical Practice guidelines. The results of this study will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER: EudraCT 2018-A02535-50; NCT03757143.

Anti-Infecciosos Locais/uso terapêutico , Antissepsia/métodos , Infecções Relacionadas a Cateter/prevenção & controle , Clorexidina/uso terapêutico , Etanol/uso terapêutico , Povidona-Iodo/uso terapêutico , Adulto , Idoso , Infecções Relacionadas a Cateter/epidemiologia , Cateterismo Periférico/métodos , Cateteres de Demora/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Falha de Equipamento/estatística & dados numéricos , Feminino , Humanos , Incidência , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Análise Multivariada
Med. intensiva (Madr., Ed. impr.) ; 43(supl.1): 13-17, mar. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-188590


La higiene y el cuidado de la piel de los pacientes ingresados en las Unidades de Cuidados Intensivos (UCI) forman parte de los cuidados básicos. Desde hace unos años, existe la evidencia de colonización de la piel por patógenos multirresistentes, tanto de bacterias gramnegativas como grampositivas. El auge de infecciones nosocomiales por microorganismos multirresistentes ha llevado a evaluar el papel del uso de antisépticos, principalmente clorhexidina, como estrategia para disminuir el número de infecciones nosocomiales. En este artículo revisamos la situación actual de esta estrategia, así como un posicionamiento de los autores ante la extensión de esta estrategia en las UCI

Hygiene and skin care of patients admitted to the Intensive Care Unit (ICU) are part of basic care. For some years there has been evidence of skin colonization by multiresistant gramnegative and grampositive pathogens. The increase in nosocomial infections due to multiresistant microorganisms has led to evaluation of the role of the use of antiseptics, mainly chlorhexidine, as a strategy for reducing the number of such infections. This article reviews the current situation of this strategy, as well as the positioning of the authors in relation to the spreading of its use in ICUs

Humanos , Anti-Infecciosos Locais/uso terapêutico , Antissepsia/métodos , Higiene da Pele/métodos , Cuidados Críticos , Clorexidina/uso terapêutico , Unidades de Terapia Intensiva , Desinfecção das Mãos
Med. intensiva (Madr., Ed. impr.) ; 43(supl.1): 18-22, mar. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-188591


La infección de la herida quirúrgica es una de las principales complicaciones del paciente intervenido con cirugía y tiene graves consecuencias clínicas y económicas, sobre todo cuando afecta a implantes prostéticos o si está causada por bacterias multirresistentes. Dentro de las medidas preventivas, la preparación cutánea es uno de los elementos fundamentales. Las principales guías de práctica clínica recomiendan no retirar el pelo de la zona de la cirugía a no ser que interfiera con la intervención y, en caso de ser necesario, hacerlo con cortadora de uso único, lo más cercano en el tiempo a la cirugía. En cuanto a la ducha previa a la cirugía, la recomendación actual es hacerlo con un jabón (antimicrobiano o no) o con un producto antiséptico al menos la noche anterior. Para la preparación de la zona de incisión y el área de alrededor, se recomienda en general el empleo de antisépticos de base alcohólica, preferiblemente clorhexidina alcohólica por su alta actividad antibacteriana y su efecto residual prolongado, respetando de manera conveniente el tiempo de secado por evaporación

Surgical wound infection is one of the main complications of patients undergoing surgery and has significant clinical and economical consequences, especially when it affects prosthetic implants or is caused by multidrug resistant bacteria. Cutaneous preparation is one of the main preventive measures. Clinical practice guidelines recommend not to remove the hair from the surgery site unless it interferes with the operation, and that if removal proves necessary, it should be done with a single-use cutter, as close as possible to the time of surgery. With regard to preoperative showering, the current recommendation is to perform it with a soap (whether antimicrobial or otherwise) or an antiseptic product, at least the night before surgery. Regarding preparation of the incision area and surrounding zone, the use of an alcohol-based antiseptic is generally advised, preferably alcoholic chlorhexidine, due to its high antibacterial activity and prolonged residual effect, respecting the evaporation drying time

Humanos , Antissepsia/métodos , Anti-Infecciosos Locais/uso terapêutico , Infecção da Ferida Cirúrgica/prevenção & controle , Cuidados Pré-Operatórios , Banhos/métodos , Clorexidina/uso terapêutico
Med. intensiva (Madr., Ed. impr.) ; 43(supl.1): 23-30, mar. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-188592


