Incidence Of Surgical Wound Infection Research Articles

EFEKTIFITAS PREPARASI KULIT MENGGUNAKAN KLORHEXIDIN 7,5% SETRIMID 15%-POVIDON IODIN 10% DAN POVIDON IODIN 10%-ALKOHOL 70% TERHADAP INFEKSI LUKA OPERASI SEKSIO SESAREA DI RSUD DR. HARYOTO LUMAJANG

Surgical wound infections are the second most common cause of nosocomial infections and have high morbidity and mortality rates. The use of antiseptic skin preparations is effective in preventing surgical wound infections. There is still insufficient evidence to evaluate the type, concentration and method of use of antiseptic agents for skin preparation in cesarean section. The aim of the study was to determine the effectiveness of skin preparation using chlorhexidine 7.5%, cetrimide 15%-povidone iodine 10% and povidone iodine 10%-alcohol 70% against Wound Infections for Caesarean Section Operations in RSUD Dr. Haryoto Lumajang.
 The research design used is quantitative research with a quasi-experimental approach, post test only-control group design. The population in this study were patients who underwent cesarean section at RSUD Dr. Haryoto Lumajangl. The sample was selected by accidental sampling from 27 February 2023 to 25 March 2023, and 66 respondents were found who met the inclusion and exclusion criteria. The samples were divided into 2 groups: the test group (33 samples) received a combination skin preparation of 7.5% chlorhexidine, setrimide 15% - 10% povidone iodine and the control group (33 samples) received a skin preparation combination of 10% povidone iodine - 70% alcohol . Observation of the surgical wound was carried out on day 3 and day 10.
 The results of this study indicated that there was no incidence of surgical wound infection on the third day. Surgical wound infections on the 10th day in the 7.5% chlorhexidine skin preparation group, setrimide 15% - 10% povidone iodine by 2 respondents and in the 10% povidone iodine skin preparation group - alcohol by 4 respondents. But statistically it was not significantly different from the value of p = 0.395, meaning that Ho was accepted and Ha was rejected, so there was no significant difference between skin preparation using chlorhexidine 7.5% setrimide 15% - 10% povidone iodine and 10% povidone iodine - 70% alcohol on the Incidence of Wound Infection by Caesarean Section at RSUD Dr. Haryoto Lumajang.
 With the difference in the incidence of surgical wound infection, it can be considered and an alternative for Dr. Haryoto Lumajang to use skin preparation using 7.5% chlorhexidine, 15% setrimide-10% povidone iodine
 Keywords: Surgical wound infection, skin preparation, chlorhexidine, povidone iodine, alcohol, cesarean section.

The impact of COVID-19 prevention measures on surgical wound infection rates post-cardiac surgery.

The COVID-19 pandemic had a huge impact on medical services. Several measures have been implemented to reduce the risk of viral transmission. In this paper, we assessed the impact of these measures on surgical wound infection rates in patients post-cardiac surgery. Hypothesis testing was used to compare post-cardiac operation infection rates between the year prior to the COVID-19 pandemic being declared and the first 13 months of the pandemic. The infection rates in 969 patients with operations between 01/03/2019 and 29/02/2020 were compared to those of 925 patients with cardiac surgery between 01/03/2020 and 31/03/2021. Infection rates for various operative urgencies and infection types were analysed. To compare infection rates, a two-tailed pooled z-test using the difference in infection proportions was performed. A 5% significance level was used and only categories with at least 10 patients in both the pre-covid and covid populations were tested. For leg infections, only operations involving coronary artery bypass grafting were included. To ensure that any differences in outcomes were not due to differences in patient demographics resulting in unequal operative risks, Euroscore II values, a measure of cardiac operative risk, were compared between the pre-covid and post-covid cohorts. The Mann-Whitney U-test was used to determine whether the distributions of Euroscore II values were likely to be drawn from the same population. A significance level of 5% was used. A total of 1901 patients (932 during the COVID-19 pandemic) were included in this study. Significant reduction in post-operative infections for all patients undergoing cardiac surgery from 4.3% of patients before COVID to 1.5% during the pandemic. During the pandemic, fewer elective and more urgent operations were performed. This study suggests a significant role of iatrogenic causes in wound infections prior to the pandemic. The implementation of COVID-19 prevention measures in healthcare providers can reduce surgical infection rates. As COVID-19-related restrictions have been eased, we suggest maintaining them in healthcare providers to reduce the incidence of surgical wound infections.

