Dirty Cases Research Articles

Surgical Site Infections in Elective and Emergency Abdominal Surgeries: A Prospective Observational Study About Incidence, Risk Factors, Pathogens, and Antibiotic Sensitivity at a Government Tertiary Care Teaching Hospital in India.

Background Surgical site infections (SSIs), the third most common nosocomial infection, endanger hospitals and patients. SSIs must be monitored continuously. This present study examined SSI incidence, risk factors, pathogens, and antibiotic sensitivity in emergency and elective or planned abdominal surgeries. Methods The Dr. S.N. Medical College General Surgery Department in Jodhpur, India, operated on 100 patients. The sample was divided into two 50-person groups. Group A includes emergency surgery patients, while Group B includes elective surgery patients. The samples were aseptically collected and processed according to microbiological methods. Data were processed with IBM SPSS Statistics for Windows, version 20 (released 2011; IBM Corp., Armonk, New York, United States). Results Out of a sample size of 100 patients, 17 individuals experienced SSIs. SSIincidence was 16.66% in male patients and 18.18% in female patients. In addition, the rate of SSIs was 26% in the emergency group and 8% in the planned group. The association was stronger among elderly individuals, diabetics (33.33% in Group A and 12.5% in Group B), and anemics with a history of smoking. The association was higher in those who underwent surgery for more than 60 minutes (34.37% in Group A and 18.8% in Group B). The incidence of SSIs was higher in emergency cases compared to elective surgeries, with rates of 26% and 8%, respectively, but was statistically insignificant. The infection rate in clean cases during planned surgery was 3.70%, while clean contaminated cases during planned surgery had a wound infection rate of approximately 13.04%. In emergency surgery, no clean case was operated on, but the SSI rate in the emergency group was 9.09%, 22.22%, and 47.36% in the clean-contaminated, contaminated, and dirty cases, respectively.In Group A, Escherichia coli was the predominant organism found in SSI wounds, while in Group B, Staphylococcus aureus was the predominant organism, accounting for 46.15% and 50% of infections, respectively. Amikacin and metronidazole exhibited the highest efficacy against E. coli, with amikacin demonstrating the highest sensitivity. Conclusion SSIs are more common in emergencies than planned procedures. Age, gender, diabetes, hypertension, smoking, and prolonged surgery are risk factors for SSIs. Effective antibiotic policy and infection control can greatly prevent SSIs.

Dirty Hands Defended

Abstract This paper defends the possibility of dirty hands against the longstanding skepticism that an action cannot be simultaneously right and wrong and that dirty hands cases are therefore impossible. While skeptics are right to recognize that prima facie reasons against violating moral duties may be overridden, they are wrong to deny that actions required by necessity may nevertheless remain wrong. Dirty hands cases capture the simultaneous necessity of disregarding moral duties in certain circumstances and the reprehensibility of wronging people even in cases in which this is all-things-considered permissible. Rather than indicating any deficiency in our moral reasoning, the capacity to accommodate the possibility of dirty hands, along with the reality of moral conflict, is a strength of a moral theory.

Quality improvement approach for surgical-site infection prevention in a Philippine provincial hospital

Background: Globally, the 30-day cumulative incidence of surgical-site infections (SSI) was 11% (95% CI, 10%–13%) based on the systematic review and meta-analysis derived from 57 studies. SSIs are poorly studied in the Philippines. Americares and its hospital partner, Camarines Norte Provincial Hospital, Philippines, sought to reduce SSIs through (1) establishing SSI surveillance in the hospitals’ surgical departments, (2) implementing quality improvement processes, and (3) developing and implementing an SSI prevention care bundle. Methods: A quality improvement methodology was used to introduce SSI surveillance and care-bundle checklist in partnership with Americares. Using paired t tests, pre- and posttest scores of the SSI care bundle training were analyzed. SSI surveillance was established based on the adapted CDC criteria. All clean surgeries were monitored except orthopedic surgeries. The number of surgeries performed, monitored, and SSIs identified were documented using the surveillance forms and plotted using Microsoft Excel software. A care bundle based on WHO evidence-based interventions for SSI prevention was designed and implemented. Compliance with the SSI care bundle was documented using Microsoft Excel. The relationship between the use of a care bundle and SSIs was analyzed using the Pearson correlation coefficient. Results: An online SSI care bundle training session was conducted. Overall, 150 participants had a mean pretraining test score of +6.46. After the training was conducted, the same participants had a mean posttraining test score of + 1.76). a statistically significant increase of 5.29 (95% CI). Thereby, the mean score difference after training showed that knowledge increased overall. These findings show an average of 90.43% compliance with the SSI care-bundle checklist over the 18-month window from May 2021 to November 2022. From a baseline of 0%, compliance increased from 80% upon its introduction in May 2021. Lastly, the SSI incidence rate from May 2021to November 2022 averaged 1.89%. The days between reported SSIs averaged 16.85. No baseline was available for comparison prior to the introduction of the surveillance and care bundle. A Pearson r data analysis (n = 1,850) was used to determine the relationship between the use of the care bundle and SSIs. The data illustrated a moderate negative correlation (r = −.31). Therefore, higher care-bundle compliance yielded fewer SSI cases. Conclusions: The use of an evidence-based care bundle paired with a local quality improvement process significantly improved SSI prevention and surveillance. Future studies are needed that include clean-contaminated, contaminated, and dirty surgical cases to test the degree of SSI reduction possible.Disclosures: None

