术前备皮是否必须剃毛的临床观察

本文探讨外科手术前剃除体毛是否必要,经过３１９例择期手术病人分别采用剃除体毛和不剃除体毛备皮方法的前瞻性研究,发现术前剃除体毛备皮组与不剃除体毛备皮组术后切口感染的切口愈合的差异无显著性意义。术前不剃毛的备皮方法并不影响切口愈合,产增加切口感染率。     

心脏介入性治疗术前备皮是否剃毛的研究

目的 研究心脏介入性治疗术前备皮剃毛与不剃毛对术后穿刺口感染率的影响。方法 将126例病人随机分为实验组与对照组。实验组仅剪去可能影响手术操作的阴毛，术前2小时用1／2000的洗必泰溶液冲洗会阴部。对照组则常规剃去所有的阴毛及汗毛，术前用清水清洗会阴部。分别于手术消毒前及术后12小时在穿刺口处取样做培养，并观察穿刺口感染情况。结果 实验组与对照组在术后12小时细菌培养和术后穿刺口感染之间无显著性差异。在手术消毒前细菌培养之间有显著性差异。结论 心脏介入治疗术前备皮不剃毛不会增加穿刺口感染的机会，也不是影响穿刺口愈合的因素。     

术前剃毛备皮的循证护理

目的 循证护理1例术前病人不剃毛备皮的可行性.方法 根据该病人情况和各数据库的特点,用主题词及其与关键词搭配的检索策略检索下列数据库(Cochrane Library CDSR、CCTR,NHS Economic EvaluationDatabase、Health Technology Assessment、MEDLINE及中国生物医学文献数据库)获得相关证据.结果 从上述数据库中获得文献检索结果并仔细阅读,筛选出相关文献并进行分析.结论 该病人术前不进行剃毛备皮是可行的.     

术前备皮对胸腔手术术后切口感染发生的影响

目的 探讨常规术前剃毛备皮对胸腔手术术后切口感染发生率的影响。方法 以60例拟行胸腔手术的患诬蔑国研究对象，随机分为剃毛组和简单清洁皮肤组。在皮肤准备16h后对术野皮肤进行细菌培养和菌落计数测定，并统计两组术后的切口感染发生率。结果 显示两组在术前皮肤准备16h后的皮肤采样中细菌的种类及菌落计数及两组的手术切口感染率无明显统计学差异。结论 胸腔手术术前1d剃毛有着诸多缺点，而且无助于预防术后切口感染。     

循证护理在术前备皮中的应用

目的 为一例经腹胆囊切除患者制定合理备皮方式的循证护理方案。方法 根据患者情况提出问题,搜索NGC(2000.1~2010.12),Pubmed(2000.1~2010.12),JBI(2000.1~2010.12),Cochrane Library(2000.1~2010.12)以及CNKI原始文献数据库(2000.1~2010.12)中文数据库中有关术前备皮的相关文献。结果 从上述数据库中获得文献并进行分析,向患者提出不去毛备皮的建议。结论 术前不去毛备皮是可行的。     

手术前备皮方法-剃毛与不剃毛的实验研究与临床意义

手术前清洁皮肤剃除手术野的毛发,被列为外科手术前常规,其利弊如何,已有学者提出异议,笔者做了一组临床实验证明:剃毛备皮组24h后皮肤表面细菌存留数明显高于不剃毛备皮组。剃毛备皮组每平方厘米细菌菌落数在8个以上者有17例,不剃毛备皮组仅4例。两组备皮后24h表面单位面积菌落数有显著意义(P<0.01),为此,剃毛备皮法易增加术后感染。     

术前不同时间备皮对切口感染有无差异的临床观察

探讨外科手术前备皮的时间对切口感染有无差异，经对227例手术病人分别采用术前1d和术前2h内备皮的前瞻性研究，发现2组不同时期备皮对切口感染有显著意义。术前2h内备皮老切口感染率远低于术前1d备皮者。     

术前不同时间备皮对切口感染有无差异的临床观察

探讨外科手术前备皮的时间对切口感染有无差异,经对227例手术病人分别采用术前1d和术前2h内备皮的前瞻性研究,发现2组不同时期备皮对切口感染有显著意义。术前2h内备皮者切口感染率远低于术前1d备皮者。     

