Meta-analysis of intraoperative povidone-iodine application to prevent surgical-site infection.

BACKGROUND: The effectiveness of intraoperative povidone-iodine (PVI) application in the reduction of surgical-site infection (SSI) remains controversial. This meta-analysis was performed to assess the effect of intraoperative PVI application compared with no antiseptic solution (saline or nothing) on the SSI rate. METHODS: The meta-analysis included randomized controlled trials that compared intraoperative PVI lavage with no PVI in patients undergoing surgery with SSI as the primary outcome. A fixed-effects or random-effects model was used as appropriate, and heterogeneity was assessed by the Cochran Q and the I(2) value. RESULTS: Twenty-four randomized controlled trials totalling 5004 patients (2465 patients with PVI and 2539 patients without) were included: 15 in the main analysis and nine in the sensitivity analysis. The rate of SSI was 8.0 per cent in the PVI group and 13.4 per cent in the control group. Intraoperative PVI application significantly decreased the SSI rate (relative risk 0.58, 95 per cent confidence interval 0.40 to 0.83; P = 0.003) and consistent results were observed in subgroup analyses according to the method of PVI administration, its timing and the type of surgery. CONCLUSION: The meta-analysis results suggested that the use of intraoperative PVI reduced rates of SSI.

Randomisation and sample size for clinical audit on infection control.

Clinical audit is both a part of clinical governance and an essential component of infection prevention and control. It is frequently performed on a proportion of the target population. The sample should represent the source population and be sufficient for statistical analysis. In a hospital, infection control practices are likely to be quite similar within the same clinical area (cluster effect). This must be taken into consideration when calculating the necessary number of patients. Sample size is determined by the desired level of precision for estimating the compliance rate, or by the difference between observed and expected rates, or on the difference before and after implementation of interventions. To estimate the hospital-wide compliance rate without additional costs we suggest focusing the audit on a large number of wards, even if fewer observations within each ward are obtained, rather than auditing a large number of practices on a restricted number of wards.

[Evolution of the number of rotavirus and respiratory syncytial virus infections in children hospitalised in a French university hospital between 1998 and 2005]. / Évolution du nombre d'infections àRotavirus et à virus respiratoire syncytial chez les enfants hospitalisés au CHU de Dijon entre 1998 et 2005.

AIM: Respiratory syncytial virus (RSV) and Rotavirus infections represent up to 30% of cross infections in pediatric units. As they are a major public health problem, we studied their evolution and distribution at the Dijon University Hospital. POPULATION AND METHODS: This exhaustive retrospective study included children under 15 with a new Rotavirus or RSV infection who were hospitalised at the Dijon University Hospital between 1998 and 2005. The general trend was determined by using moving averages, and the Spearman correlation coefficient r(s) was calculated. RESULTS: From 1998 to 2005, 1886 new RSV (n=981) or Rotavirus (n=905) infections were identified in hospitalised children. The number of the infections decreased significantly, both for RSV (r(s)=-0.71 ; p<0.0001) and for Rotavirus (r(s)=-0.77 ; p<0.0001). Almost half of Rotavirus infections were nosocomial (46.3%) vs 5.3% of RSV infections, p<0.0001. There was no significant difference in the proportion of RSV nosocomial infections between the epidemic and non-epidemic period (4.9% of nosocomial infections vs 7.1% respectively, p=0.25). Rotavirus nosocomial infections were less frequent in epidemic period (41.6%) than in non-epidemic period (54.6%); p=0.0002. CONCLUSION: RSV and Rotavirus infections significantly decreased between 1998 and 2005. Proportion of RSV or Rotavirus infections didn't increase in epidemic period, which could be explained both by an increased attention from healthcare professionals and by the effectiveness of hygiene measures taken.

[Evaluation of hygiene practices during ophthalmologists' consultations in Burgundy, France]. / Evaluation des pratiques professionnelles en matière de gestion du risque infectieux au cabinet d'ophtalmologie en région Bourgogne.

OBJECTIVES: To evaluate the hygiene practices during ophthalmologists'consultations in Burgundy, France, so as to identify the difficulties they encounter in implementing new professional guidelines. METHOD: The survey was based on an anonymous transversal descriptive survey conducted via a questionnaire sent in May 2006 to 102 ophthalmologists. RESULTS: Data from 51 questionnaires were included in the survey, showing a good response rate (50%). The survey revealed that the perception of the risk of transmitting an infection was "important" to "most important" (59.2%). A steam autoclave was used by 38.8% of the ophthalmologists. Those who did not sterilize instruments disinfected them (30%). Finally, ophthalmologists preferred more information to training (90% versus 50%, p=0.015). CONCLUSION: This survey highlights the need for improvements in education for practitioners and their assistants, especially in the sterilization of instruments and equipment.

[Disposable vs reusable laryngeal mask airway: a cost-minimization analysis]. / Masques laryngés à usage unique vs réutilisable : une étude de minimisation de coûts.

JUSTIFICATION: According to French regulations concerning the risk of Creutzfeldt-Jakob disease transmission, traceability procedures of all sterile medical devices which need to be reused are mandatory. Despite sterilization processes, the reusable laryngeal mask airway (LMA) prion disease transmission remains possible. As a result, the disposable LMA has been introduced. OBJECTIVE: Assuming clinical equivalence was achieved, the cost of disposable vs reusable LMA was studied in a university hospital. STUDY DESIGN: A Cost-minimization analysis of disposable vs reusable laryngeal mask airway was realised. METHODS: Disposable LMA cost was calculated as the sum of product cost and elimination cost. Reusable LMA were autoclaved after hospital purchasing in two separate sterilizing processing units of the same hospital. Reusable LMA cost was determined combining materiel and labor costs. RESULTS: The reusable LMA cost depended on the sterilizing processing unit concerned and varied between 9.59 Euros and 9.69 vs 8.38 Euros for the single-use LMA. CONCLUSION: With the cost savings made possible by use of disposable LMA in both labor and consumables, this practice should be considered.