Decrease In Surgical Site Infections Research Articles

Coronavirus Disease 2019 Pandemic and Reduced Surgical Site Infection After Cardiac Surgery: A Potential Blessing in Disguise.

Background: The coronavirus disease 2019 (COVID-19) pandemic has brought about drastic hygienic measures, one upside of which might be the mitigated occurrence of surgical site infection (SSI). This study investigated the association of the pandemic with SSI occurrence after cardiac surgeries. Patients and Methods: From 2014 to 2022, patients undergoing cardiac surgery were included and categorized into pre-pandemic and during-pandemic groups. Surgical site infections were classified into harvest-site, superficial sternal, and complex sternal infection. Multiple logistic regression and inverse probability weighting assessed the association of the pandemic with SSI. Results: Among a total of 26,143 patients, 793 SSIs occurred. The during-pandemic patients were younger (61.87 ± 10.58 vs. 65.64 ± 11.82) with a higher male proportion (70.1% vs. 67.4%) and a higher prevalence of all studied comorbidities/risk factors (expect cigarette smoking). Total SSI rate decreased substantially from 3.3% before COVID-19 to 1.8% afterward (p < 0.001). Inverse probability weights analyses evinced an independent association of the pandemic with a reduced risk of total (adjusted odds ratio [OR]; 0.59; 95% confidence interval [CI], 0.45-0.78), harvest-site (adjusted OR, 0.36; 95% CI, 0.19-0.70), and superficial sternal infection (adjusted OR, 0.60; 95% CI, 0.43-0.81). No significant association was observed with complex sternal site infection (adjusted OR, 1.05; 95% CI, 0.55-2.01). Multivariable regression recapitulated these findings. Conclusions: The COVID-19 pandemic independently pertained to more than a 40% reduction in SSI occurrence, particularly affecting harvest-site and superficial sternal infections. However, there remains the possibility of the implications of other known and unknown confounders on the observed association. To some extent, the decrease in SSIs after the pandemic can be justified by reinforced hygienic precautions, emphasizing the necessity of extending the adherence to these measurements into the post-COVID-19 era to maintain the status quo.

Optimizing antibiotic management for patients with acute appendicitis: A quality improvement study

BackgroundTo decrease surgical site infections after appendectomy for acute appendicitis, preoperative broad-spectrum antibiotics are often used in clinical practice. However, this treatment strategy has come under scrutiny because of increasing rates of antibiotic-resistant infections. MethodsThe aim of this multisite quality improvement project was to decrease the treatment of uncomplicated acute appendicitis with piperacillin-tazobactam without increasing the rate of surgical site infections. Our quality improvement intervention had 2 distinct components: (1) updating electronic health record orders to encourage preoperative administration of narrow-spectrum antibiotics and (2) educating surgeons and emergency department clinicians about selecting appropriate antibiotic therapy for acute appendicitis. Patient demographics, clinical characteristics, and outcomes were compared 6 months before and after implementation of the quality improvement intervention. ResultsA total of 352 laparoscopic appendectomies were performed during the 6-month preintervention period, and 369 were performed during the 6-month postintervention period. The preintervention period and postintervention period groups had similar baseline demographics, vital signs, and laboratory test values. The rate of preoperative piperacillin-tazobactam administration significantly decreased after the intervention (51.4% preintervention period vs 20.1% postintervention period, P < .001). The rate of surgical site infections was similar in both groups (superficial surgical site infections = 1.4% preintervention period vs 0.8% postintervention period, P = .50; deep surgical site infections = 1.1% preintervention period vs 0.0% postintervention period, P = .06; and organ space surgical site infections = 3.1% preintervention period vs 3.0% postintervention period, P > .99). Rates of 30-day readmission, reoperation, and Clostridioides difficile infection also did not differ between groups. ConclusionOur quality improvement intervention successfully decreased piperacillin-tazobactam administration without increasing the rate of surgical site infections in patients with acute appendicitis.

Does a Presurgical Antisepsis Protocol Decrease Surgical Site Infections in Young Children?

