Facial Hair and Its Influence on Surgical Site Infection: A Systematic Review to Address a Bald Spot in the Literature.

Surgical site infection (SSI) is accountable for a third of postoperative deaths and for 8% of all deaths due to hospital-acquired infections. There is a wide disparity in the incidence and burden of SSI in low and high-income countries. To assess the rates and risk factors of SSI in a tertiary hospital in a resource-limited sub-Saharan African country and generate institutional baseline data for future monitoring and interventions. This was a descriptive prospective cohort study done at John F Kennedy Memorial Hospital, a tertiary hospital in Monrovia, Liberia, from October 18 to December 18, 2021. Consecutive participants, including children and adults that had surgical operations within the study period, were recruited. Criteria for diagnosis of SSI were as defined by the Centre for Disease Control (1999). Data were collected on the demography of the participants, type of surgery done, presence of SSI, comorbidities, and risk factors for SSI. Of the 111 patients analyzed, thirty-two patients had SSI giving a hospital incident rate of 28.8%. This comprises superficial SSI (22/31; 71.0%), deep SSI (6/31; 19.4%), and organ/space SSI (3/31; 9.7%). Twelve out of 42 females (28.6%) and 20 of 69 males (29.0%) had SSI. There is no statistically significant difference in gender SSI rate (P = 0.963). SSI occurred more in dirty wounds (13/23; 56.5%), compared to contaminated wounds (6/11, 54.6%), clean contaminated (7/22; 31.8%), and clean wounds (6/55, 10.9%). There is a statistical difference in the rate of SSI among the wound classes (P = 0.001). The infection rate is also more in emergency surgeries (18/39, 46.2%) compared to elective surgeries (14/72, 19.4%), and it is significant (P = 0.003). Statistically, there was no significant difference between the two skin preparation agents used (P = 0.351). The abdomen was the most common site of surgical incision and had the highest rate of SSI (24/79; 30.4%) (P = 0.045). There was no statistical difference in SSI rate between those whose hairs were removed in the ward or in the theatre (P = 0.114); length of incision (P = 0.297), or duration of surgery (P = 0.715) (see table for classification and rates). The SSI rate in our study is high at 28.8%. Abdominal surgeries, emergencies, and wound class accounted for the majority of the SSIs. The baseline data will be useful in developing infection control strategies.

Closed incision negative pressure therapy (ciNPT) has been adopted into practices of diverse surgical specialties to help reduce postsurgical complication risks. There are two primary commercially available systems that deliver ciNPT through different mechanisms. The purpose of this meta-analysis is to compare the potential effects of two different ciNPT systems on clinical outcomes following hip and knee arthroplasty. A systematic literature search was conducted to identify hip and knee arthroplasty studies comparing the incidence of surgical site infections (SSIs) and surgical site complications (SSCs) versus standard of care (SOC) following the use of two different ciNPT systems. Four meta-analyses were performed by calculating risk ratios (RR) to assess the effect of (1) ciNPT with foam dressing (ciNPT-F) versus SOC and (2) ciNPT with multilayer absorbent dressing (ciNPT-MLA) versus SOC. Comprehensive Meta-Analysis Version 3.0 (Biostat Inc., Englewood, NJ) software was used to perform the analyses. Twelve studies comparing ciNPT-F to SOC and six studies comparing ciNPT-MLAto SOC were analyzed. SSI rates were reported in seven of 12 studies involving ciNPT-F. In those, ciNPT-F significantly reduced the incidence of SSI (RR = .401, 95% confidence interval (CI) = .190, .844; p = .016). Across four of six studies that reported SSI rates, there was no significant difference in SSI rates between ciNPT-MLAvs SOC (RR = .580, 95% CI = .222, 1.513; p = .265). SSC rates were evaluated in eight of 12 ciNPT-F studies that reported SSC rates. This meta-analysis of the eight ciNPT-F studies showed significantly reduced SSC rates with ciNPT-F vs SOC (RR = .332, 95% CI = .236, .467; p < 0.001). For ciNPT-MLA, five of six studies reported SSC rates. In those, there was no significant difference in SSC rates between ciNPT-MLA vs SOC (RR = .798, 95% CI = .458, 1.398; p = .425). These meta-analyses results showed a significant reduction in SSI and SSC rates in the ciNPT-F group vs SOC and no difference in SSI and SSC rates in the ciNPT-MLA group vs SOC. The reasons for these observed differences were not evaluated as part of this study. Future controlled clinical studies comparing outcomes between different ciNPT systems over closed orthopedic incisions would help to validate these study results.

