Rate Of Deep Surgical Site Infection Research Articles

Impact of a surgical site infection reduction strategy after colorectal resection.

This study was performed to determine the impact of a surgical site infection (SSI) reduction strategy on SSI rates following colorectal resection. American College of Surgeons National Surgical Quality Improvement Program (NSQIP) data from 2006-14 were utilized and supplemented by institutional review board-approved chart review. The primary end-point was superficial and deep incisional SSI. The inclusion criterion was colorectal resection. The SSI reduction strategy consisted of preoperative (blood glucose, bowel preparation, shower, hair removal), intra-operative (prophylactic antibiotics, antimicrobial incisional drape, wound protector, wound closure technique) and postoperative (wound dressing technique) components. The SSI reduction strategy was prospectively implemented and compared with historical controls (pre-SSI strategy arm). Statistical analysis included Pearson's chi-square test, and Student's t-test performed with spss software. Of 1018 patients, 379 were in the pre-SSI strategy arm, 311 in the SSI strategy arm and 328 were included to test durability. The study arms were comparable for all measured parameters. Preoperative wound class, operation time, resection type and stoma creation did not differ significantly. The SSI strategy arm demonstrated a significant decrease in overall SSI rates (32.19% vs 18.97%) and superficial SSI rates (23.48% vs 8.04%). Deep SSI and organ space rates did not differ. A review of patients testing durability demonstrated continued improvement in overall SSI rates (8.23%). The implementation of an SSI reduction strategy resulted in a 41% decrease in SSI rates following colorectal resection over its initial 3years, and its durability as demonstrated by continuing improvement was seen over an additional 2years.

Intraoperative Hypothermia During Surgical Fixation of Hip Fractures.

Hip fractures are common orthopedic injuries and are associated with significant morbidity/mortality. Intraoperative normothermia is recommended by national guidelines to minimize additional morbidity/mortality, but limited evidence exists regarding hypothermia's effect on orthopedic patients. The purpose of this study was to determine the incidence of intraoperative hypothermia in patients with operatively treated hip fractures and evaluate its effect on complications and outcomes. Retrospective chart review was performed on clinical records from 1541 consecutive patients who sustained a hip fracture and underwent operative fixation at the authors' institution between January 2005 and October 2013. A total of 1525 patients were included for analysis, excluding those with injuries requiring additional surgical intervention. Patient demographic data, surgery-specific data, postoperative complications, length of stay, and 30-day readmission were recorded. Patients with a mean intraoperative temperature less than 36°C were identified as hypothermic. Statistical analysis with univariate and multivariate logistic regression modeling evaluated associations with hypothermia and effect on complications/outcomes. The incidence of intraoperative hypothermia in operatively treated hip fractures was 17.0%. Hypothermia was associated with an increase in the rate of deep surgical-site infection (odds ratio, 3.30; 95% confidence interval, 1.19-9.14; P=.022). Lower body mass index and increasing age demonstrated increased association with hypothermia (P=.004 and P=.005, respectively). To the authors' knowledge, this is the first and largest study analyzing the effect of intraoperative hypothermia in orthopedic patients. In patients with hip fractures, the study's findings confirm evidence found in other surgical specialties that hypothermia may be associated with an increased risk of deep surgical-site infection and that lower body mass index and increasing age are risk factors for intraoperative hypothermia. [Orthopedics. 2016; 39(6):e1170-e1177.].

