Wound Contamination Research Articles

Motion-capture system to assess intraoperative staff movements and door openings: Impact on surrogates of the infectious risk in surgery.

We longitudinally observed and assessed the impact of the operating room (OR) staff movements and door openings on surrogates of the exogenous infectious risk using a new technology system. This multicenter observational study included 13 ORs from 10 hospitals, performing planned cardiac and orthopedic surgery (total hip or knee replacement). Door openings during the surgical procedure were obtained from data collected by inertial sensors fixed on the doors. Intraoperative staff movements were captured by a network of 8 infrared cameras. For each surgical procedure, 3 microbiological air counts, longitudinal particles counts, and 1 bacteriological sample of the wound before skin closure were performed. Statistics were performed using a linear mixed model for longitudinal data. We included 34 orthopedic and 25 cardiac procedures. The median frequency of door openings from incision to closure was independently associated with an increased log10 0.3 µm particle (ß, 0.03; standard deviation [SD], 0.01; P = .01) and air microbial count (ß, 0.07; SD, 0.03; P = .03) but was not significantly correlated with the wound contamination before closure (r = 0.13; P = .32). The number of persons (ß, -0.08; SD, 0.03; P < .01), and the cumulated movements by the surgical team (ß, 0.0004; SD, 0.0005; P < .01) were associated with log10 0.3 µm particle counts. This study has demonstrated a previously missing association between intraoperative staff movements and surrogates of the exogenous risk of surgical site infection. Restriction of staff movements and door openings should be considered for the control of the intraoperative exogenous infectious risk.

Provision of care to hospitalized pediatric burn patients: a qualitative study among nurses at Muhimbili National Hospital, Dar es Salaam, Tanzania

BackgroundBurn injury is a significant problem in low and middle-income countries. Moreover, across regions children are more affected by burn injury than adults. The outcome of burn injury is greatly influenced by the quality of care patients receive. This care includes meeting nutritional needs, availability of resources such as dressing supplies, and skills among health care providers. This study describes factors that influence provision of nursing care to the hospitalized pediatric patients with burn injuries at Muhimbili National Hospital, Dar es Salaam, Tanzania.MethodsA descriptive qualitative study was conducted among registered nurses working in the Pediatric Burn Unit. Purposeful sampling was used to recruit the participants in the study. Five in-depth interviews were done and content analysis approach was used.ResultsThe nurses in the study described how they provided nursing care to pediatric patients with burn injuries. They described the use of closed method wound dressing, as an essential skill that accelerated wound healing, decreased the risk of wound contamination, and the incidence of contractures. The nurses felt gratified when they saw patients who had sustained severe burn injury recover well and be discharged home. They appreciated the influence of teamwork in burn patients’ recovery. However, the interviews revealed systematic deficiencies that hindered provision of quality care to patients with burn injuries. The flaws included: inadequate staffing resulting in increased workload among the nurses; a lack of standard skills in burn care among nurses; lack of access to water, which is the mainstay of infection prevention control, and lack of specimen collection equipment.ConclusionsFindings in this study revealed both positive and negative factors which appear to influence care of burn patients. The positive factors (motivation) need to be maintained, and immediate actions should be taken to address the negative (hindering) factors. Large scale studies to quantify these results are deemed necessary, and public health measures are needed to prevent burn injuries in children.

Risk factors and intervention measures of pulmonary infection after thoracoscopic mediastinal tumor resection

Objective To investigate the risk factors and intervention measures of pulmonary infection after thoracoscopic mediastinal tumor resection. Methods The clinical data of 128 patients who underwent thoracoscopic mediastinal tumor resection in this hospital from June 2016 to June 2017 were retrospectively analyzed, and the incidence of postoperative respiratory tract infection and related risk factors were analyzed, and intervention measures were formulated. Results The incidence of postoperative pulmonary infection was 20.31% in 128 patients with mediastinal tumor resection under thoracoscopy (26/128). Logistic multivariate analysis showed that age over 60, lymph node dissection, preoperative diabetes mellitus, thoracic drainage indwelling time over 3 days, and postoperative wound contamination were all independent risk factors for postoperative pulmonary infection in patients undergoing thoracoscopic mediastinal tumor resection(P<0.05). Preoperative antibiotic prophylaxis and expectoration training were protective factors(P<0.05). Conclusions There are many risk factors for postoperative pulmonary infection in patients undergoing thoracoscopic mediastinal tumor resection, and the preoperative preventive application of antibiotics and the preoperative sputum expectoration and discharge training will help to prevent and reduce the incidence of postoperative pulmonary infection. Key words: Thoracoscopy; Mediastinal tumor resection; Postoperative pulmonary infection; Risk factors