Comparing and ranking hospitals based on health outcomes is becoming increasingly popular, although case-mix differences between hospitals and random variation are known to distort interpretation. The aim of this study was to explore whether surgical-site infection (SSI) rates are suitable for comparing hospitals, taking into account case-mix differences and random variation. Data from the national surveillance network in the Netherlands, on the eight most frequently registered types of surgery for the year 2009, were used to calculate SSI rates. The variation in SSI rate between hospitals was estimated with multivariable fixed- and random-effects logistic regression models to account for random variation and case mix. 'Rankability' (as the reliability of ranking) of the SSI rates was calculated by relating within-hospital variation to between-hospital variation. Thirty-four hospitals reported on 13 629 patients, with overall SSI rates per surgical procedure varying between 0 and 15·1 per cent. Statistically significant differences in SSI rate between hospitals were found for colonic resection, caesarean section and for all operations combined. Rankability was 80 per cent for colonic resection but 0 per cent for caesarean section. Rankability was 8 per cent in all operations combined, as the differences in SSI rates were explained mainly by case mix. When comparing SSI rates in all operations, differences between hospitals were explained by case mix. For individual types of surgery, case mix varied less between hospitals, and differences were explained largely by random variation. Although SSI rates may be used for monitoring quality improvement within hospitals, they should not be used for ranking hospitals.