Intraoperative airborne bacterial contamination and covered sterile instrument tables: Is the standard two-drape method better than the single-drape method? Experimental study

BackgroundWe purposed to assess and compare the effectiveness and safety of covering with the single-drape method versus the standard two-drape method recommended by the Association of Perioperative Registered Nurses (AORN) in reducing contamination of the prepared sterile instrument tables (PSITs) with airborne bacteria-carrying particles (ABCPs). MethodsSix agar plates (n = 810) were used to measure the load of ABCPs on each PSIT both at rest (static period) and during a simulated surgical operation (dynamic period). At every time point, this arrangement was repeated two times during data collecting (81 PSITs were established in total). Experimental groups contained PSITs covered with the single-drape and the standard two-drape methods or no cover. We collected the plates after 60, 120, 180, 240 min, and 24 h. ResultsAt all-time points, covering the PSITs during static and dynamic operating theater (OT) conditions led to a meaningfully reduced load of ABCPs on the PSITs (P < 0.05). Moreover, no differences were found between the recommended two-drape method by the AORN and the single-drape method (P > 0.05). ConclusionCovering the PSITs during nonuse and active surgeries helps prevent the PSITs from becoming contaminated and thus can help decrease the incidence of surgical wound infection (SWI). Covering the PSITs with a sterile drape helps protect them from ABCPs that may be shed from the hair and skin of OT nurses (OTNs). Our study showed no priority for using the standard two-drape method compared with the single-drape method.

Determinants That Influence on Infection in Sectio Caesarea Patients at Hermina Bekasi Hospital Period 2021-2022

Nosocomial infections are the leading cause of the world's high rates of morbidity and death. In 2002 the CDC estimated the incidence rate of nosocomial infections in hospitals at approximately 1.7 million people and about 99,000 people dying from these infections. Surgical area infection (IDO) is one of the most nosocomial infections that occurs in hospitals. The use of appropriate prophylactic antibiotics can reduce the incidence of surgical wound infections. In 2014 WHO survey showed that the incidence of surgical area infection (IDO) increased by 1.2 cases per 100 surgical procedures to 23.6 cases per 100 surgical procedures. One of the infections included in the Health Care Associated Infections (HAIs) group is surgical area infections (IDO). The study aims to determine the determinants that affect the incidence of infection in caesarean section patients in hospitals through several determinants studied, namely age, gestational age, maternal parity, comorbidities, maternal health conditions (Hb value), antibiotic type, time of administration, duration of use, route of administration, type of surgery, duration of surgery and Length Of Stay (LOS) with the incidence of IDO in Sectio Caesarea (SC) patients at Hermina Bekasi Hospital for the 2021-2022 period. The design of the retrospective observational study research was carried out with a sample of 350 people. Data were obtained through the Medical Record File (BRM), observation from the time the patient finished SC treatment until control 7 days after treatment at the polyclinic. Data analysis includes univariate analysis, bivariate analysis using quadratic kai test and multivariate analysis with multiple logistic regression non-parametric tests. The results showed that there was an influence between comorbidities (OR = 3,886; 95% CI = 0.948 _ 15,925) and the incidence of IDO. Other factors did not have a significant influence on the incidence of IDO. The results of the double logistic regression non-parametric test found comorbidities to be the most dominant determinant of IDO events. Identification of IDO risk factors can be useful for planning efforts to minimize the incidence of IDO in post-cesarean patients. The use of an improper type of prophylactic antibiotic (ceftriaxone injection) shows an IDO incidence of 0.85% with an effective and efficient cost to be considered to the management of Hermina Bekasi Hospital.

