Cases Of Surgical Site Infection Research Articles

Intervention to reduce the incidence of surgical site infection in spine surgery

This study examines the incidence, characteristics, and risk factors of surgical site infections (SSIs) after spine surgery and evaluates the efficacy of a preventive intervention. This was a quasi-experimental pretest/posttest study in patients undergoing spinal surgery in an orthopedic surgery department from December 2014 to November 2016. Based on the results of the study, we revised the preventive protocol with modification of wound dressing, staff training, and feedback. SSI rates were compared between the pre-intervention (December 2014 to November 2015) and post-intervention (December 2015 to November 2016) periods. The risk factors were analyzed using univariate and multivariate analyses. Of the 139 patients included, 14 cases of SSI were diagnosed, with a significant decrease in the incidence of SSIs from the pre-intervention period to the post-intervention period (19.4% vs 2.6%; P = .001). The etiology was known in 13 cases, with enteric flora being predominant in the pre-intervention group. Univariate analysis showed that age, body mass index, days until sitting and ambulation, and incontinence were statistically significant risk factors. After multivariate analysis, only body mass index and days until ambulation remained significant. When the effect of intervention was adjusted with other risk factors, this variable remained statistically significant. An intervention that includes modification of wound dressing and early mobilization, as well as staff awareness training, monitoring, and feedback, allowed a significant reduction in the incidence of SSI following spinal surgery, particularly infections caused by enteric flora.

Incidence study of surgical site infections in a large University Hospital in Rome, first results

Abstract Background Surgical Site Infections (SSI) represent about a quarter of healthcare associated infections (HAI), increase the risk of mortality and hospital stay and extend healthcare costs. The aim of this work is to evaluate the incidence of SSI in patients undergoing surgical procedures of Hospital Units in the Fondazione Policlinico A. Gemelli IRCCS (FPG). Methods This descriptive observational monocentric study has a 30-months duration: the first phase was conducted between July 2018 and March 2019. Patients undergoing abdominal surgery procedures were enrolled. Active infection surveillance was performed, according to the ECDC, during the hospital stay and the surgical outpatient visits. We also performed a post-discharge surveillance (PDS) at 30 days (or 90 days if an implant has been inserted), through a telephone interview, made by a medical doctor resident in Public Health. Results During the first phase were enrolled 431 procedures in 2 Hospital Units, about emergency and hepatobiliary surgery. There were 53 cases of surgical site infection (SSI) highlighted in these procedures. Therefore, SSI’s were reported in 12.09% of the procedures. In particular, in 6.28% of cases, SSIs were diagnosed during the hospital stay. The results of this study showed statistically significant differences (p < 0.005) in incidence rate of emergency (10,70%) and hepatobiliary tract (13,17%) procedures. The average hospital stay was significant higher (p < 0.001) in patients who developed an SSI (17.27 days) than in patients without SSI (4.89 days). Conclusions These preliminary results show that the incidence rate of SSI for gastrointestinal procedures is similar to other European Countries (9.6%). The Hospital Health Management of FPG take care to the surveillance of hospital infections and monitor the correct application of the procedures, in line with the standards defined by Joint Commission International for guarantee high level in patients’ care. Key messages Performing a survey to measure the incidence of surgical site infections for surgery procedures is very important to define it and to improve surveillance systems of hospital infections in FPG. Active surveillance of surgical site infections may allow to enhance appropriate preventive measures.

PREVALENCE OF SURGICAL SITE INFECTION ASSOCIATED RISK FACTORS IN A TERTIARY CARE HOSPITAL OF VEDANTA INSTITUTE OF MEDICAL SCIENCES

