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Background and AimsUltrasound(US) guided techniques have been preferably used for peripheral nerve blocks. However, to follow aspetic measures for these procedures is still challenging. The purpose of this re audit is to know the best compliance of the doctors to the asepsis protocols defined on the basis of quality improvement audit done in September 2021 for peripheral nerve blocks using US machine.MethodsThis was an observational study done in a tertiary Hospital of Dublin in one month duration. A questionnaire was handed to the anesthetic nurses and data was collected with respect to the type of block performed, aseptic techniques employed and the use of monitoring.ResultsA total of 42 blocks were included in this study; single shot (100%), lower limb blocks (88%) were in majority. Aseptic techniques outlined by the Association of Anesthetists of Great Britain and Ireland were followed 100%inall cases including use of sterile gloves, drapes, skin decontamination , hand washing and the use of sterile gel and probe cover, except the use of sterile gown(20%). In comparison to the last audit in 2017, the percentages were as follows: Use of sterile gloves (93%), drapes (85%), skin decontamination (93%), sterile gowns(0%)and sterile probe cover(91%). Interestingly, Level 2 monitoring was done by 100% block performers both times.ConclusionsIn comparison to previous audit, asepsis protocols except for sterile gowns were strictly followed by all the block performers and it has markedly reduced the chances of cross contamination.

The currently accepted assumption that most surgical site infections (SSIs) occurring after elective surgery under standard methods of antisepsis are due to an intraoperative contamination event, remains unproven. We examined the available evidence in which microbial cultures of surgical wounds were taken at the conclusion of an operation and determined that such studies provide more evidence to refute that an SSI is due to intraoperative contamination than support it. We propose that alternative mechanisms of SSI development should be considered, such as when a sterile postoperative wound becomes infected by a pathogen originating from a site remote from the operative wound—eg, from the gums or intestinal tract (ie, the Trojan Horse mechanism). We offer a path forward to reduce SSI rates after elective surgery that includes undertaking genomic-based microbial tracking from the built environment (ie, the operating room and hospital bed), to the patient's own microbiome, and then to the surgical site. Finally, we posit that only by generating this dynamic microbial map can the true pathogenesis of SSIs be understood enough to inform novel preventive strategies against infection following elective surgery in the current era of asepsis.

Infection prevention is a critical aspect of healthcare, particularly in perioperative settings. This comprehensive literature review explores the role of nurses in maintaining asepsis and preventing infections during surgical procedures. The study focuses on the application of aseptic techniques within surgical units in the KSA region, where nearly 90,000 surgeries were performed in 2016. The purpose of this review was to develop an aseptic checklist for registered nurses in the perioperative units in KSA. The literature review covers key topics such as perioperative nursing, asepsis, aseptic conscience, sterility, personal hygiene, and protective equipment. The findings emphasize the importance of proper hand hygiene, including surgical hand disinfection and handwashing, as well as the appropriate use of personal protective equipment like aprons, gowns, face masks, and gloves. Maintaining an aseptic conscience among staff is crucial for minimizing infection transmission risk. Operating rooms should be meticulously prepared, and unnecessary movement in and out of the room should be minimized. Perioperative nurses play a vital role in infection prevention, with scrub nurses maintaining the sterility of the surgical field and instruments and circulating nurses overseeing the aseptic practices of the entire surgical team. The final aseptic checklist, informed by the literature review, comprises two themes with 10 true/false statements each and one additional theme with five true/false statements. Regular assessments of nurses' knowledge of aseptic practices should be conducted, and the checklist could be integrated into daily practices across different perioperative units to enhance patient safety and minimize infection risk.

