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      The need for maximal sterile barrier precaution in routine interventional coronary procedures; microbiology analysis

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          Abstract

          Background

          Maximal sterile barrier precautions (MSBP) including head coverings and face masks are advocated for use in invasive procedures, including coronary interventions. The rationale for MSBP assumes it is an obligatory measure for infection prevention. However, in many coronary catheterization laboratories, head coverings/face masks are not used in daily practice. This study prospectively evaluated the potential hazards of not routinely using head coverings/face masks in routine coronary interventions.

          Methods

          This is a prospective study of ambulatory patients in hospital care. A total of 110 successive elective patients undergoing cardiac catheterizations were recruited. Patients were catheterized by several interventional cardiologists who employed only routine infection control precautions without head coverings or face masks. For each patient, we took blood cultures and cultures from the tips of the coronary catheters and from the sterile saline water flush bowl. Cultures were handled and analyzed at our certified hospital microbiology laboratory.

          Results

          In none of the cultures was a clinically significant bacterial growth isolated. No signs of infection were reported later by any of the study patients and there were no relevant subsequent admissions.

          Conclusion

          Operating in the catheterization lab without head coverings/face masks was not associated with any bacterial infection in multiple blood and equipment cultures. Accordingly, we believe that the use of head coverings/face masks should not be an obligatory requirement and may be used at the interventional cardiologist’s discretion.

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          Most cited references 12

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          Coagulase-negative staphylococci.

          The definition of the heterogeneous group of coagulase-negative staphylococci (CoNS) is still based on diagnostic procedures that fulfill the clinical need to differentiate between Staphylococcus aureus and those staphylococci classified historically as being less or nonpathogenic. Due to patient- and procedure-related changes, CoNS now represent one of the major nosocomial pathogens, with S. epidermidis and S. haemolyticus being the most significant species. They account substantially for foreign body-related infections and infections in preterm newborns. While S. saprophyticus has been associated with acute urethritis, S. lugdunensis has a unique status, in some aspects resembling S. aureus in causing infectious endocarditis. In addition to CoNS found as food-associated saprophytes, many other CoNS species colonize the skin and mucous membranes of humans and animals and are less frequently involved in clinically manifested infections. This blurred gradation in terms of pathogenicity is reflected by species- and strain-specific virulence factors and the development of different host-defending strategies. Clearly, CoNS possess fewer virulence properties than S. aureus, with a respectively different disease spectrum. In this regard, host susceptibility is much more important. Therapeutically, CoNS are challenging due to the large proportion of methicillin-resistant strains and increasing numbers of isolates with less susceptibility to glycopeptides.
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            Guideline for Hand Hygiene in Health-Care Settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force.

            The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health-care settings. In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission of pathogenic microorganisms to patients and personnel in health-care settings. This report reviews studies published since the 1985 CDC guideline (Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231-43) and the 1995 APIC guideline (Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251-69) were issued and provides an in-depth review of hand-hygiene practices of HCWs, levels of adherence of personnel to recommended handwashing practices, and factors adversely affecting adherence. New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.
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              Summary of recommendations: Guidelines for the Prevention of Intravascular Catheter-related Infections.

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                Author and article information

                Contributors
                +972-4-665-2322 , aperetz@poria.health.gov.il
                fkuzniec@poria.health.gov.il
                dganem@poria.health.gov.il
                Nsalman@poria.health.gov.il
                Dqarawani@poria.health.gov.il
                Oamir@poria.health.gov.il
                Journal
                Eur J Med Res
                Eur. J. Med. Res
                European Journal of Medical Research
                BioMed Central (London )
                0949-2321
                2047-783X
                10 November 2016
                10 November 2016
                2016
                : 21
                Affiliations
                [1 ]Clinical Microbiology Laboratory, Baruch Padeh Medical Center, Tiberias, Israel
                [2 ]Faculty of Medicine in the Galilee, Bar Ilan University, Zefat, Israel
                [3 ]Cardio-Vascular Institute, Baruch Padeh Medical Center, Poriya, Tiberias, Israel
                Article
                239
                10.1186/s40001-016-0239-4
                5103405
                © The Author(s) 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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                Research
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                © The Author(s) 2016

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