Using vancomycin for perioperative ...

Using vancomycin for perioperative prophylaxis

Emerging Infectious Diseases, September/October 2001

This inquiry assessed outcomes and costs associated with discouraging the routine use of vancomycin as a perioperative prophylaxis. (1) A cost-effectiveness analysis using a hypothetical cohort of 10000 patients undergoing coronary artery bypass grafting deeds was conducted. A decision-analytic archetype was developed to calculate the clinical benefits and preciousnesss associated with three strategies--no prophylaxis; routine use of cefazolin with the exception of use of vancomycin for patients with a history of allergic reaction to beta-lactam; and routine use of vancomycin. Univariate and multivariate analyses were careered to assess the cost effectiveness of the three strategies.

Findings, Overall, using vancomycin was effective and les expensive than using cefazolin or no prophylaxis. It was associated with the fewest unfathomable and superficial surgical site infections and the fewest deaths.

Clinical Implications. Vancomycin use as a prophylactic, especially in cardiac surgery may increase. National initiatives to decrease the use of vancomycin mostly likely will be reevaluated because of this and other studies documenting the superiority of vancomycin use as a prophylaxis in cardiac surgery festers need to understand that the antibiotic must be available in sufficient time in like manner that it can be given slowly generally from one side of to the other one hour. The effectiveness of prophylaxis securitys on having adequate concentration of the antibiotic in the offspring before the incision is made, Prophylaxis must begin between 30 minutes to sum of two units hours before the incision. Adverse reactions, including r neck syndrome can come if the prophylactic is administered too rapidly.

Transmitting hepatitis B from surgeon to patient

Infection mastery and Hospital Epidemiology, June 2002

This retrospective cohort inquiry conducted in the Netherlands, a land with a low incidence of hepatitis B virus infection, examined hepatitis B virus transmission from a general surgeon to his patients during a four-year period. (2) The surgeon was a known nonresponder after hepatitis B vaccination, had been infected more than l0 years previously, and was not experimented for hepatitis B surface antigen (HBsAg) until agreeing to participate in this application of mind High, medium, and low risk performances were defined based on complexity, invasiveness, potential risk of frontage to the surgeon, and classification of the procedure

Findings. A stored serum sample drawn from the surgeon in 1989 and standarded in 1999 revealed that the surgeon had positive HBsAg and hepatitis Be antibody. From 1994 to 1999 the surgeon performed 2010 surgical acts on 1,803 patients. Transmission of hepatitis B was confirmed in eight patients, probable in sum of two units patients, and possible in 18 patients. Of the 51 managements performed by the surgeon upon these 28 patients, 39% were classified as high risk, 20% as medium risk, and 41% as depressed risk.

Clinical Implications. For the two patients and personnel, the OR is a high risk environment for the transmission of bloodborne diseases, including hepatitis B regardless of whether the performance has been identified as high, medium, or soft risk. Personnel who are not immune to hepatitis B have not taken the vaccine, or have not soared an adequate humoral response after repeated vaccination should assess their status periodically. Consideration should be given to testing, at a minimum, in succession an annual basis or each six months, depending on the risk of chisel injuries and exposure to progeny Infected personnel may not have symptoms and could transmit hepatitis B to several patients through the whole extent of a long period of time before it is discovered.

Antimicrobial efficacy of chlorhexidine gluconate/ethanol

American Journal of infection superintendence December 2001

pair prospective, randomized, partially blinded, well-controlled clinical studies evaluated the antimicrobial effectiveness of a chlorhexidine gluconate (CHG)/ ethanol hand preparation applied without scrubbing and the use of water and a traditional three-minute surgical work hard with a brush and 4% CHG (3) In the same study, participants were assigned randomly to use CHG/ethanol or 4% CHG In the other studious mood participants were assigned randomly to receive individual of three treatments--CHG/ethanol, 4% CHG or an ethanol vehicle repress Changes in baseline skin condition were measured using a self-assessment questionnaire. Log reduction from baseline bacterial deems was determined and analyzed with a t test

Findings. Overall, the CHG/ ethanol hand preparation was superior in bourns of antimicrobial effectiveness and persistence of the bactericidal result It resulted in greater log reduction in judges of hand bacteria and greater persistence, as protracted as six hours, of the bactericidal result Additionally, the CHG/ethanol preparation was associated with les drying of the skin and significantly better skin condition scores for appearance, intactness, moisture contented and sensation.