Episode 72: Inside the Monitor – Perioperative Infection Control

Perioperative Echocardiography During the Coronavirus Crisis: Considerations in Pediatrics and Congenital Heart Disease

This review highlights the importance of the anesthesia team in minimizing perioperative infection risks and prevention of surgical site infection. Due to the immense financial and patient care burden that results from perioperative infection, a foundational knowledge in preventive measures is essential. Perioperative infection control, the role of the anesthesia team in reducing infection risk, and more specifically the outsized importance of hand hygiene in this space have become increasingly apparent. Maintenance of workspace cleanliness along with hand hygiene forms the cornerstone of preventing microbial transmission. Unfortunately, improvements around perioperative infection control are lacking. The importance of the anesthesia team in maintaining proper hand hygiene, a clean work environment, and appropriate patient conditions to minimize risk of perioperative infection cannot be overstated. Poor clinical outcomes, economic burden, and external pressure from payers highlight the need for anesthesia providers to have an up-to-date knowledge of best practices in this area. In this article, we will review the current recommendations for hand hygiene practices and perioperative infection prevention.

Diabetes is a common disease in Germany. Due to diabetes-associated end-organ disease, such as large and small vessel disease and neuropathy, diabetic patients require more intense anesthesia care during the perioperative phase. An in-depth and comprehensive medical history focusing on hemodynamic alterations, gastroparesis, neuropathy and stiff joint syndrome is a cornerstone of perioperative care and may affect outcome of diabetes patients more than specific anesthetic medications or the anesthetic procedure. Intraoperative anesthetic care needs to focus on preservation of hemodynamic stability, perioperative infection control and maintenance of glucose homeostasis. Whereas some years ago strict glucose control by aggressive insulin therapy was adamantly advocated, the results of recent studies have put the risk of such therapeutic algorithms into perspective. Therefore, optimized perioperative care of diabetic patients consists of setting a predefined targeted blood glucose level, evidence-based therapeutic approaches to reach that goal and finally adequate and continuous monitoring and amendment of the therapeutic approach if required.

Anesthesia Management and Perioperative Infection Control in Patients With the Novel Coronavirus

MANAGEMENT OF COVID-19 IN PERSPECTIVE OF CARDIOLOGISTS

Perceptions of capacity for infectious disease control and prevention to meet the challenges of dengue fever in the face of climate change: A survey among CDC staff in Guangdong Province, China

Systematic Review: National Notifiable Infectious Disease Surveillance System in China

Post-hepatectomy infections require careful attention, because they may deteriorate into liver failure. We retrospectively reviewed such infections in cases without biliary or intestinal reconstruction. This retrospective study involved 535 patients with liver tumors who underwent hepatectomy at the Department of Gastroenterological Surgery of Yokohama City University Hospital between April 1992 and March 2005. After classification into four groups depending on changes in infection countermeasures used during different periods, the treatment outcomes were examined. No such anti-infection measures were taken during the first period; a closed suction drainage system and early enteral nutrition after surgery were introduced between the first and second periods; thorough management of bile leakage and prevention of nosocomial infection were added between the second and third periods; and surgical site infection (SSI) surveillance together with absorbable sutures instead of silk sutures between the third and fourth periods. The incidence of postoperative infection decreased significantly with additional countermeasures: first period 44.7%; second period 24.1%; third period 15.0%; and fourth period 9.2%. The incidence of both SSI and remote infection were similarly reduced. Postoperative infection risk factors were age, presence of diabetes mellitus, the use of silk sutures and bile leakage, while those for SSI were the use of silk sutures and bile leakage. The incidence of postoperative infection and SSI were significantly reduced by our infection countermeasures, especially by bile leakage management and the use of absorbable sutures.

Introduction: Hip fractures are the most common serious injury in the elderly, associated with disability, morbidity, and mortality. Surgical site infection (SSI) is a serious post-operative complication. This prospective cohort study outlines how our center made cumulative improvements in SSI incidence rates, reaching a 12-month average of 0.5%. Methods: All patients undergoing hip fracture operation between 2016 and 2021 were included. The primary outcome measure was confirmed SSI, according to the Public Health England definition. Results were compared with the baseline recordings by an independent SSI team in 2013. Demographic data were compared with National Hip Fracture Database records. Peri-operative infection control and wound management tactics introduced between 2014 and 2021 were collated to gain an overview care bundle. Results: Baseline recordings identified a 9.0% SSI rate in a three-month observation period. In our study, 3,138 hip fracture operative cases were completed between October 2016 and December 2021. There were 9 superficial and 32 deep infections identified, yielding an overall infection rate of 1.3%. However, when analyzing the 12-month average, there was consistent decline in SSI from the baseline 9.0% in 2013 to 0.5% in 2021 (p < 0.05). A peri-operative care bundle included pre-operative bleeding risk assessment. Intra-operatively, double preparation and draping is used for arthroplasty. Broad-spectrum antibiotic agents and tranexamic acid are administered. Meticulous hemostasis and watertight wound closure are observed. Anti-coagulated patients received negative pressure dressings. Post-operatively, a dedicated senior lead team provided daily inpatient review of patients, with urgent consultant review of all wound healing concerns. Conclusion: Patients with a hip fracture have numerous risk factors for SSI. A dedicated multi-focal tactic, adopted by a multi-disciplinary department, can yield substantial risk reduction. Each intervention is evidence based and contributes to cumulative improvement. By prioritizing infection prevention, we have minimized the need for complex infection management interventions and achieved an annual saving of £860,000 for our trust.

