Clean Surgery Research Articles

DESIGN OF FLOOR CLEANING MACHINE EQUIPPED WITH SENSORS AND VARIOUS CLEANING OPERATIONS

DESIGN OF FLOOR CLEANING MACHINE EQUIPPED WITH SENSORS AND VARIOUS CLEANING OPERATIONS

Prospective analysis of risk factors for perioperative infections in clean and clean-contaminated surgeries in dogs and cats with special reference to perioperative and postoperative antibiotic use

With every surgical procedure there is a risk of postoperative infection (surgical site infection = SSI). This risk of infection can be influenced by various factors, including perioperative antibiotic prophylaxis. In terms of antibiotic stewardship, antibiotics should only be used if there is a proven benefit for the patient. However, this advantage has not yet been conclusively proven, especially for clean and clean-contaminated surgeries. The aim of our study was to document various relevant influencing factors on the infection rate after clean and clean-contaminated surgeries in dogs and cats. In particular, it was documented to what extent a reduced use of antibiotics affects the infection rate in the context of all influencing factors. Over a period of eleven months, 807 clean and clean-contaminated surgeries in dogs and cats were prospectively analyzed with possible influencing factors (gender, ASA classification, underlying endocrinological diseases, duration of anesthesia, duration of surgery, type of surgery, perioperative antibiotic prophylaxis (POA), duration of hospitalization) affecting the infection rate. After surgery all cases were followed up either 30 or 90 days, if implants were used. The effect of the various factors was evaluated using multivariable logistic regression analysis. SSI was detected in 25/664 clean and 10/143 clean-contaminated surgeries. Longer hospitalization, without antimicrobial prophylaxis, and male animals had a significantly higher risk of SSI. In clean surgeries, SSI occurred in 2,3 % of all cases with POA and 5,3 % without POA. The SSI in clean-contaminated was 3,6 % with POA and 9 % without. This difference resulted mainly from the results of osteosynthesis, gastrointestinal and skin surgeries. However, other types of surgeries, such as castrations, neurological interventions, abdominal and thoracic surgeries, and surgeries in the head and neck region, showed comparable infection rates with and without POA.

Unclear fertility-related losses in cattle - a pilot study to evaluate the occurrence of bovine endometrosis

With every surgical procedure there is a risk of postoperative infection (surgical site infection = SSI). This risk of infection can be influenced by various factors, including perioperative antibiotic prophylaxis. In terms of antibiotic stewardship, antibiotics should only be used if there is a proven benefit for the patient. However, this advantage has not yet been conclusively proven, especially for clean and clean-contaminated surgeries. The aim of our study was to document various relevant influencing factors on the infection rate after clean and clean-contaminated surgeries in dogs and cats. In particular, it was documented to what extent a reduced use of antibiotics affects the infection rate in the context of all influencing factors. Over a period of eleven months, 807 clean and clean-contaminated surgeries in dogs and cats were prospectively analyzed with possible influencing factors (gender, ASA classification, underlying endocrinological diseases, duration of anesthesia, duration of surgery, type of surgery, perioperative antibiotic prophylaxis (POA), duration of hospitalization) affecting the infection rate. After surgery all cases were followed up either 30 or 90 days, if implants were used. The effect of the various factors was evaluated using multivariable logistic regression analysis. SSI was detected in 25/664 clean and 10/143 clean-contaminated surgeries. Longer hospitalization, without antimicrobial prophylaxis, and male animals had a significantly higher risk of SSI. In clean surgeries, SSI occurred in 2,3 % of all cases with POA and 5,3 % without POA. The SSI in clean-contaminated was 3,6 % with POA and 9 % without. This difference resulted mainly from the results of osteosynthesis, gastrointestinal and skin surgeries. However, other types of surgeries, such as castrations, neurological interventions, abdominal and thoracic surgeries, and surgeries in the head and neck region, showed comparable infection rates with and without POA.