X‐ray fluorescence analysis of samples simulating blood collected from uranium‐contaminated wounds

Personnel working in nuclear fuel handling facilities incur a finite risk of injury and uranium contamination in any resulting wounds. The accidental absorption of uranium from the likes of wounds can lead to a significant degree of internal exposure due to its hazardous nature. Although an appropriate surgical resection of tissue in the contaminated wound is useful for suppressing the additional intake of uranium, the rapid quantification of uranium in the wound is required to avoid unnecessary surgery. For surface contamination, the detection of uranium is usually performed using an α‐particle counting method. However, in the case of wound contamination, most of the α‐particles emitted from the uranium cannot pass through the blood oozing from the wound. Therefore, X‐ray fluorescence (XRF) analysis has been proposed as an alternative means of detecting uranium contamination because X‐rays can pass through several millimeters of blood or soft tissue. In the present study, we developed a new methodology for the rapid detection of uranium in wounds that is based on an XRF analysis of contaminated blood collected on filter paper. With XRF, the detection limit for uranium in blood is 0.45 ppm. This value is lower than those of commercially available α‐survey meters by a factor of ~103. Thus, the proposed method could be adopted for the rapid, on‐site detection of uranium in wounds.

Surgical site infection in a tertiary care centre-an overview - A cross sectional study

BackgroundSurgical Site Infections (SSIs) are the third most frequently reported nosocomial infection, accounting for 14 to 16 percent of all nosocomial infections among hospitalized patients according to National Nosocomial Infections Surveillance. SSIs are responsible for the increased morbidity and mortality related to surgery. Surgical wounds are classified as clean, clean contaminated, contaminated and dirty wounds as per CDC criteria. Better understanding of the causal factors of SSIs and prevention will reduce the cost of the surgery. Materials and methods1570 patients who underwent surgery in the dept. of General surgery in a tertiary care hospital were taken for the study. Out of which 990 patients underwent elective surgical procedures and 580 underwent emergency procedures. An elaborate study of these cases with regard to date of admission, history, clinical features, type of surgery, emergency or elective, preoperative preparation, type of incision, contamination, procedure done, peroperative findings, drain used and its type and duration of operation and postoperative management and signs of wound infection were done and the findings are tabulated. Results115 cases out of 1570 surgeries had surgical site infections. The overall post-operative SSI rate in elective clean and clean contaminated cases is 4.34% and emergency cases is 12.41%. The study showed that the superficial surgical site infections are the commonest type and accounted for about 72.09% in elective and 61.11% in emergency of all the SSI's and deep surgical site infection accounted for about 23% in elective and 30.55% in emergency cases. E. Coli is the commonest organism isolated from the surgical wounds that is 30.23% in elective cases. In emergency cases Proteus mirabilis is the most common organism involved in SSI followed by E. Coli. ConclusionE. coli is the commonest organism isolated from elective surgical wounds and Proteus mirabilis is the commonest organism isolated from emergency surgical wounds. A change in the pre operative antibiotics may reduce the incidence even lower. A preexisting medical illness like diabetes mellitus and duration of operating time, class of the wound, emergency surgeries and wound contamination had strong effect on the development of surgical site infection.