Incidence of Surgical Site Infection in Patients Presented for Orthopaedic Surgery

Objective: To find out the incidence of surgical site infection in clean cases of orthopaedic surgery. Study design: Retrospective descriptive study. Setting: Trauma and orthopaedic unit Gulab Devi Hospital. Duration: April 2018 to November 2021 Methodology: Using non probability (purposive) sampling a total of 800 patients who underwent an invasive surgical procedure during the specified time period was included in the study. While all non-invasive procedures such as manipulations, application of plaster casts and image guided intra-articular injections were excluded from study. p-value< 0.05 was considered as significant Results: There were 504(63%) male patients and 296(37%) female patients. Age range was between 01 to 86 years. Mean age was 30±6.7 years. After performing surgery, all patients were followed up for minimum of four weeks to record SSIs. Post-operatively infection was detected in 17(2.12%) of our patients. SSI was 5.8% in clean cases, 23.5% in clean contaminated and 70.5% in dirty cases. The prevalence of SSI were significantly higher in those patients already having dirty wound before procedure as p<0.05 Conclusion: Surgical Site infection (SSI) rates reported in this study setting are are comparable to international standards. Keywords: Orthopedic, Surgical site infections, Trauma, Wound management

Sequence of mixed ophthalmic operating lists: A national survey of UK consultants

Ophthalmic surgical operating lists include intraocular and extraocular procedures, as well as clean non-infectious and dirty infectious cases. Patient age, diabetic status, local or general anaesthesia must be considered during ophthalmic theatre scheduling. Traditionally children and 'clean cases' are prioritised. However, factors such as the need for an interpreter, patient transport and latex allergy affect the sequencing of ophthalmic lists. An electronic survey was sent to all UK ophthalmology consultants through the Royal College of Ophthalmologists registry, enquiring about their preference in sequencing mixed theatre lists, what operations they considered clean and dirty, and the presence of departmental protocol for list sequencing. There was a 16.9% response rate (n = 222/1311). A majority of 75.2% (n = 167/222) had mixed operating lists of intraocular and extraocular cases. Of those performing mixed operating lists, 44.3% (n = 74/167) stated they would operate on intraocular cases before extraocular cases, and 92.8% (n = 155/167) would perform 'clean' before 'dirty' cases. Fifty-nine per cent (n = 98/167) have a departmental protocol to help determine list order. This survey has demonstrated that there is a trend to perform 'clean' before 'dirty' and intraocular before extraocular cases. Given the results of the survey, we outline our recommendation on how to sequence mixed ophthalmic theatre lists.

Observational Cohort Study on the Use of a Slowly Fully Resorbable Synthetic Mesh (Phasix™) in the Treatment of Complex Abdominal Wall Pathology with Different Grades of Contamination

