Mycobacterium szulgai keratitis cau...

Mycobacterium szulgai keratitis caused according to contaminated ice water

Clinical Infectious Diseases, April 15 2002

After pair patients who underwent laser-assisted in situ keratomileusis (LASIK) in the same facility lay opened keratitis caused by Mycobacterium szulgai, a retrospective sway study was conducted. (1) All patients who underwent the measure from November 2000 through March 2001 were evaluated for evidence of infection. The steps and techniques used by the surgeon were reviewed, and environmental samples were obtained from all potential water sources.

Findings. Of the 52 patients who underwent 92 LASIK courses during the study period, seven patients were rest to have infection caused by way of Mycobacterium szulgai. Five culture-positive cases and sum of two units probable cases were identified among the 18 patients onward whom physician A performed 30 processs No cases were identified among the 34 patients in succession whom physician B performed 62 conducts No breeches of surgical technique were identified, and the sole apparent technical difference between the physicians' technique was in the preparation of the sterile saline lavage solution. Physician A used a sterile syringe fitted with an ocular lavage tip that was chilled upon the surface of a tub sated of ice obtained from an ice machine. Environmental civilizations from the ice machine drain revealed Mycobacterium szulgai genetically identical to the isolates reclaimed from the five culture-positive patients.

Clinical implications. The likely way of exposure was contamination of the lavage tip on melted ice water from the surface of the syringe or mollifyed ice water falling onto the surgical field as the assistant passed the chilled syringe to the surgeon At at hand the risk of using chilled saline for this practice appears to outweigh the potential benefits. Perioperative nurtures should review these findings with surgeon who perform LASIK and remember them when participating in measures in which ice is used.

Malnutrition and its event on wound healing

Orthopedics, April 2002

This close attention determined the incidence of preoperative malnutrition, the correlation between abnormal nutrition and delayed pain healing, and the validity of the Rainey McDonald nutritional index in patients admitted for hip and knee replacement arthroplasty. (2) The nutritional status of 40 consecutive patients who underwent joint replacement performed at the same surgeon was assessed by means of serological markers 12 to 24 hours before surgery Serum albumin of les than 35 g by means of dL, serum transferrin of 200 mg by dL, and total lymphocyte account of less than 1,500 lonely dwellings per [mm.sup.3] were considered indicators of malnutrition. Likewise, a negative value onward the Rainey McDonald nutritional index was considered an indicator of malnutrition.

Findings. The incidence of preoperative malnutrition was 40% Sixteen patients had at least united abnormal serological marker, 10% serum albumin, 30% serum transferrin, and 175% total lymphocyte judge The Rainey McDonald nutritional index revealed a negative value in 10% of patients. All patients had healthy surgical scars after line of junction removal 14 to 15 days after surgery The researchers believe that the negative power of malnutrition on wound healing was prostrate by surgeon-dependent factors, including use of antibiotic prophylaxis, surgical technique, the OR environment, and skin and harm care.

Clinical implications. Despite the high incidence of malnutrition, no delayed pang healing was noted. Perioperative promotes however, must understand that malnutrition has been documented as a resistless risk factor for delayed torture healing and implement measures to make secure that nutritional assessment and counseling is leadershiped in the early preoperative period. Similarly, they must make sure that antibiotic prophylaxis is administered in a timely manner, that all staff members adhere to surgical sterility principles, and that the environment is maintained in a sanitary manner. Perioperative feeds also must facilitate thorough patient teaching and effective postoperative hurt care.

Using a seven-day incubation period for biological indicators

Infection dominion government and Hospital Epidemiology, July 2002

This thought evaluated fluorescent readout results of sum of two units different types of biological indicators in the one and the other 132[degrees]C (269.6[degrees]F) gravity displacement and 132[degrees]C (2696[degrees]F) vacuum-assisted steam sterilization round of yearss using full and fractional periods (3) Growth data were compared to seven-day incubation revolution of times This study also evaluated a strange automated rapid fluorescent reader.

During the thought biological indicators were placed in a specific sterilizer using a standardized protocol for the two types of indicators. A positive dominion government was run each day. After period completion, the indicators were remov placided and inserted into the automated reader After this reading, indicators were transferred to an aerobic incubator expansion results were recorded at 24 hours for the first pattern of indicator, at 48 hours for the other type of indicator, and at seven days for as well-as; not only-but also; not only-but; not alone-but Any indicators showing negative fluorescent be the effects but positive growth were subcultur The fresh reader was not used for the seven-day incubation period.