human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: We r and omly allocated 50 total knee replacements to scrub teams wearing body-exhaust suits ( BES ) or Rotecno occlusive clothing .  The effectiveness of the clothing was assessed using air and wound bacterial counts . Bacteria were recovered from 62 % of wounds ( 64 % BES , 60 % Rotecno ) . The mean air count was 0.5 CFU/ m3 with BES and 1.0 CFU/m3 with Rotecno ( p = 0.014 ) . The mean wound counts were 14 bacteria/wound with BES and eight bacteria/wound with Rotecno ( p = 0.171 ) . There was no correlation between the air and wound counts ( r = -0.011 , Spearman 's ) . The higher air counts suggest that Rotecno occlusive clothing is less effective than BES , but wounds were equally contaminated with both types of clothing suggesting that at very low levels of air contamination the contribution of bacteria to the wound from the air is irrelevant . Even doubling the air counts from 0.5 to 1.0 CFU/m3 had no detectable effect on the wound . This allows a re assessment to be made of other sources of contamination the effect of which would previously have been overwhelmed by contamination from air An evaluation of the effect of total body exhaust clothing on air and wound contamination was made in an operating theatre with a zonal ventilation system . Sixty-four patients who underwent total hip replacement using the Charnley-Müller prosthesis were studied . The members of the surgical team wore total body exhaust suits ( TBE-suit ) , or conventional theatre clothing ( C-clothing ) at alternate operations . Nearly half of the patients in each group were given prophylactic antibiotics . Both the mean and median values of airborne bacteria in the operating theatre were significantly lower during operations with TBE-suits than with conventional theatre clothing . The lowest number , 4.0 cfu/m3 , was found at the site of the operation wound . Cultures from adhesive drapes showed growth in 46 per cent of the C-group and in 43 per cent of the TBE-group sample s. Wound washouts showed growth in 43 per cent of the C-group and in 10 per cent of the TBE-group sample s. Staphylococcus epidermidis was the most frequently isolated bacteria both from adhesive drapes and from wound washouts . The rate of superficial infections was slightly higher when C-clothing was used . Deep infections were found in one patient in the TBE-group and in two patients in the C-group . None of the infected patients had received prophylactic antibiotics The effect of preoperative whole-body washing with chlorhexidine detergent on the incidence of  postoperative wound infection  was assessed in a  placebo-controlled trial of 1989 patients . Patients bathed or showered with chlorhexidine , placebo , or conventional bar soap , on two occasions in the 24 h before operation . The overall infection rate for patients treated with chlorhexidine was 9 % , against 12.8 % in the bar soap and 11.7 % in the placebo groups ; in the ' clean ' surgery group infections were 7.2 % against 10.2 % and 10 % , respectively . The Staphylococcus aureus infection rate in the ' clean ' group was 3 % for chlorhexidine against 6 % for bar soap Background : The purpose of this study was threefold : ( 1 ) to determine the scientific quality of published r and omized trials in the American Volume of The Journal of Bone and Joint Surgery from 1988 through 2000 , ( 2 ) to identify predictors of study quality , and ( 3 ) to evaluate inter-rater agreement in the scoring of study quality with use of a simple scale . Methods : H and search es of The Journal of Bone and Joint Surgery were conducted in duplicate to identify r and omized clinical trials . Of 2468 studies identified , seventy-two ( 2.9 % ) met all eligibility criteria . Two investigators each assessed the quality of the study under blinded conditions and abstract ed relevant data . Results : The mean score ( and st and ard error ) for the quality of the seventy-two r and omized trials was 68.1 % ± 1.6 % ; 60 % ( forty-three ) scored < 75 % . Drug trials had a significantly higher mean quality score than did surgical trials ( 72.8 % compared with 63.9 % , p < 0.05 ) . Regression analysis revealed that cited affiliation with an epidemiology department and cited funding were