Operation Field Contamination During Intraoperative Fluoroscopy

Background: intraoperative C-arm fluoroscopy is commonly performed during traumatic orthopedic surgeries. The C-arm sterile drape is often used in cases of contamination of the operative field following postoperative infection. The aim of the present study was to investigate operation field contamination during traumatic orthopedic surgeries and evaluate the factors, especially intraoperative fluoroscopy, which affect operation field contamination. Methods: sterile 5% sheep blood Columbia agar plates were used to simulate the operation field. The C-arm was moved over the operation field in different grade clean operating rooms, simulating intraoperative fluoroscopy. The agar plates were then incubated and assessed for bacterial colony growth. Results: our results showed significant differences between the 3rd grade clean operating room and the 2nd or 1st grade clean operating rooms in the risk of operation field contamination. Nevertheless, there were no significant differences in the operation field contamination between the C-arm drape group and the control group. Conclusions: we conclude that C-arm equipment can be used without the drape during orthopedic surgeries to avoid contact with the operation field.

Contamination and current practice in decontamination pof nebulisers in ventilated patients

To examine the incidence of contamination and current practice of decontamination of nebulisers after use within a ventilator circuit, in public- and private sector intensive care units (ICUs) in Johannesburg; to assess the presence of and adherence to a decontamination protocol in these ICUs and to identify which practices were associated with lower or no bacterial growth. Methods: A cross-sectional study design was used which included a semi-structured interview with the ICU manager and an audit of current nebuliser practice. Nebulisers that were identified in the interview were swabbed and streaked on blood agar plates (BAPs). BAPs were incubated and assessed for bacterial colonisation, number of colony forming units (CFUs) and number of different species of CFUs present. Results: Two hundred and sixty-nine ICU beds were surveyed over a two-month period resulting in 45 nebulisers used within a ventilator circuit that could be tested. The majority (93%) were single-use jet nebulisers, all were being re-used and 52% presented with contamination. None of the ICUs had a nebuliser decontamination protocol in place. Contaminated nebulisers that were stored in a sterile drape had significantly higher concentrations of bacterial growth (p=0.03). Conclusion: The rate of colonisation of re-used jet nebulisers is high. Nebuliser decontamination protocols are urgently needed.

Lead Contamination of Surgical Gloves by Contact with a Lead Hand

Background. “Lead hands” are frequently used to maintain hand and finger position in hand surgery. The malleability and strength of lead make it ideal for this purpose. The aim of this study was to determine the amount of lead transferred to a surgeon's glove during handling of a lead hand. Method. Sterile surgical gloves were wiped over the surface of a lead hand. The number of wipes was varied, the gloves were then sent to a trace elements laboratory, and the lead content transferred to each glove was determined. Results. The amount of lead transferred to each glove increased with increasing exposure to the lead hand. After twenty wipes, up to 2 mg of lead was transferred to the surgeon's glove. Covering the lead hand with a sterile drape markedly reduced the lead transferred to the surgeon's glove. Conclusion. Significant amount of lead is transferred on to the gloves after handling a lead hand. This risks wound contamination and a foreign body reaction. Covering the lead hand with a sterile drape may minimise the risk of surgical wound contamination.

Prevention of Central Venous Catheter–Related Bloodstream Infections Using Non-Technologic Strategies

Objective:To evaluate the incidence of nosocomial bacteremias related to the use of non-impregnated central venous catheters (CVCs) when only non-technologic strategies were used to prevent them.Design:This was a prospective study of infectious complications of CVCs placed in intensive care unit (ICU) patients from April 1997 to December 2001.Setting:The medical–surgical ICU of a tertiary-care, university-affiliated hospital in Argentina.Methods:We studied all patients admitted to the ICU using non-impregnated CVCs. Maximal sterile barrier precautions (ie, use of cap, mask, sterile gown, sterile gloves, and large sterile drape), strict handwashing, preparation of the patients' skin with antiseptic solutions, insertion and management of catheters by trained personnel, and continuing quality improvement programs aimed at appropriate insertion and maintenance of catheters were employed.Results:During the study period, 2,525 patients were admitted to the ICU. Eight hundred sixty-eight patients had 1,037 CVCs inserted. The number of CVC-related bloodstream infections (BSIs), acquired in the ICU, was 2.7 per 1,000 CVC-days (13 nosocomial CVC-related BSIs during 4,770 days of CVC use). Microorganisms isolated included methicillin-susceptible Staphylococcus aureus (n = 6), methicillin-resistant S. aureus (n = 2), coagulase-negative methicillin-resistant Staphylococcus (n = 2), Escherichia coli (n = 1), Klebsiella pneumoniae (n = 1), and Enterobacter cloacae (n = 1).Conclusions:A low rate of catheter-related BSI was achieved without antimicrobial-impregnated catheters. The incidence of CVC-associated bacteremias corresponded to the 10th to 20th percentile range of the National Nosocomial Infections Surveillance System hospitals for the same type of ICU.

Prevention of Central Venous Catheter–Related Bloodstream Infections Using Non-Technologic Strategies

Objective: To evaluate the incidence of nosocomial bacteremias related to the use of non-impregnated central venous catheters (CVCs) when only non-technologic strategies were used to prevent them. Design: This was a prospective study of infectious complications of CVCs placed in intensive care unit (ICU) patients from April 1997 to December 2001. Setting: The medical–surgical ICU of a tertiary-care, university-affiliated hospital in Argentina. Methods: We studied all patients admitted to the ICU using non-impregnated CVCs. Maximal sterile barrier precautions (ie, use of cap, mask, sterile gown, sterile gloves, and large sterile drape), strict handwashing, preparation of the patients' skin with antiseptic solutions, insertion and management of catheters by trained personnel, and continuing quality improvement programs aimed at appropriate insertion and maintenance of catheters were employed. Results: During the study period, 2,525 patients were admitted to the ICU. Eight hundred sixty-eight patients had 1,037 CVCs inserted. The number of CVC-related bloodstream infections (BSIs), acquired in the ICU, was 2.7 per 1,000 CVC-days (13 nosocomial CVC-related BSIs during 4,770 days of CVC use). Microorganisms isolated included methicillin-susceptible Staphylococcus aureus (n = 6), methicillin-resistant S. aureus (n = 2), coagulase-negative methicillin-resistant Staphylococcus (n = 2), Escherichia coli (n = 1), Klebsiella pneumoniae (n = 1), and Enterobacter cloacae (n = 1). Conclusions: A low rate of catheter-related BSI was achieved without antimicrobial-impregnated catheters. The incidence of CVC-associated bacteremias corresponded to the 10th to 20th percentile range of the National Nosocomial Infections Surveillance System hospitals for the same type of ICU.