Influence of the physico-chemical form on americium biodistribution after wound contamination: re-analysis of experimental data using STATBIODIS

Influence of the physico-chemical form on americium biodistribution after wound contamination: re-analysis of experimental data using STATBIODIS

Adherence of surgeons to surgical prophylaxis guidelines

Background: surgical site infections (SSIs) are microbial contamination of the surgical wound during a period of one month that could result in major post-operative morbidity and mortality rates. Objectives: this study aimed to identify the adhesion of surgeons to antibiotics prophylaxis guidelines at Kingdom of Saudi Arabia (KSA). Methods: this study included 180 adult subjects who were scheduled to undergo major surgeries in the hospital. The data of the patients were collected from the surgical wards and day care unit. Results: most of the included surgeons showed no error during pre, intra and post operative duration as give the required antibiotics and didn’t give the non-require antibiotics. The preoperative adherence of surgeons as most of the surgeons (73.9%) followed the prophylactic measures that included correct choice, indications, dosage and duration. Most of the surgeons (76.1%) followed the prophylactic measures including correct choice, indications, dosage and duration during intra-operative period. The majority of the surgeons (75%) followed the prophylactic measures including correct choice, indications, dosage and duration during post-surgical duration. Conclusion: The level of surgeon’s adherence to antibiotic prophylactic guidelines was efficient among most of surgeons regarding the proper choice of antibiotic, duration, timing and indication. However, these results differ from other available studies, this study showed a good sign for application of antibiotic prophylactic measures in KSA hospitals. Further studies should be conducted to increase the knowledge and adherence of surgeons all over KSA.

Modified photodynamic therapy of purulent wounds (experimental study)

Introduction. The widespread use of antibiotics that have a mutagenic effect on the microflora causes a change in the etiological structure of purulent infection, as well as the biological properties of the microbial cell with the appearance of antibiotic-resistant strains of microorganisms. The consequence of this was a decrease in the effectiveness of antibiotic therapy, traditionally prescribed local treatment of wounds and amid growing allergization of the population. One of the promising methods of combating the antibiotic resistance of microorganisms is antimicrobial photodynamic therapy. Purpose. An experimental study is devoted to studying the results of the treatment of purulent wounds in the first phase of the wound process using modified photodynamic therapy depending on the species of the pathogen. Materials and methods. The study was conducted on 18 white Wistar male rats, divided into three groups depending on the type of sanation of purulent wounds (6 animals in each series). In the control group, wound treatment was performed by reorganization with chlorhexidine, in the second experimental group, photodynamic therapy sessions were performed, in the third experimental group, the photosensitizer was modified with chitosan. In dynamics, we studied the microbial contamination of wounds, the lethality of animals, and also performed histological and morphometric studies. Results. With regard to gram-negative rods, the use of «Photolon» as a photosensitizer led to a significant reduction in bacterial contamination: in the crops, the number of germinated colonies was less than 10 bacteria/ ml, which suggests the selectivity of this type of photochemical effect with respect to gram-negative flora. Conclusions. Modified PDT was effective against gram-negative bacilli (plating decreased from 3.70 ± 0.05 × 104 (log CFU/ml = 4.5682) to 2.90 ± 0.05 × 104 (log CFU/ml = 4.4623) and with respect to gram-positive pathogens: the number of CFU/ml after the second session was &lt; 1.0 ± 0.05 (log CFU/ml = 1). Histological and morphometric studies showed the advantages of modified PDT compared to traditional treatment of purulent wounds.

Effect of Incise Drape on Contamination Rate of Surgical Wound during Surgical Procedures of Lumbar Spine.

Background:The aim of this study was to investigate the effect of the incise drape (ID) on surgical wound bacterial contamination during lumbar spine surgical procedures in treatment group (with ID) and control group (without ID).Materials and Methods:The present study was conducted on 88 patients who were a candidate for lumbar spine surgery. The patients were randomly assigned to one of the two groups, treatment and control. The ID was only used in the treatment group. The surgical wound sampling for bacterial culture was done in two steps, immediately after surgical incision (IASI) and immediately prior to the surgical wound closure (IPSWC). The samples were then sent to the laboratory.Results:The mean total bacterial count of the surgical wound in the stage IASI was not significantly different between treatment and control groups (0.09 vs. 0.02, P = 0.31). However, this means in the stage IPSWC in treatment group was significantly more than the control group (18.6 vs. 0.41, P = 0.04). The frequency distribution of Staphylococcus aureus (25% vs. 3%, P = 0.02) and Staphylococcus epidermidis (36.4% vs. 9.1%, P = 0.002) was significantly higher in the treatment group compared with control group in the stage IPSWC.Conclusion:The results suggest that the use of ID is unable to reduce surgical wound bacterial contamination in clean lumbar spine surgery. Therefore, based on the results obtained in our study, the application of ID is not recommended as an essential action for the prevention of surgical wound contamination.

