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Las biopsias en el campo de la ortopedia se utilizan para guiar las opciones de diagnóstico y tratamiento para el proceso de la enfermedad que puede estar ocurriendo. La preparación de la piel de estas biopsias sigue la preparación estándar para un procedimiento quirúrgico, con el objetivo de disminuir la cantidad de microbiota que podría conducir a la contaminación del tejido de la biopsia e incluso a una posible infección. El tejido obtenido de la biopsia a menudo se somete a un studio histopatológico y cultivo. La tasa de contaminación bacteriana informada es aproximadamente inferior al 4%. Esta revisión cuestiona si las muestras de las biopsias se contaminan con la microbiota que permanece en la piel y cómo puede afectar el manejo. Además, qué técnicas o pasos pueden disminuir la tasa de contaminación al realizar una biopsia. Nuestra revisión bibliográfica identificó pocos estudios sobre la contaminación bacteriana de las biopsias. Identificamos diferentes factores implicados en el conocimiento de la microbiota de la piel: técnicas y soluciones de preparación de la piel, variación de la microbiota típica que coloniza la piel según la región anatómica, retención preoperatoria versus administración profiláctica de antibióticos y uso de diferentes hojas de bisturí para la piel superficial y para tejidos profundos, entre otros. Aunque no pudimos identificar ningún dato que proporcionara respuestas a nuestra pregunta original y cuantificar cada factor individualmente, la mayoría de los estudios en diferentes campos ortopédicos proporcionaron hallazgos significativos hasta cierto punto. Describimos algunas recomendaciones prácticas basadas en el consenso y la efectividad teórica para disminuir la tasa de contaminación. Se necesitan más investigaciones en el campo de la ortopedia que impliquen la contaminación por microbiota de la piel de una biopsia

Biopsies in the field of orthopaedics are used to guide diagnostics and treatment options for the disease process that may be occurring such as a tumor or infection. Skin preparation of these biopsies follows the standard skin preparation for a surgical procedure, with the aim to decrease the amount of microbiota that could lead to contamination of the tissue biopsy and even possible infection. The tissue obtained from the biopsy often undergoes pathology and culture. The reported bacterial contamination rate is roughly below 4%. This review questions how samples from the biopsies are getting contaminated by microbiota that remains on the skin and how it affects infection management. In addition, which techniques or steps can decrease the rate of contamination when performing a biopsy. Our review identified little to no data on investigating bacterial contamination of biopsies. In doing this, the review identified different factors implicated in skin microbiota awareness: skin preparation techniques and solutions, variation of typical microbiota that colonize the skin based on the anatomical region, preoperative withholding versus administrating antibiotics prophylactically and using different scalpel blades for superficial and deep incisions, among others. Although we failed to identify any data that provided answers to our original question and quantify each factor individually, most studies in different orthopaedic fields provided significant findings to some extent. We outline some practical recommendations based on consensus and theoretical effectiveness in decreasing the contamination rate. Further research entailing skin microbiota contamination of a biopsy is needed in the field of orthopaedics.

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The challenge of knowing the events surrounding the modern origins of the different specialties of Chilean medicine should be of interest to the specialists of these specialties. Thus, in the case of surgery, fortunately in Chile there are testimonial documents, which reviewed and analyzed can suggest this question, mentioning the one who today is considered the world father of modern surgery, whose important surgical teachings were delivered to Chilean disciples who introduced it in our country. In the context of the War of the Pacific, in the year 1879, a "blood hospital" was built in Santiago, donated by Domingo Matte, a Chilean politician, to receive the many war wounded who were transported from the north. It was Dr. Manuel Barros Borgoño, a young surgeon recently graduated from the Faculty of Medicine in Paris, with a degree revalidated in Chile, who in 1880 took charge of this hospital, and together with his team, began to apply his experience in listerian methods learned in Paris from his teacher Dr. Just Lucas Champonniere. Just Lucas Champonniere, giving beginning to the Chilean antiseptic surgery, managing to reduce the mortality of surgeries to 3%, compared to 80% of other Chilean hospitals that refused to change, and continued with the use of sponge soaked in cerato (lard).

