In cardiac surgery patients, especially when more than three blood transfusions are required, leukocyte depletion by filtration results in a significant reduction of the postoperative mortality that can only partially be explained by the higher incidence of postoperative infections in the PC group.

The interaction between povidone-iodine, phagocytic cells, and microorganisms was studied. Three preparations of povidone-iodine were investigated: commercially available povidone-iodine solution Betadine, pure high-molecularweight povidone-iodine as used in Betadine, and a low-molecular-weight povidone-iodine. Low concentrations of povidone-iodine (-0.005%) have considerable activity in vitro. The concentrations used clinically (0.1 to 20%) are toxic for granulocytes and monocytes. Leukocytes reduce the in vitro microbicidal activity of povidone-iodine. No differences of any importance were found between the three preparations of povidone-iodine.Povidone-iodine (polyvinylpyrrolidone-iodine) is a potent microbicidal drug. It is used for several purposes: prophylactically for disinfection (3), irrigation of surgical wounds (4, 8), and bladder irrigation in patients with urinary catheters (6) and therapeutically in infections of the peritoneal and pleural cavities (5, 7) and cutaneous candidiasis (9). Thus, povidone-iodine is applied not only to the surface of the body, but also in tissues and body cavities, where its interaction with phagocytic cells can be of importance because these cells are involved in the host defense against infection. Povidone-iodine can influence the function of such cells, since it is known to reduce chemotaxis (2). Since nothing was known about the effect of povidoneiodine on phagocytosis and intracellular killing or about the influence exerted by cells or tissue on the microbicidal activity of povidone-iodine, this quantitative study was performed to investigate possible interactions between povidoneiodine, leukocytes, and microorganisms. MATERIALS AND METHODSThe materials and methods used for preopsonization and the phagocytosis and intracellular killing assay have been described in detail elsewhere (10). Here, only the bactericidal agents are referred to, and the methods are briefly described.Povidone-odine. Betadine. Solutions of Betadine were made by diluting the commercially available Betadine (10o solution of the high-molecular-weight povidone-iodine PVPK30-J in water; Dagra N.V., Diemen, The Netherlands) in phosphate-buffered saline. The available iodine is about 10%6. PVPK30-J. PVPK30-J is a povidone-iodine compound prepared with the high-molecular-weight povidone PVPK30 and iodine. The available iodine in this preparation is 11.2%. Solutions were made by dissolving the substances in phosphate-buffered saline.PVPK17-J. PVPK17-J is prepared with the lowmolecular-weight povidone PVPK17 and iodine. The available iodine in this compound is 11.4%. Solutions were made by dissolving the substance in phosphatebuffered saline.Iodine. Solutions of iodine were made by diluting iodine 1% (wt/vol) in 70%o (vol/vol) ethanol in phosphate-buffered saline.Mkroorganisms. The bacteria used for the study were cultured at 37C overnight in nutrient broth no. 2 (Oxoid Ltd., London, England). Candida albicans was cultured for 5 days at 30°C in nutrient broth no. 2 containing 1% (wt/vol) glucose. After...

BackgroundIndwelling urinary catheters are the main cause of healthcare-associated urinary tract infections. It can be expected that reduction of the use of urinary catheters will lead to decreased numbers of urinary tract infection.MethodsThe efficacy of an intervention programme to improve adherence to recommendations to reduce the use of urethral catheters was studied in a before-after comparison in ten Dutch hospitals. The programme detected barriers and facilitators and each individual facility was supported with developing their own intervention strategy. Outcome was evaluated by the prevalence of catheters, alternatives such as diapers, numbers of urinary tract infections, the percentage of correct indications and the duration of catheterization. The costs of the implementation as well as the catheterization were evaluated.ResultsOf a population of 16,495 hospitalized patients 3335 patients of whom 2943 were evaluable for the study, had a urethral catheter. The prevalence of urethral catheters decreased insignificantly in neurology (OR 0.93; 95% CI 0.77 - 1.13) and internal medicine wards (OR 0.97; 95% CI 0.83 - 1.13), decreased significantly in surgical wards (OR 0.84; 95% CI 0.75 - 0.96), but increased significantly in intensive care (IC) and coronary care (CC) units (OR 1.48; 95% CI 1.01 - 2.17). The use of alternatives was limited and remained so after the intervention. Duration of catheterization decreased insignificantly in IC/CC units (ratio after/before 0.95; 95% CI 0.78 - 1.16) and neurology (ratio 0.97; 95% CI 0.80 - 1.18) and significantly in internal medicine (ratio 0.81; 95% CI 0.69 - 0.96) and surgery wards (ratio 0.80; 95% CI 0.71 - 0.90). The percentage of correct indications on the day of inclusion increased from 50 to 67% (p < 0.0001). The prevalence of urinary tract infections in catheterized patients did not change. The mean cost saved per 100 patients was € 537.ConclusionTargeted implementation of recommendations from an existing guideline can lead to better adherence and cost savings. Especially, hospitals which use a lot of urethral catheters or where catheterization is prolonged, can expect important improvements.

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