THE OR MANAGER sat and listened to the surgical services director's challenge: Reduce the surgical site infection (SSI) rate by 50%. "Our infection rate is only 1%, below the national average of 2% to 5%," she thought. "What more can we do?" But being a quality leader, she recognized that although the current SSI rate was admirable, reducing it even further would greatly benefit Saint Francis Medical Center in Cape Girardeau, Mo., and its patients. This article describes an initiative focused on preventing deep SSIs and their potentially devastating complications, as well as how resulting procedural changes dramatically reduced the facility's SSI rate. (For a general overview and guidelines, see How can SSIs be prevented?) Preliminary approach First, the previous 3 years of SSI data were analyzed. Statistically significant results showed that 62% of those infections involved skin and respiratory tract pathogens. This indicated possible contamination from environmental and human factors such as cleaning the facility, hand hygiene practices, and surgical staff and healthcare provider attire. After researching evidence-based practices, the hospital enhanced cleaning measures and introduced testing for methicillin-resistant Staphylococcus aureus (MRSA) carriers. Another finding revealed a relationship between an increase in SSI and patient comorbidities such as hypertension, obesity, peripheral vascular disease, tobacco usage, diabetes mellitus, obstructive sleep apnea, heart failure, and chronic obstructive pulmonary disease. We then considered how to support each patient's health status to reduce SSI risk. Looking for problems and solutions A team of medical staff caring for each patient assembled to look at each deep SSI in an apparent cause analysis (ACA) meeting. In one case, the caregivers found a problem with the patient's preexisting positive MRSA nasal culture. This patient had been treated with intranasal mupirocin but had received only cefazolin, not vancomycin as recommended.1 After staff members realized this, a procedural change was made. Patients presenting with a MRSA-positive culture are pretreated with intranasal mupirocin and I.V. vancomycin in addition to another appropriate antibiotic. For example, an orthopedic patient without beta-lactam allergy should receive cefazolin as a preoperative antibiotic. If this same orthopedic patient were MRSA-positive, he or she would receive both cefazolin and vancomycin preoperatively after pretreatment with mupirocin.2 Routine MRSA nasal swab testing was expanded to include preoperative patients undergoing orthopedic, neurosurgery, cardiovascular, and vascular surgery. Wound care specialists and surgeons were recommended to obtain swab wound culture specimens from the patient for any suspected infections. At that first ACA meeting, a pharmacist pointed out that we were giving patients half of the recommended dose for some antibiotics.2 To correct this problem, an update was added to the computerized provider order entry (CPOE) system with the pharmacy providing weight-based dosages of prescribed antibiotics. CPOE sets were updated to include pretreatment with mupirocin and vancomycin for patients who were MRSA-positive and to verify that surgeons' admission orders include both MRSA testing and treatment as well as the appropriate antibiotics, per American Society of Health-System Pharmacists guidelines.2 An antibiotic redosing schedule was hardwired into the electronic health record to remind anesthesia care providers to redose during long surgical procedures. Improving environmental care The healthcare professionals attending ACA meetings after each SSI successfully identified problems and implemented needed changes. For example, improved cleaning practices were implemented in the ORs. The new one-step 0.55% sodium hypochlorite cleaning wipe approved for the OR and patient-care areas kills fungi, spores, viruses, and bacteria, including Mycobacterium tuberculosis and Clostridium difficile.3 An educational review reminded staff members of proper cleaning techniques. The OR staff-development program included the enhanced cleaning protocol recommended by the Association of periOperative Registered Nurses (AORN).3 The environmental cleaning staff attended a staff-development program on this enhanced cleaning protocol. Another change was exchanging cotton string mops for microfiber mops. Although either type of mop is acceptable per AORN guidelines, one study found microfiber mops removed microorganisms more effectively (95%) than cotton string mops (68%).3 The environmental cleaning staff was assigned to clean rooms used during the weekend, which was previously done by the perioperative staff, to provide a terminally cleaned room as we improved overall cleaning practices. Improved lidded trash bins were provided for OR trash. More frequent trash pickups also helped prevent insects, such as flies, in the OR. Changing OR practices Staff and management recognize that although doors must be opened for patient and equipment traffic, the OR doors need to be closed to allow air exchanges to function properly. Air exchanges make the OR safer for patients and decrease the risk of SSIs.4 After education and reinforcement, the OR staff became more mindful to keep the doors closed. Another change involved covering male healthcare workers' facial hair with fine mesh beard covers. In addition, circulating nurses in the OR were asked to wear long-sleeved jackets while performing surgical skin prep, which helps prevent surgical site contamination from arm hair or skin cells that are shed during the procedure.5 Brushing up on hygiene issues Performing hand hygiene is a basic but critically important behavior for healthcare workers throughout any facility. Not only does performing hand hygiene protect the patient from healthcare workers' organisms, but it also protects healthcare workers from the patients' organisms.6 Proper hand hygiene includes wetting hands under warm running water, applying soap to all surfaces and rubbing for 15 seconds, then rinsing and drying with a paper towel, which is used to turn off the faucet. When hands are not visibly soiled, an alcohol-based antiseptic is an acceptable alternative. Proper technique for alcohol-based hand hygiene involves applying the gel and rubbing hands together until they are dry (approximately 20 seconds).7 The CDC recommends healthcare workers perform hand hygiene at these times: before and after touching the patient's intact skin after contact with any body fluids including blood, wounds, mucous membranes, and contaminated dressings after contact with furniture or medi-cal equipment in the patient's vicinity after removing gloves after touching a contaminated area of the patient's body and before touching anywhere else before eating and after using the restroom.7 Healthcare facilities may find the free Joint Commission Hand Hygiene Targeted Solutions Tool (TST) helpful.8 The recommended steps involve setting up a team that observes healthcare workers' hand hygiene practices and documents the observations in the TST. The tool generates charts and gives feedback on staff members' hand hygiene practices. For example, do nurses and other staff members wash their hands or use alcohol-based gel as they enter and leave each patient room? The TST can be found at www.centerfortransforminghealthcare.org/tst_hhy.aspx. Surgical hand rubs and scrubs A review of surgical hand scrubs was conducted during staff re-education. These AORN standards for hand rub include the following: removing jewelry putting on a surgical mask washing soiled hands with soap and water cleaning under fingernails before drying hands and arms applying the hand rub product to hands and arms and allowing it to dry before putting on a sterile gown and gloves. Always follow recommendations provided by the manufacturer of the surgical hand rub product. For those who prefer a surgical scrub, follow the first four steps of AORN standards for hand rub, then follow these steps: Scrub according to product instructions. Rinse hands and arms while holding your hands higher than your elbow. Enter the OR to dry your hands while keeping surgical clothes from getting wet before putting on a gown and gloves.7 Optimizing patient status During this project, staff members recognized that some patients arrive malnourished and some surgeries put patients at risk for protein depletion, especially gastrointestinal or cancer surgeries. This increases the risk of poor healing, infection, and pressure injuries.9 Changes intended to optimize nutrition began with patients scheduled for elective colon and cystectomy-ileal conduit surgeries. These patients are screened at the general surgeons' office preoperatively using the Malnutrition Screening Tool, which identifies malnourished patients and patients at risk for malnourishment based on recent weight loss and appetite.10 Patients are sent home with an immunonutrition drink to help reduce the risk of infection after major elective surgery and instructed to drink it twice a day for 5 days before surgery and the first 5 days postoperatively as soon as diet permits. In this population, nutritional optimization decreased the SSI rate from 5% to 1.5% and readmissions from 20% to 3%. The patients receiving this nutritional supplement have had no readmissions or infections. Because of the success of this program, it has been expanded to include all malnourished patients and patients at risk for malnutrition. Certain general surgeries put patients at increased risk for infection.10 During these surgeries, the general surgeons have begun irrigating the abdominal cavity with a chlorhexidine solution and applying new technology called negative-pressure incision therapy (NPIT). This NPIT protocol shows promise, lowering infection rates to 2% versus 11% when used after colorectal surgery.11 Educating patients and their caregivers about the best ways to prevent infections at home includes having them watch an educational video, "Keep it Clean: Preventing Surgical Site Infections," before leaving the medical center. This video provides instructions appropriate for both inpatient and outpatient surgical patients. Improving for the future Current analysis shows for the first 6 months of 2017, the facility's deep SSI rate is 0.1% and overall SSI rate is 0.3%, a new low. Analyzing data on that 0.1% population, we learned that 40% of those patients have diabetes mellitus. Evidence-based practice shows that maintaining normal blood glucose levels before and during surgery and immediately postoperatively helps the patient heal.12 Would optimal blood glucose control for a longer time frame postoperatively decrease the risk of deep SSI? This future challenge involves teaching patients to ensure they control their blood glucose levels after being discharged from the medical center. This project achieved a dramatic reduction in the deep SSI rate at our facility. The medical center staff is proud of our 0.1% deep SSI rate but continues working toward zero. How can SSIs be prevented?1,2 Efforts to decrease SSIs have been ongoing for years. Current best OR practices for preventing infections include the following: Timely delivery of prophylactic I.V. antibiotics within 1 hour before incision. I.V. vancomycin and fluoroquinolones should be infused over 2 hours. These antibiotics should be infused before tourniquets on the operative limb are inflated. Appropriate antibiotics (per guidelines) will be given. Antibiotics should be discontinued within 24 hours after surgery. Dosing of antibiotics should be weight-based. Redosing antibiotics for long surgical procedures is recommended at intervals of two half-lives. Razors to shave the surgical site have not been recommended for years because of the risk of nicks and of introducing bacteria into the area. Instead, clippers or a depilatory agent is appropriate preoperatively for hair removal if necessary. Maintaining the patient's blood glucose level at less than 180 mg/dL helps prevent infections and complications. Keeping the patient normothermic helps prevent blood loss and decreases the risk of SSIs. Using supplemental oxygen during and immediately following surgical procedures involving general anesthesia and mechanical ventilation helps improve tissue perfusion and healing and decreases the risk of SSIs. Alcohol-based surgical skin prep solutions (2% chlorhexidine gluconate in 70% isopropyl alcohol or povidone-iodine-alcohol), unless contraindicated, are associated with lower rates of infection than alcohol-free surgical skin prep solutions. Using an impervious plastic wound protector for abdominal surgery helps prevent SSIs.

