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The British Journal of Surgery Jan 2017Surgical-site infection (SSI) occurs in 1-10 per cent of all patients undergoing surgery; rates can be higher depending on the type of surgery. The aim of this review... (Review)
Review
BACKGROUND
Surgical-site infection (SSI) occurs in 1-10 per cent of all patients undergoing surgery; rates can be higher depending on the type of surgery. The aim of this review was to establish whether (or not) surgical hand asepsis, intraoperative skin antisepsis and selected surgical dressings are cost-effective in SSI prevention, and to examine the quality of reporting.
METHODS
The authors searched MEDLINE via Ovid, CINAHL via EBSCO, Cochrane Central and Scopus databases systematically from 1990 to 2016. Included were RCTs and quasi-experimental studies published in English, evaluating the economic impact of interventions to prevent SSI relative to surgical hand and skin antisepsis, and wound dressings. Characteristics and results of included studies were extracted using a standard data collection tool. Study and reporting quality were assessed using SIGN and CHEERS checklists.
RESULTS
Across the three areas of SSI prevention, the combined searches identified 1214 articles. Of these, five health economic studies evaluating the cost-effectiveness of selected surgical dressings were eligible. Study authors concluded that the interventions being assessed were cost-effective, or were potentially cost-saving. Still, there is high uncertainty around the decision to adopt these dressings/devices in practice. The studies' reporting quality was reasonable; three reported at least 15 of the 24 CHEERS items appropriately. Assessment of methodological quality found that two studies were considered to be of high quality.
CONCLUSION
With few economic studies undertaken in this area, the cost-effectiveness of these strategies is unclear. Incorporating economic evaluations alongside RCTs will help towards evidence-informed decisions.
Topics: Bandages; Cost-Benefit Analysis; Humans; Negative-Pressure Wound Therapy; Surgical Wound Infection
PubMed: 28121042
DOI: 10.1002/bjs.10428 -
Acute Medicine & Surgery 2022Surgical site infections (SSIs) and catheter-related bloodstream infections (CRBSIs) caused by bacteria from surfaces poorly disinfected with chlorhexidine gluconate... (Review)
Review
Surgical site infections (SSIs) and catheter-related bloodstream infections (CRBSIs) caused by bacteria from surfaces poorly disinfected with chlorhexidine gluconate (CHG) and povidone-iodine (PVP-I) are increasing. Olanexidine gluconate (OLG) was developed in 2015 in Japan to prevent SSI and CRBSI caused by bacteria resistant to CHG and PVP-I. This scoping review aimed to identify the knowledge gap between what is known and what is not known about the disinfection efficacy of OLG. We searched MEDLINE through PubMed, the Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the International Clinical Trials Registry Platform search database, ClinicalTrials.gov, and the Web-based database of Japanese medical articles for works published to July 18, 2021. Manual reference searches were also carried out. A total of 131 studies were screened. Forty-seven studies were included in this review and classified into two major categories: studies on pharmacological effects and spectrum ( = 29) and studies on clinical and adverse effects ( = 18). Olanexidine gluconate showed bactericidal activity against methicillin-resistant and vancomycin-resistant enterococci, in addition to common Gram-positive and Gram-negative bacteria. In clinical settings, although there is limited evidence on SSI prevention, 1.5% OLG might be more effective than 10% PVP-I and 1% CHG in preventing SSI. However, the clinical usefulness of OLG is unclear due to the limited number of clinical studies. Also, clinical research is limited to studies targeting SSI prevention, and there are no clinical studies on CRBSI. Further clinical studies are needed on SSI and CRBSI prevention.
PubMed: 35028157
DOI: 10.1002/ams2.723 -
Frontiers in Bioengineering and... 2021The integrity of soft tissue seal is essential for preventing peri-implant infection, mainly induced by established bacterial biofilms around dental implants. Nowadays,...
The integrity of soft tissue seal is essential for preventing peri-implant infection, mainly induced by established bacterial biofilms around dental implants. Nowadays, graphene is well-known for its potential in biocompatibility and antisepsis. Herein, a new titanium biomaterial containing graphene (Ti-0.125G) was synthesized using the spark plasma sintering (SPS) technique. After material characteristics detection, the subsequent responses of human gingival fibroblasts (HGFs) and multiple oral pathogens (including , , and ) to the graphene-reinforced sample were assessed, respectively. Also, the dynamic change of the bacterial multispecies volume in biofilms was evaluated using absolute quantification PCR combined with Illumina high-throughput sequencing. Ti-0.125G, in addition to its particularly pronounced inhibitory effect on at 96 h, was broadly effective against multiple pathogens rather than just one strain. The reinforced material's selective responses were also evaluated by a co-culture model involving HGFs and multiple strains. The results disclosed that the graphene-reinforced samples were highly effective in keeping a balance between the favorable fibroblast responses and the suppressive microbial growth, which could account for the optimal soft tissue seal in the oral cavity. Furthermore, the underlying mechanism regarding new material's bactericidal property in the current study has been elucidated as the electron transfer, which disturbed the bacterial respiratory chain and resulted in a decrease of microbial viability. According to the Kyoto Encyclopedia of Genes and Genomes (KEGG) database, the PICRUSt tool was conducted for the prediction of microbial metabolism functions. Consequently, it is inferred that Ti-0.125G has promising potentials for application in implant dentistry, especially in enhancing the integrity of soft tissue and improving its resistance against bacterial infections around oral implants.
