Operative Surgical Site Infection Research Articles

Does spinal surgery for spinal tuberculosis during active infection predispose to post operative surgical site infection?: Experience From Kenyatta national hospital

Background : Spinal Tuberculosis (TB) is the most common form of skeletal TB. Its incidence has seen an increase over the past 3 decades due to the AIDS epidemic. Absolute non-operative treatment was offered in pre antibiotic era. Surgery has become an integral component in the management of spinal TB in current practice. The rate of SSI varies from 2% to 20% for all surgical spinal procedures. Objective : Does spinal surgery for spinal tuberculosis during active infection predispose to post operative Surgical Site Infection (SSI). The aim of this study was to note the incidence of infection in patients undergoing spinal surgery for tuberculosis. Methods : All patients who had complete medical records and had surgery for spinal tuberculosis were recruited into the study. The study period was from 2005 to 2015. Relevant data was collected and appropriately analyzed . Results: For all the patients, chemotherapy was started immediately after tuberculosis of the spine was diagnosed. Five patients had involvement of the lumbar region, one patient with involvement of the cervical region and the rest had involvement of the thoracic region. One patient had 3 vertebrae involved, 3 patients had one vertebrae involved and 14 patients had 2 vertebrae involved. Out of the 18 patients, 12 showed improvement after surgery, 4 patients had no difference after surgery and 2 patients worsened after surgery. Two patients showed improvement after 1 week; 3 patients after 2 weeks; 3 patients after 1 month; 4 patients after 2 months. Of the patients who worsened; 1 patient worsened by 1 grade while another worsened by 2 grades. No patient had any SSI. This was irrespective of whether they had instrumented spine surgery or not. Conclusion : This study shows that spinal surgery for spinal tuberculosis does not lead to increased surgical site infection even in the presence of active tuberculosis infection. Addition of spinal instrumentation to the surgical strategy does not predispose to increased infection rate. Larger studies need to be carried out to validate this data. Key words: Spinal tuberculosis, Spinal surgery, Surgical site infections

Operative traffic in orthopedics: A glimpse into surgical team transformations

Operative traffic can reduce the sterility of the operating room (OR) and put patients at risk of infection. Such traffic can also change the makeup of the surgical team, yet these transformations have not been investigated. The aim of this study was to analyze operative traffic in regards to the number of people that entered the OR and characterize personnel transformations within operative teams across a surgical day and surgical procedure. Over three months, surgical cases performed by one orthopedic surgeon in an academic hospital were observed. Data were collected on the time of personnel entry and exit, and the characteristics of the case. Transition patterns were classified based on the number of transitions for each personnel role. Overall, 465 individuals (M = 23.21 individuals, SD = 7.25) entered the OR across all 19 surgical days, with 286 identified as surgical personnel (M = 15.05 personnel, SD = 3.05). Six transition patterns were found in the data. Patterns with three or more transitions per role occurred 38.9% of the time and were observed for registered nurses, certified surgical technicians, certified registered nurse anesthetists, and anesthesiologists. The transition patterns of these roles present increased opportunity for errors during a procedure and should be further investigated. In future studies, the authors plan to study other specialties, procedures, and accrue a larger sample to further understand how operative traffic and surgical site infections relate to one another.

Pre-Operative Shaving Versus Trimming and Their Relation to Post Operative Surgical Site Infection (SSI), A Randomized Controlled Trial

Pre-Operative Shaving Versus Trimming and Their Relation to Post Operative Surgical Site Infection (SSI), A Randomized Controlled Trial

A prospective, randomized, double blind controlled trial of the use of preoperative antibiotics in routine abdominal surgery: A comparative analysis between Ofloxacin + Metronidazole, Cefotaxime + Sulbactum and Cefepime +Tazobactum (Single does vs. Three