To investigate the impact of postdischarge surveillance (PDS) on surgical-site infection (SSI) rates for selected surgical procedures in acute care hospitals in Scotland. Prospective surveillance of SSI after selected surgical procedures. The Scottish Surveillance of Healthcare Associated Infection Programme (SSHAIP), which is based on the methodology of the Centers for Disease Control and Prevention (CDC) National Nosocomial Infections Surveillance system (NNIS). Thirty-two of 46 acute care hospitals throughout Scotland contributed data to SSHAIP for this study. Data were from 21,710 operations that took place between April 1, 2002, and June 30, 2004; nine categories of surgical procedures were analyzed. CDC NNIS system definitions and methods were used for SSI PDS. PDS is a voluntary component of the mandatory SSI surveillance program in Scotland. PDS was categorized as none, passive, active without direct observation, and active with direct observation. From our study information, PDS data were available for 12,885 operations (59%). A total of 2,793 procedures (13%) were associated with passive PDS and 10,092 (46%) with active PDS. The SSI rate among the 8,825 operations with no PDS was 2.61% (95% confidence interval [CI], 2.3%-3.0%), which was significantly lower than the SSI rate found among the 12,885 operations for which PDS was performed (6.34% [95% CI, 5.9%-6.8%]). For breast surgery, cesarean section, hip replacement, and abdominal hysterectomy, the rate of SSI when PDS was performed was significantly higher than that when PDS was not performed (P<.01 for each procedure). No differences in SSI rates were found for surgery to repair fractured neck of the femur or for knee replacement. SSI rates were examined according to procedure type, performance of PDS, and NNIS risk index; rates of SSI increased with NNIS risk index within procedure group and PDS group. Logistic regression analyses confirmed that procedure type, performance of PDS, and NNIS risk index were all statistically independent predictors of report of an SSI (P<.05). This Scottish national data set incorporates a substantial amount of PDS data. We recommend a procedure-specific approach to PDS, with direct observation of patients after breast surgery, cesarean section, and hysterectomy, for which the length of stay is typically short. Readmission surveillance may be adequate to detect most SSIs after orthopedic surgery or vascular surgery, for which the length of stay is typically longer.

