[HSF] Re: Post op antibiotics
David Harris
drdharris at yahoo.co.uk
Tue Oct 2 00:50:49 EDT 2007
Dear Ani,
Many thanks for your interesting comments, yes i think
double gloving makes more sense than anything else,
and has better protection for the patient AND surgeon.
In our speciality this is seldom done. When I was a
resident doing orthopaedics, this was standard
practice (when the initial fear for the HIV virus was
much greater than now!).
I think you have raised an essential point that we
should all be using double gloves, for the sake of
ourselves, and our patients (even if it is a bit
uncomfortable)
Dave Harris
--- Ani Anyanwu <anianyanwu at hotmail.com> wrote:
> Dr Harris
>
> Do you really think scrubbing matters that much? I
> must confess that I have not scrubbed with water and
> a brush for over 2 years. I just use a chlorexidine
> cream which I rub for maybe 20 to 30 seconds. I have
> not noted an out of ordinary problem with infection
> even for the heart transplants who are
> immunosuppressed. I must say though that I do double
> glove for all cases and I think this is more
> important than scrubbing. Within the course of most
> cardiac operations the surgeon's hand is repopulated
> with microbes which makes me ponder the usefulness
> of scrubbing. The surgeon with a single pair of
> gloves may often have a (unrecognised) defect in the
> gloves and a possible source of contamination which
> is why i wear two gloves. Also glove changes of a
> single glove may themselves be a source of
> contamination, compared to double gloves where glove
> changes are certainly aspetic.
>
> I would suggest that it is your attention to detail
> and your technique that gets you a low infection
> rate and not the manner of scrubbing - I find in
> particular the comments on the impact of volume,
> personnel, large operating rooms and ICU size very
> interesting and are likely far more relevant.
>
>
> Ani
>
>
>
>
> > Date: Sun, 23 Sep 2007 01:27:22 +0100> From:
> drdharris at yahoo.co.uk> Subject: RE: [HSF] Re: Post
> op antibiotics> To: OpenHeart-L at lists.hsforum.com>
> CC: > > Thanks, Ani.> > I have been in private
> practice for a few years so> have no trainees
> working with me. In the training> hospital where I
> worked, the mediastinitis rate was> also low, less
> than 1 %.> I think there are a number of factors:
> Lower volume of> cases in each centre, so less
> crowded icu, strict> antibiotic policy, very large
> operating rooms in each> centre, less complex cases
> performed (therefore> shorter operating times). Also
> we had fewer surgeons> than the average unit, and
> each surgeon therefore> performing more cases.> We
> are also very strict with our aseptic technique in>
> the OR, especially a long period scrubbing up,>
> changing cloves frequently if contamination
> suspected.> When I visited surgeons in the USA I was
> amazed about> the short period of time spent
> scrubbing for a case,> compared with back home, and
> noticed that generally> only washing of hands and
> forearms was done, and no> scrubbing of the nails.>
> > Dave Harris> > > --- Ani Anyanwu
> <anianyanwu at hotmail.com> wrote:> > > Dr Harris> > >
> > Amazing series - I suspect more though that your>
> > surgical technique and infection control
> practices> > may contribute more to the rarity of
> mediastinitis> > than the antibiotics and CRP. What
> protocol did you> > use before the last 700 cases
> and what was your> > infection rate then? Do you
> have trainee surgeons? > > > > Thanks> > > > Ani> >
> > > > > > > > Date: Sat, 22 Sep 2007 22:16:23 +0100>
> From:> > drdharris at yahoo.co.uk> Subject: RE: [HSF]
> Re: Post> > op antibiotics> To:
> OpenHeart-L at lists.hsforum.com>> > CC: > > For CABG
> patients 24 hrs.> > For valves,> > until lines and
> drains out.> > Then track the CRP> > levels every
> second day to make> sure the trend is> > downward,
> and there is no peak just> before> > discharge. This
> way you can avoid> mediastinitis, as> > you can
> treat it as it starts.> Since doing this> > have not
> had a single case of sternal> sepsis in the> > last
> 700 patients, but have had CRP> peaks which we> >
> then confirm the next day, then treat.> Some> >
> developed cellulitis a few days afterwards, while>>
> > on treatment, but we were able to avoid> >
> debridements.> > Dave Harris> > > --- Adam Saltman>
> > <aes.md.phd at hotmail.com> wrote:> > > It is
> actually> > policy at our institution now to> >
> discontinue all> > prophylactic antibiotics
> according> > to a time> > schedule. For general
> surgery patients> > this is> > after 24 hours, and
> for cardiac patients it> > is 48> > hours (which
> actually has no data behind it,> > just> > some
> hysterical cardiac surgeons). This is now> >> >
> becoming a nation-wide initiative in the
> prevention>> > > of infection by drug-resistant
> organisms... But> > as> > far as I know, there is no
> data to support or> > refute> > any particular
> strategy in cardiac> > patients...> > > > Adam> > >
> > > > > > > From:> > alsadd at ksu.edu.sa> > > To:> >
> OpenHeart-L at lists.hsforum.com> > > Date: Wed, 19
> Sep> > 2007 14:58:29 -0700> > > CC: > > > Subject:
> [HSF]> > Re: Post op antibiotics > > > > > > Dear
> Forum> > Members:> > > > > > > > > > > > Do the
> honorable> > members keep the open heart> > patients
> on> > antibiotics for as> > > long as they have> >
> mediastinal and chest tubes in> > place? I do not,>
> > but some> > > of my colleagues do. I went over
> the> > STS> > guidelines the two parts and I> > >
> could not> > find the answer to this question.> > >
> > > > Your> > response is greatly appreciated.> > >
> > > > Thank> > you> > > > > > > > > > > > Ahmed> > >
> > > >> >
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> -----------------------------------------> > > > >>
> > Dr. David G. Harris, FCS, MMED,> Cardiothoracic> >
> Surgeon > Suite 207 > Kuils River Private Hospital,>
> > > PO Box 1200, Kuils River, 7579, Cape Town,
> South> > Africa. > Tel +27-21-9006411 > Fax
> +27-21-9006412> > Mobile +27-83-3309587> >> >
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> -----------------------------------------> > > > >
> Dr. David G. Harris, FCS, MMED,> Cardiothoracic
> Surgeon > Suite 207 > Kuils River Private Hospital,
> > PO Box 1200, Kuils River, 7579, Cape Town, South
> Africa. > Tel +27-21-9006411 > Fax +27-21-9006412
> Mobile +27-83-3309587> >
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Dr. David G. Harris, FCS, MMED,
Cardiothoracic Surgeon
Suite 207
Kuils River Private Hospital,
PO Box 1200, Kuils River, 7579, Cape Town, South Africa.
Tel +27-21-9006411
Fax +27-21-9006412 Mobile +27-83-3309587
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