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OBJECTIVE: to compare the use of 0.5% alcoholic chlorhexidine and 70% alcohol in skin antisepsis for neuraxial blocks. METHOD: this is a non-inferiority randomized clinical trial, with two parallel arms. Seventy patients who were candidates for neuraxial block were randomly allocated to group A (n = 35), in whom antisepsis was performed with 0.5% alcoholic chlorhexidine, or to group B (n = 35), in whom we used 70% hydrated ethyl alcohol. Swabs were harvested for culture at three times: before antisepsis, two minutes after application of the antiseptic, and immediately after puncture. The samples were sown in three culture media and the number of colony forming units (CFU) per cm² was counted. RESULTS: there was no difference between the groups regarding age, sex, body mass index, time to perform the block or type of block. There were no differences between groups in the CFU/cm² counts before antisepsis. There was less bacterial growth in group B two minutes after application of the antiseptic (p = 0.048), but there was no difference between the groups regarding the number of CFU/cm² at the end of the puncture. CONCLUSION: 70% alcohol was more effective in reducing the number of CFU/cm² after two minutes, and there was no difference between the two groups regarding skin colonization at the end of the procedure. These results suggest that 70% alcohol may be an option for skin antisepsis before neuraxial blocks. Trial registration: ClinicalTrials.gov, NCT02833376.

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ABSTRACT Objective: to compare the use of 0.5% alcoholic chlorhexidine and 70% alcohol in skin antisepsis for neuraxial blocks. Method: this is a non-inferiority randomized clinical trial, with two parallel arms. Seventy patients who were candidates for neuraxial block were randomly allocated to group A (n = 35), in whom antisepsis was performed with 0.5% alcoholic chlorhexidine, or to group B (n = 35), in whom we used 70% hydrated ethyl alcohol. Swabs were harvested for culture at three times: before antisepsis, two minutes after application of the antiseptic, and immediately after puncture. The samples were sown in three culture media and the number of colony forming units (CFU) per cm² was counted. Results: there was no difference between the groups regarding age, sex, body mass index, time to perform the block or type of block. There were no differences between groups in the CFU/cm² counts before antisepsis. There was less bacterial growth in group B two minutes after application of the antiseptic (p = 0.048), but there was no difference between the groups regarding the number of CFU/cm² at the end of the puncture. Conclusion: 70% alcohol was more effective in reducing the number of CFU/cm² after two minutes, and there was no difference between the two groups regarding skin colonization at the end of the procedure. These results suggest that 70% alcohol may be an option for skin antisepsis before neuraxial blocks. Trial registration: ClinicalTrials.gov, NCT02833376.

RESUMO Objetivo: comparar o uso de solução alcoólica de clorexidina 0,5% e de álcool 70% na antissepsia da pele para bloqueios do neuroeixo. Método: ensaio clínico randomizado de não inferioridade, com dois braços paralelos. Foram selecionados 70 pacientes candidatos à bloqueio do neuroeixo, randomicamente alocados para o grupo A (n=35), em que a antissepsia foi realizada com clorexidina alcoólica 0,5%, ou para o grupo B (n=35), em que se utilizou álcool etílico hidratado 70%. Foram coletadas, com swab, amostras para cultura em três momentos: antes da antissepsia, dois minutos após aplicação do antisséptico, e imediatamente após a punção. As amostras foram semeadas em três meios de cultura e foi contabilizado o número de unidades formadoras de colônias (UFC) por cm². Resultados: não houve diferença entre os grupos quanto à idade, ao sexo, ao índice de massa corporal, ao tempo para realização do bloqueio ou tipo de bloqueio. Também não houve diferenças entre os grupos na contagem de UFC/cm² antes da antissepsia. Constatou-se menor crescimento bacteriano no grupo B dois minutos após aplicação do antisséptico (p=0,048), mas não houve diferença entre os grupos quanto ao número de UFC/cm² ao final da punção. Conclusão: o álcool 70% mostrou-se mais efetivo em reduzir o número de UFC/cm² após dois minutos, e não houve diferença entre os dois grupos quanto à colonização da pele ao final do procedimento. Esses resultados sugerem que o álcool 70% pode ser opção para antissepsia da pele antes de bloqueios do neuroeixo. Registro ensaio clínico: ClinicalTrials.gov, NCT02833376.

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Introduction: This study analyzed dental consultation requests to the division of oral and maxillofacial surgery in a Brazilian tertiary hospital. Methods: A cross-sectional study with data collected retrospectively from inpatients' electronic medical records containing dental consultation requests made between January 2013 and December 2017. Results: 327 consultation requests were analyzed. Mean (SD) patient age was 38.71 (24.4) years; 164 (50.2%) were male and 267 (81.7%) were Caucasian. Regarding systemic conditions, 34 (10.4%) were classified as ASA I, 86 (26.3%) as ASA II, 182 (55.7%) as ASA III, and 25 (7.6%) as ASA IV. Dental consultations were mostly requested by the internal medicine team (n = 42, 12.8%). The most common reason for consultation was septic teeth (n = 131, 40.1%). Complementary tests were required in 188 (57.5%) cases. Surgical intervention was required in 82 (25.0%), with tooth extraction as the most prevalent procedure (20.2%). The most demanding service was inpatient care, with 276 (84.4%) requests. Cases were resolved in 249 (76.1%). Conclusions: The division of oral and maxillofacial surgery in our hospital deals with a great amount of consultations, contributing with surgical procedures to the adequacy of patients' oral health with a high effectiveness rate. Our data illustrate the contribution of dentists in a hospital setting, assisting the medical team in providing comprehensive care for inpatients. (AU)

