Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 67
Filtrar
3.
Urol J ; 18(3): 307-313, 2020 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-32869256

RESUMO

PURPOSE: To investigate biopsy needle tip culture after prostate biopsies for bacteria prediction and antibiotics selection. MATERIALS AND METHODS: From May 2017 to April 2019, 121 patients who underwent a prostate biopsy were enrolled. All biopsy needle tips were sent for aerobic and anaerobic culture. Patients were divided into positive and negative culture groups. Perioperative data were recorded and compared between the two groups. The culture time and susceptibility of febrile patients were analyzed. Blood cultures were conducted for all patients who experienced fever after biopsy. The time and results of the needle and blood cultures were recoded for descriptive analysis. RESULTS: There were 59 (48.8%) positive needle cultures. Other than fever (p = 0.023), there were no statistical significances in clinical data between the two groups. Fever occurred in eight patients, and seven febrile patients had positive needle cultures, six of whom had positive blood cultures. These six needle and blood cultures were consistent with the susceptibility test results. As compared to the waiting time for blood cultures, target antibiotics were administered at an average of 48.0 h earlier based on needle cultures. None of the patients with positive anaerobic cultures developed a fever, while all eight febrile patients had negative anaerobic cultures. CONCLUSION: Fevers developed at statistically significant higher rate among those who had positive needle cultures. Needle and blood cultures were consistent with the susceptibility test results. Needle cultures can help us administer target antibiotics earlier to febrile patients without the need to wait for blood cultures.


Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/prevenção & controle , Agulhas/microbiologia , Complicações Pós-Operatórias/microbiologia , Complicações Pós-Operatórias/prevenção & controle , Próstata/patologia , Idoso , Biópsia por Agulha/instrumentação , Diagnóstico Precoce , Humanos , Masculino , Pessoa de Meia-Idade
4.
Adv Mater ; 32(33): e2002129, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32602146

RESUMO

Skin infections caused by bacteria, viruses and fungi are difficult to treat by conventional topical administration because of poor drug penetration across the stratum corneum. This results in low bioavailability of drugs to the infection site, as well as the lack of prolonged release. Emerging antimicrobial transdermal and ocular microneedle patches have become promising medical devices for the delivery of various antibacterial, antifungal, and antiviral therapeutics. In the present review, skin anatomy and its barriers along with skin infection are discussed. Potential strategies for designing antimicrobial microneedles and their targeted therapy are outlined. Finally, biosensing microneedle patches associated with personalized drug therapy and selective toxicity toward specific microbial species are discussed.


Assuntos
Anti-Infecciosos/farmacologia , Agulhas/microbiologia , Dermatopatias/tratamento farmacológico , Animais , Anti-Infecciosos/uso terapêutico , Técnicas Biossensoriais , Humanos , Dermatopatias/microbiologia , Dermatopatias/virologia
5.
Am J Infect Control ; 48(3): 281-284, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31551122

RESUMO

BACKGROUND: Needle-free connectors (NFCs) were introduced to eliminate the use of needles in intravascular catheters, and their newest generations were designed to improve patient safety and reduce catheter-related bloodstream infection (CRBSI) risks. The aim of this meta-analysis was to compare NFCs with 3-way stopcocks (3WSCs) and their effects on CRBSI rates. METHODS: A meta-analysis was conducted using a research protocol consistent with the PRISMA statement for reporting meta-analyses. The Cochrane Database of Systematic Reviews and MEDLINE were searched for relevant randomized studies published from January 2000 to September 2018. RESULTS: We identified and selected for the meta-analysis 8 studies comparing CRBSI rates (according to the Centers for Disease Control and Prevention's National Healthcare Safety Network definition) associated with NFCs utilizing negative-displacement, neutral-displacement, or positive-displacement devices with rates for 3WSCs. Relative risk was 0.53 with a 95% CI of 0.28 to 1.00, and the relative difference was -0.018 with a 95% CI of -0.039 to 0.004. CONCLUSIONS: CRBSI risk was statistically higher for 3WSCs compared to NFCs.


