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Antibiotics (Basel, Switzerland) Mar 2022In many parts of the world, antiseptic agents remain non-indicated in chronic wound care. In the current context of bacterial resistance to antibiotics and the... (Review)
Review
In many parts of the world, antiseptic agents remain non-indicated in chronic wound care. In the current context of bacterial resistance to antibiotics and the development of new-generation antiseptic agents, wound antisepsis represents an asset for the prevention of wound infection. We aimed to evaluate four common antiseptic agents in chronic wound care complete healing. The review protocol was based on the Cochrane Handbook for Systematic Reviews of Intervention and devised in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement guidelines. Five databases and three clinical trials registries were searched from inception to 30 June 2021 without language restrictions. We included randomised trials evaluating the efficacy of antiseptic agents in chronic wound care in adults. Interventions considered were those using antiseptics for cleansing or within a dressing. Risk of bias was assessed using the bias excel tool provided by the Bristol Academy. Evidence quality was assessed using Grading of Recommendation Assessment, Development and Evaluation (GRADE) criteria. Of 838 studies, 6 were finally included, with a total of 725 patients. The included studies assessed iodine (cadexomer or povidone iodine) ( = 3), polyhexanide ( = 2), and octenidine ( = 1). Limited evidence suggested a better wound healing completion with iodine compared to saline (two randomised controlled trials (RCT), 195 patients, pooled RR 1.85 (95%CI (1.27 to 2.69)), moderate-quality evidence). There was not enough evidence to suggest a difference in wound healing using octenidine or polyhexamide. None of the antiseptic agents influenced adverse event occurrence compared to saline.
PubMed: 35326813
DOI: 10.3390/antibiotics11030350 -
Journal of Pharmacy & Pharmaceutical... 2009To review microbial contamination rates about preparation of individual and batch doses using aseptic techniques within pharmaceutical (controlled) and clinical (ward... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To review microbial contamination rates about preparation of individual and batch doses using aseptic techniques within pharmaceutical (controlled) and clinical (ward and theatre) environments.
METHODS
Systematic review, involving amalgamation of data using a random effect model and metaanalysis.
RESULTS
A total of 19 studies from 17 reports (7277 doses), mostly single arm studies, were identified for analysis. The overall contamination rates for doses prepared in clinical environments were found to be 5.0% (95% CI; 1.8%, 13.1%, n = 8 studies) for individual doses and 2.0% (95% CI; 0.3%, 13.1%; n = 5) for doses prepared as part of a batch. Rates for doses prepared in pharmaceutical environments were found to be 1.9% (95% CI; 0.8%, 4.2%; n = 5) for individual doses and 0.0% (95% CI; 0.0%, 0.8%; n= 1) for doses prepared as part of a batch. The results indicate greater overall contamination rates of doses prepared in clinical than pharmaceutical environments, in those prepared individually than in batch preparation, and in those in which additions rather than no additions were made. Significant differences were only found between pharmaceutical and clinical environments for batch doses, and between batch and individual doses prepared in a pharmaceutical environment. The studies differed substantially in sample size, interventions and comparison conditions, especially in the clinical setting. The quality of the data was judged to be low.
CONCLUSION
Contamination rates in clinical and pharmaceutical environments were commonly found to be unacceptably high. Intuitive recommendations for reducing contamination rates by carrying out the procedures in a pharmaceutical environment using batch doses are supported by an evidence base that needs to be strengthened further.
Topics: Asepsis; Drug Compounding; Drug Contamination; Environment, Controlled; Pharmaceutical Preparations; Pharmaceutical Services; Risk
PubMed: 19732500
DOI: 10.18433/j3jp4b -
The Orthopedic Clinics of North America Jan 2023Skin antisepsis, such as ready-to-use, no-rinse, 2% chlorhexidine-impregnated cloths, is one of the fundamental cornerstones for reducing periprosthetic infections after... (Meta-Analysis)
Meta-Analysis Review
The Utility of Chlorhexidine Cloth Use for the Prevention of Surgical Site Infections in Total Hip Arthroplasty and Surgical as well as Basic Science Applications: A Meta-Analysis and Systematic Review.
Skin antisepsis, such as ready-to-use, no-rinse, 2% chlorhexidine-impregnated cloths, is one of the fundamental cornerstones for reducing periprosthetic infections after primary lower extremity total joint arthroplasties. This systematic review presents background material concerning the problem and methods to deal with and then describes the use of chlorhexidine cloth prophylaxis related to various surgical applications. The authors found an almost universal benefit of the cloths. In the meta-analysis, the total pooled effect showed a reduction in infection rates. The use of chlorhexidine cloths is appropriate for prophylaxis for knee arthroplasty, hip arthroplasty, and a variety of other surgeries.
