Invasive electrical stimulation in the treatment of avascular osteonecrosis of the femoral head - mid-term results.

The study aimed to evaluate the outcomes of osteonecrosis of the femoral head (ONFH) in adults after surgical treatment including invasive electromagnetic osteostimulation (E-Stim). Further, the influence of disease stage and several comorbidities on the joint preservation rate should be examined. Sixty patients (66 hip joints) with ONFH were included in this retrospective cross-sectional analysis (mean follow-up: 58 months, 19-110 months). Potential ONFH risk factors and comorbidities (ONFH stage, age, sex, alcohol, smoking, cortisone medication, chemotherapy) were recorded. The influence of specific parameters on the joint preservation rates was evaluated by a multivariate logistic regression analysis. Finally, patients with preserved hip joints underwent an assessment of their last available X-rays. The joint preservation rate depended on the initial ONFH Steinberg stage (I+II: 82.8%, III: 70.8%, ≥ IVa: 38.5%). Initially collapsed ONFH (p ≤ 0.001) and cortisone therapy (p = 0.004) significantly decreased the joint preservation rates. In case of progressed ONFH, the presence of ≥ 2 risk factors resulted in higher THA conversion rates (stage III: OR 18.8; stage ≥IVa: OR 12). In 94% of the available X-rays, the ONFH stage improved or did not progress. No complications could be attributed to the E-Stim device or procedure. The present surgical protocol including minimally invasive E-Stim revealed high joint preservation rates for non-collapsed ONFH after mid-term postoperative follow-up. Especially in progressed ONFH, the-risk profile seems to be crucial and hence, for joint preserving surgery, careful patient selection is recommended.

Predictors of colonization with Staphylococcus species among patients scheduled for cardiac and orthopedic interventions at tertiary care hospitals in north-eastern Germany-a prevalence screening study.

As methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection in humans are a global challenge. In Mecklenburg and Western Pomerania (Germany) 1,517 patients who underwent surgical interventions were systematically screened for MRSA and MSSA colonization on the day of hospital admission and discharge. Demographic data, risk factors and colonization status of the (i) nose, (ii) throat, (iii) groin, and (iv) thorax or site of surgical intervention were determined. Of the 1,433 patients who were included for further evaluation, 331 (23.1%) were colonized with MSSA, while only 17 (1.2%) were MRSA carriers on the day of hospital admission. A combination of nose, throat and groin swabs returned a detection rate of 98.3% for MSSA/MRSA. Trauma patients had lower prevalence of MRSA/MSSA (OR 0.524, 95% CI: 0.37-0.75; p < 0.001) than patients with intended orthopedic interventions. Males showed significantly higher nasal S. aureus carrier rates than females (odds ratio (OR) = 1.478; 95% CI: 1.14-1.92; p = 0.003). Nasal S. aureus colonization was less frequent among male smokers as compared to non-smokers (chi2 = 16.801; phi = 0.154; p < 0.001). Age, gender and smoking had a significant influence on S. aureus colonization. Combining at least three different swabbing sites should be considered for standard screening procedure to determine S. aureus colonization at patients scheduled for cardiac or orthopedic interventions at tertiary care hospitals.

Potential infection control risks associated with roaming healthcare industry representatives.

BACKGROUND: Healthcare industry representatives (HCIR) visit multiple hospitals every day. Most enter hygiene sensitive areas and work in close proximity to caregivers and patients. OBJECTIVE: The objective of the present study was to evaluate the HCIRs' current status in hygiene training and vaccination. METHODS: An anonymous walking intercept study was used based on questionnaires to evaluate industry representatives in comparison to physicians and nurses (n = 311 participants, participation rate 30.2%) after their visit to the MEDICA Congress. The valid participants consisted of HCIR (n = 208), hospital nurses (n = 49) and physicians (n = 41). A total of 82.2% (n = 171) HCIR worked in varying hospitals. RESULTS: They frequently request access to hygiene and data-privacy sensitive areas: Among them 51.9% (n = 108) accessed the outpatient clinic, 41.8% (n = 87) the operating room (OR), 33.7% (n = 70) the central supply and sterilisation department (CSSD), and 32.7% (n = 68) the intensive care unit. HCIR requesting access to hygiene sensitive areas showed the lowest scores in hygiene training and a significantly lower Hepatitis B vaccination status, i.e. 37.5% compared to 70.7% for physicians and 53.1% for nurses. DISCUSSION: Status of HCIR hygiene training was inadequate - as was vaccination and contamination control. Therefore, HCIR are exposed to increased infection risk and may unknowingly act as infection vector between different hospitals.