National Nosocomial Infections Surveillance Research Articles

Data quality review of the Brazilian nosocomial infections surveillance system

BackgroundSurveillance of healthcare-associated infections (HAIs) is an essential component of hospital infection prevention and control systems. We aimed to assess the quality of the data compiled by the Brazilian HAI Surveillance System from pediatric (PICUs) and neonatal intensive care units (NICUs), between 2012 and 2021. MethodsData Quality Review, including adherence, completeness, internal consistency, consistency over time, and consistency of population trend, were computed at both national and state levels based on quality metrics from World Health Organization Toolkit. Incidence rates (or incidence density) of ventilator-associated pneumonia (VAP) and central line-associated bloodstream infection (CLABSI) were obtained from the Brazilian National Nosocomial Infections Surveillance (NNIS) system. Data on sepsis-related mortality, spanning the period from 2012 to 2021, were extracted from the Brazilian National Health Service database (DATASUS). Additionally, correlations between sepsis-related mortality and incidence rates of VAP or CLABSI were calculated. ResultsThroughout the majority of the study period, adherence to VAP reporting remained below 75%, exhibiting a positive trend post-2016. Widespread outliers, as well as inconsistencies over time and in population trends, were evident across all 27 states. Only four states maintained consistent adherence levels above 75% for more than 8 years regarding HAI incidence rates. Notably, CLABSI in NICUs boasted the highest reporting adherence among all HAIs, with 148 periods out of 270 (54.8%) exhibiting reporting adherence surpassing 75%. Three states achieved commendable metrics for CLABSI in PICUs, while five states demonstrated favorable results for CLABSI in NICUs. ConclusionsWhile adherence to HAI report is improving among Brazilian states, an important room for improvement in the Brazilian NNIS exists. Additional efforts should be made by the Brazilian government to improve the reliability of HAI data, which could serve as valuable guidance for hospital infection prevention and control policies.

A predictive nomogram for surgical site infection in patients who received clean orthopedic surgery: a retrospective study

BackgroundSurgical site infection (SSI) is a common and serious complication of elective clean orthopedic surgery that can lead to severe adverse outcomes. However, the prognostic efficacy of the current staging systems remains uncertain for patients undergoing elective aseptic orthopedic procedures. This study aimed to identify high-risk factors independently associated with SSI and develop a nomogram prediction model to accurately predict the occurrence of SSI.MethodsA total of 20,960 patients underwent elective clean orthopedic surgery in our hospital between January 2020 and December 2021, of whom 39 developed SSI; we selected all 39 patients with a postoperative diagnosis of SSI and 305 patients who did not develop postoperative SSI for the final analysis. The patients were randomly divided into training and validation cohorts in a 7:3 ratio. Univariate and multivariate logistic regression analyses were conducted in the training cohort to screen for independent risk factors of SSI, and a nomogram prediction model was developed. The predictive performance of the nomogram was compared with that of the National Nosocomial Infections Surveillance (NNIS) system. Decision curve analysis (DCA) was used to assess the clinical decision-making value of the nomogram.ResultsThe SSI incidence was 0.186%. Univariate and multivariate logistic regression analysis identified the American Society of Anesthesiology (ASA) class (odds ratio [OR] 1.564 [95% confidence interval (CI) 1.029–5.99, P = 0.046]), operative time (OR 1.003 [95% CI 1.006–1.019, P < 0.001]), and D-dimer level (OR 1.055 [95% CI 1.022–1.29, P = 0.046]) as risk factors for postoperative SSI. We constructed a nomogram prediction model based on these independent risk factors. In the training and validation cohorts, our predictive model had concordance indices (C-indices) of 0.777 (95% CI 0.672–0.882) and 0.732 (95% CI 0.603–0.861), respectively, both of which were superior to the C-indices of the NNIS system (0.668 and 0.543, respectively). Calibration curves and DCA confirmed that our nomogram model had good consistency and clinical predictive value, respectively.ConclusionsOperative time, ASA class, and D-dimer levels are important clinical predictive indicators of postoperative SSI in patients undergoing elective clean orthopedic surgery. The nomogram predictive model based on the three clinical features demonstrated strong predictive performance, calibration capabilities, and clinical decision-making abilities for SSI.