Purpose: Abdominal wall hernia repair in contaminated cases remains a therapeutic challenge due to the high risk of post-operative surgical site occurrences (SSO). Slowly resorbable synthetic (biosynthetic) meshes have recently been introduced and may offer unique advantages when challenged with bacterial colonization during abdominal wall reconstruction. Methods: A multicenter single-arm retrospective observational cohort study examined all consecutive patients in whom a poly-4-hydroxybutyrate mesh (Phasix™ or Phasix™ ST; Becton Dickinson, Franklin Lakes, NJ, USA) was used for the repair of an inguinal or ventral/incisional hernia, or to replace an infected synthetic mesh. Patient records were analyzed according to the level of contamination, using the classification score of the Centers for Disease Control and Prevention (CDC). The primary objective was to evaluate short-term postoperative morbidity by assessing SSOs and the need for reoperation or even mesh excision. Results: A total of 47 patients were included. The median age was 68 years (30-87), the male/female ratio was 26/21, and the median BMI was 26.5 kg/m2 (16.4-46.8). There were 17 clean cases, 17 clean-contaminated, 6 contaminated and 7 dirty. Median follow-up time was 48 days. An SSO was seen in 4 clean (23.5%), 7 clean-contaminated (41.2%), 2 contaminated (33.3%) and 5 dirty cases (71.4%). A surgical site occurrence requiring procedural intervention (SSOPI) was seen in 2 clean (11.8%), 3 clean-contaminated (17.6%), 1 contaminated (16.7%) and 2 dirty cases (28.6%). Hernia recurrence was seen in 1 clean (5.9%), 2 clean-contaminated (11.8%) and 3 dirty cases (42.9%). Mesh excision had to be performed in only one case in the contaminated group. Conclusion: The Phasix™ mesh shows promising short-term results when used in contaminated hernia-related surgery. Even in contaminated or dirty conditions, with or without infection of the mesh, resection of the mesh only had to be performed once and patients could be managed either conservatively or by relatively minor reoperations. However, further research is needed to fully evaluate the safety and efficacy of these meshes.

A STUDY OF POST OPERATIVE WOUND INFECTION AND MANAGEMENT

OBJECTIVE:-this study was designed to evaluate the postoperative wound Infection, common risk factors and the different organisms which were involved in cases of clean and clean-contaminated, contaminated and dirty surgeries. Method and materials: - The study was conducted in the department of surgery, JA group of hospital, Gwalior in collaboration with departmental of microbiology. G.R.MEDICAL COLLEGE GWALIOR. For duration of one year. The bio data of the patients, together with their clinical features, diagnosis, the type of surgery which was performed and the development of any complications, which included wound infections, was noted and the data was analyzed. RESULTS:-out of 150 patients, we found that age of more than 60 years was to be more risk factor 20%(5 of out of 25) and less risk factor to be present in below 20 years age group 8.33%(1 out of 12). The incidence amongst the clean case was 2.7 %(1 out of 36), among the clean contaminated cases , it was 9.3% (6 out of 64), among the contaminated cases it was 17.6%(3 out of 17), among the dirty cases , it was 24.2%(8 out of 33). Positive cultures were obtained from the infected wounds. The commonest bacterial isolates were staph aureus(32%), S.epid, E.coli, Ps.aureginosa, Klebseilla

The Gor'kov and Melik‐Barkhudarov Correction to the Mean‐Field Critical Field Transition to Fulde–Ferrell–Larkin–Ovchinnikov States

AbstractThe Fulde–Ferrell–Larkin–Ovchinnikov (FFLO) states, characterized by Cooper pairs condensed at finite‐momentum are, at the same time, exotic and elusive. It is partially due to the fact that the FFLO states allow superconductivity to survive even in strong magnetic fields at the mean‐field level. The effects of induced interactions at zero temperature are calculated in both clean and dirty cases, and it is found that the critical field at which the quantum phase transition to an FFLO state occurs at the mean‐field level is strongly suppressed in imbalanced Fermi gases. This strongly shrinks the phase space region where the FFLO state is unstable and more exotic ground state is to be found. In the presence of high level impurities, this shrinkage may destroy the FFLO state completely.

Relation of Superconducting Pairing Symmetry and Non-Magnetic Impurity Effects in Vortex States

Non-magnetic impurity scattering effects on the vortex core states are theoretically studied to clarify the contributions from the sign-change of the pairing function in anisotropic superconductors. The vortex states are calculated by the Eilenberger theory in superconductors with p x -wave pairing symmetry, as well as the corresponding anisotropic s-wave symmetry. From the spatial structure of the pair potential and the local electronic states around a vortex, we examine the differences between anisotropic superconductors with and without sign-change of the pairing function, and estimate how twofold symmetric vortex core images change with increasing the impurity scattering rate both in the Born and the unitary limits. We found that twofold symmetric vortex core image of zero-energy local density of states changes the orientation of the twofold symmetry with increasing the scattering rate when the sign change occurs in the pairing function. Without the sign change, the vortex core shape reduces to circular one with approaching dirty cases. These results of the impurity effects are valuable for identifying the pairing symmetry by observation of the vortex core image by the STM observation.