National standards for surgical site infection (SSI) prevention for children remain elusive. Our institution developed a presurgical antisepsis protocol that included the three components of chlorhexidine gluconate bathing wipes, chlorhexidine gluconate oral rinse, and povidone-iodine nasal swab. This retrospective cohort study examined data from electronic health records to compare SSI rates before and after protocol implementation. We included children aged 2 through 11years undergoing any surgical procedure with the use of an incision in the OR (N=1,356). We did not find any difference in the occurrence of SSI before and after the protocol was implemented. Logistic regression showed that an infection present at the time of surgery was the only significant predictor of an SSI. The implementation of a presurgical antisepsis protocol was not associated with SSI rate reduction in this pediatric cohort.

Optimizing care of patients undergoing cardiac surgery using a digital platform and a multidisciplinary team approach

ObjectiveRestrictions to care access during the pandemic along with the increasing complexity of patients awaiting cardiac surgery provides unique challenges for care delivery. The University of Ottawa Heart Institute has developed a novel multidisciplinary digital platform, the Prehab Automated Follow-Up (AFU) Program, which delivers patient/caregiver teaching regarding risk factor mitigation, tracks patient symptoms, and screens for optimization using best practice guidelines. This study was conducted to quantify patient outcomes following initiation of the AFU Program. MethodsPatients awaiting elective cardiac surgery are enrolled and screened via automated telephone conversation, according to best practice guidelines, and a Short Form-12 preoperative assessment. Following this screen, patients are referred for an in-person assessment by an appropriate multidisciplinary team member; namely, a diabetes specialist, physiotherapist, dietitian, smoking cessation counselor, social worker, vocational counselor, and/or psychologist. ResultsSince initiation in February 2021, the AFU Program has enrolled more than 1237 patients with 508 multidisciplinary team referrals prompted by the AFU screening platform. Before program initiation, there were no multidisciplinary team referrals for preoperative optimization. Compared with patients treated between February 2020 and February 2021, there was a 2.5% decrease in hospital readmission rate within 30 days of surgery, a 0.6-day shorter hospital stay, and a 2.5% decrease in surgical site infection. ConclusionsOur cardiac surgery AFU Program reduced adverse health outcomes for patients by identifying and optimizing risk factors that increased quality of patient care. The AFU Program provides patient/caregiver engagement through educational support and multidisciplinary team counseling.

A Novel Protocol for Nasal Decolonization Using Prolonged Application of an Alcohol-Based Nasal Antiseptic Reduces Surgical Site Infections in Total Joint Arthroplasty Patients: A Retrospective Cohort Study.

Background: Current nasal decolonization strategies utilize pre-operative agents without consideration for short-term re-colonization or de novo colonization. Many strategies utilize an antibiotic-based agent, raising concerns of limited gram-negative antimicrobial coverage and the emergence of resistant bacterial strains. This study evaluated the clinical utility of a non-antibiotic, alcohol-based nasal decolonization agent in decreasing surgical site infection (SSI) rates after total joint arthroplasty. Patients and Methods: We retrospectively compared an 18-month cohort of elective primary total joint arthroplasty patients treated peri-operatively with an alcohol-based sanitizer to historical controls. The alcohol-based agent was administered pre-operatively the day of surgery and for two weeks after surgery. Patients were followed for 90 days and assessed for signs or symptoms of SSI. Patient and caregiver compliance was recorded. There were 779 patients included in the experimental group and 647 included in the historical control group. Results: Patients receiving alcohol-based nasal decolonization had a lower rate of SSI compared with controls not receiving nasal decolonization (0.64% [5/779] vs. 1.55% [10/647]; p = 0.048; odds ratio, 2.43). Utilization of an alcohol-based nasal sanitizer in the pre-operative and prolonged post-operative setting decreased infection rates by 41.3% in our elective total joint arthroplasty setting. Conclusions: When used pre- and post-operatively, alcohol-based nasal decolonization of bacteria in patients undergoing total joint arthroplasty led to a substantial decrease in SSIs.

A systematic review with meta-analysis on prophylactic negative pressure wound therapy versus standard dressing for obese women after caesarean section.

The purpose of this study is to assess the efficacy of prophylactic negative pressure wound therapy (NPWT) in obese women undergoing caesarean section. An updated review and meta-analysis of randomized controlled trials following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, Medline, Web of Science, and Cochrane Library were searched from inception up to March 2022 without restriction in language. We chose surgical site infection as the primary outcome. NPWT resulted in a lower surgical site infection rate compared with conventional dressing (risk ratio [RR] = 0.76). The infection rate after low transverse incision was lower comparing the NPWT group with the control group ([RR] = 0.76). No statistically significant difference was detected in blistering([RR] = 2.91). The trial sequential analysis did not support the 20% relative decrease in surgical site infection in the NPWT group. (type II error of 20%).

