Prevention Of Surgical Infection Research Articles

When Antimicrobial Treatment and Surgical Prophylaxis Collide: A Stewardship Opportunity

Background: In 2002, the Centers for Medicare and Medicaid Services (CMS) in collaboration with the Centers for Disease Control and Prevention (CDC) established the Surgical Infection Prevention (SIP) project for the purposes of developing and standardizing quality improvement measures known to reduce the rates of post-operative surgical site infections (SSIs). Four years later the Surgical Care Improvement Project (SCIP), an expansion of SIP, was published in governmental Specifications Manual for National Inpatient Quality Measures and provided several additional initiatives applicable to the perioperative period. Central to both projects are the assurance of the timeliness, selection, and duration of peri-operative surgical prophylactic antibiotics. In support of this objective, various medical associations, such as the American Society of Health-System Pharmacists (ASHP) and the Infectious Diseases Society of America (IDSA), have developed the Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery. To ensure compliance with quality measures, hospitals are required to report data to the Physicians Quality Reporting System, which is then reviewed by CMS for reimbursement purposes and to measure hospital performance. To maintain optimal standards of care and satisfy all core measures, it is expected that patients undergoing most categories of surgical procedures receive prophylactic antibiotics. We recognized that patients already being administered antimicrobial therapy as treatment for the condition requiring the surgery not uncommonly also were prescribed unwarranted and redundant pre-operative antibiotics. Our study was meant to quantify such antibiotic redundancy, which only risks the development of antimicrobial resistance and adverse events, to bolster our and other hospitals antimicrobial stewardship programs. Methods: A retrospective analysis of computerized hospital records over a one-month period of time (November 2022) was conducted focusing on hospital admissions that involved surgical operative procedures. Only those patients who had received a pre-operative surgical prophylactic antibiotic were included in the analysis. Results: Of the 92 surgeries that fulfilled the inclusion criteria, 38 (41.3%) were performed on patients who were already receiving therapeutic antibiotics for more than 24 hours targeted to treat the infection for which they were undergoing surgery. These included laparoscopic cholecystectomy (24), appendectomy (12), wound debridement (12), and soft tissue incision and drainage procedures (9), comprising nearly 50% of each type of these operations performed during the study time period. Conclusion: These findings demonstrate a clear opportunity to strengthen both our, and presumably other, hospitals antimicrobial stewardship programs. Together with physician education, granting the pharmacy the ability to cancel unnecessary and redundant surgical prophylactic antibiotics would conceivably be of great benefit.

Evaluating risk factors and complications in mandibular ramus block grafting: a retrospective cohort study

ObjectivesThis retrospective cohort study aimed to identify the complications and risk factors associated with alveolar grafting using autologous mandibular ramus grafts, guided by the research question: What are the complications encountered in patients undergoing alveolar bone grafting using autologous mandibular ramus block and what are the risk factors associated with the development of these complications?Materials and methodsThe study included 70 patients who underwent alveolar crest augmentation with autologous mandibular ramus block grafting. Intraoperative, early postoperative, and late postoperative complications were analyzed, as were various risk factors.ResultsThe results showed that the majority of patients had successful outcomes with minimal complications. Sex was found to significantly influence the visibility of the inferior alveolar nerve (IAN). Early postoperative complications were associated with IAN visibility and the use of a single screw for graft fixation. Late postoperative complications were significantly associated with the presence of infection.ConclusionThe findings emphasize the importance of careful surgical techniques, infection prevention, and patient selection in minimizing complications.Clinical relevanceThis article may contribute to clinicians’ and so patients’ understanding of potential risk factors associated with over all ramus block grafting procedure. Based on this information, clinicians can also improve their ability to manage risk factors and associated complications and compare ramus block grafting with other alternatives to determine the best treatment approach for that particular patient.

