The Experts below are selected from a list of 132 Experts worldwide ranked by ideXlab platform
Timothy L Mcauliffe - One of the best experts on this subject based on the ideXlab platform.
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a randomized trial comparing povidone iodine to a chlorhexidine gluconate impregnated Dressing for prevention of central venous catheter infections in neonates
Pediatrics, 2001Co-Authors: Jeffery S Garland, Colleen P Alex, Chris D Mueller, Dewey Otten, Chandra Shivpuri, Mary Catherine Harris, Mary Naples, James Pellegrini, Rosanne K Buck, Timothy L McauliffeAbstract:Neonates who require a central venous catheter (CVC) for prolonged vascular access experience high rates of catheter-related bloodstream infection (CRBSI). Purpose. A multicenter randomized clinical trial was undertaken to ascertain the efficacy of a novel chlorhexidine-impregnated Dressing (Biopatch Antimicrobial Dressing) on the CVC sites of neonates for the prevention of catheter tip colonization, CRBSI, and bloodstream infection (BSI) without a source. Setting. Six level III neonatal intensive care units. Patients Studied. Neonates admitted to study units who would require a CVC for at least 48 hours. Methods. Eligible infants were randomized before catheter placement to 1 of the 2 catheter site antisepsis regimens: 1) 10% povidone-iodine (PI) skin scrub, or 2) a 70% alcohol scrub followed by placement of a chlorhexidine-impregnated disk over the catheter insertion site. A transparent polyurethane Dressing (Bioclusive Transparent Dressing) was used to cover the insertion site in both study groups. Primary study outcomes evaluated were catheter tip colonization, CRBSI, and BSI without an identified source. Results. Seven hundred five neonates were enrolled in the trial, 335 randomized to receive the chlorhexidine Dressing and 370 to skin disinfection with PI (controls). Neonates randomized to the Antimicrobial Dressing group were less likely to have colonized CVC tips than control neonates (15.0% vs 24.0%, relative risk [RR]: 0.6 95% confidence interval [CI]: 0.5–0.9). Rates of CRBSI (3.8% vs 3.2%, RR: 1.2, CI: 0.5–2.7) and BSI without a source (15.2% vs 14.3%, RR: 1.1, CI: 0.8–1.5) did not differ between the 2 groups. Localized contact dermatitis from the Antimicrobial Dressing, requiring crossover into the PI treatment group, occurred in 15 (15.3%) of 98 exposed neonates weighing ≤1000 g. No neonates in the PI group developed contact dermatitis. Conclusion. The novel chlorhexidine-impregnated Dressing, replaced weekly, was as effective as cutaneous disinfection with 10% PI and reDressing the site every 3 to 7 days for preventing CRBSI and BSI without a source in critically ill neonates requiring prolonged central venous access. The risk of local contact dermatitis under the chlorhexidine Dressing limits its use in low birth weight infants who require prolonged central access during the first 2 weeks of life.
Jeffery S Garland - One of the best experts on this subject based on the ideXlab platform.
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a randomized trial comparing povidone iodine to a chlorhexidine gluconate impregnated Dressing for prevention of central venous catheter infections in neonates
Pediatrics, 2001Co-Authors: Jeffery S Garland, Colleen P Alex, Chris D Mueller, Dewey Otten, Chandra Shivpuri, Mary Catherine Harris, Mary Naples, James Pellegrini, Rosanne K Buck, Timothy L McauliffeAbstract:Neonates who require a central venous catheter (CVC) for prolonged vascular access experience high rates of catheter-related bloodstream infection (CRBSI). Purpose. A multicenter randomized clinical trial was undertaken to ascertain the efficacy of a novel chlorhexidine-impregnated Dressing (Biopatch Antimicrobial Dressing) on the CVC sites of neonates for the prevention of catheter tip colonization, CRBSI, and bloodstream infection (BSI) without a source. Setting. Six level III neonatal intensive care units. Patients Studied. Neonates admitted to study units who would require a CVC for at least 48 hours. Methods. Eligible infants were randomized before catheter placement to 1 of the 2 catheter site antisepsis regimens: 1) 10% povidone-iodine (PI) skin scrub, or 2) a 70% alcohol scrub followed by placement of a chlorhexidine-impregnated disk over the catheter insertion site. A transparent polyurethane Dressing (Bioclusive Transparent Dressing) was used to cover the insertion site in both study groups. Primary study outcomes evaluated were catheter tip colonization, CRBSI, and BSI without an identified source. Results. Seven hundred five neonates were enrolled in the trial, 335 randomized to receive the chlorhexidine Dressing and 370 to skin disinfection with PI (controls). Neonates randomized to the Antimicrobial Dressing group were less likely to have colonized CVC tips than control neonates (15.0% vs 24.0%, relative risk [RR]: 0.6 95% confidence interval [CI]: 0.5–0.9). Rates of CRBSI (3.8% vs 3.2%, RR: 1.2, CI: 0.5–2.7) and BSI without a source (15.2% vs 14.3%, RR: 1.1, CI: 0.8–1.5) did not differ between the 2 groups. Localized contact dermatitis from the Antimicrobial Dressing, requiring crossover into the PI treatment group, occurred in 15 (15.3%) of 98 exposed neonates weighing ≤1000 g. No neonates in the PI group developed contact dermatitis. Conclusion. The novel chlorhexidine-impregnated Dressing, replaced weekly, was as effective as cutaneous disinfection with 10% PI and reDressing the site every 3 to 7 days for preventing CRBSI and BSI without a source in critically ill neonates requiring prolonged central venous access. The risk of local contact dermatitis under the chlorhexidine Dressing limits its use in low birth weight infants who require prolonged central access during the first 2 weeks of life.
