povidone-iodine and Transfusion-Reaction

During a period of five years, the rate of surgical site infection (SSI) after abdominal hysterectomy at our institution was >10%. With the implementation of a multifaceted intervention designed to reduce this, the rate of SSI fell to <2% in the post-intervention period. The pre- and post-intervention periods were compared to determine which of the interventions in the multifaceted array of interventions was most valuable in decreasing SSI.. A retrospective chart review was done to identify: (1) Parameters associated with SSI, and (2) parameters that differed in the pre- and post-intervention periods. The intervention included providing departmental SSI rates to the gynecology faculty, re-educating operating room (OR) staff personnel about appropriate perioperative antibiotic choice and timing, and changing the preferred sterile preparation for abdominal surgery from 10% povidone-iodine (PI) to 4% chlorhexidine gluconate (CHG). The preliminary results of our review also led to the suggestion that surgeons use blood products sparingly, although an absolute threshold for transfusion was not specified.. Twenty-one of 192 patients (10.7%) developed an SSI in the pre-intervention period, whereas 1 of 84 patients (1.2%) developed an SSI in the post-intervention period (p=0.006). Surgical site infection was associated with obesity (a body mass index [BMI] ≥30) (11.5% vs. 4.8%, p=0.04), receipt of a blood transfusion (18.2% vs. 6.6%, p=0.03), and abdominal skin preparation with PI as opposed to CHG (10.1% vs. 2.0%, p=0.07). Chlorhexidine gluconate was used more commonly for abdominal skin preparation in the post- than in the pre-intervention period (6.6% pre-intervention vs. 50.7% post-intervention, p <0.0001).. A multifaceted intervention decreased dramatically the rate of SSI after abdominal hysterectomy at our institution. No single component of the intervention could be identified as most responsible for the improvement.

Topics: Administration, Cutaneous; Anti-Bacterial Agents; Antibiotic Prophylaxis; Chlorhexidine; Female; Humans; Hysterectomy; Intraoperative Care; Medical Staff, Hospital; Obesity; Povidone-Iodine; Surgical Wound Infection; Transfusion Reaction

To validate a standardized optimal national procedure for donor arm disinfection.. A direct swabbing and plating technique was used to enumerate bacteria present on the arm pre- and postdisinfection. Twelve donor arm disinfection techniques were evaluated.. The Medi-Flex Adapted method, consisting of a two-stage process with an initial application of isopropyl alcohol followed by tincture of iodine, produced the best arm disinfection. A percentage reduction in bacterial counts of 99.79% (logarithmic reduction of 2.67) was obtained. Postdisinfection, 70% of donors had bacterial counts of zero, and 98% had counts of 10 or less.. The Medi-Flex disinfection method offers the English National Blood Service a validated, optimal 'best practice' disinfection technique and should contribute significantly to the reduction in risk of transmission of bacteria by transfusion.

Topics: 2-Propanol; Administration, Cutaneous; Arm; Bacteremia; Bacteria; Bacteriological Techniques; Blood Donors; Chlorhexidine; Disinfectants; Disinfection; Humans; Hydrogen Peroxide; Infection Control; Phlebotomy; Povidone-Iodine; Skin; Transfusion Reaction

From January 1980 to July 1990, the Hospital Infections Program of the Centers for Disease Control conducted 125 on-site epidemiologic investigations of nosocomial outbreaks. Seventy-seven (62%) were caused by bacterial pathogens, 11 (9%) were caused by fungi, 10 (8%) were caused by viruses, five (4%) were caused by mycobacteria, and 22 (18%) were caused by toxins or other organisms. The majority of fungi and mycobacterial outbreaks occurred since July 1985. Fourteen (11%) outbreaks were device related, 16 (13%) were procedure related, and 28 (22%) were product related. The proportion of outbreaks involving products, procedures, or devices increased from 47% during 1980-1985 to 67% between 1986 and July 1990. Recent outbreaks have shown that packed red blood cell transfusion-associated Yersinia enterocolitica sepsis results from contamination of the blood by the asymptomatic donor; that povidone-iodine solutions can become intrinsically contaminated and cause outbreaks of infection and/or pseudoinfection; and that rapidly growing mycobacteria can cause chronic otitis media, surgical wound infection, and hemodialysis-associated infections. These and other outbreaks demonstrate how epidemiologic and laboratory investigations can be combined to identify new pathogens and sources of infection and ultimately result in disease prevention.

Topics: Centers for Disease Control and Prevention, U.S.; Cross Infection; Disease Outbreaks; Drug Contamination; Humans; Povidone-Iodine; Transfusion Reaction; United States; Vitamin E