Background and AimsUltrasound(US) guided techniques have been preferably used for peripheral nerve blocks. However, to follow aspetic measures for these procedures is still challenging. The purpose of this re audit is to know the best compliance of the doctors to the asepsis protocols defined on the basis of quality improvement audit done in September 2021 for peripheral nerve blocks using US machine.MethodsThis was an observational study done in a tertiary Hospital of Dublin in one month duration. A questionnaire was handed to the anesthetic nurses and data was collected with respect to the type of block performed, aseptic techniques employed and the use of monitoring.ResultsA total of 42 blocks were included in this study; single shot (100%), lower limb blocks (88%) were in majority. Aseptic techniques outlined by the Association of Anesthetists of Great Britain and Ireland were followed 100%inall cases including use of sterile gloves, drapes, skin decontamination , hand washing and the use of sterile gel and probe cover, except the use of sterile gown(20%). In comparison to the last audit in 2017, the percentages were as follows: Use of sterile gloves (93%), drapes (85%), skin decontamination (93%), sterile gowns(0%)and sterile probe cover(91%). Interestingly, Level 2 monitoring was done by 100% block performers both times.ConclusionsIn comparison to previous audit, asepsis protocols except for sterile gowns were strictly followed by all the block performers and it has markedly reduced the chances of cross contamination.

In this single-center trial comparing chlorhexidine–alcohol with iodine–alcohol for skin antisepsis before cesarean delivery, the use of chlorhexidine–alcohol resulted in a risk of surgical-site infection that was significantly lower than that associated with iodine–alcohol. Cesarean delivery is the most common major surgical procedure among women in the United States. 1 In 2013, more than 32.7% (1.3 million) of the 3.9 million births were by cesarean section. 2 Surgical-site infections complicate 2 to 5% of all surgical procedures and 5 to 12% of cesarean deliveries. 3 – 6 Infection occurring after delivery places an extra burden on the new mother and may impair mother–infant bonding and breast-feeding. The average attributable hospital cost per surgical-site infection after cesarean delivery is estimated to be $3,529. 7 The skin is a major source of pathogens that cause surgical-site infections. Therefore, preoperative skin antisepsis . . .

Intravascular-catheter-related infections are frequent life-threatening events in health care, but incidence can be decreased by improvements in the quality of care. Optimisation of skin antisepsis is essential to prevent short-term catheter-related infections. We hypothesised that chlorhexidine–alcohol would be more effective than povidone iodine–alcohol as a skin antiseptic to prevent intravascular-catheter-related infections. In this open-label, randomised controlled trial with a two-by-two factorial design, we enrolled consecutive adults (age ≥18 years) admitted to one of 11 French intensive-care units and requiring at least one of central-venous, haemodialysis, or arterial catheters. Before catheter insertion, we randomly assigned (1:1:1:1) patients via a secure web-based random-number generator (permuted blocks of eight, stratified by centre) to have all intravascular catheters prepared with 2% chlorhexidine–70% isopropyl alcohol (chlorhexidine–alcohol) or 5% povidone iodine–69% ethanol (povidone iodine–alcohol), with or without scrubbing of the skin with detergent before antiseptic application. Physicians and nurses were not masked to group assignment but microbiologists and outcome assessors were. The primary outcome was the incidence of catheter-related infections with chlorhexidine–alcohol versus povidone iodine–alcohol in the intention-to-treat population. This study is registered with ClinicalTrials.gov, number NCT01629550 and is closed to new participants. Between Oct 26, 2012, and Feb 12, 2014, 2546 patients were eligible to participate in the study. We randomly assigned 1181 patients (2547 catheters) to chlorhexidine–alcohol (594 patients with scrubbing, 587 without) and 1168 (2612 catheters) to povidone iodine–alcohol (580 patients with scrubbing, 588 without). Chlorhexidine–alcohol was associated with lower incidence of catheter-related infections (0·28 vs 1·77 per 1000 catheter-days with povidone iodine–alcohol; hazard ratio 0·15, 95% CI 0·05–0·41; p=0·0002). Scrubbing was not associated with a significant difference in catheter colonisation (p=0·3877). No systemic adverse events were reported, but severe skin reactions occurred more frequently in those assigned to chlorhexidine–alcohol (27 [3%] patients vs seven [1%] with povidone iodine–alcohol; p=0·0017) and led to chlorhexidine discontinuation in two patients. For skin antisepsis, chlorhexidine–alcohol provides greater protection against short-term catheter-related infections than does povidone iodine–alcohol and should be included in all bundles for prevention of intravascular catheter-related infections. University Hospital of Poitiers, CareFusion.