associated with higher quality scores . Failure to conceal r and omization , to blind outcome assessors , and to describe why patients were excluded result ed in significantly lower quality scores ( p < 0.05 ) , more than the 5 % decrease expected by removal of each item . A priori calculations of sample size were rarely performed in the review ed studies , and only 2 % of the studies with negative results included a post hoc power analysis . The Detsky quality scale met accepted st and ards of interobserver reliability ( kappa , 0.87 ; 95 % confidence interval , 0.70 to 0.95 ) . Conclusions : Few studies published in The Journal of Bone and Joint Surgery were r and omized trials . More than half of the trials were limited by a lack of concealed r and omization , lack of blinding of outcome assessors , or failure to report reasons for excluding patients . Application of st and ardized guidelines for the reporting of clinical trials in orthopaedics should improve quality The literature is used to analyse the significance of the use of iodine-impregnated incision drape ( Ioban ® 2 ) for the prevention of  postoperative wound infections ( SSI ) .  The drape has a microbiocidal effect in vitro . Consequently an antiseptic effect also occurs under the incision drape when it is applied to the skin ; at the same time , bacterial wound contamination is reduced . Overall , based on the efficacy strength of the antiseptic incision drape , a reduction of the SSI rate can , however , be confirmed only with a large sample size . A meta analysis which evaluated four prospect i ve studies and one retrospective study was able to provide significant confirmation of a reduction in the SSI rate . There are no limitations in terms of the biocompatibility of the iodine-impregnated incision drape BACKGROUND Skin asepsis is a sentinel strategy for reducing risk of  surgical site infections .  In this study , chlorhexidine gluconate ( CHG ) skin concentrations were determined after preoperative showering/skin cleansing using 4 % CHG soap or 2 % CHG-impregnated polyester cloth . STUDY DESIGN Subjects were r and omized to one of three shower ( 4 % soap)/skin cleansing ( 2 % cloth ) groups ( n = 20 per group ) : ( group 1 A/B ) evening , ( group 2 A/B ) morning , or ( group 3 A/B ) evening and morning . After showering or skin cleansing , volunteers returned to the investigator 's laboratory where  CHG skin surface concentrations were determined at five separate skin sites . CHG concentrations were compared with CHG minimal inhibitory concentration that inhibits 90 % ( MIC(90 ) ) of staphylococcal skin isolates . RESULTS CHG MIC(90 ) for 61 skin isolates was 4.8 parts per million ( ppm ) . In group 1A , 4 % CHG skin concentrations ranged from 17.2 to 31.6 ppm , and CHG concentrations were 361.5 to 589.5 ppm ( p < 0.0001 ) in group 1B ( 2 % ) . In group 2A ( 4 % ) , CHG levels ranged from 51.6 to 119.6 ppm and 848.1 to 1,049.6 ppm in group 2B ( 2 % ) , respectively ( p < 0.0001 ) . CHG levels ranged from 101.4 to 149.4 ppm in the 4 % CHG group ( group 3A ) compared with 1,484.6 to 2,031.3 ppm in 2 % CHG cloth ( group 3B ) group ( p < 0.0001 ) . Effective CHG levels were not detected in the 4 % CHG group in selected sites in seven ( 35 % ) subjects in group 1A , three ( 15 % ) in group 2A , and five ( 25 % ) in group 3A . CONCLUSIONS Effective CHG levels were achieved on most skin sites after using 4 % CHG ; gaps in antiseptic coverage were noted at selective sites even after repeated application . Use of the 2 % CHG polyester cloth result ed in considerably higher skin concentrations with no gaps in antiseptic coverage . Effective decolonization of the skin before hospital admission can play an important role in reducing risk of surgical site infections Despite the use of ultraclean air , there are still cases of infection in total joint arthroplasty . One possible route by which bacteria may enter the wound is indirectly by contamination of instruments during skin preparation and draping . We found that bacterial air counts were 4.4 times higher during preparation and draping for hip or knee arthroplasty using an unscrubbed , ungowned leg holder than during the operation itself . With the leg holder scrubbed and gowned during preparation and draping , the