Medicina intensiva
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Hygiene and skin care of patients admitted to the Intensive Care Unit (ICU) are part of basic care. For some years there has been evidence of skin colonization by multiresistant gramnegative and grampositive pathogens. ⋯ This article reviews the current situation of this strategy, as well as the positioning of the authors in relation to the spreading of its use in ICUs. This article is part of a supplement entitled "Antisepsis in the critical patient", which is sponsored by Becton Dickinson.
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Surgical wound infection is one of the main complications of patients undergoing surgery and has significant clinical and economical consequences, especially when it affects prosthetic implants or is caused by multidrug resistant bacteria. Cutaneous preparation is one of the main preventive measures. ⋯ Regarding preparation of the incision area and surrounding zone, the use of an alcohol-based antiseptic is generally advised, preferably alcoholic chlorhexidine, due to its high antibacterial activity and prolonged residual effect, respecting the evaporation drying time. This article is part of a supplement entitled "Antisepsis in the critical patient", which is sponsored by Becton Dickinson.
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Blood cultures are the gold standard for the etiological diagnosis of bacteremia, though false-positive results are relatively frequent primarily due to contamination from skin flora during sample extraction. Correct skin antisepsis is important for reducing the bacterial load and opportunities for contamination. ⋯ Some authors even suggest that the chosen antiseptic is irrelevant to the contamination rate, provided the blood culture extraction method is adequate and is performed by a trained professional. This article is part of a supplement entitled "Antisepsis in the critical patient", which is sponsored by Becton Dickinson.
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Skin antisepsis in invasive procedures aims to reduce the bacterial load at the site of incision or puncture. Alcohol solutions seem to be more effective in preventing surgical site infection. ⋯ Given the potential neurotoxicity of alcohol and chlorhexidine gluconate, contact of antiseptic solutions with the central nervous system should be avoided. This article is part of a supplement entitled "Antisepsis in the critical patient", which is sponsored by Becton Dickinson.
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The series of updates on methodology for research in critically ill patients has addressed the difficulties caused by the characteristics of patients of this kind, bioethics, the interpretation of results, and methodological error. New statistical methods for causality research, meta-analysis and big data analysis have also been described. ⋯ We close the series with the hope of having provided a global vision of the statistical methods oriented toward the future, with the aim of promoting statistical culture. In parallel, we have analyzed the evolution in complexity of the methodological analysis in the journal.