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PubMed2005

Why is it that internists do not follow guidelines for preventing intravascular catheter infections?

BACKGROUND AND OBJECTIVE: High morbidity of CVC-related infections has led to national guidelines for their prevention. Despite recommendations for the use of maximal barrier precautions (mask, sterile gloves, gown, and large drape) and skin antisepsis with 2% chlorhexidine gluconate during CVC insertion, internists in the United States are not implementing these practices frequently. This study sought to identify and characterize the obstacles to and potential opportunities for improving adherence. DESIGN: Cross-sectional survey. PARTICIPANTS: One thousand randomly selected physician-members of the American College of Physicians-American Society of Internal Medicine. METHODS: Several potential determinants of adherence to maximal barrier precautions were assessed, including awareness of, agreement with, and ability to implement the recommendation, as well as the practice and training characteristics of the respondents. Factors influencing antiseptic selection were also recorded. RESULTS: Of 526 respondents, 178 (34%) had recently inserted CVCs. Clinician experience and subspecialty, awareness of CDC guidelines, and external influences (eg, time to collect equipment) did not affect maximal barrier precautions adherence. The only independent predictor of adherence was high outcome expectancy for the use of large sterile drapes (OR, 5.3; CI95, 2.2-12.6). Availability had the greatest influence on internists' selection of specific antiseptic agents, whereas cost was the least important determinant. CONCLUSIONS: Despite established efficacy, use of maximal barrier precautions and chlorhexidine gluconate is low among internists. Because improved adherence to these practices will require increased outcome expectancy for maximal barrier precautions and availability of chlorhexidine gluconate, targeting these areas through focused education and systems modifications is essential.

Anti-Infective Agents, Local↗

PubMed1991

[The advantage of preventive vaginal antisepsis with hexetidine in obstetrics and gynecology].

In five studies, the advantage of repeated vaginal prophylaxis by a new preparation of hexetidine vaginal suppositories (10 mg) was investigated prospectively, randomised and method-controlled (n = 2 x 50). After a five-day application, the hexetidine group achieved bacterial reductions of five log CFU/ml in the vagina and nearly three log CFU/ml in the cervix uteri, whilst no reduction was found in the controls at any time (p less than 0.01). The reduction of individual bacterial species was investigated in 224 pregnant and also gynaecological patients. In cases of impending preterm childbirth, a five-day application of 20 mg hexetidine/day could reduce all bacteria sufficiently with the exception of lactobacilli; especially beta Streptococci were reduced. The same was achieved by a three-day application of 10 mg hexetidine/day pre-operatively. A long-term study in 11,724 deliveries showed, that neonatal infectious mortality and morbidity after 36 gestational weeks could be reduced significantly by hexetidine. The new hexetidine preparation appeared to be efficient in vaginal antisepsis, especially in pregnancy. A favourable lactobacilli-selective effect was demonstrated. Since the importance of lactobacilli in vaginal ecology is known, hexetidine prophylaxis must be considered as advantageous in Obstetrics and Gynecology. From a practical and economic point of view, the application of hexetidine as vaginal suppositories appears favourable compared to antiseptic solutions.

Adult↗

PubMed1999

An appreciation of A.E. Malloch, MB, MD (1844-1919): a forgotten surgical pioneer.

Dr. Archibald Edward Malloch was a surgeon whose life and work were greatly influenced by Joseph Lister and his revolutionary system of antiseptic surgery. This paper describes how a young Canadian medical man came to introduce Lister's system to North America in 1869 and studies his career in the light of Lister's surgical epoch.

Antisepsis↗

PubMed1999

Clinical correlation of a skin antisepsis model.

The use of pigskin as a test substrate for evaluating topical antimicrobial activity has been developed. Simulated handwashing protocols with this in vitro model in parallel with in vivo studies have been evaluated, based on an ASTM method for the clinical evaluation of a healthcare personnel handwash. Using Serratia marcescens as the test organism, similar log reductions were observed using the in vitro model when compared to in vivo efficacy. Results suggest that this model can be used as a reliable indicator of antiseptic efficacy on the skin. The use of sterilized skin simplifies the use of this model for both efficacy and skin-pathogen interaction studies.

Adolescent↗

PubMed1975

Prophylaxis against infection and septicemia in parenteral nutrition via central intravenous catheter.

