Incidence Of Pin Site Infection Research Articles

The Influence of Pin Material and Coatings on the Incidence of Pin Site Infection after External Fixation

Introduction: External fixation is used for a wide variety of surgical treatments. The transcutaneous pins used in external fixation, however, provide a route for bacterial migration from the external to subcutaneous space, and high rates of pin site infection have been reported. The material of which the pin is composed, or any surface coating that is applied, may significantly influence tissue integration and pin site infection. However, clinical data are scarce. The aim of this systematic review and meta-analysis was to summarize the clinical evidence for the role of pin material, and surface coatings, on the incidence of infection at external fixator pin sites. Materials and Methods: A systematic review was performed following registration with PROSPERO. A search was performed using Medline, Embase, and Cochrane. Inclusion criteria were (1) recorded diagnosis of infection, (2) involved external fixation, (3) any bone, (4) English language, (5) human subjects, (5) pin material known, and (6) all levels of evidence. All stages of the review process were performed by two independent reviewers. A meta-analysis was performed using a random effects model meta-analysis to produce odds ratios. Study bias was assessed using the Cochrane risk of bias tool Rob II. Strength of evidence was based on the American Academy of Orthopaedic Surgeons methodology for defining the strength of recommendation. Results: After exclusion, 8 studies were further analyzed. One study compared stainless steel and titanium with an odds ratio of 1.00 (95% confidence interval [CI]: −0.70–2.70). Three studies compared stainless steel to hydroxyapatite (HA)-coated pins with an odds ratio of 0.25 (95% CI: −0.52–1.02). Two studies analyzed titanium compared to HA-coated pins with an odds ratio of 1.12 (95% CI: −4.25–6.48). Two studies analyzed silver compared to stainless steel with an odds ratio of 0.12 (95% CI: −0.89–1.12). However, the strength of evidence was limited for all studies. Overall, 0 studies had a low risk of bias, 4 studies had an unknown risk of bias, and 4 studies had a high risk of bias. Conclusion: There is currently limited evidence of the effect of different pin material or coatings on the incidence of pin site infection, with the available studies showing contrasting results. Further high-quality and adequately powered studies are required to provide definitive guidance.

Reducing the incidence of pin site infection in hand surgery with the use of a protocol from Ilizarov.

Reported pin site infection rates in Kirschner wire fixation in the hand and wrist vary from 2% to 35%. In our unit we follow a strict pin site management protocol adapted from the Russian Ilizarov Scientific Centre. This study aims to identify if our current protocol reduces the incidence of pin site infection in hand and wrist surgery, and improves wire survival rates, to a level where exposed wires can be used safely. A retrospective review of 200 patients, treated with 369 percutaneous wires, in our hand surgery department over a 6-year period was carried out. Nine patients (4.5%) were diagnosed with a pin site infection with a wire survival rate of 99.5%.In our unit using our current protocol, results support the safe use of exposed wires with appropriate pin site care initiated in theatre. Adherence to this protocol allows wires to remain in-situ throughout treatment with minimal complications.Level of evidence: IV.

A Staged Approach to Combined Extra-articular Limb Deformity Correction and Total Ankle Arthroplasty for End-Stage Ankle Arthritis.