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The objective of this study was to evaluate and compare the bactericidal efficacy of 2% chlorhexidine surfactant solution + 70% alcohol and 2% chlorhexidine surfactant solution + 0.5% chlorhexidine-alcohol, and standardize skin antisepsis for blood collection from donor dogs. One hundred and twenty skin swabsof the jugular regions of 20 dogs were evaluated. Swabs were distributed into six treatment(T) groups according to the disinfectant used and removal or retention of local hair: T1involved neither antisepsisnorhair removal; T2comprised 2% chlorhexidine + 0.5% chlorhexidine-alcoholwithout hair removal;T3 comprised 2% chlorhexidine + 70% alcohol without hair removal; T4comprised hair removal but no antisepsis;T5comprised 2% chlorhexidine + 0.5% chlorhexidine-alcohol withhair removal; and T6comprised 2% chlorhexidine + 70% alcohol with hair removal. Antiseptic agents were continuously applied in a single direction for a total of 3 min. Use of antiseptics was effective with or without hair removal, resulting in the absence of bacterial growth. Complete efficacy of the technique used in this study may have been due to the increased antiseptic application time. In conclusion,the antisepsis protocols tested in this study can be safely used for the collection of blood from dogs; although,removal of hair prior to antisepsis is still recommended.(AU)

O objetivo deste estudo foi avaliar e comparar o potencial de redução bacteriana proporcionado peloclorexidinadegermante 2% + álcool 70% eclorexidinadegermante 2% + clorexidinaalcoolica 0,5% e padronizar a antissepsia de pele para colheita de sangue de cães doadores. Foram avaliados 120 zaragatoas de pele da região da jugular de 20 cães, que foram distribuídos em seis tratamentos (T) de acordo com oagente usado para desinfecção, associado, ou não, a tricotomia local: T1 - Tratamento sem tricotomia e sem antissepsia, T2 - Tratamento clorexidinadegermante 2% + clorexidinaalcoolica 0,5% sem tricotomia, T3 - Tratamento clorexidina 2% + álcool 70% sem tricotomia, T4 - Tratamento com tricotomia e sem antissepsia, T5 - Tratamento clorexidina 2% + clorexidina alcoólica 0,5% com tricotomia, T6 - Tratamento clorexidina 2% + álcool 70% com tricotomia. A antissepsia foi feita de forma contínua em um único sentido, totalizando 3 minutos. O uso dos antissépticos se mostraram eficazes nos tratamentos com e sem tricotomia não apresentando crescimento bacteriano. A eficácia de 100% da técnica utilizada no presente trabalho pode ser decorrente do maior tempo de antissepsia. Conclui-se que os protocolos de antissepsia realizados neste estudo podem ser utilizados com segurança para a colheita de sangue de cães, embora ainda o recomendado seja a tricotomia antes da antissepsia.(AU)

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The objective of this study was to evaluate and compare the bactericidal efficacy of 2% chlorhexidine surfactant solution + 70% alcohol and 2% chlorhexidine surfactant solution + 0.5% chlorhexidine-alcohol, and standardize skin antisepsis for blood collection from donor dogs. One hundred and twenty skin swabsof the jugular regions of 20 dogs were evaluated. Swabs were distributed into six treatment(T) groups according to the disinfectant used and removal or retention of local hair: T1involved neither antisepsisnorhair removal; T2comprised 2% chlorhexidine + 0.5% chlorhexidine-alcoholwithout hair removal;T3 comprised 2% chlorhexidine + 70% alcohol without hair removal; T4comprised hair removal but no antisepsis;T5comprised 2% chlorhexidine + 0.5% chlorhexidine-alcohol withhair removal; and T6comprised 2% chlorhexidine + 70% alcohol with hair removal. Antiseptic agents were continuously applied in a single direction for a total of 3 min. Use of antiseptics was effective with or without hair removal, resulting in the absence of bacterial growth. Complete efficacy of the technique used in this study may have been due to the increased antiseptic application time. In conclusion,the antisepsis protocols tested in this study can be safely used for the collection of blood from dogs; although,removal of hair prior to antisepsis is still recommended.

