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Sample records for aureus surgical site

  1. Risk factors for Staphylococcus aureus surgical site infection during an outbreak in patients undergoing cardiovascular surgery.

    Science.gov (United States)

    Tadros, Manal A; Williams, Victoria R; Plourde, Suzanne; Callery, Sandra; Simor, Andrew E; Vearncombe, Mary

    2013-06-01

    This study examined the epidemiology of an outbreak of Staphylococcus aureus surgical site infections (SSI) after cardiovascular surgery, and analyzed risk factors for S aureus SSIs. This was a retrospective case-control study to determine risk factors for S aureus SSI in 38 patients who developed S aureus SSI during the outbreak period, compared with age-, sex-, and procedure-matched controls. S aureus strains were typed by pulsed-field gel electrophoresis. A total of 38 patients had S aureus SSI. Pulsed-field gel electrophoresis identified transmission of 3 S aureus clones (2 MSSA clones and 1 MRSA clone). Twenty-one health care workers were carriers of outbreak strains. In multivariate analysis, the significant risk factors for S aureus SSI were previous cardiac surgery (odds ratio, 7.41; 95% confidence interval, 1.05-52.16) and long procedure duration (odds ratio, 1.49; 95% confidence interval, 1.00-2.21). This outbreak demonstrates evidence of nosocomial transmission of 3 clones of S aureus in the setting of incomplete compliance with recommended standard perioperative infection control measures, associated with a high prevalence of staff carriage of the predominant outbreak strains. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  2. Mitigation of Staphylococcus aureus-mediated surgical site infections with ir photoactivated TiO2 coatings on Ti implants.

    Science.gov (United States)

    Aboelzahab, Asem; Azad, Abdul-Majeed; Dolan, Shawn; Goel, Vijay

    2012-05-01

    Surgical site infections caused by methicillin-resistant and methicillin-susceptible Staphylococcus aureus (MRSA, MSSA) lead to patient hospitalization for an extended period coupled with concomitant hospitalization resources and cost. The detrimental effect resulting from the onset of these infections poses great health risks, leading to death in some instances. Titanium dioxide (TiO(2) ) is endowed with the unique capability of photoactivity which has been extensively exploited in antibacterial activities. It has been shown to be very effective in its bactericidal efficacy against infection-causing bacterial strains, namely, E. coli and S. aureus. In this study, the use of IR-photoactivated TiO(2) nanocoatings on titanium implants to mitigate the onset of surgical site infections is described. TiO(2) coatings were created on implantable materials by way of an aqueous plasma electrodeposition technique and were used to mitigate the harmful bacterial growth upon brief activation by an infrared (IR) laser source. The necrosis of S. aureus cells was found to exceed 90% within 30 min. following a 30s exposure of the titania-coated model implants (Ti mesh and plate). Promising potential of antibacterial coatings in mitigating surgical site infections has been shown. Copyright © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  3. Viable adhered Staphylococcus aureus highly reduced on novel antimicrobial sutures using chlorhexidine and octenidine to avoid surgical site infection (SSI)

    Science.gov (United States)

    Schneider, Jochen; Harrasser, Norbert; Tübel, Jutta; Mühlhofer, Heinrich; Pförringer, Dominik; von Deimling, Constantin; Foehr, Peter; Kiefel, Barbara; Krämer, Christina; Stemberger, Axel; Schieker, Matthias

    2018-01-01

    coated sutures with higher roughness for palmitate coatings and sustaining integrity of coated sutures. Adherent S. aureus were found via SEM on all types of investigated sutures. The novel antimicrobial sutures showed significantly less viable adhered S. aureus bacteria (up to 6.1 log) compared to Vicryl® Plus (0.5 log). Within 11 μg/cm drug-containing sutures, octenidine-palmitate (OL11) showed the highest number of viable adhered S. aureus (0.5 log), similar to Vicryl® Plus. Chlorhexidine-laurate (CL11) showed the lowest number of S. aureus on sutures (1.7 log), a 1.2 log greater reduction. In addition, planktonic S. aureus in suspensions were highly inhibited by CL11 (0.9 log) represents a 0.6 log greater reduction compared to Vicryl® Plus (0.3 log). Conclusions Novel antimicrobial sutures can potentially limit surgical site infections caused by multiple pathogenic bacterial species. Therefore, a potential inhibition of multispecies biofilm formation is assumed. In detail tested with S. aureus, the chlorhexidine-laurate coating (CL11) best meets the medical requirements for a fast bacterial eradication. This suture coating shows the lowest survival rate of adhering as well as planktonic bacteria, a high drug release during the first–clinically most relevant– 48 hours, as well as biocompatibility. Thus, CL11 coatings should be recommended for prophylactic antimicrobial sutures as an optimal surgical supplement to reduce wound infections. However, animal and clinical investigations are important to prove safety and efficacy for future applications. PMID:29315313

  4. Viable adhered Staphylococcus aureus highly reduced on novel antimicrobial sutures using chlorhexidine and octenidine to avoid surgical site infection (SSI).

    Science.gov (United States)

    Obermeier, Andreas; Schneider, Jochen; Harrasser, Norbert; Tübel, Jutta; Mühlhofer, Heinrich; Pförringer, Dominik; Deimling, Constantin von; Foehr, Peter; Kiefel, Barbara; Krämer, Christina; Stemberger, Axel; Schieker, Matthias; Burgkart, Rainer; von Eisenhart-Rothe, Rüdiger

    2018-01-01

    palmitate coatings and sustaining integrity of coated sutures. Adherent S. aureus were found via SEM on all types of investigated sutures. The novel antimicrobial sutures showed significantly less viable adhered S. aureus bacteria (up to 6.1 log) compared to Vicryl® Plus (0.5 log). Within 11 μg/cm drug-containing sutures, octenidine-palmitate (OL11) showed the highest number of viable adhered S. aureus (0.5 log), similar to Vicryl® Plus. Chlorhexidine-laurate (CL11) showed the lowest number of S. aureus on sutures (1.7 log), a 1.2 log greater reduction. In addition, planktonic S. aureus in suspensions were highly inhibited by CL11 (0.9 log) represents a 0.6 log greater reduction compared to Vicryl® Plus (0.3 log). Novel antimicrobial sutures can potentially limit surgical site infections caused by multiple pathogenic bacterial species. Therefore, a potential inhibition of multispecies biofilm formation is assumed. In detail tested with S. aureus, the chlorhexidine-laurate coating (CL11) best meets the medical requirements for a fast bacterial eradication. This suture coating shows the lowest survival rate of adhering as well as planktonic bacteria, a high drug release during the first-clinically most relevant- 48 hours, as well as biocompatibility. Thus, CL11 coatings should be recommended for prophylactic antimicrobial sutures as an optimal surgical supplement to reduce wound infections. However, animal and clinical investigations are important to prove safety and efficacy for future applications.

  5. Correlation of mupirocin resistance with biofilm production in methicillin-resistant Staphylococcus aureus from surgical site infections in a tertiary centre, Egypt.

    Science.gov (United States)

    Barakat, Ghada I; Nabil, Yasmin M

    2016-03-01

    The aim of this study was to detect mupirocin-resistant isolates from pus/wound swabs taken postoperatively in a tertiary centre in Egypt and to determine their ability to form biofilm in order to establish its correlation with mupirocin resistance. This was a prospective study including 513pus/wound swabs from patients suffering from postoperative surgical site infections over the period July 2013-January 2015. Samples were cultured and isolates were identified by coagulase activity, DNase test, mannitol fermentation by mannitol salt agar followed by API Staph 32. Oxacillin agar screen test, agar dilution test for mupirocin, and mupA gene detection by PCR were performed for all methicillin-resistant Staphylococcus aureus (MRSA) isolates. Biofilm detection was carried out by the microtitre plate and Congo red agar methods. Of the 161 S. aureus isolates identified, 73 (45.3%) were MRSA, among which 82.2% were mupirocin-susceptible and 17.8% were mupirocin-resistant. Among the resistant isolates, 38.5% showed low-level resistance and 61.5% were high-level mupirocin-resistant. The mupA gene was detected in 75.0% of high-level mupirocin-resistant strains and in none of the low-level mupirocin-resistant strains. Among the mupirocin-susceptible isolates, 95.0% were biofilm-producers and 5.0% did not produce biofilm. All mupirocin-resistant isolates produced biofilm. Moreover, 15.3% of high-level mupirocin-resistant strains were negative for the mupA gene but showed evidence of biofilm formation. In conclusion, biofilm formation may be suggested to play a role in mupirocin resistance besides the presence of a genetic element encoding abnormal isoleucyl-tRNA synthetase, however further studies are needed to confirm these findings. Copyright © 2016 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved.

  6. Methicillin-resistant Staphylococcus Aureus Nasal Swab and Suction Drain Tip Cultures in 4573 Spinal Surgeries: Efficacy in Management of Surgical Site Infections.

    Science.gov (United States)

    Kawabata, Atsuyuki; Sakai, Kenichiro; Sato, Hirokazu; Sasaki, Shinichi; Torigoe, Ichiro; Tomori, Masaki; Yuasa, Masato; Matsukura, Yu; Arai, Yoshiyasu

    2017-08-01

    A retrospective single-center study. To assess the diagnostic value of methicillin-resistant Staphylococcus aureus (MRSA) nasal swab and suction drain tip cultures. The prognostic value of MRSA nasal swab and suction drain tip cultures has not been firmly established in spinal surgery. This study retrospectively included 4573 consecutive patients who underwent spinal surgery between January 2008 and December 2014. Patients diagnosed with infectious disease were excluded. Prophylactic antibiotics were administered intraoperatively and postoperatively for 48 h. MRSA nasal swab cultures were taken from all patients before surgery. Drains were removed when the volume of postoperative fluid drainage was less than 50 mL in the preceding 24 h and cultures were made. Surgical site infection (SSI) was defined according to Centers for Disease Control and Prevention criteria. SSI was identified in 94 cases (2.1%) and bacteria were isolated in 87 cases (92.6%). Positive MRSA nasal swab cultures were identified in 49 cases (1.1%). There was no significant difference in the SSI positivity rate between the MRSA nasal swab culture (+) and (-) groups. Positive drain tip cultures were found in 382 cases (8.4%), 28 of which developed SSI. There was a significant difference in the SSI positivity rate between the drain tip culture (+) and (-) groups. The sensitivity of drain tip culture was 29.8% and the specificity was 92.1%. In 16 of the 28 patients in the SSI (+) group with positive drain cultures, the same bacteria were isolated from the surgical site, giving a bacteria matching rate of 57.1%. MRSA nasal swab and drain tip cultures were not useful for predicting SSI. However, drain tip culture had a high positivity rate in the SSI group and the coincidence rate for the causative pathogen was relatively high. 4.

  7. Nosocomial infections: surgical site infection in UCH Ibadan, Nigeria ...

    African Journals Online (AJOL)

    The prevalence of HAI was 3.0%, Surgical Site Infection was the second most prevalent HAI. Surgical Site Infection was responsible for 27.9% of the nosocomial infections recorded. The ratio of Gram Positive to Gram Negative organisms was 1:2.3. Bacterial agents of Surgical Site Infection were Staphylococcus aureus ...

  8. Surgical site infections

    African Journals Online (AJOL)

    Surgical site infections (SSIs) are a worldwide problem that has far reaching implications on patient morbidity and ... was complicated by a SSI had a 2-11% higher risk of death. In those patients who died, 75% was directly .... genital and uninfected urinary tract is not entered. In addition, clean wounds are primarily closed ...

  9. Antimicrobial Activity of Artemisia absinthium Against Surgical Wounds Infected by Staphylococcus aureus in a Rat Model.

    Science.gov (United States)

    Moslemi, Hamid Reza; Hoseinzadeh, Hesamoddin; Badouei, Mahdi Askari; Kafshdouzan, Khatereh; Fard, Ramin Mazaheri Nezhad

    2012-12-01

    The wound infection is one of the frequent complications in patients undergoing surgical operations. Staphylococcus aureus is the most common cause of surgical wounds. Artemisia absinthium has been shown to bear strong antimicrobial activity, especially against Gram-positive pathogens. This study was designed to investigate the antimicrobial effects of A. absinthium against surgical wounds infected by S. aureus in a rat model. Twenty male Sprague-Dawley rats were divided randomly into two equal groups of treated and control rats. A circular incision was created on the dorsal inter-scapular region of each rat. After skin wounding, rats were inoculated locally with 1 × 10(4) CFU of S. aureus at sites of skin wounds. The extract was applied topically twice a day throughout the experiment. Animals of the control group were left untreated. Results have revealed that topical application of A. absinthium extract on the infected wound sites produced significant antibacterial activity against S. aureus.

  10. Staphylococcus aureus Nasal Carriage among Surgical personnel ...

    African Journals Online (AJOL)

    Introduction: Staphylococcus aureus (S. aureus) is one of the most common causes of both community and hospital acquired bacterial infection. There is strong correlation between S aureus nasal carriage and disease progress. Nasal carriage is high among health care workers. Inappropriate usage of antibiotic may

  11. Surgical site infections

    African Journals Online (AJOL)

    Organ space SSI. • Infection occurs within 30 days if no implant, or within a year if implant and the infection seems to be related to the operation and infection occurs in any anatomical site ... Diagnosis of an organ/space SSI made by the surgeon or ..... selected projects ”enlist the best academic researchers and industry to.

  12. Preventing surgical site infection. Where now?

    LENUS (Irish Health Repository)

    Humphreys, H

    2009-12-01

    Surgical site infection (SSI) is increasingly recognised as a measure of the quality of patient care by surgeons, infection control practitioners, health planners and the public. There is increasing pressure to compare SSI rates between surgeons, institutions and countries. For this to be meaningful, data must be standardised and must include post-discharge surveillance (PDS) as many superficial SSIs do not present to the original institution. Further work is required to determine the best method of conducting PDS. In 2008 two important documents on SSI were published from the Society for Healthcare Epidemiology of America\\/The Infectious Disease Society of America and the National Institute for Health and Clincal Excellence, UK. Both emphasise key aspects during the preoperative, operative and postoperative phases of patient care. In addition to effective interventions known to be important for some time, e.g. not shaving the surgical site until the day of the procedure, there is increasing emphasis on physiological parameters, e.g. blood glucose concentrations, oxygen tensions and body temperature. Laparoscopic procedures are increasingly associated with reduced SSI rates, and the screening and decontamination of meticillin-resistant Staphylococcus aureus carriers is effective for certain surgical procedures but has to be balanced by cost and the risk of mupirocin resistance. Finally, there is a need to convert theory into practice by the rigorous application of SSI healthcare bundles. Recent studies suggest that, with a multidisciplinary approach, simple measures can be effective in reducing SSI rates.

  13. Nasal Methicillin Resistant Staphylococcus aureus Associated Post-surgical Wounds Infections

    Directory of Open Access Journals (Sweden)

    Ikpeme, E. M.

    2012-01-01

    Full Text Available Aims: Staphylococcus aureus nasal colonization is an important risk factor for developing a wide range of infections in clinical setting. This study was aimed at determining the extent of staphylococcal carriages including methicillin resistant Staphylococcus aureus (MRSA in post-surgical patients and employees in a tertiary health facility. Methodology and Results: Between April and July 2010, 240 post-surgical patients and 80 hospital personnel at the University of Calabar Teaching Hospital, Calabar were enrolled in the present study. All subjects consented to participation in the study and those who had previous medical history or treatment on antibiotic in the last six months prior to enrolment were noted. Nasal specimens collected from carrier and post-surgical sites in individuals (15-63 years who were hospitalized for at least 21 days were immediately placed in Staurts’ transport medium and kept at 4 °C before being analyzed accordingly and screened for methicillin resistant Staphylococcus aureus. Out of a total number of 320 subjects examined within a period of 4 months 144 (45% were carriers of Staphylococcus aureus and 55 (38% of these were MRSA. Demographic and clinical data of subjects indicated more male carriers (60.7% confined to older age groups above 35 years. There was a significant difference (p> 0.05 in Staphylococcus aureus carriage for subjects with recent medical history of hospitalization or treatment with antibiotics. There also appears to be a considerable association (50.9% between nasal carriage status and autoinfection of post-surgical wounds. A good proportion of all strains tested were resistant to commonly used antibiotics. Approximately 89% of MRSA were resistant to penicillin. Resistant rate against other antibiotics was largely below 30%. Conclusion, significance and impact of study: An improved understanding of nasal carriage is needed to foster development of new strategies to reduce colonization and

  14. Variation in the type and frequency of postoperative invasive Staphylococcus aureus infections according to type of surgical procedure.

    Science.gov (United States)

    Anderson, Deverick J; Arduino, Jean Marie; Reed, Shelby D; Sexton, Daniel J; Kaye, Keith S; Grussemeyer, Chelsea A; Peter, Senaka A; Hardy, Chantelle; Choi, Yong Il; Friedman, Joelle Y; Fowler, Vance G

    2010-07-01

    To determine the epidemiological characteristics of postoperative invasive Staphylococcus aureus infection following 4 types of major surgical procedures.design. Retrospective cohort study. Eleven hospitals (9 community hospitals and 2 tertiary care hospitals) in North Carolina and Virginia. Adults undergoing orthopedic, neurosurgical, cardiothoracic, and plastic surgical procedures. We used previously validated, prospectively collected surgical surveillance data for surgical site infection and microbiological data for bloodstream infection. The study period was 2003 through 2006. We defined invasive S. aureus infection as either nonsuperficial incisional surgical site infection or bloodstream infection. Nonparametric bootstrapping was used to generate 95% confidence intervals (CIs). P values were generated using the Pearson chi2 test, Student t test, or Wilcoxon rank-sum test, as appropriate. In total, 81,267 patients underwent 96,455 procedures during the study period. The overall incidence of invasive S. aureus infection was 0.47 infections per 100 procedures (95% CI, 0.43-0.52); 227 (51%) of 446 infections were due to methicillin-resistant S.aureus. Invasive S. aureus infection was more common after cardiothoracic procedures (incidence, 0.79 infections per 100 procedures [95%CI, 0.62-0.97]) than after orthopedic procedures (0.37 infections per 100 procedures [95% CI, 0.32-0.42]), neurosurgical procedures (0.62 infections per 100 procedures [95% CI, 0.53-0.72]), or plastic surgical procedures (0.32 infections per 100 procedures [95% CI, 0.17-0.47]) (P < .001). Similarly, S. aureus bloodstream infection was most common after cardiothoracic procedures (incidence, 0.57 infections per 100 procedures [95% CI, 0.43-0.72]; P < .001, compared with other procedure types), comprising almost three-quarters of the invasive S. aureus infections after these procedures. The highest rate of surgical site infection was observed after neurosurgical procedures (incidence, 0

  15. Fighting surgical site infections in small animals

    DEFF Research Database (Denmark)

    Verwilghen, Denis; Singh, Ameet

    2015-01-01

    A diverse array of pathogen-related, patient-related, and caretaker-related issues influence risk and prevention of surgical site infections (SSIs). The entire surgical team involved in health care settings in which surgical procedures are performed play a pivotal role in the prevention of SSIs. ...

  16. The role of antimicrobial sutures in preventing surgical site infection.

    Science.gov (United States)

    Leaper, D; Wilson, P; Assadian, O; Edmiston, C; Kiernan, M; Miller, A; Bond-Smith, G; Yap, J

    2017-07-01

    INTRODUCTION Healthcare associated infections (HCAIs) are falling following widespread and enforced introduction of guidelines, particularly those that have addressed antibiotic resistant pathogens such as methicillin resistant Staphylococcus aureus or emergent pathogens such as Clostridium difficile, but no such decline has been seen in the incidence of surgical site infection (SSI), either in the UK, the EU or the US. SSI is one of the HCAIs, which are all avoidable complications of a surgical patient's pathway through both nosocomial and community care. METHODS This report is based on a meeting held at The Royal College of Surgeons of England on 21 July 2016. Using PubMed, members of the panel reviewed the current use of antiseptics and antimicrobial sutures in their specialties to prevent SSI. FINDINGS The group agreed that wider use of antiseptics in surgical practice may help in reducing reliance on antibiotics in infection prevention and control, especially in the perioperative period of open elective colorectal, hepatobiliary and cardiac operative procedures. The wider use of antiseptics includes preoperative showering, promotion of hand hygiene, (including the appropriate use of surgical gloves), preoperative skin preparation (including management of hair removal), antimicrobial sutures and the management of dehisced surgical wounds after infection. The meeting placed emphasis on the level I evidence that supports the use of antimicrobial sutures, particularly in surgical procedures after which the SSI rate is high (colorectal and hepatobiliary surgery) or when a SSI can be life threatening even when the rate of SSI is low (cardiac surgery).

  17. Modifiable risk factors for surgical site infection.

    Science.gov (United States)

    Moucha, Calin S; Clyburn, Terry A; Evans, Richard P; Prokuski, Laura

    2011-01-01

    Multiple risk factors for orthopaedic surgical site infection have been identified. Some of these factors directly affect the wound-healing process, whereas others can lead to blood-borne sepsis or relative immunosuppression. Modifying a patient's medications; screening for comorbidities, such as HIV or diabetes mellitus; and advising the patient on options to diminish or eliminate adverse behaviors, such as smoking, should lower the risk for surgical site infections.

  18. Initial adhesion of methicillin-sensitive and methicillin-resistant Staphylococcus aureus strains to untreated and electropolished surgical steel drill bits.

    Science.gov (United States)

    Langsteiner, Annemarie; Loncaric, Igor; Henkel-Odwody, Anna-Maria; Tichy, Alexander; Licka, Theresia F

    2017-10-01

    Electropolishing of stainless steel has been thoroughly investigated as a prophylactic measure to prevent bacterial colonization of orthopaedic implants and infection. Initial bacterial adhesion onto surgical drill bits as a possible factor for orthopaedic surgical site infections has not yet been documented. The present study investigated the influence of electropolishing on initial staphylococcal adhesion onto AISI 440A stainless steel drill bits. Specifically, one methicillin-susceptible standard laboratory Staphylococcus aureus type strain (DSM 20231(T)), one methicillin-resistant S. aureus reference strain (DSM 46320) and one methicillin-resistant clinical isolate from an infected orthopaedic implant were used. After standard sterilization, drill bits were immersed in the respective bacterial suspension; bacteria adherent to surface were harvested by vortexing the drill bits in phosphate-buffered saline and viable counts of bacteria transferred from the suspension were made (transferred to log10 for further analysis). Electropolishing significantly reduced adhesion of the clinical S. aureus strain and the S. aureus DSM 20231(T). However, electropolishing significantly increased adhesion of the S. aureus DSM 46320. These results show that electropolishing significantly influences initial adhesion of S. aureus strains to surgical drill bits and that the nature of this influence depends on the S. aureus strain examined. For a general recommendation of electropolishing drill bits and guidelines for their handling during surgery, further studies with more strains isolated from infected wounds are suggested. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. MRSA – ‘Bug-Bear’ of a Surgical Practice: Reducing the Incidence of MRSA Surgical Site Infections

    OpenAIRE

    Guyot, Andrea; Layer, Graham

    2006-01-01

    Adverse publicity (the ‘superbug') has demonstrated that the problem of MRSA (methicillin-resistant Staphylococcus aureus) is prevalent in many of the country's most prestigious hospitals. The results of the mandatory UK Department of Health (DH) surveillance for early surgical site infections in orthopaedic surgery (SSIS) have been published recently for the period April 2004 to March 2005 when 41,242 operations were studied ( 28 October 2005). Infection rates were generally and gratifyingly...

  20. [Surgical site infections: antibiotic prophylaxis in surgery].

    Science.gov (United States)

    Asensio, Angel

    2014-01-01

    Surgical site infections (SSI) are very common, and represent more than 20% of all hospital-acquired infections. SSIs are associated with a higher mortality, as well as to an extended hospital stay and costs, depending on the surgical procedure and type of SSI. Advances in control practices for these infections include improvement in operating room ventilation, sterilization methods, barriers, and surgical techniques, as well as in surgical antimicrobial prophylaxis. For the latter, the antimicrobial agent should: be active against the most common pathogens, be administered in an appropriate dosage and in a time frame to ensure serum and tissue concentrations over the period of potential contamination, be safe, and be administered over the shortest effective time period to minimize adverse events, development of resistances, and cost. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  1. Impact of surgical training on incidence of surgical site infection.

    Science.gov (United States)

    Rosenthal, Rachel; Weber, Walter P; Zwahlen, Marcel; Misteli, Heidi; Reck, Stefan; Oertli, Daniel; Widmer, Andreas F; Marti, Walter R

    2009-06-01

    Despite availability of other training forms, tutorial assistance cannot be entirely replaced in surgical education. Concerns exist that tutorial assistance may lead to an increased rate of surgical site infection (SSI). The purpose of the present study was to investigate whether the risk of SSI is higher after surgery with tutorial assistance than after surgery performed autonomously by a fully trained surgeon. All consecutive visceral, vascular, and traumatological inpatient procedures at a Swiss University Hospital were prospectively recorded during a 24-month period, and the patients were followed for 12 months to ascertain the occurrence of SSI. Using univariable and multivariable logistic regressions, we assessed the association of tutorial assistance surgery with SSI in 6,103 interventions. Autonomously performed surgery was associated with SSI in univariable analysis (5.36% SSI vs. 3.81% for tutorial assistance, p = 0.006). In multivariable analysis, the odds of SSI for tutorial assistance was no longer significantly lower (Odds Ratio [OR] = 0.82; 95% Confidence Interval [CI]: 0.62-1.09; p = 0.163). Surgical training does not lead to higher SSI rate if trainees are adequately supervised and interventions are carefully selected. Although other forms of training are useful, tutorial assistance in the operating room continues to be the mainstay of surgical education.

  2. Surgical site infections in spine surgery: identification of microbiologic and surgical characteristics in 239 cases.

    Science.gov (United States)

    Abdul-Jabbar, Amir; Berven, Sigurd H; Hu, Serena S; Chou, Dean; Mummaneni, Praveen V; Takemoto, Steven; Ames, Christopher; Deviren, Vedat; Tay, Bobby; Weinstein, Phil; Burch, Shane; Liu, Catherine

    2013-10-15

    Retrospective analysis. The objective of this study was to describe the microbiology of surgical site infection (SSI) in spine surgery and relationship with surgical management characteristics. SSI is an important complication of spine surgery that results in significant morbidity. A comprehensive and contemporary understanding of the microbiology of postoperative spine infections is valuable to direct empiric antimicrobial treatment and prophylaxis and other infection prevention strategies. All cases of spinal surgery associated with SSI between July 2005 and November 2010 were identified by the hospital infection control surveillance program using Centers for Disease Control National Health Safety Network criteria. Surgical characteristics and microbiologic data for each case were gathered by direct medical record review. Of 7529 operative spine cases performed between July 2005 and November 2010, 239 cases of SSI were identified. The most commonly isolated pathogen was Staphylococcus aureus (45.2%), followed by Staphylococcus epidermidis (31.4%). Methicillin-resistant organisms accounted for 34.3% of all SSIs and were more common in revision than in primary surgical procedures (47.4% vs. 28.0%, P = 0.003). Gram-negative organisms were identified in 30.5% of the cases. Spine surgical procedures involving the sacrum were significantly associated with gram-negative organisms (P spine. Cefazolin-resistant gram-negative organisms accounted for 61.6% of all gram-negative infections and 18.8% of all SSIs. Although gram-positive organisms predominated, gram-negative organisms accounted for a sizeable portion of SSI, particularly among lower lumbar and sacral spine surgical procedures. Nearly half of infections in revision surgery were due to a methicillin-resistant organism. These findings may help guide choice of empiric antibiotics while awaiting culture data and antimicrobial prophylaxis strategies in specific spine surgical procedures. 3.

  3. Surgical Site Infection In Orthopaedic Surgery: Correlation Between Age, Diabetes, Smoke And Surgical Risk.

    Science.gov (United States)

    Fisichella, Leonardo; Fenga, Domenico; Rosa, Michele Attilio

    2014-01-01

    Surgical site infection is a common complication after orthopaedic surgery. It can be associated with increased morbidity rate and social cost. The accurate identification of risk factors is essential so that strategies to prevent these potentially devastating infections can be developed. We have conducted this study to determine the possible risk factors for the surgical site infections. We aimed at finding exhaustive evidence concerning the potential risk factors for infections in orthopaedic surgery. Between October 2009 and December 2011, we identified 84 patients with a superficial and/or deep surgical site infection and compared them with 203 uninfected patients (control group), taken out from a series of 486 patients. We considered the following risk factors: diabetes, BMI >30, ASA Score of 3 or 4, smoking and age. The most frequently performed operations of the 287 examined patients were the knee and hip arthroplasties (n = 32, 11.14%) and open fracture reductions (n = 178, 62.02%). Staphylococcus Aureus was the most common identified pathogen (n = 63, 75%). The analyses (preoperative and postoperative) of the infected patients showed them to have significantly high serum glucose levels in comparison with the control group (odds ratio = 8.7). We found a significant high rate of infection in patients smoking for more than 20 years (67 patients, 79.7%). The remaining variables (BMI, OR = 2.21; ASA score, OR = 1.3) showed no significant differences between the study group and controls. We also found a correlation between > 65-year-old patients and infections at the surgical site (61 patients, 72.6%). We found that there was correlation between diabetes, smoking and age as risk factors with the development of infection at the surgical site; other variables such as the ASA score and BMI are not relevant here (contrary to what is reported in literature). We believe that postoperative results can be improved considerably with a properly conducted antibiotic

  4. Surgical hand antisepsis to reduce surgical site infection.

    Science.gov (United States)

    Tanner, Judith; Dumville, Jo C; Norman, Gill; Fortnam, Mathew

    2016-01-22

    Medical professionals routinely carry out surgical hand antisepsis before undertaking invasive procedures to destroy transient micro-organisms and inhibit the growth of resident micro-organisms. Antisepsis may reduce the risk of surgical site infections (SSIs) in patients. To assess the effects of surgical hand antisepsis on preventing surgical site infections (SSIs) in patients treated in any setting. The secondary objective is to determine the effects of surgical hand antisepsis on the numbers of colony-forming units (CFUs) of bacteria on the hands of the surgical team. In June 2015 for this update, we searched: The Cochrane Wounds Group Specialized Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations) and EBSCO CINAHL. There were no restrictions with respect to language, date of publication or study setting. Randomised controlled trials comparing surgical hand antisepsis of varying duration, methods and antiseptic solutions. Three authors independently assessed studies for inclusion and trial quality and extracted data. Fourteen trials were included in the updated review. Four trials reported the primary outcome, rates of SSIs, while 10 trials reported number of CFUs but not SSI rates. In general studies were small, and some did not present data or analyses that could be easily interpreted or related to clinical outcomes. These factors reduced the quality of the evidence. SSIsOne study randomised 3317 participants to basic hand hygiene (soap and water) versus an alcohol rub plus additional hydrogen peroxide. There was no clear evidence of a difference in the risk of SSI (risk ratio (RR) 0.97, 95% CI 0.77 to 1.23, moderate quality evidence downgraded for imprecision).One study (500 participants) compared alcohol-only rub versus an aqueous scrub and found no clear evidence of a difference in the risk of SSI (RR 0.56, 95% CI 0.23 to 1.34, very low quality

  5. Variable performance of models for predicting methicillin-resistant Staphylococcus aureus carriage in European surgical wards

    OpenAIRE

    Lee, Andie S; Pan, Angelo; Harbarth, Stephan; Patroni, Andrea; Chalfine, Annie; Daikos, George L; Garilli, Silvia; Mart?nez, Jos? Antonio; Cooper, Ben S

    2015-01-01

    BACKGROUND: Predictive models to identify unknown methicillin-resistant Staphylococcus aureus (MRSA) carriage on admission may optimise targeted MRSA screening and efficient use of resources. However, common approaches to model selection can result in overconfident estimates and poor predictive performance. We aimed to compare the performance of various models to predict previously unknown MRSA carriage on admission to surgical wards. METHODS: The study analysed data collected during a prospe...

  6. Detection of bacterial pathogens in surgical site infections and their antibiotic sensitivity profile

    Directory of Open Access Journals (Sweden)

    Ghaleb Adwan

    2016-05-01

    Full Text Available Surgical site infections considered as a major problem in health care centers, resulting in extended length of stay, substantial associated morbidity and mortality, and high excess hospital cost. Thirty wound swabs were collected from patients who had developed postoperative wound infections at Rafidia Hospital-Nablus, Palestine. Bacterial isolates were identified according to standard microbiological methods. Antibiotics susceptibility test was applied for all isolated bacterial species. ERIC-PCR was carried out to determine the identity between isolated clones. The results of this research showed that the prevalence of pathogens among surgical site infections was 56.7%, 30%, 6.7%, 3.3% and 3.3% for E. coli, S. aureus, Klebsiella sp., Enterobacter sp., and Acinatobacter sp., respectively. E. coli isolates showed high resistance against Nalidixic acid (88.2%, Trimethoprim/Sulfamethoxazole (76.5%, Tetracycline (70.6%, Norfloxacin (64.7% and Ciprofloxacin (58.5%. S. aureus showed high resistance against Nalidixic acid (88.9%, Norfloxacin (77.8%, Amoxycillin/clavulanic acid (77.8%, Kanamycin (66.7% and Ciprofloxacin (55.6%. Methicillin resistant S. aureus (MRSA accounted for 33.3% of a total of S. aureus isolates. Resistant to 3 or more antibiotics were detected in 94.1% (16/17 and 77.8% (7/9 of E. coli and S. aureus isolates, respectively. ERIC-PCR typing E. coli and S. aureus isolates showed that each was consisted of 4 ERIC-PCR clusters at a 50% similarity level. Indistinguishable and closely related strains were detected for both microorganisms. Results of this study might be important in provoking awareness to postoperative wound infections and further studies are needed to identify other pathogens responsible for SSIs and the source of infections. Using effective antibiotic policy will restrict further spread of postoperative wound infections.

  7. Characterization of colonizing Staphylococcus aureus isolated from surgical wards' patients in a Nigerian university hospital.

    Directory of Open Access Journals (Sweden)

    Deboye O Kolawole

    Full Text Available In contrast to developed countries, only limited data on the prevalence, resistance and clonal structure of Staphylococcus aureus are available for African countries. Since S. aureus carriage is a risk factor for postoperative wound infection, patients who had been hospitalized in surgical wards in a Nigerian University Teaching Hospital were screened for S. aureus carriage. All S. aureus isolates were genotyped (spa, agr and assigned to multilocus sequence types (MLST. Species affiliation, methicillin-resistance, and the possession of pyrogenic toxin superantigens (PTSAg, exfoliative toxins (ETs and Panton-Valentine Leukocidin (PVL were analyzed. Of 192 patients screened, the S. aureus carrier rate was 31.8 % (n = 61. Of these isolates, 7 (11.5% were methicillin-resistant (MRSA. The isolates comprised 24 spa types. The most frequent spa types were t064, t084, t311, and t1931, while the most prevalent MLST clonal complexes were CC5 and CC15. The most frequent PTSAg genes detected were seg/sei (41.0% followed by seb (29.5%, sea (19.7%, seh (14.7% and sec (11.5. The difference between the possession of classical and newly described PTSAg genes was not significant (63.9% versus 59.0% respectively; P = 0.602. PVL encoding genes were found in 39.3% isolates. All MRSA isolates were PVL negative, SCCmec types I and VI in MLST CC 5 and CC 30, respectively. Typing of the accessory gene regulator (agr showed the following distribution: agr group 1 (n = 20, group II (n = 17, group III (n = 14 and group IV (n = 10. Compared to European data, enterotoxin gene seb and PVL-encoding genes were more prevalent in Nigerian methicillin-susceptible S. aureus isolates, which may therefore act as potential reservoir for PVL and PTSAg genes.

  8. Evolving issues in the prevention of surgical site infections.

    LENUS (Irish Health Repository)

    Quinn, A

    2009-06-01

    Surgical site infection is one of the more common causes of post-operative morbidity. Such infections contribute to prolonged recovery, delayed discharge and increasing costs to both patients and the health service. In the current climate increased emphasis is being placed on minimising the risks of acquiring or transmitting these nosocomial infections. This article reviews the current literature obtained from a Pubmed database search in relation to three specific aspects of surgical site infection: compliance with prophylactic antibiotics, post-discharge surveillance and novel methods for preventing surgical site infections. These topics represent areas where many institutions will find room for improvement in the prevention of surgical site infections. Tight adherence to prophylactic antibiotic guidelines, close followup of surgical wounds during and after hospital discharge, and attention to oxygenation status and the body temperature of patients may all prove to be useful adjuncts in significantly decreasing surgical site infections.

  9. Methicillin-resistant Staphylococcus aureus (MRSA) in a tertiary surgical and trauma hospital in Benghazi, Libya.

    Science.gov (United States)

    Buzaid, Najat; Elzouki, Abdel-Naser; Taher, Ibrahim; Ghenghesh, Khalifa Sifaw

    2011-10-13

    Methicillin resistant Staphylococcus aureus (MRSA) is a multidrug resistant organism that threatens the continued effectiveness of antibiotics worldwide and causes a threat almost exclusively in hospitals and long-term care settings. This study investigated the prevalence of MRSA strains and their sensitivity patterns against various antibiotics used for treating hospitalized patients in a major tertiary surgical hospital in Benghazi, Libya. We investigated 200 non-duplicate S. aureus strains isolated from different clinical specimens submitted to the Microbiology Laboratory at Aljala Surgical and Trauma Hospital, Benghazi, Libya from April to July 2007. Isolates were tested for methicillin resistance by the oxacillin disc-diffusion assay according to Clinical and Laboratory Standards Institute guidelines. MRSA strains were tested for antimicrobial resistance (i.e., vancomycin, ciprofloxacin, erythromycin, chloramphenicol and fusidic acid) using commercial discs. Information on patient demographics and clinical disease was also collected. Of the isolates examined 31% (62/200) were MRSA. No significant differences were observed in the prevalence of MRSA among S. aureus from females or males or from different age groups. Most MRSA were isolated from burns and surgical wound infections. Antibiotic resistance patterns of 62 patients with MRSA to vancomycin, ciprofloxacin, fusidic acid, chloramphenicol and erythromycin were 17.7%, 33.9%, 41.9%, 38.7% and 46.8% of cases, respectively. MRSA prevalence in our hospital was high and this may be the case for other hospitals in Libya. A sound surveillance program of nosocomial infections is urgently needed to reduce the incidence of infections due to MRSA and other antimicrobial-resistant pathogens in Libyan hospitals.

  10. Incidence of Surgical Site Infections and Microbial Pattern at ...

    African Journals Online (AJOL)

    15 bacterial isolates and multidrug resistance was also observed in a number of bacterial isolates. Conclusion. The incidence of infection in our centre is low and the pattern of microbes causing surgical site infection at the centre has remained the same over time. Introduction. Surgical site infection (SSI) is an infection that.

  11. Incidence of Surgical Site Infections and Microbial Pattern at ...

    African Journals Online (AJOL)

    Background Surgical site infection (SSI) remains a major cause of morbidity and death. We conducted a study to determine the incidence of surgical site infections and microbial pattern at Kilimanjaro Christian Medical Centre. Patients and Methods A prospective hospital based study was conducted at KCMC general ...

  12. The Role of MDR-Acinetobacter baumannii in Orthopedic Surgical Site Infections.

    Science.gov (United States)

    Helal, Sohier; El Anany, Mervat; Ghaith, Doaa; Rabeea, Samar

    2015-10-01

    Gram-positive microorganisms were the main causative organisms of orthopedic surgical site infections (SSI); however the rising incidence of multiple drug resistant Acinetobacter baumannii (MDR-AB) infections in orthopedic operations causes a great concern because of their limited array of therapeutic options. Our objective was to remark the changing microbiology in orthopedic SSI and to evaluate the MDR CHROMagar Acinetobacter media for screening of MDR-AB. Aspirated pus samples were collected from infected wounds of 100 patients in the orthopedics unit of El-Helal Hospital, samples were cultured on conventional media and MDR CHROMagar Acinetobacter media, the reveled MDR-AB colonies were subjected to polymerase chain reaction (PCR) to detect blaOXA-51 like gene. Out of 100 infected wounds SSI cases represented 90/100 (90%) according to CDC 2013 definitions. Staphylococcus aureus was the dominant organism 40/90 (44.4%) (P value 0.038), all S. aureus isolates were methicillin-resistant Staphylococcus aureus (MRSA), followed by Klebsiella pneumoniae 22/90 (24.44%) and Acinetobacter 15/90 (16.67%). Implant was highly associated with SSI cases 80/90 (89%). Also, prolonged hospital stay>7 d was significantly associated with SSI 69/90 (77%) (p=0.001). Staphylococcus aureus was the main causative organism of orthopedic SSI (44.4%), whereas A. baumannii represented only (16.67%) of the causative organisms. MDR Acinetobacter CHROMagar reduced the turnaround time for screening of MDR-AB.

  13. Risk factors for deep surgical site infections after spinal fusion.

    Science.gov (United States)

    Schimmel, J J P; Horsting, P P; de Kleuver, M; Wonders, G; van Limbeek, J

    2010-10-01

    Surgical site infections (SSI) are undesired and troublesome complications after spinal surgery. The reported infection rates range from 0.7 to 11.9%, depending on the diagnosis and the complexity of the procedure. Besides operative factors, patient characteristics could also account for increased infection rates. Because the medical, economic and social costs of SSI are enormous, any significant reduction in risks will pay dividends. The purpose of this study is to compare patients who developed deep SSI following lumbar or thoracolumbar spinal fusion with a randomly selected group of patients who did not develop this complication in order to identify changeable risk factors. With a case-control analysis nested in a historical cohort of patients who had had a spinal fusion between January 1999 and December 2008, we identified 36 cases with deep SSI (CDC criteria). Information regarding patient-level and surgical-level risk factors was derived from standardized but routinely recorded data and compared with those acquired in a random selection of 135 uninfected patients. Univariate analyses and a multivariate logistic regression were performed. The overall rate of infection in 1,615 procedures (1,568 patients) was 2.2%. A positive history of spinal surgery was associated with an almost four times higher infection rate (OR = 3.7, 95% BI = 1.6-8.6). The risk of SSI increased with the number of levels fused, patients with diabetes had an almost six times higher risk and smokers had more than a two times higher risk for deep SSI. The most common organism cultured was Staphylococcus aureus. All infected patients underwent at least one reoperation, including an open débridement and received appropriate antibiotics to treat the organism. Patients who had had a previous spinal surgery are a high-risk group for infection compared with those that never had surgery. Total costs associated with preventive measures are substantial and should be compensated by health care

  14. Prevalence of Surgical Site Infection in a Nigerian University ...

    African Journals Online (AJOL)

    Surgical Site Infection (SSI) is a serious complication that limits the benefits of surgical interventions. It is a serious problem globally and particularly in Africa and other developing countries where inadequate resources and skilled personnel among others are contributing to the acquisition and spread of this infection.

  15. Surgical site fire during cesarean section

    Directory of Open Access Journals (Sweden)

    Leena Goel

    2013-01-01

    Full Text Available Electrocautery has become an indispensable tool in the operating room mainly, to achieve a bloodless surgical field. At the same time, the use of alcohol-based antiseptics, like spirit, is commonly used these days for skin preparation before surgery. However, it does carry several risks including fire burns, with the use of electrocautery in a field smeared with spirit. Here, we report a case of pregnant patient undergoing elective cesarean-section under spinal anesthesia who suffered 17% second degree-superficial partial thickness burns due to electrocautery where spirit was used for skin preparation resulting in circulatory shock managed by inducing general anesthesia. Perioperative management was uncomplicated and both mother and newborn were discharged without any untoward problem. This report highlights general safety issues relating to the risk of fire in all surgical patients and the preventive measures for such injury.

  16. Elderly diabetic patient with surgical site mucormycosis extending to bowel

    Directory of Open Access Journals (Sweden)

    Atul K Patel

    2010-01-01

    Full Text Available Mucormycosis is rare in clinical practice. Most infections are acquired by inhalation; other portals of entry are traumatic implantation and ingestion in immunocompromised host. Mucormycosis is life threatening infection in immunocompromised host with variable moratlity ranging from 15 -81% depending upon site of infection. General treatment principles include early diagnosis, correction of underlying immunosuppression and metabolic disturbances, adequate surgical debridement along with amphotericin therapy. We describe surgical site mucormycosis extended to involve large bowel in elderly diabetic patient.

  17. Mupirocin prophylaxis against nosocomial Staphylococcus aureus infections in nonsurgical patients: a randomized study

    NARCIS (Netherlands)

    M.C. Vos (Margreet); A. Ott (Alewijn); A. Voss (Andreas); J.A.J.W. Kluytmans (Jan); C.M.J.E. Vandenbroucke-Grauls (Christina); M.H.M. Meester (Marlene); P.H.J. van Keulen (Peter); H.A. Verbrugh (Henri); H.F.L. Wertheim (Heiman)

    2004-01-01

    textabstractBACKGROUND: Staphylococcus aureus nasal carriage is a major risk factor for nosocomial S. aureus infection. Studies show that intranasal mupirocin can prevent nosocomial surgical site infections. No data are available on the efficacy of mupirocin in nonsurgical

  18. Scalp flora in Indian patients undergoing craniotomy for brain tumors - Implications for pre-surgical site preparation and surgical site infection

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    Aliasgar V Moiyadi

    2012-01-01

    Full Text Available Introduction: Causation of surgical site infection (SSI following craniotomy is multifactorial. Most preventive strategies (including site preparation and antibiotic prophylaxis revolve around reducing preoperative contamination of the local site. There is little evidence, however, linking site contamination with postoperative infections. This is important given the preference for performing non-shaved cranial surgery. We undertook a prospective study to document the scalp flora in neurosurgical patients in an Indian setting and to assess possible association with SSI. Materials and Methods: A prospective study recruited 45 patients undergoing non-shaved clean craniotomies for various brain tumors. Standard perioperative procedures and antibiotic policy were employed. Prior to and immediately following the pre-surgical scrubbing, we collected swabs and evaluated their growth qualitatively. SSI was documented adhering to CDC guidelines. The association of swab-positivity with various parameters (including SSI was evaluated. Results: Pre-scrub positivity was seen in 18 of 44 patients, three of them developed subsequent SSI. Most were known skin contaminants. Five patients had swab positivity after scrubbing, though none of these developed any SSI. Four of these five had pre-scrub positivity. In three the same organisms persisted (two being Staphylococcus aureus, and one had different growth post-scrub, whereas one patient developed new growth (contaminant mycelial fungus in the post-scrub swab. We did not find any association between swab positivity and SSI. Swab positivity was also not related to hair-length or hygiene. Conclusion: Scalp flora in Indian patients is similar to that described. Pre-surgical preparation does not always eliminate this contamination (especially staphylococcus. However, this does not necessarily translate into increased SSI. Moreover, the results also provide objective evidence to support the performance of non

  19. Rapid control of a methicillin resistant Staphylococcus aureus (MRSA) outbreak in a medical surgical intensive care unit (ICU).

    Science.gov (United States)

    Khan, Anjum; Lampitoc, Marianita; Salaripour, Maryam; McKernan, Patricia; Devlin, Roslyn; Muller, Matthew P

    2009-01-01

    Outbreaks of methicillin resistant Staphylococcus aureus in the intensive care unit setting can be prolonged and difficult to control. This report describes the rapid control of an outbreak of methicillin resistant Staphylococcus aureus in a 24-bed open-concept medical surgical intensive care unit with a baseline methicillin resistant Staphylococcus aureus acquisition rate of 1.5 cases per 1000 patient days. This institution's infection control policy mandates an outbreak investigation if two cases of hospital-acquired methicillin resistant Staphylococcus aureus colonization or infection are identified in an intensive care unit within a four-week period. In July 2007, methicillin resistant Staphylococcus aureus was identified in the sputum of two patients within a one-week period. Screening of all patients in the intensive care unit identified one additional case and a fourth case was identified from a clinical specimen before control measures were implemented. Initial control measures included healthcare worker education, enhanced surveillance, patient cohorting, and enhanced environmental cleaning. Despite these measures, three more cases occurred. All patients were then placed in contact isolation, healthcare workers were screened, and the nursing staff was cohorted. After two weeks without a case, two additional cases were identified. Decolonization of all positive patients was initiated. No further cases occurred over a five-week period and the outbreak was declared over. The outbreak resulted in nine cases of methicillin resistant Staphylococcus aureus colonization (n = 8) or infection (n = 1) over an 11-week period. Only one of 175 healthcare workers was colonized and it was not the outbreak strain. Early detection and the stepwise addition of infection control measures resulted in the rapid control of an outbreak of methicillin resistant Staphylococcus aureus in a medical surgical intensive care unit without unit closure. A low threshold of suspicion and

  20. Evaluation of two surveillance methods for surgical site infection

    Directory of Open Access Journals (Sweden)

    M. Haji Abdolbaghi

    2006-08-01

    Full Text Available Background: Surgical wound infection surveillance is an important facet of hospital infection control processes. There are several surveillance methods for surgical site infections. The objective of this study is to evaluate the accuracy of two different surgical site infection surveillance methods. Methods: In this prospective cross sectional study 3020 undergoing surgey in general surgical wards of Imam Khomeini hospital were included. Surveillance methods consisted of review of medical records for postoperative fever and review of nursing daily note for prescription of antibiotics postoperatively and during patient’s discharge. Review of patient’s history and daily records and interview with patient’s surgeon and the head-nurse of the ward considered as a gold standard for surveillance. Results: The postoperative antibiotic consumption especially when considering its duration is a proper method for surgical wound infection surveillance. Accomplishments of a prospective study with postdischarge follow up until 30 days after surgery is recommended. Conclusion: The result of this study showed that postoperative antibiotic surveillance method specially with consideration of the antibiotic usage duration is a proper method for surgical site infection surveillance in general surgery wards. Accomplishments of a prospective study with post discharge follow up until 30 days after surgery is recommended.

  1. Surgical attire, practices and their perception in the prevention of surgical site infection.

    Science.gov (United States)

    McHugh, S M; Corrigan, M A; Hill, A D K; Humphreys, H

    2014-02-01

    Clean surgical scrubs, surgical gowns and headgear are worn by operative teams to decrease bacterial contamination and lower surgical site infection (SSI) rates. A detailed review was undertaken of peer-reviewed publications and other sources of material in the English language over the last 50 years included. Surgical scrubs should be clean and made of tightly woven material. Studies investigating single-use gowns and drapes versus reusable gowns report conflicting evidence. Double gloving may reduce SSI rates in procedures where no antibiotic prophylaxis was administered. Bacterial contamination of the operative field has been shown to be decreased by the wearing of surgical headgear by the operating team. Further consideration and better trials are required to determine the impact of different theatre clothing on SSI rates. Copyright © 2013 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  2. Improved Surgical Site Infection (SSI) rate through accurately assessed surgical wounds

    OpenAIRE

    John, Honeymol; Nimeri, Abdelrahman; Ellahham, Samer

    2015-01-01

    Sheikh Khalifa Medical City's (SKMC) Surgery Institute was identified as a high outlier in Surgical Site Infections (SSI) based on the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) - Semi-Annual Report (SAR) in January 2012. The aim of this project was to improve SSI rates through accurate wound classification. We identified SSI rate reduction as a performance improvement and safety priority at SKMC, a tertiary referral center. We used the American Col...

  3. Community-acquired methicillin-resistant Staphylococcus aureus in surgically treated hand infections.

    Science.gov (United States)

    Imahara, Scott D; Friedrich, Jeffrey B

    2010-01-01

    An increase in the incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections has been observed. The purpose of this study is to determine the change in proportion of surgically treated CA-MRSA hand infections over the last decade and to identify associated risk factors. A retrospective review was performed of all 159 hand infections treated in the operating room over an 11-year period (1997-2007). Mean age overall was 40 years, mean inpatient length of stay was 4.9 days, and 115 of the 159 patients were male. Examined data included known risk factors for MRSA, including human immunodeficiency virus infection, diabetes mellitus, intravenous drug use, incarceration, and homelessness. Forty-eight patients had surgery for hand infections due to CA-MRSA. The yearly proportion of CA-MRSA increased over the study period, and the risk of having an MRSA infection was 41% higher with each progressive calendar year during the study period relative to the apparent incidence of non-MRSA hand infections. Other factors associated with CA-MRSA were intravenous drug use, felon-type infection, and prior hand infection. Multivariable logistic regression identified intravenous drug use as a significant, independent risk factor for CA-MRSA hand infection. The proportion of surgically treated hand infections due to CA-MRSA has increased during the last decade. Intravenous drug use was the only independent risk factor for CA-MRSA infections treated in the operating room at our institution. Copyright 2010. Published by Elsevier Inc.

  4. Surgical Site Infection Rate and Risk Factors among Obstetric Cases ...

    African Journals Online (AJOL)

    Chorioamnionitis, presence of meconium, large intraoperative blood loss and Perioperative blood transfusion were associated with increased severity of SSIs with p < 0.001. Absence of antenatal care follow up was also associated with increased severity of Surgical Site Infections. CONCLUSION: it has been revealed that ...

  5. Magnitude and factors associated with post-cesarean surgical site ...

    African Journals Online (AJOL)

    Background: Surgical site infection (SSI) after cesarean section (CS) increases maternal morbidity, hospital stay and medical cost. However, in Ethiopia, limited evidence exists regarding ... Factors associated with SSI were identified using multivariate logistic regression analysis. The output of the analysis is presented using ...

  6. Aerobic bacteriology of surgical site infection in implant surgery: The ...

    African Journals Online (AJOL)

    Aerobic bacteriology of surgical site infection in implant surgery: The experience at a Tertiary Hospital in Nigeri. UO Ikeanyi, SO Mbaleme. Abstract. No Abstract. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL.

  7. Risk Factors of Surgical Site Infection at Muhimbili National Hospital ...

    African Journals Online (AJOL)

    Superficial SSI was the most commonly observed type, 54.8%. Overall HIV prevalence in this study was 16.9% with a 5 times risk of developing SSI. Conclusions: Surgical site infection has remained a major Nosocomial infection in developing countries. Factors shown to be associated with increased risk are wound class, ...

  8. [Pathogenic mechanisms in the development of surgical site infections].

    Science.gov (United States)

    Jovanović, Zorica; Ilić, Milena; Janković, Slobodan

    2007-01-01

    Surgical site infections represent a major problem in modern medicine. Bacterial survival and growth in surgical wounds depends on the effectiveness of the host defense mechanisms and on the ability of bacteria to resist these defensive mechanisms. Surgical site contamination causes cellular injury and triggers the inflammatory response. An acute inflammatory response occurs within seconds to minutes of injury or invasion; it is non-specific and self-limiting. Mast cell degranulation, activation of three plasma systems and release of subcellular components from damaged cells occur as a consequence of cellular injury. Inflammation is mediated by a variety of soluble factors, including the complement system, the clotting system and the kinin system. The cell-derived mediators include histamine and serotonin, platelet activating factor, arachidonic acid metabolites (prostaglandins, leukotrienes, lipoxins), nitric oxide, and cytokines (regulators of host responses to infection, inflammation and immune responses). The main role of an inflammatory reaction is to recruit various cells and plasma components to the surgical site. Neutrophils are the first immune cells recruited at the site infection. Intracelhular killing of microbes by neutrophils is accomplished through several mechanisms, including lysosomal enzymes and oxygen-dependent mechanisms. Later, local and blood-borne macrophages also migrate to the surgical site, initiate phagocytosis, and present antigens to T-lymphocytes in a recognizable form. Sepsis is a common systemic complication of infection. Septic shock is associated with severe infection and release of inflammatory mediators into the systemic circulation. The lipopolysaccharide from gram-negative bacteria contributes significantly to the pathogenesis of septic shock. The most common clinical manifestations of sepsis include fever or hypothermia, tachycardia, tachypnea, altered blood pressure, either leukocytosis or leukopenia, and change in mental

  9. Updated recommendations for control of surgical site infections.

    Science.gov (United States)

    Alexander, J Wesley; Solomkin, Joseph S; Edwards, Michael J

    2011-06-01

    The objective of this study is to provide updated guidelines for the prevention of surgical wound infections based upon review and interpretation of the current and past literature. The development and treatment of surgical wound infections has always been a limiting factor to the success of surgical treatment. Although continuous improvements have been made, surgical site infections continue to occur at an unacceptable rate, annually costing billions of dollars in economic loss caused by associated morbidity and mortality. The Centers for Disease Control (CDC) provided extensive recommendations for the control of surgical infections in 1999. Review of the current literature with interpretation of the findings has been done to update the recommendations. New and sometimes conflicting studies indicate that coordination and application of techniques and procedures to decrease wound infections will be highly successful, even in patients with very high risks. This review suggests that uniform adherence to the proposed guidelines for the prevention of surgical infections could reduce wound infections significantly; namely to a target of less than 0.5% in clean wounds, less than 1% in clean contaminated wounds and less than 2% in highly contaminated wounds and decrease related costs to less than one-half of the current amount.

  10. Variable performance of models for predicting methicillin-resistant Staphylococcus aureus carriage in European surgical wards.

    Science.gov (United States)

    Lee, Andie S; Pan, Angelo; Harbarth, Stephan; Patroni, Andrea; Chalfine, Annie; Daikos, George L; Garilli, Silvia; Martínez, José Antonio; Cooper, Ben S

    2015-02-27

    Predictive models to identify unknown methicillin-resistant Staphylococcus aureus (MRSA) carriage on admission may optimise targeted MRSA screening and efficient use of resources. However, common approaches to model selection can result in overconfident estimates and poor predictive performance. We aimed to compare the performance of various models to predict previously unknown MRSA carriage on admission to surgical wards. The study analysed data collected during a prospective cohort study which enrolled consecutive adult patients admitted to 13 surgical wards in 4 European hospitals. The participating hospitals were located in Athens (Greece), Barcelona (Spain), Cremona (Italy) and Paris (France). Universal admission MRSA screening was performed in the surgical wards. Data regarding demographic characteristics and potential risk factors for MRSA carriage were prospectively collected during the study period. Four logistic regression models were used to predict probabilities of unknown MRSA carriage using risk factor data: "Stepwise" (variables selected by backward elimination); "Best BMA" (model with highest posterior probability using Bayesian model averaging which accounts for uncertainty in model choice); "BMA" (average of all models selected with BMA); and "Simple" (model including variables selected >50% of the time by both Stepwise and BMA approaches applied to repeated random sub-samples of 50% of the data). To assess model performance, cross-validation against data not used for model fitting was conducted and net reclassification improvement (NRI) was calculated. Of 2,901 patients enrolled, 111 (3.8%) were newly identified MRSA carriers. Recent hospitalisation and presence of a wound/ulcer were significantly associated with MRSA carriage in all models. While all models demonstrated limited predictive ability (mean c-statistics MRSA-positive individuals despite screening fewer patients than the Stepwise model. Moreover, the Simple model improved

  11. Creation and Evaluation of New Porcine Model for Investigation of Treatments of Surgical Site Infection.

    Science.gov (United States)

    Mohiti-Asli, Mahsa; Risselada, Marije; Jacob, Megan; Pourdeyhimi, Behnam; Loboa, Elizabeth G

    2017-11-01

    Surgical site infection (SSI) is the most common cause of surgical failure, increasing the risks of postoperative mortality and morbidity. Recently, it has been reported that the use of antimicrobial dressings at the incision site help with prevention of SSI. Despite the increased body of research on the development of different types of antimicrobial dressings for this application, to our knowledge, nobody has reported a reliable large animal model to evaluate the efficacy of developed materials in a preclinical SSI model. In this study, we developed a porcine full-thickness incision model to investigate SSI caused by methicillin-resistant Staphylococcus aureus (MRSA), the leading cause of SSI in the United States. Using this model, we then evaluated the efficacy of our newly developed silver releasing nanofibrous dressings for preventing and inhibiting MRSA infection. Our results confirmed the ease and practicality of a new porcine model as an in vivo platform for evaluation of biomaterials for SSI. Using this model, we found that our silver releasing scaffolds significantly reduced bacterial growth in wounds inoculated with MRSA relative to nontreated controls and to wounds treated with the gold standard, silver sulfadiazine, without causing inflammation at the wound site. Findings from this study confirm the potential of our silver-releasing nanofibrous scaffolds for treatment/prevention of SSI, and introduce a new porcine model for in vivo evaluation of additional SSI treatment approaches.

  12. Adhering to a national surgical care bundle reduces the risk of surgical site infections

    NARCIS (Netherlands)

    Koek, Mayke B. G.; Hopmans, Titia E. M.; Soetens, Loes C.; Wille, Jan C.; Geerlings, Suzanne E.; Vos, Margreet C.; van Benthem, Birgit H. B.; de Greeff, Sabine C.

    2017-01-01

    In 2008, a bundle of care to prevent Surgical Site Infections (SSIs) was introduced in the Netherlands. The bundle consisted of four elements: antibiotic prophylaxis according to local guidelines, no hair removal, normothermia and 'hygiene discipline' in the operating room (i.e. number of door

  13. Adhering to a national surgical care bundle reduces the risk of surgical site infections

    NARCIS (Netherlands)

    Koek, M.B.G. (Mayke B. G.); Hopmans, T.E.M. (Titia E. M.); Soetens, L.C. (Loes C.); J.C. Wille (Jan); S.E. Geerlings (Suzanne); M.C. Vos (Margreet); B.H. van Benthem (Birgit); S.C. de Greeff (Sabine C.)

    2017-01-01

    textabstractBackground: In 2008, a bundle of care to prevent Surgical Site Infections (SSIs) was introduced in the Netherlands. The bundle consisted of four elements: antibiotic prophylaxis according to local guidelines, no hair removal, normothermia and ‘hygiene discipline’

  14. STUDY ON SURGICAL SITE INFECTIONS CAUSED BY ESBL PRODUCING GRAM NEGATIVE BACTERIA

    Directory of Open Access Journals (Sweden)

    Rambabu

    2015-09-01

    Full Text Available Surgical site infections have been a major problem, because of the emergence of drug resistant bacteria, in particular B - lactamase producing bacteria. Extended spectrum beta lactamase producing gram negative organisms pose a great challenge in treatment o f SSI present study is aimed at determining multiple drug resistance in gram negative bacteria & to find out ESBL producers, in correlation with treatment outcome. A total of 120 wound infected cases were studied. Staphylococcus aureus was predominant bact erium - 20.Among gram negative bacteria, Pseudomonas species is predominant (14 followed by Escherichia coli (13 , Klebsiella species (12 , Proteus (9 Citrobacter (4 Providencia (2 & Acinetobacter species (2 . Out of 56 gramnegative bacteria isolated, 20 were i dentified as ESBL producers, which was statistically significant. Delay in wound healing correlated with infection by ESBL producers, which alarms the need of abstinence from antibiotic abuse

  15. A single copy integration vector that integrates at an engineered site on the Staphylococcus aureus chromosome

    Directory of Open Access Journals (Sweden)

    Lei Mei G

    2012-01-01

    Full Text Available Abstract Background Single-copy integration vectors based upon the site-specific recombination systems of bacteriophage are invaluable tools in the study of bacterial pathogenesis. The utility of such vectors is often limited, however, by the fact that integration often results in the inactivation of bacterial genes or has undesirable effects on gene transcription. The aim of this study is to develop an integration vector that does not have a detectable effect on gene transcription upon integration. Findings We have developed a single-copy integration system that enables the cloning vector to integrate at a specific engineered site, within an untranscribed intergenic region, in the chromosome of Staphylococcus aureus. This system is based on the lysogenic phage L54a site-specific recombination system in which the L54a phage (attP and chromosome (attB attachment sites, which share an 18-bp identical core sequence, were modified with identical mutations. The integration vector, pLL102, was constructed to contain the modified L54a attP site (attP2 that was altered at 5 nucleotide positions within the core sequence. In the recipient strain, the similarly modified attB site (attB2 was inserted in an intergenic region devoid of detectable transcription read-through. Integration of the vector, which is unable to replicate in S. aureus extrachromosomally, was achieved by providing the L54a integrase gene in a plasmid in the recipient. We showed that pLL102 integrated specifically at the engineered site rather than at the native L54a attB site and that integration did not have a significant effect on transcription of genes immediately upstream or downstream of the integration site. Conclusions In this work, we describe an E. coli-S. aureus shuttle vector that can be used to introduce any cloned gene into the S. aureus chromosome at a select site without affecting gene expression. The vector should be useful for genetic manipulation of S. aureus and for

  16. Is chlorhexidine-gluconate superior than Povidone-Iodine in preventing surgical site infections? A multicenter study.

    Science.gov (United States)

    Bibi, Safia; Shah, Syed Aslam; Qureshi, Shamim; Siddiqui, Taranum Ruba; Soomro, Iftikhar Ahmed; Ahmed, Waquaruddin; Alam, Syed Ejaz

    2015-11-01

    To compare the efficacy of povidone-iodine and chlorhexidine gluconate scrubs in preventing surgical site infections. The randomised controlled clinical trial was conducted from May 2012 to April 2013 in two public-sector hospitals of Pakistan; one each in Karachi and Islamabad. Patients undergoing clean or clean contaminated surgeries were included and were randomly assigned to one of the two groups: group I comprised patients whose skin was preoperatively disinfected using 10% povidone-iodine, and in group II by 2% chlorhexidine gluconate in 70% alcohol. A predesigned proforma was filled for all patients to record demographic data, diagnosis, surgical procedure and antibiotic used. Patients in both groups were followed up for one month postoperatively to monitor any signs of surgical site infections. SPSS 16 was used for statistical analysis. Of the 388 patients from the two hospitals, 220(57%) were in group I and 168(43%) were in group II. Surgical site infection was observed in 22(10%) cases in group I and 12(7.1%) in group II (p=0.324). Pseudomonas aeruginosa (23.5%) was the predominant pathogen associated with surgical site infections followed by Staphylococcus aureus (17.6%). Chlorhexidine gluconate was associated with lower infection rates compared to povidone-iodine; but it was not statistically significant.

  17. Comprehensive review of methicillin-resistant Staphylococcus aureus: screening and preventive recommendations for plastic surgeons and other surgical health care providers.

    Science.gov (United States)

    O'Reilly, Eamon B; Johnson, Mark D; Rohrich, Rod J

    2014-11-01

    Up to 2.3 million people are colonized with methicillin-resistant Staphylococcus aureus in the United States, causing well-documented morbidity and mortality. Although the association of clinical outcomes with community and hospital carriage rates is increasingly defined, less is reported about asymptomatic colonization prevalence among physicians, and specifically plastic surgeons and the subsequent association with the incidence of patient surgical-site infection. A review of the literature using the PubMed and Cochrane databases analyzing provider screening, transmission, and prevalence was undertaken. In addition, a search was completed for current screening and decontamination guidelines and outcomes. The methicillin-resistant S. aureus carriage prevalence of surgical staff is 4.5 percent. No prospective data exist regarding transmission and interventions for plastic surgeons. No studies were found specifically looking at prevalence or treatment of plastic surgeons. Current recommendations by national organizations focus on patient-oriented point-of-care testing and intervention, largely ignoring the role of the health care provider. Excellent guidelines exist regarding screening, transmission prevention, and treatment both in the workplace and in the community. No current such guidelines exist for plastic surgeons. No Level I or II evidence was found regarding physician screening, treatment, or transmission. Current expert opinion, however, indicates that plastic surgeons and their staff should be vigilant for methicillin-resistant S. aureus transmission, and once a sentinel cluster of skin and soft-tissue infections is identified, systematic screening and decontamination should be considered. If positive, topical decolonization therapy should be offered. In refractory cases, oral antibiotic therapy may be required, but this should not be used as a first-line strategy.

  18. Increased use of surgical energy promotes methicillin-resistant Staphylococcus aureus colonization in rabbits following open ventral hernia mesh repair.

    Science.gov (United States)

    Fernandez-Moure, Joseph S; Van Eps, Jeffrey L; Peress, Lilia; Cantu, Concepcion; Olsen, Randall J; Jenkins, Leslie; Cabrera, Fernando J; Tasciotti, Ennio; Weiner, Bradley K; Dunkin, Brian J

    2017-02-01

    Surgical energy has been widely implemented because of ease of use, effective hemostasis, and surgical dissection. Studies demonstrate its use to be an independent risk factor for postoperative wound infection. Methicillin-resistant Staphylococcus aureus (MRSA) is the most common bacteria found in postoperative mesh infection. No reports are available on the sequelae of surgical energy use for open ventral hernia repair (oVHR) with mesh. We hypothesized that increasing amounts of surgical energy will result in higher infectious burden after oVHR with composite multifilament polyester mesh (Parietex™ PCO). New Zealand rabbits underwent bridging oVHR with Parietex™ PCO and were divided into three surgical treatment groups: (1) scalpel alone, (2) 120 J of energy, and (3) 600 J of energy. The bioprosthesis was then inoculated with 105 colony-forming units of MRSA. Rabbits were survived for 7 days with daily physical examination. Complete blood count, basci metabolic panel, and blood cultures were performed on postoperative days one, four, and seven. Surviving rabbits were killed, and meshes explanted for MRSA colony counts. Rabbits receiving the most surgical energy developed signs and symptoms of severe sepsis and wound necrosis within 24 h. In comparison, rabbits receiving no surgical energy had significantly less MRSA recovered from explanted mesh, significantly less bacteremia, and fewer adhesions. Increased use of surgical energy promoted greater colonization, exaggerated septic response to bacterial contamination, and more severe adhesions. In the absence of devitalized tissue, rabbits can effectively limit bacterial contamination. These findings support the surgical principles of proper tissue handling and highlight the detrimental effects of indiscriminant surgical energy usage, thus emphasizing the importance of programs such as Fundamental Use of Surgical Energy.

  19. Association of Safety Culture with Surgical Site Infection Outcomes.

    Science.gov (United States)

    Fan, Caleb J; Pawlik, Timothy M; Daniels, Tania; Vernon, Nora; Banks, Katie; Westby, Peggy; Wick, Elizabeth C; Sexton, J Bryan; Makary, Martin A

    2016-02-01

    Hospital workplace culture may have an impact on surgical outcomes; however, this association has not been established. We designed a study to evaluate the association between safety culture and surgical site infection (SSI). Using the Hospital Survey on Patient Safety Culture and National Healthcare Safety Network definitions, we measured 12 dimensions of safety culture and colon SSI rates, respectively, in the surgical units of Minnesota community hospitals. A Pearson's r correlation was calculated for each of 12 dimensions of surgical unit safety culture and SSI rate and then adjusted for surgical volume and American Society of Anesthesiologists (ASA) classification. Seven hospitals participated in the study, with a mean survey response rate of 43%. The SSI rates ranged from 0% to 30%, and surgical unit safety culture scores ranged from 16 to 92 on a scale of 0 to 100. Ten dimensions of surgical unit safety culture were associated with colon SSI rates: teamwork across units (r = -0.96; 95% CI [-0.76, -0.99]), organizational learning (r = -0.95; 95% CI [-0.71, -0.99]), feedback and communication about error (r = -0.92; 95% CI [-0.56, -0.99]), overall perceptions of safety (r = -0.90; 95% CI [-0.45, -0.99]), management support for patient safety (r = -0.90; 95% CI [-0.44, -0.98]), teamwork within units (r = -0.88; 95% CI [-0.38, -0.98]), communication openness (r = -0.85; 95% CI [-0.26, -0.98]), supervisor/manager expectations and actions promoting safety (r = -0.85; 95% CI [-0.25, -0.98]), non-punitive response to error (r = -0.78; 95% CI [-0.07, -0.97]), and frequency of events reported (r = -0.76; 95% CI [-0.01, -0.96]). After adjusting for surgical volume and ASA classification, 9 of 12 dimensions of surgical unit safety culture were significantly associated with lower colon SSI rates. These data suggest an important role for positive safety and teamwork culture and engaged hospital management in producing high-quality surgical

  20. Biopsy site selfies--a quality improvement pilot study to assist with correct surgical site identification.

    Science.gov (United States)

    Nijhawan, Rajiv I; Lee, Erica H; Nehal, Kishwer S

    2015-04-01

    Determining the biopsy site location of a skin cancer before treatment is often challenging. To study the implementation and effectiveness of biopsy site selfies as a quality improvement measure for correct surgical site identification. In the first phase, the ability of dermatologic surgeon and patient to definitively identify the biopsy site and whether photography was needed to ensure site agreement were recorded. In the second phase, patients were requested to take biopsy site selfies, and after implementation, similar data were collected including whether a biopsy site selfie was helpful for definitive site identification. In the first phase, the physician and patient were unable to identify the biopsy site 17.6% (49/278) and 25.5% (71/278) of cases, respectively. A photograph was needed in 22.7% of cases (63/278). After implementation of biopsy site selfies, the physician and patient were unable to identify the biopsy site 17.4% (23/132) and 15.2% (20/132) of cases, respectively. Biopsy site selfies were available for 64.1% of cases for which no internal image was available and critical for site identification in 21.4% of these cases. Biopsy site selfies has proven to be helpful for correct surgical site identification by both the physician and the patient and may also provide further reassurance and confidence for patients.

  1. Effectiveness of local vancomycin powder to decrease surgical site infections: a meta-analysis.

    Science.gov (United States)

    Chiang, Hsiu-Yin; Herwaldt, Loreen A; Blevins, Amy E; Cho, Edward; Schweizer, Marin L

    2014-03-01

    Some surgeons use systemic vancomycin to prevent surgical site infections (SSIs), but patients who do not carry methicillin-resistant Staphylococcus aureus have an increased risk of SSIs when given vancomycin alone for intravenous prophylaxis. Applying vancomycin powder to the wound before closure could increase the local tissue vancomycin level without significant systemic levels. However, the effectiveness of local vancomycin powder application for preventing SSIs has not been established. Our objective was to systematically review and evaluate studies on the effectiveness of local vancomycin powder for decreasing SSIs. Meta-analysis. We included observational studies, quasi-experimental studies, and randomized controlled trials of patients undergoing surgical procedures that involved vancomycin powder application to surgical wounds, reported SSI rates, and had a comparison group that did not use local vancomycin powder. The primary outcome was postoperative SSIs. The secondary outcomes included deep incisional SSIs and S. aureus SSIs. We performed systematic literature searches in PubMed, the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, the Cochrane Central Register of Controlled Trials via Wiley, Scopus (including EMBASE abstracts), Web of Science, ClinicalTrials.gov, BMC Proceedings, ProQuest Dissertation, and Thesis in Health and Medicine, and conference abstracts from IDWeek, the Interscience Conference on Antimicrobial Agents and Chemotherapy, the Society for Healthcare Epidemiology of America, and the American Academy of Orthopedic Surgeons annual meetings, and also the Scoliosis Research Society Annual Meeting and Course. We ran the searches from inception on May 9, 2013 with no limits on date or language. After reviewing 373 titles or abstracts and 22 articles in detail, we included 10 independent studies and used a random-effects model when pooling risk estimates to assess the effectiveness of local

  2. Short-term glycemic control is effective in reducing surgical site infection in diabetic rats.

    Science.gov (United States)

    Kroin, Jeffrey S; Buvanendran, Asokumar; Li, Jinyuan; Moric, Mario; Im, Hee-Jeong; Tuman, Kenneth J; Shafikhani, Sasha H

    2015-06-01

    Patients and animals with diabetes exhibit enhanced vulnerability to bacterial surgical infections. Despite multiple retrospective studies demonstrating the benefits associated with glycemic control in reducing bacterial infection after cardiac surgery, there are fewer guidelines on the use of glycemic control for noncardiac surgeries. In the current study, we investigated whether long-term (begun 2 weeks before surgery) or immediate (just before surgery) glycemic controls, continued postoperatively, can reduce surgical site infection in type 1 diabetic-induced rats. Rats were injected with streptozotocin to induce type 1 diabetes. Four groups of animals underwent surgery and thigh muscle Staphylococcus aureus bacteria challenge (1 × 10 colony forming units) at the time of surgery. Group 1 diabetic rats received insulin treatment just before surgery and continued until the end of study (short-term glycemic control group). Group 2 diabetic rats received insulin treatment 2 weeks before surgery and continued until the end of study (long-term glycemic control). Group 3 diabetic rats received no insulin treatment (no glycemic control group). Group 4 nondiabetic rats served as a healthy control group. Rats were euthanized at 3 or 6 days after surgery. Blood glucose and muscle bacterial burden were measured at 3 or 6 days after surgery. Glycemic control was achieved in both long- and short-term insulin-treated diabetic rats. Compared with untreated diabetic rats, the bacterial burden in muscle was significantly lower in both groups of glycemic controlled diabetic rats at 3 (all P control regimen, initiated just before surgery and bacterial exposure, was as effective in reducing surgical site infection as a long-term glycemic control in type 1 diabetic rats. These data suggest that immediately implementing glycemic control in type 1 diabetic surgical patients before undergoing noncardiac surgery may decrease the risk of infection.

  3. Surveillance of post-caesarean surgical site infections in a hospital with limited resources, Cambodia.

    Science.gov (United States)

    Srun, Sok; Sinath, Yin; Seng, An Thoun; Chea, Meas; Borin, Mony; Nhem, Somary; Daniel, Amanda; Chea, Nora; Asgari, Nima; Rachline, Anne; Reed, Za; Hoff, Rodney; Cavailler, Philippe; Goyet, Sophie

    2013-08-15

    In Cambodia, we implemented a pilot surveillance of superficial surgical site infections (SSSI) following caesarean deliveries (CD) in a provincial hospital, to estimate their incidence, describe their clinical management, and determine their causative pathogens. Between October 2010 and February 2011, all women admitted for CD were included in the surveillance. Their clinical condition was monitored for a post-operative period of 30 days, including two assessments performed by surgeons. Cases were clinically diagnosed by surgeons, with bacterial cultures performed. Of the 222 patients admitted for CD, 176 (79.3%) were monitored for 30 days. Of these, 11 were diagnosed with a SSSI, giving an incidence rate of 6.25% (95% CI 3.2-10.9). Four of the cases (36.4%) were detected after hospital discharge. Length of hospitalization was significantly longer for the SSSI cases. All 222 patients were prescribed antibiotics. Ampicillin was administered intravenously to 98.6% of them, with subsequent oral amoxicillin given to 82.9%. Three of six pus samples collected were positive on culture: two with Staphylococcus aureus and one with Staphylococcus lugdunensis. One S.aureus was methicillin resistant (MRSA). The other was clindamycin and erythromycin resistant. Surveillance of health-care associated infections in a setting with limited resources is challenging but feasible. Effective post-discharge surveillance was essential for the estimation of the incidence rate of SSSI following caesarean deliveries. This surveillance led to a peer-review of medical practices.