Use of Platelet-Rich Plasma in the prevention of cardiovascular surgical wound infections: Integrative review

This integrative review seeks to evaluate the effectiveness of the use of platelet-rich plasma in preventing infections after cardiovascular surgeries through the analysis and comparison of existing studies in the database, given that sternal infections are common complications in cardiac surgeries and the search for its prevention is of high importance in medical care. Articles were searched using the descriptors: Surgical wound infection and Platelet-rich plasma, on the platforms: PubMed, Scielo, and BVS. The inclusion criteria used were: articles related to the area of ​​cardiovascular surgery with the use of PRP, published in the last 10 years and written in Portuguese or English. 7 articles were selected and later analyzed according to their degree of recommendation and level of evidence. The study concluded that the use of PRP is effective in reducing post-surgical complications and improving wound healing, however, the lack of studies in the area makes it necessary to carry out more high-quality studies.

Non-Surgery Management of Globe Rupture in Rural Area

Introduction : Globe rupture is a vision-threatening emergency. The management of globe rupture must arrange immediate.
 Case Illustration : A 59-year-old woman presented with painful and sudden vision loss on her left eye after hit by wood an hour prior. From the examination, the palpebra was oedema, and spasm, the conjunctiva was chemosis and bleeding, the sclera was laceration. Visual acuity of the left eye was 1/~. We diagnosed as globe rupture of the left eye. We gave levofloxacin injection, methylprednisolone injection, tranexamic acid injection, prednisolone eyedrop every 3 hours, levofloxacin topical every hour, and oxytetracycline eye ointment once a day in night. After 10 days, clinical manifestation was improved, but the visual acuity. From the examination, we found retinal detachment on her left eye. Patient was referred to the primary health care.
 Discussion : In globe rupture, infection risk is high and requires immediate systemic empiric antibiotics and surgical management. The conservative treatment was administered since the patient rejected for the globe exploration and scleral suture surgery. The aim treatment for this case is to prevent the infection. We used combination systemic and topical levofloxacin antibiotics and corticosteroid. Systemic tranexamic acid was to control the bleeding. No improvement of visual acuity after 10 days, we suspected because of retinal detachment and need surgery management.
 Conclusion : Surgical exploration and infection prevention are needed for globe injury. The sooner management, the better prognosis it could be.

Non-Surgery Management of Globe Rupture in Rural Area

Introduction : Globe rupture is a vision-threatening emergency. The management of globe rupture must arrange immediate.
 Case Illustration : A 59-year-old woman presented with painful and sudden vision loss on her left eye after hit by wood an hour prior. From the examination, the palpebra was oedema, and spasm, the conjunctiva was chemosis and bleeding, the sclera was laceration. Visual acuity of the left eye was 1/~. We diagnosed as globe rupture of the left eye. We gave levofloxacin injection, methylprednisolone injection, tranexamic acid injection, prednisolone eyedrop every 3 hours, levofloxacin topical every hour, and oxytetracycline eye ointment once a day in night. After 10 days, clinical manifestation was improved, but the visual acuity. From the examination, we found retinal detachment on her left eye. Patient was referred to the primary health care.
 Discussion : In globe rupture, infection risk is high and requires immediate systemic empiric antibiotics and surgical management. The conservative treatment was administered since the patient rejected for the globe exploration and scleral suture surgery. The aim treatment for this case is to prevent the infection. We used combination systemic and topical levofloxacin antibiotics and corticosteroid. Systemic tranexamic acid was to control the bleeding. No improvement of visual acuity after 10 days, we suspected because of retinal detachment and need surgery management.
 Conclusion : Surgical exploration and infection prevention are needed for globe injury. The sooner management, the better prognosis it could be.

Impact of the 4th of August Beirut explosion mass casualty incident on a university hospital microbial Flora