Catheter sepsis has become a serious problem due to increased use of parenteral nutrition. A well functioning catheter system, where a minimum of manipulations are necessary, is of great importance from a prophylatic point of view. Meticulous aseptic and antiseptic technique must be observed in all handling of the catheter system. Daily sterilization by flambage with alcohol flame of the connection in the catheter system, where the most important risk of contamination exists, is recommended.

Antisepsis↗

PubMed1979

[Antiseptics and aseptics in changing times].

The history of wound healing is a series of errors not to be understood today. Historical aspects of anti- and aseptis are dealt with; the merits of Ignaz Semmelweis, Joseph Lister and Robert Koch are stressed; conclusions for the time being are drawn.

Antisepsis↗

PubMed1981

Nosocomial infection control: scope and implications for health care--a historical view.

Knowing where we have come from helps to decide where we should be going. Many principles and practices of modern infection control were developed in the nineteenth and early twentieth century. The story is one of halting, yet relentless, progress. The history of these discoveries and their application to infection control, then and now, is described, such as principles of hygiene, antiseptic surgery, antimicrobial therapy, and improved hospital design. Many of the issues today are not new, nor are some of the fundamental solutions. An acceptance of this historical continuum may temper expectations and make us more accepting of change.

Antisepsis↗

PubMed1977

Safety of Hibitane. II. Human experience.

Chlorhexidine has been widely used in medical practice since its introduction on to the marked in the early 1950s. Primarily it has been used for topical antisepsis, e.g. pre-surgery skin preparation, burns prophylaxis, and prior to obstetrical/gynaecological procedures. This extensive experience has demonstrated the virtual absence of sensitization and a low irritancy potential for the compound. Only one significant adverse effect has been identified during medical use, namely, the production of sensorineural deafness after direct instillation into the middle ear, a property shared by several commonly used antiseptics. The encouraging reports of the use of chlorhexidine for plaque control prompted further safety investigations. It has been shown that absorption after oral ingestion is very low, and long-term oral use has not produced changes in haematological and biochemical parameters. Occasional oral intolerance of mouthrinse formulations has been reported, although no histological abnormalities were present in gingival biopsies taken after 18 months' daily use. Very occasionally, a reversible swelling of the parotid glands has been reported after use of chlorhexidine in mouthrinse formulations, but not after other methods of administration. Tooth discoloration, which shows wide inter-individual variation is seen after all dental formulations. This undesirable cosmetic effect would appear to represent the only significant argument against everyday prophylactic oral use of chlorhexidine.

Administration, Oral↗

PubMed1982

Evaluation of aseptic techniques and chlorhexidine on the rate of catheter-associated urinary-tract infection. Southampton Infection Control Team.

Aseptic techniques used together with chlorhexidine reduced the infection rate and prevented cross-infection in patients undergoing urinary-tract catheterisation. Infection of the bladder appears to have arisen by contamination of the catheter-meatal junction, at which site antiseptic prophylaxis in the presence of bathing was ineffective. Patients having short-term catheterisation should not be placed in baths, since wetting the perineum will contaminate the urethral meatus with mixed enterobacteria, predisposing the female patient in particular to infection.

Aged↗

PubMed2004

Evidence-based nursing practice to prevent infection in hospitalized neutropenic patients with cancer.

PURPOSE/OBJECTIVES: To review studies that have assessed the effectiveness of selected nursing interventions used in hospitals to prevent healthcare-associated infections in neutropenic patients with cancer. DATA SOURCES: Literature review of low microbial diets, protective clothing and environments, personal hygiene, and oral care in English-language articles from PubMed; the Cumulative Index of Nursing and Allied Health Literature; the National Guideline Clearinghouse, 1980-June 2003; and Cochrane Database of Systematic Reviews. DATA SYNTHESIS: Few studies have demonstrated the effectiveness of low microbial food and water and protective environments and clothing in reducing infections in neutropenic patients with cancer, and hospitals vary in these practices. Skin antisepsis reduces microbial counts, but data regarding the effect on infections are lacking. Many studies were characterized by insufficient sample sizes or use of multiple interventions. CONCLUSIONS: Major gaps exist in empirical evidence regarding which nursing interventions might be helpful in preventing or controlling healthcare-associated infections in neutropenic patients. IMPLICATIONS FOR NURSING: Although the evidence base for clinical practices such as a low microbial diet, protective environments and clothing, and special skin antisepsis regimens is weak, some of these practices seem prudent and reasonable. Until further evidence is available, clinicians can use consensus guidelines and should assist in identifying clinical practices that require additional research. Ultimately, interventions with little or no demonstrated efficacy should be examined systematically or abandoned. Additional studies of sufficient sample size regarding nursing practices such as the role of protective environments, room placement, antiseptic bathing, and prevention and treatment of oral complications are indicated. Because of difficulties in randomization and risk stratification, rigorous observational studies often may be an acceptable alternative to clinical trials.