Nosocomial infections in patients admitted in medical intensive care units in a tertiary health center in Western part of India and their hematological correlation

Background and Aim: Acquired infections (AIs) in medical intensive care units (MICUs) have become serious threats with increasing mortality and morbidity more so in the developing countries. The most common reason is lack of efficient infection control protocols. The national nosocomial infections surveillance system defines a nosocomial infection as a localized or systemic condition that results from adverse reaction to the presence of infectious agents or their toxins that were not present or incubating at the time of admission to the hospital. Critically ill patients are at increased risk of acquiring nosocomial infections because of their lower immune status. These infections being opportunistic, microbes of low virulence cause also cause disease in hospital patients whose immune systems are impaired. This study was conducted to study the association of leukocytosis in relation to nosocomial infections in MICU. Methods: A retrospective study was conducted at the MICU under the Department of Anesthesiology in collaboration with the Department of Microbiology and Department of Pathology of Mahatma Gandhi Medical College and Hospital, Navi Mumbai over six months. All the patients who were admitted in MICU and stayed for more than 48 hours were included in the present study. Results: A total of 805 patients were admitted in the MICU from January 1st to June 30th, 2017, for a period of 6 months. Out of 805 cases, 27 patients developed nosocomial infections amounting to 3.3% with male-to-female ratio of 2.8:1. The age of the patient ranged from 15 to 85 years with the mean age of 50 years. Male predominance was seen with 74% cases with mean age of 48.5 years. Maximum cases were seen in the geriatric age group mainly 6th to 7th decade comprising of 40.7% of all cases. In our study, bloodstream infection was the most common finding constituting 100% of the cases, followed by urinary tract infections. All the cases of nosocomial infections showed polymorphonuclear leukocytosis with shift to left. In our study, diabetes mellitus followed by hypertension and chronic kidney disease was the major contributory comorbidities comprising of 29.6%, 29.6%, and 22.2%, respectively. In our study, the invasive devices contributed to the overall outcome of the patients. Urinary catheters (all cases) were the most prevalent invasive device followed closely by Ryle’s tube (90%) and endotracheal tube (60%). Conclusions: Intensive care units (ICUs) comprise of less than 10% of the total hospital beds but contribute &gt;20% of all the nosocomial infections acquired in the hospital. World Health Organization (WHO) estimates the burden of nosocomial infections in hospitalized patients to be 7–12% globally, in contrast to the figures from India being alarmingly high varying from 11–83%.

Etiology of nosocomial infections in intensive care patients in German hospitals: An analysis of trends between 2008 and 2022

PurposeData from the intensive care component of the German hospital infection surveillance system (KISS) was used to investigate the epidemiology of pathogens responsible for the most frequent device-associated infections and their development over time. MethodThe 10 most common pathogens were identified for ventilator-associated lower respiratory tract infections (VALRTI), catheter associated urinary tract infections (CAUTI), and central venous catheter associated bloodstream infections (CVC-BSI). The development over time was analyzed based on three five-year time periods: 2008–2012, 2013–2017, 2018–2022. ResultsData from 1425 ICUs were included together with 121,762 device-associated infections with 138,299 isolated pathogens. A remarkable and significant increase in the frequency of Klebsiella spp. was found for VALRTI, that was almost twice as high during 2018–2022 compared to 2008–2012. For CAUTI, there was a significant increase of all Enterobacterales with the most prominent increase in Klebsiella spp. With regard to CVC-BSI, the situation for coagulase-negative staphylococci and E. coli was relatively stable; while there was a significant increase in Enterococcus spp. and Klebsiella spp. and a decrease in S. aureus. ConclusionKnowledge about the current frequency of pathogens responsible for nosocomial infections in intensive care units is important for guiding empirical antimicrobial therapy. Data from national nosocomial infection surveillance systems can provide relevant information about the development of pathogens.

Comprehensive analysis of risk factors and pathogenetic characteristics associated with surgical site infections following craniotomy procedures.