BackgroundFollowing the Beirut explosion, our university hospital received at least 350 casualties. Subsequently, infection control standard practices were compromised. Concerns for Multi-Drug Resistant Organisms (MDROs) infections in injured patients and a resulting hospital outbreak were raised. The objectives of the study were to compare the rate of hospital growing MDROs 6 months before and 6 months after the Beirut explosion, to identify emerging microorganisms and to evaluate the change in surgical infection prevention practices.MethodsThis is a retrospective chart review of patients with hospital acquired infections (HAI) admitted to the hospital before and after the Beirut explosion. The study was conducted between February 4, 2020 and January 4, 2021. Excluded patients were those transferred from other hospitals and those with community acquired infections. The primary outcome was to identify the rate of growing MDROs post explosion. The secondary outcomes were identifying antibiotics used for surgical prophylaxis in patients requiring surgeries and patients diagnosed with a HAI. Therefore, patients were divided in three groups. Control group included patients admitted with explosion-related injuries on that same day. Patients admitted and between February 4 and August 4 and diagnosed with HAI were compared to those admitted post August 4 with explosion-related HAI and to patients diagnosed with non-explosion-related HAI between August 4 and January 4, 2021. An estimated rate of 18-22% MDRO was needed to achieve a statistical significance with 80% power and 0.05 α. Pearson Chi square test was used to analyze the primary outcome.ResultsA total of 82 patients with 150 cultures were included in this study. Data showed an increase in the rate of MDRO after the explosion with 37.1% of the cultures taken before the explosion and 53.1% after the explosion (p = 0.05). When comparing the types of HAI in both groups, culture sites were significantly different between pre- and post-explosion patients (p = 0.013). However, both groups had similar types of microbes (p = 0.996) with an increase in candida related infections.ConclusionThese findings confirmed that the Beirut explosion impact on antimicrobial resistance was similar to combat zone incidence, where an increase in MDROs rate such as Escherichia coli (E.Coli) and Stenotrophomonas maltophilia, in addition to the increase in candida related infections.

Scalability and Sustainability of a Surgical Infection Prevention Program in Low-Income Environments

Surgical infections are a major cause of perioperative morbidity and mortality, particularly in low-resource settings. Clean Cut, a 6-month quality improvement program developed by the global nonprofit organization Lifebox, has demonstrated improvements in postoperative infectious complications. However, the pilot program required intense external programmatic and resource support. To examine the improvement in adherence to infection prevention and control standards and rates of postoperative infections in hospitals in the Clean Cut program after implementation strategies were updated and program execution was refined. This cohort study evaluated and refined the Clean Cut implementation strategy to enhance scalability based on a qualitative study of its pilot phase, including formalizing programmatic and educational materials, building an automated data entry and analysis platform, and reorganizing hospital-based team composition. Clean Cut was introduced from January 1, 2019, to February 28, 2022, in 7 Ethiopian hospitals that had not previously participated in the program. Prospective data initiated on arrival in the operating room were collected, and patients were followed up through hospital discharge and with 30-day follow-up telephone calls. Implementation of the refined Clean Cut program. The primary outcome was surgical site infection (SSI); secondary outcomes were adherence to 6 infection prevention standards, mortality, hospital length of stay, and other infectious complications. A total of 3364 patients (mean [SD] age, 26.5 [38.0] years; 2196 [65.3%] female) from 7 Ethiopian hospitals were studied (1575 at baseline and 1789 after intervention). After controlling for confounders, the relative risk of SSIs was reduced by 34.0% after program implementation (relative risk, 0.66; 95% CI, 0.54-0.81; P < .001). Appropriate Surgical Safety Checklist use increased from 16.3% to 43.0% (P < .001), surgeon hand and patient skin antisepsis improved from 46.0% to 66.0% (P < .001), and timely antibiotic administration improved from 17.8% to 39.0% (P < .001). Surgical instrument (38.7% vs 10.2%), linen sterility (35.5% vs 12.8%), and gauze counting (89.2% vs 82.5%; P < .001 for all comparisons) also improved significantly. A modified implementation strategy for the Clean Cut program focusing on reduced external resource and programmatic input from Lifebox, structured education and training materials, and wider hospital engagement resulted in outcomes that matched our pilot study, with improved adherence to recognized infection prevention standards resulting in a reduction in SSIs. The demonstration of scalability reinforces the value of this SSI prevention program.