Issues arising in wound healing are very common, and chronic wound infections affect approximately 1.5% of the population. The main substances used in wound washing, cleansing and treatment are antiseptics. Today, there are many compounds with a known antiseptic activity. Older antiseptics (e.g., boric acid, ethacridine lactate, potassium permanganate, hydrogen peroxide, iodoform, iodine and dyes) are not recommended for wound treatment due to a number of disadvantages. According to the newest guidelines of the Polish Society for Wound Treatment and the German Consensus on Wound Antisepsis, only the following antiseptics should be taken into account for wound treatment: octenidine (OCT), polihexanide (PHMB), povidone-iodine (PVP-I), sodium hypochlorite (NaOCl) and nanosilver. This article provides an overview of the five antiseptics mentioned above, their chemical properties, wound applications, side effects and safety.

PurposeWhether skin disinfection of the surgical site using chlorhexidine-alcohol is superior to povidone-iodine-alcohol in reducing reoperation and surgical site infection rates after major cardiac surgery remains unclear.MethodsCLEAN 2 was a multicenter, open-label, randomized, two-arm, assessor-blind, superiority trial conducted in eight French hospitals. We randomly assigned adult patients undergoing major heart or aortic surgery via sternotomy, with or without saphenous vein or radial artery harvesting, to have all surgical sites disinfected with either 2% chlorhexidine-alcohol or 5% povidone-iodine-alcohol. The primary outcome was any resternotomy by day 90 or any reoperation at the peripheral surgical site by day 30.ResultsOf 3242 patients (1621 in the chlorhexidine-alcohol group [median age, 69 years; 1276 (78.7%) men] and 1621 in the povidone-iodine-alcohol group [median age, 69 years; 1247 (76.9%) men], the percentage required reoperation within 90 days was similar (7.7% [125/1621] in the chlorhexidine-alcohol group vs 7.5% [121/1621] in the povidone-iodine-alcohol group; risk difference, 0.25 [95% confidence interval (CI), − 1.58–2.07], P = 0.79). The incidence of surgical site infections at the sternum or peripheral sites was similar (4% [65/1621] in the chlorhexidine-alcohol group vs 3.3% [53/1621] in the povidone-iodine-alcohol group; risk difference, 0.74 [95% CI − 0.55–2.03], P = 0.26). Length of hospital stay, intensive care unit or hospital readmission, mortality and surgical site adverse events were similar between the two groups.ConclusionAmong patients requiring sternotomy for major heart or aortic surgery, skin disinfection at the surgical site using chlorhexidine-alcohol was not superior to povidone-iodine-alcohol for reducing reoperation and surgical site infection rates.

Globally breast cancer is the leading cause of cancer death among women. The breast consists of epithelium, stroma and a mucosal immune system that make up a complex microenvironment. Growing awareness of the role of microbes in the microenvironment recently has led to a series of findings important for human health. The microbiome has been implicated in cancer development and progression at a variety of body sites including stomach, colon, liver, lung and skin. In this study, we assessed breast tissue microbial signatures in intraoperatively obtained samples using 16S rDNA hypervariable tag sequencing. Our results indicate a distinct breast tissue microbiome that is different from the microbiota of breast skin tissue, breast skin swabs and buccal swabs. Furthermore, we identify distinct microbial communities in breast tissues from women with cancer as compared to women with benign breast disease. Malignancy correlated with enrichment in taxa of lower abundance including the genera Fusobacterium, Atopobium, Gluconacetobacter, Hydrogenophaga and Lactobacillus . This work confirms the existence of a distinct breast microbiome and differences between the breast tissue microbiome in benign and malignant disease. These data provide a foundation for future investigation on the role of the breast microbiome in breast carcinogenesis and breast cancer prevention.

Antibiotika-Fehlverordung im großen Stil: Multiresistenzen und Todesfälle durch nosokomiale Infektionen sind inzwischen Alltagsthemen in der Publikumspresse wie im Fernsehen. Wie konnte es soweit kommen? Und vor allem: Was kann der einzelne Arzt dagegen tun?