Peter Vowden - One of the best experts on this subject based on the ideXlab platform.
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diabetic foot ulcer management in clinical practice in the uk costs and outcomes
International Wound Journal, 2018Co-Authors: Julian F Guest, Graham W Fuller, Peter VowdenAbstract:: The aim of this study was to estimate the patterns of care and annual levels of health care resource use attributable to managing diabetic foot ulcers (DFUs) in clinical practice by the UK's National Health Service (NHS), and the associated costs of patient management. This was a retrospective cohort analysis of the records of 130 patients with a newly diagnosed DFU in The Health Improvement Network (THIN) database. Patients' characteristics, wound-related health outcomes and health care resource use were quantified, and the total NHS cost of patient management was estimated at 2015-2016 prices. Patients were predominantly managed in the community by nurses, with minimal clinical involvement of specialist physicians. 5% of patients saw a podiatrist, and 5% received a pressure-offloading device. Additionally, 17% of patients had at least one amputation within the first 12 months from initial presentation of their DFU. 14% of DFUs were documented as being clinically infected at initial presentation, although an additional 31% of patients were prescribed an Antimicrobial Dressing at the time of presentation. Of all the DFUs, 35% healed within 12 months, and the mean time to healing was 4·4 months. Over the study period, 48% of all patients received at least one prescription for a compression system, but significantly more patients healed if they never received compression (67% versus 16%; P < 0·001). The mean NHS cost of wound care over 12 months was an estimated £7800 per DFU (of which 13% was attributable to amputations), ranging from £2140 to £8800 per healed and unhealed DFU, respectively, and £16 900 per amputated wound. Consolidated medical records from a primary care held database provided 'real-world evidence' highlighting the consequences of inefficient and inadequate management of DFUs in clinical practice in the UK. Clinical and economic benefits to both patients and the NHS could accrue from strategies that focus on (i) wound prevention, (ii) improving wound-healing rates and (iii) reducing infection and amputation rates.
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the prevalence management equipment provision and outcome for patients with pressure ulceration identified in a wound care survey within one english health care district
Journal of Tissue Viability, 2009Co-Authors: Kath Vowden, Peter Vowden, Peter VowdenAbstract:The prevalence of pressure ulceration within the population receiving health care in Bradford, UK was 0.74 people with a pressure ulcer per 1000 population (95% CI 0.6-0.8). This prevalence includes a number of tertiary referrals and if these are removed the prevalence falls to 0.71 people with a pressure ulcer per 1000 population. Of the pressure ulcers encountered 195 (53.7%) were classed as grade 2 pressure ulcers with 80 grade 3 wounds and 40 grade 4 pressure ulcers. Forty-eight pressure ulcers were identified as grade 1 wounds but the accuracy of this classification may be in doubt given that 24 apparent grade 1 pressure ulcers were reported to have visible wound beds with common reports of slough and granulation tissue. Severe pressure ulcers differed from less severe partial thickness wounds--grade 3 and 4 pressure ulcers tended to be larger, of longer duration, with greater coverage of the wound bed with necrotic tissue and less granulation and epithelial tissue. Wound exudate was heavier where people presented with severe pressure ulcers while there was a greater probability of wound infection (37.5% of grade 4 pressure ulcers were infected). Given these challenges it was perhaps unsurprising that people with severe pressure ulcers were more likely to have been risk assessed, to have had a critical incident form completed (although only 35% of grade 4 pressure ulcers were identified as having been reported on a critical incident form), to be provided with a powered PR mattress in bed and to be dressed with an Antimicrobial Dressing. The time to treat each severe pressure ulcer tended to be longer than was the treatment times for less severe wounds. Only 40 people with pressure ulcers (11%) as their most serious wound were located in hospital, suggesting that current pressure ulcer epidemiology and costs may be understated given their reliance on previous hospital based surveys of pressure ulcers. Another potential confounder of pressure ulcer epidemiological studies may be the number of nursing home beds in the surveyed population. On breaking down the Bradford audit data by postcode the pressure ulcer prevalence ranged between 0.13 and 1.39 people with a pressure ulcer per 1000 population with the higher prevalence proportions found in postcodes with large numbers of nursing home beds. It would appear to be prudent to record the number of nursing home beds within community based populations where pressure ulcers (and potentially other wounds) are being recorded.