Negative pressure therapy is effective in abdominal incision closure

BackgroundCDC wound classification demonstrates surgical site infection (SSI) occurs in 15%-30% of contaminated (class III) and >30% of dirty-infected (class IV) wounds. Several techniques have been used to decrease SSI rates in midline laparotomy incisions; however, no technique has shown superiority. Evidence suggests incisional negative pressure wound therapy (INPWT) can decrease wound complications, but no literature exists regarding INPWT for high-risk laparotomy incisions. We sought to analyze the efficacy of INPWT in the management of high-risk midline laparotomy incisions. MethodsRetrospective review of adult patients who underwent laparotomy between January 2013 and June 2014 with midline closure using INPWT. Only class III or IV wounds were included. Laparotomy incisions were loosely closed. INPWT set at 125 mm Hg is placed over oil emulsion impregnated gauze. INPWT is removed after 5 d and the wound left open to air. Records were reviewed for immediate and/or delayed surgical site complications. Primary end point was 30-d incisional SSI. Secondary end points included other surgical site complications. ResultsOne class III and 12 class IV wounds were treated with INPWT for a median of 5 d. The class III wound developed a small skin dehiscence with no evidence of superficial or deep SSI. Among class IV wounds, the rate of superficial and deep incisional SSI was 25% and 0%, respectively. The overall surgical site complication rate was 41.7%. ConclusionsINPWT in closure of high-risk midline laparotomy incisions is a safe, effective method of wound closure with equivalent SSI rates to previously described methods.

Vancomycin Powder in Spine Surgery: Still a Work in Progress

Surgical site infections (SSIs) after complex spinal surgery are associated with significant neurological morbidity and mortality and can lead to increased medical costs. Reasons for the development of these types of infection can be multifactorial. Those risk factors that are patient related include advanced age, diabetes mellitus, smoking, malnutrition, drug abuse, alcoholism, increased body mass index, and immunosuppression. All of these factors will decrease a patient’s ability to mount an adequate immune response that will prevent the development of an infection. Microvascular injury resulting in tissue ischemia contributes to the risk of SSI in diabetes mellitus and in smokers. Smoking cessation, strict blood glucose control, and an optimized nutritional state can diminish the potential for postoperative SSI. SSIs have been classified into superficial or deep depending on the location in which the infection occurs. Involvement of the skin and subcutaneous tissue defines a superficial infection in contrast to a deep SSI where the fascial and muscle layers are involved. It has been estimated that the rate of deep SSI in lumbar spinal instrumentation surgery ranges from 1%e14% (3). Specific prognostic variables that are associated with an increased risk of postoperative SSI are repeat/revision surgery, type of surgery (i.e., deformity correction vs. fusion procedure), longer operative time, intraoperative blood loss, blood transfusion, number of spinal levels fused, posterior surgical approach, pelvic instrumentation, and the number of personnel in the operating room (3). The use of drains postoperatively has not been shown to reduce SSIs and may in fact lead to the development of SSIs with prolonged usage.

Effects of regional versus general anesthesia on outcomes after total hip arthroplasty: a retrospective propensity-matched cohort study.

Many orthopaedic surgical procedures can be performed with either regional or general anesthesia. We hypothesized that total hip arthroplasty with regional anesthesia is associated with less postoperative morbidity and mortality than total hip arthroplasty with general anesthesia. This retrospective propensity-matched cohort study utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database included patients who had undergone total hip arthroplasty from 2007 through 2011. After matching, logistic regression was used to determine the association between the type of anesthesia and deep surgical site infections, hospital length of stay, thirty-day mortality, and cardiovascular and pulmonary complications. Of 12,929 surgical procedures, 5103 (39.5%) were performed with regional anesthesia. The adjusted odds for deep surgical site infections were significantly lower in the regional anesthesia group than in the general anesthesia group (odds ratio [OR] = 0.38; 95% confidence interval [CI] = 0.20 to 0.72; p < 0.01). The hospital length of stay (geometric mean) was decreased by 5% (95% CI = 3% to 7%; p < 0.001) with regional anesthesia, which translates to 0.17 day for each total hip arthroplasty. Regional anesthesia was also associated with a 27% decrease in the odds of prolonged hospitalization (OR = 0.73; 95% CI = 0.68 to 0.89; p < 0.001). The mortality rate was not significantly lower with regional anesthesia (OR = 0.78; 95% CI = 0.43 to 1.42; p > 0.05). The adjusted odds for cardiovascular complications (OR = 0.61; 95% CI = 0.44 to 0.85) and respiratory complications (OR = 0.51; 95% CI = 0.33 to 0.81) were all lower in the regional anesthesia group. Compared with general anesthesia, regional anesthesia for total hip arthroplasty was associated with a reduction in deep surgical site infection rates, hospital length of stay, and rates of postoperative cardiovascular and pulmonary complications. These findings could have an important medical and economic impact on health-care practice.

