Blood cultures are the gold standard for diagnosing bloodstream infections and identifying causative organisms. Every effort should be made to improve diagnostic yield, and obtained results should be interpreted cautiously in the context of clinical findings. In this review, several issues of clinical relevance with regard to blood culturing are addressed; these issues include indications, skin antisepsis, timing and number of blood cultures, volume of obtained, and interpretation of positive blood culture results.
Antisepsis ; Skin

Blood cultures are the gold standard for diagnosing bloodstream infections and identifying causative organisms. Every effort should be made to improve diagnostic yield, and obtained results should be interpreted cautiously in the context of clinical findings. In this review, several issues of clinical relevance with regard to blood culturing are addressed; these issues include indications, skin antisepsis, timing and number of blood cultures, volume of obtained, and interpretation of positive blood culture results.
Antisepsis ; Skin

BACKGROUND: Reducing skin contamination rate and improving the positive rate in blood culture is essential for the correct diagnosis and management of sepsis. Chlorhexidine-alcohol was compared with povidone-iodine for the efficiency of disinfection. Positive rates were compared between the collection of 10 mL and 20 mL of blood per sample. METHODS: The study population included adult patients > or = 18 years old requested for blood culture in the Emergency Department. Povidone-iodine (10%) was used for antiseptic skin preparation from March to June 2011, and 0.5% chlorhexidine-alcohol from July to October 2011. The standard for blood collection was 10 mL in the first period and 20 mL in the second period. The dedicated phlebotomists had been educated on the optimal skin preparation and sample collection. RESULTS: After 10% povidone-iodine application, 31 of 2,755 samples (1.1%) were considered to be contaminated; whereas, a total of 60 of 3,064 samples (2.0%) were contaminated (P=0.011) after application of 0.5% chlorhexidine-alcohol. The positive rate of blood culture was 12.5% (345/2,755) in the first period versus 17.1% (524/3,064) in the second period (P<0.001). CONCLUSION: Both disinfectants appeared acceptable for skin preparation for blood culture collection, although chlorhexidine-alcohol had a higher contamination rate than povidone-iodine. The positive rate of blood culture was in accordance with the amount of sample collected. Continuous education and monitoring are needed for the proper collection and management of blood culture.
Adult ; Antisepsis ; Blood Volume ; Disinfectants ; Disinfection ; Emergencies ; Humans ; Povidone-Iodine ; Sepsis ; Skin

Intracanal antisepsis acts as one of the fundamental steps in root canal therapy. Intracanal medication is very common among the multitudinous root canal disinfection methods so far. However, as the most frequently-used intracanal medication, calcium hydroxide exists some problems, such as insufficient antimicrobial power and antibiogram. Thus exploring new root canal disinfectant is necessary. Herbal medicine is gaining favor for its wide varieties, broad efficacy and affordable prices. The current researches revealed that many kinds of herbs or compound herbal preparations possess good ability of antimicrobial and other properties that superior to those of traditional root canal disinfectants. However, herbal medicine itself and the studies have shortcomings. This paper will provide a review of various herbal alternatives that are being studied of late years.
Antisepsis ; Calcium Hydroxide ; Herbal Medicine ; Root Canal Irrigants ; Root Canal Therapy

BACKGROUNDFingertip defect significantly affects the appearance of the hand. The aim of this research was to evaluate the clinical effect of aesthetic fingertip reconstruction with partial second toe transfer.

METHODSBetween July 2005 and December 2008, 17 patients underwent aesthetic fingertip reconstruction with partial second toe transfer. The mean size of fingertip defects was 0.7 cm (ranging from 0.5 - 1.1 cm). Anastomosis was performed between one dominant plantar digital artery and one proper digital artery, between two dorsal digital veins of the toe and two dorsal digital veins of the finger, respectively, for the reconstruction of blood supply to the reconstructed finger. Two plantar digital nerves of the toe were then sutured to two proper digital nerves of the finger for the restoration of fingertip sensation.

RESULTSAll reconstructed fingers survived completely. The follow-up period ranged from 6 to 24 months, and the appearance of the reconstructed fingertip was similar to that of the normal fingertip. Two-point discrimination of the reconstructed fingertip was (7.8 ± 1.3) mm. The recovered pinch strength of the reconstructed finger was about (89.0 ± 5.1)% of that of the normal finger. Donor site healed well without complications.

