PubMed · 12497765
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James E Akers. Science based aseptic processing.. https://pubmed.ncbi.nlm.nih.gov/12497765/
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Surveillance for surgical site infection (SSI) in cesarean-section (C-section) in our hospital, carried out between September 1998 and July 1999, identified areas of deficiency in aseptic techniques that have contributed to increased incisional surgical site infection rates (ISSI) rates. On the basis of these findings, we intensified the infection control presence in this area and increased the number of in-services to our staff, with attention to infection control practices. Our senior infection control staff carried out ongoing monitoring of the ISSI rates as well as careful observation of aseptic technique. The aim was to reduce the rates of C-section ISSI in our hospital. We used the Centers for Disease Control and Prevention definitions for infection and the National Nosocomial Infections Surveillance System (NNISS) risk index in measuring the ISSI rates in the 2 time periods. We compared the ISSI rates with those of our preintervention period in an attempt to evaluate our interventional measures. Eight hundred seventy-five (875) C-sections were performed at King Fahad National Guard Hospital between January and December 2000. The overall ISSI rate was 1.37%. The ISSI rate for the NNISS risk category 0 (zero) was 1.2% and for the NNISS risk category 1 was 4.1%. There was a 50% reduction in the overall ISSI rates from our preintervention period (P <.05). Even though there were no objective means by which we measured the effect of infection control presence on the asepsis practices, there were no other changes that could have attributed to this significant reduction in ISSI rates in our C-section population.
Professor Ignác Semmelweis (1818-1865) is one of the great personalities of medical history. He insisted on washing hands with chlorine water before any obstetrical intervention, he was the first to demonstrate its importance in preventing puerperal fever. Thus, the principle of asepsis was introduced prior to the discovery of bacteria and bacterial diseases. Semmelweis carefully documented his findings and in this way pioneered the scientific analysis of clinical data Medical community of that time misinterpreted Semmelweis' great ideas, he died abandoned and forgotten. A Finnish doctor Josef Adam Joachim Pippingsköld was one of the first obstetricians who had realized the importance of Semmelweis' work. In 1861, in his letter to Semmelweis he reported about his own findings and favorable results in prevention of puerperal fever in Helsinki. Two decades earlier, Dr. Ehrström in the University of Helsinki had submitted his thesis on pathophysiology of puerperal fever that was similar to the ideas of Semmelweis. Long before modern times in Finland, mothers traditionally had their babies delivered in smoke saunas, where heating and smoke of bactericidal phenols created a clean, rather aseptic environment. Hand washing was self-evident necessity. However, the situation was quite different in the Central European universities and departments of obstetrics, where the medical training and clinical practice took place side by side. Semmelweis' life and his contribution to medicine was appreciated even in the theatrical circles of Finland. The piece "Semmelweis" of Norwegian playwright Jens Bjørneboe got its World Premier in the Swedish Theatre in Turku, former capital of Finland, in September 1969.
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