Safety and Efficacy of Synthetic Mesh for Ventral Hernia Repair in a Contaminated Field

Controversy remains about appropriate mesh selection during ventral hernia repair (VHR) in a contaminated field. Fear of mesh infection has led to increased use of biologic and absorbable synthetic meshes rather than permanent synthetic mesh in these cases. We report the safety and efficacy of permanent synthetic mesh during contaminated VHR. Retrospective review of our database identified all cases of contaminated VHR from July 2007 to May 2019. Student's t-test and Wilcoxon rank sum were used to analyze continuous variables, and discrete variables with Fisher's or Kruskal-Wallis test. There were 541 contaminated cases: 245 clean-contaminated, 214 contaminated, and 82 dirty cases. Suture repair was performed in 46 patients, biologic mesh was used in 38, absorbable synthetic mesh in 55, and permanent synthetic mesh in 402. Mesh was extraperitoneal in 97% of cases. Incidence of surgical site infection in each group was 17.4%, 36.8%, 32.7%, and 14.2%, respectively (p < 0.001). Multivariate analysis showed no effect of mesh selection on risk of surgical site infection. Mesh was removed in 7 patients; 5 were permanent synthetic (1.2%), 1 was absorbable synthetic (1.8%), and 1 was biologic (2.6%). In 4 patients there was mesh-specific complication and the remaining meshes were removed during exploration for indications unrelated to the mesh. At a median follow-up of 30.2 months, recurrence occurred in 15.2% of patients and was significantly lower with permanent synthetic mesh. Permanent synthetic mesh placed in an extraperitoneal position is not only safe for VHR in a contaminated field, but it confers a significantly lower rate of surgical site infection and recurrence compared with biologic or bioabsorbable meshes.

Dirty hands and the fragility of democracy

Dirty hands cases are often seen as a crucial challenge for political ethics. Michael Walzer’s analysis of dirty hands cases has been especially influential. On closer inspection, however, Walzer’s analysis contains some serious flaws. This article examines how and to what extent the political ethics of Paul Ricoeur can remedy the problems in Walzer’s approach. It is shown that Ricoeur’s approach can offer a better understanding of what is at stake in dilemmas in political action and that it can provide guidance for dealing with such issues. Ricoeur’s analysis, furthermore, provides the foundation for a more critical political ethics than Walzer can offer.

Minimizing Risks in Minimally Invasive Surgery: Rates of Surgical Site Infection Across Subtypes of Laparoscopic Hysterectomy

To compare the 30-day incidence of deep or organ-space and/or superficial incisional surgical site infections (SSIs) by the subtype of laparoscopic hysterectomy and to report on additional risk factors for SSIs following laparoscopic hysterectomy. Retrospective cohort study. American College of Surgeons National Surgical Quality Improvement Program Database. Women undergoing laparoscopic hysterectomy from 2012 to 2014. Women were stratified into 3 groups by the type of hysterectomy: total laparoscopic hysterectomy (TLH), laparoscopic-assisted vaginal hysterectomy (LAVH), and laparoscopic supracervical hysterectomy (LSCH). Demographic and clinical characteristics were compared for the 3 groups using the Kruskal-Wallis test or 1-way analysis of variance, where appropriate, for continuous variables and the chi-square or Fisher's exact test for categoric variables. Post hoc analyses were performed for multiple comparisons. Univariate analyses to examine the association with SSI were performed using the t test or Wilcoxon rank sum test as appropriate for continuous variables and the chi-square test or Fisher's exact test as appropriate for categoric variables. Significant variables on univariate analysis were included in a stepwise, backward multivariable logistic regression to identify the independent risk factors of SSI. In total, 46 755 women underwent laparoscopic hysterectomy. Most were classified as TLH (26 009, 56%), followed by LAVH (13 884, 30%), and LSCH (6862, 14%). The overall rate of 30-day deep or organ-space SSI was 1.8% (n = 445). Thirty-day deep or organ-space SSI was lower in women who underwent LSCH (0.6%) than in women who underwent TLH (1.0%) or LAVH (1.1%; p = .001), but there was no difference in the incidence of superficial incisional SSI (0.8%, 0.8%, and 0.8% for TLH, LAVH, and LSCH, respectively; p = .75). On multivariate regression analysis, LSCH remained independently associated with a decreased risk of deep or organ-space SSI (adjusted odds ratio, 0.60; 95% confidence interval, 0.43-0.84; p = .003). In addition, relative to the women who were discharged on the same day, women admitted for >24 hours had 2-fold increased odds of deep or organ-space SSI. Asian race, smoking, perioperative transfusion, dirty or infected cases, and American Society of Anesthesiologist class 3 were associated with increased odds for deep or organ-space SSI. Length of stay >24 hours and Native Hawaiian/Pacific Islander race were associated with increased odds of superficial incisional SSI. LSCH is associated with a decreased risk of deep or organ-space SSI compared with other subtypes of laparoscopic hysterectomy. Same-day discharge after laparoscopic hysterectomy is associated with decreased odds of SSI.

