Pioneers of the transition from antiseptic to aseptic surgery.
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Resulting from the infectiologically established novel definition of antiseptic which contains the local application of antiseptics for prophylactical, preventive or therapeutical indication on skin, mucous membrane, wounds, in body cavities or on surgical exposed resp. opened endosomatic areas the antiseptical indications in a branch of dermatology and venereal diseases are represented. With the analysis of the actual knowledge in vitro and in vivo requirements to local antiinfectiva are defined combined with the recommendations for the clinical use. At present mainly prophylactically used agents are submitted to an benefit risk analysis with refer to the choice of agents. There by agents for the application on skin as well as on genitals, in mouth cavity and on wounds were taken into consideration.
OBJECTIVE: To compare the efficacy of 0.3% stabilized glutaraldehyde and alcohol (SG+A), 0.3% SG and water (SG+W), and 4% chlorhexidine gluconate tincture (CG+A), as skin disinfectants in dogs undergoing ovariohysterectomy. STUDY DESIGN: Prospective, blinded clinical study. ANIMALS: One hundred and twenty-one dogs. METHODS: Cutaneous bacterial colony forming units (CFU) from the perioperative site after skin preparation, after antisepsis, and after surgery (incisional and paramedian), were quantified. The influence of high initial bacterial counts (> or =150 CFU) and surgical time on antibacterial efficacy was examined and the proportion of dogs from which Staphylococcus intermedius was cultured, determined. Perioperative skin reactions and wound infections were documented. RESULTS: All 3 antiseptic solutions significantly and equally reduced CFU to all post-antisepsis sampling levels irrespective of surgical duration (mean surgical times 151.6, 136.2, and 149.6 minutes for CG+A, SG+A and SG+W, respectively). Median percentage reductions in CFU ranged between 99.3% and 100%. In dogs with initial high counts and disinfected with CG+A and SG+W, the incisional samples had significantly higher counts than the post-antisepsis samples. In the CG+A and SG+W groups, the proportion of post-surgery samples yielding S. intermedius was significantly higher at the incisional than the paramedian sites. Eight mild cutaneous reactions were recorded in equal proportions for the 3 solutions. There were no recorded infections. CONCLUSIONS: All 3 preparations had an equal ability to reduce and maintain low CFU counts, with minimal cutaneous reactions. CLINICAL RELEVANCE: SG solutions are safe and effective preoperative skin antiseptics for elective clean-contaminated surgical procedures.
An underpinning tenet of evidence-based practice is that all routine practices should be open to scrutiny. Questioning practice should not be limited to new, experimental procedures, but should also include examination of 'tried and trusted' techniques. Taking this perspective, the author recently contributed to a systematic review evaluating the use of antiseptics preoperatively.
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12.5% solution of betadine is used for conjunctival sac antiseptics. To estimate effectiveness of betadine in 50 eyes, bacteriological examination was performed before and after local betadine application. Betadine is effective against Staphylococcus. Peptococcaceae were cultured after betadine application, in 3 cases.
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Therapeutic acts often surgically practised in the dental office can lead to the transmission of infectious diseases such as A.I.D.S. To prevent this, the authors propose guideline base acts for antisepsis and asepsis. In conclusion, the authors exhort for an integration of these antiseptic acts in the efficient working of the dental office for an effective prevention of these infectious diseases in the area.
Indications and contraindications of local application of PVP-iodine in accident surgery were obtained on account of own investigations and the study of literature. For disinfection aqueous solutions of PVP-iodine do not have a complete antimicrobial spectrum. Only alcoholic PVP-iodine-solutions have complete spectra. Using alcoholic PVP-iodine-solutions to disinfect usually hands for surgery or hygiene the resorption of iodine is evident. This may cause disturbances of the thyroid gland. Disinfecting the area of surgery in one patient the resorption of iodine is tolerable. In contrary PVP-iodine today is needed for antisepsis especially in purulent situations. Additionally PVP-iodine is still the antiseptic of choice in the treatment of burn injuries. But because of the resorption of iodine the danger of hyperthyroidism in the group of patients with high risk must be kept in mind. Contraindications for the antiseptic therapy with PVP-iodine result from the investigations concerning the cytotoxicity and resorption of iodine. The application of PVP-iodine to rinsing fluids during aseptic operations, in the treatment of peritonitis or in suction drainages are not recommended any more.
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