Introduction: Anti microbial prophylaxis before any elective surgery is a preferred deterrent to post operative surgical site infection now. We have used different antibiotics, two being from the cephalosporin class, one from the fluoroxoqiuinolones and anti beta lactamases in combination along with metronidazole. The aim was to find out the best and most economical pre operative prophylaxis in our surgical practice. Three antibiotics regimens were studied. Patients were divided into two groups against each agent of Ofloxacin +Metronidazole, Cefotaxime + Sulbactum and Cefepime +Tazobactum. They were again subdivided into two groups one receiving single dose and another three doses of the antibiotics regimens. Methods: A total of 138 patients (above 16 years) were taken for the study. It was a randomized and blind study. Patients were prospectively analysed. First, the patients were divided into two groups. First group received a single dose of antibiotic at incision and those who received two more doses at eight hours interval after the dose at incision. Discussion: The single dose pre operative prophylaxis scored over three doses regime in all the cases for lap surgery irrespective of OT condition. Three doses regime worked better in combined OT condition for the open elective procedures. The study also revealed the most economic choice for routine elective abdominal surgery. Conclusion: Multiday and antibiotics use for a prolonged period is not advisable these days after a routine elective abdominal surgery. Single dose injection of antibiotics at a proper time is good enough for preventing postoperative surgical site infection after a routine Laparoscopic surgery. Three doses regime is better in open surgical cases performed in OTs where emergency procedures are undertaken. It is advisable to use the most cost effective regime to reduce the healthcare cost in the country.

A prospective study to find out the most cost effective preoperative prophylactic antibiotic regime in elective abdominal routine surgeries

Introduction: Anti microbial prophylaxis before any elective surgery is a preferred deterrent to post operative surgical site infection now. A study was undertaken to evaluate the efficacy of preoperative prophylaxis in our hospital setting. We have used different antibiotics, two being from the cephalosporin class, one from the fluoroqiuinolones and anti beta lactamases in combination along with metronidazole. These were used in different combinations and for different durations. The aim was to find out the best and most economical pre operative prophylaxis in our surgical practice. Methods: A total of 138 patients (above 16 years) were taken for the study. It was a randomized and blind study. Patients were prospectively analysed. First, the patients were divided into two groups, those who would receive a single dose of antibiotic at incision and those who received two more doses after the dose at incision. Next, the patients were analysed depending on operation room condition wise. The open elective as well as the laparoscopic elective procedures done in an OT condition where emergencies are undertaken as well as open and lap cases done in OTs where only elective cases are undertaken. The routine practice of preoperative bath, preoperative preparations of the area with iodophores and spirit, operating under normothermia and hydration were as per the institutional philosophy and common to all the patients. Cefotaxime+ Sulbactum, Ofloxacin + Metronidazole, Cefepime+ Tazobactum. Result: Keeping the outcome of the study in mind all the materials was analysed and statistical analysis done and confidence intervals were noted. The single dose pre operative prophylaxis scored over three doses regime in all the cases for lap surgery irrespective of OT condition. Three doses regime worked better in combined OT condition for the open elective procedures. The study also revealed the most economic choice for routine elective abdominal surgery. Conclusion: Multiday and antibiotics use for a prolonged period is not advisable these days after a routine elective abdominal surgery. Single dose injection of antibiotics at a proper time is good enough for preventing postoperative surgical site infection after a routine Laparoscopic surgery. Three doses regime is better in open surgical cases performed in OTs where emergency procedures are undertaken. It is advisable to use the most cost effective regime to reduce the healthcare cost in the country.

Study of Various Organisms Associated with Surgical Site Infection and their Sensitivity Pattern

Aim : The objectives of this study was to study the various micro-organisms causing surgical site infection, to study their antibiotic sensitivity and resistance pattern. Setting : Department of Surgery of a tertiary health care centre with an attached medical college. Material and methods : A total of 89 patients with post operative surgical site infection occurring within 30 days of surgery or 1 year of implant were included as subject material after they satisfy inclusion and exclusion criteria. Results : E.coli is the commonest organism isolated in SSI wounds. Overall Imipenem and Amikacin are the most sensitive antibiotics. Over all gentamycin, cefotaxime and clindamycin are the most resistant antibiotics noted. Conclusion : The most common organisms associated with SSI are E. coli and Pseudomonas. Most of the organisms were sensitive to imipenem, amikacin. Sensitivity pattern of the of the organism is changing with time. The common organisms are now no longer sensitive to routinely used cheaper antibiotics. Newer antibiotics, which are more costly, are required to treat the infection which is a burden to the patient.