Topics: Humans; Chlorhexidine; Arthroplasty, Replacement, Hip; Surgical Wound Infection; Anti-Infective Agents, Local; Preoperative Care
PubMed: 36402512
DOI: 10.1016/j.ocl.2022.08.004 -
Injury Jun 2020Surgical hand rubbing (SHR) and surgical hand scrubbing (SHS) are two common methods used by surgeons to reduce surgical site infections. To date, the optimal method... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
Surgical hand rubbing (SHR) and surgical hand scrubbing (SHS) are two common methods used by surgeons to reduce surgical site infections. To date, the optimal method that can effectively reduce these infections remains unknown. In this study, we performed a comprehensive statistical analysis to compare the efficacy of these two methods in effectively controlling surgical site infections.
METHODS
A systemic review and meta-analysis was performed by mining literature from major databases, including Pubmed, Embase, Cochrane library, Ovid and Google Scholar, and recruiting studies published between 1980 and 1st April 2019. Analysis was performed using Revman, version 5.3, software, and focused on primary outcomes that included colony-forming unit (CFU) counts and logarithmic reduction of CFU after hand antisepsis and after surgery.
RESULTS
Seven clinical trials met our inclusion criteria, with a total of 764 healthcare workers analyzed. We found no statistically significant differences between the two methods with regards to CFU counts and logarithmic reduction of CFU after hand antisepsis and surgery, as well as antisepsis and surgery times.
CONCLUSION
From the literature, it was evident that SHR had similar efficacy to SHS, without necessarily increasing costs. Owing to advantages such as ease of application, exposure to less dermal irritation, and less time consumption, SHR is recommended as a cost-effective alternative for management of surgical site infections.
Topics: Anti-Infective Agents, Local; Antisepsis; Clinical Trials as Topic; Colony Count, Microbial; Hand; Hand Disinfection; Humans; Operative Time; Surgical Wound Infection
PubMed: 32331847
DOI: 10.1016/j.injury.2020.03.007 -
International Journal of Surgery... Mar 2017This meta-analysis aims to assess the incidences of surgical site infection of patients who applied preadmission chlorhexidine skin preparation, versus those who applied... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This meta-analysis aims to assess the incidences of surgical site infection of patients who applied preadmission chlorhexidine skin preparation, versus those who applied the traditional skin preparation before undergoing total knee and hip arthroplasty.
METHODS
A systematic search is carried out through Medline (1966-2016.11), PubMed (1966-2016.11), Embase (1980-2016.11), ScienceDirect (1985-2016.11) and the Cochrane Library. Only high quality studies are identified. Meta-analysis is conducted with the use of Stata 11.0 software.
RESULTS
One RCT and five retrospective studies, published between 2010 and 2016, are included in the present meta-analysis. The present meta-analysis indicates that there are significant differences in surgical site infection rate (RD = -0.02, 95% CI: -0.02 to -0.01, P < 0.00001), revision surgery rate (RD = -0.01, 95% CI: -0.01 to -0.01, P < 0.00001) and length of stay (MD = -0.29, 95% CI: -0.48 to -0.11, P = 0.002) between groups.
CONCLUSION
Preoperative chlorhexidine skin preparation appears to reduce the risk of infection, the incidence of revision surgery, and the length of stay for patients undergoing total knee and hip arthroplasty. No adverse effects, such as DVT or PE, appear to be related to chlorhexidine preparation. Due to the limited quality of the evidence currently available, high quality RCTs with better study designs, larger sample sizes and longer follow-ups are needed.
Topics: Anti-Infective Agents, Local; Antisepsis; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Chlorhexidine; Cross Infection; Humans; Incidence; Preoperative Care; Reoperation; Retrospective Studies; Surgical Wound Infection
PubMed: 28189811
DOI: 10.1016/j.ijsu.2017.02.004 -
The Journal of Knee Surgery Jul 2022Surgical site infections (SSIs) are among the most prevalent and devastating complications following lower extremity total joint arthroplasty (TJA). Strategies to reduce...