Detection of Cutibacterium acnes in Tissue Samples from Clean Primary Shoulder Surgeries - Part II.

Objective Research and identification of Cutibacterium acnes ( C. acnes ) and other microorganisms in deep tissue samples collected in clean shoulder surgeries of patients who did not undergo any previous invasive joint procedure and who had no clinical history of infection. Methods We analyzed the results of cultures of intraoperative deep tissue samples from 84 patients submitted to primary clean shoulder surgery. Tubes containing culture medium were used for storage and transport of anaerobic agents, prolonged incubation time, and mass spectrometer for diagnosis of bacterial agents. Results Bacteria growth was evidenced in 34 patients (40.4%) of the 84 included in the study. Of these, 23 had growth of C. acnes in at least one sample of deep tissue collected, corresponding to 27.3% of the total patients. The second most common agent was Staphylococcus epidermidis , present in 7.2% of the total individuals included. We showed a higher relationship between sample positivity and males, a lower mean age, absence of diabetes mellitus, ASA I score, and antibiotic prophylaxis in anesthetic induction with cefuroxime. Conclusions A high percentage of isolates of different bacteria was found in shoulder tissue samples of patients undergoing clean and primary surgeries, who had no history of previous infection. Identification of C. acnes was high (27.6%), and Staphylococcus epidermidis was the second most frequent agent (7.2%).

Prospective analysis of risk factors for perioperative infections in clean and clean-contaminated surgeries in dogs and cats with special reference to perioperative and postoperative antibiotic use

Prospective analysis of risk factors for perioperative infections in clean and clean-contaminated surgeries in dogs and cats with special reference to perioperative and postoperative antibiotic use

Developing a new methodology for wastewater pipes cleaning prioritization using integrating Induced Ordered Weighted Averaging and fuzzy logic methods

ABSTRACT This paper proposes a method for prioritizing sewer cleaning operations in the absence of historical data on failures. The method utilizes the Induced Ordered Weighted Averaging (IOWA) multi-criteria decision-making technique, incorporating experts' opinions to regulate subjective inferences and ascertain uncertainty. The study considers ten parameters categorized into three main focuses: structural, environmental, and operational to analyze sewer pipe conditions. As a case study, four small zones in Tehran city were prioritized using the proposed methodology. The findings reveal that (1) decision-makers' subjective priorities and evaluations do not significantly influence critical cleaning options, (2) pipe diameter is the most effective parameter for prioritizing since it allows pipes to be meaningfully categorized and compared, and (3) slope, age, depth, upstream manhole condition, and the number of connections and laterals are more important than other parameters. Overall, this study provides valuable insights into developing effective prioritization strategies for sewer cleaning operations.

Informing Building Strategies to Reduce Infectious Aerosol Transmission Risk by Integrating DNA Aerosol Tracers with Quantitative Microbial Risk Assessment.

Using aerosol-based tracers to estimate risk of infectious aerosol transmission aids in the design of buildings with adequate protection against aerosol transmissible pathogens, such as SARS-CoV-2 and influenza. We propose a method for scaling a SARS-CoV-2 bulk aerosol quantitative microbial risk assessment (QMRA) model for impulse emissions, coughing or sneezing, with aerosolized synthetic DNA tracer concentration measurements. With point-of-emission ratios describing relationships between tracer and respiratory aerosol emission characteristics (i.e., volume and RNA or DNA concentrations) and accounting for aerosolized pathogen loss of infectivity over time, we scale the inhaled pathogen dose and risk of infection with time-integrated tracer concentrations measured with a filter sampler. This tracer-scaled QMRA model is evaluated through scenario testing, comparing the impact of ventilation, occupancy, masking, and layering interventions on infection risk. We apply the tracer-scaled QMRA model to measurement data from an ambulatory care room to estimate the risk reduction resulting from HEPA air cleaner operation. Using DNA tracer measurements to scale a bulk aerosol QMRA model is a relatively simple method of estimating risk in buildings and can be applied to understand the impact of risk mitigation efforts.