O objetivo deste estudo foi avaliar e comparar o potencial de redução bacteriana proporcionado peloclorexidinadegermante 2% + álcool 70% eclorexidinadegermante 2% + clorexidinaalcoolica 0,5% e padronizar a antissepsia de pele para colheita de sangue de cães doadores. Foram avaliados 120 zaragatoas de pele da região da jugular de 20 cães, que foram distribuídos em seis tratamentos (T) de acordo com oagente usado para desinfecção, associado, ou não, a tricotomia local: T1 - Tratamento sem tricotomia e sem antissepsia, T2 - Tratamento clorexidinadegermante 2% + clorexidinaalcoolica 0,5% sem tricotomia, T3 - Tratamento clorexidina 2% + álcool 70% sem tricotomia, T4 - Tratamento com tricotomia e sem antissepsia, T5 - Tratamento clorexidina 2% + clorexidina alcoólica 0,5% com tricotomia, T6 - Tratamento clorexidina 2% + álcool 70% com tricotomia. A antissepsia foi feita de forma contínua em um único sentido, totalizando 3 minutos. O uso dos antissépticos se mostraram eficazes nos tratamentos com e sem tricotomia não apresentando crescimento bacteriano. A eficácia de 100% da técnica utilizada no presente trabalho pode ser decorrente do maior tempo de antissepsia. Conclui-se que os protocolos de antissepsia realizados neste estudo podem ser utilizados com segurança para a colheita de sangue de cães, embora ainda o recomendado seja a tricotomia antes da antissepsia.

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OBJECTIVE: To compare 2 alcohol-based, dual-action skin preparations for surgical site infection (SSI) prevention in elective colorectal surgery. BACKGROUND: Colorectal surgery is associated with the highest SSI rate among elective surgical procedures. Although evidence indicates that alcohol-based skin preparations are superior in SSI prevention, it is not clear if different alcohol-based preparations are equivalent in clean-contaminated colorectal procedures. METHODS: We performed a blinded, randomized, noninferiority trial comparing iodine povacrylex-alcohol (IPA) and chlorhexidine-alcohol for elective, clean-contaminated colorectal surgery. The primary outcome was the presence or absence of SSI, defined as superficial or deep SSI, within 30 days postdischarge. A 6.6% noninferiority margin was chosen. RESULTS: Between January 2011 and January 2015, 802 patients were randomized with 788 patients included in the intent to treat analysis (396 IPA and 392 chlorhexidine-alcohol). The difference in overall SSI rate between IPA (18.7%) and chlorhexidine-alcohol (15.9%) was 2.8% (P = 0.30). The upper bound of the 2.5% confidence interval of this difference was 8.9%, which is greater than the prespecified noninferiority margin of 6.6%. Other endpoints, including individual SSI types, time to SSI diagnosis, and length of stay were not different between the 2 arms. CONCLUSIONS: In patients undergoing elective, clean contaminated colorectal surgery, the use of IPA failed to meet criterion for noninferiority for overall SSI prevention compared with chlorhexidine-alcohol. Photodocumentation of wounds and rigorous tracking of outcomes up to 30 days postdischarge contributed to high fidelity to current standard SSI descriptions and wound classifications.

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Aseptic techniques are those practices designed to reduce the risk of surgical site infection (SSI), defined as such, all those that occur within the first 30 days of the procedure. While the patient’s risk of developing an SSI in dermatologic surgery is low since many of the procedures are considered sterile, there are different factors associated with an increased or decreased risk of developing SSI. The characteristics of the surgical wound (such as involving infected or inflamed tissue or when breaks in the aseptic technique occur), patient characteristics (such as age, comorbidities, medication use and smoking) and procedure factors (such as setting, surgical technique, type of procedure, duration and body region involved). In this article we discuss the management of potential sources of infections such as personnel (hand washing, dressing), preparation of the patient, maintenance of a clean surgical environment, sterilization and the use of antiseptic solutions. Similarly, the current indications for prophylactic antibiotics for these procedures are considered.

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Aseptic techniques are those practices designed to reduce the risk of surgical site infection (SSI), defined as such, all those that occur within the first 30 days of the procedure. While the patient’s risk of developing an SSI in dermatologic surgery is low since many of the procedures are considered sterile, there are different factors associated with an increased or decreased risk of developing SSI. The characteristics of the surgical wound (such as involving infected or inflamed tissue or when breaks in the aseptic technique occur), patient characteristics (such as age, comorbidities, medication use and smoking) and procedure factors (such as setting, surgical technique, type of procedure, duration and body region involved). In this article we discuss the management of potential sources of infections such as personnel (hand washing, dressing), preparation of the patient, maintenance of a clean surgical environment, sterilization and the use of antiseptic solutions. Similarly, the current indications for prophylactic antibiotics for these procedures are considered.

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