  4. Evaluation of adherence to measures for the prevention of surgical site infections by the surgical team

    Directory of Open Access Journals (Sweden)

    Adriana Cristina de Oliveira

    2015-10-01

    Full Text Available AbstractOBJECTIVEEvaluate pre- and intraoperative practices adopted by medical and nursing teams for the prevention of surgical infections.METHODA prospective study carried out in the period of April to May 2013, in a surgical center of a university hospital in Belo Horizonte, Minas Gerais.RESULTS18 surgeries were followed and 214 surgical gloves were analyzed, of which 23 (10.7% had postoperative glove perforation detected, with 52.2% being perceived by users. Hair removal was performed on 27.7% of patients in the operating room, with the use of blades in 80% of the cases. Antibiotic prophylaxis was administered to 81.8% of patients up to 60 minutes prior to surgical incision. An average of nine professionals were present during surgery and the surgery room door remained open in 94.4% of the procedures.CONCLUSIONPartial adhesion to the recommended measures was identified, reaffirming a need for greater attention to these critical steps/actions in order to prevent surgical site infection.

  5. Surveillance and epidemiology of surgical site infections after cardiothoracic surgery in The Netherlands, 2002-2007

    NARCIS (Netherlands)

    Manniën, Judith; Wille, Jan C.; Kloek, Jaap J.; van Benthem, Birgit H. B.

    2011-01-01

    Surgical site infections after cardiothoracic surgery substantially increase the risk for illness, mortality, and costs. Surveillance of surgical site infections might assist in the prevention of these infections. This study describes the Dutch surveillance methods and results of data collected

  6. Laparoscopic surgery compared with open surgery decreases surgical site infection in obese patients

    DEFF Research Database (Denmark)

    Shabanzadeh, Daniel M; Sørensen, Lars T

    2012-01-01

    : To compare surgical site infections rate in obese patients after laparoscopic surgery with open general abdominal surgery.......: To compare surgical site infections rate in obese patients after laparoscopic surgery with open general abdominal surgery....

  7. Surgical site infections following transcatheter apical aortic valve implantation: incidence and management

    Directory of Open Access Journals (Sweden)

    Baillot Richard

    2012-11-01

    Full Text Available Abstract Objective The present study was undertaken to examine the incidence and management of surgical site infection (SSI in patients submitted to transapical transcatheter aortic valve implantation (TA-TAVI. Methods From April 2007 to December 2011, 154 patients underwent TA-TAVI with an Edwards Sapien bioprosthesis (ES at the Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ as part of a multidisciplinary program to prospectively evaluate percutaneous aortic valve implantation. Patient demographics, perioperative variables, and postoperative complications were recorded in a prospective registry. Results Five (3.2% patients in the cohort presented with an SSI during the study period. The infections were all hospital-acquired (HAI and were considered as organ/space SSI’s based on Center for Disease Control criteria (CDC. Within the first few weeks of the initial procedure, these patients presented with an abscess or chronic draining sinus in the left thoracotomy incision and were re-operated. The infection spread to the apex of the left ventricle in all cases where pledgeted mattress sutures could be seen during debridement. Patients received multiple antibiotic regimens without success until the wound was surgically debrided and covered with viable tissue. The greater omentum was used in three patients and the pectoralis major muscle in the other two. None of the patients died or had a recurrent infection. Three of the patients were infected with Staphylococcus epidermidis, one with Staphylococcus aureus, and one with Enterobacter cloacae. Patients with surgical site infections were significantly more obese with higher BMI (31.4±3.1 vs 26.2±4.4 p=0.0099 than the other patients in the cohort. Conclusions While TA-TAVI is a minimally invasive technique, SSIs, which are associated with obesity, remain a concern. Debridement and rib resection followed by wound coverage with the greater omentum and/or the pectoralis major

  8. The impact of surgical hand antisepsis technique on surgical site infection.

    Science.gov (United States)

    Oriel, Brad S; Chen, Qi; Itani, Kamal M F

    2017-01-01

    Limited evidence exists regarding the effect on superficial and deep incisional surgical site infections (SDSSIs) of alcohol-based hand rubs (ABR) versus traditional aqueous surgical scrubs (TSS). User preferences and practice are unknown. A retrospective cohort study examining SDSSIs using VA Surgical Quality Improvement Program cases before ABR implementation (2007-2009, TSS group) and after (2013-2014, ABR group). A descriptive survey. SDSSI rates were 1.8% and 1.5% for TSS (n=4051) and ABR (n=2293), respectively (p=0.31). The adjusted odds of SDSSI using ABR was not significant (OR 0.82; 95% CI, 0.51-1.32). Greatest SDSSI risk was from preoperative radiotherapy (OR, 2.78; 95% CI, 1.14-6.78), general surgery (OR, 2.39; 95% CI, 1.30-4.39) and preoperative smoking (OR, 1.58; 95% CI, 1.02-2.44). Of 95 surveys included, 52% favored ABR. Although 95% self-reported correct product application, improper duration was revealed in both groups (TSS 18% and ABR 10%). Implementation of an ABR for use in surgical hand antisepsis did not alter SDSSI rates. Improving product knowledge and compliance may improve SSI rates. Published by Elsevier Inc.

  9. Surgical site infections following instrumented stabilization of the spine

    Directory of Open Access Journals (Sweden)

    Dapunt U

    2017-09-01

    Full Text Available Ulrike Dapunt,1 Caroline Bürkle,1 Frank Günther,2 Wojciech Pepke,1 Stefan Hemmer,1 Michael Akbar1 1Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, 2Department for Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University, Heidelberg, Germany Background: Implant-associated infections are still a feared complication in the field of orthopedics. Bacteria attach to the implant surface and form so-called biofilm colonies that are often difficult to diagnose and treat. Since the majority of studies focus on prosthetic joint infections (PJIs of the hip and knee, current treatment options (eg, antibiotic prophylaxis of implant-associated infections have mostly been adapted according to these results. Objective: The aim of this study was to evaluate patients with surgical site infections following instrumented stabilization of the spine with regard to detected bacteria species and the course of the disease. Patients and methods: We performed a retrospective single-center analysis of implant-associated infections of the spine from 2010 to 2014. A total of 138 patients were included in the study. The following parameters were evaluated: C-reactive protein serum concentration, microbiological evaluation of tissue samples, the time course of the disease, indication for instrumented stabilization of the spine, localization of the infection, and the number of revision surgeries required until cessation of symptoms. Results: Coagulase-negative Staphylococcus spp. were most commonly detected (n=69, 50%, followed by fecal bacteria (n=46, 33.3%. In 23.2% of cases, no bacteria were detected despite clinical suspicion of an infection. Most patients suffered from degenerative spine disorders (44.9%, followed by spinal fractures (23.9%, non-degenerative scoliosis (20.3%, and spinal tumors (10.1%. Surgical site infections occurred predominantly within 3

  10. Surgical Site Infection Reduction Program: Challenges and Opportunities.

    Science.gov (United States)

    Shea, Kevin G; Styhl, Alexandra C; King, Howard A; Hammons, Jerrie; Clapp, Melissa

    2015-01-01

    Surgical site infections (SSIs) make up about 23% of hospital-acquired infections and may cost up to 10 billion dollars annually in direct medical expenses. St. Luke's Health System of Boise, Idaho implemented a committee to reduce its incidence of SSIs, focusing on the orthopaedic and neurosurgical departments. After identifying risk factors associated with patient medical comorbidities, operating room practices, and type of procedure, Project Zero recommended changes. The implementation of a preoperative clinic and protocol management of environmental and procedural factors reduced the hospitals rate by 50%. Project Zero continues to research best practices for clean room management and preventative care, striving to reach the overall goal of zero infections.

  11. Incidence and predictors of surgical site infection in a general surgery department in Algeria.

    Science.gov (United States)

    Atif, M L; Azouaou, A; Bouadda, N; Bezzaoucha, A; Si-Ahmed, M; Bellouni, R

    2015-08-01

    Little is known about the epidemiology of surgical site infection (SSI) in Algeria. To determine the incidence and predictors of SSI in the 70-bed general surgery department at the Blida University Hospital, a 1-year prospective study (May 2006 to April 2007) was conducted. SSIs were classified according to the National Nosocomial Infection Surveillance (NNIS) System criteria and identified by bedside surveillance and post-discharge follow-up. Predictors were identified using a logistic regression model. Of 593 surgical procedures, 32 SSIs were identified (5.4%). Twenty-eight (43.8%) of the infections were diagnosed after discharge. The incidence of SSIs varied by procedure and risk category. On multivariate regression analysis, age (OR=1.35) and NNIS risk index (OR=3.02) were significant predictors of SSI. The causative pathogens were isolated in 12 (37.5%) of the 32 recorded SSIs. Staphylococcus aureus was predominant (n=5). The high SSI rates reported in this study suggest the need to implement preventive measures in the surgery department. Potential areas for intervention include antibiotic prophylaxis and shaving practices for skin preparation. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  12. The effect of antibiotic irrigation of surgical Incisions in prevention of Surgical Site Infection

    Directory of Open Access Journals (Sweden)

    Mirsharifi S R

    2008-05-01

    Full Text Available Background: surgical site infection is one of the most common post operative complications alongside with sepsis, cardiovascular, pulmonary and thromboembolic complications. The development of surgical site infection is related to three factors: the degree of microbial contamination of the wound during surgery, the duration of the procedure, and host factors such as diabetes, malnutrition, obesity, immune suppression, and a number of other underlying disease states. The purpose of this study was to evaluate the effects of topical cephazolin in controlling infection of the site of surgery after non-laparoscopic cholecystecomy.Methods: One hundred and two of patients referred to the outpatient clinic of Imam Khomeini Hospital from fall 2005 to fall 2006 non- laparoscopic cholecystectomy enrolled in a randomized clinical trial. All patients underwent the same procedure of anesthesia and surgery and they were randomly assigned into two groups of cases with irrigation of the site of surgery with 1g of topical Cephazolin prior to the termination of the operation- and controls. Cephazolin is a first generation cephalosporin which binds penicillin binding protein and is a potent cell wall synthesis inhibitor. The patients were followed up for six weeks for symptoms and signs of infection including discharge of the wound; and presence of pain, warmness, swelling and erythema of the wound.Results: There were no significant differences between two study groups regarding mean age, duration of operation, and sex. There was no significant difference in the incidence of infection of the site of surgery (11.8% in both groups with p=0.99 between two groups.Conclusion: Analyzing the collected data confirms that prophylactic use of topical cephazolin was unable to decrease the risk of infection of the site of surgery in patients undergoing non- laparascopic cheolecystectomy.

  13. Prevention and control of surgical site infections: review of the Basel Cohort Study.

    Science.gov (United States)

    Junker, Till; Mujagic, Edin; Hoffmann, Henry; Rosenthal, Rachel; Misteli, Heidi; Zwahlen, Marcel; Oertli, Daniel; Tschudin-Sutter, Sarah; Widmer, Andreas F; Marti, Walter R; Weber, Walter P

    2012-09-04

    Surgical site infections (SSI) are the most common hospital-acquired infections among surgical patients, with significant impact on patient morbidity and health care costs. The Basel SSI Cohort Study was performed to evaluate risk factors and validate current preventive measures for SSI. The objective of the present article was to review the main results of this study and its implications for clinical practice and future research. The prospective observational cohort study included 6,283 consecutive general surgery procedures closely monitored for evidence of SSI up to 1 year after surgery. The dataset was analysed for the influence of various potential SSI risk factors, including timing of surgical antimicrobial prophylaxis (SAP), glove perforation, anaemia, transfusion and tutorial assistance, using multiple logistic regression analyses. In addition, post hoc analyses were performed to assess the economic burden of SSI, the efficiency of the clinical SSI surveillance system, and the spectrum of SSI-causing pathogens. The overall SSI rate was 4.7% (293/6,283). While SAP was administered in most patients between 44 and 0 minutes before surgical incision, the lowest risk of SSI was recorded when the antibiotics were administered between 74 and 30 minutes before surgery. Glove perforation in the absence of SAP increased the risk of SSI (OR 2.0; CI 1.4-2.8; p tutorial assistance with the risk of SSI. The mean additional hospital cost in the event of SSI was CHF 19,638 (95% CI, 8,492-30,784). The surgical staff documented only 49% of in-hospital SSI; the infection control team registered the remaining 51%. Staphylococcus aureus was the most common SSI-causing pathogen (29% of all SSI with documented microbiology). No case of an antimicrobial-resistant pathogen was identified in this series. The Basel SSI Cohort Study suggested that SAP should be administered between 74 and 30 minutes before surgery. Due to the observational nature of these data, corroboration is

  14. Surgical risk index and surgical site infection in postpartum women submitted to cesarean section.

    Directory of Open Access Journals (Sweden)

    Luana Machado Chianca

    2015-01-01

    Full Text Available Backgound and Objectives: Considering the use of active surveillance assists in infection identification and the need for studies that use Surgical Risk Index (SRI for assessment of Surgical Site Infection (SSI in cesareans, this study aims to determine the incidence of SSI and analyze the applicability of SRI in the prediction of SSI in women in the postpartum period after being submitted to a cesarean section at a university hospital between April 2012 and March of 2013. Methods: Prospective cohort study. Information notifying SSI by active surveillance was collected daily from the medical records. After hospital discharge, the mothers were contacted through telephone calls to identify infection criteria within 30 days after the cesarean. Descriptive and comparative analyses were performed. The chi-square test was used to compare groups. Results: 737 cesareans were performed. Telephone contact was achieved with 507 (68.8% women up to 30 days postpartum, with loss of follow-up of 230 cases (31.2%. The medical consultation in the post-partum period occurred with 188 (37.08% women, with whom telephone contact was obtained, on average, 17.28 days (SD=8.39 after delivery. It was verified that 21 patients met the criteria for SSI, with a 4.14% rate. A total of 12 cases (57.1% were classified as superficial SSI, 5 (23.8% as deep and 4 (19.1% as infection of organs and cavities. The SRI and its risk variables were not associated with SSI in patients submitted to cesarean sections. Conclusion: The SRI and the risk variables included in this index were not associated to SSI in patients submitted to cesarean sections. KEYWORDS: Cesarean Section; Surgical Wound Infection; Epidemiological Surveillance; Infection Control; Risk Index; Disease Notification.

  15. Deep Surgical Site Infections Following Pediatric Cervical Spine Surgery.

    Science.gov (United States)

    Porter, David A; Glotzbecker, Michael P; Timothy Hresko, M; Hedequist, Daniel J

    2017-12-01

    This is the first reported series looking specifically at factors associated with deep surgical site infections (SSI) following pediatric cervical spine surgery. To identify risk factors present in pediatric patients who are at risk for SSI following cervical spine surgery. Level of evidence: level IV-retrospective case series. To date there are no studies regarding SSI in pediatric cervical spine surgery and thus no benchmark data or risk factors have been identified. Patients with acute deep SSIs occurring within 90 days of the index operation were identified. Patient and surgical characteristics were analyzed for possible predictors of SSI outcome using penalized likelihood logistic regression analysis. Characteristics analyzed included: age, diagnosis, comorbidity, levels fused, approach, implants used, allograft, halo, body mass index, revision, antibiotic dosing, and occipital plating. A total of 112 patients were included in the study at a mean age of 12.5 years (2 to 18 y). Comorbidities were present in 51 (46%) patients, 15 patients had a documented connective tissue disorder (CTD). The mean number of levels fused was 3.7 (2 to 7) and mean number of screws was 4.4 (2 to 11). Allograft was used alone in 48 patients, occipital plating in 28 patients, and a halo in 39 patients. Deep SSI occurred in 3 patients: two of which had a CTD (1 Trisomy 21, 1 Ehlers-Danlos) and 1 patient with postradiation cervical kyphosis. All were gram-positive infections requiring return to operating room with prolonged IV antibiotics. All patients recovered and fused with spinal implant retention. The incidence of deep SSI was 2.7%. It was determined that a CTD was the only significant predictor of SSI. Subjects with a CTD had 12 times the odds of SSI [odds ratio=12 (1.5, 137.0); P=0.02]. In our series of pediatric patients the incidence of a deep SSI was 2.7%. The only predictor of SSI was the presence of a CTD.

  16. Reducing surgical site infection in spinal surgery with betadine irrigation and intrawound vancomycin powder.

    Science.gov (United States)

    Tomov, Marko; Mitsunaga, Lance; Durbin-Johnson, Blythe; Nallur, Deepak; Roberto, Rolando

    2015-04-01

    Retrospective analysis. The objective of this study was to evaluate the efficacy of a surgical site infection (SSI) prevention protocol instituted in the Orthopaedic Spine Department at our institution. SSI is an undesired complication of orthopedic spine surgical procedures. It poses a significant risk to the patient, as well as a financial toll on the health care system. A wide range of prophylactic measures have been used to attempt to reduce SSI rates. A protocol consisting of a combination of 0.3% Betadine wound irrigation and 1 g of intrawound Vancomycin powder application was developed at our institution. Multiple data sources were consolidated for thorough evaluation of changes in SSI rates, patient risk factors, and changes in bacteriology. Identification of risk factors that predispose patients to SSI was performed using mixed-effects logistic regression in a univariate fashion. Risk factors with P values of 0.05 or less in univariate analysis were included together in a multivariate mixed-effects logistic regression model. SSI rates were reduced by 50% after the intervention; χ analysis comparing the SSI rates between the pre- and postintervention periods yielded a P value of 0.042. Rates of methicillin-resistant Staphylococcus aureus dropped from 30% to 7% and the rates of multibacterial infections dropped from 37% to 27%. The risk factors that were statistically significant in multivariate analysis were the following: age (odds ratio [OR] = 0.93), anemia (OR = 30.73), prior operation (OR = 27.45), and vertebral fracture (OR = 22.22). The combination of Betadine wound irrigation and intrawound vancomycin powder application led to both a clinically and statistically significant decrease in SSI rates by 50%. Bacteriology analysis and risk factor assessment proved to be valuable tools in assessing the efficacy of a new prophylactic measure and in the planning of future protocols. 4.

  17. Risk Factors for Surgical Site Infections Following Neurosurgical Spinal Fusion Operations: A Case Control Study.

    Science.gov (United States)

    Walsh, Thomas L; Querry, Ashley M; McCool, Sheila; Galdys, Alison L; Shutt, Kathleen A; Saul, Melissa I; Muto, Carlene A

    2017-03-01

    OBJECTIVE To determine risk factors for the development of surgical site infections (SSIs) in neurosurgery patients undergoing spinal fusion. DESIGN Retrospective case-control study. SETTING Large, academic, quaternary care center. PATIENTS The study population included all neurosurgery patients who underwent spinal fusion between August 1, 2009, and August 31, 2013. Cases were defined as patients in the study cohort who developed an SSI. Controls were patients in the study cohort who did not develop an SSI. METHODS To achieve 80% power with an ability to detect an odds ratio (OR) of 2, we performed an unmatched case-control study with equal numbers of cases and controls. RESULTS During the study period, 5,473 spinal fusion procedures were performed by neurosurgeons in our hospital. With 161 SSIs recorded during the study period, the incidence of SSIs associated with these procedures was 2.94%. While anterior surgical approach was found to be a protective factor (OR, 0.20; 95% confidence interval [CI], 0.08-0.52), duration of procedure (OR, 1.58; 95% CI, 1.29-1.93), American Society of Anesthesiologists score of 3 or 4 (OR, 1.79; 95% CI, 1.00-3.18), and hospitalization within the prior 30 days (OR, 5.8; 95% CI, 1.37-24.57) were found in multivariate analysis to be independent predictors of SSI following spinal fusion. Prior methicillin-resistant Staphylococcus aureus (MRSA) nares colonization was highly associated with odds 20 times higher of SSI following spinal fusion (OR, 20.30; 95% CI, 4.64-8.78). CONCLUSIONS In additional to nonmodifiable risk factors, prior colonization with MRSA is a modifiable risk factor very strongly associated with development of SSI following spinal fusion. Infect Control Hosp Epidemiol 2017;38:348-352.

  18. Triclosan sutures for surgical site infection in colorectal cancer.

    Science.gov (United States)

    Yamashita, Kanefumi; Takeno, Shinsuke; Hoshino, Seiichiro; Shiwaku, Hironari; Aisu, Naoya; Yoshida, Yoichiro; Tanimura, Syu; Yamashita, Yuichi

    2016-11-01

    Among all procedures, surgical site infections (SSIs) in colorectal surgery continue to have the highest rate, accounting for 5%-45%. To prevent the bacterial colonization of suture material, which disables local mechanisms of wound decontamination, triclosan-coated sutures were developed. We assessed the effectiveness of triclosan-coated sutures used for skin closure on the rate of SSIs in colorectal cancer surgery. Until August 2012, we used conventional methods for skin closure in colorectal cancer surgery at the Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine. Therefore, for the control group, we retrospectively collected surveillance data over a 1.5-y period. From September 2012, we began using triclosan-coated polydioxanone antimicrobial sutures (PDS plus) for skin and fascia closure. Hence, we collected data for the study group from September 2012 to October 2013. Differences in baseline characteristics and selection bias were adjusted using the propensity score-matching method. A total of 399 patients who underwent colorectal surgery were included in this study. There were 214 patients in the control group and 185 patients in the study group. Baseline patient characteristics were similar between the propensity score-matched groups. The incidence of SSIs was less in the study group. Multivariate logistic regression analysis showed that the site of the procedure, laparoscopic surgery, and using triclosan-coated sutures remained the independent predictors of SSIs. The use of triclosan-coated sutures was advantageous for decreasing the risk of SSIs after colorectal surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Medical device SALs and surgical site infections: a mathematical model.

    Science.gov (United States)

    Srun, Sopheak W; Nissen, Brian J; Bryans, Trabue D; Bonjean, Maxime

    2012-01-01

    It is commonly accepted that terminally sterilized healthcare products are rarely the source of a hospital-acquired infection (HAI). The vast majority of HAIs arise from human-borne contamination from the workforce, the clinical environment, less-than-aseptic handling techniques, and the patients themselves. Nonetheless, the requirement for a maximal sterility assurance level (SAL) of a terminally sterilized product has remained at 10(-6), which is the probability of one in one million that a single viable microorganism will be on a product after sterilization. This paper presents a probabilistic model that predicts choosing an SAL greater than 10(-6) (e.g. 10(-5) or 10(-4), and in some examples even 10(-3) or 10(-2)) does not have a statistically significant impact on the incidence of surgical site infections (SSIs). The use of a greater SAL might allow new, potentially life-saving products that cannot withstand sterilization to achieve a 10(-6) SAL to be terminally sterilized instead of being aseptically manufactured.

  20. Risk factors for surgical site infection after dermatological surgery.

    Science.gov (United States)

    Heal, Clare F; Buettner, Petra G; Drobetz, Herwig

    2012-07-01

    Surgical site infection (SSI) following minor surgery contributes to patient morbidity and compromises cosmetic outcomes. The purpose of this study was to determine the incidence of and risk factors for SSI after dermatological surgery in general practice.   A prospective, observational study which assessed infection among 972 patients was conducted in regional north Queensland, Australia. Consecutive patients presenting for minor skin excisions were invited to participate. Wounds were assessed for SSI at the time of removal of sutures. Infection occurred in 85 of the 972 excisions; thus, the overall incidence of infection was 8.7% (95% confidence interval 6.5-11.0). Excisions in the upper (Pfactors for wound infection. The length of the excision (Pfactors for infection. Diabetes was not found to be an independent risk factor for infection (P=0.891). Prophylactic antibiotics are probably prescribed excessively or inappropriately for dermatological surgery, and overall we wish to discourage their use. The results of this study may encourage the more judicial use of prophylactic antibiotics by defining high-risk procedures, such as excisions from the extremities, excision of BCC or SCC, and larger excisions, and patients who are at high risk for infection, such as ex-smokers. © 2012 The International Society of Dermatology.

  1. Risk Factors for Surgical Site Infections in Dermatological Surgery

    Directory of Open Access Journals (Sweden)

    Xiaomeng Liu

    2017-11-01

    Full Text Available Current literature on risk factors for surgical site infection (SSI in dermatological surgery in the absence of antibiotic prophylaxis is limited. The aim of this study was to retrospectively evaluate patients presenting for dermatological surgery. A total of 1,977 procedures were reviewed. SSI was clinically suspected in 79 (4.0% patients and confirmed by culture in 38 (1.9%. Using the strictest definition of SSI (clinical symptoms with positive culture significantly higher risk of SSI was found for location on the ear (odds ratio (OR 6.03, 95% confidence interval (95% CI 2.12–17.15, larger defects (OR 1.08 per cm2 increase, 95% CI 1.03–1.14, closure with flaps (OR 6.35, 95% CI 1.33–30.28 and secondary intention (OR 3.01, 95% CI 1.11–8.13. These characteristics were also associated with higher risk of clinically suspected SSI regardless of culture results with slightly lower ORs. In conclusion, the risk of acquiring a SSI is increased in surgeries performed on the ear, in larger wounds and in defects closed with flaps or healed by secondary intention.

  2. [Surgical site infections in orthognathic surgery and risk factors associated].

    Science.gov (United States)

    Barrier, A; Breton, P; Girard, R; Dubost, J; Bouletreau, P

    2009-06-01

    Surgical site infections (SSI) in orthognathic surgery are considered infrequent and without any important consequence for the final operative result. A procedure of epidemiological surveillance was implemented to determine the frequency of SSI in orthognathic surgery and to better document their risk factors. This prospective study included all interventions in our orthognathic surgery department between September 1(st) 2006 and August 31(st) 2007. SSI and their risk factors were documented for up to one year of follow-up. Risk factors were correlated to SSI using monovariate and multivariate analyses. Ten (7%) out of 143 consecutive interventions in orthognathic surgery were complicated by a SSI. All the SSI were secondary to a mandibular ramus sagittal split osteotomy. The two significantly correlated risk factors with the SSI in multivariate analysis were the length of surgery and the type of antibiotic prophylaxis. This rate of SSI correlates to published data. To decrease this rate, it would be necessary, in association with the usual precautionary measures, to limit the operating time and to recommend an antibioprophylaxis combining amoxicillin plus clavulanic acid (Augmentin).

  3. Surgical site infection in patients submitted to heart transplantation.

    Science.gov (United States)

    Rodrigues, Jussara Aparecida Souza do Nascimento; Ferretti-Rebustini, Renata Eloah de Lucena; Poveda, Vanessa de Brito

    2016-08-29

    to analyze the occurrence and predisposing factors for surgical site infection in patients submitted to heart transplantation, evaluating the relationship between cases of infections and the variables related to the patient and the surgical procedure. retrospective cohort study, with review of the medical records of patients older than 18 years submitted to heart transplantation. The correlation between variables was evaluated by using Fisher's exact test and Mann-Whitney-Wilcoxon test. the sample consisted of 86 patients, predominantly men, with severe systemic disease, submitted to extensive preoperative hospitalizations. Signs of surgical site infection were observed in 9.3% of transplanted patients, with five (62.5%) superficial incisional, two (25%) deep and one (12.5%) case of organ/space infection. There was no statistically significant association between the variables related to the patient and the surgery. there was no association between the studied variables and the cases of surgical site infection, possibly due to the small number of cases of infection observed in the sample investigated. analisar a ocorrência e os fatores predisponentes para infecção de sítio cirúrgico em pacientes submetidos a transplante cardíaco e verificar a relação entre os casos de infecção e as variáveis referentes ao paciente e ao procedimento cirúrgico. estudo de coorte retrospectivo, com exame dos prontuários médicos de pacientes maiores de 18 anos, submetidos a transplante cardíaco. A correlação entre variáveis foi realizada por meio dos testes exato de Fischer e de Mann-Whitney-Wilcoxon. a amostra foi constituída por 86 pacientes, predominantemente homens, com doença sistêmica grave, submetidos a internações pré-operatórias extensas. Apresentaram sinais de infecção do sítio cirúrgico 9,3% dos transplantados, sendo cinco (62,5%) incisionais superficiais, duas (25%) profundas e um (12,5%) caso de infecção de órgão/espaço. Não houve associa

  4. Incidence and risk factors for surgical site infection following ...

    African Journals Online (AJOL)

    Prolonged preoperative and intraoperative duration, dirty wounds and perioperative transfusion was associated with increased rate of SSI. Surveillance on SSI by surgical team, public health education on alcohol and cigarettes consumption, prompt surgical intervention and judicial use of blood could reduce incidence of ...

  5. Selection of egg attachment sites by the Indian Golden Gecko Calodactylodes aureus (Beddome, 1870 (Reptilia: Gekkonidae in Andhra Pradesh, India

    Directory of Open Access Journals (Sweden)

    R. Sreekar

    2010-10-01

    Full Text Available Some geckos lay eggs at communal egg deposition sites with as many as 300 eggs per site. Selection of egg deposition sites is important to avoid egg damage and predation. We investigated survival rates of communal egg clutches of the Indian Golden Gecko Calodactylodes aureus (Reptilia: Gekkonidae. Our results show that communal clutches have a higher survival rate in sites with water bodies and without anthropogenic activities, in comparison to sites having the opposite combination. These findings are discussed in the context of the status of this gecko.

  6. Does Minimally Invasive Spine Surgery Minimize Surgical Site Infections?

    Science.gov (United States)

    Patel, Ravish Shammi; Dutta, Shumayou

    2016-01-01

    Study Design Retrospective review of prospectively collected data. Purpose To evaluate the incidence of surgical site infections (SSIs) in minimally invasive spine surgery (MISS) in a cohort of patients and compare with available historical data on SSI in open spinal surgery cohorts, and to evaluate additional direct costs incurred due to SSI. Overview of Literature SSI can lead to prolonged antibiotic therapy, extended hospitalization, repeated operations, and implant removal. Small incisions and minimal dissection intrinsic to MISS may minimize the risk of postoperative infections. However, there is a dearth of literature on infections after MISS and their additional direct financial implications. Methods All patients from January 2007 to January 2015 undergoing posterior spinal surgery with tubular retractor system and microscope in our institution were included. The procedures performed included tubular discectomies, tubular decompressions for spinal stenosis and minimal invasive transforaminal lumbar interbody fusion (TLIF). The incidence of postoperative SSI was calculated and compared to the range of cited SSI rates from published studies. Direct costs were calculated from medical billing for index cases and for patients with SSI. Results A total of 1,043 patients underwent 763 noninstrumented surgeries (discectomies, decompressions) and 280 instrumented (TLIF) procedures. The mean age was 52.2 years with male:female ratio of 1.08:1. Three infections were encountered with fusion surgeries (mean detection time, 7 days). All three required wound wash and debridement with one patient requiring unilateral implant removal. Additional direct cost due to infection was $2,678 per 100 MISS-TLIF. SSI increased hospital expenditure per patient 1.5-fold after instrumented MISS. Conclusions Overall infection rate after MISS was 0.29%, with SSI rate of 0% in non-instrumented MISS and 1.07% with instrumented MISS. MISS can markedly reduce the SSI rate and can be an

  7. Combined surgical procedures using laparoendoscopic single-site surgery approach.

    Science.gov (United States)

    Palanivelu, C; Ahluwalia, Jasmeet Singh; Palanivelu, Praveenraj; Palanisamy, Senthilnathan; Vij, Anirudh

    2013-08-01

    As our experience with laparoendoscopic single-site (LESS) surgeries increased, we considered how it might be employed if two or more surgeries were to be combined. LESS surgeries' cosmetic advantages, decreased parietal trauma and better patient satisfaction relative to standard multiport laparoscopy have been previously reported, but its special role in combined surgeries has never been stressed. In this series, we present the advantages of LESS procedure over multiport laparoscopy in combined surgical procedures. To the best of our knowledge, this has never been reported before. A retrospective analysis of 27 patients was performed. The patients underwent combined LESS procedures between February 2010 and January 2012 at GEM Hospital, Coimbatore, India. All patients were of ASA grade 1 or 2. Patients with previous surgery in the umbilical region were not offered single-incision surgery. We successfully performed 27 combined LESS procedures over a span of 2 years. Twenty patients were women and seven were men. Mean age was 35.94 years (range, 10-66 years). Mean BMI was 27.2. There were no major intraoperative complications. Mean blood loss was 45.7 mL (range, 0.0-120.0 mL). Mean postoperative hospital stay was 3.08 days (range, 1-5 days). When a suitable case of multiple pathologies is encountered and LESS surgery is feasible for all of them, performing LESS surgery not only has cosmetic advantages over standard laparoscopy, but it also avoids the need for additional ports to achieve adequate visualization and access. All quadrants of the abdomen remain under reach through umbilicus. © 2013 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

  8. Predictors of surgical site infections among patients undergoing major surgery at Bugando Medical Centre in Northwestern Tanzania

    Directory of Open Access Journals (Sweden)

    Imirzalioglu Can

    2011-08-01

    Full Text Available Abstract Background Surgical site infection (SSI continues to be a major source of morbidity and mortality in developing countries despite recent advances in aseptic techniques. There is no baseline information regarding SSI in our setting therefore it was necessary to conduct this study to establish the prevalence, pattern and predictors of surgical site infection at Bugando Medical Centre Mwanza (BMC, Tanzania. Methods This was a cross-sectional prospective study involving all patients who underwent major surgery in surgical wards between July 2009 and March 2010. After informed written consent for the study and HIV testing, all patients who met inclusion criteria were consecutively enrolled into the study. Pre-operative, intra-operative and post operative data were collected using standardized data collection form. Wound specimens were collected and processed as per standard operative procedures; and susceptibility testing was done using disc diffusion technique. Data were analyzed using SPSS software version 15 and STATA. Results Surgical site infection (SSI was detected in 65 (26.0% patients, of whom 56 (86.2% and 9 (13.8% had superficial and deep SSI respectively. Among 65 patients with clinical SSI, 56(86.2% had positive aerobic culture. Staphylococcus aureus was the predominant organism 16/56 (28.6%; of which 3/16 (18.8% were MRSA. This was followed by Escherichia coli 14/56 (25% and Klebsiella pneumoniae 10/56 (17.9%. Among the Escherichia coli and Klebsiella pneumoniae isolates 9(64.3% and 8(80% were ESBL producers respectively. A total of 37/250 (14.8% patients were HIV positive with a mean CD4 count of 296 cells/ml. Using multivariate logistic regression analysis, presence of pre-morbid illness (OR = 6.1, use of drain (OR = 15.3, use of iodine alone in skin preparation (OR = 17.6, duration of operation ≥ 3 hours (OR = 3.2 and cigarette smoking (OR = 9.6 significantly predicted surgical site infection (SSI Conclusion SSI is common

  9. Reducing Surgical Site Infection in Spinal Surgery with Betadine Irrigation and Intra-Wound Vancomycin Powder

    Science.gov (United States)

    Tomov, Marko; Mitsunaga, Lance; Durbin-Johnson, Blythe; Nallur, Deepak; Roberto, Rolando

    2015-01-01

    Study Design Retrospective analysis. Objective The objective of this study was to evaluate the efficacy of a surgical site infection (SSI) prevention protocol instituted in the Orthopaedic Spine Department at our institution. Summary of Background Data SSI is an undesired complication of orthopaedic spine surgeries. It poses a significant risk to the patient, as well as a financial toll on the healthcare system. A wide range of prophylactic measures have been used to attempt to reduce SSI rates. Methods A protocol consisting of a combination of 0.3% Betadine wound irrigation and 1 gram of intra-wound Vancomycin powder application was developed at our institution. Multiple data sources were consolidated for thorough evaluation of changes in SSI rates, patient risk factors, and changes in bacteriology. Identification of risk factors that predispose patients to SSI was performed using mixed effects logistic regression in a univariate fashion. Risk factors with p-values of ≤ 0.05 in univariate analysis were included together in a multivariate mixed effects logistic regression model. Results SSI rates were reduced by 50% following the intervention; Chi square analysis comparing the SSI rates between the pre- and post-intervention periods yielded a p-value of 0.042. Rates of methicillin resistant Staphylococcus aureus dropped from 30% to 7% and the rates of multi-bacterial infections dropped from 37% to 27%. The risk factors that were statistically significant in multivariate analysis were the following: age (OR 0.93), anemia (OR 30.73), prior operation (OR 27.45), and vertebral fracture (OR 22.22). Conclusion The combination of Betadine wound irrigation and intra-wound vancomycin powder application led to both a clinically and statistically significant decrease in SSI rates by 50%. Bacteriology analysis and risk factor assessment proved to be valuable tools in assessing the efficacy of a new prophylactic measure and in the planning of future protocols. PMID:25608241

  10. Risk factors for surgical site infections after neurosurgery: A focus on the postoperative period.

    Science.gov (United States)

    Cassir, Nadim; De La Rosa, Silvestre; Melot, Anthony; Touta, Adamou; Troude, Lucas; Loundou, Anderson; Richet, Hervé; Roche, Pierre-Hugues

    2015-12-01

    Surgical site infection (SSI) after neurosurgery has potentially devastating consequences. A prospective cohort study was conducted over a period of 24 months in a university center. All adult patients undergoing neurosurgical procedures, with exception of open skull fractures, were included. Multivariate logistic regression analysis was used to identify independent risk factors. We included 949 patients. Among them, 43 were diagnosed with SSI (4.5%). A significant reduction in postneurosurgical SSI from 5.8% in 2009 to 3.0% in 2010 (P = .04) was observed. During that period, an active surveillance with regular feedback was established. The most common microorganisms isolated from SSI were Staphylococcus aureus (23%), Enterobacteriaceae (21%), and Propionibacterium acnes (12%). We identified the following independent risk factors for SSI postcranial surgery: intensive care unit (ICU) length of stay ≥7 days (odds ratio [OR] = 6.1; 95% confidence interval [CI], 1.7-21.7), duration of drainage ≥3 days (OR = 3.3; 95% CI, 1.1-11), and cerebrospinal fluid leakage (OR = 5.6; 95% CI, 1.1-30). For SSIs postspinal surgery, we identified the following: ICU length of stay ≥7 days (OR = 7.2; 95% CI, 1.6-32.1), coinfection (OR = 9.9; 95% CI, 2.2-43.4), and duration of drainage ≥3 days (OR = 5.7; 95% CI, 1.5-22). Active surveillance with regular feedback proved effective in reducing SSI rates. The postoperative period is associated with overlooked risk factors for neurosurgical SSI. Infection control measures targeting this period are therefore promising. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  11. Prophylactic Antibiotic Choice and Risk of Surgical Site Infection After Hysterectomy.

    Science.gov (United States)

    Uppal, Shitanshu; Harris, John; Al-Niaimi, Ahmed; Swenson, Carolyn W; Pearlman, Mark D; Reynolds, R Kevin; Kamdar, Neil; Bazzi, Ali; Campbell, Darrell A; Morgan, Daniel M

    2016-02-01

    To evaluate associations between prophylactic preoperative antibiotic choice and surgical site infection rates after hysterectomy. A retrospective cohort study was performed of patients in the Michigan Surgical Quality Collaborative undergoing hysterectomy from July 2012 to February 2015. The primary outcome was a composite outcome of any surgical site infection (superficial surgical site infections or combined deep organ space surgical site infections). Preoperative antibiotics were categorized based on the recommendations set forth by the American College of Obstetricians and Gynecologists and the Surgical Care Improvement Project. Patients receiving a recommended antibiotic regimen were categorized into those receiving β-lactam antibiotics and those receiving alternatives to β-lactam antibiotics. Patients receiving nonrecommended antibiotics were categorized into those receiving overtreatment (excluded from further analysis) and those receiving nonstandard antibiotics. Multivariable logistic regression models were developed to estimate the independent effect of antibiotic choice. Propensity score matching analysis was performed to validate the results. The study included 21,358 hysterectomies. The overall rate of any surgical site infection was 2.06% (n=441). Unadjusted rates of "any surgical site infection" were 1.8%, 3.1%, and 3.7% for β-lactam, β-lactam alternatives, and nonstandard groups, respectively. After adjusting for patient and operative factors within clusters of hospitals, compared with the β-lactam antibiotics (reference group), the risk of "any surgical site infection" was higher for the group receiving β-lactam alternatives (odds ratio [OR] 1.7, confidence interval [CI] 1.27-2.07) or the nonstandard antibiotics (OR 2.0, CI 1.31-3.1). Compared with women receiving β-lactam antibiotic regimens, there is a higher risk of surgical site infection after hysterectomy among those receiving a recommended β-lactam alternative or nonstandard regimen.

  12. Occurrence of nosocomial methicillin-resistant Staphylococcus aureus as a marker for transmission in a surgical intensive care unit in China

    NARCIS (Netherlands)

    Chen, Yong; Zhao, Wei; Liu, Hui; Song, Qing; Wang, Yan; Zhao, Jingya; Zheng, Dongyu; Han, Xuelin; Hu, Xiaohua; Grundmann, Hajo; Han, Li

    In 2008, an intensive care unit (ICU) in a large Chinese hospital was moved from a 6-bed old ward to a 20-bed new ward. After the move, the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in patients and environmental sites decreased significantly, but the number of ICU-acquired

  13. A comparative assessment of surgeons' tracking methods for surgical site infections

    NARCIS (Netherlands)

    G.H. van Ramshorst (Gabrielle); M.C. Vos (Margreet); D. den Hartog (Dennis); W.C.J. Hop (Wim); J. Jeekel (Hans); S.E.R. Hovius (Steven); J.F. Lange (Johan)

    2013-01-01

    textabstractBackground: The incidence of surgical site infections (SSI) is considered increasingly to be an indicator of quality of care. We conducted a study in which daily inspection of the surgical incision was performed by an independent, trained team to monitor the incidence of SSI using U.S.

  14. A study comparing preoperative intra-incisional antibiotic infiltration and prophylactic intravenous antibiotic administration for reducing surgical site infection

    Directory of Open Access Journals (Sweden)

    Bharat Bhushan Dogra

    2013-01-01

    Full Text Available Introduction: Surgical site infection (SSI continues to be a distressing problem since time immemorial, as it happens to be one of the major causes of post-operative morbidity and mortality. Many methods have been evolved to combat wound infection, but the rate of wound infection has been more or less static over the past few decades. The search for alternative modes of management is going on and one of the methods is intra-incisional infiltration of antibiotics. Aims and Objectives: To study the comparative efficacy of pre-operative intra-incisional antibiotic infiltration and prophylactic parenteral antibiotic therapy in reducing surgical site infection. Materials and Methods: This is a prospective randomized controlled study comprising of 120 patients divided in to three groups i.e. 40 in each group. Group A comprising 40 patients were subjected to local infiltration of 1 gram of Cefotaxime around the site of incision, 20 min before the induction of anesthesia. Group B comprising of 40 patients were administered a single dose of 1 gram of Cefotaxime intravenously 20 minutes before the surgical incision and Group C comprising of 40 patients were administered local infiltration of 1 gram of Cefotaxime as well as intravenous administration of 1 gram of Cefotaxime, 20 minutes before surgical incision. Inclusion criteria were patients in age group of 20-60 yrs, procedures that lasted for less than 2 hours, clean and clean contaminated surgical procedures. The exclusion criteria were patients with diabetes mellitus and those on steroid therapy. Incidence of SSI, type of organisms cultured in case of infection were studied. Results: Overall incidence of SSI in Group A was 10%, in Group B 18%, and Group C 2.5%. Frequency of infection due to gram positive bacteria was more as compared to gram negative in the cases that developed SSI. The commonest organism isolated was Methicillin Sensitive Staphylococcus aureus (MSSA. Conclusion: The incidence of SSI

  15. PROPHYLAXIS OF SURGICAL SITE INFECTION WITH VANCOMYCIN IN 513 PATIENTS THAT UNDERWENT TO LUMBAR FUSION

    OpenAIRE

    Scheverin, Nicolas; Steverlynck, Alejandro; Castelli, Roberto; Sobrero, Diego; Kopp, Nicolas Videla; Dinelli, Dino; Sarotto, Anibal; Falavigna, Asdrubal

    2015-01-01

    Objective:To assess the prophylactic effects of local vancomycin on an infection of the surgical site in patients undergoing lumbar instrumented fusion.Methods:Retrospective study from January 2011 to June 2014 in patients with symptomatic and refractory lumbar spine stenosis and listhesis who underwent instrumented pedicle screw spinal fusion. Two groups of patient were analyzed, one using vancomycin on the surgical site, vancomycin group (VG) and the control group (CG) without topical vanco...

  16. Mupirocin prophylaxis against nosocomial Staphylococcus aureus infections in nonsurgical patients: a randomized study.

    NARCIS (Netherlands)

    Wertheim, H.F.; Vos, A.M.C.; Ott, A.; Voss, A.; Kluytmans, J.A.J.W.; Broucke-Grauls, C.M. van den; Meester, M.; Keulen, P.H. van; Verbrugh, H.A.

    2004-01-01

    BACKGROUND: Staphylococcus aureus nasal carriage is a major risk factor for nosocomial S. aureus infection. Studies show that intranasal mupirocin can prevent nosocomial surgical site infections. No data are available on the efficacy of mupirocin in nonsurgical patients. OBJECTIVE: To assess the

  17. Mupirocin prophylaxis against nosocomial Staphylococcus aureus infections in nonsurgical patients: a randomized study

    NARCIS (Netherlands)

    Wertheim, Heiman F. L.; Vos, Margreet C.; Ott, Alewijn; Voss, Andreas; Kluytmans, Jan A. J. W.; Vandenbroucke-Grauls, Christina M. J. E.; Meester, Marlene H. M.; van Keulen, Peter H. J.; Verbrugh, Henri A.

    2004-01-01

    BACKGROUND: Staphylococcus aureus nasal carriage is a major risk factor for nosocomial S. aureus infection. Studies show that intranasal mupirocin can prevent nosocomial surgical site infections. No data are available on the efficacy of mupirocin in nonsurgical patients. OBJECTIVE: To assess the

  18. Antimicrobial susceptibility pattern of bacterial isolates from surgical ...

    African Journals Online (AJOL)

    E. coli and S. aureus were the most common and Salmonella spp. and Acinetobacter spp. were the least common organism causing surgical site infections. The definitive therapy included ciprofloxacin and gentamicin for E. coli; linezolid and vancomycin for S. aureus and Streptococcus spp; ceftriaxone and ciprofloxacin for ...

  19. Performance assessment of the risk index category for surgical site infection after colorectal surgery.

    Science.gov (United States)

    Watanabe, Masanori; Suzuki, Hideyuki; Nomura, Satoshi; Hanawa, Hidetsugu; Chihara, Naoto; Mizutani, Satoshi; Yoshino, Masanori; Uchida, Eiji

    2015-02-01

    The traditional National Healthcare Safety Network (previously National Nosocomial Infections Surveillance) risk index is used to predict the risk of surgical site infection across many operative procedures. However, this index may be too simple to predict risk in the various procedures performed in colorectal surgery. The aim of this study was to evaluate the usefulness of the risk index by analyzing the impact of the risk index factors on surgical site infection after abdominal colorectal surgery. Using our surgical site infection surveillance database, we analyzed retrospectively 538 consecutive patients who underwent abdominal colorectal surgery between 2005 and 2010. Correlations between surgical site infection and the following risk index factors were analyzed: length of operation, American Society of Anesthesiologists score, wound classification, and use of laparoscopy. The 75th percentile for length of operation was determined separately for open and laparoscopic surgery in the study model. Univariate analyses showed that surgical site infection was more strongly associated with a >75th percentile length of operation in the study model (odds ratio [OR], 2.07) than in the traditional risk index model (OR, 1.64). Multivariable analysis found that surgical site infection was independently associated with a >75th percentile length of operation in the study model (OR, 2.75; 95% confidence interval [CI], 1.66-4.55), American Society of Anesthesiologists score ≥3 (OR, 2.22; 95% CI, 1.10-4.34), wound classification ≥III (OR, 5.29; 95% CI, 2.62-10.69), and open surgery (OR, 2.21; 95% CI, 1.07-5.17). Performance of the risk index category was improved in the study model compared with the traditional model. The risk index category is sufficiently useful for predicting the risk of surgical site infection after abdominal colorectal surgery. However, the 75th percentile length of operation should be set separately for open and laparoscopic surgery.

  20. Intraoperative technique as a factor in the prevention of surgical site infection.

    LENUS (Irish Health Repository)

    McHugh, S M

    2012-02-01

    Approximately five percent of patients who undergo surgery develop surgical site infections (SSIs) which are associated with an extra seven days as an inpatient and with increased postoperative mortality. The competence and technique of the surgeon is considered important in preventing SSI. We have reviewed the evidence on different aspects of surgical technique and its role in preventing SSI. The most recent guidelines from the National Institute for Health and Clinical Excellence in the UK recommend avoiding diathermy for skin incision even though this reduces incision time and blood loss, both associated with lower infection rates. Studies comparing different closure techniques, i.e. continuous versus interrupted sutures, have not found a statistically significant difference in the SSI rate, but using continuous sutures is quicker. For contaminated wounds, the surgical site should be left open for four days to allow for treatment of local infection before subsequent healing by primary intention. Surgical drains should be placed through separate incisions, closed suction drains are preferable to open drains, and all drains should be removed as soon as possible. There are relatively few large studies on the impact of surgical techniques on SSI rates. Larger multicentre prospective studies are required to define what aspects of surgical technique impact on SSI, to better inform surgical practice and support education programmes for surgical trainees.

  1. Intraoperative technique as a factor in the prevention of surgical site infection.

    LENUS (Irish Health Repository)

    McHugh, S M

    2011-02-28

    Approximately five percent of patients who undergo surgery develop surgical site infections (SSIs) which are associated with an extra seven days as an inpatient and with increased postoperative mortality. The competence and technique of the surgeon is considered important in preventing SSI. We have reviewed the evidence on different aspects of surgical technique and its role in preventing SSI. The most recent guidelines from the National Institute for Health and Clinical Excellence in the UK recommend avoiding diathermy for skin incision even though this reduces incision time and blood loss, both associated with lower infection rates. Studies comparing different closure techniques, i.e. continuous versus interrupted sutures, have not found a statistically significant difference in the SSI rate, but using continuous sutures is quicker. For contaminated wounds, the surgical site should be left open for four days to allow for treatment of local infection before subsequent healing by primary intention. Surgical drains should be placed through separate incisions, closed suction drains are preferable to open drains, and all drains should be removed as soon as possible. There are relatively few large studies on the impact of surgical techniques on SSI rates. Larger multicentre prospective studies are required to define what aspects of surgical technique impact on SSI, to better inform surgical practice and support education programmes for surgical trainees.

  2. Cyanoacrylate Skin Microsealant for Preventing Surgical Site Infection after Vascular Surgery : A Discontinued Randomized Clinical Trial

    NARCIS (Netherlands)

    Vierhout, Bastiaan P.; Ott, Alewijn; Reijnen, Michel M. P. J.; Oskam, Jacques; Ott, Alewijn; van den Dungen, Jan J. A. M.; Zeebregts, Clark J.

    Background: Surgical site infections (SSI) after vascular surgery are related to substantial morbidity. Restriction of bacterial access to the site of surgery with a cyanoacrylate sealant is a new concept. We performed a randomized clinical trial to assess the effect of the sealing of skin with a

  3. Impact of the difference in surgical site on the physique in gastrointestinal tract cancer patients.

    Science.gov (United States)

    Hara, Tsuyoshi; Kubo, Akira; Kogure, Eisuke; Ishii, Takaya

    2016-01-01

    [Purpose] The purpose of the present study was to observe physical function, physique (only BMI), and nutrition status (evaluated by serum albumin levels) from before surgery to after discharge among perioperative patients with gastrointestinal tract cancer and to examine the effect of difference in surgical site (i.e., stomach, colon, and rectum) in these patients. [Subjects and Methods] The study subjects were 70 patients who underwent surgical treatment for gastrointestinal tract cancer [36 males and 34 females, aged 59.3 ± 11.4 years (mean ± SD)]. The subjects were classified into three levels according to surgical site (stomach, colon, and rectum). We evaluated patients' physical function, physique, and nutrition status in the three points: before surgery, after surgery, and after discharge. The 6-minute walk distance was measured for physical function. Body mass index was measured for physique. The serum albumin level was measured for nutrition status. [Results] Significant declines in 6-minute walk distance, body mass index, and serum albumin were observed after surgery among the study subjects. In addition, a significant decline in body mass index was observed after discharge compared with before surgery. Regarding body mass index, a significant interaction between surgical site and evaluation times was observed for ANOVA. [Conclusion] These results suggest that BMI after discharge is significantly less than that before surgery and that body mass index changes from before surgery to after surgery are efficacy the difference of surgical site in patients who undergo surgical treatment for gastrointestinal tract cancer.

  4. Surgical Site Infections in Pediatric Spine Surgery: Comparative Microbiology of Patients with Idiopathic and Nonidiopathic Etiologies of Spine Deformity.

    Science.gov (United States)

    Maesani, Matthieu; Doit, Catherine; Lorrot, Mathie; Vitoux, Christine; Hilly, Julie; Michelet, Daphné; Vidal, Christophe; Julien-Marsollier, Florence; Ilharreborde, Brice; Mazda, Keyvan; Bonacorsi, Stéphane; Dahmani, Souhayl

    2016-01-01

    Surgical site infections (SSIs) are a concern in pediatric spine surgery with unusually high rates for a clean surgery and especially for patients with deformity of nonidiopathic etiology. Microbiologic differences between etiologies of spine deformities have been poorly investigated. We reviewed all cases of SSI in spinal surgery between 2007 and 2011. Characteristics of cases and of bacteria according to the etiology of the spine disease were investigated. Of 496 surgeries, we identified 51 SSIs (10.3%) in 49 patients. Staphylococcus aureus was the most frequent pathogen whatever the etiology (n = 31, 61% of infection cases). The second most frequent pathogens vary according to the etiology of the spine deformity. It was Gram-negative bacilli (GNB) in nonidiopathic cases (n = 19, 45% of cases) and anaerobe in idiopathic cases (n = 8, 38% of cases), particularly Gram-positive anaerobic cocci (n = 5, 24% of cases). Infection rate was 6.8% in cases with idiopathic spine disease (n = 21) and 15.9% in cases with nonidiopathic spine disease (n = 30). Nonidiopathic cases were more frequently male with lower weight. American Society of Anesthesiologists score was more often greater than 2, they had more frequently sacral implants and postoperative intensive care unit stay. GNB were significantly associated with a nonidiopathic etiology, low weight, younger age and sacral fusion. SSIs were polymicrobial in 31% of cases with a mean of 1.4 species per infection cases. S. aureus is the first cause of SSI in pediatric spine surgery. However, Gram-positive anaerobic cocci should be taken into account in idiopathic patients and GNB in nonidiopathic patients when considering antibiotic prophylaxis and curative treatment.

  5. Fluid Overload and Cumulative Thoracostomy Output Are Associated With Surgical Site Infection After Pediatric Cardiothoracic Surgery.

    Science.gov (United States)

    Sochet, Anthony A; Nyhan, Aoibhinn; Spaeder, Michael C; Cartron, Alexander M; Song, Xiaoyan; Klugman, Darren; Brown, Anna T

    2017-08-01

    To determine the impact of cumulative, postoperative thoracostomy output, amount of bolus IV fluids and peak fluid overload on the incidence and odds of developing a deep surgical site infection following pediatric cardiothoracic surgery. A single-center, nested, retrospective, matched case-control study. A 26-bed cardiac ICU in a 303-bed tertiary care pediatric hospital. Cases with deep surgical site infection following cardiothoracic surgery were identified retrospectively from January 2010 through December 2013 and individually matched to controls at a ratio of 1:2 by age, gender, Risk Adjustment for Congenital Heart Surgery score, Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery category, primary cardiac diagnosis, and procedure. None. Twelve cases with deep surgical site infection were identified and matched to 24 controls without detectable differences in perioperative clinical characteristics. Deep surgical site infection cases had larger thoracostomy output and bolus IV fluid volumes at 6, 24, and 48 hours postoperatively compared with controls. For every 1 mL/kg of thoracostomy output, the odds of developing a deep surgical site infection increase by 13%. By receiver operative characteristic curve analysis, a cutoff of 49 mL/kg of thoracostomy output at 48 hours best discriminates the development of deep surgical site infection (sensitivity 83%, specificity 83%). Peak fluid overload was greater in cases than matched controls (12.5% vs 6%; p analysis, a threshold value of 10% peak fluid overload was observed to identify deep surgical site infection (sensitivity 67%, specificity 79%). Conditional logistic regression of peak fluid overload greater than 10% on the development of deep surgical site infection yielded an odds ratio of 9.4 (95% CI, 2-46.2). Increased postoperative peak fluid overload and cumulative thoracostomy output were associated with deep surgical site infection after pediatric cardiothoracic surgery. We

  6. Mapping three-dimensional digital model to surgical site in facial surgery

    Directory of Open Access Journals (Sweden)

    Xudong Wang

    2017-01-01

    Full Text Available Reconstructive surgery in the facial and oral sites requires high levels of precision. Intraoperative guidance can enhance surgical precision with three-dimensional (3D image model. Here, case report was our endeavor of creating a 3D digital image model to guide plastic procedure is performed on the soft tissue of a patient's cheek. 3D facial structure was taken preoperatively by scanning the contours of the patient's head. The defect on patient's left cheek due to an aneurysm was identified and virtually corrected by mirroring image from the healthy right side of the cheek. Once the 3D virtual model was created, we displayed the 3D model onto the surgical site during the operation to guide surgical procedure. Digital technology is developing rapidly and is unavoidable to merge with surgical care. Clinical judgment and intraoperative performance will be improved by our efforts of integrating digital technology into the operating room.

  7. Preoperative skin preparation with 2% chlorhexidine as a factor in the prevention of surgical site infection

    OpenAIRE

    Evelyn Solano Castro

    2014-01-01

    The results of secondary research that refers to preoperative skin preparation with antiseptic chlorhexidine 2% are presented. Surgical Site Infections are one of the most common complications in surgical procedures are associated with significant morbidity and mortality in the user and are the third -associated infection more frequent in the health care . Steps of clinical practice based on evidence were applied, considering in the first instance a question in PICO format, then a search for ...

  8. Prevention and control of surgical site infections: review of the Basel Cohort Study

    OpenAIRE

    Junker, Till; Mujagic, Edin; Hoffmann, Henry; Rosenthal, Rachel; Misteli, Heidi; Zwahlen, Marcel; Oertli, Daniel; Tschudin-Sutter, Sarah; Widmer, Andreas F.; Marti, Walter R; Weber, Walter P

    2012-01-01

    INTRODUCTION: Surgical site infections (SSI) are the most common hospital-acquired infections among surgical patients, with significant impact on patient morbidity and health care costs. The Basel SSI Cohort Study was performed to evaluate risk factors and validate current preventive measures for SSI. The objective of the present article was to review the main results of this study and its implications for clinical practice and future research. SUMMARY OF METHODS OF THE BASEL SSI COHORT STUDY...

  9. The role of topical antibiotics used as prophylaxis in surgical site infection prevention.

    LENUS (Irish Health Repository)

    McHugh, S M

    2012-02-01

    Compared with systemic antibiotic therapy, the topical or local delivery of an antibiotic has many potential advantages. However, local antibiotics at the surgical site have received very limited approval in any of the surgical prophylaxis consensus guidelines that we are aware of. A review of the literature was carried out through searches of peer-reviewed publications in PubMed in the English language over a 30 year period between January 1980 and May 2010. Both retrospective and prospective studies were included, as well as meta-analyses. With regard to defining \\'topical\\' or \\'local\\' antibiotic application, the application of an antibiotic solution to the surgical site intraoperatively or immediately post-operatively was included. A number of surgical procedures have been shown to significantly benefit from perioperative topical prophylaxis, e.g. joint arthroplasty, cataract surgery and, possibly, breast augmentation. In obese patients undergoing abdominal surgery, topical surgical prophylaxis is also proven to be beneficial. The selective use of topical antibiotics as surgical prophylaxis is justified for specific procedures, such as joint arthroplasty, cataract surgery and, possibly, breast augmentation. In selective cases, such as obese patients undergoing abdominal surgery, topical surgical prophylaxis is also proven to be beneficial. Apart from these specific indications, the evidence for use of topical antibiotics in surgery is lacking in conclusive randomized controlled trials.

  10. The role of topical antibiotics used as prophylaxis in surgical site infection prevention.

    LENUS (Irish Health Repository)

    McHugh, S M

    2011-04-01

    Compared with systemic antibiotic therapy, the topical or local delivery of an antibiotic has many potential advantages. However, local antibiotics at the surgical site have received very limited approval in any of the surgical prophylaxis consensus guidelines that we are aware of. A review of the literature was carried out through searches of peer-reviewed publications in PubMed in the English language over a 30 year period between January 1980 and May 2010. Both retrospective and prospective studies were included, as well as meta-analyses. With regard to defining \\'topical\\' or \\'local\\' antibiotic application, the application of an antibiotic solution to the surgical site intraoperatively or immediately post-operatively was included. A number of surgical procedures have been shown to significantly benefit from perioperative topical prophylaxis, e.g. joint arthroplasty, cataract surgery and, possibly, breast augmentation. In obese patients undergoing abdominal surgery, topical surgical prophylaxis is also proven to be beneficial. The selective use of topical antibiotics as surgical prophylaxis is justified for specific procedures, such as joint arthroplasty, cataract surgery and, possibly, breast augmentation. In selective cases, such as obese patients undergoing abdominal surgery, topical surgical prophylaxis is also proven to be beneficial. Apart from these specific indications, the evidence for use of topical antibiotics in surgery is lacking in conclusive randomized controlled trials.

  11. Postoperative prophylactic antibiotics and surgical site infection rates in breast surgery patients.

    Science.gov (United States)

    Throckmorton, Alyssa D; Boughey, Judy C; Boostrom, Sarah Y; Holifield, Andrea C; Stobbs, Melissa M; Hoskin, Tanya; Baddour, Larry M; Degnim, Amy C

    2009-09-01

    A single preoperative prophylactic dose of an intravenous antibiotic with antistaphylococcal activity is standard of care for breast and axillary surgical procedures. Some surgeons also prescribe postoperative prophylaxis for all patients with drains to prevent infection despite its lack of proven efficacy. A retrospective chart review of patients with breast and/or axillary surgical procedures between July 2004 and June 2006 were included. Data were collected on patient demographics, procedure types, and use of prophylactic antibiotics. Surgical site infection (SSI) was defined by means of Centers for Disease Control and Prevention criteria, including patients meeting the physician diagnosis criterion if an antibiotic was prescribed for a clinical diagnosis of cellulitis. chi(2) and Fisher's exact tests were used to compare SSI rates. Three hundred fifty-three patients with 436 surgical sites who received either preoperative or both pre- and postoperative antibiotic were analyzed. Overall, the SSI rate was 7.8% (34 of 436 surgical sites). Eighty-five patients (24%) with 127 surgical sites were provided both preoperative and postoperative prophylactic antibiotics. The SSI rates did not differ statistically (P = .67) for the groups that did (95% confidence interval, 4.8-15.0; 11 of 127 surgical sites, 8.7%) and did not receive postoperative antibiotic prophylaxis (95% confidence interval, 5.0-11.0; 23 of 309, 7.4%). Although the overall number of patients who developed SSI was relatively small, there was no reduction in the SSI rate among those who received postoperative antibiotic prophylaxis. Because of the potential adverse events associated with antibiotic use, further evaluation of this practice is required.

  12. Risk factors for surgical site infection following cesarean delivery: a retrospective cohort study.

    Science.gov (United States)

    Ketcheson, Felicia; Woolcott, Christy; Allen, Victoria; Langley, Joanne M

    2017-07-11

    The rate of cesarean delivery is increasing in North America. Surgical site infection following this operation can make it difficult to recover, care for a baby and return home. We aimed to determine the incidence of surgical site infection to 30 days following cesarean delivery, associated risk factors and whether risk factors differed for predischarge versus postdischarge infection. We identified a retrospective cohort in Nova Scotia by linking the provincial perinatal database to hospital admissions and physician billings databases to follow women for 30 days after they had given birth by cesarean delivery between Jan. 1, 1997 and Dec. 31, 2012. Logistic regression with generalized estimating equations was used to determine risk factors for infection. A total of 25 123 women had 33 991 cesarean deliveries over the study period. Of the 25 123, 923 had surgical site infections, giving an incidence rate of 2.7% (95% CI 2.54%-2.89%); the incidence decreased over time. Risk factors for infection (adjusted odds ratios ≥ 1.5) were prepregnancy weight 87.0 kg or more, gaining 30.0 kg or more during pregnancy, chorioamnionitis, maternal blood transfusion, anticoagulation therapy, alcohol or drug abuse, second stage of labour before surgery, delivery in 1997-2000 and delivery in a hospital performing 130-1249 cesarean deliveries annually. Women who gave birth earlier in the study period, those who gave birth in a hospital with 130-949 cesarean deliveries per year and those with more than 1 fetus were at a significantly higher risk for surgical site infection before discharge; women who smoked were at significantly higher risk for surgical site infection after discharge. Most risk factors are known before delivery, and some are potentially modifiable. Although the incidence of surgical site infection decreased over time, targeted clinical and infection prevention and control interventions could further reduce the burden of illness associated with this health

  13. [Use of vacuum-assisted closure in the topical treatment of surgical site infections].

    Science.gov (United States)

    Kiliç, Ayhan; Ozkaya, Ufuk; Sökücü, Sami; Basilgan, Seçkin; Kabukçuoğlu, Yavuz

    2009-01-01

    This study was designed to evaluate the results of vacuum-assisted closure in the topical treatment of surgical site infections. Vacuum therapy was performed in 17 patients (10 males, 7 females; mean age 60 + or - 20 years) using the VAC system (Vacuum-Assisted Closure, Kinetic Concept Inc) for the treatment of surgical site infections. Infective wounds were in the hip (n=6), crus (n=5), knee (n=3), sacrum (n=2), and hand (n=1). The causative organism for infections was gram-positive bacteria in 15 patients (88.2%), and six patients (35.3%) had nosocomial infections. The wounds were treated with a negative pressure of 100-125 mmHg applied continuously for the first two days, and then intermittently for the following days. The mean follow-up period was 11 + or - 6 months. The mean duration of vacuum therapy was 16 + or - 4 days and the mean length of hospitalization was 31 + or - 19 days. The patients underwent a mean number of three surgical procedures (range 1 to 6) before vacuum therapy. The mean amount of discharge from the wound was 500 + or - 150 ml. Tissue edema and discharge problems were resolved in all the wounds and a hygienic and dry-looking surgical site was attained. In 11 patients (64.7%), clinical and bacteriologic eradication of infections was achieved at the surgical site through antibiotic use and vacuum therapy. Six patients with nosocomial infections continued to receive antibiotic treatment following resolution of surgical site problems. The mean wound area showed a significant reduction from 36 + or - 14 cm(2) to 11 + or - 10 cm(2) following vacuum therapy (pclosure of wound site. Two patients (11.8%) complained of pain associated with vacuum application. Besides its topical advantages in the care of infected wounds, vacuum-assisted closure provides a more rapid and comfortable treatment opportunity, representing a reliable alternative to conventional wound care methods.

  14. Department of Veterans Affairs Cooperative Studies Program Network of Dedicated Enrollment Sites: Implications for Surgical Trials.

    Science.gov (United States)

    Bakaeen, Faisal G; Reda, Domenic J; Gelijns, Annetine C; Cornwell, Lorraine; Omer, Shuab; Al Jurdi, Rayan; Kougias, Panos; Anaya, Daniel; Berger, David H; Huang, Grant D

    2014-06-01

    Surgical clinical trials have played a critical role in shaping clinical practice, yet their launch and conduct remain challenging. Innovative approaches to carrying out such studies can not only help transform how trials produce definitive evidence but also move the field toward increased participation in trials. To review a recently launched pilot program aimed at enhancing patient enrollment and improving surgical trial operations at individual sites and nationally. After a solicitation to create a national network focused on making the conduct of clinical trials more efficient, 10 Department of Veterans Affairs (VA) sites were selected. These sites, collectively called the Cooperative Studies Program (CSP) Network of Dedicated Enrollment Sites (NODES), were evaluated with regard to their previous participation in CSP multisite trials, the strength of the local clinical research environment, and presentation of innovative plans to coordinate and enhance the operations of local CSP studies and share best practices with other centers. Node accountability was also emphasized and involved metrics that tracked productivity and efficiency. Building from available CSP experience in a range of clinical trials, including ones involving surgical interventions, NODES provides VA surgeons with resources for facilitating timely study initiation, determining patient availability, and addressing enrollment barriers. Such resources are particularly important for surgical studies, which often face challenges in patient recruitment and retention. In addition, NODES can maintain qualified and trained personnel at sites to support surgeons with limited time to fulfill the numerous administrative and regulatory responsibilities that often fall to the investigators. The VA's approach to enhancing trial efficiency may reinvigorate interest in surgical trials by offering a redesigned cooperative framework that builds on a core of high-yield sites and could mitigate traditional

  15. Prevalence and Characteristics of Surgical Site Infections Caused by Gram-negative Rod-shaped Bacteria from the Family Enterobacteriacae and Gram-positive Cocci from the Genus Staphylococcus in Patients who Underwent Surgical Procedures on Selected Surgical Wards.

    Science.gov (United States)

    Tomaszewska-Kowalska, Małgorzata; Kołomecki, Krzysztof; Wieloch-Torzecka, Maria

    2016-10-01

    Surgical site infections on surgical wards are the most common cause of postoperative complications. Prevalence of surgical site infections depends on the surgical specialization. Analysis of the causes of surgical site infections allows to conclude that microorganisms from the patient's own microbiota - Gram-negative rod-shaped bacteria from the family Enterobacteriacae and from the patient's skin microbiota - Gram-positive cocci - Staphylococcus are the most common agents inducing surgical site infections. The aim of the study was to assess prevalence and characteristics of surgical site infections caused by Gram-negative rod-shaped bacteria from the family Eneterobacteriacae and Gram-positive cocci from the genus Staphylococcus in patients who underwent surgical procedures at the Regional Specialist Hospital named after M. Copernika in Łódź on selected surgical wards. The study was performed based on retrospective analysis of medical documentation of the treated patients. The study included 195 patients of the Regional Specialist Hospital named after M. Copernik in Łódź who were treated between 2012 and 2014 on the wards of: Vascular, General and Oncological Surgery, Trauma and Orthopaedic Surgery, Neosurgery and Nervous System Tumors and the Ward of Endocrine Surgery - in the Clinic of Endocrine Surgery. The study included 84 women and 111 men. Mean age was 59 years (18 - 94 years old). \\ Results. Surgical site infections caused by Gram-negative rod-shaped bacteria from the family Enterobacteriacae were reported in 84 out of 195 patients (43.08% of the study group) and by Gram-positive cocci from the genus Staphylococcus were reported in 52 patients (26.67% of the study group). Mixed microbiota was an etiological agent of surgical site infections in four patients (2.5% of the study group). Etiological agent of surgical site infections depends on the ward profile, surgical field cleanliness and a form of surgical site infection.

  16. Incidence and predictors of surgical site infection in Ethiopia: prospective cohort.

    Science.gov (United States)

    Legesse Laloto, Tamrat; Hiko Gemeda, Desta; Abdella, Sadikalmahdi Hussen

    2017-02-03

    Surgical site infections are commonest nosocomial infections and responsible for considerable morbidity and mortality as well as increased hospitalizations and treatment cost related to surgical operations. The aim of this study was to determine incidence and predictors of surgical site infections at surgical ward of Hawassa University Referral Hospital, Southern Ethiopia. We performed prospective study involving 105 patients that undergone major surgical procedure at Hawassa University Referral Hospital from March 2 to May 2, 2015. Data were extracted from paper based medical charts, operational and anesthesia note, by direct observation and patients' interview. All patients were followed daily before, during and after operation for 30 days starting from the date of operation. Data were analyzed using Statistical Package for Social Science (SPSS) for window version 20.0 software. Predictors of Surgical site infections were identified using multivariable logistic regression model. P-value less than 0.05 was considered to be statistically significant. We studied 105 patients. Sixty four patients (61%) were males. The mean age of the patients was 30.85 ± 17.72 years. The mean Body Mass Index (BMI) was 21.6 ± 4 kg/m2. Twenty patients (19.1%) developed surgical site infections. Age greater than 40 years, AOR = 7.7(95% CI [1.610-40.810 p = 0.016,]), preoperative hospital stay more than 7 days, AOR = 22.4(95% CI [4.544-110.780, p = 0.001]), duration of operation more than 1 hour, AOR = 8.01(95% CI [1.562-41.099, p = 0.013]) and administering antimicrobial prophylaxis before 1 hour of operation, AOR = 11.1 (95% CI [1.269-75.639, p = 0.014]) were independent predictors for surgical site infections. Surgical site infection is relatively high.

  17. Consensus Bundle on Prevention of Surgical Site Infections After Major Gynecologic Surgery.

    Science.gov (United States)

    Pellegrini, Joseph E; Toledo, Paloma; Soper, David E; Bradford, William C; Cruz, Deborah A; Levy, Barbara S; Lemieux, Lauren A

    2017-02-06

    Surgical site infections are the most common complication of surgery in the United states. Of surgeries in women of reproductive age, hysterectomy is one of the most frequently performed, second only to cesarean birth. Therefore, prevention of surgical site infections in women undergoing gynecologic surgery is an ideal topic for a patient safety bundle. The primary purpose of this safety bundle is to provide recommendations that can be implemented into any surgical environment in an effot to reduce the incidence of surgical site infection. This bundle was developed by a multidisciplinary team convened by the Council on Patient Safety in Women's Health Care. The bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. In addition to recommendations for practice, each of the domains stresses communication and teamwork between all members of the surgical team. Although the bundle components are designed to be adaptable to work in a variety of clinical settings, standardization within institutions is encouraged. Copyright ©2016 American College of Obstetricians and Gynecologists.

  18. Sodium Mercaptoethane Sulfonate Reduces Collagenolytic Degradation and Synergistically Enhances Antimicrobial Durability in an Antibiotic-Loaded Biopolymer Film for Prevention of Surgical-Site Infections

    Directory of Open Access Journals (Sweden)

    Joel Rosenblatt

    2017-01-01

    Full Text Available Implant-associated surgical-site infections can have significant clinical consequences. Previously we reported a method for prophylactically disinfecting implant surfaces in surgical pockets, where an antibiotic solution containing minocycline (M and rifampin (R was applied as a solid film in a crosslinked biopolymer matrix that partially liquefied in situ to provide extended prophylaxis. Here we studied the effect of adding sodium 2-mercaptoethane sulfonate (MeSNA on durability of prophylaxis in an in vitro model of implant-associated surgical-site infection. Adding MeSNA to the M/R biopolymer, antimicrobial film extended the duration for which biofilm formation by multidrug-resistant Pseudomonas aeruginosa (MDR-PA was prevented on silicone surfaces in the model. M/R films with and without MeSNA were effective in preventing colonization by methicillin-resistant Staphylococcus aureus. Independent experiments revealed that MeSNA directly inhibited proteolytic digestion of the biopolymer film and synergistically enhanced antimicrobial potency of M/R against MDR-PA. Incubation of the MeSNA containing films with L929 fibroblasts revealed no impairment of cellular metabolic activity or viability.

  19. An outbreak of Streptococcus pyogenes surgical site infections in a cardiovascular surgery department.

    Science.gov (United States)

    Tezer Tekçe, Yasemin; Erbay, Ayşe; Ünaldı, Özlem; Çabadak, Hatice; Şen, Süha; Durmaz, Rıza

    2015-04-01

    We report an outbreak of surgical site infections due to genetically related strains of Streptococcus pyogenes in a cardiovascular surgery department. The practices that were possibly related to the outbreak were investigated through direct observation and interviews with staff by an infection control team. Surveillance sampling from patients, health-care workers, and environment were done for the investigation of the source. Pulsed-field gel electrophoresis was used to investigate a clonal relationship among the S. pyogenes isolates. Four patients operated on in the cardiovascular surgery department developed surgical site infection due to S. pyogenes. Molecular characterization of S. pyogenes done by pulsed-field gel electrophoresis revealed the same strain. Although a definite source for the outbreak could not be identified, probably lack of adherence to hand hygiene practices during surgical dressings, contamination, and cross contamination led to this outbreak.

  20. Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk.

    NARCIS (Netherlands)

    Pull ter Gunne, A.F.; Laarhoven, C.J.H.M. van; Cohen, D.B.

    2010-01-01

    Surgical site infection (SSI) following spinal surgery is a frequent complication and results in higher morbidity, mortality and healthcare costs. Patients undergoing surgery for spinal deformity (scoliosis/kyphosis) have longer surgeries, involving more spinal levels and larger blood losses than

  1. Is there an increased risk of post-operative surgical site infection ...

    African Journals Online (AJOL)

    Background: There is dilemma as to whether patients infected with the Human Immunodeficiency Virus (HIV) requiring implant orthopaedic surgery are at an increased risk for post-operative surgical site infection (SSI). We conducted a systematic review to determine the effect of HIV on the risk of post-operative SSI and ...

  2. Role of Antibiotics on Surgical Site Infection in Cases of Open and ...

    African Journals Online (AJOL)

    Role of Antibiotics on Surgical Site Infection in Cases of Open and Laparoscopic Cholecystectomy: A Comparative Observational Study. P Gharde, M Swarnkar, L S Waghmare, V M Bhagat, D S Gode, D D Wagh, P Muntode, H Rohariya, A Sharma ...

  3. Active prospective surveillance study with post-discharge surveillance of surgical site infections in Cambodia.

    Science.gov (United States)

    Guerra, José; Guichon, Céline; Isnard, Margaux; So, Saphy; Chan, Sophors; Couraud, Sébastien; Duong, Bunn

    2015-01-01

    Barriers to the implementation of the Centers for Disease Control and Prevention (CDC) guidelines for surgical site infection (SSI) surveillance have been described in resource-limited settings. This study aimed to estimate the SSI incidence rate in a Cambodian hospital and to compare different modalities of SSI surveillance. We performed an active prospective study with post-discharge surveillance. During the hospital stay, trained surveyors collected the CDC criteria to identify SSI by direct examination of the surgical site. After discharge, a card was given to each included patient to be presented to all practitioners examining the surgical site. Among 167 patients, direct examination of the surgical site identified a cumulative incidence rate of 14 infections per 100 patients. An independent review of medical charts presented a sensitivity of 16%. The sensitivity of the purulent drainage criterion to detect SSIs was 83%. After hospital discharge, 87% of the patients provided follow-up data, and nine purulent drainages were reported by a practitioner (cumulative incidence rate: 20%). Overall, the incidence rate was dependent on the surveillance modalities. The review of medical charts to identify SSIs during hospitalization was not effective; the use of a follow-up card with phone calls for post-discharge surveillance was effective. Copyright © 2014 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

  4. Aetiological agents of surgical site infection in a specialist hospital in ...

    African Journals Online (AJOL)

    Abstract: Despite the advances made in asepsis, antimicrobial drugs, sterilization and operative techniques, surgical site infections (SSI) continue to be a major problem in all branches of surgery in the hospitals. The objective of this study was to establish the incidence of SSI, the type and frequency of various pathogens.