Community Health Practitioners [CHPs] play a critical role in Nigeria's primary healthcare system, serving as frontline workers in infectious disease prevention and control. Despite their importance, a comprehensive synthesis of their roles, the diseases they address, and the challenges they face remains limited. The aim of this review is to map and synthesize available evidence on the roles of Community Health Practitioners in infectious disease prevention and control in Nigeria. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews [PRISMA-ScR] 2020 guidelines and the Joanna Briggs Institute [JBI] methodology. The protocol was formally registered on the Open Science Framework [OSF]. A comprehensive search was conducted across PubMed/MEDLINE, Google Scholar, SciSpace, African Journals Online [AJOL], WHO reports, and Nigerian Ministry of Health publications. Studies published up to December 2025 that examined CHPs' involvement in infectious disease prevention and control in Nigeria were included. Data were extracted on CHP roles, infectious diseases addressed, challenges faced, and gaps in the literature. A total of 93 unique studies were identified and screened, with 30 studies meeting the inclusion criteria for detailed analysis. CHPs performed diverse roles, including disease surveillance and notification, case detection and diagnosis, treatment, health education and community mobilization, immunization services, outbreak response, and infection prevention and control. The most frequently addressed infectious diseases were malaria [n=15], COVID-19 [n=10], vaccine-preventable diseases including measles, polio, and meningitis [n=8], and other diseases such as Lassa fever, tuberculosis, HIV/AIDS, diarrheal diseases, and pneumonia. Major challenges included inadequate training and knowledge gaps [n=12], resource and infrastructure limitations [n=10], poor remuneration and lack of incentives [n=7], inadequate supervision and administrative support [n=6], and community acceptance issues [n=4]. Conclusively, CHPs are integral to infectious disease prevention and control in Nigeria, performing multifaceted roles across diverse disease contexts. However, significant systemic challenges, including inadequate training, resource constraints, and poor remuneration, limit their effectiveness. Strengthening CHP capacity through enhanced training, improved resource allocation, better remuneration, and robust supervision systems is essential for optimizing their contribution to infectious disease control and achieving universal health coverage in Nigeria.

Features| August 2022 Practical Approaches to Reducing Cross-Contamination Barry Swerdlow, MD, FASA; Barry Swerdlow, MD, FASA Search for other works by this author on: This Site PubMed Google Scholar Harriet W. Hopf, MD, FUHM, FASA Harriet W. Hopf, MD, FUHM, FASA Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor August 2022, Vol. 86, 23. https://doi.org/10.1097/01.ASM.0000855668.67412.6a Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Barry Swerdlow, Harriet W. Hopf; Practical Approaches to Reducing Cross-Contamination. ASA Monitor 2022; 86:23 doi: https://doi.org/10.1097/01.ASM.0000855668.67412.6a Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: anesthesia machine, gloves, protective, pathogenic organism, perioperative care, washing hands, infectious disease prevention / control, professors, therapeutics, infections, laryngoscopes Anesthesiologists and patients are at risk for cross-contamination and cross-infection during routine clinical care (Clinical Anesthesia. 2017; Anesth Analg 2020;131:37-42; Curr Anesthesiol Rep 2020;10:233-41; J Anesth 2020;34:575-84). The SARS-CoV-2 pandemic emphasized the risk of such perioperative transmission (Anesth Analg 2020;131:37-42; Cardiothorac Vasc Anesth 2021;35:1503-8). In this article, we review practical considerations related to these hazards. Hand hygiene, including hand washing, use of hand sanitizer, and appropriate use of gloves, reduces transmission of pathogens to patients and protects anesthesia providers from spread of disease via fomites, secretions, and blood (Clinical Anesthesia. 2017; Anesth Analg 2020;131:37-42; Curr Anesthesiol Rep 2020;10:233-41). Alcohol-based hand sanitizer, either body-worn or placed in proximity to the anesthesia machine, enhances compliance with hand hygiene protocols and reduces postoperative infection rates (Clinical Anesthesia. 2017; Anesth Analg 2020;131:37-42; Curr Anesthesiol Rep 2020;10:233-41). Gloves are... You do not currently have access to this content.