1246. Outcomes of Extended Spectrum β-Lactamases Producing Enterobacteriaceae Colonization among Patients Underwent Abdominal Surgery

BackgroundTo evaluate the outcomes of surgical patients colonized with extended-spectrum β-lactamases (ESBL) producing enterobacteriaceae (EN).MethodsA prospective cohort study was performed from February 1, 2016 to April 1, 2019. All patients who underwent abdominal surgical procedures were enrolled. Enrolled surgical patients were screened for ESBL EN colonization by rectal swab culture 1 day before and 5 days after surgery. Data collection included clinical characteristics, risk of SSIs, previous hospitalization, and type of surgical procedure, antibiotic prophylaxis and duration, ASA risk class, and 28-day postoperative outcomes, inclusive of SSIs and associated microbiological data.ResultsAmong 360 prospectively enrolled patients, 204 (56%) were male; the abdominal surgical types included 234 (65%) clean-contaminated, 90 (25%) contaminated, and 36 (10%) dirty cases. Pre-op,129 patients (36%) had ESBL EN colonization. Surgical prophylaxis included second-generation cephalosporins (N = 224, 62%), third-generation cephalosporins (N = 92, 25%), and carbapenems (N = 44, 12%). Post-operative SSIs were identified in 51 patients (14.1%) [superficial SSIs (N = 41) and intra-abdominal SSIs (N = 10)] By multivariate analysis, ESBL EN colonization (aOR = 2.4; 95% CI = 1.19–19.91) and dirty abdominal wound classification (aOR = 3.6; 95% CI = 1.94–16.99) were independent risk factors for SSIs. Culture detection of SSI pathogens differed for superficial vs. intra-abdominal SSIs. Pathogens associated with superficial SSIs included Staphylococcus aureus (10/41;24%), Streptococcus spp. (5/41; 12%), Pseudomonas aeruginosa (6/41; 15%) and non-ESBL EN (16/41;39%). In contrast, all 10 cases of intra-abdominal SSIs were attributed to ESBL EN.ConclusionEnteric colonization with ESBL EN was an independent predictor of intra-abdominal SSIs due to ESBL EN, while superficial SSIs were associated with a variety of non-ESBL pathogens. Our study support the need for awareness of the SSI risks associated with ESBL EN. Additionally, the findings support current surgical prophylactic guideline for the use of non-carbapenem among ESBL EN colonizer undergoing abdominal surgery.Disclosures All authors: No reported disclosures.

Electron transport properties of silicene: Intrinsic and dirty cases with screening effects

The electronic transport characteristics of silicene sheets are studied by an Ensemble Monte Carlo (EMC) technique in the presence of phonon (acoustic, non-polar optic, surface polar optic), surface roughness and ionized impurity scattering mechanisms. Both intrinsic and silicene on an Al2O3 substrate are considered. Screening is also considered for both ionized impurity and surface polar optic phonon scattering of electrons. The velocity-applied field characteristics are obtained for both cases. A negative differential resistance (NDR) behaviour is observed for intrinsic case only. The mobility of carriers are calculated as a function of temperature for both cases and the results are compatible with existing experimental results and theoretical predictions. The effects of screening and flexural phonons on mobility are also studied.

Accuracy of Parental-Reported Tetanus Vaccination Status for Children With Lacerations.

