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A new efficacious Ag-coated dressing II: In vivo assay
AJIC Volume23, Number2
Control Committee (ICC) requested that this surveillance be repeated biannually as part of our continuous quality improvement activities. The membership of an OBS/GYN surgeon on the ICC contributed to the success of this program. He has facilitated the ongoing participation of his entire department in this surveillance activity. Surgeon specific response rares to the mailed out questionnaire continues m exceed 80%. This is rarely reported in the literature. The accumulated data are consistent with the findings of the initial study. Our experience suggests that lobbying of an individual member of the ICC for support of a specific Infection Control activity resulted in improved participation, interest and compliance within a group of surgeons in our hospital. We believe this approach can increase the support necessary to successfully complete otherwise "destined to fail" projects. Broad-based input into the ICC improves the objective formulation and results of target surveillance.
A NEW EFFICACIOUS Ag-COATED DRESSING II" IN VIVO ASSAY. J. P. Heggers, PhD,* J. Stabenau, AAS, D. Lisrengarten, MD, J. Davis, PhD, B. Rogers, PhD, D. N. Herndon, MD, R. Burrell, PhD. Shriners Burns Institute, University of Texas Medical Branch, Galveston, TX, and Sherritt Corp., Canada.
The available topical armamentarium for the treatment of burn wound infections is limited. However, the delivery of Ag++ ions from an antiinfective dressing may augment current treatment modalities. The penetration of an inoctdum of]?. aeruginosa was examined in both an in vitro and in vivo assay. Dressings were placed on agar surfaces and inoculated with concentrations of bacteria ranging from 105 to 10L At certain time intervals the dressings were removed and the plates incubated overnight. In the in vivo model, the Walker burn model was used. Four groups of 10 animals each were established. A burn control, a burn inoculated control, a burn, inoculated control dressing (gauze) and burn, inoculated test dressing (Ag metal coated gauze). After 24 hours all dressings were removed and placed on an agar surface to measure penetration of the inoculum. The in vitro assessment demonstrated that the fig++ dressing significandy impeded all concentrations of bacteria in an order of magnitude of 10o when compared m the control. Time sequences were equally as significant demonstrating that bactericidal effect occurred within the first few hours. The in vivo study was more dramatic. By days 8 and 11 both inoculated controls, no dressing and control dressing had expired while 70% of the test dressing group survived. The study was carried for 14 days with 50% of the test dressing group surviving. The dressing incubated on the ~-garplates 24 hours post inoculum revealed a confluent lawn of bacteria while only isolated indMdual colonies were observed under the test dressing and they were at periphery of the dressing which lacked die Ag ++ metal coating. The Ag++ metal coated dressing significantly abrogated the penetration of/?. aeruginosa and should provi& excellent protection from infection in fresh burns and initially excised burns. It may also be of some therapeutic value in already colonized burn wounds. Coupled with standard wound care this dressing can significantly reduce the potential for an exogenous infection m develop.
T O P I C A L S E N S I T I V I T I E S O F V I B R I O SPP. ISOLATED F R O M W O U N D S IN A GULF COAST LOCATION. M. A. Walton, M T (ASCP),* E. R. Bannister, PhD, T. Dinuzzo, MS, J. E Heggers, PhD. Shriners Burns Institute and University of Texas Medical Center, Galveston, TX.
Abstracts 135
It has long been recognized that eating raw or poorly cooked
seafood could lead m several disease states, including infections with Vibrio spp. Vibrios have also been implicated in causing severe cutaneous infections incurred by persons coming in contact with raw seafood or saltwater. This study was designed to test the sensitivity of Vibrio spp. m topical antimicrobial agents. Twenty-seven wound isolates treated in a large Gulf Coast medical center, induding 17..alginolyticus, V. fluvialis, V. cholerae, V. parahaemolyticus, V. damse&, and V. vulnificus, were tested against eight topical preparations: silver sulfadiazine (Silvadene), nitrofurazone, mupirocin ointment (Bactroban), polymyxin B/bacitracin, nystarin/Silvadene, nystatin/polymyxin B/bacitracin, and 0.25% Dakin's solution. The results show that 100% of the isolates were resistant to polymyxin B/bacitracin and nystatin/polymyxin B/bacitracin. Ninety-six percent were sensitive to Sulfamylon, 85% to Sitvadene, and only 41% to nystatin/Silvadene. One hundred percent were sensitive to nitrofurazone, Bactroban and Dakin's, with Dakin's showing the best results. Based on these data, it is suggested that Dakin's solution may be efficacious in the treatment of cutaneous wotmd infections caused by gTbrios, followed by Bactroban and nkrofurazone.