PubMed: 33928075
DOI: 10.3389/fbioe.2021.665305 -
Revista Brasileira de Enfermagem 2023to assess the effect of an educational intervention based on clinical simulation on nursing professionals' compliance with practices to prevent peripherally inserted...
OBJECTIVES
to assess the effect of an educational intervention based on clinical simulation on nursing professionals' compliance with practices to prevent peripherally inserted central venous catheter-associated primary bloodstream infections in a Neonatal Intensive Care Unit.
METHODS
a quasi-experimental study, with preand post-intervention assessment with a single group. The population consisted of 41 nursing professionals, with 31 observations being made before and after the intervention. Analyzes were performed using descriptive statistics and the McNemar non-parametric test. A significance level of 5% was adopted.
RESULTS
after the intervention, there was an increase in compliance with prevention practices of surgical antisepsis and professional hand hygiene, skin antisepsis with chlorhexidine, waiting for the time of the effect of alcoholic chlorhexidine and compliance with the sterile technique.
CONCLUSIONS
the educational intervention showed an effect on increasing compliance with catheter-associated infection prevention practices.
Topics: Humans; Infant, Newborn; Catheter-Related Infections; Catheterization, Central Venous; Central Venous Catheters; Chlorhexidine; Intensive Care Units, Neonatal; Guideline Adherence; Infection Control; Education, Nursing
PubMed: 37820143
DOI: 10.1590/0034-7167-2022-0574 -
Journal of Bone and Joint Infection 2017Prosthetic joint infection (PJI) is a serious complication after total joint arthroplasty (TJA). Chlorhexidine is a widely used antiseptic because of its rapid and... (Review)
Review
Prosthetic joint infection (PJI) is a serious complication after total joint arthroplasty (TJA). Chlorhexidine is a widely used antiseptic because of its rapid and persistent action. It is well tolerated and available in different formulations at various concentrations. Chlorhexidine can be used for pre-operative skin cleansing, surgical site preparation, hand antisepsis of the surgical team and intra-articular irrigation of infected joints. The optimal intra-articular concentration of chlorhexidine gluconate in irrigation solution is 2%, to provide a persistent decrease in biofilm formation, though cytotoxicity might be an issue. Although chlorhexidine is relatively cheap, routine use of chlorhexidine without evidence of clear benefits can lead to unnecessary costs, adverse effects and even emergence of resistance. This review focuses on the current applications of various chlorhexidine formulations in TJA. As the treatment of PJI is challenging and expensive, effective preparations of chlorhexidine could help in the prevention and control of PJI.
PubMed: 28529860
DOI: 10.7150/jbji.16934 -
International Journal of Antimicrobial... Oct 2020Acanthamoebae are facultative parasites causing rare but serious infections such as keratitis and encephalitis and are also known as vectors for several bacterial...
Acanthamoebae are facultative parasites causing rare but serious infections such as keratitis and encephalitis and are also known as vectors for several bacterial pathogens, including legionellae and pseudomonads. Acanthamoeba cysts are particularly resilient and enable the amoebae to withstand desiccation and to resist disinfection and therapy. While the search for new therapeutic options has been intensified in the past years, hand and surface disinfectants as well as topical antiseptics for preventing infections have not been studied in detail to date. The aim of this study was to screen well-known and commonly used antimicrobial products in various formulations and different concentrations for their efficacy against Acanthamoeba trophozoites and cysts, including aliphatic alcohols, quaternary ammonium compounds (QACs), peracetic acid (PAA), potassium peroxymonosulfate sulfate (PPMS) and octenidine dihydrochloride (OCT). Of all products tested, OCT and QACs showed the highest efficacy, totally eradicating both trophozoites and cysts within 1 min. The determined 50% effective concentration (EC) for cysts was 0.196 mg/mL for OCT and 0.119 mg/mL for QACs after 1 min of exposure. PAA and PPMS showed reliable cysticidal efficacies only with prolonged incubation times of 30 min and 60 min, respectively. Aliphatic alcohols generally had limited efficacy, and only against trophozoites. In conclusion, OCT and QACs are potent actives against Acanthamoeba trophozoites and cysts at concentrations used in commercially available products, within contact times suitable for surface and hand disinfection as well as topical antisepsis.