  5. Alcohol Drinking does not Affect Postoperative Surgical Site Infection or Anastomotic Leakage

    DEFF Research Database (Denmark)

    Shabanzadeh, Daniel Mønsted; Sørensen, Lars Tue

    2014-01-01

    Alcohol abuse appears to increase postoperative complications, but clinical trials have reported conflicting results. The objective of this systematic review and meta-analysis is to clarify how alcohol drinking affects postoperative surgical site infection and anastomotic leakage and to determine...... the impact of perioperative alcohol intervention....

  6. Treatment of surgical site infections (SSI) IN patients with peripheral arterial disease : an observational study

    NARCIS (Netherlands)

    van der Slegt, Jasper; Kluytmans, Jan A J W|info:eu-repo/dai/nl/323262139; de Groot, Hans G W; van der Laan, Lijckle

    INTRODUCTION: The management of surgical site infections (SSI's) in vascular surgery has been challenging over the years. To assess the outcomes associated with the various strategies, we performed a review of all SSI's after elective vascular procedures in patients with moderate to severe

  7. Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery

    DEFF Research Database (Denmark)

    Meyhoff, Christian S; Wetterslev, Jørn; Jorgensen, Lars N

    2009-01-01

    Control and Prevention. Secondary outcomes included atelectasis, pneumonia, respiratory failure, and mortality. RESULTS: Surgical site infection occurred in 131 of 685 patients (19.1%) assigned to receive 80% oxygen vs 141 of 701 (20.1%) assigned to receive 30% oxygen (odds ratio [OR], 0.94; 95...

  8. Use of plastic adhesive drapes during surgery for preventing surgical site infection.

    Science.gov (United States)

    Webster, Joan; Alghamdi, Abdullah

    2015-04-22

    Surgical site infection has been estimated to occur in about 15% of clean surgery and 30% of contaminated surgery cases. Using plastic adhesive drapes to protect the wound from organisms that may be present on the surrounding skin during surgery is one strategy used to prevent surgical site infection. Results from non-randomised studies have produced conflicting results about the efficacy of this approach. A systematic review was required to guide clinical practice. To assess the effect of adhesive drapes used during surgery on surgical site infection, cost, mortality and morbidity. For this fourth update we searched the Cochrane Wounds Group Specialised Register (searched 4th March 2015); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015, Issue 2); Ovid MEDLINE (2012 to 3rd March 2015); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, 2012 to 3rd March 2015); Ovid EMBASE (2012 to 3rd March 2015); and EBSCO CINAHL (2012 to 4th March 2015). Randomised controlled trials comparing any plastic adhesive drape with no plastic adhesive drape, used alone or in combination with woven (material) drapes or disposable (paper) drapes, in patients undergoing any type of surgery. Ring drapes were excluded. Two review authors independently selected and assessed studies for trial quality and both independently extracted data. We contacted study authors for additional information. We identified no new studies for this fourth update. The review includes five studies involving 3082 participants comparing plastic adhesive drapes with no drapes and two studies involving 1113 participants comparing iodine-impregnated adhesive drapes with no drapes. A significantly higher proportion of patients in the adhesive drape group developed a surgical site infection when compared with no drapes (risk ratio (RR) 1.23, 95% confidence interval (CI) 1.02 to 1.48, P = 0.03). Iodine-impregnated adhesive drapes had no effect on the surgical site infection rate

  9. Microbial colonisation of orthopaedic tourniquets: A potential risk for surgical site infection

    Directory of Open Access Journals (Sweden)

    S K Sahu

    2015-01-01

    Full Text Available Pneumatic tourniquets have been used in orthopaedic surgery to get avascular fields. Sixteen such tourniquets were analysed for microbial colonisation. Samples were taken from two inner and two outer areas of each tourniquet and cultured on sheep blood agar. Eight of these were wiped with Savlon and the rest with Sterillium solution. Post-treatment samples from the same sites were again cultured. After incubation, colonies from each site were identified and counted. It was observed that the tourniquets were colonised with coagulase-negative staphylococci, Staphylococcus aureus, Bacillus, diphtheroids, Pseudomonas, Acinetobacter, enterococci, enterobacteria, and Candida. On treating with Savlon and Sterillium, there was 92.18% and 95.70% reduction in the colony count, respectively.

  10. The registration of surgical site infections: a comparison of two different methods in vascular surgery.

    Science.gov (United States)

    Donker, Jeroen M W; Kluytmans, Jan A J W; Veen, Eelco J; Ho, Gwan H; Hendriks, Yvonne J A M; van der Laan, Lijckle

    2013-08-01

    Registration of complications of treatment is an important instrument for measuring the quality of health care. Reliable registration depends on definitions, the case-finding method that is used, and the registration method itself. We conducted a comparative study of two different methods of registration for the surveillance of surgical site infections (SSIs) in a single hospital. The study included all patients in both the surgical database and the microbiology and infection-prevention database of the hospital who underwent surgery on the abdominal aorta or peripheral vascular procedures from March 1, 2009 to March 1, 2010. The surgical database included positive scores for SSI in cases of positive wound swabs, the need for incision drainage, or the need for antibiotic treatment. The microbiology and infection-prevention database used criteria from the U.S. Centers for Disease Control and Prevention (CDC), and based positive scores on redness, heat, swelling, or pain in the area of a surgical incision within 30 d after a procedure, and on a positive swab, drainage from an incision, or the presence of pus following a diagnostic puncture. The surgical complication database included 218 patients, of whom 20 (9.2%) had a SSI. The microbiology and infection-prevention database included 236 patients, of whom 33 (14%) had a SSI. The databases were merged and all infections were ascertained by an expert team. The surgical database had a sensitivity of 57% for SSIs, whereas the microbiology and infection-prevention database had a sensitivity of 93% (pcare.

  11. Prevalence of Pathogenic Bacteria Isolated from Surgical Site and Wound Infection among Patients Admitted in some selected Hospitals in Sokoto Metropolis, Nigeria

    Directory of Open Access Journals (Sweden)

    UK Muhammad

    2014-09-01

    Full Text Available Surgical and open wounds are commonly encountered in clinical practice. This study was aim to determine the prevalence of pathogenic bacteria in surgical and open wound infection among patients admitted in some selected hospitals in Sokoto metropolis. A total of one hundred and fifty one (151 isolates were obtained from two hundred (200 surgical site and wound samples collected from patients in this study. The result showed that Usmanu Danfodiyo Teaching Hospital Sokoto (UDUTH had the highest number of clinical isolates with 64 gram positive and gram negative bacteria followed by Specialist Hospital Sokoto (S.H.S with 57 gram positive and gram negative bacteria and then Maryam Abacha Women and Children Hospital (MAWCH with 30 gram positive and gram negative bacteria. Gram positive cocci 108 (71.5% were more predominant pathogen isolated in the hospitals than gram negative bacilli 43 (28.5%. Staphylococcus aureus had the highest number of occurrence with 54(35.76% followed by Coagulate negative Staphylococci with 47(31.1% while Citrobacter freundii had the lowest number of occurrence with 2(1.32% isolates. Also, the susceptibility of the isolates to antimicrobial agents were carried out using Amoxacillin, Ampicillin, Erythromycin, Chloramphenicol, Ampiclox, Ciprofloxacin, Gentamycin, Tetracycline, Pefloxacin and Cotrimoxazole. The mean zone of inhibition recorded against Staphlococcus aureus by using Amoxacillin antibiotic is 2.20mm while with Citrobacter freundii is 1.00. DOI: http://dx.doi.org/10.3126/ije.v3i3.11066 International Journal of Environment Vol.3(3 2014: 89-103

  12. Neuropathy and poorly controlled diabetes increase the rate of surgical site infection after foot and ankle surgery.

    Science.gov (United States)

    Wukich, Dane K; Crim, Brandon E; Frykberg, Robert G; Rosario, Bedda L

    2014-05-21

    This prospective study was designed to evaluate the frequency of surgical site infection in patients treated with foot and ankle surgery. Our hypothesis was that patients with complications of diabetes are at increased risk for surgical site infection compared with patients without diabetes and patients with diabetes who do not have diabetic complications. Another goal was to compare the association of neuropathy with surgical site infection in both nondiabetic and diabetic patients. Two thousand and sixty consecutive surgical cases were evaluated. Group 1 included nondiabetic patients without neuropathy, Group 2 included nondiabetic patients with neuropathy, Group 3 included patients with diabetes but no diabetic complications, and Group 4 included patients with diabetes who had at least one complication of diabetes. The surgical site infection rate in this study was 3.1%. Patients with complicated diabetes had a 7.25-fold increased risk of surgical site infection compared with nondiabetic patients without neuropathy and a 3.72-fold increased risk compared with patients with uncomplicated diabetes. Patients with complicated diabetes had a nonsignificant 1.54-fold higher rate of surgical site infection compared with nondiabetic patients with neuropathy. Nondiabetic patients with neuropathy had a significant 4.72-fold increased risk of surgical site infection compared with nondiabetic patients without neuropathy. Despite this, nondiabetic patients with neuropathy did not have a significantly higher rate of surgical site infection than patients with uncomplicated diabetes, and the frequency of surgical site infection in the group with uncomplicated diabetes was not significantly different from that in the nondiabetic patients without neuropathy. Multivariable logistic regression analysis demonstrated that peripheral neuropathy and a hemoglobin A1c of ≥8% were independently associated with surgical site infection. Complicated diabetes increases the risk of surgical

  13. Post-Caesarean Section Surgical Site Infection Surveillance Using an Online Database and Mobile Phone Technology.

    Science.gov (United States)

    Castillo, Eliana; McIsaac, Corrine; MacDougall, Bhreagh; Wilson, Douglas; Kohr, Rosemary

    2017-08-01

    Obstetric surgical site infections (SSIs) are common and expensive to the health care system but remain under reported given shorter postoperative hospital stays and suboptimal post-discharge surveillance systems. SSIs, for the purpose of this paper, are defined according to the Center for Disease Control and Prevention (1999) as infection incurring within 30 days of the operative procedure (in this case, Caesarean section [CS]). Demonstrate the feasibility of real-life use of a patient driven SSIs post-discharge surveillance system consisting of an online database and mobile phone technology (surgical mobile app - how2trak) among women undergoing CS in a Canadian urban centre. Estimate the rate of SSIs and associated predisposing factors. Prospective cohort of consecutive women delivering by CS at one urban Canadian hospital. Using surgical mobile app-how2trak-predetermined demographics, comorbidities, procedure characteristics, and self-reported symptoms and signs of infection were collected and linked to patients' incision self-portraits (photos) on postpartum days 3, 7, 10, and 30. A total of 105 patients were enrolled over a 5-month period. Mean age was 31 years, 13% were diabetic, and most were at low risk of surgical complications. Forty-six percent of surgeries were emergency CSs, and 104/105 received antibiotic prophylaxis. Forty-five percent of patients (47/105) submitted at least one photo, and among those, one surgical site infection was detected by photo appearance and self-reported symptoms by postpartum day 10. The majority of patients whom uploaded photos did so multiple times and 43% of them submitted photos up to day 30. Patients with either a diagnosis of diabetes or self-reported Asian ethnicity were less likely to submit photos. Post-discharge surveillance for CS-related SSIs using surgical mobile app how2trak is feasible and deserves further study in the post-discharge setting. Copyright © 2017. Published by Elsevier Inc.

  14. Optimum Operating Room Environment for the Prevention of Surgical Site Infections.

    Science.gov (United States)

    Gaines, Sara; Luo, James N; Gilbert, Jack; Zaborina, Olga; Alverdy, John C

    Surgical site infections (SSI), whether they be incisional or deep, can entail major morbidity and death to patients and additional cost to the healthcare system. A significant amount of effort has gone into optimizing the surgical patient and the operating room environment to reduce SSI. Relevant guidelines and literature were reviewed. The modern practice of surgical antisepsis involves the employment of strict sterile techniques inside the operating room. Extensive guidelines are available regarding the proper operating room antisepsis as well as pre-operative preparation. The use of pre-operative antimicrobial prophylaxis has become increasingly prevalent, which also presents the challenge of opportunistic and nosocomial infections. Ongoing investigative efforts have brought about a greater appreciation of the surgical patient's endogenous microflora, use of non-bactericidal small molecules, and pre-operative microbial screening. Systematic protocols exist for optimizing the surgical sterility of the operating room to prevent SSIs. Ongoing research efforts aim to improve the precision of peri-operative antisepsis measures and personalize these measures to tailor the patient's unique microbial environment.

  15. Prophylactic retention suture for surgical site infection: a retrospective cohort study.

    Science.gov (United States)

    Ito, Eisaku; Yoshida, Masashi; Suzuki, Norihiko; Imakita, Tomonori; Tsutsui, Nobuhiro; Ohdaira, Hironori; Kitajima, Masaki; Suzuki, Yutaka

    2018-01-01

    Surgical site infection (SSI) is a common complication of gastrointestinal surgery. Because retention suture is known to prevent abdominal wound dehiscence, it is only considered indicated in high-risk patients. At present, there are no clear indications for retention suture. The purpose of this study was to analyze the effect of prophylactic retention suture and to determine what situations indicate prophylactic retention suture against SSI. Between January 2014 and January 2016, 135 patients who underwent midline laparotomy in our hospital were analyzed. Inclusion criteria for this study were patients with American Society Anesthesiologists' physical status classification system (ASA-PS score) ≥ 3 or emergent surgery. Of the 135 patients, 30 (22.2%) received prophylactic retention suture. Diabetes mellitus, surgical wound classification, large incision, and retention suture were associated with SSI in multivariate analysis. In subgroup analysis, SSI risk factors were analyzed in each surgical wound classification. Only in surgical wound classification class II and III did retention suture significantly reduce the risk of SSI (odds ratio = 0.100 [0.012-0.837], P = 0.034). In class IV, however, half the patients developed SSI, regardless of retention suture. Table 3 summarizes the results of the subgroup analysis. The present data suggest that prophylactic retention suture reduces SSI for surgical wound classification class II or III. For class IV operations, however, other methods to prevent SSI are necessary. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Reducing the risk of surgical site infection: a case controlled study of contamination of theatre clothing.

    Science.gov (United States)

    Sivanandan, Indu; Bowker, Karen E; Bannister, Gordon C; Soar, Jasmeet

    2011-02-01

    Surgical site infections are one of the most important causes of healthcare associated infections (HCAI), accounting for 20% of all HCAIs. Surgical site infections affect 1% of joint replacement operations. This study was designed to assess whether theatre clothing is contaminated more inside or outside the theatre suite. Petri dishes filled with horse blood agar were pressed on theatre clothes at 0, 2, 4, 6 and 8 hours to sample bacterial contamination in 20 doctors whilst working in and outside the theatre suite. The results showed that there was greater bacterial contamination when outside the theatre suite at 2 hours. There were no differences in the amount of contamination at 4, 6 and 8 hours. This study suggests that the level of contamination of theatre clothes is similar both inside and outside the theatre setting.

  17. Off-label Usage of Absorbable Beads Containing Antibiotics for Prevention of Surgical Site Infections.

    Science.gov (United States)

    Trujillo, Jeffrey M; Logue, Mary E; Kunkel, Ryan; Demas, Christopher P

    2017-10-01

    Surgical site infections account for about 17% of all nosocomial infections, second only to urinary tract infections. Antibiotic beads deliver high local antibiotic concentrations and maintain low systemic levels. The authors assessed the efficacy of calcium sulfate absorbable antibiotic beads (CSAAB) in the prevention of surgical site infections (SSIs) for complex wound closures. Patient records from the University of New Mexico Hospital (UNMH; Albuquerque, NM) and Dartmouth-Hitchcock Medical Center (DHMC; Lebanon, NH) were retrospectively analyzed from 2004 to 2015. Each patient received CSAAB prophylaxis during operations performed by the principle investigator. Charts were grouped by wound location and category. Outcomes were defined solely by readmission within 30 days for repeat intervention. Zero of the 38 UNMH and 15 of the 104 DHMC patients were readmitted. Data reached statistical significance based on 95% confidence intervals using the binomial distribution. This brief retrospective chart review shows promising use for CSAAB in the prevention of soft tissue SSIs.

  18. Risk Factors and Predictive Model Development of Thirty-Day Post-Operative Surgical Site Infection in the Veterans Administration Surgical Population.

    Science.gov (United States)

    Li, Xinli; Nylander, William; Smith, Tracy; Han, Soonhee; Gunnar, William

    2018-02-01

    Surgical site infection (SSI) complicates approximately 2% of surgeries in the Veterans Affairs (VA) hospitals. Surgical site infections are responsible for increased morbidity, length of hospital stay, cost, and mortality. Surgical site infection can be minimized by modifying risk factors. In this study, we identified risk factors and developed accurate predictive surgical specialty-specific SSI risk prediction models for the Veterans Health Administration (VHA) surgery population. In a retrospective observation study, surgical patients who underwent surgery from October 2013 to September 2016 from 136 VA hospitals were included. The Veteran Affairs Surgical Quality Improvement Program (VASQIP) database was used for the pre-operative demographic and clinical characteristics, intra-operative characteristics, and 30-day post-operative outcomes. The study population represents 11 surgical specialties: neurosurgery, urology, podiatry, otolaryngology, general, orthopedic, plastic, thoracic, vascular, cardiac coronary artery bypass graft (CABG), and cardiac valve/other surgery. Multivariable logistic regression models were developed for the 30-day post-operative SSIs. Among 354,528 surgical procedures, 6,538 (1.8%) had SSIs within 30 days. Surgical site infection rates varied among surgical specialty (0.7%-3.0%). Surgical site infection rates were higher in emergency procedures, procedures with long operative duration, greater complexity, and higher relative value units. Other factors associated with increased SSI risk were high level of American Society of Anesthesiologists (ASA) classification (level 4 and 5), dyspnea, open wound/infection, wound classification, ascites, bleeding disorder, chemotherapy, smoking, history of severe chronic obstructive pulmonary disease (COPD), radiotherapy, steroid use for chronic conditions, and weight loss. Each surgical specialty had a distinct combination of risk factors. Accurate SSI risk-predictive surgery specialty

  19. Suction Drain Tip Culture after Spine Surgery: Can It Predict a Surgical Site Infection?

    OpenAIRE

    Ahn, Jae-Sung; Lee, Ho-Jin; Park, Eugene; Park, Il-Young; Lee, Jae Won

    2015-01-01

    Study Design Retrospective clinical study. Purpose To assess the diagnostic value of suction drain tip culture in patients undergoing primary posterior spine surgery. Overview of Literature To date, the diagnostic value of suction drain tip culture for predicting surgical site infection (SSI) has not been firmly established in orthopedic or spinal surgery. Methods In total, 133 patients who underwent primary posterior spine surgery from January 2013 to April 2015 were included in this retrosp...

  20. A benchmark too far: findings from a national survey of surgical site infection surveillance

    OpenAIRE

    Tanner, Judith; Padley, Wendy; Kiernan, Martin; Leaper, David; Norrie, Peter; Baggott, Rob

    2013-01-01

    Background The national surgical site infection (SSI) surveillance service in England collates and publishes SSI rates that are used for benchmarking and to identify the prevalence of SSIs. However, research studies using high-quality SSI surveillance report rates that are much higher than those published by the national surveillance service. This variance questions the validity of data collected through the national service. Aim To audit SSI definitions and data collection methods ...

  1. Surgical site infection after total en bloc spondylectomy: Risk factors and the preventive new technology

    OpenAIRE

    Hayashi, Hiroyuki; Murakami, Hideki; Demura, Satoru; Kato, Satoshi; Yoshioka, Katsuhito; Shinmura, Kazuya; Yokogawa, Noriaki; Ishii, Takayoshi; Fang, Xiang; Shirai, Toshiharu; Tsuchiya, Hiroyuki

    2015-01-01

    Background context Surgical site infection (SSI) associated with instruments remains a serious and common complication in patients who undergo total en bloc spondylectomy (TES). It is very important that the risk factors for SSI are known to prevent it.Purpose The purpose of the study was to identify independent risk factors for SSI after TES and evaluate the positive effect of iodine-supported spinal instruments in the prevention of SSI after TES.Study design This is a retrospective clinical...

  2. The Baltodano Breast Reduction Score: A Nationwide, Multi-Institutional, Validated Approach to Reducing Surgical-Site Morbidity.

    Science.gov (United States)

    Baltodano, Pablo A; Reinhardt, Myrna Eliann; Ata, Ashar; Simjee, Usamah F; Roth, Malcolm Z; Patel, Ashit

    2017-08-01

    Breast reduction remains associated with significantly higher rates of overall morbidity, superficial surgical-site infections, and wound disruptions. The authors developed a validated risk model to identify patients at higher risk for postoperative surgical-site morbidity after breast reduction. A retrospective review was performed of all women undergoing breast reduction from the American College of Surgeons National Surgical Quality Improvement Program 2005 to 2012 data. Surgical-site morbidity included surgical-site infection and wound disruption events. Stepwise multivariable logistic regression identified risk factors associated with surgical-site morbidity. The model was validated using bootstrap replications (n = 100) and the Hosmer-Lemeshow test, and converted into the Baltodano breast reduction score, a clinical risk tool predictive of surgical-site morbidity. The authors identified 7068 breast reductions. Rate of 30-day surgical-site morbidity was 3.98 percent. Independent risk factors included resident participation (OR, 1.5; 95 percent CI, 1.1 to 2.0; p = 0.004), body mass index (for every 5-unit increase: OR, 1.3; 95 percent CI, 1.1 to 1.4; p morbidity associated with each risk score was estimated. Predicted and observed risks of surgical-site morbidity were highly comparable. The authors present the Baltodano breast reduction score, a validated risk-stratification tool for predicting 30-day surgical-site morbidity following breast reduction using data that are readily available to the clinician. This may allow targeted screening and intervention in high-risk patients, better counseling, selective resident participation, and ultimately a decrease in overall health care costs. Risk, III.

  3. Lymphoscintigraphy Defines New Lymphatic Pathways from Cutaneous Melanoma Site: Clinical Implications and Surgical Management

    Directory of Open Access Journals (Sweden)

    Ugo Marone

    2011-01-01

    Full Text Available Sentinel lymph node biopsy is commonly applied as staging procedure of regional lymph nodes in patients with cutaneous melanoma. Dynamic lymphoscintigraphy defines the lymphatic pathways from a primary melanoma site and allows to identify the node receiving lymphatic drainage from the primary tumor, which is the sentinel lymph node. In rare cases, lymphoscintigraphy shows sites of lymphatic drainage in nonclassical basins never described in the past when lymphatic drainage was considered only according to the anatomical proximity of the tumor primary site. These peculiar sentinel nodes, so-called “uncommon/interval” nodes, must be surgically removed because they may contain micrometastatic disease and may be the only site of nodal involvement.

  4. High prevalence of colonization with Staphylococcus aureus clone USA300 at multiple body sites among sexually transmitted disease clinic patients: an unrecognized reservoir.

    Science.gov (United States)

    Miko, Benjamin A; Uhlemann, Anne-Catrin; Gelman, Amanda; Lee, Caroline J; Hafer, Cory A; Sullivan, Sean B; Shi, Qiuhu; Miller, Maureen; Zenilman, Jonathan; Lowy, Franklin D

    2012-10-01

    Extranasal colonization is increasingly recognized as an important reservoir for Staphylococcus aureus among high-risk populations. We conducted a cross-sectional study of multiple body site colonization among 173 randomly selected STD clinic patients in Baltimore, Maryland. Staphylococcal carriage at extranasal sites, including the oropharynx, groin, rectum, and genitals, was common among study subjects. The USA300 clone was particularly associated with multiple sites of colonization compared with non-USA300 strains (p = .01). Given their high burden of multi-site colonization and confluence of established staphylococcal risk factors, STD clinic patients may represent a community-based reservoir for S. aureus and be well suited for innovative infection control initiatives. Copyright © 2012 Institut Pasteur. Published by Elsevier Masson SAS. All rights reserved.

  5. Preoperative delay of more than 1 hour increases the risk of surgical site infection.

    Science.gov (United States)

    Radcliff, Kris E; Rasouli, Mohammad R; Neusner, Alex; Kepler, Christopher K; Albert, Todd J; Rihn, Jeffrey A; Hilibrand, Alan S; Vaccaro, Alexander R

    2013-07-01

    Retrospective institutional database review. To determine whether preoperative in-room time is a risk factor for surgical site infection (SSI). Prior to spine surgery, while the patient is in the operating room, several procedures may be performed that may delay surgery. During this time, the sterile field may be exposed and may become contaminated. The hypothesis of this study was that the length of time in the operative room prior to surgical incision (anesthesia ready time [ART]) was related to the risk of SSI. From 2005 to 2009, we identified 276 patients who developed SSI out of 7991 cases that underwent spine surgery from 2005 to 2009. Patient demographic factors, American Society of Anesthesiologists score, wound classification, number of levels, anatomic region, type of surgical approach, and length of surgery were extrapolated. ART was calculated as the time after the patient was brought into the operating room prior to surgical incision. Multivariate analysis was performed to identify risk factors for SSI. Mean ART was significantly (P = 0.001) higher in patients with infection (68 min) compared with those without infection (60 min). The infection rate was higher in cases with ART more than 1 hour compared with those with less than 1 hour (4.9% vs. 2.3%, P = 0.001). In multivariate analysis, ART more than 1 hour was an independent risk factor for SSI, along with number of levels, American Society of Anesthesiologists score and posterior approach. The highest percentage of cases with ART more than 1 hour occurred in August and September. Preoperative in-room time prior to the start of surgical incision is an independent risk factor for SSI. All possible steps should be taken prior to entry into the operating theater to reduce in-room time and opening of surgical sterile instrumentation be delayed until the surgery is ready to proceed.

  6. Preoperative Chlorhexidine Gluconate Use Can Increase Risk for Surgical Site Infections after Ventral Hernia Repair.

    Science.gov (United States)

    Prabhu, Ajita S; Krpata, David M; Phillips, Sharon; Huang, Li-Ching; Haskins, Ivy N; Rosenblatt, Steven; Poulose, Benjamin K; Rosen, Michael J

    2017-03-01

    There is varying evidence about the use of preoperative chlorhexidine gluconate to decrease surgical site infection for elective surgery. This intervention has never been studied in ventral hernia repair, the most common general surgery procedure in the US. We aimed to determine whether preoperative chlorhexidine gluconate decreases the risk of 30-day wound morbidity in patients undergoing ventral hernia repair. All patients undergoing ventral hernia repair in the Americas Hernia Society Quality Collaborative were separated into 2 groups: 1 group received preoperative chlorhexidine scrub and the other did not. The 2 groups were evaluated for 30-day wound morbidity, including surgical site occurrence (SSO), surgical site infection (SSI), and SSO requiring procedural intervention. Statistical analysis was performed using multivariate regression analysis and propensity score modeling. Multiple factors were controlled for statistical analysis, including patient-related factors and operative factors. In total, 3,924 patients were included for comparison. After multivariate logistic regression modeling, the preoperative chlorhexidine scrub group had a higher incidence of SSOs (odds ratio [OR] = 1.34; 95% CI 1.11 to 1.61) and SSIs (OR = 1.46; 95% CI 1.03 to 2.07). After propensity score modeling, the increased risk of SSO and SSI persisted (SSO: OR = 1.39; 95% CI 1.15 to 1.70; SSI: OR = 1.45; 95% CI 1.011 to 2.072, respectively). Prehospital chlorhexidine gluconate scrub appears to increase the risk of 30-day wound morbidity in patients undergoing ventral hernia repair. These findings suggest that the generalized use of prehospital chlorhexidine might not be desirable for all surgical populations. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Risk of surgical site infection in paediatric herniotomies without any prophylactic antibiotics: A preliminary experience

    Directory of Open Access Journals (Sweden)

    Dhananjay Vaze

    2014-01-01

    Full Text Available Background: Different studies underline the use of pre-operative antibiotic prophylaxis in clean surgeries like herniotomy and inguinal orchiopexy. But, the meta-analyses do not recommend nor discard the use of prophylactic pre-operative antibiotics. The scarcity of controlled clinical trials in paediatric population further vitiates the matter. This study assessed the difference in the rate of early post-operative wound infection cases in children who received single dose of pre-operative antibiotics and children who did not receive antibiotics after inguinal herniotomy and orchiopexy. Materials and Methods: This randomised prospective study was conducted in Paediatric Surgery department of PGIMER Chandigarh. Out of 251 patients, 112 patients were randomised to the case group and 139 were ascribed to the control group. The patients in control group were given a standard regimen of single dose of intravenous antibiotic at the time of induction followed by 3-4 days of oral antibiotic. Case group patients underwent the surgical procedure in similar manner with no antibiotic either at the time of induction or post-operatively. Results: The incidence of surgical site infection in case group was 3.73 % and that in control group was 2.22%. The observed difference in the incidence of surgical site infection was statistically insignificant (P value = 0.7027. The overall infection rate in case and control group was 2.89%. Conclusions: Our preliminary experience suggests that there is no statistically significant difference in the proportion of early post-operative wound infection between the patients who received single dose of pre-operative antibiotics and the patients who received no antibiotics after inguinal herniotomy and orchiopexy. The risk of surgical site infection in paediatric heriotomies does not increase even if the child′s weight is less than his/her expected weight for age.

  8. Compact teleoperated laparoendoscopic single-site robotic surgical system: Kinematics, control, and operation.

    Science.gov (United States)

    Isaac-Lowry, Oran Jacob; Okamoto, Steele; Pedram, Sahba Aghajani; Woo, Russell; Berkelman, Peter

    2017-12-01

    To date a variety of teleoperated surgical robotic systems have been developed to improve a surgeon's ability to perform demanding single-port procedures. However typical large systems are bulky, expensive, and afford limited angular motion, while smaller designs suffer complications arising from limited motion range, speed, and force generation. This work was to develop and validate a simple, compact, low cost single site teleoperated laparoendoscopic surgical robotic system, with demonstrated capability to carry out basic surgical procedures. This system builds upon previous work done at the University of Hawaii at Manoa and includes instrument and endoscope manipulators as well as compact articulated instruments designed to overcome single incision geometry complications. A robotic endoscope holder was used for the base, with an added support frame for teleoperated manipulators and instruments fabricated mostly from 3D printed parts. Kinematics and control methods were formulated for the novel manipulator configuration. Trajectory following results from an optical motion tracker and sample task performance results are presented. Results indicate that the system has successfully met the goal of basic surgical functionality while minimizing physical size, complexity, and cost. Copyright © 2017 John Wiley & Sons, Ltd.

  9. Surgical site infections in adults patients undergoing of clean and contaminated surgeries at a university Brazilian hospital

    Directory of Open Access Journals (Sweden)

    Maria de Lourdes Gonçalves Santos

    2010-12-01

    Full Text Available CONTEXT: Surgical site infections are a risk inherent to surgical procedures, especially after digestive surgeries. They occur up to 30 days after surgery, or up to a year later if a prosthesis is implanted. The Surgical-site Infection Risk Index (SIRI, NISS (National Nosocomial Infection Surveillance methodology, is a method to evaluate the risk of surgical site infections, which takes into account the potential contamination of the surgery, the patient's health status and surgery duration. OBJECTIVES: To evaluate the correlation between the surgical-site infection risk index score on the 1st day postoperatively, and the development of surgical site infection up to 30 days postoperatively. METHODS: The postoperative surgical site infections (NNIS was evaluated by following-up in hospital and as an outpatient. The patients followed prospectively were those submitted to elective surgeries, clean (hernioplasties or contaminated (colorretal, performed by conventional approach at a university hospital, during the period from June 2007 to August 2008. The mean age of the patients was 55.5 years, 133 (65.5% male; 120 (59.1% submitted to clean surgeries and 83 (40.9% contaminated. RESULTS: The global index of surgical site infections was 10.3%; 10 (8.3% in clean procedures and 111(3.2% in contaminated ones. Four (19.1% of the surgical site infections were diagnosed at the time of hospitalization and 17 (80.9% at post-discharge follow-up. Twelve (57.1% of the surgical site infections were superficial, 2 (9.5% deep and 7 (33.3% at a specific site. Of these, 5 (6.6% were in patients classified as SIRI 0 (76; 9 (15% for SIRI 1 (60; 5 (9.1% for SIRI 2 (55 and 2 (16.7% for SIRI 3. CONCLUSION: The global index of surgical site infections and its incidence among contaminated procedures are within the expected limits. On the other hand according to SIRI, the surgical site infection indexes are above the expected standards both for the clean and for the

  10. ‘This wound has spoilt everything’: emotional capital and the experience of surgical site infections

    Science.gov (United States)

    Brown, Brian; Tanner, Judith; Padley, Wendy

    2014-01-01

    In this article we explore the experience of suffering from a surgical site infection, a common complication of surgery affecting around 5 per cent of surgical patients, via an interview study of 17 patients in the Midlands in the UK. Despite their prevalence, the experience of surgical site infections has received little attention so far. In spite of the impairment resulting from these iatrogenic problems, participants expressed considerable stoicism and we interpret this via the notion of emotional capital. This idea derives from the work of Pierre Bourdieu, Helga Nowotny and Diane Reay and helps us conceptualise the emotional resources accumulated and expended in managing illness and in gaining the most from healthcare services. Participants were frequently at pains not to blame healthcare personnel or hospitals, often discounting the infection's severity, and attributing it to chance, to ‘germs’ or to their own failure to buy and apply wound care products. The participants' stoicism was thus partly afforded by their refusal to blame healthcare institutions or personnel. Where anger was described, this was either defused or expressed on behalf of another person. Emotional capital is associated with deflecting the possibility of complaint and sustaining a deferential and grateful position in relation to the healthcare system. PMID:25470322

  11. 'This wound has spoilt everything': emotional capital and the experience of surgical site infections.

    Science.gov (United States)

    Brown, Brian; Tanner, Judith; Padley, Wendy

    2014-11-01

    In this article we explore the experience of suffering from a surgical site infection, a common complication of surgery affecting around 5 per cent of surgical patients, via an interview study of 17 patients in the Midlands in the UK. Despite their prevalence, the experience of surgical site infections has received little attention so far. In spite of the impairment resulting from these iatrogenic problems, participants expressed considerable stoicism and we interpret this via the notion of emotional capital. This idea derives from the work of Pierre Bourdieu, Helga Nowotny and Diane Reay and helps us conceptualise the emotional resources accumulated and expended in managing illness and in gaining the most from healthcare services. Participants were frequently at pains not to blame healthcare personnel or hospitals, often discounting the infection's severity, and attributing it to chance, to 'germs' or to their own failure to buy and apply wound care products. The participants' stoicism was thus partly afforded by their refusal to blame healthcare institutions or personnel. Where anger was described, this was either defused or expressed on behalf of another person. Emotional capital is associated with deflecting the possibility of complaint and sustaining a deferential and grateful position in relation to the healthcare system. © 2014 The Authors. Sociology of Health & Illness © 2014 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

  12. A study of the efficacy of antibacterial sutures for surgical site infection: a retrospective controlled trial.

    Science.gov (United States)

    Hoshino, Seiichiro; Yoshida, Yoichiro; Tanimura, Syu; Yamauchi, Yasushi; Noritomi, Tomoaki; Yamashita, Yuichi

    2013-01-01

    To reduce bacterial adherence to surgical sutures, triclosan-coated polyglactin 910 suture materials with antiseptic activity were developed. The aim of this study was to evaluate whether the incidence of surgical site infections can be reduced when triclosan-coated sutures are used. Until December 2009, we used conventional polyglactin 910 sutures (VICRYL, Ethicon) for the closure of the fascia in digestive tract surgery. Therefore, for the control group we retrospectively collected surveillance data for 1.5 years. In the control group, 611 patients underwent digestive tract surgery with VICRYL sutures. Beginning in July 2010, we used triclosan-coated polyglactin 910 sutures (VICRYL Plus, Ethicon, Tokyo, Japan) for the closure of the fascia in all digestive surgeries. So, we collected data for the study group from July 2010 until June 2011. In the study group, 467 patients underwent digestive tract surgery with triclosan-coated VICRYL Plus sutures. In the control group, 75 patients (12.2%) developed wound infections. In the study group, 31 patients (6.6%) developed wound infections, which was significantly lower. Emergency cases; laparoscopic cases, including some cholecystectomy and colectomy cases; American Society of Anesthesiologists classification; the use of immunosuppressive therapy; colostomy cases; wound classification; and suture material were identified as the risk factors for wound infections. In both groups, as the wound classification worsened, the wound infection rate increased. Triclosan-coated polyglactin 910 antimicrobial sutures lead to a significant decrease in the incidence of surgical site infections, especially in clean/contaminated cases.

  13. Improving surgical site infection prevention practices through a multifaceted educational intervention.

    LENUS (Irish Health Repository)

    Owens, P

    2015-03-01

    As part of the National Clinical Programme on healthcare-associated infection prevention, a Royal College of Surgeons in Ireland (RCSI) and Royal College of Physicians of Ireland (RCPI) working group developed a quality improvement tool for prevention of surgical site infection (SS). We aimed to validate the effectiveness of an educational campaign, which utilises this quality improvement tool to prevent SSI in a tertiary hospital. Prior to the SSI educational campaign, surgical patients were prospectively audited and details of antibiotic administration recorded. Prophylactic antibiotic administration recommendations were delivered via poster and educational presentations. Post-intervention, the audit was repeated. 50 patients were audited pre-intervention, 45 post-intervention. Post-intervention, prophylaxis within 60 minutes prior to incision increased from 54% to 68% (p = 0.266). Appropriate postoperative prescribing improved from 71% to 92% (p = 0.075). A multifaceted educational program may be effective in changing SSI prevention practices.

  14. Impact of target site distribution for Type I restriction enzymes on the evolution of methicillin-resistant Staphylococcus aureus (MRSA) populations.

    Science.gov (United States)

    Roberts, Gareth A; Houston, Patrick J; White, John H; Chen, Kai; Stephanou, Augoustinos S; Cooper, Laurie P; Dryden, David T F; Lindsay, Jodi A

    2013-08-01

    A limited number of Methicillin-resistant Staphylococcus aureus (MRSA) clones are responsible for MRSA infections worldwide, and those of different lineages carry unique Type I restriction-modification (RM) variants. We have identified the specific DNA sequence targets for the dominant MRSA lineages CC1, CC5, CC8 and ST239. We experimentally demonstrate that this RM system is sufficient to block horizontal gene transfer between clinically important MRSA, confirming the bioinformatic evidence that each lineage is evolving independently. Target sites are distributed randomly in S. aureus genomes, except in a set of large conjugative plasmids encoding resistance genes that show evidence of spreading between two successful MRSA lineages. This analysis of the identification and distribution of target sites explains evolutionary patterns in a pathogenic bacterium. We show that a lack of specific target sites enables plasmids to evade the Type I RM system thereby contributing to the evolution of increasingly resistant community and hospital MRSA.

  15. 5-millimeter Trocar-site Hernias After Laparoscopy Requiring Surgical Repair.

    Science.gov (United States)

    Pereira, Nigel; Hutchinson, Anne P; Irani, Mohamad; Chung, Eric R; Lekovich, Jovana P; Chung, Pak H; Zarnegar, Rasa; Rosenwaks, Zev

    2016-01-01

    Trocar-site hernias are rare complications of laparoscopic surgery. Although trocar-site hernias occur more often at >10-mm sites, hernias can still develop at 5-mm sites after laparoscopy and can lead to serious complications. The primary objective of this review is to summarize the current medical literature pertaining to the clinical presentation and predisposing risk factors of trocar-site hernias at 5-mm sites after laparoscopy. A total of 295 publications were identified, 17 (5.76%) of which met the inclusion criteria. Twenty-seven patients with trocar-site hernias were identified after laparoscopic cases. The median age (interquartile range) for all adult patients with trocar-site hernias was 63 years (interquartile range, 39.5-66.5 years). Eight of the 18 patients (44.4%) undergoing gynecologic laparoscopy were parous although details of parity were not reported in most publications. Simple manual reduction or laparoscopic reduction with fascial closure (21 patients [84%]) was used more often compared with exploratory laparotomy (4 patients [16%], p manipulation can extend 5-mm fascial incisions, thereby increasing the risk of trocar-site hernias. Parous women older than 60 years may have unrecognized fascial defects, which confer a higher risk of trocar-site hernias after laparoscopic surgery, even in the absence of incision manipulation or prolonged surgical duration. Such patients may benefit from closure of 5-mm fascial incisions although prospective data are required to validate the overall generalizability of this management strategy. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

  16. Laminar airflow and the prevention of surgical site infection. More harm than good?

    Science.gov (United States)

    McHugh, S M; Hill, A D K; Humphreys, H

    2015-02-01

    Laminar airflow (LAF) systems are thought to minimise contamination of the surgical field with airborne microbes and thus to contribute to reducing surgical site infections (SSI). However recent publications have questioned whether LAF ventilation confers any significant benefit and may indeed be harmful. A detailed literature review was undertaken through www.Pubmed.com and Google scholar (http://scholar.google.com). Search terms used included "laminar flow". "laminar airflow", "surgical site infection prevention", "theatre ventilation" and "operating room ventilation", "orthopaedic theatre" and "ultra-clean ventilation". Peer-reviewed publications in the English language over the last 50 years were included, up to and including March 2014. Laminar airflow systems are predominantly used in clean prosthetic implant surgery. Several studies have demonstrated decreased air bacterial contamination with LAF using bacterial sedimentation plates placed in key areas of the operating room. However, apart from the initial Medical Research Council study, there are few clinical studies demonstrating a convincing correlation between decreased SSI rates and LAF. Moreover, recent analyses suggest increased post-operative SSI rates. It is premature to dispense with LAF as a measure to improve air quality in operating rooms where prosthetic joint surgery is being carried out. However, new multi-centre trials to assess this or the use of national prospective surveillance systems to explore other variables that might explain these findings such as poor operating room discipline are needed, to resolve this important surgical issue. Copyright © 2014 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  17. Normothermia to prevent surgical site infections after gastrointestinal surgery: holy grail or false idol?

    Science.gov (United States)

    Lehtinen, Simon J; Onicescu, Georgiana; Kuhn, Kathy M; Cole, David J; Esnaola, Nestor F

    2010-10-01

    To analyze the association between perioperative normothermia (temperature ≥36°C) and surgical site infections (SSIs) after gastrointestinal (GI) surgery. Although active warming during colorectal surgery reduces SSIs, there is limited evidence that perioperative normothermia is associated with lower rates of SSI. Nonetheless, hospitals participating in the Surgical Care Improvement Project must report normothermia rates during major surgery. We conducted a nested, matched, case-control study; cases consisted of GI surgery patients enrolled in our National Surgical Quality Improvement Program database between March 2006 and March 2009 who developed SSIs. Patient/surgery risk factors for SSI were obtained from the National Surgical Quality Improvement Program database. Perioperative temperature/antibiotic/glucose data were obtained from medical records. Cases/controls were compared using univariate/random effects/logistic regression models. Independent risk factors for SSIs were identified using multivariate/random effects/logistic regression models. A total of 146 cases and 323 matched controls were identified; 82% of patients underwent noncolorectal surgery. Cases were more likely to have final intraoperative normothermia compared with controls (87.6% vs. 77.8%, P = 0.015); rates of immediate postoperative normothermia were similar (70.6% vs. 65.3%, respectively, P = 0.19). Emergent surgery/higher wound class were associated with higher rates of intraoperative normothermia. Independent risk factors for SSI were diabetes, surgical complexity, small bowel surgery, and nonlaparoscopic surgery. There was no independent association between perioperative normothermia and SSI (adjusted odds ratio, 1.05; 95% confidence interval, 0.48-2.33; P = 0.90). Pay-for-reporting measures focusing on perioperative normothermia may be of limited value in preventing SSI after GI surgery. Studies to define the benefit of active warming after noncolorectal GI surgery are warranted.

  18. Surgical site infection rates in six cities of India: findings of the International Nosocomial Infection Control Consortium (INICC).

    Science.gov (United States)

    Singh, Sanjeev; Chakravarthy, Murali; Rosenthal, Victor Daniel; Myatra, Sheila N; Dwivedy, Arpita; Bagasrawala, Iqbal; Munshi, Nita; Shah, Sweta; Panigrahi, Bishnu; Sood, Sanjeev; Kumar-Nair, Pravin; Radhakrishnan, Kavitha; Gokul, B N; Sukanya, R; Pushparaj, L; Pramesh, C S; Shrikhande, S V; Gulia, A; Puri, A; Moiyadi, A; Divatia, J V; Kelkar, Rohini; Biswas, Sanjay; Raut, Sandhya; Sampat, Sulochana; Shetty, Suvin; Binu, Sheena; Pinto, Preethi; Arora, Sohini; Kamble, Asmita; Kumari, Neelakshi; Mendonca, Angelina; Singhal, Tanu; Naik, Reshma; Kothari, Vatsal; Sharma, Bindu; Verma, Neeru; Khanna, D K; Chacko, Felcy

    2015-09-01

    Surgical site infections are a threat to patient safety. However, in India, data on their rates stratified by surgical procedure are not available. From January 2005 to December 2011, the International Nosocomial Infection Control Consortium (INICC) conducted a cohort prospective surveillance study on surgical site infections in 10 hospitals in 6 Indian cities. CDC National Healthcare Safety Network (CDC-NHSN) methods were applied and surgical procedures were classified into 11 types, according to the ninth edition of the International Classification of Diseases. We documented 1189 surgical site infections, associated with 28 340 surgical procedures (4.2%; 95% CI: 4.0-4.4). Surgical site infections rates were compared with INICC and CDC-NHSN reports, respectively: 4.3% for coronary bypass with chest and donor incision (4.5% vs 2.9%); 8.3% for breast surgery (1.7% vs 2.3%); 6.5% for cardiac surgery (5.6% vs 1.3%); 6.0% for exploratory abdominal surgery (4.1% vs 2.0%), among others. In most types of surgical procedures, surgical site infections rates were higher than those reported by the CDC-NHSN, but similar to INICC. This study is an important advancement towards the knowledge of surgical site infections epidemiology in the participating Indian hospitals that will allow us to introduce targeted interventions. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  19. Use of antibacterial sutures for skin closure in controlling surgical site infections: a systematic review of published randomized, controlled trials.

    Science.gov (United States)

    Sajid, Muhammad S; Craciunas, L; Sains, P; Singh, K K; Baig, M K

    2013-07-01

    The objective of this article is to systematically analyse the randomized, controlled trials that compare the use of antibacterial sutures (ABS) for skin closure in controlling surgical site infections. Randomized, controlled trials on surgical patients comparing the use of ABS for skin closure in controlling the surgical site infections were analysed systematically using RevMan® and combined outcomes were expressed as odds ratios (OR) and standardized mean differences (SMD). Seven randomized, controlled trials evaluating 1631 patients were retrieved from electronic databases. There were 760 patients in the ABS group and 871 patients in the simple suture group. There was moderate heterogeneity among trials (Tau(2) = 0.12; chi(2) = 8.40, df = 6 [P surgical patients was associated with a reduced risk of developing surgical site infections (OR, 0.16; 95% CI, 0.37, 0.99; z = 2.02; P surgical procedures. Use of ABS for skin closure in surgical patients is effective in reducing the risk of surgical site infection and postoperative complications. ABS is comparable with SS in terms of length of hospital stay and duration of operation.

  20. Quality improvement of surgical prophylaxis in Dutch hospitals: evaluation of a multi-site intervention by time series analysis.

    NARCIS (Netherlands)

    Kasteren, M.E.E. van; Mannien, J.; Kullberg, B.J.; Boer, A.S. de; Nagelkerke, N.J.; Ridderhof, M.; Wille, J.C.; Gyssens, I.C.J.

    2005-01-01

    OBJECTIVES: Misuse of antibiotics in surgical prophylaxis is still quite common. The objectives of this study were to reduce the quantity and improve the quality of surgical prophylaxis and to reduce costs. METHODS: Prospective multi-site study of elective procedures in 13 Dutch hospitals. The

  1. Wound management with vacuum assisted closure in surgical site infection after ankle surgery.

    Science.gov (United States)

    Zhou, Zhen-Yu; Liu, Ya-Ke; Chen, Hong-Lin; Liu, Fan

    2015-05-01

    The aim of this study was to compare the efficacy of vacuum assisted closure (VAC) with standard moist wound care (SMWC) in surgical site infection after ankle surgery. A prospective cohort was performed among patients with surgical site infection after ankle surgery between 2012 and 2013. The follow-up period was three month, and the efficacy end point was complete wound closure rate. Ninety-four patients were analyzed, with 61 patients in the VAC group and 33 in the SMWC group. The complete wound closure rate in the VAC group was higher than that in the SMWC group at 3 month follow up (90.2% Vs. 72.7%, p = 0.028). The median time to complete wound closure was 31 days (95% CI 20.2-41.8) for VAC, and 63 days (95% CI 46.9-79.1) for SMWC (χ(2) = 4.023, p = 0.045). In the superficial infection subgroup, the median times to complete wound closure were 20 days (95% CI 14.2-35.1) in the VAC group and 42 days (95% CI 35.4-69.4) in SMWC group (χ(2) = 4.331, p = 0.041). In the deep subgroup, the median times to complete wound closure were 46 days (95% CI 28.2-65.9) in the VAC group and 75 days (95% CI 43.2-79.6) in SMWC group (χ(2) = 6.475, p = 0.026). Our result showed that vacuum assisted closure was more effective than standard moist wound care in surgical site infection after ankle surgery. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  2. [Effect of compliance with an antibiotic prophylaxis protocol in surgical site infections in appendectomies. Prospective cohort study].

    Science.gov (United States)

    Sánchez-Santana, Tomás; Del-Moral-Luque, Juan Antonio; Gil-Yonte, Pablo; Bañuelos-Andrío, Luis; Durán-Poveda, Manuel; Rodríguez-Caravaca, Gil

    Antibiotic prophylaxis is the most suitable tool for preventing surgical site infection. This study assessed compliance with antibiotic prophylaxis in surgery for acute appendicitis, and the effect of this compliance on surgical site infection. Prospective cohort study to evaluate compliance with antibiotic prophylaxis protocol in appendectomies. An assessment was made of the level of compliance with prophylaxis, as well as the causes of non-compliance. The incidence of surgical site infection was studied after a maximum incubation period of 30 days. The relative risk adjusted with a logistic regression model was used to assess the effect of non-compliance of prophylaxis on surgical site infection. The study included a total of 930 patients. Antibiotic prophylaxis was indicated in all patients, and administered in 71.3% of cases, with an overall protocol compliance of 86.1%. The principal cause of non-compliance was time of initiation. Cumulative incidence of surgical site infection was 4.6%. No relationship was found between inadequate prophylaxis compliance and infection (relative risk=0.5; 95% CI: 0.1-1.9) (P>.05). Compliance of antibiotic prophylaxis was high, but could be improved. No relationship was found between prophylaxis compliance and surgical site infection rate. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  3. Prolonged Operative Duration Increases Risk of Surgical Site Infections: A Systematic Review.

    Science.gov (United States)

    Cheng, Hang; Chen, Brian Po-Han; Soleas, Ireena M; Ferko, Nicole C; Cameron, Chris G; Hinoul, Piet

    The incidence of surgical site infection (SSI) across surgical procedures, specialties, and conditions is reported to vary from 0.1% to 50%. Operative duration is often cited as an independent and potentially modifiable risk factor for SSI. The objective of this systematic review was to provide an in-depth understanding of the relation between operating time and SSI. This review included 81 prospective and retrospective studies. Along with study design, likelihood of SSI, mean operative times, time thresholds, effect measures, confidence intervals, and p values were extracted. Three meta-analyses were conducted, whereby odds ratios were pooled by hourly operative time thresholds, increments of increasing operative time, and surgical specialty. Pooled analyses demonstrated that the association between extended operative time and SSI typically remained statistically significant, with close to twice the likelihood of SSI observed across various time thresholds. The likelihood of SSI increased with increasing time increments; for example, a 13%, 17%, and 37% increased likelihood for every 15 min, 30 min, and 60 min of surgery, respectively. On average, across various procedures, the mean operative time was approximately 30 min longer in patients with SSIs compared with those patients without. Prolonged operative time can increase the risk of SSI. Given the importance of SSIs on patient outcomes and health care economics, hospitals should focus efforts to reduce operative time.

  4. Chronic swelling from entrapment of acrylic resin in a surgical extraction site

    Directory of Open Access Journals (Sweden)

    Weiting Ho

    2010-01-01

    Full Text Available When acrylic resin is inadvertently embedded in oral tissue, it can result in a pronounced chronic inflammatory response. This report describes a case in which temporary crown and bridge resin was forced into a surgical extraction site after the two adjacent teeth were prepared for a bridge immediately following extraction of a maxillary premolar. The patient experienced swelling at the extraction site over a ten month period despite treatment with antibiotics and anti-inflammatory drugs. After detection and removal of the foreign body, the symptoms resolved. The episode contributed to periodontal bone loss around an adjacent tooth. While morbidity of this nature is rare, this case reinforces the need to investigate persistent signs of inflammation and account for dental materials that are lost during the course of treatment.

  5. Diagnosing Surgical Site Infection Using Wound Photography: A Scenario-Based Study.

    Science.gov (United States)

    Sanger, Patrick C; Simianu, Vlad V; Gaskill, Cameron E; Armstrong, Cheryl A L; Hartzler, Andrea L; Lordon, Ross J; Lober, William B; Evans, Heather L

    2017-01-01

    Postoperative surgical site infections (SSI) are common and costly. Most occur post discharge, and can result in potentially preventable readmission or unnecessary urgent evaluation. Mobile health approaches incorporating patient-generated wound photos are being implemented in an attempt to optimize triage and management. We assessed how adding wound photos to existing data sources modifies provider decision making. We used a web-based simulation survey using a convenience sample of providers with expertise in surgical infections. Participants viewed a range of scenarios, including surgical history, physical exam, and description of wound appearance. All participants reported SSI diagnosis, diagnostic confidence, and management recommendations (main outcomes) first without, and then with, accompanying wound photos. At each step, participants ranked the most important features contributing to their decision. Eighty-three participants completed a median of 5 scenarios (interquartile range 4 to 7). Most participants were physicians in academic surgical specialties (n = 70 [84%]). The addition of photos improved overall diagnostic accuracy from 67% to 76% (p < 0.001), and increased specificity from 77% to 92% (p < 0.001), but did not significantly increase sensitivity (55% to 65%; p = 0.16). Photos increased mean confidence in diagnosis from 5.9 of 10 to 7.4 of 10 (p < 0.001). Overtreatment recommendations decreased from 48% to 16% (p < 0.001), and undertreatment did not change (28% to 23%; p = 0.20) with the addition of photos. The addition of wound photos to existing data as available via chart review and telephone consultation with patients significantly improved diagnostic accuracy and confidence, and prevented proposed overtreatment in scenarios without SSI. Post-discharge mobile health technologies have the potential to facilitate patient-centered care, decrease costs, and improve clinical outcomes. Copyright © 2016 American College of Surgeons. Published by

  6. Medicaid status is associated with higher surgical site infection rates after spine surgery.

    Science.gov (United States)

    Manoso, Mark W; Cizik, Amy M; Bransford, Richard J; Bellabarba, Carlo; Chapman, Jens; Lee, Michael J

    2014-09-15

    The Spine End Results Registry (2003-2004) is a registry of prospectively collected data of all patients undergoing spinal surgery at the University of Washington Medical Center and Harborview Medical Center. Insurance data were prospectively collected and used in multivariate analysis to determine risk of perioperative complications. Given the negative financial impact of surgical site infections (SSIs) and the higher overall complication rates of patients with a Medicaid payer status, we hypothesized that a Medicaid payer status would have a significantly higher SSI rate. The medical literature demonstrates lesser outcomes and increased complication rates in patients who have public insurance than those who have private insurance. No one has shown that patients with a Medicaid payer status compared with Medicare and privately insured patients have a significantly increased SSI rate for spine surgery. The prospectively collected Spine End Results Registry provided data for analysis. SSI was defined as treatment requiring operative debridement. Demographic, social, medical, and the surgical severity index risk factors were assessed against the exposure of payer status for the surgical procedure. The population included Medicare (N = 354), Medicaid (N = 334), the Veterans' Administration (N = 39), private insurers (N = 603), and self-pay (N = 42). Those patients whose insurer was Medicaid had a 2.06 odds (95% confidence interval: 1.19-3.58, P = 0.01) of having a SSI compared with the privately insured. The study highlights the increased cost of spine surgical procedures for patients with a Medicaid payer status with the passage of the Patient Protection and Affordable Care Act of 2010. The Patient Protection and Affordable Care Act of 2010 provisions could cause a reduction in reimbursement to the hospital for taking care of patients with Medicaid insurance due to their higher complication rates and higher costs. This very issue could inadvertently lead to access

  7. Glycemic control strategies and the occurrence of surgical site infection: a systematic review.

    Science.gov (United States)

    Domingos, Caroline Maria Herrero; Iida, Luciana Inaba Senyer; Poveda, Vanessa de Brito

    2016-01-01

    To analyze the evidence available in the scientific literature regarding the relationship between the glycemic control strategies used and the occurrence of surgical site infection in adult patients undergoing surgery. This is a systematic review performed through search on the databases of CINAHL, MEDLINE, LILACS, Cochrane Database of Systematic Reviews and EMBASE. Eight randomized controlled trials were selected. Despite the diversity of tested interventions, studies agree that glycemic control is essential to reduce rates of surgical site infection, and should be maintained between 80 and 120 mg/dL during the perioperative period. Compared to other strategies, insulin continuous infusion during surgery was the most tested and seems to get better results in reducing rates of surgical site infection and achieving success in glycemic control. Tight glycemic control during the perioperative period benefits the recovery of surgical patients, and the role of the nursing team is key for the successful implementation of the measure. Analisar as evidências disponíveis na literatura científica sobre a relação entre as estratégias de controle glicêmico efetuadas e a ocorrência de infecção do sítio cirúrgico em pacientes adultos submetidos à cirurgia. Trata-se de revisão sistemática, por meio das bases de dados CINAHL, MEDLINE, LILACS, Cochrane Database of Systematic Reviews e EMBASE. Foram selecionados oito ensaios clínicos randomizados. Apesar da diversidade de intervenções testadas, os estudos concordam que o controle glicêmico é essencial para a redução das taxas de infecção do sítio cirúrgico e deve ser mantido entre 80 e 120 mg/dL durante o perioperatório. A infusão contínua de insulina no transoperatório foi a mais testada e parece obter melhores resultados na redução das taxas de infecção do sítio cirúrgico e sucesso no controle glicêmico comparada às demais estratégias. O controle glicêmico rigoroso durante o perioperat

  8. Incidence and Etiology of Surgical Site Infections in Appendectomies: A 3-Year Prospective Study

    Directory of Open Access Journals (Sweden)

    Humberto Guanche Garcell

    2017-01-01

    Full Text Available Objectives: Surgical site infections (SSIs constitute a threat, especially in complicated appendicitis, and are commonly due to gram-negative organisms. We sought to describe the incidence of SSIs in appendectomies performed during a three-year period (January 2013 to December 2015 in a community hospital in Qatar, and compare this with external benchmarks. Methods: We conducted a longitudinal study at The Cuban Hospital, Qatar. We used the standardized surveillance criteria to define SSI developed by the Centers for Disease Control. Information about age, sex, smoking habits, diabetes mellitus status, body mass index, and the result of bacteriologic studies were collected. Results: Of a total 603 patients, 22 (3.6% cases of SSI were reported, with an infection rate of 13.6%, 4.5%, and 1.0% in 2013, 2014, and 2015, respectively. SSIs were observed more frequently in patients with contaminated/dirty wounds (6.6%. About 65% of isolates from the surgical site were multidrug-resistant organisms (Escherichia coli and Klebsiella spp.. Conclusions: This study describes the incidence of SSI in appendectomy, which could be used as a benchmark for the facility improvement program. The high frequency of multidrug-resistant organisms in SSIs requires additional studies focused on evaluating the effectiveness of the current preventive practices with a particular reference to antimicrobial prophylaxis.

  9. Bacterial Biofilms on Implanted Suture Material Are a Cause of Surgical Site Infection

    Science.gov (United States)

    Nistico, Laura; Tower, Irene; Lasko, Leslie-Ann; Stoodley, Paul

    2014-01-01

    Abstract Background: Surgical site infection (SSI) has been estimated to occur in up to 5% of all procedures, accounting for up to 0.5% of all hospital costs. Bacterial biofilms residing on implanted foreign bodies have been implicated as contributing or causative factors in a wide variety of infectious scenarios, but little consideration has been given to the potential for implanted, submerged suture material to act as a host for biofilm and thus serve as a nidus of infection. Methods: We report a series of 15 patients who underwent open Roux-en-Y gastric bypass (with musculofascial closure with permanent, multifilament sutures) who developed longstanding and refractory SSIs in the abdominal wall. Explanted suture material at subsequent exploration was examined for biofilm with confocal laser-scanning microscopy (CLSM) and fluorescence in situ hybridization (FISH). Results: All 15 patients at re-exploration were found to have gross evidence of a “slimy” matrix or dense reactive granulation tissue localized to the implanted sutures. Confocal laser-scanning microscopy revealed abundant biofilm present on all sutures examined; FISH was able to identify the presence of specific pathogens in the biofilm. Complete removal of the foreign bodies (and attendant biofilms) resulted in all cases in cure of the SSI. Conclusion: Bacterial biofilms on implanted suture material can manifest as persistent surgical site infections that require complete removal of the underlying foreign body substrata for resolution. PMID:24833403

  10. Epidemiological Aspects of Surgical Site Infections in an Income Country: The Case of Regional Hospital Centre, Borgou (Benin

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    Hodonou M Adrien

    2017-03-01

    Full Text Available Background: Surgical site infection is frustrating for the care team and depressing for the patient. Objective: To determine the epidemiological aspects of surgical site infections in regional hospital, Borgou. Methods: The study was crossed with prospective data collection. Recruitment was done for six months (from February 2013 to July 2013, each patient operated in both surgical services (general surgery and maternity consents to be followed for one month or year. The surgical site infection was defined according to the CDC/NHSN 2009. Results: The frequency of surgical site infections was 7.3% (44/603. The mean age was 30.7 ± 15.8 years with minimum and maximum of 5 months and 70 years, respectively. They were significantly (p<0.05 more common in general surgery than that of maternity and visceral surgery and obstetrics were more concerned (14/44 each; the median time to SSI onset was 7.8 ± 3.8 days. The deep incisional infection was the most frequent (34/44. The most encountered organism was Escherichia coli (64.7%; multidrug resistance was 41.2%. The healing time averaged 30.5 ± 13.8 days with minimum and maximum of 20 and 92 days. Conclusion: Monitoring measures must be taken to reduce surgical site infection at the Regional Hospital Centre of Borgou

  11. Variability of Surgical Site Infection With VEPTR at Eight Centers: A Retrospective Cohort Analysis.

    Science.gov (United States)

    Garg, Sumeet; Cyr, Micaela; St Hilaire, Tricia; Flynn, Tara; Carry, Patrick; Glotzbecker, Michael; Smith, John T; Sawyer, Jeffrey; Pahys, Joshua; Luhmann, Scott; Flynn, John M; El-Hawary, Ron; Vitale, Michael

    2016-01-01

    Retrospective review. To describe clinical characteristics and infection rates in modern vertical expandable prosthetic titanium rib (VEPTR) surgery. Prior studies have demonstrated infection rates from 10% to 30% with VEPTR surgery. A retrospective query was done on an institutional review board-approved, multicenter prospectively collected database for patients implanted with VEPTR from 2007 to 2013 at eight sites. This identified 213 patients with appropriate data for analysis. Average follow-up was 4.1 years (range 1.7-6.3). Data collected included a Classification of Early-Onset Scoliosis (C-EOS) diagnosis, American Society of Anesthesiologists Physical Status (ASA-PS), major Cobb angle, construct type, clinical symptoms, and microbiology. The distribution of infection rates across all the study sites was compared. The exact p value was estimated by Monte Carlo simulation. Overall, 18% (38/213) of patients implanted with VEPTR developed infection requiring operative debridement. There were significantly different infection rates among the sites, ranging from 2.9% to 42.9% (p = .029). The average time to infection was 70 days (range 8-236) after the infecting procedure. The majority of infections were due to gram-positive bacteria (80%, 44/55), the most prevalent being methicillin-sensitive Staphylococcus aureus (45%, 25/55). There were 20 patients (53%, 20/38) with either partial or complete implant removal to resolve infection; however, only 3 of 38 (8%) of these resulted in abandonment of VEPTR treatment. There was no difference in infection rate across the primary C-EOS diagnosis categories (p = .21) or based on ASA score (p = .53). After controlling for study site, the odds ratio of an infection following an implant procedure versus an expansion was 2.8 (p = .002). There was no difference in the odds ratio of an infection between the other procedure types (implant, expansion, exchange/revision). There were significant differences in infection rates between

  12. Da Vinci single site© surgical platform in clinical practice: a systematic review.

    Science.gov (United States)

    Morelli, Luca; Guadagni, Simone; Di Franco, Gregorio; Palmeri, Matteo; Di Candio, Giulio; Mosca, Franco

    2016-12-01

    The Da Vinci single-site© surgical platform (DVSSP) is a set of single-site instruments and accessories specifically dedicated to robot-assisted single-site surgery. The PubMed database from inception to June 2015 was searched for English literature on the clinical use of DVSSP in general surgery, urology and gynecology. Twenty-nine articles involving the clinical application of DVSSP were identified; 15 articles on general surgery (561 procedures), four articles on urology (48 procedures) and 10 articles on gynecology (212 procedures). All studies have proven the safety and feasibility of the use of DVSSP. The principal reported advantage is the restoration of intra-abdominal triangulation, while the main reported limitation is the lack of the endowrist. Da Vinci systems have proven to be valuable assets in single-site surgery, owing to the combination of robot use with the dedicated single-incision platform. However, case-control or prospective trials are warranted to draw more definitive conc lusions. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  13. Predictors of surgical site infection in laparoscopic and open ventral incisional herniorrhaphy.

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    Kaafarani, Haytham M A; Kaufman, Derrick; Reda, Domenic; Itani, Kamal M F

    2010-10-01

    Surgical site infection (SSI) after ventral incisional hernia repair (VIH) can result in serious consequences. We sought to identify patient, procedure, and/or hernia characteristics that are associated with SSI in VIH. Between 2004 and 2006, patients were randomized in four Veteran Affairs (VA) hospitals to undergo laparoscopic or open VIH. Patients who developed SSI within eight weeks postoperatively were compared to those who did not. A bivariate analysis for each factor and a multiple logistic regression analysis were performed to determine factors associated with SSI. The variables studied included patient characteristics and co-morbidities (e.g., age, gender, race, ethnicity, body mass index, ASA classification, diabetes, steroid use), hernia characteristics (e.g., size, duration, number of previous incisions), procedure characteristics (e.g., open versus laparoscopic, blood loss, use of postoperative drains, operating room temperature) and surgeons' experience (resident training level, number of open VIH previously performed by the attending surgeon). Antibiotic prophylaxis, anticoagulation protocols, preparation of the skin, draping of the wound, body temperature control, and closure of the surgical site were all standardized and monitored throughout the study period. Out of 145 patients who underwent VIH, 21 developed a SSI (14.5%). Patients who underwent open VIH had significantly more SSIs than those who underwent laparoscopic VIH (22.1% versus 3.4%; P = 0.002). Among patients who underwent open VIH, those who developed SSI had a recorded intraoperative blood loss greater than 25 mL (68.4% versus 40.3%; P = 0.030), were more likely to have a drain placed (79.0% versus 49.3%; P = 0.021) and were more likey to be operated on by surgeons with less than 75 open VIH case experience (52.6% versus 28.4%; P = 0.048). Patient and hernia characteristics were similar between the two groups. In a multiple logistic regression analysis, the open surgical technique was

  14. Factors predicting surgical site infection after posterior lumbar surgery: A multicenter retrospective study.

    Science.gov (United States)

    Wang, Tao; Wang, Hui; Yang, Da-Long; Jiang, Li-Qiang; Zhang, Li-Jun; Ding, Wen-Yuan

    2017-02-01

    This is a retrospective study.The purpose of this study is to explore incidence and risk factors for surgical site infection (SSI) after posterior lumbar surgery.SSI is a common complication after posterior lumbar surgery, bringing mental and physical pain and prolonging hospital stay. However, predisposing factors, as reported less, remain controversial.Patients who underwent posterior lumbar surgery at 3 centers between 2006 and 2016 were included. The possible factors include 3 aspects: demographic variables-age, sex, body mass index (BMI), waist-to-hip radio (WHR), hypertension, diabetes, heart disease, smoking, drinking, steroidal injection, surgical time between June and September, preoperative shower; blood test variables-white blood cell (WBC), neutrophil, red blood cell (RBC), hemoglobin (Hb), total protein (TP), albumin, albumin/globulin (A/G), C-reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR) and surgical related variables-operation time, blood loss, operative level, instrumentation, incision length. Factors related with SSI were also performed by multivariate analysis.The prevalence of SSI was 3.00% (267 cases of 8879) had a postoperative wound infection. There were significant difference in WHR (0.92 vs 0.83), WBC (4.31 vs 6.69), TP (58.7 vs 65.2), albumin (36.9 vs 43.2), CRP (2.01 vs 0.57), PCT (0.097 vs 0.067), operation time (217.9 vs 195.7), blood loss (997.1 vs 915.3) and operative level (3.05 vs 2.45) and incision length (24.1 vs 20.0) between SSI group and non-SSI group. >60 years old, female, BMI 30.0, diabetes, male smoking, preoperative steroidal injection, surgical time between June and September, no preoperative shower, instrumentation surgery were risk factors for SSI after posterior lumbar surgery.Many factors, >60 years old, female, BMI, WHR, diabetes, male smoking, preoperative steroidal injection, surgical time between June and September, preoperative shower, WBC, TP, albumin, CRP, PCT, operation time

  15. Comparison of preoperative hair removal methods for the reduction of surgical site infections: a meta-analysis.

    Science.gov (United States)

    Shi, Dingmei; Yao, Yao; Yu, Weifei

    2017-10-01

    To evaluate the efficacy of different methods of preoperative hair removal in reducing surgical site infections. Surgical site infections are a major source of morbidity and prolonged hospitalisation following surgery. However, there is a lack of data regarding the impact of different preoperative hair removal techniques on the incidence of surgical site infections. A systematic literature review and meta-analysis. Randomised controlled trials and controlled clinical trials reporting the impact of different methods of preoperative hair removal on reducing surgical site infections were collected through databases, including the Cochrane Library, Joanna Briggs Institute Library, PubMed, Elsevier, EMBASE, Nursing Consult, China Biology Medicine disc, China National Knowledge Infrastructure and Wanfang data. The articles were published from 1 January 1990-15 March 2016. Meta-analyses were conducted with review manager version 5.0. Fourteen trials were included (16 comparisons) in the review, including 11 randomised controlled trials and three controlled clinical trials. Interventions in the studies were shaving, clipping, no hair removal and the use of depilatory cream. The meta-analyses included 7278 patients, from 10 countries. Nine studies compared shaving with no hair removal, four studies compared shaving with clipping, two studies compared shaving with depilatory cream, and one study compared clipping with no hair removal. No significant differences in the frequency of surgical site infections were observed between any of the methods assessed. No significant differences between shaving, clipping, no hair removal and depilatory cream were observed in the frequency of surgical site infections. Preoperative hair removal should be avoided unless necessary. When it is necessary to remove hair, the existing evidence suggests that clipping is more effective in reducing surgical site infections than shaving or depilatory cream. © 2016 John Wiley & Sons Ltd.

  16. Staphylococcus aureus infections following knee and hip prosthesis insertion procedures.

    Science.gov (United States)

    Arduino, Jean Marie; Kaye, Keith S; Reed, Shelby D; Peter, Senaka A; Sexton, Daniel J; Chen, Luke F; Hardy, N Chantelle; Tong, Steven Yc; Smugar, Steven S; Fowler, Vance G; Anderson, Deverick J

    2015-01-01

    Staphylococcus aureus is the most common and most important pathogen following knee and hip arthroplasty procedures. Understanding the epidemiology of invasive S. aureus infections is important to quantify this serious complication. This nested retrospective cohort analysis included adult patients who had undergone insertion of knee or hip prostheses with clean or clean-contaminated wound class at 11 hospitals between 2003-2006. Invasive S. aureus infections, non-superficial incisional surgical site infections (SSIs) and blood stream infections (BSIs), were prospectively identified following each procedure. Prevalence rates, per 100 procedures, were estimated. 13,719 prosthetic knee (62%) and hip (38%) insertion procedures were performed. Of 92 invasive S. aureus infections identified, SSIs were more common (80%) than SSI and BSI (10%) or BSI alone (10%). The rate of invasive S. aureus infection/100 procedures was 0.57 [95% CI: 0.43-0.73] for knee insertion and 0.83 [95% CI: 0.61-1.08] for hip insertion. More than half (53%) were methicillin-resistant. Median time-to-onset of infection was 34 and 26 days for knee and hip insertion, respectively. Infection was associated with higher National Healthcare Safety Network risk index (p ≤ 0.0001). Post-operative invasive S. aureus infections were rare, but difficult-to-treat methicillin-resistant infections were relatively common. Optimizing preventative efforts may greatly reduce the healthcare burden associated with S. aureus infections.

  17. Effect of a preoperative decontamination protocol on surgical site infections in patients undergoing elective orthopedic surgery with hardware implantation.

    Science.gov (United States)

    Bebko, Serge P; Green, David M; Awad, Samir S

    2015-05-01

    Surgical site infections (SSIs), commonly caused by methicillin-resistant Staphylococcus aureus (MRSA), are associated with significant morbidity and mortality, specifically when hardware is implanted in the patient. Previously, we have demonstrated that a preoperative decontamination protocol using chlorhexidine gluconate washcloths and intranasal antiseptic ointment is effective in eradicating MRSA in the nose and on the skin of patients. To examine the effect of a decontamination protocol on SSIs in patients undergoing elective orthopedic surgery with hardware implantation. A prospective database of patients undergoing elective orthopedic surgery with hardware implantation at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, was analyzed from October 1, 2012, to December 31, 2013. Cohort groups before and after the intervention were compared. Starting in May 2013, during their preoperative visit, all of the patients watched an educational video about MRSA decontamination and were given chlorhexidine washcloths and oral rinse and nasal povidone-iodine solution to be used the night before and the morning of scheduled surgery. Thirty-day SSI rates were collected according to the definitions of the Centers for Disease Control and Prevention National Nosocomial Infections Surveillance. Data on demographics, comorbidities such as chronic obstructive pulmonary disease and coronary artery disease, tobacco use, alcohol use, and body mass index were also collected. Univariate analysis was performed between the 2 groups of patients. Multivariate analysis was used to identify independent predictors of SSI. A total of 709 patients were analyzed (344 controls and 365 patients who were decolonized). Both groups were well matched with no significant differences in age, body mass index, sex, or comorbidities. All of the patients (100%) completed the MRSA decontamination protocol. The SSI rate in the intervention group was significantly lower (1.1%; 4 of

  18. Protective or deleterious role of scavenger receptors SR-A and CD36 on host resistance to Staphylococcus aureus depends on the site of infection.

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    Charlène Blanchet

    Full Text Available Staphylococcus aureus is a major human opportunistic pathogen responsible for a broad spectrum of infections ranging from benign skin infection to more severe life threatening disorders (e.g. pneumonia, sepsis, particularly in intensive care patients. Scavenger receptors (SR-A and CD36 are known to be involved in S. aureus recognition by immune cells in addition to MARCO, TLR2, NOD2 and α5β1 integrin. In the present study, we further deciphered the contribution of SR-A and CD36 scavenger receptors in the control of infection of mice by S. aureus. Using double SR-A/CD36 knockout mice (S/C-KO and S. aureus strain HG001, a clinically relevant non-mutagenized strain, we showed that the absence of these two scavenger receptors was protective in peritoneal infection. In contrast, the deletion of these two receptors was detrimental in pulmonary infection following intranasal instillation. For pulmonary infection, susceptible mice (S/C-KO had more colony-forming units (CFU in their broncho-alveolar lavages fluids, associated with increased recruitment of macrophages and neutrophils. For peritoneal infection, susceptible mice (wild-type had more CFU in their blood, but recruited less macrophages and neutrophils in the peritoneal cavity than resistant mice. Exacerbated cytokine levels were often observed in the susceptible mice in the infected compartment as well as in the plasma. The exception was the enhanced compartmentalized expression of IL-1β for the resistant mice (S/C-KO after peritoneal infection. A similar mirrored susceptibility to S. aureus infection was also observed for MARCO and TLR2. Marco and tlr2 -/- mice were more resistant to peritoneal infection but more susceptible to pulmonary infection than wild type mice. In conclusion, our results show that innate immune receptors can play distinct and opposite roles depending on the site of infection. Their presence is protective for local pulmonary infection, whereas it becomes detrimental

  19. Polymorphism Analysis of the CoA (Coagulase Gene in Isolates of Methicillin-Resistant Staphylococcus aureus with AluI Restriction Sites

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    Anita Dwi Anggraini

    2017-07-01

    Full Text Available Abstract: Analysis of the polymorphism of a gene is important to obtain early information in identifying genetic markers related to the characteristics to be seen. The RFLP method becomes one of the chosen methods because it can see polymorphism that can be detected by using the different fragments of DNA that have been cut by using certain endonuclease enzyme so that it is possible to describe the polymorphism of a gene. Application of RFLP in this study was devoted to see the coagulase gene polymorphism of methichillin-resistant S. aureus. Based on the description above, researcher was interested in conducting the analysis of CoA (coagulase gene polymorphism with AluI restriction site of methicillin-resistant S. aureus isolates. The results of this study are aimed to be scientific information about the genetic variation of the coagulase gene of methicillin-resistant S. aureus, and as information in the management of diseases related to antibiotic resistance. This was a descriptive study intended to discover the coagulase gene polymorphism of methichillin-resistant S. aureus. The research was conducted in Microbiology Laboratory of Health Analyst Department, Surabaya, and Human Genetic Laboratory of Institute of Tropical Disease of Airlangga University Surabaya. Samples from this study was a collection of isolates of MRSA in Microbiology Laboratory of Dr. Soetomo Hospital Surabaya selected by using consecutive sampling. Based on the bacteriological examination, all of the samples were S. aureus and the results of amplification showed that PCR product (amplicon of mecA and CoA gene from specific primers, that were 304 bp and 756 bp, had a positivity of 100%. The results of PCR-RFLP of CoA gene showed that all 25 samples underwent polymorphism which was divided into four RFLP patterns and the biggest one was RFLP I pattern (the one which was not digested by AluI restriction enzyme with a proportion of 64%.