The effect of antibiotic prophylaxis guidelines on surgical-site infections associated with cesarean delivery

ObjectiveTo evaluate the effect of Norwegian antibiotic prophylaxis guidelines on rates of superficial and deep surgical-site infections (SSIs) associated with cesarean delivery (CD). MethodsA cross-sectional study was conducted that analyzed the physician-diagnosed SSIs by regimen of antibiotic prophylaxis among women who underwent planned or emergency CD at one of 42 hospitals between January 1, 2008, and December 31, 2010. The antibiotic prophylaxis regimen was verified using a hospital survey, whereas guideline compliance was assessed as part of the mandatory Norwegian Surveillance System for Healthcare-Associated Infections. ResultsData for 4498 patients were used. Hospitals that practiced antibiotic prophylaxis for all CDs (n=4) provided antibiotics more often in both emergency and planned CDs than did those that used this approach for emergency CDs only (n=33) or had no written guidelines or used prophylaxis on indication only (n=5) (P<0.001). The provision of antibiotic prophylaxis for all cases of CD was associated with markedly lowered rates of superficial SSIs among planned CDs, whereas no differences in rates of deep SSIs were observed between the guidelines in either planned or emergency CDs. ConclusionHospitals that provided antibiotic prophylaxis to all women undergoing CD reported high compliance and had reduced rates of superficial SSIs among planned CDs.

Predictors and Complications of Blood Transfusion in Total Hip and Knee Arthroplasty

Perioperative patient optimization can minimize the need for blood transfusions in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). The purpose of this study was to determine predictors and complications of transfusions. This retrospective review analyzed 1795 patients who underwent primary THA and TKA at our institution between January 2011 and December 2012. Of the 1573 patients ultimately included the rates of transfusion were 9.27% in TKA and 26.6% in THA. Significant predictors for transfusion include: preoperative hemoglobin, age, female gender, body mass index, creatinine, TKA, operating room time, operative blood loss, and intra-operative fluids. The DVT rate was comparable, but deep surgical site infection rate among transfused patients was 2.4% compared to 0.5% in non-transfused patients (P = 0.0065).

Simple Steps to Minimize Spine Infections in Adolescent Idiopathic Scoliosis

To examine the surgical site infection (SSI) rates in patients undergoing posterior spinal fusion surgery for adolescent idiopathic scoliosis (AIS) after implementation of a change in antibiotic prophylaxis and intraoperative irrigation. A retrospective review of all consecutive spinal fusions for AIS from 1996 to 2008 was performed. In 2003, 2 changes in our protocol were implemented: (1) routine antibiotic prophylaxis was changed from cefazolin alone to vancomycin and ceftazidime; (2) intraoperative irrigation technique was changed from bulb syringe to pulse lavage irrigation. We compared the rates of deep SSI requiring irrigation and debridement before institution of these changes (1996 to 2002) to the rates after these changes (2003 to 2008). Before the change in the antibiotic and lavage regimen, 261 spinal fusions were performed. Of these, 28/261 (11%) patients underwent irrigation and debridement for SSI. The most common infecting pathogen was coagulase-negative Staphylococcus aureus (47%). Between the years 2003 and 2008, 263 spinal fusions were performed. Only 2/263 (0.7%) patients underwent irrigation and debridement for SSI. This decrease in infection rate is highly significant (P<0.001). Routine use of vancomycin and ceftazidime and pulsatile lavage for posterior spinal fusion in AIS patients decreased the rates of postoperative infection by 10 fold. As 2 variables were changed, it is impossible to know the relative effect of each. However, as spine infections can be so devastating, and the potential risks of these changes are small, we recommend both the new antibiotic and irrigation protocol. Level III.