Introduction: Skin is generally colonised by a wide range of microorganisms that could cause infection. Surgical site infection (SSI) requires evidence of clinical signs and symptoms of infection rather than microbiological evidence alone. SSIs generally affect the superficial tissues, but some more serious infections affect the deeper tissues or other parts of the body manipulated during the surgical procedure.About 5% of patients posted for surgery develop surgical site infections (SSIs), which may cause much morbidity and may sometimes mortality. Treatment of SSIs imposes a substantial financial burden on the health care system. Patients who develop SSI are more likely to spend 60% more time in an Intensive care unit (ICU), they are 5 times as likely to be readmitted and their mortality rate is twice of non-infected patient. But to great surprise 40-60% of these infections are preventable.
 Material and Methods: A total of 500 patients who had undergone surgical procedure at the teaching hospitalwere studied prospectively. A total of 464(92.8%) elective surgical patients and 36(7.2%) emergency surgical patients were included in the study.Patient information gathered from the data chart, treatment chart and from ward rounds in the hospital. All patients were followed up from the time of admission until the time of discharge and 30 days postoperatively to inspect the incidence of SSI. Wound infection was diagnosed. SSI diagnosed was divided into three categories: Superficial incision SSI, Deep incision SSI and Organ/space SSI. SSI is considered if an infection occurred within 30 days after the operation, if no implant is left in place SSI was considered.
 Results: In the present study 500 patients were included of which 464(92.8%) were elective surgical patients and 36(7.2%) were emergency surgical patients. Total SSI cases were 41 (8.2%) of which 29 (70.7%) were identified in elective surgery cases and 12 (29.3%) were observed in emergency surgery superficial incision SSI was most prevalent 25 (61%) followed by deep incisional SSI 11(26.8%) and then by organ/space SSI 5(12.2%).Mean age in elective surgery group was 52.4±7.48 and in emergency surgery group was 56.2± 6.78. In elective surgery group there were 296 (63.8%) male and 168 (36.2%) female. In emergency group there were 29 (80.6%) male and 7 (19.4%) female. Prophylactic antibiotics were given to 404 (87.1%) in elective surgery group and 30 (83.3%) in emergency surgery group. SSI rate observed in elective surgery group was 29/464 (6.25%) while in emergency surgery group was 12/36 (33.33%).BMI (Body mass index) in elective surgery group was 28.7 ±2.45and in emergency surgery group was 27.6 ± 2.89.
 Conclusion: higher incidence of SSI with increasing age of the patient.it was observed that to prevent SSI prophylactic antibiotics should be initiated within one hour before surgical incision.
 Keywords: SSI, Surgery, Superficial incision SSI, Deep incision SSI, Organ/space SSI

A study of surgical site infections in a tertiary care hospital

Background: Health care-associated infections remain as an important public health concern. Surgical site infections (SSIs) are known to be one of the most common causes of nosocomial infections worldwide.Methods: A prospective observational study was conducted across 12 months (May 2018-April 2019) in a tertiary care hospital. The present study includes 223 patients who were undergoing clean and clean contaminated surgery in the hospital. Contaminated and dirty surgeries were excluded. The demographic data of the patient, diagnostic criteria used, associated risk factors, use of prophylactic antimicrobial agents, the type and duration of surgery, clinical evaluation of wound and laboratory data was collected. All the pus samples or wound swabs of clinically suspects of SSI cases received in the Department of Microbiology were inoculated and interpreted according to Centre for Disease Control and Infection guidelines.Results: The study included 223 patients who underwent surgery in the hospital. Amongst them 9 (4%) developed SSI. The incidence of SSI was 4.03%. There was a direct relationship observed between the occurrence of SSI and certain co-morbid conditions such as diabetes. It was also observed that prolonged surgeries above two hours and females were more predisposed to develop a surgical site infection.Conclusions: SSIs being one of the most common causes of nosocomial infections. It was also the most important factor responsible for significant morbidity, mortality, unwanted prolonged hospitalization and additional cost of treatment in surgical patients which can be reduced by strictly following the guidelines of infection control along with judicious and rational use of antibiotics.

The impact of surgical site infections on hospital contribution margin-a European prospective observational cohort study.

