Bacterial recolonization of the skin and wound contamination during cardiac surgery: a randomized controlled trial of the use of plastic adhesive drape compared with bare skin

Falk-Brynhildsen, Karin; Söderquist, Bo; Friberg, Örjan; Nilsson, Ulrica

doi:10.1016/j.jhin.2013.02.011

Cited by 66 publications

(33 citation statements)

References 37 publications

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“…The use of drapes does not allow water to pass, however it may allow bacterial transfer to the surgical field; additionally iodophore impregnated plastic adesive drape use is stated to reduce bacterial recolonization. [5,20] A study using drapes observed that proliferation occurred after the 2nd hour, similar to our study. [26] A study using a single drape found that bacteria passed the re-usable surgical drapes in 30 minutes and that due to the [11] In our study, on the tables without sterile plastic (no-plastic and non-sterile plastic groups) proliferation was observed on half the tables ( Table 2).…”

Section: Discussionsupporting

confidence: 90%

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Ortopedi Ameliyatlarında Cerrahi Sahanın Örtülmesinde Steril Poşet Kullanımının Enfeksiyon Açısından Etkinliği

Aytekin¹,

Direkel²,

Kır³

et al. 2017

Journal of Contemporary Medicine

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Introduction: Surgical site infections (SSI) are situations with difficult treatment processes for patients and clinicians. Though the precautions are taken to reduce this risk, they continue to occur. One of the most important sources of SSI is known to be the individual's own flora. The tables that contaminated with the patient's own flora lies under the sterile covers. This study simulated surgical conditions to research the efficacy of the use of sterile plastic against the incidence of surgical site infections. Methods: Total of 18 surgical areas were imitated in 3 different groups by using full blood in the tables covered in real operating theater conditions. Each table was contaminated with a healthy individual's forearm flora. All tables used 3 sterile re-usable surgical drapes spread one on top of the other. The difference between the groups was using a sterile plastic or non-sterile plastic below sterile re-usable surgical drapes and no using of plastic. So groups were defined as no sterile plastic group, non-sterile plastic group and sterile plastic group. Additionally the cost of using a sterile plastic was calculated. The Fisher exact test used to calculate the propability of infection development. Results: The use of sterile plastic was found to statistically reduce the possibility of infection development. The cost of using sterile plastic was was about 2,5 tl (0,8 $) when the study performed. The probability of infection development was statistically significantly lower in the sterile-plastic group. Discussion and Conclusion: After skin preparation with an appropriate antiseptic agent, we recommend covering the table with sterile nylon plastic and then re-usable surgical drapes to reduce the possibility of SSI development.

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Section: Discussionsupporting

confidence: 90%

“…[2,[6][7][8][9][10][11] However, in spite of all these precautions there is always a risk of infection. [18][19][20] It is known that the air in the surgery may be contaminated. [21] The most significant source of SSI is the patient's own skin flora.…”

Section: Discussionmentioning

confidence: 99%

Ortopedi Ameliyatlarında Cerrahi Sahanın Örtülmesinde Steril Poşet Kullanımının Enfeksiyon Açısından Etkinliği

Aytekin¹,

Direkel²,

Kır³

et al. 2017

Journal of Contemporary Medicine

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“…3,4,32 Importantly, despite proper skin disinfectant and draping during surgery, bacteria including coagulase-negative staphylococci and Propionibacterium acnes will begin to colonize the skin within 1 hour, with a marked bacterial colonization load at 2 hours. 12 S. aureus is a common commensal species that affects up to two-thirds of healthy individuals throughout their lifetime. 22,25 The skin provides a remarkably resistant barrier to infection by colonized bacteria due to a large extent on the production of antimicrobial proteins such as defensins and cathelicidins.…”