Craniotomies are intricate neurosurgical procedures susceptible to post-operative complications, among which surgical site infections (SSIs) are particularly concerning. This study sought to elucidate the potential risk factors and pathogenetic characteristics associated with SSIs following craniotomy procedures in a clinical setting. A retrospective study was conducted from May 2020 to May 2023, examining patients subjected to elective or emergency craniotomies. The cohort underwent post-operative surveillance for SSIs, facilitating patient classification into SSI and Non-SSI groups based on infection occurrence. Data collection encapsulated demographic and clinical parameters, including American Society of Anesthesiologists (ASA) classifications, and operative factors. SSIs were diagnosed via an integrated approach combining clinical symptoms, microbiological culture findings and pertinent laboratory tests. A rigorous statistical methodology employing IBM's SPSS version 27.0 was utilised for data analysis. In a univariate analysis, significant risk factors for post-craniotomy SSIs were identified, with patients aged over 60 displaying a pronounced susceptibility. Moreover, surgeries exceeding a duration of 4 h heightened infection risks. Elevated ASA grades denoted an increased prevalence of SSIs, as did emergency procedures and higher National Nosocomial Infections Surveillance scores. Multivariate analysis pinpointed epidural/subdural drainage as a protective measure against SSIs, whereas emergency surgeries, operative times beyond 4 h and subsequent surgeries within the hospital stay amplified infection risks. Notably, coagulase-negative Staphylococcus dominated the identified pathogens at 28.09%, followed by Escherichia coli (17.98%), Klebsiella pneumoniae (10.11%) and Staphylococcus aureus (11.24%), underscoring the need for diverse prophylactic measures. SSIs following craniotomies present a multifaceted challenge influenced by a confluence of patient-related, operative and post-operative determinants. Understanding these risk factors is paramount in refining surgical protocols and post-operative care strategies to mitigate SSI incidence.

Appropriateness of Surgical Antimicrobial Prophylaxis in a tertiary care hospital: A prospective observational study

Surgical site infections (SSIs) are a significant concern in global healthcare, particularly in middle and low-income countries, leading to increased hospitalizations, morbidity, mortality, and financial strain. Ranked third in the CDC's National Nosocomial Infections Surveillance System, SSIs have prompted a focus on preventive measures, notably surgical antimicrobial prophylaxis (SAP). However, SAP is often used inappropriately, contributing to the rise of Antimicrobial Resistance (AMR). Addressing this, a six-month prospective observational study was conducted in a tertiary care hospital to assess the adherence to SAP guidelines among 386 patients undergoing surgeries in various specialties. The study aimed to evaluate the appropriateness of SAP practices and identify factors leading to non-compliance. Results showed that only 58.3% of patients fully adhered to the guidelines. While 100% compliance was observed in SAP indication, lower adherence was noted in the timing of administration (97.7%), choice of SAP (85%), and duration of prophylaxis (70.2%). These findings underscore a significant gap between recommended SAP practices and actual implementation. This gap highlights the need for stronger Institutional Antimicrobial Stewardship (AMS) programs and the critical role of clinical pharmacists in regularly evaluating SAP and prescribing practices. To combat the rise of antibiotic resistance while ensuring patient safety, enhancing SAP practices in line with national and international recommendations is essential. The study advocates for more active interventions at the time of order to optimize antibiotic use, thereby addressing the challenge of compliance in SAP guidelines.

Using the National Nosocomial Infections Surveillance risk index to determine risk factors associated with surgical site infections following gynecologic surgeries.

We used the National Nosocomial Infections Surveillance (NNIS) risk index to determine risk factors associated with surgical site infections (SSIs) following gynecologic surgeries. A retrospective study was conducted based on the medical records of 185 patients with SSIs, following gynecologic surgeries at a Grade A tertiary gynecologic and obstetric hospital in southwest China during September 2013-June 2021. Suspected risk factors associated with SSIs were: length of hospital stay, age, whether the patient had cancer, whether the patient had chemotherapy or high-dose antibiotic therapy before surgery, duration of surgery, amount of blood loss, and whether a blood transfusion was done. It was found that SSIs were more likely to occur in cancer patients with an NNIS risk index score of 1 and in patients with preoperative chemotherapy and an NNIS risk index score of 2. Among the patients with an NNIS risk index score of 2, the older the patient, the higher incidence of SSIs. Gynecologic surgery teams should pay more attention to the independent risk factors associated with SSIs determined by the NNIS risk index score to prevent SSIs following gynecologic surgeries, thus ensuring patient safety.

