A technique for surgical treatment of infected wounds based on photodynamic and ultrasound therapy

The goal of this work was to compare the photodynamic, ultrasound, and combined methods for treatment of pyonecrotic and sluggish wounds. The advantages and disadvantages of the methods are discussed. Equipment for implementation of the combined method is considered. The interaction between the equipment and biological object is described in terms of a bioengineering system.     

Risk factors for surgical wound infection in digestive surgery. Retrospective study of 3,000 surgical wounds

A retrospective consecutive study was made of 3000 surgical wounds. All wounds were examined for ten days after operation. The overall infection rate of surgical wound infection (SWI) was 3.53%. SWI lengthened significantly duration of hospital stay (12 days vs 4 days, p < 10-6). Monovariate analysis had shown as significantly risk factors: diabetes (12.26% vs 5.49%, p < 10-6), emergency operation (5.64% vs 2.43%, p < 10-3), acute appendicitis (24.53% vs 13.06%, p < 10-3), biliary emergencies (10.37% vs 4.73%, p < 10-3), operations achieved by young surgeons (5.55% vs 2.83%, p < 10-3), choledochotomy (10.38% vs 5.46%, p < 0.05), colorectal resection (8.50% vs 4.14%, p < 0.05), open laparotomy versus laparoscopy (19.81% vs 1.89%, p < 0.05) and operating time (148 mn vs 104 mn, p < 0.05). Logistic regression showed that diabetes (p = 0.00488), biliary emergencies (p = 0.0016), seniority of surgeon (p = 0.0023), type of skin incision (p = 0.0196) and operating time (p = 0.0005) were the independent risk factors for surgical wound infection.     

Use of photo-ultrasound technology in the treatment of infected wounds

The paper details three of the technologies used in the treatment of infected wounds (ultrasound, photodynamic, photomatrix ones) with emphasis on the authors' developed combined photo ultrasound technique. It presents the results of clinical application of these technologies, discusses its capacities, limitations, and prospects alone and in combination. The high efficiency of combined exposure--the photo ultrasound method--is shown.     

Antibacterial activity of honey against strains of Staphylococcus aureus from infected wounds.

The antibacterial action of honey in infected wounds does not depend wholly on its high osmolarity. We tested the sensitivity of 58 strains of coagulase-positive Staphylococcus aureus, isolated from infected wounds, to a pasture honey and a manuka honey. There was little variation between the isolates in their sensitivity to honey: minimum inhibitory concentrations were all between 2 and 3% (v/v) for the manuka honey and between 3 and 4% for the pasture honey. Thus, these honeys would prevent growth of S. aureus if diluted by body fluids a further seven-fold to fourteen-fold beyond the point where their osmolarity ceased to be completely inhibitory. The antibacterial action of the pasture honey relied on release of hydrogen peroxide, which in vivo might be reduced by catalase activity in tissues or blood. The action of manuka honey stems partly from a phytochemical component, so this type of honey might be more effective in vivo. Comparative clinical trials with standardized honeys are needed.     

不同生肌药治愈感染性伤口的时间比较

目的 探讨不同生肌药治疗感染性伤口的愈合时间.方法 2009年1月～2010年12月,北京市顺义区第二医院外科分别应用湿润烧伤膏、京万红软膏各治疗15例感染性伤口患者,将两组患者伤口愈合时间进行比较.结果湿润烧伤膏组患者伤口愈合时间明显短于京万红软膏组,差异有统计学意义.结论湿润烧伤膏治疗感染性伤口,伤口愈合更快.     

A cross‐sectional survey of patients with open surgical wounds in Slovenia

Most surgical wounds heal by primary intention, that is, the wound is closed with sutures, clips, or glue. However, some surgical wounds are either left open to heal from the bottom up (“healing by secondary intention”) or break open partially or fully after primary closure. There is little basic knowledge about the occurrence and natural history of surgical wounds healing by secondary intention (SWHSI); therefore, the aim of this survey was to estimate the number of people with SWHSI in Slovenia, the nature of these wounds, and to investigate how they are managed. A multiservice, cross‐sectional survey was carried out over a 2‐week period in the city of Ljubljana, Slovenia (population 288,919). Healthcare professionals across health and social care settings completed one anonymised form for each patient with a SWHSI. Forms were completed for 110 patients. The point prevalence of SWHSI was 0.38 per 1,000 of the population (95% CI: 0.33–0.44). Patients’ mean age was 50.5 years. The majority of SWHSI were planned to heal by secondary intention before surgery (76/110, 69%). Of SWHSI, 83% (92/110) were treated with wound dressings, and 6% were treated with negative pressure wound therapy. Data were missing for 11 cases. This survey is the first to provide essential information about the extent, nature, and treatment of SWHSI in Slovenia. Furthermore, it is one of the latest of a very small number of studies to have contributed to knowledge about SWHSI globally. The results from the survey can be used for planning future research, health resources management, and policy development.     

