Skin Antiseptics Research Articles

Опыт организации дезинфекционных мероприятий в условиях пандемии коронавирусной инфекции 2020 года

Ensuring biosafety in the territory of the country is one of the key functions (tasks) of the state. The pandemic of a new coronavirus infection has affected absolutely all areas of human activity in all countries of the world. Approaches to prevention have not changed, but the whole country has faced a number of challenges at various levels. With a sharply increased demand for non-specific prophylaxis (including skin antiseptics and disinfectants), not all manufacturers were ready to meet the demand with a quality product. The scarcity of resources (raw materials, components, cash shortages, personnel, etc.) constrained the rapid increase in production capacity to ensure a sharply increased demand. Keywords: pandemic COVID-19, disinfectants, skin antiseptics.

Efficacy and safety of 1.5% aqueous olanexidine gluconate antiseptic solution compared to 1% alcoholic chlorhexidine for the prevention of intravenous catheter-related infections (Apollo study): a protocol for a randomised controlled trial

IntroductionChlorhexidine alcohol (1.0%–2.0%) is currently recommended as a skin disinfectant to be used prior to catheterisation for preventing catheter-related infections. However, chlorhexidine alcohol has various side effects and has little antibacterial effect on methicillin-resistant Staphylococcus aureus (MRSA). Therefore, MRSA remains a concern for catheter-related bloodstream infection (CRBSI) prevention. Olanedine, containing 1.5% olanexidine gluconate in aqueous solution, was developed in Japan in 2015 and is structurally similar to chlorhexidine. Olanexine has been used as a disinfectant against various gram-positive and gram-negative bacteria and MRSA. This study aims to compare the efficacy of 1.5% aqueous olanexidine gluconate and 1% chlorhexidine alcohol as skin antiseptics for the prevention of catheter-related infections.Methods and analysisThis Apollo study is an open-label, multicentre, non-inferiority, two-arm, parallel-group, randomised controlled trial conducted at 21 intensive care units (ICUs) and high-care units (HCUs) in Japan. All patients scheduled to be admitted to the ICU or HCU of a facility participating in this study, who require central venous catheter insertion are eligible. Eligible patients will be assigned to either the 1.5% aqueous olanexidine gluconate or 1% chlorhexidine alcohol group by randomisation in a ratio of 1:1 with stratification by centres. The antibacterial agents are to be used as a skin disinfectant before and during catheter placement. The primary endpoint is the proportion of catheter-related infections, defined as a composite of catheter-related sepsis without bacteraemia and CRBSI. A total of 1980 patients will be included in this study.Ethics and disseminationThis clinical trial was approved by the Institutional Review Board of Jichi Medical University and the ethics committees of the participating institutions. The study results will be disseminated through conferences, peer-reviewed publications and meetings with interested parties.Trial registration numberUniversity hospital Medical Information Network (registration ID: UMIN000042343). This registration includes all items in the WHO Trial Registration Data Set.Protocol versionThis protocol corresponds to the original protocol version 5.

Antimicrobial performance of two preoperative skin preparation solutions containing iodine and isopropyl alcohol

BackgroundHealthcare-associated infections (HAIs) are a persistent clinical challenge caused primarily by bacteria on the skin. Proper utilization of optimized antiseptic skin preparation solutions helps reduce the prevalence and impact of HAIs by decreasing patient skin microorganisms preoperatively. The purpose of this study was to evaluate the efficacy of 2 antimicrobial solutions containing iodine and isopropyl alcohol (IPA): Povidone iodine (PVP-I) with IPA (ie, PVP-I+IPA, PurPrep) and Iodine Povacrylex+IPA (DuraPrep). MethodsThe antimicrobial activity of the test solutions was evaluated in vitro by determinations of minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) against 1105 diverse microbial isolates and a time-kill assay to evaluate efficacy against 120 strains of Gram-positive and Gram-negative bacteria and yeasts. Peel tests were performed between skin samples treated with test solutions and representative drape/dressing materials to determine effects of test solutions on the biomechanical adhesion properties. Finally, an Institutional Review Board (IRB)-approved, randomized, controlled, single-center, partially blinded in vivo study was performed to assess the immediate and persistent antimicrobial activity of the test solutions on the abdomen and groin. ResultsBoth PVP-I+IPA and Iodine Povacrylex+IPA solutions demonstrated broad-spectrum antimicrobial activity with MIC and MBC at less than 1% of the full-strength concentration of each product against a wide variety of microorganisms. In the time-kill tests, both solutions were able to successfully reduce all microbial populations by 99.99% (ie, 4 log10) at the contact times of 30 seconds, 2 minutes and 10 minutes. The 2 solutions showed relatively similar adhesion results when tested with 3 representative operating room materials. Both PVP-I+IPA and Iodine Povacrylex+IPA met the expected Food and Drug Administration (FDA) efficacy requirements at 10 minutes and 6 hours post-treatment for both anatomic sites (ie, groin, and abdomen) in the clinical study, with no safety issues or adverse events. ConclusionsAnalysis of the in vitro antimicrobial activity, biomechanical adhesive strength, and in vivo efficacy of PVP-I+IPA demonstrated similar results compared to Iodine Povacrylex+IPA. Both products were efficacious at reducing or eliminating a wide range of clinically-relevant microorganisms in lab-based and clinical settings, supporting their use as antiseptic skin preparation solutions to reduce bacteria on the skin that can cause infection.

Association of COVID-19 With Achieving Time-to-Surgery Benchmarks in Patients With Musculoskeletal Trauma

In response to the COVID-19 pandemic, many hospital systems were forced to reduce operating room capacity and reallocate resources. The outcomes of these policies on the care of injured patients and the maintenance of emergency services have not been adequately reported. To evaluate whether the COVID-19 pandemic was associated with delays in urgent fracture surgery beyond national time-to-surgery benchmarks. This retrospective cohort study used data collected in the Program of Randomized Trials to Evaluate Preoperative Antiseptic Skin Solutions in Orthopaedic Trauma among at 20 sites throughout the US and Canada and included patients who sustained open fractures or closed femur or hip fractures. COVID-19-era operating room restrictions were compared with pre-COVID-19 data. Surgery within 24 hours after injury. A total of 3589 patients (mean [SD] age, 55 [25.4] years; 1913 [53.3%] male) were included in this study, 2175 pre-COVID-19 and 1414 during COVID-19. A total of 54 patients (3.1%) in the open fracture cohort and 407 patients (21.8%) in the closed hip/femur fracture cohort did not meet 24-hour time-to-surgery benchmarks. We were unable to detect any association between time to operating room and COVID-19 era in either open fracture (odds ratio [OR], 1.40; 95% CI, 0.77-2.55; P = .28) or closed femur/hip fracture (OR, 1.01; 95% CI, 0.74-1.37; P = .97) cohorts. In the closed femur/hip fracture cohort, there was no association between time to operating room and regional COVID-19 prevalence (OR, 1.07; 95% CI, 0.70-1.64; P = .76). In this cohort study, there was no association between meeting time-to-surgery benchmarks in either open fracture or closed femur/hip fracture during the COVID-19 pandemic compared with before the pandemic. This is counter to concerns that the unprecedented challenges associated with managing the COVID-19 pandemic would be associated with clinically significant delays in acute management of urgent surgical cases and suggests that many hospital systems within the US were able to effectively implement policies consistent with time-to-surgery standards for orthopedic trauma in the context of COVID-19-related resource constraints.

To Investigate the Effect of Using Ethanol Containing Wipes in Collecting Blood for the Measurement of Alcohol Concentration

This study was aimed to establish whether the skin preparation using ethanol-containing skin antiseptics causes ethanol contamination through blood collection. Venous blood was collected from 40 healthy volunteers according to the national guidelines for blood sampling, with four sequential procedures as follows: 1) collecting blood immediately (within 5 seconds) after cleaning the skin with an individually packaged type of ethanol-containing wipe, 2) collecting blood 1 minute after cleaning the skin with an individually packaged type of ethanol-containing wipe, 3) collecting immediately (within 5 seconds) after cleaning the skin with a traditional cleaning method (thoroughly ethanol-impregnated wipe, and 4) collecting 1 minute after cleaning the skin with a traditional cleaning method. Each sequential procedure was performed with and without the ethanol-containing wipe used for skin cleaning on the puncture site on their right and left arms at the time the needle was withdrawn, respectively. The collected specimens were subjected to the determination of ethanol by using headspace gas chromatography-mass spectrometry. In every 80 blood specimens obtained from 40 participants, ethanol was undetectable (<0.001 mg/mL). This study demonstrates that disinfection using ethanol-containing skin antiseptics is unlikely to cause ethanol contamination through blood collection regardless of skin preparation technique according to the guidelines for blood sampling. This may have implications in forensic science.

1137 Improving the Use of Pre-Operative Skin Antiseptics (Chlorhexidine Pink and Betadine) To Reduce Umbilical Port Site Infections Following Laparoscopic Cholecystectomy and Appendicectomy

Abstract Introduction Approximately 8% of patients who undergo laparoscopic surgery develop port site infections1. This would negatively impact recovery and increase rates of readmission. Patients’ skin is a major source of pathogens that results in surgical site infection (SSI). Therefore, optimisation of antiseptic skin preparations may decrease postoperative umbilical port site infection (UPSI). Method A retrospective analysis of 226 cases from August 2019 till October 2020 at East Lancashire Hospital NHS Trust was performed. The first cycle included 122 patients (58 cholecystectomies and 64 appendicectomies), and a further 104 patients (51 cholecystectomies and 53 appendicectomies) after emphasising on using chlorhexidine pink as skin preparation. The presence of UPSIs within 30 days post-surgery was recorded. Results In the first cycle, the local preparation that was used in patients with UPSI was chlorhexidine pink (21.4%) and betadine (78.6%). The surgical team were then educated regarding the benefits of chlorhexidine pink over betadine as local skin preparation. In the second cycle, 63.3% used chlorhexidine pink and 36.7% used betadine. After the above implementation, there was a reduction in the rate of UPSI (18.0% to 15.7%) and readmission rates (7.2% to 5.9%) in patients who had undergone laparoscopic cholecystectomy. In patients who had undergone laparoscopic appendicectomy, a similar trend in UPSI rates was identified as well (7.1% to 5.5%) and readmission rates (5.5% to 1.9%). Conclusions The incidence of UPSI was reduced with the use of chlorhexidine pink compared to betadine. This may have contributed to the decrease in UPSI cases and led to a reduction in re-admission rates.

Antiseptic Skin Agents to Prevent Surgical Site Infection After Incisional Surgery: A Randomized, Three-armed Combined Non-inferiority and Superiority Clinical Trial (NEWSkin Prep Study).

To compare SSI rates between the skin preparation agents: PI-Aq, povidone-iodine with alcohol (PI-Alc), and chlorhexidine with alcohol (C-Alc). Guidelines suggest that alcohol-containing chlorhexidine solutions are the gold standard for skin preparation before surgery. It remains difficult to determine whether it is the chlorhexidine component or the addition of alcohol that confers the most benefit. We conducted a multicenter, prospective, combined non-inferiority (PI-Alc vs C-Alc) and superiority (PI-Alc vs PI-Aq) randomized clinical trial. Participants were randomized 1:1:1 to receive either C-Alc, PI-Alc, or PI-Aq. The primary outcome was SSI rate as defined by the Centers for Disease Control. Secondary outcomes were complication rates, length of hospital stay, readmissions, and skin reactions. Between January 2015 and December 2018, 3213 patients were randomized (C-Alc: 1076, PI-Alc: 1075, and PI-Aq: 1062). Mean age of participants was 57% and 55% were female. SSI rates were: C-Alc 11.09%, PI-Alc 10.88%, and PI-Aq 12.56%. PI-Alc was found to be non-inferior to C-Alc (mean difference, -0.21%; 95% confidence interval, -2.85 to 2.44; P = 0.0009 non-inferiority), whereas PI-Alc was not superior to PI-Aq (mean difference, -1.68%; 95% confidence interval, -4.40 to 1.05; P = 0.2302). There were no differences seen in secondary outcomes between groups and no treatment related adverse events or deaths occurred. PI-Alc is non-inferior to C-Alc and not superior to PI-Aq. This is at odds with current guidelines that suggest alcohol-based chlorhexidine solutions should routinely be used for surgical skin preparation. Australia and New Zealand Clinical Trials Registry: ANZCTRN12615000021571. www.anzctr.org.au.

Umbilical microflora and pediatric surgery.

In pediatric surgery, the umbilicus with humid environment prone to bacterial colonization has become the most common site of entrance into the peritoneum. However, the umbilical flora in children has never been reported. This study aimed to describe the characteristics of umbilical microflora in children before antiseptic skin preparation. We prospectively reviewed all children (age, ≤ 15years) undergoing surgical procedures using umbilical access between April 2020 and June 2021. Before antiseptic skin preparation, culture swabs were taken from the umbilicus. Data on age, sex, and surgical procedure as well as microflora results and clinical findings were analyzed. Overall, data on 123 children aged between 9days and 15years (median: 3years) were obtained. In the umbilicus, the most frequent colonizing bacteria were coagulase-negative Staphylococcus species and Corynebacterium. The isolation of intestinal bacteria from children aged ≤ 3years was significantly increased (P = 0.03). The results of the multidrug resistance test revealed that the bacteria from the umbilicus exhibited a high frequency of cefazolin (CEZ) resistance (46.1%). No postoperative surgical site infection was recorded in our study. This prospective study is the first report to investigate the umbilical microflora in over 100 children. In this study, a large spectrum of both resident and transient microflora was cultured from the umbilicus. This umbilical microflora was similar to previous reports of adult microflora except in children aged ≤ 3years. Our data suggest that in children ≤ 3years, preoperative and postoperative antibiotics should be chosen by considering CEZ resistance and intestinal bacteria. The result of umbilical microflora would be useful to select the antibiotics for treatment of surgical site infection (SSI), and the culture swabs from the umbilicus before the operation for the children at high risk for SSI are highly recommended.

Chlorhexidine\u2013alcohol versus povidone\u2013iodine as preoperative skin antisepsis for prevention of surgical site infection in cesarean delivery\u2014a pilot randomized control trial

ObjectivesTo compare the efficacy of chlorhexidine–alcohol and povidone–iodine as preoperative antiseptic skin preparation for prevention of surgical site infection (SSI) after cesarean delivery (CD).Materials and methodsA total of 311 eligible women who underwent CS were recruited in the study after fulfilling all the eligibility and exclusion criteria. Patients were randomized into two groups (153 in chlorhexidine–alcohol group and 158 in povidone–iodine group) by a computer-generated randomization table. Patients were followed for a period of 30 days in postoperative period to monitor for SSI.ResultsThe rate of SSI in the chlorhexidine–alcohol group is 5.4% and that of the povidone–iodine group is 8.6%. E. coli, K. pneumoniae, and Acinetobacter baumannii were the most common organisms isolated. E. coli was found in 9.5% of the total SSI cases.ConclusionsThe study found that the patients who received chlorhexidine–alcohol as skin antiseptic had less chance of developing SSI than those who received povidone–iodine; however, it did not reach a statistical significance.Trial registrationClinical Trials Registry of India CTRI/2018/05/014294. Registered on May 31, 2018

27494 Novel high emollient hand sanitizers improve skin condition without compromising antiseptic efficacy

A key patient complaint with increased hand sanitizing is skin dryness and irritation, which can lead to hand dermatitis. While traditional alcohol-based hand sanitizers are known to be effective against bacteria, they may exacerbate hand dryness. The objective of this research was to develop high emollient hand sanitizers, with humectants and triglyceride oils, to provide both antiseptic efficacy and skin condition benefits. Standard in vitro methods were performed to evaluate antiseptic efficacy.

Оценка безопасности кожных антисептиков методом in vitro

InVitro laboratory has investigated and made comparative analysis of irritant effect of disinfectants on rabbits. Main active substances of studied skin antiseptics were: alcohols, chlorhexidine bigluconate, alkyldime­thylbenzylammonium chloride, didecyldimethylammonium chloride, N,N-bis(3-aminopropyl)dodecylamine. Has been developed method for evaluating the irritant effect of skin antiseptics on bull sperm suspensions.

Implementation of a Universal Decolonization Protocol to Reduce Surgical Site Infections in Orthopedic Surgery Patients

Background : Orthopedic surgical site infections (SSISs) are costly complications, increasing morbidity and mortality. between CY2018 and July 2019, our facility experienced an increase in complex (deep and organ space) SSIs, most due to common skin organisms. During this period, our preoperative process included the use of 2% chlorhexidine (CHG) impregnated cloths for patient self-application the night before and the morning of surgery. Day of surgery (DOS), the preoperative nurse repeated the CHG cloth application on the surgical site and applied an iodophor product to the patient's nose. Methods : A multidisciplinary team was engaged to develop a preoperative five-day universal decolonization (UD) protocol: daily use of a 4% CHG antiseptic foam skin cleanser and twice a day use of an alcohol-based nasal sanitizer. Kits with UC products and instruction were distributed by the surgeons’ offices during the preoperative appointment. Kit receipt was confirmed during the preadmission phone call. Alcohol-based nasal sanitizer repeated DOS. Compliance with UC kit use was confirmed DOS. The 12-month pre- and post-implementation periods were compared. Results : In the pre- and post-intervention periods 4,610 and 4,361 procedures were performed, respectively. Random sampling of procedure documentation showed greater than 99% patient-reported compliance. No reports of adverse effects were received. Analysis of the pre- and post-implementation data revealed a decrease in all NHSN procedure complex SSI standardized infection ratio (SIR) from 1.287 to 0.762. The SSI SIR for individual procedure types (spinal fusion, hip/knee replacement) were also decreased with the exception of laminectomies. The complex SSI rate per 100 procedure was decreased overall and for each individual procedure category. Conclusions : The implementation of a preoperative five-day UC protocol decreased the complex SSI SIR and complex SSI rate per 100 procedures for all NHSN procedures.

Clinical Issues—June 2021

Selecting an antiseptic skin preparation agent according to the patient's skin pigmentation Key words: preoperative patient skin antisepsis, surgical site marking pen, Fitzpatrick skin type scale, tinted antiseptic, ink visibility. Developing a preoperative bathing protocol Key words: preoperative bathing protocol, preoperative showering regimen, antiseptic soap, antiseptic solution, patient education. Decolonizing health care personnel Key words: methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant organism (MDRO), colonization, transmission, nasal decolonization. Composition of bone cement and precautions for perioperative personnel Key words: bone cement, absorption exposure, methyl methacrylate (MMA), occupational hazards, personal protective equipment (PPE).

Disinfectant testing for veterinary and agricultural applications: A review.

Disinfectants for veterinary and livestock use, plus skin antiseptics, are critical elements for the control of infectious agents, including zoonotic and antimicrobial-resistant micro-organisms, in managed animal species. Such agents impact animal welfare, economic performance and human health. Testing of disinfectants is needed for safety, efficacy and quality control. The present review examines the principal types of test (carrier, suspension, surface and field) that have been developed or attempted, plus the features inherent in the respective tests, particularly with respect to variability. Elements of testing that have to be controlled, or which can be manipulated, are discussed in the context of real-world scenarios and anticipated applications. Current national and international testing regimes are considered, with an emphasis on the UK, continental Europe and North America, and with further detail provided in the Supporting Information. Challenges to disinfectant efficacy include: the nature of the biological targets (bacteria, fungi, yeasts, spores, viruses and prions), the need for economical and safe working concentrations, the physical and chemical nature of contaminated surfaces, constraints on contact times and temperatures, the presence of organic soil and other barrier or neutralising substances (including biofilms), and thoroughness of pre-cleaning and disinfectant application. The principal challenges with veterinary disinfectant testing are the control of test variability, and relating test results to likely performance in variable field conditions. Despite some ambitions to develop standardised field tests for disinfectants, aside from skin antiseptic trials the myriad problems such tests pose with respect to cost, reproducibility and generalisability remain intractable.

Pragmatic randomized trial evaluating pre-operative aqueous antiseptic skin solution in open fractures (Aqueous-PREP): the feasibility of a cluster randomized crossover study

BackgroundPreoperative antiseptic skin solutions are used prior to most surgical procedures; however, there is no definitive research comparing infection-related outcomes following use of the various solutions available to orthopedic trauma surgeons. The objective of this pilot study was to test the feasibility of a cluster randomized crossover trial that assesses the comparative effectiveness of a 10% povidone-iodine solution versus a 4% chlorhexidine gluconate solution for the management of open fractures.MethodsTwo orthopedic trauma centers participated in this pilot study. Each of these clinical sites was randomized to a starting solution (povidone-iodine solution or chlorhexidine gluconate) then subsequently crossed over to the other treatment after 2 months. During the 4-month enrollment phase, we assessed compliance, enrollment rates, participant follow-up, and accurate documentation of the primary clinical outcome. Feasibility outcomes included (1) the implementation of the interventions during a run-in period; (2) enrollment of participants during two 2-month enrollment phases; (3) application of the trial interventions as per the cluster randomization crossover scheme; (4) participant follow-up; and (5) accurate documentation of the primary outcome (surgical site infection). Feasibility outcomes were summarized using descriptive statistics reported as means (standard deviation) or medians (first quartile, third quartile) for continuous variables depending on their distribution and counts (percentage) for categorical variables. Corresponding 95% confidence intervals (CIs) were also reported.ResultsAll five of the criteria for feasibility were met. During the run-in phase, all 18 of the eligible patients identified at the two clinical sites received the correct cluster-assigned treatment. A total of 135 patients were enrolled across both sites during the 4-month recruitment phase, which equates to 92% (95% CI 85.9 to 96.4%) of eligible patients being enrolled. Compliance with the assigned treatment in the pilot study was 98% (95% CI 93.5 to 99.8%). Ninety-eight percent (95% CI 93.5 to 99.8%) of participants completed the 90-day post-surgery follow-up and the primary outcome (SSI) was accurately documented for 100% (95% CI 96.6 to 100.0%) of the participants.ConclusionsThese results confirm the feasibility of a definitive study comparing antiseptic solutions using a cluster randomized crossover trial design. Building upon the infrastructure established during the pilot phase, a definitive study has been successfully initiated.Trial registrationClincialTrials.gov, number NCT03385304. Registered December 28, 2017.

Disinfectants and Skin Antiseptics for Safe prophylaxis against COVID-19, Review of Literature.

Coronavirus disease 2019 (COVID-19) is currently receiving the whole world's attention. It appeared first in Wuhan city of China and rapidly spread to the world, causing many mortalities and morbidities; the disease is mainly transmitted via respiratory droplets and has a long infectivity period of about 14 days. Science shows that the virus is also transmitted via the skin if the virus by any means finds its way and land on the skin surface. Infection occurs when touching the face, eyes, or nose with the hand after the virus has landed upon it. This is the main reason for the widespread usage of skin antiseptics and disinfectants. We included the most commonly used skin antiseptics, sterilizing methods, and disinfectants, such as household bleach, hydrogen peroxide gas plasma, Formaldehyde, Glutaraldehyde, Alcohol, Chlorohexidine, Povidone-iodine, Chloroxylenol, and alcohol-based hand sanitizer (e.g. Sterlelium). We will discuss their role in preventing acquired infection of COVID-19, as well as discussing the efficacy, costs, and side effects of different sterilizers, including general health hazards, as well as skin affection as irritant contact dermatitis, which is the commonest side effect. After conducting this work, we summarized the results &amp; started sending them to our patients &amp; medical personnel, and we observed 60% decrease in the cases of disinfectants induced allergic contact dermatitis /month compared to the previous two months.

Nurses' Attitude Towards Various Hand Hygiene Products. Soap vs Antiseptics.

According to the latest recommendations of WHO, in most situations requiring hands treatment, alcohol-based skin antiseptics should be used. This study is aimed to determine the awareness and preferences of nurses in the city of Moscow regarding the choice of methods regarding hand hygiene treatment and the factors influencing this choice. Using the specially designed questionnaire, 184 nurses working in Moscow hospitals were interviewed to find out the attitude of nurses to various methods of hand hygiene. The questionnaire was developed on the basis of WHO Recommendations and Russian Recommendations. The survey was conducted from May 2017 to July 2017. To confirm the statistical significance of the identified associations a chi-square test was used. To find the 95% confidence interval to the relative values the Clopper-Pearson method was used. Only 3 (1.63%) of respondents indicated that they use antiseptic as the most frequently used hand hygiene product, 27 (14.67%) use liquid soap more often, 153 (83.15%) indicated that they use soap and antiseptic with equal frequency. In none of the standard situations we examined the use of antiseptic was the most frequent choice. Only in three cases antiseptic was chosen more often than soap - before and after manipulations with wounds and catheters (36.96%) or before performing invasive procedures (36.41%) and after contact with biological material (29.35%). At the same time nurses with more than 15 years of experience have preferred antiseptic. Based on the study it can be assumed that despite the implementation of the Russian guidelines on hand hygiene developed according to WHO recommendations, nurses prefer the traditional method of washing hands with soap. This suggests that in the current conditions additional measures are needed to train nurses and to monitor their work.