SG-APSIC1175: Reusing of single-use devices management

Objectives: Single-use devices are supposed to be used only once, but under some conditions those devices need to be reused. Therefore, we conducted the “Reuse of Single-Use Devices Management” project in our hospital. We evaluated single-use devices that are reused for the following factors: (1) reuse of the single-use device with the same patient; (2) a manufacturer stop production order; (3) lack of devices in inventory; and (4) device value &gt;5,000 Thai baht (US $150). Every unit in the hospital is able to handle and monitor the reuse of single-use devices systematically for patient safety. We performed a quality surveillance project to monitor and prevent patient infection and injury from worn-out reused single-use devices, and we collected data related to the cost of reusing single-use devices. Methods: In a working group that studied single-use devices, responsibilities and roles were assigned and the purposes and scope of work were established. We reviewed the reuse of single-use devices policy. We created a request form for the reuse of single-use devices and a quality record form for use in units that reused single-use devices. We analyzed outcomes, monitored data, and audited the completion of these forms on these units. We assured the completion of single-use device registration. We measured the rate of reuse of single-use devices. We monitored the incidence of surgical wound infections related to reuse of a single-use device. Results: Both of these forms were implemented at 100%, and the number of surgical wound infections was zero. Conclusions: The project focused on single-use device registration and the rate of devices ready to use. The uptake of new procedures was 100%, and the expected number of surgical wound infections in patients was zero.

The effectiveness of Barbagli technique compared to Kulkarni technique for urethral strictures: a systematic review and meta-analysis

Introduction: Urethroplasty is one of the management of urethral stricture. Various studies reported that urethroplasty procedures have a higher long-term success rate than urethrotomy for treating urethral stricture. We aim to compare the efficacy and safety of urethroplasty using the Barbagli and Kulkarni approaches. Materials and Methods: This systematic review and meta-analysis were performed in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We systematically searched for relevant articles through several databases. The outcomes evaluated in this study were success rate, mean operative time, and complication rate. Outcomes with dichotomous data were analyzed using odds ratio (OR). Continuous data will be analyzed using mean difference (MD) and standard deviation (SD). Statistical analysis using RevMan 5.4 for Windows. Results: Three studies were evaluated involving 272 urethral stricture patients. Urethroplasty procedure using the Barbagli technique had a success rate that was not significantly different from that of the Kulkarni technique (OR 0.55, 95% CI 0.28-1.08, p = 0.08). The Barbagli technique had a significantly longer duration of operation (MD 10.34, 95% CI 3.83-16.85, p = 0.002). The incidence of surgical wound infection was not significantly different in both groups (OR 2.13, 95% CI 0.46-9.83, p = 0.33). There was no significant difference in overall complication rates between patients undergoing urethroplasty using the Barbagli and Kulkarni technique (OR 1.52, 95% CI 0.42-5.55, p = 0.52). Conclusion: This SRMA found that the success rate in the Barbagli technique urethroplasty procedure was not significantly different from the Kulkarni technique. However, the operation duration was significantly longer in the Barbagli technique. Complication rates were minimal in both groups.

The Quantitative and Qualitative Analysis of Antibiotic Use in Bone Fracture Patients in a Public Hospital in Indonesia

Introduction: Prophylactic antibiotic therapy has an important role in facilitating optimal postoperative healing. Inappropriate use of antibiotics in hospitals will increase the cost of therapy and the incidence of nosocomial infections of infectious microorganisms. Preoperative prophylactic antibiotics are believed to reduce the incidence of surgical site infections. Objective: This study aims to determine the pattern of antibiotic use and analyse the use of antibiotics qualitatively by the Gyssen method and quantitatively by the defined daily dose (DDD) method in inpatients with bone fractures at the Haji General Hospital Surabaya, Indonesia. Methods: This study was a descriptive observational study conducted on 89 samples. Data were collected retrospectively through medical records in the period January-December 2019. Antibiotic use data were then analysed qualitatively and quantitatively using the Gyssen and DDD methods. Results: In this study, the antibiotic that was widely used as a prophylactic and therapeutic antibiotic in patients with bone fractures was ceftriaxone. Quantitative analysis using the DDD method showed that the value of ceftriaxone was 45.6/100 patient-days and cefazoline was 3.1/100 patient-days. Analysis of antibiotic use in bone fracture patients using the Gyssen method showed that the rational use of antibiotics was 84.3%, the use of antibiotics was not timely as much as 4.5%, and the interval of antibiotic administration was not appropriate as much as 11.2%. Conclusion: the use of antibiotics in fracture surgery patients is classified as rational use of antibiotics but the use of antibiotics still exceeds WHO standards. Furthermore, it is necessary to conduct a similar study with prospective data collection so that it can observe the incidence of surgical wound infection.

