Search

There is a need for cheap and efficacious wound dressings in developing countries. Banana leaves have been described as an excellent, inexpensive, easily available dressing material in tropical countries. As a natural product, banana leaves are heavily contaminated with various pathogens that must be removed before they can be used as wound dressings, but effective sterilization methods that do not affect the beneficial wound-dressing properties of banana leaves have not been described.To study different sterilization methods and determine which can be used on banana leaves without affecting their beneficial wound-dressing properties.We first compared the use of different decontamination techniques to reduce the natural microflora of the leaves and then tested the wound-dressing properties of the leaves in a mouse model of skin transplantation and in postsurgical patients in Uganda, Africa.Steam sterilization proved to be the optimal sterilization technique. Banana leaves displayed wound-dressing properties that equaled those of petroleum jelly gauze dressings and were tested successfully in a clinical setting in postsurgical patients in Uganda, Africa.We found banana leaves to be an excellent alternative wound dressing, combining the desirable properties of modern wound-dressing material with low cost.

Zusammenfassung Es wird ein kurzer Uberblick uber die Entstehung der Krankenhaushygiene in Europa und ihre weitere Entwicklung Deutschland gegeben. Von besonderer Bedeutung sind dabei, nach der Entdeckung und Einfuhrung der Antibiotika, die Anwendung des Qualitatsmanagements und die Platzierung der Krankenhaushygiene im System einer evidenzbasierten Medizin. Schlieslich stellt die Zunahme von multiresistenten Erregern eine alarmierende Entwicklung dar, die durch die Krankenhaushygiene alleine zwar nicht zu beherrschen, in ihren Auswirkungen aber zu beschranken ist.

The following on new requirements of endoscopy contains commentaries on the risk of infection in endoscopy, the need to eliminate contamination, and the use of a disposable system in transnasal endoscopy.

Zusammenfassung Ziel Das Ziel dieser Untersuchungen war herauszufinden, ob eine Kontamination des Fusbodens in einem OP mit Schichtluftungssystem zu einer Kontamination des OP-Gebiets fuhrt. Hintergrund Schichtuftungssysteme fuhren die Luft bodennah dem Raum zu und sie steigt an Warmequellen (z.B. Gerate, Personen) auf. Dabei konnten potentiell Verunreinigungen vom Fusboden in das OP-Gebiet getragen werden. Methoden Es wurde verschiedene Methoden (u.a. aktive Luftkeimsammlung, Sedimentationsplatten, Starkenachweis) angewendet. Ergebnis Mit keiner der angewandten Methoden konnte die Kontamination des Fusbodens auf den OP-Tisch wiedergefunden werden. Schlussfolgerung Die Versuche legen die Schlussfolgerung nahe, dass die Kontamination des Fusbodens im OP – wenn uberhaupt – eine untergeordnete Rolle fur die Kontamination des Operationsgebietes spielt.

Summary Background: Accurate pre-operative or intra-operative labeling of the skin is often necessary to mark exactly the surgical excision lines. Pre-operative “unsterile” permanent skin labeling systems are needed for example for vein and sentinel lymph node surgery; here the dyes must resist two surgical skin disinfection procedures. In contrast, excision borders are labeled during surgery using a “sterile” skin marking system. Methods: Many commercial and non-commercial pre- and intra-operative skin-labeling systems are available, such as autologous patient blood, fluorescence triphenylmethane dyes and commercial skin markers. The available skin marking systems have specific advantages and disadvantages. We review the different labeling systems, offering guidelines to help choose a cost-effective system appropriate for a given surgical procedure. Results: The Edding® permanent markers 400 und 3000 are well suited for preoperative skin labeling and less expensive than commercial skin labeling systems. Autologous patient blood and eosin are well suited for intra-operative labeling and are most cost effective. Eosin Y is widely used and well suited for labeling of dark skin, bone, cartilage, and muscle tissue and spares the expense of expensive commercial skin markers. Conclusion: Knowledge of the many commercial and non-commercial pre- and intra-operative skin labeling systems and their advantages and disadvantages helps to reduce the use of relatively expensive commercial skin markers.