  20. Reducing the risk of surgical site infection using a multidisciplinary approach: an integrative review

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    Gillespie BM

    2015-10-01

    Full Text Available Brigid M Gillespie,1 Evelyn Kang,1 Shelley Roberts,1 Frances Lin,1,2 Nicola Morley,3 Tracey Finigan,3 Allison Homer,3 Wendy Chaboyer1 1National Health and Medical Research Council Research Centre for Clinical Excellence in Nursing Interventions (NCREN and Centre for Healthcare Practice Innovation (HPI, Menzies Health Institute, 2School of Nursing and Midwifery, Griffith University, 3Surgical and Procedural Services, Gold Coast University Hospital, Gold Coast, QLD, Australia Purpose: To identify and describe the strategies and processes used by multidisciplinary teams of health care professionals to reduce surgical site infections (SSIs.Materials and methods: An integrative review of the research literature was undertaken. Searches were conducted in April 2015. Following review of the included studies, data were abstracted using summary tables and the methodological quality of each study assessed using the Standards for Quality Improvement Reporting Excellence guidelines by two reviewers. Discrepancies were dealt with through consensus. Inductive content analysis was used to identify and describe the strategies/processes used by multidisciplinary health care teams to prevent SSI.Results and discussion: In total, 13 studies met the inclusion criteria. Of these, 12 studies used quantitative methods, while a single study used qualitative interviews. The majority of the studies were conducted in North America. All quantitative studies evaluated multifaceted quality-improvement interventions aimed at preventing SSI in patients undergoing surgery. Across the 13 studies reviewed, the following multidisciplinary team-based approaches were enacted: using a bundled approach, sharing responsibility, and, adhering to best practice. The majority of studies described team collaborations that were circumscribed by role. None of the reviewed studies used strategies that included the input of allied health professionals or patient participation in SSI prevention

  1. Surgical site infections in women and their association with clinical conditions

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    Maria Zélia de Araújo Madeira

    2014-07-01

    Full Text Available Introduction Surgical site infections (SSIs can affect body tissues, cavities, or organs manipulated in surgery and constitute 14% to 16% of all infections. This study aimed to determine the incidence of SSIs in women following their discharge from a gynecology outpatient clinic, to survey different types of SSIs among women, and to verify the association of SSIs with comorbidities and clinical conditions. Methods Data were collected via analytical observation with a cross-sectional design, and the study was conducted in 1,026 women who underwent gynecological surgery in a teaching hospital in the municipality of Teresina, in the northeast Brazilian State of Piauí, from June 2011 to March 2013. Results The incidence of SSIs after discharge was 5.8% among the women in the outpatient clinic. The most prevalent surgery among the patients was hysterectomy, while the most prevalent type of SSI was superficial incisional. Comorbidities in women with SSIs included cancer, diabetes mellitus, and hypertension. Conclusions Surveillance of SSIs during the post-discharge period is critical for infection prevention and control. It is worth reflecting on the planning of surgical procedures for patients who have risk factors for the development of SSIs.

  2. Use of an antimicrobial skin sealant reduces surgical site infection in patients undergoing routine cardiac surgery.

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    Dohmen, Pascal M; Weymann, Alexander; Holinski, Sebastian; Linneweber, Jörg; Geyer, Torsten; Konertz, Wolfgang

    2011-12-01

    With high morbidity and potentially devastating consequences, surgical site infections (SSIs) after cardiac surgery add substantially to the healthcare burden. Inhibiting migration of skin microbes is likely to reduce contamination of the surgical incision by endogenous potential pathogens. We studied the effect of treatment with a cyanoacrylate-based antimicrobial skin sealant (INTEGUSEAL®) on the SSI rate in cardiac surgery patients. In a consecutive series of 910 prospective patients undergoing routine cardiac surgery, standard pre-operative preparation was performed on 721 patients of whom 189 also received antimicrobial skin sealant. A further 189 consecutive patients who received only standard pre-operative care were studied retrospectively. The primary study endpoint was occurrence of superficial or deep SSI according to the definitions of the U.S. Centers for Disease Control and Prevention. The mean (standard deviation) SSI risk score based on combined pre-operative and intra-operative factors according to the Society of Thoracic Surgeons risk scoring system was significantly higher for the skin sealant group (9.1±1.0) than for the prospective (7.1±3.2; pantimicrobial skin sealant decreased the incidence of SSI in cardiac surgery patients.

  3. Surgical site infection in tibial plateau fractures with ipsilateral compartment syndrome.

    Science.gov (United States)

    Dubina, Andrew G; Paryavi, Ebrahim; Manson, Theodore T; Allmon, Christopher; O'Toole, Robert V

    2017-02-01

    The aim of this study was to investigate the effects of compartment syndrome and timing of fasciotomy wound closure on surgical site infection (SSI) after surgical fixation of tibial plateau fractures. Our primary hypothesis was that SSI rate is increased for fractures with compartment syndrome versus those without, even accounting for confounders associated with infection. Our secondary hypothesis was that infection rates are unrelated to timing of fasciotomy closure or fixation. We conducted a retrospective cohort study of operative tibial plateau fractures with ipsilateral compartment syndrome (n=71) treated with fasciotomy at our level I trauma center from 2003 through 2011. A control group consisted of 602 patients with 625 operatively treated tibial plateau fractures without diagnosis of compartment syndrome. The primary outcome measure was deep SSI after ORIF. Fractures with compartment syndrome had a higher rate of SSI (25% versus 8%, pcompartment syndrome have a significant increase in rates of SSI compared with those without compartment syndrome (p<0.001). Delays in fasciotomy wound closure were also associated with increased odds of SSI (p<0.05). Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Triclosan-coated sutures for the prevention of surgical-site infections: a meta-analysis.

    Science.gov (United States)

    Konstantelias, Athanasios A; Andriakopoulou, Chrysi Stefania I; Mourgela, Sofia

    2017-06-01

    The scope of this article is to perform a meta-analysis of the studies that compare the use of triclosan-coated sutures (TCS) to uncoated sutures in prevention of surgical-site infections (SSIs). A systematic search of randomized and non-randomized studies was carried out on Pubmed and Scopus databases until July 2016. The meta-analysis of 30 studies (19 randomized, 11 non-randomized; 15,385 procedures) gave evidence that TCS were associated with a lower risk of SSIs (risk ratio [RR] = 0.68; 95% confidence interval [CI] 0.57-0.81). Triclosan-coated sutures were associated with lower risk for SSIs in high-quality randomized studies (Jadad score 4 or 5). A lower risk for the development of SSIs based on wound classification was observed in clean, clean-contaminated, and contaminated but not for dirty procedures. No benefit was observed in specific types of surgery: colorectal, cardiac, lower limb vascular or breast surgery. Only a trend was found for lower risk for wound dehiscence, whereas no difference was observed for all-cause mortality. Further randomized studies are needed to confirm the role of TCS in specific surgical procedures and whether or not they are related with lower risk for mortality.

  5. Preoperative skin preparation with 2% chlorhexidine as a factor in the prevention of surgical site infection

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    Evelyn Solano Castro

    2014-04-01

    Full Text Available The results of secondary research that refers to preoperative skin preparation with antiseptic chlorhexidine 2% are presented. Surgical Site Infections are one of the most common complications in surgical procedures are associated with significant morbidity and mortality in the user and are the third -associated infection more frequent in the health care . Steps of clinical practice based on evidence were applied, considering in the first instance a question in PICO format, then a search for information in databases recommended in the Course of Clinical Nursing Practice Evidence-Based, taught by the program for Collaborative Research in Evidence-Based Nursing of Costa Rica ( CIEBE -CR . The PubMed database and Cochrane LIBRARY was consulted, National Center for Biotechnology Information ( NCBI, Google Scholar, CINAHL (cummulative Index of Nursing and Allied Health Literature. SCIELO (Scientific Electronic Library on line www.Scielo.org . 22 documents were recovered, but only three were selected because had methodological rigor. For the critical analysis Critical Reading Sheets 2.0 ( FLC software was used. Was concluded that 2% chlorhexidine, is the best choice for preoperative skin preparation antiseptic, however, it is necessary to conduct further studies in order to determine which is the correct way in strength, frequency, technical and adverse effects in the pediatric population.

  6. Incisional surgical site infections after colorectal surgery: time to appraise its true incidence.

    Science.gov (United States)

    Sergeant, G; Buffet, W; Fieuws, S; de Gheldere, C; Vanclooster, P

    2008-01-01

    Surgical site infections (SSI) are the leading cause of complications in surgical patients. For colorectal surgery the reported incidence of SSI varies between 10 and 15%. This incidence however, has been challenged recently. In this study, we evaluated the incidence of incisional SSI after colorectal surgery in our department. We performed a retrospective analysis of 115 non-laparoscopic colorectal resections between July 1st 2004 and July 31st 2005. After exclusion, 101 patients were retained. Demographic, clinical and operative variables were collected. Univariable and multivariable analysis were performed to identify risk factors for the development of incisional SSI. 21 SSI were diagnosed (20.7%). Seventeen cases were incisional SSI (16.8%). Multivariable analysis identified longer operation time (p = 0.014), pre-operative obstructive lung disease (p = 0.02) and fewer postoperative days on TPN (p = 0.04) as independent predictors of incisional SSI. In comparison with recent publications, the incidence of SSI in our series was higher compared to what is generally reported.

  7. Obesity and the Risk for Surgical Site Infection in Abdominal Surgery.

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    Winfield, Robert D; Reese, Stacey; Bochicchio, Kelly; Mazuski, John E; Bochicchio, Grant V

    2016-04-01

    Obesity is a risk factor for surgical site infection (SSI) after abdominal procedures; however, data characterizing the risk of SSI in obese patients during abdominal procedures are lacking. We hypothesized that obesity is an independent risk factor for SSI across wound classes. We analyzed American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data for 2011. We calculated body mass index (BMI), classifying patients according to National Institute of Health (NIH) BMI groups. We excluded records in which height/weight was not recorded and patients with BMI less than 18.5. We examined patients undergoing open abdominal procedures, performing univariate and multivariate analyses to assess the relative contribution of obesity to SSI. Study criteria were met by 89,148 patients. Obese and morbidly obese patients had significantly greater SSI rates in clean and clean-contaminated cases but not contaminated or dirty/infected cases. Logistic regression confirmed obesity and morbid obesity as being independently associated with the overall SSI development, specifically in clean [Obesity odds ratio (OR) = 1.757, morbid obesity OR = 2.544, P < 0.001] and clean-contaminated (obesity OR = 1.239, morbid obesity OR = 1.287, P < 0.001) cases. Obesity is associated with increased risk of SSI overall, specifically in clean and clean-contaminated abdominal procedures; this is independent of diabetes mellitus. Novel techniques are needed to reduce SSI in this high-risk patient population.

  8. Surgical Site Infection by Corynebacterium macginleyi in a Patient with Neurofibromatosis Type 1

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    Bruno Cacopardo

    2013-01-01

    Full Text Available Corynebacterium (C. macginleyi is a gram positive, lipophilic rod, usually considered a colonizer of skin and mucosal surfaces. Several reports have associated C. macginleyi with ocular infections, such as conjunctivitis and endophthalmitis. However, even if rare, extraocular infections from C. macginleyi may occur, especially among immunocompromised patients and patients with indwelling medical devices. We report herein the first case of surgical site infection by C. macginleyi after orthopaedic surgery for the correction of kyphoscoliosis in a patient with neurofibromatosis type 1. Our patient developed a nodular granulomatous lesion of about two centimetres along the surgical scar, at the level of C4-C5, with purulent discharge and formation of a fistulous tract. Cervical magnetic resonance imaging showed the presence of a two-centimetre fluid pocket in the subcutaneous tissue. Several swabs were collected from the borders of the lesion as well as from the exudate, with isolation of C. macginleyi. The isolate was susceptible to beta-lactams, cotrimoxazole, linezolid, and glycopeptides but resistant to quinolones, third-generation cephalosporins, and erythromycin. Two 30-day courses of antibiotic therapy with amoxicillin/clavulanate (1 g three times/day and cotrimoxazole (800/160 mg twice a day were administered, obtaining a complete healing of the lesion.

  9. Using a change model to reduce the risk of surgical site infection.

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    Burden, Mel

    2016-09-22

    A surgical site infection (SSI) surveillance module completed in 2014 highlighted that infection rates for breast surgery inpatients and readmissions at an acute trust had increased to 2.2%, from 0.5% in 2012. The national benchmark for 2014 established by Public Health England (PHE) was 1.0%. This demonstrated a greater than fourfold absolute increase in SSI for breast surgery during these periods. The infection rate could have been due to chance, but warranted investigation. The results were presented to the breast team and used to drive practice transformation through audit and observation, identifying areas of change to improve patient safety. The project used a recognised 8-step model for leading change developed by John Kotter, a professor at Harvard Business School and world-renowned change expert. The project presented opportunities to promote infection prevention while implementing care improvement strategies and behaviour change in partnership with the breast team.

  10. Effect of Preoperative Nutritional Status on Surgical Site Infection in Colorectal Cancer Resection.

    Science.gov (United States)

    Tanaka, Toshimichi; Sato, Takeo; Yamashita, Keishi; Hosoda, Kei; Nakamura, Takatoshi; Watanabe, Masahiko

    2017-01-01

    Postoperative complications of colorectal cancer (CRC) can sometimes be life threatening. Prevention of morbidity is therefore the most important issue, and among such complications, surgical site infections (SSIs) are the most critical. Predictive factors for SSI were evaluated. This was a retrospective study of 432 patients with CRC. SSIs were classified into incisional SSIs (iSSIs) and organ/space SSIs (o/sSSIs). Preoperative serum albumin (relative risk (RR) 2.51, p = 0.01) and body mass index (BMI: RR 2.36, p = 0.02) were the independent risk factors for iSSIs, while rectal cancer (RR 6.34, p cancer and low serum albumin had the highest incidence of o/sSSIs (57.1%). Preoperative nutritional status is a risk factor for SSIs in CRC, and its proper preoperative management may reduce the risk of SSIs. © 2016 S. Karger AG, Basel.

  11. Prevalence of surgical site infection at the stoma site following four skin closure techniques: a retrospective cohort study.

    Science.gov (United States)

    Li, Linda T; Brahmbhatt, Reshma; Hicks, Stephanie C; Davila, Jessica A; Berger, David H; Liang, Mike K

    2014-01-01

    Surgical site infection (SSI) is a common complication of stoma reversal. Studies have suggested that different skin closures affect SSI rates. Our aim was to determine which skin closure technique following stoma reversal leads to the lowest rate of SSI. We conducted a retrospective review of all adult patients undergoing stoma reversal at a single institution (2005-2011) and compared the rate of SSI following four skin closure techniques: primary closure (PC), secondary closure (SC), loose PC (LPC), and circular closure (CC). Univariate analysis included χ(2) or Fisher's exact test and ANOVA or Kruskal-Wallis H test for categorical and continuous data, respectively. A multivariate logistic regression model was created to identify predictors of SSI. One hundred and forty-six patients were identified: 40 (27%) PC, 68 (47%) SC, 20 (14%) LPC, and 18 (12%) CC. CC was less likely to have SSI (6%) compared to PC (43%), SC (16%), and LPC (15%; p stomas that were closed with CC. © 2014 S. Karger AG, Basel.

  12. [Post-appendectomy surgical site infection: overall rate and type according to open/laparoscopic approach].

    Science.gov (United States)

    Aranda-Narváez, José Manuel; Prieto-Puga Arjona, Tatiana; García-Albiach, Beatriz; Montiel-Casado, María Custodia; González-Sánchez, Antonio Jesús; Sánchez-Pérez, Belinda; Titos-García, Alberto; Santoyo-Santoyo, Julio

    2014-02-01

    To compare the incidence and profile of surgical site infection (SSI) after laparoscopic (LA) or open (OA) appendicectomy. Observational and analytical study was conducted on patients older than 14years-old with suspected acute appendicitis operated on within a 4-year period (2007-2010) at a third level hospital (n=868). They were divided in two groups according to the type of appendicectomy (LA, study group, 135; OA, control group, 733). The primary endpoint was a surgical site infection (SSI), and to determine the overall rate and types (incisional/organ-space). The risk of SSI was stratified by: i)National Nosocomial Infection Surveillance (NNIS) index (low risk: 0E, 0 and 1; high risk: 2 and 3); ii)status on presentation (low risk: normal or phlegmonous; high risk: gangrenous or perforated). The statistical analysis was performed using the software SPSS. The main result and stratified analysis was determined with χ(2), and the risk parameters using OR and Mantel-Haenszel OR with 95%CI, accepting statistical significance with P<.05. Age, gender, ASA index and incidence of advanced cases were similar in both groups. The overall SSI rate was 13.4% (more than a half of them detected during follow-up after discharge). Type of SSI: OA, 13% (superficial 9%, deep 2%, organ-space 2%); AL, 14% (superficial 5%, deep 1%, organ-space 8%) (overall: not significant; distribution: P<.000). Stratified analysis showed that there is an association between incisional SSI/OA and organ-space SSI/LA, and is particularly stronger in those patients with high risk of postoperative SSI (high risk NNIS or gangrenous-perforated presentation). OA and LA are associated with a higher rate of incisional and organ-space SSI respectively. This is particularly evident in patients with high risk of SSI. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  13. Post liposuction Mycobacterium abscessus surgical site infection in a returned medical tourist complicated by a paradoxical reaction during treatment

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    Siong H. Hui

    2015-12-01

    Full Text Available Rapidly growing mycobacterial skin and soft tissue infections are known to complicate cosmetic surgical procedures. Treatment consists of more surgery and prolonged antibiotic therapy guided by drug susceptibility testing. Paradoxical reactions occurring during antibiotic therapy can further complicate treatment of non-tuberculous mycobacterial infections. We report a case of post liposuction Mycobacterium abscessus surgical site infection in a returned medical tourist and occurrence of paradox during treatment.

  14. Surgical site infections following colorectal cancer surgery: a randomized prospective trial comparing common and advanced antimicrobial dressing containing ionic silver

    Directory of Open Access Journals (Sweden)

    Biffi Roberto

    2012-05-01

    Full Text Available Abstract Background An antimicrobial dressing containing ionic silver was found effective in reducing surgical-site infection in a preliminary study of colorectal cancer elective surgery. We decided to test this finding in a randomized, double-blind trial. Methods Adults undergoing elective colorectal cancer surgery at two university-affiliated hospitals were randomly assigned to have the surgical incision dressed with Aquacel® Ag Hydrofiber dressing or a common dressing. To blind the patient and the nursing and medical staff to the nature of the dressing used, scrub nurses covered Aquacel® Ag Hydrofiber with a common wound dressing in the experimental arm, whereas a double common dressing was applied to patients of control group. The primary end-point of the study was the occurrence of any surgical-site infection within 30 days of surgery. Results A total of 112 patients (58 in the experimental arm and 54 in the control group qualified for primary end-point analysis. The characteristics of the patient population and their surgical procedures were similar. The overall rate of surgical-site infection was lower in the experimental group (11.1% center 1, 17.5% center 2; overall 15.5% than in controls (14.3% center 1, 24.2% center 2, overall 20.4%, but the observed difference was not statistically significant (P = 0.451, even with respect to surgical-site infection grade 1 (superficial versus grades 2 and 3, or grade 1 and 2 versus grade 3. Conclusions This randomized trial did not confirm a statistically significant superiority of Aquacel® Ag Hydrofiber dressing in reducing surgical-site infection after elective colorectal cancer surgery. Trial registration Clinicaltrials.gov: NCT00981110

  15. Surgical-site infections and postoperative complications: agreement between the Danish Gynecological Cancer Database and a randomized clinical trial

    DEFF Research Database (Denmark)

    Antonsen, Sofie L; Meyhoff, Christian Sylvest; Lundvall, Lene

    2011-01-01

    -operation, urinary tract infection, pneumonia and sepsis. RESULTS: Surgical-site infection was found in 21 of 222 patients (9.5%) in the PROXI trial versus 6 of 222 patients (2.7%) in the DGCD (p infections were...... registered in the PROXI trial, but not in the DGCD. Agreements between secondary outcomes were very varying (kappa-value 0.77 for re-operation, 0.37 for urinary tract infections, 0.19 for sepsis and 0.18 for pneumonia). CONCLUSIONS: The randomized trial reported significantly more surgical-site infections......OBJECTIVE: Surgical-site infections are serious complications and thorough follow-up is important for accurate surveillance. We aimed to compare the frequency of complications recorded in a clinical quality database with those noted in a randomized clinical trial with follow-up visits. DESIGN...

  16. Convergent evolution in peptidoglycan cut sites of phage endolysins protecting mice from methicillin-resistant Staphylococcus aureus septicemia

    Science.gov (United States)

    Staphylococcus S. aureus is a Gram-positive pathogen relevant for both human and animal health. It is one of the most common causes of nosocomial infections and associated with a wide range of life-threatening human diseases. As the major causative agent of bovine mastitis, it also has significant ...

  17. Does laparoendoscopic single-site adrenalectomy increase surgical risk in patients with pheochromocytoma?

    Science.gov (United States)

    Hattori, Seiya; Miyajima, Akira; Maeda, Takahiro; Hasegawa, Masanori; Takeda, Toshikazu; Kosaka, Takeo; Kikuchi, Eiji; Nakagawa, Ken; Oya, Mototsugu

    2013-02-01

    LESS (laparoendoscopic single-site) surgery has been developed as a treatment option for adrenal tumors that has less postoperative pain and greater cosmetic benefits. Some reports proposed that patient selection criteria should be stringent, and pheochromocytoma (PHE) should be taken as an advanced indication. The aim of this study is to compare LESS adrenalectomy (ADX) with conventional adrenalectomy (CL-ADX) in patients with PHE, with attention paid not only to immediate postoperative outcomes but also to the intraoperative hemodynamic changes that occur with each technique. The records of 265 consecutive patients who underwent laparoscopic ADX at Keio University Hospital in Tokyo from January 2001 to June 2011 were entered into a database. Surgical procedures were performed or supervised by two experienced laparoscopic surgeons, who performed more than 100 cases of urologic laparoscopic surgery in 2011. Twenty consecutive patients who underwent LESS-ADX from December 2009 to October 2011 were compared with patients who underwent CL-ADX (controls, n = 30) to look at differences in hemodynamic parameters and surgical outcomes in a case-control analysis. Each group was equivalent with respect to age, sex, and BMI. The mean size of 50 PHE was 45.1 ± 4.0 mm, the mean operative time was 151.8 ± 10.6 min, and there was no significant difference between the two groups. In one case of LESS-ADX, two additional ports were added. There was no significant difference between the CL-ADX and LESS-ADX groups in terms of operation time, total fluid during the operation, estimated blood loss, first oral feeding, postoperative stay in the intensive care unit, or postoperative hospital stay. We consider the safety of LESS-ADX of PHE as similar to that of CL-ADX. With appropriate pre- and intraoperative hemodynamic control and experienced hands, LESS-ADX could become one of the treatments of choice for resection of PHE.

  18. Is Intraoperative Local Vancomycin Powder the Answer to Surgical Site Infections in Spine Surgery?

    Science.gov (United States)

    Hey, Hwee Weng Dennis; Thiam, Desmond Wei; Koh, Zhi Seng Darren; Thambiah, Joseph Shantakumar; Kumar, Naresh; Lau, Leok-Lim; Liu, Ka-Po Gabriel; Wong, Hee-Kit

    2017-02-15

    This is a retrospective cohort comparative study of all patients who underwent instrumented spine surgery at a single institution. To compare the rate of surgical site infection (SSI) between the treatment (vancomycin) and the control group (no vancomycin) in patients undergoing instrumented spine surgery. SSI after spine surgery is a dreaded complication associated with increased morbidity and mortality. Prophylactic intraoperative local vancomycin powder to the wound has been recently adopted as a strategy to reduce SSI but results have been variable. In the present study, there were 117 (30%) patients in the treatment group and 272 (70%) patients in the comparison cohort. All patients received identical standard operative and postoperative care procedures based on protocolized department guidelines. The present study compared the rate of SSI with and without the use of prophylactic intraoperative local vancomycin powder in patients undergoing various instrumented spine surgery, adjusted for confounders. The overall rate of SSI was 4.7% with a decrease in infection rate found in the treatment group (0.9% vs. 6.3%). This was statistically significant (P = 0.049) with an odds ratio of 0.13 (95% confidence interval 0.02-0.99). The treatment group had a significantly shorter onset of infection (5 vs. 16.7 days; P < 0.001) and shorter duration of infection (8.5 vs. 26.8 days; P < 0.001). The most common causative organism was Pseudomonas aeruginosa (35.2%). Patient diagnosis, surgical approach, and intraoperative blood loss were significant risk factors for SSI after multivariable analysis. Prophylactic Intraoperative local vancomycin powder reduces the risk and morbidity of SSI in patients undergoing instrumented spine surgery. P. aeruginosa infection is common in the treatment arm. Future prospective randomized controlled trials in larger populations involving other spine surgeries with a long-term follow-up duration are recommended. 3.

  19. Prevention and treatment of surgical site infection in HIV-infected patients

    Directory of Open Access Journals (Sweden)

    Zhang Lei

    2012-05-01

    Full Text Available Abstract Background Surgical site infection (SSI are the third most frequently reported nosocomial infection, and the most common on surgical wards. HIV-infected patients may increase the possibility of developing SSI after surgery. There are few reported date on incidence and the preventive measures of SSI in HIV-infected patients. This study was to determine the incidence and the associated risk factors for SSI in HIV-infected patients. And we also explored the preventive measures. Methods A retrospective study of SSI was conducted in 242 HIV-infected patients including 17 patients who combined with hemophilia from October 2008 to September 2011 in Shanghai Public Health Clinical Center. SSI were classified according to Centers for Disease Control and Prevention (CDC criteria and identified by bedside surveillance and post-discharge follow-up. Data were analyzed using SPSS 16.0 statistical software (SPSS Inc., Chicago, IL. Results The SSI incidence rate was 47.5% (115 of 242; 38.4% incisional SSIs, 5.4% deep incisional SSIs and 3.7% organ/space SSIs. The SSI incidence rate was 37.9% in HIV-infected patients undergoing abdominal operation. Patients undergoing abdominal surgery with lower preoperative CD4 counts were more likely to develop SSIs. The incidence increased from 2.6% in clean wounds to 100% in dirty wounds. In the HIV-infected patients combined with hemophilia, the mean preoperative albumin and postoperative hemoglobin were found significantly lower than those in no-SSIs group (P Conclusions SSI is frequent in HIV-infected patients. And suitable perioperative management may decrease the SSIs incidence rate of HIV-infected patients.

  20. Surgical site infection surveillance in orthopedic patients in the Military Medical Academy, Belgrade

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    Starčević Srđan

    2015-01-01

    Full Text Available Background/Aim. Active surveillance is an important component of surgical site infection (SSI reduction strategy. The aim of this study was to analyze and compare SSI surveillance data in orthopedic patients in the Military Medical Academy (MMA, Belgrade. Methods. A 4-year prospective cohort study was performed to identify the incidence rate and risk factors for SSI in orthopedic patients in the MMA, Belgrade. We collected data regarding patients characteristics, health care and microorganisms isolated in SSI. The National Nosocomial Infection Surveillance (NNIS risk index was subsequently calculated for each patient. The Centers for Disease Control and Prevention criteria were used for the diagnosis of SSI. Results. Assessment of 3,867 patients after different orthopedic operations revealed SSI in 109 patients. The overall incidence rate of SSI was 2.8% with the decrease from 4.6% in 2007 to 1.6% in 2010. Using NNIS risk index for surgical procedures there were: 53.7% (2,077 patients with risk 0 - the incidence rate of 1.4%; 38.9% (1,506 patients with risk 1 - the incidence rate of 3.1%; 7.3% (281 patients with risk 2 - the incidence rate of 11.7%; 0.1% (3 patients with risk 3 - without infection within the risk. Multivariate logistic regression analysis identified 6 independent risk factors associated with SSI: contaminated or dirty wounds, smoking, preoperative infection, NNIS risk index, body mass index and the length of hospital stay. Conclusion. The results of our study are valuable confirmation of relations between risk factors and SSI in orthopedic patients. A decreasing incidence rate of SSI (from 4.6% to 1.6% during a 4-year active surveillance approved its implementation as an important component of SSI reduction strategy.

  1. Surgical site infection reduction bundle in patients with gynecologic cancer undergoing colon surgery.

    Science.gov (United States)

    Schiavone, Maria B; Moukarzel, Lea; Leong, Kam; Zhou, Qin C; Afonso, Anoushka M; Iasonos, Alexia; Roche, Kara Long; Leitao, Mario M; Chi, Dennis S; Abu-Rustum, Nadeem R; Zivanovic, Oliver

    2017-10-01

    Surgical site infections (SSIs) can lead to substantial morbidity, prolonged hospitalization, increased costs, and death in patients undergoing colorectal procedures. We sought to investigate the effect of using an SSI reduction bundle on the rate of SSIs in gynecologic cancer patients undergoing colon surgery. We identified all gynecologic cancer patients who underwent colon resection at our institution from 2014 to 2016, during which time a service-wide SSI reduction bundle was introduced. The intervention included preoperative oral antibiotics with optional mechanical bowel preparation, skin preparation with antibacterial solution, and the use of a separate surgical closing tray. SSI rates were assessed within 30days post-surgery. Of 233 identified patients, 115 had undergone colon surgery prior to (PRE) and 118 after (POST) the implementation of the intervention. A low anterior resection was the most common colon surgery in both cohorts. The incidence of SSI within 30days of surgery was 43/115 (37%) in the PRE and 14/118 (12%) in the POST cohorts (p≤0.001). Wound dehiscence was noted in 30/115 (26%) and 2/118 (2%) patients, respectively (p≤0.001). In patients whose operation took longer than 360min, 30-day SSI rates were 37% (28/76) and 12% (8/67), respectively (p≤0.001). In patients with an estimated blood loss >500cm3, SSI rates were 44% (27/62) and 15% (10/67), respectively (p≤0.001). The implementation of an SSI reduction bundle was associated with a significant reduction in 30-day SSIs in these patients. The intervention remained effective in patients undergoing longer operations and in those with increased blood loss. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Perioperative, local and systemic warming in surgical site infection: a systematic review and meta-analysis.

    Science.gov (United States)

    Ousey, K; Edward, K-L; Lui, S; Stephenson, J; Walker, K; Duff, J; Leaper, D

    2017-11-02

    Surgical site infection (SSI) is a common cause of postoperative morbidity. Perioperative hypothermia may contribute to surgical complications including increased risk of SSI. In this systematic review and meta-analysis, the effectiveness of active and passive perioperative warming interventions to prevent SSI was compared with standard (non-warming) care. Ovid MEDLINE; Ovid EMBASE; EBSCO CINAHL Plus; The Cochrane Wounds Specialised Register, and The Cochrane Central Register of Controlled Trials were searched, with no restrictions on language, publication date or study setting for randomised controlled trials (RCTs) and cluster RCTs. Adult patients undergoing elective or emergency surgery under general anaesthesia, receiving any active or passive warming intervention perioperatively were included. Selection, risk of bias assessment and data extraction were performed by two review authors, independently. Outcomes studied were SSI (primary outcome), inpatient mortality, hospital length of stay and pain (secondary outcomes). We identified four studies, including 769 patients. The risk ratio (RR) for SSI in warming groups was 0.36 [95% confidence interval (CI): 0.23, 0.56; p<0. 001]. Length of hospitalisation was 1.13 days less in warming groups [95% CI: -3.07, 5.33; p=0.600]. The RR for mortality in the warming groups was 0.77 [95% CI: 0.17, 3.43; p=0.730]. A meta-analysis for pain outcome could not be conducted. This review provides evidence in favour of active warming to prevent SSI, but insufficient evidence of active warming to reduce length of hospital stay and mortality. Benefits of passive warming remain unclear and warrant further research.

  3. Failure to Redose Antibiotic Prophylaxis in Long Surgery Increases Risk of Surgical Site Infection.

    Science.gov (United States)

    Kasatpibal, Nongyao; Whitney, Joanne D; Dellinger, E Patchen; Nair, Bala G; Pike, Kenneth C

    Antibiotic prophylaxis is a key component of the prevention of surgical site infection (SSI). Failure to manage antibiotic prophylaxis effectively may increase the risk of SSI. This study aimed to examine the effects of antibiotic prophylaxis on SSI risk. A retrospective cohort study was conducted among patients having general surgery between May 2012 and June 2015 at the University of Washington Medical Center. Peri-operative data extracted from hospital databases included patient and operation characteristics, intra-operative medication and fluid administration, and survival outcome. The effects of antibiotic prophylaxis and potential factors on SSI risk were estimated using multiple logistic regression and were expressed as risk ratios (RRs). A total of 4,078 patients were eligible for analysis. Of these, 180 had an SSI. Mortality rates within and after 30 days were 0.8% and 0.3%, respectively. Improper antibiotic redosing increased the risk of SSI (RR 4.61; 95% confidence interval [CI] 1.33-15.91). Other risk factors were in-patient status (RR 4.05; 95% CI 1.69-9.66), smoking (RR 1.63; 95% CI 1.03-2.55), emergency surgery (RR 1.97; 95% CI 1.26-3.08), colectomy (RR 3.31; 95% CI 1.19-9.23), pancreatectomy (RR 4.52; 95% CI 1.53-13.39), proctectomy (RR 5.02; 95% CI 1.72-14.67), small bowel surgery (RR 6.16; 95% CI 2.13-17.79), intra-operative blood transfusion >500 mL (RR 2.76; 95% CI 1.45-5.26), and multiple procedures (RR 1.40; 95% CI 1.01-1.95). These data demonstrate that failure to redose prophylactic antibiotic during long operations increases the risk of SSI. Strengthening a collaborative surgical quality improvement program may help to eradicate this risk.

  4. Detection of clinically important colorectal surgical site infection using Bayesian network.

    Science.gov (United States)

    Sohn, Sunghwan; Larson, David W; Habermann, Elizabeth B; Naessens, James M; Alabbad, Jasim Y; Liu, Hongfang

    2017-03-01

    Despite extensive efforts to monitor and prevent surgical site infections (SSIs), real-time surveillance of clinical practice has been sparse and expensive or nonexistent. However, natural language processing (NLP) and machine learning (i.e., Bayesian network analysis) may provide the methodology necessary to approach this issue in a new way. We investigated the ability to identify SSIs after colorectal surgery (CRS) through an automated detection system using a Bayesian network. Patients who underwent CRS from 2010 to 2012 and were captured in our institutional American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) comprised our cohort. A Bayesian network was applied to detect SSIs using risk factors from ACS-NSQIP data and keywords extracted from clinical notes by NLP. Two surgeons provided expertise informing the Bayesian network to identify clinically meaningful SSIs (CM-SSIs) occurring within 30 d after surgery. We used data from 751 CRS cases experiencing 67 (8.9%) SSIs and 78 (10.4%) CM-SSIs. Our Bayesian network detected ACS-NSQIP-captured SSIs with a receiver operating characteristic area under the curve of 0.827, but this value increased to 0.892 when using surgeon-identified CM-SSIs. A Bayesian network coupled with NLP has the potential to be used in real-time SSI surveillance. Moreover, surgeons identified CM-SSI not captured under current NSQIP definitions. Future efforts to expand CM-SSI identification may lead to improved and potentially automated approaches to survey for postoperative SSI in clinical practice. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Prospective nationwide surveillance of surgical site infections after gastric surgery and risk factor analysis in the Korean Nosocomial Infections Surveillance System (KONIS).

    Science.gov (United States)

    Kim, Eu Suk; Kim, Hong Bin; Song, Kyoung-Ho; Kim, Young Keun; Kim, Hyung-Ho; Jin, Hye Young; Jeong, Sun Young; Sung, Joohon; Cho, Yong Kyun; Lee, Yeong-Seon; Oh, Hee-Bok; Kim, Eui-Chong; Kim, June Myung; Choi, Tae Yeol; Choi, Hee Jung; Kim, Hyo Youl

    2012-06-01

    To evaluate the risk factors for surgical site infection (SSI) after gastric surgery in patients in Korea. A nationwide prospective multicenter study. Twenty university-affiliated hospitals in Korea. The Korean Nosocomial Infections Surveillance System (KONIS), a Web-based system, was developed. Patients in 20 Korean hospitals from 2007 to 2009 were prospectively monitored for SSI for up to 30 days after gastric surgery. Demographic data, hospital characteristics, and potential perioperative risk factors were collected and analyzed, using multivariate logistic regression models. Of the 4,238 case patients monitored, 64.9% (2,752) were male, and mean age (± SD) was 58.8 (± 12.3) years. The SSI rates were 2.92, 6.45, and 10.87 per 100 operations for the National Nosocomial Infections Surveillance system risk index categories of 0, 1, and 2 or 3, respectively. The majority (69.4%) of the SSIs observed were organ or space SSIs. The most frequently isolated microorganisms were Staphylococcus aureus and Klebsiella pneumoniae. Male sex (odds ratio [OR], 1.67 [95% confidence interval (CI), 1.09-2.58]), increased operation time (1.20 [1.07-1.34] per 1-hour increase), reoperation (7.27 [3.68-14.38]), combined multiple procedures (1.79 [1.13-2.83]), prophylactic administration of the first antibiotic dose after skin incision (3.00 [1.09-8.23]), and prolonged duration (≥7 days) of surgical antibiotic prophylaxis (SAP; 2.70 [1.26-5.64]) were independently associated with increased risk of SSI. Male sex, inappropriate SAP, and operation-related variables are independent risk factors for SSI after gastric surgery.

  6. A STUDY OF COMPARATIVE EVALUATION OF PREOPERATIVE SKIN PREPARATION WITH CHLORHEXIDINE-ALCOHOL VERSUS POVIDONE-IODINE IN PREVENTION OF SURGICAL SITE INFECTIONS

    Directory of Open Access Journals (Sweden)

    Geetha Danasekaran

    2017-05-01

    Full Text Available BACKGROUND Surgical site infections is a dangerous condition posing a heavy burden on the patient and social health system. The use of preoperative skin preparation by effective antiseptic plays an important role in reducing postoperative wound infections. Hence, the present study was undertaken to compare and evaluate the efficacy of 2% chlorhexidine-alcohol versus 5% povidone-iodine in abdominal surgeries for prevention of SSI. MATERIALS AND METHODS The present one year randomised controlled trial was conducted in the Department of General Surgery, Government Rajaji Hospital, Madurai, over a period from 2014 to 2015 on 120 patients undergoing elective abdominal surgeries. The patients were divided into two groups by computer randomisation that is Group A (chlorhexidine-alcohol group and Group B (povidone-iodine group. The surgical wounds were examined for any infections present. RESULTS Most of the patients were males in both the groups (73.33% and 61.67% in group A and B, respectively. Half of the patients (50% in both the groups had chronic appendicitis. The mean duration of surgery in group A was 44.66 ± 5.86 minutes, and in group B, it was 45.00 ± 6.24 minutes. Staphylococcus aureus (1.67% in group A and 10% in group B was the most common organism isolated after skin preparation. After the application of antiseptic agents, there was reduction of bacterial colonisation in both the groups, but significant reduction was seen in chlorhexidine group. In group A, two patients had superficial SSIs compared to 14 patients in group B (p=0.001. The mean length of hospital stay in group A was significantly less (7.20 ± 1.10 vs. 8.67 ± 3.17. CONCLUSION Preoperative skin cleansing with chlorhexidine significantly reduces risk of postoperative SSIs and colonisation of bacteria in clean abdominal surgeries.

  7. Surgical site infections after lower extremity revascularization procedures involving groin incisions.

    Science.gov (United States)

    Kuy, SreyRam; Dua, Anahita; Desai, Sapan; Dua, Arshish; Patel, Bhavin; Tondravi, Nader; Seabrook, Gary R; Brown, Kellie R; Lewis, Brian D; Lee, Cheong J; Kuy, SreyReath; Subbarayan, Rishi; Rossi, Peter J

    2014-01-01

    We sought to evaluate the incidence, epidemiology, and factors associated with surgical site infections (SSIs) after lower extremity revascularization procedures involving groin incisions and determine outcomes based on SSI status. This is a single-institution, retrospective cohort study of 106 patients who underwent lower extremity revascularization procedures involving femoral artery exposure through a groin incision at a tertiary referral hospital. The primary outcome was occurrence of SSI at the groin wound. The duration of hospital stay, reoperation within 30 days, discharge disposition, and 30-day mortality were also evaluated. Independent variables included patient demographics and operative variables (i.e., procedure type, transfusion requirements, preoperative antibiotics, intraoperative vasopressors, and operative duration). Statistical analysis included chi-squared tests, t-tests, and multivariable regression analysis. Of the 106 patients who underwent a lower extremity revascularization procedure with a groin incision for femoral artery exposure, 62% were male, and the mean age was 62 years. Comorbidities included hypertension (93%), dyslipidemia (65%), statin use (63%), active smoker (50%), diabetes (24%), and chronic obstructive pulmonary disease (23%). All patients received preoperative antibiotics, 50% required intraoperative pressors, 21% received a blood transfusion, and the mean operative time was 296 min. The overall duration of stay was 10.7 days, the 30-day reoperation rate was 18%, and the 30-day mortality rate was 12%. Overall, 22% developed a seroma or hematoma, and 31% developed a SSI. Patients who developed an SSI compared with those who did not were more likely to have a postoperative seroma or hematoma (55% vs 5%) and to receive a blood transfusion (33% vs 15%), but less likely to be treated with a statin (47% vs 69%) or carry a diagnosis of dyslipidemia (50% vs 72%), respectively, all P wound seroma or hematoma remained an

  8. aerobic bacteriological profile and antibiotic resistance of surgical ...

    African Journals Online (AJOL)

    2015-07-06

    . (Suppl); Vol-6(7): p(1266-71). 10.Kownhar H, Shankar EM, Vignesh R. High isolation rate of Staphylococcus aureus from surgical site infections in an Indian hospital. J AntimicrobChemother 2008;61(3):758–60. 11.Yadav S ...

  9. Tuning of the Lethal Response to Multiple Stressors with a Single-Site Mutation during Clinical Infection by Staphylococcus aureus.

    Science.gov (United States)

    Kumar, Krishan; Chen, John; Drlica, Karl; Shopsin, Bo

    2017-10-24

    The agr system of Staphylococcus aureus promotes invasion of host tissues, and as expected, agents that block agr quorum sensing have anti-infective properties. Paradoxically, agr-defective mutants are frequently recovered from patients, especially those persistently infected with S. aureus We found that an agr deficiency increased survival of cultured bacteria during severe stress, such as treatment with gentamicin, ciprofloxacin, heat, or low pH. With daptomycin, deletion of agr decreased survival. Therefore, agr activity can be either detrimental or protective, depending on the type of lethal stress. Deletion of agr had no effect on the ability of the antimicrobials to block bacterial growth, indicating that agr effects are limited to lethal action. Thus, the effect of an agr deletion is on bacterial tolerance, not resistance. For gentamicin and daptomycin, activity can be altered by agr-regulated secreted factors. For ciprofloxacin, a detrimental function was downregulation of glutathione peroxidase (bsaA), an enzyme responsible for defense against oxidative stress. Deficiencies in agr and bsaA were epistatic for survival, consistent with agr having a destructive role mediated by reactive oxygen species. Enhanced susceptibility to lethal stress by wild-type agr, particularly antimicrobial stress, helps explain why inactivating mutations in S. aureus agr commonly occur in hospitalized patients during infection. Moreover, the agr quorum-sensing system of S. aureus provides a clinically relevant example in which a single-step change in the response to severe stress alters the evolutionary path of a pathogen during infection.IMPORTANCE When phenotypes produced in response to an environmental stress are inadequate to buffer against that stress, changes that do buffer may become genetically encoded by natural selection. A clinically relevant example is seen with S. aureus mutants that are deficient in the key virulence regulator agr Paradoxically, defects in agr

  10. Chlorhexidine-alcohol versus povidone-iodine as preoperative skin preparation to prevent surgical site infection: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Tasya Anggrahita

    2017-05-01

    Full Text Available Background: Surgical site infection remains substantial problems to surgeons and patients as it increases the morbidity, mortality, length of stay, hospital cost, rate of re-admission, and rate of re-surgery. This study aims to compare the use of chlorhexidine-alcohol versus povidone-iodine for preoperative skin preparation to prevent surgical site infection.Methods: The literature search was conducted through the PubMed database on November 2015. Included studies were RCTs with the year of publication up to 2015 which compared the use of chlorhexidine-alcohol versus povidone-iodine in its effectiveness reducing surgical site infection in adult patients. The quality of the study was assessed using Jadad Score. A meta-analysis was conducted in the included study to obtain a pooled estimate of the effect size. The evidence of heterogeneity and publication bias was also assessed.Results: Six RCTs with a total of 2,080 patients were included in the meta-analysis. It showed that the use of chlorhexidine-alcohol was associated significantly with fewer SSIs (pooled risk ratio=0.60 (95% CI=0.45-0.79 and fewer positive skin culture results (pooled risk ratio, RR=0.38 (95% CI=0.28-0.51 compared with povidone iodine.Conclusion: Preoperative skin antisepsis with chlorhexidine is more effective than povidone-iodine in preventing surgical site infection.

  11. Intracavity lavage and wound irrigation for prevention of surgical site infection

    Science.gov (United States)

    Norman, Gill; Atkinson, Ross A; Smith, Tanya A; Rowlands, Ceri; Rithalia, Amber D; Crosbie, Emma J; Dumville, Jo C

    2017-01-01

    Background Surgical site infections (SSIs) are wound infections that occur after an operative procedure. A preventable complication, they are costly and associated with poorer patient outcomes, increased mortality, morbidity and reoperation rates. Surgical wound irrigation is an intraoperative technique, which may reduce the rate of SSIs through removal of dead or damaged tissue, metabolic waste, and wound exudate. Irrigation can be undertaken prior to wound closure or postoperatively. Intracavity lavage is a similar technique used in operations that expose a bodily cavity; such as procedures on the abdominal cavity and during joint replacement surgery. Objectives To assess the effects of wound irrigation and intracavity lavage on the prevention of surgical site infection (SSI). Search methods In February 2017 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase and EBSCO CINAHL Plus. We also searched three clinical trials registries and references of included studies and relevant systematic reviews. There were no restrictions on language, date of publication or study setting. Selection criteria We included all randomised controlled trials (RCTs) of participants undergoing surgical procedures in which the use of a particular type of intraoperative washout (irrigation or lavage) was the only systematic difference between groups, and in which wounds underwent primary closure. The primary outcomes were SSI and wound dehiscence. Secondary outcomes were mortality, use of systemic antibiotics, antibiotic resistance, adverse events, re-intervention, length of hospital stay, and readmissions. Data collection and analysis Two review authors independently assessed studies for inclusion at each stage. Two review authors also undertook data extraction, assessment of risk of bias and GRADE assessment. We calculated risk ratios or differences in means with 95% confidence intervals where

  12. [Implementation of a post-discharge surgical site infection system in herniorrhaphy and mastectomy procedures].

    Science.gov (United States)

    San Juan Sanz, Isabel; Díaz-Agero-Pérez, Cristina; Robustillo-Rodela, Ana; Pita López, María José; Oliva Iñiguez, Lourdes; Monge-Jodrá, Vicente

    2014-10-01

    Monitoring surgical site infection (SSI) performed during hospitalization can underestimate its rates due to the shortening in hospital stay. The aim of this study was to determine the actual rates of SSI using a post-discharge monitoring system. All patients who underwent herniorraphy or mastectomy in the Hospital Universitario Ramón y Cajal from 1 January 2011 to 31 December 2011 were included. SSI data were collected prospectively according to the continuous quality improvement indicators (Indicadores Clinicos de Mejora Continua de la Calidad [INCLIMECC]) monitoring system. Post-discharge follow-up was conducted by telephone survey. A total of 409patients were included in the study, of whom 299 underwent a herniorraphy procedure, and 110 underwent a mastectomy procedure. For herniorrhaphy, the SSI rate increased from 6.02% to 7.6% (the post-discharge survey detected 21.7% of SSI). For mastectomy, the SSI rate increased from 1.8% to 3.6% (the post-discharge survey detected 50% of SSI). Post-discharge monitoring showed an increased detection of SSI incidence. Post-discharge monitoring is useful to analyze the real trend of SSI, and evaluate improvement actions. Post-discharge follow-up methods need to standardised. Copyright © 2013 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  13. Surgical site infections after abdominal surgery: incidence and risk factors. A prospective cohort study.

    Science.gov (United States)

    Aga, Emil; Keinan-Boker, Lital; Eithan, Arieh; Mais, Tamar; Rabinovich, Alia; Nassar, Faris

    2015-01-01

    Abdominal surgeries have high rates of surgical site infections (SSIs), contributing to increased morbidity and mortality and costs for hospitalization. The aim of this study was to determine the SSI incidence rates and risk factors after abdominal surgeries. This prospective cohort study included all patients undergoing abdominal surgeries between 2005 and 2007 in the Western Galilee Medical Center in Nahariya, Israel. SSI incidence rates were calculated per 100 operations. Odds ratios (ORs) were estimated for each risk factor using univariate and multivariate analyses by logistic regression models. Among 302 patients in the study cohort, the total SSI incidence rate was 22.2%. The univariate analysis defined 13 variables significantly associated with SSI: age > 60 years, lower functional status, diabetes mellitus, congestive heart failure, immunocompromising underlying disease, treatment with chemotherapy and other immunosuppressive medications, impaired immune system open cholecystectomy, laparotomy, an American Society of Anesthesiologists (ASA) score > 2, drain insertion, and 'dirty wound' classification. In multivariate regression analysis, treatment with immunosuppressive medications (OR = 2.5, 95% confidence interval (CI) = 1.099-143.443), open cholecystectomy (OR = 2.25, 95% CI = 2.242-40.109), and dirty wound classification (OR = 2.179, 95% CI = 3.80-20.551) were significantly associated with SSI. The significant risk factors defined should be addressed preoperatively to decrease the risk for SSI. Wound surveillance in the post-discharge period is necessary for correct estimation of SSI rates.

  14. Development of a surgical site infection prediction model in orthopaedic trauma: The Denver Health Model.

    Science.gov (United States)

    Reese, Sara M; Knepper, Bryan; Young, Heather L; Mauffrey, Cyril

    2017-12-01

    The CDC's National Healthcare Safety Network's (NHSN) current risk adjustment model for surgical site infections (SSI) following open reduction internal fixation (ORIF) of long bone fractures is a suboptimal predictor of risk. We hypothesized that by including variables known to be associated with SSI following ORIF, we would develop a model that would increase the accuracy and predictability of SSI risk. Patients who underwent ORIF of a long bone between January 1, 2012 and December 31, 2014 were included in the study (n=1543). Patient risk factors, injury risk factors and perioperative risk factors were considered in the development of this model. We developed a risk prediction model for SSI following ORIF and then applied this to a new dataset of ORIF to determine the expected number of infections. This was compared to the expected number of infections calculated using the NHSN risk adjusted model. The final multivariate model included age (odds ratio: 1.02, p-valuemodel, indicating that our model more accurate in estimating infection risk. When the developed model was used to predict the number of expected infections on a new dataset from 2015, 36.3 SSI were expected compared to 5.7 calculated by the NHSN model. The model that was developed uses five easily identifiable risk factors that result in a more accurate prediction of infection at our facility than the currently used model. Prognostic and epidemiologic study, level III. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Amikacin prophylaxis and risk factors for surgical site infection after kidney transplantation.

    Science.gov (United States)

    Freire, Maristela P; Antonopoulos, Ioannis M; Piovesan, Affonso Celso; Moura, Maria L; de Paula, Flávio Jota; Spadão, Fernanda; Guimarães, Thais; David-Neto, Elias; Nahas, William C; Pierrotti, Ligia C

    2015-03-01

    Antibiotic prophylaxis plays a major role in preventing surgical site infections (SSIs). This study aimed to evaluate antibiotic prophylaxis in kidney transplantation and identify risk factors for SSIs. We evaluated all kidney transplantation recipients from January 2009 and December 2012. We excluded patients who died within the first 72 hr after transplantation, were undergoing simultaneous transplantation of another organ, or were below 12 years of age. The main outcome measure was SSI during the first 60 days after transplantation. A total of 819 kidney transplants recipients were evaluated, 65% of whom received a deceased-donor kidney. The antibiotics used as prophylaxis included cephalosporin, in 576 (70%) cases, and amikacin, in 233 (28%). We identified SSIs in 106 cases (13%), the causative agent being identified in 72 (68%). Among the isolated bacteria, infections caused by extended-spectrum β-lactamase-producing Enterobacteriaceae predominated. Multivariate analysis revealed that the risk factors for post-kidney transplantation SSIs were deceased donor, thin ureters at kidney transplantation, antithymocyte globulin induction therapy, blood transfusion at the transplantation procedure, high body mass index, and diabetes mellitus. The only factor associated with a reduction in the incidence of SSIs was amikacin use as antibiotic prophylaxis. Factors associated with reduced graft survival were: intraoperative blood transfusions, reoperation, human leukocyte antigen mismatch, use of nonstandard immunosuppression therapy, deceased donor, post-kidney transplantation SSIs, and delayed graft function. Amikacin prophylaxis is a useful strategy for preventing SSIs.

  16. Surgical site infection after breast surgery: impact of 2010 CDC reporting guidelines.

    Science.gov (United States)

    Degnim, Amy C; Throckmorton, Alyssa D; Boostrom, Sarah Y; Boughey, Judy C; Holifield, Andrea; Baddour, Larry M; Hoskin, Tanya L

    2012-12-01

    Reported surgical site infection (SSI) rates after breast operations ranges 0.8-26 % in the literature. The aims of the present study were to characterize SSI after breast/axillary operations and determine the impact on the SSI rate of the 2010 Centers for Disease Control and Prevention (CDC) reporting guidelines that now specifically exclude cellulitis. Retrospective chart review identified 368 patients with 449 operated sides between July 2004 and June 2006. SSI was defined by CDC criteria: purulent drainage (category 1), positive aseptically collected culture (category 2), signs of inflammation with opening of incision and absence of negative culture (category 3), and physician diagnosis of infection (category 4). The impact of excluding cellulitis was assessed. Prior CDC reporting guidelines revealed that among 368 patients, 32 (8.7 %) experienced SSI in 33 (7.3 %) of 449 operated sides. Of these, 11 (33 %) met CDC criteria 1-3, while 22 (67 %) met CDC criterion 4. Excluding cellulitis cases per 2010 CDC SSI reporting guidelines eliminates 21 of the 22 infections previously meeting CDC criterion 4. Under the new reporting guidelines, the SSI rate is 12 (2.7 %) of 449 operated sides. SSI rates varied by procedure, but these differences were not statistically significant. Cellulitis after breast and axillary surgery is much more common than other criteria for SSI, and SSI rates are reduced almost threefold if cellulitis cases are excluded. Recently revised CDC reporting guidelines may result in underestimates of the clinical burden of SSI after breast/axillary surgery.

  17. High-concentration oxygen and surgical site infections in abdominal surgery: a meta-analysis.

    Science.gov (United States)

    Patel, Sunil V; Coughlin, Shaun C; Malthaner, Richard A

    2013-08-01

    There has been recent interest in using high-concentration oxygen to prevent surgical site infections (SSIs). Previous meta-analyses in this area have produced conflicting results. With the publication of 2 new randomized controlled trials (RCTs) that were not included in previous meta-analyses, an updated review is warranted. Our objective was to perform a meta-analysis on RCTs comparing high- and low- concentration oxygen in adults undergoing open abdominal surgery. We completed independent literature reviews using electronic databases, bibliographies and other sources of grey literature to identify relevant studies. We assessed the overall quality of evidence using grade guidelines. Statistical analysis was performed on pooled data from included studies. A priori subgroup analyses were planned to explain statistical and clinical heterogeneity. Overall, 6 studies involving a total of 2585 patients met the inclusion criteria. There was no evidence of a reduction in SSIs with high-concentration oxygen (risk ratio 0.77, 95% confidence interval 0.50-1.19, p = 0.24). We observed substantial heterogeneity among studies. There is moderate evidence that high-concentration oxygen does not reduce SSIs in adults undergoing open abdominal surgery.

  18. Analysis of Surgical Site Infection after Musculoskeletal Tumor Surgery: Risk Assessment Using a New Scoring System

    Directory of Open Access Journals (Sweden)

    Satoshi Nagano

    2014-01-01

    Full Text Available Surgical site infection (SSI has not been extensively studied in musculoskeletal tumors (MST owing to the rarity of the disease. We analyzed incidence and risk factors of SSI in MST. SSI incidence was evaluated in consecutive 457 MST cases (benign, 310 cases and malignant, 147 cases treated at our institution. A detailed analysis of the clinical background of the patients, pre- and postoperative hematological data, and other factors that might be associated with SSI incidence was performed for malignant MST cases. SSI occurred in 0.32% and 12.2% of benign and malignant MST cases, respectively. The duration of the surgery (P=0.0002 and intraoperative blood loss (P=0.0005 was significantly more in the SSI group than in the non-SSI group. We established the musculoskeletal oncological surgery invasiveness (MOSI index by combining 4 risk factors (blood loss, operation duration, preoperative chemotherapy, and the use of artificial materials. The MOSI index (0–4 points score significantly correlated with the risk of SSI, as demonstrated by an SSI incidence of 38.5% in the group with a high score (3-4 points. The MOSI index score and laboratory data at 1 week after surgery could facilitate risk evaluation and prompt diagnosis of SSI.

  19. Review of Subcutaneous Wound Drainage in Reducing Surgical Site Infections after Laparotomy

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    B. Manzoor

    2015-01-01

    Full Text Available Purpose. Surgical site infections (SSIs remain a significant problem after laparotomies. The aim of this review was to assess the evidence on the efficacy of subcutaneous wound drainage in reducing SSI. Methods. MEDLINE database was searched. Studies were identified and screened according to criteria to determine their eligibility for meta-analysis. Meta-analysis was performed using the Mantel-Haenszel method and a fixed effects model. Results. Eleven studies were included with two thousand eight hundred and sixty-four patients. One thousand four hundred and fifty patients were in the control group and one thousand four hundred and fourteen patients were in the drain group. Wound drainage in all patients shows no statistically significant benefit in reducing SSI incidence. Use of drainage in high risk patients, contaminated wound types, and obese patients appears beneficial. Conclusion. Using subcutaneous wound drainage after laparotomy in all patients is unnecessary as it does not reduce SSI risk. Similarly, there seems to be no benefit in using it in clean and clean contaminated wounds. However, there may be benefit in using drains in patients who are at high risk, including patients who are obese and/or have contaminated wound types. A well designed trial is needed which examines these factors.

  20. The Impact of a Reported Penicillin Allergy on Surgical Site Infection Risk.

    Science.gov (United States)

    Blumenthal, Kimberly G; Ryan, Erin E; Li, Yu; Lee, Hang; Kuhlen, James L; Shenoy, Erica S

    2018-01-18

    A reported penicillin allergy may compromise receipt of recommended antibiotic prophylaxis intended to prevent surgical site infections (SSIs). Most patients with a reported penicillin allergy are not allergic. We determined the impact of a reported penicillin allergy on the development of SSIs. In this retrospective cohort study of Massachusetts General Hospital hip arthroplasty, knee arthroplasty, hysterectomy, colon surgery, and coronary artery bypass grafting patients from 2010 to 2014, we compared patients with and without a reported penicillin allergy. The primary outcome was an SSI, as defined by the Centers for Disease Control and Prevention's National Healthcare Safety Network. The secondary outcome was perioperative antibiotic use. Of 8385 patients who underwent 9004 procedures, 922 (11%) reported a penicillin allergy, and 241 (2.7%) had an SSI. In multivariable logistic regression, patients reporting a penicillin allergy had increased odds (adjusted odds ratio, 1.51; 95% confidence interval, 1.02-2.22) of SSI. Penicillin allergy reporters were administered less cefazolin (12% vs 92%; P penicillin allergy. The increased SSI risk was entirely mediated by the patients' receipt of an alternative perioperative antibiotic; between 112 and 124 patients with reported penicillin allergy would need allergy evaluation to prevent 1 SSI. Patients with a reported penicillin allergy had a 50% increased odds of SSI, attributable to the receipt of second-line perioperative antibiotics. Clarification of penicillin allergies as part of routine preoperative care may decrease SSI risk.

  1. Laparoscopic Repair Reduces Incidence of Surgical Site Infections for All Ventral Hernias

    Science.gov (United States)

    Arita, Nestor A.; Nguyen, Mylan T.; Nguyen, Duyen H.; Berger, Rachel L.; Lew, Debbie F.; Suliburk, James T.; Askenasy, Erik P.; Kao, Lillian S.; Liang, Mike K.

    2014-01-01

    Background The role of laparoscopic repair of ventral hernias remains incompletely defined. We hypothesize that laparoscopy, compared to open repair with mesh, decreases surgical site infection (SSI) for all ventral hernia types. Methods MEDLINE, EMBASE, and Cochrane databases were reviewed to identify studies evaluating outcomes of laparoscopic versus open repair with mesh of ventral hernias and divided into groups (primary or incisional). Studies with high risk of bias were excluded. Primary outcomes of interest were recurrence and SSI. Fixed effects model was used unless significant heterogeneity, assessed with the Higgins I-square (I2), was encountered. Results There were five and fifteen studies for primary and incisional cohorts. No difference was seen in recurrence between laparoscopic and open repair in the two hernia groups. SSI was more common with open repair in both hernia groups: primary (OR 4.17, 95%CI [2.03–8.55]) and incisional (OR 5.16, 95%CI [2.79–9.57]). Conclusions Laparoscopic repair, compared to open repair with mesh, decreases rates of SSI in all types of ventral hernias with no difference in recurrence. This data suggests that laparoscopic approach may be the treatment of choice for all types of ventral hernias. PMID:25294541

  2. The Combined Impact of Surgical Team Education and Chlorhexidine 2% Alcohol on the Reduction of Surgical Site Infection following Cardiac Surgery.

    Science.gov (United States)

    Hannan, Margaret M; O'Sullivan, Katie E; Higgins, Ann M; Murphy, Ann-Marie; McCarthy, James; Ryan, Edmund; Hurley, John P

    2015-12-01

    The use of 2% chlorhexidine in 70% alcohol (CHG) has been associated with reduction in catheter-related bloodstream infections and surgical site infection (SSI) in general surgery. Also, improved awareness of best practice from the perspective of the operative team is likely to result in reductions in SSI rates. This is an ambispective cohort study of patients undergoing elective cardiac surgery. Between January 2010 and December 2010, patients underwent surgical preparation using Alcohol Povidone Iodine (API). Between January 2011 and December 2011, the surgical team received education and switched to CHG for surgical preparation. Univariate analysis was performed to identify the impact of known risk factors for SSI. A logistic regression model was then fit to estimate the effect of education and CHG in the reduction of SSI in 2011, controlling for known SSI risk factors. There was a substantial reduction in overall SSI rate in 2011 following staff education and the introduction of CHG. The overall unadjusted SSI rate was 4.67% versus 2.08% (peducation and CHG in 2011 was a 63% reduction in SSI in cardiothoracic surgery (OR 0.37, 95% CI: 0.17-0.83, p=0.016), controlling for age, major co-morbidities, and SSI risk factors. Using CHG as pre-operative antiseptic in cardiothoracic surgery in a risk-adjusted cohort with education of the surgical team is associated with significantly lower SSI infection rates when compared with API. Emphasis must be placed on the multifactorial approach required to prevent postoperative wound infections.

  3. Tuning of the Lethal Response to Multiple Stressors with a Single-Site Mutation during Clinical Infection by Staphylococcus aureus

    Directory of Open Access Journals (Sweden)

    Krishan Kumar

    2017-10-01

    Full Text Available The agr system of Staphylococcus aureus promotes invasion of host tissues, and as expected, agents that block agr quorum sensing have anti-infective properties. Paradoxically, agr-defective mutants are frequently recovered from patients, especially those persistently infected with S. aureus. We found that an agr deficiency increased survival of cultured bacteria during severe stress, such as treatment with gentamicin, ciprofloxacin, heat, or low pH. With daptomycin, deletion of agr decreased survival. Therefore, agr activity can be either detrimental or protective, depending on the type of lethal stress. Deletion of agr had no effect on the ability of the antimicrobials to block bacterial growth, indicating that agr effects are limited to lethal action. Thus, the effect of an agr deletion is on bacterial tolerance, not resistance. For gentamicin and daptomycin, activity can be altered by agr-regulated secreted factors. For ciprofloxacin, a detrimental function was downregulation of glutathione peroxidase (bsaA, an enzyme responsible for defense against oxidative stress. Deficiencies in agr and bsaA were epistatic for survival, consistent with agr having a destructive role mediated by reactive oxygen species. Enhanced susceptibility to lethal stress by wild-type agr, particularly antimicrobial stress, helps explain why inactivating mutations in S. aureus agr commonly occur in hospitalized patients during infection. Moreover, the agr quorum-sensing system of S. aureus provides a clinically relevant example in which a single-step change in the response to severe stress alters the evolutionary path of a pathogen during infection.

  4. Strain Specific Phage Treatment for Staphylococcus aureus Infection Is Influenced by Host Immunity and Site of Infection.

    Directory of Open Access Journals (Sweden)

    Nathan B Pincus

    Full Text Available The response to multi-drug resistant bacterial infections must be a global priority. While mounting resistance threatens to create what the World Health Organization has termed a "post-antibiotic era", the recent discovery that antibiotic use may adversely impact the microbiome adds further urgency to the need for new developmental approaches for anti-pathogen treatments. Methicillin-resistant Staphylococcus aureus (MRSA, in particular, has declared itself a serious threat within the United States and abroad. A potential solution to the problem of antibiotic resistance may not entail looking to the future for completely novel treatments, but instead looking into our history of bacteriophage therapy. This study aimed to test the efficacy, safety, and commercial viability of the use of phages to treat Staphylococcus aureus infections using the commercially available phage SATA-8505. We found that SATA-8505 effectively controls S. aureus growth and reduces bacterial viability both in vitro and in a skin infection mouse model. However, this killing effect was not observed when phage was cultured in the presence of human whole blood. SATA-8505 did not induce inflammatory responses in peripheral blood mononuclear cultures. However, phage did induce IFN gamma production in primary human keratinocyte cultures and induced inflammatory responses in our mouse models, particularly in a mouse model of chronic granulomatous disease. Our findings support the potential efficacy of phage therapy, although regulatory and market factors may limit its wider investigation and use.

  5. Strain Specific Phage Treatment for Staphylococcus aureus Infection Is Influenced by Host Immunity and Site of Infection.

    Science.gov (United States)

    Pincus, Nathan B; Reckhow, Jensen D; Saleem, Danial; Jammeh, Momodou L; Datta, Sandip K; Myles, Ian A

    2015-01-01

    The response to multi-drug resistant bacterial infections must be a global priority. While mounting resistance threatens to create what the World Health Organization has termed a "post-antibiotic era", the recent discovery that antibiotic use may adversely impact the microbiome adds further urgency to the need for new developmental approaches for anti-pathogen treatments. Methicillin-resistant Staphylococcus aureus (MRSA), in particular, has declared itself a serious threat within the United States and abroad. A potential solution to the problem of antibiotic resistance may not entail looking to the future for completely novel treatments, but instead looking into our history of bacteriophage therapy. This study aimed to test the efficacy, safety, and commercial viability of the use of phages to treat Staphylococcus aureus infections using the commercially available phage SATA-8505. We found that SATA-8505 effectively controls S. aureus growth and reduces bacterial viability both in vitro and in a skin infection mouse model. However, this killing effect was not observed when phage was cultured in the presence of human whole blood. SATA-8505 did not induce inflammatory responses in peripheral blood mononuclear cultures. However, phage did induce IFN gamma production in primary human keratinocyte cultures and induced inflammatory responses in our mouse models, particularly in a mouse model of chronic granulomatous disease. Our findings support the potential efficacy of phage therapy, although regulatory and market factors may limit its wider investigation and use.

  6. A surgical site infection cluster: the process and outcome of an investigation--the impact of an alcohol-based surgical antisepsis product and human behavior.

    Science.gov (United States)

    Haessler, Sarah; Connelly, Neil Roy; Kanter, Gary; Fitzgerald, Jan; Scales, Mary Ellen; Golubchik, Anneta; Albert, Michael; Gibson, Charles

    2010-04-01

    The institution of a process used to successfully execute a perioperative antibiotic administration system is but 1 component of preventing postoperative infections. Continued surveillance of infections is an important part of the process of decreasing postoperative infections. We recently experienced an increase in the number of postoperative infections in our patients. Using standard infection control methods of outbreak investigation, we tracked multiple variables to search for a common cause. We describe herein the process by which Quality Improvement methodology was used to investigate and manage this surgical site infection (SSI) cluster. As part of routine surveillance for SSI, the infection control division seeks out evidence of postoperative infections. Patients were defined as having an SSI according to National Healthcare Safety Network SSI criteria. SSI data are reviewed monthly and aggregated on a quarterly basis. The SSI rate was above our usual level for 3 consecutive quarters of 2007. This increase in the infection rate led to an internal outbreak investigation, termed a "cluster investigation." This investigation comprised multiple concurrent methods including manual chart review of all cases; review of microbiological data; and inspection of operating rooms, instrument processing facilities, and storage areas. During 3 quarters, a trend emerged in our general surgical population that demonstrated that 4 surgical types had a sustained increase in SSI. The institutional antibiotic protocol was appropriate for prevention of the majority of these SSIs. As part of the investigation, direct observation of hand hygiene and surgical hand antisepsis technique was undertaken. At this time, there were 2 types of surgical hand preparation being used, at the discretion of the clinician: either a "standard" scrub with an antimicrobial soap or the application of a chlorhexidine gluconate and alcohol-based surgical hand antisepsis product. Observers noted

  7. Intracavity lavage and wound irrigation for prevention of surgical site infection.

    Science.gov (United States)

    Norman, Gill; Atkinson, Ross A; Smith, Tanya A; Rowlands, Ceri; Rithalia, Amber D; Crosbie, Emma J; Dumville, Jo C

    2017-10-30

    Surgical site infections (SSIs) are wound infections that occur after an operative procedure. A preventable complication, they are costly and associated with poorer patient outcomes, increased mortality, morbidity and reoperation rates. Surgical wound irrigation is an intraoperative technique, which may reduce the rate of SSIs through removal of dead or damaged tissue, metabolic waste, and wound exudate. Irrigation can be undertaken prior to wound closure or postoperatively. Intracavity lavage is a similar technique used in operations that expose a bodily cavity; such as procedures on the abdominal cavity and during joint replacement surgery. To assess the effects of wound irrigation and intracavity lavage on the prevention of surgical site infection (SSI). In February 2017 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase and EBSCO CINAHL Plus. We also searched three clinical trials registries and references of included studies and relevant systematic reviews. There were no restrictions on language, date of publication or study setting. We included all randomised controlled trials (RCTs) of participants undergoing surgical procedures in which the use of a particular type of intraoperative washout (irrigation or lavage) was the only systematic difference between groups, and in which wounds underwent primary closure. The primary outcomes were SSI and wound dehiscence. Secondary outcomes were mortality, use of systemic antibiotics, antibiotic resistance, adverse events, re-intervention, length of hospital stay, and readmissions. Two review authors independently assessed studies for inclusion at each stage. Two review authors also undertook data extraction, assessment of risk of bias and GRADE assessment. We calculated risk ratios or differences in means with 95% confidence intervals where possible. We included 59 RCTs with 14,738 participants. Studies assessed comparisons

  8. The Use of Vacuum Dressings for Dead Space Management in Deep Surgical Site Infections Allows Implant and Bone Graft Retention.

    Science.gov (United States)

    Watt, James P; Dunn, Robert N

    2017-12-01

    Retrospective, descriptive study. Managing early surgical site infection following elective lumbar spine surgery remains a challenge with controversy regarding retention of instrumentation and bone graft. Wound closure may also pose considerable challenges. We aim to report on our method of managing deep surgical site infections complicating elective spine surgery with surgeon assembled deep vacuum dressings. Identification of causative organisms with their sensitivities was a secondary objective. Patients were identified from a prospectively maintained, single-surgeon database from 2003-2015. Patients who had an infective or trauma related diagnosis, cervical procedures, and were younger than 18 years were excluded. Records were reviewed to identify bacteriology, laboratory tests performed, antibiotics administered, and type and frequency of surgical management. One thousand two hundred twenty patients qualified for inclusion, with 19 identified as having developed acute wound sepsis. All patients had surgical debridement on the day of presentation and the majority of wounds were managed with a vacuum dressing. In all but 1 patient was instrumentation retained. Specimens for culture were taken at each debridement and antibiotics changed accordingly. Patients received a minimum 6 weeks of antibiotics. The management of deep surgical site infection is labor intensive and frustrating for both surgeon and patient due to the unexpected prolonged admission. Management goals are identification and eradication of the causative organism with subsequent healing of the surgical wound. This process is enhanced with the use of negative-suction dressings made from theatre stock replaced at regular intervals and allows retention of bone graft and instrumentation in the majority of cases.

  9. Type-II NADH:quinone oxidoreductase from Staphylococcus aureus has two distinct binding sites and is rate limited by quinone reduction.

    Science.gov (United States)

    Sena, Filipa V; Batista, Ana P; Catarino, Teresa; Brito, José A; Archer, Margarida; Viertler, Martin; Madl, Tobias; Cabrita, Eurico J; Pereira, Manuela M

    2015-10-01

    A prerequisite for any rational drug design strategy is understanding the mode of protein-ligand interaction. This motivated us to explore protein-substrate interaction in Type-II NADH:quinone oxidoreductase (NDH-2) from Staphylococcus aureus, a worldwide problem in clinical medicine due to its multiple drug resistant forms. NDHs-2 are involved in respiratory chains and recognized as suitable targets for novel antimicrobial therapies, as these are the only enzymes with NADH:quinone oxidoreductase activity expressed in many pathogenic organisms. We obtained crystal and solution structures of NDH-2 from S. aureus, showing that it is a dimer in solution. We report fast kinetic analyses of the protein and detected a charge-transfer complex formed between NAD(+) and the reduced flavin, which is dissociated by the quinone. We observed that the quinone reduction is the rate limiting step and also the only half-reaction affected by the presence of HQNO, an inhibitor. We analyzed protein-substrate interactions by fluorescence and STD-NMR spectroscopies, which indicate that NADH and the quinone bind to different sites. In summary, our combined results show the presence of distinct binding sites for the two substrates, identified quinone reduction as the rate limiting step and indicate the establishment of a NAD(+)-protein complex, which is released by the quinone. © 2015 John Wiley & Sons Ltd.

  10. The Adjunctive Use of Vancomycin Powder Appears Safe and May Reduce the Incidence of Surgical-Site Infections After Deep Brain Stimulation Surgery.

    Science.gov (United States)

    Rasouli, Jonathan J; Kopell, Brian Harris

    2016-11-01

    Postoperative surgical-site infections (SSIs) are a common complication after deep brain stimulation (DBS) surgery, occurring at a quoted rate of approximately 1%-9%. Intraoperative vancomycin powder has demonstrated efficacy in reducing SSIs after cranial and spinal surgery; however, its use during DBS surgery has yet to be established. In this study, we describe the senior author's experience with the use of intraoperative vancomycin powder to prevent SSIs after DBS surgery. We retrospectively examined the incidence of SSI in 297 patients who underwent DBS surgery at the Mount Sinai Health System from September 2012 to December 2015. All patients underwent a uniform perioperative antiseptic protocol, including thorough skin cleansing, intravenous anticephalosporin antibiotics, copious irrigation, and the application of topical vancomycin powder (1 g) before skin closure. Patient information was obtained through a review of electronic medical records. Primary outcome was the incidence of SSI, which was defined per the standards of the Centers for Disease Control and Prevention and confirmed with wound cultures. Four patients developed clinical signs and symptoms of SSI (1.3%); all were men with Parkinson disease. The primary organism responsible was Staphylococcus aureus (75%). Two patients presented with neurostimulator infections, and 2 presented with parietal connector-site infections between 2 months and 1 year after initial surgery. No patients in our series developed topical or systemic reactions attributable to the use of vancomycin powder. In our experience, vancomycin powder has demonstrated safety and efficacy as an adjunct medication for infection prophylaxis after DBS surgery. Further prospective studies with larger patient cohorts are warranted. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. The Impact of Kidney Disease on Acute Tubular Necrosis and Surgical Site Infection After Lumbar Fusion.

    Science.gov (United States)

    Nakhla, Jonathan; de la Garza Ramos, Rafael; Bhashyam, Niketh; Kobets, Andrew; Nasser, Rani; Echt, Murray; Lang, Gernot; Navarro-Ramirez, Rodrigo; Jada, Ajit; Kinon, Merritt; Yassari, Reza

    2017-09-01

    Kidney disease in spine surgery can be associated with serious complications. To investigate the rate of acute tubular necrosis (ATN) and surgical site infection (SSI) after lumbar fusion in patients with kidney disease. A review of the U.S. Nationwide Inpatient Sample from 2002 to 2011 was performed to identify patients who underwent lumbar fusion for degenerative spine disease or disk herniation. Four groups were established: no kidney disease, chronic kidney disease (CKD), end-stage renal disease (ESRD), and posttransplant. A multivariate analysis was performed to control for age, sex, and comorbidities. A total of 268,158 patients met the criteria; 263,757 with no kidney disease (98.4%), 3576 with CKD (1.3%), 586 with ESRD (0.2%), and 239 posttransplant (0.1%). Rates of ATN were 0.1%, 2.9%, 3.6%, and 0.0% for the 4 groups, respectively (P < 0.001). Rates of SSI were 0.3%, 0.4%, 1.0%, and 0.0%, respectively (P = 0.002). After controlling for patient age, sex, and medical comorbidities, patients with CKD (odds ratio [OR], 5.42; 95% confidence interval [CI], 4.14-7.09; P < 0.001) and ESRD (OR, 6.32; 95% CI, 3.89-10.33; P < 0.001) were significantly more likely to develop ATN compared with patients without kidney disease. However, CKD (OR, 0.80; 95% CI, 0.20-3.12; P = 0.754) or ESRD (OR, 1.96; 95% CI, 0.38-10.00; P = 0.415) did not increase the risk for SSI on multivariate analysis. The rate of ATN significantly increases based on severity of kidney disease. However, patients with transplants have ATN and SSI rates comparable with patients without kidney disease. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Short Operative Duration and Surgical Site Infection Risk in Hip and Knee Arthroplasty Procedures

    Science.gov (United States)

    Dicks, Kristen V.; Baker, Arthur W.; Durkin, Michael J.; Anderson, Deverick J.; Moehring, Rebekah W.; Chen, Luke F.; Sexton, Daniel J.; Weber, David J.; Lewis, Sarah S.