REDUCING THE INCIDENCE OF COLORECTAL SURGICAL SITE INFECTIONS BY INSTITUTING OPTIMAL TIMING OF PROPHYLACTIC ANTIBIOTICS. K. Mullaney, RN, BSN, CIC,* A. Adams, RN, MPH, CIC, B. Enright, RN, MSN, CIC, T. Lemon, RN, MPH, CIC, B. Currie, MD. Montefiore Medical Center, Bronx, NY.
The use of prophylactic antibiotics has been shown to reduce postoperative infections for selected surgical procedures, inducling colorectal surgery. Prophylactic antibiotics are most effective if given during the 2-hour period before the surgical incision and ideally should be administered within 1/2 hour of incision. In 1990 our Pharmacy and Therapeutics Committee issued Guidelines for Antimicrobial Prophylaxis for Colorectal Surgery that induded administering parenteral antibiotics within 1/2 hour of surgical incision. Our hospital participates in the National Nosocomial Infection Surveillance System (NNIS) and surveillance of colon procedures was performed for 4 months (November-February) in 1991 and 1992. The surgical site infection (SSI) rates for the two time periods were 8.8% and 15.3%, exceeding NNIS' 50th and 90th percentiles, respectively. Investigation of prophylactic antibiotic usage patterns in 1992 revealed that of 71 procedures performed, 73% of antibiotics were given within 2 hours of incision, 9% were given >2 hours prior to incision, time of administration was unknown for 11% and no antibiotics were ordered for 7% of the procedures. Subsequent analysis revealed that optimally timed antibiotic prophylaxis could only be achieved by designating anesthesia personnel to administer antibiotics in the operating room. This protocol was initiated and follow-up surveillance for 4 months in 1993 revealed that the SSI rate had decreased to 6.8%. By the end of the surveillance period issues regarding ordering, timing and documentation of prophylactic antibiotics prior to colon surgery were largely resolved, achieving 90% compliance with the guidelines. The optimal use of prophylactic antibiotics contributed to a reduction of colorectal surgical site infections.
HAND DISINFECTANT USE IN CLINICAL PRACTICE. J. Faoagali, MD, N. George, MSc,* J. Fong, BSc, J. Dav~ BAppSc, M. Dowzer, RN. Royal Brisbane Hospital, Herston, Queensland, Australia.
Control Committee (ICC) requested that this surveillance be repeated biannually as part of our continuous quality improvement activities. The membership of an OBS/GYN surgeon on the ICC contributed to the success of this program. He has facilitated the ongoing participation of his entire department in this surveillance activity. Surgeon specific response rares to the mailed out questionnaire continues m exceed 80%. This is rarely reported in the literature. The accumulated data are consistent with the findings of the initial study. Our experience suggests that lobbying of an individual member of the ICC for support of a specific Infection Control activity resulted in improved participation, interest and compliance within a group of surgeons in our hospital. We believe this approach can increase the support necessary to successfully complete otherwise "destined to fail" projects. Broad-based input into the ICC improves the objective formulation and results of target surveillance.
A NEW EFFICACIOUS Ag-COATED DRESSING II" IN VIVO ASSAY. J. P. Heggers, PhD,* J. Stabenau, AAS, D. Lisrengarten, MD, J. Davis, PhD, B. Rogers, PhD, D. N. Herndon, MD, R. Burrell, PhD. Shriners Burns Institute, University of Texas Medical Branch, Galveston, TX, and Sherritt Corp., Canada.
The available topical armamentarium for the treatment of burn wound infections is limited. However, the delivery of Ag++ ions from an antiinfective dressing may augment current treatment modalities. The penetration of an inoctdum of]?. aeruginosa was examined in both an in vitro and in vivo assay. Dressings were placed on agar surfaces and inoculated with concentrations of bacteria ranging from 105 to 10L At certain time intervals the dressings were removed and the plates incubated overnight. In the in vivo model, the Walker burn model was used. Four groups of 10 animals each were established. A burn control, a burn inoculated control, a burn, inoculated control dressing (gauze) and burn, inoculated test dressing (Ag metal coated gauze). After 24 hours all dressings were removed and placed on an agar surface to measure penetration of the inoculum. The in vitro assessment demonstrated that the fig++ dressing significandy impeded all concentrations of bacteria in an order of magnitude of 10o when compared m the control. Time sequences were equally as significant demonstrating that bactericidal effect occurred within the first few hours. The in vivo study was more dramatic. By days 8 and 11 both inoculated controls, no dressing and control dressing had expired while 70% of the test dressing group survived. The study was carried for 14 days with 50% of the test dressing group surviving. The dressing incubated on the ~-garplates 24 hours post inoculum revealed a confluent lawn of bacteria while only isolated indMdual colonies were observed under the test dressing and they were at periphery of the dressing which lacked die Ag ++ metal coating. The Ag++ metal coated dressing significantly abrogated the penetration of/?. aeruginosa and should provi& excellent protection from infection in fresh burns and initially excised burns. It may also be of some therapeutic value in already colonized burn wounds. Coupled with standard wound care this dressing can significantly reduce the potential for an exogenous infection m develop.