air counts were reduced but were still 2.4 fold greater than intraoperatively . On some occasions , the air counts during preparation and draping exceeded the st and ards for ultraclean air irrespective of the attire of the leg holder . We recommend that the leg is held by a scrubbed and gowned member of the team . More importantly , we consider that instrument packs should be opened only after skin preparation and draping have been completed BACKGROUND Previous studies have demonstrated higher infection rates following orthopaedic procedures on the foot and ankle as compared with procedures involving other areas of the body . Previous studies also have documented the difficulty of eliminating bacteria from the forefoot prior to surgery . The purpose of the present study was to evaluate the efficacy of three different surgical skin-preparation solutions in eliminating potential bacterial pathogens from the foot . METHODS A prospect i ve study was undertaken to evaluate 125 consecutive patients undergoing surgery of the foot and ankle . Each lower extremity was prepared with one of three r and omly selected solutions : DuraPrep ( 0.7 % iodine and 74 % isopropyl alcohol ) , Techni-Care ( 3.0 % chloroxylenol ) , or ChloraPrep ( 2 % chlorhexidine gluconate and 70 % isopropyl alcohol ) . After preparation , quantitative culture specimens were obtained from three locations : the hallux nailfold ( the hallux site ) , the web spaces between the second and third and between the fourth and fifth digits ( the toe site ) , and the anterior part of the tibia ( the control site ) . RESULTS In the Techni-Care group , bacteria grew on culture of specimens obtained from 95 % of the hallux sites , 98 % of the toe sites , and 35 % of the control sites . In the DuraPrep group , bacteria grew on culture of specimens obtained from 65 % of the hallux sites , 45 % of the toe sites , and 23 % of the control sites . In the ChloraPrep group , bacteria grew on culture of specimens from 30 % of the hallux sites , 23 % of the toe sites , and 10 % of the control sites . ChloraPrep was the most effective agent for eliminating bacteria from the halluces and the toes ( p < 0.0001 ) . CONCLUSIONS The use of effective preoperative preparation solution is an important step in limiting surgical wound contamination and preventing infection , particularly in foot and ankle surgery . Of the three solutions tested in the present study , the combination of chlorhexidine and alcohol ( ChloraPrep ) was most effective for eliminating bacteria from the forefoot prior to surgery BACKGROUND The actual risk of prosthetic joint infection as a result of dental procedures and the role of antibiotic prophylaxis have not been defined . METHODS To examine the association between dental procedures with or without antibiotic prophylaxis and prosthetic hip or knee infection , a prospect i ve , single-center , case-control study for the period 2001 - 2006 was performed at a 1200-bed tertiary care hospital in Rochester , Minnesota . Case patients were patients hospitalized with total hip or knee infection . Control subjects were patients who underwent a total hip or knee arthroplasty but without a prosthetic joint infection who were hospitalized during the same period on the same orthopedic floor . Data regarding demographic features and potential risk factors were collected . Logistic regression was used to assess the association of variables with the odds of infection . RESULTS A total of 339 case patients and 339 control subjects were enrolled in the study . There was no increased risk of prosthetic hip or knee infection for patients undergoing a high-risk or low-risk dental procedure who were not administered antibiotic prophylaxis ( adjusted odds ratio [ OR ] , 0.8 ; 95 % confidence interval [ CI ] , 0.4 - 1.6 ) , compared with the risk for patients not undergoing a dental procedure ( adjusted OR , 0.6 ; 95 % CI , 0.4 - 1.1 ) respectively . Antibiotic prophylaxis in high-risk or low-risk dental procedures did not decrease the risk of subsequent total hip or knee infection ( adjusted OR , 0.9 [ 95 % CI , 0.5 - 1.6 ] and 1.2 
    Output:
    
agent