Patients presenting with end-stage ankle osteoarthritis (OA) in the setting of a concomitant extra-articular limb deformity pose a challenging problem that has not yet been described in the literature. We describe a case series of patients treated with external and internal fixation techniques followed by total ankle arthroplasty (TAA) in a staged approach to treat this complex presentation. Eight patients with limb deformity and end-stage ankle OA who underwent staged deformity correction and TAA from 2016 to 2019 at our institution were retrospectively identified. Average age was 58.5 (range, 49-68) years, with an average follow-up of 2.6 (range, 0.8-4.2) years. All patients underwent limb reconstruction with either tibial osteotomy with a circular frame (n=6) or intramedullary nail (n=2). Limb deformities consisted of the following: posttraumatic tibial malunion (2), limb length discrepancy (1), acquired tibial deformity (1), genu varum (2), or genu valgum (2). Radiographic parameters were assessed pre- and postoperatively on 51-inch standing and ankle radiographs: limb length discrepancy (LLD), genu varum/valgum deformity, recurvatum deformity, mechanical axis deviation, medial proximal tibial angle, lateral distal tibial angle, anterior distal tibial angle, and tibiotalar alignment. Pre- and postoperative patient-reported outcomes were assessed using 2 metrics, the Limb Deformity-Scoliosis Research Society (LD-SRS) and Patient-Reported Outcomes Measurement Information System (PROMIS) scores (Physical Function, Pain Intensity, Pain Interference, Global Physical Function, and Global Mental Function). Following staged limb deformity correction and TAA, all patients achieved correction of LLD and angular deformities of the lower limb, along with restoration of normal alignment of the ankle joint. There was significant mean improvement in all patient-reported LD-SRS and PROMIS domains, except for LD-SRS mental health. LD-SRS function improved from 2.6 (±0.7) to 4.6 (±0.2), P = .008; pain improved from 2.9 (±0.9) to 4.8 (±0.2), P = .012; self-image improved from 2.9 (±0.4) to 4.7 (±0.3), P < .001; and total LD-SRS improved from 3.3 (±0.4) to 4.8 (±0.2), P = .002. Average satisfaction was 4.9 (±0.3). PROMIS physical function improved from 32.3 (±6.8) to 51.3 (±5.3), P = .008; pain interference improved from 66.0 (±9.1) to 41.3 (±6.2), P = .004; pain intensity improved from 60.0 (±13.3) to 33.1 (±5.3), P = .007; global physical health improved from 39.3 (±6.8) to 60.7 (±5.1), P = .002; global mental health improved from 54.8 (±5.9) to 65.6 (±2.8), P = .007. There was one incidence of pin site infection and one reoperation. Deformity correction with either external frame or intramedullary nail fixation followed by TAA in a staged approach was a viable surgical option in the treatment of end-stage ankle OA with concurrent extra-articular limb deformity. This unique approach was capable of achieving deformity correction with improved patient-reported outcomes, minimal complications, and good patient satisfaction. Level IV, retrospective case series.

Nursing performance associated with providing complete preventive nursing care and its relation with incidence of pin site infection: turn the lens inside

Background Nurses are health care workers who play an essential role in protecting patients from infection. Nurses spend more time with patients than do any other health care providers, and patient outcomes are affected by nursing care quality. Thus, improvements in patient safety can be achieved by improving nurse performance. Aim The aim was to explore nursing performance related to quality of providing complete preventive nursing care and incidence of pin site infection. Participants and methods Nursing performance associated with quality of providing complete preventive nursing care will be associated with low incidence of pin site infection. A quasi-experimental design was used. this study was conducted in the trauma department of Assiut University Hospital. The study included 50 nurses and 60 patients. Three tools were used, namely, sociodemographic data of studied nurses and patients; clinical nurses’ performance observational checklist; and infection staging tool. Results There is a statistically significant between clinical nurses’ performance and low incidence of pin site infection with respect to study and control groups. Only two cases of grade I (6.7%) appeared in the study group, whereas 10 (33.3%) cases were grades I, II, and III (6.7, 20.0, and 6.7%, respectively) in the control group. Conclusion The authors found that nurses have moderate performance level, and it is associated positively with low incidence of pin site infection in patients who perceived complete preventive nursing care. Recommendation Nursing management, as represented by supervisors and head nurses, must ensure that staff nurses in clinical units perform nursing care completely under their supervision. Nursing and medical management should conduct workshops about the importance of providing complete nursing care and its effect on patients’ outcome and consequently on organization as a whole.