Impact of a Surgical Wound Infection Prevention Bundle in Pediatric Cardiothoracic Surgery

BackgroundThe aim of this project was to decrease the incidence of surgical wound infection (SWI) to <1.5% in our pediatric cardiothoracic surgery patients using a prevention bundle and quality improvement process. MethodsAn SWI prevention bundle addressing preoperative, intraoperative, and postoperative risks was implemented. The primary outcome was SWI based on Society of Thoracic Surgeons criteria (superficial, deep, or mediastinitis). Novel aspects of the bundle included standardization of surgical closure and wound coverage for 14 days with a negative pressure dressing or a silicone dressing. Data were collected from January 2017 to November 2021; bundle intervention began in December 2019. SWIs were tracked using a g-chart. Preintervention and postintervention cohorts were compared by standard descriptive statistics. There were no changes in SWI tracking methods during the study. ResultsDuring the study, 1159 individuals underwent 1768 surgical interventions. Preintervention (n = 931) and postintervention (n = 837) groups were clinically similar, with fewer neonatal surgeries in the postintervention group. SWI decreased in all patients (preintervention period: 1 SWI per 22 surgeries; postintervention period: 1 SWI per 62.6 surgeries) and in neonates (preintervention period: 1 SWI per 12 surgeries; postintervention period: 1 SWI per 26.7 surgeries). Special cause variation was achieved in the entire cohort by March 2021 and in neonates by April 2021. Decreases in SWI occurred in superficial and deep wounds but not in mediastinitis. Annual rate of total SWIs decreased from 2.83% in 2019 to 1.15% in 2021. Intensive care unit and hospital length of stay did not change. ConclusionsWe demonstrated a reduction in SWI rates after implementing an SWI prevention bundle including standardized surgical closure and prolonged wound protection.

An Overview of Patients of Appendicitis and Surgical Site Infection Postappendectomy at Bethesda Hospital Yogyakarta Period 2019-2020

Appendicitis is inflammation of the appendix and is the case most often encountered by surgeons. This study aims to study the description of appendicitis and surgical site infection post appendectomy patients based on age, gender, type of appendicitis, chief complaint, temperature, leukocytes, preoperative antibiotics, type of appendectomy, duration of surgery, and surgical wound infection. The design of this study was descriptive observation using retrospective data from the medical records of appendicitis patients treated at Bethesda Hospital, Yogyakarta City in 2019-2020 with the whole sampling method. The highest distribution of age is the young adult age group at 43.58%. Appendicitis patients were more male (58.46%). The highest distribution of types of appendicitis was appendicitis simplex (39.48%). The chief complaint of right lower abdominal pain was found in all patients (100%). The highest distribution of body temperature was under 38ºC (94.36%) and the highest distribution of leukocyte count was under 16.000/mm3 (67.18%). Preoperative antibiotics were given to 89.74% of patients. The most common type of appendectomy performed was open appendectomy (60.51%) with the highest distribution of operation duration being 60–90 minutes (57.95%). The incidence of surgical wound infection was found in 4 people (2.05%). In conclusion, the results of this study are in accordance with the theory that has been included in the background.