CONCLUSIONSPartial second toe transfer is an ideal aesthetic reconstruction method for fingertip defects; it can not only achieve a satisfactory appearance of the fingertip, but can also obtain excellent sensory and motor functions.

Adolescent ; Adult ; Antisepsis ; Female ; Fingers ; blood supply ; surgery ; Humans ; Male ; Reconstructive Surgical Procedures ; methods ; Toes ; transplantation

OBJECTIVE: To compare the effect on Total Aerobic Count (TAC) of application of Isopropyl alcohol, Chlorhexidine, and povidone iodine plus alcohol prior to venipuncture and development of phlebitis in children admitted at a tertiary hospital.

METHODS: A prospective randomized clinical trial in a tertiary hospital in Quezon City. A total of 129 patients one-year old and above with physician orders for IV insertion and extractions. Pre and post swabbing of the venipuncture site was done and placed on a blood agar plate. The three antiseptic solutions were applied over the venipuncture site and swabbed and placed on the agar plate. The primary outcome measure was the TAC in each blood agar of the tested antiseptic solution and correlation to developing phlebitis.

RESULTS: The CFU/mL after disinfection was significantly different between groups, with the lowest CFU/mL observed among patients disinfected with Chlorohexidine. Phlebitis was only noted in the alcohol group. No reactions were observed from patients who were disinfected with povidone iodine and chlorohexidine.

CONCLUSIONS: Single application of Chlorhexidine is the optimal method to be used as antisepsis prior to procedures like venipuncture. However, the use of povidone iodine plus 70% isopropyl alcohol also has comparable effect to Chlorhexidine.

Human ; Phlebotomy ; Antisepsis ; 2-propanol ; Chlorhexidine ; Povidone-iodine ; Phlebitis ; Anti-infective Agents, Local ; Philippines

During the second half of the 19th century many operations were developed after anesthesia was introduced but advances were limited for many years because of the high rate of infection and the high mortality rate that followed infections. After the introduction of the principle of antisepsis, postoperative infectious morbidity decreased substantially. With the introduction of antibiotic therapy in the middle of the 20th century, a new adjunctive method to treat and prevent surgical infections was discovered. However, not only have postoperative wound and hospital required infections continued, but widespread antibiotic therapy has often made prevention and control of surgical infections more difficult. Based on National Nosocomial Infection Surveillance (NNIS) system reports, SSIs (Surgical Site Infections) are the third most common nosocomial infection, accounting for 14% to 16% of all nosocomial infections among hospitalized patients. It is also a significant source of postoperative morbidity, resulting in increased hospital length of stay and increased cost. Determination of risk factors for the development of SSI has been a major focus of surgical research. To reduce the rate of SSIs we have to eliminate risk factors of SSIs and keep a continuous surveillance with feedback of information to surgeons and other relevant staff. A successful SSI surveillance program includes standardized definition of infection, effective surveillance method, and stratification of the SSIs rates according to risk factors. Because SSIs may be the most preventable of nosocomial infections, health care facilities should make special efforts to reduce the risk of development of these surgical complications. The evaluation of infection control programs and the development of more effective infection control strategies should be established and surgeons should be more concern about SSI control.
Anesthesia ; Antisepsis ; Cross Infection ; Delivery of Health Care ; Humans ; Infection Control ; Length of Stay ; Mortality ; Risk Factors ; Wounds and Injuries

History of the thyroidectomy is a history in the advancement of surgery itself. Prior to the 19th century, the surgery of thyroid gland was clouded in lack of understanding. However, references to the thyroid disease and its treatment can be found in the literature and paintings of ancient medicine. Due to the lack of awareness and poor nutrition including iodine deficiency, Thyroid disease like goiter was widespread in that era. Many physicians had described the thyroid disease in various explanations and had attempted to cure that disease in many ways which was not on the scientific basis. By the 19th century, reasonable basis and explanation of the thyroid gland and its disease enabled the surgical treatment with resecting thyroid gland. However, like other surgery, surgical resection of the thyroid gland was limited by the lack of anesthesia, proper instruments and antibiotics in that time. Much of the progress in thyroid surgery occurred in 20th century by the contribution of the pioneering European and American surgeons with the advances of the surgical technique using proper instrument, antisepsis and biochemical products. Nowadays, modern imaging methods and remarkable surgical devices like endoscope or robot allow the variable access to the thyroid gland, which can be an alternative to the conventional method.
Anesthesia ; Anti-Bacterial Agents ; Antisepsis ; Endoscopes ; Goiter ; Iodine ; Methods ; Paint ; Paintings ; Surgeons ; Thyroid Diseases ; Thyroid Gland* ; Thyroidectomy

