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Infection control in a hernia clinic: 24 year results of aseptic and antiseptic measure implementation in 4,620 “clean cases”

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Abstract

Post Mesh Herniorrhaphy Infection [PMHI] occurs between 3 to 4% of inguinal and 8 to 14% of ventral herniorrhaphies producing an unacceptably high morbidity. Before opening a Hernia Clinic, our infection rate was around 5% for “clean” inguinals and 8% for “clean” ventral herniorrhaphies. Starting in 1982 we implemented a stricter operative aseptic protocol plus the per-operative administration of 1 g of intravenous Cefazolin. In addition, wounds were irrigated with a solution containing 80 mgs of Gentamycin Sulphate dissolved in 250 ml of Normal Saline Solution. During a period of 25 years these measures were used in 4300 consecutive “clean “Inguinal and 320 “clean” Ventral herniorrhaphies. Since the implementation of the above-mentioned aseptic and antiseptic steps no further wound infections were encountered. In our hands, the combination of rigorous aseptic operating room routine plus intravenous and topical antibiotics have, up to now, effectively eliminated wound infections in “clean” herniorrhaphy cases.

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References

  1. Bendavid R (2004) Recurrences, the fault of the surgeon. In: Shumpelick V, Nyhus LM (eds) Meshes: benefits and risks. Springer, Berlin Heidelberg New York, pp 51–62

    Google Scholar 

  2. Deysine M (2004) Historical evolution of asepsis and antisepsis. In: Deysine M (ed) Hernia infections; pathophysiology, diagnosis treatment and prevention. Marcel Dekker Inc, New York, pp 1–16

    Google Scholar 

  3. Sanchez Montes I, Sanchez Montes J. Deysine M (2004) Epidemiology and incidence of post external abdominal wall herniorrhaphy. In: Deysine M (ed) Hernia infections; pathophysiology, diagnosis treatment and prevention. Marcel Dekker Inc, New York, pp 17–57

    Google Scholar 

  4. Deysine M (1998) Pathophysiology, prevention and management of prosthetic infections in hernia surgery. Surg Clin North Am 78:1105–1115

    Article  PubMed  CAS  Google Scholar 

  5. Gristina AG, Oga M, Well LX et al (1985) Adherent bacterial colonization in the pathogenesis of osteomylitis. Science 228:990–993

    Article  PubMed  CAS  Google Scholar 

  6. Patti JM, Allen BL, McGavin MJ et al (1994) MSCRAMM—Mediated adherence of microorganisms to host tissues. Annu Rev Microbiol 48:585–617

    Article  PubMed  CAS  Google Scholar 

  7. Shive MS, Hasan SM, Anderson JM (1999) Shear stress effect on bacterial adhesion, and leukocyte oxidative capacity on polyetherurethane. J Biomed Mater Res 46:511–519

    Article  PubMed  CAS  Google Scholar 

  8. Bryers JD (2000) Biofilms II – Process Analysis and Application. J. Wiley Interscience, New York

    Google Scholar 

  9. Salvati EA, Gonzalez Della Valle A, Masri BA, Duncan CP(2003) The infected total hip arthroplasty. Instr Course Lect 52:223–245

    PubMed  Google Scholar 

  10. Deysine M (1998) Ventral Herniorrhaphy: treatment evolution in a hernia service. Hernia 2:15–18

    Article  Google Scholar 

  11. Deysine M (1991) Inguinal herniorhaphy. Reduced morbidity by service standardization. Arch Surg 126:628–630

    PubMed  CAS  Google Scholar 

  12. Deysine M (1991) Hernia clinic in a teaching institution: creation and development. HERNIA 2001 5:65–69

    Google Scholar 

  13. Hubble MJ, Weale AE, Perez JV et al (1996) Clothing in laminar-flow operating theaters. J Hosp Infect 32:1–7

    Article  PubMed  CAS  Google Scholar 

  14. Taylor S, Bannister GC (1993) Infection and interposition between ultraclean air source and wound. J Bone Joint Surg 75B:503–504