Assuntos
Bacteriemia/etiologia , Infecções Relacionadas a Cateter/etiologia , Cateteres Venosos Centrais/microbiologia , Agulhas/microbiologia , Sepse/etiologia , Bacteriemia/microbiologia , Infecções Relacionadas a Cateter/microbiologia , Cateterismo Venoso Central/efeitos adversos , Infecção Hospitalar/etiologia , Infecção Hospitalar/microbiologia , Desinfecção/métodos , Humanos , Estudos Observacionais como Assunto , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Sepse/microbiologia
6.
Am J Infect Control ; 48(3): 275-280, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31604623

RESUMO

BACKGROUND: Microorganisms causing catheter-related bloodstream infections colonize to intravenous catheters (IVC)-particularly to connectors mounted to catheters. The aim of this study was to examine the colonization in 3-way stopcock (TWS) connectors and needleless connectors (NCs) that integrated into central, port, and peripheral venous catheters. METHODS: This random, experimental study consisted of 180 connectors that were inserted into the IVCs of patients in general surgery, reanimation intensive care, and daily chemotherapy units. Cultures of the connectors were obtained at least 48 hours after connecting to IVCs. RESULTS: This study showed that gram-negative, gram-positive, and other pathogens reproduced, although their colonization level was not high enough to develop an infection. When the results of colonization for patients using TWS and NC were compared, the peripheral venous catheters (using a TWS) resulted in a significantly higher increase in reproduction than in patients using NC (P ≤ .01) and no significant difference in the level of colonization in other types of connectors or catheters (P ˃ .05). CONCLUSIONS: The study's results indicated no significant difference between NC and TWSs in terms of reproduction. It should also be noted that connectors integrated into IVC pose a risk in the development of catheter-related bloodstream infections.


Assuntos
Bacteriemia/etiologia , Infecções Relacionadas a Cateter/etiologia , Infecções Relacionadas a Cateter/microbiologia , Cateteres Venosos Centrais/microbiologia , Agulhas/microbiologia , Sepse/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Infecções Relacionadas a Cateter/tratamento farmacológico , Cateterismo Venoso Central/efeitos adversos , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/etiologia , Infecção Hospitalar/microbiologia , Desinfetantes/farmacologia , Contaminação de Equipamentos , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Sepse/tratamento farmacológico , Sepse/microbiologia
7.
Anesthesiology ; 131(2): 305-314, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31166244

RESUMO

BACKGROUND: Health care-associated hepatitis C virus outbreaks from contaminated medication vials continue to be reported even though most practitioners deny reusing needles or syringes. The hypothesis was that when caring for hepatitis C virus-infected patients, healthcare providers may inadvertently contaminate the medication vial diaphragm and that subsequent access with sterile needles and syringes can transfer hepatitis C virus into the medication, where it remains stable in sufficient quantities to infect subsequent patients. METHODS: A parallel-arm lab study (n = 9) was performed in which contamination of medication vials in healthcare settings was simulated using cell culture-derived hepatitis C virus. First, surface-contaminated vials were accessed with sterile needles and syringes, and then hepatitis C virus contamination was assessed in cell culture. Second, after contaminating several medications with hepatitis C virus, viral infectivity over time was assessed. Last, surface-contaminated vial diaphragms were disinfected with 70% isopropyl alcohol to determine whether disinfection of the vial surface was sufficient to eliminate hepatitis C virus infectivity. RESULTS: Contamination of medication vials with hepatitis C virus and subsequent access with sterile needles and syringes resulted in contamination of the vial contents in sufficient quantities to initiate an infection in cell culture. Hepatitis C virus remained viable for several days in several commonly used medications. Finally, a single or 2- to 3-s wipe of the vial diaphragm with 70% isopropyl alcohol was not sufficient to eliminate hepatitis C virus infectivity. CONCLUSIONS: Hepatitis C virus can be transferred into commonly used medications when using sterile single-use needles and syringes where it remains viable for several days. Furthermore, cleaning the vial diaphragm with 70% isopropyl alcohol is not sufficient to eliminate the risk of hepatitis C virus infectivity. This highlights the potential risks associated with sharing medications between patients.