The increasing number of complicated soft-tissue or invasive infections caused by methicillin-resistant Staphylococcus aureus (MRSA) is a frequent reason for elaborate treatment regimens. Unidentified MRSA carriers may be the origin of endemic spread to other patients and medical staff. Recently, community-associated cMRSA with particular virulence factors were isolated from persons without the typical history of hospital contacts. Molecular tools for the timely detection of the mecA resistance gene for the identification of MRSA in medical test specimens have become a standard approach in MRSA-related diagnostic procedures. The actual therapy of MRSA infections requires consideration of both the appropriate spectrum of activity and the adequate pharmacological properties of a chosen antimicrobial. Preventive strategies rely on the consistent application of standard hygiene precautions, which have to be supplemented with increased barriers for the isolation of identified MRSA patients.

This report describes the isolation of a linezolid-resistant Enterococcus faecium and a carbapenem-resistant Acinetobacter baumannii from an infected open patella fracture after a car accident in southern Italy.

Objectives:To establish an animal model to study transmissible spongiform encephalopathy using hamsters and steel wires contaminated with infectious brain materials as transfer vehicles, and, based on this model, to test decontamination procedures against the infectious prion proteins on the steel wires as a near real situation bioassay.Design:Infectious brain materials were given to healthy hamsters intracerebrally either as a suspension or as dried materials on the surface of steel wires. The animals were observed for 18 months. During this period, animals showing definitive clinical signs were euthanized. Decontamination studies were performed by reprocessing contaminated steel wires with different disinfection agents and procedures before implantation.Results:Pathological prion proteins were able to bind to the steel wires and caused disease after the contaminated wires were implanted in the brains of hamsters. When the contaminated wires were treated with different reprocessing procedures before implantation, infectivity was reduced, which was manifested directly by prolonged survival time of the test animals. These results show that this model can be used as a bioassay to validate reprocessing procedures for surgical instruments.Conclusions:At the time of submission of this article, only the group of hamsters incubated with wires reprocessed with an alkaline detergent, followed by sterilization with a modified cycle in a hydrogen peroxide gas plasma sterilizer (4 injections), showed no clinical signs of disease and remained alive. Two animals from the group receiving sodium hydroxide followed by autoclaving (at 134° C for 18 minutes) died. Furthermore, the tested enzymatic cleaning agent seemed to have no positive effect.

Summary In 2001 two outbreak episodes (January – March and June – July) caused by vancomycin-resistant E. faecium (VRE) of the VanA-type were observed at a neonatal intensive care unit (NICU) of a university hospital in south-west Germany. To identify the initial source and the route of transmission environmental samples were examined as well as stool samples from patients and the staff. VRE was not found in environmental samples. However, stool samples from 24 hospitalised children tested positive and bacterial clonality was assessed by Smal-based macro restriction analysis. Furthermore, esp gene and vancomycin resistance gene carriage were examined as well as bacteriocin production. PCR analysis showed that all 24 isolates carried vanA gene cluster, encoding resistance to vancomycin and teicoplanin. However, five of the vanA-positive isolates were resistant to vancomycin but not to teicoplanin. Only these five isolates produced bacteriocin, but in none of the isolates esp gene was detected. PFGE revealed that both outbreaks were caused by two different clones. The patient initiating the first episode, was identified whereas the origin of the second episode remained unknown. From one of the 40 staff stool samples VRE was isolated. This strain was related to the clone of the summer outbreak. In conclusion there were two independent episodes of self limiting VRE outbreaks and transmission on the ward is highly probable.

Outbreaks of gram-negative bacteria such as Pseudomonas aeruginosa in neonatal intensive care units (NICU) can be life-threatening to pre-term infants, which are highly susceptible to serious infections with bacteria. Forty-two ventilated neonates in the NICU of the University Children's Hospital of Tuebingen were found to be colonized (n = 40) or infected (n = 2) with P. aeruginosa within a sampling period of one year. To investigate the colonization patterns and identify potential outbreak sources, epidemiological investigations, environmental surveillance and typing by serotyping and pulsed-field gel electrophoresis of the recovered isolates were performed. The investigation demonstrated a genetically related cluster of P. aeruginosa isolates during the surveillance period in 39 neonates and a second cluster at the end of the period in two neonates. A third strain representing a genetically distinct group was found in only one patient. Environmental investigations demonstrated the presence of P. aeruginosa in the ventilation equipment of 22 patients: binasal prongs (n = 22), water reservoir (n = 9), and heater (n = 1). In one case, P. aeruginosa was found in breast milk. Other environmental investigations revealed no P. aeruginosa. Although no evidence for a unique source was found, a series of intervention steps were initiated by the NICU personnel, medical microbiologists and infection control experts. The intervention steps included reinforced training of health care staff and a change from chemical to thermal disinfection of binasal prongs. Implementation of these measurements successfully stopped the recurrent occurrence of P. aeruginosa colonization.

Die Erfassung und Bewertung (Surveillance) von Wundinfektionen bildet die Basis fur hygienische Interventionen zur Reduktion der postoperativen Infektionshaufigkeit. Empfohlen wird eine prospektive Erfassung durch qualifiziertes Personal auf der Grundlage allgemein anerkannter Fallkriterien. Die Berechnung der Infektionsrate muss nach den unterschiedlichen Risiken der Patienten stratifiziert werden. Angaben aus Referenzdatenbanken erlauben die Berechnung standardisierter Wundinfektionsraten, die schlieslich zur Bewertung der eigenen Daten im Sinne eines Qualitatsmanagementsystems herangezogen werden konnen. Besonders schwierig gestaltet sich die nachstationare Erfassung, mit deren Hilfe jedoch ein erheblicher Teil der Wundinfektionen identifiziert werden kann.

Objective: To determine whether reprocessed single-use devices (SUD) would (1) meet regulatory standards for sterility, and (2) meet the same material standards as new devices or if they pose an infection risk to other patients. Design: The study included in the first stage single-use laparoscopic dissection devices and in the second stage a variety of clinically used and reprocessed SUDs. The suitability of these devices for cleaning, disinfection, and sterilization was examined.Methods: Testing of cleanability was conducted on devices contaminated with radioactively labeled blood. Instruments were cleaned using hospital recommended practices. Gamma counts/second were determined before and after cleaning to localize contaminants, which were additionally visualized using light and scanning electron microscopy (SEM). X-ray photoelectron spectroscopy (XPS) was used to quantify contamination elements on the materials tested. Residual bioburden testing on instruments contaminated with microorganisms suspended in blood prior to reprocessing was carried out to establish the efficacy of disinfection and sterilization.Results: During the first stage of the study all devices remained contaminated after cleaning, but were effectively disinfected. Sterilization could not eliminate the challenge microorganisms completely. The findings during the second stage — examination of clinically used devices — were as follows: 11% of the sterile packages were damaged; 33% of the devices were incomplete and parts were missing; 54% did not meet the criteria for functionality; light microscopy, SEM, and XPS showed contamination on the outside and inside of all devices. Of the tested SUDs, 40% remained unsterile following resterilization.Conclusions: None of the reprocessed SUDs were effectively cleaned or sterilized. This may provide an opportunity for survival and growth of non-resistant or nosocomial organisms and viruses. The use of such inadequately reprocessed SUDs increases the risk for the patient, and can lead to nosocomial infection and to legal consequences for the health care facility.

Objective:To determine whether reprocessed single-use devices would meet regulatory standards for sterility and meet the same materials standards as a new device.Design:The study included single-use and reusable biopsy forceps and papillotomes and a reusable stone retrieval basket. The suitability of these devices for cleaning and disinfection or sterilization was examined.Methods:Testing of cleanability was conducted on devices contaminated with technetium 99-radiolabeled human blood. Instruments were cleaned using hospital recommended practices for manual cleaning. Gamma counts per second were determined before and after cleaning to localize contaminants, which were additionally visualized using light and scanning electron microscopy. X-ray phc-toelectron spectroscopy was used to quantify contamination elements on the materials tested. Residual bioburden testing on instruments contaminated with microorganisms suspended in coagulable sheep blood was carried out to establish the efficacy of disinfection and sterilization.Results:All devices remained contaminated after cleaning, but single-use devices and the stone basket tended to be more heavily contaminated than reusable forceps and papillotomes. Cleaning procedures facilitated distribution of contaminants further into the lumens of the disposable forceps. Decreased concentrations of silicon and increased concentrations of carbon and nitrogen suggested that layers of silicon lubricant had been removed and contaminants were organic material. Reusable devices were effectively disinfected, but single-use devices were not Sterilization could not eliminate the challenge microorganisms completely.Conclusions:None of the reprocessed single-use instruments were effectively cleaned, disinfected, or sterilized. This condition may provide an opportunity for the viability of non-resistant or nosocomial organisms and viruses. Additionally, reprocessing procedures may result in material destruction of fragile devices. Cost-saving initiatives that have inspired reprocessing of single-use devices, despite the absence of data establishing the efficacy of decontamination and the durability of materials throughout reprocessing, should be pushed into the background.