Surgical site infections (SSIs) are among the most prevalent and devastating complications following lower extremity total joint arthroplasty (TJA). Strategies to reduce the rates can be divided into preoperative, perioperatives, and postoperative measures. A multicenter trial is underway to evaluate the efficacy of implementing a bundled care program for SSI prevention in lower extremity TJA including: (1) nasal decolonization; (2) surgical skin antisepsis; (3) antimicrobial incise draping; (4) temperature management; and (5) negative-pressure wound therapy for selected high-risk patients. The purposes of this systematic review were to provide a background and then to summarize the available evidence pertaining to each of these SSI-reduction strategies with special emphasis on total knee arthroplasty. A systematic review of the literature was conducted in accordance with the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. Five individual literature searches were performed to identify studies evaluating nasal decolonization temperature management, surgical skin antisepsis, antimicrobial incise draping, and negative-pressure wound therapy. The highest level of evidence reports was used in each product review, and if there were insufficient arthroplasty papers on the particular topic, then papers were further culled from the surgical specialties to form the basis for the review. There was sufficient literature to assess all of the various prophylactic and preventative techniques. All five products used in the bundled program were supported for use as prophylactic agents or for the direct reduction of SSIs in both level I and II studies. This systematic review showed that various pre-, intra-, and postoperative strategies are efficacious in decreasing the risks of SSIs following lower extremity TJA procedures. Thus, including them in the armamentarium for SSI-reduction strategies for hip and knee arthroplasty surgeons should decrease the incidence of infections. We expect that the combined use of these products in an upcoming study will support these findings and may further enhance the reduction of total knee arthroplasty SSIs in a synergistic manner.
Topics: Anti-Bacterial Agents; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Humans; Lower Extremity; Multicenter Studies as Topic; Negative-Pressure Wound Therapy; Surgical Wound Infection
PubMed: 34875715
DOI: 10.1055/s-0041-1740394 -
Systematic Reviews Jan 2019Architectural division of aseptic and septic operating theatres is a distinct structural feature of surgical departments in Germany. Internationally, hygienists and...
BACKGROUND
Architectural division of aseptic and septic operating theatres is a distinct structural feature of surgical departments in Germany. Internationally, hygienists and microbiologists mainly recommend functional separation (i.e. aseptic procedures first) without calling for separate operating floors and rooms. However, patients with severe musculoskeletal infections (e.g. joint empyema, spondylodiscitis, deep implant-associated infections) may benefit from the permanent availability of septic operating capacities without delay caused by an ongoing aseptic surgical program. A systematic literature review on the influence of a structural separation of septic and aseptic operating theatres on process and/or outcome quality has not yet been conducted.
METHODS
Systematic literature search in PubMed MEDLINE, Ovid Embase, CINAHL and the Cochrane Library, screening of referenced citations, and assessment of grey literature.
RESULTS
A total of 572 articles were found through the systematic literature search. No head-to-head studies (neither randomised, quasi-randomised nor observational) were identified which examined the impact of structural separation of septic and aseptic operating theatres on process and/or outcome quality.
CONCLUSIONS
This review did not identify evidence in favour nor against architectural separation of septic or aseptic operating theatre. Specifically, there is no evidence of a harmful effect of architectural separation. Unless prospective studies, ideally randomised trials, will be available, it is unjustified to call for abolishing established hospital structures. Future investigations must address patient-centered endpoints, surgical site infections, process quality and hospital economy.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO (International prospective register of systematic reviews): CRD42018086568.
Topics: Asepsis; Cross Infection; Drug Resistance, Multiple; Equipment Contamination; Germany; Hospital Design and Construction; Humans; Infection Control; Operating Rooms; Outcome and Process Assessment, Health Care; Prosthesis-Related Infections; Quality Improvement; Time Factors; Wound Healing
PubMed: 30626433
DOI: 10.1186/s13643-018-0937-9 -
Journal of Global Antimicrobial... Sep 2021Chronic wound infections may delay the healing process and are responsible for a significant burden on healthcare systems. Since inappropriate management may commonly... (Review)
Review
OBJECTIVES
Chronic wound infections may delay the healing process and are responsible for a significant burden on healthcare systems. Since inappropriate management may commonly occur in the care of these patients, this review aims to provide a practical guide underlining actions to avoid in the management of chronic wound infections.
METHODS
We performed a systematic review of the literature available in PubMed in the last 10 years, identifying studies regarding the management of patients with chronic wound infections. A panel of experts discussed the potential malpractices in this area. A list of 'Don'ts', including the main actions to be avoided, was drawn up using the 'Choosing Wisely' methodology.
RESULTS
In this review, we proposed a list of actions to avoid for optimal management of patients with chronic wound infections. Adequate wound bed preparation and wound antisepsis should be combined, as the absence of one of them leads to delayed healing and a higher risk of wound complications. Moreover, avoiding inappropriate use of systemic antibiotics is an important point because of the risk of selection of multidrug-resistant organisms as well as antibiotic-related adverse events.
CONCLUSION
A multidisciplinary team of experts in different fields (surgeon, infectious disease expert, microbiologist, pharmacologist, geriatrician) is required for the optimal management of chronic wound infections. Implementation of this approach may be useful to improve the management of patients with chronic wound infections.
Topics: Anti-Bacterial Agents; Humans; Wound Healing; Wound Infection
PubMed: 34144200
DOI: 10.1016/j.jgar.2021.05.010 -
Surgical Infections Apr 2017The purpose of the study was to identify patient-specific and procedure-specific risk and protective factors associated with post-operative surgical site infections... (Review)
Review
BACKGROUND
The purpose of the study was to identify patient-specific and procedure-specific risk and protective factors associated with post-operative surgical site infections (SSIs) among surgical spine patients.