Las infecciones del tracto respiratorio inferior que afectan al paciente intubado constituyen un serio problema de salud por la morbimortalidad asociadas. Las microaspiraciones de las secreciones de la cavidad bucofaríngea constituyen el principal mecanismo fisiopatológico que explica el desarrollo de la neumonía y la traqueobronquitis asociadas a la ventilación mecánica. En todos los paquetes de medidas para prevención de estas infecciones, se incluye la antisepsia orofaríngea para disminuir la colonización orofaríngea. La clorhexidina es el antiséptico más evaluado en ensayos clínicos y metaanálisis que concluyen que la higiene bucal con clorhexidina reduce la incidencia de neumonía asociada a ventilación mecánica, siendo mayor la eficacia cuando se administra al 2%. Sin embargo, 2metaanálisis han alertado sobre un posible aumento de mortalidad cuando se emplea la clorhexidina como antiséptico oral. Eso nos lleva a recomendar su uso pero extremando la precaución en su aplicación para impedir aspiración de la misma

Lower respiratory tract infections in the intubated patient constitute a serious health problem due to their associated morbidity and mortality. Microaspiration of the buccopharyngeal secretions is the main physiopathological mechanism underlying the development of pneumonia and tracheobronchitis in intubated patients. All care bundles designed to prevent these infections include the use of antiseptics to reduce buccopharyngeal colonization. Chlorhexidine is the antiseptic most frequently assessed in clinical trials and meta-analyses that conclude that oral hygiene with chlorhexidine reduces the incidence of ventilator-associated pneumonia - maximum effectiveness being achieved when the product is administered at a concentration of 2%. However, 2meta-analyses have warned of a possible increase in mortality when chlorhexidine is used as an oral antiseptic. We therefore recommend its use but with extreme caution during application in order to avoid aspiration of the antiseptic

Humanos , Antissepsia/métodos , Cuidados Críticos , Orofaringe , Pneumonia/prevenção & controle , Resultado do Tratamento , Bronquite/prevenção & controle , Clorexidina/uso terapêutico , Infecções Respiratórias/prevenção & controle , Escovação Dentária
Med. intensiva (Madr., Ed. impr.) ; 43(supl.1): 31-34, mar. 2019.
Artigo em Espanhol | IBECS | ID: ibc-188593


El hemocultivo es el principal método de diagnóstico etiológico de la bacteriemia, pero los falsos positivos son relativamente frecuentes, fundamentalmente por contaminación de origen cutáneo en el momento de extracción de la muestra. La correcta antisepsia cutánea es importante para disminuir la carga bacteriana y las posibilidades de contaminación, pero actualmente no existe un consenso al respecto de cuál es el mejor antiséptico: el alcohol posee un potente efecto bactericida inmediato y existe cierta evidencia científica a favor de la superioridad de la combinación de clorhexidina y alcohol, pero la mayoría de los estudios son heterogéneos y con resultados poco concluyentes. Algunos autores sugieren incluso que, con una técnica de extracción adecuada por parte de personal debidamente formado, el antiséptico elegido es poco relevante en la tasa de contaminación de hemocultivos

Blood cultures are the gold standard for the etiological diagnosis of bacteremia, though false-positive results are relatively frequent primarily due to contamination from skin flora during sample extraction. Correct skin antisepsis is important for reducing the bacterial load and opportunities for contamination. However, there is currently no solid consensus on the best antiseptic method. Alcohol has a potent immediate bactericidal effect, and there is some scientific evidence in favor of its combination with chlorhexidine, but most studies on this issue are heterogeneous and with inconclusive results. Some authors even suggest that the chosen antiseptic is irrelevant to the contamination rate, provided the blood culture extraction method is adequate and is performed by a trained professional

Humanos , Antissepsia/métodos , Hemocultura/métodos , Contaminação de Equipamentos/prevenção & controle , Coleta de Amostras Sanguíneas/estatística & dados numéricos , Coleta de Amostras Sanguíneas/normas , Higiene das Mãos/normas
Med. intensiva (Madr., Ed. impr.) ; 43(supl.1): 35-38, mar. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-188594


