The relevance of topical drugs endaural use in otosurgical practice

Introduction. Preoperative, in particular, antiseptic, preparation of the external auditory canal (EAC) is an important issue for the otosurgeon to take in mind, especially with endaural approach.The aim of the study is to assess the skin microbiota of the EAC and the effectiveness of antiseptic treatment before endaural intervention.Materials and methods. A prospective study including 19 patients who underwent ear surgery by endaural approach: 10 stapedoplasty; 9 tympanoplasty. Ear swabs culture were taken from all the patients preoperatively and after removing the tamponade. Of the 10 patients with otosclerosis, 5 underwent skin preparation with 10% povidone iodine and a swab culture.Results. According to the microbiological examination results, Staphulacoccus Auricularis prevailed in the first smear - 52.6%. In 5 patients with otosclerosis, in comparison to the 1st swab: one case with absence of microorganisms growth, in the other 4 -decrease in the degree of contamination by half. In the 3rd swab, there was no growth in these patients and in the rest, who didn't undergo antiseptic preparation. Patients, without antiseptic preparation of the ear canal, after tympanoplasty (9 patients) in the second smear, had an increase of contamination (from 105 to 106 CFU/ml).Conclusions. Analysis of the microbiome before and after the operation revealed the growth of predominantly (94.7%) opportunistic microorganisms. Preoperative antiseptic preparation reduces the degree of contamination of the skin, which, in our opinion, prevents complications and improves the healing process.

776. Reducing Central Line Associated Bloodstream Infections (CLABSI) in a High-Risk Cohort of Patients by Standardizing Skin Preparation Prior to Pulmonary Artery Catheter Insertion

Background Central line associated bloodstream infections (CLABSI) are a recognized complication of all central venous access devices including pulmonary artery catheters (PAC). At our institution, PACs are utilized frequently, often for prolonged durations, for patients with advanced heart failure in the cardiac care unit (CCU) who are awaiting heart transplant. In early summer 2018, our hospital infection prevention (IP) department detected an uptick in CLABSI attributable to the CCU. After 9 months of zero CLABSI, two CLABSIs attributable to the CCU were identified during a 3 month period from November 2017-January 2018. Four additional CLABSIs were identified between May-July 2018 prompting an investigation by IP. Review of the 9 CLABSIs attributed to the CCU from May 2018 – June 2019 led IP to prioritize improving PAC insertion practices in our cardiac catheterization lab as a mean to reducing CLABSI (see table 1). Methods IP performed 5 observations of PAC insertion in the cath lab. During the observations of skin preparation, the prep time was performed correctly 40% of the time, correct application 60% of the time and dry time 60% of the time (see table 2, Figure1). Interventions included scheduling a training day for all cath lab staff with the skin prep vendor, performing competency check-offs, and identifying super-users to train future staff. Furthermore, skin antiseptic utilization according the manufacturer's instructions for use was implemented, the coverage area for the applicator was reviewed and a chart for reference was provided.The staff was provided with posters on correct skin prep technique as a visual cue in the procedure room. Results Since the project was implemented in September 2019, there has been 1 CLABSI identified that was possibly related to a PAC inserted in the cath lab. During this time 3 CLABSIs were identified in the CCU but were felt to be unrelated to cath lab insertion. Conclusion Since the project was implemented in September 2019, there has been 1 CLABSI identified that was possibly related to a PAC inserted in the cath lab. During this time 3 CLABSIs were identified in the CCU but were felt to be unrelated to cath lab insertion. Disclosures All Authors: No reported disclosures

A variable stiffness morphing skin: preparation and properties

In the course of flight, morphing skins play an important role in morphing aircrafts. Shape memory polymer (SMP) with variable stiffness performance is a good candidate material for skin. In this paper, a series of SMP morphing skins were prepared from hydro-epoxy resin (HEP), carboxyl-terminated butadiene acrylonitrile (CTBN) and maleic anhydride (MA). By adjusting molecular weight and content of CTBN, in-plane properties and out-of-plane properties of morphing skins can be adjusted. Due to the in-plane tensile stress acting on the skin during flight, tensile test was carried out to study its in-plane performance. After testing, skin can resist maximum in-plane tensile strength of 63.7 MPa. As for the out-of-plane performance of the skin, shape memory test was studied in this paper. All morphing skins have 100% shape fixity rate (Rf) and fast shape recovery rate (Rr). When toughened by CTBN of 10% of 4000 molecular weight with a mass fraction, the skin can recover its out-of-plane deformed shape in 33s. The SMP skins were proved to be a promising candidate for morphing skins.

Effect of Preoperative Skin Preparation Methods on Sternotomy Surgical Site Infection Rates: A Quasi-Experimental Study

BACKGROUND: A surgical site infection (SSI) reduces patient quality of life, increases morbidity and mortality rates, and increases health care costs. Results of studies comparing the effects of preoperative skin preparations are contradictory. PURPOSE: This study aimed to determine the effect of different preoperative skin preparation methods on the rate of SSIs in patients undergoing sternotomy. METHODS: A quasi-experimental study was conducted among 96 male patients undergoing sternotomy. The control group (CG) (n = 34) received routine care consisting of shaving body hair with a razor blade followed by instructions to take a bath or shower. In the intervention groups, patients received education about SSI prevention and body hair was removed with an electric clipper, followed by bathing with daphne soap containing olive oil (IG-1) (n = 31) or 2% chlorhexidine solution (IG-2) (n = 31). Patient demographic, medical history, surgical, and wound assessment variables were obtained. Potential SSI signs and symptoms were assessed for up to 90 days following surgery. RESULTS: Patient demographic, medical history, and surgical variables did not differ among the 3 groups. Sternal SSI occurred in 10.4% of all study patients; 8.8% of the CG patients, 12.9% of the IG-1 patients, and 9.7% of the IG-2 patients developed an SSI (P > .05). CONCLUSION: There were no significant differences in the rate of sternotomy SSI among the 3 groups. Randomized controlled trials with large samples are needed to compare these methods to determine optimal and affordable preoperative skin preparation methods.

SP3.1.3 Use of a Care Bundle to reduce Surgical Site Infection after Emergency Laparotomy

Aim Surgical Site Infection (SSI) is common after abdominal surgery. A care bundle was introduced to sustainably reduce SSI after elective colorectal surgery. This study aimed to implement an expanded care bundle after emergency laparotomy. Methods Quality improvement methodology was used. SSI was measured by direct assessment of the wound in patients in hospital at 30 days. For discharged patients, the PHE SSI surveillance questionnaire was used to measure patient-reported SSI 30 days post-operatively. The care bundle included: 2% chlorhexidine skin preparation; dual ring wound protectors; triclosan-coated sutures for wound closure; second dose of antibiotics >4 hours, betadine to the wound and glove change before closure. Bundle compliance was measured and fed back to surgical teams. Results Baseline SSI was 13.5% (178 patients) which reduced to 8.5% (118 patients) following bundle introduction. Response rate was 60%. Compliance with antibacterial sutures was measured for patients whose wounds were closed; 10% received negative pressure dressings. Mortality within 30 days was 9%. Length of stay reduced from mean 22.6 to 12.45, median 13.5 to 9 days. Conclusion The care bundle reduced SSI after emergency laparotomy. Measuring SSI is more difficult after emergency surgery due to higher death rate, longer length of stay and use of laparostomy. Other challenges include difficulty using wound protectors for some procedures e.g. adhesiolysis and changing practice from use of skin clips.