Surgical site infection following elective nonspinal paediatric orthopaedic surgery: a prospective review.

The aim of this study was to determine the rate of surgical site infection (SSI) and the factors that predispose to it in children undergoing nonspinal orthopaedic surgery. Over a 6-month period, 326 children who underwent 334 nonspinal elective orthopaedic surgical procedures were prospectively reviewed for the development of surgical site infections. A total of 14 sites became infected, with an overall infection rate of 4.19%. All the infections were superficial, and the only causative organism detected was Staphylococcus aureus. Operating times longer than 1 h and surgical wounds greater than 10 cm in length were positively associated with SSIs. Although there were differences between male and females, type of admission, the use of prophylactic antibiotics, degree of wound contamination and the grades of surgeons, these differences were not statistically significant. The results of this prospective study provide valuable information that was not previously available to the practicing paediatric orthopaedic surgeon.

Nursing Practice on Post-Operative Wound Care in Surgical Wards at Muhimbili National Hospital, Dar-es-Salaam, Tanzania

Background: Postoperative wound healing has been a problem which causes high mortality in the developing world; postoperative wound has been reported to cause devastating consequences and a measurable mortality. There is a limited number of published studies in Tanzania investigating Nursing practice on post-operative wound care in surgical wards at Muhimbili National Hospital, Dar-es-Salaam, Tanzania. This study assesses nursing practice on postoperative wound care by nurses in surgical wards at Muhimbili National Hospital. Methods: A cross-sectional study of surgical nurses was carried out through the use of randomly selected surgical wards at Muhimbili National Hospital in Tanzania from September 2011 to July 2013. A multistage cluster sampling technique was used to obtain a suitable number of study participants. Data collection was done using a checklist from a convenient sample of 71 nurses in selected surgical wards. Results: The result indicates that a big number of the participants were female (76.5%) and those of the age group 25 to 34 years were 40.8%. Participants exceeding a half of the selected sample reported to have poor post-operative wound care practice (57.7%). In comparison, male participants scored higher, and had better practice than their female counterparts, however, there was no considerable difference in the scores (P = 0.803). During set-up and preparation phase, the washing of hands before starting and after the completion of procedure was taken into consideration by less than half of the participants (49.3%). All participants did not ensure the environment is clean and take into account the patient’s privacy through the use of screen or even closing the room. The report shows that nurses take into consideration putting on clean gloves during the removal of the old dressing (99%), the use of sterile gloves during wound dressing was taken into consideration by most of the nurses (63%). Good practice was noted in applying dressing solution as recommended (85%), dry sterile dressing was applied by (90%), arrangement and setting up of dressing forceps and other items that may be needed in order of their application using forceps (20%), usage of forceps to dip gauze into antiseptic solution (35%) and cleaning of the wound cleaning from least contaminated to most contaminated area was only adhered to by (34%). Post-operative counseling and giving to the patient not to temper with the wound was done by a representation of only 15% of nurses. All the nurses did not do the documentation of the changes observed on the wound nor did they report on the patients comfort and the date and time after the procedure wound changes, reported patient comfort, and recorded date or time after the procedure. Conclusion: Majority of the nurses in surgical wards do not follow the postoperative wound care checklist provided by MNH although they know its importance. Assessment of the wound and documentation continues to be a problem in the nursing profession in Tanzania. Nurses are reasonably knowledgeable about the principal of wound dressing; however, lack of knowledge on some of the key principles of wound dressing is worth noting. Almost half of the nurses do not wash hands before and after the procedures, they don’t use single gauze in one direction only, not cleaning from least contaminated to most contaminated area, which can lead to wound contamination.

