Perioperative Infection Control Research Articles

Anesthesia Management and Perioperative Infection Control in Patients with the Novel Coronavirus

Anesthesia Management and Perioperative Infection Control in Patients with the Novel Coronavirus

[Expert consensus on the prevention of catheter-related bloodstream infection in the department of anesthesiology].

Endovascular catheters play an important role in modern medical diagnosis and treatment. Catheter-related bloodstream infection (CRBSI) is one of the common complications during catheter indwelling, which seriously affects the prognosis of patients. In order to standardize the prevention, diagnosis and treatment strategies of catheter-related bloodstream infections in the Department of Anesthesiology in China, the perioperative Infection Control Branch of the Chinese Society of Cardiothoracic Anesthesia reached a consensus based on the current evidence-based medicine. The consensus elaborates on the aspects of diagnosis, prevention strategy, maintenance and treatment of catheter-associated bloodstream infection, aiming to provide reference for the standardized diagnosis, treatment and management of catheter-associated bloodstream infection in the Department of Anesthesiology.

Perioperative Infection Control Recommendations during the SARS-CoV-2 Omicron Variant Pandemic

<p class="MsoNormal"> COVID-19 significantly increased perioperative risks including mortality and complications. Currently, the Omicron variant is the dominant strain worldwide. Omicron variant is highly contagious with lower incidence of severe diseases. Therefore, it is necessary to update recommendations for managing perioperative anesthesia equipment and protecting perioperative healthcare providers. This article aims to describe perioperative risks, anesthesia equipemnt management, and personelll protection when caring for Omicron patients.

Patient Safety in Anesthesia: Hand Hygiene and Perioperative Infection Control.

This review highlights the importance of the anesthesia team in minimizing perioperative infection risks and prevention of surgical site infection. Due to the immense financial and patient care burden that results from perioperative infection, a foundational knowledge in preventive measures is essential. Perioperative infection control, the role of the anesthesia team in reducing infection risk, and more specifically the outsized importance of hand hygiene in this space have become increasingly apparent. Maintenance of workspace cleanliness along with hand hygiene forms the cornerstone of preventing microbial transmission. Unfortunately, improvements around perioperative infection control are lacking. The importance of the anesthesia team in maintaining proper hand hygiene, a clean work environment, and appropriate patient conditions to minimize risk of perioperative infection cannot be overstated. Poor clinical outcomes, economic burden, and external pressure from payers highlight the need for anesthesia providers to have an up-to-date knowledge of best practices in this area. In this article, we will review the current recommendations for hand hygiene practices and perioperative infection prevention.

Episode 72: Inside the Monitor – Perioperative Infection Control

Central Line Podcast Series| August 2022 Episode 72: Inside the Monitor – Perioperative Infection Control Kumar Belani, MBBS, MS; Kumar Belani, MBBS, MS Search for other works by this author on: This Site PubMed Google Scholar Adam Striker, MD, FASA Adam Striker, MD, FASA Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor August 2022, Vol. 86, 1. https://doi.org/10.1097/01.ASM.0000884324.41787.2e Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Kumar Belani, Adam Striker; Episode 72: Inside the Monitor – Perioperative Infection Control. ASA Monitor 2022; 86:1 doi: https://doi.org/10.1097/01.ASM.0000884324.41787.2e Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: infectious disease prevention / control, perioperative care Dr. Striker discusses infection control in the perioperative period with Dr. Kumar Belani, co-guest editor of the ASA Monitor's August issue. Listen as they discuss the role of anesthesiologists in preventing infections and reducing post-operative infections, the specifics of hand hygiene and disposables, best practices for mitigating COVID transmission, and more. Recorded June 2022. You do not currently have access to this content.