Outcome of Conventional Linear Versus Purse String Skin Closure of Intestinal Stoma Reversal

Background: Stoma closure is one of the most frequently performed surgery. The common complications are surgical site infection (SSI) and poor scar cosmesis. Compared to the conventional linear closure, the pursestring closure technique is expected to have less wound infection, smaller size scar and good patient satisfaction. The aim of this study is to evaluate the feasibility of PSC of stoma site at a tertiary hospital and comparing it with LC of stoma.&#x0D; Materials and methods: This study was performed in the Department of General Surgery, Chittagong Medical College Hospital for a period of one year with a sample size of 72. About 36 subjects were enrolled in each group, Group-A (Linear closure) and Group-B (Purse string closure). Each patient of both group were observed for wound infection, post-operative pain, scar formation, patient satisfaction, and length of post-operative hospital stay.&#x0D; Results: The level of pain according to VAS score was 4 in 36 (100.0%) in Group A and 6(16.7%) in Group B. One third (33.3%) patients had wound infection in Group A and 4(11.1%) in Group B. The mean duration of hospital stay was 9.72±3.46 days in Group A and 7.97±2.46 days in Group B which is statistically significant (p&lt;0.05). The mean patient satisfaction score was 17.75±1.59 in Group A and 22.12±0.73 in Group B which is statistically significant (p&lt;0.05). The mean patient scar assessment scale was 42.47±0.99 in Group A and 35.88±2.81 in Group B which is statistically significant (p&lt;0.05). The mean observer scar assessment scale was 41.97±1.28 in Group A and 36.22±2.73 in Group B which is statistically significant (p&lt;0.05).&#x0D; Conclusion: Purse-string skin closure for stoma reversal had significantly less incidence of surgical wound infection, improved the scar outcome, good patient satisfaction, reduce complications and better cosmesis.&#x0D; JCMCTA 2022 ; 33 (1) : 25-28

KIDNEY TRANSPLANTATION – EARLY POSTOPERATIVE COMPLICATIONS

Introduction: Kidney transplantation is an established surgical method for the treatment of end-stage chronic renal failure with good long-term results. Despite the continuous progress and development of transplantology, a number of postoperative surgical and urological complications still occur today, which could compromise the success of this operative method. Purpose: All possible surgical and urological complications in the first 60 days after kidney transplantation were followed up. Materials and Methods: This study is based on a retrospective analysis of the disease history of 35 patients who underwent kidney transplantation at the Clinic of Urology at the UMHAT "Alexandrovska" for the period from 02.2018 to 12.2019. Results: Early postoperative complications were found in 46% of the observed transplant patients. Urological complications were found in 26% of them. Discussion: The incidence of urinary tract infections in transplanted patients was 26%. During the follow-up period, there were no cases of urinary retention, stricture of the ureter and urinoma in the group of patients. The incidence of surgical complications in the transplanted patients was 29%. The incidence of postoperative hematomas was 23%. Postoperative lymphocele was diagnosed in one patient, which shows a complication rate of 3% for this diagnosis. The incidence of surgical wound infection in transplanted patients during the follow-up period was 3%. Conclusions: Our results show that the frequency of the different early postoperative urological and surgical complications correspond to the literature data from other transplant centers. They show that the transplantation activities in the Clinic of Urology in UMHAT "Alexandrovska" correspond to the world standards.

Detection the Antibiotyping Patterns of the Most That Common Bacterial Pathogens Susceptible to Different Antimicrobial Agents That Cause Wound Infections, in Duhok, Iraq

Background: Wound infections are considered a major problem in the field of surgery for a long time, with growing bacterial resistance to drugs that were once considered the first line of treatment for post-operative wound infections, according to data spanning two years. The objectives of this research were to evaluate the prevalence of bacteriological profiles that cause surgical wound infections and the antimicrobial susceptibility patterns between outpatient clinics at Azadi teaching hospital in Duhok, Iraq. Methods: 165 wound swab samples were collected from surgical wound infections and tested on Blood agar, MacConkey agar, and Nutrient agar, then identified using different cultures and standard biochemical tests. On Muller Hinton Agar, all of the isolates were tested for antimicrobial susceptibility using the disk diffusion technique, as defined by the Clinical and Laboratory Standards Institute (CLSI). Results: 90 (54.5%) of the 165 surgical wound swab samples cultured had a positive bacterial culture, with Klebsiella pneumoniae 25 samples (27.8%) being the most common pathogen, followed by Staphylococcus aureus (20 samples). Some gram-negative bacteria such as Pseudomonas aeruginosa (14 samples), Escherichia coli (13 samples), Proteus mirabilis (7 samples), and Enterobacter cloacae were also isolated (2 samples). Except for amikacin, imipenem, and ciprofloxacin, the majority of pathogens isolated demonstrated greater resistance to most other antibiotics. Conclusion: In this research, the incidence of surgical wound infection was found to be higher in the study region. Klebsiella pneumoniae was isolated as the most common causative agent, with multi-drug resistance and antibiotype patterns that varied.