Newer infection prevention techniques , such as preoperative antiseptic scrubbing , are affected and may help reduce the infection rate , while traditionally accepted methods of prophylaxis such as laminar-flow operating rooms and body exhaust suits may raise the infection rate
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: We r and omly allocated 50 total knee replacements to scrub teams wearing body-exhaust suits ( BES ) or Rotecno occlusive clothing .  The effectiveness of the clothing was assessed using air and wound bacterial counts . Bacteria were recovered from 62 % of wounds ( 64 % BES , 60 % Rotecno ) . The mean air count was 0.5 CFU/ m3 with BES and 1.0 CFU/m3 with Rotecno ( p = 0.014 ) . The mean wound counts were 14 bacteria/wound with BES and eight bacteria/wound with Rotecno ( p = 0.171 ) . There was no correlation between the air and wound counts ( r = -0.011 , Spearman 's ) . The higher air counts suggest that Rotecno occlusive clothing is less effective than BES , but wounds were equally contaminated with both types of clothing suggesting that at very low levels of air contamination the contribution of bacteria to the wound from the air is irrelevant . Even doubling the air counts from 0.5 to 1.0 CFU/m3 had no detectable effect on the wound . This allows a re assessment to be made of other sources of contamination the effect of which would previously have been overwhelmed by contamination from air An evaluation of the effect of total body exhaust clothing on air and wound contamination was made in an operating theatre with a zonal ventilation system . Sixty-four patients who underwent total hip replacement using the Charnley-Müller prosthesis were studied . The members of the surgical team wore total body exhaust suits ( TBE-suit ) , or conventional theatre clothing ( C-clothing ) at alternate operations . Nearly half of the patients in each group were given prophylactic antibiotics . Both the mean and median values of airborne bacteria in the operating theatre were significantly lower during operations with TBE-suits than with conventional theatre clothing . The lowest number , 4.0 cfu/m3 , was found at the site of the operation wound . Cultures from adhesive drapes showed growth in 46 per cent of the C-group and in 43 per cent of the TBE-group sample s. Wound washouts showed growth in 43 per cent of the C-group and in 10 per cent of the TBE-group sample s. Staphylococcus epidermidis was the most frequently isolated bacteria both from adhesive drapes and from wound washouts . The rate of superficial infections was slightly higher when C-clothing was used . Deep infections were found in one patient in the TBE-group and in two patients in the C-group . None of the infected patients had received prophylactic antibiotics The effect of preoperative whole-body washing with chlorhexidine detergent on the incidence of  postoperative wound infection  was assessed in a  placebo-controlled trial of 1989 patients . Patients bathed or showered with chlorhexidine , placebo , or conventional bar soap , on two occasions in the 24 h before operation . The overall infection rate for patients treated with chlorhexidine was 9 % , against 12.8 % in the bar soap and 11.7 % in the placebo groups ; in the ' clean ' surgery group infections were 7.2 % against 10.2 % and 10 % , respectively . The Staphylococcus aureus infection rate in the ' clean ' group was 3 % for chlorhexidine against 6 % for bar soap Background : The purpose of this study was threefold : ( 1 ) to determine the scientific quality of published r and omized trials in the American Volume of The Journal of Bone and Joint Surgery from 1988 through 2000 , ( 2 ) to identify predictors of study quality , and ( 3 ) to evaluate inter-rater agreement in the scoring of study quality with use of a simple scale . Methods : H and search es of The Journal of Bone and Joint Surgery were conducted in duplicate to identify r and omized clinical trials . Of 2468 studies identified , seventy-two ( 2.9 % ) met all eligibility criteria . Two investigators each assessed the quality of the study under blinded conditions and abstract ed relevant data . Results : The mean score ( and st and ard error ) for the quality of the seventy-two r and omized trials was 68.1 % ± 1.6 % ; 60 % ( forty-three ) scored < 75 % . Drug trials had a significantly higher mean quality score than did surgical trials ( 72.8 % compared