Topics: Acanthamoeba; Acanthamoeba Keratitis; Alcohols; Antiparasitic Agents; Disinfectants; Disinfection; Hand Disinfection; Humans; Imines; Peracetic Acid; Pyridines; Quaternary Ammonium Compounds; Sulfuric Acids; Trophozoites
PubMed: 32739477
DOI: 10.1016/j.ijantimicag.2020.106122 -
EFORT Open Reviews Oct 2020Rates of peri-prosthetic joint infection (PJI) in primary total hip and total knee arthroplasty range between 0.3% and 1.9%, and up to 10% in revision cases. Significant... (Review)
Review
Rates of peri-prosthetic joint infection (PJI) in primary total hip and total knee arthroplasty range between 0.3% and 1.9%, and up to 10% in revision cases. Significant morbidity is associated with this devastating complication, the economic burden on our healthcare system is considerable, and the personal cost to the affected patient is immeasurable.The risk of surgical site infection (SSI) and PJI is related to surgical factors and patient factors such as age, body mass index (BMI), co-morbidities, and lifestyle. Reducing the risk of SSI in primary hip and knee arthroplasty requires a multi-faceted strategy including pre-operative patient bacterial decolonization, screening and avoidance of anaemia, peri-operative patient warming, skin antisepsis, povidone-iodine wound lavage, and anti-bacterial coated sutures.This article also considers newer concepts such as the influence of bearing surfaces on infection risk, as well as current controversies such as the potential effects of blood transfusion, laminar flow, and protective hoods and suits, on infection risk. Cite this article: 2020;5:604-613. DOI: 10.1302/2058-5241.5.200004.
PubMed: 33204502
DOI: 10.1302/2058-5241.5.200004 -
Journal of Chemical Information and... Oct 2021Lipopolysaccharide (LPS) is the primary component of the outer leaflet of Gram-negative bacterial outer membranes. LPS elicits an overwhelming immune response during... (Review)
Review
Lipopolysaccharide (LPS) is the primary component of the outer leaflet of Gram-negative bacterial outer membranes. LPS elicits an overwhelming immune response during infection, which can lead to life-threatening sepsis or septic shock for which no suitable treatment is available so far. As a result of the worldwide expanding multidrug-resistant bacteria, the occurrence and frequency of sepsis are expected to increase; thus, there is an urge to develop novel strategies for treating bacterial infections. In this regard, gaining an in-depth understanding about the ability of LPS to both stimulate the host immune system and interact with several molecules is crucial for fighting against LPS-caused infections and allowing for the rational design of novel antisepsis drugs, vaccines and LPS sequestration and detection methods. Molecular dynamics (MD) simulations, which are understood as being a computational microscope, have proven to be of significant value to understand LPS-related phenomena, driving and optimizing experimental research studies. In this work, a comprehensive review on the methods that can be combined with MD simulations, recently applied in LPS research, is provided. We focus especially on both enhanced sampling methods, which enable the exploration of more complex systems and access to larger time scales, and free energy calculation approaches. Thereby, apart from outlining several strategies for surmounting LPS-caused infections, this work reports the current state-of-the-art of the methods applied with MD simulations for moving a step forward in the development of such strategies.
Topics: Bacterial Infections; Bacterial Outer Membrane; Humans; Lipopolysaccharides; Molecular Dynamics Simulation; Sepsis
PubMed: 34559524
DOI: 10.1021/acs.jcim.1c00613 -
Heliyon Nov 2023Sepsis is an abnormal immune response to infections and can trigger MODS. Despite the availability of advanced clinical techniques and monitoring methods, the mortality... (Review)
Review
Sepsis is an abnormal immune response to infections and can trigger MODS. Despite the availability of advanced clinical techniques and monitoring methods, the mortality rate of the disease is still high, posing a heavy burden to patients and the whole society. Hence, the research on novel drugs and targets is particularly important. As a natural phyto-flavonoid, apigenin boasts anti-inflammatory, antioxidant, anti-cancer, anti-viral, and anti-bacterial effects. Besides, experiments and animal models have also revealed the crucial role of apigenin in the treatment of infectious diseases and sepsis. In this context, this paper reviews the pharmacological activity and underlying mechanisms of action of apigenin in sepsis treatment and organ protection, as well as the potential apigenin-based therapeutic strategies against sepsis. Therefore, this review will shed new light on the scientific research and clinical treatment of sepsis.
PubMed: 38045180
DOI: 10.1016/j.heliyon.2023.e22290