Outcomes of Incisional Surgical Site Infection without Mesh to Prevent Incisional Hernia

Background: wound infections that develop after a hernia repair can be linked to systemic issues, mesh infections, and hernia recurrence. Objective: To assess outcomes of incisional surgical site infection without mesh to prevent incisional hernia. Methodology: This was a Prospective interventional study which was conducted in Department of Colorectal Surgery Bangabandhu Sheikh Mujib Medical University fromApril, 2019- September, 2020 using a semi-structured questionnaire through face to face interview. Data were analysed using a computer programme SPSS 24.0 version. Result: the mean age of the respondents was 56.73±7.72 years. About 80% were male. The mean BMI was 25±5.5. About 16.7% had Parastomal Hernia and 8.3% had midline Incisional Hernia. 3 patients at 4th week and 1 patient at 3rd month had surgical site infection. Conclusion: Hernia operations are traditionally regarded as clean operations due to the anticipated, low likelihood of infection at the site of surgical intervention (SSI).

Clinical evaluation of preoperative skin preparation with aqueous povidone iodine only and in combination with alcoholic chlorhexidine in patients undergoing clean elective surgeries

Background: Surgical site infections (SSIs) is a dangerous condition posing a heavy burden on the patient and social health system. Adequate pre operative skin preparation helps in reducing the SSIs and this study is undertaken to compare the efficacy of povidone iodine alone and in combination with chlorhexidine

COMPARISION OF OUTCOME BETWEEN SKIN CLOSURES WITH ADHESIVE GLUE 2-OCTYLCYANOACRYLATE AND SUTURE MATERIAL IN CLEAN ELECTIVE SURGERIES

Introduction: Surgical wound closure aims to move close the skin aps for good cosmetic outcome and to favour rapid healing with low risk of complications. Present study aimed to Compare skin closures with adhesive glue 2-octylcyanoacrylate and suture material in clean elective surgeries. Material & Method: This comparative observational study was conducted among the patients undergoing clean elective surgical procedure in the department of General Surgery AVMC medical college and hospital. Skin closure was done with suturing or with 2- octylcyanoacrlate adhesive glue under same antibiotic coverage for same duration. Ethics committee clearance was obtained, and informed consent was taken from the study participant. Patient not agreeing for 2-octylocyanoacrylate skin closure, mucocutaneous junctional wound or not willing to be part of study were excluded from the study. Both group of patients were compared using pain, Asepsis score and Modied Hollander Cosmesis scale. The collected data were analysed using SPSS v21 operating on windows 10, with p-value of <0.05 considered statistically signicant. Result: In present study total of 120 patients included with 60 in each group. The mean age of patients was 39.41±12.63yrs. Among them 53 were female and 67 were male patients. On assessment of the pain score was signicantly less(p=0.03) using 2-octylcyanoacrlate adhesive glue (0.18±0.39) than suture (0.37±0.55).Asepsis score was signicantly less(p=0.01) using 2-octylcyanoacrlate adhesive glue(11.28±4.23) than suture(16.28±4.23).Modied Hollander cosmesis scale was signicantly higher(p=0.01) using 2-octylcyanoacrlate adhesive glue(4.33±0.68) than suture(4.07±0.76). At various interval the Adhesive glue group showed superior result compared to the skin suture group which was statistically signicant. (p<0.05) Conclusion: Adhesive glue group found to have better tolerance towards the pain in post-operative period compared to the suture. Also, there was better Asepsis score in adhesive glue group and also better Modied Hollander Cosmesis scale score and overall Cosmetic outcome among the patients of adhesive glue compared to skin suture.

Sustained Improvement of Appropriateness in Surgical Antimicrobial Prophylaxis with the Application of Quality Control Circle.