Surgical site infections (SSIs) are common surgical complications that lead to increased costs. Depending on payer type, however, they do not necessarily translate into deficits for every hospital. We investigated how surgical site infections (SSIs) influence the contribution margin in 2 reimbursement systems based on diagnosis-related groups (DRGs). This preplanned observational health cost analysis was nested within a Swiss multicenter randomized controlled trial on the timing of preoperative antibiotic prophylaxis in general surgery between February 2013 and August 2015. A simulation of cost and income in the National Health Service (NHS) England reimbursement system was conducted. Of 5,175 patients initially enrolled, 4,556 had complete cost and income data as well as SSI status available for analysis. SSI occurred in 228 of 4,556 of patients (5%). Patients with SSIs were older, more often male, had higher BMIs, compulsory insurance, longer operations, and more frequent ICU admissions. SSIs led to higher hospital cost and income. The median contribution margin was negative in cases of SSI. In SSI cases, median contribution margin was Swiss francs (CHF) -2045 (IQR, -12,800 to 4,848) versus CHF 895 (IQR, -2,190 to 4,158) in non-SSI cases. Higher ASA class and private insurance were associated with higher contribution margins in SSI cases, and ICU admission led to greater deficits. Private insurance had a strong increasing effect on contribution margin at the 10th, 50th (median), and 90th percentiles of its distribution, leading to overall positive contribution margins for SSIs in Switzerland. The NHS England simulation with 3,893 patients revealed similar but less pronounced effects of SSI on contribution margin. Depending on payer type, reimbursement systems with DRGs offer only minor financial incentives to the prevention of SSI.

2529 Increased Surgical Site Infections in Robotic Hysterectomies in a Large Health System

Study Objective To describe cases of surgical site infection (SSI) after hysterectomy in a large health system and investigate adherence to infection prevention guidelines Design Retrospective observational study Setting 6 hospitals in New York, both community and academic centers Patients or Participants Patients with surgical site infections as defined by CDC after hysterectomy in 2016 and 2017 Interventions n/a Measurements and Main Results Available data from 6 hospitals across a large health system in New York were analyzed. A total of 4589 inpatient open, robotic, and laparoscopic hysterectomies were performed in 2016 and 2017 of which 48 cases of surgical site infection were identified and reviewed. Overall SSI incidence was found to be 1.05%. Mean age of SSI cases was 53.5, and mean BMI 33.7. Among the SSI cases, 20 (41.7%) originated from a robotic approach, 1 (2.1%) straight laparoscopic, and 27 (56.2%) were open. This gave an SSI incidence of 1.98% for robotic, 0.13% for straight laparoscopic, and 0.97% for open approach. 41 (85.4%) SSI cases had total hysterectomies vs 7 (14.6%) supracervical. 34 (70.8%) of cases had a history of prior abdominal surgery. The most common infection type was intraabdominal at 19 cases (39.6%). Incisional infections accounted for 11 cases (22.9%), and vaginal cuff infection accounted for 4 (8.3%). The most common pathogens encountered were bacteroides fragilis (16.2%) and staphylococcus aureus (16.2%). Of 10 cases that used second-line antibiotics, 70% did not adhere to system protocol for dosing or antibiotic choice. Conclusion A review of cases reveals robotic hysterectomies as having the largest rate of SSI in the 6 hospitals examined at 1.98% as compared to laparoscopic hysterectomies with an SSI rate of 0.13% over 2 years. Further research is needed to validate these findings over time and geographic location, and examine reasons why robotic surgery may confirm a higher infection rate than laparoscopic in these locations.

Outcomes of an Intraoperative Povidone-Iodine Irrigation Protocol in Spinal Surgery for Surgical Site Infection Prevention.

This was a retrospective observational study. The aim of this study was to evaluate the efficacy of our new protocol for preventing postoperative surgical site infection (SSI) following spinal surgery. SSI following spinal surgery is a serious postoperative complication. Several studies have recently assessed the effectiveness of wound irrigation with povidone-iodine (PVP-I) for SSI prevention, but no consensus has been reached as to how PVP-I should be used in clinical practice. We formed a PVP-I irrigation protocol focusing on the pharmacological properties of PVP-I. This study aimed to evaluate the efficacy and safety of our protocol for preventing SSI. All cases of spinal surgery at our hospital between October 2011 and September 2016 were retrospectively reviewed. The exclusion criteria were PVP-I allergy, prior surgical debridement for infection, and implant removal surgery. The patients were subdivided into those who had received normal saline irrigation after 90 seconds of 1% PVP-I pooling every 1.5 hours (study group) or only routine saline irrigation every 1.5 hours (control group). The study and control groups comprised of 177 and 146 patients, respectively. This study compared the rate of SSI with and without the use of the PVP-I irrigation protocol. The SSI rates were 1.7% for the study group (3/177 patients) and 3.4% for the control group (5/146 patients), showing no significant statistical difference (P=0.32). There were no cases of deep SSI in the study group, whereas there were 4 cases in the control group. The deep SSI rate significantly decreased in the study group (P=0.027). No adverse events occurred in the study group. In this study, 90 seconds of 1% PVP-I pooling every 1.5 hours followed by saline irrigation demonstrated the effectiveness of our protocol for the prevention of postoperative deep SSI after spinal surgery.