Surgical site infection rates: open versus hand-assisted colorectal resections

This study was performed to determine impact of open and hand-assisted colorectal resection on surgical site infection (SSI) rates. National Surgical Quality Improvement Project data from 2006 to 2008 were supplemented with an institutional review board-approved chart review. Primary endpoint was SSI rates defined by the Centers for Disease Control National Nosocomial Infections Surveillance system and classified as superficial, deep incisional, and organ space. Inclusion criteria were elective or emergency open or hand-assisted colorectal resections. Wounds were classified as clean-contaminated, contaminated, or dirty-infected. Patients were not included if they underwent laparoscopic colorectal resection, small bowel resection, or stoma creation. Two hundred and forty-five consecutive patients were included over a 29-month period. One hundred and ninety-five open and 50 hand-assisted patients were comparable for gender, body mass index, ethnicity, tobacco addiction, steroid use, type of colorectal resection, operating time, and method of wound closure. Differences in ASA class, wound classification, and preexisting comorbidities resolved when 80 open and 5 hand-assisted patients who underwent emergency resections were excluded from analysis. Rate of stoma creation remained higher in open patients even after excluding emergency cases (p<0.01). Overall SSI rates following open and hand-assisted resections were 28 and 44%, respectively (p=0.015). Superficial SSI rates were higher in hand-assisted patients (20 vs. 40%, p=0.006). Deep (2.1 vs. 4%, p=0.605) and organ space SSI rates (5.1 vs. 0%, p=0.221) did not differ. These results did not change when emergency resections were excluded: overall 28 and 44% (p=0.015), superficial (23 vs. 44%, p=0.009), deep (3.5 vs. 4.4%, p=0.541), and organ space (7 vs. 0%, p=0.066). This study seems to suggest possibly higher rates of incisional SSI in patients who underwent hand-assisted colorectal resection as compared to open. This retrospective study had, however, insufficient power to stratify by surgeon and control for risk factors by logistic regression.

Surgical Care Improvement Project (SCIP): Has Its Mission Succeeded?

The purpose of this study was to determine if adherence to the surgical care improvement project (SCIP) measures could further reduce rate of surgical site infection (SSI) and venous thromboembolism (VTE) in total joint arthroplasty (TJA) patients. We retrospectively identified all patients who underwent primary or revision TJA at our institution between July 2000 and June 2009. After implementation of SCIP measures, rate of superficial SSI increased (0.42% versus 0.60%, P=0.05) while rate of deep SSI decreased from 0.92% to 0.82% (P=0.46). The rate of DVT was 0.92% before and 0.83% after implementation of SCIP (P=0.51); however, rate of PE increased from 0.87% to 1.30% (P=0.002). Our findings indicated that SCIP has not been successful in reducing complications in TJA patients.

The use of antibiotic-impregnated fibrin sealant for the prevention of surgical site infection associated with spinal instrumentation

The purpose of this study was to determine if the use of antibiotic-impregnated fibrin sealant (AFS) was effective in preventing surgical site infections (SSI) associated with spinal instrumentation. In a preliminary study, five pieces of vancomycin-impregnated fibrin sealant, five nuts that were not treated with the sealant, and five nuts that were treated with the sealant were subjected to agar diffusion testing. In a clinical study, the rates of deep SSI were compared between 188 patients who underwent procedures involving spinal instrumentation without AFS (group 1) and 196 patients who underwent procedures involving spinal instrumentation with AFS (group 2). All five pieces of vancomycin-impregnated fibrin sealant and the five nuts treated with the sealant exhibited antimicrobial efficacy, while the five untreated nuts did not exhibit antimicrobial efficacy in the agar diffusion test. In the clinical study, 11 (5.8%) of the 188 patients in group 1 acquired a deep SSI, while none (0%) of the 196 patients in group 2 acquired a deep SSI. The present study demonstrated that the application of AFS to spinal instrumentation yielded good clinical outcomes in terms of the prevention of postoperative spinal infections. It is hoped that limiting AFS use to patients requiring spinal instrumentation and those with risk factors for SSI will reduce the overall costs while preventing SSIs.