Anti-Infective Agents, Local↗

PubMedDate not supplied

[From miasmata to germs. The impact of bacteriology on medical practice in Canadian territory from 1870 to 1930].

This article analyzes some aspects concerning the introduction of bacteriological theory and practice into Canadian territory from 1870 to 1930. The author begins by presenting the principal explanatory models characterizing the transition period from pre-bacteriological discourse--referring to infectious diseases and surgical infections--to new bacteriological paradigms. He goes on to analyze the different ways in which the germ theory and then bacteriology spread into Canadian territory. The transition periods, where old and new coexisted, reveal a kind of syncretism by physicians in relation to both aetiology of infectious diseases and surgical procedures. The author then shows that there were two distinct phases in the overall context of the history of antiseptic surgery from 1868 to 1890. He demonstrates that the use of antiseptics did not necessarily mean either adherence to Pasteur's postulates on fermentation or strict observance of Listerian methods. Finally, the article expounds on the role played by European institutions in importing bacteriological knowledge and institutionalizing this new discipline in Canadian territory.

Antisepsis↗

PubMed2006

Are antiseptic-coated central venous catheters effective in a real-world setting?

BACKGROUND: Catheter-related bloodstream infections are common, costly, and morbid. Randomized controlled trials indicate that antiseptic-coated central venous catheters reduce infection rates. OBJECTIVE: To assess the clinical and economic effectiveness of antiseptic-coated catheters for critically ill patients in a real-world setting. METHODS: Central venous catheters coated with chlorhexidine/silver-sulfadiazene were introduced in all patients requiring central venous access in adult intensive care units at the University of Michigan Health System, a large, tertiary care teaching hospital. A pretest-posttest cohort design measured the primary outcome of catheter-related bloodstream infection rate, comparing the 2 years prior to the intervention with the 2 years following the intervention. We also evaluated cost-effectiveness and changes in vancomycin use. RESULTS: The intervention was associated with a 4% per month relative reduction in the incidence of catheter-related bloodstream infection, after controlling for the effects of time. Overall, a 35% relative risk reduction (P < .0003) in the catheter-related bloodstream infection rate occurred in the posttest phase. The use of antiseptic-coated catheters reduced costs more than $100,000 annually. Vancomycin use was less in units in which antiseptic catheters were used compared with wards in which these catheters were not used. CONCLUSION: Antiseptic-coated catheters appear to be clinically effective and economically efficient in a real-world setting.

Anti-Bacterial Agents↗

PubMed2004

Jan Mikulicz-Radecki (1850-1905): pioneer of endoscopy and surgery of the sinuses, throat, and digestive tract.

The authors described the medical achievements of Jan Antoni Mikulicz-Radecki--a famous surgeon and laryngologist of Polish origin, belonging to the Viennese surgical school of Prof. Theodor Billroth at the turn of the 20th century. His scientific and clinical activity in Vienna, Cracow, Konigsberg, and Wroclaw resulted in 232 publications and several new surgical methods. He changed the opinion on scleroma and described benign lymphoepithelial lesions. He was one of the authors of modern aseptics, antisepsis in surgery, and is regarded as a pioneer of endoscopic procedures. He was interested mainly in thoracic surgery, surgery of the abdomen, orthopedics, and laryngology. Mikulicz was the first to describe the method of surgical treatment of the maxillary sinus, osteoplastic surgery of the nose, esophagoscopy, and lateral pharyngotomy in tonsil carcinoma. Prof. Mikulicz was the first to perform thoracic surgery; he performed the first pyloroplasty, the first partial esophagectomy and gave rise to antiseptic procedures and general surgical management. He described many modifications of surgical operations and he constructed the esophagoscope, scoliozymeter, and many other useful surgical devices.

Austria↗

PubMed1992

[The antiseptic role of saliva].