    2016-01-01

    OBJECTIVE To determine the association (1) between shorter operative duration and surgical site infection (SSI) and (2) between surgeon median operative duration and SSI risk among first-time hip and knee arthroplasties. DESIGN Retrospective cohort study SETTING A total of 43 community hospitals located in the southeastern United States. PATIENTS Adults who developed SSIs according to National Healthcare Safety Network criteria within 365 days of first-time knee or hip arthroplasties performed between January 1, 2008 and December 31, 2012. METHODS Log-binomial regression models estimated the association (1) between operative duration and SSI outcome and (2) between surgeon median operative duration and SSI outcome. Hip and knee arthroplasties were evaluated in separate models. Each model was adjusted for American Society of Anesthesiology score and patient age. RESULTS A total of 25,531 hip arthroplasties and 42,187 knee arthroplasties were included in the study. The risk of SSI in knee arthroplasties with an operative duration shorter than the 25th percentile was 0.40 times the risk of SSI in knee arthroplasties with an operative duration between the 25th and 75th percentile (risk ratio [RR], 0.40; 95% confidence interval [CI], 0.38–0.56; P operative duration did not demonstrate significant association with SSI for hip arthroplasties (RR, 1.04; 95% CI, 0.79–1.37; P =.36). Knee arthroplasty surgeons with shorter median operative durations had a lower risk of SSI than surgeons with typical median operative durations (RR, 0.52; 95% CI, 0.43–0.64; P operative durations were not associated with a higher SSI risk for knee or hip arthroplasty procedures in our analysis. PMID:26391277

  13. Surgical Site Infection Reduction by the Solutions for Patient Safety Hospital Engagement Network.

    Science.gov (United States)

    Schaffzin, Joshua K; Harte, Lory; Marquette, Scott; Zieker, Karen; Wooton, Sharyl; Walsh, Kathleen; Newland, Jason G

    2015-11-01

    Surgical site infections (SSIs) negatively affect patients and the health care system. National standards for SSI prevention do not exist in pediatric settings. We sought to reduce SSI-related harm by implementing a prevention bundle through the Solutions for Patient Safety (SPS) national hospital engagement network. Our study period was January 2011 to December 2013. We formed a national workgroup of content and quality improvement experts. We focused on 3 procedure types at high risk for SSIs: cardiothoracic, neurosurgical shunt, and spinal fusion surgeries. We used the Model for Improvement methodology and the Centers for Disease Control and Prevention SSI definition. After literature review and consultation with experts, we distributed a recommended bundle among network partners. Institutions were permitted to adopt all or part of the bundle and reported local bundle adherence and SSI rates monthly. Our learning network used webinars, discussion boards, targeted leader messaging, and in-person learning sessions. Recommended bundle elements encompassed proper preoperative bathing, intraoperative skin antisepsis, and antibiotic delivery. Within 6 months, the network achieved 96.7% reliability among institutions reporting adherence data. A 21% reduction in SSI rate was reported across network hospitals, from a mean baseline rate of 2.5 SSIs per 100 procedures to a mean rate of 1.8 SSIs per 100 procedures. The reduced rate was sustained for 15 months. Adoption of a SSI prevention bundle with concomitant reliability measurement reduced the network SSI rate. Linking reliability measurement to standardization at an institutional level may lead to safer care. Copyright © 2015 by the American Academy of Pediatrics.

  14. Randomized trial of antimicrobial-coated sutures to prevent surgical site infection after breast cancer surgery.

    Science.gov (United States)

    Williams, Nia; Sweetland, Helen; Goyal, Sumit; Ivins, Nicola; Leaper, David J

    2011-12-01

    Surgical site infection (SSI) is the fourth commonest healthcare-associated infection and complicates at least 5% of open operations. In a randomized clinical trial, antimicrobial-coated sutures were compared with their conventional counterparts, polyglactin and poliglecaprone, for skin closure after breast cancer surgery to assess their role in reducing the rate of SSI. Between November 2008 and February 2011, 150 female patients presenting with breast cancer to a single center were randomized to skin closure with antimicrobial-coated or plain sutures. Postoperatively, SSI was defined using the U.S. Centers for Disease Control and Prevention (CDC) definitions and scored using the ASEPSIS or Southampton systems by trained, blinded observers with close post-discharge surveillance and patient diaries. Surgeons and patients were blinded to the type of suture used. Using CDC criteria, the overall rate of SSI was 18.9% at six weeks. Six patients (4.7%) needed intervention or readmission for SSI. Skin closure with antimicrobial sutures showed a non-statistically significant reduction in the SSI rate, to 15.2%, compared with conventional sutures (22.9%). A uniform tendency for fewer SSIs in the antimicrobial-coated suture group was found using ASEPSIS and Southampton scores, but again, the difference was not statistically significant. The previously reported high rate of SSI related to breast surgery was confirmed. Using statistical modeling and earlier reports, the study was powered to show a difference using ASEPSIS scores, but the modification used in this trial failed to find a difference. Finding a statistically significant difference would have needed two to three times the number of patients recruited. Further evaluation of antimicrobial-coated sutures is merited, particularly if used as part of a care bundle to reduce SSI after breast cancer surgery.

  15. Incidence and risk factors of surgical site infection and septic arthritis after elective arthroscopy in horses.

    Science.gov (United States)

    Brunsting, Julie Y; Pille, Frederik J; Oosterlinck, Maarten; Haspeslagh, Maarten; Wilderjans, Hans C

    2017-10-16

    To determine the incidence of infection and associated risk factors, after elective arthroscopy. Retrospective case study. Horses (n=1079) undergoing elective arthroscopy. Medical records of all horses that underwent elective arthroscopy between 2006 and 2013 were reviewed. Age, gender, breed, surgeon, number of joints operated, total anesthetic time, perioperative antimicrobial administration, and the presence and size of osteochondral fragments/subchondral lesions were recorded. For each operated joint, the development of postoperative infection (surgical site infection [SSI] and/or septic arthritis) and long-term outcome (>6 months) were recorded. Multivariate logistic regression was used to test for association between the independent variables and the dependent outcomes. A total of 1741 joints in 1079 horses underwent arthroscopy. SSI without septic arthritis occurred in 1 fetlock joint (0.14%), 1 tibiotarsal joint (0.19%), and 6 femoropatellar joints (1.67%). Thirteen joints (0.75%) were diagnosed with septic arthritis, including 1 fetlock joint (0.14%), 4 tibiotarsal joints (0.74%), and 8 femoropatellar joints (2.23%). The probability of postoperative SSI was higher when large lesions (>40 mm long) were treated, compared to medium (20-40 mm, P = .005) and small (<20 mm, P < .001) lesions. SSI was a significant risk factor for the development of septic arthritis (P < .001). Although age did not affect the incidence of SSI, increasing age was associated with a lower rate of septic arthritis rate (P = .028). Septic arthritis after elective arthroscopy was more likely in the presence of SSI and younger age. Horses with large lesions were at risk for SSI, which translated into a higher incidence of postoperative septic arthritis after femoropatellar arthroscopy. © 2017 The American College of Veterinary Surgeons.

  16. Nasal photodisinfection and chlorhexidine wipes decrease surgical site infections: a historical control study and propensity analysis.

    Science.gov (United States)

    Bryce, E; Wong, T; Forrester, L; Masri, B; Jeske, D; Barr, K; Errico, S; Roscoe, D

    2014-10-01

    Pre-operative decolonization therapy (DcTx) using chlorhexidine (CHG) body washes and/or intranasal mupirocin can reduce surgical site infections (SSIs), but compliance is often suboptimal. To assess the effectiveness of immediate DcTx using a novel approach of intranasal antimicrobial photodisinfection therapy (PDT) combined with CHG body wipes for the reduction of SSIs. Between 1(st) September 2011 and 31(st) August 2012, 3068 elective cardiac, orthopaedic, spinal, vascular, thoracic and neurosurgical patients were treated with CHG in the 24h preceding surgery, and received intranasal PDT in the pre-operative area. SSI surveillance methodology remained unchanged from previous years and patients were followed for one year. Results were compared with those for a four-year historical control group of 12,387 patients as well as those for a concurrent control group of 206 untreated patients. A significant reduction in the SSI rate was observed between treated patients and the historical control group [1.6% vs 2.7%, P = 0.0004, odds ratio (OR) 1.73, 95% confidence interval (CI) 1.2815-2.3453]. This significant reduction was maintained on intent-to-treat analysis (P = 0.021, OR 1.37, 95% CI 1.0476−1.7854) [corrected]. Overall compliance with DcTx was 94%. A 1:4 propensity score analysis of matched treated and untreated patients demonstrated that DcTx reduced the risk of SSIs significantly (P = 0.00026, z = 3.65). The combination of CHG wipes and PDT immediately before surgery reduced SSIs, achieved excellent compliance, and was easily integrated into the pre-operative routine. Copyright © 2014 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  17. Surgical Site Infection (SSI) After Breast Surgery: Impact of 2010 CDC Reporting Guidelines

    Science.gov (United States)

    Degnim, Amy C.; Throckmorton, Alyssa D.; Boostrom, Sarah Y.; Boughey, Judy C.; Holifield, Andrea; Baddour, Larry M.; Hoskin, Tanya L.

    2014-01-01

    Introduction Reported surgical site infection (SSI) rates after breast operations range from 0.8–26% in the literature. Aims of the present study were to characterize SSI after breast/axillary operations and determine the impact on the SSI rate of the 2010 Centers for Disease Control and Prevention (CDC) reporting guidelines that now specifically exclude cellulitis. Methods Retrospective chart review identified 368 patients, with 449 operated sides, between 07/2004 and 6/2006. SSI was defined using CDC criteria: purulent drainage (CDC #1), positive aseptically collected culture (CDC #2), signs of inflammation with opening of incision and absence of negative culture (CDC#3), or physician diagnosis of infection (CDC #4). The impact of excluding cellulitis was assessed. Results Using prior CDC reporting guidelines, among 368 patients, 32 (8.7%) experienced SSI in 33/449 (7.3%) operated sides. Of these, 11 (33%) met CDC criteria 1–3, while 22 (67%) met CDC criterion 4. Excluding cellulitis cases per 2010 CDC SSI reporting guidelines eliminates 21 of the 22 infections previously meeting CDC criterion 4. Under the new reporting guidelines, the SSI rate is 12/449 (2.7%) operated sides. SSI rates varied by procedure but these differences were not statistically significant. Conclusions Cellulitis after breast and axillary surgery is much more common than other criteria for SSI, and SSI rates are reduced almost three-fold if cellulitis cases are excluded. Recently revised CDC reporting guidelines may result in underestimates of the clinical burden of SSI after breast/axillary surgery. PMID:22732837

  18. Risk Factors for Surgical Site Infection After Spinal Surgery: A Meta-Analysis.

    Science.gov (United States)

    Fei, Qi; Li, Jinjun; Lin, JiSheng; Li, Dong; Wang, BingQiang; Meng, Hai; Wang, Qi; Su, Nan; Yang, Yong

    2016-11-01

    Surgical-site infection (SSI) after spinal surgery is the most common complication, which results in greater morbidity, mortality, and health care costs. Identifying risk factors of SSI is an important point for preventive strategies to reduce the incidence of SSI. The aim of this meta-analysis is to investigate the most important risk factors for SSI after spinal surgery. PubMed, Embase, and Web of Science were systematically searched to identify cohort or case-control studies that investigated the risk factors for SSI following spinal surgery. A fixed-effects or random-effects model was used to pool the estimates, depending on the heterogeneity among the included studies. Heterogeneity between the studies was assessed by I2 and Cochran's Q test. Twelve studies with a total of 13,476 patients met the inclusion criteria were included in this meta-analysis. Of them, 1 was a nested case-control studies, 7 were case-control studies, and 4 were cohort studies. The most important predictors of SSI were diabetes (risk ratio [RR] = 2.22, 95% confidence interval [95% CI] 1.38-3.60; P = 0.001), prolonged operative times (>3 hours) (RR = 2.16, 95% CI 1.12-4.19; P = 0.009), body mass index more than 35 (RR = 2.36, 95% CI 1.47-3.80; P = 0.000), and posterior approach (RR = 1.22, 95% CI 1.05-1.41; P = 0.009). Diabetes, prolonged operative times (>3 hours), body mass index more than 35, posterior approach, and number of intervertebral levels (≥7) are associated with an increased risk of SSI after spinal surgery. Almost all these risk factors are in line with the known risk factors for SSI in patients who underwent spinal surgery. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. A benchmark too far: findings from a national survey of surgical site infection surveillance.

    Science.gov (United States)

    Tanner, J; Padley, W; Kiernan, M; Leaper, D; Norrie, P; Baggott, R

    2013-02-01

    The national surgical site infection (SSI) surveillance service in England collates and publishes SSI rates that are used for benchmarking and to identify the prevalence of SSIs. However, research studies using high-quality SSI surveillance report rates that are much higher than those published by the national surveillance service. This variance questions the validity of data collected through the national service. To audit SSI definitions and data collection methods used by hospital trusts in England. All 156 hospital trusts in England were sent questionnaires that focused on aspects of SSI definitions and data collection methods. Completed questionnaires were received from 106 hospital trusts. There were considerable differences in data collection methods and data quality that caused wide variation in reported SSI rates. For example, the SSI rate for knee replacement surgery was 4.1% for trusts that used high-quality postdischarge surveillance (PDS) and 1.5% for trusts that used low-quality PDS. Contrary to national protocols and definitions, 10% of trusts did not provide data on superficial infections, 15% of trusts did not use the recommended SSI definition, and 8% of trusts used inpatient data alone. Thirty trusts did not submit a complete set of their data to the national surveillance service. Unsubmitted data included non-mandatory data, PDS data and continuous data. The national surveillance service underestimates the prevalence of SSIs and is not appropriate for benchmarking. Hospitals that conduct high-quality SSI surveillance will be penalized within the current surveillance service. Copyright © 2012 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  20. Timing of Antibiotic Prophylaxis for Preventing Surgical Site Infections in Foot and Ankle Surgery.

    Science.gov (United States)

    Tantigate, Direk; Jang, Eugene; Seetharaman, Mani; Noback, Peter C; Heijne, A M; Greisberg, Justin K; Vosseller, J Turner

    2017-03-01

    Surgical site infections (SSIs) are one of the most troublesome complications after foot and ankle surgery. Previous literature has emphasized the significance of appropriate timing of antibiotic prophylaxis. However, the optimal timing of antibiotic prophylaxis for SSI prevention is still inconclusive. Our study aimed to investigate the optimal timing of antibiotic administration and to elucidate the risk factors for SSIs in foot and ankle surgery. A retrospective review of 1933 foot and ankle procedures in 1632 patients from January 1, 2011, through August 31, 2015, was performed. Demographic data; type, amount, and timing of antibiotic administration; incision; and closure time were recorded. Subsequent wound infection and incision and drainage procedure (I&D) within 30 days and 90 days were documented. Outcomes and demographic variables were compared between procedures in which antibiotics were administered less than 15 minutes and between 15 to 60 minutes prior to incision. A total of 1569 procedures met inclusion criteria. There were 17 cases (1.1%) of subsequent wound infection, of which 6 required a subsequent I&D within 30 days. There were 63 additional cases (4%) of wound complications, which did not meet SSI criteria. When comparing SSI and non-SSI groups, the only significant independent predictors were longer surgeries and nonambulatory surgeries (both P foot and ankle surgeries, the timing of intravenous antibiotic prophylaxis did not appear to play a significant role in the risk of SSI. Host factors and duration of surgery appear to have played a much larger role in SSI than the timing of antibiotic prophylaxis. Level III, retrospective comparative study.

  1. Surgical site infection after stoma closure in children: outcomes and predictors.

    Science.gov (United States)

    Gonzalez, Dani O; Ambeba, Erica; Minneci, Peter C; Deans, Katherine J; Nwomeh, Benedict C

    2017-03-01

    Surgical site infection (SSI) is a burdensome complication following intestinal stoma closure, with reported rates ranging from 0% to 40%. We aimed to identify risk factors for SSI in children undergoing stoma closure. Using 2012-2014 NSQIP Pediatric data, we identified patients aged 0-18 years undergoing stoma closure. Demographic, clinical, and 30-day outcome characteristics between children with and without SSI were compared. A multivariable logistic model was used to identify predictors of SSI. Among 2110 children who underwent stoma closure, 7.6% developed SSI. Patients who developed SSI had significantly longer time in the operating room, longer anesthesia times, longer total operation times, and longer lengths of stay (all P ≤ 0.01). Patients who developed SSI postoperatively had significantly higher rates of postoperative complications, including need for postoperative ventilation, sepsis, need for nutritional support on discharge, unplanned reoperation, unplanned readmission, postoperative lengths of stay >30 days, and transfusion within 72 hours after the start of surgery (all P ≤ 0.018). There was a significant relationship between operation time and SSI probability. Specifically, operation time greater than 105 minutes was associated with a higher SSI risk. On adjusted multivariable analyses, age, cardiac risk factors, Hirschsprung disease, and operation time greater than 105 minutes were independently predictive of SSI. Longer operation time, age, Hirschsprung disease, and cardiac risk factors are associated with an increased risk for SSI after stoma closure. Studies of perioperative adjuncts to reduce SSI in high-risk children based on expected procedure length and other preoperative characteristics are warranted. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Systematic review of risk factors for surgical site infection in pediatric scoliosis surgery.

    Science.gov (United States)

    Subramanyam, Rajeev; Schaffzin, Joshua; Cudilo, Elizabeth M; Rao, Marepalli B; Varughese, Anna M

    2015-06-01

    Risk factors for surgical site infection (SSI) in children derived from the studies in the adult population are potentially misleading because of differences in pathophysiology and management. This systematic review addresses the key question: What are the risk factors for SSI in pediatric patients undergoing scoliosis surgery? This is a qualitative systematic literature review. Retrospective and observational trials of children undergoing scoliosis surgery reported on the occurrence of risk factors for SSI and the occurrence of SSI. Pubmed (Medline), Ovid Evidence-Based Medicine Reviews (EBMR), Scopus, and Cumulative Index to Nursing and Allied Health (CINAHL) were searched electronically for relevant articles in all the languages between January 1, 1991 and August 27, 2012, and cross-references were checked. Two independent reviewers identified articles and appraised quality with the Agency for Healthcare Research and Quality (AHRQ) criteria based on a weighted scoring of 0 to 100. Our search identified 135 abstracts and 14 studies meeting the inclusion criteria. The AHRQ grading showed that five articles were high quality with a score of greater than 67, and five articles were moderate quality with a score between 50 and 67. The percent agreement between the two independent reviewers was 84%, and kappa agreement score was 0.91 (95% confidence interval [CI]: 0.78-1.03). There were 76 risk factors identified, of which 22 factors were reported in more than one study. Odds ratios and 95% CIs were reported inconsistently. Pooled p analysis of high- and moderate-quality articles identified five risk factors predictive of SSI: inappropriate antibiotic use (p=.001), neuromuscular scoliosis (p=.014), instrumentation (p=.023), increased hospital stay days (p=.003), and residual postoperative curve (p=.003). The systematic review identified inappropriate antibiotic use, neuromuscular scoliosis, instrumentation, increased hospital stay days, and residual postoperative curve

  3. Perioperative high inspired oxygen fraction therapy reduces surgical site infection with Pseudomonas aeruginosa in rats.

    Science.gov (United States)

    Kroin, Jeffrey S; Li, Jinyuan; Goldufsky, Josef W; Gupta, Kajal H; Moghtaderi, Masoomeh; Buvanendran, Asokumar; Shafikhani, Sasha H

    2016-08-01

    Surgical site infection (SSI) remains one of the most important causes of healthcare-associated infections, accounting for ~17 % of all hospital-acquired infections. Although short-term perioperative treatment with high fraction of inspired oxygen (FiO2) has shown clinical benefits in reducing SSI in colorectal resection surgeries, the true clinical benefits of FiO2 therapy in reducing SSI remain unclear because randomized controlled trials on this topic have yielded disparate results and inconsistent conclusions. To date, no animal study has been conducted to determine the efficacy of short-term perioperative treatments with high (FiO2>60 %) versus low (FiO2oxygen in reducing SSI. In this report, we designed a rat model for muscle surgery to compare the effectiveness of short-term perioperative treatments with high (FiO2=80 %) versus a standard low (FiO2=30 %) oxygen in reducing SSI with Pseudomonas aeruginosa - one of the most prevalent Gram-negative pathogens, responsible for nosocomial SSIs. Our data demonstrate that 5 h perioperative treatment with 80 % FiO2 is significantly more effective in reducing SSI with P. aeruginosa compared to 30 % FiO2 treatment. We further show that whilst 80 % FiO2 treatment does not affect neutrophil infiltration into P. aeruginosa-infected muscles, neutrophils in the 80 % FiO2-treated and infected animal group are significantly more activated than neutrophils in the 30 % FiO2-treated and infected animal group, suggesting that high oxygen perioperative treatment reduces SSI with P. aeruginosa by enhancing neutrophil activation in infected wounds.

  4. Standard abdominal wound edge protection with surgical dressings vs coverage with a sterile circular polyethylene drape for prevention of surgical site infections (BaFO): study protocol for a randomized controlled trial.

    Science.gov (United States)

    Mihaljevic, André L; Michalski, Christoph W; Erkan, Mert; Reiser-Erkan, Carolin; Jäger, Carsten; Schuster, Tibor; Schuhmacher, Christoph; Kleeff, Jörg; Friess, Helmut

    2012-05-15

    Postoperative surgical site infections cause substantial morbidity, prolonged hospitalization, costs and even mortality and remain one of the most frequent surgical complications. Approximately 14% to 30% of all patients undergoing elective open abdominal surgery are affected and methods to reduce surgical site infection rates warrant further investigation and evaluation in randomized controlled trials. To investigate whether the application of a circular plastic wound protector reduces the rate of surgical site infections in general and visceral surgical patients that undergo midline or transverse laparotomy by 50%. BaFO is a randomized, controlled, patient-blinded and observer-blinded multicenter clinical trial with two parallel surgical groups. The primary outcome measure will be the rate of surgical site infections within 45 days postoperative assessed according to the definition of the Center for Disease Control. Statistical analysis of the primary endpoint will be based on the intention-to-treat population. The global level of significance is set at 5% (2 sided) and sample size (n = 258 per group) is determined to assure a power of 80% with a planned interim analysis for the primary endpoint after the inclusion of 340 patients. The BaFO trial will explore if the rate of surgical site infections can be reduced by a single, simple, inexpensive intervention in patients undergoing open elective abdominal surgery. Its pragmatic design guarantees high external validity and clinical relevance.

  5. Daptomycin as a possible new treatment option for surgical management of Methicillin-Resistant Staphylococcus aureus sternal wound infection after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Emmert Alexander

    2010-08-01

    Full Text Available Abstract We present a case of a 77-year old female who had undergone a coronary artery bypass grafting with an aortic valve replacement and developed three month later a Methicillin-Resistant Staphylococcus aureus (MRSA sternal wound infection which was successful treated with Daptomycin combined with vacuum-assisted closure (VAC.

  6. Staphylococcal phage 2638A endolysin is lytic for Staphylococcus aureus and harbors an inter-lytic-domain secondary translational start site.

    Science.gov (United States)

    Abaev, Igor; Foster-Frey, Juli; Korobova, Olga; Shishkova, Nina; Kiseleva, Natalia; Kopylov, Pavel; Pryamchuk, Sergey; Schmelcher, Mathias; Becker, Stephen C; Donovan, David M

    2013-04-01

    Staphylococcus aureus is a notorious pathogen highly successful at developing resistance to virtually all antibiotics to which it is exposed. Staphylococcal phage 2638A endolysin is a peptidoglycan hydrolase that is lytic for S. aureus when exposed externally, making it a new candidate antimicrobial. It shares a common protein organization with more than 40 other reported staphylococcal peptidoglycan hydrolases. There is an N-terminal M23 peptidase domain, a mid-protein amidase 2 domain (N-acetylmuramoyl-L-alanine amidase), and a C-terminal SH3b cell wall-binding domain. It is the first phage endolysin reported with a secondary translational start site in the inter-lytic-domain region between the peptidase and amidase domains. Deletion analysis indicates that the amidase domain confers most of the lytic activity and requires the full SH3b domain for maximal activity. Although it is common for one domain to demonstrate a dominant activity over the other, the 2638A endolysin is the first in this class of proteins to have a high-activity amidase domain (dominant over the N-terminal peptidase domain). The high activity amidase domain is an important finding in the quest for high-activity staphylolytic domains targeting novel peptidoglycan bonds.

  7. Surgical Site Infection Rate Drops to 0% Using a Vacuum-Assisted Closure in Contaminated/Dirty Infected Laparotomy Wounds.

    Science.gov (United States)

    Lozano-Balderas, Gerardo; Ruiz-Velasco-Santacruz, Alejandro; Díaz-Elizondo, José Antonio; Gómez-Navarro, Juan Antonio; Flores-Villalba, Eduardo

    2017-05-01

    Wound site infections increase costs, hospital stay, morbidity, and mortality. Techniques used for wounds management after laparotomy are primary, delayed primary, and vacuum-assisted closures. The objective of this study is to compare infection rates between those techniques in contaminated and dirty/infected wounds. Eighty-one laparotomized patients with Class III or IV surgical wounds were enrolled in a three-arm randomized prospective study. Patients were allocated to each group with the software Research Randomizer® (Urbaniak, G. C., & Plous, S., Version 4.0). Presence of infection was determined by a certified board physician according to Centers for Disease Control's Criteria for Defining a Surgical Site Infection. Twenty-seven patients received primary closure, 29 delayed primary closure, and 25 vacuum-assisted closure, with no exclusions for analysis. Surgical site infection was present in 10 (37%) patients treated with primary closure, 5 (17%) with primary delayed closure, and 0 (0%) patients receiving vacuum-assisted closure. Statistical significance was found between infection rates of the vacuum-assisted group and the other two groups. No significant difference was found between the primary and primary delayed closure groups. The infection rate in contaminated/dirty-infected laparotomy wounds decreases from 37 and 17 per cent with a primary and delayed primary closures, respectively, to 0 per cent with vacuum-assisted systems.

  8. Predictive factors for surgical site infection in head and neck cancer surgery: A case-control study.

    Science.gov (United States)

    Henry, J S; Buffet-Bataillon, S; Deberge, S; Jegoux, F

    2014-01-01

    Surgical Site Infection (SSI) after head and neck cancer surgery may be life threatening and induces increasing in healthcare cost. The objective of this present study was to identify predictive factors associated to surgical site infection in head and neck cancer surgery. Numerous predictive factors were analyzed with univariate case-control method, then with multivariate method. This retrospective study included 71 patients who have been hospitalized in our department during 2010 for a head and neck cancer surgery. The incidence of surgical site infection was 15.5%. The T3-T4 stages were identified as an independent predictive factor (p = 0.04). Our study does not find other predictive factor for a SSI. The NNIS index (National Nosocomial Infections Surveillance), used by the Center for disease control and prevention as predictive factor, was not valid in our study. A specific predictive index should include the tumor stage for Head and Neck Cancer surgery and should be taken into account for the management of a preventive antibiotic treatment.

  9. A Prognostic Model of Surgical Site Infection Using Daily Clinical Wound Assessment.

    Science.gov (United States)

    Sanger, Patrick C; van Ramshorst, Gabrielle H; Mercan, Ezgi; Huang, Shuai; Hartzler, Andrea L; Armstrong, Cheryl A L; Lordon, Ross J; Lober, William B; Evans, Heather L

    2016-08-01

    Surgical site infection (SSI) remains a common, costly, and morbid health care-associated infection. Early detection can improve outcomes, yet previous risk models consider only baseline risk factors (BF) not incorporating a proximate and timely data source-the wound itself. We hypothesize that incorporation of daily wound assessment improves the accuracy of SSI identification compared with traditional BF alone. A prospective cohort of 1,000 post open abdominal surgery patients at an academic teaching hospital were examined daily for serial features (SF), for example, wound characteristics and vital signs, in addition to standard BF, for example, wound class. Using supervised machine learning, we trained 3 Naïve Bayes classifiers (BF, SF, and BF+SF) using patient data from 1 to 5 days before diagnosis to classify SSI on the following day. For comparison, we also created a simplified SF model that used logistic regression. Control patients without SSI were matched on 5 similar consecutive postoperative days to avoid confounding by length of stay. Accuracy, sensitivity/specificity, and area under the receiver operating characteristic curve were calculated on a training and hold-out testing set. Of 851 patients, 19.4% had inpatient SSIs. Univariate analysis showed differences in C-reactive protein, surgery duration, and contamination, but no differences in American Society of Anesthesiologists scores, diabetes, or emergency surgery. The BF, SF, and BF+SF classifiers had area under the receiver operating characteristic curves of 0.67, 0.76, and 0.76, respectively. The best-performing classifier (SF) had optimal sensitivity of 0.80, specificity of 0.64, positive predictive value of 0.35, and negative predictive value of 0.93. Features most associated with subsequent SSI diagnosis were granulation degree, exudate amount, nasogastric tube presence, and heart rate. Serial features provided moderate positive predictive value and high negative predictive value for early

  10. Surgical site infection after total en bloc spondylectomy: risk factors and the preventive new technology.

    Science.gov (United States)

    Hayashi, Hiroyuki; Murakami, Hideki; Demura, Satoru; Kato, Satoshi; Yoshioka, Katsuhito; Shinmura, Kazuya; Yokogawa, Noriaki; Ishii, Takayoshi; Fang, Xiang; Shirai, Toshiharu; Tsuchiya, Hiroyuki

    2015-01-01

    Surgical site infection (SSI) associated with instruments remains a serious and common complication in patients who undergo total en bloc spondylectomy (TES). It is very important that the risk factors for SSI are known to prevent it. The purpose of the study was to identify independent risk factors for SSI after TES and evaluate the positive effect of iodine-supported spinal instruments in the prevention of SSI after TES. This is a retrospective clinical study. One hundred twenty-five patients who underwent TES for vertebral tumor were evaluated. Incidence rate of SSI, risk factors for SSI after TES, and safety of iodine-supported spinal instruments were the outcome measures. Risk factors for SSI were analyzed using logistic regression. In recent 69 patients with iodine-supported spinal instruments, the thyroid hormone levels in the blood were examined to confirm if iodine from the implant influenced thyroid function. Postoperative radiological evaluations were performed regularly. The rate of SSI was 6.4% (8/125 patients). By multivariate logistic regression, combined anterior and posterior approach and nonuse of iodine-supported spinal instruments were associated with an increased risk of SSI. The rate of SSI without iodine-supported spinal instruments was 12.5%, whereas the rate with iodine-supported spinal instruments was 1.4%. This difference was statistically significant. There were no detected abnormalities of thyroid gland function with the use of iodine-supported instruments. Among the 69 patients with iodine-supported spinal instruments, 2 patients required additional surgery because of instrument failure. However, there were no obvious involvements with the use of iodine-supported spinal instruments. This study identified combined anterior and posterior approach and nonuse of iodine-supported spinal instruments to be independent risk factors for SSI after TES. Iodine-supported spinal instrument was extremely effective for prevention of SSI in patients

  11. Central venous oxygen saturation does not correlate with the venous oxygen saturation at the surgical site during abdominal surgery.

    Science.gov (United States)

    Weinrich, Malte; Scheingraber, Stefan; Stephan, Bernhard; Weiss, Christel; Kayser, Anna; Kopp, Berit; Schilling, Martin K

    2008-01-01

    Measurement of central venous oxygen saturation has become a surrogate parameter for fluid administration, blood transfusions and treatment with catecholamines in (early) goal directed therapy in the treatment of acute septic patients. These strategies are not easily transferred to the postoperative management of abdominal surgery due to the different conditions in surgical patients. A study population of 15 patients (8 females/7 males) underwent elective major abdominal surgery: 6 gastrectomies, 5 major liver resections and 4 lower anterior rectum resections. Surgery was performed for primary or secondary malignancy. The patients' age was 65.4+/-12.7 (mean+/-standard deviation, range 44-84, median 62) years. Blood samples were taken intraoperatively from indwelling central venous lines as well as from draining veins at the surgical site. Blood gas analyses to determine the oxygen saturations were performed immediately. All patients were operated in standardized general anesthesia including epidural analgesia and in a balanced volume status. Central venous oxygen saturations and oxygen saturations in blood from the draining veins of the surgical site showed a wide range with high intra- and interindividual differences intraoperatively. Overall, at most time points no correlation between the two oxygen saturations could be detected in three operation types. A significant correlation was only observed at one time point during liver resections. Our results show a lack of correlation between central venous oxygen saturations and oxygen saturations in the draining veins of the surgical site during major abdominal surgery. Measurement of central venous oxygen saturations does not seem to be a good surrogate for the local oxygen supply in the field of interest in major abdominal surgery even under standardized conditions.

  12. Economic and organizational sustainability of a negative-pressure portable device for the prevention of surgical-site complications.

    Science.gov (United States)

    Foglia, Emanuela; Ferrario, Lucrezia; Garagiola, Elisabetta; Signoriello, Giuseppe; Pellino, Gianluca; Croce, Davide; Canonico, Silvestro

    2017-01-01

    Surgical-site complications (SSCs) affect patients' clinical pathway, prolonging their hospitalization and incrementing their management costs. The present study aimed to assess the economic and organizational implications of a portable device for negative-pressure wound therapy (NPWT) implementation, compared with the administration of pharmacological therapies alone for preventing surgical complications in patients undergoing general, cardiac, obstetrical-gynecological, or orthopedic surgical procedures. A total of 8,566 hospital procedures, related to the year 2015 from one hospital, were evaluated considering infection risk index, occurrence rates of SSCs, drug therapies, and surgical, diagnostic, and specialist procedures and hematological exams. Activity-based costing and budget impact analyses were implemented for the economic assessment. Patients developing an SSC absorbed i) 64.27% more economic resources considering the length of stay (€ 8,269±2,096 versus € 5,034±2,901, peconomic resources related to hematological and diagnostic procedures (€ 639±117 versus € 449±72, psustainable strategy for reducing the management costs of patients. Economic and organizational savings could be reinvested, thus i) treating a wider population and ii) reducing waiting lists, with a higher effectiveness in terms of a decrease in complications.

  13. Percutaneous jejunostomy: repeat access at the healed site of prior surgical jejunostomy with US and fluoroscopic guidance.

    Science.gov (United States)

    Morrison, James J; McVinnie, David W; Suiter, Paul A; de Quadros, Nishant M

    2012-12-01

    To evaluate the safety and efficacy of ultrasound (US)- and fluoroscopy-guided jejunostomy tube placement in patients with a history of surgical jejunostomy. Between June 2003 and June 2012, percutaneous US-guided jejunostomy placement was attempted 28 times in 26 patients with a history of surgical jejunostomy (14 men and 12 women). Retrospective chart review was performed to determine procedural success, complications, and interval between original jejunostomy and new tube placement. Clinical outcomes were evaluated with a mean follow-up period of 110 days (range, 3-631 d; median, 68 d). Successful tube placement was achieved in 26 of 28 attempts (92%). The mean time between removal of the original surgical jejunostomy and percutaneous placement of the new tube was 278 days (range, 3 d to 8 y; median, 88 d). A single minor complication involved a tube site infection 4 days after the procedure. There were no major complications. Mean procedure time was 49 minutes (range, 15-125 min; median, 45 min). Percutaneous jejunostomy access can be reliably and safely reestablished with US and fluoroscopic guidance in patients with a history of surgical jejunostomy. Copyright © 2012 SIR. Published by Elsevier Inc. All rights reserved.

  14. Assessing clarity and erasability of commercially available pens for surgical site marking: a comparative study in human volunteers.

    Science.gov (United States)

    Sim, F C J; Angadi, D; Jarvis, G E; Porteous, M

    2016-01-01

    Marking the surgical site is a well-established part of pre-operative protocol and errors in marking have been implicated in wrong site surgery incidents and are a significant patient safety issue. There are many commercially available marker pens and anecdotally very little consistency in which pen is used or the clarity of marking. Previous studies have shown subjective differences between different pens and the current paper sought to support this evidence with objective data and widen the investigation of commercially available pens. Eight marker pens were used to mark two separate sites on three caucasian volunteers. These marks were photographed and assessed by six observers before and after the application of chlorhexidine skin preparation. The observers were blinded to which pen was used for each mark, and rated the clarity of the marks subjectively. The photographs were assessed using image analysis software to give an objective measure of clarity against the skin. There was a wide variation between the clarity of marks made by the different pens, and also a wide variation in the resistance to skin preparation. The Pentel N50 pen was the outstanding best performing pen across all categories. It is recommended that the Pentel N50 black marker pen be used for surgical site marking to improve patient safety and avoid adverse events.

  15. Cervical cancer with a rare umbilical metastases in prior surgical site

    Directory of Open Access Journals (Sweden)

    Shivam Kharod

    2015-01-01

    Conclusion: To our knowledge, this represents the first reported case of a port-site metastasis to an incision site created for an unrelated laparoscopic surgery, performed well in advance of the diagnosis of cervical cancer.

  16. Case of late-onset, relapsing surgical site infection related to a venous coupler placed during free flap reconstruction for major head and neck cancer.

    Science.gov (United States)

    Ren, Yin; Deschler, Daniel G; Sajed, Dipti; Durand, Marlene L

    2018-01-12

    Venous coupling devices are widely used during reconstructive surgery involving microvascular anastomosis but have not served as foreign bodies in head and neck surgical site infections. We conducted a case report. A patient underwent resection and free flap reconstruction for recurrent tongue squamous cell carcinoma. She developed a neck abscess due to Streptococcus intermedius 7 weeks postoperatively, days after starting chemoradiotherapy. The surgical site infection healed with drainage and antibiotics. Two surgical site infection relapses due to S. intermedius occurred 3 and 8 weeks after completing radiation, the second relapse after a prolonged course of i.v. antibiotics. Surgical exploration revealed a venous coupler within granulation tissue. The device was removed and no further surgical site infection relapses occurred. To the best of our knowledge, this is the first report of a delayed-onset head and neck surgical site infection in which a venous coupler served as a foreign body. An infected foreign body should be suspected in relapsing surgical site infections due to a single organism. © 2018 Wiley Periodicals, Inc.

  17. The Allosteric Site for the Nascent Cell Wall in Penicillin-Binding Protein 2a: An Achilles' Heel of Methicillin-Resistant Staphylococcus aureus.

    Science.gov (United States)

    Acebrón, Iván; Chang, Mayland; Mobashery, Shahriar; Hermoso, Juan A

    2015-01-01

    The ability to resist the effect of a wide range of antibiotics makes methicillin-resistant Staphylococcus aureus (MRSA) a leading global human pathogen. A key determinant of resistance to β-lactam antibiotics in this organism is penicillin-binding protein 2a (PBP2a), an enzyme that catalyzes the crosslinking reaction between two adjacent peptide stems during the peptidoglycan biosynthesis. The recently published crystal structure of the complex of PBP2a with ceftaroline, a cephalosporin antibiotic that shows efficacy against MRSA, has revealed the allosteric site at 60-Å distance from the transpeptidase domain. Binding of ceftaroline to the allosteric site of PBP2a triggers conformational changes that lead to the opening of the active site from a closed conformation, where a second molecule of ceftaroline binds to give inhibition of the enzyme. The discovery of allostery in MRSA remains the only known example of such regulation of cellwall biosynthesis and represents a new paradigm in fighting MRSA. This review summarizes the present knowledge of the allosteric mechanism, the conformational changes allowing PBP2a catalysis and the means by which some clinical strains have acquired resistance to ceftaroline by disrupting the allosteric mechanism.

  18. Detection of staphylococcus aureus and streptococcus pyogenes in the personnel of the department of surgery and surgical rooms at the San Jose Universitary Hospital Popayan, Colombia

    Directory of Open Access Journals (Sweden)

    Liliana Caldas

    2010-03-01

    Full Text Available Objective: To detect Staphylococcus aureus and Streptococcus pyogenes in health personnel of the surgical and surgery services at Hospital San José. Methodology. Descriptive, Prospective cross-sectional study. The techniques used were surveys and sampling nasal and pharyngeal microbiological cultures. Results. It was found that from 29 persons under study, 10 (34.40yo were S. aureus carriers, and it was not found S. pyogenes carriers. From the positives, 8 (80% were S. aureus nasal carriers, and 2 (20% pharyngeal carriers. From 8 people (80%, 4 (40% belonged to the department ofsurgery and another 4 (40% to the surgical services; 2 (20% from the pharyngeal positives worked at the surgery services. From the carriers, 5 people (50% were nursing assistants, followed by 4 (40%, who belong to doctors and 1 person (10% belonged to nursing.

  19. Abdominal wall thickness: is it associated with superficial and deep incisional surgical site infection after colorectal surgery?

    Science.gov (United States)

    Kwaan, Mary R; Sirany, Anne Marie E; Rothenberger, David A; Madoff, Robert D

    2013-08-01

    Colorectal surgical procedures have a high rate of surgical site infection (SSI), and obesity has been implicated as a predictor of such infection. We hypothesized that abdominal wall thickness (AWT), as a metric of obesity, would predict postoperative superficial and deep incisional SSI after colorectal surgery, and conducted a study to assess superficial and deep incisional SSI and its relationship to abdominal wall thickness. To measure pre-operative AWT through cross-sectional imaging, and to analyze its relationship to SSI, we conducted a retrospective study at a single academic medical center of patients who had had colorectal resection for any indication in 2008 and 2009. We identified 143 patients for inclusion in the study. Superficial or deep incisional SSI occurred in 43 patients (30%). Abdominal wall thickness at the midpoint between the umbilicus and pubis was associated with SSI (OR 1.03; p=0.014). Body-mass index (BMI) was also significantly associated with SSI (OR 1.08; p=0.014). Other significant (p<0.05) predictors of SSI by univariate analysis included a history of soft tissue infection, a surgical wound classification of 3 or 4, and lack of compliance with perioperative antibiotic guidelines. In a multivariable analysis of factors that were statistically significantly associated with SSI in univariate comparisons, lack of appropriate preoperative antibiotic administration independently predicted SSI (OR 4.33; 95% CI 1.08-17.40), but AWT and BMI were not significantly associated with SSI. Surgical site infection is common after colorectal surgery. Increased AWT predicts SSI by univariate analysis. Our findings could guide further studies of interventions that may decrease the risk of SSIs in patients with a thick abdominal wall.

  20. Quantification of surgical margin length changes after excision of feline injection site sarcomas-A pilot study.

    Science.gov (United States)

    Terry, Jesse L; Milovancev, Milan; Nemanic, Sarah; Löhr, Christiane V

    2017-02-01

    To evaluate degree length change of lateral surgical margins at various stages of processing for histological examination and quantify the length change between grossly normal surgical margins (GNSM) and pathologist-reported histologic tumor-free margin (HTFM) in widely resected feline injection site sarcoma (FISS) specimens. Prospective clinical study. Five client-owned cats with injection site sarcomas. All cats underwent wide surgical excision (35-55 mm gross lateral margins, 2 fascial planes deep). Gross normal lateral margin measurements from tumor edge were recorded in 4 directions (cranial, caudal, dorsal, ventral) at 5 time points: intra-op (in vivo GNSM); immediately following excision (ex vivo GNSM); following formalin fixation (post-fixation GNSM); after trimming and mounting on glass slides (on-slide GNSM); and HTFM at the narrowest point from the HTFM from the same slides used for on-slide GNSM. Percent change in lateral margin length from in vivo measurements was quantified at each time point and compared using 1-way repeated measures ANOVA. The largest mean decrease in percent GNSM length occurred immediately after excision (in vivo to ex vivo GNSM = 29%; P = .016). Formalin fixation, trimming, and mounting on slides did not result in additional significant changes in length. Mean HTFM length was significantly decreased compared to both in vivo GNSM (33%; P = .014) and on-slide GNSM (7%; P = .024). Significant decreases in surgical margin length in FISS specimens occur immediately following excision (prior to formalin fixation). Subgross evaluation of tumor-free margins from on-slide GNSM to HTFM overestimates the actual (histologic) tumor-free margins. © 2016 The American College of Veterinary Surgeons.

  1. Surgical site infections following oral cavity cancer resection and reconstruction is a risk factor for plate exposure.

    Science.gov (United States)

    Yao, Christopher M; Ziai, Hedyeh; Tsang, Gordon; Copeland, Andrea; Brown, Dale; Irish, Jonathan C; Gilbert, Ralph W; Goldstein, David P; Gullane, Patrick J; de Almeida, John R

    2017-04-08

    Plate-related complications following head and neck cancer ablation and reconstruction remains a challenging problem often requiring further management and reconstructive surgeries. We aim to identify an association between surgical site infections (SSI) and plate exposure. A retrospective study between 1997 and 2014 was performed to study the association between postoperative SSI and plate exposures. Eligible patients included those with a history of oral squamous cell carcinoma who underwent surgical resection, neck dissection, and free tissue reconstruction. Demographic and treatment related information was collected. SSI were classified based on CDC definition and previously published literature. Univariable analysis on demographic factors, smoking history, diabetes, radiation, surgical and hardware related factors; while multivariable analysis on SSI, plate height, segmental mandibulectomy defects and radiation were conducted such as using cox proportional hazard models. Three hundred sixty-five patients were identified and included in our study. The mean age of the study group was 59.2 (+/-13.8), with a predominance of male patients (61.9%). 10.7% of our patient cohort had diabetes, and another 63.8% had post-operative radiation therapy. Patients with SSI were more likely to have plate exposure (25 vs. 6.4%, p <0.001). Post-operative SSI, mandibulectomy defects, and plate profile/thickness were associated with plate exposure on univariable analysis (OR = 5.72, p < 0.001; OR = 2.56, p = 0.014; OR = 1.44, p = 0.003 respectively) and multivariable analysis (OR = 5.13, p < 0.001; OR = 1.36, p = 0.017; OR = 2.58, p = 0.02 respectively). Surgical site infections are associated with higher rates of plate exposure. Plate exposure may require multiple procedures to manage and occasionally free flap reconstruction.

  2. Economic and clinical contributions of an antimicrobial barrier dressing: a strategy for the reduction of surgical site infections.

    Science.gov (United States)

    Leaper, David; Nazir, Jameel; Roberts, Chris; Searle, Richard

    2010-01-01

    In patients at risk of surgical site infection (SSI), there is evidence that an antimicrobial barrier dressing (Acticoat* ) applied immediately post-procedure is effective in reducing the incidence of infection. The objective of this study was to assess when it is appropriate to use an antimicrobial barrier dressing rather than a post-operative film dressing, by evaluating the net cost and budget impact of the two strategies. An economic model was developed, which estimates expected expenditure on dressings and the expected costs of surgical site infection during the initial inpatient episode, based on published literature on the pre-discharge costs of surgical infection and the efficacy of an antimicrobial barrier dressing in preventing SSI. At an SSI risk of 10%, an antimicrobial barrier dressing strategy is cost neutral if the incidence of infection is reduced by at least 9% compared with a post-operative film dressing. At 35% efficacy, expenditure on dressings would be higher by £30,760 per 1000 patients, and the cost of treating infection would be lower by £111,650, resulting in a net cost saving of £80,890. The break-even infection risk for cost neutrality is 2.6%. Although this cost analysis is based on published data, there are limitations in methodology: the model is dependent on and subject to the limitations of the data used to populate it. Further studies would be useful to increase the robustness of the conclusions, particularly in a broader range of surgical specialties. A strategy involving the use of an antimicrobial barrier dressing in patients at moderate (5-10%) or high (>10%) risk of infection appears reasonable and cost saving in light of the available clinical evidence.

  3. Pursestring Closure versus Conventional Primary Closure Following Stoma Reversal to Reduce Surgical Site Infection Rate: A Meta-analysis of Randomized Controlled Trials.

    Science.gov (United States)

    Hsieh, Meng-Chiao; Kuo, Liang-Tseng; Chi, Ching-Chi; Huang, Wen-Shih; Chin, Chih-Chien

    2015-08-01

    Stoma reversal is a surgical procedure commonly used following temporary defunctioning stoma surgery. Surgical site infection is one of the most common postoperative morbidities. A few skin closure methods have been developed to decrease surgical site infection. However, the optimal skin closure method is still in debate. The aim of this study was to compare the surgical site infection rate and other postoperative outcomes between the pursestring closure and conventional primary closure techniques. We searched the MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for relevant trials. We conducted a meta-analysis of randomized controlled trials that compared the surgical outcomes following pursestring closure and conventional primary closure techniques. We conducted the meta-analysis by using the random-effects model. The primary outcome of interest was surgical site infection following stoma reversal within 30 days after operation. This meta-analysis included 4 randomized controlled trials with a total of 319 participants (162 in the pursestring closure group and 157 in the conventional primary closure group). Compared with the conventional primary closure group, the pursestring closure group had a significant decrease in surgical site infection (risk difference, -0.25; 95% CI, -0.36 to -0.15; p stoma reversal than conventional primary closure.

  4. Prospective Randomized Evaluation of Intraoperative Application of Autologous Platelet-Rich Plasma on Surgical Site Infection or Delayed Wound Healing.

    Science.gov (United States)

    SanGiovanni, Thomas P; Kiebzak, Gary M

    2016-05-01

    Prevention of surgical site infections and the reduction of wound-related complication rates have become increasingly emphasized by hospital task groups and government agencies given the degree of economic burden it places on the health care system. Platelet-rich plasma (PRP) contains growth factors and other biomolecules that promote endogenous microbicidal activity. We hypothesized that PRP would help prevent postoperative infection and delayed wound healing (DWH). We randomized patients having foot or ankle surgery to the treatment group receiving intraoperative PRP (applied to operative field) and platelet-poor plasma at closing (PPP, on the sutured skin) or the control group (no PRP/PPP). The incidence of deep surgical site infection and DWH (collectively called endpoints) was compared between groups (n = 250/group). PRP had a mean 5.3-fold platelet concentration compared to whole blood, with concentrated white blood cells. Mean age (±SD) of patients was 52 years (±15), 65% were women. Minor and major operative procedures were included. Patients were followed for 60 days. Seventy controls had PRP prepared for assay of growth factors. Procedure mix, ASA scores, mean operative times, and comorbidity mix were similar between groups. The primary result was no difference in number of endpoints between groups: 19 patients in the PRP group (7.6%) versus 18 controls (7.2%). Endpoints were deep surgical site infections in 2 PRP/PPP patients and 1 control, and DWH in 17 PRP/PPP patients and 17 controls. Analysis of PRP samples revealed a large variation in growth factor concentrations between patients. Intraoperative application of PRP/PPP did not reduce the incidence of postoperative infection or DWH. Growth factor profiles varied greatly between patients, suggesting that the potentially therapeutic treatment delivered was not consistent from patient-to-patient. Level I, prospective randomized trial. © The Author(s) 2015.

  5. Prevalence of Malnutrition Among Gastric Cancer Patients Undergoing Gastrectomy and Optimal Preoperative Nutritional Support for Preventing Surgical Site Infections.

    Science.gov (United States)

    Fukuda, Yasunari; Yamamoto, Kazuyoshi; Hirao, Motohiro; Nishikawa, Kazuhiro; Maeda, Sakae; Haraguchi, Naotsugu; Miyake, Masakazu; Hama, Naoki; Miyamoto, Atsushi; Ikeda, Masataka; Nakamori, Shoji; Sekimoto, Mitsugu; Fujitani, Kazumasa; Tsujinaka, Toshimasa

    2015-12-01

    Malnutrition is an independent risk factor for postoperative mortality and morbidity in major gastrointestinal surgery. The aim of this study was to investigate the prevalence of malnutrition and identify the optimal preoperative nutritional support for preventing postoperative surgical site infections (SSIs) in malnourished gastric cancer patients undergoing gastrectomy. We analyzed 800 patients with gastric cancer who underwent gastrectomy. Nutritional risk factors included weight loss >10 % within 6 months, body mass index Malnutrition, a risk factor for SSI, was prevalent in gastric cancer patients preoperatively. Well-managed preoperative nutritional support decreased the incidence of postoperative SSIs in malnourished patients.

  6. Meta-Analysis of Comparative Trials Evaluating a Prophylactic Single-Use Negative Pressure Wound Therapy System for the Prevention of Surgical Site Complications

    OpenAIRE

    Strugala, Vicki; Martin, Robin

    2017-01-01

    Abstract Background: We report the first meta-analysis on the impact of prophylactic use of a specific design of negative pressure wound therapy (NPWT) device on surgical site complications. Methods: Articles were identified in which the specific single-use NPWT device (PICO⋄, Smith & Nephew) was compared with standard care for surgical site infection (SSI), dehiscence, or length of stay (LOS). Risk ratio (RR) ±95% confidence interval (CI) (SSI; dehiscence) or mean difference in LOS ±95% CI w...

  7. Standard abdominal wound edge protection with surgical dressings vs coverage with a sterile circular polyethylene drape for prevention of surgical site infections (BaFO: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Mihaljevic André L

    2012-05-01

    Full Text Available Abstract Background Postoperative surgical site infections cause substantial morbidity, prolonged hospitalization, costs and even mortality and remain one of the most frequent surgical complications. Approximately 14% to 30% of all patients undergoing elective open abdominal surgery are affected and methods to reduce surgical site infection rates warrant further investigation and evaluation in randomized controlled trials. Methods/design To investigate whether the application of a circular plastic wound protector reduces the rate of surgical site infections in general and visceral surgical patients that undergo midline or transverse laparotomy by 50%. BaFO is a randomized, controlled, patient-blinded and observer-blinded multicenter clinical trial with two parallel surgical groups. The primary outcome measure will be the rate of surgical site infections within 45 days postoperative assessed according to the definition of the Center for Disease Control. Statistical analysis of the primary endpoint will be based on the intention-to-treat population. The global level of significance is set at 5% (2 sided and sample size (n = 258 per group is determined to assure a power of 80% with a planned interim analysis for the primary endpoint after the inclusion of 340 patients. Discussion The BaFO trial will explore if the rate of surgical site infections can be reduced by a single, simple, inexpensive intervention in patients undergoing open elective abdominal surgery. Its pragmatic design guarantees high external validity and clinical relevance. Trial registration http://www.clinicaltrials.gov NCT01181206. Date of registration: 11 August 2010; date of first patient randomized: 8 September 2010

  8. Incidence and risk factors for surgical site infection after open reduction and internal fixation of tibial plateau fracture: A systematic review and meta-analysis.

    Science.gov (United States)

    Shao, Jiashen; Chang, Hengrui; Zhu, Yanbin; Chen, Wei; Zheng, Zhanle; Zhang, Huixin; Zhang, Yingze

    2017-05-01

    This study aimed to quantitatively summarize the risk factors associated with surgical site infection after open reduction and internal fixation of tibial plateau fracture. Medline, Embase, CNKI, Wanfang database and Cochrane central database were searched for relevant original studies from database inception to October 2016. Eligible studies had to meet quality assessment criteria according to the Newcastle-Ottawa Scale, and had to evaluate the risk factors for surgical site infection after open reduction and internal fixation of tibial plateau fracture. Stata 11.0 software was used for this meta-analysis. Eight studies involving 2214 cases of tibial plateau fracture treated by open reduction and internal fixation and 219 cases of surgical site infection were included in this meta-analysis. The following parameters were identified as significant risk factors for surgical site infection after open reduction and internal fixation of tibial plateau fracture (p external fixation (OR 2.07; 95% CI 1.05-4.09). Other factors, including male sex, were not identified as risk factors for surgical site infection. Patients with the abovementioned medical conditions are at risk of surgical site infection after open reduction and internal fixation of tibial plateau fracture. Surgeons should be cognizant of these risks and give relevant preoperative advice. Copyright © 2017. Published by Elsevier Ltd.

  9. Silver-based dressings for the reduction of surgical site infection: review of current experience and recommendation for future studies.

    Science.gov (United States)

    Abboud, Elia Charbel; Settle, Judson C; Legare, Timothy B; Marcet, Jorge E; Barillo, Dave J; Sanchez, Jaime E

    2014-12-01

    Surgical site infections (SSIs) are the most common hospital acquired infection in surgical patients, occurring in approximately 300,000-500,000 patients a year. SSIs occur across all surgical specialties, but have increased importance in abdominal, colorectal, obstetrical, gynecological, cardiac, vascular, neurological, transplant, and orthopedic procedures where either the inherent risk is elevated or the consequence of an infection would be severe. Current prevention guidelines reduce, but do not completely eliminate, the occurrence of SSIs. We have found the use of silver-nylon wound dressings to significantly reduce the risk SSI associated with colorectal surgery. In this review, we examine the incidence of SSI in high-risk groups, and identify procedures where silver dressings, and other silver products, have been evaluated for the prevention of SSI. Silver-nylon dressings are a useful adjunct in the prevention of SSI in colorectal surgery, neurological surgery, spinal surgery, and certain cardiovascular and orthopedic procedures. Gynecologic, obstetric, breast, transplant, neck, and bariatric procedures, and surgery in obese and diabetic patients, represent other areas where patients are at increased risk of SSI, but in which silver dressings have not been adequately evaluated yet. Recommendation is made for large prospective studies of silver dressings in these populations.

  10. Association Between Smoking Status, Preoperative Exhaled Carbon Monoxide Levels, and Postoperative Surgical Site Infection in Patients Undergoing Elective Surgery.

    Science.gov (United States)

    Nolan, Margaret B; Martin, David P; Thompson, Rodney; Schroeder, Darrell R; Hanson, Andrew C; Warner, David O

    2017-05-01

    Cigarette smoking is a risk factor for many perioperative complications, including surgical site infection (SSI). The duration of abstinence from smoking required to reduce this risk is unknown. To evaluate if abstinence from smoking on the day of surgery is associated with a decreased frequency of SSI in patients who smoke cigarettes and to confirm that smoking is significantly independently associated with SSI when adjustment is made for potentially relevant covariates, such as body mass index. In this observational, nested, matched case-control study, 2 analyses were performed at an academic referral center in the upper Midwest. Cases included all patients undergoing elective surgical procedures at Mayo Clinic, Rochester, Minnesota, between January 1, 2009, and July 31, 2014 (inclusive) who subsequently developed an SSI. Controls for both analyses were matched on age, sex, and type of surgery. Smoking status and preoperative exhaled carbon monoxide level, assessed by nurses in the preoperative holding area. Patients were classified as smoking on the day of surgery if they self-reported smoking or if their preoperative exhaled carbon monoxide level was 10 ppm or higher. Surgical site infection after a surgical procedure at Mayo Clinic, Rochester, as identified by routine clinical surveillance using National Healthcare Safety Network criteria. Of the 6919 patients in the first analysis, 3282 (47%) were men and 3637 (53%) were women; median age (interquartile range) for control and SSI cases was 60 (48-70). Of the 392 patients in the second analysis, 182 (46%) were men and 210 (54%) were women; median age (interquartile range) for controls was 53 (45-49) and for SSI cases was 51 (45-60). During the study period, approximately 2% of surgical patients developed SSI annually. Available for the first analysis (evaluating the influence of current smoking status) were 2452 SSI cases matched to 4467 controls. The odds ratio for smoking and SSI was 1.51 (95% CI, 1

  11. Risk Factors Influencing Development Of Surgical Site Infection In Patients Who Were Operated Due To Endometrial Cancer

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    Ayse Inci

    2016-06-01

    Full Text Available Endometrial cancer is the most commonly encountered malignancy of female genital system. Surgery is the main treatment approach in endometrial cancer. The frequency of surgical site infections (SSI has recently increased. Prediction of risk factors which may cause SSI and taking due precautions may provide a decrease in frequency of these infections. The aim of this study was to determine the risk factors for SSI after surgery for endometrial cancer. The medical records of patients who were operated due to endometrial cancer in Kanuni Sultan Suleyman Education and Research Hospital between January 1st, 2015 and July 31st, 2015 were retrospectively reviewed. Patients were divided into two groups; those that developed SSI following the operation and those that did not develop SSI. Surgical site infections were diagnosed based on Center for Disease Control and Prevention criteria. Ages, co-morbid diseases, body mass index (BMI, ASA (American Society of Anesthesiologists scores, smoking, durations of operation, presence of drainage, blood transfusion, pre-op hemoglobin level and pre-op glucose level of patients were recorded. A p [Dis Mol Med 2016; 4(2.000: 13-17

  12. Pattern of Bacterial Pathogens and Their Susceptibility Isolated from Surgical Site Infections at Selected Referral Hospitals, Addis Ababa, Ethiopia

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    Walelign Dessie

    2016-01-01

    Full Text Available Background. The emergence of multidrug resistant bacterial pathogens in hospitals is becoming a challenge for surgeons to treat hospital acquired infections. Objective. To determine bacterial pathogens and drug susceptibility isolated from surgical site infections at St. Paul Specialized Hospital Millennium Medical College and Yekatit 12 Referral Hospital Medical College, Addis Ababa, Ethiopia. Methods. A cross-sectional study was conducted between October 2013 and March 2014 on 107 surgical site infected patients. Wound specimens were collected using sterile cotton swab and processed as per standard operative procedures in appropriate culture media; and susceptibility testing was done using Kirby-Bauer disc diffusion technique. The data were analyzed by using SPSS version 20. Result. From a total of 107 swabs collected, 90 (84.1% were culture positive and 104 organisms were isolated. E. coli (24 (23.1% was the most common organism isolated followed by multidrug resistant Acinetobacter species (23 (22.1%. More than 58 (75% of the Gram negative isolates showed multiple antibiotic resistance (resistance ≥ 5 drugs. Pan-antibiotic resistance was noted among 8 (34.8% Acinetobacter species and 3 (12.5% E. coli. This calls for abstinence from antibiotic abuse. Conclusion. Gram negative bacteria were the most important isolates accounting for 76 (73.1%. Ampicillin, amoxicillin, penicillin, cephazoline, and tetracycline showed resistance while gentamicin and ciprofloxacin were relatively effective antimicrobials.

  13. 73. Surgical site infection after CABG: Root cause analysis and quality measures recommendation SSI quality improvement project

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    A. Arifi

    2016-07-01

    Full Text Available Surgical site infection (SSI, is a preventable and devastating complication with significant morbidity after cardiac surgery. The reported SSI rate at our center, ranging from 3.4% to 11.2% (2007–2013. This rate is considered to be above the standardized rate recommended by the NHSN. Quality improvement project team to address the issue of SSI, (SCIP, where formed by the medical administration late 2014. The aim of the study was to identify SSI risk factors at our cardiac surgical unit, using evidence based practices while taking a local approach to problem solving. We performed Root Cause Analysis (RCA, and we applied other quality improvement tools to identify the area for potential improvement. Data include a Process Map of the pre-operative, intra-operative and post-operative factors that might contribute to SSI risk. We prospectively used the RCA form to investigate all the stages of the patient process map (pre, intra op, and post operatively. The data included the Patient related factors, the sterilization and the hygiene practice in the operating room, and the operating room traffic, and the compliance to the bundle of care. Figure represent the “Fishbone” diagram of the possible causes of SSI after cardiac surgery in our unit. Demographic features of patients with SSI were as follows: mean age-65 years; female 83%; time to infection (mean 101 days; range 1–36 days;. The root cause analysis identified a significant weakness in the compliance to the bundle of care to prevent SSI. Furthermore, the patient flow, the operating theatre cleaning and traffic was also identified as a contributing factor to SSI. Surgical site infection after cardiac surgery is a preventable complication. The application of the evidence based practice and structured way of thinking in problem solving, will help identify the potential risk factors. Focusing on solving the right patient process and visually represents the problem will help identifying the

  14. Surgical site infection associated with the use of bovine serum albumine-glutaraldehyde surgical adhesive (BioGlue) in cranial surgery: a case-control study.

    Science.gov (United States)

    Gaberel, Thomas; Borgey, France; Thibon, Pascal; Lesteven, Claire; Lecoutour, Xavier; Emery, Evelyne

    2011-01-01

    To enhance the water tightness of dura mater closure in cranial surgery, an organic glue called BioGlue was used in our neurosurgical department between January 2006 and June 2007. During this period of time, we noticed an important increase in the surgical site infection (SSI) incidence. We conducted a case-control study to identify risk factors for these infections. Our objective was to test the hypothesis that BioGlue was one of the risk factors. Cases with infection were defined retrospectively. We included two controls per case. Study data were age, sex, time of year, in stay hospital preoperative time, length of surgery, type of surgery, surgeon, use of BioGlue, and use of duraplasty. We first performed a univariate analysis and then the significant variables were introduced in a logistic regression model. Thirty patients were defined as cases (60 controls). In multivariate analysis, risk factors were young age (p = 0.04), extended operative length (p = 0.02) and the use of BioGlue (p = 0.007). The combined use of BioGlue and Neuropatch appeared to be a significant risk factor for SSI (p = 0.002). BioGlue seems to increase the risk of SSI for patients who underwent craniotomy, especially when associated with synthetic dural graft. BioGlue triggers an intense inflammatory response, which causes wound breaches allowing bacteria to spread down in the wound, and then creates an ideal environment for bacterial growth.

  15. Staphylococcal phage 2638a endolysin is lytic for Staphylococcus aureus and harbors an inter-lytic-domain cryptic translational start site.

    Science.gov (United States)

    Staphylococcus aureus, a notorious pathogen with a propensity for developing resistance to virtually all antibiotics. Staphylococcal phage 2638A endolysin is a peptidoglycan hydrolase that is lytic for Staphylococcus aureus when exposed externally, making it a new candidate antimicrobial. It sha...

  16. Multi-Drug Resistant Surgical Site Infection Due to Mycobacterium abscessus Complex.

    Science.gov (United States)

    Misra, Richa; Jain, Vidhi; Tejan, Nidhi; Negi, Aarti; Umrao, Jyoti; Dhole, Tapan Nirodhechand

    2017-08-01

    M. abscessus complex is notoriously resistant to most antimicrobial agents. The complex is differentiated into 3 subspecies: M. abscessus subsp. abscessus, M. abscessus subsp. massiliense, and M. abscessus subsp. bolletii. Skin and soft tissue infections due to this organism can be acquired by direct contact with contaminated material through traumatic injury, surgical wound and environmental exposure or by secondary involvement of skin/soft tissue during disseminated disease. We report a case of Mycobacterium abscessus infection recovered from a post-operative mid-line abdominal wound to illustrate the diagnostic and management difficulties encountered in such patients. © American Society for Clinical Pathology, 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  17. Docking of the da Vinci Si Surgical System® with single-site technology.

    Science.gov (United States)

    Iranmanesh, Pouya; Morel, Philippe; Buchs, Nicolas C; Pugin, François; Volonte, Francesco; Kreaden, Usha Seshadri; Hagen, Monika E

    2013-03-01

    Strategies to spare operating room (OR) times are crucial to limiting the costs involved in robotic surgery. Among other factors, the pre-operative set-up and docking phases have been incriminated at first to be time consuming. The docking process on the standard multiport da Vinci Surgical System has not been shown to significantly prolong the overall OR time. This study aims to analyse whether the length of the docking process on the new da Vinci Si Surgical System with Single-Site™ technology remains acceptable. We prospectively analysed all of the robotic single-incision cholecystectomies performed at our institution for docking and operating times during 2011-2012. The docking task load was assessed each time in a self-administered fashion by the docking surgeon using the NASA TLX visual scale. Sixty-four robotic single-incision cholecystectomies were included and analysed. The mean operative time was 78 min. Two surgeons with previous robotic surgery experience and a group of three less experienced robotic surgeons were responsible for docking the system. They performed 45, 10 and nine dockings, respectively. The overall mean docking time was 6.4 min with no significant difference between the groups. The docking process represented approximately 8% of the operating time. The surgeon with the most procedures showed significant progress in his docking times. The different task load parameters did not show a statistical difference between the three groups, with the exception of the frustration parameter, which was higher in the group of less experienced surgeons. There were significant correlations between docking times and the assessment of the various task load parameters. The docking process for a robotic single-incision cholecystectomy is learned rapidly and does not significantly increase the overall OR time. Copyright © 2013 John Wiley & Sons, Ltd.

  18. The sensitivity status of community-acquired Staphylococcus aureus ...

    African Journals Online (AJOL)

    Community acquired Staphylococcus aureus was isolated from various infectious sites in two private laboratories in Kano-city, Nigeria. A total of 247 (11%) Staphylococcu aureus isolates were recovered from all infectious sites except cerebro-spinal fluid. The least Staphylococcus aureus isolates were found in urine ...

  19. [Differentiation of spa types and staphylococcal cassette chromosome mec (SCCmec) in clinical methicillin-resistant Staphylococcus aureus isolated in medical sites of Gdańsk region].

    Science.gov (United States)

    Kasprzyk, Joanna; Piechowicz, Lidia; Wiśniewska, Katarzyna; Dziewit, Łukasz; Bronk, Marek; Świeć, Krystyna

    2015-01-01

    Methicillin-resistant Staphylococcus aureus bacteria are one of the key etiological factors of hospital-acquired and community-acquired infections. MRSA strains have an ability of causing a broad spectrum infections: from a relatively mild skin infections to severe life-threatening systemic infections. They are characterized by multi-drug resistance, virulence of a number of factors, may clonally spread within the hospitals and between hospitals. The study embraced a number of 75 isolates of MRSA isolated from patients of 7 medical sites of the Gdansk region within the period of six months (June to December 2013). Strains have derived from various clinical materials, both of hospitalized patients (n=59) and outpatient (n=16). The isolates were tested for the susceptibility to antimicrobial agents accordance with the guidelines EUCAST. To estimate of the variability of occurrence of S. aureus clones used were standard spa gene, consisting in the amplified polymorphic region of the X gene encoding the protein A gene (spa). After receiving the results, a spa types were identified using international database Ridom Spa Server (www.spaserver.ridom.de). To determine the polymorphism cassette carrying the inecA gene from MRSA strains, used typing five major chromosomal cassette SCCmec (I-V) by multiplex PCR. MRSA population genetic analysis carried out on the basis of typing SCCmec cassettes and spa gene has showed a predominance of strains with SCCmec type II casette (46.7%) and SCCmec IV casette (38.7%). Less frequently detected were strains containing SCCmec I cassette (12.0%) and SCCmec III cassette (2.6%). Spa typing revealed the presence of 13 gene types in MRSA. The most frequently observed spa types were: t151 (24.0%), t003 (16.0%) in strains of the SCCmec II cassette and t437 (16.0%) and t008 (14.8%) in the isolates with SCCmec cassette IV, whereas staphylococcus with the type of spa t011 (12.0%) had SCCmec cassette I. In our population most frequent strains

  20. Effects of surgical side and site on mood and behavior outcome in children with pharmacoresistant epilepsy

    Directory of Open Access Journals (Sweden)

    Elizabeth N Andresen

    2014-02-01

    Full Text Available Children with epilepsy have a high rate of mood and behavior problems yet few studies consider the emotional and behavioral impact of surgery. No study to date has been sufficiently powered to investigate effects of both side (left/right and site (temporal/frontal of surgery. One hundred patients (aged 6-16 and their families completed measures of depression, anxiety and behavioral function as part of neuropsychological evaluations before and after surgery for pharmacoresistant epilepsy. Among children who had left-sided surgeries (frontal=16; temporal=38, there were significant interactions between time (pre to postoperative neuropsychological assessment and resection site (frontal/temporal on Anhedonia, Social Anxiety, and Withdrawn/Depressed scales. Patients with frontal lobe epilepsy (FLE endorsed greater presurgical anhedonia and social anxiety than patients with temporal lobe epilepsy (TLE, with scores normalizing following surgery. While scores on the Withdrawn/Depressed scale were similar between groups before surgery, the FLE group showed greater symptom improvement after surgery. In children who underwent right-sided surgeries (FLE=20; TLE=26 main effects of time (patients in both groups improved and resection site (caregivers of FLE patients endorsed greater symptoms than those with TLE were observed primarily on behavior scales. Individual data revealed that a greater proportion of children with left FLE demonstrated clinically significant improvements in Anhedonia, Social Anxiety, and Aggressive Behavior than children with TLE. This is the first study to demonstrate differential effects of both side and site of surgery in children with epilepsy at group and individual levels. Results suggest that children with FLE have greater emotional and behavioral dysfunction before surgery, but show marked improvement after surgery. Overall, most children had good emotional and behavioral outcomes, with most scores remaining stable or improving.

  1. Characterization of the Staphylococcus aureus rRNA Methyltransferase Encoded by orfX, the Gene Containing the Staphylococcal Chromosome Cassette mec (SCCmec) Insertion Site*

    Science.gov (United States)

    Boundy, Sam; Safo, Martin K.; Wang, Lei; Musayev, Faik N.; O'Farrell, Heather C.; Rife, Jason P.; Archer, Gordon L.

    2013-01-01

    The gene orfX is conserved among all staphylococci, and its complete sequence is maintained upon insertion of the staphylococcal chromosome cassette mec (SCCmec) genomic island, containing the gene encoding resistance to β-lactam antibiotics (mecA), into its C terminus. The function of OrfX has not been determined. We show that OrfX was constitutively produced during growth, that orfX could be inactivated without altering bacterial growth, and that insertion of SCCmec did not alter gene expression. We solved the crystal structure of OrfX at 1.7 Å and found that it belongs to the S-adenosyl-l-methionine (AdoMet)-dependent α/β-knot superfamily of SPOUT methyltransferases (MTases), with a high structural homology to YbeA, the gene product of the Escherichia coli 70 S ribosomal MTase RlmH. MTase activity was confirmed by demonstrating the OrfX-dependent methylation of the Staphylococcus aureus 70 S ribosome. When OrfX was crystallized in the presence of its AdoMet substrate, we found that each monomer of the homodimeric structure bound AdoMet in its active site. Solution studies using isothermal titration calorimetry confirmed that each monomer bound AdoMet but with different binding affinities (Kd = 52 ± 0.4 and 606 ± 2 μm). In addition, the structure shows that the AdoMet-binding pocket, formed by a deep trefoil knot, contains a bound phosphate molecule, which is the likely nucleotide methylation site. This study represents the first characterization of a staphylococcal ribosomal MTase and provides the first crystal structure of a member of the α/β-knot superfamily of SPOUT MTases in the RlmH or COG1576 family with bound AdoMet. PMID:23150671

  2. Patient perspectives on post-discharge surgical site infections: towards a patient-centered mobile health solution.

    Directory of Open Access Journals (Sweden)

    Patrick C Sanger

    Full Text Available Post-discharge surgical site infections (SSI are a major source of morbidity, expense and anxiety for patients. However, patient perceptions about barriers experienced while seeking care for post-discharge SSI have not been assessed in depth. We explored patient experience of SSI and openness to a mobile health (mHealth wound monitoring "app" as a novel solution to address this problem.Mixed method design with semi-structured interviews and surveys. Participants were patients who had post-discharge surgical wound complications after undergoing operations with high risk of SSI, including open colorectal or ventral hernia repair surgery. The study was conducted at two affiliated teaching hospitals, including an academic medical center and a level 1 trauma center.From interviews with 13 patients, we identified 3 major challenges that impact patients' ability to manage post-discharge surgical wound complications, including required knowledge for wound monitoring from discharge teaching, self-efficacy for wound monitoring at home, and accessible communication with their providers about wound concerns. Patients found an mHealth wound monitoring application highly acceptable and articulated its potential to provide more frequent, thorough, and convenient follow-up that could reduce post-discharge anxiety compared to the current practice. Major concerns with mHealth wound monitoring were lack of timely response from providers and inaccessibility due to either lack of an appropriate device or usability challenges.Our findings reveal gaps and frustrations with post-discharge care after surgery which could negatively impact clinical outcomes and quality of life. To address these issues, we are developing mPOWEr, a patient-centered mHealth wound monitoring application for patients and providers to collaboratively bridge the care transition between hospital and home.

  3. Surgical site infection in cesarean sections with the use of a plastic sheath wound retractor compared to the traditional self-retaining metal retractor.

    Science.gov (United States)

    Hinkson, Larry; Siedentopf, Jan-Peter; Weichert, Alexander; Henrich, Wolfgang

    2016-08-01

    A cesarean section rate of up to 19.4% is reported worldwide. Surgical site infection occurs with rates of up to 13.5%. Plastic-sheath wound retractors show reduced rates of surgical site infections in abdominal surgery. There is limited evidence in women having cesarean sections. This study evaluates the use of the Alexis(®) O C-Section Retractor in the prevention of surgical site infection in patients undergoing their first planned cesarean section compared to the traditional Collins self-retaining metal retractor. A single center, prospective, randomized, controlled, observational trial. The primary outcome is surgical site infection as defined by the Centers for Disease Control and Prevention. The secondary outcomes included intraoperative surgical parameters, postoperative pain scores and the short and long-term satisfaction with wound healing. From October 2013 to December 2015 at the Charité University Hospital, Berlin. 98 patients to the Alexis(®) O C-Section Retractor group and 100 to the traditional Collins self-retaining metal retractor group. A statistically significant reduction in the rate of surgical site infections, when the Alexis(®) O C-Section Retractor was used for wound retraction compared to the traditional Collins metal self-retaining wound retractor, 1% vs. 8% (RR 7.84, 95% CI (2.45-70.71) p=0.035). The use of plastic-sheath wound retractors compared to the traditional self-retaining metal retractor in low risk women, having the first cesarean section is associated with a significantly reduced risk of surgical site infection. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  4. Perioperative Glycemic Control and the Effect on Surgical Site Infections in Diabetic Patients Undergoing Foot and Ankle Surgery.

    Science.gov (United States)

    Sadoskas, David; Suder, Natalie C; Wukich, Dane K

    2016-02-01

    Diabetes mellitus is one of the leading causes of hyperglycemia in the perioperative setting. Hyperglycemia has been shown to cause increased risk of surgical site infections (SSIs) in multiple surgical specialties, but to our knowledge it has not been investigated for orthopaedic foot and ankle surgery. The aim of this study was to determine if hyperglycemia increased the rate of SSI in elective, diabetic patients that required perioperative hospitalization. A total of 348 consecutive inpatients after foot and ankle surgery were retrospectively evaluated. Patients who had a random serum glucose ≥200 mg/dL during the admission (Group 1) were compared to patients whose serum glucose never exceeded 200 mg/dL (Group 2). Our 2 groups were similar with regard to age, gender, and body mass index. Twenty-one of 176 patients (11.9%) whose serum glucose was ≥200 mg/dL during the admission developed an SSI as compared to 9 of 172 patients (5.2%) whose serum glucose remained Control. © 2015 The Author(s).

  5. Topical vancomycin to reduce surgical-site infections in neurosurgery: Study protocol for a multi-center, randomized controlled trial.