Study of Various Organisms Associated with Surgical Site Infection and their Sensitivity Pattern

<strong>Aim</strong>: The objectives of this study was to study the various micro-organisms causing surgical site infection, to study their antibiotic sensitivity and resistance pattern. <strong>Setting</strong>: Department of Surgery of a tertiary health care centre with an attached medical college. <strong>Material and methods</strong>: A total of 89 patients with post operative surgical site infection occurring within 30 days of surgery or 1 year of implant were included as subject material after they satisfy inclusion and exclusion criteria. <strong>Results</strong>: <em>E.coli</em> is the commonest organism isolated in SSI wounds. Overall Imipenem and Amikacin are the most sensitive antibiotics. Over all gentamycin, cefotaxime and clindamycin are the most resistant antibiotics noted. <strong>Conclusion</strong>: The most common organisms associated with SSI are <em>E. coli</em> and Pseudomonas. Most of the organisms were sensitive to imipenem, amikacin. Sensitivity pattern of the of the organism is changing with time. The common organisms are now no longer sensitive to routinely used cheaper antibiotics. Newer antibiotics, which are more costly, are required to treat the infection which is a burden to the patient.

Short Operative Duration and Surgical Site Infection Risk in Hip and Knee Arthroplasty Procedures.

To determine the association (1) between shorter operative duration and surgical site infection (SSI) and (2) between surgeon median operative duration and SSI risk among first-time hip and knee arthroplasties. Retrospective cohort study A total of 43 community hospitals located in the southeastern United States. Adults who developed SSIs according to National Healthcare Safety Network criteria within 365 days of first-time knee or hip arthroplasties performed between January 1, 2008 and December 31, 2012. Log-binomial regression models estimated the association (1) between operative duration and SSI outcome and (2) between surgeon median operative duration and SSI outcome. Hip and knee arthroplasties were evaluated in separate models. Each model was adjusted for American Society of Anesthesiology score and patient age. A total of 25,531 hip arthroplasties and 42,187 knee arthroplasties were included in the study. The risk of SSI in knee arthroplasties with an operative duration shorter than the 25th percentile was 0.40 times the risk of SSI in knee arthroplasties with an operative duration between the 25th and 75th percentile (risk ratio [RR], 0.40; 95% confidence interval [CI], 0.38-0.56; P<.01). Short operative duration did not demonstrate significant association with SSI for hip arthroplasties (RR, 1.04; 95% CI, 0.79-1.37; P=.36). Knee arthroplasty surgeons with shorter median operative durations had a lower risk of SSI than surgeons with typical median operative durations (RR, 0.52; 95% CI, 0.43-0.64; P<.01). Short operative durations were not associated with a higher SSI risk for knee or hip arthroplasty procedures in our analysis.

English

It is a prospective study carried out on patients who underwent clean and clean contaminated elective general surgical procedures from June 2012 to May 2014 at Govt. General Hospital, Kakinada, East Godavari District of Andhra Pradesh. Patients with diabetes mellitus, Patients on steroids, chemotherapy, and immunosuppression are excluded. Total of 100 cases were studied.50 cases of clean and 50 cases of clean contaminated procedures were selected. Out of 50 cases of clean procedures 25 were given prophylactic and 25 were given empirical antibiotics. Out of 50 cases of clean contaminated cases 25 were given prophylactic and 25 were given empirical antibiotic. Data analysis was done with SPSS software. To present the results mean+SD was used and a 'P' value of 0.05, which was not significant. CONCLUSION: Thus it can be concluded from this study that a single dose antibiotic prophylaxis prior to surgery is sufficient to prevent post- operative surgical site infections in clean and clean contaminated surgeries thus preventing adverse outcomes of inadvertent antibiotic usage, such as multi-drug resistance and drug toxicity, financial burden on the hospital can be decreased,work load on junior doctors can be reduced.