PD31-02 ROBOTIC ASSISTED KIDNEY TRANSPLANT STILL FAILING TO IMPRESS: A SYSTEMATIC REVIEW AND META-ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023PD31-02 ROBOTIC ASSISTED KIDNEY TRANSPLANT STILL FAILING TO IMPRESS: A SYSTEMATIC REVIEW AND META-ANALYSIS Tuan Thanh Nguyen, Adnan El-Achkar, Berut Lebanon, Ho Yee Tiong, Ryan W. Dobbs, Huy Gia Vuong, Jacob Basilius, Le Quy Van Dinh, Ho Chi Minh, Vietnam, Jad Najdi, Trong Hieu Le, Tien-Dat Hoang, Khoa Quy, Ali Sohrab Naushad, Mohammed Shahait, Amman Jordan, and David I. Lee Tuan Thanh NguyenTuan Thanh Nguyen More articles by this author , Adnan El-AchkarAdnan El-Achkar More articles by this author , Berut LebanonBerut Lebanon More articles by this author , Ho Yee TiongHo Yee Tiong More articles by this author , Ryan W. DobbsRyan W. Dobbs More articles by this author , Huy Gia VuongHuy Gia Vuong More articles by this author , Jacob BasiliusJacob Basilius More articles by this author , Le Quy Van DinhLe Quy Van Dinh More articles by this author , Ho Chi MinhHo Chi Minh More articles by this author , Vietnam Vietnam More articles by this author , Jad NajdiJad Najdi More articles by this author , Trong Hieu LeTrong Hieu Le More articles by this author , Tien-Dat HoangTien-Dat Hoang More articles by this author , Khoa QuyKhoa Quy More articles by this author , Ali Sohrab NaushadAli Sohrab Naushad More articles by this author , Mohammed ShahaitMohammed Shahait More articles by this author , Amman JordanAmman Jordan More articles by this author , and David I. LeeDavid I. Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003324.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Several centers have reported their recent experiences with the robotic approach in kidney transplantation. Previous reports suggest lower incidence of incisional hernia and lymphocele. However, these reported improvements in perioperative and follow-up outcomes are still debated. This most comprehensive and updated meta-analysis sought to compare the perioperative and follow-up outcomes between robot-assisted kidney transplantation (RAKT) and open kidney transplantation (OKT). METHODS: For relevant articles, three electronic databases, including PubMed, Scopus, and Web of Science, were searched from their inception until May 21, 2022. A meta-analysis has been reported in line with PRISMA 2020 and AMSTAR Guidelines. The risk ratio (RR) and mean difference (MD) were applied for the comparison of dichotomous and continuous variables with 95% confidence intervals (CI). RESULTS: Of the 1580 retrieved abstracts, 95 underwent full-text review, and 15 studies were included in the final analysis, comprising a total cohort of 2,319 cases of kidney transplantation (667 RAKT and 1,652 OKT). The quality of the studies remains low with large heterogeneity in the cohorts. the RAKT group still has longer warm ischemia time, cold ischemia time, rewarming time, total ischemia time and operative time compared to the OKT group. Even though RAKT group had shorter incision length (RR=1.42, 95%CI (0.350 - 5.766), p=0.623) resulting in lower pain score (MD=-1.37, 95%CI (-1.59 - -1.15), p=<0.001), less morphine use (SMD=-3.478, 95%CI (-5.619 - -1.336), p=0.001), and shorter length of stay (LOS) (SMD=-0.496, 95%CI (-0.819 - -0.173), p=0.003), it has similar clinical estimated blood loss, similar rates of surgical site hernia and postoperative lymphocele. Both techniques have equivalent renal function, graft, and patient survival. Decrease surgical site infection remains only significant in obese patients. CONCLUSIONS: Our study showed that with a larger series and more patients, the initial promise that RAKT have lower rates rate of lymphocele incisional hernia is not true. While RKT does have shorter wound incision, less pain, and LOS, this comes at a cost of longer op times with no improvement in graft survival. The answer to whether RAKT is worthwhile remains to be answered by a randomized controlled study. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e900 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tuan Thanh Nguyen More articles by this author Adnan El-Achkar More articles by this author Berut Lebanon More articles by this author Ho Yee Tiong More articles by this author Ryan W. Dobbs More articles by this author Huy Gia Vuong More articles by this author Jacob Basilius More articles by this author Le Quy Van Dinh More articles by this author Ho Chi Minh More articles by this author Vietnam More articles by this author Jad Najdi More articles by this author Trong Hieu Le More articles by this author Tien-Dat Hoang More articles by this author Khoa Quy More articles by this author Ali Sohrab Naushad More articles by this author Mohammed Shahait More articles by this author Amman Jordan More articles by this author David I. Lee More articles by this author Expand All Advertisement PDF downloadLoading ...