Quality control circle (QCC) has acquired success in many fields in healthcare industry as a process management tool, whereas its efficacy in surgical antimicrobial prophylaxis (SAP) remains unknown. This study aimed to implement QCC interventions to improve the appropriateness of SAP. A QCC activity team was established to grasp the current situation of SAP in clean surgery procedure, set target, formulate corresponding countermeasures and implement and review them in stages. The plan-do-check-act (PDCA) method was cyclically applied. The appropriateness of antibiotic prophylaxis before (January to December 2020) and after (January to December 2021) the implementation of QCC activities were evaluated based on relevant international and Chinese SAP guidelines. The overall SAP appropriateness was significantly improved from 68.72% before QCC to 93.7% post QCC implementation (P<0.01). A significant improvement (P<0.05) was also determined for each category: selection (from 78.82% to 96.06%), duration (from 90.15% to 96.46%), indication (from 94.09% to 97.64%), timing of first dose (from 96.55% to 99.21%), antimicrobial usage (from 96.8% to 99.41%), re-dosing of antimicrobial (from 96.55% to 99.21%). Implementation of a QCC program can optimize the use of antibiotics and improve the appropriateness of SAP and is of practical importance to their standardization.

Incidence of surgical site infections in clean and clean contaminated surgeries

Background: Health care-associated infections (HAI) continue to be a significant global community health issue and a concern to patient safety despite significant progress in infection control strategies. Among the most often reported illnesses acquired in hospitals are surgical site infections (SSI) (HAI). Methods: This prospective observational study was held in the various Surgical departments of Bakhtawar Amin Trust Teaching Hospital Multan and Fauji foundation hospital Peshawar cantt.April, 2022 to September, 2022. The study comprised a total of 400 individuals who underwent clean and clean contaminated procedures. Data on comorbidities, post-operative stay, kind of surgery, length of operation, use of prosthesis, day of SSI event, demographics, and re-suturing were gathered and evaluated. Pus aspirate/swab from patients suspected of having SSI was sent for culture and sensitivity testing. Results: The study covered 400 clean contaminated and clean surgeries. 5 percent of cases developed SSI. There was a correlation between SSI and age group, gender and also depends on the procedure type as emergency or elective. The stay in hospital was prolonged post-operatively (&gt;7 days) in 14 (70%) patients who acquired SSI. 13 (65%) of the patients with SSI had co-morbidities. E.

Optimization of Surface Cleaning and Painting Methods for DIC Measurements on Automotive and Railway Aluminum Materials

The preparatory operations of DIC (Digital Image Correlation) tests were investigated in this study, with special emphasis on specimen cleaning and painting operations. As it is well known, DIC tests are non-contact and applied in materials research, the analysis of complex structures, and, nowadays, the construction industry. The use of DIC technologies has seen a dynamic increase in all scientific fields. In our study, aluminum body panels for automotive and railway applications were tested using this technique. There are many articles on proper patterning in the literature but fewer on preparation and priming. These are critical for a successful DIC measurement. This paper looks at different surface cleaners and primers with different grading procedures and will also determine the time window within which the paint should be applied. Finally, the GOM ARAMIS system was applied to measure and characterize the painted surface and visible deformation defects resulting from inadequate painting.

Management of Surgical Site Infections in Spine Surgery: A Current Concept Review