Assuntos
Embalagem de Medicamentos , Contaminação de Equipamentos , Hepacivirus/crescimento & desenvolvimento , Agulhas/microbiologia , Seringas/microbiologia , Células Cultivadas
8.
Respir Investig ; 56(4): 356-360, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29764751

RESUMO

BACKGROUND: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure with a high diagnostic yield in lesions adjacent to the airways. However, complications associated with EBUS-TBNA, such as mediastinitis, have recently been reported. Oral bacteria contamination in punctured lymph nodes can cause severe infections. In the current study, we investigated whether endobronchial intubation using EBUS-TBNA can prevent oral bacterial contamination of punctured lymph nodes. METHODS: We retrospectively evaluated 80 patients (102 lymph nodes) who had undergone EBUS-TBNA and divided them two groups: Group A comprised 60 patients who had undergone EBUS-TBNA with endobronchial intubation and Group B consisted of 20 patients who had undergone EBUS-TBNA without endobronchial intubation. The patients' medical records were examined and the two groups were compared using the unpaired Student's t-test. RESULTS: EBUS-TBNA needle wash cultures were positive in only two Group A cases (3.3%), but in all 20 Group B cases (100%) (P < 0.05). Except for one case of Mycobacterium tuberculosis, all bacterial isolates yielded typical oropharyngeal commensal flora. Fever (≥ 38.0 °C) was observed in six Group A cases (10%) and two Group B cases (10%; P = 0.526). This was treated by cooling, a single administration of non-steroidal anti-inflammatory drugs, and/or antibiotic therapy. Fever was not associated with any clinical features, including malignancy in punctured lesions, number of punctures, echo features, simultaneous peripheral biopsy, additional oral prophylactic antibiotics, or positive needle wash cultures. CONCLUSIONS: Endobronchial intubation may prevent contamination by oropharyngeal commensal bacteria.


Assuntos
Técnicas Bacteriológicas , Broncoscopia/instrumentação , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/instrumentação , Intubação Intratraqueal/instrumentação , Agulhas/microbiologia , Antibacterianos/administração & dosagem , Anti-Inflamatórios não Esteroides/administração & dosagem , Broncoscopia/efeitos adversos , Broncoscopia/métodos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/efeitos adversos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Feminino , Febre/tratamento farmacológico , Febre/etiologia , Humanos , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/métodos , Linfonodos/microbiologia , Masculino , Mediastinite/etiologia , Boca/microbiologia , Mycobacterium tuberculosis/isolamento & purificação , Estudos Retrospectivos , Resultado do Tratamento
9.
Technol Health Care ; 26(S1): 291-306, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29710757

RESUMO

This study was conducted according to the method presented in the Republic of Korea Pharmacopoeia 11th Revision, aseptic test method to evaluate the suitability of sterilization for a sterile needle (4 Pin Multi-needle). In this study, four tests were conducted: sterility test, cytotoxicity test, acute toxicity test, skin sensitization test. First, in the aseptic test, the microorganism was not proliferated in the aseptic test of the medium. As a result of the performance test of the medium, it was confirmed that the microorganism developed within 3 days and the fungus was evident within 5 days. Based on this, it was confirmed that the medium was suitable, and as a result of the aseptic test, the development of microorganisms was not observed during the total culture period. Based on these results, tests were conducted which were confirmed to be suitable for aseptic testing because the development of bacteria on the provided samples was not recognized. For cytotoxicity tests ISO10993-5; 2009 (Biological Evaluation of Medical Devices, Part 5: Test for in vitro Cytotoxicity). As a result, the MEM eluate of the test substance caused very slight cytotoxicity to the fibroblasts of the mouse and was judged to be Grade 1 (Slightly cytotoxic) according to the judgment standard of ISO 10993-5. On the other hand, solvent control, negative control and positive control showed the expected results on the test. Acute Toxicity Test Results: It was judged that there was no systemic toxicity change when ICR mice were treated with 50 mL/kg B.W. of the eluate of sterile injectable needle for 72 hours. Skin sensitization test result: The Hartley guinea pig was evaluated as a substance which is evaluated as a substance which does not induce any skin reaction when skin sensitization is applied to the dissected material of the sterile injectable needle and is weak in skin sensitivity. Based on the above tests, we will study the stability and efficacy of more reliable medical devices based on the verification and performance of medical devices.


