Surgical hand antisepsis: experimental study

PURPOSE: Nosocomial infections account for one of the most serious complications in hospitalized patients around the world. Surgical site infections have significant economic implications, and surgical antisepsis plays an important role in such processes. METHODS: With prior approval by the Institutional Review Board and informed consent, 10 volunteers were randomly assigned to 3 protocols on hand antisepsis: protocol A (chloroxylenol 3%), protocol B (benzalkonium chloride at 1%), and protocol C (ethyl alcohol 61%, 1% chlorhexidine gluconate). Smears from both hands were cultured after each hand pro tocol (t0) and at the end of suturing (t1). Colony forming units were counted (CFUs on blood agar dishes) with digital counting software (Open CFU). Friedman test was used to compare the mean values among the groups, and a Bonferroni correction was made to determine the dissimilar group, with a P = 0.015. RESULTS: At t0 for protocol A the CFU count was 82.8 ± 1.3; protocol B was 9.7 ± 30; protocol C was 0.1 ± 0.3 (P < 0.001). At t1 for protocol A the CFU was 80.7 ± 89.4; protocol B was 7.5 ± 32; protocol C was 0.0 ± 0.0 (P < 0.001). No adverse events were present among the subjects. CONCLUSION: Ethyl alcohol at 61% with 1% chlorhexidine gluconate showed higher efficacy than the traditional washing antiseptics.

Duración de la antiagregación dual postintervencionismo percutáneo / Duration of dual antiaggregation therapy after percutaneous intervention

Resumen Introducción: Con el uso de stents medicados de primera generación, el riesgo de trombosis es de 1,9% a 18 meses, con consecuencias que suelen ser graves y potencialmente fatales. La antiagregación doble, que previene tal efecto, conlleva un riesgo de sangrado que se incrementa según la duración de la misma, por tanto, tratar de alcanzar el equilibrio entre riesgo y beneficio es el objetivo primordial. Objetivo: Presentar la evidencia actual sobre la duración óptima de la doble antiagregación y brindar pautas para establecer cuál debe ser esta para los pacientes. La antiagregación doble busca evitar el riesgo de trombosis temprana y reducir los eventos coronarios no relacionados con el inicial, sobre todo en pacientes con alto riesgo de eventos cardiovasculares o trombosis tardía. La terapia de corta duración puede ser una alternativa más segura que el estándar de un año y sin diferencia en eficacia en pacientes de bajo riesgo cardiovascular. La antiagregación de larga duración disminuye la trombosis del stent y los eventos coronarios, pero puede incrementar el riesgo de sangrado clínicamente importante. Conclusiones: Hasta hoy la literatura no permite definir un tiempo ideal para la antiagregación dual; este debe definirse para cada caso en particular.

Abstract Introduction: With the use of first-generation drug-eluting stents, the risk of thrombosis is of 1.9% at 18 months, with consequences that are usually severe and are potentially fatal. Dual antiaggregation therapy, that prevents such effects, entails a bleeding risk that is increased according to its duration, therefore, trying to achieve a balance between risk and benefit is the key goal. Objective: To present current evidence of the optimal duration of dual antiaggregation therapy and to provide guidelines to establish the duration for patients. Dual antiaggregation therapy seeks to avoid the risk of early thrombosis and to reduce coronary events not related to the initial one, specially in patients with high risk of cardiovascular events or late thrombosis. Short duration therapy can be a safer alternative than the standard of one year and without a difference in patients with low cardiovascular risk. Long duration antiaggregation therapy reduces the risk of stent thrombosis and coronary events, but can increase the risk of a clinically important bleeding. Conclusions: Until today literature does not allow to define an ideal time for dual antiaggregation therapy; this must be defined according to each particular case.