Open anterolateral fracture dislocation of ankle joint: a rare case report

&lt;p class="abstract"&gt;Anterior ankle dislocation with associated compound bi-malleolar fracture is a rare injury. Ankle fracture dislocations most frequently occurs in young males caused by high energy trauma. The direction of the joint dislocation is determined by the position of the foot and the direction of the force being applied. A middle aged male presented to us with history of road traffic accident and was diagnosed to have anterior dislocation of right ankle joint with compound bi-malleolar fracture. Patient was taken to emergency operation theatre for wound debridement and immediate ankle reduction done under sedation. Due to wound contamination fracture fixation was delayed, once the wound healed bi-malleolar fracture fixation was done.&lt;/p&gt;

Evaluation of postoperative wound infection in children

This study was conducted to assess postoperative wound infection in children. It was also decided to estimate the rate of wound infection in children and to identify the factor that best predicts postoperative wound infection in children. This prospective study was carried out in the Department of Paediatric Surgery, BSMMU, Dhaka during the period of January 2009 to September 2010 and included consecutive 100 children undergoing routine surgery. The children were assessed during the first 30 postoperative days for the evidence of wound infection that were confirmed by culture and sensitivity.&#x0D; This study shows majority of the children were found in the age group of 13 – 60 months in both groups. The mean (±SD) age was 67.74±58.25 months with ranged from 13 months to 180 months. It was found that majority were male (73%). The post operative wound infection was 16% and the status of wound infection according to nature of wound was assessed and found that 7(43.8%) were clean and 9(56.2%) were potentially contaminated among the children who had wound infection. However, 65(77.4%) and 19(22.6%) were clean and potentially contaminated respectively among the children who didn’t had any wound infection. The status of would infection according to BMI was assessed and found that BMI ˂20 kg/m2 in 15(93.8%) children who had wound infection and in 61(72.6%) of the children who didn’t had any wound infection. BMI 20 – 25 kg/m2 was in 1(6.2%) child who had wound infection and in 23(27.4%) of children who had no wound infection. The status of would infection according to serum albumin was assessed and found that serum albumin ˂35 gm/L was in 14(87.5%) of the children who had wound infection and 4(4.8%) of the children who didn’t had any wound infection. Serum albumin level ³35 gm/L in 2(12.5%) of children who had wound infection and in 80(95.2%) of the children who had no wound infection. An increased rate of wound infection was associated with operative procedures longer than 1 hour and with the presence of an associated illness. It could be concluded that the greatest risk factors were those associated with local contamination of the surgical wound.&#x0D; Journal of Paediatric Surgeons of Bangladesh (2017) Vol. 8 (1): 11-14

Types of Wounds and the Prevalence of Bacterial Contamination of Wounds in the Clinical Practice of Small Animals

Abstract Skin wounds are a common presentation in small animal practice. The successful management of wound healing in dogs and cats requires knowledge of the physiology of the wound healing process and the application of an appropriate therapeutic intervention. Many wounds are colonised by bacteria or show signs of clinical infection. Infections can delay wound healing, impair cosmetic outcome and increase healthcare costs. Because of a lack of papers giving an overall prevalence of bacteria in different types of wounds, 45 samples were taken from patients treated at the Small Animals Clinic, Section of Surgery, Orthopaedics, Roentgenology and Reproduction of the University of Veterinary Medicine and Pharmacy in Košice during the years 2017 — 2018 to determine the types of wounds and the prevalence of bacterial contamination of the wounds. Samples were obtained by using cotton-tipped swabs and then cultivated on Sabouraud’s plates in the Institute of Microbiology and Gnotobiology of the University. All 45 animals used in this research were first subjected to an anatomical and clinical exam to determine the patient’s health condition and the status of the wounds. Of these 45 samples, 9 were negative. Of the remaining 36 samples, 12 were cultivated and tested to give only the genera of the bacteria present, whilst 24 were tested more extensively for a specific diagnosis of the species. The most common wound was due to a bite from another animal; these made up 12 out of the 45 cases (26.67 %). There were 10 cases of dehiscence of old wounds (22.22 %), whereas there were only 2 cases of surgical wound complications (4.44 %). There were 5 puncture wounds or fistulas (11.11 %), 4 lacerations (8.88 %), 1 degloving injury (2.22 %), 1 seroma (2.22 %), 1 foreign body (2.22 %), 1 crushing injury (2.22 %), 1 case of contusion and necrosis (2.22 %), 1 cases of dermatitis with resulting pruritic lesions (2.22 %), and 1 cutting injury from a tight wire collar (2.22 %). Five cases (11.11 %) were wounds of unknown aetiology. The most commonly found bacteria was Staphylococcus intermedius, which was found in 14 out of the 45 wounds (31.11 %). From this study it appears that the first consideration for treatment of infected wounds should be a treatment plan which will have a high efficacy against Staphylococcus spp. However, despite the high prevalence of Staphylococcus spp., our results revealed that they are not present all of the time.