Incidence of Pin Site Infection in Buried versus Unburied K-wire Fixation Techniques in Fracture Fixation

Incidence of Pin Site Infection in Buried versus Unburied K-wire Fixation Techniques in Fracture Fixation

Evidence-based nursing for a pin site nursing method among patients with bone pin surgery

Objective To formulate an evidence-based nursing scheme of a pin site nursing method to reduce the incidence of pin site infection among patients with bone pin surgery. Methods Under the principle of PICO, the issue was put forward aiming directly at patient's clinical manifestations. By some database retrieval and evaluate the retrieval of literature evidence, the optimal evidence will be applied to the patients and the curative effect were observed. Results A total of 1 systematic review, 1 cohort study and 9 randomized controlled trials (RCTs) were included. According to the available evidence mentioned herein and patient's conditions, they developed a new pin site nursing method and applied to patients. Seven days later, the two pin sites with infection symptoms obviously improved, with decreasing secretion, without skin redness and pain, and the temperature of skin was normal. The other six pin sites without infection did not occur infection. Conclusions The patients with pin sites using based iodine disinfection and sterile gauze strip winding better than the conventional alcohol drop pin site in reducing infection. Key words: Nursing care; Evidence-based nursing; Pin site; Pin site infection; Disinfection

Pin site care for preventing infections associated with external bone fixators and pins

Metal pins are used to apply skeletal traction or external fixation devices in the management of orthopaedic fractures. These percutaneous pins protrude through the skin, and the way in which they are treated after insertion may affect the incidence of pin site infection. This review set out to summarise the evidence of pin site care on infection rates. To assess the effect on infection rates of different methods of cleansing and dressing orthopaedic percutaneous pin sites. In September 2013, for this third update, we searched the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. We evaluated all randomised controlled trials (RCTs) that compared the effect on infection and other complication rates of different methods of cleansing or dressing orthopaedic percutaneous pin sites. Two review authors independently assessed the citations retrieved by the search strategies for reports of relevant RCTs, then independently selected trials that satisfied the inclusion criteria, extracted data and undertook quality assessment. A total of eleven trials (572 participants) were eligible for inclusion in the review but not all participants contributed data to each comparison. Three trials compared a cleansing regimen (saline, alcohol, hydrogen peroxide or antibacterial soap) with no cleansing (application of a dry dressing), three trials compared alternative sterile cleansing solutions (saline, alcohol, peroxide, povidone iodine), three trials compared methods of cleansing (one trial compared identical pin site care performed daily or weekly and the two others compared sterile with non sterile techniques), one trial compared daily pin site care with no care and six trials compared different dressings (using different solutions/ointments and dry and impregnated gauze or sponges). One small blinded study of 38 patients found that the risk of pin site infection was significantly reduced with polyhexamethylene biguanide (PHMB) gauze when compared to plain gauze (RR 0.23, 95% CI 0.12 to 0.44) (infection rate of 1% in the PHMB group and 4.5% in the control group) but this study was at high risk of bias as the unit of analysis was observations rather than patients. There were no other statistically significant differences between groups in any of the other trials. The available trial evidence was not extensive, was very heterogeneous and generally of poor quality, so there was insufficient evidence to be able to identify a strategy of pin site care that minimises infection rates. Adequately-powered randomised trials are required to examine the effects of different pin care regimens, and co-interventions - such as antibiotic use - and other extraneous factors must be controlled in the study designs.

Complications of transcutaneous metal devices

A high incidence of associated infection with the use of transcutaneous metal devices has been widely reported. The aims of this study were: (1) to record the incidence of pin site infection in a Plastic Surgery department, (2) to compare the infection rate in our department with published literature and (3) to identify factors that contribute to infection. A prospective cohort study was performed including all patients presenting to the plastic surgery unit with any type of transcutaneous metal in situ over a 3-month period. Patients and staff were questioned on wound hygiene and whether they had been provided with specific protocols. Our study revealed an infection rate of 24%. Patients and staff were not aware of preventive protocols. From this study, the following conclusions are made: (1) pin site infection is a major problem, and no consensus has been reached on the best way to manage pin sites, (2) there is variable knowledge of pin-site care, (3) there is a need for a clearer definition of pin-site infection and a standardised system of assessment, classification and treatment and (4) there is a need for more innovative technology in pin-site manufacture as studies reveal that the type of material used in the pins does affect infection rates.