Die Retransfusion postoperativ gesammelten Drainageblutes ist eine bei orthopadischen Eingriffen weit verbreitete Methode zur Einsparung von Fremdblutkonserven. Vorteile gegenuber der Verwendung homogener Blutkonserven bestehen darin, dass immunologische Reaktionen auf Fremdblut unterbleiben und Infektionskrankheiten nicht ubertragen werden konnen. Nachteilig ist die Gefahr der Sekundarverkeimung und der hamatogenen Streuung von Infektionen. Zur Verringerung dieser Risiken werden folgende Masnahmen empfohlen: Die Kontraindikationen Infektionen, maligne Erkrankungen und Gerinnungsstorungen sind vor dem Einsatz zu beachten. Eine perioperative Antibiotikaprophylaxe ist empfehlenswert. Das System muss steril angeschlossen werden. Antikoagulanzien und Stabilisatoren sollten nicht nachgespritzt werden. Ein Offnen von Leitungen ist zu vermeiden. Bei Auftreten febriler Reaktionen sollte die Retransfusion abgebrochen werden. Die Methode sollte nur wahrend der ersten sechs postoperativen Stunden angewendet werden.

UNLABELLED Reprocessing (repeated cleaning, disinfection, and sterilization) and reuse of single-use medical devices has been performed safely with some devices. The aim of our study was to analyze whether reprocessing of the Combitubes (Kendall-Sheridan, Argyll, NY) airway device, used for emergency endotracheal intubation and difficult airway management, is possible and can be performed appropriately and safely. Microbiological, microstructure, and material science examinations were performed with unused, as well as multiple reused and reprocessed Combitubes. The reprocessing procedure consisted of a cleaning, a disinfection, a final inspection, and a sterilization. Microbiological examinations of multiple reused and reprocessed Combitubes found no test organisms in quantitative cultures. A microbial reduction between four and five log levels compared with nonreprocessed tubes was found. Microstructure analysis for the examination of topographical alterations and changes in the chemical composition of the surface demonstrated nonsignificant alterations between new and reprocessed medical devices. In material science examinations, cuff burst pressures were not different between unused and multiple reprocessed Combitubes. The results of all examinations proved that the decontamination process is adequately effective, and that no significant superficial alterations are generated by the multiple reuse and reprocessing of the Combitubes. To assure uniformly good results, a quality management system must be established and only validated methods should be used. IMPLICATIONS Reprocessing of single-use medical devices offers the opportunity of significant savings and is already performed with some devices. Microbiological, microstructure, and material science examinations proved that reprocessing of multiple reused Combitubes (Kendall-Sheridan, Argyll, NY), mainly used for emergency airway management, is possible and safe.

The benefit of using retrieval systems in minimally-invasive surgery is to facilitate the removal of operative specimen, while minimising the contamination of the peritoneum and port-sites in the abdominal wall. We have developed an innovative retrieval system with a mechanism of action and design that differs widely from other devices. Its increased functionality is achieved by combining it with a laparoscopic instrument: the resected tissue is wrapped in plastic foil, rather than being entrapped in a bag. During delivery through the abdominal wall, permanent traction is exerted on the specimen and thus obstruction in the port-site is avoided. The retrieval system has been tested for impermeability and proven to be safe and able to avoid spillage of cells.