    CAS  Google Scholar 

  15. Dillon 11 - Hubble MJ, Weale AE, Perez JV et al (1996) Clothing in laminar-flow operating theaters. J Hosp Infect 32:1–7

    Google Scholar 

  16. Charnley J, Efrekhar N (1969) Postoperative infection in total prosthetic arthroplasty of the hip joint. Brit J Sur 56:641–649

    Article  CAS  Google Scholar 

  17. Lidwell OM, Lowbury EJL, Whyte W et al (1982) Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomised study. Brit Med J 285:10–14

    Article  CAS  Google Scholar 

  18. Ibd (1983) Airborne contamination of wounds in joint replacement operations: the relationship to sepsis rates. J Hosp Infect 4:111–131

  19. Operating-Theater Hygiene (1962) Subcommittee of the committee on control of cross-infection. Design and ventilation of operating-room suites for control of infection. Lancet 2:945–951

    Google Scholar 

  20. Deysine M (2004) Prevention. In: Deysine M. (ed) Hernia infections; pathophysiology, diagnosis treatment and prevention. Marcel Dekker Inc, New York, pp 301–324

    Google Scholar 

  21. Lortholary O, Tod M, Cohen Y et al (1995) “Aminoglycosides” In: antimicrobial therapy II. Med Clin N AM 79:761–787

    PubMed  CAS  Google Scholar 

  22. Drugeon HB, Caillon J, Juvin ME et al (1988) Bases theoriques de l’ association de la cefazidine avec les autres antibiotiques. Recherche de synergie. Presse Med 17:1900

    PubMed  CAS  Google Scholar 

  23. Salvati EA, CallaghanJJ, Brause BD et al (1986) Reimplantation in infection. Elution of gentamycin from cement and beads. Clin orthop Relat Res 207:83–93

    Google Scholar 

  24. Dirschl DR, Wilson FC (1991) Topical antibiotic irrigation in the prophylaxis of operative wound infections in orthopedic surgery. Orthop Clin North Am 22:419–426

    PubMed  CAS  Google Scholar 

  25. Wahlig H, Dingeldein E, Bergmann R et al (1978) The release of Gentamycin from polymethylmethacrylate beads. J Bone J surg 60B(2):270–275

    Google Scholar 

  26. Voos K, Rosenberg B, Fagrhi M et al (1999) Use of Tobramicin impregnated polymethylmethacrylate pin sleeves for the prevention of pin-tract infection in goats. J Orthop Trauma 13:98–101

    Article  PubMed  CAS  Google Scholar 

  27. Yamamoto M, Jimbo M, Ide M et al (1996) Perioperative antimicrobial prophylaxis in neurosurgery: Clinical trial of systemic flomex administration and saline containing gentamycin for irrigation. Neurol Med Chir (Tokyo) 36:370–376

    Article  CAS  Google Scholar 

  28. Junge K, Rosh R, Klinge U et al (2005) Gentamycin supplementation of polyvinylidenfluoride mesh materials for infection prophylaxis. Biomaterials 26:787–793

    Article  PubMed  CAS  Google Scholar 

  29. Waldogel FA, Vaudaux PE, Pittet D et al (1991) Perioperative antibiotic prophylaxis of wound and foreign body infections: microbial factors affecting efficacy. Rev Infect Dis 13 (supl):782–789

    Google Scholar 

  30. Classen DC, Scott Evans R, Pestotnik SL et al (1992) The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. The New Engl J Med 326:281–286

    Article  CAS  Google Scholar 

  31. Wong-Beringer A, Corelli RL, Schrock TR et al (1995) Influence of timing of antibiotic administration on tissue concentrations during surgery. Am J Surg 169:379–381

    Article  CAS  Google Scholar 

  32. Hill C, Mazas F, Flamant R et al (1981) Prophylactic cefazolin versus placebo en total hip replacement. Lancet 11:795–797

    Article  Google Scholar 

  33. Troy MG, Quan-Sheng Dong, Dobrin PB et al (1996) Do topical antibiotics provide improved prophylaxis against bacterial growth in the presence of polypropylene mesh? Am J Surg 171:391–393

