Reduction Of Surgical Site Infections Research Articles

P-357. Maximizing Value in Public Healthcare: Assessing the Financial Return on Investment in Surgical Infection Prevention at a Philanthropic Teaching Hospital Serving Exclusively Public Patients

Abstract Background This study aimed to evaluate the cost-effectiveness of hospitals’ continuous investments in HAI prevention, focusing specifically, on the prevention of SSIs. The objective was to estimate the impact of SSIs on hospital profitability.Figure 1The infection prevention programs to prevent Surgical Site Infections (SSIs) The infection prevention programs to prevent Surgical Site Infections (SSIs) Methods A single-center retrospective cohort study was conducted between January 2019 and September 2023, involving patients undergoing arthroplasty, small bowel surgeries, cholecystectomy, herniorrhaphy, and open fracture reduction. The cost of each infection was obtained in the literature. The study compared SSI incidence between 2019-2022 and 2023. The hospital implemented a Value Management Office (VMO) in 2022 to accelerate the dissemination of value-based healthcare, with a focus on IPP, including measures to prevent SSIs. The infection prevention programs to prevent SSI consisted of maximum adherence to antimicrobial prophylaxis, SSI rate feedback for surgical team with root cause, auditing surgical procedures, reinforcing good practices in the operating room and improvement of the materials and sterilization center.Table 1Comparison of Surgical Site Infection Rates: Baseline Period (2019-2022) vs. Current Period (2023)Comparison of Surgical Site Infection Rates: Baseline Period (2019-2022) vs. Current Period (2023) Results During the baseline period, January 2019 to December 2022, 9,235 patients were included, being 59% female and a mean age of 51 years. 368 were diagnosed with SSI and the mortality rate was 1.4%. When an SSI occurs, the length of stay is longer (p=0.001) and the risk of death doubles (RR=2.1; p=0.033). The analysis shows a remarkable 64% decrease in SSI rates, from 4% in 2019-2022 to 1.4% in 2023. This translates into 63 prevented infections and 2 fewer deaths. The study attributes this success to implemented preventive measures because there was no significant difference in terms of the duration of the surgery (p= 0.411) and age of patients in each group (p=0.843). Additionally, the reduced SSI rate led to shorter hospital stays and an estimated monthly cost savings of US$52,160-US$93,865.Table 2Impact of Surgical Site Infections on Mortality Risk and Extended Hospital StayImpact of Surgical Site Infections on Mortality Risk and Extended Hospital Stay Conclusion Investing in interventions aimed at reducing adverse events, such as SSIs, is essential for enhancing patient care and safety. This study highlights the significant financial returns associated with investing in infection prevention: 52,160 to 93,865 USD, particularly in reducing surgical infections.Table 3Reduction in Costs, Hospital Stay Duration, and Prevented Deaths Associated with Surgical Site InfectionsReduction in Costs, Hospital Stay Duration, and Prevented Deaths Associated with Surgical Site Infections Disclosures All Authors: No reported disclosures

P-381. Enhancing Economic Outcomes by Strategic Investment in Orthopedic Surgical Infection Control