Suspension of zinc oxide nanoparticles (ZnO-NP) as an intraoperative wound irrigation to prevent infection after fracture fixation

Background: Infection after fracture fixation (IAFF) associated with an implant in orthopaedic surgery is a feared complication, leading to non-union, loss of function, amputation, and even mortality and morbidity to the patient. A biofilm formation on the implant surface increases the difficulty of treatment. Therefore, surgical infection prevention with an effective antiseptic solution is required. This study aims to reveal more about the antibacterial effect of ZnO-NP suspension, particularly Staphylococcus aureus and its biofilm, in preventing surgical infection. Method: An in vitro experimental study with a posttest-only control group design was used to see the antimicrobial activity and inhibitory effect of Staphylococcus aureus biofilm formation between a 20% zinc oxide nanoparticle (ZnO-NP) suspension (20 mg/mL) compared to 0.3% povidone-iodine solution. The statistical result was tested using an independent t-test antibacterial activity. Meanwhile biofilm identification was evaluated using Mann-Whitney &amp; Kruskal Wallis test for each group. Result: 20% ZnO-NP suspension has a minimum inhibitory concentration at 4 μg/mL and a minimum bactericidal concentration at 16 μg/mL, same as 0.3% povidone-iodine administration and its statistically significant (p-value 0.001). Minimum biofilm inhibitory concentration was seen at a concentration of 20% ZnO-NP suspension of 2 μg, while at higher doses, it showed lysis of bacterial cells. Conclusion: 20% ZnO-NP suspension is a promising solution for preventing surgical infection due to its antibacterial and antibiofilm effects.

Effectiveness of nursing intervention in the operating room to prevent wound infections in patients undergoing orthopaedic surgery: A meta-analysis.

Surgical site wound infection is one of the most common postoperative complications in orthopaedic clinical practice. This study employed a meta-analysis approach to comprehensively evaluate the effect of operating room nursing interventions on the prevention of surgical site wound infections in orthopaedic surgical patients. A computer search was conducted using PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), VIP, and Wanfang databases from the inception of each database until May 2023 for randomised controlled trials (RCTs) that investigated the application of operating room nursing interventions in orthopaedic surgery. Two reviewers independently screened the literature, extracted data, and assessed study quality. The meta-analysis was conducted using Stata 17.0. A total of 29 studies involving 3567 patients were included, with 1784 patients in the intervention group, and 1783 patients in the control group. The results of the meta-analysis showed that compared with the control group, the use of operating room nursing interventions significantly reduced the incidence of surgical site wound infection after orthopaedic surgery (2.85% vs. 13.24%; odds ratio: 0.18, 95% confidence interval: 0.14-0.25; p < 0.001). Current evidence suggests that operating room nursing interventions reduce the incidence of surgical site wound infections. However, owing to the limited number and low quality of the studies, more high-quality, large-sample RCTs are needed to further verify these findings.

Suspension of zinc oxide nanoparticles (ZnO-NP) as an intraoperative wound irrigation to prevent infection after fracture fixation

Background: Infection after fracture fixation (IAFF) associated with an implant in orthopaedic surgery is a feared complication, leading to non-union, loss of function, amputation, and even mortality and morbidity to the patient. A biofilm formation on the implant surface increases the difficulty of treatment. Therefore, surgical infection prevention with an effective antiseptic solution is required. This study aims to reveal more about the antibacterial effect of ZnO-NP suspension, particularly Staphylococcus aureus and its biofilm, in preventing surgical infection. Method: An in vitro experimental study with a posttest-only control group design was used to see the antimicrobial activity and inhibitory effect of Staphylococcus aureus biofilm formation between a 20% zinc oxide nanoparticle (ZnO-NP) suspension (20 mg/mL) compared to 0.3% povidone-iodine solution. The statistical result was tested using an independent t-test antibacterial activity. Meanwhile biofilm identification was evaluated using Mann-Whitney &amp; Kruskal Wallis test for each group. Result: 20% ZnO-NP suspension has a minimum inhibitory concentration at 4 g/mL and a minimum bactericidal concentration at 16 g/mL, same as 0.3% povidone-iodine administration and its statistically significant (p-value 0.001). Minimum biofilm inhibitory concentration was seen at a concentration of 20% ZnO-NP suspension of 2 μg, while at higher doses, it showed lysis of bacterial cells. Conclusion: 20% ZnO-NP suspension is a promising solution for preventing surgical infection due to its antibacterial and antibiofilm effects.

