[HSF] Re: Post op antibiotics

Fri Sep 28 04:54:28 EDT 2007

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> -----------------------------------------
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