Compliance with surgical antibiotic prophylaxis at an Australian teaching hospital

Surgical antibiotic prophylaxis (SAP) is one practice proven to prevent surgical site infections. Compliance of SAP choice, timing, and duration with guidelines was assessed utilizing prospectively collected surgical site infection (SSI) surveillance data from January 2008 through September2010. Antibiotic choice was adequate or optimal in 97% of cardiac and orthopedic joint replacement procedures and 89% of colorectal procedures. In 6% to 8% of surgical procedures, SAP was not administered within 1 hour of the incision. SAP was continued beyond 24 hours in 20% of cardiac operations and 13% of colorectal procedures. Numerous combinations of antibiotics were used for prophylaxis, including ticarcillin/clavulanic acid in 67% of colorectal procedures. Many choices were not in keeping with both local and international recommendations. Deep SSI rates for cardiac procedures were above the state aggregate rate in 2010 only, whereas SSI rates for colorectal surgery were in excess of the state aggregate rate for all quarters. Antimicrobial-resistance data indicate a gradual increase in extended-spectrum β-lactamase-producing bacteria. In cardiac and colorectal surgery, the optimal choice of SAP is seldom administered, and duration of SAP is excessively long. More education and communication are required to improve these practices.

53 SURGICAL SITE INFECTIONS IN UROLOGIC SURGERY

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes I1 Apr 201253 SURGICAL SITE INFECTIONS IN UROLOGIC SURGERY Lee C. Zhao, James M. Dupree, Brian V. Le, Marc Bjurlin, and Shilajit Kundu Lee C. ZhaoLee C. Zhao Chicago, IL More articles by this author , James M. DupreeJames M. Dupree Chicago, IL More articles by this author , Brian V. LeBrian V. Le Chicago, IL More articles by this author , Marc BjurlinMarc Bjurlin Chicago, IL More articles by this author , and Shilajit KunduShilajit Kundu Chicago, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.098AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Entering the urinary tract during urologic surgery may increase risk for surgical site infections (SSI). We evaluated the rate and risk factors for SSIs in common major urologic procedures. METHODS The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) is a risk-adjusted data collection mechanism for analyzing clinical outcomes data including 30-day peri-operative complications. Using NSQIP data from 2005 to 2009, we identified patients who underwent cystectomy, laparoscopic (LPx) and open prostatectomy (OPx), laparoscopic (LPNx) and open radical partial nephrectomy (OPNx), and laparoscopic (LNx) and open (ONx) radical nephrectomy. Rates of superficial, deep, and organ space SSI were investigated. RESULTS From 2005-2009, 5,378 cases were identified. Superficial SSI was found in 1.6% of urologic cases. Deep incisional infections and organ space SSI were rare (0.3% and 0.7%, respectively). Cystectomy had the highest rate of SSI at 13.4%. Patients with SSI were older (age 63.7 vs 61.5), more likely to be smokers (3.6% vs 2.3%), had higher BMI (30.8 vs 28.9), and longer operative time (261 vs 202 minutes). Length of stay was increased for patients with infectious complications (see Table 1). The average post-operative day of occurrence for superficial, deep, and organ space SSI was day 13, 11, and 15, respectively. The rate of SSI was lower for laparoscopic prostatectomy compared to open (0.9% vs 2.0%, p = 0.007), and for laparoscopic partial nephrectomy compared to open (0.8% vs 4.0%, p = 0.01). There was a trend towards lower SSI for laparoscopic nephrectomy, but this did not reach statistical significance (2.0% vs 3.7%, p = 0.08). Table 1. Procedure N Superficial SSI Deep SSI Organ Space SSI Any SSI LOS without SSI LOS with SSI Cystectomy 343 31(9.0%) 2(0.5%) 15(4.4%) 46(13.4%) 11.1 days 16.6 days LPx 2205 13(0.6%) 1(0.0%) 5(0.2%) 19(0.9%) 1.8 days 3.9 days OPx 888 12(1.4%) 4(0.4%) 3(0.3%) 18(2.0%) 3.0 days 5.1 days LPN 261 0(0.0%) 1(0.4%) 1(0.4%) 2(0.8%) 3.2 days 6.5 days OPN 405 7(1.7%) 4(1.0%) 7(1.7%) 16(4.0%) 5.3 days 20.9 days LNx 824 13(1.6%) 3(0.4%) 1(0.1%) 17(2.0%) 4.5 days 7.6 days ONx 460 11(2.4%) 2(0.4%) 5(1.1%) 17(3.7%) 6.9 days 13.2 days CONCLUSIONS Surgical site infections were rare overall at 1.6% of all major urologic cases, but most common for cystectomy. The frequency of SSI was low for nephrectomy and prostatectomy, and laparoscopic procedures appear to have lower rates of SSIs compared open procedures. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e22-e23 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lee C. Zhao Chicago, IL More articles by this author James M. Dupree Chicago, IL More articles by this author Brian V. Le Chicago, IL More articles by this author Marc Bjurlin Chicago, IL More articles by this author Shilajit Kundu Chicago, IL More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Preoperative Hypoalbuminemia is an Independent Risk Factor for the Development of Surgical Site Infection Following Gastrointestinal Surgery