Abstract Background This study aims to assess the financial impact of investments in combating hospital-acquired infections, particularly surgical site infections (SSIs) in orthopedic procedures.Figure 1The infection prevention programs to prevent Surgical Site Infections (SSIs) Methods A retrospective cohort study from January 2019 to September 2023 included patients undergoing knee arthroplasty (KA), hip arthroplasty (HA), and open fracture reduction (OFR), defining SSI according to CDC criteria. Costs per SSI patient were retrieved from literature sources: $13,539.50 for hospital costs (LUNA et al., 2022) and $7,523.77 for direct treatment costs, adjusted for inflation (STARLING et al., 2022).Figure 2.Chart of Year-to-Year Surgical Site Infection Rates, Stratified by Type of Orthopedic Surgery Chart of Year-to-Year Surgical Site Infection Rates, Stratified by Type of Orthopedic Surgery Results During the baseline period, January 2019 to to December 2022, 4,258 patients underwent orthopedic surgeries: HA (11%), KA (9%), OFR (80%). Of these, 2,439 were female (57%), 1,819 male (43%), mean and median age 51 years, standard deviation 21 years. 68 patients died in-hospital (1.6%), 239 diagnosed with SSI (5.6%). Postoperative infection increased mortality risk over twofold: without infection (1.5% mortality risk), with infection (3.8% mortality risk), relative risk 2.5, p-value=0.014. SSI was associated with prolonged hospitalization; average length of stay doubled with infection (18.2 days) compared to without (9 days), p-value: 0.001. Comparing infection risks from 2019-2022 (5.6%) to 2023 (1.4%) post-investment in infection control demonstrated a risk reduction. Relative risk (0.25) p-value < 0.001.Table 1.Annual Comparative Analysis of Surgical Site Infection Rates by Orthopedic Surgery Type Conclusion SSIs in orthopedic surgeries pose dual risks, increasing readmissions and impairing hospital performance. Investing in SSI reduction enhances patient care, safety, and yields significant financial returns. This study underscores the ROI of infection prevention, especially targeting orthopedic surgical infections. Preventing SSIs can yield monthly savings of $25,781.49 to $46,393.48Table 2.Reduction in Costs, Hospital Stay Duration, and Prevented Deaths Associated with Surgical Site Infections after Orthopedic Surgeries Disclosures All Authors: No reported disclosures

Povidone-Iodine Versus Saline Irrigation on Reduction of Surgical Site Infections in Total Hip and Knee Arthroplasty: A Retrospective, Propensity-Matched Cohort.

Introduction: Surgical site infection (SSI) after total hip and knee arthroplasty (THA/TKA) is a major complication leading to morbidity and mortality. Perioperative irrigation, frequently with antiseptic compounds including povidone-iodine (PI), is the standard of care in reducing SSI. Evidence supporting the value of PI versus nonantiseptic substances varies. This study aims to identify whether PI irrigation in THA/TKA reduces the rate of SSI versus normal saline irrigation. Patients and Methods: A retrospective, propensity-matched cohort study of patients who underwent TKA or THA was conducted using data from patient charts, hospital infection control surveillance software, and operative reports. SSI rates of patients who had received PI versus saline irrigation were compared. Patient medical status, demographics, and procedure details were considered for propensity score determination and matching. Results: The study encompassed 21,482 patients. The unadjusted univariate analysis demonstrated no statistically significant difference in SSI rate between PI and saline (p = 0.759). Multivariate analysis showed that men, patients with diabetes, and those with a 2-3 h procedure time had increased risk of SSI, but differences were not observed between irrigation groups. Propensity score matching yielded 21 (0.25%) SSI in the matched PI group and 19 (0.23%) in the saline group (odds ratio: 1.10; confidence interval: 0.59-2.06). Conclusions: This investigation proposes that PI irrigation is not significantly different to saline in reducing SSI in this population. When cost is of concern, saline irrigation is equally effective and therefore a sensible option.

Reducing Surgical Site Infections With Silver Impregnated Dressings in Lower Extremity Bypass Patients.