The national nosocomial surveillance network in Hungary: results of two years of surgical site infection surveillance

The CDC estimates 23% of healthcare-associated infections to be surgical site infections, with alarming prevalence of antibiotic-resistant organisms. While there is consensus regarding preoperative prophylaxis, orthopaedic surgeons' use of prophylactic postoperative oral antibiotics is less defined. We investigated surgeons' use of prophylactic postoperative oral antibiotics after elective outpatient foot or ankle procedures, identifying (1) frequency of use, (2) regimen preferences, (3) personal indications, and (4) associated experience and demographics. Using a cross-sectional survey design, a questionnaire was emailed to all active and candidate members of the American Orthopaedic Foot and Ankle Society. Supplementary questions captured demographic information. We invited 1136 members to participate; 22 addresses produced delivery failure messages, leaving 1114 members as potential participants. After nonresponses and exclusions, 312 (28%) responses were analyzed. Statistical analysis used Pearson's chi-square test, Fisher's exact test, and multivariate regression. The majority (75%) of respondents reported use of prophylactic postoperative oral antibiotics. Most users (69%) prescribed to fewer than 25% of patients, although 16% prescribed for all elective cases. The most frequent regimen was cephalexin 500 mg four times a day (63%) and the most common duration was 5 to 7 days (50%). Surgeons' most common indications were previous infection (71%), medical comorbidities (65%), and previous wound-healing difficulties (56%). Those who do and do not prescribe prophylactic postoperative oral antibiotics showed no difference in surgical site infection rate or any demographic category. Surgeons' reported use of prophylactic postoperative oral antibiotics after elective foot or ankle surgery was common, without demographic association. Commonalities were identified in antibiotic regimen and personal indications for this practice. Comparative clinical studies are warranted to elucidate the efficacy of prophylactic postoperative oral antibiotics and establish evidence-based guidelines for their use.