On the basis of a large outbreak of vancomycin-resistant Enterococcus faecium in a German university hospital, we estimated costs ( approximately 1 million Euros) that could have been avoided by early detection of the imminent outbreak. For this purpose, we demonstrate an easy-to-use statistical method.

Epidemiologie Die Haufigkeit von Infektionen im Krankenhaus durch Methicillin-(Oxacillin-)resistente Staphylococcus aureus (MRSA/ORSA) liegt in Europa zwischen 30% (Spanien, Italien, Frankreich), in Deutschland bei 8,7%. Diese Angaben in der Literatur erfassen den gegenwartigen Stand jedoch nicht zuverlassig.

In general, the desinfection of surfaces is done through scrubbing and wiping using substances on the basis of aldehydes, oxidants and tensides. We propose a 4-stage procedure (see Table 1). The concentration of the agent and the duration of application depend on the circumstances, whether one is dealing with a prophylactic measure, a nosocomial infection or an infection which has to be reported. The epidemiologic relevance dictates the extent of desinfection.

Background In this study we investigate the accuracy of industrial six axes robots employed for patient positioning at the Heidelberg Ion Beam Therapy Center. Methods In total 1018 patient setups were monitored with a laser tracker and subsequently analyzed. The measurements were performed in the two rooms with a fixed horizontal beam line. Both, the 3d translational errors and the rotational errors around the three table axes were determined. Results For the first room the 3d error was smaller than 0.72 mm in 95 percent of all setups. The standard deviation of the rotational errors was at most 0.026° for all axes. For the second room Siemens implemented an improved approach strategy to the final couch positions. The 95 percent quantile of the 3d error could in this room be reduced to 0.53 mm; the standard deviation of the rotational errors was also at most 0.026°. Conclusions Robots are very flexible tools for patient positioning in six degrees of freedom. This study proved that the robots are able to achieve clinically acceptable accuracy in real patient setups, too.

SummaryAn important aspect for the safety of the patient is the hygienic condition of employed instruments. These recommendations will help to achieve a reproducible standard on a high level in processing of MIS instruments. Instruments are classified into four categories. The processing cycle is divided into single steps and the requirements for the processing cycle are described.

Hand washing and hand disinfection put considerable stress on the skin thus requiring specific hand care. It is important however that the care products do not impair the effect of hand disinfectants. We therefore investigated the interaction of two hand care products (oil-in-water and water-in-oil emulsions) on the microbicidal efficacy of different alcoholic hand-rubs, using the contamination model described in EN 1500. The mean log10-reduction factors for three hand-rubs varied between 4.03 and 4.22 compared with 3.76 and 4.43 for six possible combinations of hand-rubs and hand care products applied immediately prior to disinfection. Differences between reduction factors achieved with hand-rubs alone and in combination with hand care were not significant. Repeated application of care products with subsequent hand disinfection also did not result in significantly lower reduction factors than achieved with hand disinfection alone. Our data suggest that administration of selected products for hand care does not necessarily impair hand disinfection and is therefore recommended for occupational health as well as for infection control reasons.

We determined interleukin-6 (IL-6) concentrations in collected shed drainage blood intended for retransfusion in a prospective study in 81 patients after total knee replacement. We found large increases in IL-6 levels, averaging 6.5 (SD 3.9) ng/mL, in shed blood collected in the first 6 postoperative hours. 3 patients had febrile reactions after collected blood was retransfused. The IL-6 levels in the drainage blood of these patients were very high (9.6-13.4 ng/mL). In the blood collected after 6 hours, IL-6 concentrations increased to 47 (SD 33) ng/mL (p < 0.001). These results suggest a relation between increased interleukin-6 concentrations in shed drainage blood and the occurrence of febrile reactions after retransfusion of such blood.

Recently, it has been suspected that long durations of hospitalization might be a possible risk factor to get colonized by multiple VRE strains. Here we present the case of a patient who underwent stem cell transplantation and subsequently stayed at the hospital for about 4 months until death. At least four different Enterococcus faecium strains were identified from routinely taken microbiological specimens as demonstrated by pulsed-field gel-electrophoresis. Additionally, these strains showed variable susceptibility to quinupristine/dalfopristine, vancomycin, and/or linezolid depending on different antibiotic administrations. These findings indicate that patients might be colonized with multiple Enterococcus faecium strains and that the enterococcal flora quickly adapts due to antibiotic exposure.