    Science.gov (United States)

    Jonokuchi, Alexander J; Knopman, Jared; Radwanski, Ryan E; Martinez, Moises A; Taylor, Blake Eaton Samuel; Rothbaum, Michael; Sullivan, Sean; Robison, Trae R; Lo, Eric; Christophe, Brandon R; Bruce, Eliza M; Khan, Sabrina; Kellner, Christopher P; Sigounas, Dimitri; Youngerman, Brett; Bagiella, Emilia; Angevine, Peter D; Lowy, Franklin D; Sander Connolly, E

    2018-01-01

    Surgical-site infections (SSIs) account for 20% of all healthcare-associated infections, are the most common nosocomial infection among surgical patients, and are a focus of quality improvement initiatives. Despite implementation of many quality care measures (e.g. prophylactic antibiotics), SSIs remain a significant cause of morbidity, mortality, and economic burden, particularly in the field of neurosurgery. Topical vancomycin is increasingly utilized in instrumented spinal and cardiothoracic procedures, where it has been shown to reduce the risk of SSIs. However, a randomized controlled trial assessing its efficacy in the general neurosurgical population has yet to be done. The principle aim of "Topical Vancomycin for Neurosurgery Wound Prophylaxis" (NCT02284126) is to determine whether prophylactic, topical vancomycin reduces the risk of SSIs in the adult neurosurgical population. This prospective, multicenter, patient-blinded, randomized controlled trial will enroll patients to receive the standard of care plus topical vancomycin, or the standard of care alone. The primary endpoint of this study is a SSI by postoperative day (POD) 30. Patients must be over 18years of age. Patients are excluded for renal insufficiency, vancomycin allergy, and some ineligible procedures. Univariate analysis and logistic regression will determine the effect of topical vancomycin on SSIs at 30days. A randomized controlled trial is needed to determine the efficacy of this treatment. Results of this trial are expected to directly influence the standard of care and prevention of SSIs in neurosurgical patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Post-appendectomy surgical site infection rate after using an antimicrobial film incise drape: a prospective study.

    Science.gov (United States)

    Al-Qahtani, Saleh M; Al-Amoudi, Hani M; Al-Jehani, Suhad; Ashour, Abdullah S; Abd-Hammad, Mohammed R; Tawfik, Omar R; Baslaim, Muna M; Farrokhyar, Forough

    2015-04-01

    An appendectomy is a contaminated or potentially dirty surgical procedure that can be associated with surgical site infection (SSI). A single-center unblinded prospective cohort study examined the role of antimicrobial incise film drapes in lowering the rate of SSI after appendectomy. Any patient aged 12 years or older who was scheduled for open appendectomy for acute appendicitis was included. Patients were assigned to two groups. Group 1 (n=52) had the standard five-minute skin preparation with 10% povidone-iodine soap followed by the application of an antimicrobial film incise drape, and group 2 (n=39) had the standard skin preparation alone. Six (11.5%) of the 52 patients who had the antimicrobial film incise drape and two (5.1%) of the 39 patients who did not have the drape developed SSI (p=NS). Of the six patients in the antimicrobial film group with post-operative SSI, three had a perforated appendix, two had a gangrenous appendix, and one had an inflamed appendix. In group 2, one patient had an inflamed appendix and the other had a perforated appendix. The median length of stay in the hospital was two days (range 1-11 days) for both groups. Our study did not support the view that antimicrobial film incise drapes can lower the rate of post-appendectomy SSI. Moreover, the length of stay was not minimized by the use of these drapes.

  7. Antibiotic Prophylaxis With Trimethoprim/Sulfamethoxazole Instead of Cloxacillin Fails to Improve Inguinal Surgical Site Infection Rate After Vascular Surgery.

    Science.gov (United States)

    Hasselmann, Julien; Kühme, Tobias; Acosta, Stefan

    2015-01-01

    Surgical site infections (SSIs) and their prevention continue to be a major point of focus in all surgical specialties today. Antibiotic prophylaxis is one of the mainstays in their prevention. Due to the consistently high proportion of infections caused by intestinal flora from the start of our wound surveillance registry in 2005, we conducted a change in prophylactic antibiotic therapy from cloxacillin in 2012 to trimethoprim/sulfamethoxazole (TMP-SMX) in 2013. The study included all patients undergoing vascular surgery with groin incisions between March 1 and June 30 in 2012 and 2013, respectively, whereby the antibiotic regime was changed in between the 2 sampling periods. The diagnosis of SSI was based on clinical examination and microbiological results. Two hundred nineteen patients with inguinal incisions were included in the analysis: 105 in the cloxacillin group of which 19% had SSI and 114 in the TMP-SMX group with an SSI rate of 18% (P = .77), without differences between the 2 groups regarding age, gender, proportion of emergency surgery, type of surgery, or frequency of concomitant foot ulcers. The high proportion of infections caused by intestinal flora between time periods was unchanged (67% vs 81%, P = .34). There was no difference between the 2 groups, suggesting that the choice of antibiotic prophylaxis had a limited role in preventing SSI at our center. Despite this, the lower cost and ease of the administration of TMP-SMX can be seen as convincing advantages. © The Author(s) 2015.

  8. Topically Applied Vancomycin Powder Reduces the Rate of Surgical Site Infection in Diabetic Patients Undergoing Foot and Ankle Surgery.

    Science.gov (United States)

    Wukich, Dane K; Dikis, Jeffrey W; Monaco, Spencer J; Strannigan, Kristin; Suder, Natalie C; Rosario, Bedda L

    2015-09-01

    The purpose of this study was to evaluate the efficacy of topically applied vancomycin powder in reducing the rate of surgical site infections (SSIs) in patients with diabetes mellitus (DM) undergoing foot and ankle surgery. Eighty-one patients with DM who underwent reconstructive surgery of a foot and/or ankle deformity and/or trauma and who received topically applied vancomycin were matched to 81 patients with DM who did not receive topically applied vancomycin. The mean age was 60.6 years in the vancomycin group and 59.4 years in the control group (P infection was not significantly different between the 2 groups (OR, 0.400; 95% CI, 0.078-2.062; P = .2734); however, deep infections were 80% less likely in patients who received vancomycin powder (OR, 0.200; 95% CI, 0.044-0.913; P = .0377). High-risk diabetic patients undergoing foot and ankle surgery were notably less likely to develop an SSI with the use of topically applied vancomycin powder in the surgical wound, particularly with regard to deep infections. Topically applied vancomycin was associated with a very low rate of complications and was inexpensive ($5 per 1000 mg). Based on this study, foot and ankle surgeons may consider applying 500 to 1000 mg of vancomycin powder prior to skin closure in diabetic patients who are not allergic to vancomycin. Level III, retrospective case control series. © The Author(s) 2015.

  9. Risk factors for surgical site infection and delayed wound healing after orthopedic surgery in rheumatoid arthritis patients.

    Science.gov (United States)

    Kadota, Yasutaka; Nishida, Keiichiro; Hashizume, Kenzo; Nasu, Yoshihisa; Nakahara, Ryuichi; Kanazawa, Tomoko; Ozawa, Masatsugu; Harada, Ryozo; Machida, Takahiro; Ozaki, Toshifumi

    2016-01-01

    To investigate the prevalence and the risk factors of surgical-site infection (SSI) and delayed wound healing (DWH) in patients with rheumatoid arthritis (RA) underwent orthopedic surgery. We reviewed the records of 1036 elective orthopedic procedures undertaken in RA patients. Risk factors for SSI and DWH were assessed by logistic regression analysis using age, body mass index, disease duration, pre-operative laboratory data, surgical procedure, corticosteroid use, co-morbidity, and use of conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) and biological DMARDs (bDMARDs) as variables. SSI and DWH were identified in 19 cases and 15 cases, respectively. One case of SSI and three cases of DWH were recorded among 196 procedures in patients using bDMARDs. Foot and ankle surgery was associated with an increased risk of SSI (odds ratio (OR), 3.167; 95% confidence interval (CI), 1.256-7.986; p = 0.015). Total knee arthroplasty (TKA; OR, 4.044; 95% CI, 1.436-11.389; p = 0.008) and disease duration (OR, 1.004; 95% CI, 1.000-1.007; p = 0.029) were associated with an increased risk of DWH. Our results indicated foot and ankle surgery, and TKA and disease duration as risk factors for SSI and DWH, respectively. bDMARDs was not associated with an increased risk of SSI and DWH.

  10. Developing algorithms for healthcare insurers to systematically monitor surgical site infection rates

    Directory of Open Access Journals (Sweden)

    Livingston James M

    2007-06-01

    Full Text Available Abstract Background Claims data provide rapid indicators of SSIs for coronary artery bypass surgery and have been shown to successfully rank hospitals by SSI rates. We now operationalize this method for use by payers without transfer of protected health information, or any insurer data, to external analytic centers. Results We performed a descriptive study testing the operationalization of software for payers to routinely assess surgical infection rates among hospitals where enrollees receive cardiac procedures. We developed five SAS programs and a user manual for direct use by health plans and payers. The manual and programs were refined following provision to two national insurers who applied the programs to claims databases, following instructions on data preparation, data validation, analysis, and verification and interpretation of program output. A final set of programs and user manual successfully guided health plan programmer analysts to apply SSI algorithms to claims databases. Validation steps identified common problems such as incomplete preparation of data, missing data, insufficient sample size, and other issues that might result in program failure. Several user prompts enabled health plans to select time windows, strata such as insurance type, and the threshold number of procedures performed by a hospital before inclusion in regression models assessing relative SSI rates among hospitals. No health plan data was transferred to outside entities. Programs, on default settings, provided descriptive tables of SSI indicators stratified by hospital, insurer type, SSI indicator (inpatient, outpatient, antibiotic, and six-month period. Regression models provided rankings of hospital SSI indicator rates by quartiles, adjusted for comorbidities. Programs are publicly available without charge. Conclusion We describe a free, user-friendly software package that enables payers to routinely assess and identify hospitals with potentially high SSI

  11. A Quality Improvement Approach to Reducing the Caesarean section Surgical Site Infection Rate in a Regional Hospital

    LENUS (Irish Health Repository)

    O’ Hanlon, M

    2016-09-01

    Surgical site infection (SSI) rates are used extensively by hospitals as a basis for quality improvement. A 30-day post-discharge SSI programme for Caesarean section operations has been implemented in Our Lady of Lourdes Hospital since 2011. It has been shown that skin antisepsis and antibiotic prophylaxis are key factors in the prevention of SSI. Using quality improvement methodology, an infection prevention bundle was introduced to address these two factors. Skin antisepsis was changed from povidone-iodine to chlorhexidine-alcohol. Compliance with choice of antibiotic prophylaxis increased from 89.6% in 2014 to 98.5% in 2015. Compliance with timing also improved. The SSI rate of 7.5% was the lowest recorded to date, with the majority of SSIs (64%) diagnosed after hospital discharge. The level of variation was also reduced. However, the continued presence of variation and possibility of lower infection rates from the literature imply that further improvements are required.

  12. Intraoperative PaO2 is not related to the development of surgical site infections after major cardiac surgery

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    Fierro Inma

    2011-01-01

    Full Text Available Abstract Background The perioperative use of high inspired oxygen fraction (FIO2 for preventing surgical site infections (SSIs has demonstrated a reduction in their incidence in some types of surgery however there exist some discrepancies in this respect. The aim of this study was to analyze the relationship between PaO2 values and SSIs in cardiac patients. Methods We designed a prospective study in which 1,024 patients undergoing cardiac surgery were analyzed. Results SSIs were observed in 5.3% of patients. There was not significant difference in mortality at 30 days between patients with and without SSIs. In the uni and multivariate analysis no differences in function of the inspired oxygen fraction administrated were observed. Conclusions We observed that the PaO2 in adult cardiac surgery patients was not related to SSI rate.

  13. Cost Analysis and Surgical Site Infection Rates in Total Knee Arthroplasty Comparing Traditional vs. Single-Use Instrumentation.

    Science.gov (United States)

    Siegel, Geoffrey W; Patel, Neil N; Milshteyn, Michael A; Buzas, David; Lombardo, Daniel J; Morawa, Lawrence G

    2015-12-01

    Surgical site infections (SSIs) are a significant complications in total knee arthroplasty (TKA). The purpose of this study was to evaluate if traditional vs. single-use instrumentation had an effect on SSI's. We compared SSI rates and costs of TKAs performed with single-use (449) and traditional (169) TKA instrumentation trays. Total OR Time was, on average, 30 min less when single-use instrumentation was used. SSIs decreased in the single-use group (n=1) compared to the traditional group (n=5) (P=0.006). Single-use instrumentation added $490 in initial costs; however it saved between $480 and $600. Single-use instrumentation may provide a benefit to the patient by potentially decreasing the risk of infection and reducing the overall hospital costs. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Povidone-Iodine Irrigation of Subcutaneous Tissues May Decrease Surgical Site Infections in Elective Colorectal Operations: A Systematic Review.

    Science.gov (United States)

    Gill, Richdeep S; Al-Adra, David P; Campbell, Sandy; Olson, David W; Rowe, Brian H

    2011-06-01

    Postoperative wound infection is the most common complication following abdominal surgery and leads to delayed wound healing, prolonged hospital length of stay (LOS), and causes morbidity. Povidone-Iodine (PVI) is a broad-spectrum anti-septic and disinfectant solution, and can be used intra-operatively to irrigate subcutaneous tissues prior to abdominal skin closure. We systematically reviewed the literature regarding the efficacy of intra-operative PVI irrigation of subcutaneous tissues following elective colorectal surgery. A comprehensive search of electronic databases and various grey literature sources was completed. Unpublished and non-English-language results were included. All clinical controlled trials involving PVI solution in adult colorectal surgery were included. Two independent reviewers assessed the studies for relevance, inclusion, methodological quality and extracted data from the full versions of the manuscripts. Disagreements were resolved by re-extraction or third party adjudication. Data for dichotomous outcomes are reported as relative risks (RR) with 95% confidence intervals (CI). For continuous data, mean differences (MD) are reported with 95% CIs. Five randomized controlled trials (RCTs) involving 205 patients comparing PVI solution or spray to a control group following abdominal fascial closure in elective colorectal or clean-contaminated operations were identified. Pooled results demonstrated a reduction in surgical site infection for patients treated with PVI (RR = 1.97; 95% CI: 1.22 to 3.17) compared to controls. Irrigation of subcutaneous tissues with PVI following abdominal fascial closure is associated with a reduced incidence of surgical site infection. Due to the small number of included trials and patients, additional robust randomized trials are needed.

  15. National surveillance of surgical site infections after coronary artery bypass grafting in Norway: incidence and risk factors.

    Science.gov (United States)

    Berg, Thale Cathrine; Kjørstad, Knut E; Akselsen, Per Espen; Seim, Bjørn Edvard; Løwer, Hege Line; Stenvik, Maryann Nesset; Sorknes, Nina Kristine; Eriksen, Hanne-Merete

    2011-12-01

    A mandatory national surveillance system for surgical site infections (SSIs) following certain surgical procedures, including coronary artery bypass grafting (CABG), was introduced in Norway in 2005. The objectives of this study were to measure national baseline incidence rates of SSIs after CABG, describe the characteristics of the patients and procedures, and identify possible risk factors for infection. In 2005-2009, all hospitals that performed CABG were invited to assess all patients undergoing CABG surgery in 3-month periods for SSIs. The hospitals evaluated infection status at discharge and 30 days after surgery by sending post-discharge questionnaires to all patients. We calculated incidence proportions and risk ratios for different risk factors. We applied the National Nosocomial Infection Surveillance (NNIS) risk index to the data. In total, 2440 patients were included. Altogether, 124 sternal and 217 harvest site infections were registered, giving incidence proportions of 5.1% and 8.9%, respectively. Over 95% of infections occurred post-discharge from the hospital. No risk factors were identified. Incidence did not significantly increase with higher NNIS risk index; however, 93% of the patients fell into the same risk category. We have provided a baseline rate for SSIs after CABG procedures in Norway. The results show the importance of post-hospital discharge follow-up. The NNIS risk index did not adequately stratify CABG patients. We recommend that more potential risk variables should be included in the surveillance, such as the European System for Cardiac Operative Risk Evaluation (EuroSCORE), height, weight, and diabetes. Copyright © 2011 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

  16. A classification system of intraocular lens dislocation sites under operating microscopy, and the surgical techniques and outcomes of exchange surgery.

    Science.gov (United States)

    Hayashi, Ken; Ogawa, Soichiro; Manabe, Shin-Ichi; Hirata, Akira; Yoshimura, Koichi

    2016-03-01

    The aim of this study was to examine the recent status of intraocular lens (IOL) dislocation according to a classification system based on vertical dislocation position, as well as the surgical techniques and outcomes of IOL exchange surgery. The medical records of 230 eyes from 214 consecutive patients who experienced IOL dislocation and underwent exchange surgery between 2006 and 2014 were reviewed. Vertical dislocation sites observed preoperatively under operating microscopy were examined, along with the surgical techniques and outcomes of IOL exchange. Dislocation sites included (1) the anterior chamber (12.2 %), (2) pseudophakodonesis (19.1 %), (3) the anterior vitreous cavity (47.4 %), (4) trap door-like dislocation (dangling in the peripheral vitreous cavity; 16.1 %), and (5) the retinal surface (5.2 %). The IOL retained in the anterior segment was moved onto the iris by pulling it up through the limbal side ports with an anterior vitrectomy (67.8 %), or by pushing it up from the pars plana with an anterior vitrectomy (26.5 %), while the IOL dropped on the retina was lifting it up from the retina after pars plana vitrectomy (5.7 %). Mean uncorrected and distance-corrected visual acuity significantly improved postoperatively (p system, approximately 95 % of dislocated IOLs were retained in the anterior segment, and these IOLs were exchanged using an anterior approach through limbal incisions with an anterior vitrectomy. Visual acuity improved significantly, and serious complications were uncommon, probably because the IOL exchange techniques were standardized and simplified without pars plana vitrectomy.

  17. Incidence and risk factors for surgical site infections in obstetric and gynecological surgeries from a teaching hospital in rural India

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    Ashish Pathak

    2017-06-01

    Full Text Available Abstract Background Surgical site infections (SSI are one of the most common healthcare associated infections in the low-middle income countries. Data on incidence and risk factors for SSI following surgeries in general and Obstetric and Gynecological surgeries in particular are scare. This study set out to identify risk factors for SSI in patients undergoing Obstetric and Gynecological surgeries in an Indian rural hospital. Methods Patients who underwent a surgical procedure between September 2010 to February 2013 in the 60-bedded ward of Obstetric and Gynecology department were included. Surveillance for SSI was based on the Centre for Disease Control (CDC definition and methodology. Incidence and risk factors for SSI, including those for specific procedure, were calculated from data collected on daily ward rounds. Results A total of 1173 patients underwent a surgical procedure during the study period. The incidence of SSI in the cohort was 7.84% (95% CI 6.30–9.38. Majority of SSI were superficial. Obstetric surgeries had a lower SSI incidence compared to gynecological surgeries (1.2% versus 10.3% respectively. The risk factors for SSI identified in the multivariate logistic regression model were age (OR 1.03, vaginal examination (OR 1.31; presence of vaginal discharge (OR 4.04; medical disease (OR 5.76; American Society of Anesthesia score greater than 3 (OR 12.8; concurrent surgical procedure (OR 3.26; each increase in hour of surgery, after the first hour, doubled the risk of SSI; inappropriate antibiotic prophylaxis increased the risk of SSI by nearly 5 times. Each day increase in stay in the hospital after the surgery increased the risk of contacting an SSI by 5%. Conclusions Incidence and risk factors from prospective SSI surveillance can be reported simultaneously for the Obstetric and Gynecological surgeries and can be part of routine practice in resource-constrained settings. The incidence of SSI was lower for Obstetric surgeries

  18. Economic and organizational sustainability of a negative-pressure portable device for the prevention of surgical-site complications

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    Foglia E

    2017-06-01

    Full Text Available Emanuela Foglia,1 Lucrezia Ferrario,1 Elisabetta Garagiola,1 Giuseppe Signoriello,2 Gianluca Pellino,3 Davide Croce,1,4 Silvestro Canonico3 1Centre for Health Economics, Social and Health Care Management - LIUC University, Castellanza, Italy; 2Department of Mental Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy; 3School of Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy; 4School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South \tAfrica Purpose: Surgical-site complications (SSCs affect patients’ clinical pathway, prolonging their hospitalization and incrementing their management costs. The present study aimed to assess the economic and organizational implications of a portable device for negative-pressure wound therapy (NPWT implementation, compared with the administration of pharmacological therapies alone for preventing surgical complications in patients undergoing general, cardiac, obstetrical–gynecological, or orthopedic surgical procedures.Patients and methods: A total of 8,566 hospital procedures, related to the year 2015 from one hospital, were evaluated considering infection risk index, occurrence rates of SSCs, drug therapies, and surgical, diagnostic, and specialist procedures and hematological exams. Activity-based costing and budget impact analyses were implemented for the economic assessment.Results: Patients developing an SSC absorbed i 64.27% more economic resources considering the length of stay (€ 8,269±2,096 versus € 5,034±2,901, p<0.05 and ii 42.43% more economic resources related to hematological and diagnostic procedures (€ 639±117 versus € 449±72, p<0.05. If the innovative device had been used over the 12-month time period, it would have decreased the risk of developing SSCs; the hospital would have realized an average reduction in health care expenditure equal to −0.69% (−€ 483

  19. Achieving and Sustaining Zero: Preventing Surgical Site Infections After Isolated Coronary Artery Bypass With Saphenous Vein Harvest Site Through Implementation of a Staff-Driven Quality Improvement Process.

    Science.gov (United States)

    Kles, Candis Lee; Murrah, C Patrick; Smith, Kerry; Baugus-Wellmeier, Elizabeth; Hurry, Terri; Morris, Cullen D

    2015-01-01

    Surgical site infections (SSI) increase morbidity and mortality, hospital costs, length of stay, readmissions, and risk of litigation and may impact a facility's reputation. Through implementation of a Six Sigma, interdisciplinary team process and the Contextual Model for change engaged all stakeholders. A total of 44 perioperative processes were evaluated, with 15 processes ultimately altered. Revisions involved identifying inconsistent implementation of procedures and standardizing processes, as well as utilizing new suture techniques and products including disposable electrocardiogram leads and pacing wires, antibiotic-coated sutures, and silver-impregnated midsternal dressings. In isolated coronary artery bypass grafting with donor-site procedures, an incidence of 3.74 per 100 procedures was reduced to 0.7 and ultimately to 0. No patients who underwent coronary artery bypass grafting developed a deep sternal wound infection in over 30 months and 590 procedures, resulting in an estimated cost savings of more than $600 000, from May 2012 through December 2014. A significant reduction in deep sternal wound infections was achieved by working at all levels of the organization through a multidisciplinary approach to create sustained change. Using real-time observations for current practices, areas for improvement were identified. By engaging frontline staff in the process, ownership of the outcomes and adherence to practice change were promoted. The result was a dramatic, rapid, and sustainable improvement in the prevention of deep sternal wound infection.

  20. Prognostic impact of the site of portal vein invasion in patients with surgically resected perihilar cholangiocarcinoma.

    Science.gov (United States)

    Nakanishi, Yoshitsugu; Tsuchikawa, Takahiro; Okamura, Keisuke; Nakamura, Toru; Tamoto, Eiji; Murakami, Soichi; Ebihara, Yuma; Kurashima, Yo; Noji, Takehiro; Asano, Toshimichi; Shichinohe, Toshiaki; Hirano, Satoshi

    2016-06-01

    The aim of this study was to determine the impact of the site of portal vein invasion on survival after hepatectomy for perihilar cholangiocarcinoma. This study classified 168 patients undergoing resection for perihilar cholangiocarcinoma histologically as without portal vein resection or tumor invasion to the portal vein (PV0), with tumor invasion to unilateral branches of the portal vein (PVt3), or with tumor invasion to the main portal vein or its bilateral branches, or to unilateral second-order biliary radicals with contralateral portal vein involvement (PVt4). Patients in PVt4 were subclassified into the A-M group (cancer invasion limited to the tunica adventitia or media) or the I group (cancer invasion reaching the tunica intima). Of the patients, 121 were in PV0, 21 were in PVt3, and 26 were in PVt4. There was no difference in survival between the PV0 and PVt3 groups (P = .267). The PVt4 group had a worse prognosis than the PVt3 group (P = .046). In addition, the A-M (n = 19) and I subgroups (n = 7) of PVt4 had worse prognoses than the PV0 or PVt3 groups (P = .005 and portal vein invasion, although patients with tumor invasion to the main or contralateral branches of the portal vein, especially with tunica intima invasion, had extremely poor prognoses. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Negative Pressure Wound Therapy on Surgical Site Infections in Women Undergoing Elective Caesarean Sections: A Pilot RCT

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    Wendy Chaboyer

    2014-09-01

    Full Text Available Obese women undergoing caesarean section (CS are at increased risk of surgical site infection (SSI. Negative Pressure Wound Therapy (NPWT is growing in use as a prophylactic approach to prevent wound complications such as SSI, yet there is little evidence of its benefits. This pilot randomized controlled trial (RCT assessed the effect of NPWT on SSI and other wound complications in obese women undergoing elective caesarean sections (CS and also the feasibility of conducting a definitive trial. Ninety-two obese women undergoing elective CS were randomized in theatre via a central web based system using a parallel 1:1 process to two groups i.e., 46 women received the intervention (NPWT PICO™ dressing and 46 women received standard care (Comfeel Plus® dressing. All women received the intended dressing following wound closure. The relative risk of SSI in the intervention group was 0.81 (95% CI 0.38–1.68; for the number of complications excluding SSI it was 0.98 (95% CI 0.34–2.79. A sample size of 784 (392 per group would be required to find a statistically significant difference in SSI between the two groups with 90% power. These results demonstrate that a larger definitive trial is feasible and that careful planning and site selection is critical to the success of the overall study.

  2. Risk factors for superficial vs deep/organ-space surgical site infections: implications for quality improvement initiatives.

    Science.gov (United States)

    Lawson, Elise H; Hall, Bruce Lee; Ko, Clifford Y

    2013-09-01

    Surgical site infections (SSIs) are the focus of numerous quality improvement initiatives because they are a common and costly cause of potentially preventable patient morbidity. Superficial and deep/organ-space SSIs differ in terms of anatomical location and clinical severity. To identify risk factors that are uniquely predictive of superficial vs deep/organ-space SSIs occurring after colectomy procedures. Retrospective cohort study. American College of Surgeons National Surgical Quality Improvement Program. Patients undergoing colectomy procedures in 2011 were identified by Current Procedural Terminology codes. Colectomy procedures. We compared rates of superficial SSI and deep/organ-space SSI associated with perioperative variables of interest: demographics; preoperative clinical severity, risk factors, and comorbidities and variables related to the hospitalization or procedure. Hierarchical multivariable logistic regression models were developed to identify risk-adjusted predictors of each SSI type. Among 27 011 patients identified from 305 hospitals, 6.2% developed a superficial SSI and 4.7% developed a deep/organ-space SSI. Risk factors common to the occurrence of both SSI types were identified: open surgery (vs laparoscopic) and current smoker. Risk factors with differential effects on each SSI type included specific postoperative diagnoses, disseminated cancer, and irradiation therapy, which were all associated with increased odds of deep/organ-space SSI only. The graded relationship between increasing body mass index and SSI occurrence appeared to be stronger for superficial SSI. Risk factors for superficial SSI and deep/organ-space SSI vary in terms of magnitude and significance, suggesting that these SSI types are somewhat different disease processes. Groups interested in preventing SSIs might improve success by considering these SSI types independently for root-cause analyses and development of best practices and interventions.

  3. The incidence of surgical site dehiscence following full-thickness gastrointestinal biopsy in dogs and cats and associated risk factors.

    Science.gov (United States)

    Swinbourne, F; Jeffery, N; Tivers, M S; Artingstall, R; Bird, F; Charlesworth, T; Doran, I; Freeman, A; Hall, J; Hattersley, R; Henken, J; Hughes, J; de la Puerta, B; Rutherford, L; Ryan, T; Williams, H; Woods, S; Nicholson, I

    2017-09-01

    The objectives of this study were to: (1) document the incidence of surgical site dehiscence after full-thickness gastrointestinal biopsy in dogs and cats and (2) identify potential risk factors. Data relating to dogs and cats undergoing full-thickness gastrointestinal biopsy were reviewed retrospectively following submission of a completed questionnaire by 12 referral institutions. Outcome measures were definite dehiscence, possible dehiscence (clinical records suggestive of dehiscence but not confirmed), suspected dehiscence (definite and possible combined) and death within 14 days. Logistic regression was planned for analysis of association of dehiscence with low preoperative serum albumin, biopsy through neoplastic tissue, biopsy alongside another major abdominal surgical procedure and biopsy of the colon. Of 172 cats, two (1·2%) had definite dehiscence, and four (2·3%) had possible dehiscence. Low preoperative serum albumin was significantly associated with definite dehiscence in univariable analysis and with suspected dehiscence and death within 14 days in univariable analysis, but all odds ratios had wide 95% confidence intervals. A histopathological diagnosis of neoplasia was significantly associated with death within 14 days in univariable analysis. Of 195 dogs, two (1·0%) had definite dehiscence, and three (1·5%) had possible dehiscence. In dogs, there was no association between any outcome measure and the putative risk factors. Incidence of dehiscence following full-thickness gastrointestinal biopsy was low in this study. When determining the appropriateness of biopsy in individual cases, this information should be balanced against the potentially life-threatening consequences of dehiscence. © 2017 British Small Animal Veterinary Association.

  4. Reducing Surgical Site Infections in Abdominal Surgery: Are Ring Retractors Effective? A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Ahmed, Khalid; Bashar, Khalid; Connelly, Tara T M; Fahey, Tom; Walsh, Stewart R

    2016-04-01

    Surgical site infection (SSI) is one of the main causes of morbidity and death after surgical intervention. The use of physical barriers, including gloves, drapes, and gowns to reduce SSI after abdominal surgery is long-standing practice. The aim of this systematic review and meta-analysis was to determine the efficacy of ring incision retractors in reducing the risk of SSI in abdominal surgery. PubMed, CINAHL, the Cochrane randomized controlled trials (RCTs) Central Register, and the ISRCTN registry were searched for RCTs in which ring retractors were utilized to reduce SSI in abdominal surgery. The PRISMA guidelines and RevMan 5.3 were used for study selection and analysis. Additional subgroup analyses were performed, including trials using incision class (clean, clean-contaminated contaminated, and dirty) and trials that used the U.S. Centers for Disease Control and Prevention's SSI definition in their protocol. A total of 19 RCTs inclusive of 4,229 patients were included. The utility of ring retractors in reducing SSI was suggested by an overall risk ratio of 0.62 (95% confidence interval 0.48-0.81). However, study heterogeneity caused by differences in effect size between individual RCTs, the non-standardized utilization of concomitant measures to reduce SSI, and an overall lack of high-quality trials was found. A reduction in SSI incidence with the use of ring retractors is suggested by the findings. However, this result must be treated with caution because in addition to some old trials poor quality and the large number of factors affecting SSI, there were substantial differences between trials in effect sizes in statistical heterogeneity. Further RCTs are needed to confirm this provisional finding.

  5. Preoperative bathing of the surgical site with chlorhexidine for infection prevention: Systematic review with meta-analysis.

    Science.gov (United States)

    Franco, Lúcia Maciel de Castro; Cota, Gláucia Fernandes; Pinto, Tatiana Saraiva; Ercole, Flávia Falci

    2017-04-01

    Preoperative bathing with 4% chlorhexidine is recommended as a measure to prevent surgical site infection (SSI) despite uncertainty regarding the effectiveness of the intervention. This review aimed to assess the effect of bathing with 4% chlorhexidine on the prevention of SSIs in clean surgeries compared with bathing with placebo solution or soap. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews and the Cochrane manual were followed. Sources were MEDLINE and Latin American and Caribbean Health Sciences Literature databases and manual search of references from evaluated studies. We included randomized studies evaluating clean surgical wounds and reporting SSIs after preoperative bathing with 4% chlorhexidine. A total of 243 primary studies were identified and 8 were considered methodologically appropriate based on the Jadad Scale. Data were gathered from 10,655 patients. The global SSI rate was 7.2%. The SSI rate for chlorhexidine bathing, placebo, and soap without antiseptic groups was 7.1%, 9.1%, and 5.1%, respectively. A significant reduction in the infection rates was not found in the comparison between patients subjected to preoperative bathing with 4% chlorhexidine versus placebo solution (relative risk, 0.91; 95% confidence interval, 0.76-1.09). The same absence of benefit was observed comparing chlorhexidine bathing with soap (relative risk, 1.06; 95% confidence interval, 0.68-1.66). Controlled clinical trials are needed to assess the effect of preoperative chlorhexidine bathing on infection rates following clean surgery before the incorporation of this intervention in health care services. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  6. Risk factors and outcomes of organ-space surgical site infections after elective colon and rectal surgery

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    Aina Gomila

    2017-04-01

    Full Text Available Abstract Background Organ-space surgical site infections (SSI are the most serious and costly infections after colorectal surgery. Most previous studies of risk factors for SSI have analysed colon and rectal procedures together. The aim of the study was to determine whether colon and rectal procedures have different risk factors and outcomes for organ-space SSI. Methods A multicentre observational prospective cohort study of adults undergoing elective colon and rectal procedures at 10 Spanish hospitals from 2011 to 2014. Patients were followed up until 30 days post-surgery. Surgical site infection was defined according to the Centers for Disease Control and Prevention criteria. Oral antibiotic prophylaxis (OAP was considered as the administration of oral antibiotics the day before surgery combined with systemic intravenous antibiotic prophylaxis. Results Of 3,701 patients, 2,518 (68% underwent colon surgery and 1,183 (32% rectal surgery. In colon surgery, the overall SSI rate was 16.4% and the organ-space SSI rate was 7.9%, while in rectal surgery the rates were 21.6% and 11.5% respectively (p < 0.001. Independent risk factors for organ-space SSI in colon surgery were male sex (Odds ratio -OR-: 1.57, 95% CI: 1.14–2.15 and ostomy creation (OR: 2.65, 95% CI: 1.8–3.92 while laparoscopy (OR: 0.5, 95% CI: 0.38–0.69 and OAP combined with intravenous antibiotic prophylaxis (OR: 0.7, 95% CI: 0.51–0.97 were protective factors. In rectal surgery, independent risk factors for organ-space SSI were male sex (OR: 2.11, 95% CI: 1.34–3.31 and longer surgery (OR: 1.49, 95% CI: 1.03–2.15, whereas OAP with intravenous antibiotic prophylaxis (OR: 0.49, 95% CI: 0.32–0.73 was a protective factor. Among patients with organ-space SSI, we found a significant difference in the overall 30-day mortality, being higher in colon surgery than in rectal surgery (11.5% vs 5.1%, p = 0.04. Conclusions Organ-space SSI in colon and rectal surgery has some

  7. Waterless Hand Rub Versus Traditional Hand Scrub Methods for Preventing the Surgical Site Infection in Orthopedic Surgery.

    Science.gov (United States)

    Iwakiri, Kentaro; Kobayashi, Akio; Seki, Masahiko; Ando, Yoshiyuki; Tsujio, Tadao; Hoshino, Masatoshi; Nakamura, Hiroaki

    2017-11-15

    MINI: Fourteen hundred consecutive patients were investigated for evaluating the utility of waterless hand rub before orthopaedic surgery. The risk in the surgical site infection incidence was the same, but costs of liquids used for hand hygiene were cheaper and the hand hygiene time was shorter for waterless protocol, compared with traditional hand scrub. A retrospective cohort study with prospectively collected data. The aim of this study was to compare SSI incidences, the cost of hand hygiene agents, and hand hygiene time between the traditional hand scrub and the waterless hand rub protocols before orthopedic surgery. Surgical site infections (SSI) prolong hospitalization and are a leading nosocomial cause of morbidity and a source of excess cost. Recently, a waterless hand rub protocol comprising alcohol based chlorhexidine gluconate for use before surgery was developed, but no studies have yet examined its utility in orthopedic surgery. Fourteen hundred consecutive patients who underwent orthopedic surgery (spine, joint replacement, hand, and trauma surgeries) in our hospital since April 1, 2012 were included. A total of 712 cases underwent following traditional hand scrub between April 1, 2012 and April 30, 2013 and 688 cases underwent following waterless hand rub between June 1, 2013 and April 30, 2014. We compared SSI incidences within all and each subcategory between two hand hygiene protocols. All patients were screened for SSI within 1 year after surgery. We compared the cost of hand hygiene agents and hand hygiene time between two groups. The SSI incidences were 1.3% (9 of 712) following the traditional protocol (2 deep and 7 superficial infections) and 1.1% (8 of 688) following the waterless protocol (all superficial infections). There were no significant differences between the two groups. The costs of liquids used for one hand hygiene were about $2 for traditional hand scrub and less than $1 for waterless hand rub. The mean hand hygiene time was 264

  8. Risk factors for surgical site infection in a teaching hospital: a prospective study of 1,138 patients

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    Cheng K

    2015-08-01

    Full Text Available Keping Cheng, Jiawei Li, Qingfang Kong, Changxian Wang, Nanyuan Ye, Guohua Xia Department of Infection Control, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu Province, People’s Republic of China Background: The purpose of this study was to identify risk factors for surgical site infection (SSI in a teaching hospital.Methods: A prospective study was initiated to investigate risk factors for SSI at a university-affiliated tertiary care center from July 2013 to December 2014. The chi-square test for categorical variables was used to determine the significance of association, whereas the multivariate logistic regression model was used to examine independent risk factors for SSI.Results: A total of 1,138 patients met the inclusion criteria, in whom 36 cases of infection occurred during the hospitalization period and two cases occurred after discharge. Univariate analysis showed that SSI was associated with the type of operation, wound classification, volume of blood loss, blood transfusion, American Society of Anesthesiology score before surgery, risk index, duration of surgery, diabetes, cancer, gastrointestinal catheter, urinary catheter, postoperative drainage, and preprocedural white blood cell count. Multivariate analysis identified six independent parameters correlating with the occurrence of SSI: diabetes (odds ratio [OR] 6.400; 95% confidence interval [CI] 2.582–15.866; P=0.000; cancer (OR 2.427; 95% CI 1.028–5.732; P=0.043; preprocedural white blood cell count more than 10×109/L (OR 6.988; CI 3.165–15.425; P=0.000; wound classification (clean contaminated [OR: 7.893; CI: 2.244–27.762; P=0.001]; contaminated [OR: 7.031; CI: 1.652–29.922; P=0.008]; dirty [OR: 48.778; CI: 5.418–439.164; P=0.001]; operative duration more than 120 minutes (OR 4.289; CI 1.773–10.378; P=0.001; and postoperative drainage (OR 3.957; CI 1.422–11.008; P=0.008.Conclusion: Our data suggest that all these risk factors

  9. Perioperative oxygen fraction - effect on surgical site infection and pulmonary complications after abdominal surgery: a randomized clinical trial. Rationale and design of the PROXI-Trial

    DEFF Research Database (Denmark)

    Meyhoff, Christian Sylvest; Wetterslev, Jørn; Jorgensen, Lars N

    2008-01-01

    A high perioperative inspiratory oxygen fraction may reduce the risk of surgical site infections, as bacterial eradication by neutrophils depends on wound oxygen tension. Two trials have shown that a high perioperative inspiratory oxygen fraction (FiO(2) = 0.80) significantly reduced risk of surg...... complications, such as atelectasis, pneumonia and respiratory failure. The aim of our trial is to assess the potential benefits and harms of a high perioperative oxygen fraction in patients undergoing abdominal surgery....... of surgical site infections after elective colorectal surgery, but a third trial was stopped early because the frequency of surgical site infections was more than doubled in the group receiving FiO(2) = 0.80. It has not been settled if a high inspiratory oxygen fraction increases the risk of pulmonary......A high perioperative inspiratory oxygen fraction may reduce the risk of surgical site infections, as bacterial eradication by neutrophils depends on wound oxygen tension. Two trials have shown that a high perioperative inspiratory oxygen fraction (FiO(2) = 0.80) significantly reduced risk...

  10. The New World Health Organization Recommendations on Perioperative Administration of Oxygen to Prevent Surgical Site Infections: A Dangerous Reductionist Approach?

    Science.gov (United States)

    Wenk, Manuel; Van Aken, Hugo; Zarbock, Alexander

    2017-08-01

    In October 2016, the World Health Organization (WHO) published recommendations for preventing surgical site infections (SSIs). Among those measures is a recommendation to administer oxygen at an inspired fraction of 80% intra- and postoperatively for up to 6 hours. SSIs have been identified as a global health problem, and the WHO should be commended for their efforts. However, this recommendation focuses only on the patient's "wound," ignores other organ systems potentially affected by hyperoxia, and may ultimately worsen patient outcomes.The WHO advances a "strong recommendation" for the use of a high inspired oxygen fraction even though the quality of evidence is only moderate. However, achieving this goal by disregarding other potentially lethal complications seems inappropriate, particularly in light of the weak evidence underpinning the use of high fractions of oxygen to prevent SSI. Use of such a strategy thus should be intensely discussed by anesthesiologists and perioperative physicians.Normovolemia, normotension, normoglycemia, normothermia, and normoventilation can clearly be safely applied to most patients in most clinical scenarios. But the liberal application of hyperoxemia intraoperatively and up to 6 hours postoperatively, as suggested by the WHO, is questionable from the viewpoint of anesthesia and perioperative medicine, and its effects will be discussed in this article.

  11. Prevention of Incisional Surgical Site Infection Using a Subcuticular Absorbable Suture in Elective Surgery for Gastrointestinal Cancer.

    Science.gov (United States)

    Bou, Hideki; Suzuki, Hideyuki; Maejima, Kentarou; Uchida, Eiji; Tokunaga, Akira

    2015-06-01

    This study examined whether subcuticular absorbable sutures actually reduce incisional SSI in patients undergoing surgery for gastrointestinal (GI) cancer. Surgical site infection (SSI) is still a source of major complications in digestive tract surgery. Reportedly, incisional SSI can be reduced using subcuticular suturing. We performed subcuticular suturing using a 4-0 absorbable monofilament in patients undergoing elective surgery for GI cancer beginning in 2008. Using an interrupted technique, sutures were placed 1.5-2.0cm from the edge of the wound, with everted subcuticular sutures created at intervals of 1.5-2.0cm. The control group consisted of cases in which the common subcutaneous suture method using clip. One hundred cases were examined in the subcuticular group. The incidence of SSI was 0% in the subcuticular suture group, compared with 13.9% in the control group; this difference was significant. Incisional SSI can be prevented using the devised subcuticular absorbable sutures in patients undergoing elective surgery for GI cancer.

  12. Skin antisepsis with chlorhexidine versus iodine for the prevention of surgical site infection: A systematic review and meta-analysis.

    Science.gov (United States)

    Privitera, Gaetano Pierpaolo; Costa, Anna Laura; Brusaferro, Silvio; Chirletti, Piero; Crosasso, Paola; Massimetti, Gabriele; Nespoli, Angelo; Petrosillo, Nicola; Pittiruti, Mauro; Scoppettuolo, Giancarlo; Tumietto, Fabio; Viale, Pierluigi

    2017-02-01

    Surgical site infection (SSI) is one of the most frequent health care-associated infections. One of the practices to reduce their incidence is preoperative skin antisepsis. Two of the most commonly active components used are chlorhexidine gluconate and povidone iodine. Of 3 reviews conducted between 2010 and 2012 comparing antiseptics, 2 were in favor of chlorhexidine; however, the latest was unable to draw conclusions. To verify whether recent evidence supports the hypothesis that chlorhexidine in preoperative antisepsis is more efficient than other antiseptics in reducing SSI rates. We conducted a systematic review from 2000-2014 in all languages. The primary end point was SSI incidence and secondary skin bacterial colonization. Nineteen studies were included. Meta-analysis were conducted for comparable studies for both outcomes. The results of the meta-analysis, including all of the studies in which chlorhexidine was compared with iodophor, were in favor of chlorhexidine for both SSI incidence (risk ratio [RR], 0.70; 95% confidence interval [CI], 0.52-0.92) and bacterial skin colonization (RR, 0.45; 95% CI, 0.36-0.55). There is moderate-quality evidence supporting the use of chlorhexidine for preoperative skin antisepsis and high-quality evidence that the use of chlorhexidine is associated with fewer positive skin cultures. Further rigorous trials will be welcomed to attain stronger evidence as to the best antiseptic to be used before surgery. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  13. Nutritional risk index as an independent predictive factor for the development of surgical site infection after pancreaticoduodenectomy.

    Science.gov (United States)

    Shinkawa, Hiroji; Takemura, Shigekazu; Uenishi, Takahiro; Sakae, Masayuki; Ohata, Kazunori; Urata, Yorihisa; Kaneda, Kazuhisa; Nozawa, Akinori; Kubo, Shoji

    2013-03-01

    Malnutrition has been considered a risk factor for the development of a surgical site infection (SSI). The aim of this study was to determine the relationship between preoperative nutritional screening scores and the development of SSI after pancreaticoduodenectomy. We examined 64 patients who had undergone pancreaticoduodenectomy. Their clinical data, nutritional risk index (NRI), and nutritional risk screening 2002 (NRS-2002) score were recorded. SSIs were diagnosed according to the definitions of wound infection established by the Center for Disease Control and Prevention and were confirmed by a microbiological examination. Data were analyzed using the Fisher exact probability method and a multivariate logistic regression analysis. SSIs developed in 21 patients (33 %). Eleven patients had wound infections, and 14 patients had an intra-abdominal abscess. A univariate analysis of perioperative factors revealed that a pancreatic fistula, the NRS-2002, and the NRI were significantly associated with the development of SSI (p risk factors for SSI. By analyzing the pre- and intra-operative factors after excluding the 11 patients with pancreatic fistulas, the NRI was still an independent risk factor for SSI. The present study showed the NRI to be an independent factor for predicting the risk of SSI after pancreaticoduodenectomy.

  14. Surgical site infections

    African Journals Online (AJOL)

    Old traumatic wounds with retained devitalized tissue and those that involve existing clinical infection or perforated viscera. This definition suggests that the organisms that caused the post-operative infection had been present at the start of the procedure. * Garner JS and Simmons. Table II: National nosocomial Infections ...

  15. [Evaluation of Staphylococcus aureus and Escherichia coli biofilm formation on the surface of polypropylene mesh].

    Science.gov (United States)

    Reśliński, Adrian; Mikucka, Agnieszka; Kwiecińska-Piróg, Joanna; Głowacka, Katarzyna; Gospodarek, Eugenia; Dabrowiecki, Stanisław

    2011-01-01

    A serious complication of hernioplasty with the use of a biomaterial implant is deep surgical site infection (SSI) encompassing the implant. Among the most common etiological factors of deep SSI in patients after hernioplasty are Staphylococcus aureus and Escherichia coli strains, which may create a biofilm on the surface of synthetic implants. The aim of this study was assessment of biofilm formation by S. aureus and E. coli on the surface ofpolypropylene mesh. The study included 108 strains (62 S. aureus and 46 E. coli) from the collection of Department of Microbiology Collegium Medicum im. L. Rydygier in Bydgoszcz, Nicolaus Copernicus University in Torun (CM UMK). Evaluation of biofilm formation was performed using the method of reduction of 2,3,5-triphenyltetrazolium chloride (TTC) and a scanning electron microscope. In the group of S. aureus strains, 88.7% isolates formed biofilm very strongly, 1.6% strongly, and 9.7% poor. Among E. coli strains, 54.3% isolates were characterized by very strong biofilm formation, while 45.7% strong biofilm formation. Strains ofS. aureus strongly than E. coli form a biofilm on the surface of monofilament polypropylene mesh.

  16. Initial investigation of 18F-NaF PET/CT for identification of vertebral sites amenable to surgical revision after spinal fusion surgery

    OpenAIRE

    Quon, Andrew; Dodd, Robert; Iagaru, Andrei; de Abreu, Marcelo Rodrigues; Hennemann, Sergio; Neto, Jose Maria Alves; Sprinz, Clarice

    2012-01-01

    Purpose A pilot study was performed in patients with recurrent back pain after spinal fusion surgery to evaluate the ability of 18F-NaF PET/CT imaging to correctly identify those requiring surgical intervention and to locate a site amenable to surgical intervention. Methods In this prospective study 22 patients with recurrent back pain after spinal surgery and with equivocal findings on physical examination and CT were enrolled for evaluation with 18F-NaF PET/CT. All PET/CT images were prospe...

  17. THERE IS NO DIFFERENCE OF SURGICAL SITE INFECTION BETWEEN SINGLE-DOSE AND MULTIPLE-DOSE OF PROPHYLAXIS ANTIBIOTIC IN OPEN APPENDECTOMY OF NON-PERFORATED ACUTE APPENDICITIS

    Directory of Open Access Journals (Sweden)

    B Tiono

    2012-09-01

    Full Text Available Objective: Acute appendicitis is the most common surgical emergency encountered compared with other non-traumatic acute abdomens. Sanglah General Hospital recorded there were 470 cases of acute appendicitis in the year 2006. This study aims to determine the effectiveness of a single-dose antibiotic prophylaxis in prevention of surgical site infection in open appendectomy of non-perforated acute appendicitis. Method: A single blind randomized controlled trial in 110 nonperforated acute appendicitis patients that underwent open appendectomy at Sanglah General Hospital emergency operating theatre from April to June 2012 was conducted. Cefazolin 1 g and Metronidazole 500 mg were administered intravenously prior operation. Samples were divided intotwo groups by permuted block. Following operation, the single-dose group was administered placebo, while the multiple-dose group received two additional doses of antibiotics. Surgical site infection (SSI of both groups in every week for one month was evaluated. Surgical site infection wasdetermined based on Hulton’s criteria. Risk of surgical site infection of both groups was analyzed with Relative Risk (chi-square.Results: In the single-dose group 49.1% were males and 50.9% were females with a mean age of 28.71 years old, and in the multiple-dose group 40% were males and 60%were females with a mean age of 29.07 years old. Risk of SSI in single-dose group was 7.3% and multiple-dose group was 5.5% with Relative Risk (RR = 1.33% (95% CI RR: 0.31-5.68, p= 1.000.Conclusion: There is no difference of SSI risk between single and multiple-dose antibiotic prophylaxisinopen appendectomy of non-perforated acute appendicitis.

  18. Laparoscopic Appendectomy Is Safe: Influence of Appendectomy Technique on Surgical-site Infections and Intra-abdominal Abscesses.

    Science.gov (United States)

    Sohn, Maximilian; Hoffmann, Maria; Hochrein, Alfred; Buhr, Heinz J; Lehmann, Kai S

    2015-06-01

    Surgical-site infections (SSIs) and intra-abdominal abscesses (IAAs) are the most frequent complications of appendectomy. The role of laparoscopy in the treatment of appendicitis remains controversial concerning the complication rate. The aim of this retrospective cohort study was to compare open and laparoscopic appendectomy for SSI and IAA. All patients undergoing appendectomy between January 1, 2007 and May 31, 2010 were included in the study. Perioperative data and data on postoperative complications were collected from patient files. A questionnaire was used to assess complications after discharge. Main outcome parameters were SSI and IAA. Open appendectomy (OAG) and laparoscopic appendectomy (LAG) were compared with univariate and multivariate analyses for the outcome parameters. Four hundred thirty patients were included in the study. SSI (all: 10.6%, OAG: 11.7%, LAG: 7.5%, P=0.293) and IAA (all: 2.8%, OAG: 2.4%, LAG: 3.8%, P=0.506) were not significantly different between OAG and LAG. Risk factors for SSI were age (P=0.003), body mass index (P=0.017), ASA score (P=0.001), the intraoperative grade of inflammation (P=0.004), and the histologic grade of inflammation (P=0.015). The only risk factor for IAA was the intraoperative grade of inflammation (P=0.028). ASA score (odds ratio: 1.992, P=0.032) and the intraoperative grade of inflammation (odds ratio: 1.573, P=0.006) remained significant in the multivariate analysis for SSI. A higher ASA score correlates with SSI. A higher grade of intraoperative inflammation correlates with SSI and IAA. Laparoscopy has no impact on SSI and IAA in appendectomy.

  19. Smoking and Risk of Surgical Site Infection after Spinal Surgery: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Kong, Lingde; Liu, Zhao; Meng, Fei; Shen, Yong

    The effect of smoking on the risk of surgical site infection (SSI) after spinal surgery remains controversial. Therefore, we conducted a meta-analysis to determine whether there is an association between smoking and the risk of SSI and to calculate the relative risk of infections attributable to smoking. We performed a literature search of cohort and case-control studies in the MEDLINE, Embase, and ISI Web of Science databases. Sensitivity and subgroup analyses were performed to test the robustness of overall estimates of risk and to investigate potential sources of heterogeneity. We further calculated the population-attributable fraction (PAF) to evaluate the proportion of SSIs associated with smoking. In total, 26 independent observational studies involving 67,405 patients who underwent spinal surgery were analyzed. Smokers had a significantly higher risk of SSI than did nonsmokers (odds ratio [OR] 1.26; 95% confidence interval [CI] 1.05-1.51). Subgroup analysis according to the study design revealed an apparent association between smoking and SSI in the cohort subgroup (OR 1.40; 95% CI 1.17-1.66), but not in the case-control subgroup (OR 0.99; 95% CI 0.64-1.53). After evaluation of the PAF, the proportion of SSIs associated with smoking increased to 10.37%. This meta-analysis demonstrated that smoking increases the risk of SSI after spinal surgery. False-negative associations in other studies may have resulted from defects in the study design. However, because of the heterogeneity among the studies in the present meta-analysis, the results should be interpreted with caution.

  20. Does Fine Needle Aspiration Microbiology Offer Any Benefit Over Wound Swab in Detecting the Causative Organisms in Surgical Site Infections?

    Science.gov (United States)

    Sudharsanan, Sundaramurthi; Gs, Sreenath; Sureshkumar, Sathasivam; Vijayakumar, Chellappa; Sujatha, Sistla; Kate, Vikram

    2017-09-01

    The objective of this study is to determine the role of ne needle aspiration microbiology (FNAM) in detecting the causative organisms of postoperative surgical site infections (SSIs) in comparison with the standard technique of surface swabbing. Ma- terials and Methods. In this study, 150 patients with SSIs following elective and emergency operations were included. In all patients, FNAM was performed along with conventional surface swabbing to identify the causative microorganism. Sensitivity of surface swab and FNAM was calculated as the number of samples collected from the diagnosed case of SSI. A total of 115 positive cultures were obtained from the 150 patients with SSIs; surface swab was positive in 110 cases and FNAM was positive in 94 cases. The mean number of organisms isolated by surface swab, and FNAM was 0.95 and 0.8, respectively. The sensitivity of surface swab was 94.3% in elective cases and 96.25% in emergency cases. The sensitivity of FNAM was 82.8% in elective cases and 82.5% in emergency cases. The sensitivity and negative predictive value of FNAM and surface swab did not signi cantly differ in clean elective cases. The overall sensitivity of surface swab and FNAM was 95.65% and 81.7%, respectively. Comparing the antibiotic suscep- tibility pattern, no difference was observed when the same organ- ism was isolated by both methods, indicating that FNAM does not offer bene t over the conventional wound surface swab in detecting microorganisms in SSI in both elective and emergency surgeries. In certain cases with unexplained wound infections, FNAM can be used as an investigation to identify speci c pathogens not detected by conventional surface swab.

  1. Meta-analysis and trial sequential analysis of triclosan-coated sutures for the prevention of surgical-site infection.

    Science.gov (United States)

    de Jonge, S W; Atema, J J; Solomkin, J S; Boermeester, M A

    2017-01-01

    Triclosan-coated sutures (TCS) were developed to reduce the risk of surgical-site infection (SSI). Level 1A evidence of effectiveness has been presented in various recent meta-analyses, yet well designed RCTs have not been able to reproduce these favourable results. The aim of this study was to evaluate all available evidence critically with comprehensive analysis to seek a more reliable answer regarding the effectiveness of TCS in the prevention of SSI. PubMed, MEDLINE, Embase and Cochrane Library databases were searched from 1990 to November 2015 for RCTs that compared TCS with sutures that were exactly the same, but uncoated, in the prevention of SSI. Pooled relative risks (RRs) with corresponding 95 per cent confidence intervals were estimated using a random-effects model. Metaregression was used to substantiate subgroup effects, trial sequential analysis was employed to assess the risk of random error, and quality of evidence was determined using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Twenty-one RCTs including 6462 patients were included. Risk of bias was serious. Pooled effects showed a RR of 0·72 (95 per cent c.i. 0·60 to 0·86; P < 0·001) for all publications. At a risk of 138 SSIs per 1000 procedures, the use of TCS reduced this by 39 (95 per cent c.i. 19, 55). Trial sequential analysis confirmed a RR reduction of 15 per cent for the use of TCS. GRADE assessment shows moderate-quality evidence that TCS are effective in reducing SSI. Trial sequential analysis indicates that the effect was robust, and additional data are unlikely to alter the summary effect. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

  2. Network meta-analysis of antibiotic prophylaxis for prevention of surgical-site infection after groin hernia surgery.

    Science.gov (United States)

    Boonchan, T; Wilasrusmee, C; McEvoy, M; Attia, J; Thakkinstian, A

    2017-01-01

    First-generation cephalosporins (such as cefazolin) are recommended as antibiotic prophylaxis in groin hernia repair, but other broad-spectrum antibiotics have also been prescribed in clinical practice. This was a systematic review and network meta-analysis to compare the efficacy of different antibiotic classes for prevention of surgical-site infection (SSI) after hernia repair. RCTs were identified that compared efficacy of antibiotic prophylaxis on SSI after inguinal or femoral hernia repair from PubMed and Scopus databases up to March 2016. Data were extracted independently by two reviewers. Network meta-analysis was applied to assess treatment efficacy. The probability of being the best antibiotic prophylaxis was estimated using surface under the cumulative ranking curve (SUCRA) analysis. Fifteen RCTs (5159 patients) met the inclusion criteria. Interventions were first-generation (7 RCTs, 1237 patients) and second-generation (2 RCTs, 532) cephalosporins, β-lactam/β-lactamase inhibitors (6 RCTs, 619) and fluoroquinolones (2 RCTs, 581), with placebo as the most common comparator (14 RCTs, 2190). A network meta-analysis showed that β-lactam/β-lactamase inhibitors and first-generation cephalosporins were significantly superior to placebo, with a pooled risk ratio of 0·44 (95 per cent c.i. 0·25 to 0·75) and 0·62 (0·42 to 0·92) respectively. However, none of the antibiotic classes was significantly different from the others. SUCRA results indicated that β-lactam/β-lactamase inhibitors and first-generation cephalosporins were ranked first and second respectively for best prophylaxis. β-Lactam/β-lactamase inhibitors followed by first-generation cephalosporins ranked as the most effective SSI prophylaxis for adult patients undergoing groin hernia repair. © 2017 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.

  3. Independent risk factors for surgical site infection after cesarean delivery in a rural tertiary care medical center.

    Science.gov (United States)

    Vallejo, Manuel C; Attaallah, Ahmed F; Shapiro, Robert E; Elzamzamy, Osama M; Mueller, Michael G; Eller, Warren S

    2017-02-01

    We aimed to determine the incidence of surgical site infection (SSI) after cesarean delivery (CD) and identify the risk factors in a rural population. We identified 218 SSI patients by International Classification of Disease codes and matched them with 3131 parturients (control) from the electronic record database in a time-matched retrospective quality assurance analysis. The incidence of SSI after CD was 7.0 %. Risk factors included higher body mass index (BMI) [40.30 ± 10.60 kg/m2 SSI (95 % CI 38.73-41.87) vs 34.05 ± 8.24 kg/m2 control (95 % CI 33.75-34.35, P < 0.001)], years of education [13.28 ± 2.44 years SSI (95 % CI 12.9-13.66) vs 14.07 ± 2.81 years control (95 % CI 13.96-14.18, P < 0.001)], number of prior births [2 (1-9) SSI vs 1 (1-11) control (P < 0.001)], tobacco use (OR 1.49; 95 % CI 1.06-2.09, P = 0.03), prior diagnosis of hypertension (OR 1.80; 95 % CI 1.34-2.42, P < 0.001), gestational diabetes (OR 1.59; 95 % CI 1.18-2.13, P = 0.003), and an emergency/STAT CD (OR 1.6; 95 % CI 1.1-2.3, P = 0.01). Risk factors for SSI after CD included higher BMI, less years of education, higher prior births, tobacco use, prior diagnosis of hypertension, gestational diabetes, and emergency/STAT CD. The presence of ruptured membranes was protective against SSI.

  4. Suction drains in esthetic breast implant exchange are associated with surgical site infections: A retrospective cohort study.

    Science.gov (United States)

    Hadad, Eran; Wiser, Itay; Rosenthal, Adaya; Landau, Geva; Ziv, Ella; Heller, Lior

    2017-11-01

    Surgical site infection (SSI) following esthetic breast implant exchange occurs in up to 2% of procedures. The effect of suction drains on SSI risk in these cases remains controversial. This study aimed to assess the SSI risk in the presence of suction drains after esthetic exchange of breast implants. This is a retrospective cohort study of patients undergoing esthetic breast implant exchange between 2012 and 2015. SSI was determined according to the definition of the Center for Disease Control and Prevention. Multivariate analysis using a logistic regression model to identify independent risk factors for SSI was performed. A total of 256 women (504 breasts) met the inclusion criteria and were included in the study. The mean age was 44 ± 11 years. The mean operative time was 93 ± 40 min. The mean implant age at the time of the exchange was 10.3 ± 6.5 years. Suction drains were used in 229 breasts (45.4%) and were removed after 6 ± 7 days. Twenty (4%) breasts were diagnosed with SSI, of which 17 had suction drains. Suction drain use and days until drain removal were associated with a higher risk of SSI (85.0% vs. 43.8%, p suction drains remained an independent risk factor for SSI after adjustment for age, smoking, and previous capsular contracture (OR = 10.66, CI 95% 2.42-46.82). Suction drain use in esthetic breast implant exchange is associated with an increased risk of SSI. Surgeons should carefully consider using suction drains in selected cases only. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  5. Performance of statistical process control methods for regional surgical site infection surveillance: a 10-year multicentre pilot study.

    Science.gov (United States)

    Baker, Arthur W; Haridy, Salah; Salem, Joseph; Ilieş, Iulian; Ergai, Awatef O; Samareh, Aven; Andrianas, Nicholas; Benneyan, James C; Sexton, Daniel J; Anderson, Deverick J

    2017-11-24

    Traditional strategies for surveillance of surgical site infections (SSI) have multiple limitations, including delayed and incomplete outbreak detection. Statistical process control (SPC) methods address these deficiencies by combining longitudinal analysis with graphical presentation of data. We performed a pilot study within a large network of community hospitals to evaluate performance of SPC methods for detecting SSI outbreaks. We applied conventional Shewhart and exponentially weighted moving average (EWMA) SPC charts to 10 previously investigated SSI outbreaks that occurred from 2003 to 2013. We compared the results of SPC surveillance to the results of traditional SSI surveillance methods. Then, we analysed the performance of modified SPC charts constructed with different outbreak detection rules, EWMA smoothing factors and baseline SSI rate calculations. Conventional Shewhart and EWMA SPC charts both detected 8 of the 10 SSI outbreaks analysed, in each case prior to the date of traditional detection. Among detected outbreaks, conventional Shewhart chart detection occurred a median of 12 months prior to outbreak onset and 22 months prior to traditional detection. Conventional EWMA chart detection occurred a median of 7 months prior to outbreak onset and 14 months prior to traditional detection. Modified Shewhart and EWMA charts additionally detected several outbreaks earlier than conventional SPC charts. Shewhart and SPC charts had low false-positive rates when used to analyse separate control hospital SSI data. Our findings illustrate the potential usefulness and feasibility of real-time SPC surveillance of SSI to rapidly identify outbreaks and improve patient safety. Further study is needed to optimise SPC chart selection and calculation, statistical outbreak detection rules and the process for reacting to signals of potential outbreaks. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights

  6. Face, content, and construct validity of four, inanimate training exercises using the da Vinci ® Si surgical system configured with Single-Site ™ instrumentation.

    Science.gov (United States)

    Jarc, Anthony M; Curet, Myriam

    2015-08-01

    Validated training exercises are essential tools for surgeons as they develop technical skills to use robot-assisted minimally invasive surgical systems. The purpose of this study was to show face, content, and construct validity of four, inanimate training exercises using the da Vinci (®) Si surgical system configured with Single-Site (™) instrumentation. New (N = 21) and experienced (N = 6) surgeons participated in the study. New surgeons (11 Gynecology [GYN] and 10 General Surgery [GEN]) had not completed any da Vinci Single-Site cases but may have completed multiport cases using the da Vinci system. They participated in this study prior to attending a certification course focused on da Vinci Single-Site instrumentation. Experienced surgeons (5 GYN and 1 GEN) had completed at least 25 da Vinci Single-Site cases. The surgeons completed four inanimate training exercises and then rated them with a questionnaire. Raw metrics and overall normalized scores were computed using both video recordings and kinematic data collected from the surgical system. The experienced surgeons significantly outperformed new surgeons for many raw metrics and the overall normalized scores derived from video review (p Vinci Single-Site surgery and actually testing the technical skills used during da Vinci Single-Site surgery. In summary, the four training exercises showed face, content, and construct validity. Improved overall scores could be developed using additional metrics not included in this study. The results suggest that the training exercises could be used in an overall training curriculum aimed at developing proficiency in technical skills for surgeons new to da Vinci Single-Site instrumentation.

  7. In vitro activity of tedizolid against Staphylococcus aureus and Streptococcus pneumoniae collected in 2013 and 2014 from sites in Latin American countries, Australia, New Zealand, and China.

    Science.gov (United States)

    Biedenbach, D J; Bouchillon, S K; Johnson, B; Alder, J; Sahm, D F

    2016-12-01

    Tedizolid is an oxazolidinone with an antimicrobial in vitro potency advantage against Gram-positive bacterial pathogens compared to other currently marketed drugs in this class, including linezolid. Tedizolid was compared to linezolid when tested against Staphylococcus aureus and Streptococcus pneumoniae isolates collected from countries in Latin America and the Asia-Pacific. Isolates were tested by broth microdilution susceptibility methods against tedizolid, linezolid, and non-class comparators in accordance with the Clinical and Laboratory Standards Institute (CLSI) guidelines. The activity of tedizolid against S. aureus was potent and consistent in Latin America (MIC90, 0.5 mg/L), Australia and New Zealand (MIC90, 0.25 mg/L), and China (MIC90, 0.5 mg/L). Based on MIC90 results, tedizolid was four- to eight-fold more active than linezolid against S. aureus, including both methicillin-susceptible and -resistant isolates. Only two tedizolid non-susceptible strains were observed; both had intermediate minimum inhibitory concentration (MIC) values of 1 mg/L, for which the MICs of linezolid was higher (≥2 mg/L). Tedizolid (MIC90, 0.25 mg/L) was four-fold more potent than linezolid (MIC90, 1 mg/L) against S. pneumoniae in all countries that provided isolates. The findings from this study support the global clinical development of tedizolid for Gram-positive infections.

  8. The effect of triclosan coated sutures on rate of surgical site infection after hip and knee replacement: a protocol for a double-blind randomised controlled trial.

    Science.gov (United States)

    Sprowson, Andrew P; Jensen, Cyrus D; Parsons, Nick; Partington, Paul; Emmerson, Kevin; Carluke, Ian; Asaad, Seif; Pratt, Roland; Muller, Scott; Reed, Mike R

    2014-07-14

    187,000 hip and knee joint replacements are performed every year in the National Health Service (NHS). One of the commonest complications is surgical site infection (SSI), and this represents a significant burden in terms of patient morbidity, mortality and cost to health services around the world. The aim of this randomised controlled trial (RCT) is to determine if the addition of triclosan coated sutures to a standard regimen can reduce the rate of SSI after total knee replacement (TKR) and total hip replacement (THR). 2400 patients due to undergo a total hip or knee replacement are being recruited into this two-centre RCT. Participants are recruited before surgery and randomised to either standard care or intervention group. Participants, outcome assessors and statistician are blind to treatment allocation throughout the study. The intervention consists of triclosan coated sutures vs. standard non-coated sutures. The primary outcome is the Health protection Agency (HPA) defined superficial surgical site infection at 30 days. Secondary outcomes include HPA defined deep surgical site infection at 12 months, length of hospital stay, critical care stay, and payer costs. To date there are no orthopaedic randomised controlled trials on this scale assessing the effectiveness of a surgical intervention, particularly those that can be translated across the surgical specialities. The results from this trial will inform evidence-based recommendations for suture selection in the management of patients undergoing total hip or knee replacement. If triclosan coated sutures are found to be an effective intervention, implementation into clinical practice could improve long-term outcomes for patients undergoing hip and knee replacement. Current Controlled Trials ISRCTN 17807356.

  9. Staphylococcus aureus infections; Lead by the nose

    NARCIS (Netherlands)

    H.F.L. Wertheim (Heiman)

    2005-01-01

    textabstractAn overview and the latest insights regarding S. aureus nasal carriage, associated risks of developing infections and possible preventive measures, will be given in Chapter 2. Since mupirocin efficacy studies in preventing nosocomial infections have only been performed in surgical and

  10. Comparison of surgical site infection rates in clean and clean-contaminated wounds in dogs and cats after minimally invasive versus open surgery: 179 cases (2007-2008).

    Science.gov (United States)

    Mayhew, Philipp D; Freeman, Lynetta; Kwan, Toni; Brown, Dorothy C

    2012-01-15

    To report and compare the surgical site infection (SSI) rates for clean and clean-contaminated procedures performed by either a minimally invasive surgical or open surgical approach in a large population of dogs and cats. Prospective case series. 179 patients (dogs and cats) undergoing minimally invasive abdominal or thoracic surgery. Case information from all animals that underwent minimally invasive abdominal or thoracic surgery was prospectively collected and compared with an existing database of the same information collected from 379 patients undergoing laparotomy or thoracotomy via an open surgical approach. For both groups, an SSI was defined as any surgical wound in which purulent discharge was observed within 14 days after the procedure. Follow-up for all patients was obtained by direct examination or telephone interviews. Overall SSI rate in the minimally invasive surgery (MIS) group was 1.7% and in the open surgery (OS) group was 5.5%. On univariate analysis, there was a significantly lower SSI rate in the MIS group, compared with the SSI rate for the OS group. On multivariable logistic regression analysis, this difference appeared to be a result of the fact that surgery times were longer (median, 105 vs 75 minutes) and hair was clipped ≥ 4 hours prior to surgery for more animals (23% vs 11 %) in the OS group, compared with the MIS group. MIS may be associated with a lower SSI rate, compared with OS, but confounding factors such as differences in surgery time and preoperative preparation contributed in part to this finding. As such, surgical approach cannot be categorized as an independent risk factor for SSIs in small animals until further studies are performed.

  11. Evidence-Based Update to the U.S. Centers for Disease Control and Prevention and Healthcare Infection Control Practices Advisory Committee Guideline for the Prevention of Surgical Site Infection: Developmental Process.

    Science.gov (United States)

    Berríos-Torres, Sandra I

    2016-04-01

    Recommendations in the "Guideline for Prevention of Surgical Site Infection, 1999" were based on experts' selective interpretation of the scientific evidence. Effective 2009, the U.S. Centers for Disease Control and Prevention (CDC) and its Healthcare Infection Control Practices Advisory Committee (HICPAC) updated their guideline development process. This is a narrative summary of the updated process focusing on key changes and challenges specific to the Guideline for Prevention of Surgical Site Infection. The guideline development process now incorporates evidence-based methodology and provides explicit links between the evidence and the recommendations using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. There is also participation by professional surgical societies, an updated guideline structure (core and procedure-specific sections), additional planned related manuscripts (introductions to the guideline and research opportunities), and new proposed venues for publication. The new CDC and HICPAC "Guideline for the Prevention of Surgical Site Infection" represents a substantial advancement from recommendations for infection control practices based on expert opinion to evidence-based practices. The new structure is meant to facilitate future updates, in particular, those addressing specialty or procedure-specific surgical site infection prevention questions. Increased presence by the surgical community through the professional surgical societies' engagement in the guideline development process, lead authorship of related manuscripts, and proposed publication in the surgical literature not only increase adherence by the surgical community, but also promote an ongoing collaboration with public health and other partners in a multidisciplinary approach to SSI prevention.

  12. The extent of environmental and body contamination through aerosols by hydro-surgical debridement in the lumbar spine.

    Science.gov (United States)

    Putzer, David; Lechner, Ricarda; Coraca-Huber, Debora; Mayr, Astrid; Nogler, Michael; Thaler, Martin

    2017-06-01

    Surgical site infections occur in 1-6% of spinal surgeries. Effective treatment includes early diagnosis, parenteral antibiotics and early surgical debridement of the wound surface. On a human cadaver, we executed a complete hydro-surgery debridement including a full surgical setup such as draping. The irrigation fluid was artificially contaminated with Staphylococcus aureus (ATCC 6538). Surveillance cultures were used to detect environmental and body contamination of the surgical team. For both test setups, environmental contamination was observed in an area of 6 × 8 m. Both test setups caused contamination of all personnel present during the procedure and of the whole operating theatre. However, the concentration of contamination for the surgical staff and the environment was lower when an additional disposable draping device was used. The study showed that during hydro-surgery debridement, contaminated aerosols spread over the whole surgical room and contaminate the theatre and all personnel.

  13. Meta-Analysis of Comparative Trials Evaluating a Prophylactic Single-Use Negative Pressure Wound Therapy System for the Prevention of Surgical Site Complications.

    Science.gov (United States)

    Strugala, Vicki; Martin, Robin

    2017-10-01

    We report the first meta-analysis on the impact of prophylactic use of a specific design of negative pressure wound therapy (NPWT) device on surgical site complications. Articles were identified in which the specific single-use NPWT device (PICO⋄, Smith & Nephew) was compared with standard care for surgical site infection (SSI), dehiscence, or length of stay (LOS). Risk ratio (RR) ±95% confidence interval (CI) (SSI; dehiscence) or mean difference in LOS ±95% CI was calculated using RevMan v5.3. There were 1863 patients (2202 incisions) represented by 16 articles. Among 10 randomized studies, there was a significant reduction in SSI rate of 51% from 9.7% to 4.8% with NPWT intervention (RR 0.49 [95% CI 0.34-0.69] p cesarean section), although the numbers needed to treat (NNT) were lower in operations with higher frequencies of complications. There was a significant reduction in dehiscence from 17.4% to 12.8% with NPWT (RR 0.71 [95% CI 0.54-0.92] p wound dehiscence, and LOS on the basis of pooled data from 16 studies shows a benefit of the PICO single-use NPWT system compared with standard care in closed surgical incisions.

  14. Staphylococcus aureus and Pregnancy

    Science.gov (United States)

    Staphylococcus aureus (Staph Infection) In every pregnancy, a woman starts out with a 3-5% chance of having a baby with ... from your health care provider. What is a staph infection? Staphylococcus aureus (staph) is a type of ...

  15. Central venous catheter-related bloodstream infection caused by Staphylococcus aureus: microbiology and risk factors

    Directory of Open Access Journals (Sweden)

    Geraldo Sadoyma

    Full Text Available Although central vascular catheters (CVC are indispensable in modern medicine, they are an important risk factor for primary bacteremias. We examined the incidence and risk factors associated with catheter-related bloodstream infection (CR-BSI caused by Staphylococcus aureus in surgical patients. A prospective study was carried out in the Hospital das Clínicas da Universidade Federal de Uberlândia (HC-UFU from September 2000 to December 2002. The skin insertion site, catheter tip, and blood were microbiologically analyzed. Demographics and risk factors were recorded for each patient, and cultures were identified phenotypically. Staphylococcus aureus was the most frequent pathogen, with an incidence rate of 4.9 episodes of CR-BSIs per 1,000 catheter/days. Based on logistic regression, the independent risk factors were: colonization on the insertion site =200 colony forming units (CFU/20 cm² (p=0.03; odds ratio (OR =6.89 and catheter tip (p=0.01; OR=7.95. The CR-BSI rate was high; it was mainly associated with S. aureus, and skin colonization at the insertion site and on the catheter tip were important risk factors for CR-BSI.

  16. Prophylactic negative-pressure wound therapy after cesarean is associated with reduced risk of surgical site infection: a systematic review and meta-analysis.

    Science.gov (United States)

    Yu, Lulu; Kronen, Ryan J; Simon, Laura E; Stoll, Carolyn R T; Colditz, Graham A; Tuuli, Methodius G

    2017-09-23

    The objective of the study was to assess the effect of prophylactic negative-pressure wound therapy on surgical site infections and other wound complications in women after cesarean delivery. We searched Ovid Medline, Embase, SCOPUS, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov. We included randomized controlled trials and observational studies comparing prophylactic negative-pressure wound therapy with standard wound dressing for cesarean delivery. The primary outcome was surgical site infection after cesarean delivery. Secondary outcomes were composite wound complications, wound dehiscence, wound seroma, endometritis, and hospital readmission. Heterogeneity was assessed using Higgin's I2. Relative risks with 95% confidence intervals were calculated using random-effects models. Six randomized controlled trials and 3 cohort studies in high-risk mostly obese women met inclusion criteria and were included in the meta-analysis. Six were full-text articles, 2 published abstracts, and 1 report of trial results in ClinicalTrials.gov. Studies were also heterogeneous in the patients included and type of negative-pressure wound therapy device. The risk of surgical site infection was significantly lower with the use of prophylactic negative-pressure wound therapy compared with standard wound dressing (7 studies: pooled risk ratio, 0.45; 95% confidence interval, 0.31-0.66; adjusted risk ratio, -6.0%, 95% confidence interval, -10.0% to -3.0%; number needed to treat, 17, 95% confidence interval, 10-34). There was no evidence of significant statistical heterogeneity (I2 = 9.9%) or publication bias (Egger P = .532). Of the secondary outcomes, only composite wound complications were significantly reduced in patients receiving prophylactic negative-pressure wound therapy compared with standard dressing (9 studies: pooled risk ratio, 0.68, 95% confidence interval, 0.49-0.94). Studies on the effectiveness of prophylactic negative-pressure wound therapy at

  17. Can the surgical checklist reduce the risk of wrong site surgery in orthopaedics? - can the checklist help? Supporting evidence from analysis of a national patient incident reporting system

    Directory of Open Access Journals (Sweden)

    Cleary Kevin

    2011-04-01

    Full Text Available Abstract Background Surgical procedures are now very common, with estimates ranging from 4% of the general population having an operation per annum in economically-developing countries; this rising to 8% in economically-developed countries. Whilst these surgical procedures typically result in considerable improvements to health outcomes, it is increasingly appreciated that surgery is a high risk industry. Tools developed in the aviation industry are beginning to be used to minimise the risk of errors in surgery. One such tool is the World Health Organization's (WHO surgery checklist. The National Patient Safety Agency (NPSA manages the largest database of patient safety incidents (PSIs in the world, already having received over three million reports of episodes of care that could or did result in iatrogenic harm. The aim of this study was to estimate how many incidents of wrong site surgery in orthopaedics that have been reported to the NPSA could have been prevented by the WHO surgical checklist. Methods The National Reporting and Learning Service (NRLS database was searched between 1st January 2008- 31st December 2008 to identify all incidents classified as wrong site surgery in orthopaedics. These incidents were broken down into the different types of wrong site surgery. A Likert-scale from 1-5 was used to assess the preventability of these cases if the checklist was used. Results 133/316 (42% incidents satisfied the inclusion criteria. A large proportion of cases, 183/316 were misclassified. Furthermore, there were fewer cases of actual harm [9% (12/133] versus 'near-misses' [121/133 (91%]. Subsequent analysis revealed a smaller proportion of 'near-misses' being prevented by the checklist than the proportion of incidents that resulted in actual harm; 18/121 [14.9% (95% CI 8.5 - 21.2%] versus 10/12 [83.3% (95%CI 62.2 - 104.4%] respectively. Summatively, the checklist could have been prevented 28/133 [21.1% (95%CI 14.1 - 28.0%] patient safety

  18. Staphylococcus aureus toxins.

    Science.gov (United States)

    Otto, Michael

    2014-02-01

    Staphylococcus aureus is a dangerous pathogen that causes a variety of severe diseases. The virulence of S. aureus is defined by a large repertoire of virulence factors, among which secreted toxins play a preeminent role. Many S. aureus toxins damage biological membranes, leading to cell death. In particular, S. aureus produces potent hemolysins and leukotoxins. Among the latter, some were recently identified to lyse neutrophils after ingestion, representing an especially powerful weapon against bacterial elimination by innate host defense. Furthermore, S. aureus secretes many factors that inhibit the complement cascade or prevent recognition by host defenses. Several further toxins add to this multi-faceted program of S. aureus to evade elimination in the host. This review will give an overview over S. aureus toxins focusing on recent advances in our understanding of how leukotoxins work in receptor-mediated or receptor-independent fashions. Published by Elsevier Ltd.

