Assessment of occupational exposure to airborne chlorine dioxide of healthcare workers using impregnated wipes during high-level disinfection of non-lumened flexible nasoendoscopes.

Routine flexible nasoendoscopy in otolaryngology clinics is well established, the rate-limiting step of which being the speed of the nasoendoscopes reprocessing method used. Non-lumened flexible nasoendoscopes are expensive, heat-sensitive, delicate instruments that cannot be sterilized in an autoclave but must be disinfected by means of high level disinfection (HLD). In one of the public hospitals in Singapore, the method of disinfection was recently changed to the use of commercial impregnated wipes which generates less than 1% chlorine dioxide upon activation. An exposure assessment was performed to assess the potential exposure of healthcare workers (HCWs) to airborne chlorine dioxide during nasoendoscope disinfection. A total of 14 long-term personal samples, four short-term personal samples and 16 long-term area samples were collected over 8 days in midget impingers containing 0.02% potassium iodide in sodium carbonate/sodium bicarbonate buffer during the nasoendoscope disinfection. The samples were then analyzed by ion-chromatograph. The chlorine dioxide concentrations and upper confidence limit at 95% confidence level (UCL95%) for personal and area samples collected were all below the occupational exposure limits (OEL) for chlorine dioxide (Singapore Workplace Safety and Health PELs, ACGIH TLVs, U.S. OSHA PELs). The study presented evidence that the exposure of HCWs to chlorine dioxide during high-level disinfection of flexible nasoendoscopes were deemed insignificant.

Epidemiology of hand infection--a comparative study between year 2000 and 2009.

This study aims to analyze the bacteriology and antibiotic resistance in hand infection between 2000 and 2009 at a local hospital in Asia. It is a retrospective study involving all adult patients with hand infections that were treated surgically, with tissue or wound culture sent. A total of 100 cases in 2000 and 98 cases in 2009 were included in this study. Standard epidemiology information, bacteriology, antibiotic sensitivity and treatment outcome were analyzed. Particular interest was given to diabetic hand infection. There was no significant difference of outcome in hand infection between the two years. The outcome of diabetics was not statistically worse than the non-diabetics. Comparing the patients in 2000 and 2009, more younger patients were affected with hand infection in 2009. While length of stay is shorter in 2009. Mixed infection was more common in diabetics in 2009. There was trend of clindamycin resistance in methicillin-sensitive staphylococcus aureus in 2009.

Outcomes of open carpal tunnel releases and its predictors: a prospective study.

A prospective study of 74 patients who underwent open carpal tunnel releases was conducted, with a follow-up period of six months. We analyzed multiple preoperative variables in order to identify factors that might predict outcomes. These outcomes included improvement in symptom severity and functional severity scores, grip strength as well as patient satisfaction. All the patients showed improvement in symptoms with 72% showing complete symptomatic relief, 74% showing improvement in function and 66% showing improvement in grip strength, and 82% were either completely or very satisfied with the results of surgery. Older patients and patients with weakness were associated with poorer outcomes. Higher preoperative symptom severity and functional severity scores were also associated with less improvement in symptoms and function, respectively. This information would benefit the surgeons and patients during preoperative counseling and help facilitate the decision-making process for both parties.

Factors affecting the prognosis of pyogenic flexor tenosynovitis.

BACKGROUND: Pyogenic flexor tenosynovitis is a closed space infection involving the digital flexor tendon sheaths of the upper extremity that can cause considerable morbidity. The purpose of the present report is to describe the various risk factors leading to poor outcomes and to recommend a clinical classification system for this condition. METHODS: We studied seventy-five patients with pyogenic flexor tenosynovitis over a six-year period. The amputation rate and total active motion were used as outcomes measures. The clinical factors influencing outcomes were identified and analyzed. RESULTS: The five risk factors associated with poor outcomes were (1) an age of more than forty-three years, (2) the presence of diabetes mellitus, peripheral vascular disease, or renal failure, (3) the presence of subcutaneous purulence, (4) digital ischemia, and (5) polymicrobial infection. On the basis of the clinical findings and outcomes, three distinct groups of patients could be identified, each with a progressively worse outcome. Patients in Group I had no subcutaneous purulence or digital ischemia; these patients had the best prognosis, with no amputations and a mean 80% return of total active motion. Patients in Group II demonstrated the presence of subcutaneous purulence but no ischemic changes; these patients had an amputation rate of 8% and a mean 72% recovery of total active motion. Patients in Group III had both extensive subcutaneous purulence and ischemic changes; these patients had the worst prognosis, with an amputation rate of 59% and a mean 49% return of total active motion. CONCLUSIONS: We propose a three-tier clinical classification system that can aid in prognosis and guidance in the treatment of pyogenic flexor tenosynovitis of the upper extremity.

Mycobacterium marinum as a cause of chronic granulomatous tenosynovitis in the hand.

OBJECTIVE: Mycobacterium marinum is an uncommon cause of chronic granulomatous flexor tenosynovitis and leads to significant morbidity in the hand. This paper aims to review our treatment of this infection and its clinical outcomes. METHODS: We treated five cases of M. marinum flexor tenosynovitis from 2001 to 2006, which were confirmed after 6 weeks of mycobacterial culture. RESULTS: All the patients were healthy immuno-competent hosts. There was a history of injury by a marine animal in each patient. Presentation was delayed at an average of 32.0 days after the injury. Excisional debridement was performed at an average of 63.4 days after the injury. The average number of debridements performed was 3.4. One patient had to undergo ray amputation to control the infection. The average duration of oral antibiotics was 15.4 weeks. Post-operatively, there were reductions in total active motion in all patients. CONCLUSION: A high index of suspicion, based on the history and intra-operative findings, is necessary when managing these patients. This infection runs a protracted course that requires multiple debridements and is associated with poor functional outcome.