Section: Discussionmentioning

confidence: 99%

Changing of the guard: reducing infection when replacing neural pacemakers

Pepper

Meliak

Akram

et al. 2017

JNS

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OBJECTIVE Infection of deep brain stimulation (DBS) hardware has a significant impact on patient morbidity. Previous experience suggests that infection rates appear to be higher after implantable pulse generator (IPG) replacement surgery than after the de novo DBS procedure. In this study the authors examine the effect of a change in practice during DBS IPG replacements at their institution. METHODS Starting in January 2012, patient screening for methicillin-resistant Staphylococcus aureus (MRSA) and, and where necessary, eradication was performed prior to elective DBS IPG change. Moreover, topical vancomycin was placed in the IPG pocket during surgery. The authors then prospectively examined the infection rate in patients undergoing DBS IPG replacement at their center over a 3-year period with at least 9 months of follow-up. RESULTS The total incidence of infection in this prospective consecutive series of 101 IPG replacement procedures was 0%, with a mean follow-up duration of 24 ± 11 months. This was significantly lower than the authors' previously published historical control group, prior to implementing the change in practice, where the infection rate for IPG replacement was 8.5% (8/94 procedures; p = 0.003). CONCLUSIONS This study suggests that a change in clinical practice can significantly lower infection rates in patients undergoing DBS IPG replacement. These simple measures can minimize unnecessary surgery, loss of benefit from chronic stimulation, and costly hardware replacement, further improving the cost efficacy of DBS therapies.

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“…Despite these disinfection regimens, the prevalences of deep post‐operative infections still remain at approximately 1% and 4%, respectively . In a recent study , we were also able to isolate CoNS from the skin immediately before incision in cardiac patients, i.e., after disinfection with chlorhexidine in alcohol in the operating theatre.…”

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confidence: 89%

Decreased susceptibility to chlorhexidine and prevalence of disinfectant resistance genes among clinical isolates of Staphylococcus epidermidis

Prag

Falk-Brynhildsen

Jacobsson

et al. 2014

APMIS

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Staphylococcus epidermidis is a versatile agent, being both a commensal and a nosocomial pathogen usually with an opportunistic role in association with implanted foreign body materials. Pre-operative antiseptic preparation is an important strategy for reducing the risk of complications such as surgical site infection (SSI). Currently, the most widely used antiseptics are alcohols, quaternary ammonium compounds (QACs), and the bisbiguanide chlorhexidine. Occurrence of resistance to the latter agent has drawn increasing attention. The aim of this study was to investigate if decreased susceptibility to chlorhexidine among S. epidermidis was present in our setting, a Swedish university hospital. Staphylococcus epidermidis (n = 143), retrospectively collected, were obtained from prosthetic joint infections (PJI) (n = 61), post-operative infections after cardiac surgery (n = 31), and the skin of the chest after routine disinfection prior to cardiac surgery (n = 27). In addition, 24 commensal isolates were included. Minimum inhibitory concentration (MIC) of chlorhexidine was determined on Mueller Hinton agar plates supplemented with serial dilutions of chlorhexidine. Five QAC resistance genes, qacA/B, smr, qacH, qacJ, and qacG, were detected using PCR. Decreased susceptibility to chlorhexidine was found in 54% of PJI isolates, 68% of cardiac isolates, 21% of commensal isolates, and 7% of skin isolates from cardiac patients, respectively. The qacA/B gene was present in 62/143 isolates (43%), smr in 8/143 (6%), and qacH in one isolate (0.7%). The qacA/B gene was found in 52% of PJI isolates, 61% of cardiac isolates, 25% of commensal isolates, and 19% of the skin isolates. In conclusion, decreased susceptibility to chlorhexidine, as well as QAC resistance genes, were prevalent among S. epidermidis isolates associated with deep SSIs.

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Bacterial recolonization of the skin and wound contamination during cardiac surgery: a randomized controlled trial of the use of plastic adhesive drape compared with bare skin

Cited by 66 publications

References 37 publications

Ortopedi Ameliyatlarında Cerrahi Sahanın Örtülmesinde Steril Poşet Kullanımının Enfeksiyon Açısından Etkinliği

Ortopedi Ameliyatlarında Cerrahi Sahanın Örtülmesinde Steril Poşet Kullanımının Enfeksiyon Açısından Etkinliği

Changing of the guard: reducing infection when replacing neural pacemakers

Decreased susceptibility to chlorhexidine and prevalence of disinfectant resistance genes among clinical isolates of Staphylococcus epidermidis

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