Summary Background Ralstonia mannitolilytica is a non-fermentative, Gram-negative bacterium isolated infrequently from clinical samples. However, within a period of 11weeks five inpatients of the tertiary care hospital of the University of Tubingen developed clinical signs of infection and R. mannitolilytica was cultivated from blood samples of all patients suggesting an outbreak. Methods Blood cultures and one catheter tip were analysed by standard microbiological procedures. Genetic relatedness of the isolates was investigated by pulsed-field gel electrophoresis. To ascertain the possible source of the outbreak, environmental sampling and challenge-recovery experiments to test filters used for multi-dose solution bottles were performed. Results In the present study a monoclonal outbreak with R. mannitolilytica causing catheter-related infection of five haematological patients is reported. Underlying severe diseases with consecutive immunosuppression, permanent indwelling intravenous devices, multiple intravenous applications, and chemotherapy were possible risk factors promoting the infection. Challenge-recovery experiments revealed that R. mannitolilytica to a high extent even passed through Mini-spike Plus ® filters of pore size 0.2μm. Conclusion Although the source of the outbreak could not be identified, it is possible that solutions given intravenously were contaminated. Since R. mannitolilytica had never been isolated in our laboratory before and environmental testings performed were negative, it cannot be excluded that commercial products like drugs, saline solutions or infusion systems (filters) were contaminated.

Unvertraglichkeitsreaktionen gegenuber Latexhandschuhen treten immer haufiger auf und sollen inzwischen bei etwa 10% des medizinischen Personals beobachtet werden. Sie ausern sich hauptsachlich als Kontakturtikaria, Rhinitis und Konjunktivitis, Asthma und sogar anaphylaktischer Schock und werden entweder durch direkten Hautkontakt mit den Allergenen, wie bei Latexhandschuhen, oder Schleimhautkontakt mit latexhaltigen Gegenstanden oder Inhalation von Puderpartikeln mit Latexproteinen hervorgerufen. Dabei spielen auch sogenannte Kreuzallergene aus Fruchten, wie Bananen, Mango u. a., eine nicht geringe epidemiologische Rolle. Eine fruhzeitige allergologische Diagnostik ist notwendig. Besonders gefahrdet sind Personen mit atopischen Krankheiten und vorbestehenden Hautschaden, die die Hautbarriere beeintrachtigen. Zur Pravention werden empfohlen

Pumice is a potential source of infection for the dental technician and of cross-contamination between different dentures and patients. In this study, the number of microorganisms in two different combinations of pumice and disinfectant was compared with a conventional mixture of pumice and water. The results revealed that under practical conditions the mix of Steribim (pumice containing benzoic acid added by the manufacturer) with water reduced the number of bacteria by 99% compared with a mix of a conventional pumice and water. The addition of an antiseptic product that contained octenidine as active agent to conventional pumice reduced the number of microorganisms by 99.999%.

Outbreaks of Acinetobacter baumannii demonstrating multiple antibiotic resistance, including meropenem resistance, have been described as severe therapeutic problems. Here we describe a monoclonal outbreak of infection and colonization with multidrug-resistant A. baumannii over a two-month period. Resistance to meropenem was mediated by expression of a metallo-beta-lactamase enzyme. Four of 14 patients showed clinical signs of infection and two died. Contamination of the environment, water, or instruments were excluded as causes of the outbreak. All patients, except one, underwent surgery in a specific operation theatre where surgery of contamination class IV (infected, dirty) was performed. Although individual surgeon error was eliminated, analyses of the patients' histories suggested that bacterial transmission had occurred during surgery. Five patients showed signs of A. baumannii infection and two of these patients suffered from large abdominal wounds infected with a high density of A. baumannii requiring repeated revisions. Presumably, these revisions favoured the transmission of A. baumannii, which is remarkably resistant to various environmental stresses including soaps, disinfectants and dry conditions. No case of meropenem-resistant A. baumannii had been observed in the hospital before the outbreak. Interestingly, the resistant bacteria appear to have been imported by a patient returning from West Africa. This indicates that, similar to MRSA, multiresistant A. baumannii may be introduced by patients from foreign hospitals. The outbreak was stopped in the following months by reinforcing standard procedures and by taking all necessary precautions such as patient isolation, and finally only one new case was detected.