Meta Analysis: Correlation between Diabetes Mellitus and Surgical Wound Infection

Background: Surgical wound infections complicate 10-20% of operations with a considerable burden of increasing morbidity, mortality, and health care costs. One third of postoperative deaths are associated with surgical wound infections. The risk of surgical site infection is associated with the presence of risk factors for diabetes mellitus. This causes patients undergoing surgery with diabetes mellitus to have a higher risk of developing surgical site infections. This study aims to examine the effect of diabetes mellitus on the incidence of surgical wound infection. Subjects and Method : This research was conducted using a systematic review design and meta-analysis using PRISMA flow diagrams. The article search was conducted by selecting articles published between the years 2000-2022 which were obtained from several databases of PubMed, Google Scholar, Science Direct, and Springer Link. The keywords used to search for articles were “Diabetes Mellitus”, “Surgical Site Infection”, “cohort”, “Diabetes Mellitus” AND “Surgical Site Infection”, “Diabetes Mellitus” AND “Surgical Site Infection” AND “adjusted odd ratio”. The analysis was carried out using RevMan 5.3 software. Results : Meta-analysis of 9 articles of diabetes mellitus (aOR= 2.54; 95% CI= 1.93 to 3.34; p&lt;0.001) affected the incidence of surgical wound infection. Conclusion: Diabetes mellitus increases the incidence of surgical wound infections. Keywords: diabetes mellitus, surgical wound infection Correspondence: Chattrin Fahrezi. Masters Program in Public Health, Universitas Sebelas Maret, Jl.Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: chattrinfahrezi311@gmail.com. Mobile: 08812­532292. Indonesian Journal of Medicine (2022), 07(02): 122-130 https://doi.org/10.26911/theijmed.2022.07.02.01

The Prevalence of Surgical Wound Infection in Post-Mandibular Resection of Ameloblastoma Patients

Ameloblastoma, a common form of odontogenic tumor, is usually treated by surgery. However, wound infections remain a significant source of postoperative morbidity, accounting for about a quarter of the total number of nosocomial conditions. Surgical wound infection (SWI) is common after surgery, and in particular, wound infection has been linked with an intraoral surgical opening in 20–40-year-old patients. Common incisional closure complications in oral and maxillofacial surgery include postoperative wound infection, dehiscence, formation of hematomas, and skin flap necrosis, which lead to delayed healing of the incision. The data relating to the incidence of post-mandible resection SWI in Dr. Hasan Sadikin Bandung Hospital are not yet known. Therefore, the objective of this research was to assess the incidence of SWI in ameloblastoma patients after mandible resection treatment. This research adopted an observational and descriptive approach. Based on the inclusion and exclusion criteria, the research subjects were recruited between January 2018 and December 2019. This study showed the occurrence of SWI in 7 patients (2 men and five women) who had mandibular resection treatment for ameloblastoma and whose age range was 30–40 years. The results also revealed that the surgical openings in these patients were intraoral. In conclusion, findings demonstrated a higher prevalence of SWI in women after mandibular resection treatment than in men.

Perioperative Morbidity and Complications in Patients With an Established Ileostomy Undergoing Major Abdominal Surgery: A Retrospective Study.

