Antisepsis in surgery

During the past decades, encouraging progress has been made in the prevention of surgical site infections (SSI). However, as SSI still occur today, strategic prevention measures such as standardized skin antisepsis must be implemented and rigorously promoted. Recent discoveries in skin physiology necessitate the development of novel antiseptic agents and procedures in order to ameliorate their efficacy. In particular, alternate target structures in the skin need to be taken into consideration for the development of the next generation of antiseptics...

BACKGROUND: Infection after shoulder surgery can have devastating consequences. Recent literature has implicated Propionibacterium acnes as a causative agent for postoperative shoulder infections. Axillary hair removal has been suggested as a method for infection prevention, although data quantifying its effect on the bacterial load around the shoulder are lacking. METHODS: We clipped one randomly selected axilla in 85 healthy male volunteers with commercially available surgical clippers...

Performing preoperative skin antisepsis to remove soil and microorganisms at the surgical site may help prevent patients from developing a surgical site infection. The updated AORN "Guideline for preoperative skin antisepsis" addresses the topics of preoperative patient bathing and hair removal, selection and application of skin antiseptics, and safe handling, storage, and disposal of skin antiseptics. This article focuses on key points of the guideline to help perioperative personnel develop protocols for patient skin antisepsis...

PURPOSE OF REVIEW: Prevention of surgical site infections is a key issue to patient safety and the success of surgical interventions. Systemic antimicrobial prophylaxis is one important component of a perioperative infection prevention bundle. This review focuses on selected recent developments and important concepts in the field. RECENT FINDINGS: Joint guidelines (American Society of Health-System Pharmacists, Infectious Diseases Society of America, Surgical Infection Society, Society for Healthcare Epidemiology of America) for antimicrobial prophylaxis in surgery have been recently revised and updated...

BACKGROUND: Central venous catheter-related infection (CVC-RI) is considered a common cause of increased morbidity, mortality, and medical care costs in intensive care units (ICUs). The objective in this descriptive study was to assess the knowledge of health care workers in ICUs about guidelines for the prevention of CVC-RI and their adherence to these guidelines in practices. METHODS: Health care workers were assessed for their actual practices during central venous catheter (CVC) insertion and care...

BACKGROUND: Safe and effective patient preoperative skin antisepsis is recommended to prevent surgical site infections (SSIs), reduce patient morbidity, and reduce systemic costs. However, there is lack of consensus among best practice recommendations regarding the optimal skin antiseptic solution and method of application. METHODS: In 2010 and 2011 the health technology appraisal committee of the Surgery Operational Clinical Network (SOCN), of Alberta Health Services (AHS), conducted an environmental scan to determine the current preoperative skin antisepsis in Alberta, reviewed key publications and existing guidelines, and requested a systematic review from the Canadian Agency for Drugs and Technologies in Health (CADTH)...

BACKGROUND: Surgical site infection (SSI) is the second most common type of nosocomial infections in the United States. In Uruguay, the incidence after prostatectomies is 2.6%. The aim of our study was to compare the efficacy of two skin antiseptics and to determine possible risk factors for SSI in patients undergoing surgery for benign prostatic hyperplasia (BPH). METHODS: A randomized trial included 70 patients operated on for BPH, of whom 56 (80%) underwent open surgery...

OBJECTIVE: To estimate the incidence of surgical-site infection with use of chlorhexidine-alcohol compared with povidone-iodine among women undergoing cesarean deliveries. METHODS: This was a retrospective cohort review of 1,000 consecutive cases in women who underwent cesarean delivery over a 1-year interval. The primary outcome was any surgical-site infection within 30 days (Centers for Disease Control and Prevention criterion). RESULTS: Mean age and parity were equivalent (29...

BACKGROUND: Surgical site infection rates in the month following clean surgery vary from 0.6% (knee prosthesis) to 5% (limb amputation). Due to the large number of clean surgical procedures conducted annually the costs of these surgical site infections (SSIs) can be considerable in financial and social terms. Preoperative skin antisepsis using antiseptics is performed to reduce the risk of SSIs by removing soil and transient organisms from the skin where a surgical incision will be made...

We report a systematic review and meta-analysis of published randomised and quasi-randomised trials evaluating the efficacy of pre-operative skin antisepsis and cleansing techniques in reducing foot and ankle skin flora. The post-preparation culture number (Post-PCN) was the primary outcome. The data were evaluated using a modified version of the Cochrane Collaboration’s tool. We identified eight trials (560 participants, 716 feet) that met the inclusion criteria. There was a significant difference in the proportions of Post-PCN between hallux nailfold (HNF) and toe web spaces (TWS) sites: 0...

