Infection-the Last Bony Frontier

Infection- The Last Bony Frontier

Eugene Sherry (Univ. Sydney) Patrick H Warnke (Univ.Kiel,Germany) Suresh Sivananthan (Univ. Malaya).

to operate you need: • the right team • the right tools • and a sterile zone

OR=sacred place of trust ?deserves our best efforts

INFECTION CONTROL

• Critical for the Success of Surgery

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 J Surg 2004 74: 465-469) -suggested hand washing and nasal mupirocin

or ‘GET RID OF IT’

Sterile(Operating)Zone Key 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 what’s already there • -

Looked at: hand wash mask gloving gowning draping handling the scalpel

yeS-WIPE your hands naturally

• SQUEEZE • WASH • DRY

Clinical Results • Soap & Water: <10% clean hands • Hibicol: 50% clean hands • yeS-WIPE: >90% clean hands reproduced the surgical scrub with

yeS-Wipe (72cc device replaces sink area); >99% saving on:water,soap and space

•

Pooled data Overall mean

Colony Counts

Baseline F.Surg Scrub

225,979 6,487

yeS-WIPE

478

(Int J Environ Res -accepted for pub 2004)

Gloving Errors seen: - opening - donning - glove/sleeve interface Challenge: - is to make easier and safer

SE 51,900 4,706 94

Gowning - violations related to final flap tie - <8% are properly applied - multi-center trial underway in Australia Challenge is to to free scrub and surgeon for their work

S-Gown is Taking the Spin out of the OR

S-Gown robing process

Solution

1.Pull Perform neck & mid-back tie as normal.

1. Unfold sterile flap & pull across back

2.Press

2. Press flap onto gown

3.Peel

3. Peel S-Gown device off

Robing complete - No visible ties

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 t l/ i

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

Face Masks March 2003 Found air levels of bugs and that masks did NOT function as barriers Staph epidermidis new mask design..TRIALS

FACEMASK POLLUTION OF THE OPERATING ROOM AIR

INTRODUCTION: A clean Operating Room (OR) is essential for successful surgical outcomes. To date little is known about the biological load of the OR air. We decided to investigate this during a knee replacement operation. METHOD: Air samples were taken, using a vacuum pump drawing air sample through sterile 0.42 micron filters, at the beginning of the operation, and for every 30 minutes until the end. Two sets of samples were taken. All micron filters were transferred onto Tryptic Soy Agar and Malt Agar plates immediately. At the end (3.5 hours) all plates were incubated for 24 hours and the results tabulated. All surfaces in the OR were cultured. Also, all facemasks used were collected and checked, both back and front. These microorganisms were identified. Then we introduced a new facemask(infiltrated with a phytochemical) and tested same( x 5). RESULTS: The biological profile showed increased bacteria and mold in the air of the OR from 10x1 to 10x4. All OR surfaces remained sterile. However, all masks were found to be contaminated at 15 mins., both back and front, with the same high levels of throat and nasal flora. In contrast, the new facemasks remained sterile for 3.5 hrs. (13x longer). DISCUSSION AND CONCLUSIONS: It is postulated that this increased bio load was introduced into the OR by the masks of the surgeons and nurses. Our new facemask may solve this problem and prevent pollution of the OR air.

Scalpel Blade Pick-up - slow/dangerous Challenge: - make easier and faster - met

S-Foam

S-Foam

Scalpel Held Perpendicular to Bottom of Dish - Easy Pick Up

TM

Handle End Up

Large Tactile Body – For Easy Blind Location, Also for Scraping Debris Off Blade V- Shaped Slot - Provides Added Grip

NEW

Available in Sterile Packaging Easy Peel - Backing Paper Blade End Down

Low Tack Adhesive - Leaves no Residue

An Important Infection Control Device... ...for the safe and efficient handling of sharps in the Operating Theatre Designed and Made in Australia

Distributed & Packaged by DEFRIES INDUSTRIES

Patent Pending

id.S

old crowded

id.S(2)

id.S

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

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 patients P.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

MRSA case

Tumour work SINUS PapersPalliative Care

Further tumour/pallaitive care work

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

the new OR:

-yeS-WIPE → Surgical Scrub

-S-Gown -id.s -new masks

→ Gowning → Draping → clean air

-phytos to seal wound But need to CONVINCE industry????????? to make all these changes

Basics: Swedish Hip Registry, 2003 Critical issues are: -surgical technique- OPTIMIZED -implant design- NO CHANGE

? < 4% soft tissue problems vol=(1/3(¶r2)(height) -Assume cone of dissection; - vol=(1/3(¶r2)(height) -Then 5 cm versus 25 cm incision means 1/25 volume of soft tissue trauma and ? <1/25(or <4%) of soft tissue complications (infection, DVT…)

Incision 5cm or 25cm

Technique Highlights „

NO “significant” DVTs DVTs// NO pulmonary embolus

„

NO Infections

„

Hospital stays one third

MIS Hip Surgery

the end of: -Surgeons taking control and working INSIDE the body Hospitals( as we know them) -Day surgery or outpatient procedures

Strategy -reduce size frontier(incisio -in vivo tissue engineering( -surgeon in control