Pediatric Laparoscopic Gastrostomy With T-Fasteners: A Technique to Decrease Surgical Site Infection.

Pediatric Laparoscopic Gastrostomy With T-Fasteners: A Technique to Decrease Surgical Site Infection.

Incisional Negative Pressure Wound Therapy to Decrease the Incidence of Surgical Site Infections in Trauma Laparotomy Wounds.

Surgical site infection (SSI) is a common post-operative complication, especially in trauma laparotomies. Incisional negative pressure wound therapy (iNPWT) is a novel technique in reducing SSIs. We aim to study the rate of wound complications in trauma laparotomy with standard primary closure with staples vs iNPWT. We had 152 patients meeting inclusion criteria who underwent emergent trauma laparotomies performed at Sentara Norfolk General from 2017 to 2020. We had 79 patients in the standard staple group and 73 patients in the iNWPT group. We then analyzed surgical site infection rates and wound complication rates in both groups within a 30-day period. The wound infection rate in the staple vs staple plus iNPWT was 10.0% vs 3.8%, respectively (P = .13). Wound dehiscence rates were 24.1% vs 10.13%, respectively (P = .02). When looking at a subset of patients with hollow viscous injury, the rate of SSIs was statistically lower in the iNPWT group. Prior to the introduction of the incisional vacuum-assisted closure (VAC) to our practice compared to after its introduction, 39.25% of wounds were left open vs 19.51%, respectively (P = .001). Our data identified a trend toward a decrease in overall SSIs in trauma laparotomies closed with iNPWT. The use of iNPWT demonstrated a decrease in superficial wound dehiscence and a decrease in SSIs in patients with associated full thickness bowel injury. With iNPWT, we are more aggressive with primarily closing trauma laparotomy wounds. This shows promise for increasing primary closure rates while simultaneously decreasing overall superficial surgical site infection rate.

Awareness and wound assesment decrease surgical site infections.

Various surveillance methods have been described for surveillance of surgical site infections (SSI). The aim of this study was to examine prac- ticality of SSI risk assessment methods (SENIC and NNIS) with a postoperative wound monitoring scale (ASEPSIS) as an outcome assessment measure and evaluation of the contribution of wound assesment to the reduction of wound infection. Patients were followed with a prospective data chart through four year. Correlation of SENIC and NNIS together with ASEPSIS were performed. During the study period, 275 SSI occurred. SSIs were determined within the 21 days-period after operations. Correlation between SENIC with ASEPSIS (rs= 0.41, p <0.001) was found better than that for NNIS with ASEPSIS (rs= 0.37, p <0.001). Type of operation (emergency vs. elective), body mass index, operation class and American Society of Anesthesiologists scores were found independently predictive factors for SSI. The forth year SSI rate was found to be significantly lower than the other years (p <0.001). This study indicates weak but significant correlation between preoperative risk assessment methods for SSI and ASEPSIS method. In addi- tion, surgical wound assesment and awarness of the wound infection rates, have decreased the SSI rates over the years.

Using a Data-Driven Improvement Methodology to Decrease Surgical Site Infections in a Community Neurosurgery Practice: Optimizing Preoperative Screening and Perioperative Antibiotics