La antisepsia cutánea en los procedimientos invasivos tiene como objetivo disminuir la carga bacteriana en el lugar de la incisión o punción. Las soluciones alcohólicas parecen ser más eficaces en la prevención de la infección del sitio quirúrgico. Desde el punto de vista de la seguridad existe el potencial riesgo de ignición cuando se utilizan soluciones alcohólicas. Dada la potencial neurotoxicidad del alcohol y del gluconato de clorhexidina, debe evitarse el contacto de las soluciones antisépticas con el sistema nervioso central

Skin antisepsis in invasive procedures aims to reduce the bacterial load at the site of incision or puncture. Alcohol solutions seem to be more effective in preventing surgical site infection. From the safety point of view there is the potential risk of ignition when using alcohol solutions. Given the potential neurotoxicity of alcohol and chlorhexidine gluconate, contact of antiseptic solutions with the central nervous system should be avoided

Humanos , Antissepsia/métodos , Anti-Infecciosos Locais/uso terapêutico , Pele/efeitos dos fármacos , Procedimentos Cirúrgicos Operatórios , Unidades de Terapia Intensiva , Traqueotomia , Drenagem
Med. intensiva (Madr., Ed. impr.) ; 43(supl.1): 39-43, mar. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-188595


Se ha propuesto la aplicación de diferentes medidas relacionadas con la asepsia para la prevención de bacteriemia relacionada con catéter endovascular. Entre estas medidas de asepsia recomendadas por diferentes sociedades científicas se encuentra la higiene de manos de la persona que canaliza o manipula el catéter, la aplicación de unas máximas medidas de barrera durante la canalización del catéter, la desinfección de las llaves de 3pasos y los puntos de inyección, la no utilización de cremas antibióticas (salvo en los catéteres de hemodiálisis), el cambio del apósito si se encuentra manchado, húmedo o despegado, y el uso de una técnica aséptica durante el cambio de apósito. Otras medidas recomendadas solo en las pautas publicadas más recientemente (es posible que por la publicación de recientes estudios que objetivan su efecto beneficioso) son la utilización de apósitos impregnados en antimicrobianos, el cambio de apósitos transparentes cada 7 días y los baños del paciente con clorhexidina

Several measures related to asepsis for preventing catheter-related bloodstream infection have been proposed. The aseptic measures recommended by scientific societies include hand hygiene of the person who is inserting or manipulating the catheter; maximum sterile barrier precautions during catheter insertion; disinfection of catheter hubs; the use of needle-less connectors and injection ports; the avoidance of antibiotic ointments (except in hemodialysis catheters); change the dressing if it is soiled, loose or damp; and aseptic technique during dressing changes. Other measures only recommended by the most recently published guides (possibly due to the publication of recent studies reporting their beneficial effects) are the use of antimicrobial-impregnated dressings, changing transparent dressings every 7 days, and bathing of the patient with chlorhexidine

Humanos , Antissepsia/métodos , Procedimentos Endovasculares/métodos , Cateteres/normas , Cateteres/microbiologia , Assepsia/normas , Higiene das Mãos/normas , Bacteriemia/prevenção & controle , Clorexidina/uso terapêutico , Banhos/métodos , Bandagens/microbiologia
Med. intensiva (Madr., Ed. impr.) ; 43(supl.1): 44-47, mar. 2019.
Artigo em Espanhol | IBECS | ID: ibc-188596


Los conectores sin aguja proporcionan puntos de acceso fácil al sistema vascular para la administración de fluidos, evitando riesgos de punción accidental y aumentando la seguridad en la manipulación del acceso vascular. Una manipulación no aséptica puede favorecer su contaminación, convirtiéndolos en puerta de entrada de contaminantes endoluminales con capacidad de desencadenar complicaciones infecciosas de graves consecuencias para el paciente. ave y evitable, es necesario incluir en los programas de prevención aquellas medidas que eviten factores predisponentes como serían el aumento de la capacitación del personal, el diseño seguro de los dispositivos, la mejora del procedimiento de desinfección y el uso óptimo del antiséptico. Monitorizar la aplicación de prácticas seguras y difundir los resultados es importante para promover la comprensión de riesgos y beneficios que comporta la descontaminación de las conexiones y mejorar así la seguridad de los pacientes

Needleless connectors provide easy access points to the vascular system for the administration of fluids, avoiding the risk of accidental punctures and increasing safety in vascular access manipulation. Non-aseptic manipulation can favor contamination, turning connectors into the penetration route for endoluminal contaminants with the capacity of triggering infectious complications, with serious consequences for the patient. Considering catheter-related bacteremia as a serious and avoidable adverse effect, prevention programs should incorporate measures to combat predisposing factors, such as improved staff training, the safe design of devices, improved disinfection procedures, and optimized antiseptic use. Monitoring adherence to safe practices and reporting results are important to promote understanding of the risks and benefits of decontaminating connections and thus to improve patient safety