Surgical site infection (SSI) after lower extremity (LE) bypass surgery is associated with longer length of stay, higher hospital cost, increased morbidity, and even graft loss. Silver impregnated dressings have been used by other surgical subspecialties to decrease SSI with reported success. The National Surgical Quality Improvement Program (NSQIP) published a national expected rate of 7.9% for SSI after open LE bypass surgery in 2018. Our institutional SSI rate in 2018 was 12.8%. In order to reduce this rate, we transitioned to silver impregnated dressings for all LE bypass procedures and studied any subsequent changes in rates of SSI. We used NSQIP data to retrospectively study two consecutive cohorts of vascular surgery patients at a single institution who underwent LE bypasses. Inclusion criteria were open infrainguinal LE bypass patients who were selected via Current Procedural Terminology codes. Patients in 2019 who underwent LE bypass received dry sterile dressing (DSD) postoperatively. Patients in 2020 who underwent LE bypass were treated with silver impregnated dressings postoperatively. NSQIP criteria were used to determine if patients in both cohorts developed SSIs within 30d of surgery. Fischer's exact and Χ2 test were used to compare groups before and after the intervention. Placement of silver dressings in the intervention cohort was confirmed using review of the medical chart and operative billing reports. A total of 282 patients who underwent LE bypass in 2019 and 2020 met inclusion criteria. The standard of care cohort had 168 patients with DSD, while the cohort after intervention had 114 patients with silver impregnated dressings. The groups were similar in terms of demographics and comorbidities (Table1). There was a statistically significant reduction in superficial SSI in the silver dressing group compared to the DSD group (9.6% versus 20.8%, P=0.014, Table2). There was a 63% compliance with silver dressing placement in the intervention group. This subset of patients with confirmed dressing placement was similar in terms of demographics and comorbidities (Table3). Superficial SSI in this patient cohort was decreased from 20.8 to 12.5% (P=0.15, Table4). There was no observed difference in deep or organ space infections, wound dehiscence, readmission, and return to operating room between both groups. This study demonstrated a statistically significant reduction in the rate of superficial SSI in patients undergoing open LE bypass with the use of a silver impregnated dressing when compared to a sterile gauze dressing. Although our study does not demonstrate a causal relationship, this relatively inexpensive and low-risk intervention's association with a significant decrease in an otherwise very serious postoperative complication argues for a change in clinical practice or prospective confirmatory studies to optimize patient outcomes after LE bypass.

Dilute Povidone-Iodine Irrigation: The Science of Molecular Iodine (I2) Kinetics and Its Antimicrobial Activity.

Dilute povidone-iodine (polyvinylpyrrolidone iodine [PVP-I]) irrigation in spine surgery and total joint arthroplasty has seen a rapid and substantial increase in its use during the past decade. Yet, most surgeons do not know the chemistry and biochemistry that explain its efficacy in preventing infections. PVP-I forms a complex with molecular iodine (I2), facilitating the delivery of I2 to the membrane of the infectious organism. Here, PVP-I establishes an equilibrium between complexed and noncomplexed (free) I2 in the aqueous solution. The I2 acts at numerous cellular targets of infecting organisms augmenting its role as a biocidal molecule. The paradoxical increase in the concentration of I2 that occurs with dilution of PVP-I is a result of equilibrium kinetics and is associated with an enhanced antimicrobial activity. Cytotoxicity studies have yielded conflicting results, but most endorse diluted concentrations as being less damaging to tissues. Clinical studies have verified notable reductions in surgical site infections with a 3-minute soak of 0.35% dilute povidone-iodine irrigation. Guidelines from the World Health Organization, Centers for Disease Control and Prevention, and International Consensus Meeting on Musculoskeletal Infection support the use of prophylactic incisional wound irrigation with aqueous PVP-I to reduce and prevent surgical site infections.

Incidence of surgical infection in cefazolin 3 g versus 2 g for colorectal surgery in obese patients.