Aquacel Ag Surgical - One of the best experts on this subject based on the ideXlab platform.
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randomised clinical trial of hydrofiber Dressing with silver versus povidone iodine gauze in the management of open surgical and traumatic wounds
International Wound Journal, 2007Co-Authors: Florent Jurczak, Thierry Dugre, Alison Johnstone, Theodor Offori, Zorica Vujovic, Dirk A Hollander, Aquacel Ag SurgicalAbstract:This prospective, randomised clinical trial compared pain, comfort, exudate management, wound healing and safety with Hydrofiber Dressing with ionic silver (Hydrofiber Ag Dressing) and with povidone-iodine gauze for the treatment of open surgical and traumatic wounds. Patients were treated with Hydrofiber Ag Dressing or povidone-iodine gauze for up to 2 weeks. Pain severity was measured with a 10-cm visual analogue scale (VAS). Other parameters were assessed clinically with various scales. Pain VAS scores decreased during Dressing removal in both groups, and decreased while the Dressing was in place in the Hydrofiber Ag Dressing group (n = 35) but not in the povidone-iodine gauze group (n = 32). Pain VAS scores were similar between treatment groups. At final evaluation, Hydrofiber Ag Dressing was significantly better than povidone-iodine gauze for overall ability to manage pain (P < 0.001), overall comfort (P < or = 0.001), wound trauma on Dressing removal (P = 0.001), exudate handling (P < 0.001) and ease of use (P < or = 0.001). Rates of complete healing at study completion were 23% for Hydrofiber Ag Dressing and 9% for povidone-iodine gauze (P = ns). No adverse events were reported with Hydrofiber Ag Dressing; one subject discontinued povidone-iodine gauze due to adverse skin reaction. Hydrofiber Ag Dressing supported wound healing and reduced overall pain compared with povidone-iodine gauze in the treatment of open surgical wounds requiring an Antimicrobial Dressing.
Jean-françois Timsit - One of the best experts on this subject based on the ideXlab platform.
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Cost-Effectiveness Analysis of a Transparent Antimicrobial Dressing for Managing Central Venous and Arterial Catheters in Intensive Care Units
PloS one, 2015Co-Authors: Franck Maunoury, Anastasiia Motrunich, Maria Palka-santini, Stéphanie F. Bernatchez, Stéphane Ruckly, Jean-françois TimsitAbstract:Objective To model the cost-effectiveness impact of routine use of an Antimicrobial chlorhexidine gluconate-containing securement Dressing compared to non-Antimicrobial transparent Dressings for the protection of central vascular lines in intensive care unit patients. Design This study uses a novel health economic model to estimate the cost-effectiveness of using the chlorhexidine gluconate Dressing versus transparent Dressings in a French intensive care unit scenario. The 30-day time non-homogeneous markovian model comprises eight health states. The probabilities of events derive from a multicentre (12 French intensive care units) randomized controlled trial. 1,000 Monte Carlo simulations of 1,000 patients per Dressing strategy are used for probabilistic sensitivity analysis and 95% confidence intervals calculations. The outcome is the number of catheter-related bloodstream infections avoided. Costs of intensive care unit stay are based on a recent French multicentre study and the cost-effectiveness criterion is the cost per catheter-related bloodstream infections avoided. The incremental net monetary benefit per patient is also estimated. Patients 1000 patients per group simulated based on the source randomized controlled trial involving 1,879 adults expected to require intravascular catheterization for 48 hours. Intervention Chlorhexidine Gluconate-containing securement Dressing compared to non-Antimicrobial transparent Dressings. Results The chlorhexidine gluconate Dressing prevents 11.8 infections /1,000 patients (95% confidence interval: [3.85; 19.64]) with a number needed to treat of 85 patients. The mean cost difference per patient of €141 is not statistically significant (95% confidence interval: [€-975; €1,258]). The incremental cost-effectiveness ratio is of €12,046 per catheter-related bloodstream infection prevented, and the incremental net monetary benefit per patient is of €344.88. Conclusions According to the base case scenario, the chlorhexidine gluconate Dressing is more cost-effective than the reference Dressing. Trial Registration This model is based on the data from the RCT registered with www.clinicaltrials.gov (NCT01189682).