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Brindle T. Horizontal approaches to infection prevention: daily chlorhexidine gluconate bathing. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:502-507. [PMID: 37289709 DOI: 10.12968/bjon.2023.32.11.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Healthcare-associated infections (HAIs) pose a significant challenge in hospitals. Infection control strategies have been widely employed to mitigate their incidence. In hospitals, chlorhexidine gluconate (CHG) solutions are commonly used as antiseptic skin cleansers as part of comprehensive infection prevention bundles, with daily CHG bathing being highly effective in reducing HAIs and lowering skin micro-organism density. This evidence review addresses the challenges of risk stratification in implementing CHG bathing protocols in hospitals. It highlights the benefits of a horizontal approach, where CHG bathing is implemented across the entire facility rather than being limited to specific patient populations. Evidence from systematic reviews and studies suggests that CHG bathing consistently reduces HAI rates in both intensive care unit (ICU) and non-ICU settings, supporting the adoption of a hospital-wide approach. The findings emphasise the significance of incorporating CHG bathing as part of a comprehensive approach to infection prevention in hospitals and highlight the potential for cost savings.
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Affiliation(s)
- Tod Brindle
- Global Surgical Medical Director, Mölnlycke Health Care
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Changjun C, Xin Z, Yue L, Liyile C, Pengde K. Key Elements of Enhanced Recovery after Total Joint Arthroplasty: A Reanalysis of the Enhanced Recovery after Surgery Guidelines. Orthop Surg 2023; 15:671-678. [PMID: 36597677 PMCID: PMC9977593 DOI: 10.1111/os.13623] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 11/03/2022] [Accepted: 11/14/2022] [Indexed: 01/05/2023] Open
Abstract
Recent guidelines have produced a consensus statement for perioperative care in hip and knee replacement. However, there is still a need for reanalysis of the evidence and recommendations. Therefore, we retrieved and reanalyzed the evidence of each recommended components of enhanced recovery after surgery (ERAS) based on the guidelines of total joint arthroplasty. For each one, we included for the highest levels of evidence and those systematic reviews and meta-analyses were preferred. The full texts were analyzed and the evidence of all components were summarized. We found that most of the recommended components of ERAS are supported by evidence, however, the implementation details of each recommended components need to be further optimized. Therefore, implementation of a full ERAS program may maximize the benefits of our clinical practice but this combined effect still needs to be further determined.
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Affiliation(s)
- Chen Changjun
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, China; Department of Orthopedics, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Zhao Xin
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, China; Department of Orthopedics, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.,Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Luo Yue
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, China; Department of Orthopedics, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Chen Liyile
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, China; Department of Orthopedics, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Kang Pengde
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, China; Department of Orthopedics, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
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Dai W, Fang F. Pre-Admission Use of Chlorhexidine-Impregnated Gauze for Skin Preparation Reduces the Incidence of Peri-Prosthetic Joint Infection after Primary Total Knee Arthroplasty: A Prospective Cohort with Retrospective Controls. Surg Infect (Larchmt) 2022; 23:717-721. [PMID: 36067078 DOI: 10.1089/sur.2022.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Peri-prosthetic joint infection (PJI) has long been a devastating complication after total knee arthroplasty (TKA), with native skin flora always identified as the causative agents. The aim of this study was to investigate the efficacy of pre-admission use of chlorhexidine-impregnated gauze for pre-operative skin preparation on infection rates after primary TKA surgeries. Patients and Methods: Patients undergoing TKAs performed from January 2017 until January 2021 were prospectively recruited. The experimental group included patients who used chlorhexidine-impregnated gauze the evening before surgery for skin preparation. These patients were compared with a retrospective cohort of TKAs performed during the previous four years without this step as control group. During a one-year follow-up, complications including PJI and superficial infections were collected as the primary outcomes for analysis. Results: A total of 1,218 TKAs in the experimental group and 1,033 TKAs in the control group were included in the study. A total of seven (0.6%) cases of PJI were identified in the experimental group, whereas 16 (1.5%) cases were diagnosed in the control group; a significant difference was detected (χ2 = 5.245; p = 0.022). Eighteen (1.5%) cases of superficial infection were identified in the experimental group, and 28 (2.7%) cases were observed in the control group; a significant difference was found between groups (χ2 = 4.243; p = 0.039). No significant differences were found on other wound-related complications. Conclusions: Pre-admission use of chlorhexidine-impregnated gauze for skin preparation was found to be an effective practice in reducing the incidence of PJI after TKA procedures, which has the potential of being utilized for patients undergoing TKA surgeries.