Studies of Photokilling of Bacteria Using Titanium Dioxide Nanoparticles

Metal pins used to apply skeletal traction or external fixation devices protruding through skin are susceptible to the increased incidence of pin site infection. In this work, we tried to establish the photokilling effects of titanium dioxide (TiO2) nanoparticles on an orthopedic implant with an in vitro study. In these photocatalytic experiments, aqueous TiO2 was added to the tested microorganism. The time effect of TiO2 photoactivation was evaluated, and the loss of viability of five different bacteria suspensions (Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus hirae, and Bacteroides fragilis) was examined by the viable count procedure. The bactericidal effect of TiO2 nanoparticle-coated metal plates was also tested. The ultraviolet (UV) dosage used in this experiment did not affect the viability of bacteria, and all bacteria survived well in the absence of TiO2 nanoparticles. The survival curve of microorganisms in the presence of TiO2 nanoparticles showed that nearly complete killing was achieved after 50 min of UV illumination. The formation of bacterial colonies above the TiO2 nanoparticle-coated metal plates also decreased significantly. In this study, we clearly demonstrated the bactericidal effects of titanium dioxide nanoparticles. In the presence of UV light, the titanium dioxide nanoparticles can be applicable to medical facilities where the potential for infection should be controlled.

Pin site care for preventing infections associated with external bone fixators and pins.

Metal pins are used to apply skeletal traction or external fixation devices in the management of orthopaedic fractures. These pins protrude through the skin and are therefore described as 'percutaneous' and much has been written on the management of the associated skin wound. The way in which percutaneous pins are treated may affect the incidence of pin site infection. Recommendations for care are not necessarily evidence based. This review set out to summarise the research evidence on the effect of pin site care on infection rates. To assess the effect on infection rates of different methods of cleansing and dressing orthopaedic percutaneous pin sites. The following electronic databases were searched: Medline (from 1966), the Cochrane Central Register of Controlled Trials (2003 issue 1) and the Wounds Group Specialised Trials Register (March 2003). In addition reference lists of review articles and relevant trials were also searched and some handsearching undertaken. All randomised controlled trials (RCTs) in people comparing the effect on infection rates of different methods of cleansing or dressing orthopaedic percutaneous pin sites were evaluated. Two reviewers independently assessed the citations retrieved by the search strategies for reports of relevant RCTs. Only one trial was eligible for inclusion in the review. Henry (1996) compared cleansing with 0.9% saline, cleansing with 70% alcohol and no cleansing and found significantly fewer infections in pin sites which had not been cleansed. There is very little evidence as to which pin site care regimen best reduces infection rates. Clearly there is a need for large RCTs to determine the best method of pin site management.

External fixation – the incidence of pin site infection: a prospective audit

The need for external fixation arose from the limitations of available techniques for non-operative immobilization and the poor results of operative techniques. External fixation offers several advantages over other fixation methods but has its complications, the most common being pin site infection. This prospective study investigates the factors affecting the incidence of pin site infection, and in particular the location of the fixator and if corrections were being carried out. Seventy-one percent of the population audited developed infection. Femoral fixators had the highest incidence rate (86.5%), with those femoral fixators undergoing corrections having a 2.5-fold greater incidence than those which were not.

Fracture of the tibial diaphysis treated by external fixation and the axial alignment grid: a single surgeon's experience

The results of tibial fracture fixation for 50 unstable closed and open fractures, using the dynamic axial fixator (DAF) and the limb axial alignment grid have been assessed both clinically and radiologically. Each patient has been carefully followed up in a dedicated clinic and each procedure was conducted or directly supervised by the senior author. All patients achieved union, although 16 per cent required a further procedure such as bone grafting or fibula osteotomy to secure this and a further 6 per cent were revised to intramedullary nails. There was a malunion rate of 16 per cent, but no patients requested further treatment for functional problems. The incidence of pin-site infection was 10.4 per cent, each patient taking responsiblity for their own pin-site care. There were no deep infections. The results achieved in this series compare favourably with those of other treatment modalities for this fracture, which may often be difficult to manage. Given the stringent adherence to the important principles of fixator application and well supervised follow-up which are practised on this unit, we believe that the results as presented here may well represent the limit achievable with this device. Furthermore, the authors would recommend that the technique remains an important option in tibial fracture management, particularly for the unstable closed and open fractures.