The Epidemiology of Hospital-Acquired Urinary Tract Infections in Intensive Care Units in Kermanshah Hospitals (Iran)

Background: Urinary tract infection (UTI) is the highest incidence of hospital-acquired infection (HAI), and hospital-acquired urinary tract infections (HAUTI) are a common problem of critical illness. Objectives: This study aimed to determine the epidemiology of HAUTIs in medical intensive care units (ICUs) and hospitals in Kermanshah, Iran. Methods: This cross-sectional and descriptive/analytical study was conducted in the ICUs of hospitals in Kermanshah from March 2018 to 2019. All the recognized HAUTIs were recorded in the Iranian National Nosocomial Infection Surveillance System. Descriptive and inferential statistics such as t-tests and chi-square were used for data interpretation. Results: A total of 1136 patients were admitted to the two ICUs (61 missed out of 1197 patients). The number of patients with UTI was 51, and the overall HAI rate was 4.5%. The results showed a significant relationship between sex and HAUTI (P = 0.038), so women tended to have more HAUTIs than men (6.3 and 3.6%, respectively). A significant relationship was observed between age, date (different seasons of the year), and HAUTI (P = 0.588, 0.115, respectively). Conclusions: There are few studies on HAUTIs, especially on intensive care unit-acquired infections, and more studies are required to describe the epidemiology and management of these problems. Improving conditions for expanding any strategy to reduce infections associated with HAUTIs in ICUs is recommended.

Assessment of Healthcare Associated Infections in a Medical Intensive Care Unit

Objective: This study was undertaken to assess the current status of healthcare associated infections (HAIs) in our institution during a 2-year period in relation to causative agents and their distribution, use and duration of invasive mechanical ventilation, and infection rate and incidence in comparison with national data.&#x0D; Methods: Patients admitted to Medical ICUs of Meram State Hospital between 1st Jan 2019 and 31st Dec 2020 wereincluded. During a 2-year period a total of 47 patients were diagnosed with HAIs based on Centers for Disease Control and Prevention (CDC) and National Nosocomial Infection Surveillance Network (NNISN) criteria.&#x0D; Results: During 6041 follow-up days for 922 patients admitted to ICU, a total of 47 HAIs cases were detected. The most common types of HAIs included healthcare-associated pneumonia in 21 patients (45.6%) and other infections of the respiratory system in 12 patients (26.1%). The most common causative agent was Acinetobacter baumannii, which was found in 27 patients (50.9%).&#x0D; Conclusion: HAIs is an unavoidable condition in ICUs owing to a number of factors such as frequent use of invasive devices, prolonged length of admission, and increased number of complications. One of the major health targets in healthcare facilities is to control an manage HAIs. Avoidance from unnecessary catheterizations, timely removal of invasive catheters, increased adherence to infection control measures, prevention of inappropriate antibiotic use, compliance with isolation procedures, and initiation of appropriate antibiotherapy based on documentation of causative organisms will significantly reduce HAIs incidence.

Comorbidities directly extracted from the hospital database for adjusting SSI risk in the new national semiautomated surveillance system in France: The SPICMI network.

To evaluate the performance of a comorbidity-based risk-adjustment model for surgical-site infection (SSI) reporting and benchmarking using a panel of variables extracted from the hospital discharge database (HDD), including comorbidities, compared to other models that use variables from different data sources. The French national surveillance program for SSI (SPICMI) has collected data from voluntary hospitals in the first 6 months of 2020 and 2021, for 16 selected surgery procedures, using a semiautomated algorithm for detection. Four risk-adjustment models were selected with logistic regression analysis, combining the different patterns of variables: National Nosocomial Infections Surveillance System (NNIS) risk-index components, individual operative data, and 6 individual comorbidities according to International Classification of Disease, Tenth Revision (ICD-10) diagnosis: obesity, diabetes, malnutrition, hypertension, cancer, or immunosuppression. Areas under the curve (AUCs) were calculated and compared. Overall, 294 SSI were detected among 11,975 procedures included. All 6 comorbidities were related to SSI in the univariate analysis. The AUC of the selected model including comorbidities (0.675; 95% confidence interval [CI], 0.642-0.707), was significantly higher than the AUC of the model without comorbidities (0.641; 95% CI, 0.609-0.672; P = .016) or the AUC using the NNIS-index components (0.598; 95% CI, 0.564-0.630; P < .001). The HDD-based model AUC (0.659; 95% CI, 0.625-0.692) did not differ significantly from the selected model without comorbidities (P = .23). Including HDD-based comorbidities as patient case-mix variables instead of NNIS risk index factors could be an effective approach for risk-adjustment of automated SSI surveillance more widely accessible to hospitals.

