AW: [HSF] Re: Post op antibiotics

Tue Oct 2 16:34:34 EDT 2007

I single glove with 7's.  It's bad enough doing robotic procedures with no tactile feedback.  I'd hate to have the same restriction every time I operate.  BTW, my incidence of postop SBE seems to be nearly nonexistent.  Certainly, I've never been cited for it being a problem.  The main thing is to change gloves at once if there is ever a question.

Hal
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-----Original Message-----
From: Ani Anyanwu <anianyanwu at hotmail.com>

Date: Tue, 2 Oct 2007 14:07:27 
To:<openheart-l at lists.hsforum.com>
Subject: RE: AW: [HSF] Re: Post op antibiotics

Dear Roberto

I also use 8/0 prolene for coronary bypass and have no problems doing it with two pairs of gloves. One just has to adjust to reduced sensitivity and feedback in the way one does when performing minimally invasive surgery. Tactile feedback becomes a less critical part of the technique and one learns to compensate with visual, indirect tactile and auditory perceptions. If one wishes to minimize the reduction in tactile perception, then rather than use standard gloves, you could double glove with "microsurgery" or "supersensitive" gloves like the ophthalmic surgeons use to handle 10/0 prolene and such fine sutures. I used to use two supersensitive gloves in training and found them equivalent to a single standard glove. Now I use two standard gloves and find it satisfactory.

Do you not double glove in a known Hepatitis C or HIV patient or you not use 8/0 prolene for those cases? What about valve cases - why could we not double glove on those, after all infection of our prosthesis is far more catastrophic than the now relatively rare occurrence of infection in an orthopaedic prosthesis? 

Ani

> From: battr at medizin.uni-leipzig.de> To: OpenHeart-L at lists.hsforum.com> Subject: AW: [HSF] Re: Post op antibiotics> Date: Tue, 2 Oct 2007 08:30:50 +0200> CC: > > In Germany after washing our hands we use a germicide solution called> Skinman or Spitacid. We believe it works.I personally cannot palpate plaques> and do a LIMA anastomosis with 8 x 0 and 2 pairs of gloves.> Roberto> > -----Ursprüngliche Nachricht-----> Von: openheart-l-bounces at lists.hsforum.com> [mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von David Harris> Gesendet: Montag, 1. Oktober 2007 23:51> An: OpenHeart-L at lists.hsforum.com> Betreff: RE: [HSF] Re: Post op antibiotics> > 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> > >> > > > >> >> >_______________________________________________> >> > >> > OpenHeart-L mailing list> > > > > > Send> > postings> > to:> > > OpenHeart-L at lists.hsforum.com>> > > > > > > To> > UNSUBSCRIBE, to CHANGE email> > address, or to> > view> > archives:> > >> >> > http://mmp.cjp.com/mailman/listinfo/openheart-l> >> > >> > > > > All messages transmitted by the> > OpenHeart-L> > are> > subject to the policies and >> > > > disclaimers> > posted at:> > >> > http://www.hsforum.com/listdisclaim>> > > >> > -----------------------------------------> > >> >> > >>> >>> >>_________________________________________________________________>>> > > > Gear up for Halo® 3 with free downloads and an>> > >> > exclusive offer. It’s our way of saying thanks> > for>> > > using Windows Live™.> >>> >>> >> http://gethalo3gear.com?ocid=SeptemberWLHalo3_WLHMTxt_2_____________________>__________________________>>> > > > OpenHeart-L mailing list> > > > Send postings> > to:>> > > OpenHeart-L at lists.hsforum.com> > > > To> >> > UNSUBSCRIBE, to CHANGE email address, or to view> >>> > > archives:> >> >> > http://mmp.cjp.com/mailman/listinfo/openheart-l> >> > >> > > All messages transmitted by the OpenHeart-L> > are> >> > subject to the policies and> > disclaimers> > posted> > at:> >> > http://www.hsforum.com/listdisclaim> >> >> > -----------------------------------------> > > > >>> > > 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> >> >> >_______________________________________________>> >> > OpenHeart-L mailing list> > Send postings to:>> >> > OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to>> > > CHANGE email address, or to view archives:>> >> > http://mmp.cjp.com/mailman/listinfo/openheart-l> >>> > > All messages transmitted by the OpenHeart-L are> >> > subject to the policies and > disclaimers posted> >> > at:> http://www.hsforum.com/listdisclaim>> >> > -----------------------------------------> >>> >>_________________________________________________________________>> > > Feel like a local wherever you go.> >>> >> http://www.backofmyhand.com_______________________________________________>> > > OpenHeart-L mailing list> > > > Send postings to:>> > > OpenHeart-L at lists.hsforum.com> > > > To> > UNSUBSCRIBE, to CHANGE email address, or to view> >> > archives:> >> > http://mmp.cjp.com/mailman/listinfo/openheart-l> > >> > > All messages transmitted by the OpenHeart-L are> >> > subject to the policies and> > disclaimers posted> > at:> > http://www.hsforum.com/listdisclaim> >> > -----------------------------------------> > > > >> > 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> >> >_______________________________________________>> > OpenHeart-L mailing list> > Send postings to:>> > OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to> > CHANGE email address, or to view archives:>> > http://mmp.cjp.com/mailman/listinfo/openheart-l> >> > All messages transmitted by the OpenHeart-L are> > subject to the policies and > disclaimers posted> > at:> http://www.hsforum.com/listdisclaim>> > -----------------------------------------> >>_________________________________________________________________> > Feel like a local wherever you go.> >> http://www.backofmyhand.com_______________________________________________> > OpenHeart-L mailing list> > > > Send postings to:> > OpenHeart-L at lists.hsforum.com> > > > To UNSUBSCRIBE, to CHANGE email address, or to view> > archives:> > http://mmp.cjp.com/mailman/listinfo/openheart-l> > > > All messages transmitted by the OpenHeart-L are> > subject to the policies and> > disclaimers posted at:> > http://www.hsforum.com/listdisclaim> > -----------------------------------------> > > > > 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> >_______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------> >_______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------
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