We used a data-driven methodology to decrease the departmental surgical site infection rate to a goal of 1%. A prospective interventional study with historical controls comparing preimplementation/intervention (unknown methicillin-sensitive Staphylococcus aureus [MSSA]/methicillin-resistant Staphylococcus aureus [MRSA] status and standard weight and drug allergy-based preoperative antibiotics) with postimplementation/intervention (optimized preoperative chlorhexidine showers, MSSA/MRSA screening, MSSA/MRSA decolonization, and optimized preoperative antibiotic order set implementation). The American College of Surgeons National Surgical Quality Improvement Program was used for case surveillance. The primary outcome was the presence of a surgical site infection with a secondary outcome of cost(s) of implementation. A total of 317 National Surgical Quality Improvement Program abstracted neurosurgical cases were analyzed, 163 cases before implementation and 154 cases after implementation. There were no significant differences between the preimplementation and postimplementation cohorts regarding patient demographics and baseline comorbidities, with the exceptions of inpatient and functional status (P < 0.001). The most common procedures were lumbar decompression (31%), lumbar discectomy (27%), and anterior cervical discectomy and fusion (10.4%). After implementation, 30 patients were MSSA positive (20%) and 4 MRSA positive (2.6%). Thirty patients received preoperative intranasal mupirocin decolonization (88%), and 4 patients received adjusted preoperative antibiotics (12%). After protocol implementation, the surgical site infection rate decreased from 6.7% (odds ratio, 2.82) to 0.96% (odds ratio, 0.91). The cost of implementation was $27,179, or $58 per patient. The findings highlight the importance of systematically investigating areas of gap in existing clinical practice and quality improvement projects to increase patient safety and enhance the value of care delivered to neurosurgical patients.

Enhanced Bundled Interventions to Reduce Surgical Site Infections for Patients with Congenital Cardiac Disease

Background: Surgical site infections (SSIs) among cardiothoracic (CT) patients are associated with high rates of morbidity and mortality. Data are limited regarding SSI incidence among pediatric patients undergoing primary reparative procedures for congenital cardiac disease. Published evidence on targeted interventions to prevent pediatric CT-surgery SSI is lacking. We aimed to establish standard metrics for measuring CT-surgery SSI incidence and to implement bundled interventions for SSI prevention. Methods: A dedicated CT-surgery SSI prevention workgroup was established, consisting of hospital leadership, CT surgeons, cardiac critical care unit staff, anesthesia, perfusion, environmental services, instrument sterile processing, risk management, infection prevention and antibiotic stewardship. We created a standard definition for CT-surgery SSI and calculated retrospective SSI rates over a 24-month period (2017–2019). The outcome measured was incidence of CT-surgery SSI per 100 primary cardiac procedures with delayed ( 3 days after primary surgery) or non-delayed chest closure. The difference in proportion of SSI was reported separately for delayed closure and non-delayed closure; statistical significance was tested using a Fisher’s Exact test. We identified many potential improvement opportunities, including gaps in SSI surveillance, poor compliance with daily bathing, inconsistent perioperative antimicrobial prophylaxis, lack of controlled environment for bedside chest closures, and lapses in environmental cleaning. These issues informed the enhanced SSI prevention bundle, which included education on sterility with the operating room (OR) staff. Protocols for care of cardiac patients with delayed chest closures focused on universal daily and preoperative chlorhexidine baths. In addition, the bundle incorporated stringent environmental cleaning interventions including scheduled decluttering of patient rooms and clinical spaces, terminal cleaning of patient rooms prior to returning from the OR, and use of adjunctive ultraviolet light for the daily cleaning of operating rooms and patient rooms at discharge. Results: Surveillance definition of microbiological growth from a clinical sample obtained within 30 days of primary cardiac procedure sufficiently captured all CT-surgery SSIs. Of 551 CT-surgery procedures prior to intervention, 91 (17%) had delayed final operative closures. Prior to the intervention, 16 SSIs were identified from July 2017 – May 2019 for a rate of 2.90 per /100 procedures, and was higher among patients with delayed chest closure 6.59 per /100 procedures (6 SSIs/91 procedures) versus those with primary chest closure 2.17 per /100 procedures (10 SSIs/460 procedures; P = 0.034). Gram-positive organisms, including coagulase coagulase-negative Staphylococci, were most frequently identified as the causative organisms for SSIs. Compliance with bundled intervention, rolled out over a 2-month period, was associated with an immediate decrease in the number of SSIs for primary and delayed chest closures 6SSIs /185 procedures in the initial quarters (August – December 2019) of the post-intervention period. However, this decrease was not reflected in the overall rate (3.24 per /100 procedures) due to fewer procedures performed. Data collection to measure sustainability is ongoing. Conclusions: Bundled interventions targeting skin antisepsis and environmental cleaning may be associated with a decrease in SSIs among pediatric CT-surgery patients. Ongoing surveillance is required to determine sustainability of these interventions.Funding: NoneDisclosures: None

