ABSTRACT
BACKGROUND: The aim of this cluster-randomized, crossover trial was to compare the efficacy of plain soap and water with an alcohol-based handrub for surgical hand preparation and prevention of surgical-site infection (SSI) in a Kenyan rural hospital. METHODS: A total of 3317 patients undergoing clean and clean-contaminated surgery were included. Follow-up data 30 days after discharge were available for 3133 patients (94.5 per cent). RESULTS: SSI occurred in 255 patients (8.1 per cent), with similar rates for both study arms: 8.3 per cent for alcohol-based handrub versus 8.0 per cent for plain soap and water (odds ratio 1.03, 95 per cent confidence interval 0.80 to 1.33). After adjustment for imbalances between study arms and clustering effects, the main outcome measure remained unchanged (adjusted odds ratio 1.06, 0.81 to 1.38). The duration of surgery and wound contamination class independently predicted SSI. The cost difference between the methods was small (4.60 per week for alcohol-based handrub compared with 3.30 for soap and water). CONCLUSION: There was no statistically or clinically significant difference in SSI rates, probably because more important factors contribute to SSI development. However, this study demonstrated the feasibility and affordability of alcohol-based handrubs for hand preparation before surgery in settings without continuous, clean water. REGISTRATION NUMBER: NCT00987402 (http://www.clinicaltrials.gov).
Subject(s)
Ethanol , Hand Disinfection/methods , Preoperative Care/methods , Soaps , Surgical Wound Infection/prevention & control , Adult , Baths/methods , Epidemiologic Methods , Female , Hospitals, Rural , Humans , Kenya , Male , Treatment Outcome , WaterABSTRACT
Surgical hand preparation has been recommended since the nineteenth century as a measure to reduce infection resulting from surgery. We review the evidence and major objectives of surgical hand preparation, as well as the criteria for the choice of products currently in use. Test and validation procedures for selecting products for surgical hand preparation in North America and Europe are compared. Surgical hand antisepsis using medicated soap and alcohol-based hand-rub formulations is discussed, including the technical aspects, time required for the procedure, drying time, potential for side-effects, and the parameters for the selection of the most appropriate formulations. Brushes are not recommended for surgical hand preparation. Rapid antimicrobial action, wider spectrum of activity, lower side-effects, and the absence of the risk of hand contamination by the rinsing water, clearly favour the use of alcohol-based hand rubs for surgical hand preparation, even in countries with limited resources where the provision of water is scarce or of doubtful quality.
Subject(s)
General Surgery/methods , Hand Disinfection/methods , Europe , Humans , North America , Surgical Wound Infection/prevention & controlABSTRACT
Allograft recipients are exposed to risks owing to immunosuppression, and there is always the possibility that psychological issues interfere with the procedure's outcomes. An episode of blindness was suspected in a bilateral hand allograft recipient. The patient underwent a multidisciplinary evaluation, and clinical, electrophysiological, laboratory and a combination of functional and morphological magnetic resonance imaging (MRI) tests ruled out any visual process and revealed a secondary benefit, which turned out to be the use of privileges of the transplant support centre for several months. Composite tissue allograft recipients require a thorough psychological assessment before and after transplant procedures to prevent malingering.
Subject(s)
Graft Rejection/complications , Hand Injuries/surgery , Immunosuppressive Agents/adverse effects , Stress, Psychological/complications , Tissue Transplantation/adverse effects , Vision Disorders/etiology , Visual Acuity/physiology , Diagnosis, Differential , Electroretinography , Female , Follow-Up Studies , Graft Rejection/diagnosis , Graft Rejection/drug therapy , Humans , Magnetic Resonance Imaging , Middle Aged , Transplantation, Homologous , Vision Disorders/diagnosis , Vision Disorders/physiopathologyABSTRACT
Background: Church/mission hospitals and other non-government health institutions inKenya provide 30of the healthcare needs; providing affordable care to the rural poor. This review presents the surgical pathology to which a general surgeon working in a rural Kenyan hospital is exposed through training and beyond. Additionally; some ofthe rarer surgical pathology; `rare birds'; encountered during this period is reported. Methods: In this retrospective study; all the surgical specimens submitted by the author for histopathological examination over a period of thirteen years were reviewed and analyzed. The findings are reported. Results: The results of 1826 surgical specimens were divided into the major surgical specialties that a surgeon working in this environment is exposed to. General surgical specimens constituted 48.4of the total specimens; while urology; gynecology; maxillofacial/otolaryngology and `other' specialties made up 34.6; 7.8; 6.7; and 2.5respectively. There were a total of 389 malignancies; of which 55were in general surgery and 31.1in urology. Rare surgical pathologies encountered over this period included acne conglobata; an intramuscular lipoma of the forearm; intraosseous lipoma of the fibula; primary tuberculosis of the prostate gland and of the thyroid gland; amongst others. Conclusion: Church/mission hospitals currently present excellent opportunities both for training and career development in general surgery and related disciplines
