Preoperative cleansing of the patient's skin with chlorhexidine-alcohol is superior to cleansing with povidone-iodine for preventing surgical-site infection after clean-contaminated surgery. (ClinicalTrials.gov number, NCT00290290.)

It is possible that orthopaedic devices coated with this unique combination of antimicrobial agents may protect against the development of clinical infection in humans.

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SUMMARYSince the number of organisms isolated from a medical device is crucial in assessing the likelihood of device-associated infection, we examined whether incubation of catheters in trypsin before sonication can increase the yield of superficially colonised vascular catheters in vitro and those removed from patients. Polyurethane and silicone catheters were individually colonised in vitro with individual clinical isolates including Staphylococcus aureus and Escherichia coli. Equal numbers of 1 cm segments of colonised catheters were then individually incubated either in a trypsin-containing solution or a control solution without trypsin. Each solution containing the segment was then sonicated and cultured quantitatively. In the clinical arm, indwelling catheters removed from patients were also cut into 1 cm segments that were equally suspended in the trypsin-containing or control solution and then sonicated and cultured quantitatively. Trypsin-based sonication enhanced the detection of S. aureus on colonised polyurethane and silicone catheters in vitro by 14-and 30-fold, respectively (P = 0.03 and P = 0.04), and the detection of E. coli on colonised polyurethane and silicone catheters by 3-and 6-fold, respectively (P = 0.04 and P = 0.05). Compared with sonication alone, trypsin followed by sonication resulted in 10% increase in the detectability of significant colonisation of indwelling catheters removed from patients and 11% increase in the mean colony counts of colonising organisms (P = 0.04). Exposure of catheters to trypsin before sonication improves the sensitivity of sonication and enhances the accuracy of assessing significant catheter colonisation.

Background: There is no consensus about whether a double-J ureteric stent (DJ-US) should be placed following uncomplicated ureteroscopy for stone retrieval. This study aimed to compare three groups of patients who underwent uncomplicated ureteroscopic lithotripsy (URSL) and to evaluate whether stents could be eliminated after the procedure. Methods: A total of 105 patients underwent uncomplicated URSL for ureteric stones were prospectively randomized into three groups: group 1 (34 patients) with DJ-US, group 2 (35 patients) with DJ-US on extraction string, and group 3 (36 patients) with no DJ-US after the procedure. The outcomes measured were; postoperative Visual Analog Score (VAS) for flank pain and dysuria score, urgency, frequency, suprapubic pain, hematuria, analgesia requirement, operative time, re-hospitalization, and return to normal physical activity. Results: Mean operative time was significantly longer in groups 1 and 2 compared to group 3 [mean time ± SD, 22.2 ± 9.1 min, 20.2 ± 6 min, 15.1 ± 7.1 min respectively, p<0.0001]. The results of the VAS for flank pain and dysuria scores, urgency, frequency, hematuria, and suprapubic pain showed a significant difference at all time points of follow-up, with significantly higher in groups 1 and 2 compared to group 3. Further analysis showed that measured outcomes, and analgesia need for groups 1 and 2 were similar, at all time points except at week 1 and 1 month where group 2 patient's had less symptoms. Conclusion: