Use Of Aseptic Technique Research Articles

Non-ischemic complications of dermal fillers

Dermal fillers have been commonly used for the filling of facial rhytids. As the use of dermal fillers has grown, so has the incidence of non-ischemic complications. These complications range from edema, bruising, and erythema to more complex conditions such as delayed hypersensitivity nodules and biofilms. This article sought to review the causes of various non-ischemic complications, discuss their risk factors, and review management techniques. Certain predisposing factors to delayed hypersensitivity nodules, such as Vycross technology, a history of viral illness, or coronavirus disease 19 (COVID-19) infections, are discussed in detail in this review. Prevention techniques such as patient counseling, elucidating certain patient history (viral illness, dental procedures), the use of aseptic technique, and procedural factors are also discussed. Understanding appropriate management for these complications can also help in treatment. Imaging, such as ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI), has taken on a larger role in the management of non-ischemic complications.

Pancreatitis as a Consequence of Endoscopic Retrograde Cholangiopancreatography: A Comprehensive Review of the Literature from a Case Report

Post ERCP pancreatitis, also known as post-endoscopic retrograde cholangiopancreatography pancreatitis, is a potentially serious complication that can occur after this endoscopic procedure. It is characterized by acute inflammation of the pancreas, triggered by the manipulation and trauma induced during ERCP. This clinical condition manifests with severe abdominal pain, nausea, vomiting, bloating and fever. It varies in severity and may be associated with significant complications, such as pancreatic pseudocysts, abscesses, systemic infections, gastrointestinal bleeding, bile duct and pancreatic duct obstruction, as well as the possibility of pancreatic necrosis. Management involves a multidisciplinary approach, including supportive measures, analgesic therapy and, in severe cases, hospitalization and additional procedures such as percutaneous drainage or surgery. To prevent this complication, precautions are recommended during ERCP, such as the use of aseptic techniques, careful handling of endoscopic instruments and prophylactic use of medications. In conclusion, post-ERCP pancreatitis requires early diagnosis, an appropriate therapeutic approach and close surveillance to avoid adverse consequences and promote patient recovery.

Unified methods in collecting, preserving, and archiving coral bleaching and restoration specimens to increase sample utility and interdisciplinary collaboration.

Coral reefs are declining worldwide primarily because of bleaching and subsequent mortality resulting from thermal stress. Currently, extensive efforts to engage in more holistic research and restoration endeavors have considerably expanded the techniques applied to examine coral samples. Despite such advances, coral bleaching and restoration studies are often conducted within a specific disciplinary focus, where specimens are collected, preserved, and archived in ways that are not always conducive to further downstream analyses by specialists in other disciplines. This approach may prevent the full utilization of unexpended specimens, leading to siloed research, duplicative efforts, unnecessary loss of additional corals to research endeavors, and overall increased costs. A recent US National Science Foundation-sponsored workshop set out to consolidate our collective knowledge across the disciplines of Omics, Physiology, and Microscopy and Imaging regarding the methods used for coral sample collection, preservation, and archiving. Here, we highlight knowledge gaps and propose some simple steps for collecting, preserving, and archiving coral-bleaching specimens that can increase the impact of individual coral bleaching and restoration studies, as well as foster additional analyses and future discoveries through collaboration. Rapid freezing of samples in liquid nitrogen or placing at -80 °C to -20 °C is optimal for most Omics and Physiology studies with a few exceptions; however, freezing samples removes the potential for many Microscopy and Imaging-based analyses due to the alteration of tissue integrity during freezing. For Microscopy and Imaging, samples are best stored in aldehydes. The use of sterile gloves and receptacles during collection supports the downstream analysis of host-associated bacterial and viral communities which are particularly germane to disease and restoration efforts. Across all disciplines, the use of aseptic techniques during collection, preservation, and archiving maximizes the research potential of coral specimens and allows for the greatest number of possible downstream analyses.

Quality Improvement Report: Safety Program for Prevention of Central Line-associated Bloodstream Infections.

The increasing usage of peripherally inserted central catheters (PICCs) in medical imaging departments has led to a corresponding increase in cases of central line-associated bloodstream infection (CLABSI). However, this condition is preventable with proper monitoring and use of aseptic techniques. A Comprehensive Unit-based Safety Program (CUSP) is a quality improvement (QI) measure implemented by health care institutions to reduce the incidence of CLABSI. However, effective strategies have yet to be established. The authors describe a QI project that evaluated the implementation of CUSP at a teaching hospital to reduce PICC-associated bloodstream infection (BSI). The framework consists of a five-step process: understand and train staff on the science of safety, assemble a team, engage senior executives, identify defects through sensemaking, and implement teamwork and communication strategies in a series of related and sequential steps that use QI tools. Targets were identified for improvement from existing processes, and the workflow was reengineered. Nine months after the start of the CUSP intervention, PICC-associated BSI incidence in the hospital had been reduced from 3.4 to 2.7 per 1000 central lines days after intervention. The incidence of BSI was also reduced correspondingly from 8.8% to 5.9%. The QI processes in this study may be adopted by other hospitals, as they involve minimal cost with significant impact on patient safety and well-being. The QI sequential steps described capture the implementation processes that can be modified for use in other department settings where patient safety could be compromised. Online supplemental material is available for this article. ©RSNA, 2022.

Small-bowel aspiration during upper esophagogastroduodenoscopy: Rao technique.

Small-bowel aspiration during upper esophagogastroduodenoscopy: Rao technique.

Limit of detection of bacterial contaminant in living bacterial vaccine

A total number of 30 vaccine vials including 3 batches of 3 different types of live bacterial poultry vaccines (Mycoplasma red vaccine, Mycoplasma yellow vaccine and non colored Mycoplasma vaccine) were experimentally contaminated with 1,5,10 CFU of Escherichia coli reference strain (ATCC25992) /dose then subjected for sterility testing as referenced in world organization of animal health(OIE). The sterility is defined as the absence of viable microorganisms, includes viruses. It should be achieved by the use of aseptic techniques and validated sterilization methods, including heating, filtration, chemical treatments and irradiation that fit the intended purpose. Further dilution was carried out of vaccines showing negative results.Kappa index in different contamination levels in all tested vaccines after dilution was ranged between high Kappa index and almost total . In this study , it could be concluded that the applied testing method is appropriate for testing sterility of living bacterial poultry vaccines and it is fit to use

Acellular Dermal Matrix, Smooth Tissue Expanders, and Betadine: Histologic Assessment in a Primate Model

INTRODUCTION: It is known that an overabundance of pathogens in the setting of prosthetic breast devices can lead to infection, prolonged inflammation, and capsular contracture. As such, there has been increasing emphasis on the use of aseptic techniques that include antimicrobial irrigation solutions such as Betadine. The increasing use of human acellular dermal matrices (HADM) and prosthetic devices have raised questions as to whether exposure of the implant or tissue expander (TE) to Betadine may lead to deleterious effects related to HADM incorporation. The aim of this study was to determine if exposure of HADM to a Betadine-saturated TE would affect the corresponding biological response. METHODS: Samples (1.5 × 1.5 cm) cut from custom-made smooth silicone TEs (Allergan plc) were soaked in 100% Betadine for 2 minutes, without a subsequent saline rinse, or soaked in control saline alone, and then sutured to equivalently sized HADM samples (AlloDerm, Allergan plc) to form an HADM:TE construct. Eighteen African Green monkeys were each implanted subcutaneously with a pair of Betadine and saline-treated HADM:TE constructs and evaluated for overall biologic response to Betadine treatment following implantation at 2 or 4 weeks as demonstrated by hematoxylin and eosin histologic staining and using a subjective scoring scale (0–9) inclusive of recellularization, neovascularization, and inflammatory responses. The presence of individual cell types involved in inflammation (eosinophils, lymphocytes, neutrophils, histiocytes, foreign body giant cells) and HADM remodeling (fibroblasts) was also evaluated based on hematoxylin and eosin histologic staining (0–3 scoring scale) and in some cases corroborated by immunohistochemical staining (CD-3, CD-20, CD-68). Betadine-treated constructs were compared at 2-week (n = 9) and 4-week (n = 9) implantation to saline control-treated constructs with no exposure to Betadine also at 2-week (n = 9) and 4-week (n = 9) implantation. RESULTS: Overall biologic response to the HADM in the presence of Betadine or saline control was similar at 2-week implantation, scoring 5.6 ± 0.5 and 5.3 ± 0.9, respectively (P = 0.41) and remained similar at 4 weeks, scoring 4.6 ± 1.0 and 4.2 ± 0.8, respectively (P = 0.46). Although the presence of individual inflammatory cell types appeared to trend higher in the saline control group than in the Betadine-treated group at 2 weeks, the difference was not statistically significant, and the trend did not persist at 4 weeks. Likewise, differences in HADM fibroblast infiltration were not significant between Betadine-treated and control groups. However, the presence of fibroblasts within the implanted HADM did increase over time between 2 and 4 weeks, for both the Betadine-treated (increase from 1.0 ± 0.9 to 1.8 ± 1.0) and saline control groups (increase from 1.4 ± 0.9 to 1.8 ± 0.8), indicative of ongoing HADM incorporation. CONCLUSIONS: The data suggest that exposure of the HADM to a Betadine-treated TE did not negatively impact the host response to the implanted HADM in terms of inflammation, vascularization, recellularization, or overall HADM incorporation.

Types and frequency of errors in the preparation and administration of drugs.

ABSTRACTObjective:To identify compatibility, types and frequency of errors in preparation and administration of intravenous drugs.Methods:A cross-sectional and descriptive study performed at the emergency department of a university hospital in the city of São Paulo (SP). The sample consisted of 303 observations of the preparation and administration of intravenous drugs by nursing aides, nursing technicians and registered nurses, using a systematized script, similar to a checklist. The following variables were collected: errors related to dispensing, omission, schedule, unauthorized administration, dosage, formulation, incompatibility, preparation and administration.Results:In the preparation stage, the following errors were identified: no hand hygiene (70.29%), and no use of aseptic technique (80.85%). Upon administration, no hand hygiene (81.18%), and no use of aseptic technique (84.81%). In 31.35% of observations, there was more than one medication at the same time for the same patient, of which 17.89% were compatible, 56.84% were incompatible and 25.26% were not tested, according to the Micromedex database.Conclusion:In both preparation and administration stages, the most frequent errors were no hand hygiene and no use of aseptic technique, indicating the need to develop and implement education programs focused on patient safety.

Best Practices for Handling and Administration of Expressed Human Milk and Donor Human Milk for Hospitalized Preterm Infants.

The importance of human milk for the preterm infant is well established (1–3). However, the feeding of human milk to preterm infants is typically much more complicated than the mere act of breastfeeding (3, 4). The limited oral feeding skills of many preterm infants often results in human milk being administered via an enteral feeding tube (4). In addition, fortification is commonly required to promote optimal growth and development—particularly in the smallest of preterm infants (2, 4, 5). Consequently, a mother's own milk must be pumped, labeled, transported to the hospital, stored, tracked for appropriate expiration dates and times, thawed (if previously frozen), fortified, and administered to the infant with care taken at each step of the process to avoid microbial contamination, misadministration (the wrong milk for the wrong patient), fortification errors, and waste (1–5). Furthermore, the use of pasteurized donor human milk (DHM) for preterm infants when a mother's own milk is not available has been endorsed by many organizations (1). Therefore, appropriate procurement, storage, thawing (if received frozen), fortification, labeling, and administration must occur with the same considerations of preventing contamination and fortification errors while ensuring the correctly prepared final product reaches the correct patient (1). Many professional organizations have published best practices to provide hospitals with guidelines for the safe and accurate handling and preparation of expressed human milk (EHM) and DHM feedings for preterm infants (1–5). These best practices emphasize the importance of preparation location, trained staff, proper identification of human milk to prevent misadministration, and strategies to prevent fortification errors (1–6). The purpose of this mini-review article is to summarize current published best practices for the handling of human milk for preterm infants within the hospital setting (1–6). Emphasis will focus on the use of aseptic technique with proper sanitation and holding times/temperatures to limit microbial growth; use of technology to prevent misadministration of human milk and fortification errors as well as for tracking of expiration dates/times and lot numbers; and workflow strategies to promote safety while improving efficiencies (1–7).

Analysis of potential contamination factors in musculoskeletal tissues.

Tissue Banks have become the main source for bone grafts, due to preference for homologous tissues. Notwithstanding the use of aseptic techniques for procurement of tissues and judicious selection of donors, microorganisms are frequently found in procured bones. Purpose of this study is to evaluate the factors that increase safety of procurement and minimize discard of procured tissues. Microbiological contamination was analyzed in 1271 musculoskeletal tissues removed from 138 multi-organ donors over a period extending from 2006 to 2016. Effects of various risk factors related with contamination were estimated using a logistic regression model. Microbiological contamination rate in the tissues was 17.1%; low pathogenic microorganisms were cultivated in 12.9% of the tissues, while highly pathogenic ones were cultivated in 4.2% of the tissues. Evolution of one single team was monitored during that period, verifying a fall in the general contamination level from 22.5 to 9.2%. Absence of antibiotics increased low pathogenic contamination risk. Every additional day in intensive care unit (ICU) increased the risk of highly pathogenic contamination. Time elapsed between death and the beginning of removal procedures was found to be relevant for both low pathogenic and highly pathogenic microorganisms. Among the studied factors, the following contributed for a significant increase in contamination by microorganisms in removed tissues: lack of use of prophylactic antibiotic therapy in donors, quantity of removed tissues, length of admission in ICU and the time elapsed between aortic clamping and beginning of the removal procedure.

AIUM Practice Parameter for the Performance of Selected Ultrasound‐Guided Procedures

AIUM Practice Parameter for the Performance of Selected Ultrasound‐Guided Procedures

AIUM Practice Parameter for the Performance of Selected Ultrasound-Guided Procedures

AIUM Practice Parameter for the Performance of Selected Ultrasound-Guided Procedures

Hand Contamination, Cross-Transmission, and Risk-Associated Behaviors: An Observational Study of Team Members in ORs

Team members in ORs have frequent hand contact with many surfaces and sites during high workload, thus increasing the risk for microorganism cross-transmission. This study aimed at identifying risks for hand contamination and microorganism cross-transmission during invasive procedures in ORs. We carried out observations during 22 daytime sessions and analyzed data using qualitative content analysis. The results revealed that clinicians’ hands may be contaminated by self-contamination, via objects, or by touching the patient. Contamination may occur before, during, or directly after performing an invasive procedure requiring the use of aseptic technique, which risks cross-transmitting microorganisms. The results of the study contribute detailed knowledge about risk-associated activities and behaviors in relation to performing invasive procedures in the OR. This knowledge provides clinicians, managers, and educators with specific information that can be used in nursing and medical education and in quality improvement projects aimed at improving hand hygiene routines and enhancing aseptic technique.

Generation of Mammalian Host-adapted Leptospira interrogans by Cultivation in Peritoneal Dialysis Membrane Chamber Implantation in Rats.

Leptospira interrogans can infect a myriad of mammalian hosts, including humans (Bharti et al., 2003; Ko et al., 2009). Following acquisition by a suitable host, leptospires disseminate via the bloodstream to multiple tissues, including the kidneys, where they adhere to and colonize the proximal convoluted renal tubules (Athanazio et al., 2008). Infected hosts shed large number of spirochetes in their urine and the leptospires can survive in different environmental conditions before transmission to another host. Differential gene expression by Leptospira spp. permits adaption to these new conditions. Here we describe a protocol for the cultivation of Leptospira interrogans within Dialysis Membrane Chambers (DMCs) implanted into the peritoneal cavities of Sprague-Dawley rats (Caimano et al., 2014). This technique was originally developed to study mammalian adaption by the Lyme disease spirochete, Borrelia burgdorferi (Akins et al., 1998; Caimano, 2005). The small pore size (8,000 MWCO) of the dialysis membrane tubing used for this procedure permits access to host nutrients but excludes host antibodies and immune effector cells. Given the physiological and environmental similarities between DMCs and the proximal convoluted renal tubule, we reasoned that the DMC model would be suitable for studying in vivo gene expression by L. interrogans. In a 20 to 30 min procedure, DMCs containing virulent leptospires are surgically-implanted into the rat peritoneal cavity. Nine to 11 days post-implantation, DMCs are explanted and organisms recovered. Typically, a single DMC yields ~109 mammalian host-adapted leptospires (Caimano et al., 2014). In addition to providing a facile system for studying the transcriptional and physiologic changes pathogenic L. interrogans undergo within the mammal, the DMC model also provides a rationale basis for selecting new targets for mutagenesis and the identification of novel virulence determinants. Caution: Leptospira interrogans is a BSL-2 level pathogen and known to be excreted in the urine of infected animals. Animals should be handled and disposed of using recommended Animal Biosafety Levels (ABSL) for infectious agents using vertebrate animal guidelines. Note: All protocols using live animals must conform to governmental regulations regarding the care and use of laboratory animals. The success of this protocol is dependent on the proper use of aseptic techniques during all stages of both dialysis membrane chamber preparation and animal surgery.

A Reply to Jepsen, N., K. Aarestrup and S.J. Cooke. Tagging Fish in the Field: Ethical and Procedural Considerations. A Comment to the Recent Paper of D. Mulcahy; Legal, Ethical and Procedural Bases for the Use of Aseptic Techniques to Implant Electronic Devices, (Journal of Fish and Wildlife Management 4:211–219)

Citation: Mulcahy DM. 2014. A reply to Jepsen, N., K. Aarestrup and S.J. Cooke. Tagging fish in the field: ethical and procedural considerations. A comment to the recent paper of D. Mulcahy; Legal, ethical and procedural bases for the use of aseptic techniques to implant electronic devices, ( Journal of Fish and Wildlife Management 4: 211–219). Journal of Fish and Wildlife Management 5(2):445–449; e1944-687X. doi: 10.3996/052014-JFWM-040

Tagging Fish in the Field: Ethical and Procedural Considerations. A Comment to the Recent Paper of D. Mulcahy; Legal, Ethical and Procedural Bases for the Use of Aseptic Techniques to Implant Electronic Devices, (Journal of Fish and Wildlife Management 4:211–219)

Tagging Fish in the Field: Ethical and Procedural Considerations. A Comment to the Recent Paper of D. Mulcahy; <i>Legal, Ethical and Procedural Bases for the Use of Aseptic Techniques to Implant Electronic Devices</i>, (Journal of Fish and Wildlife Management 4:211–219)

Catheter-related bloodstream infection: burden of disease in a tertiary hospital

Surveillance programmes have become the most effective tool for controlling catheter-related bloodstream infections (CRBSI). However, few studies have investigated programmes covering all hospital settings. To describe the results of a control and prevention programme for CRBSI based on compliance with recommendations for insertion and maintenance, using annual burden of disease in a tertiary level hospital. A CRBSI control and prevention programme involving all hospital settings was implemented. The programme consisted of CRBSI surveillance, direct observation of insertion and maintenance of catheters to determine performance, and education for healthcare workers. In total, 2043 short-term catheters were inserted in 1546 patients for 18,570 catheter-days, and 279 long-term catheters were inserted in 243 patients for 40,440 catheter-days. The annual incidence density was 5.98 (first semester 6.40, second semester 5.64) CRBSI per 1000 catheter-days for short-term catheters, and 0.57 (first semester 0.66, second semester 0.43) CRBSI per 1000 catheter-days for long-term catheters. One hundred and forty insertion procedures were observed, with an average insertion time of 13 (standard deviation 7) min. Compliance with recommendations was as follows: hand hygiene, 86.8%; use of alcoholic chlorhexidine solution for skin disinfection, 35.5%; use of mask, 93.4%; use of gloves, 98.7%; use of gown, 75.0%; use of sterile cloth, 93.8%; use of cap, 92.2%; bandage application, 62.7%; and use of aseptic technique, 89.5%. Forty-five maintenance procedures were observed, and compliance rates were as follows: hand hygiene, 42.1%; use of gloves, 78.1%; and port disinfection with alcoholic chlorhexidine solution, 32.5%. The CRBSI control and prevention programme implemented at the study hospital has decreased the rate of CRBSI, provided important information about the total burden of disease, and revealed possible ways to improve interventions in the future.

G269 The CAKE Study: Cake Aids Knowledge and Experience

Background‘See one, do one, teach one’ has long been the philosophy when it comes to developing procedural skills in medicine. Anecdotally trainees do not feel confident when undertaking procedures such...

A prática do (a) enfermeiro (a) na inserção do cateter de Folley em pacientes de unidade de terapia intensiva: limites e possibilidades

Backgound and Objectives: Nursing has an important role in urinary tract infection prevention and control. Urinary catheters insertion represents the local topography with the highest rate of hospital infection. Foley catheter placement is performed solely by the nurse and requires aseptic techniques during its performance, thus preventing risks to the patients. The study aimed to evaluate the training of nurses on Foley catheter insertion and point out limits and possibilities of this practice in patients at the Intensive Care Unit (ICU) of Hospital Geral do Interior da Bahia (HGIB). Methods: This was a qualitative, exploratory and descriptive study. Data collection was carried out through semi-structured interviews. After data analysis, two categories were evaluated, namely: the training of nurses on Foley catheter insertion in ICU patients and the limits and possibilities of Foley catheter insertion practice by nurses in ICU patients. Bardin analysis was used for data analysis. Results: The study shows that the nurse’s practice on Foley catheter insertion in ICU patients is based on the use of aseptic techniques for urinary tract infection prevention, theoretical and practical knowledge on Foley catheter insertion in ICU patients, knowledge on urinary tract infections and associations with catheter insertion, whereas the limits and possibilities of Foley catheter insertion practice by nurses are understood through measures to minimize the risk of hospital infection caused by long-term catheter use in the ICU. Nurses point out that the risks of hospital infection are inherent to long-term catheter use. This is an important fact, as the knowledge or its absence may constitute a limit or possibility for Foley catheter insertion practice by the nurse in ICU patients. Conclusion: Nurses must seek the systematization of knowledge, which warrants support for the team, as well as information, safety and prompt care, allowing the reduction of urinary tract infection rates and its complications in critically-ill patients. Training of the multidisciplinary team is necessary, as well as continuing education, interaction and communication with the medical team and the Hospital Infection Control Committee (CCIH) to prevent and fi ght against hospital infections. KEYWORDS: Nursing. Hospital Infection Control. Intensive Care Unit. Catheter Folley.

Legal, Ethical, and Procedural Bases for the Use of Aseptic Techniques to Implant Electronic Devices

Legal, Ethical, and Procedural Bases for the Use of Aseptic Techniques to Implant Electronic Devices