Natural Language Processing for the Identification of Surgical Site Infections in Orthopaedics.

The identification of surgical site infections for infection surveillance in hospitals depends on the manual abstraction of medical records and, for research purposes, depends mainly on the use of administrative or claims data. The objective of this study was to determine whether automating the abstraction process with natural language processing (NLP)-based models that analyze the free-text notes of the medical record can identify surgical site infections with predictive abilities that match the manual abstraction process and that surpass surgical site infection identification from administrative data. We used surgical site infection surveillance data compiled by the infection prevention team to identify surgical site infections among patients undergoing orthopaedic surgical procedures at a tertiary care academic medical center from 2011 to 2017. We compiled a list of keywords suggestive of surgical site infections, and we used NLP to identify occurrences of these keywords and their grammatical variants in the free-text notes of the medical record. The key outcome was a binary indicator of whether a surgical site infection occurred. We estimated 7 incremental multivariable logistic regression models using a combination of administrative and NLP-derived variables. We split the analytic cohort into training (80%) and testing data sets (20%), and we used a tenfold cross-validation approach. The main analytic cohort included 172 surgical site infection cases and 200 controls that were repeatedly and randomly selected from a pool of 1,407 controls. For Model 1 (variables from administrative data only), the sensitivity was 68% and the positive predictive value was 70%; for Model 4 (with NLP 5-grams [distinct sequences of 5 contiguous words] from the medical record), the sensitivity was 97% and the positive predictive value was 97%; and for Model 7 (a combination of Models 1 and 4), the sensitivity was 97% and the positive predictive value was 97%. Thus, NLP-based models identified 97% of surgical site infections identified by manual abstraction with high precision and 43% more surgical site infections compared with models that used administrative data only. Models that used NLP keywords achieved predictive abilities that were comparable with the manual abstraction process and were superior to models that used administrative data only. NLP has the potential to automate and aid accurate surgical site infection identification and, thus, play an important role in their prevention. This study examines NLP's potential to automate the identification of surgical site infections. This automation can potentially aid the prevention and early identification of these surgical complications, thereby reducing their adverse clinical and economic impact.

Caracterização das infecções de sítio cirúrgico em um hospital público de ensino na cidade de Cascavel, Paraná

Introduction: Surgical Site Infection (SSI) is one of the major Health Care-Related Infections (HAI) and a persistent problem in the hospital setting. Objective: To characterize SSI in a public teaching hospital located in the city of Cascavel-PR. Method: cross-sectional retrospective study of documentary source and quantitative approach. The SSIs notified from May 2017 to May 2018 were analyzed. The variables of interest were tabulated and submitted to descriptive statistical analysis. Results: there were 5,169 surgical procedures in the period, with 196 (100%) cases of SSI. Of these, there was a predominance in young adults aged between 21 and 40 years (39.3%). The specialty of Gynecology / Obstetrics (30.1%) and General Surgery (29.1%) presented the highest rates of SSI, most frequently in Potentially Contaminated surgeries (53.1%); with superficial incisional SSI (59.7%); and with clinical confirmation criteria (79.1%). Regarding the microorganisms isolated in the cultures, Pseudomonas aeruginosa (16.7%) and Enterococcus spp (16.7%) stood out. Conclusions: It is noted that there is a need to review SSI prevention measures, especially due to the proportion of clean surgeries that developed the adverse event. However, considering the values reported in the literature, the overall rate of SSI was discrete.