To compare the incidence of surgical site infection (SSI) between cefazolin 3 g and 2 g surgical prophylaxis in patients weighing ≥120 kg that undergo elective colorectal surgery. A multicenter, retrospective cohort study was performed utilizing a validated database of elective colorectal surgeries in Michigan acute care hospitals. Adults weighing ≥120 kg who received cefazolin and metronidazole for surgical prophylaxis between 7/2012 and 6/2021 were included. The primary outcome was SSI, which was defined as an infection diagnosed within 30 days following the principal operative procedure. Multivariable logistic regression was used to identify variables associated with SSI; the exposure of interest was cefazolin 3 g surgical prophylaxis. A total of 581 patients were included; of these, 367 (63.1%) received cefazolin 3 g, while 214 (36.8%) received 2 g. Patients who received cefazolin 3 g had less optimal antibiotic timing (324 [88.3%] vs 200 [93.5%]; P = .043) and a higher receipt of at least 1 of the prophylaxis antibiotics after incision (22 [6%] vs 5 [2.3%]; P = .043). There was no SSI difference between cefazolin 3 g and 2 g cohorts (23 [6.3%] vs 16 [7.5%], P = .574). When accounting for age, smoking status, and surgical duration, cefazolin 3 g was not associated with a reduction in SSI (adjOR, .64; 95%CI, .32-1.29). Surgical prophylaxis with cefazolin 3 g, in combination with metronidazole, was not associated with decreased SSI compared to 2 g dosing in obese patients undergoing elective colorectal surgery.

Implementation of Surgical Site Infection Prevention Bundle in Gynaecological Surgeries: A Quality Control Initiative

Background: Surgical site infection (SSI) is the most common post operative morbidity after gynaecological surgeries. There can be multiple risk associated that may or may not be modifiable. Therefore, perioperative bundled approach are designed to reduce surgical site infections. Aim/Objective: To determine whether surgical site infection (SSI) prevention bundle reduces the risk of SSI by 30 days postoperatively compared with the standard hospital protocol. Methods: A randomized control trial was conducted on women who underwent elective gynaecologic surgery from January 2019 to May 2020. The subjects were divided into intervention and control group. The primary outcome was the rate of SSI by 30 days postoperatively. Results: Total 192 women were randomized. the intervention group included 94 and 98 were assigned to the control group. The SSI rate at 30 days after surgery was 8 /85 (9.5%) in intervention group and 22/85 (25.8%) in control group (p value=0.005; RR=0.36;95% confidence interval [CI], 0.17-0.77). The relative risk reduction of SSI was 64% (p value=0.005) after the bundle was implemented. In subgroup analysis, the primary outcomes were affected by the subgroups like age, co morbidities and operative characteristics. Conclusion: SSI prevention bundle intervention led to significant decrease in overall SSI rate in electively planned gynecological surgeries.

ROSSINI-Platform - Reduction of surgical site infection with a platform trial utilising a 'Basket-MAMS' design - Application acceleration award

ROSSINI-Platform - Reduction of surgical site infection with a platform trial utilising a 'Basket-MAMS' design - Application acceleration award

Optimizing Surgical Site Infection Prevention in Dermatologic Surgery.

We aim to review modifiable risk factors and practices for surgical site infections (SSIs) reduction in cutaneous surgeries. The existing norms are assessed with the latest evidence, with the aim of enhancing and optimizing intra and postoperative strategies. This review seeks to offer an updated summary of the results of evidence for SSI reduction strategies tailored for practicing general dermatologists. Searches were conducted for "cutaneous surgery surgical site infection complications" using PubMed Central® and DynaMed®. Articles with pragmatic guideline recommendations were selected. We found evidence for intraoperative factors such as non-sterile gloves, brushless hand scrubbing/simple hand washing, sterile materials, and chlorhexidine gluconate as a skin antiseptic. For postoperative factors, there is a lack of evidence to support the use of topical antibiotic ointments, dressings, or waiting 48 hours before wetting to prevent SSI. Several intra/postoperative factors not specific to dermatologic procedures are briefly discussed for additional context. Several SSI risk factors are inherent to patients or necessary procedures; however, dermatologists have identified modifiable risk factors and developed protocols to mitigate SSI risks intraoperatively and postoperatively. By questioning established practices in cutaneous surgery aimed at preventing SSIs, we can work towards the optimal utilization of resources. This dual-focused approach not only enhances the efficiency of the healthcare system but also diminishes the risks associated with SSIs. It is important to acknowledge that this review does not encompass all factors essential for consideration in these recommendations. Nonetheless, it will approach these factors with an evidence-based lens, placing SSI prevention at the forefront.