Comparison of the National Surgical Site Infection surveillance data between The Netherlands and Germany: PREZIES versus KISS

BackgroundReported incidence of surgical site infections (SSIs) in the United States commonly ranges from approximately 0.5–20%. An infection preventionist at a critical access hospital (CAH) notified the Nebraska Department of Health Human Services (NDHHS) Healthcare-Associated Infection (HAI) program of a surgeon with a 6-month SSI rate of 29% (N = 7) and requested assistance.MethodsNDHHS HAI program and local health department personnel conducted an investigation. Overall SSI rates were calculated, and seven reported SSI charts were abstracted using the Centers for Disease Control and Prevention’s HAI Outbreak Investigation Form. An additional nine-patient charts with similar characteristics were abstracted and used as the control group. These cases had the same procedures performed at the same facility, by the same surgeon, and during the same period of time but did not develop infections.ResultsIn 2016, of the 452 procedures at this CAH, 17 developed SSIs (rate = 3.8%). SSIs occurred following the most invasive procedures being performed on the sickest patients at this CAH. Of the 17 SSIs, 15 (88.2%) were orthopedic and performed by three surgeons. Surgeon A performed 24 procedures with seven SSIs (rate = 29.2%). Surgeon B performed 171 procedures with five SSIs (rate = 2.9%) and Surgeon C performed 13 procedures with three SSIs (rate = 23.1%). The seven SSIs associated with Surgeon A used different operating room (OR) personnel, rooms, antibiotics, and durations. There were 0 deaths. The seven SSIs and nine controls were evaluated using a stepwise regression model. Using the variables for bone graft, hardware, OR location, and number of people in the OR, the only significant variable was the number of people in the OR. There was an average of 10 people in the OR among cases and seven among controls. Logistic regression yielded an odds ratio of 1.8 (95% CI: 0.99–3.26).ConclusionSSIs occurred primarily after orthopedic procedures, and two of three surgeons were found to have elevated rates. Analysis showed the number of people in the OR was potentially associated with SSIs. After following NDHHS recommendations to limit door openings and OR traffic, there were no additional cases. Additionally, we outlined our methodology in a publically-available response guideline posted to the NDHHS web page.DisclosuresAll authors: No reported disclosures.

Despite many advances in surgical asepsis, surgical site infection (SSI) remains a challenging and costly problem. Decontamination of the skin with an antiseptic agent is standard practice before any trans-cutaneous invasive procedure, but the antiseptic agent of choice to best reduce the risk of SSI remains controversial. Review of relevant literature. Many randomized controlled trials (RCTs) have evaluated chlorhexidine-based and iodine-based preparation solutions, with and without an alcohol component. Most of these trials are underpowered to detect differences in SSI rates. The largest modern RCT showed that a chlorhexidine-isopropyl alcohol preparation reduced the risk of SSI substantially compared with a povidone-iodine preparation without alcohol in clean-contaminated surgery. Many smaller RCTs have shown that chlorhexidine-isopropyl alcohol is superior to povidone-iodine plus isopropyl alcohol or iodine povacrylex plus isopropyl alcohol in pre-operative skin decontamination; whether or not this translates into lower SSI rates is unknown. A mixed treatment comparison of 10 RCTs concluded that alcohol-based preparations have a 98% probability of reducing the risk of SSI more effectively than aqueous-based preparations. Non-randomized observational studies have generally found no difference in SSI rates among various skin antiseptic preparations. Alcohol-based agents are likely superior to aqueous agents. Chlorhexidine may decrease SSI rates compared with povidone-iodine, and chlorhexidine-isopropyl alcohol likely offers better skin decontamination before clean surgery than povidone-iodine plus isopropyl alcohol or iodine povacrylex plus isopropyl alcohol. The quality of the available data is moderate. Rigorous, well-powered RCTs with appropriate treatment comparisons are needed to establish the optimal and most cost-effective pre-operative skin preparation in various operations and wound classifications.