Bacterial pattern of hemodialysis central catheter associated infections in end stage renal disease patients in north eastern Egypt

Background: Hemodialysis-catheter associated infections are a crucial problem for hemodialysis patients in the inpatient and outpatient venues. So, our aim was to identify bacterial pattern of hemodialysis central catheter associated infection (HD-CAI) and also study the risk factors in developing HD-CAI.Patients and methods: The study done as a cross sectional descriptive study that was conducted on 62 patients who admitted and followed in the Clinical Nephrology unit, Suez Canal University Hospital, Ismailia, Egypt. From each patient with evidence of Catheter Related Infections (CRI), three specimens (swabs, catheter tips and blood cultures) were aseptically collected and processed in the Microbiology Department. Isolated colonies from catheter tip culture and blood culture were identified by colony morphology, Gram staining and biochemical tests. The antibiotic Susceptibility Testing was performed using disc diffusion method outlined by Clinical and Laboratory Standard Institute depending on the isolated organism.Results: The prevalence of HD-CAI was 14.5%. It was found that 88.9% of the study participants who developed HD-CAI did not use skin antiseptics. Also the gram positive bacteria represented 88.9% of the isolated organisms, comprised mainly of S.epidermidis) representing 55.6%, followed by S .aureus in 33.3%. While, gram negative bacteria were recovered from 11.1% of the isolated organisms. All isolates of S. epidermidis and S. aureus were sensitive to Amoxicillin (100%) & Linezolid (100%), while S. epidermidis showed resistance to Cefoxitin (80%). Conclusion: The frequency of HD-CAI was 14.5% with significant relationship between usage of skin antiseptics and decreasing the chance of developing HD-CAI.

Treatment of trophic ulcers of the lower extremities

Background. In 50 % of cases trophic ulcers (TU) are caused by chronic venous insufficiency, in 10 % – by arterial insufficiency, in 5 % – by disorders of nerve trophic. Treatment of ischemic TU includes conservative and surgical tactics, wound dressings, pain management, use of hydrogel dressings, antibacterial therapy, measures to improve blood circulation.&#x0D; Objective. To describe the treatment of TU of the lower extremities.&#x0D; Materials and methods. Analysis of literature data on this issue.&#x0D; Results and discussion. The pathogenesis of chronic venous ulcers includes persistent venous hypertension and microcirculation disorders. Varicose veins, postthrombotic disease and congenital vascular malformations are the main causes of such ulcers. In postthrombotic disease affecting the veins of the lower extremities in patients with severe symptoms, surgery (femoro-femoral or femoro-caval bypass), percutaneous endovascular recanalization (stenting, balloon angioplasty), combined surgical-endovenous desobliteration, transposition of the segmentary vein valves and relocation of autoveins may be considered. After the operations on veins, surgical interventions for TU are performed. Antibiotic therapy (Leflocin, “Yuria-Pharm”, 500 mg intravenously once before surgery), topical antiseptic Dekasan (“Yuria-Pharm”) and skin disinfectant Gorosten (“Yuria-Pharm”) are used to accompany interventions for postthrombotic disease. Vasodilation disorders, which are one of the links in the TU pathogenesis, are the result of endothelial dysfunction and nitric oxide (NO) deficiency. To eliminate these factors, L-arginine (Tivortin, “Yuria-Pharm”) is used. Tivortin catalyzes the synthesis of NO in endothelial cells, reduces the activation and adhesion of leukocytes and platelets to the vascular endothelium, prevents the formation and progression of atherosclerotic plaques. In the treatment of lower extremity ischemia and TU, it is advisable to use the infusion therapy scheme “TRIO”: Reosorbilact 400 ml + Latren 400 ml + Tivortin 100 ml (“Yuria-Pharm”).&#x0D; Conclusions. 1. Minimally invasive methods are effective and minimally traumatic option of TU treatment, which should actively displace open methods. 2. Conservative TU treatment includes the microcirculation improvement, the use of antiseptics, strengthening of the vascular wall, antibacterial and rheological support.

Современные средства для обработки рук хирурга и операционного поля (обзор литературы)

The aim – analyze modern Russian and foreign literary sources in order to determine modern means for treating the hands of the surgeon and the operating field. Results. One of the key points in the prevention of surgical infection is the treatment of the surgeon’s hands and the operating field with effective skin antiseptics in order to destroy pathogenic and opportunistic microorganisms that colonize intact skin. In modern practice, skin antiseptics are predominantly used containing alcohols as active substances, in particular ethyl, propyl and isopropyl, halogenated substances such as iodine and iodophores, guanidines, which include chlorhexidine digluconate, as well as quaternary ammonium compounds. Moreover, the most widespread are combined preparations containing several active substances and functional additives, which makes it possible to neutralize the negative properties of various active substances. Also, an interesting and promising direction is the use of polymer operating films or film-forming antiseptics. Currently, research is being actively carried out aimed at finding and developing modern highly effective antiseptic agents and their rational combinations that meet the necessary requirements, are optimal in their properties, cost-effective and comfortable to use.