The influence of acid-citrate-dextrose (ACD) anticoagulant on the blood quality was assessed in this prospective, randomized, controlled study. The clinical consequences with regard to retransfusion of drainage blood following total knee arthroplasty were evaluated. After total knee arthroplasty, retransfusion was performed utilizing a "SureTrans" retransfusion system in 81 patients. In 42 of them, blood was collected adding an ACD anticoagulant (group A), while in the remaining 39 patients blood was collected without any additives (group B). Blood losses were retransfused over a 6-h period after attaching the retransfusion system to the patient of either group. Blood samples of the 6-h blood collection were taken and analysed for several blood quality parameters. Significant differences were found in the platelet count (61,200+/-16,700 microl(-1) in group A versus 70,100+/-21,600 microl(-1) in group B, p=0.042), the lactate concentration (4.09+/-0.86 mmol/l vs 4.82+/-0.83 mmol/l, p0.001), the pH (6.96+/-0.10 vs 7.18+/-0.06, p0.001), as well as the protein content (5.44+/-0.57 g/dl vs 5.85+/-0.43 g/dl, p0.001). These observed significant differences were, however, of no clinical relevance to the patients' treatment. Hemoglobin concentration, hematocrit, mean corpuscular volume (MCV), erythrocyte count, leukocyte count, concentration of free hemoglobin in the blood plasma (fHb), potassium concentration, lactate dehydrogenase (LDH), serotonin concentration, triglyceride concentration, free fatty acid concentration, and interleukin-6 concentration did not differ significantly. This study indicates that the blood quality in retransfusion systems is not substantially influenced by adding ACD anticoagulant.

Background: Local anesthesia often suffices for surgery on the outside of the body. In recent years, it has been found that such local anesthesia can be adequately carried out using large amounts of highly diluted anesthetic solutions. Methods: Using one or more common infusomats, we injected mixed anesthetic solutions slowly, painlessly, paravenously, and automatically via subcutaneous infusion anesthesia (SIA) into the subcutaneous layer in a large group of patients scheduled for surgery. The local anesthetics used were prilocaine and ropivacaine (Xylonest and Naropin); these were diluted with original Ringer's solution with epinephrine (1:1,000,000) in 500-ml bottles. The concentration of the mixture varied between 0.3% and 0.08% depending on the requirements of surgery. The needles used ranged from 30-gauge to 20-gauge needles, with a length of 1.5–10 cm. The speed of injection varied between 30 ml/h and 1500 ml/h, depending on the location, the requirements of the surgery and the needle size. Volumes usually ranged from 2 ml to 600 ml depending on the concentrations used. The maximum dose was approximately 4 mg/kg prilocaine and 2 mg/kg ropivacaine. Patients: We used this technique in preparing for 5020 major and minor skin operations in 3270 patients ranging in age from 0.5 years to 95 years (mean age 54 years). Microbiological tests of the infusion system were carried out. Patients were asked about their pain during anesthesia, operation, and postoperatively. Results: There were no complications from local anesthesia. The technique proved safe and comfortable even for children and very sensitive patients. The median duration of postoperative anesthesia was 5 h (maximum 23 h). Choosing the concentration, the needle, the needle position, the flow rate, and the volume requires some experience.

In the present stage between the technological realization and the clinical phase, quality management gains a predominant role at the heavy ion therapy facility at GSI. Specific quality inspection procedures had to be developed for the subsequent parts of the beam delivery system, the treatment planning, the raster scanning device, the patient positioning, the dose verification and the safety interlock system. In the meantime the acceptance test of the whole facility has been carried out and an overview about our first experience with quality assurance procedures at the heavy ion irradiation facility is given, with a special emphasis on the medical physics part.

A new treatment planning program was developed for the heavy-ion therapy facility at GSI. In addition, a concise quality standard for treatment planning has been set up. It covers acceptance and constancy checks of all critical aspects in treatment planning. Dose verification measurements done during the commissioning phase show an overall good agreement with the treatment planning calculations.