Evidence-based practice in perioperative infection control

Evidence-based practice in perioperative infection control

Emergency surgery performed in a case of tuberculous peritonitis: perioperative infection control

Emergency surgery performed in a case of tuberculous peritonitis: perioperative infection control

Strategies for daily operating room management of ambulatory surgery centers following resolution of the acute phase of the COVID-19 pandemic

We performed a narrative review to explore the economics of daily operating room management decisions for ambulatory surgery centers following resolution of the acute phase of the Coronavirus Disease 2019 (COVID-19) pandemic. It is anticipated that there will be a substantive fraction of patients who will be contagious, but asymptomatic at the time of surgery.Use multimodal perioperative infection control practices (e.g., including patient decontamination) and monitor performance (e.g., S. aureus transmission from patient to the environment). The consequence of COVID-19 is that such processes are more important than ever to follow because infection affects not only patients but the surgery center staff and surgeons.Dedicate most operating rooms to procedures that are not airway aerosol producing and can be performed without general anesthesia. Increase throughput by performing nerve blocks before patients enter the operating rooms. Bypass the phase I post-anesthesia care unit whenever possible by appropriate choices of anesthetic approach and drugs. Plan long-duration workdays (e.g., 12-h).For cases where the surgical procedure does not cause aerosol production, but general anesthesia will be used, have initial (phase I) post-anesthesia recovery in the operating room where the surgery was done. Use anesthetic practices that achieve fast initial recovery of the brief ambulatory cases.When the surgical procedure causes aerosol production (e.g., bronchoscopy), conduct phase I recovery in the operating room and use multimodal environmental decontamination after each case. Use statistical methods to plan for the resulting long turnover times. Whenever possible, have the anesthesia and nursing teams stagger cases in more than one room so that they are doing one surgical case while the other room is being cleaned.In conclusion, this review shows that while COVID-19 is prevalent, it will markedly affect daily ambulatory workflow for patients undergoing general anesthesia, with potentially substantial economic impact for some surgical specialties.