Extended Drain Dwell Duration Following Muscle Flap Closure for Complex Spine Surgery Does Not Increase the Risk of Surgical Site Infections

PURPOSE: Surgical drains are routinely used to prevent the accumulation of fluid at the operative site, an effect known to decrease the risk of seroma and theoretically lower the chance of abscess or small hematoma formation. Despite these potential benefits, significant debate exists in the literature regarding the risk that such drains might be imparting on the development of surgical site infections (SSIs), and the use of prophylactic antibiotics to “cover the drain” remains a common practice despite scant evidence that closed suction drains increase the risk for SSI. The purpose of the present study is to examine our database of over 12 years of muscle flap closure following complex spinal surgery to determine the effect of drain dwell duration on postoperative wound complications including SSI. METHODS: For this retrospective review, 301 consecutive index cases of complex spine surgery with immediate muscle flap closure (paraspinous, trapezius, latissimus dorsi, and/or thoracolumbar fascia) by the senior author from 2006 to 2018 were identified. The electronic medical record was reviewed for patient characteristics, perioperative details, and outcomes. Examination of the effect of median drain dwell duration on the primary endpoint, SSI, was first conducted via the Mann-Whitney test followed by univariable logistic regression analysis for both the primary endpoint and secondary endpoints including wound complication requiring reoperation and the need for hardware removal due to infection. RESULTS: The cohort was 50.8% male and with an average age of 59.0 ± 18.0 years and body mass index of 27.8 ± 6.7 kg/m2. In 85% of cases, ≥1 drain was in intimate contact with the hardware and/or bone graft, and patients received no >24 hours of postoperative intravenous cefazolin (or other appropriate perioperative coverage in case of documented allergy) unless further antibiotics were indicated. There were 15 cases of SSI, overall, making for an incidence of 4.9%. Drain durations were clearly documented in 271 cases. Median drain dwell duration among these cases was 19 days (interquartile range [IQR], 14–27 days), overall, 19 days (IQR, 14–27 days) among cases which did not develop SSI, and 22 days (IQR, 15–30 days) among cases which did develop SSI (P = 0.231). Univariable logistic regression analysis also demonstrated no increased risk with longer drain dwell times for the development of SSI (odds ratio [OR], 1.03; 95% confidence interval [CI], 0.98–1.08; P = 0.282), wound complication requiring reoperation (OR, 1.02; 95% CI, 0.96–1.09; P = 0.559), or subsequent removal of hardware due to infection (OR, 1.03; 95% CI, 0.95–1.11; P = 0.528). CONCLUSIONS: In this large retrospective series of 301 cases spanning over 12 years, we demonstrate that increased drain dwell duration is not associated with SSI, wound complication requiring reoperation, or need for hardware removal due to infection. These findings, particularly in light of the high-risk nature of the cohort in which 85% of patients had drains placed adjacent to hardware and/or bone graft, contribute to the evidence that increased drain dwell times do not place patients at greater risk of SSI and that such patients do not need prophylactic antibiotics for drain coverage.

When should we measure surgical site infection in patients undergoing a craniotomy? A consideration of the current practice

Introduction: Surgical site infection (SSI) is a common postoperative complication that causes significant morbidity, particularly in patients undergoing cranial neurosurgery. The treatment of SSI can attract a significant cost by way of increasing length of stay, readmission and reoperation in some cases. Cranial neurosurgical cases without implant surgery are recommended by the centre for disease control to be surveyed for SSI for a 30-day period. The number and proportion of SSI cases that present outside of this 30-day period is unknown.Method: All cranial, neurosurgical procedures at Salford Royal Foundation NHS Trust (SRFT) between October 2011 and April 2015 (n = 3513) were identified and followed up prospectively. The number of SSIs detected, the length of time following operation, microbiological organisms cultured and the need for further neurosurgical procedure was recorded. Mean length of time from operation to detection of SSI was calculated and a hazard function analysis was undertaken.Results: Of the 3531 cases (m = 1903, f = 1628) that underwent cranial neurosurgery included in this series 86 cases of SSI were noted. The mean number of days at which SSI was first clinically diagnosed in this series was 53 days. The time period in which 75% of cases were identified to be SSI was 49 days from the date of the surgical procedure, with 32 cases (37%) presenting outside of the 30-day period of surveillance. Over half of cases required some degree of operative intervention to treat SSI.Conclusion: A longer period of surveillance in cranial neurosurgical procedures is likely to detect a truer rate of SSI in addition to the identification of a notable number of cases that require surgical intervention. We recommend a period of at at least 50 days.