The aim of this study was to determine whether emergency department (ED) providers are able to accurately assess whether a child with a laceration needs tetanus prophylaxis. We conducted an 8-month prospective cross-sectional study of children presenting with a laceration to a pediatric ED. We asked ED providers whether tetanus prophylaxis was necessary. An ED pharmacist accessed the Utah Statewide Immunization Information System (USIIS), and we assessed the accuracy of the ED provider's determination of necessary tetanus prophylaxis compared with USIIS records. Among 375 patients aged 5 months to 17 years, ED providers made an inaccurate assessment of necessary tetanus prophylaxis in 33 cases (8.8%; 95% confidence interval [CI], 6.3%-12.1%). Emergency department providers would have inappropriately administered tetanus prophylaxis in 5 cases (1.3%; 95% CI, 0.5%-3.2%) and would have missed the need for tetanus prophylaxis in 28 cases (7.5%; 95% CI, 5.2%-10.6%). Emergency department providers were more likely to provide an inaccurate recommendation in older children (8.3 vs 4.8 years; P < 0.001), in patients with a dirty wound (45.5% vs 11.7%; P < 0.001), and in children who had fewer than 3 vaccines recorded in the USIIS (54.5% vs 1.2%; P < 0.001). Emergency department providers may inaccurately assess the need for tetanus prophylaxis in children. Special attention should be paid to cases of dirty wounds and cases in which fewer than 3 tetanus-containing vaccines have been given.

Evaluation of various pre and postoperative parameters associated with types of surgical site infections in abdominal surgeries

Background: Surgical Site Infections (SSIs) contributing to substantial rate of mortality, significant morbidity, considerable prolongation in length of hospitalization and added treatment expenses. The Centers for Disease Control and Prevention (CDC) has classified Surgical site infections (SSI) into superficial, deep, or organ/space SSIs. The objective of study was to evaluate pattern of surgical site infection in various abdominal surgeries.Methods: All patients who admitted in surgical OPD/emergency and undergoing abdominal surgical procedures were included in study. Patients were observed in wards and during follow up to assess signs and symptoms of surgical site infection.Results: Result were analysed in terms of etiology, distribution of cases based on case scenario, wound type, clinical features, number of re-explorations done after development of SSI, type of surgery (laparoscopic v/s open), type of organisms cultured, mortality, co-morbid condition, number of extra days in hospital after SSI and average amount spent after SSI.Conclusions: Surgical site infection is associated with high incidence of morbidity in terms of treatment cost and hospital stay. Average hospital stay, expenditure, co-morbidities and mortality were more in organ/space SSI. Superficial SSI is most common in both laparoscopy and open procedures. Deep and organ/space SSI not seen with laparoscopy. Superficial SSI were more common in clean and clean contaminated cases while superficial SSI was more common in contaminated and dirty cases. In superficial and deep SSI staphylococcus aureus was more common whereas in organ/space SSI E. coli and pseudomonas were common bacterial isolates.

Use of polypropylene mesh in contaminated and dirty strangulated hernias: short-term results.

Synthetic non-absorbable meshes are routinely used in hernia surgery for clean cases but are avoided in the case of clean-contaminated or contaminated hernia or dirty cases to minimize the risk of infection. The present study was conducted to evaluate the outcome of polypropylene mesh in the settings of bowel resection performed for strangulated hernias of the abdominal wall. This prospective observational study was conducted in the Department of Surgery of a teaching hospital in central India between 1st March 2015 and 31st Aug 2017. Adult patients > 18years age, with abdominal wall hernias, presenting with strangulation, and requiring resection and anastomosis for gangrenous bowel were included in the study. Outcomes noted were wound infection, morbidity and mortality, need for the removal of the mesh, and recurrence of the hernia. 30 (22 men and 8 women) patients with strangulated hernias underwent emergency surgery with resection of gangrenous bowel and anastomosis. The 30 cases included 21 inguinal, seven incisional, one femoral and one umbilical hernia. 12 of the 30 cases having gross contamination of the operative wound due to perforated gangrenous bowel were classified as 'dirty'; while the remaining 18 cases with non-perforated gangrenous herniating bowel were classified as 'contaminated'. Wound infection occurred in 8/30 patients (26.67%); but these healed with antibiotics and dressing. Mesh removal was not required in any patient during entire study period. Two recurrences (6.7%; one inguinal and one incisional hernia) were observed. There was no mortality. The use of polypropylene mesh for contaminated and dirty strangulated hernias is effective and safe, with acceptable morbidity and good short-term results.