AHP SO04 - ''Effectiveness of a surgical wound care bundle for reducing surgical site infection after emergency abdominal surgery''

Abstract Background Surgical site infection (SSI) imposes a considerable financial burden to both hospital and patient by increasing the hospital stay, utilization of resources and readmission rates. This study compared the effectiveness of surgical wound care bundle concept with traditional ongoing wound care for reduction of SSI after emergency abdominal surgery. Method This cross-sectional analytical study was carried out with a total of 120 patients who underwent emergency abdominal surgery were included after taking informed written consent and divided into two groups: Group-A (n=60, surgical wound care bundle) and Group-B (n=60, traditional ongoing care). A detailed history and thorough clinical examination were carried out in each patient. Data were collected in separated case-record form and analyzed by SPSS 24. Results Mean age of Group A and Group B was 44.88 ±11.2 years and 44.82±13.3 years accordingly (p=0.391) with male majority in both groups (70% in Group-A and 80% in Group-B, p<0.292). Both groups were statistically similar regarding comorbidities, baseline laboratory parameters and pre-operative diagnosis (p>0.05).Group-B patients had higher frequency of SSI development compared to Group-A(43.3% vs. 15%, p-0.001). Besides, patients having traditional ongoing care had longer hospital duration than surgical wound care bundle (10.1±2.7 vs. 6.9±1.9 days, p<0.01). Though not significant, 30-day readmission rate was also higher in Group-B than Group-A (16.7% vs. 5%, p=0.075). Conclusion Surgical wound care bundle reduce surgical site infections in patients with emergency surgery. However, further multicenter studies are warranted.

Prophylactic 24 versus 48 h cephalosporins in cardiac surgery: A randomized trial.

Recommendations for cardiac surgery advocate for antibiotic prophylaxis for up to 48 hour after surgery. However, recent reports found a significant reduction in surgical site infection with extended duration. We evaluated the effect of the type of prophylactic antibiotics and administration durations on the postoperative surgical site infection rate following cardiac surgery in adults. An investigator-initiated randomized controlled trial was conducted from 2018 to 2022 on adult patients undergoing cardiac surgery. Patients were randomized into four groups based on antibiotic treatment type and duration: 24 h cefazolin, 24 h cefuroxime, 48 h cefazolin, and 48 h cefuroxime. The primary outcome was the rate of surgical site infections within 90 days of surgery. A total of 568 patients were included in this study. The four groups had similar baseline characteristics, including age, sex, EuroSCORE II, and baseline HbA1c. A total of 75 patients developed infection within 90 days postoperative. The overall infection rate was not statistically different across the four groups (p = 0.193). The efficacy of cefazolin and cefuroxime in reducing infection was comparable (p = 0.901). Extended prophylaxis was associated with a significantly reduced overall infection rate within 90 days postoperatively compared to 24-h prophylaxis (10.2% vs. 16.3%; risk ratio = 0.62, 95% confidence interval: 0.40-0.96, p = 0.032). Using cefazolin or cefuroxime for 48 h instead of 24 h was more effective in reducing the overall surgical site infections rate up to 90 days after surgery.

ERAS and Gastrointestinal Site Infections: Insights from a Comprehensive Systematic Review and Meta-Analysis.