Does state-mandated reporting work? The case of surgical site infection in CABG patients

ABSTRACTThis paper is the first empirical study to explore the relationship between the state-mandated reporting of surgical site infections (SSIs) and changes in infection rates, length of stay and costs among coronary artery bypass grafting (CABG) patients. This paper uses generalized difference-in-difference (DID) methods to analyze patient discharge data from the Nationwide Inpatient Sample (NIS) from January 2004 to December 2011 merged with state-level data on mandatory reporting status. After controlling patient and hospital characteristics, and state and year fixed effects, we do not find empirical evidence that state-mandated reporting leads to lower odds of SSIs in CABG procedure. Although it is associated with shorter length of stay and lower costs, the effect is not significant. These results suggest that merely requiring hospitals to report outcomes may not lead to significant changes at least in the case of SSIs among CABG patients.

Incisional surgical site infection following cesarean section: A national retrospective cohort study

ObjectiveTo determine the rate and associated risk factors for incisional surgical site infection following cesarean section in Ireland. Study DesignThis study was a retrospective population-based cohort study, conducted using the Hospital In-Patient Enquiry database (HIPE) for the period 2005–2016. All women who underwent cesarean section between 2005 and 2016 in Ireland were included. Potential risk factors for incisional surgical site infection were selected based on the existing literature and their availability within the HIPE database. The risk of incisional surgical site infection following cesarean section with exact Poisson 95% confidence intervals were reported. Multivariable Poisson regression included all potential risk factors simultaneously. Risk ratios are reported with their 95% confidence intervals and P-values. ResultsThere were 802,182 deliveries during the study period, 219,859 of which (27.4%) were by cesarean section. There were 1396 cases of incisional surgical site infection, a risk of 0.63% (95% confidence interval: 0.60–0.67%). Public patients had approximately 20% higher risk and the risk was almost 40% higher among women aged over 35 years compared with those aged under 25 years. Most notable, related to the morbidities assessed, was the twofold increased risk of incisional surgical site infection associated with pre-existing diabetes and with urinary tract infection in pregnancy. Premature rupture of membranes, pyrexia during labour and postpartum haemorrhage each increased risk by 40–60%. Hematoma of a cesarean section wound remained by far the strongest risk factor for incisional surgical site infection. ConclusionOf all the risk factors we studied, hematoma had the strongest association with development of incisional surgical site infection. Of all women birthing by cesarean section in Ireland during 2005–2016, 25% had at least one of the risk factors identified by our study. Approximately 40% of the incisional surgical site infection cases came from this 25%. This might suggest that a universal approach to reducing risk of surgical site infection is warranted.

Surgical site infection after hip replacement due to a novel Peptoniphilus species, provisionally named ‘Peptoniphilus nemausus’ sp. nov.

We report a case of surgical site infection after total hip prosthesis replacement due to an ofloxacin-resistant Peptoniphilus isolate belonging to an unknown species for which the name ‘Peptoniphilus nemausus’ sp. nov. is proposed. Follow-up was favourable under clindamycin and rifampin for 3 months in this patient whom had a Proteus mirabilis infection treated by fluoroquinolone.

Getting It Right First Time: the national survey of surgical site infection rates in NHS trusts in England.

Surgical site infections are associated with increased morbidity and mortality in patients. The Getting It Right First Time surgical site infection programme set up a national survey to review surgical site infection rates in surgical units in England. The objectives were for frontline clinicians to assess the rates of infection following selected procedures, to examine the risk of significant complications and to review current practice in the prevention of surgical site infection. A national survey was launched in April 2017 to assess surgical site infections within 13 specialties: breast surgery, cardiothoracic surgery, cranial neurosurgery, ear, nose and throat surgery, general surgery, obstetrics and gynaecology, ophthalmology, oral and maxillofacial surgery, orthopaedic surgery, paediatric surgery, spinal surgery, urology and vascular surgery. All participating trusts prospectively identified and collected supporting information on surgical site infections diagnosed within the six-month study period. Data were received from 95 NHS trusts. A total of 1807 surgical site infection cases were reported. There were variations in rates reported by trusts across specialties and procedures. Reoperations were reported in 36.2% of all identified cases, and surgical site infections are associated with a delayed discharge rate of 34.1% in our survey. The Getting It Right First Time surgical site infection programme has introduced a different approach to infection surveillance in England. Results of the survey has demonstrated variation in surgical site infection rates among surgical units, raised the importance in addressing these issues for better patient outcomes and to reduce the financial burden on the NHS. Much work remains to be done to improve surgical site infection surveillance across surgical units and trusts in England.