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Affiliation(s)
- Wei Dai
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Orthopedic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fang Fang
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Medina Garzón M, Castaño Plata MC, Moreno Herrera CC. Preparación de la piel para la prevención de la Infección del Sitio Operatorio: Revisión de Alcance. REVISTA CUIDARTE 2021. [DOI: 10.15649/cuidarte.1054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introducción: La Infección del sitio operatorio genera un impacto económico y social debido a los altos costos durante la recuperación, la estancia hospitalaria y la afectación de la calidad de vida, por esto, es necesario identificar las intervenciones y recomendaciones para la preparación de la piel, encaminadas a la prevención de la infección del sitio operatorio, basado en la evidencia científica. Materiales y Métodos: Se realizó una revisión sistemática de alcance en el marco del Instituto Joanna Briggs y los parámetros Prisma-P. En las bases de datos Medline, OVID, Pubmed, Scielo, BVS y Cochrane, publicadas entre los años 2010–2019, en los idiomas inglés, portuges y español. Resultados: Se analizaron 28 artículos. De estos, se identificaron 6 de la categoría general incluidas las guías de prevención de infección del sitio operatorio, 6 para el baño preoperatorio, 6 para la realización del rasurado y 10 de asepsia y antisepsia. Discusión: Con respecto al baño preoperatorio, es una práctica recomendada internacionalmente, la evidencia demuestra que esta actividad no representa ningún beneficio; en la categoría de rasurado, la recomendación es no remover el vello a menos que sea absolutamente necesario. Frente a la asepsia del sitio quirúrgico, el aporte es más que todo informativo acerca de los antisépticos y se recomienda el uso de la clorhexidina. Conclusiones: De acuerdo a la revisión sistemática de alcance de la literatura, no se evidencia una estandarización en las recomendaciones e intervenciones, para la preparación de la piel en la prevención de Infección del Sitio Operatorio.
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Rodriguez-Merchan EC, Liddle AD. Prevention of Periprosthetic Joint Infection in Total Knee Arthroplasty: Main Studies Reported Between November 2017 and January 2020. THE ARCHIVES OF BONE AND JOINT SURGERY 2020; 8:465-469. [PMID: 32884967 DOI: 10.22038/abjs.2020.48489.2403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Scallan RM, Gerathy S, Price J, Lazarus AM, Metter EJ, Talbot LA. Preoperative Chlorhexidine Gluconate Bathing on a Military Medical-Surgical Unit. Mil Med 2020; 185:15-20. [PMID: 32561930 DOI: 10.1093/milmed/usz186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION AND SCOPE OF THE PROBLEM Surgical site infections (SSIs) are associated with increased length of hospital stays, poor patient outcomes, and increased health care costs making prevention of SSI a high priority for the U.S. Military Health Care System. The focus of this project was to develop and pilot a preoperative antiseptic bathing regimen on an inpatient medical-surgical telemetry unit using 4% chlorhexidine gluconate (CHG), and to compare SSI rates with this new protocol to previous SSI rates on the unit. MATERIALS AND METHODS A literature review guided the development of the protocol and clinical question. A unit project was conducted using SSI rates from an inpatient military medical-surgical telemetry unit over 4 yr. From 2014 to 2016, 3 yr before implementing the protocol, a non-standardized CHG scrub was compared to 12 mo after implementing the standardized 4% CHG protocol in 2017 using up to four daily washings (three evenings and one morning surgery) on inpatient admissions to the unit. SSI rates were compared. RESULTS After implementing a 4-d preoperative bathing regimen with 4% CHG for patients scheduled for surgery, SSI rates decreased from an average rate of 0.0072 infections (7.2 infections per 1,000 surgeries) to 0.0035 infections (3.5 infections per 1,000 surgeries) in the subsequent year of data collection. Although not a statistically significant change, further analysis using a Bayesian Poisson regression model found an 84% probability the new protocol would lower SSI rate by 1 or more cases per 1,000 surgeries on this inpatient unit. CONCLUSION The findings suggest the proposed approach to control infection that may reduce the number of SSIs on a military medical-surgical unit, but this needs to be demonstrated through further longitudinal research on military surgical units.