To compare hemilaminectomy surgical site infection (SSI) rates in dogs treated with or without postoperative prophylactic antibiotics. Medical records of 275 client-owned dogs from 1 tertiary referral hospital were retrospectively reviewed for dogs treated with thoracolumbar hemilaminectomy for intervertebral disk herniation between 2018 and 2023. Dogs were grouped according to whether they were treated with prophylactic postoperative antibiotics (group A) or not (group B). Relevant case details including dog signalment, duration of anesthetic procedure, method of incision closure, perioperative and prophylactic postoperative antibiotic prescription, and diagnosis of postoperative SSI (as defined by the CDC) were recorded. Wilson binomial CIs were calculated for SSI rates. Surgical site infection rates between dogs given or not given antibiotics were analyzed with a Fisher exact test. The overall SSI rate was 3% (8 of 275; 95% CI, 1% to 6%). The SSI rate in group A was 3% (5 of 147; 95% CI, 1% to 8%), which was not statistically different from the 2% SSI rate (3 of 128; 95% CI, 1% to 7%) in group B (P = .728). There was not a statistical difference in SSI rates between closure methods (intradermal absorbable, 1% [1 of 79]; cutaneous staples, 4% [7 of 184]; cutaneous nylon, 0% [0 of 12]; P = .611). Overall hemilaminectomy SSI rates in this study were low, and prescription of prophylactic antibiotics was not associated with a decreased SSI rate. Practicing antimicrobial stewardship through avoidance of antimicrobial prophylaxis in clean surgical procedures may not be clinically detrimental to outcomes in hemilaminectomy dogs.

Surgical site infections (SSIs) are common complications following major lower limb amputation (MLLA), particularly among patients with diabetes and peripheral vascular disease. Postoperative dressing choice may influence SSI risk, yet the effect of rigid dressings (RDs) compared to soft dressings (SDs) on SSI risk is unknown. This review aimed to synthesise current literature analysing the effect of RDs versus SDs on SSIs and wound complications following MLLA. This study was conducted according to PRISMA and Cochrane guidelines. Medline, Embase, CINAHL, CENTRAL, and ClinicalTrials.gov were searched from inception to January 2025. Eligible studies included randomised controlled trials (RCTs), observational studies, and case series reporting SSI rates after MLLA managed with RD or SD. Due to the limited number of RCTs and substantial heterogeneity, a planned meta-analysis was not feasible, and a narrative synthesis was conducted. Risk of bias was assessed using RoB 2, ROBINS-I, and JBI tools, and certainty of evidence was evaluated with GRADE. Ten studies (1 RCT, 6 observational, 3 case series) with 956 participants undergoing 1018 MLLAs were included. Reported SSI rates ranged from 0% to 77.8% in RD groups and from 13.5% to 65.9% in SD groups. The RCT demonstrated no significant difference in SSI rates between participants in the RD group (21.4%, 12/56) and the SD group (17.9%, 10/56), p = 0.47. Three observational studies reported lower SSI rates with RDs, while one reported higher rate. Wound dehiscence and revision surgery rates were generally lower in RD groups. Overall risk of bias was high across all studies, and no study reported SSIs as a primary outcome. Certainty of evidence was judged very low for all outcomes. While some studies suggest a potential benefit of rigid dressings in reducing postoperative complications, the current evidence does not support the superiority of rigid or non-rigid dressings for SSI prevention. Findings are limited by substantial heterogeneity, confounding, and inconsistent reporting. High-quality prospective studies with standardised outcome measures are urgently needed to inform clinical practice. PROSPERO CRD42024607144.

Surgical site infection, ultraclean ventilated operating theatres and prosthetic joint surgery: where now?