Managing early complications in total hip arthroplasty: the safety of immediate revision

PurposeImmediate revision refers to a reoperation that involves resetting, draping, and exchanging the implant, after wound closure in total hip arthroplasty. The purpose of this study is to investigate the impact of immediate revision after total hip arthroplasty on subsequent infection and complication rates.MethodsA total of 14,076 primary total hip arthroplasties performed between 2010 and 2020 were identified in our institutional database, of which 42 underwent immediate revision. Infection rates were determined 2 years after the index arthroplasty. The cause and type of revision, duration of primary and revision surgeries, National Nosocomial Infections Surveillance score, implant type, changes in implants, complications, and preoperative and intraoperative antibiotic prophylaxis were all determined.ResultsNo infections were observed within 2 years after the index arthroplasty. Leg length discrepancy (88%, n = 37) and dislocation (7.1%, n = 3) were the main causes of immediate revision. In most cases of discrepancy, the limb was clinically and radiologically longer before the immediate revision. The mean operative time was 48 ± 14 min for the primary procedure and 23.6 ± 9 min for the revision. The time between the first incision and last skin closure ranged from 1 to 3 h. None of the patients were extubated between the two procedures. Two patients had a National Nosocomial Infections Surveillance score of 2, 13 had a score of 1, and 27 had a score of 0.ConclusionImmediate revision is safe for correcting clinical and radiological abnormalities, and may not be associated with increased complication or infection rates.Study designRetrospective cohort study; level of evidence, 3.

Intraoperative techniques to prevent deep incisional or organ-space surgical site infection after emergency surgery for nonappendiceal perforation peritonitis: a prospective two-center observational study.

The rate of surgical site infection (SSI) after surgery for secondary peritonitis is very high. This study investigated the relationship between intraoperative procedures of emergency surgery for nonappendiceal perforation peritonitis and deep incisional or organ-space SSI. This prospective, two-center observational study included patients aged ≥ 20years who underwent emergency surgery for perforation peritonitis between April 2017 and March 2020. We compared patients with deep incisional or organ-space SSI (Group S) to patients without SSIs or with superficial incisional SSIs (Group C). Thereafter, we evaluated the association between intraoperative technical variables and deep incisional or organ-space SSI using a multivariate logistic regression model. All multivariate analyses were adjusted for potentially relevant risk factors (e.g., age, body mass index, diabetes, smoking habit, and National Nosocomial Infection Surveillance risk index). Of the 75 participants, 14 were in Group S and 61 were in Group C. The use of a wound protector device was significantly associated with decreased odds of deep incisional or organ-space SSI (adjusted odds ratios [AOR], 0.017; 95% confidence intervals [CI] 0.0014-0.19, p = 0.0011). A 1000ml increase in intra-abdominal lavage with normal saline was significantly associated with increased odds of deep incisional or organ-space SSI (AOR: 1.28, 95% CI 1.02-1.61, p = 0.033). Wound protector devices should be used in emergency surgery for nonappendiceal perforation peritonitis. Excessive intra-abdominal lavage with normal saline for peritonitis may have unsatisfactory benefits and increases the incidence of deep incisional or organ-space SSI.

Risk factors and prediction model for inpatient surgical site infection after elective abdominal surgery.