BACKGROUND: Hand hygiene is the cornerstone of aseptic techniques to reduce surgical site infection. Conventional surgical scrub is effective for disinfecting a surgeon's hands. However, the compliance of conventional scrub may be hindered by skin damage, allergy, and time. Alcohol-based hand rub has a satisfactory antimicrobial effect, but mostly in laboratory settings. Our aim was to compare a conventional surgical scrub with an alcohol-based hand rub to evaluate antimicrobial efficacy...

BACKGROUND: Surgical site infections adversely affect patients' well-being. In this study, hand-washing details and adherence to surgical site antisepsis applications among surgical staff were observed and recorded. Then, a questionnaire was given to test surgeons' theoretical knowledge on operating room principles. METHODS: Staffs from 5 surgical units were selected (surgeons and nurses from general surgery, urology, plastic surgery, thoracic surgery, and gynecology and obstetrics) and observed...

This article highlights a neglected feature of Joseph Lister's work, namely how, in addition to promoting germ theories and the principles of the antiseptic system, he also devoted much time and effort to communicating the performative aspects of antisepsis and of the many other surgical innovations that he developed. Attention to 'detail' and striving for 'improvement' were crucial to Listerian practice, and he sought to convey his credo in three main ways: first, his publications aimed at 'bringing the subject out in the same sort of way as it had been worked out by himself'; second, he set out strict protocols and information on materials and methods, yet also encouraged surgeons to improvise; and third, he made himself an exemplar of a new form of professionalism, which made constancy and vigilance in practice a moral duty for surgeons...

Chlorhexidine has attracted increasing attention for its role in skin antisepsis in recent years. It was tested in several prominent clinical trials and subsequently recommended in important guidelines for blood culture collection, vascular catheter insertion and surgical skin preparation. We noticed and subsequently reported a widespread misinterpretation of evidence surrounding chlorhexidine and its role in skin antisepsis. Multiple clinical trial reports and systematic reviews that had assessed the clinical efficacy of chlorhexidine/alcohol combinations for skin antisepsis had attributed efficacy solely to the chlorhexidine component...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

INTRODUCTION: The surgeon uses different methods of surgical hand antisepsis with the aim of reducing surgical site infections. To date, there are no local studies comparing the efficacy of iodine hand scrub against newer alcohol-based hand rubs with active ingredients. Our pilot study compares a traditional aqueous hand scrub using 7.5% Povidone iodine (PVP-I) against a hand rub using Avagard: 61% ethyl alcohol, 1% chlorhexidine gluconate. The outcome measure is the number of Colony Forming Units (CFU) cultured from 10-digit fingertip imprints on agar plates...

BACKGROUND: Surgical site infections (SSIs) cause severe morbidity and are associated with tremendous health costs. Skin antisepsis (cleansing) with chlorhexidine and alcohol solutions has demonstrated superiority to povidone-iodine in a variety of surgical interventions. Our objective was to determine if chlorhexidine and alcohol antisepsis protocol reduces the rate of SSIs in elective gynecological laparotomies compared with povidone-iodine antisepsis. METHODS: This retrospective study was carried out at the Department of Gynecology in a tertiary medical center in Tel Aviv...

OBJECTIVE: To compare use of chlorhexidine with use of iodine for preoperative skin antisepsis with respect to effectiveness in preventing surgical site infections (SSIs) and cost. METHODS: We searched the Agency for Healthcare Research and Quality website, the Cochrane Library, Medline, and EMBASE up to January 2010 for eligible studies. Included studies were systematic reviews, meta-analyses, or randomized controlled trials (RCTs) comparing preoperative skin antisepsis with chlorhexidine and with iodine and assessing for the outcomes of SSI or positive skin culture result after application...

BACKGROUND AND OBJECTIVES: Recent reports of infectious complications after neuraxial procedures highlight the importance of scrupulous aseptic technique. Although chlorhexidine gluconate (CHG) has several advantages over other antiseptic agents; including a more rapid onset of action, an extended duration of effect, and rare bacterial resistance, it is not approved by the US Food and Drug Administration for use before lumbar puncture because of absence of clinical safety evidence. The objective of this retrospective cohort study was to test the hypothesis that the incidence of neurologic complications associated with spinal anesthesia after CHG skin antisepsis is not different than the known incidence of neurologic complications associated with spinal anesthesia...