A study of patients' expectations and satisfaction in Singapore hospitals

In today's highly competitive healthcare environment, hospitals increasingly realise the need to focus on service quality as a means to improve their competitive position. Customer-based determinants and perceptions of service quality therefore play an important role when choosing a hospital. This paper attempts to determine the expectations and perceptions of patients through the use of a generic, internationally used market research technique called SERVQUAL. An analysis covering 252 patients revealed that there was an overall service quality gap between patients' expectations and perceptions. Thus, improvements are required across all the six dimensions, namely, tangibility, reliability, responsiveness, assurance, empathy and accessibility and affordability.     

Endoscopic versus surgical treatment of infected necrotising pancreatitis: the TENSION study

In patients with infected necrotising pancreatitis there is a significant risk (40%) of complications and mortality with the surgical step-up approach. This approach consists of percutaneous retroperitoneal drainage, if necessary followed by video-assisted retroperitoneal débridement. An alternative treatment is an endoscopic step-up approach consisting of endoscopic transluminal drainage, if necessary followed by endoscopic transluminal necrosectomy. The Dutch Pancreatitis Study Group has recently started the nationwide randomized TENSION-trial, in which in 98 patients the endoscopic step-up approach is compared with the surgical method. The primary endpoint is a composite of mortality and major morbidity (new onset organ failure, bleeding, perforation of a hollow organ or incisional hernia for which intervention is needed).     

Bacterial decontamination of surgical wounds treated with Lavasept

In a prospective randomized controlled double-blind study in 50 acutely injured patients, bacterially contaminated type 2–4 soft tissue wounds were treated with moist dressings of 0.2% Lavasept^® (fractionated polyhexamethylenbiguanide and macrogolum 4000) solution (n=28) in comparison with Ringer solution (n=22). Standardized swabs were taken on days 0, 2, 8 and 15 and investigated for microorganisms. For a quantitative evaluation, the number of colony forming units (CFU) was determined by a serial dilution technique. The tissue compatibility and anti-inflammatory effect were rated on a scale of 0 (=bad) to 3 (=very good). The most frequently found microorganism was Staphylococcus aureus, which was isolated from 13 wounds. Use of Lavasept^® led to a faster and significant reduction in microorganisms on the wound surfaces. The number of CFU per wound remained constant or decreased, in contrast to the wounds treated with Ringer solution. This was true for both Gram-positive and Gram-negative bacteria. There was no evidence of impaired wound healing in either group. The anti-inflammatory effect and the tissue compatibility of Lavasept^® were rated significantly better than that of Ringer solution. It is concluded that Lavasept^® combines antiseptic action with good tissue compatibility.     

A review of current strategies to reduce intraoperative bacterial contamination of surgical wounds

Surgical site infections are a mean topic in cardiac surgery, leading to a prolonged hospitalization, and substantially increased morbidity and mortality. One source of pathogens is the endogenous flora of the patient’s skin, which can contaminate the surgical site. A number of preoperative skin care strategies are performed to reduce bacterial contamination like preoperative antiseptic showering, hair removal, antisepsis of the skin, adhesive barrier drapes, and antimicrobial prophylaxis. Furthermore we can also support the natural host defense by optimal intra-operative management of oxygen supply, normoglycemia, and temperature. Nevertheless we still have a number of patients, who develop a surgical site infection. Therefore new skin care strategies are introduced to reduce the contamination by the endogenous skin flora. We present the use of a new microbial sealant, InteguSeal^®, which was evaluated in patients undergoing cardiac surgery. The preliminary results of this investigation showed a trend in surgical site infection reduction by the use of this new microbial sealant.     

A study of residents of five old people's homes in Singapore

Summary Singapore is a multi-racial community, undergoing rapid transformation into an urban and industrialized society. Many Eastern traditions, such as the extended family system, are rapidly dying out. There is also a problem of aged people who migrated long ago to Singapore from China or India without their spouses or children. Many have lost all contact with their families. A study was carried out among 449 residents of five old people's Homes in Singapore. It was found that Chinese and Christians were over-represented. Only 21.8 per cent were born in Singapore. The majority were over 70 years of age, and were single or widowed. More than 70 per cent did not have children or grandchildren in Singapore, and the absence of relatives was the most common reason for admission. Most had very little income or savings. No visits during the past one year were received by 34.1 per cent and most others received very few visits. During one year 69.5 per cent never left the Homes and most others did so very infrequently. Almost three-quarters of the subjects did not participate in any home activities, and slightly over 10 per cent helped in the home. However, fewer than 10 per cent were dissatisfied with their living conditions and only 20.5 per cent said they often felt lonely. The vast majority (86.9 per cent) were happy.     