Surgical site infection (SSI) is an infection occurring in an incisional wound within 30 days of surgery and significantly effects patient recovery and hospital resources. This study sought to determine the relationship between preoperative serum albumin and SSI. A study of 524 patients who underwent gastrointestinal surgery in 4 institutions was performed. Patients were identified using a prospective SSI database and hospital records. Serum albumin was determined preoperatively in all patients. Hypoalbuminemia was defined as albumin <30 mg/dL. Data are presented as median (interquartile range) and a difference between groups was examined using Mann-Whitney U and Fisher exact test and multiple logistic regression analysis. A total of 105 patients developed a SSI (20%). The median time to the development of SSI was 7 (5-10) days. Having an emergency procedure (P = 0.003), having a procedure over 3 hours in duration (P = 0.047), being American Society of Anaesthetics grade 3 (P = 0.03) and not receiving preoperative antibiotics (P = 0.007) were associated with SSI while having a laparoscopic procedure reduced the likelihood of SSI (P = 0.004). Patients who developed a SSI had a lower preoperative serum albumin (30 [25-34.5] vs. 36 [32-39], P < 0.001). On multivariate analysis, hypoalbuminemia was an independent risk factor for SSI development (relative risk, RR = 5.68, 95% confidence interval: 3.45-9.35, P < 0.001). Albumin <30 mg/dL was associated with an increased rate of deep versus superficial SSI (P = 0.002). The duration of inpatient stay was negatively correlated with preoperative albumin (R = -0.319, P < 0.001). Hypoalbuminemia is an independent risk factor for the development of SSI following gastrointestinal surgery and is associated with deeper SSI and prolonged inpatient stay.

Comparison of the National Surgical Site Infection surveillance data between The Netherlands and Germany: PREZIES versus KISS