    Article  PubMed  CAS  Google Scholar 

  34. Gurleyik E, Gurleyic G, Cetinkaya F et al (1998) The inflammatory response to open-tension-free inguinal hernioplasty versus conventional repairs. Am J Surg 175:179–182

    Article  PubMed  CAS  Google Scholar 

  35. Musella M, Guido A, Musella S (1998) Collagen tampons as aminoglycoside carriers to reduce postoperative infection rate in prosthetic repair of groin hernia. Eur J Surg 2001 167:130–132

    Google Scholar 

  36. Hopkins CC (1991) Antibiotic prophylaxis in clean surgery, peripheral vascular surgery, non cardiovascular thoracic surgery, herniorrhaphy and mastectomy. Rev Infect Dis 13(supl):869–873

    Google Scholar 

  37. Abramov D, Jeroukhimov I, Yinnon AM (1996) Antibiotic prophylaxis in umbilical and incisional hernia repair. Eur J Surg 162:945–948

    PubMed  CAS  Google Scholar 

  38. Gilbert AI, Felton LL (1993) Infections in inguinal hernia repair considering biomaterials and antibiotics. Surg Gynecol Obstet 177:126–130

    PubMed  CAS  Google Scholar 

  39. Dineen P (1978) Hand-washing de-germen: a comparison of povidone-iodine and chlorhexidine. Clin Pharmacol Ther 23:63–67

    PubMed  CAS  Google Scholar 

  40. Von Bergmann E, von Bruns P, von Mikulicz J (1904) A system of practical surgery. Lea Brothers & Co., New York

    Google Scholar 

  41. Watson-Jones R (1955) Fractures and Joint Injuries, 4th edn. E & S Livingstone Ltd., Edinburgh and London, pp 191–197

    Google Scholar 

  42. Hochberg J, Murray GF (1955) Principles of operative surgery. In: Sabiston DC, Lyerly HK (eds) Textbook of Surgery. The Biological Basis of Modern Surgical Practice. 15th edn 1997. WB Saunders Co.

  43. Rutkow IM (1999) The surgeon’s glove. Arch Surg 134:223–224

    Article  CAS  Google Scholar 

  44. Sohn RL, Murray MT, Franko A (2000) Detection of surgical glove integrity. The AM Surg 66:302–306

    CAS  Google Scholar 

  45. Muto CA, Sistrom MG, Strain BA (2000) Glove leakage rates as a function of latex content and brand. Arch Surg 135:982–985

    Article  CAS  Google Scholar 

  46. Porter KA, O’Connor S, RimmE et al (1998) Electrocautery as a factor in seroma formation following mastectomy. Am J Surg 176:8–11

    Article  PubMed  CAS  Google Scholar 

  47. Onbargi LC, Hayden R, Valle RF et al (1993) Effects of power and electrical current density variations in an in-vitro endometrial ablation model. Obstet Gynecol 82:912–918

    PubMed  CAS  Google Scholar 

  48. Madden JE, Edlich RF, Custer JR et al (1970) Studies in the management of the contaminated wound. IV. Resistance to infection of surgical wounds made by knife, electrosurgery and laser. Am J Surg 119:222–224

    Article  PubMed  CAS  Google Scholar 

  49. Olivar AC, Forouhar FA, Gillies CG et al (1999) Transmission electron microscopy: evaluation of damage in human oviducts caused by different surgical instruments. Ann Clin Lab sci 29:281–285

    PubMed  CAS  Google Scholar 

  50. Deysine M (2004) Post mesh herniorrhaphy control: are we doing all we can? Letter to the editor. Hernia 8:90–91

    Article  PubMed  Google Scholar 

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  1. Winthrop University Hospital, 120 Mineola Avenue, Mineola, NY, 11501, USA

    M. Deysine

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Deysine, M. Infection control in a hernia clinic: 24 year results of aseptic and antiseptic measure implementation in 4,620 “clean cases”. Hernia 10, 25–29 (2006). https://doi.org/10.1007/s10029-005-0028-4

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