Background Recent research suggests that alcohol-based skin antiseptics exhibit their efficacy on the resident skin flora of the forehead in less than 10 minutes. That is why we have looked at the efficacy of two ethanol-based skin antiseptics applied for 10, 2.5 and 2 minutes on skin with a high density of sebaceous glands. Each experiment was performed in a reference-controlled cross-over design with at least 20 participants. Application of isopropanol (70%, v/v) for 10 minutes to the forehead served as the reference treatment. The clear (skin antiseptic A) and coloured preparations (skin antiseptic B) contain 85% ethanol (w/w). Pre-values and post-values (immediately after the application and after 30 min) were obtained by swabbing a marked area of 5 cm2 for about 10 s. Swabs were vortexed in tryptic soy broth containing valid neutralizing agents. After serial dilution aliquots were spread on tryptic soy agar. Colonies were counted after incubation of plates at 36°C for 48 h. The mean log10 reduction of bacteria was calculated. The Wilcoxon matched-pairs signed-ranks test was used for a comparison of treatments. Results Skin antiseptic A applied for 10 min was significantly more effective than the reference treatment. When applied for 2.5 min (three experiments) it was significantly more effective than the reference treatment immediately after application (2.7 versus 2.2 log10 reduction; p < 0.001) and equally effective after 30 min (2.8 versus 2.6 log10 reduction; p = 0.053). Skin antiseptic B applied for 2.5 min (three experiments) was significantly more effective than the reference treatment both immediately after application (2.3 versus 1.9 log10 reduction; p < 0.001) and after 30 min (2.5 versus 2.1 log10 reduction; p = 0.002). Conclusion The clear and coloured skin antiseptics applied for 2.5 min on the skin of the forehead fulfilled the efficacy requirements for skin antisepsis. The shorter application time on skin with a high density of sebaceous glands will allow to act more efficiently in clinical practice.

Transmission of infection through airborne pathogens has already been suspected in ancient times ("mal-aria') and has been confirmed as the cause of numerous infectious diseases since the beginning of the bacteriological era. However, the significance of airborne spread of nosocomial infections is often overestimated. In general, transmission may happen through microorganisms in the air delivered to the room through the ventilation system or more likely through microorganisms, which are spread by the personnel, Indirect transmission through contaminated aerosols or dust is possible as well. Ventilation systems are mandatory for rooms, which cannot be ventilated from outside (e.g. windowless rooms) as well as for rooms with special requirements regarding prevention of infection, occupational health or protection of products

Zur Verringerung homogener Transfusionen als Ausgleich f/ir perioperativen Blutverlust nimmt die intraoperative Autotransfusion seit einiger Zeit in einer Reihe von operativen Disziplinen unter anderem auch in der Orthopfidie einen festen Platz ein [1, 6]. Konsequenterweise wird an einer Reihe von Kliniken auch ein Teil des postoperativ durch geschlossene Saugdrainage gewonnenen Blutes in gleicher Weise aufbereitet. Bei den heute verwendeten Autotransfusionsgerfiten (zum Beispiel Cell Saver 1) wird das bei der Operation austretende Blut in ein Reservoir gesaugt, filtriert und initial mit Antikoagulans versetzt. Die Erythrozyten werden vom bisweilen stark hfimolytischen Plasma separiert und mit physiologischer Kochsalzl6sung gewaschen. Dadurch werden die unerw/inschten Bestandteile wie Antikoagulans, freies Hfimoglobin, Zelldetritus und aktivierte Gerinnungsfaktoren eliminiert. Anschlief3end steht ein gewaschenes, autogenes Erythrozytenkonzentrat f/ir die Transfusion zur Verf/igung. Mikrobielle Kontamination des Operationsgebietes gilt als eine der Kontraindikationen f/ir die intraund postoperative Autotransfusion [5, 7]. Da mit dem Sauger wfihrend der Operation neben Blut und Gewebeteilchen stfindig keimhaltige Raumluft mit aspiriert wird, kann eine mikrobielle Kontamination des Autotransfusionssystems nicht ausgeschlossen werden [2, 3].