Background: Recently formed ileostomies may produce an average of 1,200 ml of watery stool per day, while an established ileostomy output varies between 600–800 ml per day. The reported incidence of renal impartment in patients with ileostomy is 8–20%, which could be caused by dehydration (up to 50%) or high output stoma (up to 40%). There is a lack of evidence if an ileostomy could influence perioperative fluid management and/or surgical outcomes.Methods: Subjects aged ≥18 years old with an established ileostomy scheduled to undergo an elective non-ileostomy-related major abdominal surgery under general anesthesia lasting more than 2 h and requiring hospitalization were included in the study. The primary outcome was to assess the incidence of perioperative complications within 30 days after surgery.Results: A total of 552 potential subjects who underwent non-ileostomy-related abdominal surgery were screened, but only 12 were included in the statistical analysis. In our study cohort, 66.7% of the subjects were men and the median age was 56 years old (interquartile range [IQR] 48-59). The median time from the creation of ileostomy to the qualifying surgery was 17.7 months (IQR: 8.3, 32.6). The most prevalent comorbidities in the study group were psychiatric disorders (58.3%), hypertension (50%), and cardiovascular disease (41.7%). The most predominant surgical approach was open (8 [67%]). The median surgical and anesthesia length was 3.4 h (IQR: 2.5, 5.7) and 4 h (IQR: 3, 6.5), respectively. The median post-anesthesia care unit (PACU) stay was 2 h (IQR:0.9, 3.1), while the median length of hospital stay (LOS) was 5.6 days (IQR: 4.1, 10.6). The overall incidence of postoperative complications was 50% (n = 6). Two subjects (16.7%) had a moderate surgical wound infection, and two subjects (16.7%) experienced a mild surgical wound infection. In addition, one subject (7.6%) developed a major postoperative complication with atrial fibrillation in conjunction with moderate hemorrhage.Conclusions: Our findings suggest that the presence of a well-established ileostomy might not represent a relevant risk factor for significant perioperative complications related to fluid management or hospital readmission. However, the presence of peristomal skin complications could trigger a higher incidence of surgical wound infections.

Antibiotic prophylaxis adequacy assessment and its influence on surgical site infection in peripheral vascular bypass surgery.

We sought to assess the degree of antibiotic prophylaxis adequacy to our surgical antibiotic prophylaxis protocol among patients who underwent peripheral vascular bypass surgery. Prospective cohort study. Adequacy to protocol was studied by comparing the different aspects of prophylaxis received by patients to those stipulated in the protocol in force at our hospital. Incidence of surgical wound infection was calculated and the effect of prophylaxis inadequacy on the incidence of surgical wound infection was estimated using the relative risk. The study covered 266 patients. Incidence of surgical site infection (SSI) after the follow-up period was 5.3% (95% Confidence interval [CI]: 3.0-9.4). Overall adequacy to the protocol of antibiotic prophylaxis was 91.0% (95% CI: 87.6-94.4). The most frequent cause of inadequacy to the protocol was time of initiation of antibiotic prophylaxis (94.1%). No relationship was found between SSI and antibiotic prophylaxis inadequacy (relative risk: 2.4; 95% CI: 0.49-12.5; p > 0.05). Global adequacy to protocol of antibiotic prophylaxis was high. The most frequent cause of inadequacy to the protocol was time of initiation of antibiotic prophylaxis.

Analysis of prophylactic antibiotic use and risk factor of postoperative infection in urological surgery patients.

The widespread use of inappropriate prophylactic antibiotics in urological surgery patients can increase the risk of resistance and development of postoperative infection. This study was aimed to analyze the quality of prophylactic antibiotics use and identify the risk factor of postoperative nosocomial infection in urological surgery patients. Observational prospective data were obtained from patients' medical records. Data were the pattern of prophylactic antibiotic use in surgical patients' urology in Dr. H. Slamet Martodirdjo Hospital, Pamekasan, for the period of April-June 2020. Inclusion criteria included patients hospitalized with urological surgery and received prophylactic antibiotics before surgery. Exclusion criteria consisted of medical records that were incomplete, and the patient disagreed to participate in the research. Analysis qualitative antibiotic prophylactic used the Gyssens method and risk factor used Chi square. Seventeen patients were not administered for antibiotic prophylactic and nine patients with skin incision were observed to determine the incidence of surgical site infection (SSI) and 55 patients with urethral incision were observed to determine the incidence of urinary tract infection (UTI) postoperative. There was no incidence of SSI and there were three incidences of UTI. The qualitative analysis of the Gyssens method showed that category-0 was of 51 (79.7%) and category-I was of 13 (20.31%). The quality of the use of prophylactic antibiotics with the Gyssens method shows that there is an appropriate category (category-0) and a few are in category-I (inappropriate administration time) and no incidence of surgical wound infection.