T O P I C A L S E N S I T I V I T I E S O F V I B R I O SPP. ISOLATED F R O M W O U N D S IN A GULF COAST LOCATION. M. A. Walton, M T (ASCP),* E. R. Bannister, PhD, T. Dinuzzo, MS, J. E Heggers, PhD. Shriners Burns Institute and University of Texas Medical Center, Galveston, TX.
Abstracts 135
It has long been recognized that eating raw or poorly cooked
seafood could lead m several disease states, including infections with Vibrio spp. Vibrios have also been implicated in causing severe cutaneous infections incurred by persons coming in contact with raw seafood or saltwater. This study was designed to test the sensitivity of Vibrio spp. m topical antimicrobial agents. Twenty-seven wound isolates treated in a large Gulf Coast medical center, induding 17..alginolyticus, V. fluvialis, V. cholerae, V. parahaemolyticus, V. damse&, and V. vulnificus, were tested against eight topical preparations: silver sulfadiazine (Silvadene), nitrofurazone, mupirocin ointment (Bactroban), polymyxin B/bacitracin, nystarin/Silvadene, nystatin/polymyxin B/bacitracin, and 0.25% Dakin's solution. The results show that 100% of the isolates were resistant to polymyxin B/bacitracin and nystatin/polymyxin B/bacitracin. Ninety-six percent were sensitive to Sulfamylon, 85% to Sitvadene, and only 41% to nystatin/Silvadene. One hundred percent were sensitive to nitrofurazone, Bactroban and Dakin's, with Dakin's showing the best results. Based on these data, it is suggested that Dakin's solution may be efficacious in the treatment of cutaneous wotmd infections caused by gTbrios, followed by Bactroban and nkrofurazone.
REDUCING THE INCIDENCE OF COLORECTAL SURGICAL SITE INFECTIONS BY INSTITUTING OPTIMAL TIMING OF PROPHYLACTIC ANTIBIOTICS. K. Mullaney, RN, BSN, CIC,* A. Adams, RN, MPH, CIC, B. Enright, RN, MSN, CIC, T. Lemon, RN, MPH, CIC, B. Currie, MD. Montefiore Medical Center, Bronx, NY.
The use of prophylactic antibiotics has been shown to reduce postoperative infections for selected surgical procedures, inducling colorectal surgery. Prophylactic antibiotics are most effective if given during the 2-hour period before the surgical incision and ideally should be administered within 1/2 hour of incision. In 1990 our Pharmacy and Therapeutics Committee issued Guidelines for Antimicrobial Prophylaxis for Colorectal Surgery that induded administering parenteral antibiotics within 1/2 hour of surgical incision. Our hospital participates in the National Nosocomial Infection Surveillance System (NNIS) and surveillance of colon procedures was performed for 4 months (November-February) in 1991 and 1992. The surgical site infection (SSI) rates for the two time periods were 8.8% and 15.3%, exceeding NNIS' 50th and 90th percentiles, respectively. Investigation of prophylactic antibiotic usage patterns in 1992 revealed that of 71 procedures performed, 73% of antibiotics were given within 2 hours of incision, 9% were given >2 hours prior to incision, time of administration was unknown for 11% and no antibiotics were ordered for 7% of the procedures. Subsequent analysis revealed that optimally timed antibiotic prophylaxis could only be achieved by designating anesthesia personnel to administer antibiotics in the operating room. This protocol was initiated and follow-up surveillance for 4 months in 1993 revealed that the SSI rate had decreased to 6.8%. By the end of the surveillance period issues regarding ordering, timing and documentation of prophylactic antibiotics prior to colon surgery were largely resolved, achieving 90% compliance with the guidelines. The optimal use of prophylactic antibiotics contributed to a reduction of colorectal surgical site infections.
HAND DISINFECTANT USE IN CLINICAL PRACTICE. J. Faoagali, MD, N. George, MSc,* J. Fong, BSc, J. Dav~ BAppSc, M. Dowzer, RN. Royal Brisbane Hospital, Herston, Queensland, Australia.