MANAGEMENT OF COVID-19 IN PERSPECTIVE OF CARDIOLOGISTS

After influenza Coronavirus Disease 2019 (COVID-19) is pandemic. The outbreak of the disease started in China and the number of cases exceeded in the world as of March 15, 2020 and the rate is multiplicating tremendously.1 COVID-19 has its effect on cardiovascular system increasing morbidity with underlying cardiovascular condition and causing myocardial infarction and dysfunction.2 COVID-19 is caused by severe acute respiratory syndrome Coronavirus-2 (SARS-COV-2). It is believed that SARS-COV-2 entered in humans after it shifted from cats to an intermediate host (Malayan Pangolin).3 SARS-COV-2 spread by respiratory droplets and can be found in stool. The secondary infection rates range from 0.5-5%.4,5 The most common symptoms are fever (88%), dry cough (67.7%), rhinorrhea (4.8%) less frequent is gastrointestinal symptoms (diarrhea 4-14%, nausea/emesis 5%).5 Chinese reports presented with more significant symptoms in which 14% presented with dyspnea, respiratory rate ≥ 30 bpm blood oxygen saturation ≤ 93%, PO2 to fraction of impaired oxygen ratio &lt; 300 and/or lung infiltrates &gt;50% within 24 to 48 hours and 5% with respiratory failure, septic shock, and/or multiple organ dysfunction or failure.6 COVID-19 caused myocardial injury as presented in Wuhan China with elevated high sensitivity troponin I (hs-CTNI) or new ECG changes in 7.2% and 2.2% required ICU care.7 There is an elevation of other inflammatory biomarkers (D-dimer, ferritin, interleukin-6, lactate dehydrogenase) reflects cytokine storm or secondary hemophagocytic lymphohistiocytosis. The presentation of cardiac problem misleads viral myocarditis or stress cardiomyopathy. There is left ventricular dysfunction (EF 27%, LVEDD 5.8cm) and elevated cardiac biomarkers.8 The exact mechanism of cardiac involvement is not known. It is postulate that myocardial involvement may be via ACE2 or cytokine storm with T helper cells or hypoxia induced excessive intracellular calcium leading to cardiac myocyte apoptosis.9-11 Preventive measure are best strategy for COVID-19. Vaccines and monoclonal antibodies against SARS-CoV-2 are in investigation stages. Recombinant human ACE2 (APN01) has been proposed as treatment to prevent SARS-COV-2. 12-13 Remdesevir and Chloroquineare other drugs that may add clinical benefits in reduction of pneumonia and hospital stay.14-17 In mild to severe cases of COVD-19 typical imaging findings are not different (e.g. ground-glass opacification with or without consolidative abnormalities, consistent with viral pneumonia, minimal or no pleural effusions).18 CT chest was performed in Chinese cohort, though one should avoid its use unless necessary.  If it is mandatory to use as a diagnostic tool it should be balanced with risk to other patients and health care workers during process of patient transport and time that is spent in diagnostic area. An alternative approach on bedside is use of lung ultrasound that presents with thickening of the pleural line and B line supporting alveolar consolidation. Pleural effusions are unusual.19 In a study of 1014 patients in Wuhan who underwent reverse transcription polymerase chain reaction (RT-PCR) testing and chest CT for evaluation of COVID-19 a posterior chest CT for COVID-19 had sensitivity of 97% and specificity of 25% using PCR test as a reference.20 Chest CT abnormalities has also been identified in development of symptoms and even prior to detection of viral RNA from upper respiratory symptoms.21 In cardiac medicine the view points as a cardiologist for the diseases and management are;7,22 A relatively high percent of patients admitted with COVID-19 will have underlying coronary artery disease (CAD). For most, symptoms of CAD will not be present on admissionIt is likely that COVID-19 directly and indirectly affects the cardiovascular system, causing acute and chronic coronary syndrome.In patients with known or suspected COVID-19, approach for the diagnosis and management of ST-elevation myocardial infarction (MI) similar to those without. On occasion, it is reasonable to liberalize the use of fibrinolytic therapy relative to primary percutaneous coronary intervention in low risk patients in centers where PPE and COVID cath labs are not available. In centers where proper PPE kits are available and can manage appropriately keeping in view the benefit and transferability to patients and health workers primary PCI can be undertaken.Try to delay elective revascularization procedures in patients for whom the indication is relief of symptoms. Such an approach protects the patient and health care workers from potential exposure. For patients who must have revascularization for reasons such as extremely poor quality of life or prolongation of life, as with significant left main CAD, test the patient for COVID-19 infection.None of the usual medications for the management of CAD, such as aspirin, beta blockers, statins, and nitrates, have been associated with worse outcomes in the setting of COVID-19 infection. Continue angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers.Underlying medical comorbidities appear to significantly impact COVID-19 severity and mortality. Patients with underlying cardiovascular disease and hypertension have been reported to have significantly high-case fatality rates compared with patients without these underlying comorbidities (10.5% and 6% mortality, respectively, compared with 0.9% mortality without underlying comorbidities).23 COVID-19 with view as a cardiac anesthetist are;24 Incidence of deep vein thrombosis and pulmonary embolism is due to immobility, systemic inflammation and disseminated intravascular coagulation.During the preoperative evolution, focus should be on respiratory compromise assessment of organ failure particularly signs of shock, liver failure, renal failure and