Assuntos
Mesoterapia/métodos , Agulhas/microbiologia , Esterilização/métodos , Animais , Dermatite Alérgica de Contato/microbiologia , Fibroblastos/microbiologia , Cobaias , Camundongos , Reprodutibilidade dos Testes , República da Coreia , Testes Cutâneos , Esterilização/normas , Testes de Toxicidade
10.
Urology ; 115: 102-106, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29499262

RESUMO

OBJECTIVE: To compare 3 prophylactic regimens to assess their impact on postbiopsy sepsis incidence. METHODS: Data were reviewed for 829 consecutive patients who underwent prostate biopsy in a community practice setting between January 2013 and October 2017. Group 1 patients received ciprofloxacin 500 mg two times a day orally for 4 days starting the day prior to biopsy and gentamicin 80 mg intramuscularly 20 minutes prior to biopsy. From April 2015 to October 2017, 2 groups of patients were followed in parallel in a randomized manner. Group 2 received ciprofloxacin 500 mg two times a day orally for 4 days starting the day prior to biopsy and ceftriaxone 1 g intramuscularly 20 minutes prior to biopsy. Group 3 received the same antibiotic regimen as group 2 and also underwent isopropyl alcohol needle washing. RESULTS: All study groups were demographically equivalent. Microscopic bacterial counts were substantially decreased after isopropyl alcohol needle washing. Incidence of postbiopsy sepsis in groups 1 (n = 313), 2 (n = 259), and 3 (n = 257) was 3.8%, 2%, and 0%, respectively (analysis of variance; P = .006). Risk factors for sepsis included elevated body mass index, Charlson Comorbidity Score, and presence of type 2 diabetes mellitus. CONCLUSION: There was a significant reduction in the incidence of sepsis after prostate biopsy using a combination of a ciprofloxacin-ceftriaxone antibiotic regimen and isopropyl alcohol needle washing. The technique for needle washing is inexpensive and quick, and can be easily adopted into current biopsy protocols.


Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Desinfecção/métodos , Próstata/patologia , Sepse/epidemiologia , Sepse/prevenção & controle , 2-Propanol , Idoso , Biópsia/efeitos adversos , Biópsia/instrumentação , Índice de Massa Corporal , Ceftriaxona/uso terapêutico , Ciprofloxacina/uso terapêutico , Comorbidade , Diabetes Mellitus Tipo 2/epidemiologia , Quimioterapia Combinada , Gentamicinas/uso terapêutico , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Agulhas/microbiologia , Distribuição Aleatória , Fatores de Risco
11.
BJU Int ; 121(2): 232-238, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28796919

RESUMO

OBJECTIVES: To determine whether a needle disinfectant step during transrectal ultrasonography (TRUS)-guided prostate biopsy is associated with lower rates of infection-related hospitalisation. PATIENTS AND METHODS: We conducted a retrospective analysis of all TRUS-guided prostate biopsies taken across the Michigan Urological Surgery Improvement Collaborative (MUSIC) from January 2012 to March 2015. Natural variation in technique allowed us to evaluate for differences in infection-related hospitalisations based on whether or not a needle disinfectant technique was used. The disinfectant technique was an intra-procedural step to cleanse the biopsy needle with antibacterial solution after each core was sampled (i.e., 10% formalin or 70% isopropyl alcohol). After grouping biopsies according to whether or not the procedure included a needle disinfectant step, we compared the rate of infection-related hospitalisations within 30 days of biopsy. Generalised estimating equation models were fit to adjust for potential confounders. RESULTS: During the evaluated period, 17 954 TRUS-guided prostate biopsies were taken with 5 321 (29.6%) including a disinfectant step. The observed rate of infection-related hospitalisation was lower when a disinfectant technique was used during biopsy (0.60% vs 0.90%; P = 0.04). After accounting for differences between groups the adjusted hospitalisation rate in the disinfectant group was 0.85% vs 1.12% in the no disinfectant group (adjusted odds ratio 0.76, 95% confidence interval 0.50-1.15; P = 0.19). CONCLUSIONS: In this observational analysis, hospitalisations for infectious complications were less common when the TRUS-guided prostate biopsy included a needle disinfection step. However, after adjusting for potential confounders the effect of needle disinfection was not statistically significant. Prospective evaluation is warranted to determine if this step provides a scalable and effective method to minimise infectious complications.