Isolation of anaerobic and aerobic bacteria from clean surgical wounds: an experimental and clinical study

A pad imprint method was evaluated for quantitative sampling of anaerobic and aerobic bacteria from clean surgical wounds. The best recovery of bacteria from the pads was obtained when they were treated with a rinsing solution in a 'Stomacher' apparatus. Pads of three different fabrics were compared, but no difference was noted in their efficiency in sampling anaerobic and aerobic bacteria from clean surgical wounds. Sampling of known quantities of Staphylococcus aureus from experimental wounds in rabbits performed with the pad method gave a threefold better recovery than with a swab. The pad method was superior to the wound wash-out method when sampling wounds in hip surgery.     

Early and long-term results of treatment for infected deep sternotomy wounds

A retrospective study and follow-up was undertaken to determine the optimal treatment of poststernotomy wound infections. Between January 1990 and April 2000 mediastinitis developed in 62 patients following 7458 heart operations (0.83%). Median age of 50 males and 12 females was 59.1 +/- 9.1 years (27-77). Mediastinal infections occurred within 14.2 +/- 10.9 days (3-90) following cardiac surgery. Most common symptoms and clinical findings were purulent wound drainage or dehiscence (50%), sternal instability (46.7%) and fever (35.5%). Most commonly isolated pathogens were Staphylococcus aureus and coagulase-negative Staphylococci which alone or together with other Gram-positive bacteria caused nearly 70% of all infections. Following the exploration and radical debridement, the wounds in two patients were left to heal by open granulation, 26 patients were initially treated by closed mediastinal suction--or irrigation, and 43 patients were treated with muscle and/or omental flap transposition (34 primarily, 9 following the failure of other methods). Recurrence of infections occurred in 16 patients: 10 from the "closed treatment" group (38.5%) and 6 from the "soft tissue flap" group (14%). Nine patients died during the hospital stay. The mortality rate was 15.4% following the closed method (4/26) and 14.7% following the treatment with flap reconstructions (5/34). There were 6 late deaths, non-related to recurrent infection. Healed wounds were obtained in 96.2% of all patients. About one third of patients noted continuous or intermittent chest pain or discomfort in the closed and the soft tissue flap transposition group. 22.6% of patients claimed sternal instability and 9.7% shoulder weakness--each of them underwent muscle and/or omental flap closure. Abdominal hernias or bulges were present in 4 patients (12.9%) following the use of abdominal flap for wound reconstruction. These results suggest that early debridement and closed method would be successful when employed soon after cardiac surgery. When reexploration is delayed for any reason or obvious extensive involvement of bone or cartilage is present, the wound should be reopened, debrided and treated with muscle and/or omental flaps. Patients in whom closed method fails could probably treated with soft tissue flap transposition soon after the reoperation. Long-term results of closed mediastinal drainage or lavage and flap closure are favourable to open granulation technique regarding wound healing and elimination of infection.     

Torulopsis glabrata infections in Singapore: a 4-year study.

During the period 1971-4, Torulopsis glabrata formed 42% of yeasts isolated from 5677 clinical specimens from patients with cancers, diabetes mellitus, chronic renal failure, pregnacy or major surgical operations complicated by mycotic infections. The significance of T. glabrata in these patients is discussed.     

Health systems reforms in Singapore: A qualitative study of key stakeholders

In response to a growing chronic disease burden and ageing population, Singapore implemented Regional Health Systems (RHS) in 2008. In January 2017, the MOH announced that the six RHS clusters would be reorganised into three in 2018. This qualitative study sought to identify the health system challenges, opportunities, and ways forward for the implementation of the RHS. We conducted semi-structured interviews with 35 key informants from RHS clusters, government, academia, and private and voluntary sectors. Integration, innovation, and people-centeredness were identified as the key principles of the RHS. The RHS was described as an opportunity to holistically care for a person across the care continuum, address social determinants of health, develop new models of care, and work with social and community partners. Challenges to RHS implementation included difficulties aligning the goals, values, and priorities of multiple actors, the need for better integration across clusters, differing care capabilities and capacities across partners, healthcare financing structures that may not reflect RHS goals, scalability and evaluation of pilot programmes, and disease-centricity, provider-centricity, and medicalisation in health and healthcare. Suggested ways forward included building relationships between actors to facilitate integration; exploring innovative new models of care; clear long-term/scale-up plans for successful pilots; healthcare financing reforms to meet changing patient and population needs; and developing evaluation systems reflective of RHS principles and priorities.