assessment of airway and to formulate airway plan. If the patient is considered high risk then it should be brought in notice of surgeons on urgency of operation and delay if possible. During perioperative period, approach to infection control for all health care workers and patient in pre and postoperative area according to hospital guideline is mandatory. In addition, droplet and contact precautions should be taken care to patients who are highly suspected and confirmed case of COVID 19. Hospital management plays pivotal role in multidisciplinary team between anesthesiologist, medical team, surgical team, infection control and intensive care to implement isolation practices.According to WHO recommendations N95 mask eye protective goggles, gown, gloves, and caps are necessary for all care provider. Operations on confirmed positive cases should be performed in an airborne infection isolation room (AIIR). Existing operating rooms should be converted to AIIR and maintained negative pressure. To prevent cross infection, single use of all anesthetic equipment, utensils, and drugs for individual patients must be drawn.Anesthesia devices to maintain airway such as laryngoscope blades, circuits, filter, respiratory balloons, and suction tubes should be discarded after single use. At the end of surgery in operating room thorough disinfection and sterilization should be carried out that includes anesthesia machine, operating room spray and mopping, and ultraviolet radiation.All health care providers involved in procedure may transmit infections to others so strict hospital policies should be addresses regarding dispose of potential, contaminated clothing. In conclusion chest CT findings may be characteristics of COVID-19. No funding can completely rule in or rule out the possibility of COVID-19. CT chest though can be used for screening or diagnosis of COVID-19 and should be reserved for hospitalized patients when needed for management. All measures for care of health care worker and patients in view of cardiologist and anesthetist should be appropriately followed. References Organization WH. WHO Director-General’s remarks at the media briefing on 2019-nCoV on 11 February 2020. [Internet] World Health Organization. 2020.Clerkin KJ, Fried JA, Raikhelkar J, Sayer G, Griffin JM, Masoumi A, et al. Coronavirus Disease 2019 (COVID-19) and Cardiovascular Disease. Circulation 2020 Mar 21. DOI: 10.1161/CIRCULATIONAHA.120.046941Zhang T, Wu Q, Zhang Z. Probable pangolin origin of SARS-CoV-2 associated with the COVID-19 outbreak. Curr Biol. 2020;30(8):1578.Zou L, Ruan F, Huang M, Liang L, Huang H, Hong Z, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med. 2020;382(12):1177-9.World Health Organization. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). February 28, 2020. https://www.who.int/publications-detail/reportof-the-who-china-joint-mission-on-coronavirus-disease-2019-(covid-19).Zhang H, Penninger JM, Li Y, Zhong N, Slutsky AS. Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target. Intensive Care Med. 20203:1-5.Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA. 2020;323:1061-1069.Hu H, Ma F, Wei X, Fang Y. Coronavirus fulminant myocarditis saved with glucocorticoid and human immunoglobulin. Eur Heart J. 2020. DOI: 10.1093/eurheartj/ehaa190Oudit GY, Kassiri Z, Jiang C, Liu PP, Poutanen SM, Penninger JM, et al. SARS‐coronavirus modulation of myocardial ACE2 expression and inflammation in patients with SARS. Eur J Clin Invest. 2009;39(7):618-25.Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229): 1054-1062.Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol 2020;17:259-260.Khan A, Benthin C, Zeno B, Albertson TE, Boyd J, Christie JD, et al. A pilot clinical trial of recombinant human angiotensin-converting enzyme 2 in acute respiratory distress syndrome. Critical Care. 2017;21(1):234.Kawase M, Shirato K, van der Hoek L, Taguchi F, Matsuyama S. Simultaneous treatment of human bronchial epithelial cells with serine and cysteine protease inhibitors prevents severe acute respiratory syndrome coronavirus entry. J Virol. 2012;86(12):6537-45.Gordon CJ, Tchesnokov EP, Feng JY, Porter DP, Gotte M. The antiviral compound remdesivir potently inhibits RNA-dependent RNA polymerase from Middle East respiratory syndrome coronavirus. J Biol Chem. 2020;295:4773-4779.Clinicaltrials.gov. Comparison of Lopinavir/Ritonavir or Hydroxychloroquine in patients with mild coronavirus disease (COVID-19). Identifier: NCT04307693. Updated March 13, 2020. https://clinicaltrials.gov/ct2/show/NCT04307693.ClinicalTrials.gov. Efficacy and Safety of Hydroxychloroquine for Treatment of Pneumonia Caused by 2019-nCoV ( HC-nCoV ). Identifier: NCT04261517. Updated March 4, 2020. https://clinicaltrials.gov/ct2/show/NCT04261517.Gao J, Tian Z, Yang X. Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends. 2020;14(1):72-73.Yang X, Yu Y, Xu J, Shu H, Liu H, Wu Y, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020. DOI: 10.1016/S2213-2600(20)30079-5Peng QY, Wang XT, Zhang LN, Chinese Critical Care Ultrasound Study Group. Findings of lung ultrasonography of novel corona virus pneumonia during the 2019–2020 epidemic. Intensive Care Med. 2020. DOI: 10.1007/s00134-020-05996-6Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases. Radiology. 2020. DOI: 10.1148/radiol.2020200642Shi H, Han X, Jiang N, Cao Y, Alwalid O, Gu J, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis. 2020. DOI: 10.1016/S1473-3099(20)30086-4Musher DM, Abers MS, Corrales-Medina VF. Acute infection and myocardial infarction. N Engl J Med. 2019;380(2):171-6.Bansal M. Cardiovascular disease and COVID-19. Diabetes Metab Syndr 2020;14(3):247.Li W, Huang J, Guo X, Zhao J, Mandell MS. Anesthesia management and perioperative infection control in patients with the novel coronavirus. J Cardiothorac Vasc Anesth. 2020. DOI: 10.1053/j.jvca.2020.03.035 