Targeting Zero-Preventing Surgical Site Infections by Reducing Immediate-Use Steam Sterilization (IUSS)

Objective: To reduce the number of immediate-use steam sterilization (IUSS) cycles performed to below 2% to increase patient safety and decrease surgical site infections (SSIs). Methods: The facility decide to make a “hard stop” date at which IUSS cycles were no longer going to be allowed without operating room (OR) and Sterile Processing Department (SPD) leadership approval, based on standardized indications for IUSS cycles. Before the start date, extensive education was given to surgeons, OR clinical teams, and SPD team members to ensure understanding of the process and risk of infection due to IUSS. The facility also recognized that workflow was a large part of why instruments were being sent through IUSS cycles, due to a backup of sets in the department and because some items could not be processed before the next day. Many items were purchased to increase workflow capabilities: such as a new washer, sonic, adding a pass-through window, a low-temperature sterilizer, Also, 3 sterilizers were replaced with newer, more efficient models. The facility also purchased a large number of instruments to create new and additional trays to accommodate the surgical volume. The SPD also underwent LEAN Kaizen events on both the clean and dirty sides to improve workflow and efficiency to prevent further IUSS. Project Results: The facility saw immediately results in reduction of IUSS cycles being performed and were the department was able to drop below the goal of 2% after the first month of using the new process. The rate has continued to be &lt;2% for &gt;5 months. Communication and partnership between the OR, infection prevention staff, and SPD were beneficial and will continue to move the facility forward in a shared decision-making model as improvement continues in the future.Funding: NoneDisclosures: None

Pediatric Laparoscopic Gastrostomy with T-Fasteners: A Technique to Decrease Surgical Site Infection

Introduction: Laparoscopic gastrostomy (LG) is a popular technique for establishing long-term enteral access in children. During LG, there are several methods available to create a secure gastropexy, including the subcuticular (SC) and T-fastener (TF) techniques. The purpose of this study is to compare local wound infections between these two techniques. Methods: A retrospective review was performed of all pediatric patients …

Pediatric Laparoscopic Gastrostomy with T-Fasteners: A Technique to Decrease Surgical Site Infection

Pediatric Laparoscopic Gastrostomy with T-Fasteners: A Technique to Decrease Surgical Site Infection

Surgical site infection prevention protocol for pediatric spinal deformity surgery: does it make a difference?

Retrospective. Can a standardized, hospital-wide care bundle decrease surgical site infection (SSI) rate in pediatric spinal deformity surgery? SSI is a major concern in pediatric spinal deformity surgery. We performed a retrospective review of our primary scoliosis surgeries between 1999 and 2017. In 2008, we implemented a standardized infection reduction bundle. Interventions included preoperative nares screening for methicillin-resistant staphylococcus aureus or methicillin-sensitive Staphylococcus aureus 2weeks preoperatively, and treatment with intranasal mupirocin when positive, a bath or shower the night before surgery, a preoperative chlorohexidine scrub, timing of standardized antibiotic administration, standardized intraoperative re-dosing of antibiotics, limiting operating room traffic, and standardized postoperative wound care. In 2011, we added intrawound vancomycin powder at wound closure. Our inclusion criteria were patients 21years of age or less with idiopathic, neuromuscular, syndromic, or congenital scoliosis who had a primary spinal fusion or a same day anterior and posterior spine fusion with segmental spinal instrumentation of six levels or more. We compared the incidence of early (within 90days of surgery) and late (> 91days) SSI during the first postoperative year. There were 804 patients who met inclusion criteria: 404 in the non-bundle group (NBG) for cases prior to protocol change and 400 in the bundle group (BG) for cases after the protocol change. Postoperatively, there were 29 infections (7.2% of total cases) in the NBG: 9 early (2.2%) and 20 late (5.0%) while in the BG there were only 10 infection (2.5%): 6 early (1.5%) and 4 late (1.0%). The reduction in overall SSIs was statistically significant (p = 0.01). There was a trend toward decreased early infections in the BG, without reaching statistical significance (p = 0.14). Standardized care bundles appear effective in reducing the incidence of postoperative pediatric spine SSIs. Level III.

"Smart" Antimicrobial Nanocomplexes with Potential to Decrease Surgical Site Infections (SSI).