The oral flora is under the control of both immunity and non specific defense factors. The immunity factors are mostly represented by polymorphonuclears immunoglobulins Non specific defense factors include lysozyme lactoferrin high molecular weight proteins, such as mucins fibronectin and beta 2 microglobulin histidine rich proteins cystatins salivary amylases salivary peroxidase system.

Antisepsis↗

PubMed2006

Fires in the operating room and intensive care unit: awareness is the key to prevention.

Recent recommendations from the Centers for Disease Control (CDC) to use alcohol-based substances for hand hygiene and skin antisepsis could introduce new fire hazards in the operating room (OR). This potential for an increase in the number of fires in the hospital setting with wide spread use of alcohol-based agents warrants heightened awareness of the risks and implementation of safety measures when using these agents. Here, we report a patient who, during a tracheostomy, sustained severe burns resulting from a fire in the OR. In this case, the use of an alcohol-based antiseptic was the major contributing factor to the surgical fire.

Aged↗

PubMed2004

Alcohol-based handrub: evaluation of technique and microbiological efficacy with international infection control professionals.

BACKGROUND AND OBJECTIVE: The Centers for Disease Control and Prevention has published a new guideline on hand hygiene promoting the use of the alcohol-based handrub, but the technique was not addressed. The goal of this study was to evaluate the influence of technique on the efficacy of the alcohol-based handrub. PARTICIPANTS: Healthcare workers (HCWs) attending a course in hospital epidemiology. METHODS: A fluorescent dye was added to a hand antiseptic, and hands were checked under ultraviolet light after antiseptic cleansing. Data regarding the numbers of predefined fluorescent areas on the skin were collected in addition to demographic data such as age, gender, job description, and job experience. Results of the visualization test were compared with the data from microbiological samples before and after the procedure by the hand plate technique. RESULTS: Sixty HCWs were tested, 63% of whom had worked in infection control for more than 10 years. Sixty-six percent of all participants still had detectable bacteria after antisepsis. The mean log10 CFU reduction was 2.0 (range, 0-3.85). Twenty-five percent of all HCWs achieved less than 1.1 log10 CFU. Staphylococcus aureus was isolated from 13% (one of them being methicillin resistant) and gram-negative bacilli from 6.7%. After using the alcohol handrub, one subject still remained positive for S. aureus. Years of experience was the single most important factor predicting antimicrobial efficacy. CONCLUSIONS: Technique is of crucial importance in hand antisepsis. Major deficiencies were detected among even highly trained HCWs. Training should be provided before switching from handwashing to the alcohol handrub

Adult↗

PubMed1997

Prevention of catheter-associated urinary tract infection by meatal disinfection.

The incidence of catheter-associated urinary tract infections (UTIs) becomes higher with prolongation of the indwelling period of a catheter. As to the entry of bacteria, ascending UTIs have now attracted attention. In the present study. the metal area was examined bacteriologically and the possibility to use antiseptics for blocking the route of developing infections was investigated. The subjects included 72 patients with an indwelling, urethral catheter inserted post-operatively. These patients were divided into three groups treated with once or twice daily application of povidone-iodine or once daily application of povidone-iodine cream. In these groups, the relation between changes in isolation of bacteria from the meatal area and the incidence of UTI was evaluated. It was found that reduction in bacterial count by antisepsis is effective to prevent ascending UTIs. Moreover, once daily application of povidone-iodine was proven to be effective in male patients. The effective antisepsis in females was twice daily application of povidone-iodine.

Anti-Infective Agents, Local↗

PubMed2007

Antisepsis.

All dialysis treatments include a certain risk of infection because of the decreased immune defenses of the patients and because of dialytic techniques that increase the potential of microbial contamination. Peritoneal dialysis, and in particular continuous ambulatory peritoneal dialysis (CAPD), has a higher risk of infections of the peritoneum, but even of the subcutaneous tunnel. These infections are caused by environmental microorganisms principally gram-positives (Staphylococcus epidermidis and Staphylococcus aureus). We tested three active ingredients, electrolytic chloroxidizer, iodine and chlorhexidine gluconate. It is evident that because of the large spectrum of activity, the good effectiveness even at the lowest concentration, coupled with good tolerability (and to the fact of not causing allergic reactions) the electrolytic chloroxidizer appears to be an ideal antiseptic in CAPD.

Anti-Infective Agents, Local↗