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Biomedical subjects

A Napier

Publications and source records attributed to A Napier.

11 recordsLinked to original sources
PubMed1992

Cost-effectiveness analysis of the use of chlorhexidine detergent in preoperative whole-body disinfection in wound infection prophylaxis.

A total of 3482 general surgical patients entered a trial in which they had a chlorhexidine or placebo detergent shower three times before elective clean wound or potentially contaminated surgery. Patients who showered with a chlorhexidine detergent (N = 1744) had a significant reduction in skin flora compared with those who showered with a placebo detergent (N = 1738). The majority of wound infections occurred outside hospital (312 outpatient infections vs. 201 inpatient infections). Wound infection rates were similar in the chlorhexidine and placebo groups (5.79% vs. 5.75% for inpatient infections and 8.54% vs. 9.38% for outpatient infections). The average hospital cost of both non-infected and infected patients was higher in the chlorhexidine group. The average cost of a non-infected chlorhexidine patient was 847.95 pounds as opposed to 804.60 pounds for a non-infected placebo patient, whilst the average cost of an infected patient was 1459.70 pounds (chlorhexidine) and 1414.22 pounds (placebo). A cross-match comparison of patients undergoing vascular surgery revealed no statistical significance in the difference between the two experimental groups. Patients were matched for age, sex, type of operation and surgeon. We conclude that preoperative whole-body disinfection with a chlorhexidine detergent is not a cost-effective treatment for reducing wound infection.

Adolescent↗
PubMed1992

The effect of diclofenac sodium ophthalmic solution on intraocular pressure following cataract extraction.

Ninety-two nonglaucomatous patients undergoing extracapsular cataract extraction with implantation of a posterior chamber intraocular lens by residents at a Veterans hospital were randomized in double-masked fashion to receive either a topical nonsteroidal antiinflammatory agent, diclofenac sodium 0.1%, or a placebo consisting of vehicle only. One drop of placebo or diclofenac sodium 0.1% was administered on an inpatient basis by trained staff every 6 hours for three doses, starting the afternoon prior to surgery. A further drop was given at 90, 60, 30, and 15 minutes before the operation. Starting 24 hours after surgery, all patients received diclofenac sodium 0.1%. All patients remained hospitalized for 72 hours postoperatively. Mean baseline intraocular pressure (IOP) was 14.0 and 14.1 mm Hg in the diclofenac and placebo groups, respectively. IOP rose 8.6 mm Hg in both groups at 6 hours after surgery. At 24 hours, the mean IOP elevation from baseline was 11.3 mm Hg in the diclofenac group and 9.6 mm Hg in the placebo group (P = .47). Within the first 24 hours, IOP spiked more than 10 mm Hg in 57% (26/46) of the diclofenac patients and in 54% (25/46) of the placebo patients. These results suggest that diclofenac sodium 0.1% drops affect neither the incidence nor the height of IOP elevation following cataract surgery.

Aged↗
PubMed1991

The effect of whole body disinfection on intraoperative wound contamination.

As part of a large whole body disinfection (WBD) trial two small sub-groups of patients who showered preoperatively with either a 4% chlorhexidine (CHX: N = 29) or placebo (N =27) detergent were studied to assess intraoperative wound contamination. The groups were well matched for age, sex and length of surgery. A membrane filter contact technique was used for bacterial recovery from the wounds after the initial skin incision and before wound closure. The membrane filters were incubated aerobically on blood agar plates with a CHX neutralizer for 48 h at 37 degrees C and colonies were counted. The results show a significant difference, between the bacterial counts at the start and end of surgery in the CHX and placebo groups. There was no difference in bacterial counts at the start of surgery between the CHX and placebo groups. There was a significant difference in the bacterial counts at the end of surgery between the CHX and placebo groups. These results indicate that preoperative WBD with CHX reduces intraoperative wound contamination but the effect of this on postoperative wound sepsis rates awaits the results of a large WBD trial.

Adult↗
PubMed1991

Effects of whole body disinfection on skin flora in patients undergoing elective surgery.

Bacterial skin flora were studied in two groups of patients having three showers with either a 4% chlorhexidine detergent solution (Group A, N = 57) or a placebo detergent (Group B, N = 58). Previous reports on the efficacy of chlorhexidine in decreasing bacterial counts on the skin were confirmed and the time taken to recolonization (median 5 days; range 1-10 days) was in broad agreement with previous reports. However, concern regarding the colonization of the skin of the patients in the chlorhexidine group by potential pathogens during the recolonization period appears unfounded as there was no significant difference in the incidence of non-resident skin flora between the chlorhexidine (17/57; 30%) and the placebo (14/58; 24%) groups. These non-residents are generally lost from the skin before discharge in the chlorhexidine group but nine patients in the placebo group had abnormal skin flora at discharge from hospital. All those patients tested after discharge had lost the non-resident flora within 2 weeks of discharge. The results of this study indicate that recolonization of the skin after whole body disinfection does not present a clinical problem.

Adolescent↗
PubMed1990

Rationalizing whole body disinfection.

As part of the preparation for a large prospective trial investigating the effect of preoperative whole body disinfection on the postoperative wound infection rate, this preliminary volunteer study was carried out to establish (a) the optimum number of preoperative washes required to achieve a maximum level of skin disinfection and (b) if showering or bathing is a more efficient method of skin disinfection. Ten healthy volunteers were recruited. The results show a significant decrease (p less than 0.005) in the skin flora after the first and second showers (a decrease of 93.55% and 77.49% respectively), but no further significant fall with subsequent showers. There was a significant fall (p less than 0.005) in skin flora after a single bath (a decrease of 70.98%) with subsequent baths producing no further significant reduction in skin flora. From these results it is recommended that three preoperative showers with 4% chlorhexidine detergent be used as an optimum preoperative whole body disinfection regimen. Three showers ensures against less thorough washing by the patients compared to the healthy volunteers in the study and fits easily into a preoperative regimen.

Adult↗
PubMed1988

How informed is signed consent?

The assurance that patients fully understand the information given to them before they sign the consent form for operation has never been validated in this country. One hundred patients were interviewed by an independent medical observer in one surgical unit in a teaching hospital between two and five days after their operation. Although all the patients interviewed were fully aware that they had had an operation, 27 did not know which organ was operated on and 44 were unaware of the exact nature of the surgical procedure. A significantly higher age group was observed in the group of patients who were unaware of the basic facts relating to their operation, and the problem was encountered most commonly in patients over the age of 60. Because of the medical and legal importance the findings of this pilot study warrant further large scale investigations.

Age Factors↗