METHODS
CINAHL, PubMed, Ovid, Medline, and EBSCO databases were searched for articles within the past 10 years (January 2003-March 2015). The keywords and combinations used in the search included: Spine surgery, post-operative infection, risk factors, orthopedic infections. The search resulted in 842 articles of which 29 met inclusion criteria. This systematic review adheres to preferred reporting items for systematic reviews and meta-analyses guidelines.
RESULTS
Evidence about patient-specific and procedure-specific factors associated with increased risk of post-operative SSIs among patients undergoing orthopedic spinal surgery is inconclusive. Gender (male), age, body mass index, cigarette smoking, diabetes mellitus, a history of infection and alcohol abuse were identified as common patient-specific risk factors. Blood transfusion, implantation, and steroid use were found to increase SSIs in certain studies and associated with no significant difference in other studies. Protective factors include the implementation of pre-operative elements to reduce infection; protocols addressing patient-related factors (smoking, weight, glucose) and operation-related factors (antibiotic prophylaxis, prosthetics, length of operation, and pre-operative cultures); incision drains placed intra-operatively; anterior approach; laminar-flow operating theater, and skin antisepsis using chlorhexidine.
CONCLUSIONS
Interventions focusing on minimizing patient-specific risk factors and operation-specific risk factors and optimizing patient-specific protective factors and operation-specific protective factors are most effective in minimizing the likelihood of a post-operative infection among patients undergoing orthopedic spinal surgical procedures. The studies reviewed provide conflicting evidence relative to risk and protective factors.
Topics: Humans; Protective Factors; Risk Factors; Spinal Diseases; Spinal Injuries; Surgical Wound Infection
PubMed: 28394747
DOI: 10.1089/sur.2016.183 -
Journal of Vascular Surgery Jul 2007The aim of this systematic review and meta-analysis was to determine the effectiveness of perioperative strategies to prevent infection in patients undergoing peripheral... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The aim of this systematic review and meta-analysis was to determine the effectiveness of perioperative strategies to prevent infection in patients undergoing peripheral arterial reconstruction.
METHODS
All randomized controlled trials (RCTs) evaluating measures intended to reduce or prevent infection in arterial surgery were identified through searches of the Cochrane Peripheral Vascular Diseases Group specialized trials register, the Cochrane Central Register of Controlled Trials (CENTRAL), and reference lists of relevant articles. Two authors independently selected and assessed the quality of included trials. Relative risk (RR) was used as a measure of effect for each dichotomous outcome.
RESULTS
The study included 34 RCTs. Of these, 22 were trials of prophylactic systemic antibiotics, 3 of rifampicin-bonded grafts, 3 of preoperative skin antisepsis, 2 of suction wound drainage, 2 of minimally invasive in situ bypass techniques, and individual trials of intraoperative glove change and wound closure techniques. Wound infection or early graft infection outcomes were recorded in all trials. Only two trials, both of rifampicin bonding, followed up graft infection outcomes to 2 years. Prophylactic systemic antibiotics reduced the risk of wound infection (RR, 0.25; 95% confidence interval [CI], 0.17 to 0.38) and early graft infection in a fixed-effect model (RR, 0.31; 95% CI, 0.11 to 0.85, P = .02). Antibiotic prophylaxis for >24 hours appeared to be of no added benefit (RR, 1.28; 95% CI, 0.82 to 1.98). There was no evidence that prophylactic rifampicin bonding to Dacron grafts reduced graft infection at 1 month (RR, 0.63; 95% CI, 0.27 to 1.49), or 2 years (RR, 1.05; 95% CI, 0.46 to 2.40). There was no evidence of a beneficial or detrimental effect on rates of wound infection with suction groin wound drainage (RR, 0.96; 95% CI, 0.50 to 1.86) or from preoperative bathing with antiseptic agents compared with unmedicated bathing (RR, 0.97; 95% CI, 0.70 to 1.36).
CONCLUSIONS
There is clear evidence of the benefit of prophylactic broad-spectrum antibiotics for vascular reconstruction. Many other interventions intended to reduce the risk of infection in arterial reconstruction lack evidence of effectiveness.
Topics: Anti-Infective Agents; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Antisepsis; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Drug Administration Schedule; Humans; Peripheral Vascular Diseases; Prosthesis Design; Prosthesis-Related Infections; Rifampin; Risk Assessment; Risk Factors; Suction; Surgical Wound Infection; Treatment Outcome
PubMed: 17606135
DOI: 10.1016/j.jvs.2007.02.065