Infection-The Last Bony Frontier

8/14/2019 Infection-The Last Bony Frontier

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OR=sacred place of trust?deserves our best efforts

INFECTION CONTROL

Critical for the Success of Surgery


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the COST to the hospital (Nepean-500 cases@yr.)

to the economy-Aust $300M@ yr., AUD

20,000/patient) The additional cost imposed on the US health system

annually by antibiotic resistance has been estimated to

range between US $100 million and US $30 billion.[Hellinger WC, Confronting the problem of Increasing Antibiotic

Resistance, South Med J 93(9): 842-848, 2000

MRSA

learn to live with it

(MRSA and beyond. Marshall et al. ANZ JSurg 2004 74: 465-469)

-suggested hand washing and nasal mupirocin

or GET RID OF IT


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Sterile(Operating)ZoneKey Concept

= area between incision&surgical team

- the surgical workplace

- must be ultraclean

build(wash/gown/drape)

maintain (intra-op)dismantle (?after you leave the OR)

Challenge to:

restructure whats already there Looked at:

- hand wash

- mask

- gloving

- gowning

- draping

- handling the scalpel-


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yeS-WIPEyour handsnaturally

SQUEEZE

WASH

DRY

Clinical Results

Soap & Water: 90% clean hands

reproduced the surgical scrub with

yeS-Wipe (72cc device replaces sink area);

>99% saving on:water,soap and space


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Gowning- violations related to final flap tie

-


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Multi-Centre Clinical trial

Sydney March 2000

5 x Hospitals (Development of a new

surgical gown: a multicenter study. Surg Today. 2006;36(5):490.

200 gowns tested

Faster to don in 75%(90%)

Remained closed 92%(vs. 8%)(100%)

Infection control improved 75%(82%)

Use again 70%(100%)

i.e.. Faster to don/remains closed/infection

Draping

- 100 cases examined

- 4 violations of sterile technique

(one major) per operation

- slow

- surgeon & scrub dependent

Challenge:Make easier & free surgeon & scrub to work


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Scalpel Blade Pick-up

- slow/dangerous

Challenge:

- make easier and faster

- met

S-Foam

S-Foam

An ImportantInfection ControlDevice......for the safe and efficient handling of sharps in the Operating Theatre

Low Tack Adhesive-Leaves noResidue

Easy Peel- Backing Paper

V- Shaped Slot- Provides Added Grip

Blade End Down

Large Tactile Body For

Easy Blind Location, Also forScraping Debris Off Blade

Handle End Up

TMScalpel Held Perpendicular toBottom of Dish- Easy Pick Up

Designed and Made in Australia Distributed & Packaged by DEFRIES INDUSTRIES Patent Pending

Available in SterilePackaging

NEW


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id.Sid.S

old

crowded

id.S(2)


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id.S(2)

Phytochemicals

-plant derived substance with active

hydrocarbons for :

antisepsis(high MRSA activity)

wound healing problems

biological sealant(tissue healing problems)

treatment of TB/Malaria


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Phytochemical papers

Sherry E, Warnke PH, Boeck H.

Percutaneous treatment of chronic MRSA osteomyelitis with a novel plant-derived antiseptic.

BMC Surg. 2001;1(1):1. Epub 2001 May 16.

Sherry E, Boeck H, Warnke PH

Topical application of a new formulation of eucalyptus oil phytochemical clears methicillin-resistant

Staphylococcus aureus infection.Am J Infect Control. 2001 Oct;29(5):346. No abstract available.

Sherry E, Warnke PH.

Alternative for MRSA and Tuberculosis (TB): Eucalyptus and Tea-Tree Oils as New Topical

Antibacterials

AAOS, Dallas.Feb 2002 Sherry E , Warnke PH, Boeck H.

Sherry E, Sivananthan S, Warnke PH, Eslick G.

Topical phytochemicals used to salvage the gangrenous lower limbs of type 1 diabetic patients.

Diabetes Res Clin Pract. 2003 Oct;62(1):65-6. No abstract available.

Phytochemical papers (ctd)

Warnke PH, Terheyden H, Acil Y, Springer IN, Sherry E, Reynolds M, Russo PA, Bredee JP,

Podschun R. Related Tumor smell reduction with antibacterial essential oils.Cancer. 2004 Feb 15;100(4):879-880.

E Sherry , PH Warnke

Successful use of an inhalational phytochemical to treat pulmonary tuberculosis: A case report.

Phytomedicine vol 11/issue 2-3, Feb.,p95. 2004.

Antibacterial essential oils reduce bad smell in cancer patientsP.H. WARNKE1, E. SHERRY2, R. PODSCHUN1, H. TERHEYDEN1, Y. ACIL1, and I.N.SPRINGER1, 1 University of Kiel, Germany, 2 University of Sydney, Penrith, Australia. 4026

The IADR/AADR/CADR 82nd General Session (March 10-13, 2004)

Honolulu, HI

E Sherry S Sivananthan PH Warnke Inhalational phytochemicals to treat pulmonary tuberculosis;

tyo case reports AJIC Oct 2004


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MRSA case


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Tumour work

Papers- Palliative CareSINUS

Further tumour/pallaitive care work


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Papers-TB

28F, first case

Treatment costs around US $2500 per patient,

rising to US $250,000 in multi drug resistant TB,

with the overall potential cost of lost productivity due to

TB is in the order of 4%-7% of GDP

new era of...

local treatment with:

debridement & local antiseptic


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the new OR:

-yeS-WIPE Surgical Scrub-S-Gown Gowning

-id.s Draping

-new masks clean air-phytos to seal wound

But need to CONVINCE industry?????????to make all these changes

Basics:Basics:

Swedish Hip Registry, 2003Swedish Hip Registry, 2003

Critical issues are:Critical issues are:

-surgical technique- OPTIMIZED-surgical technique- OPTIMIZED

-implant design- NO CHANGE-implant design- NO CHANGE


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vol=(1/3(r2)(height)

-

? < 4% soft tissue problems? < 4% soft tissue problems

-Assume-Assume conecone of dissection;of dissection;

vol=(1/3(r2)(height)vol=(1/3(r2)(height)

-Then-Then 5 cm versus 255 cm versus 25cm incisioncm incision

means 1/25 volume ofmeans 1/25 volume of

soft tissue traumasoft tissue trauma

and ?


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Strategy

-reduce size frontier(incisi-in vivo tissue engineering(

-surgeon in control

Infection-The Last Bony Frontier

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