IJU this issue

In this issue, seven Original Articles with four Editorial Comments, two Review Articles and three Urological Notes were published in the International Journal of Urology. Urinary tract infection or perioperative infection control is one of the important clinical issues for urologists. A rapid increase of carbapenem-resistant Enterobacteriaceae and its outbreak is a grave worldwide problem. Kitano et al. (Hiroshima, Japan) reviewed mechanisms behind antimicrobial resistance, and new antimicrobials to treat resistant microbes. This article concisely describes the current state of resistant microbes associated with urinary tract infections and countermeasures for antimicrobial resistance, including new antimicrobials. As the author denotes in Table 3 of that article, the World Health Organization priority list for antibiotic-resistant bacteria should be recognized by urologists. As different treatment modalities for localized prostate cancer yield similar patient outcomes, the focus in determining appropriate treatment has shifted toward health-related quality of life. Murakami et al. (Kanagawa, Japan) reviewed the impact of brachytherapy and other modalities on health-related quality of life. Except for the inferior outcome regarding urinary obstruction and irritation, brachytherapy is likely to yield similar or better health-related quality of life than other treatment modalities, such as operation, active surveillance or external beam radiation therapy. Due to scant data on prospective direct comparison among modalities and recent replacement by sophisticated technologies, such as intensity-modulated radiation therapy or robot-assisted radical prostatectomy, it seems hardly difficult to draw a convincing conclusion. Sazuka et al. (Chiba, Japan) retrospectively examined the impact of post-void residual urine volume on the risk of postoperative intravesical recurrence in 81 patients with upper urinary tract urothelial carcinoma undergoing nephroureterectomy. The authors found the presence of pyuria and a residual urine volume (defined as ≥30 mL) were associated with bladder recurrence in the multivariate analysis, and the 2-year postoperative recurrence-free rates of patients with and without a residual urine volume were 32% and 82%, respectively. Although the number of the cohort for a propensity-score match study is limited, the authors’ hypothesis is unique and is worthwhile for a large-scale prospective analysis. Choo et al. (Suwon, Korea) carried out to a web-based questionnaire survey regarding the individual treatment trend and adherence to international guidelines on non-muscle-invasive bladder cancer. Out of 2334 urologists who were active members of the Japanese Society of Urological Oncology, the Korean Urological Oncology Society and the Taiwan Urological Association, 701 (30%) responded to the survey from June 2016 to February 2017. The authors found significant differences in the management of intermediate- to high-risk non-muscle-invasive bladder cancer between Japan, Korea and Taiwan. As the authors described, East Asian countries are geographically close together, and share ethnic and sociocultural similarities, such that the survey can serve as the basis for joint efforts among East Asian urologists to develop common clinical guidelines for the management of non-muscle-invasive bladder cancer. Nephrostomy tube after percutaneous intrarenal surgeries, such as percutaneous nephrolithotomy (PCNL), sometimes prevents a short hospital stay and adversely affects patients’ quality of life. A tubeless procedure would be ideal after PCNL. Takeda et al. (Miyazaki, Japan) compared the efficacy and safety among patients who received trans-tract electrocoagulation at the end of endoscopic combined intrarenal surgery (225 patients) with that of those who did not (72 patients). Although stone number or size was in favor of the trans-tract electrocoagulation group, the nephrostomy tube-free rate and other postoperative clinical parameters were significantly higher in the trans-tract electrocoagulation group. As Kakinoki (Saga, Japan) indicated in the Editorial Comment, all patients do not always require such procedure, particularly when miniaturized PCNL is used. To clarify the necessity of hemostasis, a prospective randomized study comparing miniaturized PCNL is warranted. None declared.

Successful perioperative infection control measures after gastroenterological surgery reduced the number of cases of methicillin-resistant Staphylococcus aureus or Clostridioides (Clostridium) difficile infection to almost zero over a 30-year period: a single-department experience.