Short Operative Duration and Surgical Site Infection Risk in Hip and Knee Arthroplasty Procedures

Short Operative Duration and Surgical Site Infection Risk in Hip and Knee Arthroplasty Procedures

1011Quick But Not Dirty: Short Operative Time and Surgical Site Infection Rates In Knee and Hip Arthroplasty Procedures

1011Quick But Not Dirty: Short Operative Time and Surgical Site Infection Rates In Knee and Hip Arthroplasty Procedures

Plastic surgeons' self-reported operative infection rates at a Canadian academic hospital

Background Surgical site infection rates are of great interest to patients, surgeons, hospitals and third-party payers. While previous studies have reported hospital-acquired infection rates that are nonspecific to all surgical services, there remain no overall reported infection rates focusing specifically on plastic surgery in the literature. Objective To estimate the reported surgical site infection rate in plastic surgery procedures over a 10-year period at an academic hospital in Canada. Methods A review was conducted on reported plastic surgery surgical site infection rates from 2003 to 2013, based on procedures performed in the main operating room. For comparison, prospective infection surveillance data over an eight-year period (2005 to 2013) for nonplastic surgery procedures were reviewed to estimate the overall operative surgical site infection rates. Results A total of 12,183 plastic surgery operations were performed from 2003 to 2013, with 96 surgical site infections reported, corresponding to a net operative infection rate of 0.79%. There was a 0.49% surgeon-reported infection rate for implant-based procedures. For non-plastic surgery procedures, surgical site infection rates ranged from 0.04% for cataract surgery to 13.36% for high-risk abdominal hysterectomies. Discussion The plastic surgery infection rate at the study institution was found to be &lt;1%. This rate was equal to, or somewhat less than, surgical site infection rates. However, these results do not report patterns of infection rates germane to procedures, season, age groups or sex. To provide more in-depth knowledge of this topic, multicentre studies should be conducted.

Efficacy analysis of laparoscopic sleeve gastrectomy in treatment of obesity with type 2 diabetes mellitus

To investigate the efficacy and safety of laparoscopic sleeve gastrectomy(LSG) for the treatment of obesity with type 2 diabetes mellitus(T2DM). Clinical data of 32 obesity patients with T2DM patients undergoing LSG from May 2010 to February 2012 in our department were retrospectively analyzed. Their body weight indexes (body weight, waist circumference, BMI, EWL), blood glucose indexes [glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), insulin resistance index (HOMA-IR)], and blood lipid indexes [total cholesterol, triglyceride, low density lipoprotein cholesterol(LDL-C), high density lipoprotein cholesterol(HDL-C)] were measured 1, 3, 6, 12 months after operation and compared with preoperative levels. Improvement in complications was observed. All the patients completed operation under laparoscopy except 1 case because of abdominal cavity adhesion. The average operative time was (115.0±19.6) min, and the average blood loss (69.0±29.7) ml. No operative death, anastomotic leakage, or surgical site infection were found. The body weight, waist circumference and BMI at 1, 3, 6, and 12 months after surgery were significantly lower(all P<0.05) showing a decreasing trend over time. EWL showed significant increasing trend (P<0.05). During 12 months of follow-up, no over-low weight was observed. From 1 month after surgery, HbA1c, FPG and HOMA-IR decreased significantly (P<0.05). HbA1c and FPG maintained stable level at 12 and 6 months after operation respectively. FPG of 28 patients returned to normal 3 months after operation. Clinical complete remission rate of T2DM was 87.5%(28/32), and clinical partial remission rate was 12.5%(4/32) at the 12-month follow-up. Serum total cholesterol, triglyceride and LDL-C decreased obviously after surgery(P<0.05). LSG procedure is a safe and effective surgical method in treatment of obesity with T2DM.

