May 16, 2012

Medical Pearls: Safety

  • There is a significant interaction between fluconazole and warfarin. Prescribing fluconazole may significantly increase the INR and lead to significant side-effects. Important interactions with warfarin that INCREASE THE INR include:
    • amiodarone
    • azole antifungals
    • metronidazole
    • corticosteroids
    • sulfa and trimethoprim
    • fluoroquinolones
  • Dabigtran [ avoid use with p-glycoprotein inhibitors (e.g. ketoconazole, amiodarone, dronedarone, verapamil, quinidine)], and rivaroxaban [avoid use with e.g. ketoconazole, itraconazole, ritonavir, conivaptan] are anticoagulants used in atrial fibrillation that do not require anticoagulant monitoring 
  • When you touch a surface such as a bed handrail next to a patient, there is about a 50% chance that cultures from your hand will show organisms like MRSA and VRE (Bhalla, 2004)
  • Alcohol based hand rubs (e.g. purell) are more effective in killing bacteria than soap and water
  • Transmission-based precautions:
    • Contact: e.g. MRSA, VRE, C. difficile (wash hands, wear gloves, gowns)
    • Droplet: influenza, RSV (also wear mask)
    • Airborne: TB, measles, chickenpox (also respirator)
  • Purell is not effective against C. difficile, must use soap and water
  • 90% of all blood stream infections are associated with central line catheters. Use a checklist to ensure proper practices are followed when inserting a central line.
  • To help prevent surgical site infections:
    • control blood glucose (HgbA1C to < 7%)
    • encourage smoking cessation > 30 days prior
    • chlorhexidine washes the night before and day of surgery