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Management of head injury in adults
212
Injury (1984) 16, 212-214
Printed
in Great Britain
Abstracts BACTERIOLOGY
AND
INFECTION
Hyperadrenergic syndrome in tetanus
The high and fluctuant levels of blood pressure and heart beat in a 75-year-old man with tetanus were gradually brought under control with an infusion of labetalol. Domenighetti G. M., Savary G. and Stricker H. (1984) Hyperadrenergic syndrome in severe tetanus: extreme rise in catecholamines responsive to labetalol. Br. Med. J. 288, 1483. Bacteraemia and intravenous devices
A survey in 42 hospitals in eight countries showed that 63 per cent (varying from 40 to 99 per cent in different countries) of the patients surveyed had an intravenous device inserted at some stage of their hospital stay. The average incidence of thrombophlebitis associated with intravenous procedures was 10.3 per cent, with a range from 7.8 to 28.4 per cent in different countries. Bacteraemia occurred in 0.5-1.5 per cent of patients who had no intravenous device, in 3.7-6.9 per cent of patients with a peripheral intravenous device and in 44-59 per cent of patients with a central venous catheter. There was no correlation between the number of catheter days and the frequency of hospital-acquired infection. Nystrdm B. et al. (European Working Party on Control of Hospital Infections (1983) Bacteraemia in surgical patients with intravenous devices: a European multicentre study. J. Hosp. Infection 4, 338. Preoperative total body bathing
‘Hibiscrub’ (4 per cent chlorhexidine detergent solution) was compared with a non-medicated soap for preoperative total body bathing in a controlled trial. Swabs from the anterior nares, peri-anal skin and skin at the operation site before and after bathing (at 2 hours and on the 3rd and 4th postoperative days) showed a greater reduction in bacterial flora from the skin of those who used ‘Hibiscrub’ than from the controls. Staphylococcus aureus, present on the skin of four patients, was removed from the three who used ‘Hibiscrub’ but persisted on the skin of the one patient with Staph. awe& who used unmedicated soap. There was no significant difference in postoperative wound sepsis rates of patients in the two groups, probably because most of the infections were exogenous. Leigh D. A., Stronge J. L., Marriner J. and Sedgwick J. (1983) Total body bathing with ‘Hibiscrub’ (chlorhexidine) in surgical patients: a controlled trial. J. Hosp. Infection 4, 229. Preoperative bathing and wound infection
A controlled comparison in 5536 patients of 4 per cent of chlorhexidine-detergent and unmedicated soap for a single preoperative bathing showed no evidence of any protection by the antiseptic against postoperative infection; a similar proportion of patients in the two groups developed postoperative wound infection. AyliBe G. A. J., Noy M. F., Babb J. R., Davies J. G. and Jackson J. (1983) A comparison of pre-operative bathing with chlorhexidine-detergent and unmedicated soap in the prevention of wound infection. J. Hosp. Infection 4, 237.
Prevention of cannula thrombophlebitis
The value of povidone-iodine ointment applied at the insertion site of intravenous catheters for prevention of thombophlebitis was assessed in a controlled trial on 100 consecutive patients in a coronary care unit. Thrombophlebitis occurred slightly more often in patients who were treated with povidone-iodine ointment than in the controls. There was no significant association between inflammation and bacterial growth from cannula cultures. Thompson D. R., Jones G. R. and Sutton T. W. (1983) A trial of povidone-iodine ointment for the prevention of cannula thrombophlebitis. J. Hosp. Infection 4, 285. Non-sporing
anaerobic bacteria
The bacterial flora of 52 clean surgical wounds (hip replacements) were studied by qualitative and quantitative culture techniques. Thirty per cent of the bacteria isolated from wounds were non-sporing anaerobes, including Propionibacterium spp. and Peptococcus spp. When disposable fabric operating clothes were worn by the surgical team the counts of airborne bacteria in the theatre were less than half those found when conventional theatre clothes were worn. Benediktsdottir E. and Kolstad K. (1984) Non-sporeforming anaerobic bacteria in clean surgical wounds. J. Hosp. Infection 5, 38.
INJURIES
OF THE HEAD
AND
SPINE
Management of head injury in adults
The title is self-explanatory and the subject as discussed will be of value, particularly to junior doctors and casualty officers. Jennett B. (1984) Guidelines for initial management after head injury in adults. Suggestions from a group of neurosurgeons. Br. Med. J. 288, 983. Ocular injuries from road traffic accidents
During a 24-week period in 198124 patients with injuries of the eye and adjoining structures resulting from road accidents were seen; 12 required emergency operations. Over a similar period 2 years later only six patients’ eyes were injured in road accidents and only three required emergency operations. Of the latter group, all were wearing seat belts and were injured by flying glass. Laminated glass should be fitted to all new cars in Britain. Vernon S. A. and Yorston D. B. (1984) Incidence of ocular injuries from road traffic accidents after introduction of seat belt legislation. J. R. Sot. Med. 77, 198.