Assuntos
Desinfecção/métodos , Hospitalização/estatística & dados numéricos , Agulhas/microbiologia , Próstata/patologia , Neoplasias da Próstata/patologia , Idoso , Biópsia com Agulha de Grande Calibre/efeitos adversos , Infecção Hospitalar/etiologia , Febre/etiologia , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sepse/etiologia , Infecções Urinárias/etiologia
12.
Curr Probl Dermatol ; 52: 30-41, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28288467

RESUMO

Bacterial infection of tattoos remains a common complication. Pyogenic bacteria can cause infections shortly after the tattoo is made. Severity of infection varies from minor to major, ultimately with life-threatening septicemia. Viral infections may be introduced, i.e. HVB, HVC, and HIV. The risk of infection depends on the following triad: microbial pathogen and its aggressiveness, individual resistance of the tattooed, and inoculation and exposures by the tattoo needle and in the tattoo parlor. Some infectious risks can be controlled. Persons with weaknesses can refrain from tattooing. Tattoo parlors and tattooing can be hygienic and clean albeit not sterile; much has improved helped by hygiene guidelines of professional tattooists' organizations and through control instituted by local and national authorities. Tattoo inks remain a potential source of infection difficult to control in a low-priced competitive market operating over the Internet and across national borders. Ten percent of new inks are contaminated with bacteria pathogenic to humans, independent of a claim of 'sterility'. Known brands and established manufacturers are considered safer. Work is in progress aiming at common European standards for tattoo hygiene. Doctors have a role not only in treating tattoo infections but also in reporting cases to the competent authority in their country to support the monitoring of tattoo infections at any time, as an instrument for the authority to detect local outbreaks of tattoo infections early and prevent that new tattoo customers become infected. It is a potential risk of the future that new and very aggressive bacteria not seen in the past may unexpectedly show up in the tattoo scene.


Assuntos
Dermatopatias Bacterianas/etiologia , Tatuagem/efeitos adversos , Contraindicações , Dinamarca , Contaminação de Equipamentos , Europa (Continente) , Humanos , Higiene/normas , Tolerância Imunológica , Tinta , Agulhas/efeitos adversos , Agulhas/microbiologia , Fatores de Risco , Dermatopatias Bacterianas/microbiologia , Tatuagem/normas
13.
Dig Endosc ; 29(2): 175-181, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27634338

RESUMO

BACKGROUND AND AIM: Endoscopic ultrasound (EUS) aspiration needles are single-use devices. However, in many centers, because of cost-constraints, these devices are reused multiple times. We studied microbiological contamination and bioburden on reprocessed needles to evaluate whether these devices can be successfully sterilized. METHODS: We studied 10 EUS needles each of 19 G, 22 G, and 25 G in size, and five 22-G ProCore needles. After initial use, each needle was reprocessed by a standardized protocol. We used standard microbiological cultures, as well as ATP bioluminescence technique to quantify bioburden as relative light units (RLU). We defined significant soil contamination by RLU values >200. We also used extractant fluid to disrupt cell membranes in an attempt to enhance ATP detection. RESULTS: We found culture positivity in 3/34 (8.8%), and detectable bioburden on the exposed surface of 33/35 (94.3%), and inside lumen of 29 (82.9%) reprocessed FNA needles. Significant bioburden was found in three (8.6%) and two (5.7%) needles on the surface and lumen, respectively. We found that use of extractant fluid enhanced detection of bioburden. Larger (19 G) needles had higher surface contamination (P = 0.016), but there was no relation of luminal contamination with needle diameter (P = 0.138). Sheath design and presence of side bevel did not influence extent of contamination. There was significant correlation between the surface and intraluminal bioburden (P < 0.001). CONCLUSIONS: There is significant bioburden in reprocessed EUS needles; standard microbiological cultures have low sensitivity for detection of needle contamination. We have provided objective evidence for the futility of reprocessing attempts, and practice of EUS needle reuse should be discontinued.


Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/instrumentação , Contaminação de Equipamentos , Agulhas/microbiologia , Esterilização , Humanos , Medições Luminescentes , Pseudocisto Pancreático/patologia
14.
Int J Obstet Anesth ; 29: 45-49, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27884664

