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Baltimore Highlands, MD, United States

Zywiel M.G.,Rubin Institute for Advanced Orthopedics | Daley J.A.,Infection Prevention and Control | Delanois R.E.,Rubin Institute for Advanced Orthopedics | Naziri Q.,Rubin Institute for Advanced Orthopedics | And 2 more authors.
International Orthopaedics | Year: 2011

Surgical site infections following elective knee arthroplasties occur most commonly as a result of colonisation by the patient's native skin flora. The purpose of this study was to evaluate the incidence of deep surgical site infections in knee arthroplasty patients who used an advance cutaneous disinfection protocol and who were compared to patients who had peri-operative preparation only. All adult reconstruction surgeons at a single institution were approached to voluntarily provide patients with chlorhexidine gluconate-impregnated cloths and a printed sheet instructing their use the night before and morning of surgery. Records for all knee arthroplasties performed between January 2007 and December 2008 were reviewed to determine the incidence of deep incisional and periprosthetic surgical site infections. Overall, the advance pre-operative protocol was used in 136 of 912 total knee arthroplasties (15%). A lower incidence of surgical site infection was found in patients who used the advance cutaneous preparation protocol as compared to patients who used the in-hospital protocol alone. These findings were maintained when patients were stratified by surgical infection risk category. No surgical site infections occurred in the 136 patients who completed the protocol as compared to 21 infections in 711 procedures (3.0%) performed in patients who did not. Patient-directed skin disinfection using chlorhexidine gluconate-impregnated cloths the evening before, and the morning of, elective knee arthroplasty appeared to effectively reduce the incidence of surgical site infection when compared to patients who underwent in-hospital skin preparation only. © 2010 Springer-Verlag.

Godsell M.-R.,Infection Prevention and Control | Shaban R.Z.,Griffith University | Gamble J.,Griffith University
American Journal of Infection Control | Year: 2013

Background Preventing health care-associated infections is essential to the safety and quality of health care. Although patients' experience of care under isolation is well established, little is known of health care workers' experiences when providing such care. This study explored the health professionals; lived experience of caring for patients under transmission-based precautions. Methods Interpretive phenomenology was used to examine 12 health care professionals' lived experience of providing care under transmission-based precautions in 3 health care facilities in Australia. Data were obtained from in-depth interviews and observations of health professionals. Findings The essential phenomena of "recognizing rapport" represented the health professionals' lived experience. Three themes emerged starting with (1) relationships with others, their rapport and communication with patients, patients' families and visitors, and colleagues. These relationships are influenced by (2) barriers to practice, such as personal level of comfort when wearing personal protective equipment, physical limitations of the environment, and management of workload and resources. Such barriers influence (3) patient outcomes, namely the quality of the care provided and adverse events. Conclusion In the context of caring for patients under transmission-based precautions, the relationships between health professionals and their patients are critical to the quality and safety of health care with respect to infection prevention and control. Copyright © 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Klieger S.B.,Childrens Hospital of Philadelphia | Potter-Bynoe G.,Infection Prevention and Control | Quach C.,McGill University | Sandora T.J.,Boston Childrens Hospital | Coffin S.E.,Childrens Hospital of Philadelphia
Infection Control and Hospital Epidemiology | Year: 2013

We surveyed US and Canadian pediatric hospitals about their use of central line-associated bloodstream infection (CLABSI) prevention strategies beyond typical insertion and maintenance bundles. We found wide variation in supplemental strategies across hospitals and in their penetration within hospitals. Future studies should assess specific adjunctive prevention strategies and CLABSI rates. © 2013 by The Society for Healthcare Epidemiology of America. All rights reserved.

Kapadia B.H.,Rubin Institute for Advanced Orthopedics | Berg R.A.,Sinai Hospital of Baltimore | Daley J.A.,Infection Prevention and Control | Fritz J.,Johns Hopkins University | And 2 more authors.
The Lancet | Year: 2016

Summary Periprosthetic joint infections are a devastating complication after arthroplasty and are associated with substantial patient morbidity. More than 25% of revisions are attributed to these infections, which are expected to increase. The increased prevalence of obesity, diabetes, and other comorbidities are some of the reasons for this increase. Recognition of the challenge of surgical site infections in general, and periprosthetic joint infections particularly, has prompted implementation of enhanced prevention measures preoperatively (glycaemic control, skin decontamination, decolonisation, etc), intraoperatively (ultraclean operative environment, blood conservation, etc), and postoperatively (refined anticoagulation, improved wound dressings, etc). Additionally, indications for surgical management have been refined. In this Review, we assess risk factors, preventive measures, diagnoses, clinical features, and treatment options for prosthetic joint infection. An international consensus meeting about such infections identified the best practices and further research needs. Orthopaedics could benefit from enhanced preventive, diagnostic, and treatment methods. © 2016 Elsevier Ltd.

Johnson A.J.,Rubin Institute for Advanced Orthopedics | Daley J.A.,Infection Prevention and Control | Zywiel M.G.,Rubin Institute for Advanced Orthopedics | Delanois R.E.,Rubin Institute for Advanced Orthopedics | Mont M.A.,Rubin Institute for Advanced Orthopedics
Journal of Arthroplasty | Year: 2010

The purpose of this study was to evaluate effectiveness of an advance, at-home chlorhexidine-impregnated skin preparation cloth in decreasing the incidence of deep periprosthetic hip arthroplasty infections. Arthroplasty surgeons at the senior author's institution provided their patients with chlorhexidine-impregnated single-use cloths for use at home the night before and the morning of surgery. Between January 2007 and December 2009, the compliance of this practice, as well as the incidence of periprosthetic infections, was monitored for all patients who underwent hip arthroplasty. Of the 1134 patients who underwent hip arthroplasty, 157 patients completely complied with the preoperative chlorhexidine preparation protocol. There were 14 infections in the group that was not compliant (1.6% infection rate), and there were no infections in the compliant patient population. Based on the results of this study, at-home preoperative patient skin preparation appears to be a simple and cost-effective method to reduce periprosthetic hip infection rates. © 2010.

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