Content provided in partnership with

Health Care Industry

Perioperative prophylaxis; viral transmission; surgical scrubs; iodophors; hepatitis B vaccine - Evidence For Practice

AORN Journal, Oct, 2002 by George Allen

Using vancomycin for perioperative prophylaxis

Emerging Infectious Diseases, September/October 2001

This study 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 10,000 patients undergoing coronary artery bypass grafting procedures was conducted. A decision-analytic model was developed to calculate the clinical benefits and costs 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 conducted to assess the cost effectiveness of the three strategies.

Most Popular Articles in Health: Fuel your workout: exercisers who eat before they work out have more energy ...; Soothe a dry, itchy scalp: 5 easy expert solutions; Cocktails and calories: Beer, wine and liquor calories can really add up. ...; The sour truth about apple cider vinegar - evaluation of therapeutic use; The, six best supplements you've never heard of: these secret weapons can ...; More »

Findings, Overall, using vancomycin was effective and less expensive than using cefazolin or no prophylaxis. It was associated with the fewest deep 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 most likely will be reevaluated because of this and other studies documenting the superiority of vancomycin use as a prophylaxis in cardiac surgery. Nurses need to understand that the antibiotic must be available in sufficient time so that it can be given slowly, generally over one hour. The effectiveness of prophylaxis rests on having adequate concentration of the antibiotic in the blood before the incision is made, Prophylaxis must begin between 30 minutes to two hours before the incision. Adverse reactions, including red neck syndrome, can result if the prophylactic is administered too rapidly.

Transmitting hepatitis B from surgeon to patient

Infection Control and Hospital Epidemiology, June 2002

This retrospective cohort study conducted in the Netherlands, a country 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 tested for hepatitis B surface antigen (HBsAg) until agreeing to participate in this study. High, medium, and low risk procedures were defined based on complexity, invasiveness, potential risk of exposure to the surgeon, and classification of the procedure.

Findings. A stored serum sample drawn from the surgeon in 1989 and tested in 1999 revealed that the surgeon had positive HBsAg and hepatitis Be antibody. From 1994 to 1999, the surgeon performed 2,010 surgical procedures on 1,803 patients. Transmission of hepatitis B was confirmed in eight patients, probable in two patients, and possible in 18 patients. Of the 51 procedures performed by the surgeon on these 28 patients, 39% were classified as high risk, 20% as medium risk, and 41% as low risk.

Clinical Implications. For both patients and personnel, the OR is a high risk environment for the transmission of bloodborne diseases, including hepatitis B, regardless of whether the procedure has been identified as high, medium, or low risk. Personnel who are not immune to hepatitis B, have not taken the vaccine, or have not mounted an adequate humoral response after repeated vaccination should assess their status periodically. Consideration should be given to testing, at a minimum, on an annual basis or every six months, depending on the risk of cut injuries and exposure to blood. Infected personnel may not have symptoms and could transmit hepatitis B to several patients over a long period of time before it is discovered.

Antimicrobial efficacy of chlorhexidine gluconate/ethanol

American Journal of infection Control, December 2001

Two 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 scrub with a brush and 4% CHG. (3) In one study, participants were assigned randomly to use CHG/ethanol or 4% CHG. In the other study, participants were assigned randomly to receive one of three treatments--CHG/ethanol, 4% CHG, or an ethanol vehicle control. Changes in baseline skin condition were measured using a self-assessment questionnaire. Log reduction from baseline bacterial counts was determined and analyzed with a t test.

Findings. Overall, the CHG/ ethanol hand preparation was superior in terms of antimicrobial effectiveness and persistence of the bactericidal effect. It resulted in greater log reduction in counts of hand bacteria and greater persistence, as long as six hours, of the bactericidal effect. Additionally, the CHG/ethanol preparation was associated with less drying of the skin and significantly better skin condition scores for appearance, intactness, moisture content, and sensation.

Health Care Industry

Perioperative prophylaxis; viral transmission; surgical scrubs; iodophors; hepatitis B vaccine - Evidence For Practice

AORN Journal, Oct, 2002 by George Allen

Find Research Guides for:

Find Featured Titles for: Reference

Most Popular Articles in Health

Most Popular Publications in Health