Plastic surgeons' self-reported operative infection rates at a Canadian academic hospital.

Surgical site infection rates are of great interest to patients, surgeons, hospitals and third-party payers. While previous studies have reported hospital-acquired infection rates that are nonspecific to all surgical services, there remain no overall reported infection rates focusing specifically on plastic surgery in the literature. To estimate the reported surgical site infection rate in plastic surgery procedures over a 10-year period at an academic hospital in Canada. A review was conducted on reported plastic surgery surgical site infection rates from 2003 to 2013, based on procedures performed in the main operating room. For comparison, prospective infection surveillance data over an eight-year period (2005 to 2013) for nonplastic surgery procedures were reviewed to estimate the overall operative surgical site infection rates. A total of 12,183 plastic surgery operations were performed from 2003 to 2013, with 96 surgical site infections reported, corresponding to a net operative infection rate of 0.79%. There was a 0.49% surgeon-reported infection rate for implant-based procedures. For non-plastic surgery procedures, surgical site infection rates ranged from 0.04% for cataract surgery to 13.36% for high-risk abdominal hysterectomies. The plastic surgery infection rate at the study institution was found to be <1%. This rate was equal to, or somewhat less than, surgical site infection rates. However, these results do not report patterns of infection rates germane to procedures, season, age groups or sex. To provide more in-depth knowledge of this topic, multicentre studies should be conducted.

Incidência de infecção do sítio cirúrgico com o preparo pré-operatório utilizando iodopolividona 10% hidroalcoólica e clorexidina alcoólica 0,5%

To analyze the incidence of surgical site infection when the preoperative skin preparation was performed with 10% povidone-iodine and 0.5% chlorhexidine-alcohol. We conducted a randomized, longitudinal study based on variables obtained from patients undergoing clean and potentially contaminated operations. Those involved were divided into two groups. In group 1 (G1) we included 102 patients with skin prepared with povidone-iodine, and in group 2 (G2), 103, whose skin was prepared with chlorhexidine. In the third, seventh and 30th postoperative days we evaluated the surgical site, searching for signs of infection. Data related to clinical profile, such as diabetes mellitus, smoking, alcoholism, haematological data (Hb, VG and leukocytes), age and gender, and the related variables, such as number of days of preoperative hospitalization, shaving, topography of incision, antibiotic prophylaxis and resident participation in the operation were not predisposing factors for surgical site infection. Two patients in G1 and eight in G2 undergoing clean operations had some type of infection (p = 0.1789), five in G1 and three in G2 undergoing potentially contaminated operations had some type of infection (p = 0.7205). The incidence of surgical site infection in operations classified as clean and as potentially contaminated for which skin preparation was done with 10% povidone-iodine and 0.5% chlorhexidine-alcohol was similar.

CORONARY ARTERY BY PASS GRAFTING

Background: Several studies have suggested superiority of tight glycaemic control in reducing the incidence of surgical site infection and mortality after cardiac surgery. Objective: To compare the frequency of post operative surgical site infections after CABG in patients with tight glycamic control and those with standard glycamic control. Setting: Shaikh Zayed Hospital, Lahore. Period: June 2008 to March 2010. Methods: Total of 496 patients were included, they were randomized to tight glycaemic control group (TGC ,n =248) or standard control group(SC, n=248).In TGC group blood glucose was maintained between 90 – 130 mg/dl, while in SC group blood glucose was maintained between 131- 190mg/dl for 48 hours post surgery. Results were prospectively evaluated. Results: Demographic and surgical data was similar in both groups. Patients in TGC group showed significant reduction in post operative superficial sternal wound infection (4 vs 12 , p &lt; 0.05) , deep sternal wound infection (1 vs 7, p &lt;0.05) and leg wound infection ( 2vs 9, p&lt;0.05).There was also non significant reduction in the incidence of post operative mediastinitis (1 vs 3), new myocardial infarction ( 2 vs 3),and atrial fibrillation (10 vs 12). Mortality was equal in both groups (1 in each). Conclusions: Significant reduction in SSI was observed in TGC group and no change was seen in other morbidities and short term mortality in the study.