The effect of military clothing on gunshot wounding patterns in gelatine

With no two gunshot wounds (GSW) being the same, novel research into wound ballistics is challenging. It is evident that the majority of previous wound ballistic research has been conducted without the presence of clothing. Whilst the effect of clothing on wound contamination has been explored, there is a paucity of literature examining the effect of clothing on GSW patterns. The aim of this study was to test the effect of Multi-Terrain Pattern (MTP) UK military clothing on GSW patterns within calibrated blocks of 10% by mass gelatine, using two types of ammunition commonly used in recent conflicts—7.62 × 39 mm and 5.45 × 39 mm. In total, 36 blocks were shot, 18 by each projectile type, further divided into 6 with no clothing layers (Cnil), 6 with a single clothing layer (Cmin) and 6 with maximum clothing layers (Cmax) worn on active duty. Blocks were analysed with high-speed video and dissection to capture measurements of damage, and results compared using analysis of variance (ANOVA). Results showed significantly different damage measurements within blocks with Cmax for both ammunition types compared to the other clothing states. This may result in GSWs that require more extensive surgical management, inviting further study.

2136. Systematic Review of Surgical Wound Class Reveals Marked Service-Related Discrepancies and Can Improve Appropriateness of Classification Impacting the Expected Number of Infections and the Standardized Infection Ratio (SIR)

BackgroundDuring surgical operations, surgical wounds are classified according to the wound classification system (I—clean; II—clean/contaminated; III—contaminated; and IV—dirty). Accuracy in assessing the degree of wound contamination is crucial since it greatly impacts the risk of a surgical site infection (SSI). Thus, wound classifications (WC) are determinant in calculating the expected number of SSIs. At our institution we suspected that surgical wounds were not always accurately classified, and were skewed toward under-classifying wound class. This contributed to incorrect and reduced expected SSIs and an inflated SSI Standardized Infection Ratio (SIR).MethodsAn independent team reviewed 273 surgical cases from our top priority SSI reduction areas: Prosthetic knees (KPRO), coronary artery bypass grafts (CABG), abdominal hysterectomies (HYST) and colorectal surgery (COLO). Whenever there was discordance in surgeon vs. review team WC, an arbitrator reviewed the case with the surgeon and corrected misclassified cases as appropriate. Reclassifications were documented in the medical record as well as in the National Healthcare Safety Network (NHSN) system.ResultsFigure 1 shows all WC reviews. Overall, 14% of all surgeries were misclassified and 95% of misclassifications were under-classifications. Appropriateness of WC varied widely by surgical service, with 100% concordant WC for KPRO, while 9% of HYST and CABG were misclassified, and fully 38% of COLOs were misclassified (Figure 1). These errors led to under predicting expected SSIs and, if not corrected, would have a measurable impact on our SSI SIR.ConclusionThe inaccurate classifications vary by service/surgery, but in COLO we found them to be common and overwhelmingly skewed toward under-classification, which had a measurable impact on the number of expected SSIs and on SSI SIR. Focusing efforts on surgeries more prone to misclassification (such as COLO rather than KPRO) may be a worthwhile focused quality improvement effort. Disclosures J. P. Parada, Merck: Speaker’s Bureau, Speaker honorarium.

Keeping your cool - a simple reusable neck cooler in orthopaedic surgery: a pilot randomized controlled trial.