with 63.9 % , p < 0.05 ) . Regression analysis revealed that cited affiliation with an epidemiology department and cited funding were associated with higher quality scores . Failure to conceal r and omization , to blind outcome assessors , and to describe why patients were excluded result ed in significantly lower quality scores ( p < 0.05 ) , more than the 5 % decrease expected by removal of each item . A priori calculations of sample size were rarely performed in the review ed studies , and only 2 % of the studies with negative results included a post hoc power analysis . The Detsky quality scale met accepted st and ards of interobserver reliability ( kappa , 0.87 ; 95 % confidence interval , 0.70 to 0.95 ) . Conclusions : Few studies published in The Journal of Bone and Joint Surgery were r and omized trials . More than half of the trials were limited by a lack of concealed r and omization , lack of blinding of outcome assessors , or failure to report reasons for excluding patients . Application of st and ardized guidelines for the reporting of clinical trials in orthopaedics should improve quality The literature is used to analyse the significance of the use of iodine-impregnated incision drape ( Ioban ® 2 ) for the prevention of  postoperative wound infections ( SSI ) .  The drape has a microbiocidal effect in vitro . Consequently an antiseptic effect also occurs under the incision drape when it is applied to the skin ; at the same time , bacterial wound contamination is reduced . Overall , based on the efficacy strength of the antiseptic incision drape , a reduction of the SSI rate can , however , be confirmed only with a large sample size . A meta analysis which evaluated four prospect i ve studies and one retrospective study was able to provide significant confirmation of a reduction in the SSI rate . There are no limitations in terms of the biocompatibility of the iodine-impregnated incision drape BACKGROUND Skin asepsis is a sentinel strategy for reducing risk of  surgical site infections .  In this study , chlorhexidine gluconate ( CHG ) skin concentrations were determined after preoperative showering/skin cleansing using 4 % CHG soap or 2 % CHG-impregnated polyester cloth . STUDY DESIGN Subjects were r and omized to one of three shower ( 4 % soap)/skin cleansing ( 2 % cloth ) groups ( n = 20 per group ) : ( group 1 A/B ) evening , ( group 2 A/B ) morning , or ( group 3 A/B ) evening and morning . After showering or skin cleansing , volunteers returned to the investigator 's laboratory where  CHG skin surface concentrations were determined at five separate skin sites . CHG concentrations were compared with CHG minimal inhibitory concentration that inhibits 90 % ( MIC(90 ) ) of staphylococcal skin isolates . RESULTS CHG MIC(90 ) for 61 skin isolates was 4.8 parts per million ( ppm ) . In group 1A , 4 % CHG skin concentrations ranged from 17.2 to 31.6 ppm , and CHG concentrations were 361.5 to 589.5 ppm ( p < 0.0001 ) in group 1B ( 2 % ) . In group 2A ( 4 % ) , CHG levels ranged from 51.6 to 119.6 ppm and 848.1 to 1,049.6 ppm in group 2B ( 2 % ) , respectively ( p < 0.0001 ) . CHG levels ranged from 101.4 to 149.4 ppm in the 4 % CHG group ( group 3A ) compared with 1,484.6 to 2,031.3 ppm in 2 % CHG cloth ( group 3B ) group ( p < 0.0001 ) . Effective CHG levels were not detected in the 4 % CHG group in selected sites in seven ( 35 % ) subjects in group 1A , three ( 15 % ) in group 2A , and five ( 25 % ) in group 3A . CONCLUSIONS Effective CHG levels were achieved on most skin sites after using 4 % CHG ; gaps in antiseptic coverage were noted at selective sites even after repeated application . Use of the 2 % CHG polyester cloth result ed in considerably higher skin concentrations with no gaps in antiseptic coverage . Effective decolonization of the skin before hospital admission can play an important role in reducing risk of surgical site infections Despite the use of ultraclean air , there are still cases of infection in total joint arthroplasty . One possible route by which bacteria may enter the wound is indirectly by contamination of instruments during skin preparation and draping . We found that bacterial air counts were 4.4 times higher during preparation and draping for hip or knee arthroplasty using an