Effect of chlorhexidine scrub on postoperative bacterial counts

Article Abstract:

Surgical wound infection may be prevented by adequate cleansing (scrubbing) of the surgeon's hands prior to the procedure. Scrub agents that are both bactericidal (kill bacteria) and bacteriostatic (inhibit bacterial growth) appear to be more effective than when bactericidal agents are used alone. A 4 percent solution of chlorhexidine, which has both properties, is commonly used. It was hypothesized that a small amount of this solution remaining on the surgeon's hands under the gloves during the operation could reduce the bacterial level on the surgeon's hands. This is of special importance in the event of glove puncture during surgery, when contamination could occur. The hypothesis was tested during 29 orthopedic procedures and 21 vascular procedures performed by two surgeons. Before each operation, both hands were scrubbed in the usual manner for five minutes with 4 percent chlorhexidine. One hand was then rinsed and towel dried; the other was lightly patted and some scrub foam remained on the hand. The surgeon gloved, gowned, and operated in the usual fashion. After the procedure, the surgeon removed the gloves and immersed his fingertips in sterile bowls that contained a medium in which bacteria could be suspended. The number and types of bacteria so obtained were evaluated. Any case during which a glove was punctured was excluded from analysis. Results showed a higher number of bacterial colonies from the rinsed hand (73.5 CFU, a measure of bacterial number) than the unrinsed, still 'soapy', hand (2.2 CFU). The most common organism was a type of Staphylococcus. The results have special implications for longer procedures, where bacterial growth on surgeons' hands could become a more important factor in contamination. These findings are also worth noting for procedures where glove puncture is likely to occur, and when the consequences of glove puncture could be particularly serious. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Prevention, Surgical wound infections, Bacteria, Chlorhexidine, Nosocomial infections, Cross infection

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Detection of clinically suspected deep vein thrombosis using light reflection rheography

Article Abstract:

Suspected deep venous thrombosis (an abnormal condition in which clotting elements accumulate and attach to a point on the interior wall of the vein) must be confirmed or dismissed. Currently the best method of diagnosis is contrast venography, an invasive procedure in which contrast dye is injected into the vein and X-rays taken. There are several noninvasive tests available, but these have differing accuracies, are difficult to perform and subject to interpretation. A new noninvasive diagnostic method is light reflection rheography. This method uses light-emitted diodes and a sensor to measure reflected infrared light from the microcirculation of the skin. The procedure can be used to evaluate chronic venous insufficiency. A study was undertaken of 72 patients suspected of having deep venous thrombosis who underwent both venography and light reflection rheography to determine the usefulness of this procedure in the diagnosis of deep venous thrombosis. Deep venous thrombosis was diagnosed by venography in 24 patients; 23 of these patients were also positively diagnosed by light reflection rheography. Forty-five patients showed no evidence of thrombus on venography study; 35 of these had normal light reflection rheograms. Light reflection rheography showed a sensitivity of 96 percent (meaning that it was able to detect a thrombus almost all of the time) and a specificity of 76 percent (i.e. the method could distinguish between a thrombus and other conditions in about three out of four cases). These findings indicate that light reflection rheography has a sensitivity similar to that of other noninvasive tests. Its additional features include ease of performing, portability of equipment, and low cost. (Consumer Summary produced by Reliance Medical Information, Inc.)

Veins

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Use of light reflection rheography for diagnosis of axillary or subclavian venous thrombosis

Article Abstract:

Venous thrombosis is an abnormal condition in which clotting elements and cell debris accumulate and attach to a point on the interior wall of the vein, blocking blood flow. With the increasing use of central venous catheters and pacemaker wires, thrombosis of the subclavian and axillary veins of the shoulder and upper chest area due to venous injury may occur. Currently there is no definitive noninvasive procedure to diagnosis axillary or subclavian venous thrombosis. The best diagnostic method available is phlebography (X-ray examination of the veins following injection of contrast dye); this procedure exposes the patient to the risks of injection of radio-opaque dye. Light reflection rheography uses optical scanning of pressure changes in the microcirculation of the skin to evaluate venous hemodynamics. A description of the technique is presented. Eleven patients believed to have axillary or subclavian venous thrombosis were evaluated using light reflection rheography; a control group of 10 patients undergoing permanent central venous catheter placement were also evaluated. A correct diagnosis was made in the 11 patients; there were no false positive results when comparing light reflection rheography results with venogram results. This technique is simple, and the tracing obtained is easy to interpret, and the equipment used is relatively inexpensive. The test provides objective evidence of proximal venous occlusion. (Consumer Summary produced by Reliance Medical Information, Inc.)

Subclavian vein

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