To investigate changes in the incidence of postoperative infections in the surgical department of a teaching hospital. During the 30-year period from September 1987 to August 2017, 11,568 gastroenterological surgical procedures were performed in our surgical department. This 30-year period was divided into seven periods (A-G), ranging from 2 to 7years each and based on the infection control methods used in each period. We then compared the rates of incisional surgical site infection (SSI) and organ/space SSI; remote infection (RI) including respiratory tract infection (RTI), intravascular catheter-related infection, and urinary tract infection (UTI); and antibiotic-associated colitis caused by methicillin-resistant Staphylococcus aureus (MRSA) enteritis or Clostridioides (Clostridium) difficile-associated disease (CDAD) among the seven periods. In periods B (September 1990-August 1997) and E (November 2004-July 2007), when a unique antibiotic therapy devised in our department was in use, MRSA was isolated from only 0.3% and 0.4% of surgical patients, respectively, and these rates were significantly lower than those in the other periods (p < 0.05). The rate of CDAD increased during period F (August 2007-July 2014), but in period G (August 2014-August 2017), restrictions were placed on the use of antibiotics with a strong anti-anaerobic action and, in this period, the rate of CDAD was only 0.04%, which was significantly lower than that in period F (p < 0.05). Limiting the use of antibiotics that tend to disrupt the intestinal flora may reduce the rates of MRSA infection and CDAD after gastroenterological surgery.

Perioperative infection control in liver transplantation

Perioperative infection control in liver transplantation

The influence of intestinal microbiome on wound healing and infection

Wound healing problems and surgical site infections are commonly attributed to improper intraoperative technique and perioperative infection control methods. However, overwhelming evidence is emerging to suggest that the intestinal microbiome plays a profound and previously underappreciated role in infectious outcomes of surgery. Surgical stress and perioperative medical interventions alter the community structure and function of the intestinal microbiome. The resultant intestinal dysbiosis exerts overarching effects on the host immune and neuroendocrine systems. Although certainly infection is known to occur from inadvertent intraoperative contamination, a more intriguing concept is the possibility that alterations in the intestinal microbiome, occurring in response to the physiologic stress of surgery, may have a major negative influence on the host’s ability for tissue repair, regeneration, and resilience to infection.

Current perioperative practice patterns for minimizing surgical site infection during rhinologic procedures.

There is a paucity of information in the literature regarding the best practices to reduce surgical site infections associated with rhinologic surgery. We surveyed the American Rhinologic Society (ARS) membership to assess current perioperative infection control measures performed for rhinologic procedures, with the goal of establishing a baseline of current practice. Results revealed that for most rhinologic procedures performed in the operating room (OR) setting, the majority of physicians gown and drape in a sterile fashion and perform a complete surgical scrub of their hands and forearms but do not prep the facial skin with an antimicrobial agent. For rhinologic procedures performed in the office setting, the majority of physicians do not perform any of the aforementioned perioperative measures for any of the office procedures. Interestingly, for physicians that perform inferior turbinate reductions in both settings, 45% gown and drape in a sterile fashion and 28% perform a complete surgical scrub of their hands in the OR setting but not in the office setting. The most stringent measures were performed for endoscopic skull-base procedures, with over 90% of responders administering perioperative antibiotics, gowning and draping in a sterile fashion, and performing a complete surgical scrub of their hands. Despite lack of demonstrated benefit, antibiotics were used variably for the other procedures. This survey demonstrates that there is great variability in the perioperative measures rhinologists perform to reduce surgical site infection, which differs by the practice site. These data serve as a baseline for future studies.

Perioperative infection control

Over the past 50 years, the growing ability to undertake increasingly complex surgical procedures has resulted in the inevitable increase in the possibility for infection, and in numerous studies and recommendations regarding perioperative infection control.