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Affiliation(s)
- Ross M Scallan
- Department of Nursing, Surgical Section, San Antonio Military Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234
| | - Stephanie Gerathy
- Department of Nursing, Surgical Section, San Antonio Military Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234
| | - Joyce Price
- Department of Nursing, Surgical Section, San Antonio Military Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234
| | - Ann Marie Lazarus
- Department of Nursing, Center for Nursing Science & Clinical Inquiry, San Antonio Military Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234
| | - E Jeffrey Metter
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, 855 Monroe Avenue, Suite 415, Memphis, TN 38163
| | - Laura A Talbot
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, 855 Monroe Avenue, Suite 415, Memphis, TN 38163
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Analysis of chlorhexidine gluconate in skin using tape stripping and ultrahigh-performance liquid chromatography-tandem mass spectrometry. J Pharm Biomed Anal 2020; 183:113111. [PMID: 32062012 DOI: 10.1016/j.jpba.2020.113111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 01/09/2020] [Accepted: 01/14/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Topical chlorhexidine gluconate (CHG) is used widely to reduce healthcare-associated infection. The optimal therapeutic dose for maximum efficacy and reduced toxicity is unclear, in part because of the lack of analytical methods to monitor CHG levels in skin. A novel method was developed to accurately measure CHG levels in skin after topical application with the goal of determining its pharmacokinetics in skin. METHODS Ultrahigh-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) was used to develop a validated assay for measuring CHG levels in skin cells collected by a non-invasive adhesive tape-stripping method. CHG levels in the skin stratum corneum of healthy adult volunteers were measured at 0.5, 4, 8, and 24 h after its application. RESULTS Conditions for extraction of CHG were optimized and the assay was linear in the range 0.1-50 μg/mL (corresponding to 0.2-100 μg chlorhexidine/tape), with an intra-assay precision of 1.74-10.50 % and a relative error of ≤10 %. The inter-assay accuracy was in the range of 5.86-10.96 % with a relative error <9 %. CHG was stable on tapes stored at 4 °C and ambient temperature for 14 and 3 days, respectively. The recovery of CHG from the tape was quantitative and the matrix effect was determined as 2.1-14.8 %. CHG levels in healthy adult volunteer skin following topical application decreased rapidly over a 24 h period. CONCLUSIONS A rapid, accurate and specific UHPLC-MS/MS method was developed for the measurement of CHG in the skin obtained by tape stripping that was linear over a large dynamic range. This assay afforded a simple and convenient non-invasive approach to monitor CHG levels in skin after topical application that can be applied to enable the optimal dose to prevent infection and minimize toxicity.
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Ramhmdani S, Bydon A. Commentary: Chlorhexidine Showers are Associated With a Reduction in Surgical Site Infection Following Spine Surgery: An Analysis of 4266 Consecutive Surgeries. Neurosurgery 2019; 85:E1006-E1007. [PMID: 30759256 DOI: 10.1093/neuros/nyy595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 11/09/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Seba Ramhmdani
- The Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ali Bydon
- The Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Abstract
Infection can be a devastating complication of surgically inserted prosthetic implants and intramedullary rods, plates and pins. About 2 million implants were inserted in the United States in 2004, and, despite appropriate perioperative antibiotics, approximately 5% of internal fixation devices became infected. Infection rates in fractures that pierce the skin can be as high as 22.7%. Complications of infection include excessive antibiotic use, implant removal, reoperation, and potential amputation. Infections caused by colonized prosthetic implants are often difficult to predict, diagnose, and treat, because they form biofilms. This article explores the approach to infected implants.
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Affiliation(s)
- Dena El-Sayed
- Internal Medicine Clinic, Infectious Diseases Clinic, Ventura County Medical Center, Ventura, CA, USA
| | - Aksone Nouvong
- Department of Surgery, Division of Vascular Surgery, David Geffen School of Medicine at UCLA, 200 Medical Plaza, Suite 526, Los Angeles, CA 90095, USA.
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Abstract
Importance Surgical site infection (SSI) is a common complication of cesarean delivery. Seen in up to 12% of cesarean deliveries, it is a major cause of prolonged hospital stay and a burden to the healthcare system. Interventions and techniques must be identified to decrease the risk of cesarean delivery SSIs. Objective We review the categories of SSI, current studies that have focused on various interventions to decrease SSI, and preoperative, intraoperative, and postoperative recommendations for cesarean delivery SSI prevention. Evidence Acquisition A thorough search of PubMed for all current literature was performed. Various surgical interventions and techniques were reviewed. We included studies that looked at preoperative, intraoperative, and postoperative interventions for SSI prevention. Results We have summarized several surgical interventions and techniques as well as current consensus statements to aid the practitioner in preventing SSIs after cesarean delivery. Conclusions and Relevance Upon analysis of current data and consensus statements pertaining to cesarean deliveries, there are certain preoperative, intraoperative, and postoperative interventions and techniques that can be recommended to decrease the risk of cesarean delivery SSI.
