AW: AW: [HSF] Re: Post op antibiotics

Thu Oct 4 10:14:10 EDT 2007

Ani,
of course we all double gloves in an HIV and hepatitis case.

Remember I said we use an alcoholic solution after washing our hands,
Skinmann, with a composition of.
2-Propanol 0,15 gr
Benzalconiumchlorid
Tetradecan-1-ol
Glycerol 855
Undecylenacid
We also change gloves often. I see perforations only in my left index
finger...touching needles...

Roberto

-----Ursprüngliche Nachricht-----
Von: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von Ani Anyanwu
Gesendet: Dienstag, 2. Oktober 2007 15:07
An: openheart-l at lists.hsforum.com
Betreff: 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> > >> > > > >> >> >
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