Aspekte der perioperativen Behandlung von Diabetespatienten

Diabetes is a common disease in Germany. Due to diabetes-associated end-organ disease, such as large and small vessel disease and neuropathy, diabetic patients require more intense anesthesia care during the perioperative phase. An in-depth and comprehensive medical history focusing on hemodynamic alterations, gastroparesis, neuropathy and stiff joint syndrome is a cornerstone of perioperative care and may affect outcome of diabetes patients more than specific anesthetic medications or the anesthetic procedure. Intraoperative anesthetic care needs to focus on preservation of hemodynamic stability, perioperative infection control and maintenance of glucose homeostasis. Whereas some years ago strict glucose control by aggressive insulin therapy was adamantly advocated, the results of recent studies have put the risk of such therapeutic algorithms into perspective. Therefore, optimized perioperative care of diabetic patients consists of setting a predefined targeted blood glucose level, evidence-based therapeutic approaches to reach that goal and finally adequate and continuous monitoring and amendment of the therapeutic approach if required.

Risk factors for Staphylococcus aureus surgical site infection during an outbreak in patients undergoing cardiovascular surgery

This study examined the epidemiology of an outbreak of Staphylococcus aureus surgical site infections (SSI) after cardiovascular surgery, and analyzed risk factors for S aureus SSIs. This was a retrospective case-control study to determine risk factors for S aureus SSI in 38 patients who developed S aureus SSI during the outbreak period, compared with age-, sex-, and procedure-matched controls. S aureus strains were typed by pulsed-field gel electrophoresis. A total of 38 patients had S aureus SSI. Pulsed-field gel electrophoresis identified transmission of 3 S aureus clones (2 MSSA clones and 1 MRSA clone). Twenty-one health care workers were carriers of outbreak strains. In multivariate analysis, the significant risk factors for S aureus SSI were previous cardiac surgery (odds ratio, 7.41; 95% confidence interval, 1.05-52.16) and long procedure duration (odds ratio, 1.49; 95% confidence interval, 1.00-2.21). This outbreak demonstrates evidence of nosocomial transmission of 3 clones of S aureus in the setting of incomplete compliance with recommended standard perioperative infection control measures, associated with a high prevalence of staff carriage of the predominant outbreak strains.

Infektionskontrolle im OP: Präventions- und Isolierungsmaßnahmen bei multiresistenten Erregern

Providing surgical treatment for patients colonised or infected with multidrug resistant organisms (MDROs) is daily routine in German hospitals. However, there is uncertainty about the application of adequate infection control measures in the OR. One of the reasons is that specific guidelines are not available. We evaluated current practice in surgical departments of selected German university medical centres using a questionnaire. In addition, centres were asked to provide in-house standard operating procedures (SOP), if available. Nineteen questionnaires from 19 departments within 4 centres and 5 in-house SOPs were ana-lysed. The results showed a broad spectrum of applied infection control measures. Wide variations existed both within centres and within departments of the same centre regardless of existing in-house standards. Guidelines addressing perioperative infection control measures for patients harbouring MDROs should be developed with a focus on practicability to reduce both transmission of MDROs and unreasonable measures. Implementation of existing SOPs can be a target for optimisation.

Development of a Perioperative Infection Control Plan Based on Needs Assessment in a University Affiliated Hospital

Development of a Perioperative Infection Control Plan Based on Needs Assessment in a University Affiliated Hospital

The Gut Microbiota as a Target for Improved Surgical Outcome and Improved Patient Care

The 'gut origin of sepsis' concept describes the role of the intestine in the development of sepsis and the post-operative Multi Organ Dysfunction Syndrome (MODS). Translocation of the microbiota from the gut into the systemic milieu is thought to be integral to this process. However, advances in molecular biology have demonstrated numerous mechanisms of interkingdom signalling within the gut and evidence suggests that the gut microbiota may directly influence the mammalian phenotype. The gut ecosystem fluctuates significantly in response to exogenous and surgical trauma yet until recently it has not been possible to study this non invasively and thus it is not known how current perioperative infection control strategies influence the microbiome and the consequences of this intervention for the host. However, novel analytical techniques such as metabonomics and metagenomics are permitting the in vivo analysis of the gut microbiome and are creating new avenues of research that have significant surgical applications. Furthermore, the protective mechanisms of commensal biota are increasingly being recognised, suggesting that perioperative modulation of the gut microbiome with pre, pro and synbiotics may beneficially influence surgical outcome. This paper reviews the role of the gut microbiome in determining surgical outcome, and highlights research into the mammalian microbial symbiotic axis which is leading to novel therapeutic interventions in surgery.