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Atkins GJ, Alberdi MT, Beswick A, Blaha JD, Bingham J, Cashman J, Chen AF, Cooper AM, Cotacio GL, Fraguas T, Gambhir A, Gromov K, Guerra E, Hooper G, Khlopas A, Kieser D, Klaber I, Kyte R, Levine B, Mont MA, Nikolaou V, Nuñez J, Overgaard S, Parvizi J, Saxena A, Sayago G, Shahcheraghi H, Sodhi N, Solomon LB, Starczak Y, Tan TL, Tarabichi M, Olivan RT, Virolainen P, Wyatt M. General Assembly, Prevention, Surgical Site Preparation: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S85-S92. [PMID: 30348579 DOI: 10.1016/j.arth.2018.09.057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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McNeil JC, Campbell JR, Crews JD. The Role of the Environment and Colonization in Healthcare-Associated Infections. HEALTHCARE-ASSOCIATED INFECTIONS IN CHILDREN 2019. [PMCID: PMC7120697 DOI: 10.1007/978-3-319-98122-2_2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Healthcare-associated infections (HAIs) can be caused by endogenous host microbial flora or by exogenous microbes, including those found in the hospital environment. Efforts to decrease endogenous pathogens via decolonization and skin antisepsis may decrease the risk of infection in some settings. Controlling the spread of potential pathogens from the environment requires meticulous attention to cleaning and disinfection practices. In addition to selection of the appropriate cleaning agent, use of tools that assess the adequacy of cleaning and addition of no-touch cleaning technology may decrease environmental contamination. Hand hygiene is also a critical component of preventing transmission of pathogens from the environment to patients via healthcare worker hands.
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Affiliation(s)
- J. Chase McNeil
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX USA
| | - Judith R. Campbell
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX USA
| | - Jonathan D. Crews
- Department of Pediatrics, Baylor College of Medicine and The Children’s Hospital of San Antonio, San Antonio, TX USA
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Ferraz ÁAB, Vasconcelos CFDM, Santa-Cruz F, Aquino MAR, Buenos-Aires VG, Siqueira LTD. Infecção de sítio cirúrgico após cirurgia bariátrica: resultados de uma abordagem com pacote de cuidados. Rev Col Bras Cir 2019; 46:e2252. [DOI: 10.1590/0100-6991e-20192252] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/09/2019] [Indexed: 12/24/2022] Open
Abstract
RESUMO Objetivo: apresentar uma análise descritiva dos resultados de um pacote de cuidados aplicado em pacientes obesos submetidos à cirurgia bariátrica, no que diz respeito ao controle de infecção. Métodos: um pacote de cuidados foi estruturado, visando a conter as taxas de infecção de sítio cirúrgico (ISC) em pacientes submetidos à cirurgia bariátrica. O pacote incluiu interrupção de tabagismo, banho com clorexidina 4% duas horas antes da cirurgia, cefazolina 2g em bolus na indução anestésica associada à administração da mesma droga com dose de 1g em infusão contínua, tricotomia apropriada, controle glicêmico, oxigênio suplementar, normotermia, controle da dor com morfina intrarraquidiana e remoção do curativo estéril 48 horas após a cirurgia. Todos os pacientes foram seguidos por 30 dias. Resultados: entre os 1.596 pacientes incluídos, 334 (20,9%) foram submetidos à cirurgia aberta e 1.262 (79,1%) à cirurgia videolaparoscópica. As taxas de ISC foram de 0,5% no grupo submetido à cirurgia laparoscópica e de 3% nos submetidos à cirurgia aberta. A incidência geral de ISC foi de 1%. Infecções intra-abdominal, do trato respiratório e do trato urinário ocorreram em 0,9%, 1,1% e 1,5% da amostra, respectivamente. Faixas mais elevadas de índice de massa corporal foram associadas a maiores incidências de ISC (p=0,001). Entre os pacientes com diabetes, 2,2% desenvolveram ISC, enquanto a taxa de infecção entre os não diabéticos foi de apenas 0,6%. Conclusão: o pacote de cuidados instituído, estruturado por estratégias centrais baseadas em evidências, associadas à medidas secundárias, foi capaz de manter baixas taxas de ISC após cirurgia bariátrica.
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