Preoperative hair removal: a case report with implications for nursing

• ? Preoperative hair removal has been a practice since the beginning of this century. Research in the 1970s and 1980s provide support for the contention that the procedure is unnecessary for wound asepsis and may increase the rate of surgical site infections (Seropian & Reynolds, 1971; Hamilton et al., 1977; Cruse & Foord, 1980; Court-Brown, 1981; Alexander et al., 1983; Winfield, 1986; Fairclough et al., 1987). However, some hospitals have continued routine preoperative hair removal long after dissemination of recommendations against it. This begs the question, ‘Why is it that so often research findings are not applied in practice’.
• ? In Stroud v. General Hospital Corp. and Pollett (1993), a man died of sepsis resulting from cuts he gave himself after he was asked by a nurse, in complete violation of the hospital's preoperative skin preparation protocol, to clip hair from his abdomen. The court held the hospital liable for the nurse's negligent breach of its protocol. The case clearly supports findings in the literature that preoperative hair removal is potentially dangerous. It reinforces the importance of strict adherence to hospital protocols which have been put in place to protect patients' safety.

     

Nationwide surveillance of antimicrobial susceptibility patterns of pathogens isolated from surgical site infections (SSI) in Japan

To investigate the trends of antimicrobial resistance in pathogens isolated from surgical site infections (SSI), a Japanese surveillance committee conducted the first nationwide survey. Seven main organisms were collected from SSI at 27 medical centers in 2010 and were shipped to a central laboratory for antimicrobial susceptibility testing. A total of 702 isolates from 586 patients with SSI were included. Staphylococcus aureus (20.4 %) and Enterococcus faecalis (19.5 %) were the most common isolates, followed by Pseudomonas aeruginosa (15.4 %) and Bacteroides fragilis group (15.4 %). Methicillin-resistant S. aureus among S. aureus was 72.0 %. Vancomycin MIC 2 μg/ml strains accounted for 9.7 %. In Escherichia coli, 11 of 95 strains produced extended-spectrum β-lactamase (Klebsiella pneumoniae, 0/53 strains). Of E. coli strains, 8.4 % were resistant to ceftazidime (CAZ) and 26.3 % to ciprofloxacin (CPFX). No P. aeruginosa strains produced metallo-β-lactamase. In P. aeruginosa, the resistance rates were 7.4 % to tazobactam/piperacillin (TAZ/PIPC), 10.2 % to imipenem (IPM), 2.8 % to meropenem, cefepime, and CPFX, and 0 % to gentamicin. In the B. fragilis group, the rates were 28.6 % to clindamycin, 5.7 % to cefmetazole, 2.9 % to TAZ/PIPC and IPM, and 0 % to metronidazole (Bacteroides thetaiotaomicron; 59.1, 36.4, 0, 0, 0 %). MIC₉₀ of P. aeruginosa isolated 15 days or later after surgery rose in TAZ/PIPC, CAZ, IPM, and CPFX. In patients with American Society of Anesthesiologists (ASA) score ≥3, the resistance rates of P. aeruginosa to TAZ/PIPC and CAZ were higher than in patients with ASA ≤2. The data obtained in this study revealed the trend of the spread of resistance among common species that cause SSI. Timing of isolation from surgery and the patient’s physical status affected the selection of resistant organisms.     

Nurse-initiated thrombolysis: a systematic review of the literature

This article aims to review, in a systematic manner, the current published evidence base for nurse-initiated thrombolysis. Reasons for this evolution in nursing practice are outlined. Themes emerging from the review are identified. Methodological issues are discussed. This article outlines a conceptual framework for practice evolution. Further research is needed to improve the strength of the evidence base by studies with improved design.     

Change in antimicrobial susceptibility of pathogens isolated from surgical site infections over the past decade in Japanese nation-wide surveillance study