  19. Close association between oropharyngeal and rhinopharyngeal colonization with Staphylococcus aureus - clues to new insight of MRSA colonization of the oropharynx

    DEFF Research Database (Denmark)

    Petersen, I S; Larsen, P L; Brandelev, B L

    2013-01-01

    This study provides data on prevalence of Staphylococcus aureus in oropharynx, rhinopharynx and vestibulum nasi. Specimens were taken from these three pharyngeal sites in 346 patients and analysed for S. aureus. Abnormal pharyngeal findings and patient histories were recorded. S. aureus was found...... meticillin-resistant Staphylococcus aureus decolonization regimes....

  20. Effect of the Combination of Low-Speed Drilling and Cooled Irrigation Fluid on Intraosseous Heat Generation During Guided Surgical Implant Site Preparation: An In Vitro Study.

    Science.gov (United States)

    Barrak, Ibrahim; Joób-Fancsaly, Arpad; Varga, Endre; Boa, Kristof; Piffko, Jozsef

    2017-08-01

    Investigating the effect of the combination of low-speed drilling and cooled irrigation fluid on intraosseous temperature rise during guided and freehand implant surgery. Bovine ribs were used as bone specimens. Grouping determinants were as follows: drill diameter (2.0, 2.5, 3.0, and 3.5 mm), irrigation fluid temperature (10°C, 15°C, and 20°C), and surgical method (guided and freehand). Drilling speed was 800 rpm. Results were compared with previous ones using 1200 rpm. Temperature measurements were conducted using K-type thermocouples. No mean temperature change exceeded 1.0°C if irrigation fluid cooled to 10°C was used, regardless of the drill diameter or the surgical method, with the highest elevation being 2.10°C. No significant reduction was measured when comparing groups using 15°C and 20°C irrigation fluids, regardless of both drill diameter and surgical method. The use of irrigation fluid being cooled to 10°C combined with low-speed drilling (800 rpm) seems to be a safe method for implant site preparation and drilling through a drilling guide in terms of temperature control.

  1. Environment of care: Is it time to reassess microbial contamination of the operating room air as a risk factor for surgical site infection in total joint arthroplasty?

    Science.gov (United States)

    Parvizi, Javad; Barnes, Sue; Shohat, Noam; Edmiston, Charles E

    2017-11-01

    In the modern operating room (OR), traditional surgical mask, frequent air exchanges, and architectural barriers are viewed as effective in reducing airborne microbial populations. Intraoperative sampling of airborne particulates is rarely performed in the OR because of technical difficulties associated with sampling methodologies and a common belief that airborne contamination is infrequently associated with surgical site infections (SSIs). Recent studies suggest that viable airborne particulates are readily disseminated throughout the OR, placing patients at risk for postoperative SSI. In 2017, virtually all surgical disciplines are engaged in the implantation of selective biomedical devices, and these implants have been documented to be at high risk for intraoperative contamination. Approximately 1.2 million arthroplasties are performed annually in the United States, and that number is expected to increase to 3.8 million by the year 2030. The incidence of periprosthetic joint infection is perceived to be low (air quality standards on their manufacturing processes, there is currently no U.S. standard for acceptable air quality within the OR environment. This review documents the contribution of air contamination to the etiology of periprosthetic joint infection, and evidence for selective innovative strategies to reduce the risk of intraoperative microbial aerosols. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  2. Vigilancia de las infecciones de herida quirúrgica. Experiencia de 18 meses en el Instituto Nacional de Cancerología Surgical site infection surveillance at the National Cancer Institute in Mexico. An 18 months experience

    Directory of Open Access Journals (Sweden)

    Diana Vilar-Compte

    1999-01-01

    Full Text Available OBJETIVO. Conocer la frecuencia de infecciones quirúrgicas con un programa prospectivo de vigilancia de cirugías y seguimiento postegreso, en el Instituto Nacional de Cancerología, que es un hospital de tercer nivel de la Ciudad de México. MATERIAL Y MÉTODOS. Durante 18 meses se captaron y se vigilaron todas las cirugías efectuadas en el hospital. Se calcularon las razones (por 100 cirugías de infecciones de herida quirúrgica (IHQX por servicio y por el grado de contaminación bacteriana. Se utilizaron las definiciones de IHQX del Centro para la Prevención y el Control de las Enfermedades de Estados Unidos de América (1992. RESULTADOS. Se vigilaron 3 372 cirugías. Trescientos trece casos se infectaron: 140 (44.7% fueron incisionales superficiales; 137 (43.7%, incisionales profundas, y 36 (11.5%, de órganos y espacios. La frecuencia de IHQX fue de 9.28%; para las cirugías limpias, limpias-contaminadas, contaminadas y sucias fue de 7.35, 10.5, 17.3 y 21.5%, respectivamente. La frecuencia de infecciones por servicio fue: gastroenterología, 14.13%; tumores de mama, 11.08%; piel y partes blandas, 10.98%; ginecología, 9.06%; urología, 7.38%; cabeza y cuello, 7.13%, y neumología, 1.81%. La IHQX ocurrió en promedio a los 11.6±6.23 días; 85 casos (27.16% se diagnosticaron mientras el paciente estaba hospitalizado, y 228 (72.84%, después del egreso del paciente. Se obtuvo algún cultivo en 134 (42.8% casos. Los gérmenes más comunes fueron: E. coli, 38 (22.5%; estafilococo coagulasa negativo, 23 (13.6%; Pseudomonas sp., 22 (13%; S. aureus, 16 (9.4%, y enterococos,13 (7.7%. CONCLUSIONES. La vigilancia prospectiva de las cirugías con un seguimiento por 30 días aumentó hasta en 400% la posibilidad de detectar una IHQX. La frecuencia de IHQX en las cirugías limpias y limpias-contaminadas se encuentra por arriba de lo informado.OBJECTIVES. To calculate the surgical site infection (SSI rates with a surgical prospective surveillance

  3. Postoperative infection treatment score for the spine (PITSS): construction and validation of a predictive model to define need for single versus multiple irrigation and debridement for spinal surgical site infection.

    Science.gov (United States)

    Dipaola, Christian P; Saravanja, Davor D; Boriani, Luca; Zhang, Hongbin; Boyd, Michael C; Kwon, Brian K; Paquette, Scott J; Dvorak, Marcel F S; Fisher, Charles G; Street, John T

    2012-03-01

    yielded an AUC of 0.84. External validation analysis yielded AUC of 0.70 and 95% confidence interval of 0.51 to 0.89. By setting a probability cutoff of .24, the negative predictive value (NPV) for multiple I&D was 0.77 and positive predictive value (PPV) was 0.57. A probability cutoff of .53 yielded a PPV of 0.85 and NPV of 0.46. Patients with positive methicillin-resistant Staphylococcus aureus culture or those with distant site infection such as bacteremia were strong predictors of need for multiple I&D. Presence of instrumentation, location of surgery in the posterior lumbar spine, and use of nonautograft bone graft material predicted multiple I&D. Diabetes also proved to be the most significant medical comorbidity for multiple I&D. The validation of this predictive model revealed excellent PPV and good NPV with appropriately chosen probability cutoff points. This study forms the basis for an evidence-based classification system, the Postoperative Infection Treatment Score for the Spine that stratifies patients who require surgery for SSI, based on specific spine, patient, infection, and surgical factors to assess a low, indeterminate, and high risk for the need for multiple I&D. Copyright © 2012 Elsevier Inc. All rights reserved.

  4. Low skeletal muscle radiation attenuation and visceral adiposity are associated with overall survival and surgical site infections in patients with pancreatic cancer.

    Science.gov (United States)

    van Dijk, David P J; Bakens, Maikel J A M; Coolsen, Mariëlle M E; Rensen, Sander S; van Dam, Ronald M; Bours, Martijn J L; Weijenberg, Matty P; Dejong, Cornelis H C; Olde Damink, Steven W M

    2017-04-01

    Cancer cachexia and skeletal muscle wasting are related to poor survival. In this study, quantitative body composition measurements using computed tomography (CT) were investigated in relation to survival, post-operative complications, and surgical site infections in surgical patients with cancer of the head of the pancreas. A prospective cohort of 199 patients with cancer of the head of the pancreas was analysed by CT imaging at the L3 level to determine (i) muscle radiation attenuation (average Hounsfield units of total L3 skeletal muscle); (ii) visceral adipose tissue area; (iii) subcutaneous adipose tissue area; (iv) intermuscular adipose tissue area; and (v) skeletal muscle area. Sex-specific cut-offs were determined at the lower tertile for muscle radiation attenuation and skeletal muscle area and the higher tertile for adipose tissues. These variables of body composition were related to overall survival, severe post-operative complications (Dindo-Clavien ≥ 3), and surgical site infections (wounds inspected daily by an independent trial nurse) using Cox-regression analysis and multivariable logistic regression analysis, respectively. Low muscle radiation attenuation was associated with shorter survival in comparison with moderate and high muscle radiation attenuation [median survival 10.8 (95% CI: 8.8-12.8) vs. 17.4 (95% CI: 14.7-20.1), and 18.5 (95% CI: 9.2-27.8) months, respectively; P attenuation combined with either low visceral adipose tissue or age attenuation was inversely correlated with intermuscular adipose tissue (rp  = -0.697, P attenuation was associated with reduced survival, and high visceral adiposity was associated with an increase in surgical site infections. The strong correlation between muscle radiation attenuation and intermuscular adipose tissue suggests the presence of ectopic fat in muscle, warranting further investigation. CT image analysis could be implemented in pre-operative risk assessment to assist in treatment

  5. Contamination of environmental surfaces by methicillin-resistant Staphylococcus aureus (MRSA) in rooms of inpatients with MRSA-positive body sites.

    Science.gov (United States)

    Kurashige, E Jessica Ohashi; Oie, Shigeharu; Furukawa, H

    2016-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) can contaminate environmental surfaces that are frequently touched by the hands of patients with MRSA colonization/infection. There have been many studies in which the presence or absence of MRSA contamination was determined but no studies in which MRSA contamination levels were also evaluated in detail. We evaluated MRSA contamination of environmental surfaces (overbed tables, bed side rails, and curtains) in the rooms of inpatients from whom MRSA was isolated via clinical specimens. We examined the curtains within 7-14 days after they had been newly hung. The environmental surfaces were wiped using gauze (molded gauze for wiping of surface bacteria; 100% cotton, 4cm×8cm) moistened with sterile physiological saline. The MRSA contamination rate and mean counts (range) were 25.0% (6/24 samples) and 30.6 (0-255)colony-forming units (cfu)/100cm(2), respectively, for the overbed tables and 31.6% (6/19 samples) and 159.5 (0-1620)cfu/100cm(2), respectively, for the bed side rails. No MRSA was detected in 24 curtain samples. The rate of MRSA contamination of environmental surfaces was high for the overbed tables and bed side rails but low for the curtains. Therefore, at least until the 14th day of use, frequent disinfection of curtains may be not necessary. Copyright © 2016. Published by Elsevier Editora Ltda.

  6. Preoperative chlorhexidine reduces the incidence of surgical site infections in total knee and hip arthroplasty: A systematic review and meta-analysis.

    Science.gov (United States)

    Cai, Yuanzhen; Xu, Ke; Hou, Weikun; Yang, Zhi; Xu, Peng

    2017-03-01

    This meta-analysis aims to assess the incidences of surgical site infection of patients who applied preadmission chlorhexidine skin preparation, versus those who applied the traditional skin preparation before undergoing total knee and hip arthroplasty. A systematic search is carried out through Medline (1966-2016.11), PubMed (1966-2016.11), Embase (1980-2016.11), ScienceDirect (1985-2016.11) and the Cochrane Library. Only high quality studies are identified. Meta-analysis is conducted with the use of Stata 11.0 software. One RCT and five retrospective studies, published between 2010 and 2016, are included in the present meta-analysis. The present meta-analysis indicates that there are significant differences in surgical site infection rate (RD = -0.02, 95% CI: -0.02 to -0.01, P chlorhexidine skin preparation appears to reduce the risk of infection, the incidence of revision surgery, and the length of stay for patients undergoing total knee and hip arthroplasty. No adverse effects, such as DVT or PE, appear to be related to chlorhexidine preparation. Due to the limited quality of the evidence currently available, high quality RCTs with better study designs, larger sample sizes and longer follow-ups are needed. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  7. Is hospital information system relevant to detect surgical site infection? Findings from a prospective surveillance study in posterior instrumented spinal surgery.

    Science.gov (United States)

    Boetto, J; Chan-Seng, E; Lonjon, G; Pech, J; Lotthé, A; Lonjon, N

    2015-11-01

    Spinal instrumentation has a high rate of surgical site infection (SSI), but results greatly vary depending on surveillance methodology, surgical procedures, or quality of follow-up. Our aim was to study true incidence of SSI in spinal surgery by significant data collection, and to compare it with the results obtained through the hospital information system. This work is a single center prospective cohort study that included all patients consecutively operated on for spinal instrumentation by posterior approach over a six-month period regardless the etiology. For all patients, a "high definition" prospective method of surveillance was performed by the infection control (IC) department during at least 12 months after surgery. Results were then compared with findings from automatic surveillance though the hospital information system (HIS). One hundred and fifty-four patients were included. We found no hardly difference between "high definition" and automatic surveillance through the HIS, even if HIS tended to under-estimate the infection rate: rate of surgical site infection was 2.60% and gross SSI incidence rate via the hospital information system was 1.95%. Smoking and alcohol consumption were significantly related to a SSI. Our SSI rates to reflect the true incidence of infectious complications in posterior instrumented adult spinal surgery in our hospital and these results were consistent with the lower levels of published infection rate. In-house surveillance by surgeons only is insufficiently sensitive. Further studies with more patients and a longer inclusion time are needed to conclude if SSI case detection through the HIS could be a relevant and effective alternative method. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  8. Local levels of biomarkers after surgical and nonsurgical debridement of residual pockets and nonresidual sites in diabetic patients: a 12-month follow-up.

    Science.gov (United States)

    Bezerra, Joyce Pinho; Shaddox, Luciana Machion; de Mendonca, Adriana Cutrim; Bastos, Marta Ferreira; de Miranda, Tamires Szeremeske; Santos, Vanessa Renata; Duarte, Poliana Mendes

    2015-01-01

    There is scarce evidence on suitable approaches for the treatment of unresponsive or residual periodontal sites in diabetic patients. This study assessed the effects of surgical debridement (SD) and nonsurgical debridement (NSD), associated with amoxicillin and metronidazole, on clinical and immunological outcomes of residual pockets and adjacent healthy sites in patients with type 2 diabetes. A split-mouth, randomized controlled trial was conducted in 21 patients presenting at least 2 residual pockets in contralateral quadrants 12 months after basic nonsurgical periodontal therapy. Patients received systemic antibiotics, and contralateral quadrants were assigned to receive SD or NSD. The changes in clinical parameters were evaluated from baseline to 12 months. Local levels of 14 cytokines and chemokines were measured with multiplex bead immunoassays at baseline and 3 and 12 months after therapy. There were no statistically significant differences between SD and NSD for changes in clinical parameters from baseline to 12 months (P > 0.05). There was a significantly greater increase in the levels of granulocyte-macrophage colony-stimulating factor and interleukin 6 from baseline to 3 months in the healthy sites adjacent to residual pockets receiving SD (P infection and stable wound healing in these sites at 12 months.

  9. An Improved Medium for Growing Staphylococcus aureus Biofilm

    Science.gov (United States)

    2012-04-19

    Branch, US Army Dental and Trauma Research Detachment, Institute of Surgical Research, Fort Sam Houston, TX 78234, United States a b s t r a c ta r t...hlgC), are up regulated Journal of Microbiological Methods 90 (2012) 115–118 ⁎ Corresponding author at: 3650 Chambers Pass, Bldg 3610, US Army Dental ...aureus biofilm formation in real time, we used overnight green fluores cent protein (GFP) tagged clinical isolate S. aureus UAMS 1 (University of

  10. Post surgical complications from students' large animal surgical ...

    African Journals Online (AJOL)

    Surgical site debridement and surgical reconstruction coupled with antibiotic therapy were used in the management of complications. Responses from questionnaires administered to instructors of the surgical laboratories, revealed that post surgical complications were due to poor health status of sheep and goats used, ...

  11. Methicillin-resistant Staphylococcus aureus in a finger felon.

    Science.gov (United States)

    Connolly, B; Johnstone, F; Gerlinger, T; Puttler, E

    2000-01-01

    Methicillin-resistant Staphylococcus aureus is an increasingly prevalent nosocomial pathogen that presents therapeutic challenges. We report an incidence of methicillin-resistant S aureus in a felon. The biochemical and clinical characteristics of methicillin-resistant S aureus are reviewed. The alarming increase of this organism in various types of infections demands the attention of all surgeons and emphasizes the importance of early surgical drainage and culture of pus in all cases of infection. (J Hand Surg 2000; 25A:173-175. Copyright 2000 by the American Society for Surgery of the Hand.).

  12. Computed tomography evidence of fluid in the hernia sac predicts surgical site infection following mesh repair of acutely incarcerated ventral and groin hernias.

    Science.gov (United States)

    Loftus, Tyler J; Go, Kristina L; Jordan, Janeen R; Croft, Chasen A; Smith, R Stephen; Moore, Frederick A; Efron, Philip A; Mohr, Alicia M; Brakenridge, Scott C

    2017-07-01

    Mesh placement during repair of acutely incarcerated ventral and groin hernias is associated with high rates of surgical site infection (SSI). The utility of preoperative computed tomography (CT) in this setting is unclear. We hypothesized that CT evidence of bowel wall compromise would predict SSI while accounting for physiologic parameters. We performed a 4-year retrospective cohort analysis of 50 consecutive patients who underwent mesh repair of acutely incarcerated ventral or groin hernias. We analyzed chronic disease burden, acute illness severity, CT findings, operative management, and herniorrhaphy-specific outcomes within 180 days. The primary outcome was SSI by the Centers for Disease Control and Prevention criteria. Multiple logistic regression was performed to identify independent predictors of SSI. Eighty-four percent of all patients were American Society of Anesthesiologists class III or IV, 28% were active smokers, and mean body mass index (BMI) was 35 kg/m. Fifty-four percent had ventral hernias, 40% had inguinal hernias, and 6% had femoral or combined inguinal/ femoral hernias. Seventy percent of preoperative CT scans had features suggesting bowel compromise, abdominal free fluid, or fluid in the hernia sac. Surgical site infection occurred in 32% of all patients (8% superficial, 24% deep or organ/space). The strongest predictors of SSI were CT evidence of fluid in the hernia sac (odds ratio [OR], 8.3; 95% confidence interval [CI], 1.7-41), initial heart rate 90 beats/min or greater (OR, 6.3; 95% CI, 1.1-34), and BMI 35 kg/m or greater (OR, 5.8; 95% CI, 1.2-28). Surgical site infection rates were significantly higher among patients who had CT evidence of fluid in the hernia sac (56% vs. 19%, p = 0.012). More than half of all patients with CT scan evidence of fluid in the hernia sac developed an SSI. Computed tomography evidence of fluid in the hernia sac was the strongest predictor of SSI, followed by heart rate and BMI. Together, these parameters

  13. Surgical site infection in high-energy peri-articular tibia fractures with intra-wound vancomycin powder: a retrospective pilot study.

    Science.gov (United States)

    Singh, Keerat; Bauer, Jennifer M; LaChaud, Gregory Y; Bible, Jesse E; Mir, Hassan R

    2015-12-01

    Surgical site infections (SSI) continue to be a significant source of morbidity despite the introduction of perioperative intravenous antibiotics. Our objective was to assess the efficacy of local vancomycin powder on lowering deep SSI rates in high-energy tibial plateau and pilon fractures. A retrospective review of all tibial plateau and pilon fractures treated in 2012 at our level I trauma center identified 222 patients. Of these, 107 patients sustained high-energy injuries that required staged fixation, and 93 had minimum 6 month follow-up. Ten patients received 1 gram vancomycin powder directly into the surgical wound at the time of definitive fixation, and the remaining 83 patients served as controls. SSI was defined according to criteria from the Centers for Disease Control. Demographic data, patient comorbidities, injury and treatment details, and infection details were recorded. Descriptive and comparative statistics were performed. Amongst the vancomycin powder group, 1 patient (10 %) developed a deep SSI; in the control group, 14 (16.7 %) developed deep SSI. The rate of deep SSI between the groups was not statistically significantly different (P = 1.0). The groups were statistically similar with regard to injuries, treatment, comorbidities, and infectious outcomes (P values range = 0.06-1.0). The application of local vancomycin powder into surgical wounds of high-energy tibial plateau and pilon fractures did not reduce the rate of deep SSI in this retrospective review. There is a need to find effective, cheap, and widely available methods for prevention of SSI. Basic science and larger prospective clinical studies are needed to further delineate the role of local vancomycin powder as a modality to reduce deep SSI in extremity trauma.

  14. Phase II Randomized Trial of Negative-Pressure Wound Therapy to Decrease Surgical Site Infection in Patients Undergoing Laparotomy for Gastrointestinal, Pancreatic, and Peritoneal Surface Malignancies

    Science.gov (United States)

    Shen, Perry; Blackham, Aaron U; Lewis, Stacey; Clark, Clancy J; Howerton, Russell; Mogal, Harveshp D; Dodson, Rebecca M; Russell, Gregory B; Levine, Edward A

    2017-01-01

    BACKGROUND Surgical site infections (SSIs) remain a major source of morbidity and cost after resection of intra-abdominal malignancies. Negative-pressure wound therapy (NPWT) has been reported to significantly reduce SSIs when applied to the closed laparotomy incision. This article reports the results of a randomized clinical trial examining the effect of NPWT on SSI rates in surgical oncology patients with increased risk for infectious complications. STUDY DESIGN From 2012 to 2016, two hundred and sixty-five patients who underwent open resection of intra-abdominal neoplasms were stratified into 3 groups: gastrointestinal (n = 57), pancreas (n = 73), or peritoneal surface (n = 135) malignancy. They were randomized to receive NPWT or standard surgical dressing (SSD) applied to the incision from postoperative days 1 through 4. Primary outcomes of combined incisional (superficial and deep) SSI rates were assessed up to 30 days after surgery. RESULTS There were no significant differences in superficial SSIs (12.8% vs 12.9%; p > 0.99) or deep SSI (3.0% vs 3.0%; p > 0.99) rates between the SSD and NPWT groups, respectively. When stratified by type of surgery, there were still no differences in combined incisional SSI rates for gastrointestinal (25% vs 24%; p > 0.99), pancreas (22% vs 22%; p > 0.99), and peritoneal surface malignancy (9% vs 9%; p > 0.99) patients. When performing univariate and multivariate logistic regression analysis of demographic and operative factors for the development of combined incisional SSI, the only independent predictors were preoperative albumin (p = 0.0031) and type of operation (p = 0.018). CONCLUSIONS Use of NPWT did not significantly reduce incisional SSI rates in patients having open resection of gastrointestinal, pancreatic, or peritoneal surface malignancies. Based on these results, at this time NPWT cannot be recommended as a therapeutic intervention to decrease infectious complications in these patient populations. PMID:28088597

  15. Clinical relevance and effect of surgical wound classification in appendicitis: Retrospective evaluation of wound classification discrepancies between surgeons, Swissnoso-trained infection control nurse, and histology as well as surgical site infection rates by wound class.

    Science.gov (United States)

    Wang-Chan, Anastasija; Gingert, Christian; Angst, Eliane; Hetzer, Franc Heinrich

    2017-07-01

    Surgical wound classification (SWC) is used for risk stratification of surgical site infection (SSI) and serves as the basis for measuring quality of care. The objective was to examine the accuracy and reliability of SWC. This study was purposed to evaluate the discrepancies in SWC as assessed by three groups: surgeons, an infection control nurse, and histopathologic evaluation. The secondary aim was to compare the risk-stratified SSI rates using the different SWC methods for 30 d postoperatively. An analysis was performed of the appendectomies from January 2013 to June 2014 in the Cantonal Hospital of Schaffhausen. SWC was assigned by the operating surgeon at the end of the procedure and retrospectively reviewed by a Swissnoso-trained infection control nurse after reading the operative and pathology report. The level of agreement among the three different SWC assessment groups was determined using kappa statistic. SSI rates were analyzed using a chi-square test. In 246 evaluated cases, the kappa scores for interrater reliability among the SWC assessments across the three groups ranged from 0.05 to 0.2 signifying slight agreement between the groups. SSIs were more frequently associated with trained infection control nurse-assigned SWC than with surgeons based SWC. Our study demonstrated a considerable discordance in the SWC assessments performed by the three groups. Unfortunately, the currently practiced SWC system suffers from ambiguity in definition and/or implementation of these definitions is not clearly stated. This lack of reliability is problematic and may lead to inappropriate comparisons within and between hospitals and surgeons. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

  16. Abortion - surgical

    Science.gov (United States)

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...

  17. Haemodynamic consequences of targeted single- and dual-site right ventricular pacing in adults with congenital heart disease undergoing surgical pulmonary valve replacement

    Science.gov (United States)

    Plymen, Carla M.; Finlay, Malcolm; Tsang, Victor; O'leary, Justin; Picaut, Nathalie; Cullen, Shay; Walker, Fiona; Deanfield, John E; Hsia, T.Y.; Bolger, Aidan P.; Lambiase, Pier D.

    2015-01-01

    Aims The purpose of this study was to create an epicardial electroanatomic map of the right ventricle (RV) and then apply post-operative-targeted single- and dual-site RV temporary pacing with measurement of haemodynamic parameters. Cardiac resynchronization therapy is an established treatment for symptomatic left ventricular (LV) dysfunction. In congenital heart disease, RV dysfunction is a common cause of morbidity—little is known regarding the potential benefits of CRT in this setting. Methods and results Sixteen adults (age = 32 ± 8 years; 6 M, 10 F) with right bundle branch block (RBBB) and repaired tetralogy of Fallot (n = 8) or corrected congenital pulmonary stenosis (n = 8) undergoing surgical pulmonary valve replacement (PVR) for pulmonary regurgitation underwent epicardial RV mapping and haemodynamic assessment of random pacing configurations including the site of latest RV activation. The pre-operative pulmonary regurgitant fraction was 49 ± 10%; mean LV end-diastolic volume (EDV) 85 ± 19 mL/min/m2 and RVEDV 183 ± 89 mL/min/m2 on cardiac magnetic resonance imaging. The mean pre-operative QRS duration is 136 ± 26 ms. The commonest site of latest activation was the RV free wall and DDD pacing here alone or combined with RV apical pacing resulted in significant increases in cardiac output (CO) vs. AAI pacing (P < 0.01 all measures). DDDRV alternative site pacing significantly improved CO by 16% vs. AAI (P = 0.018), and 8.5% vs. DDDRV apical pacing (P = 0.02). Conclusion Single-site RV pacing targeted to the region of latest activation in patients with RBBB undergoing PVR induces acute improvements in haemodynamics and supports the concept of ‘RV CRT’. Targeted pacing in such patients has therapeutic potential both post-operatively and in the long term. PMID:25371427

  18. Rapid tests for the detection of the Mycobacterium abscessus subsp. bolletii strain responsible for an epidemic of surgical-site infections in Brazil

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    Cristianne Kayoko Matsumoto

    2012-12-01

    Full Text Available A single strain of Mycobacterium abscessus subsp. bolletii, characterised by a particular rpoB sequevar and two highly related pulsed field gel electrophoresis patterns has been responsible for a nationwide outbreak of surgical infections in Brazil since 2004. In this study, we developed molecular tests based on polymerase chain reaction restriction-enzyme analysis (PRA and sequencing for the rapid identification of this strain. Sequences of 15 DNA regions conserved in mycobacteria were retrieved from GenBank or sequenced and analysed in silico. Single nucleotide polymorphisms specific to the epidemic strain and located in enzyme recognition sites were detected in rpoB, the 3' region of the 16S rDNA and gyrB. The three tests that were developed, i.e., PRA-rpoB, PRA-16S and gyrB sequence analysis, showed 100%, 100% and 92.31% sensitivity and 93.06%, 90.28% and 100% specificity, respectively, for the discrimination of the surgical strain from other M. abscessus subsp. bolletii isolates, including 116 isolates from 95 patients, one environmental isolate and two type strains. The results of the three tests were stable, as shown by results obtained for different isolates from the same patient. In conclusion, due to the clinical and epidemiological importance of this strain, these tests could be implemented in reference laboratories for the rapid preliminary diagnosis and epidemiological surveillance of this epidemic strain.

  19. Should hip fractures be operated upon only by specialist hip unit surgeons in order to lower rates of surgical site infection?

    Science.gov (United States)

    Guerado, Enrique; Cano, Juan R; Cruz, Encarnacion; Bertrand, María Luisa; Hirschfeld, Miguel; Benitez-Parejo, Nicolas

    2015-01-01

    The purpose of this study was to compare outcomes of hip fractures treated by orthopaedic surgeons, performed by specialist vs. non-specialist surgeons. The rate of surgical site infection (SSI) obtained is taken as the main variable. This was a prospective controlled cohort study of 814 patients presenting with hip fractures, operated on by a group of orthopaedic surgeons within the same hospital department. Patients were classified according to whether the surgeons belonged to a specialist hip unit (group A = 212 cases) or not (group B = 602 cases). Multivariate logistic regression showed that there was no relation between gender, SSI, Charlson's index, preoperative period, surgical technique or study groups (A or B). Only age was a determinant factor (rank-sum test p = 0.03; OR 95% CI = 1.07, p = 0.005). Since there were no differences in the SSI outcome between surgeons working in a specialist hip unit and the general orthopaedic surgeons, delaying operative treatment for hip fractures to enable treatment in such a unit or creating a new unit of this type is not necessary. In this respect, the only significant variable is the patient's age.

  20. Vacuum-assisted closure versus closure without vacuum assistance for preventing surgical site infections and infections of chronic wounds: a meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Tansarli, Giannoula S; Vardakas, Konstantinos Z; Stratoulias, Constantinos; Peppas, George; Kapaskelis, Anastasios; Falagas, Matthew E

    2014-08-01

    We sought to examine whether vacuum-assisted closure (VAC) is associated with fewer surgical site infections (SSIs) or infections of chronic wounds than other management procedures for surgical wounds. The PubMed and Scopus databases were searched systematically. Randomized controlled trials (RCTs) comparing the development of SSIs or infections of chronic wounds between patients treated with VAC for acute or chronic wounds and those whose wounds were treated without VAC were considered eligible for inclusion in the study. Eight RCTs met the inclusion criteria for the study. Four of the studies included chronic or diabetic lower extremity wounds and four included fractures. In three of four studies reporting on fractures, the wounds were not closed post-operatively, whereas in one study primary closure of the wound was performed. With regard to wounds left open after the stabilization of fractures, patients whose wounds were treated with VAC developed fewer SSIs than those whose wounds were treated without VAC ([367 patients (196 with VAC; 171 without VAC) relative risk [RR], 0.47; 95% CI 0.28-0.81]). On the contrary, no difference in the development of SSIs occurred among patients with chronic or diabetic lower-extremity wounds treated with VAC and those whose wounds were treated without VAC ([638 patients (320 with VAC; 318 without VAC) RR 1.67; 95% CI: 0.71-3.94]). The available evidence suggests that the development of infections in wounds treated with VAC depends on the type of wound being treated.

  1. Effect of the Abdominal Fascial Closure with Triclosan-Coated Sutures in Fecal Peritonitis, on Surgical Site Infection, and Evisceration: A Retrospective Multi-Center Study.

    Science.gov (United States)

    Ruiz-Tovar, Jaime; Alonso, Natalia; Ochagavía, Aina; Arroyo, Antonio; Llavero, Carolina

    2018-01-01

    Surgical site infection (SSI) is a frequent complication in dirty surgery, reaching rates of up to 40%. The incidence of SSI might be influenced by the suture used for closure of the abdominal fascia. Sutures coated with antibacterial substances may reduce the bacterial load in the incision. A retrospective study of patients with intra-operative diagnosis of fecal peritonitis undergoing a laparotomy in three Spanish hospitals was performed. Fascial closure consisted in running loop suture of Polyglactin (Vicryl loop®, Johnson & Johnson, New Brunswick, NY; group 1), running loop suture of triclosan-coated polyglactin (Vicryl plus loop®; group 2), running loop suture of polydioxanone (PDS loop® Johnson & Johnson; group 3), and running loop suture of triclosan-coated polydioxanone (PDS plus loop®; group 4). Incisional SSI and evisceration rates were assessed. One hundred four patients were included. There were no differences in age, gender, comorbidities, etiology of peritonitis, and mortality among groups. Surgical site infection rate was 34.6% in group 1; 8% in group 2; 33% in group 3; and 10% in group 4 (p = 0.029). The use of triclosan-coated sutures is associated with lower risk of SSI (risk ratio [RR]: 9; p = 0.003). Evisceration rate was 0% in groups 1 and 2; 15.2% in group 3; and 10% in group 4 (p = 0.05). All patients suffering from evisceration presented previous SSI. The use of monofilament sutures is associated with higher risk of evisceration (RR: 6.35; p = 0.033). Triclosan-coated sutures reduce SSI rate in fecal peritonitis, without differences between braided and monofilament type. The use of monofilament sutures is related to higher risk of evisceration, independent of a triclosan coating.

  2. Systematic review of the clinical effectiveness of wound-edge protection devices in reducing surgical site infection in patients undergoing open abdominal surgery.

    Science.gov (United States)

    Gheorghe, Adrian; Calvert, Melanie; Pinkney, Thomas D; Fletcher, Benjamin R; Bartlett, David C; Hawkins, William J; Mak, Tony; Youssef, Haney; Wilson, Sue

    2012-06-01

    Assess the existing evidence on the clinical effectiveness of wound-edge protection devices (WEPDs) in reducing the surgical site infection (SSI) rate in patients undergoing open abdominal surgery. Surgical site infections are a common postoperative complication associated with considerable morbidity, extended hospital stay, increased health care costs, and reduced quality of life. Wound-edge protection devices have been used in surgery to reduce SSI rates for more than 40 years; however, they are yet to be cited in major clinical guidelines addressing SSI management. A review protocol was prespecified. A variety of sources were searched in November 2010 for studies containing primary data on the use of WEPDs in reducing SSI compared with standard care in patients undergoing open abdominal surgery. The outcome of interest was a well-specified, clinically based definition of an SSI. No language or time restrictions were applied. The quality assessment of the studies and the quantitative analyses were performed in line with the principles of the Cochrane Collaboration. Twelve studies reporting primary data from 1933 patients were included in the review. The quality assessment found all of them to be at considerable risk of bias. An exploratory meta-analysis was performed to provide a quantitative indication on the effect of WEPDs. The pooled risk ratio under a random effects model was 0.60 (95% confidence interval, 0.41-0.86), indicating a potentially significant benefit from the use of WEPDs. No indications of significant between-study heterogeneity or publication bias, respectively, were identified. Evidence to date suggests that WEPDs may be efficient in reducing SSI rates in patients undergoing open abdominal surgery. However, the poor quality of the existing studies and their small sample sizes raise the need for a large, good quality randomized controlled trial to validate this indication.

  3. Preoperative stoma siting and education by stomatherapists of colorectal cancer patients: a descriptive study in twelve Spanish colorectal surgical units.

    Science.gov (United States)

    Millan, Monica; Tegido, Montse; Biondo, Sebastiano; García-Granero, Eduardo

    2010-07-01

    Patients with colorectal cancer who need a stoma should undergo preoperative marking of the stoma site and education by a trained stomatherapist. This study examined the care received by ostomy patients with colorectal cancer in Spanish colorectal surgery units, to assess its quality and to detect areas for improvement. A prospective study was conducted in twelve Spanish colorectal surgery units in Spain including patients visited by the stomatherapist after surgery for colorectal cancer. Each patient answered a questionnaire about their stoma care. Between September 2007 and May 2008, 270 patients were included, (63% colostomies, 37% ileostomies). Of whom; 75% had elective and 25% emergency surgery. Stomatherapist marked the stoma site in 45,6% of patients (0% emergency created stomas and 58,8% elective). However, patients who saw a stoma therapist preoperatively presented significantly lower rates of stoma complications (p < 0.001) and anxiety (p < 0.001) compared to those who did not postoperatively. The study has demonstrated the importance of preoperative stomatherapy assessment.

  4. Infección de los sitios quirúrgicos: estudio de 1 año Infection of the surgical sites: a one-year study

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    Vivian Vialat Soto

    2008-03-01

    sitios quirúrgicos en el niño continúa siendo un problema de salud, al elevar la morbilidad operatoria y aumentar la duración de la estadía hospitalaria y los costes de esta.INTRODUCTION. The patient that undergoes surgery is exposed to diverse complications during the postoperative period. The Center for Disease Control (CDC, Atlanta, U.S.A. redifined the problem of postoperative infections and proposed the term "infection of the surgical sites" to refer to the third most reported cause of nosocomial infection. The objective of this study was to identify the behaviour of the infections of the surgical sites and their interrelation to the risk factors in children operated on in our surgery service during 2006. METHODS. A study on the incidence of infection of the surgical sites and the influence of the risk factors on children that were operated on at the surgery service of the Pediatric Teaching Hospital of Centro Habana in 2006 was conducted. The study group was composed of the 44 patients that presented postoperative infection of the total of 1158 patients that underwent surgery in this period. Different variables were studied and the data obtained from them were analyzed. RESULTS. The 44 patients with infection of the surgical sites accounted for an infection rate of 3.79 %. The sepsis of the surgical wound was the most frequent complication (93.2 %. In 25.0 % of the infected cases, perioperative antimicrobial prophylaxis had been used. The infection predominated in the patients that underwent emergency surgery (75.0 % and in the dirty surgeries (43.2 %. The highest number of postoperative infections (31; 70.5 % was registered in the patients operated on of acute appendicitis. Only 7 infected patients had a hospital stay of more than 9 days (15.9 %, and there were only 6 readmissions: 4 patients with sepsis of deep wounds and 3 children with intraperitoneal abscesses secondary to acute appendicitis with generalized peritonitis. CONCLUSIONS. The infection of the

  5. Staphylococcus lugdunensis, a serious pathogen in periprosthetic joint infections: comparison to Staphylococcus aureus and Staphylococcus epidermidis

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    J. Lourtet-Hascoët

    2016-10-01

    Conclusion: S. lugdunensis is an emerging pathogen with a pathogenicity quite similar to that of S. aureus. This coagulase-negative Staphylococcus must be identified precisely in PJI, in order to select the appropriate surgical treatment and antibiotics .

  6. Postoperative hypothermia and surgical site infection following peritoneal insufflation with warm, humidified carbon dioxide during laparoscopic colorectal surgery: a cohort study with cost-effectiveness analysis.

    Science.gov (United States)

    Mason, Sam E; Kinross, James M; Hendricks, Jane; Arulampalam, Thanjakumar H

    2017-04-01

    Surgical Site Infection (SSI) occurs in 9 % of laparoscopic colorectal surgery. Warming and humidifying carbon dioxide (CO2) used for peritoneal insufflation may protect against SSI by avoiding postoperative hypothermia (itself a risk factor for SSI). This study aimed to assess the impact of CO2 conditioning on postoperative hypothermia and SSI and to perform a cost-effectiveness analysis. A retrospective cohort study of patients undergoing elective laparoscopic colorectal resection was performed at a single UK specialist centre. The control group (n = 123) received peritoneal insufflation with room temperature, dry CO2, whereas the intervention group (n = 123) received warm, humidified CO2 (using HumiGard™, Fisher & Paykel Healthcare). The outcomes were postoperative hypothermia, SSI and costs. Multivariate analysis was performed. A total of 246 patients were included in the study. The mean age was 68 (20-87) and mean BMI 28 (15-51). The primary diagnosis was cancer (n = 173), and there were no baseline differences between the groups. CO2 conditioning significantly decreased the incidence of postoperative hypothermia (odds ratio 0.10, 95 % CI 0.04-0.23), with hypothermic patients found to be at increased risk of SSI (odds ratio 4.0, 95 % CI 1.25-12.9). Use of conditioned CO2 significantly decreased the incidence of SSI by 66 % (p = 0.04). The intervention group incurred costs of £155 less per patient. The incremental cost-effectiveness ratio was negative. CO2 conditioning during laparoscopic colorectal surgery is a safe, feasible and a cost-effective intervention. It improves the quality of surgical care relating to SSI and postoperative hypothermia.

  7. Non-compliance with recommendations for the practice of antibiotic prophylaxis and risk of surgical site infection: results of a multilevel analysis from the INCISO Surveillance Network.

    Science.gov (United States)

    Miliani, Katiuska; L'Hériteau, François; Astagneau, Pascal

    2009-12-01

    The aim of this study was to determine which surgical antibiotic prophylaxis (SAP) practices alter surgical site infection (SSI) risk. Data were collected during a 7 year surveillance period (2001-07) from volunteer surgery wards participating in the INCISO Surveillance Network in Northern France. Main SAP practices, i.e. antibiotic choice, timing of first dose and total SAP duration, were evaluated and compliance checked based on French recommendations. The study focused on selected procedures in digestive, orthopaedic, gynaecological and cardiovascular surgery, for which standard SAP is recommended. Multilevel logistic regression analysis (a two-level random effect model) was carried out to identify SAP-, patient- and procedure-specific factors associated with SSI. Of 8029 patients who underwent the selected surgeries, 91.3% received SAP and 2.5% developed SSI. Among those receiving SAP, 83.3% received appropriate antibiotic agents and 76.6% had an optimal timing of administration. SAP duration was considered to be appropriate in 35.0%, too long (SAP unnecessarily prolonged) in 45.2% and too short (lack of intra-operative redosing when recommended) in 19.8%. In the multivariate analysis, a too-short SAP duration remained the only inappropriate practice associated with higher SSI risk (odds ratio = 1.8, 95% confidence interval: 1.14-2.81), after adjustment for surgery procedure group, the National Nosocomial Infections Surveillance System risk index, age and infection risk variability among hospitals. No significant relationships were observed between SSI and the other SAP parameters. A too-short SAP duration was the most important SAP malpractice associated with an increased risk of SSI. Information directed at practitioners should be reinforced based on standard recommendations.

  8. Which Kind of Provider's Operation Volumes Matters? Associations between CABG Surgical Site Infection Risk and Hospital and Surgeon Operation Volumes among Medical Centers in Taiwan.

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    Tsung-Hsien Yu

    Full Text Available Volume-infection relationships have been examined for high-risk surgical procedures, but the conclusions remain controversial. The inconsistency might be due to inaccurate identification of cases of infection and different methods of categorizing service volumes. This study takes coronary artery bypass graft (CABG surgical site infections (SSIs as an example to examine whether a relationship exists between operation volumes and SSIs, when different SSIs case identification, definitions and categorization methods of operation volumes were implemented.A population-based cross-sectional multilevel study was conducted. A total of 7,007 patients who received CABG surgery between 2006 and 2008 from 19 medical centers in Taiwan were recruited. SSIs associated with CABG surgery were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9 CM codes and a Classification and Regression Trees (CART model. Two definitions of surgeon and hospital operation volumes were used: (1 the cumulative CABG operation volumes within the study period; and (2 the cumulative CABG operation volumes in the previous one year before each CABG surgery. Operation volumes were further treated in three different ways: (1 a continuous variable; (2 a categorical variable based on the quartile; and (3 a data-driven categorical variable based on k-means clustering algorithm. Furthermore, subgroup analysis for comorbidities was also conducted.This study showed that hospital volumes were not significantly associated with SSIs, no matter which definitions or categorization methods of operation volume, or SSIs case identification approaches were used. On the contrary, the relationships between surgeon's volumes varied. Most of the models demonstrated that the low-volume surgeons had higher risk than high-volume surgeons.Surgeon volumes were more important than hospital volumes in exploring the relationship between CABG operation volumes and

  9. Five-year decreased incidence of surgical site infections following gastrectomy and prosthetic joint replacement surgery through active surveillance by the Korean Nosocomial Infection Surveillance System.

    Science.gov (United States)

    Choi, H J; Adiyani, L; Sung, J; Choi, J Y; Kim, H B; Kim, Y K; Kwak, Y G; Yoo, H; Lee, Sang-Oh; Han, S H; Kim, S R; Kim, T H; Lee, H M; Chun, H K; Kim, J-S; Yoo, J D; Koo, H-S; Cho, E H; Lee, K W

    2016-08-01

    Surveillance of healthcare-associated infection has been associated with a reduction in surgical site infection (SSI). To evaluate the Korean Nosocomial Infection Surveillance System (KONIS) in order to assess its effects on SSI since it was introduced. SSI data after gastrectomy, total hip arthroplasty (THA), and total knee arthroplasty (TKA) between 2008 and 2012 were analysed. The pooled incidence of SSI was calculated for each year; the same analyses were also conducted from hospitals that had participated in KONIS for at least three consecutive years. Standardized SSI rates for each year were calculated by adjusting for SSI risk factors. SSI trends were analysed using the Cochran-Armitage test. The SSI rate following gastrectomy was 3.12% (522/16,918). There was a significant trend of decreased crude SSI rates over five years. This trend was also evident in analysis of hospitals that had participated for more than three years. The SSI rate for THA was 2.05% (157/7656), which decreased significantly from 2008 to 2012. The risk factors for SSI after THA included the National Nosocomial Infections Surveillance risk index, trauma, reoperation, and age (60-69 years). The SSI rate for TKA was 1.90% (152/7648), which also decreased significantly during a period of five years. However, the risk-adjusted analysis of SSI did not show a significant decrease for all surgical procedures. The SSI incidence of gastrectomy and prosthetic joint replacement declined over five years as a result of active surveillance by KONIS. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  10. Violation of prophylactic vancomycin administration timing is a potential risk factor for rate of surgical site infections in cardiac surgery patients: a prospective cohort study.

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    Cotogni, Paolo; Barbero, Cristina; Passera, Roberto; Fossati, Lucina; Olivero, Giorgio; Rinaldi, Mauro

    2017-03-08

    Intensivists and cardiothoracic surgeons are commonly worried about surgical site infections (SSIs) due to increasing length of stay (LOS), costs and mortality. The antimicrobial prophylaxis is one of the most important tools in the prevention of SSIs. The objective of this study was to investigate the relationship between the timing of antimicrobial prophylaxis administration and the rate of SSIs. A prospective cohort study was carried out over 1-year period in all consecutive adult patients undergoing elective cardiac surgery. The population was stratified in patients whose antimicrobial prophylaxis administration violated or not the vancomycin timing protocol (i.e., when the first skin incision was performed before the end of vancomycin infusion). To compare SSI rates, the cohort was further stratified in patients at low and high risk of developing SSIs. Over the study period, 1020 consecutive adult patients underwent cardiac surgery and according to study inclusion criteria, 741 patients were prospectively enrolled. A total of 60 SSIs were identified for an overall infection rate of 8.1%. Vancomycin prophylaxis timing protocol was violated in 305 (41%) out of 741 enrolled patients. SSIs were observed in 3% of patients without violation of the antimicrobial prophylaxis protocol (13/436) compared with 15.4% of patients with a violation of the timing protocol (47/305) (P violation had a higher occurrence of SSIs (P = 0.004) and mortality (P = 0.03) versus patients at low risk without protocol violation. Similarly, patients at high risk with protocol violation had a higher occurrence of SSIs (P violation. The logistic regression analysis showed that internal mammary artery use (P = 0.025), surgical time (P violation (P violation (P violation of the timing of prophylactic vancomycin administration significantly increased the probability of SSIs and mortality from infectious cause in cardiac surgery patients.

  11. Surgical site infections among high-risk patients in clean-contaminated head and neck reconstructive surgery: concordance with preoperative oral flora.

    Science.gov (United States)

    Yang, Ching-Hsiang; Chew, Khong-Yik; Solomkin, Joseph S; Lin, Pao-Yuan; Chiang, Yuan-Cheng; Kuo, Yur-Ren

    2013-12-01

    Salivary contamination of surgical wounds in clean-contaminated head and neck surgery with free flap reconstruction remains a major cause of infection and leads to significant morbidity. This study investigates the correlation between intraoral flora and surgical site infections (SSIs) among high-risk head and neck cancer patients undergoing resection and free flap reconstruction. One hundred twenty-nine patients were identified as being at high risk for infective complications based on cancer stage, tumor size, comorbid factors, and extent of reconstruction. All patients had intraoral swab cultures before surgery. Patients with culture-confirmed SSI after surgery were chosen for analysis, using the κ index and its 95% confidence interval for concordance analysis. All patients received clindamycin and gentamicin for antibiotic prophylaxis for 5 days. Antibiotic susceptibility testing of all isolates was obtained and analyzed. Thirty-seven patients experienced SSI, or an infection rate of 28.3%, occurring at a mean of 9.3 postoperative days. The overall concordance between oral flora and SSI was fair to moderate (κ index of 0.25), but detailed analysis shows a higher concordance for known and opportunistic pathogens, such as Pseudomonas aeruginosa and Enterococcus faecalis, compared to typical oral commensals. Antibiotic susceptibility tests show rapid and significant increases in resistance to clindamycin, indicating a need for a more effective alternative. Predicting pathogens in SSI using preoperative oral swabs did not demonstrate a good concordance in general for patients undergoing clean-contaminated head and neck surgery, although concordance for certain pathogenic species seem to be higher than for typical intraoral commensals. The rapid development of resistance to clindamycin precludes its use as a prophylactic agent.

  12. Prevention of Surgical Site Infection After Ankle Surgery Using Vacuum-Assisted Closure Therapy in High-Risk Patients With Diabetes.

    Science.gov (United States)

    Zhou, Zhen-Yu; Liu, Ya-Ke; Chen, Hong-Lin; Liu, Fan

    2016-01-01

    Patients with diabetes have a high risk of surgical site infection (SSI) after ankle surgery. The aim of the present study was to investigate the efficacy of vacuum-assisted closure (VAC) in the prevention of SSI after ankle surgery compared with the efficacy of standard moist wound care (SMWC). A retrospective study was performed of unstable ankle fractures for surgical fixation in patients with diabetes from January 2012 to December 2014. VAC and SMWC were used for surgical incision coverage. The primary outcome was the incidence of SSI, and the secondary outcomes were the length of hospital stay and crude hospital costs. The data from 76 patients were analyzed, with 22 (28.95%) in the VAC group and 54 (71.05%) in the SMWC group. The incidence of SSI was 4.6% in the VAC group compared with 27.8% in the SMWC group (chi-square 5.076; p = .024), and the crude odds ratio for SSI in the VAC group was 0.124 (95% confidence interval 0.002 to 0.938). The length of hospital stay was lower in the VAC group than in the SMWC group (12.6 ± 2.7 days and 15.2 ± 3.5 days, respectively; t = 3.122, p = .003). The crude hospital costs were also lower in the VAC group than in the SMWC group (Chinese yuan 8643.2 ± 1195.3 and 9456.2 ± 1106.3, respectively; t = 2.839, p = .006). After logistic regression analysis, the adjusted odds ratio for the total SSI rate comparing VAC and SMWC was 0.324 (95% confidence interval 0.092 to 0.804; p = .021). Compared with SMWC, VAC can decrease the SSI rate after ankle surgery in patients with diabetes. This finding should be confirmed by prospective, randomized controlled clinical trials. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  13. Delayed methicillin-resistant Staphylococcus aureus-induced osteomyelitis of the tibia after pin tract infection: two case reports.

    Science.gov (United States)

    Hamahashi, Kosuke; Uchiyama, Yoshiyasu; Kobayashi, Yuka; Watanabe, Masahiko

    2017-01-31

    Pin tract infection is a common complication of external fixation. It usually heals after treatment with debridement, antibiotics, and/or pin removal, only rarely developing into delayed osteomyelitis. We treated two patients with delayed methicillin-resistant Staphylococcus aureus-induced osteomyelitis of the tibia following pin tract infection. One patient, a diabetic 60-year-old Japanese man, underwent definitive external fixation using an Ilizarov fixator for postoperative osteomyelitis of an open fracture of his left ankle. One year after removing the external fixator, he developed methicillin-resistant Staphylococcus aureus-induced osteomyelitis of the tibial pin site. He underwent surgical debridement four times. No recurrence was seen 2 years 8 months after the last debridement. Another patient, a healthy 38-year-old Japanese man, underwent bilateral temporary external fixation for a right ankle open fracture and a comminuted fracture of the left tibial plateau. Three months after removal of the external fixator, he was diagnosed with methicillin-resistant Staphylococcus aureus-induced osteomyelitis of the bilateral tibial pin sites. He underwent surgical debridement three times, but the infection of his right tibia persisted. Finally, a gastrocnemius muscle flap was placed. No recurrence was seen 2 years after this last surgery. Pin tract infection should not be considered a minor complication because osteomyelitis may develop, requiring treatment that is more aggressive than curettage of the pin tract. A gastrocnemius flap is a useful treatment option for refractory osteomyelitis because flap harvest causes less functional disturbance and is a relatively easy surgical technique.

  14. Prevalence of Staphylococcus aureus and methicillin resistant Staphylococcus aureus (MRSA) in the oral cavity.

    Science.gov (United States)

    Koukos, Georgios; Sakellari, Dimitra; Arsenakis, Minas; Tsalikis, Lazaros; Slini, Theodora; Konstantinidis, Antonios

    2015-09-01

    To assess the prevalence of Staphylococcus aureus and methicillin resistant Staphylococcus aureus (MRSA) in plaque and tongue samples from systemically healthy subjects with periodontal health, gingivitis or chronic periodontitis. After screening 720 potentially eligible subjects, 154 systemically healthy participants were ultimately enrolled in the current study. Subgingival samples were taken from the first molars and the tongue and analyzed for the presence of S. aureus and MRSA by polymerase chain reaction (PCR), using primers and conditions previously described in the literature. In addition, samples were taken from deep periodontal pockets of chronic periodontitis patients. Statistical analysis was performed by applying non-parametric tests (Kruskal-Wallis for clinical parameters, and z-test with Bonferroni corrections for distributions of assessed parameters). All comparisons were set at the 0.05 significance level. S. aureus was detected in 18% of all participants and in 10% of the samples tested. No significant differences were found in its distribution among the three investigated groups (z-test for proportions with Bonferroni corrections, p>0.05). The mecA gene was not present in any of the S. aureus found. S. aureus can be found in the oral environment regardless of the periodontal conditions and therefore should be considered as a member of the transient flora not participating in periodontal pathology. Subgingival sites and tongue surfaces seem to be an unusual habitat of MRSA. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Risk of surgical site infection, acute kidney injury, and Clostridium difficile infection following antibiotic prophylaxis with vancomycin plus a beta-lactam versus either drug alone: A national propensity-score-adjusted retrospective cohort study.

    Science.gov (United States)

    Branch-Elliman, Westyn; Ripollone, John E; O'Brien, William J; Itani, Kamal M F; Schweizer, Marin L; Perencevich, Eli; Strymish, Judith; Gupta, Kalpana

    2017-07-01

    The optimal regimen for perioperative antimicrobial prophylaxis is controversial. Use of combination prophylaxis with a beta-lactam plus vancomycin is increasing; however, the relative risks and benefits associated with this strategy are unknown. Thus, we sought to compare postoperative outcomes following administration of 2 antimicrobials versus a single agent for the prevention of surgical site infections (SSIs). Potential harms associated with combination regimens, including acute kidney injury (AKI) and Clostridium difficile infection (CDI), were also considered. Using a multicenter, national Veterans Affairs (VA) cohort, all patients who underwent cardiac, orthopedic joint replacement, vascular, colorectal, and hysterectomy procedures during the period from 1 October 2008 to 30 September 2013 and who received planned manual review of perioperative antimicrobial prophylaxis regimen and manual review for the 30-day incidence of SSI were included. Using a propensity-adjusted log-binomial regression model stratified by type of surgical procedure, the association between receipt of 2 antimicrobials (vancomycin plus a beta-lactam) versus either single agent alone (vancomycin or a beta-lactam) and SSI was evaluated. Measures of association were adjusted for age, diabetes, smoking, American Society of Anesthesiologists score, preoperative methicillin-resistant Staphylococcus aureus (MRSA) status, and receipt of mupirocin. The 7-day incidence of postoperative AKI and 90-day incidence of CDI were also measured. In all, 70,101 procedures (52,504 beta-lactam only, 5,089 vancomycin only, and 12,508 combination) with 2,466 (3.5%) SSIs from 109 medical centers were included. Among cardiac surgery patients, combination prophylaxis was associated with a lower incidence of SSI (66/6,953, 0.95%) than single-agent prophylaxis (190/12,834, 1.48%; crude risk ratio [RR] 0.64, 95% CI 0.49, 0.85; adjusted RR 0.61, 95% CI 0.46, 0.83). After adjusting for SSI risk, no association

  16. Risk of surgical site infection, acute kidney injury, and Clostridium difficile infection following antibiotic prophylaxis with vancomycin plus a beta-lactam versus either drug alone: A national propensity-score-adjusted retrospective cohort study.

    Directory of Open Access Journals (Sweden)

    Westyn Branch-Elliman

    2017-07-01

    Full Text Available The optimal regimen for perioperative antimicrobial prophylaxis is controversial. Use of combination prophylaxis with a beta-lactam plus vancomycin is increasing; however, the relative risks and benefits associated with this strategy are unknown. Thus, we sought to compare postoperative outcomes following administration of 2 antimicrobials versus a single agent for the prevention of surgical site infections (SSIs. Potential harms associated with combination regimens, including acute kidney injury (AKI and Clostridium difficile infection (CDI, were also considered.Using a multicenter, national Veterans Affairs (VA cohort, all patients who underwent cardiac, orthopedic joint replacement, vascular, colorectal, and hysterectomy procedures during the period from 1 October 2008 to 30 September 2013 and who received planned manual review of perioperative antimicrobial prophylaxis regimen and manual review for the 30-day incidence of SSI were included. Using a propensity-adjusted log-binomial regression model stratified by type of surgical procedure, the association between receipt of 2 antimicrobials (vancomycin plus a beta-lactam versus either single agent alone (vancomycin or a beta-lactam and SSI was evaluated. Measures of association were adjusted for age, diabetes, smoking, American Society of Anesthesiologists score, preoperative methicillin-resistant Staphylococcus aureus (MRSA status, and receipt of mupirocin. The 7-day incidence of postoperative AKI and 90-day incidence of CDI were also measured. In all, 70,101 procedures (52,504 beta-lactam only, 5,089 vancomycin only, and 12,508 combination with 2,466 (3.5% SSIs from 109 medical centers were included. Among cardiac surgery patients, combination prophylaxis was associated with a lower incidence of SSI (66/6,953, 0.95% than single-agent prophylaxis (190/12,834, 1.48%; crude risk ratio [RR] 0.64, 95% CI 0.49, 0.85; adjusted RR 0.61, 95% CI 0.46, 0.83. After adjusting for SSI risk, no

  17. A systematic review and meta-analysis including GRADE qualification of the risk of surgical site infections after prophylactic negative pressure wound therapy compared with conventional dressings in clean and contaminated surgery

    NARCIS (Netherlands)

    de Vries, Fleur E. E.; Wallert, Elon D.; Solomkin, Joseph S.; Allegranzi, Benedetta; Egger, Matthias; Dellinger, E. Patchen; Boermeester, Marja A.

    2016-01-01

    Systematically review and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) studies on prophylactic negative pressure wound therapy (pNPWT) to prevent surgical site infections (SSIs). pNPWT has been suggested as a new method to prevent wound complications, specifically SSIs,

  18. Portal vein resection in surgery for cancer of biliary tract and pancreas: special reference to the relationship between the surgical outcome and site of primary tumor.

    Science.gov (United States)

    Kurosaki, Isao; Hatakeyama, Katsuyoshi; Minagawa, Masahiro; Sato, Daisuke

    2008-05-01

    Early and late outcomes after superior mesenteric-portal vein resection (VR) combined with pancreaticoduodenectomy, major hepatectomy, or both for pancreaticobiliary carcinoma were retrospectively evaluated. VR is the most frequently used vascular procedure in this field, but an exact role of VR has not been compared according to the primary site of tumor. Postoperative outcomes were compared between surgery with and without VR in each of the three disease-based groups: hilar cholangiocarcinoma and intrahepatic cholangiocarcinoma with hilar extension (HIC, 56), middle and distal cholangiocarcinoma and gallbladder carcinoma (DGC, 118), and pancreatic head adenocarcinoma (PHC, 77). VR was performed in 19.6% of HIC, 8.5% of DGC, and 45.5% of PHC. In-hospital death was 7.1% (4 of 56) patients with VR (3 of DGC and 1 of PHC). Operations with VR in DGC showed a larger amount of blood loss and more increased ratio of R1operation than those with no VR. In HIC, DGC, and PHC, median survival time of patients with VR was 37, 6.8, and 20 months and that of patients without VR was 42.9, 28.6, and 20.3 months, respectively. VR did not affect survival either in HIC or in PHC; however, in DGC, VR was accompanied with dismal outcome compared with no VR (p=0.001). Aggressive surgery with VR can be justified both in HIC and in PHC but should not be recommended for DGC. Surgical outcomes of VR differed considerably, depending on the sites of the primary tumor.

  19. The Effect of Antibiotic-Coated Sutures on the Incidence of Surgical Site Infections in Abdominal Closures: a Meta-Analysis.

    Science.gov (United States)

    Elsolh, Basheer; Zhang, Lisa; Patel, Sunil V

    2017-05-01

    This meta-analysis aims to determine if antibiotic-impregnated sutures for abdominal fascial closure prevent postoperative surgical site infections (SSIs), hernias, and/or dehiscence. MEDLINE and EMBASE databases (1946-2016) were searched. Randomized controlled trials comparing antibiotic-impregnated sutures to standard sutures for abdominal closure were eligible. Risk of bias was evaluated using the Cochrane Handbooks definitions. Four-hundred fifty articles were reviewed; five eligible studies (N = 3117) were identified. All studies routinely used prophylactic antibiotics. Overall risk of SSI in the antibiotic-impregnated suture group was 10.4 vs. 13.0% in the control group. Pooled data showed no difference in SSI between suture types (odds ratio 0.79, 95% CI 0.57-1.09, P = 0.15, I 2 = 44%). There was no evidence of subgroup effect by suture material (polydioxanone vs. polyglactin 910; P = 0.19) or by comparing colorectal surgery studies to others (P = 0.67). There was a high risk of bias in two studies, one for high loss to follow-up and one for not using an intent-to-treat analysis. Our meta-analysis is the most comprehensive review on the utility of antibiotic-impregnated sutures in abdominal surgery to prevent SSI. We found no evidence to support routine use of these sutures.

  20. Association between Triclosan-Coated Sutures for Abdominal Wall Closure and Incisional Surgical Site Infection after Open Surgery in Patients Presenting with Fecal Peritonitis: A Randomized Clinical Trial.

    Science.gov (United States)

    Ruiz-Tovar, Jaime; Alonso, Natalia; Morales, Vicente; Llavero, Carolina

    2015-10-01

    A factor that may influence the incidence of surgical site infections (SSIs) is the suture used for closure of the abdominal wall because bacteria may adhere to the suture material. Sutures can be coated with antibacterial substances that may reduce the bacterial load in the incision. The aim of this study was to evaluate the effect of triclosan-coated sutures used in abdominal wall closure in patients with fecal peritonitis. A randomized study was performed. Inclusion criteria were intra-operative diagnosis of fecal peritonitis secondary to acute diverticulitis perforation, neoplastic tumor perforation, or colorectal anastomotic leak of previous elective colorectal resection. The patients were randomly assigned to either abdominal wall closure with triclosan-coated sutures (group 1) or sutures without triclosan (group 2). Fifty patients were included in group 1 and 51 in group 2. The incisional SSI rate was 10% in group 1 and 35.3% in group 2 (p=0.004; odds ratio [OR]=0.204; 95% confidence interval [CI] 0.069-0.605). A significant reduction in SSIs caused by Escherichia coli and Enterococcus faecalis was observed in group 2. The use of triclosan-coated sutures in fecal peritonitis surgery reduces the incidence of incisional SSI.

  1. Surveillance of surgical site infections by Pseudomonas aeruginosa and strain characterization in Tanzanian hospitals does not provide proof for a role of hospital water plumbing systems in transmission.

    Science.gov (United States)

    Moremi, Nyambura; Claus, Heike; Vogel, Ulrich; Mshana, Stephen E

    2017-01-01

    The role of hospital water systems in the development of Pseudomonas aeruginosa (P. aeruginosa) surgical site infections (SSIs) in low-income countries is barely studied. This study characterized P. aeruginosa isolates from patients and water in order to establish possible epidemiological links. Between December 2014 and September 2015, rectal and wound swabs, and water samples were collected in the frame of active surveillance for SSIs in the two Tanzanian hospitals. Typing of P. aeruginosa was done by multi-locus sequence typing. Of 930 enrolled patients, 536 were followed up, of whom 78 (14.6%, 95% CI; 11.6-17.5) developed SSIs. P. aeruginosa was found in eight (14%) of 57 investigated wounds. Of the 43 water sampling points, 29 were positive for P. aeruginosa. However, epidemiological links to wound infections were not confirmed. The P. aeruginosa carriage rate on admission was 0.9% (8/930). Of the 363 patients re-screened upon discharge, four (1.1%) possibly acquired P. aeruginosa during hospitalization. Wound infections of the three of the eight P. aeruginosa SSIs were caused by a strain of the same sequence type (ST) as the one from intestinal carriage. Isolates from patients were more resistant to antibiotics than water isolates. The P. aeruginosa SSI rate was low. There was no evidence for transmission from tap water. Not all P. aeruginosa SSI were proven to be endogenous, pointing to other routes of transmission.

  2. Risk factors for surgical site infection after stoma closure comparison between pursestring wound closure and conventional linear wound closure: Propensity score matching analysis.

    Science.gov (United States)

    Yamamoto, Masashi; Tanaka, Keitaro; Masubuchi, Shinsuke; Ishii, Masatsugu; Hamamoto, Hiroki; Suzuki, Shigenori; Ueda, Yasuhiko; Okuda, Junji; Uchiyama, Kazuhisa

    2018-01-01

    Stoma closure has been associated with a high rate of surgical site infection (SSI) and the optimal skin closure method is still controversial. The aim of this study was to compare the short-term and long-term outcomes between the conventional linear closure (CC) and the persestring closure (PC) using propensity score matching analysis. We analysed the data of 360 patients who underwent stoma closure with CC or PC between January 2000 and December 2014. The propensity score was calculated from age, gender, body mass index, primary disease, type of stoma, diabetes mellitus, history of smoking, steroid use, the American Society of Anesthesiologists score, Prognostic Nutritional Index and modified Glasgow Prognostic Score. There was no difference in operative variables between the two groups. The CC group and the PC group were comparable with regards to overall SSI (25.0 vs. 7.8%; P = 0.007), superficial SSI (21.9 vs. 4.7%; P = 0.003). Significant risk factor for SSI was conventional linear closure (OR, 4.14; 95% CI, 1.448-13.91). Our study suggests that a pursestring stoma closure leads to less SSI. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Comparison of the efficacy of chlorhexidine gluconate versus povidone iodine as preoperative skin preparation for the prevention of surgical site infections in clean-contaminated upper abdominal surgeries.

    Science.gov (United States)

    Srinivas, Anirudh; Kaman, Lileswar; Raj, Prithivi; Gautam, Vikas; Dahiya, Divya; Singh, Gurpreet; Singh, Rajinder; Medhi, Bikash

    2015-11-01

    To compare the efficacy of chlorhexidine-gluconate versus povidone iodine in preoperative skin preparation in the prevention of surgical site infections (SSIs) in clean-contaminated upper abdominal surgeries. This was a prospective randomized controlled trial conducted on patients undergoing clean-contaminated upper abdominal surgeries. A total of 351 patients 18-70 years old were randomized into two groups; chlorhexidine and povidone iodine skin preparation before surgery. The incidence of SSIs in the chlorhexidine group was 10.8 %, in comparison to 17.9 % in the povidone iodine group. The odds ratio was 0.6 in favor of chlorhexidine use, but the results were not statistically significant (P = 0.06). In the first postoperative week, SSIs developed in 7 % of patients in the chlorhexidine group and 14.1 % in the povidone iodine group (P = 0.03), and in the second postoperative week, SSIs were present in 4.1 % of the patients in the chlorhexidine group and 4.4 % in the povidone iodine group, which was not statistically significant (P = 0.88). The incidence of SSIs after clean-contaminated upper abdominal surgeries was lower with the use of chlorhexidine skin preparation than with povidone iodine preparation, although the results were not statistically significant. However, the odds ratio between the two groups favored the use of chlorhexidine over povidone iodine for preventing SSIs.

  4. A preoperative low nutritional prognostic index correlates with the incidence of incisional surgical site infections after bowel resection in patients with Crohn's disease.

    Science.gov (United States)

    Maeda, Kiyoshi; Nagahara, Hisashi; Shibutani, Masatsune; Otani, Hiroshi; Sakurai, Katsunobu; Toyokawa, Takahiro; Tanaka, Hiroaki; Kubo, Naoshi; Muguruma, Kazuya; Kamata, Noriko; Yamagami, Hirokazu; Hirakawa, Kosei

    2015-11-01

    The incidence of incisional surgical site infections (SSIs) is reported to be higher among patients with Crohn's disease (CD) than among those with colorectal cancer. It has also been reported that the preoperative nutritional and inflammatory status is associated with the frequency of postoperative complications. Onodera's prognostic nutritional index (OPNI) is a simple and useful parameter for determining the nutritional and inflammatory status. In the present study, we retrospectively investigated the correlation between the OPNI and the incidence of incisional SSI in patients with CD who had undergone bowel resection. A total of 177 CD patients who underwent abdominal surgery were enrolled. Various clinical factors and the OPNI values were evaluated to identify risk factors for incisional SSIs. The incidence of incisional SSIs was 19.8 %. A multivariate analysis indicated that the OPNI was an independent risk factor for incisional SSIs. The results of this retrospective study suggest that the OPNI is an independent risk factor for incisional SSIs in patients with a history of bowel resection for CD.

  5. Surgical lighting

    NARCIS (Netherlands)

    Knulst, A.J.

    2017-01-01

    The surgical light is an important tool for surgeons to create and maintain good visibility on the surgical task. Chapter 1 gives background to the field of (surgical) lighting and related terminology. Although the surgical light has been developed strongly since its introduction a long time ago,

  6. Surgical site infections after abdominal closure in colorectal surgery using triclosan-coated absorbable suture (PDS Plus) vs. uncoated sutures (PDS II): a randomized multicenter study.

    Science.gov (United States)

    Baracs, Jozsef; Huszár, Orsolya; Sajjadi, Shahram Ghotb; Horváth, O Peter

    2011-12-01

    Surgical site infections (SSI) are the third most common hospital-acquired infections and account for 14% to 16% of all such infections. In elective colorectal operations, the international SSI rate ranges from 4.7%-25%. In a previous retrospective study in this department, the SSI rate was unacceptably high (25%), and the promising different international evaluations of triclosan-coated suture materials encouraged us to create a multicenter randomized trial to improve our results. The main goal of this study was to compare triclosan-coated and uncoated absorbable suture (PDS Plus(®) with PDS II(®)) in elective colorectal operations. This was an internet-based study involving seven surgical centers. All the elective colorectal operations were performed by experienced surgeons. For abdominal fascia closure, running looped PDS was applied; triclosan-coated or uncoated PDS was chosen by computer randomization. Pre-operative and peri-operative variables such as gender, body mass index, neoadjuvant therapy, type II diabetes mellitus, amount of wound dressing material used, nursing days, and microbiological results were recorded. After the operation, the patient's data and risk factors were collected in a password-protected online database. From 485 patients randomized, SSI was documented in 47 patients (12.5%), 23 (12.2%) in the group having triclosan-coated sutures (n=188) and 24 (12.2%) in the uncoated suture group (n=197), a non-significant difference. Of all SSIs, 13 (27.7%) were diagnosed only after discharge, being recognized in the outpatient setting, with four patients in the triclosan suture group (8.5%) and nine in the uncoated suture group (19.2%) being affected with no significant differences in the demographic data. Microbiological examinations, in addition to the same colon flora in both groups, revealed two gram-positive infections in the uncoated suture group. The hospital stay and costs of dressings were significantly higher in patients having SSIs

  7. Surgical lighting

    OpenAIRE

    Knulst, A.J.

    2017-01-01

    The surgical light is an important tool for surgeons to create and maintain good visibility on the surgical task. Chapter 1 gives background to the field of (surgical) lighting and related terminology. Although the surgical light has been developed strongly since its introduction a long time ago, the last decades only minor developments have been made. This lack of significant development suggests that the current state of surgical lighting is perfectly developed and functions without any fla...

  8. Staphylococcus aureus and the ecology of the nasal microbiome

    DEFF Research Database (Denmark)

    Liu, Cindy M; Price, Lance B; Hungate, Bruce A

    2015-01-01

    The human microbiome can play a key role in host susceptibility to pathogens, including in the nasal cavity, a site favored by Staphylococcus aureus. However, what determines our resident nasal microbiota-the host or the environment-and can interactions among nasal bacteria determine S. aureus...... colonization? Our study of 46 monozygotic and 43 dizygotic twin pairs revealed that nasal microbiota is an environmentally derived trait, but the host's sex and genetics significantly influence nasal bacterial density. Although specific taxa, including lactic acid bacteria, can determine S. aureus colonization...

  9. In Vivo Assessment of Phage and Linezolid Based Implant Coatings for Treatment of Methicillin Resistant S. aureus (MRSA Mediated Orthopaedic Device Related Infections.

    Directory of Open Access Journals (Sweden)

    Sandeep Kaur

    Full Text Available Staphylococcus comprises up to two-thirds of all pathogens in orthopaedic implant infections with two species respectively Staphylococcus aureus and Staphylococcus epidermidis, being the predominate etiological agents isolated. Further, with the emergence of methicillin-resistant S. aureus (MRSA, treatment of S. aureus implant infections has become more difficult, thus representing a devastating complication. Use of local delivery system consisting of S.aureus specific phage along with linezolid (incorporated in biopolymer allowing gradual release of the two agents at the implant site represents a new, still unexplored treatment option (against orthopaedic implant infections that has been studied in an animal model of prosthetic joint infection. Naked wire, hydroxypropyl methylcellulose (HPMC coated wire and phage and /or linezolid coated K-wire were surgically implanted into the intra-medullary canal of mouse femur bone of respective groups followed by inoculation of S.aureus ATCC 43300(MRSA. Mice implanted with K-wire coated with both the agents i.e phage as well as linezolid (dual coated wires showed maximum reduction in bacterial adherence, associated inflammation of the joint as well as faster resumption of locomotion and motor function of the limb. Also, all the coating treatments showed no emergence of resistant mutants. Use of dual coated implants incorporating lytic phage (capable of self-multiplication as well as linezolid presents an attractive and aggressive early approach in preventing as well as treating implant associated infections caused by methicillin resistant S. aureus strains as assessed in a murine model of experimental joint infection.

  10. Building consensus: development of a Best Practice Guideline (BPG) for surgical site infection (SSI) prevention in high-risk pediatric spine surgery.

    Science.gov (United States)

    Vitale, Michael G; Riedel, Matthew D; Glotzbecker, Michael P; Matsumoto, Hiroko; Roye, David P; Akbarnia, Behrooz A; Anderson, Richard C E; Brockmeyer, Douglas L; Emans, John B; Erickson, Mark; Flynn, John M; Lenke, Lawrence G; Lewis, Stephen J; Luhmann, Scott J; McLeod, Lisa M; Newton, Peter O; Nyquist, Ann-Christine; Richards, B Stephens; Shah, Suken A; Skaggs, David L; Smith, John T; Sponseller, Paul D; Sucato, Daniel J; Zeller, Reinhard D; Saiman, Lisa

    2013-01-01

    Perioperative surgical site infection (SSI) after pediatric spine fusion is a recognized complication with rates between 0.5% and 1.6% in adolescent idiopathic scoliosis and up to 22% in "high risk" patients. Significant variation in the approach to infection prophylaxis has been well documented. The purpose of this initiative is to develop a consensus-based "Best Practice" Guideline (BPG), informed by both the available evidence in the literature and expert opinion, for high-risk pediatric patients undergoing spine fusion. For the purpose of this effort, high risk was defined as anything other than a primary fusion in a patient with idiopathic scoliosis without significant comorbidities. The ultimate goal of this initiative is to decrease the wide variability in SSI prevention strategies in this area, ultimately leading to improved patient outcomes and reduced health care costs. An expert panel composed of 20 pediatric spine surgeons and 3 infectious disease specialists from North America, selected for their extensive experience in the field of pediatric spine surgery, was developed. Using the Delphi process and iterative rounds using a nominal group technique, participants in this panel were as follows: (1) surveyed for current practices; (2) presented with a detailed systematic review of the relevant literature; (3) given the opportunity to voice opinion collectively; and (4) asked to vote regarding preferences privately. Round 1 was conducted using an electronic survey. Initial results were compiled and discussed face-to-face. Round 2 was conducted using the Audience Response System, allowing participants to vote for (strongly support or support) or against inclusion of each intervention. Agreement >80% was considered consensus. Interventions without consensus were discussed and revised, if feasible. Repeat voting for consensus was performed. Consensus was reached to support 14 SSI prevention strategies and all participants agreed to implement the BPG in their

  11. Antibiotic prophylaxis for the prevention of surgical site infection after tension-free hernia repair: a Bayesian and frequentist meta-analysis.