Cardiovascular Drugs in the Perioperative Period

Well-deserved praise should be given to the authors of the article on long-term outcomes following open mesh repair of incisional hernias (IH). The authors provide important insights into recurrence rates, patient-reported outcomes, and risk factors, particularly emphasizing the role of obesity and mesh size.1 This study is valuable due to its long follow-up period, offering a more comprehensive view of patient outcomes after IH repair. The identification of obesity as a significant risk factor for hernia recurrence aligns with previous findings in the field and is well-documented in this study.1 The authors touch on this, and it opens an important door for the authors and for other studies to expand on preoperative weight management strategies, which have shown promise in improving surgical outcomes and reducing complications.2 Implementing such strategies could help address the identified increased recurrence risk in obese patients, as highlighted in the original article. The study's findings on mesh size and overlap are equally important. The observation that a mesh-defect overlap of less than 7 cm increases recurrence rates is consistent with the literature and current guidelines.3 Future studies could focus on standardizing mesh sizes in relation to hernia characteristics, which could help optimize outcomes. One of the strengths of this study is its emphasis on patient-reported outcomes, including long-term pain and discomfort. The finding that younger patients and females are more likely to report discomfort post-surgery is in line with previous studies and points to the need for tailored pain management and postoperative care strategies for these demographics.4 This could help reduce the long-term discomfort reported by these groups. The impact of surgical site infections on patient satisfaction and recovery, as highlighted in the study, underscores the importance of infection prevention protocols. As infections can significantly hinder recovery, focusing on perioperative infection control could greatly enhance patient satisfaction and long-term outcomes.5 Finally, the finding that closing the ventral aponeurosis does not significantly reduce recurrence rates raises questions about the necessity of this practice in all cases. Further research could clarify when aponeurotic closure may be beneficial, especially in technically challenging situations where achieving closure is difficult. In conclusion, this study provides valuable data on the long-term outcomes of IH repair. Further research is encouraged to study preoperative optimization strategies, demographic factors influencing postoperative discomfort, and the role of aponeurotic closure in hernia repairs to refine surgical techniques and improve patient outcomes. Amir Farah: Conceptualization; funding acquisition; investigation; methodology; resources; software; writing – original draft; writing – review and editing.

Global Trends in Postoperative Sepsis After Pancreatoduodenectomy: A Bibliometric Analysis.

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Surgical site infections (SSIs) account for 31% of all hospital-acquired infections, significantly impacting postoperative recovery and healthcare costs. Foot and ankle surgeries present infection rates between 0.5% and 6.5%, with trauma cases and comorbidities being key risk factors. Despite previous studies, long-term data on infection incidence and predictive factors remain limited. This 7-year cohort study aimed to determine the incidence of SSIs in foot and ankle surgeries and identify independent predictors of infection, particularly differentiating superficial and deep infections. Understanding these risk factors is essential for optimizing infection control protocols and refining perioperative management strategies to improve surgical outcomes. Methods: This retrospective cohort study included 2,180 patients undergoing foot and ankle surgery between 2014 and 2020 in a private hospital. Elective and trauma-related procedures were included, excluding cases of pre-existing infections, open fractures, and septic arthritis. SSIs were classified as superficial (requiring local wound care or oral antibiotics) or deep (requiring surgical debridement or implant removal). Data on age, sex, diabetes mellitus (DM), systemic arterial hypertension (SAH), smoking, ASA score, and BMI were collected. Multivariate logistic regression was used to assess independent predictors of SSIs, with statistical significance set at p &lt; 0.05. The primary outcome was infection incidence, while secondary outcomes included risk factor analysis and infection severity stratification. Results: The overall SSI incidence was 4% (83/2,180 cases), with 2.8% superficial and 1.2% deep infections. Smoking (OR 2.9, 95% CI 1.4–5.3, p = 0.001) and ASA score &gt;2 (OR 3.4, 95% CI 1.2–8.4, p = 0.013) were independent predictors of infection. The deep infection group had significantly higher rates of smoking (p = 0.002), systemic hypertension (p = 0.018), and trauma-related procedures (p = 0.049). No significant associations were found between infection and diabetes mellitus (p = 0.404) or obesity (p = 0.816). Trauma surgeries, particularly ankle fractures, had the highest infection rates, reinforcing the need for enhanced infection control measures in high-risk patients. Conclusion: This 7-year cohort study confirmed a 4% SSI incidence in foot and ankle surgeries, with smoking and ASA score &gt;2 emerging as significant risk factors. Trauma-related procedures, particularly ankle fractures, had higher infection rates, emphasizing the importance of preoperative risk stratification and perioperative infection control. Surprisingly, diabetes and BMI were not significant predictors, possibly due to effective preoperative optimization. These findings support the implementation of targeted preventive strategies, particularly in high-risk patients, to reduce infection rates and improve surgical outcomes. Characterization of the sample according to the presence of infection This table presents the demographic and clinical characteristics of patients undergoing foot and ankle surgery, stratified by infection status (no infection, superficial infection, and deep infection). Trauma cases (p = 0.049), arterial hypertension (p = 0.018), ASA score ≥ II (p &lt; 0.001), smoking (p = 0.002), and overweight status (p = 0.002) were significantly associated with infection. Diabetes mellitus (p = 0.687) and BMI (p = 0.321) were not statistically significant predictors. The findings suggest that preoperative risk factors such as smoking, ASA score, and hypertension should be considered in infection prevention strategies for foot and ankle surgery patients.