RESUMO

BACKGROUND: There is little evidence to inform practice regarding the optimum aseptic technique of drawing up saline for epidural insertion. Our regional practice is to draw up saline from a non-sterile packaged plastic ampoule, therefore introducing the risk of bacterial contamination. Usually, the anaesthetist draws up saline directly from the vial held by an assistant using a needle (needle technique). Alternatively, the saline vial is emptied onto a sterile tray by an assistant and then drawn up by the anaesthetist (tray technique). We hypothesised that the latter will lead to an increase in the number of contaminated saline samples as they are exposed to the environment. METHODS: In labour rooms and before epidural catheter insertion, 110 samples of saline 20mL were randomly drawn up using our hospital's recommended epidural aseptic precautions, using either the needle or the tray technique. Equal amounts of saline were inoculated into aerobic and anaerobic blood culture bottles. RESULTS: Eleven percent of samples in the needle arm and 24% of samples in the tray arm grew commensal micro-organisms including coagulase-negative Staphylococcus, Micrococcus luteus and Streptococcus viridans. A two-sided Fisher's exact test for categorical unpaired data showed no statistical difference between the two arms of the trial (P=0.13). CONCLUSION: The difference in the saline contamination rate between the two techniques did not reach statistical significance. As bacterial contamination occurred with both techniques, we recommend using sterile saline pre-packaged in the epidural tray or individually wrapped sterile glass saline ampoules.


Assuntos
Anestesia Obstétrica/métodos , Catéteres/microbiologia , Contaminação de Equipamentos/prevenção & controle , Agulhas/microbiologia , Cloreto de Sódio , Feminino , Humanos , Gravidez
15.
Pain Pract ; 17(6): 753-762, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-27676323

RESUMO

BACKGROUND: Percutaneous neurostimulation of the peripheral nervous system involves the insertion of a wire "lead" through an introducing needle to target a nerve/plexus or a motor point within a muscle. Electrical current may then be passed from an external generator through the skin via the lead for various therapeutic goals, including providing analgesia. With extended use of percutaneous leads sometimes greater than a month, infection is a concern. It was hypothesized that the infection rate of leads with a coiled design is lower than for leads with a noncoiled cylindrical design. METHODS: The literature was retrospectively reviewed for clinical studies of percutaneous neurostimulation of the peripheral nervous system of greater than 2 days that included explicit information on adverse events. The primary endpoint was the number of infections per 1,000 indwelling days. RESULTS: Forty-three studies were identified that met inclusion criteria involving coiled (n = 21) and noncoiled (n = 25) leads (3 studies involved both). The risk of infection with noncoiled leads was estimated to be 25 times greater than with coiled leads (95% confidence interval [CI] 2 to 407, P = 0.006). The infection rates were estimated to be 0.03 (95% CI 0.01 to 0.13) infections per 1,000 indwelling days for coiled leads and 0.83 (95% CI 0.16 to 4.33) infections per 1,000 indwelling days for noncoiled leads (P = 0.006). CONCLUSIONS: Percutaneous leads used for neurostimulation of the peripheral nervous system have a much lower risk of infection with a coiled design compared with noncoiled leads: approximately 1 infection for every 30,000 vs. 1,200 indwelling days, respectively.


Assuntos
Terapia por Estimulação Elétrica/efeitos adversos , Contaminação de Equipamentos , Agulhas/efeitos adversos , Agulhas/microbiologia , Sistema Nervoso Periférico/microbiologia , Analgesia/efeitos adversos , Analgesia/instrumentação , Analgesia/métodos , Terapia por Estimulação Elétrica/instrumentação , Terapia por Estimulação Elétrica/métodos , Humanos , Manejo da Dor/efeitos adversos , Manejo da Dor/instrumentação , Manejo da Dor/métodos , Sistema Nervoso Periférico/fisiopatologia , Estudos Retrospectivos
16.
Retina ; 36(10): 1882-7, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27046457

RESUMO

PURPOSE: To detect and quantify vitreous contamination after intravitreal injection using an experimental vitreous contamination model. METHODS: Enucleated porcine eyes served as a Type 1 experimental vitreous contamination model with fluoresbrite carboxylate microspheres applied to the conjunctival surface. Saline solution (0.05 mL) was injected using a 27-, 30-, or 32-gauge (G) needle. Injection procedures were monitored using an intraocular fiber catheter. Condensed microspheres were applied to an excised sheet of porcine sclera (Type 2 experimental vitreous contamination model). Saline solution (0.05 mL) was injected from the top of an applied condensed microsphere through the sclera using a needle of one of the aforementioned gauges, and samples were then collected. The fluorescence strength of samples was measured using fluorophotometry. RESULTS: We visually detected fluorescent microspheres in 10/10, 9/10, and 9/10 eyes injected with 27-G, 30-G, and 32-G needles, respectively. In the experimental quantification study, values at all needle gauges were significantly higher than those of controls (P < 0.01). Fluorescence strength was significantly higher in the 27-G group than in the 30- (P < 0.01) and 32-G (P < 0.01) groups. CONCLUSION: Intravitreal injection carries the risk of introducing contamination directly into the eyes even when a 32-G needle is used. Furthermore, the 27-G needle carries the highest contamination risk.