Robert Lawson Tait (1845-1899): The true innovator of aseptic surgery?

Robert Lawson Tait was an original thinker, a surgical innovator, a controversialist and an iconoclast. He made important contributions to surgery, was an eloquent supporter of Darwinian evolution and women in medicine and opposed vivisection. He is probably best remembered for his high-profile opposition to Listerian antisepsis which continued until his death. While Lister went on to receive the country's highest honours and was lauded throughout the world, Tait received much more modest honours and little subsequent recognition by historians. Yet it could be argued that Tait's system rather than Lister's was the basis of modern aseptic surgery. Tait never changed his views on asepsis over his lifetime and relied on surgical cleanliness, which, combined with his extensive clinical experience, enabled him to achieve outcomes as good or better than with antisepsis. By contrast, Listerism evolved over 30 years, claimed to be based on laboratory data and adopted the new discoveries of the germ theory of disease as they emerged. We compare the systems of Tait and Lister, explore the basis of Tait's opposition to Listerian methods and conclude that Tait's thinking underlies modern surgical practice and that he should receive greater acknowledgement for his contribution to the prevention of surgical infections.

Review of methods of impact on the wound process animals (literary review)

The present work is devoted to the study of the course of the wound process in animals as well as possible factors influencing it. The topicality of the research in this topic consists in the fact that the experimental results help to increase the survival rate among the animals which have undergone the operation, to accelerate healing, to reduce the organism rehabilitation time, to avoid the bacterial contamination of wounds, purulent diseases and re-infection, to reduce the trauma level in animals, promote the introduction of new efficient pharmacological methods of prevention and suppression of surgical infections, application of laser and ultrasound equipment, discover and use new medicines. The aim of the study. The aim of this work is to conduct a general literature review on the methods of wound management in animals. This review focuses on papers from 2012 to 2022, citing various factors that influence the wound process in order to outline the need for wound management. To make it more manageable and to speed up wound healing in animals, as well as to point out the need for additional wound management models. Conclusion. The use of a complex graft and matrix based on dextran phosphate gel, stem cells and miliacyl has been shown by biological factors to promote healing. A positive alkaline environment has been shown to promote reepithelisation, as it has no adverse effect, in contrast to a strongly acidic environment. In addition, gamma radiation treatment was found to accelerate healing. From this we can conclude that the literature review conducted on this topic indicates the relevance of the area under consideration, and further developments and more in-depth studies are required, as wound processes are a scientific problem that needs to be solved.

Surgical site infection prevention practice and associated factors among nurses working at public hospitals of the western part of southern nation, nationalities, and peoples' region, Ethiopia: Across-sectional study.

Surgical site infection is a major hazard for surgical patients and compromises their quality of life. Its effect is higher in developing countries compared to developed countries. Most of the studies done in Ethiopia regarding surgical site infection prevention practice on nurses who were not directly exposed to wound care, thus it produces less reliable results. Therefore, we aimed to assess surgical wound infection prevention practice among nurses who are directly involved in the care. To assess surgical site infection prevention practice and associated factors among nurses working at public hospitals in the western part of the southern nation, nationalities, and peoples' regions from March 1-31, 2020. An institutional-based cross-sectional study design was conducted from March 1-31, 2020 among randomly selected 402 study participants. A structured and pretested questionnaire was used. EpiData Version 3.1 and Statistical Package for Social Science Version 20 were used for analysis. Bivariable and multivariable analysis was undertaken and p-value less than 0.05 at a 95% confidence interval was considered statistically significant. The overall good self-reported surgical site infection prevention practice of nurses was 46% (95% CI: 41.3, 50.7). Nurses who were BSc degree (AOR = 2.04; 95% CI: 1.31, 3.18), working in the units having surgical site infection prevention guidelines (AOR = 2.45; 95% CI: 1.34, 4.47), had ever taken infection prevention training (AOR = 2.23; 95% CI: 1.42, 3.49), had good knowledge (AOR = 1.82;95% CI: 1.13, 2.90) and had good attitude (AOR = 2.61;95% CI: 1.67, 4.10) performed good surgical site infection prevention activities as compared to their counterparts. Nurses' surgical site infection prevention practice was found to below. To upgrade nurses' practice the hospitals should develop their surgical site infection prevention guidelines based on WHO recommendations and provide training on it.