Humanos , Sonda , Cateteres Urinários/normas , Antissepsia/métodos , Prática Clínica Baseada em Evidências/métodos , Bacteriúria/prevenção & controle , Infecções Urinárias/prevenção & controle , Cateteres/classificação , Higiene das Mãos/métodos
Med. intensiva (Madr., Ed. impr.) ; 43(supl.1): 48-52, mar. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-188597


La infección del tracto urinario asociada al catéter es muy común tanto en el entorno hospitalario comunitario como en el de agudos, especialmente en el ámbito de cuidados intensivos. Para minimizar este problema es esencial realizar un abordaje correcto desde la inserción del catéter urinario hasta la extracción del mismo y aplicar siempre medidas antisépticas adecuadas. Hay demasiada información sobre las medidas antisépticas sin resultados consistentes. Este artículo tiene como objetivo revisar la evidencia científica existente sobre el tema y hacer recomendaciones basadas en la evidencia, a fin de optimizar los resultados. Todo el proceso se complementa con algunas consideraciones para lograr un manejo adecuado del catéter urinario del paciente

Catheter-related urinary tract infections are very common both in the community and in the acute hospital care setting, particularly in the critical care environment. In order to minimize this problem, it is essential to adopt a correct approach from insertion to withdrawal of the urinary catheter, and always perform proper antisepsis. There is too much information on antisepsis measures with no consistent results. The present article reviews the existing scientific evidence on the subject and establishes recommendations based on the evidence, in order to optimize outcomes. The entire process is complemented with considerations on how to secure proper management of the indwelling urinary catheter

Humanos , Antissepsia/métodos , Cateteres Urinários/normas , Cateterismo Urinário/instrumentação , Prática Clínica Baseada em Evidências/métodos , Bacteriúria/prevenção & controle , Infecções Urinárias/prevenção & controle , Cateteres/classificação , Higiene das Mãos/métodos , Antissepsia/normas
Ann R Coll Surg Engl ; 101(4): 279-284, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30354177


INTRODUCTION: Surgical site infection is associated with significant morbidity and mortality. Effective preoperative skin decolonisation is an important preventative strategy. The National Institute for Health and Care Excellence clinical guidelines recommend decolonisation using chlorhexidine gluconate (CHG) or povidone iodine (PVI). Current evidence indicates that CHG is more effective, while the combination of CHG and PVI is greater still. This study describes current practice among neurosurgeons in the UK, including differences between trainees and consultants, to review compliance with the latest evidence. MATERIALS AND METHODS: A Society of British Neurosurgical Surgeons approved national, multicentre questionnaire was circulated online. A total of 74 complete responses were obtained from 27 trainees and 47 consultants, representing 28 of 37 neurosurgical centres. RESULTS: Of the total responding centres, 36 (49%) used a single agent and 38 (51%) used a dual-agent preparation. One respondent used Tisept®. Seventy (95%) used alcohol in some form and none used aqueous CHG. Trainees were more likely to use a dual-agent preparation (P = 0.025). Forty-seven (63%) prepared the skin three or more times, with trainees preparing the skin more times than consultants (P = 0.002). CONCLUSION: Neurosurgical practice adheres to national clinical guidelines but not the latest evidence from the literature. Given the weighting placed on randomised controlled trials, such a trial may be required to standardise practice that is likely to reduce surgical site infection.

Antissepsia , Medicina Baseada em Evidências , Procedimentos Neurocirúrgicos/métodos , Cuidados Pré-Operatórios , Anti-Infecciosos Locais/uso terapêutico , Antissepsia/métodos , Medicina Baseada em Evidências/métodos , Humanos , Padrões de Prática Médica/estatística & dados numéricos , Cuidados Pré-Operatórios/métodos , Inquéritos e Questionários , Reino Unido
Am J Perinatol ; 36(2): 118-123, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30184558