Postoperative Surgical Site Bacterial Infections and Drug Susceptibility Patterns at Gondar University Teaching Hospital, Northwest Ethiopia

The study aimed to determine the prevalence, etiological agents and drug susceptibility pattern of bacterial pathogens isolated from postoperative surgical site infections and hospital environment in Gondar University Teaching Hospital. Specimens were taken from patients with post operative surgical site infections seen at wards and from hospital environment. Specimens were processed for bacteriological analysis and antibiotic susceptibility test according standard procedures. Antimicrobial susceptibility test for isolated organisms was done using disk diffusion method. Of 111 pathogenic bacteria, Escherichia coli 27 (24.3%), Staphylococcus aureus 26 (23.4%), Coagulase negative Staphylococci 22 (19.8%) and Enterobacter spp. 11 (9.9%) were dominant isolates. The prevalence of methicillin resistant S. aureus was 9 (34.6%). Seventeen (77.3%) and 1 (4.5%) of coagulase negative Staphylococcus were methicillin and vancomycin resistant, respectively. Coagulase negative Staphylococcus 41 (41.8%), S. aureus 19 (19.4%) and P. aeruginosa 16 (16.3%) were the major isolates from 75 sites of the hospital environment with an isolation rate of 41 (54.7%). The prevalence of methicillin resistant S.aureus from the environment was 2 (2.0%). High level of multi-drug resistance was observed in bacteria isolates from patients compared to the bacteria isolated from the hospital environments. This study demonstrated high level of multi-drug resistance. Thus, antibiotic sensitivity testing should be carried out for all bacterial isolates of surgical wounds before chemotherapy administered to detect drug resistant strains.

Use of Calcium Sulphate Bone Graft at West Middlesex University Hospital: A Three Year Study of Outcomes

Use of Calcium Sulphate Bone Graft at West Middlesex University Hospital: A Three Year Study of Outcomes

Relationship between skin microbial counts and surgical site infection after neurosurgery.

A prospective study was performed to describe the density of bacterial counts on the skin of neurosurgical patients and examine the association between total colony-forming unit (cfu) counts of skin flora at the operative site and surgical site infection (SSI). Two skin cultures were obtained, immediately before and after skin preparation, from the operative sites of 609 neurosurgical patients. SSI surveillance that used Centers for Disease Control/National Nosocomial Infection Surveillance definitions was performed. Predictors for high bacterial counts and SSI among craniotomies were analyzed by means of logistic regression. Neither pre- nor postpreparation counts were associated with SSI. Other SSI risk factors were obesity (relative risk [RR], 2.5), duration of surgery (RR, 1.3 for every additional 30 minutes) and age (RR, 0.7 for each additional 10 years). Duration of skin preparation was not correlated with postpreparation cfu counts. We were unable to detect an association between preoperative bacterial skin counts and SSI.

Surgical staging of uterine cancer: An analysis of perioperative morbidity

Surgical staging documented extrauterine disease in 27.9% of 168 patients with apparent early-clinical-stage uterine cancer. An analysis of operative time (78 ± 21 min), blood loss (332 ± 160 cc), and surgical site infection risks (4.7%) indicated little additional risk of lymphadenectomy. The long-term risk of lymphocyst (1.3%) or lymphedema (0.7%) was small. The histologic information obtained from staging was utilized to rationally guide the need for adjunctive teletherapy. The overall risk of recurrence (median follow-up, 26 months) with surgical Stage I disease was 2.6%.