Inappropriate antimicrobial therapy for surgical site infections (SSIs) can lead to poor outcomes and an increased risk of antibiotic resistance. A nationwide survey was conducted in Japan from 2018 to 2019 to investigate the antimicrobial susceptibility of pathogens isolated from SSIs. The data were compared with those obtained in 2010 and 2014–2015 surveillance studies. Although the rate of detection of extended-spectrum β-lactamase producing strains of Escherichia coli was increased from 9.5% in 2010 to 23% in 2014–2015, the incidence decreased to 8.7% in 2018–2019. Although high susceptibility rates were detected to piperacillin/tazobactam (TAZ), the geometric mean MICs were substantially higher than to meropenem (2.67 vs 0.08 μg/mL). By contrast, relatively low geometric mean MICs (0.397 μg/mL) were demonstrated for ceftolozane/TAZ. Although the MRSA incidence rate decreased from 72% in the first surveillance to 53% in the second, no further decrease was detected in 2018–2019. For the Bacteroides fragilis group species, low levels of susceptibility were observed for moxifloxacin (65.3%), cefoxitin (65.3%), and clindamycin (CLDM) (38.9%). In particular, low susceptibility against cefoxitin was demonstrated in non-fragilis Bacteroides, especially B. thetaiotaomicron. By contrast, low susceptibility rates against CLDM were demonstrated in both B. fragilis and non-fragilis Bacteroides species, and a steady decrease in susceptibility throughout was observed (59.3% in 2010, 46.9% in 2014–2015, and 38.9% in 2018–2019). In conclusion, Japanese surveillance data revealed no significant lowering of antibiotic susceptibility over the past decade in organisms commonly associated from SSIs, with the exception of the B. fragilis group.     

Antiseptic barrier cap effective in reducing central line-associated bloodstream infections: A systematic review and meta-analysis

BackgroundMicroorganisms can intraluminally access a central venous catheter via the catheter hub. The catheter hub should be appropriately disinfected to prevent central line-associated bloodstream infections (CLABSIs). However, compliance with the time-consuming manual disinfection process is low. An alternative is the use of an antiseptic barrier cap, which cleans the catheter hub by continuous passive disinfection.ObjectiveTo compare the effects of antiseptic barrier cap use and manual disinfection on the incidence of CLABSIs.DesignSystematic review and meta-analysis.MethodsWe systematically searched Embase, Medline Ovid, Web-of-science, CINAHL EBSCO, Cochrane Library, PubMed Publisher and Google Scholar until May 10, 2016. The primary outcome, reduction in CLABSIs per 1000 catheter-days, expressed as an incidence rate ratio (IRR), was analyzed with a random effects meta-analysis. Studies were included if 1) conducted in a hospital setting, 2) used antiseptic barrier caps on hubs of central lines with access to the bloodstream and 3) reported the number of CLABSIs per 1000 catheter-days when using the barrier cap and when using manual disinfection.ResultsA total of 1537 articles were identified as potentially relevant and after exclusion of duplicates, 953 articles were screened based on title and abstract; 18 articles were read full text. Eventually, nine studies were included in the systematic review, and seven of these nine in the random effects meta-analysis. The pooled IRR showed that use of the antiseptic barrier cap was effective in reducing CLABSIs (IRR = 0.59, 95% CI = 0.45–0.77, P < 0.001).ConclusionsUse of an antiseptic barrier cap is associated with a lower incidence CLABSIs and is an intervention worth adding to central-line maintenance bundles.     

Intravenous acetaminophen reduces postoperative nausea and vomiting: A systematic review and meta-analysis

Opioids are a key risk factor for postoperative nausea and vomiting (PONV). As intravenous (i.v.) acetaminophen reduces postoperative pain and opioid requirements, one would expect i.v. acetaminophen to be associated with a lower incidence of opioid-induced side effects, including PONV. We conducted a systematic search using Medline and Cochrane databases supplemented with hand search of abstract proceedings to identify randomized-controlled trials of i.v. acetaminophen. Inclusion criteria were (a) randomized for i.v. acetaminophen vs a placebo control, (b) general anesthesia, and (c) reported or obtainable PONV outcomes. Primary outcome was postoperative nausea and secondary outcome was postoperative vomiting. We included 30 studies with 2364 patients (1223 in the acetaminophen group, 1141 in the placebo group). The relative risk (95% confidence interval) was 0.73 (0.60–0.88) for nausea and 0.63 (0.45–0.88) for vomiting. Data showed significant heterogeneity for both nausea (P = 0.02, I² = 38%) and vomiting (P = 0.006, I² = 47%), but were homogeneous when studies were grouped according to timing of first administration: i.v. acetaminophen reduced nausea when given prophylactically either before surgery, 0.54 (0.40–0.74), or before arrival in the postanesthesia care unit, 0.67 (0.55–0.83); but not when given after the onset of pain, 1.12 (0.85–1.48). When i.v. acetaminophen was given prophylactically, the reduction of nausea correlated with the reduction of pain (odds ratio 0.66, 0.47–0.93), but not with reduction in postoperative opioids (odds ratio 0.89, 0.64–1.22). Prophylactically administered i.v. acetaminophen reduced PONV, mainly mediated through superior pain control.