Surgical site infections (SSIs) are the commonest healthcare-associated infection. In addition to increasing mortality, it also lengthens the hospital stay and raises healthcare expenses. SSIs are challenging to predict, with most models having poor predictability. Therefore, we developed a prediction model for SSI after elective abdominal surgery by identifying risk factors. To analyse the data on inpatients undergoing elective abdominal surgery to identify risk factors and develop predictive models that will help clinicians assess patients preoperatively. We retrospectively analysed the inpatient records of Shaanxi Provincial People's Hospital from January 1, 2018 to January 1, 2021. We included the demographic data of the patients and their haematological test results in our analysis. The attending physicians provided the Nutritional Risk Screening 2002 (NRS 2002) scores. The surgeons and anaesthesiologists manually calculated the National Nosocomial Infections Surveillance (NNIS) scores. Inpatient SSI risk factors were evaluated using univariate analysis and multivariate logistic regression. Nomograms were used in the predictive models. The receiver operating characteristic and area under the curve values were used to measure the specificity and accuracy of the model. A total of 3018 patients met the inclusion criteria. The surgical sites included the uterus (42.2%), the liver (27.6%), the gastrointestinal tract (19.1%), the appendix (5.9%), the kidney (3.7%), and the groin area (1.4%). SSI occurred in 5% of the patients (n = 150). The risk factors associated with SSI were as follows: Age; gender; marital status; place of residence; history of diabetes; surgical season; surgical site; NRS 2002 score; preoperative white blood cell, procalcitonin (PCT), albumin, and low-density lipoprotein cholesterol (LDL) levels; preoperative antibiotic use; anaesthesia method; incision grade; NNIS score; intraoperative blood loss; intraoperative drainage tube placement; surgical operation items. Multivariate logistic regression revealed the following independent risk factors: A history of diabetes [odds ratio (OR) = 5.698, 95% confidence interval (CI): 3.305-9.825, P = 0.001], antibiotic use (OR = 14.977, 95%CI: 2.865-78.299, P = 0.001), an NRS 2002 score of ≥ 3 (OR = 2.426, 95%CI: 1.199-4.909, P = 0.014), general anaesthesia (OR = 3.334, 95%CI: 1.134-9.806, P = 0.029), an NNIS score of ≥ 2 (OR = 2.362, 95%CI: 1.019-5.476, P = 0.045), PCT ≥ 0.05 μg/L (OR = 1.687, 95%CI: 1.056-2.695, P = 0.029), LDL < 3.37 mmol/L (OR = 1.719, 95%CI: 1.039-2.842, P = 0.035), intraoperative blood loss ≥ 200 mL (OR = 29.026, 95%CI: 13.751-61.266, P < 0.001), surgical season (P < 0.05), surgical site (P < 0.05), and incision grade I or III (P < 0.05). The overall area under the receiver operating characteristic curve of the predictive model was 0.926, which is significantly higher than the NNIS score (0.662). The patient's condition and haematological test indicators form the bases of our prediction model. It is a novel, efficient, and highly accurate predictive model for preventing postoperative SSI, thereby improving the prognosis in patients undergoing abdominal surgery.

Health care associated infections, antimicrobial resistance and outcomes in patients admitted to intensive care unit, India: A five-Year retrospective cohort study.

The present study was conducted to study the prevalence of HAIs in a newly established MICU, common microorganisms causing HAIs and their antibiotic-sensitivity profile, and antimicrobial utilization and mortality rate. The present retrospective cohort study was carried out at AIIMS, Bhopal (2015-2019). The prevalence of HAIs was determined; sites of HAIs and common causative microorganisms were identified, and their antibiotic-sensitivity profiles were studied. The group of patients with HAIs was matched with a control group drawn from the pool of patients without HAIs; this matching was done with respect to age, gender, and clinical diagnosis. Antimicrobial utilization, Period of ICU stay, comorbidities and patient mortality rates in the two groups were analyzed. The clinical criteria by the CDC- National Nosocomial Infections Surveillance to diagnose HAIs. A total of 281 ICU patients' records were analyzed. The mean age was 47.21 ± 19.07years. Of these 89 were found to have developed ICU-acquired HAIs (Prevalance:32%). Bloodstream infections (33%) and respiratory tract infections (30.68%), catheter-associated urinary tract infections (25.56%), and surgical site infections (6.76%) were the commonest. The most frequently isolated microorganism causing HAIs was K. pneumonia (18%), A. baumannii (14%) and E. coli (12%), 31% isolates of which were multidrug resistant. The average length of ICU stay was high in patients with HAIs (13.85 vs 8.2days). The most common co-morbidity was type 2 diabetes mellitus (42.86%). Prolonged ICU stays [OR 1.13, (95% CI; 0.04-0.10)] and the presence of HAIs [OR 1.18(95%CI; (0.03-0.15)] were associated with an increased risk of mortality. An increased prevalence of HAIs essentially bloodstream infections and respiratory infections with MDR organisms to antimicrobials in the watch group is highly considerable. Acquisition of HAIs with MDR organisms and increased length of hospital stay are considerable risk factors for increased mortality in ICU-admitted patients. Regular antimicrobial stewardship activities and revising existing hospital infection control policies accordingly may reduce HAIs.

Surgical site infections in thyroid and parathyroid surgery in Japan: An analysis of the Japan Nosocomial Infections Surveillance database from 2013 to 2020.