THORACIC
AND
ABDOMINAL
INJURIES
Intestinal complications
Two toothless women of 73 and 52 swallowed the plastic clips
Injury (1984) 16, 212-214
Printed
in Great Britain
Abstracts BACTERIOLOGY
AND
INFECTION
Hyperadrenergic syndrome in tetanus
The high and fluctuant levels of blood pressure and heart beat in a 75-year-old man with tetanus were gradually brought under control with an infusion of labetalol. Domenighetti G. M., Savary G. and Stricker H. (1984) Hyperadrenergic syndrome in severe tetanus: extreme rise in catecholamines responsive to labetalol. Br. Med. J. 288, 1483. Bacteraemia and intravenous devices
A survey in 42 hospitals in eight countries showed that 63 per cent (varying from 40 to 99 per cent in different countries) of the patients surveyed had an intravenous device inserted at some stage of their hospital stay. The average incidence of thrombophlebitis associated with intravenous procedures was 10.3 per cent, with a range from 7.8 to 28.4 per cent in different countries. Bacteraemia occurred in 0.5-1.5 per cent of patients who had no intravenous device, in 3.7-6.9 per cent of patients with a peripheral intravenous device and in 44-59 per cent of patients with a central venous catheter. There was no correlation between the number of catheter days and the frequency of hospital-acquired infection. Nystrdm B. et al. (European Working Party on Control of Hospital Infections (1983) Bacteraemia in surgical patients with intravenous devices: a European multicentre study. J. Hosp. Infection 4, 338. Preoperative total body bathing
‘Hibiscrub’ (4 per cent chlorhexidine detergent solution) was compared with a non-medicated soap for preoperative total body bathing in a controlled trial. Swabs from the anterior nares, peri-anal skin and skin at the operation site before and after bathing (at 2 hours and on the 3rd and 4th postoperative days) showed a greater reduction in bacterial flora from the skin of those who used ‘Hibiscrub’ than from the controls. Staphylococcus aureus, present on the skin of four patients, was removed from the three who used ‘Hibiscrub’ but persisted on the skin of the one patient with Staph. awe& who used unmedicated soap. There was no significant difference in postoperative wound sepsis rates of patients in the two groups, probably because most of the infections were exogenous. Leigh D. A., Stronge J. L., Marriner J. and Sedgwick J. (1983) Total body bathing with ‘Hibiscrub’ (chlorhexidine) in surgical patients: a controlled trial. J. Hosp. Infection 4, 229. Preoperative bathing and wound infection
A controlled comparison in 5536 patients of 4 per cent of chlorhexidine-detergent and unmedicated soap for a single preoperative bathing showed no evidence of any protection by the antiseptic against postoperative infection; a similar proportion of patients in the two groups developed postoperative wound infection. AyliBe G. A. J., Noy M. F., Babb J. R., Davies J. G. and Jackson J. (1983) A comparison of pre-operative bathing with chlorhexidine-detergent and unmedicated soap in the prevention of wound infection. J. Hosp. Infection 4, 237.
Prevention of cannula thrombophlebitis
The value of povidone-iodine ointment applied at the insertion site of intravenous catheters for prevention of thombophlebitis was assessed in a controlled trial on 100 consecutive patients in a coronary care unit. Thrombophlebitis occurred slightly more often in patients who were treated with povidone-iodine ointment than in the controls. There was no significant association between inflammation and bacterial growth from cannula cultures. Thompson D. R., Jones G. R. and Sutton T. W. (1983) A trial of povidone-iodine ointment for the prevention of cannula thrombophlebitis. J. Hosp. Infection 4, 285. Non-sporing
anaerobic bacteria
The bacterial flora of 52 clean surgical wounds (hip replacements) were studied by qualitative and quantitative culture techniques. Thirty per cent of the bacteria isolated from wounds were non-sporing anaerobes, including Propionibacterium spp. and Peptococcus spp. When disposable fabric operating clothes were worn by the surgical team the counts of airborne bacteria in the theatre were less than half those found when conventional theatre clothes were worn. Benediktsdottir E. and Kolstad K. (1984) Non-sporeforming anaerobic bacteria in clean surgical wounds. J. Hosp. Infection 5, 38.
INJURIES
OF THE HEAD
AND
SPINE
Management of head injury in adults
The title is self-explanatory and the subject as discussed will be of value, particularly to junior doctors and casualty officers. Jennett B. (1984) Guidelines for initial management after head injury in adults. Suggestions from a group of neurosurgeons. Br. Med. J. 288, 983. Ocular injuries from road traffic accidents
During a 24-week period in 198124 patients with injuries of the eye and adjoining structures resulting from road accidents were seen; 12 required emergency operations. Over a similar period 2 years later only six patients’ eyes were injured in road accidents and only three required emergency operations. Of the latter group, all were wearing seat belts and were injured by flying glass. Laminated glass should be fitted to all new cars in Britain. Vernon S. A. and Yorston D. B. (1984) Incidence of ocular injuries from road traffic accidents after introduction of seat belt legislation. J. R. Sot. Med. 77, 198.
THORACIC
AND
ABDOMINAL
INJURIES
Intestinal complications
Two toothless women of 73 and 52 swallowed the plastic clips