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Surgical Infections Dec 2016Surgical site infections (SSI) remain a significant problem to both the patients and the healthcare system. Value care and standardized quality measures continue to... (Review)
Review
BACKGROUND
Surgical site infections (SSI) remain a significant problem to both the patients and the healthcare system. Value care and standardized quality measures continue to promote improvement in surgical asepsis, but certain debates remain unresolved in the field of surgical hand antisepsis.
METHODS
Review of relevant accounts and literature.
RESULTS
Controversy has existed regarding the U.S. Food and Drug Administration (FDA)'s 1994 Tentative Final Monograph (TFM), which defined how surgical hand antisepsis products are assessed. Issues involving neutralizers and demonstration of a cumulative effect were addressed in the FDA's Proposed Rule in 2015. Few studies have used SSI as a primary outcome and instead have used a surrogate marker (colony-forming units [CFU]). Quantitative microbiology studies suggest a minimum bacterial inoculum of 10-10 CFU/mL is necessary to cause a clinical infection. Outcomes of antisepsis likely are driven by both active ingredient(s) and overall product formulation. Povidone-iodine aqueous scrubs are inferior to chlorhexidine gluconate (CHG) 4% aqueous scrubs and alcohol-based rubs (ABR). The SSI and CFU outcomes studies support the equivalence or superiority of ABR over CHG.
CONCLUSIONS
Both ABRs and CHG 4% are preferred to povidone-iodine for surgical hand antisepsis. Well-powered randomized controlled trials measuring SSI as a primary outcome, as well as those designed according to either TFM or European methodology, with appropriate controls and neutralizers, are warranted. These trials should incorporate different ABR formulations and CHG 4%, as well as skin tolerance assessments and a cost analysis.
Topics: Anti-Infective Agents, Local; Antisepsis; Hand Disinfection; History, 19th Century; History, 20th Century; History, 21st Century; Humans; Practice Guidelines as Topic; Preoperative Care; Surgical Wound Infection
PubMed: 27508334
DOI: 10.1089/sur.2016.085 -
Vestnik Rossiiskoi Akademii... 2000
Review
Topics: Anti-Infective Agents, Local; Antisepsis; Asepsis; Disease Transmission, Infectious; Humans; Surgical Wound Infection
PubMed: 11202647
DOI: No ID Found -
Nursing Mirror and Midwives Journal Dec 1947
Topics: Antipyrine; Antisepsis; Asepsis
PubMed: 18919385
DOI: No ID Found -
The American Surgeon Jun 2018Surgical antisepsis and asepsis established the standard of using scientific evidence to determine surgical practice. The microbiological discoveries of Louis Pasteur...
Surgical antisepsis and asepsis established the standard of using scientific evidence to determine surgical practice. The microbiological discoveries of Louis Pasteur (1822-1895) were the inspiration for Joseph Lister's (1827-1912) use of carbolic acid as an antiseptic on surgical wounds. German and Swiss surgeons invented aseptic surgical practice based on the studies of Robert Koch (1843-1910), a life-saving revolution in medicine as profound as anesthesia. Together they changed human history, sparing millions the horrors of hospital gangrene and making the entire body accessible to surgical intervention. In the United States, surgeons followed the lead of their brethren across the Atlantic. Americans, characteristically pragmatic, naturally resisted what they saw as unnecessary complexity in Listerism. Once they accepted germ theory, the undeniable scientific evidence led to the rapid acceptance of asepsis. Among the wide-ranging effects of this transition in practice were the creation of the current model of the academic department of surgery and the modern concept of surgical professionalism.
Topics: Antisepsis; Asepsis; Europe; General Surgery; History, 19th Century; History, 20th Century; Humans; United States
PubMed: 29981599
DOI: No ID Found -
The Surgical Clinics of North America Apr 1956
Topics: Antisepsis; Asepsis
PubMed: 13371486
DOI: 10.1016/s0039-6109(16)34827-7 -
The Canadian Nurse Mar 1959
Topics: Antisepsis; Asepsis; Humans; Skin
PubMed: 13652049
DOI: No ID Found -
Journal of the American Medical... Dec 1953
Topics: Antisepsis; Asepsis; Intestines
PubMed: 13108639
DOI: 10.1001/jama.1953.02940340018007 -
American Journal of Public Health and... Nov 1967
Topics: Antisepsis; England; General Surgery; History, 19th Century; History, 20th Century
PubMed: 4861736
DOI: 10.2105/ajph.57.11.1899 -
The American Journal of Nursing Sep 1958
Topics: Antisepsis; Asepsis; Disinfection; Humans
PubMed: 13559298
DOI: No ID Found -
Revista de La Facultad de Ciencias... 1974
Topics: Antisepsis; Asepsis
PubMed: 4469653
DOI: No ID Found