Infection in orthopaedic surgery can be catastrophic. Increased perspiration from theatre staff has been associated with higher rates of wound contamination. Wearing lead safety gowns, which is often done during surgery to allow the use of image intensifier, may result in heavy perspiration. This study aimed to determine the feasibility of wearing a neck cooling device during surgery and whether it reduced surgeons' subjective discomfort and perspiration levels during orthopaedic procedures requiring the use of lead gowns. A pilot randomized controlled trial was conducted. Surgeons were randomized to either wearing the neck cooling device (intervention) or not wearing the device (control). Procedure duration, theatre temperature, humidity and perceived technical difficulty of operation were recorded. After the procedure, surgeons completed a questionnaire documenting how the temperature and humidity had a negative effect on their comfort and perceived level of perspiration. Multilevel mixed effects linear regression with random effects, adjusting for potential confounders was performed. Alfred Ethics Committee approved the study and the trial was registered (ACTRN12618000976280). A total of 29 cases (44.6%) were randomized to the intervention group and 36 to the control group. Adjusting for operating room temperature and perceived difficulty of surgery, the neck cooler reduced surgeons' level of discomfort by 1.9 points (95% CI 1.1-2.8, P < 0.001), as well improved on their self-reported perspiration by approximately 1.9 points (95% CI 1.0-2.8, P = 0.04). Wearing a neck cooling device during surgery is feasible, reduces perceived levels of perspiration and decreases the negative impact of temperature and humidity on surgeons' comfort levels.

Isolation and Identification of Bacterial Wound Infection Isolates and their Antibiotic Susceptibility Pattern

Wound Infections are continuous to be a major complication with significant increase in costs, morbidity and potential mortality. This study was aim to screening the bacteriological observation on wound infection in both inpatients and outpatients, the effective antibiotic and serotyping for the prevalent bacteria. The study was carried out on two hundred patients of different age groups to isolate the causative organisms encountered in wound infection and their antibiotics. The percentage of wound infection among outpatients was found to be 84%, similarly the percentage of wound contamination inside the hospital (Medical City Teaching Hospital) also was found to be 84%. The relation between sex and wound infection was studied, no effect of sex on the rate of infection was found.A total of 152 bacterial isolates were predominant Staphylococcus aureus (76, 50%), followed by Escherichia coli (36, 23.69%), Beta-haemolytic streptococci(13,8.55%),Klebsiella aerogenes (8,5.26%), Pseudomonas aeruginosa(7,4.6%), Proteus spp.

Synergistic Antibacterial Efficiency of Bacteriocin and Silver Nanoparticles Produced by Probiotic Lactobacillus paracasei Against Multidrug Resistant Bacteria

Contamination of wounds with multidrug-resistant microorganisms is one of the greatest challenges in the curing of many diseases, and therefore, the search for alternative antimicrobial agents becomes urgent. In the present study, out of 280 bacterial isolates recovered from 57 wound swabs of patients, 199 isolates (71.1%) showed multiple drug resistance (MDR). Staphylococcus aureus was the most predominant (80.0%), followed by Pseudomonas aeuroginosa (78.87%). A number of 121 isolates (60.80%) of MDR was sensitive to bacteriocin produced by a probiotic strain of Lactobacillus paracasei. However, considering that bacteriocins may be degraded before reaching its target, silver nanoparticles (AgNPs) can be used as a suitable candidate for combinations with bacteriocin in order to be more effective. AgNPs were synthesized using the same strain and then characterized by UV–Vis spectroscopy, TEM and XRD analyses. Bacteriocin/AgNPs bioconjugate exhibited a higher antibacterial efficiency against MDR strains than that of bacteriocin or AgNPs alone. Interestingly, the bioconjugate has significantly increased the disruption of cell membrane permeability, leakages of protein and DNA, in addition to the formation of bactericidal reactive oxygen species than any other extracts. Therefore, the combination of bacteriocin with metal nanoparticles is recommended as a promising approach for the elimination of MDR organisms.

A Modified Access Technique of Impella 5.0 Axillary Artery Insertion

The conventional method for the axillary artery insertion of Impella 5.0 is a nontunneling route of the side-graft. We present an alternative technique in order to facilitate device insertion and to ensure protection from potential wound contamination. The technique consists of exiting the graft separately and away from the main incision with an intact skin and subcutaneous fat between the two sites. By proper isolation of the main wound, the risk of infection can thus be largely mitigated. Furthermore, this technique allows a better landing entry angle of graft insertion; the resulting smoother curve trajectory leads to facile device insertion, while the risk of kinking after resumption of flow is readily avoided. A further possible advantage would be a less likely to produce thrombosis at the anastomosis. Differences of this technique have already been reported for insertions of extracorporeal membrane oxygenation (ECMO), and for aortic dissections and aneurysms. Our experience in 8 cases suggests the applicability of our method to access the axillary artery for Impella 5.0 insertion.