The emergence of resistant pathogens is a burden on mankind and threatens the existence of our species. Natural and plant-derived antimicrobial agents need to be developed in the race against antibiotic resistance. Nanotechnology is a promising approach with a variety of products. Biosynthesized silver nanoparticles (AgNP) have good antimicrobial activity. We prepared AgNPs with trans-cinnamic acid (TCA) and povidone–iodine (PI) with increased antimicrobial activity. We synthesized also AgNPs with natural cinnamon bark extract (Cinn) in combination with PI and coated biodegradable Polyglycolic Acid (PGA) sutures with the new materials separately. These compounds (TCA-AgNP, TCA-AgNP-PI, Cinn-AgNP, and Cinn-AgNP-PI) and their dip-coated PGA sutures were tested against 10 reference strains of microorganisms and five antibiotics by zone inhibition with disc- and agar-well-diffusion methods. The new compounds TCA-AgNP-PI and Cinn-AgNP-PI are broad spectrum microbicidal agents and therefore potential coating materials for sutures to prevent Surgical Site Infections (SSI). TCA-AgNP-PI inhibits the studied pathogens stronger than Cinn-AgNP-PI in-vitro and on coated sutures. Dynamic light scattering (DLS), ultraviolet-visible spectroscopy (UV-Vis), Fourier Transform infrared spectroscopy (FT-IR), Raman, X-ray diffraction (XRD), microstructural analysis by scanning electron microscopy (SEM) and energy dispersive spectroscopy (EDS) confirmed the composition of TCA-AgNP-PI and Cinn-AgNP-PI. Smart solutions involving hybrid materials based on synergistic antimicrobial action have promising future perspectives to combat resistant microorganisms.

Intrasite Antibiotic Powder for the Prevention of Surgical Site Infection in Extremity Surgery: A Systematic Review.

Although the role of intrasite antibiotic powder in preventing surgical site infections (SSIs) has been extensively explored in spinal surgery, it remains underevaluated in the other orthopaedic subspecialties. This systematic review examines the utilization of intrawound antibiotic powder as a prophylactic measure against SSIs in orthopaedic procedures. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, electronic searches were conducted on Ovid MEDLINE, and PubMed. Only English language, nonspine clinical studies published before May 2018 were included. The initial search identified 179 individual citations, and 11 studies met the eligibility criteria. All included studies were level III retrospective studies. Represented subspecialties included total joint arthroplasty, upper extremity, foot and ankle, and trauma. Eight studies demonstrated a statistically significant decrease in SSIs with the use of intrasite antibiotic powder. There are no current guidelines for the use of intrasite antibiotic powder for the prevention of SSIs in orthopaedic procedures. Despite the lack of high-quality evidence available in the literature, published smaller studies do suggest a significant protective effect. However, recommendations with regard to this technique after common orthopaedic procedures cannot yet be made.

Negative Pressure Wound Therapy (PICO) as a Means to Decrease Surgical Site Infection

Negative Pressure Wound Therapy (PICO) as a Means to Decrease Surgical Site Infection

Perioperative Harm Index facilitates prioritization of improvement initiatives

IntroductionPerioperative services constitute a significant portion of the care delivery, the impact, and the potential risk in healthcare organizations. Tremendous attention has been paid towards hospital-acquired conditions; however perioperative services have not received similar attention. There is a need for a standardized manner to report on conditions in perioperative services which facilitates prioritization of quality improvement initiatives. Materials and methodsPreventable harm and quality of care indicators were selected based on a review of the literature and available datasets, as well as from safety and quality measures in our organization. Metrics were derived from myriad national quality improvement initiatives and collaboratives. A structure was created to obtain the metrics in a near real-time manner and present the Perioperative Harm Index across the organization. Specific initiatives were targeted as necessitating immediate, short-term, or longer duration prioritization for improvement initiatives. ResultsA Perioperative Harm Index was created using 11 metrics that represent the spectrum of surgical care. The metrics facilitate prioritization of improvement initiatives and have resulted in improvement projects including perioperative normothermia in neonatal intensive care unit patients having procedures in the operating room, reduction of post-operative nausea and vomiting, and decrease in surgical site infections in selected procedures. ConclusionsA Perioperative Harm Index facilitates immediate shared understanding of the harm resulting from the care of surgical patients. As such, this index enables rapid and rationale prioritization for improvement activities. Our harm index is shared, is broadly generalizable, and has facilitated prioritization of improvement opportunities and appropriate allocation of improvement resources at our organization. Levels of EvidenceLevel V.