Assuntos
Modelos Animais de Doenças , Contaminação de Equipamentos , Injeções Intravítreas/efeitos adversos , Microesferas , Agulhas/microbiologia , Corpo Vítreo/microbiologia , Animais , Endoftalmite/microbiologia , Enucleação Ocular , Fluorofotometria , Suínos
17.
Ned Tijdschr Geneeskd ; 159: A9471, 2015.
Artigo em Holandês | MEDLINE | ID: mdl-26577383

RESUMO

OBJECTIVE: The Dutch national patient safety platform developed a protocol for the preparation of intravenous medication; the Aseptic Non-Touch Technique (ANTT). Use of ANTT on nursing wards has shown to reduce contamination of intravenous medication. Therefore it is dictated by the Dutch Healthcare Inspectorate that this technique has to be used at all departments in the hospital, including the operating theatre. However, because of the use of air treatment and operating theatre uniforms, the operating theatre cannot be compared with a nursing ward. In this study, the bacterial contamination of syringes prepared in the operating theatre by anesthesia nurses was determined. DESIGN: Simulation study METHOD: 45 anesthesia nurses prepared 1000 syringes of 10 ml bacterial culture medium, using their routine method of drawing up iv medication from vials. Turbidity in a syringe after culturing for 14 days at 30° C was used as evidence for bacterial contamination. Using questionnaires, nurses were interviewed in what degree their working method equals ANTT-protocol. We calculated how much extra time must be invested when using the strict ANTT-protocol in the operating theatre. RESULTS: Six syringes (0,6%) were contaminated. Normal dermal bacteria were identified in all syringes. The nurses who prepared the contaminated syringes worked similar manner as their colleagues. It takes an additional 54 minutes per day per operating theatre to work strictly using the ANTT technique. CONCLUSION: Contamination rates of aseptic preparations in the OR are very low, and are as low as ANTT preparations in a GMP-certified hospital pharmacy. Therefore it is legitimate to develop a modified ANTT-protocol for use in the operating theatre.


Assuntos
Contaminação de Equipamentos/prevenção & controle , Higiene/normas , Salas Cirúrgicas/normas , Segurança do Paciente , Hospitais , Humanos , Agulhas/microbiologia , Guias de Prática Clínica como Assunto
18.
Am J Vet Res ; 76(10): 877-81, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26413825

RESUMO

OBJECTIVE: To determine by use of an in vitro model the potential for translocating sufficient numbers of bacteria into a joint during arthrocentesis through cellulitic tissue to cause sepsis. SAMPLE: Culture media containing 4 concentrations of Staphylococcus aureus and needles of 3 sizes. PROCEDURES: Needles (22, 20, and 19 gauge) were inserted through Mueller-Hinton agar that contained known concentrations of S aureus (10(3),10(4),10(5), and 10(6) CFUs/mL). After a needle exited through the medium, any agar plug within the needle bore was ejected into a sterile syringe and the contaminated portion of the needle was harvested. Sterile saline (0.9% NaCl) solution was used to emulsify the agar plug and wash the contaminated portion of the needle. The resulting solution was cultured to determine the number of bacterial CFUs that could be deposited into a joint during arthrocentesis through contaminated tissue. RESULTS: Needle gauge and bacterial concentration were both associated with the number of bacterial CFUs deposited after insertion through contaminated agar. Although all needle sizes were capable of bacterial translocation sufficient to cause septic arthritis, ORs for 20- and 22-gauge needles translocating > 33 CFUs of S aureus were significantly higher than the OR for a 19-gauge needle. The ORs for 20- or 22-gauge needles translocating > 33 CFUs of S aureus (the minimum population of S aureus known to cause joint sepsis) were 0.22. CONCLUSIONS AND CLINICAL RELEVANCE: Results for this in vitro model indicated that caution should be used when performing arthrocentesis through cellulitic tissue.