In otolaryngology at present, evidence-based medicine (EBM) has not yet been considered for antimicrobial prophylaxis. In this study, we examined the surgical site infection (SSI) rate based on the Center for Disease Control and Prevention (CDC) Guidelines and reviewed antimicrobial prophylaxis related to surgery.Subjects were 345 patients with CDC surgical wound classes I to III. Prophylactic antimicrobial agents were intravenously administered preoperatively. Postoperative administration days, wound conditions and general medical conditions of patients were entered in the SSI Surveillance Data Sheet. In principle, we aim to end the administration of prophylactic antimicrobial agents two days after surgery.The overall SSI rate was 5.5% and by wound class, the SSI rate was 5.1% in Class I, 3.6% in Class II and 28.0% in Class III. The SSI rate of patients to whom administration of antimicrobial agents was ended within two days after surgery was 0.4%, while that of the patients to whom antimicrobial agents were administered for three days or more was 12.6%. Regarding types of antimicrobial agent, the rate was 5.6% in the CEZ group and 4.5% in the PIPC group, showing no significant difference. There were some differences in SSI rates depending on the time required for surgery and preoperative general condition of the patient, but there were no differences depending on patients' smoking history or obesity.It would appear that the SSI rate cannot be reduced by intra- and post-operative administration of antimicrobial agents for a longer period; rather, postoperative administration for only two days is sufficient, provided that preoperative risk factors are thoroughly removed and/or the postoperative wounds are completely controlled. Consequently, reducing the unnecessary administration of agents will alleviate the burden on patients, as well as reduce medical costs under Diagnosis Procedure Combination (DPC).

Although preparation of people for surgery has traditionally included removal of hair from the incision site, some studies claim that preoperative hair removal is harmful, causes surgical site infections (SSIs), and should be avoided. To determine if routine pre-operative hair removal (compared with no removal) and the timing or method of hair removal influence rates of SSI.. For this second update we searched the Cochrane Wounds Group Specialised Register (searched 12 August 2011); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 3); Ovid MEDLINE (1950 to August Week 1 2011); Ovid MEDLINE (In-Process & Other Non-Indexed Citations August 11, 2010); Ovid EMBASE (1980 to 2011 Week 31) and EBSCO CINAHL (1982 to 11August 2011). No date or language restrictions were applied. Randomised controlled trials (RCTs) or quasi randomised trials (QRCTs) that compared:1) hair removal with no hair removal; 2) different methods of hair removal; 3) hair removal at different times before surgery; and, 4) hair removal in different settings (e.g. ward, anaesthetic room). Three authors independently assessed relevance and quality of each trial. Data were extracted independently by two authors and cross-checked. We included 14 trials (17 comparisons) in the review; three trials involved multiple comparisons. Six trials, two of which had three comparison arms, (972 participants) compared hair removal (shaving, clipping, or depilatory cream) with no hair removal and found no statistically significant difference in SSI rates however the comparison is underpowered. Three trials (1343 participants) that compared shaving with clipping showed significantly more SSIs associated with shaving (RR 2.09, 95% CI 1.15 to 3.80). Seven trials (1213 participants) found no significant difference in SSI rates when hair removal by shaving was compared with depilatory cream (RR 1.53, 95% CI 0.73 to 3.21), however this comparison is also underpowered. One trial compared two groups that shaved or clipped hair on the day of surgery compared with the day before surgery; there was no statistically significant difference in the number of SSIs between groups however this comparison was also underpowered.We identified no trials that compared clipping with depilatory cream; or investigated application of depilatory cream at different pre-operative time points, or hair removal in different settings (e.g. ward, anaesthetic room). Whilst this review found no statistically significant effect on SSI rates of hair removal insufficient numbers of people have been involved in this research to allow confidence in a conclusion. When it is necessary to remove hair, the existing evidence suggests that clippers are associated with fewer SSIs than razors. There was no significant difference in SSI rates between depilatory creams and shaving, or between shaving or clipping the day before surgery or on the day of surgery however studies were small and more research is needed.