Bridging the know-do gap in low-income surgical environments: Creating contextually appropriate training videos to promote safer surgery in Ethiopia

Although international guidelines exist for the prevention of surgical site infections, their implementation in diverse clinical contexts, especially in low and middle-income countries, is challenging due to the lack of available resources and organizational structure of facilities. The goal of this project was to develop a series of video training aids to highlight best practices in surgical infection prevention in hospitals with limited resources and to provide practical solutions to common challenges faced in these settings.Using the validated Clean Cut education framework for infection prevention developed by Lifebox, a charity devoted to improving surgical and anesthetic safety, we partnered with clinicians in one Ethiopian hospital to create six educational videos giving practical guidelines for infection prevention under resource variable conditions. These include: 1) proper use of the WHO Surgical Safety Checklist, 2) hand and skin antisepsis, 3) confirming instrument sterility, 4) maintaining the sterile field, 5) antibiotic prophylaxis, and 6) gauze counting.Gaps in available online educational materials were identified in each of the six areas. Videos were created providing setting-specific education and addressing gaps in existing materials for each of the infection prevention topics. These videos are now integrated into infection prevention curricula through Lifebox in Ethiopia and ongoing data collection to evaluate acceptability and efficacy is ongoing.Surgical education videos on infection prevention topics addressing location-specific resources and workarounds can be useful to hospitals operating in resource-limited settings for training staff and supporting quality and safety efforts in surgery.

Surgical workflow and infection prevention and control strategies for patients with COVID-19 during the epidemic in Children's Hospitals.

This study sought to investigate the surgical workflow and practical effects of infection prevention and control in specialist pediatric hospitals during the Corona Virus Disease 2019 (COVID-19) epidemic to provide a foundation for ensuring the safety of children and medical staff. The Guidelines for the Management of Surgical Procedures and Infection Prevention and Control of COVID-19 Pneumonia in Children were formulated according to the industry specifications and standards, the prevention and control work system for hospitals in China, and the experiences of the Chinese Nursing Association in infection prevention and control in the operating room. These guidelines focus on the characteristics of children, and provide management priorities in relation to personnel management, infection prevention and control during surgery, intraoperative safety, and the cooperation of medical staff teams. These operation management and prevention and control strategies were applied to children who were suspected or confirmed to have COVID-19. The operation process and prevention and control measures were effectively implemented. During the epidemic, a total of 219 surgeries which patients' COVID-19 nucleic test result are not out were completed. No medical staff or nosocomial infection occurred during the surgeries. As a special group, children are susceptible to COVID-19, and should receive special attention. As the only hospital designated to treat children with COVID-19 in Hubei Province, our hospital effectively implemented the infection prevention and control measures in surgery according to the characteristics of children. These measures ensured the safety of the surgeries and reduced the risk of infection in children and medical staff.

Individualized surgical antibiotic prophylaxis – why, when, and how?

"Surgical site infections (SSI) greatly concern clinicians, as they are associated with significant morbidity and mortality, prolonged hospitalization, and costs. Antibiotic prophylaxis plays a pivotal role among the procedures that are usually employed for the prevention of surgical-related infections. This narrative review aims to cover some of the particular situations when the clinician might consider individualizing antibiotic prophylaxis for a patient. With the rising incidence of multi-drug resistant bacteria carriage among not only hospitalized or institutionalized patients but also patients from the community, there might be a tendency to use extended-spectrum antibiotics for longer periods for surgical infection prevention. However, the inappropriate use of antibiotics increases the selection pressure, thus favoring the spreading of resistant bacteria. Moreover, specific patient characteristics or pathologies might need to be considered to customize the type, dose, or length of administration of an antibiotic as surgical prophylaxis. Using prosthetic material or prolonged surgeries with large fluid shifts are other situations when individualized antibiotic prophylaxis might be thought of. Keeping in mind that it is of utmost importance that everyone adheres to the current guidelines for surgical antibiotic prophylaxis, customization of local protocols according to well-thought-out strategies might prove beneficial in SSI prevention."