OBJECTIVE: To compare chlorhexidine-alcohol with povidone-iodine solutions for skin antisepsis prior to cesarean delivery for the prevention of surgical site infection. STUDY DESIGN: Electronic databases MEDLINE, Embase, Scopus, and were searched from inception to August 2017. Eligible studies included randomized controlled trials comparing chlorhexidine-alcohol with povidone-iodine skin preparation solutions for women undergoing cesarean delivery. The primary outcome was surgical site infection including superficial or deep wound infection. Meta-analysis was performed, and risk ratios (RRs) with 95% confidence interval (CI) were calculated using the Mantel-Haenszel random effects model. Statistical heterogeneity was assessed using Higgin's I 2. RESULTS: Of 61 abstracts identified in the primary search, four studies (3,059 women) met the eligibility criteria. The risk of surgical site infection was significantly reduced with chlorhexidine-alcohol (RR: 0.72; 95% CI: 0.52-0.98). No heterogeneity across studies was observed with I 2 = 0%. Subgroup analysis of superficial infection only or deep infection only showed no statistically significant difference (RR: 0.76, 95% CI: 0.54-1.08; and RR: 0.50, 95% CI: 0.23-1.10, respectively). CONCLUSION: Preoperative skin cleansing prior to cesarean delivery with chlorhexidine-alcohol reduces surgical site infection as compared with povidone-iodine solutions.

Anti-Infecciosos Locais/administração & dosagem , Antissepsia/métodos , Cesárea , Clorexidina/administração & dosagem , Etanol/administração & dosagem , Povidona-Iodo/administração & dosagem , Infecção da Ferida Cirúrgica/prevenção & controle , Administração Cutânea , Cesárea/efeitos adversos , Combinação de Medicamentos , Feminino , Humanos , Gravidez , Cuidados Pré-Operatórios/métodos
Orthop Traumatol Surg Res ; 105(1S): S1-S6, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30393070


Surgical site infection (SSI) is the third most frequent healthcare-associated infection in France. SSI rates in total hip or knee replacement are around 2%. The main bacteria implicated in SSI in clean surgery are those of the skin flora, whence the importance of skin preparation to eliminate transient flora and reduce resident flora. Guidelines for the prevention of SSI have progressed in recent years in France: firstly in 2013, and then in 2016. That preoperative hair removal and scrubbing of clean skin ahead of cutaneous asepsis is non-contributive was confirmed in 2013. A shower with normal soap taken as close to the beginning of surgery as possible is still recommended, as is use of alcoholic antiseptics for cutaneous asepsis. The debate remains open between chlorhexidine and povidone-iodine in several surgical specialties in the absence of any multicenter studies. Future choices of antiseptic may need to take account of resistance, especially to chlorhexidine, and possible side-effects. Finally, antimicrobial skin sealants and adhesive surgical drapes are not recommended for the prevention of infection.

Infecção Hospitalar/prevenção & controle , Cuidados Pré-Operatórios , Infecção da Ferida Cirúrgica/prevenção & controle , Anti-Infecciosos Locais/uso terapêutico , Antissepsia/métodos , Banhos , Resistência Microbiana a Medicamentos , Remoção de Cabelo , Humanos , Controle de Infecções , Salas Cirúrgicas , Campos Cirúrgicos
Clin. biomed. res ; 39(4): 279-283, 2019.
Artigo em Inglês | LILACS | ID: biblio-1053445


Introduction: This study analyzed dental consultation requests to the division of oral and maxillofacial surgery in a Brazilian tertiary hospital. Methods: A cross-sectional study with data collected retrospectively from inpatients' electronic medical records containing dental consultation requests made between January 2013 and December 2017. Results: 327 consultation requests were analyzed. Mean (SD) patient age was 38.71 (24.4) years; 164 (50.2%) were male and 267 (81.7%) were Caucasian. Regarding systemic conditions, 34 (10.4%) were classified as ASA I, 86 (26.3%) as ASA II, 182 (55.7%) as ASA III, and 25 (7.6%) as ASA IV. Dental consultations were mostly requested by the internal medicine team (n = 42, 12.8%). The most common reason for consultation was septic teeth (n = 131, 40.1%). Complementary tests were required in 188 (57.5%) cases. Surgical intervention was required in 82 (25.0%), with tooth extraction as the most prevalent procedure (20.2%). The most demanding service was inpatient care, with 276 (84.4%) requests. Cases were resolved in 249 (76.1%). Conclusions: The division of oral and maxillofacial surgery in our hospital deals with a great amount of consultations, contributing with surgical procedures to the adequacy of patients' oral health with a high effectiveness rate. Our data illustrate the contribution of dentists in a hospital setting, assisting the medical team in providing comprehensive care for inpatients. (AU)

Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Antissepsia/métodos , Saúde Bucal/estatística & dados numéricos , Extração Dentária/estatística & dados numéricos , Procedimentos Cirúrgicos Bucais , Pacientes Internados/estatística & dados numéricos
Medicine (Baltimore) ; 97(42): e12831, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30334981


BACKGROUND: Chlorhexidine and parachlorometaxylenol (PCMX) are antiseptics recommended for surgical hand antisepsis. To our knowledge, PCMX has not been evaluated for bactericidal efficacy "in vivo. METHODS: We conducted a randomized, double-blind, controlled crossover trial to compare the bacterial loads on fingertips and fingernails under laboratory conditions after use of antiseptic test products, including chlorhexidine digluconate 4%, PCMX 3%, and a reference solution of propan-1-ol 60% (P-1). We assessed bacterial load after a prewash with soft soap, immediately after application of an antiseptic, and 3 hours after application and wearing of sterile, powder-free gloves. Our procedures followed those specified by European Norm (EN) 12791 for evaluating surgical hand antiseptics and using cotton swab for fingertips and fingernails. RESULTS: Chlorhexidine digluconate 4% and PCMX 3% did not decrease bacterial load on the hands. The bactericidal performances of chlorhexidine digluconate 4% and PCMX 3% did not differ significantly. Chlorhexidine digluconate 4% and PCMX 3% increased bacterial load on the fingertips after participants had worn gloves for 3 hours. Fingernails had greater bacterial loads than skin on the fingertips. CONCLUSIONS: Chlorhexidine digluconate 4% and PCMX 3% had similar bactericidal efficacy, but they failed to meet the EN 12791 efficacy standard. Fingernails should be a particular focus of antisepsis in preparation for surgery.The trial was registered at (ID: NCT02500758).

Anti-Infecciosos Locais/administração & dosagem , Clorexidina/análogos & derivados , Desinfecção das Mãos/métodos , Mãos/microbiologia , Xilenos/administração & dosagem , Adulto , Antissepsia/métodos , Carga Bacteriana/métodos , Clorexidina/administração & dosagem , Estudos Cross-Over , Método Duplo-Cego , Humanos , Pessoa de Meia-Idade
Int Urol Nephrol ; 50(9): 1563-1568, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30019310


PURPOSE: To report outcomes 5 years after a resident quality initiative incorporated topical rectal antiseptic into our ultrasound-guided prostate needle biopsy (TRUS PNB) protocol. METHODS: A chart review was conducted on 1007 men who underwent TRUS PNB between 2010 and 2017. Comparison groups include those who received a topical rectal antiseptic (N = 437) compared to those who did not (N = 570). Povidone-iodine (N = 303) or 4% chlorhexidine solution without alcohol (N = 134) were topical agents. Outcomes of interest included post-biopsy infection (urinary tract infection and/or sepsis), hospital admission, and need for ICU monitoring. RESULTS: Median age and PSA of men included in this study were 64 years and 12 ng/mL. Almost 90% of patients were Caucasian, 13% had diabetes, 3% were on immunosuppression, 32% had at least one prior biopsy, 14% received antibiotics, and 7% were hospitalized in the past 6 months. 22 patients (2.2%) developed a post-biopsy infection with a significant reduction in the group receiving topical rectal antiseptic (0.8 vs. 3.3%, p = 0.01). Post-biopsy UTI rates (p = 0.04) and hospital admission (p = 0.03) were also lower in the topical antiseptic group with trends to reduction in sepsis and need for ICU monitoring. CONCLUSIONS: What started as a resident quality safety project 5 years ago has demonstrated a reduction in infections and hospital admissions following TRUS PNB. Our institutional practice now routinely uses povidone-iodine or chlorhexidine as an adjunct to oral quinolones for TRUS PNB perioperative prophylaxis.

Anti-Infecciosos Locais/administração & dosagem , Clorexidina/administração & dosagem , Povidona-Iodo/administração & dosagem , Próstata/patologia , Sepse/prevenção & controle , Infecções Urinárias/prevenção & controle , Administração Tópica , Idoso , Antissepsia/métodos , Cuidados Críticos , Hospitalização , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/métodos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Melhoria de Qualidade , Sepse/etiologia , Infecções Urinárias/etiologia