unscrubbed , ungowned leg holder than during the operation itself . With the leg holder scrubbed and gowned during preparation and draping , the air counts were reduced but were still 2.4 fold greater than intraoperatively . On some occasions , the air counts during preparation and draping exceeded the st and ards for ultraclean air irrespective of the attire of the leg holder . We recommend that the leg is held by a scrubbed and gowned member of the team . More importantly , we consider that instrument packs should be opened only after skin preparation and draping have been completed BACKGROUND Previous studies have demonstrated higher infection rates following orthopaedic procedures on the foot and ankle as compared with procedures involving other areas of the body . Previous studies also have documented the difficulty of eliminating bacteria from the forefoot prior to surgery . The purpose of the present study was to evaluate the efficacy of three different surgical skin-preparation solutions in eliminating potential bacterial pathogens from the foot . METHODS A prospect i ve study was undertaken to evaluate 125 consecutive patients undergoing surgery of the foot and ankle . Each lower extremity was prepared with one of three r and omly selected solutions : DuraPrep ( 0.7 % iodine and 74 % isopropyl alcohol ) , Techni-Care ( 3.0 % chloroxylenol ) , or ChloraPrep ( 2 % chlorhexidine gluconate and 70 % isopropyl alcohol ) . After preparation , quantitative culture specimens were obtained from three locations : the hallux nailfold ( the hallux site ) , the web spaces between the second and third and between the fourth and fifth digits ( the toe site ) , and the anterior part of the tibia ( the control site ) . RESULTS In the Techni-Care group , bacteria grew on culture of specimens obtained from 95 % of the hallux sites , 98 % of the toe sites , and 35 % of the control sites . In the DuraPrep group , bacteria grew on culture of specimens obtained from 65 % of the hallux sites , 45 % of the toe sites , and 23 % of the control sites . In the ChloraPrep group , bacteria grew on culture of specimens from 30 % of the hallux sites , 23 % of the toe sites , and 10 % of the control sites . ChloraPrep was the most effective agent for eliminating bacteria from the halluces and the toes ( p < 0.0001 ) . CONCLUSIONS The use of effective preoperative preparation solution is an important step in limiting surgical wound contamination and preventing infection , particularly in foot and ankle surgery . Of the three solutions tested in the present study , the combination of chlorhexidine and alcohol ( ChloraPrep ) was most effective for eliminating bacteria from the forefoot prior to surgery BACKGROUND The actual risk of prosthetic joint infection as a result of dental procedures and the role of antibiotic prophylaxis have not been defined . METHODS To examine the association between dental procedures with or without antibiotic prophylaxis and prosthetic hip or knee infection , a prospect i ve , single-center , case-control study for the period 2001 - 2006 was performed at a 1200-bed tertiary care hospital in Rochester , Minnesota . Case patients were patients hospitalized with total hip or knee infection . Control subjects were patients who underwent a total hip or knee arthroplasty but without a prosthetic joint infection who were hospitalized during the same period on the same orthopedic floor . Data regarding demographic features and potential risk factors were collected . Logistic regression was used to assess the association of variables with the odds of infection . RESULTS A total of 339 case patients and 339 control subjects were enrolled in the study . There was no increased risk of prosthetic hip or knee infection for patients undergoing a high-risk or low-risk dental procedure who were not administered antibiotic prophylaxis ( adjusted odds ratio [ OR ] , 0.8 ; 95 % confidence interval [ CI ] , 0.4 - 1.6 ) , compared with the risk for patients not undergoing a dental procedure ( adjusted OR , 0.6 ; 95 % CI , 0.4 - 1.1 ) respectively . Antibiotic prophylaxis in high-risk or low-risk dental procedures did not decrease the risk of subsequent total hip or knee infection ( adjusted OR , 0.9 [ 95 % CI , 0.5 - 1.6 ] and 1.2 
    Output:
    