Background: Surgical sites infections (SSIs) in spine surgeries represent one of the commonest hospital-acquired infections. SSIs refers to infection of surgical wound within 30 days of surgery or one year of implant usage. SSIs portend a huge disease burden with devastating consequences to the patient and the hospital facility with attendant physical and psychological trauma to the patient and it is associated with increase rate of morbidity and mortality. Objective: The aim of this review is to identify factors that predispose a spine patient to SSIs and to highlight the current preventive and management concepts. Methods: We carried out a comprehensive review of literatures, using key words such as surgical site infections, spine surgery, predisposing factors, prevention, diagnosis, treatment, outcomes on search engines of Google Scholar, Scopus and PUBMED. Eligible articles for the review included full length published articles in English which we have access to contents. Results: Twenty-five full length articles were found eligible for the review. In spite of improvement in spine care and surgery, SSIs continue be a source of great concern to the patients, surgeons and healthcare system of any nation. Gram positive organisms are more common than gram negative organisms. The risk factors for SSIs include patient- and surgeon - related factors. Albeit, there is no universally accepted protocol for the prevention and treatment of SSIs in spine surgery. The incidence of SSIs is on the increase worldwide with associated high risk of morbidity, overall decrease in the quality of life and sometimes mortality. The economic burdens of the management of SSI is huge and stressful for every nation. Treating SSIs after spine surgery is daunting as the choice between removing the implants for proper bacteria clearance and the risk of causing spinal instability is a hard nut to crack. Conclusions: Despite the improved surgical technique, protocol on asepsis and role of prophylactic antibiotics in clean spine surgeries, there are still substantial increase in the rate of SSIs. Therefore, prevention is more profitable than the hope of proper treatment.

SG-APSIC1092: Bundled preoperative preparation reduced surgical-site infections

Objectives: We aimed to reduce the overall surgical-site infection (SSI) rate to 0.2%. Methods: A new checklist protocol was developed based on the APSIC guidelines. The bundle for preoperative preparation was implemented: adequate preoperative bathing, proper time of hand-forearm washing, and sufficient contact time of antiseptic application. The compliance rate was monitored with a weekly control chart from December 2019 to November 2020. Results: In total, 9,995 cases were operated at Narasuan University Hospital (NUH) in 2020, classified by surgical wound type as follows: clean wound, 62.6%; clean-contaminated wound, 32.1%; contaminated wound, 0.8%; and dirty wound, 4.5%. According to surgical wound type, the mean compliance with preoperative bathing was 68.22% for clean wounds, 68.33% for clean-contaminated wounds, and 34.82% for contaminated wounds. Hand hygiene preparation compliance was higher for clean wound surgeries (mean, 94.01%) and clean-contaminated wound surgeries (mean, 95.05%) than for contaminated wound surgeries (mean, 88.30%). A high percentage was achieved by the 3 groups. The rate of skin antiseptic preparation compliance was higher in the clean wound group (mean, 89.05%) and the clean-contaminated wound group (mean, 90.70%) than the contaminated wound group (mean, 68.12%). The lower rate might be due to time constraints in contaminated wound operations. Only 0.18% of clean-wound operations had SSIs, and the clean-contaminated wound group had 0.19% SSIs, whereas no SSIs occurred in the contaminated and dirty wound groups. The overall SSI rate was 0.17%; thus, we achieved our goal. Conclusions: A bundle of preoperative infection-prevention preparations reduced the rate of SSI. Furthermore, the bundle had a highly tangible positive impact for both internal and external stakeholders, and it was effective in ensuring good practice regarding preoperative preparation.

Effect of pharmacist intervention on antibiotic prophylaxis in orthopedic internal fixation: A retrospective study.

Despite the availability of guidelines and official policies, antibiotic prophylaxis in clean surgery remains suboptimal. The aim of this study was to evaluate the clinical effects and cost-effectiveness of pharmacist-led intervention in the perioperative anti-infection prophylaxis of patients undergoing orthopedic internal fixation. We performed a retrospective analysis based on the medical records of internal fixation surgery in a tertiary hospital from July 2019 to June 2020. Data were divided into two groups based on whether a full-time pharmacist participated in the treatment. The research parameters included use of antibiotics, rationality of medication, postoperative complications, and related cost. To deal with selection bias, propensity score matching method was employed at a ratio of 1:1. Meanwhile, a cost-effectiveness analysis was used to evaluate the impact of pharmacist intervention on antibiotic prevention in internal fixation surgery. A total of 537 participants were included in this study. After matching, 236 patients were comparable in each group. During the pharmacist intervention period, less pharmacologic prophylaxis (96.6% vs 100.0%, p=0.007) and shorter prophylaxis duration (1.60 vs 2.28 days, p<0.001) were observed. The reasonable rate increased dramatically in usage and dosage (96.6% vs 83.9%, p<0.001), timing of administration (94.5% vs 78.4%, p<0.001) and medication duration (64.4% vs 37.7%, p<0.001). In addition, pharmacist intervention yielded net economic benefits. A remarkable reduction was observed in average length of stay (10.43 vs 11.14 days, p=0.012), drug cost ($610.57 vs $706.60, p=0.001) and defined daily doses (2.31 vs 3.27, p<0.001). The cost-effectiveness ratios, divided drug cost savings by cost of pharmacist time, were 28:1 for drug and 2:1 for antibiotics, respectively. Pharmacist-driven antibiotic stewardship for orthopedic internal fixation patients improved compliance with peri-procedure antibiotic prophylaxis, and reduced the cost and utilization of antibiotics. This helped to bring significant clinical and economic benefits.