BACKGROUND: The importance and efficacy of a care bundle for preventing central line-associated bloodstream infections (CLABSIs) and infectious complications related to placing a central venous catheter (CVC) in patients in the intensive care unit (ICU). METHODS: A care bundle was implemented from July 2013 to June 2014 in a medical ICU and surgical ICU. Data were divided into three periods: the prior period (July 2012–June 2013), the intervention period (July 2013–June 2014; first and second periods), and the post-intervention period (July 2014–December 2014; third period). A care bundle consisting of optimal hand hygiene, skin antisepsis with chlorhexidine (2%) allowing the skin to dry, maximal barrier precautions for inserting a catheter (sterile gloves, gown, mask, and drapes), choice of optimal insertion site, prompt catheter removal, and daily evaluation of the need for the CVC was introduced. RESULTS: The catheterization duration was longer and femoral access was more frequently observed in patients with CLABSIs. CLABSI rates decreased with use of the care bundle. The CLABSI rate in the medical ICU was 6.20/1,000 catheter days during the prior period, 3.88/1,000 catheter days during the intervention period, and 1.05/1,000 catheter days during the third period. The CLABSI rate in the surgical ICU was 8.27/1,000, 4.60/1,000, and 3.73/1,000 catheter days during these three periods, respectively. CONCLUSIONS: The choice of an optimal catheter insertion site, use of all barrier precautions, and removal of catheters when they are no longer needed are essential to decrease the CLABSI rate.
Antisepsis ; Catheterization ; Catheters ; Central Venous Catheters ; Chlorhexidine ; Critical Care* ; Cross Infection ; Hand Hygiene ; Humans ; Intensive Care Units* ; Masks ; Patient Care Bundles* ; Skin

Surgery of the lens of the eye is almost exclusively limited to that which is done for a cataract. It is this type of operation which has it possible for the greatest number of the blind to recover vision. There is documentary historical evidence that surgery for cataracts was performed by the ancient Egyptians, Greeks and Romans. The first recorded extraction of the opapue lens was done by Davial in 1745 who used a triangular knife to section the limbus. Subsecuently the fact that many eyes lost their sight because of infection prevented the widespread use of this impor tant surgical discovery until the Listerian epoch. Since 1870 and the advent of antisepsis the use of this operation for cataracts has become generalized so that today its use is widespread. Also there has been development and progress in the method of surgery. Although there are many serious complication which may follow the extraction of a lens for cataract, the incidence of such is relatively rare. This study is based on a survey of the results of 479 cataract operations each performed under similar conditions, but using a variety of operative techniques. These operations were performed at Y.U.M.C. Department of Ophthalmology between 1964 and 1973. The results of the study are summarized as follows: 1. From 1964 through 1973 there were 384 cataracts done on 225 males and 159 females. 2. Cataract extration were done upon 479 eyes. The types of cataracts are: senile 341, traumatic 57, complicated 35, congenital 21, other 25. 3. The incidence of operative complications was: vitreous loss 17.2%, capsul rupture 6.5%, iris prolapse 1.7%. 4. Early postoperative complications included: striate keratitis 55.2%, hyphema 22.9%, infection 3.1%, pupil drown up 1.5%, iris prolapse 1.5%, conjunctival bleb 1.3%. 5. The following were late postoperative complications: corneal edema 2.4%, glaucoma 2.1%, retinal detachment 2.0%, uveitis 1.1%.
Antisepsis ; Blister ; Cataract* ; Corneal Edema ; Female ; Glaucoma ; Humans ; Hyphema ; Incidence ; Iris ; Keratitis ; Male ; Ophthalmology ; Postoperative Complications ; Prolapse ; Pupil ; Retinal Detachment ; Rupture ; Uveitis