Incidence & Antibiotics Prophylaxis of Wound Infection in Postoperative Surgery: A Hospital Based Study

criteria should be for clean cases 2.1%, clean contaminated cases 3.3% contaminated cases 6.4% and dirty cases 7.1% Post-operative wound infection has been the greatest obstacle to advancement of surgery down the centuries. Lister introduced antiseptic methods for safe surgery. Methods: All the patients were studied form the time of their admission, till their discharge from the wards, and up to second and fourth week of follow up. Details of individual cases were maintained in the proforma. Routine investigation were done pre-operatively in all the patients. In patients below 40 years complete hemogram, urine routine, blood urea, Serum creatinine and blood sugars were done. The details of the surgical procedure, the duration of surgery and any contamination on table were noted. A second dose of antibiotic was repeated at the end of two hours of operation where the surgery exceeds 2 hours Results: In our study 50 patients were included in this study each of which belong to 10-50 group. 10% belong to 10-20 age group,20% from 21-30 group, 44% from 31-40 age group and 26% belong to 40-60 age group. In our study 44% associated risk factor isolated ,13.6% anemia, DM 45.4% , 9% obesity , bronchitis and 22.7% hypertension. In our study Staphylococcus aureus isolated from two cases and E. coli and P. aeruginosa were isolated from one cases. Conclusion: :- Our study conclude that, In the clean, clean non-contaminated , and contaminated surgeries, single dose of cefazolin with addition of metronidazole when there should be anaerobic coverage can be widely applied in the routine practice.

Operative wound classification: an inaccurate measure of pediatric surgical morbidity

BackgroundWound classification has catapulted to the forefront of surgical literature and quality care discussions. However, it has not been validated in laparoscopy or children. We analyzed pediatric infection rates based on wound classification and reviewed the most common noninfectious complications which could be a more appropriate measure for quality assessment. MethodsWe performed a retrospective review of 800 patients from 2011 to 2014 undergoing common procedures at a tertiary pediatric hospital. Demographics, procedure, wound classification and complications were analyzed using descriptive statistics. ResultsInfection rates were in the expected low range for clean procedures. However, 5% of pyloromyotomy patients required readmission and 10% of circumcision patients developed penile adhesions; 2% required reoperation. Ostomy reversal, a clean contaminated case, had 17% wound infections, whereas acute appendicitis, a contaminated case had only a 4% infection rate. Laparoscopic cholecystectomy (clean-contaminated or contaminated depending on inflammation) had 2% postoperative infections. Perforated appendicitis, a dirty procedure had an 18% infection rate, below the expected >27% for dirty cases in adults. ConclusionsCurrent wound classifications do not accurately approximate the risk of surgical site infections in children, particularly for laparoscopic procedures. It would be more appropriate to grade hospitals based on disease and procedure specific complications.

Wound classification in pediatric surgical procedures: Measured and found wanting

PurposeSurgical wound classification has emerged as a measure of surgical quality of care, but scant data exist in the era of minimally invasive procedures, especially in children. The aim of this study is to examine the surgical site infection (SSI) rate by wound classification during common pediatric surgical procedures. MethodsA retrospective analysis of the 2013 Pediatric–National Surgical Quality Improvement Program (Peds-NSQIP) dataset was conducted. Patients undergoing pyloromyotomy, cholecystectomy, ostomy reversal, and appendectomy were included. Wound classification, SSI rate, reoperation, and readmission were analyzed. ResultsA total of 10,424 records were included. Pyloromyotomy, a clean case, had a 0.7% SSI rate, while ostomy reversal, a clean contaminated case, had an SSI in 6.9% of cases. Appendectomy for nonperforated acute appendicitis and laparoscopic cholecystectomy for cholecystitis, both contaminated cases, had SSI rates of 2.1% and <1%, respectively. Appendectomy for perforated appendicitis, a dirty procedure, had a 9.1% SSI rate, below the expected >40% for dirty cases. Reoperations and readmission rates ranged from <1% to 9% and increased with case complexity. ConclusionCurrent wound classifications systems do not reflect surgical risk in children and remain questionable tools for benchmarking surgical care in children. Role of readmissions and reoperations as quality of care indices needs further investigation.