Definition and Incidence of Severe Surgical Site Infections After Cesarean Delivery [24B

INTRODUCTION: Surgical site infections (SSI) are common complications following cesarean delivery. As part of a performance improvement project, we recognized the need to differentiate infections based on severity and thus sought to characterize the most severe cases of SSI. METHODS: We performed a retrospective review of women ≥18 years or older who delivered by cesarean in 2016 and 2017 at a Women's Hospital. Using a combination of ICD-10 diagnosis codes, the electronic medical record, and infection control surveillance, we identified cases and confirmed all diagnoses by chart review using CDC definitions for SSI. We defined severe SSI as cases requiring additional treatment (change in antibiotics or additional procedure), readmission, CT imaging, ICU admission, or length of stay ≥7 days. We compared maternal demographics and clinical characteristics between severe and non-severe cases using the Student t-test and Fischer exact test as appropriate. RESULTS: Among 3,507 cesarean deliveries, 141 met criteria for SSI. Of these, there were 53 cases of severe SSI. Women with severe SSI were older (31.9 vs. 30.2 years, p=0.01), had lower gestational ages at delivery (35.8 vs. 37.6 weeks, p<0.01), were more likely to have diabetes (26.4% vs. 10.2%, p=0.02) and less likely to have endometritis only (50.9% vs. 81.8%, p<0.01). There was no difference between groups in BMI, prior cesarean, hypertension, GBS status, length of labor or rupture of membranes, or emergent/urgent deliveries. CONCLUSION: In our cohort, severe SSI was associated with older age, diabetes, and earlier deliveries. Further research is needed to identify modifiable risk factors and guide prevention strategies.

Improving Detection of Surgical Site Infections After Cesarean Delivery: What Are Diagnosis Codes Missing? [28Q

INTRODUCTION: Surveillance for surgical site infections (SSI) following cesarean can be challenging. We sought to identify cases of SSI over two years and describe our methods of case ascertainment. METHODS: We queried our hospital's data warehouse for cesareans deliveries from 2016-2017 among women >18 years of age. Three methods for case finding were used: i) ICD-10 diagnoses codes, ii) reporting complications in postoperative notes, and iii) infection control surveillance activities. For ICD-10 codes, we sought endometritis following delivery and infection of obstetrical surgical wound, infection following procedure, cellulitis, and/or peritoneal abscess. We included endometritis as an organ/space SSI by CDC definitions. Chart review was performed for all cases identified by any of the 3 methods to confirm SSI diagnosis as per CDC criteria. RESULTS: Among 3,507 cesareans, ICD-10 codes identified 76 confirmed cases of endometritis and 31 SSI. The positive predictive value for endometritis was 88.0% (95% CI 80.2-93.1) and for SSI codes, 53.5% (95% CI 43.0-63.6). Adding puerperal sepsis produced one additional SSI case, and searching the postoperative note yielded another 26 cases of endometritis and one wound infection. Six SSI were identified by infection control not identified by other methods. In total, we identified 141 SSI, including 98 endometritis-only cases. The incidence of all SSI, endometritis, and SSI excluding endometritis was 4.02%, 2.79%, and 1.23%. CONCLUSION: Improved ascertainment methods are needed to inform and assess performance improvement efforts for cesarean SSI. Reliance on diagnosis codes may miss a significant number of cases and is poorly predictive of SSI other than endometritis.