The Practice of Preoperative Antibiotic Prophylaxis and the Adherence to ASHP Guideline in Different Hospitals in Riyadh

Appropriately administered antibiotic prophylaxis reduces the incidence of surgical wound infection. Prophylaxis is uniformly recommended for all clean-contaminated, contaminated and dirty procedures. It is considered optional for most clean procedures, although it may be indicated for certain patients and clean procedures that fulfill specific risk criteria.

Minipterional craniotomy for surgical clipping of anterior circulation aneurysms: compatibility between the feasibility, safety and efficiency.

ObjectiveThe aim of this study was to assess the feasibility, safety and efficiency of minipterional craniotomy (MPT) for surgical clipping of anterior circulation aneurysms.MethodsA retrospective study was conducted to compare the MPT from Jan 2015 to Dec 2018 and conventional pterional craniotomy (CPT) from Jan 2012 to Dec 2013 in unruptured intracranial aneurysms (UIA) and ruptured intracranial aneurysms (RIA). The feasibility and safety of MPT and CPT were assessed by analyzing medical records, radiologic imaging, and clinical outcomes. The efficiency of MPT and CPT were based on a survey research of temporomandibular dysfunction, facial nerve paralysis, and facial asymmetry.ResultsTotal 628 patients who underwent 458 MPT (UIA:313, RIA:145) and 170 CPT (UIA: 106, RIA: 64) with anterior circulation aneurysms were included in this study. The baseline characteristics between MPT and CPT had no difference (p>0.05). There was no difference in the incidence of postoperative hemorrhage or ischemic lesions between MPT and CPT (p>0.05). The incidence of surgical wound infection was lower in MPT (0.4%) than CPT (3.5%) (p=0.002). More than 90% of postoperative pain disappeared faster in MPT (14.25±4.83 days) than CPT (27.59±10.35 days), and the feeling of facial asymmetry in surgical side was also lower for MPT (1.7%) than CPT (7.6%) (p<0.001). In the MPT, no patients presented with progress to chronic pain, masticatory disability, discomfort of maximal mouth opening or permanent facial palsy.ConclusionsWe suggest that MPT and CPT had similar clinical outcomes, and MPT showed better functional and cosmetic outcomes than CPT in terms of temporomandibular dysfunction, facial nerve paralysis, and facial asymmetry. Therefore, MPT for surgical clipping of anterior circulation aneurysms can be a compatible technique that satisfies the feasibility, safety and efficiency.

Analysis of antibiotic usage for surgical prophylaxis in a tertiary care hospital in Bangalore, Karnataka, India

Introduction: Appropriately administered antibiotic prophylaxis reduces the incidence of surgical wound infection. The timing of antibiotic administration is very critical. The first dose should always be given before the procedure, preferably within 60 minutes before incision. Re-administration at one to two half-lives of the antibiotic is recommended for the duration of the procedure. In general, postoperative administration is not recommended except for cardiothoracic surgeries. Materials and Methods: This is a retrospective study done over a period of 6 months from January 2019 to June 2019 in a tertiary care hospital in Bangalore. A continuous 100 patients who underwent an elective surgery were audited regarding the antibiotic indication, choice, dosage, dosing interval, and timing of first antibiotic administration prior to skin incision and duration of prophylaxis were compared with the CDC guideline recommendations and hospital antibiotic policy. Results: A total of 100 surgeries were audited. Out of this, 4% were clean 84% were clean contaminated 4% were contaminated and 8% were dirty. The most commonly used antibiotics were cephalosporins 74% aminoglycosides 36%, β lactams 14%, and fluoroquinolones 2%. The three parameters tested for adherence showed individual compliance of 92% for appropriate selection of antibiotics, 85% for the appropriate administration, and 56% for the appropriate duration of antibiotics, respectively. Conclusion: The results highlight the challenges of disseminating evidence-based protocols systematically into routine clinical practice. Various measures are needed to improve appropriateness of prescriptions and adherence include the development of evidence-based guidelines in collaboration with surgeons, increased outcome-based research to document benefits of appropriate antibiotic use, continuing education to disseminate information to practitioners etc.