SKIN GLUE AS A EMERGING ALTERNATIVE IN SKIN CLOSURE-A COMPARATIVE STUDY

Introduction:Traditional wound closure techniques include skin sutures and metal clips. The ideal incision closure should be simple, effective, safe, rapid, inexpensive, painless, cosmetic, and bactericidal. Cyanoacrylate glue has good neovascularization, epithelialization,and fasterApplication.Soit can be considered an alternative for skin closures. Methods:A study was conducted on 50 individuals undergoing elective surgery in the department of general surgery. They were randomized into 2 groups. In group A skin closure was done with skin glue and in group B skin closure was done with sutures. Post-op pain was assessed with VAS and cosmesis was assessed with a modified Hollander cosmesis scale. The time taken for closure was assessed using a stopwatch. Results:Skin closure with skin glue was quicker than traditional closure. The average time for skin closure with glue was 1 minute and 14 seconds while it was 3 minutes and 47 seconds in the suture group. The postoperative pain was comparatively less in people who had closure with glue. Cosmesis was better in patients who had closure with glue compared to sutures.The overall satisfaction level was better in people who had closure with glue compared to those who had closure with sutures. Conclusion:According to this study, using skin glue for skin closure in clean surgery reduces thewound closure time with a superior cosmetic effect. The usage of skin glue can greatly save healthcare expenses and is favored by patients due to the simplicity of postoperative wound care. The study established the efficacy and advantages of this unique technique.The broad adoption of this innovative approach may drastically reduce the need for sutures in clean surgery.

Microgrid system energy management with demand response program for clean and economical operation

A fundamental microgrid system's load demand often fluctuates hourly. Utilities establish different prices at various times based on the fluctuation of the load demand curve, this is referred to as electricity price based on time-of-use (TOU). The overall contribution of the paper is manifold which involves the techno-economic impacts of grid participation, electricity pricing and renewables. However, the primary goal is to offer a demand-response (DR) model that maximizes the benefits of energy retailers, in this case the microgrid customers. DR models examine the utility and elasticity of various customers, taking into account their different behaviors during both peak and valley periods. Considering that 40 % of the customers participate in the DR program, an exhaustive optimization process is initiated to calculate the optimal incentive value. Thereafter, a novel intelligent algorithm is implemented to minimize the overall cost of a microgrid system and analyze the outcome with and without DR program. The many cost factors taken into account include fuel costs, fined pollution costs, operating and maintenance costs, depreciation costs, etc. The use of a DR-based energy management microgrid system resulted in a significant decrease in overall generating costs from 880¥ to 872¥ along with pollutants released as compared to those described in the literature, according to numerical data. Furthermore, the peak demand was lowered by 5.13 % from 180 kW to 170.754 kW. The suggested optimization method is claimed to be superior by measures of central tendency analysis.

Guest editorial: The significance of clean and energy-efficient operations in sustainable aviation

Guest editorial: The significance of clean and energy-efficient operations in sustainable aviation

What's New in Hand and Wrist Surgery.

What's New in Hand and Wrist Surgery.