Development of a Risk Assessment Tool for Surgical Site Infections (SSI) in an OBGYN Patient Population [18I

INTRODUCTION: Surgical site infections (SSI), are defined as superficial, deep, or organ space infections that occur within 30 days of surgery. SSIs are known to greatly increase health care costs and hospital length of stay. In additional to using standard sterile surgical technique and antibiotic prophylaxis, additional strategies been proposed to reduce risk of SSI which include the use of negative pressure wound therapy devices. METHODS: We identified all post-cesarean delivery and post-hysterectomy SSI cases as per infection control criteria at the University of Florida between January 1 and December 31, 2017. We developed a SSI risk assessment tool based on based on review of these cases using a defect analysis tool, literature review of SSI risk factors and surgical risk calculators. RESULTS: There were 21 OBGYN surgical site infections in 2017. Of these infections, 14 occurred after cesarean delivery and 7 after hysterectomy for a rate of 1.56 and 2.46 respectively. The mean BMI was 41.3 and 39.27 for cesarean delivery and hysterectomy, respectively. Only, 33% of cases were scheduled surgery with the remaining classified as non-scheduled urgent or emergent cases. CONCLUSION: An EPIC “smartphrase” was created in our electronic medical record system to help identify patients at increased risk for SSI. Use of this smartphrase should prompt surgeons to consider additional wound infection prophylaxis such as the use of a negative pressure would therapy device. Future direction would include whether or not the use of such a smartphrase increases the use of additional wound infection protective strategies and reduced SSI risk.

Antimicrobial susceptibility pattern of organisms causing surgical site infection in a tertiary care hospital, Valsad, South Gujarat

Introduction: A surgical site infections (SSI) are a 3rd most common nosocomial infection and is responsible for morbidity, mortality and increased healthcare costs. Aims and Objectives: The main aim of this study is to identify the isolates causing surgical site infections and its anti-microbial susceptibility pattern. Materials and Methods: A total 50 cases of surgical site infections were taken for the study. The suspected samples were processed by using standard microbiological methods. The modified Kirby-Bauer’s disc diffusion method was used for antibiotic susceptibility pattern. The isolates of Enterobacteriaceae family were initially screened for ESBL production and were further confirmed by Double Disk Synergy Test as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Reference strains of E. coli (ATCC 25922), P. aeruginosa (ATCC-27853), S. aureus (ATCC 25923) and Klebsiella 700603 were used as controls. Result: Out of 50 samples, 19(38%) were culture positive and total 23 organisms were isolated. Pseudomonas aeruginosa 9 (39.13%) was the most common organism isolated, followed by Klebsiella spp. 5 (21.73%), Staphylococcus aureus 3 (13.04%). Most of the Gram-negative isolates were sensitive to imipenem and meropenem followed by piperacillin-tazobactam. Gram-positive organisms were found to be more sensitive to levofloxacin, linezolid and vancomycin. ESBL production was seen among 44.44% isolates of Enterobacteriaceae family. Conclusion: The rate of infection reflects on patient's care and standard of treatment in any hospital. Thus, better stewardship of SSI is required with accurate antibiotic policies. Periodic monitoring of etiology and antimicrobial susceptibility in the community and hospital settings is recommended. Keywords: Surgical site infection, Bacteriological profile, Antibiotic susceptibility test, ESBL (Extended Spectrum Beta-Lactamase).

SURGICAL SITE INFECTION;

Objectives: Efficacy of postoperative Povidone-Iodine pro­phylaxis and surgical site infection in appendectomy surgery. Study Design: Randomized clinical trial. Place and Duration: Department of Surgery, Liaquat University Hospital Jamshoro/Hyderabad from March 2016 to November 2017. Subjects and Methods: Diagnosed cases of acute appendicitis with classical clinical presentation were included in the study protocol. 60 patients were those, who were applied 1% povidone-iodine solution (cases) to wound post operatively versus 60 patients (control) were those in whom wound not irrigated with Povidone- Iodine. Ethical approval and consent were taken. Data was noted in a proforma and analyzed on SPSS 22.0 (P≤0.05). Results: Age (mean ± SD) in control and cases was observed as 25.5 ± 8.5 and 24.5 ± 9.5 years respectively (P=0.76). Male and female were noted as 43 (%) and 17 (%) &amp; 45 (%) and 15 (%) in control and cases respectively (P &gt;0.05). Wound healing score by Southampton classification of wound healing shows lesser frequency of surgical site infection in cases compared to controls (P &lt;0.05). Grade 4 pus discharging wound infection was noted in 2 (3.33%) control versus 3 (5.0%) in cases (P=0.021). Conclusion: It is concluded that the 1% Povidone- Iodine solution is effective in preventing the post appendectomy surgical site infection.