Surgical site infections (SSIs) after thyroid surgery are rare complications, with incidence rates of 0.3%-1.6%. Using a Japanese database, we conducted exploratory analyses on the incidence of SSIs, investigated the incidence of SSIs by the National Nosocomial Infections Surveillance risk index, and identified the causative bacteria of SSIs. SSIs occurred in 50 (0.7%) of 7388 thyroid surgery cases. Risk index-0 patients had the lowest incidence rate of SSIs (0.41%). The incidence of SSIs in risk index-1 patients was 3.05 times the incidence of SSIs in risk index-0 patients. The rate of SSI occurrence for risk index-2 patients was 4.22 times the rate of SSI occurrence for risk index-0 patients. Thirty-one bacterial species were identified as the cause of SSIs in thyroid surgery cases, of which 12 (38.7%) SSIs were caused by Staphylococcus aureus and Staphylococcus epidermidis. Of the nine SSIs caused by Staphylococcus aureus, 55.6% (five cases) were attributed to methicillin-resistant Staphylococcus aureus. Therefore, routine prophylactic antibiotic administration should be avoided, while the target for administration should be narrowed, according to the SSI risk. Administration of prophylactic antibiotics, such as 2 g piperacillin or 1 g cefazolin, is considered appropriate.

Effects of frailty on patients undergoing head and neck cancer surgery with flap reconstruction: a retrospective analysis

ObjectivesTo establish the implications of frailty as a predictor of outcome in patients with head and neck cancer requiring flap repair.DesignRetrospective cohort.Data sourceWe captured data from patients above 60 years...

NNIS risk score or COLA score: which predicts better the risk of surgical site infection among patients undergoing colorectal resection in a tertiary care hospital setting?

Background: By using predictive scores to identify and quantify risk of Surgical site infections (SSI), preventive measures can be directed effectively to improve patient outcome post operatively. This study was undertaken to compare the National Nosocomial Infections Surveillance (NNIS) risk index and COLA (contamination, obesity, laparotomy and ASA grade) scores to predict risk of SSI among patients undergoing colorectal resection.Methods: A total of 77 patients who underwent colorectal resection at a tertiary care hospital were enrolled in this study. Wound surveillance was performed in all patients during the hospital stay and follow-up information for 30 days postoperatively was collected. Data analysis was done in SPSS version 20.0 for windows. Descriptive analysis was used to exhibit the clinical parameters. Differences between groups were tested by Pearson chi-square and fisher’s exact test. ROC curves were utilized. All the statistical tests were examined with 5% (p≤0.05) level of significance.Results: Incidence of overall SSI was 28.6%. Superficial SSI was more common (14.3%). Serious organ/deep space infection occurred only in 9.1%. Area under the curve (AUC) for NNIS score was 0.645 (95% CI: 0.510-0.781, p&lt;0.05) and 0.611 for the COLA score. (95% CI: 0.472-0.750, p&gt;0.05). Therefore, both these scores have less than acceptable accuracy in this data set to predict SSI.Conclusions: The risk prediction models (NNIS, COLA) although simple, did not accurately predict the risk of SSI in the given study population.

Effect of Supplemental Oxygen on Risk of Surgical Wound Infection

Background: There is a risk of different complication after the surgery but delaying in wound healing or infection is one of most common risk. Oxidative killing is a process of tissues partial pressure of oxygen throughout the observed values ranges. The main defense against foreign particles in result of surgery is oxidative killing through neutrophils. In a study by Greif et al4 indicated oxygen 80% during the surgery and after 2 hours later of surgery 50% risk get lesser as compared to the patient who had administrated with 30% oxygen.4 Another study proved that chances of risk for infection get increase in patients who were administrated oxygen 11 % as compared to the patients with 25% oxygen administration.5 The current study was conducted to test the hypothesis that supplemental oxygen decreases the risk of post-operative wound infection. Objective: The objective of the study was to determine the effects of supplemental oxygen on risk of surgical wound infection. Materials and Methodology: A randomized Clinical Trial- double- blinded was conducted at DHQ hospital, Karachi from March 1, 2011 to October, 31, 2016. A total of 300 subjects with age around 18 to 80 years who underwent elective colorectal surgery and satisfying the inclusion and exclusion criteria were recruited in the study. Non-probability Purposive sampling technique was used to collect the data. Double-blinded technique was used. Blinded investigators diagnosed the wounds infection by following the criteria of centers of disease control and prevention. Patients were randomly allocated in two groups by sealed-envelope method. Baseline assessment was performed on each patient which included patient’s medical history, physical examination and Lab tests i.e. complete blood picture and biochemical analysis. Characteristics for patient’s baseline and aesthetic treatment were confound factors. 3rd generation antibiotics cephalosporin were administrated 1 to 2 hours before of surgery. Patients of Group 1 received oxygen fraction of inspired oxygen FIO2 of 30 and group 2 of 80 percent. Randomly chosen concentration flow of oxygen 16l/min was given. Patient was breathing ambient air. Supplemental oxygen was given to maintain the patient’s oxygen saturation to 92% that is measured by pulse oximetry. Patient’s treatment was slandered with antibiotics and anesthesia administration. For wound evaluation, tools used were National nosocomial infection surveillance scale 6 and Efficacy of infection control,7 Wounds were checked for infection on daily basis by surgeons who were blinded. And wound thought to be infected when they full fill the criteria of Centers for Disease control and prevention standard. Main outcome measure was surgical site for infection and secondary outcomes were recovery of bowl function, duration of hospital stay, ambulation and ability to absorb the solid food. Statistical Analysis: Analysis was done on SPSS by applying parametric and non-parametric test according to normality. Results: Results showed no significant difference in %age Surgical infection site, Daily ASEPSIS value ≥20 at any time (p-value&lt;0.06), Admission in ICU (p-value= 0.74), Bowel function recovery (p-value=0.74), Solid food intake (p-value=0.54), Walking (p-value=0.57), Removal of Staples( 0.72), Duration of post-surgery hospitalization(p-value=0.09) of both the groups as p-value &gt;0.05 of all variables. Practical implication: If we provide pre-operative supplemental oxygen it will be helpful to decrease SSI. Conclusion: Patients who received supplemental oxygen showed significantly decrease in the risk of wound infection. Hence, Pre-operative supplemental oxygen proved to be an effective intervention to decrease SSI in the patients having rectal or colon surgery. Keywords: ASEPSIS, Surgical Wound, Infection, Supplemental Oxygen