Assuntos
Celulite (Flegmão)/veterinária , Modelos Animais de Doenças , Doenças dos Cavalos/prevenção & controle , Artropatias/veterinária , Sepse/veterinária , Animais , Artrocentese/efeitos adversos , Artrocentese/veterinária , Translocação Bacteriana , Celulite (Flegmão)/complicações , Celulite (Flegmão)/microbiologia , Meios de Cultura , Doenças dos Cavalos/microbiologia , Cavalos , Artropatias/etiologia , Artropatias/prevenção & controle , Agulhas/microbiologia , Sepse/etiologia , Sepse/prevenção & controle , Staphylococcus aureus/patogenicidade , Staphylococcus aureus/fisiologia
19.
J Ocul Pharmacol Ther ; 31(10): 627-30, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26287981

RESUMO

PURPOSE: The purpose of this laboratory study was to assess the effect of povidone-iodine (PI) use topically on the conjunctiva in regard to needle bore contamination and to compare these results with our previous findings from an evaluation of bacterial contamination following gatifloxacin and moxifloxacin administration. METHODS: We performed 100 conjunctival 27-gauge needle penetrations of both eyes of 13 fresh cadavers. Eyes were then soaked in 10% PI, after which conjunctiva was again penetrated 100 times. After conjunctival penetration, the needles were irrigated, and the irrigant was assessed for bacterial growth. Results were compared with previous work assessing fluoroquinolone effectiveness through the same model. RESULTS: We observed a 28% (P = 0.003) decrease in bacterial growth and 40% (P < 0.0001) decrease in colony counts after PI placement. Differences between the effect of PI versus moxifloxacin and gatifloxacin were not statistically significant. CONCLUSIONS: There is a greater decrease in bacterial load after treatment with PI for surface cultures than for cultures obtained through a needle bore passed through the conjunctiva. PI is a superior approach to topical antibiotics to decrease conjunctival bacterial load.


Assuntos
Antibacterianos/farmacologia , Antibioticoprofilaxia/métodos , Infecções Oculares Bacterianas/prevenção & controle , Povidona-Iodo/farmacologia , Administração Oftálmica , Antibacterianos/administração & dosagem , Anti-Infecciosos Locais/administração & dosagem , Anti-Infecciosos Locais/farmacologia , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Cadáver , Túnica Conjuntiva/microbiologia , Infecções Oculares Bacterianas/etiologia , Infecções Oculares Bacterianas/microbiologia , Fluoroquinolonas/administração & dosagem , Fluoroquinolonas/farmacologia , Gatifloxacina , Humanos , Injeções Intraoculares , Moxifloxacina , Agulhas/microbiologia , Povidona-Iodo/administração & dosagem
20.
Curr Probl Dermatol ; 48: 190-5, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25833643

RESUMO

Tattooing became a popular phenomenon during the late twentieth century. Because the act of tattooing involves repeated injection of ink through the skin, a risk of contracting infections from contaminated tattooing equipment and ink and the surrounding environment exists. Progress has been made in infection control strategies; however, contraction of bacterial and viral infections from tattooing continues to occur. The risk of acquiring a tattoo-related infection largely depends on the hygiene conditions under which the tattoo is applied. Nevertheless, even when adequate hygiene and sanitation measures are taken, the inks themselves may contain infectious microorganisms that are able to survive under hostile conditions, such as in inks. The results of the few studies on the microbiological quality of unopened and opened tattoo inks are reported. Some authors' conclusions demonstrated that the current ink sterilisation systems show a low capability to inactivate microbial contamination in tattoo inks. At the moment, European Resolution ResAP2008-1 recommends that the ink be sterile and supplied in containers that maintain the sterility of the product until application. In light of the outcomes of published studies, at the moment, preservation of the microbial quality and safety of ink seems challenging and still difficult to reach.


Assuntos
Bactérias/isolamento & purificação , Corantes/efeitos adversos , Contaminação de Medicamentos , Infecções/epidemiologia , Tatuagem/efeitos adversos , Corantes/normas , Contaminação de Medicamentos/prevenção & controle , Contaminação de Equipamentos , Europa (Continente) , Fungos/isolamento & purificação , Humanos , Tinta , Agulhas/microbiologia , Conservantes Farmacêuticos , Esterilização , Tatuagem/instrumentação , Tatuagem/normas
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...