Lysine Effect on Ruthenium Red and Alcian Blue Preservation and Staining of the Staphylococcal Glycocalyx

The effect of lysine on ruthenium red (RR) and alcian blue (AB) preservation arid/or staining for transmission electron microscopy of glycocalyces was evaluated for three species of the gram-positive, coagulase-negative staphylococci. A RR and an AB procedure were compared with and without lysine included in the glutaraldehyde prefixation. Minimal or no glycocalyx was preserved or stained by glutaraldehyde fixation only. For all species, the inclusion of lysine increased visualization of fibrous material. RR treatment without lysine, results in sparse or limited fibrous material or artifactual condensations which contrasts with enhanced fibrous material seen when lysine is included with RR. The effect of lysine is also to enhance the visualization of staphylococcal glycocalyx by AB. Without lysine, condensed curved structures are consistently seen following AB processing. In contrast, extensive and elaborate glycocalyces are observed with inclusion of lysine with AB. Thus, ultrastructural visualization by RR and AB of the staphylococcal glycocalyx in the species studied was enhanced by use of lysine

Perioperative hair removal in the 21st century: utilizing an innovative vacuum-assisted technology to safely expedite hair removal before surgery.

Background: Perioperative hair removal using clippers requires lengthy cleanup to remove loose hairs contaminating the operative field. We compared the amount of hair debris and associated microbiologic contamination produced during clipping of surgical sites using standard surgical clippers (SSC) or clippers fitted with a vacuum-assisted hair collection device (SCVAD). Methods: Trained nurses conducted bilateral hair clipping of the chest and groin of 18 male subjects using SSC or SCVAD. Before and during clipping, measurements of particulate matter and bacterial contamination were evaluated on settling plates placed next to each subject’s chest and groin. Skin condition after clipping and total clipping/cleanup times were compared between SSC and SCVAD. Results: The microbial burden recovered from residual hair during cleanup in the SSC group was 3.9 log10 CFU and 4.6 log10 CFU from respective, chest, and groin areas. Use of the SCVAD resulted in a significant (P < .001) reduction in both residual hair and microbial contamination within the operative field compared with SSC. Conclusions: Use of SCVAD resulted in significant (P< .001) reduction in total time required to clip and clean up residual hair contaminating the operative field compared with standard practice (ie, SSC), eliminating the need to physically remove dispersed hairs, which can harbor a significant microbial burden, from within the operative field

Surgical site infection: poor compliance with guidelines and care bundles

Surgical site infections (SSIs) are probably the most preventable of the health care- associated infections. Despite the widespread international introduction of level I evidence-based guidelines for the prevention of SSIs, such as that of the National Institute for Clinical Excellence (NICE) in the UK and the surgical care improvement project (SCIP) of the USA, SSI rates have not measurably fallen. The care bundle approach is an accepted method of packaging best, evidence-based measures into routine care for all patients and, common to many guidelines for the prevention of SSI, includes methods for preoperative removal of hair (where appropriate), rational antibiotic prophylaxis, avoidance of perioperative hypothermia, management of perioperative blood glucose and effective skin preparation. Reasons for poor compliance with care bundles are not clear and have not matched the wide uptake and perceived benefit of the WHO ‘Safe Surgery Saves Lives’ checklist. Recommendations include the need for further research and continuous updating of guidelines; comprehensive surveillance, using validated definitions that facilitate benchmarking of anonymised surgeon-specific SSI rates; assurance that incorporation of checklists and care bundles has taken place; the development of effective communication strategies for all health care providers and those who commission services and comprehensive information for patients

Recommendations for change in infection prevention programs and practice

Fifty years of evolution in infection prevention and control programs have involved significant accomplishments related to clinical practices, methodologies, and technology. However, regulatory mandates, and resource and research limitations, coupled with emerging infection threats such as the COVID-19 pandemic, present considerable challenges for infection preventionists. This article provides guidance and recommendations in 14 key areas. These interventions should be considered for implementation by United States health care facilities in the near future

The Yin and Yang of pre-operative screening for meticillin resistant and sensitive Staphylococcus aureus (MRSA and MSSA): Does the extra effort and cost of suppression reduce surgical site infections?

The inappropriate use and overuse of antibiotics, together with the demographic changes of an ageing population, chronic diseases such as diabetes mellitus, increased patient contact with healthcare facilities, high bed occupancy rates and the increase in surgical procedures, have all contributed to the rise in prevalence of Healthcare Associated Infections. These are attributable to selection and emergence of multi-resistant organisms. Additionally, there is evidence that this surveillance programme considerably underestimates true rates of SSI. Strategies for prevention of SSIs are still in development and both MSSA and MRSA surveillance/suppression are likely to be considered as a plausible strategy for identifying at-risk patient prior to surgery, but a pertinent question remains: which surgical patients are likely to benefit most from this intervention

A narrative review of microbial biofilm in postoperative surgical site infections: clinical presentation and treatment

Objective: The global impact of surgical site infections (SSIs) on healthcare systems is considerable: many are related to the formation of a microbial biofilm. Biofilm plays a significant role in the pathogenesis of implantable device-related infections and are also important in persistent postoperative skin and soft tissue wound infections. Method: PubMed and OVID databases were searched for relevant articles regarding biofilm-associated infection in surgery, including epidemiology, diagnosis, treatment and management. Results: Biofilm-associated infections increase the use of health-care resources, prolong length of stay, increase cost of antibiotic therapy, result in additional surgical revisions and extend rehabilitation after discharge from health care. Staphylococcus aureus and Staphylococcus epidermidis are the most common isolates recovered from device-related infections. Early infection occurs within two weeks of implantation and is associated with intraoperative wound contamination; late-onset infections are often occult prolonging recognition by weeks, months and in some cases, years. Biofilm is a physical barrier against antibodies and granulocytic cell populations which may also impede the penetration of antibiotics. The ideal strategy for preventing biofilm-associated SSI is to prevent intraoperative contamination through compliance with effective surgical care bundles. Management of postoperative biofilm-associated infections involves surgical debridement followed by irrigation with antimicrobial agents and removal of infected devices, followed by insertion of antimicrobial adjuncts such as antimicrobial spacers, beads or sutures together with selective therapeutic agents that penetrate the mature biofilm. Conclusion: Biofilm-associated infections are a significant source of postoperative morbidity and mortality. Appropriate interventional strategies are warranted to reduce the risk of intraoperative contaminatio