G Is for Geometric: A G-Chart Primer for Surgeons

In this issue of The Annals of Thoracic Surgery, Glenn and colleagues1 detail their experience with development, implementation, monitoring, and evaluation of a surgical wound infection (SWI) prevention bundle in a high-volume congenital heart surgery program. The study is a valuable and elegant example of applied modern continuous quality improvement (CQI) methodology, and I applaud the authors for their contribution. The authors’ use and evaluation of g-charts should be highlighted. A g-chart is a type of statistical process control (SPC) chart.

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

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

Probe into the Prevention and Clinical Nursing of Nosocomial Surgical Infection

Probe into the Prevention and Clinical Nursing of Nosocomial Surgical Infection

Addressing Surgical Site Infections: Development and Implementation of an Apparent Cause Analyses Process for Hospital and System-Level Improvement

Background Surgical site infections (SSIs) are the most costly type of healthcare-associated infection and remain one of the most complicated infection types to reduce. The need for bundled interventions, agreement from multiple parties, and difficulty assessing proven reduction methods makes sustaining improvement processes difficult. To help drive improvement work, a standardized SSI review process centered around apparent case analysis (ACA) was implemented. This review process was paired with a data dashboard to assess overall compliance with the Centers for Disease Control and Prevention (CDC) category IA recommendations. Methods Surgical services, surgeons, and infection prevention agreed to use CDC category IA recommendations to reduce SSIs as standard benchmarks to identify gaps in best practice. A standardized ACA template specific to SSIs was created to review infections. Deviations in care were communicated to site leadership and system perioperative committees. Process improvement tactics were generated at the hospital level based on site needs. Needs were determined through a baseline assessment of compliance with CDC category IA recommendations. Deficiencies were tracked systematically across each hospital and analyzed for trends through the use of a data dashboard. Results Implementation of the ACA process has led to increased surgeon understanding of SSI reduction elements and the value of infection prevention case review and surveillance. All hospitals within the healthcare system have implemented the CDC SSI reduction guidelines and are working toward 90% compliance with category IA recommendations. Conclusions Apparent cause analysis has shown to be a reliable and engaging tool to bridge communication between infection prevention and surgical services at a multi-hospital healthcare system. Using a standardized ACA reporting tool in conjunction with real-time data has allowed surgical leadership to drive change and increase compliance with CDC category IA recommendations. Surgical site infections (SSIs) are the most costly type of healthcare-associated infection and remain one of the most complicated infection types to reduce. The need for bundled interventions, agreement from multiple parties, and difficulty assessing proven reduction methods makes sustaining improvement processes difficult. To help drive improvement work, a standardized SSI review process centered around apparent case analysis (ACA) was implemented. This review process was paired with a data dashboard to assess overall compliance with the Centers for Disease Control and Prevention (CDC) category IA recommendations. Surgical services, surgeons, and infection prevention agreed to use CDC category IA recommendations to reduce SSIs as standard benchmarks to identify gaps in best practice. A standardized ACA template specific to SSIs was created to review infections. Deviations in care were communicated to site leadership and system perioperative committees. Process improvement tactics were generated at the hospital level based on site needs. Needs were determined through a baseline assessment of compliance with CDC category IA recommendations. Deficiencies were tracked systematically across each hospital and analyzed for trends through the use of a data dashboard. Implementation of the ACA process has led to increased surgeon understanding of SSI reduction elements and the value of infection prevention case review and surveillance. All hospitals within the healthcare system have implemented the CDC SSI reduction guidelines and are working toward 90% compliance with category IA recommendations. Apparent cause analysis has shown to be a reliable and engaging tool to bridge communication between infection prevention and surgical services at a multi-hospital healthcare system. Using a standardized ACA reporting tool in conjunction with real-time data has allowed surgical leadership to drive change and increase compliance with CDC category IA recommendations.