The Prevalence of Nosocomial Infections and Related Microbial Agents Based on the NNIS System in Sabzevar During 2011-2015

Background: Nosocomial infection is an infection that hospitalized patients get while receiving health care. This study aimed to determine the prevalence and factors involved in the incidence of nosocomial infections, related microbial agents, and antibiotic resistance profiles. Methods: This cross-sectional study was conducted on 390 patients with nosocomial infection admitted to Shahid Beheshti Hospital in Sabzevar from 2011 to 2015. The acquired data were assessed by the standard checklist of the National Nosocomial Infections Surveillance (NNIS) system of the Ministry of Health. The collected data were analyzed using the Stata 12 software. Results: Of the 41979 admitted patients during the mentioned period, 390 patients with an average age of 48.08 years suffered from a hospital-acquired infection. The prevalence of nosocomial infections was 1% with the highest rate related to the respiratory tract in men and surgical sites in women. Intravenous catheters, surgical wounds, urinary catheters, suction, ventilator, tracheotomy, and tracheostomy were the most commonly encountered factors (invasive measures) of nosocomial infection, respectively. The most prevalent causes of nosocomial infections were Klebsiella, Staphylococcus aureus, and Acinetobacter. Conclusions: Based on our findings, several factors play a pivotal role in preventing hospital-associated infections, including proper follow-up and timely reporting of nosocomial infection cases. The other influential factors were accurate identification of microorganisms involved, allocation of sufficient funds to provide appropriate facilities for infection prevention, the appropriate and timely medical interventions, and the rational use of antibiotics.

Epidemiological surveillance of surgical site infections in large joint replacement

Joint replacement is a reliable and effective surgery that allows profound pain relief and restores joint function in patients. Despite the progress made and the experience gained in joint replacement, surgical site infection is one of the leading postoperative complications. It can proceed as a periprosthetic joint infection, osteomyelitis, sepsis and lead to disabled or dead outcomes. Systematization of risk factors for infectious complications plays an important role as an element of epidemiological surveillance system optimization. Age, the presence of concomitant diseases (for example, diabetes mellitus, cancer, arthritis and systemic collagenosis), carriage of antimicrobial-resistant microorganisms, infectious and inflammation both outside and in the area of surgery, and external factors (surgery duration, correct antibiotic prophylaxis and surgeon's experience) are the most significant risk factors for periprosthetic joint infection. In world practice, the National Nosocomial Infections Surveillance System surgical site infection risk index is used. This criterion does not consider all potential risk factors. It is important to analyze and rank the identified risk factors according to the impact on the development of infectious complications in organizing an epidemiological surveillance system process in a medical organization. Risk factors analysis will identify the most significant modifiable factors for the development, implementation and execution of organizational, preventive measures and epidemic control. The creation and implementation of a standardized preoperative protocol based on a risk factors assessment will allow predicting the surgery outcome and arguing the strategy and tactic of preventive measures.