    Science.gov (United States)

    Mazaki, Takero; Mado, Kazunari; Masuda, Hideki; Shiono, Motomi

    2013-11-01

    Efficacy of antibiotic prophylaxis for the prevention of surgical site infection (SSI) after open tension-free hernia repair remains controversial. In light of additional data, the aim of this study was to determine whether antibiotic prophylaxis reduces SSI after hernia repair. We conducted a systematic review and meta-analysis to identify randomized controlled trials comparing antibiotic prophylaxis and the subsequent incidence of SSI after inguinal or femoral hernia repair. The primary outcomes measure was the incidence of SSI. Subgroup analysis was evaluated by stratifying the categories of SSI. The meta-analysis was performed using Bayesian and frequentist methods. Twelve studies were included in this meta-analysis; 1,902 patients received antibiotic prophylaxis and the other 1,936 patients were allocated to the control group. Incidence of SSI was 47 (pooled rate 3.0%) in the antibiotic group and 91 (6.0%) in the control group. The number needed to treat to prevent 1 episode of SSI is 41. The Bayesian meta-analysis yielded a significant reduction of SSI in the antibiotic group (odds ratio = 0.49; 95% credible interval 0.25-0.81). Subgroup analysis showed that an antibiotic prophylaxis was beneficial for the prevention of superficial SSI (odds ratio = 0.40; 95% credible interval 0.12-0.98), but not beneficial for prevention of deep SSI (odds ratio = 0.59; 95% credible interval 0.11-3.20). Also, the results were similar to those with frequentist methods. This meta-analysis suggests that antibiotic prophylaxis is efficacious for the prevention of SSI after open mesh hernia repair. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  12. Efficacy of triclosan-coated sutures for reducing risk of surgical site infection in adults: a meta-analysis of randomized clinical trials.

    Science.gov (United States)

    Guo, Jiao; Pan, Ling-Hui; Li, Yun-Xi; Yang, Xiang-Di; Li, Le-Qun; Zhang, Chun-Yan; Zhong, Jian-Hong

    2016-03-01

    Surgical site infection (SSI) is the third most frequent type of nosocomial infections. Triclosan-coated sutures are often used to reduce the risk of SSI, but studies examining this have given conflicting results. Therefore, this meta-analysis was performed to assess the efficacy of triclosan-coated sutures for reducing risk of SSI in adults. PubMed, EMBASE, Google Scholar, and ClinicalTrials.gov were searched to identify randomized clinical trials evaluating triclosan-coated sutures for preventing SSI on patients 18 y or older. Thirteen randomized clinical trials involving 5256 participants were included. Triclosan-coated sutures were associated with lower risk of SSI than uncoated sutures across all surgeries (risk ratio [RR] 0.76, 95% confidence interval [CI] 0.65-0.88, P suture (RR 0.97, 95% CI 0.49-1.89, P = 0.92). Subgroup analysis showed lower risk of SSI with triclosan-coated sutures in abdominal surgeries (RR 0.70, 95% CI 0.50-0.99, P = 0.04) and group with prophylactic antibiotic (RR 0.79, 95% CI 0.63-0.99, P = 0.04). However, such risk reduction was not observed in cardiac surgeries, breast surgeries, or group without prophylactic antibiotic. Triclosan-coated sutures can decrease the incidence of SSI in abdominal surgeries and might not interfere with wound healing process. Nevertheless, further studies are needed to examine whether triclosan-coated sutures are effective at preventing SSI in non-abdominal surgeries and to further study the interaction of antibiotic prophylaxis with triclosan-coated sutures. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Does surgical site infection after Caesarean section in Polish hospitals reflect high-quality patient care or poor postdischarge surveillance? Results from a 3-year multicenter study.

    Science.gov (United States)

    Różańska, Anna; Jarynowski, Andrzej; Kopeć-Godlewska, Katarzyna; Wójkowska-Mach, Jadwiga; Misiewska-Kaczur, Agnieszka; Lech, Marzena; Rozwadowska, Małgorzata; Karwacka, Marlena; Liberda, Joanna; Domańska, Joanna

    2018-01-01

    Caesarean sections (CSs) are associated with a high infection risk. Surgical site infection (SSI) incidence is among the markers of effectiveness of infection prevention efforts. The aim of this study was to analyze risk factors for SSI, incidence, and microbiology in patients who underwent CS. The study was conducted during 2013-2015 using active infection surveillance in 5 Polish hospitals according to the European Centre for Disease Prevention and Control surveillance network known as HAI-Net. For each procedure, the following data were registered: age, American Society of Anesthesiologists score, procedure time, elective or emergency procedure, use of perioperative antibiotic prophylaxis, microbiology, the treatment used, and other information. SSI incidence was 0.5% and significant differences were noted among hospitals (between 0.1% and 1.8%), for different American Society of Anesthesiologists scales (between 0.2% and 4.8%) and different values of standardized SSI risk index (between 0.0% and 0.8%). In 3.1% of procedures, with no antibiotic prophylaxis, SSI risk was significantly higher. Deep infections dominated: 61.5% with superficial infections in only approximately 30% of cases and 2.6% of infections were detected postdischarge without readmissions. Results showed high incidence of SSI in Poland without perioperative antibiotic prophylaxis, and secondly, ineffective surveillance according to CS status, considering outpatient obstetric care. Without postdischarge surveillance, it is not possible to recognize the epidemiologic situation, and further, to set priorities and needs when it comes to infection prophylaxis, especially because such low incidence may indicate no need for improvement in infection control. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  14. Meta-analysis of randomized and quasi-randomized clinical trials of topical antibiotics after primary closure for the prevention of surgical-site infection.

    Science.gov (United States)

    Heal, C F; Banks, J L; Lepper, P; Kontopantelis, E; van Driel, M L

    2017-08-01

    Surgical-site infections (SSIs) increase patient morbidity and costs. The aim was to identify and synthesize all RCTs evaluating the effect of topical antibiotics on SSI in wounds healing by primary intention. The search included Ovid MEDLINE, Ovid Embase, the Cochrane Wounds Specialized Register, Central Register of Controlled Trials and EBSCO CINAHL from inception to May 2016. There was no restriction of language, date or setting. Two authors independently selected studies, extracted data and assessed risk of bias. When sufficient numbers of comparable trials were available, data were pooled in meta-analysis. Fourteen RCTs with 6466 participants met the inclusion criteria. Pooling of eight trials (5427 participants) showed that topical antibiotics probably reduced the risk of SSI compared with no topical antibiotic (risk ratio (RR) 0·61, 95 per cent c.i. 0·42 to 0·87; moderate-quality evidence), equating to 20 fewer SSIs per 1000 patients treated. Pooling of three trials (3012 participants) for risk of allergic contact dermatitis found no clear difference between antibiotics and no antibiotic (RR 3·94, 0·46 to 34·00; very low-quality evidence). Pooling of five trials (1299 participants) indicated that topical antibiotics probably reduce the risk of SSI compared with topical antiseptics (RR 0·49, 0·30 to 0·80; moderate-quality evidence); 43 fewer SSIs per 1000 patients treated. Pooling of two trials (541 participants) showed no clear difference in the risk of allergic contact dermatitis with antibiotics or antiseptic agents (RR 0·97, 0·52 to 1·82; very low-quality evidence). Topical antibiotics probably prevent SSI compared with no topical antibiotic or antiseptic. No conclusion can be drawn regarding whether they cause allergic contact dermatitis. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

  15. Circular closure is associated with the lowest rate of surgical site infection following stoma reversal: a systematic review and multiple treatment meta-analysis.

    Science.gov (United States)

    Li, L T; Hicks, S C; Davila, J A; Kao, L S; Berger, R L; Arita, N A; Liang, M K

    2014-06-01

    Stoma reversal is frequently complicated by surgical site infection (SSI). To reduce SSI, several techniques for skin closure have been studied, with no agreement on which is best. The aim of this study was to identify the skin closure technique associated with the lowest rate of SSI following stoma reversal. We systematically searched MEDLINE (PubMed and OvidSP), Scopus and clinical registries from 1 January 1980 to 24 March 2012, and included original reports on adult patients following stoma reversal. A network of treatments was created to map the comparisons between skin closure techniques, including primary closure, primary closure with a drain, secondary closure, delayed primary closure, loose primary closure and circular closure. Pairwise meta-analyses were performed for all available direct comparisons of closure types and heterogeneity was assessed. A multiple-treatments meta-analysis was conducted to estimate relative treatment effects between competing closure types (reported as an odds ratio with 95% credible interval, and a probability that each treatment is best). Several sensitivity analyses were performed. Fifteen studies were identified with a total of 2921 cases of stoma reversal. Overall, study quality was poor with observed low (one study), moderate (seven studies) and high (seven studies) risk of bias. Circular closure was associated with the lowest SSI risk (OR 0.12; 95% CI 0.02-0.40) and was the best of six skin closure techniques (probability of being best = 68.9%). Circular closure remained the best after sensitivity analyses. This study showed that circular closure is the best skin closure technique after stoma reversal in terms of SSI rate, but the quality of supporting evidence is limited, precluding definite conclusions. Colorectal Disease © 2014 The Association of Coloproctology of Great Britain and Ireland.

  16. Ability to predict the development of surgical site infection in cardiac surgery using the Australian Clinical Risk Index versus the National Nosocomial Infections Surveillance-derived Risk Index.

    Science.gov (United States)

    Figuerola-Tejerina, A; Bustamante, E; Tamayo, E; Mestres, C A; Bustamante-Munguira, J

    2017-06-01

    Surgical site infection (SSI) is a major infectious complication that increases mortality, morbidity, and healthcare costs. There are scores attempting to classify patients for calculating SSI risk. Our objectives were to validate the Australian Clinical Risk Index (ACRI) in a European population after cardiac surgery, comparing it against the National Nosocomial Infections Surveillance-derived risk index (NNIS) and analyzing the predictive power of ACRI for SSI in valvular patients. All the patients that who underwent cardiac surgery in a tertiary university hospital between 2011 and 2015 were analyzed. The patients were divided into valvular and coronary groups, excluding mixed patients. The ACRI score was validated in both groups and its ability to predict SSI was compared to the NNIS risk index. We analyzed 1,657 procedures. In the valvular patient group (n: 1119), a correlation between the ACRI score and SSI development (p < 0.05) was found; there was no such correlation with the NNIS index. The area under the receiver-operating characteristic curve (AUC) was 0.64 (confidence interval [CI] 95%, 0.5-0.7) for ACRI and 0.62 (95% CI, 0.5-0.7) for NNIS. In the coronary group (n: 281), there was a correlation between ACRI and SSI but no between NNIS and SSI. The ACRI AUC was 0.70 (95% CI, 0.5-0.8) and the NNIS AUC was 0.60 (95% CI, 0.4-0.7). The ACRI score has insufficient predictive power, although it predicts SSI development better than the NNIS index, fundamentally in coronary artery bypass grafting (CABG). Further studies analyzing determining factors are needed.

  17. ALEXIS O-Ring wound retractor vs conventional wound protection for the prevention of surgical site infections in colorectal resections(1).

    Science.gov (United States)

    Cheng, K P; Roslani, A C; Sehha, N; Kueh, J H; Law, C W; Chong, H Y; Arumugam, K

    2012-06-01

    Surgical site infection (SSI) remains a common postoperative morbidity, particularly in colorectal resections, and poses a significant financial burden to the healthcare system. The omission of mechanical bowel preparation, as is performed in enhanced recovery after surgery programmes, appears to further increase the incidence. Various wound protection methods have been devised to reduce the incidence of SSIs. However, there are few randomized controlled trials assessing their efficacy. The aim of this study is to investigate whether ALEXIS wound retractors with reinforced O-rings are superior to conventional wound protection methods in preventing SSIs in colorectal resections. Patients undergoing elective open colorectal resections via a standardized midline laparotomy were prospectively randomized to either ALEXIS or conventional wound protection in a double-blinded manner. A sample size of 30 in each arm was determined to detect a reduction of SSI from 20% to 1% with a power of 80%. Secondary outcomes included postoperative pain. The operative wound was inspected daily by a specialist wound nurse during admission, and again 30 days postoperatively. Statistical analysis was performed using spss version 13 with P < 0.05 considered significant. Seventy-two patients were recruited into the study but eight were excluded. There were no SSIs in the ALEXIS study arm (n = 34) but six superficial incisional SSIs (20%) were diagnosed in the control arm (P = 0.006). Postoperative pain score analysis did not demonstrate any difference between the two groups (P = 0.664). The ALEXIS wound retractor is more effective in preventing SSI in elective colorectal resections compared with conventional methods. © 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.

  18. A randomized controlled trial of subcutaneous closed-suction Blake drains for the prevention of incisional surgical site infection after colorectal surgery.

    Science.gov (United States)

    Watanabe, Jun; Ota, Mitsuyoshi; Kawamoto, Makoto; Akikazu, Yago; Suwa, Yusuke; Suwa, Hirokazu; Momiyama, Masashi; Ishibe, Atsushi; Watanabe, Kazuteru; Masui, Hidenobu; Nagahori, Kaoru

    2017-03-01

    The effects of subcutaneous closed-suction Blake drain for preventing incisional surgical site infections (SSIs) after colorectal surgery have never been evaluated in a randomized controlled trial (RCT). Thus, we performed a RCT to evaluate the clinical benefits of using a subcutaneous closed-suction Blake drain in patients undergoing colorectal surgery. Consecutive patients who underwent colorectal surgery were enrolled in this study. Patients were randomly assigned to the subcutaneous closed-suction drainage arm or the control (no subcutaneous drainage) arm. The primary endpoint was incidence rate of incisional SSIs. And, we performed logistic regression analysis to detect predictive factors for incisional SSIs after colorectal surgery. From November 2012 to September 2014, a total of 240 patients were enrolled in this study. One-hundred-seventeen patients who were treated by the control arm and 112 patients by the subcutaneous drainage arm were judged to be eligible for analysis. The incidence of incisional SSIs rate was 8.7 % in the overall patients. The incidence of incisional SSIs rate was 12.8 % in the control arm and 4.5 % in the subcutaneous drainage arm. There was significantly reduction of the incidence in the subcutaneous drainage arm than in the control arm (p = 0.025). Logistic regression analysis demonstrated that thickness of subcutaneous fat >3.0 cm, forced expiratory volume in 1 s as percent of forced vital capacity (FEV1.0 %) >70 %, and subcutaneous drain were independent predictors of postoperative incisional SSIs (p = 0.008, p = 0.004, and p = 0.017, respectively). The results of our RCT suggest that a subcutaneous Blake drain is beneficial for preventing incisional SSIs in patients undergoing colorectal surgery.

  19. Reliability and validity of using telephone calls for post-discharge surveillance of surgical site infection following caesarean section at a tertiary hospital in Tanzania

    Directory of Open Access Journals (Sweden)

    Boniface Nguhuni

    2017-05-01

    Full Text Available Abstract Background Surgical site infection (SSI is a common post-operative complication causing significant morbidity and mortality. Many SSI occur after discharge from hospital. Post-discharge SSI surveillance in low and middle income countries needs to be improved. Methodology We conducted an observational cohort study in Dodoma, Tanzania to examine the sensitivity and specificity of telephone calls to detect SSI after discharge from hospital in comparison to a gold standard of clinician review. Women undergoing caesarean section were enrolled and followed up for 30 days. Women providing a telephone number were interviewed using a structured questionnaire at approximately days 5, 12 and 28 post-surgery. Women were then invited for out-patient review by a clinician blinded to the findings of telephone interview. Results A total of 374 women were enrolled and an overall SSI rate of 12% (n = 45 was observed. Three hundred and sixteen (84% women provided a telephone number, of which 202 had at least one telephone interview followed by a clinical review within 48 h, generating a total of 484 paired observations. From the clinical reviews, 25 SSI were diagnosed, of which telephone interview had correctly identified 18 infections; telephone calls did not incorrectly identify SSI in any patients. The overall sensitivity and specificity of telephone interviews as compared to clinician evaluation was 72 and 100%, respectively. Conclusion The use of telephone interview as a diagnostic tool for post-discharge surveillance of SSI had moderate sensitivity and high specificity in Tanzania. Telephone-based detection may be a useful method for SSI surveillance in low-income settings with high penetration of mobile telephones.

  20. Systematic Review and Meta-Analysis of Randomized Controlled Trials Evaluating Prophylactic Intra-Operative Wound Irrigation for the Prevention of Surgical Site Infections.

    Science.gov (United States)

    de Jonge, Stijn W; Boldingh, Quirine J J; Solomkin, Joseph S; Allegranzi, Benedetta; Egger, Matthias; Dellinger, E Patchen; Boermeester, Marja A

    Surgical site infections (SSIs) are one of the most common hospital-acquired infections. To reduce SSIs, prophylactic intra-operative wound irrigation (pIOWI) has been advocated, although the results to date are equivocal. To develop recommendations for the new World Health Organization (WHO) SSI prevention guidelines, a systematic literature review and a meta-analysis were conducted on the effectiveness of pIOWI using different agents as a means of reducing SSI. The PUBMED, Embase, CENTRAL, CINAHL, and WHO databases were searched. Randomized controlled trials (RCTs) comparing either pIOWI with no pIOWI or with pIOWI using different solutions and techniques were retrieved with SSI as the primary outcome. Meta-analyses were performed, and odds ratios (OR) and the mean difference with 95% confidence intervals (CI) were extracted and pooled with a random effects model. Twenty-one studies were suitable for analysis, and a distinction was made between intra-peritoneal, mediastinal, and incisional wound irrigation. A low quality of evidence demonstrated a statistically significant benefit for incisional wound irrigation with an aqueous povidone-iodine (PVP-I) solution in clean and clean contaminated wounds (OR 0.31; 95% CI 0.13-0.73; p = 0.007); 50 fewer SSIs per 1,000 procedures (from 19 fewer to 64 fewer)). Antibiotic irrigation had no significant effect in reducing SSIs (OR 1.16; 95% CI 0.64-2.12; p = 0.63). Low-quality evidence suggests considering the use of prophylactic incisional wound irrigation to prevent SSI with an aqueous povidone-iodine solution. Antibiotic irrigation does not show a benefit and therefore is discouraged.

  1. The evolution of Staphylococcus aureus

    NARCIS (Netherlands)

    Deurenberg, Ruud H; Stobberingh, Ellen E

    2008-01-01

    A broad variety of infections, ranging from minor infections of the skin to post-operative wound infections can be caused by Staphylococcus aureus. The adaptive power of S. aureus to antibiotics leaded, in the early 1960s, to the emergence of methicillin-resistant S. aureus (MRSA). The cause of

  2. Colonisation with Staphylococcus aureus and Streptococcus pyogenes in New Zealand preschool children.

    Science.gov (United States)

    Berry, Sarah; Morton, Susan; Atatoa Carr, Polly; Marks, Emma; Ritchie, Stephen; Upton, Arlo; Williamson, Debbie; Grant, Cameron

    2015-03-13

    To describe colonisation patterns of Staphylococcus aureus (S. aureus) and Streptococcus pyogenes (S. pyogenes) among pre-school children in New Zealand. Anterior nasal, oropharyngeal, and antecubital fossa swabs were collected from a diverse sample of 139 New Zealand children aged 4 years. Swabs were cultured for S. aureus and S. pyogenes. S. aureus isolates were tested for antibiotic susceptibility. S. aureus colonisation was more prevalent than S. pyogenes colonisation; 54% of the children were colonised with S. aureus whereas only 16% were colonised with S. pyogenes, at one or more sampling sites (P<0.0001). S. aureus was present in a larger proportion of swabs obtained from the anterior nasal (39%, P<0.0001) or oropharynx (32%, P=0.0002) than from the antecubital fossa (14%). S. pyogenes was present in a larger proportion of swabs obtained from the oropharynx (16%) than either the anterior nasal (4%, P=0.001) or the antecubital fossa (2%, P<0.0001). S. aureus and S. pyogenes are prevalent at superficial sites in preschool children in NZ, with S. aureus colonisation more prevalent than S. pyogenes colonisation. Colonisation frequency varies by site for both pathogens; S. aureus is more prevalent in the anterior nares and oropharynx while S. pyogenes is more prevalent in the oropharynx.

  3. Staphylococcus aureus CC398

    DEFF Research Database (Denmark)

    Price, Lance B.; Stegger, Marc; Hasman, Henrik

    2012-01-01

    Since its discovery in the early 2000s, methicillin-resistant Staphylococcus aureus (MRSA) clonal complex 398 (CC398) has become a rapidly emerging cause of human infections, most often associated with livestock exposure. We applied whole-genome sequence typing to characterize a diverse collectio...

  4. Surgical Technologists

    Science.gov (United States)

    ... State & Area Data Explore resources for employment and wages by state and area for surgical technologists. Similar Occupations Compare the job duties, education, job growth, and pay of surgical technologists with ...

  5. Risk factors for surgical site infection following nonshunt pediatric neurosurgery: a review of 9296 procedures from a national database and comparison with a single-center experience.

    Science.gov (United States)

    Sherrod, Brandon A; Arynchyna, Anastasia A; Johnston, James M; Rozzelle, Curtis J; Blount, Jeffrey P; Oakes, W Jerry; Rocque, Brandon G

    2017-04-01

    OBJECTIVE Surgical site infection (SSI) following CSF shunt operations has been well studied, yet risk factors for nonshunt pediatric neurosurgery are less well understood. The purpose of this study was to determine SSI rates and risk factors following nonshunt pediatric neurosurgery using a nationwide patient cohort and an institutional data set specifically for better understanding SSI. METHODS The authors reviewed the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (ACS NSQIP-P) database for the years 2012-2014, including all neurosurgical procedures performed on pediatric patients except CSF shunts and hematoma evacuations. SSI included deep (intracranial abscesses, meningitis, osteomyelitis, and ventriculitis) and superficial wound infections. The authors performed univariate analyses of SSI association with procedure, demographic, comorbidity, operative, and hospital variables, with subsequent multivariate logistic regression analysis to determine independent risk factors for SSI within 30 days of the index procedure. A similar analysis was performed using a detailed institutional infection database from Children's of Alabama (COA). RESULTS A total of 9296 nonshunt procedures were identified in NSQIP-P with an overall 30-day SSI rate of 2.7%. The 30-day SSI rate in the COA institutional database was similar (3.3% of 1103 procedures, p = 0.325). Postoperative time to SSI in NSQIP-P and COA was 14.6 ± 6.8 days and 14.8 ± 7.3 days, respectively (mean ± SD). Myelomeningocele (4.3% in NSQIP-P, 6.3% in COA), spine (3.5%, 4.9%), and epilepsy (3.4%, 3.1%) procedure categories had the highest SSI rates by procedure category in both NSQIP-P and COA. Independent SSI risk factors in NSQIP-P included postoperative pneumonia (OR 4.761, 95% CI 1.269-17.857, p = 0.021), immune disease/immunosuppressant use (OR 3.671, 95% CI 1.371-9.827, p = 0.010), cerebral palsy (OR 2.835, 95% CI 1.463-5.494, p = 0.002), emergency operation (OR 1

  6. Microbiology and management of post-surgical wounds infection in children.

    Science.gov (United States)

    Brook, Itzhak

    2002-01-01

    The recent increased recovery of anaerobic bacteria from children has led to greater appreciation of their role in paediatric infections at all body sites, including post-surgical wounds (PSW). In studies that employed adequate method for recovery of aerobic and anaerobic bacteria polymicrobial, aerobic and anaerobes were isolated from over half of the patients with PSW. The wounds studied were those that developed following these surgical procedures: head and neck surgery for malignancies, post-thoracotomy, spinal fusion and gastrostomy tube insertion. Staphylococcus aureus and aerobic gram-negative bacilli were found at all sites. However, a correlation was generally found between the site of the wounds and microbial flora recovered from the wound. Organisms that resided in the mucous membranes close to the surgical site predominated in the wound next to these areas. Enteric Gram-negative rods, Group D enterococcus and Bacteroides fragilis group predominated in wounds relating to the gut flora, while Streptococcus spp., pigmented Prevotella and Porphyromonas spp. and Fusobacterium spp. were most frequently recovered in wounds proximal to the oral area. Management of PSW should include administration of antimicrobials effective against the polymicrobial bacterial flora adjacent to the anatomic site of the wound.

  7. Epic Immune Battles of History: Neutrophils vs. Staphylococcus aureus

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    Fermin E. Guerra

    2017-06-01

    Full Text Available Neutrophils are the most abundant leukocytes in human blood and the first line of defense after bacteria have breached the epithelial barriers. After migration to a site of infection, neutrophils engage and expose invading microorganisms to antimicrobial peptides and proteins, as well as reactive oxygen species, as part of their bactericidal arsenal. Ideally, neutrophils ingest bacteria to prevent damage to surrounding cells and tissues, kill invading microorganisms with antimicrobial mechanisms, undergo programmed cell death to minimize inflammation, and are cleared away by macrophages. Staphylococcus aureus (S. aureus is a prevalent Gram-positive bacterium that is a common commensal and causes a wide range of diseases from skin infections to endocarditis. Since its discovery, S. aureus has been a formidable neutrophil foe that has challenged the efficacy of this professional assassin. Indeed, proper clearance of S. aureus by neutrophils is essential to positive infection outcome, and S. aureus has developed mechanisms to evade neutrophil killing. Herein, we will review mechanisms used by S. aureus to modulate and evade neutrophil bactericidal mechanisms including priming, activation, chemotaxis, production of reactive oxygen species, and resolution of infection. We will also highlight how S. aureus uses sensory/regulatory systems to tailor production of virulence factors specifically to the triggering signal, e.g., neutrophils and defensins. To conclude, we will provide an overview of therapeutic approaches that may potentially enhance neutrophil antimicrobial functions.

  8. Epic Immune Battles of History: Neutrophils vs. Staphylococcus aureus

    Science.gov (United States)

    Guerra, Fermin E.; Borgogna, Timothy R.; Patel, Delisha M.; Sward, Eli W.; Voyich, Jovanka M.

    2017-01-01

    Neutrophils are the most abundant leukocytes in human blood and the first line of defense after bacteria have breached the epithelial barriers. After migration to a site of infection, neutrophils engage and expose invading microorganisms to antimicrobial peptides and proteins, as well as reactive oxygen species, as part of their bactericidal arsenal. Ideally, neutrophils ingest bacteria to prevent damage to surrounding cells and tissues, kill invading microorganisms with antimicrobial mechanisms, undergo programmed cell death to minimize inflammation, and are cleared away by macrophages. Staphylococcus aureus (S. aureus) is a prevalent Gram-positive bacterium that is a common commensal and causes a wide range of diseases from skin infections to endocarditis. Since its discovery, S. aureus has been a formidable neutrophil foe that has challenged the efficacy of this professional assassin. Indeed, proper clearance of S. aureus by neutrophils is essential to positive infection outcome, and S. aureus has developed mechanisms to evade neutrophil killing. Herein, we will review mechanisms used by S. aureus to modulate and evade neutrophil bactericidal mechanisms including priming, activation, chemotaxis, production of reactive oxygen species, and resolution of infection. We will also highlight how S. aureus uses sensory/regulatory systems to tailor production of virulence factors specifically to the triggering signal, e.g., neutrophils and defensins. To conclude, we will provide an overview of therapeutic approaches that may potentially enhance neutrophil antimicrobial functions. PMID:28713774

  9. Systematic review and meta-analysis of sutures coated with triclosan for the prevention of surgical site infection after elective colorectal surgery according to the PRISMA statement.

    Science.gov (United States)

    Sandini, Marta; Mattavelli, Ilaria; Nespoli, Luca; Uggeri, Fabio; Gianotti, Luca

    2016-08-01

    Several randomized clinical trials (RCTs) conducted to evaluate the effect of triclosan-coated suture on surgical site infection (SSI) yield to controversial results. The primary purpose of this systematic review and meta-analysis was to analyze the available RCTs, comparing the effect of triclosan-coated suture with uncoated suture on the incidence of SSI after elective colorectal operations. As secondary endpoint of the analysis, we considered length of hospital stay after surgery. We performed a systematic literature review through Medline, Embase, Pubmed, Scopus, Ovid, ISI Web of Science, and the Cochrane Controlled Trials Register searching for RCTs published from 1990 to 2015. To conduct these meta-analyses, we followed the guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Study inclusion criteria were as follows: parallel-group RCTs in adult populations reporting the closure of the abdominal wall after elective colorectal operation with triclosan-coated suture or noncoated suture, and reporting the outcomes considered in the meta-analysis. Six trials including 2168 patients (1102 treated and 1066 controls) provided data on SSIs. The overall rate was 11.7% (129/1102) in the triclosan group and 13.4% (143/1066) in the control group (odds ratio 0.81, 95% confidence interval [CI] 0.58-1.13, P = 0.220). Heterogeneity among studies was moderate (I = 44.9%). No evidence of publication bias was detectable. Five RCTs (1783 patients; 914 treated and 689 controls) described hospital length of stay with no significant effect (mean difference: -0.02, 95% CI -0.11 to -0.07, P = 0.668). The I test for heterogeneity was 0% (P = 0.836). Moderator analyses showed no significant differences were detected in analyses comparing the suture materials (polydioxanone vs polyglactin). In open-label trials, the odds ratio for SSI risk was 0.62 (95% CI 0.20-1.93, P = 0.413), 0.77 in single-blind (95% CI 0.31-1.95, P

  10. Stress-induced hyperglycemia as a risk factor for surgical-site infection in nondiabetic orthopedic trauma patients admitted to the intensive care unit.

    Science.gov (United States)

    Richards, Justin E; Kauffmann, Rondi M; Obremskey, William T; May, Addison K

    2013-01-01

    The aim of this study was to evaluate the association between stress-induced hyperglycemia and infectious complications in nondiabetic orthopedic trauma patients admitted to the intensive care unit (ICU). : This study was a retrospective review. The study was conducted at an academic level-1 trauma center. One hundred and eighty-seven consecutive trauma patients with isolated orthopedic injuries were studied. : Blood glucose values during initial hospitalization were evaluated. The admission blood glucose (BG) and hyperglycemic index (HGI) were determined for each patient. Perioperative infectious complications: pneumonia, urinary tract infection (UTI), surgical-site infection (SSI), sepsis were the outcome measures. An average of 21.5 BG values was obtained for each patient. The mean ICU and hospital length of stay was 4.0 ± 4.9 and 10.0 ± 8.1 days, respectively. Infections were recorded in 43 of 187 patients (23.0%) and SSIs specifically documented in 16 patients (8.6%). Open fractures were not associated with SSI (8/83, 9.6% vs. 8/104, 7.7%). There was no difference in admission BG or HGI and infection. However, there was a significant difference in HGI when considering SSI alone (2.1 ± 1.7 vs. 1.2 ± 1.1). Patients with an SSI received a greater amount of blood transfusions (14.9 ± 12.1 vs. 4.9 ± 7.6). No patient was diagnosed with a separate infection (ie, pneumonia, UTI, bacteremia) before SSI. There was no significant difference in injury severity score among patients with an SSI (11.1 ± 4.0 vs. 9.6 ± 3.0). Multivariable regression testing with HGI as a continuous variable demonstrated a significant relationship (odds ratio: 1.8, 95% confidence interval: 1.3-2.5) with SSI after adjusting for blood transfusions (odds ratio: 1.1, 95% confidence interval: 1.1-1.2). : Stress-induced hyperglycemia demonstrated a significant independent association with SSIs in nondiabetic orthopedic trauma patients who were admitted to the ICU. Prognostic Level II. See

  11. [Nosocomial urinary tract and surgical site infection rates in the Maternity Ward at the General Referral Hospital in Katuba, Lubumbashi, Democratic Republic of the Congo].

    Science.gov (United States)

    Lukuke, Hendrick Mbutshu; Kasamba, Eric; Mahuridi, Abdulu; Nlandu, Roger Ngatu; Narufumi, Suganuma; Mukengeshayi, Abel Ntambue; Malou, Vicky; Makoutode, Michel; Kaj, Françoise Malonga

    2017-01-01

    In Intertropical Africa hospitalized patients are exposed to a risk of nosocomial infections. The dearth of published data on this subject limits the descriptive analysis of the situation. This study aimed to determine the incidence, the germs responsible for these infections and the risk factors of nosocomial infections in the Maternity Ward at the General Referral Hospital in Katuba, Lubumbashi, Democratic Republic of the Congo. We conducted a descriptive, longitudinal study from 1 October 2014 to 1 January 2015. Our study population consisted of 207 women who had been hospitalized in the Maternity Ward at the General Referral Hospital in Katuba. We carried out a comprehensive data collection. Nosocomial infection rate accounted for 15.5%. Parturient women who had been hospitalized for more than three days were three times more likely to develop a nosocomial infection (p=0.003), while those who had had a complicated delivery were four times more likely to be at risk of developing nosocomial infection (p = 0.000). Escherichia coli was the most isolated causative agent (38.1%), followed by Citrobacter freundi (23.8%), Acinobacter baumani (.18, 2%), Staphylococcus aureus (18.2%), Enterococcus aureus (14.3%) and Pseudomonas aeroginosa (9.1%). Ampicillin was the most prescribed antibiotic, to which isolated microbes were resistant. It is necessary to improve hospital hygiene and to conduct further study to examine the similarity between germs strains in the environment and those in biological fluids.

  12. Surgical infections: a microbiological study

    Directory of Open Access Journals (Sweden)

    Santosh Saini

    Full Text Available Surgical infections are mostly polymicrobial, involving both aerobes and anaerobes. One hundred seventeen cases comprised of abscesses (n=51, secondary peritonitis (n=25, necrotizing fascitis (n=22 and wounds with devitalized tissues (n=19 were studied. The number of microorganisms isolated per lesion was highest in secondary peritonitis (2.32. The aerobe/ anaerobe ratio was 0.81 in secondary peritonitis and 1.8 in necrotizing fascitis. Most secondary peritonitis (80%, necrotizing fascitis (75% and wounds with devitalized tissues (66.7% were polymicrobial. Common microorganisms isolated in our study were E. coli, Staphylococcus aureus, Klebsiella spp., Pseudomonas aeruginosa, Bacteroides fragilis and Peptostreptococcus spp. The most effective antibiotics for S. aureus were clindamycin (79.1% and cefuroxime (70.8%. For Gram-negatives (Klebsiella spp., E. coli and Proteus spp., the most effective antibiotics were cefotaxime, ceftizoxime, amikacin and ciprofloxacin. Pseudomonas aeruginosa was maximally sensitive to amikacin (35.2% and ciprofloxacin (35.2%. The greatest degree of multidrug resistance to all the drugs was found in P. aeruginosa (52.9%, followed by Klebsiella spp. (33.3%, Proteus spp. (33.3%, E. coli (22.2%, and S. aureus (12.5%. All the anaerobes that we isolated were 100% sensitive to metronidazole and chloramphenicol, followed by clindamycin (95% to 100%. Apart from antibiotic therapy, non-antimicrobial methods, such as hyperbaric oxygen therapy and debridement also play an important role in the treatment of surgical infections.

  13. Staphylococcus aureus and the ecology of the nasal microbiome

    Science.gov (United States)

    Liu, Cindy M.; Price, Lance B.; Hungate, Bruce A.; Abraham, Alison G.; Larsen, Lisbeth A.; Christensen, Kaare; Stegger, Marc; Skov, Robert; Andersen, Paal Skytt

    2015-01-01

    The human microbiome can play a key role in host susceptibility to pathogens, including in the nasal cavity, a site favored by Staphylococcus aureus. However, what determines our resident nasal microbiota—the host or the environment—and can interactions among nasal bacteria determine S. aureus colonization? Our study of 46 monozygotic and 43 dizygotic twin pairs revealed that nasal microbiota is an environmentally derived trait, but the host’s sex and genetics significantly influence nasal bacterial density. Although specific taxa, including lactic acid bacteria, can determine S. aureus colonization, their negative interactions depend on thresholds of absolute abundance. These findings demonstrate that nasal microbiota is not fixed by host genetics and opens the possibility that nasal microbiota may be manipulated to prevent or eliminate S. aureus colonization. PMID:26601194

  14. Methicillin-resistant Staphylococcus aureus adaptation to human keratinocytes.

    Science.gov (United States)

    Soong, Grace; Paulino, Franklin; Wachtel, Sarah; Parker, Dane; Wickersham, Matthew; Zhang, Dongni; Brown, Armand; Lauren, Christine; Dowd, Margaret; West, Emily; Horst, Basil; Planet, Paul; Prince, Alice

    2015-04-21

    Skin is the most common site of Staphylococcus aureus infection. While most of these infections are self-limited, recurrent infections are common. Keratinocytes and recruited immune cells participate in skin defense against infection. We postulated that S. aureus is able to adapt to the milieu within human keratinocytes to avoid keratinocyte-mediated clearance. From a collection of S. aureus isolated from chronically infected patients with atopic dermatitis, we noted 22% had an agr mutant-like phenotype. Using several models of human skin infection, we demonstrate that toxin-deficient, agr mutants of methicillin-resistant S. aureus (MRSA) USA300 are able to persist within keratinocytes by stimulating autophagy and evading caspase-1 and inflammasome activation. MRSA infection induced keratinocyte autophagy, as evidenced by galectin-8 and LC3 accumulation. Autophagy promoted the degradation of inflammasome components and facilitated staphylococcal survival. The recovery of more than 58% agr or RNAIII mutants (P Soong et al.

  15. Azoreductase in Staphylococcus aureus.

    Science.gov (United States)

    Zou, Wen; Cerniglia, Carl E; Chen, Huizhong

    2009-01-01

    Azoreductase(s) catalyze a NAD(P)H-dependent reaction in bacteria to metabolize azo dyes to colorless aromatic amines. Azoreductases from bacteria represent a novel family of enzymes with little similarity to other reductases. This unit will describe the current methods for measuring azoreductase from Staphylococcus aureus, which has been suggested to serve as a model strain to study the azo dye degradation by human skin microflora.

  16. Antimicrobial susceptibility pattern of bacterial isolates from surgical wound infections in Tertiary Care Hospital in Allahabad, India

    Directory of Open Access Journals (Sweden)

    A K Kapoor

    2012-01-01

    Full Text Available The aim of present study to analyze the occurrence and in-vitro antimicrobial susceptibility of bacterial pathogens isolated from surgical wound infections. Specimens from a total of 129 patients undergoing either emergency or elective surgery were collected from infected sites or stitch lines and inoculated onto appropriate media. The bacterial cultures were identified utilizing standard microbiological and biochemical methods. Isolates were tested for susceptibility to antimicrobials using the Kirby Bauer disk diffusion method. Statistical analysis was performed using the chi-square test. Of 129 patients investigated (62 emergency and 67 elective surgery cases, bacterial isolates were isolated with almost equal frequency both from emergency and elective surgery cases. Of 108 (83.72% culture positive samples, 62 (57.41% were Gram negative, 39 (36.11% Gram positive, and 7 (6.48% showed multiple organisms. Of total 115 bacteria isolated (101 single and 7 double organisms culture positive, 33 (28.69% were Escherichia coli and were also the commonest; followed by Staphylococcus aureus, 30 (26.09% cases. S. aureus and Streptococcus spp. showed maximum susceptibility (100% to linezolid and vancomycin. Maximum susceptibility of E. coli was observed to ciprofloxacin (75.7%, followed by gentamicin (54.5%; of Klebsiella spp. to ceftriaxone and gentamicin (66.6% each, of Proteus spp. to gentamicin (70% followed by ciprofloxacin (60%, and of Pseudomonas aeruginosa to piperacillin (100% and tobramycin (71.4%. E. coli and S. aureus were the most common and Salmonella spp. and Acinetobacter spp. were the least common organism causing surgical site infections. The definitive therapy included ciprofloxacin and gentamicin for E. coli; linezolid and vancomycin for S. aureus and Streptococcus spp; ceftriaxone and ciprofloxacin for Klebsiella spp., Citrobacter spp., acinetobacter spp and Salmonella spp.

  17. Haematogenous Staphylococcus aureus meningitis. A 10-year nationwide study of 96 consecutive cases

    DEFF Research Database (Denmark)

    Pedersen, Michael; Benfield, Thomas L; Skinhoej, Peter

    2006-01-01

    BACKGROUND: Haematogenous Staphylococcus aureus meningitis is rare but associated with high mortality. Knowledge about the disease is still limited. The objective of this study was to evaluate demographic and clinical prognostic features of bacteraemic S. aureus meningitis. METHODS: Nationwide...... surveillance in Denmark from 1991 to 2000 with clinical and bacteriological data. Risks of death were estimated by Cox proportional hazards regression analysis. RESULTS: Among 12480 cases of S. aureus bacteraemia/sepsis, we identified 96 cases of non-surgical bacteraemic S. aureus meningitis (0.8%). Incidence...... > or = 4) (HR, 2.14; CI, 1.09 to 4.19) remained independent predictors of mortality. CONCLUSION: The incidence, but not mortality of bacteraemic S. aureus meningitis decreased during the study period. Co morbidity and critical illness were independent predictors of a poor outcome....

  18. Importance of Reporting the Gleason Score at the Positive Surgical Margin Site: Analysis of 4,082 Consecutive Radical Prostatectomy Cases.

    Science.gov (United States)

    Kates, Max; Sopko, Nikolai A; Han, Misop; Partin, Alan W; Epstein, Jonathan I

    2016-02-01

    Since 2010 pathologists at our institution have routinely been documenting the Gleason score at the margin and length of the positive surgical margin after prostatectomy. In this study we evaluate how the Gleason score and positive surgical margin length correlate with the grade and adverse pathological characteristics of the final specimen, and whether the positive surgical margin Gleason score affects the risk of early biochemical recurrence. A total of 4,082 consecutive patients undergoing radical prostatectomy and pelvic lymph node dissection between 2010 and 2014 for localized prostate cancer were included in the study, of whom 405 had a Gleason score of 7 or greater of the primary nodule and a positive surgical margin with the length and Gleason score recorded at the margin. Concordance rates between the Gleason score at the margin and the final pathological specimen were compared. Logistic regression models were used to predict the risk of unfavorable pathology. Cox proportional hazards models controlling for Gleason score, preoperative prostate specific antigen, pathological stage and adjuvant radiation were used to predict biochemical recurrence, and Kaplan-Meier estimates of recurrence-free survival were calculated by Gleason score. Among patients with positive margins biochemical recurrence was identified in 22% (vs 5.6% without positive margins), metastases in 3% (vs 0.5%) and adjuvant radiation in 30% (vs 4.1%). Mean followup was 22 months (range 12 to 48). The Gleason score at the positive surgical margin was the same as the final pathology specimen in 44% of patients, and a lower Gleason score in 56% of patients. A shorter positive surgical margin was independently associated with a lower Gleason score at the margin (p=0.02). Kaplan-Meier estimates demonstrated improved freedom from biochemical recurrence among patients with a lower Gleason score at the margin. In multivariate Cox models having a lower grade margin was associated with a decreased

  19. Risk factors for Staphylococcus aureus nasal colonization in Danish middle-aged and elderly twins

    DEFF Research Database (Denmark)

    Andersen, P S; Larsen, Lisbeth Aagaard; Fowler, V G

    2013-01-01

    Staphylococcus aureus is a human commensal bacterium found in the nasal cavity and other body sites. Identifying risk factors for S. aureus nasal carriage is of interest, as nasal carriage is a risk factor for subsequent invasive infection. We recently investigated the influence of host genetics...

  20. SURGICAL TECHNIQUE

    African Journals Online (AJOL)

    We describe a simple posterior spinal approach tuberculosis, difficulties in surgical treatment of consisting of foraminotomy and discectomy for tuberculous spondylitis are made more complex by lumbar T B spondylosis. The patients' good response neurological deficit, bony deformities, unaffordability to this simple surgical ...

  1. Antimicrobial Analysis of an Antiseptic Made from Ethanol Crude Extracts of P. granatum and E. uniflora in Wistar Rats against Staphylococcus aureus and Staphylococcus epidermidis

    Directory of Open Access Journals (Sweden)

    Thaís Honório Lins Bernardo

    2015-01-01

    Full Text Available Introduction. Surgical site infection remains a challenge for hospital infection control, especially when it relates to skin antisepsis in the surgical site. Objective. To analyze the antimicrobial activity in vivo of an antiseptic from ethanol crude extracts of P. granatum and E. uniflora against Gram-positive and Gram-negative bacteria. Methods. Agar drilling and minimal inhibitory tests were conducted for in vitro evaluation. In the in vivo bioassay were used Wistar rats and Staphylococcus aureus (ATCC 25923 and Staphylococcus epidermidis (ATCC 14990. Statistical analysis was performed through variance analysis and Scott-Knott cluster test at 5% probability and significance level. Results. In the in vitro, ethanolic extracts of Punica granatum and Eugenia uniflora and their combination showed the best antimicrobial potential against S. epidermidis and S. aureus. In the in vivo bioassay against S. epidermidis, there was no statistically significant difference between the tested product and the patterns used after five minutes of applying the product. Conclusion. The results indicate that the originated product is an antiseptic alternative source against S. epidermidis compared to chlorhexidine gluconate. It is suggested that further researches are to be conducted in different concentrations of the test product, evaluating its effectiveness and operational costs.

  2. Antimicrobial Analysis of an Antiseptic Made from Ethanol Crude Extracts of P. granatum and E. uniflora in Wistar Rats against Staphylococcus aureus and Staphylococcus epidermidis.

    Science.gov (United States)

    Bernardo, Thaís Honório Lins; Sales Santos Veríssimo, Regina Célia; Alvino, Valter; Silva Araujo, Maria Gabriella; Evangelista Pires dos Santos, Raíssa Fernanda; Maurício Viana, Max Denisson; de Assis Bastos, Maria Lysete; Alexandre-Moreira, Magna Suzana; de Araújo-Júnior, João Xavier

    2015-01-01

    Surgical site infection remains a challenge for hospital infection control, especially when it relates to skin antisepsis in the surgical site. To analyze the antimicrobial activity in vivo of an antiseptic from ethanol crude extracts of P. granatum and E. uniflora against Gram-positive and Gram-negative bacteria. Agar drilling and minimal inhibitory tests were conducted for in vitro evaluation. In the in vivo bioassay were used Wistar rats and Staphylococcus aureus (ATCC 25923) and Staphylococcus epidermidis (ATCC 14990). Statistical analysis was performed through variance analysis and Scott-Knott cluster test at 5% probability and significance level. In the in vitro, ethanolic extracts of Punica granatum and Eugenia uniflora and their combination showed the best antimicrobial potential against S. epidermidis and S. aureus. In the in vivo bioassay against S. epidermidis, there was no statistically significant difference between the tested product and the patterns used after five minutes of applying the product. The results indicate that the originated product is an antiseptic alternative source against S. epidermidis compared to chlorhexidine gluconate. It is suggested that further researches are to be conducted in different concentrations of the test product, evaluating its effectiveness and operational costs.

  3. Antibiotic prophylaxis for preventing surgical-site infection in plastic surgery: an evidence-based consensus conference statement from the American Association of Plastic Surgeons.

    Science.gov (United States)

    Ariyan, Stephan; Martin, Janet; Lal, Avtar; Cheng, Davy; Borah, Gregory L; Chung, Kevin C; Conly, John; Havlik, Robert; Lee, W P Andrew; McGrath, Mary H; Pribaz, Julian; Young, V Leroy

    2015-06-01

    There is a growing concern for microbial resistance as a result of overuse of antibiotics. Although guidelines have focused on the use of antibiotics for surgery in general, few have addressed plastic surgery specifically. The objective of this expert consensus conference was to evaluate the evidence for efficacy and safety of antibiotic prophylaxis in plastic surgical procedures. THE AUTHORS: searched for existing high-quality systematic reviews for antibiotic prophylaxis in the literature from the MEDLINE, Cochrane Library, and Embase databases. All synonyms for antibiotics were combined with terms for relevant plastic surgery procedures. The searches were not limited by language, and included all study designs. In addition, supplemental hand searches were performed of bibliographies of relevant articles, and extensive "related articles." Meta-analyses were performed and reviewed by experts selected by the American Association of Plastic Surgeons to reach consensus recommendations. Database searches identified 4300 articles, from which 2042 full-text articles were identified for eligibility. De novo meta-analyses were performed for each plastic surgical category. In total, 67 studies met the inclusion criteria, including nine for breast surgery, 17 for head and neck surgery, 10 for orthognathic surgery, seven for rhinoplasty/septoplasty, 19 for hand surgery, five for skin surgery, and two for abdominoplasty. Systemic antibiotic prophylaxis is recommended for clean breast surgery and for contaminated surgery of the hand or the head and neck. It is not recommended to reduce infection in clean surgical cases of the hand, skin, head and neck, or abdominoplasty.

  4. Membrane damage elicits an immunomodulatory program in Staphylococcus aureus.

    Directory of Open Access Journals (Sweden)

    Ahmed S Attia

    2010-03-01

    Full Text Available The Staphylococcus aureus HrtAB system is a hemin-regulated ABC transporter composed of an ATPase (HrtA and a permease (HrtB that protect S. aureus against hemin toxicity. S. aureus strains lacking hrtA exhibit liver-specific hyper-virulence and upon hemin exposure over-express and secrete immunomodulatory factors that interfere with neutrophil recruitment to the site of infection. It has been proposed that heme accumulation in strains lacking hrtAB is the signal which triggers S. aureus to elaborate this anti-neutrophil response. However, we report here that S. aureus strains expressing catalytically inactive HrtA do not elaborate the same secreted protein profile. This result indicates that the physical absence of HrtA is responsible for the increased expression of immunomodulatory factors, whereas deficiencies in the ATPase activity of HrtA do not contribute to this process. Furthermore, HrtB expression in strains lacking hrtA decreases membrane integrity consistent with dysregulated permease function. Based on these findings, we propose a model whereby hemin-mediated over-expression of HrtB in the absence of HrtA damages the staphylococcal membrane through pore formation. In turn, S. aureus senses this membrane damage, triggering the increased expression of immunomodulatory factors. In support of this model, wildtype S. aureus treated with anti-staphylococcal channel-forming peptides produce a secreted protein profile that mimics the effect of treating DeltahrtA with hemin. These results suggest that S. aureus senses membrane damage and elaborates a gene expression program that protects the organism from the innate immune response of the host.

  5. Staphylococcus aureus in the community: colonization versus infection.

    Directory of Open Access Journals (Sweden)

    Maureen Miller

    Full Text Available BACKGROUND: Antibiotic-resistant Staphylococcus aureus infections have increased dramatically in the community, yet S. aureus nasal colonization has remained stable. The objectives of this study were to determine if S. aureus colonization is a useful proxy measure to study disease transmission and infection in community settings, and to identify potential community reservoirs. METHODOLOGY/PRINCIPAL FINDINGS: Randomly selected households in Northern Manhattan, completed a structured social network questionnaire and provided nasal swabs that were typed by pulsed field gel electrophoresis to identify S. aureus colonizing strains. The main outcome measures were: 1 colonization with S. aureus; and 2 recent serious skin infection. Risk factor analyses were conducted at both the individual and the household levels; logistic regression models identified independent risks for household colonization and infection. RESULTS: 321 surveyed households contained 914 members. The S. aureus prevalence was 25% and MRSA was 0.4%. More than 40% of households were colonized. Recent antibiotic use was the only significant correlate for household colonization (p = .002. Seventy-eight (24% households reported serious skin infection. In contrast with colonization, five of the six risk factors that increased the risk of skin infection in the household at the univariate level remained independently significant in multivariable analysis: international travel, sports participation, surgery, antibiotic use and towel sharing. S. aureus colonization was not significantly associated with serious skin infection in any analysis. Among multiperson households with more than one person colonized, 50% carried the same strain. CONCLUSIONS/SIGNIFICANCE: The lack of association between S. aureus nasal colonization and serious skin infection underscores the need to explore alternative venues or body sites that may be crucial to transmission. Moreover, the magnitude of colonization and

  6. Prevalence of β-Lactamase Production among Pathogenic Bacteria Isolated from Surgical Site and Wound Infection amoung Patients Admitted in some selected Hospitals in Sokoto Metropolis, Nigeria

    Directory of Open Access Journals (Sweden)

    UK Muhammad

    2014-09-01

    Full Text Available Antimicrobial resistance among pathogenic bacteria is increasing worldwide especially against ß-lactam drugs, due to the production of ß-lactamase enzymes which destroy the ß-lactam ring of these antibiotics, thus preventing the action of penicillin binding proteins (PBPs. The prevalence of β-lactamase producing bacteria among patients admitted in three different hospitals were carried out in this study. The results of this study shows that out of one hundred and fifty one isolates obtained in three different hospitals in Sokoto metropolis, only 82 (54.0% were resistant to the antibiotics tested. These include 42 (51.2% were isolated in Usmanu Danfodiyo Teaching Hospital (UDUT, 26 (31.7% were isolated from Specialist Hospital Sokoto (S.H.S and 14 (17.1% were isolated from Maryam Abatcha Women and Children Hospital (MAWCH which has the least number of occurrence of the resistant isolates. β-lactamase test was carried out on the resistant isolates show s that out of the 82 isolates found resistant to the antibiotics tested, about 60 (73.2% were β- lactamase positive and the remaining 22 (26.8% were β-lactamase negative. Staphylococcus aureus has the highest resistant bacteria producing β-lactamase enzyme with 22 isolates, followed by Proteus mirabilis with 10 isolates. DOI: http://dx.doi.org/10.3126/ije.v3i3.11067 International Journal of Environment Vol.3(3 2014: 89-112

  7. Indoor air bacterial load and antibiotic susceptibility pattern of isolates in operating rooms and surgical wards at jimma university specialized hospital, southwest ethiopia.

    Science.gov (United States)

    Genet, Chalachew; Kibru, Gebre; Tsegaye, Wondewosen

    2011-03-01

    Surgical site infection is the second most common health care associated infection. One of the risk factors for such infection is bacterial contamination of operating rooms' and surgical wards' indoor air. In view of that, the microbiological quality of air can be considered as a mirror of the hygienic condition of these rooms. Thus, the objective of this study was to determine the bacterial load and antibiotic susceptibility pattern of isolates in operating rooms' and surgical wards' indoor air of Jimma University Specialized Hospital. A cross sectional study was conducted to measure indoor air microbial quality of operating rooms and surgical wards from October to January 2009/2010 on 108 indoor air samples collected in twelve rounds using purposive sampling technique by Settle Plate Method (Passive Air Sampling following 1/1/1 Schedule). Sample processing and antimicrobial susceptibility testing were done following standard bacteriological techniques. The data was analyzed using SPSS version 16 and interpreted according to scientifically determined baseline values initially suggested by Fisher. The mean aerobic colony counts obtained in OR-1(46cfu/hr) and OR-2(28cfu/hr) was far beyond the set 5-8cfu/hr acceptable standards for passive room. Similarly the highest mean aerobic colony counts of 465cfu/hr and 461cfu/hr were observed in Female room-1 and room-2 respectively when compared to the acceptable range of 250-450cfu/hr. In this study only 3 isolates of S. pyogenes and 48 isolates of S. aureus were identified. Over 66% of S. aureus was identified in Critical Zone of Operating rooms. All isolates of S. aureus showed 100% and 82.8% resistance to methicillin and ampicillin respectively. Higher degree of aerobic bacterial load was measured from operating rooms' and surgical wards' indoor air. Reducing foot trafficking, improving the ventilation system and routine cleaning has to be made to maintain the aerobic bacteria load with in optimal level.

  8. Infarct size in primary angioplasty without on-site cardiac surgical backup versus transferal to a tertiary center: a single photon emission computed tomography study

    Energy Technology Data Exchange (ETDEWEB)

    Knaapen, Paul; Rossum, Albert C. van [VU University Medical Center, Department of Cardiology, Amsterdam (Netherlands); Mulder, Maarten de; Peels, Hans O.; Cornel, Jan H.; Umans, Victor A.W.M. [Medical Center Alkmaar, Department of Cardiology, Alkmaar (Netherlands); Zant, Friso M. van der [Medical Center Alkmaar, Department of Nuclear Medicine, Alkmaar (Netherlands); Twisk, Jos W.R. [VU University Medical Center, Department of Clinical Epidemiology and Biostatistics, Amsterdam (Netherlands)

    2009-02-15

    Primary percutaneous coronary intervention (PCI) performed in large community hospitals without cardiac surgery back-up facilities (off-site) reduces door-to-balloon time compared with emergency transferal to tertiary interventional centers (on-site). The present study was performed to explore whether off-site PCI for acute myocardial infarction results in reduced infarct size. One hundred twenty-eight patients with acute ST-segment elevation myocardial infarction were randomly assigned to undergo primary PCI at the off-site center (n = 68) or to transferal to an on-site center (n = 60). Three days after PCI, {sup 99m}Tc-sestamibi SPECT was performed to estimate infarct size. Off-site PCI significantly reduced door-to-balloon time compared with on-site PCI (94 {+-} 54 versus 125 {+-} 59 min, respectively, p < 0.01), although symptoms-to-treatment time was only insignificantly reduced (257 {+-} 211 versus 286 {+-} 146 min, respectively, p = 0.39). Infarct size was comparable between treatment centers (16 {+-} 15 versus 14 {+-} 12%, respectively p = 0.35). Multivariate analysis revealed that TIMI 0/1 flow grade at initial coronary angiography (OR 3.125, 95% CI 1.17-8.33, p = 0.023), anterior wall localization of the myocardial infarction (OR 3.44, 95% CI 1.38-8.55, p < 0.01), and development of pathological Q-waves (OR 5.07, 95% CI 2.10-12.25, p < 0.01) were independent predictors of an infarct size > 12%. Off-site PCI reduces door-to-balloon time compared with transferal to a remote on-site interventional center but does not reduce infarct size. Instead, pre-PCI TIMI 0/1 flow, anterior wall infarct localization, and development of Q-waves are more important predictors of infarct size. (orig.)

  9. Tolerance of Salmonella Enteritidis and Staphylococcus aureus to surface cleaning and household bleach

    NARCIS (Netherlands)

    Kusumaningrum, H.D.; Paltinaite, R.; Koomen, A.J.; Hazeleger, W.C.; Rombouts, F.M.; Beumer, R.R.

    2003-01-01

    Effective cleaning and sanitizing of food preparation sites is important because pathogens are readily spread to food contact surfaces after preparation of contaminated raw products. Tolerance of Salmonella Enteritidis and Staphylococcus aureus to surface cleaning by wiping with regular, microfiber,

  10. Comparison of serum markers for muscle damage, surgical blood loss, postoperative recovery, and surgical site pain after extreme lateral interbody fusion with percutaneous pedicle screws or traditional open posterior lumbar interbody fusion.

    Science.gov (United States)

    Ohba, Tetsuro; Ebata, Shigeto; Haro, Hirotaka

    2017-10-16

    The benefits of extreme lateral interbody fusion (XLIF) as a minimally invasive lumbar spinal fusion treatment for lumbar degenerative spondylolisthesis have been unclear. We sought to evaluate the invasiveness and tolerability of XLIF with percutaneous pedicle screws (PPS) compared with traditional open posterior lumbar interbody fusion (PLIF). Fifty-six consecutive patients underwent open PLIF and 46 consecutive patients underwent single-staged treatment with XLIF with posterior PPS fixation for degenerative lumbar spondylolisthesis, and were followed up for a minimum of 1 year. We analyzed postoperative serum makers for muscle damage and inflammation, postoperative surgical pain, and performance status. A Roland-Morris Disability Questionnaire (RDQ) and Oswestry Disability Index (ODI) were obtained at the time of hospital admission and 1 year after surgery. Intraoperative blood loss (51 ± 41 ml in the XLIF/PPS group and 206 ± 191 ml in the PLIF group), postoperative WBC counts and serum CRP levels in the XLIF/PPS group were significantly lower than in the PLIF group. Postoperative serum CK levels were significantly lower in the XLIF/PPS group on postoperative days 4 and 7. Postoperative recovery of performance was significantly greater in the XLIF/PPS group than in the PLIF group from postoperative days 2 to 7. ODI and visual analog scale (VAS) score (lumbar) 1 year after surgery were significantly lower in the XLIF/PPS group compared with the PLIF group. The XLIF/PPS procedure is advantageous to minimize blood loss and muscle damage, with consequent earlier recovery of daily activities and reduced incidence of low back pain after surgery than with the open PLIF procedure.

  11. Staphylococcus aureus and the oral cavity: an overlooked source of carriage and infection?

    Science.gov (United States)

    McCormack, M G; Smith, A J; Akram, A N; Jackson, M; Robertson, D; Edwards, G

    2015-01-01

    The role of intraoral Staphylococcus aureus in disease and cross-infection sources is controversial. We present a 10-year retrospective analysis of laboratory data reporting isolation of S aureus from oral and perioral clinical specimens. A review of laboratory records for specimens where S aureus was isolated were collated and analyzed from January 1998-December 2007 at the Oral Microbiology Laboratory, Glasgow Dental Hospital. There were 11,312 specimens submitted to the laboratory over the study time period. S aureus was isolated from 1,986 specimens (18%). Of these, 1,782 (90%) were methicillin-sensitive S aureus (MSSA), and 204 (10%) were methicillin-resistant S aureus (MRSA). The most common specimen type from which MSSA was isolated was an oral rinse, whereas for MRSA this was a tongue swab. Most of the MRSA isolates were EMRSA-15 or EMRSA-16 lineage. These findings suggest that S aureus continues to be a frequent isolate in the oral cavity and perioral region. The oral cavity should be considered a source of S aureus in terms of cross-infection and dissemination to other body sites. The role of S aureus in the pathogenesis of certain oral diseases should also be considered as part of a differential diagnosis. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  12. Surgical site infection incidence after a clean-contaminated surgery in Yasuj Shahid Beheshti hospital, Iran Incidencia de infección de herida por cirugía limpia contaminada en el hospital Yasuj Shahid Beheshti, Irán Incidência de infecção de ferida depois de cirurgia limpa-contaminada em hospital Yasuj Shahid Beheshti, Irã

    Directory of Open Access Journals (Sweden)

    Mohebbi Nobandegani Zinat

    2011-11-01

    Full Text Available Objective. To determine the incidence rate of infection after a clean-contaminated surgery and its relationship with some risk factors. Methodology. Cross sectional study, in a convenience sample of 300 patients who underwent surgery classified as clean-contaminated in a hospital of Yasuj, Iran. Samples were taken directly from the wound at the first dressing change to all the patients. They were studied to determine bacteria growth. Results. The rate of infection after a clean-contaminated surgery was 53%. The most common gram positive microorganism was Staphylococcus aureus (22%, and among gram negative: Escherichia coli (26%, Klebsiella sp (26% and Pseudomonas sp (25%. Significant correlation between the type of surgery and surgical site infection was found, it was not seen with the variables sex and surgical procedure. Conclusion. This study shows important problems regarding patient’s safety. Protocols should be reviewed to control infections.Objetivo. Determinar la tasa de incidencia por infección de herida por cirugía limpia-contaminada y su relación con algunos factores de riesgo. Metodología. Estudio de corte transversal en una muestra por conveniencia de 300 pacientes sometidos a cirugía clasificada como limpia-contaminada. A todos los pacientes les tomaron una muestra para cultivo directamente de la herida en el primer cambio del apósito, la cual se estudió para determinar el crecimiento de bacterias. Resultados. La tasa de infección en heridas quirúrgicas limpias-contaminadas fue del 53%. El microorganismo gram positivo más frecuente fue Staphylococcus aureus (22%, y dentro de los gram negatives fueron: Escherichia coli (26%, Klebsiella sp (26% y Pseudomonas sp (25%. Se encontró asociación significativa entre el tipo de cirugía y la infección de la herida quirúrgica, lo que no se observó con las variables sexo y el procedimiento quirúrgico. Conclusión. Este estudio muestra problemas importantes en el aseguramiento

  13. Soft and hard tissue modifications at immediate transmucosal implants (with Laser-Lok microtextured collar) placed into fresh extraction sites: a 6-month prospective study with surgical reentry.

    Science.gov (United States)

    Iorio-Siciliano, Vincenzo; Marzo, Giuseppe; Blasi, Andrea; Cafiero, Carlo; Mignogna, Michele; Nicolò, Michele

    2014-01-01

    Histologic and clinical studies confirm that laser-microtextured implant collars favor the attachment of connective fibers and reduce probing depth and peri-implant bone loss when compared with machined collars. This prospective study aimed at assessing the alveolar dimensional changes after immediate placement of a transmucosal implant with a Laser-Lok microtextured collar associated with bone regenerative procedures. Thirteen implants were placed immediately into single-rooted extraction sockets. Peri-implant defects were treated with bovine-derived xenografts and resorbable collagen membranes. At 6-month surgical reentry, the Laser-Lok microtextured collar provided more favorable conditions for the attachment of hard and soft tissues and reduced the alveolar bone loss.

  14. Economic impact of treatment for surgical site infections in cases of total knee arthroplasty in a tertiary public hospital in Brazil

    Directory of Open Access Journals (Sweden)

    Karine Dal-Paz

    Full Text Available The aim of this study was to estimate the additional cost of treatment of a group of nosocomial infections in a tertiary public hospital. A retrospective observational cohort study was conducted by means of analyzing the medical records of 34 patients with infection after total knee arthroplasty, diagnosed in 2006 and 2007, who met the criteria for nosocomial infection according to the Centers for Disease Control and Prevention. To estimate the direct costs of treatment for these patients, the following data were gathered: length of hospital stay, laboratory tests, imaging examinations, and surgical procedures performed. Their costs were estimated from the minimum values according to the Brazilian Medical Association. The estimated cost of the antibiotics used was also obtained. The total length of stay in the ward was 976 days, at a cost of US$ 18,994.63, and, in the intensive care unit, it was 34 days at a cost of US$ 5,031.37. Forty-two debridement procedures were performed, at a cost of US$ 5,798.06, and 1965 tests (laboratory and imaging were also performed, at a cost of US$ 15,359.25. US$ 20,845.01 was spent on antibiotics and US$ 1,735.16 on vacuum assisted closure therapy, microsurgical flaps, implant removal, spacer use, and surgical revision. The total additional cost of these cases of hospital infection in 2006 and 2007 was of US$ 91,843.75. Based on that, we demonstrate that the high cost of treatment for hospital infections emphasizes the importance of taking measures to prevent and control hospital infection.

  15. Incidence of early symptomatic port-site hernia: a case series from a department where laparoscopy is the preferred surgical approach.

    LENUS (Irish Health Repository)

    Moran, D C

    2012-12-01

    Potential benefits of laparoscopic surgery include decreased post-operative pain, improved cosmesis and a shorter hospital stay. However as the volume and complexity of laparoscopic procedures increase, there appears to be a simultaneous increase in complications relating to laparoscopic access. Development of a port-site hernia is one such complication.

  16. Staphylococcus aureus biofilms: recent developments in biofilm dispersal.

    Science.gov (United States)

    Lister, Jessica L; Horswill, Alexander R

    2014-01-01

    Staphylococcus aureus is a major cause of nosocomial and community-acquired infections and represents a significant burden on the healthcare system. S. aureus attachment to medical implants and host tissue, and the establishment of a mature biofilm, play an important role in the persistence of chronic infections. The formation of a biofilm, and encasement of cells in a polymer-based matrix, decreases the susceptibility to antimicrobials and immune defenses, making these infections difficult to eradicate. During infection, dispersal of cells from the biofilm can result in spread to secondary sites and worsening of the infection. In this review, we discuss the current understanding of the pathways behind biofilm dispersal in S. aureus, with a focus on enzymatic and newly described broad-spectrum dispersal mechanisms. Additionally, we explore potential applications of dispersal in the treatment of biofilm-mediated infections.

  17. Staphylococcus aureus paplitimas hospitalizavimo laikotarpiu

    OpenAIRE

    Maželienė, Žaneta; Kaukėnienė, Renata; Antuševas, Aleksandras; Pavilonis, Alvydas

    2008-01-01

    Objective. To determine the prevalence of Staphylococcus aureus strains among hospitalized patients at the beginning of their hospitalization and during their treatment and the resistance of strains to antibiotics, and to evaluate epidemiologic characteristics of these strains. Patients and methods. Sixty-one patients treated at the Department of Cardiac, Thoracic and Vascular Surgery were examined. Identification of Staphylococcus aureus strains was performed using plasmacoagulase and DNase ...

  18. Staphylococcus aureus isolated from tonsillectomized adult patients with recurrent tonsillitis.

    Science.gov (United States)

    Katkowska, Marta; Garbacz, Katarzyna; Stromkowski, Józef

    2017-01-01

    The aim of this study was to analyze the prevalence and antibiotic resistance of Staphylococcus aureus strains from 118 tonsillectomized adults due to recurrent tonsillitis (RT). The study included strains isolated from the tonsillar surface prior to tonsillectomy, recovered from the tonsillar core at the time of surgery, and from the posterior throat 2-4 weeks after the procedure. Susceptibility of isolates to 19 antibiotics was tested in line with the Clinical and Laboratory Standards Institute recommendations. Irrespective of the stage, the most commonly isolated bacteria were gram-positive cocci, and among them S. aureus. The tonsillar core was the most common site of S. aureus isolation (30.5%), followed by the tonsillar surface (10.8%) and the posterior pharynx (5.9%). This difference turned out to be statistically significant (p Staphylococcus aureus seems to be the most common pathogen isolated from patients tonsillectomized due to RT. Staphylococcal isolates associated with RT are present mostly within the tonsillar core and susceptible to most antibiotics. They are typically isolated from patients between 21 and 30 years of age. Tonsillectomy results in less frequent isolation of S. aureus strains. © 2016 APMIS. Published by John Wiley & Sons Ltd.

  19. [Evaluation of the effect of glucose on Staphylococcus aureus and Escherichia coli biofilm formation on the surface of polypropylene mesh].

    Science.gov (United States)

    Reśliński, Adrian; Dabrowiecki, Stanisław

    2013-01-01

    One of the most serious complications associated with the use of implants in hernia surgery is deep surgical site infection involving an implanted biomaterial. Among the major etiological factors of this complication are Staphylococcus aureus and Escherichia coli strains, which have the ability to form a biofilm on the surface of the mesh implant. This process is influenced by many factors, of which, according to current medical knowledge, the concentration of glucose may have a clinical significance. The aim of the presented study was to evaluate the effect of glucose on the formation of biofilm on the surface of monofilament polypropylene mesh. The study included 140 bacterial strains (70 S. aureus and 70 E. coli) from the collection of Department of Microbiology Collegium Medicum im. L. Rydygier in Bydgoszcz, Nicolaus Copernicus University in Torun. Evaluation of the effect of two glucose concentrations (0.1% and 0.2%) on biofilm formation was performed using a qualitative (2,3,5-triphenyltetrazolium chloride reduction) and a quantitative ( serial 10-fold dilutions) methods. A qualitative analysis, performed after a period of incubation on substrates containing various concentrations of glucose, has revealed a statistically significant increase in the percentage of S. aureus strains with a very high potential for biofilm formation, while for E. coli an increase was observed in the percentage of strains with a low potential for biofilm formation. In a quantitative analysis of the biofilm of S. aureus forming after incubation on a substrate containing 0.1% and 0.2% glucose, significantly more colony forming units (CFUs) were isolated per one milliliter of the suspension (CFU/ml) than in the control group biofilm samples. On the other hand, the biofilm created by E. coli after a period of incubation on a substrate containing 0.2% glucose yielded significantly fewer CFUs per one milliliter than from the biofilm resulting from incubation on substrate with 0

  20. Epidemiological Surveillance of Bacterial Nosocomial Infections in the Surgical Intensive Care Unit

    Science.gov (United States)

    Custovic, Amer; Smajlovic, Jasmina; Hadzic, Sadeta; Ahmetagic, Sead; Tihic, Nijaz; Hadzagic, Haris

    2014-01-01

    Introduction: Intensive care units (ICUs) are associated with a greater risk of developing nosocomial infections (NIs) than other departments. Aim: The aim of this study was to determine the rate, the site and causative organisms of NIs in the surgical ICU at University Clinical Center Tuzla. Methods: All patients admitted to the surgical ICU were followed prospectively, for the development of NIs (January-December 2010). Determination of NIs was performed using standardized the Centers for Disease Control and Prevention (CDC) criteria. Results: 94 out of 834 patients (11.27%) developed NIs. Respiratory tract infections were seen in 56 (60%), urinary tract infections in 15 (16%) and gastrointestinal tract infections in 8 (9%) patients. Other infections identified were surgical site, bloodstream and skin infections. Gram-negative organisms were reported in approximately 75% of cases (78.7% extended-spectrum beta-lactamase (ESBL)-producers). Klebsiella pneumoniae was the commonest (51.0%), followed by Proteus mirabilis (21.3%) and Pseudomonas aeruginosa (10.6%). Methicillin-resistant Staphylococcus aureus (MRSA) (16%), and Clostridium difficile (9.6%) were the commonest among gram-positive bacteria. Conclusion: Respiratory and urinary tract infections made up the great majority of NIs. ICU patients are more susceptible to NIs, emphasizing the importance of continuous surveillance and enforcement of specific infection control measures. PMID:24757393

  1. New palatal distraction device by both bone-borne and tooth-borne force application in a paramedian bone anchorage site: surgical and occlusal considerations on clinical cases.

    Science.gov (United States)

    Cortese, Antonio; Savastano, Germano; Amato, Massimo; Cantone, Antonio; Boschetti, Ciro; Claudio, Pier Paolo

    2014-03-01

    Maxillary constriction is a very common pathology with implications on dental occlusion, temporomandibular joint dysfunction, nasal breathing, and impairment on the smile and face esthetic.New techniques for expansion of the maxillary bones are particularly useful in relation to the new esthetic ideals of smile and face beauty.To achieve a bodily expansion of the maxillary bones, we developed a new rigid palatal distractor device with both tooth-borne and paramedian bone-borne anchorages to achieve a safe and simple anchorage site suitable also for orthodontic appliances.The reported cases show good results, with bodily maxillary expansion and cross-bite correction without any problems or complications. Substantial advantages of this new device and technique, in comparison with other commonly used palatal distractors, consisting of bodily maxillary movements, avoidance of relapse risks, and safe and simple screw insertion site for bone anchorage also suitable for orthodontic movements, are discussed.

  2. SURGICAL EMBRYOLOGY '

    African Journals Online (AJOL)

    SURGICAL EMBRYOLOGY ' t. Foetal alcohol syndrome: an osteometric evaluation in the wistar rat animal model. S. S. Adebisi. Department of Human Anatomy, Faculty of Medicine, Ahmadu Bello University, Zaria,. Nigeria. Reprint requests to: Dr. S. S. Adebisi. E—mail.' .s'runln'si@tzlgu.adultg,. Abstract. Background: ...

  3. Surgical Audit

    African Journals Online (AJOL)

    2010-01-06

    Jan 6, 2010 ... Key performance indicators like major complications, readmissions, reoperations, transfers, incident reports, complaints and mortalities must also be included. Surgical audits bear very similar relationship to opera- tional research. There is a critical need for the results to be representative and accurate.

  4. SURGICAL ANATOMY

    African Journals Online (AJOL)

    SURGICAL ANATOMY. Rare high origin of the radial artery: a bilateral, symmetrical ease. I. O. ()koro and B. C. J iburum. Department of Anatomy, College of Medicine, lrno State University, Owerri, Nigeria. Reprint requests to: Dr I. O. 0k0r0, Department of Anatomy, [mo State University, P. M. B. 2000. Owerri, Nigeria.

  5. Impact of intra-abdominal absorbable sutures on surgical site infection in gastrointestinal and hepato-biliary-pancreatic surgery: results of a multicenter, randomized, prospective, phase II clinical trial.

    Science.gov (United States)

    Maehara, Yoshihiko; Shirabe, Ken; Kohnoe, Shunji; Emi, Yasunori; Oki, Eiji; Kakeji, Yoshihiro; Baba, Hideo; Ikeda, Masataka; Kobayashi, Michiya; Takayama, Tadatoshi; Natsugoe, Shoji; Haraguchi, Masashi; Yoshida, Kazuhiro; Terashima, Masanori; Sasako, Mitsuru; Yamaue, Hiroki; Kokudo, Norihiro; Uesaka, Katsuhiko; Uemoto, Shinji; Kosuge, Tomoo; Sawa, Yoshiki; Shimada, Mitsuo; Doki, Yuichiro; Yamamoto, Masakazu; Taketomi, Akinobu; Takeuchi, Masahiro; Akazawa, Kouhei; Yamanaka, Takeharu; Shimokawa, Mototsugu

    2017-09-01

    The use of absorbable sutures in wound closure has been shown to reduce the incidence of surgical site infection (SSI); however, there is no evidence that the intra-abdominal use of absorbable rather than silk sutures reduces the incidence of SSI after gastrointestinal surgery. We report the findings of a phase II trial, designed to evaluate the impact of the intra-abdominal use of absorbable sutures on the incidence of SSI. At 19 Japanese hospitals, 1147 patients undergoing elective gastrectomy, colorectal surgery, hepatectomy, or pancreaticoduodenectomy (PD) were randomly assigned to absorbable or silk intra-abdominal suture groups. The primary efficacy endpoint was the incidence of SSI. The secondary efficacy endpoints were the locations of SSI, time to resolution of SSI, length of hospital stay, and the incidence of bile leakage in hepatectomy and pancreatic fistula. The incidence of SSI was 11.3%, 15.5%, 11.3%, and 36.9% after gastrectomy, colorectal surgery, hepatectomy, and PD, respectively. The incidence of SSI was higher in the absorbable suture group than in the silk suture group for all the surgical procedures, but the difference was not significant. The intra-abdominal use of absorbable sutures did not have enough of an effect on the reduction of SSI in this phase II trial to justify the planning of a large-scale phase III trial.

  6. Risk factors and mortality of nosocomial infections of methicillin-resistant Staphylococcus aureus in an intensive care unit.

    Science.gov (United States)

    Wang, Fu-Der; Chen, Yin-Yin; Chen, Te-Li; Lin, Yi-Tsung; Fung, Chang-Phone

    2011-02-01

    Methicillin-resistant Staphyl