As there has been increasing interest in comparing surgical site infection (SSI) rates between countries, we compared the SSI surveillance data for The Netherlands ('PREZIES') and Germany ('KISS'). Both surveillance systems have comparable protocols with many similar risk factors, including SSI definitions developed by the Centers for Disease Control and Prevention and optional postdischarge surveillance. Nine surgical procedure categories from several specialities were included, the reporting of which were similar, with respect to content and with enough data for proper comparison. Differences for the SSI data were found between PREZIES and KISS for duration of surgery, wound contamination class, American Society of Anesthesiologists physical status classification and the postoperative duration of hospitalization. A significantly higher superficial SSI rate was found for seven surgical procedures according to PREZIES and a higher deep SSI rate for five procedures. When considering only deep SSI during hospitalization, the differences in SSI rates were much smaller. Differences in intensity of postdischarge surveillance led to 34% of SSI being detected after discharge for PREZIES and 21% for KISS. In conclusion, even though similar infection surveillance protocols are used in The Netherlands and Germany, differences occurred in the implementation. Comparisons between countries are most reliable if only deep SSIs during hospitalization are taken into account, since these SSI are not affected by postdischarge surveillance and the diagnostic sensitivity for deep SSI is probably more alike between countries than for superficial SSI.

Patient outcomes after simultaneous bilateral total hip and knee joint replacements

Simultaneous arthroplasties are increasingly being performed during one single anaesthetic event. No national nosocomial surveillance systems have yet reported data on this issue. We compared patient populations undergoing bi- and unilateral total hip (THA) and total knee (TKA) arthroplasties in terms of two outcome variables, deep surgical site infections (SSI) and mortality, by analysing surveillance data from the Finnish Hospital Infection Programme (SIRO). A total of 8201 patients underwent 9831 total arthroplasties during 2001-2004. Of the prosthetic joints, 7.2% were inserted in a bilateral operation (range by hospital, 0.6-19.2%; range by procedure type, 5.2-9.9%). Patients who underwent bilateral operations were younger; more often males, and their ASA score was lower than those who underwent unilateral procedures. The rate of deep SSI in bi- and unilateral THAs and in bi- and unilateral TKAs was 0, 0.5, 1.0 and 0.9%, respectively. Following bilateral operations, four deep SSIs were detected, all from bilateral TKAs, three of which were on the second operative side. In these three cases, single doses of antimicrobial prophylaxis were administered 115, 155 and 218 min before incision (median time in unilateral operations: 47 min). According to multi-variate analysis, bilateral operations were not an independent risk factor for deep SSIs. Mortality did not differ between bi- and unilateral THAs or TKAs. Our surveillance data indicate that simultaneous bilateral surgery did not increase the risk of deep SSIs or death after THA and TKA. Bilateral operations may, however, require specific guidelines regarding antimicrobial prophylaxis.

Infections after coronary artery bypass graft surgery in Victorian hospitals ‐ VICNISS Hospital Acquired Infection Surveillance

Objective: To establish a surveillance program reporting surgical site infection rates after coronary artery bypass graft surgery (CABGS) in Victorian public hospitals.Methods: The VICNISS Coordinating Centre was established in 2002 to implement and co‐ordinate a standardised surveillance system for hospital‐acquired infections in acute care Victorian public hospitals. Using validated definitions and methodology from the Centers for Disease Control and Prevention's National Nosocomial Infection Surveillance (NNIS) program, data on risk‐adjusted surgical site infection (SSI) rates were collected and submitted to the Coordinating Centre for collation and reporting.Results: Six large Melbourne metropolitan hospitals contributed data for CABGS for the period 11 November 2002 to 30 June 2004, comprising a total of 3,482 patient records. Of 3,398 complete records, the aggregate SSI rates per 100 procedures for NNIS risk category 1 and 2 were 4.4 (95% CI 3.7‐5.3) and 6.0 (95% CI 4.5–7.8) respectively. The deep sternal SSI rates were 0.6 (95% CI 0.4‐1.3) and 0.5 (95% CI 0.5‐2.4 for patients in risk category 1 and 2 respectively. The most common pathogen identified was Staphylococcus aureus.Conclusion: This early data from VICNISS demonstrates similar CABGS SSI rates to those reported by NNIS in the USA, but higher than reported by the German Nosocomial Infection Surveillance System.Implications: The adoption of a statewide, co‐ordinated surveillance program using validated internationally accepted methodologies allows hospitals to benchmark their infection rates against aggregate local and international data and to examine infection prevention interventions.