Background: Enhanced recovery after surgery (ERAS) protocols are proposed to enhance perioperative care, but their impact on various surgical outcomes requires further insight. Objective: This extensive meta-analysis aimed to systematically estimate the effectiveness of ERAS in reducing postoperative complications and improving recovery metrics. Materials and Methods: We meticulously searched multiple databases and rigorously screened studies, ultimately including 16 high-quality research articles in our meta-analysis. We carefully assessed heterogeneity using the Cochran Q test and I2 index. Results were visualized using forest plots, displaying effect sizes and 95% confidence intervals (CIs). Results: The current meta-analysis reveals compelling evidence of ERAS protocols' impact on postoperative effects. Lung infection rates were significantly reduced, with an odds ratio (OR) of 0.4393 (95% CI: 0.2674; 0.7216, p = 0.0012), highlighting the protocols' effectiveness. Although the reduction in surgical site infections (SSIs) was not significant, with an OR of 0.8003 (95% CI: 0.3908; 1.6389, p = 0.5425), the data suggests a trend toward benefit. Urinary tract infections (UTI) also showed a promising decrease, with an OR of 0.4754 (95% CI: 0.2028; 1.1143, p = 0.0871), revealing ERAS protocols may mitigate UTI risks. No significant effects were observed on postoperative anastomotic leakage or ileus, with ORs indicating neutrality. The incidence of readmission was similarly unaffected, with an OR of 1.4018 (95% CI: 0.6860; 2.8647, p = 0.3543). These outcomes underscore the selective efficacy of ERAS protocols, advocating for their strategic implementation to optimize surgical recovery. Conclusions: This meta-analysis offers compelling evidence supporting the implementation of ERAS in mitigating specific post-surgical conditions. It underscores the potential of ERAS to enhance recovery experiences and improve healthcare efficiency. Further targeted research is warranted to fully understand the impact of ERAS on SSI, anastomotic leakage, ileus, and readmissions and to optimize its benefits across diverse surgical populations.

The Prophylactic Use of Negative Pressure Wound Therapy in Contaminated Wounds: A Prospective Cohort Study Conducted in ASU Hospitals

Abstract Background Contaminated wound and its complications cause increased patient morbidity, and it associated with delayed healing and increasing health care coast. Negative pressure wound therapy (NPWT) is frequently used for both chronic and acute open wounds, and studies have shown that it can speed up wound healing by encouraging the formation of granulation tissue, increasing perfusion, and enabling epithelialization and contraction. The introduction of NPWT to closed surgical incisions was motivated by improved results on open wounds. In high-risk patients, the use of NPWT in the early postoperative period lowers wound dehiscence and surgical site infections (SSIs). It minimizes hematoma and seroma rates by reducing wound edema and enhancing local perfusion and lymphatic flow. With better perfusion and oxygenation, wounds heal more quickly. Objective To evaluate the prophylactic use of negative pressure wound therapy as a technique for management and control of the contaminated wounds. Methods A prospective cohort study conducted at Ain Shams University Hospitals within a period of 6 months, 60 Patients with contaminated wounds immediately in postoperative period were included. And they are divided into two groups control group and study group each of them included 30 cases. Results 50% of the study group with application of NPWT immediately postoperative showed no discharge and no evidence of SSI, 20% showed minimal signs of inflammation in form of serous discharge and about 30% of them showed purulent discharge, erythema and evidence of SSI. In the control group with traditional gauze dressing about 46.7% showed purulent discharge and evidence of SSI. As regard muscle weakness and wound dehiscence, about 40% of the study group with NPWT showed muscle weakness and evidence of dehiscence and 46.7% of the control group with the traditional dressing showed muscle weakness and dehiscence. And as regard cosmetic appearance about 76% of the study group with NPWT showed good cosmetic appearance with average fine line scar or scar less than.5 cm in width. If take the consideration of satisfaction about the wound appearance About 56.7% of the cases showed parents' satisfaction, while 43.3% of control group showed parents' satisfaction. Conclusion Our study showed significant results in role of NPWT in reduction of SSI as 50% of the study group with application of NPWT immediately postoperative showed no evidence of SSI, 20% showed minimal signs of inflammation in form of serous discharge and about 30% of them showed purulent discharge, erythema and evidence of SSI. In the control group with traditional gauze dressing, about 46.7% showed purulent discharge and evidence of SSI. And as regard the muscle weakness and wound dehiscence, there is no significant difference in the use of NPWT or traditional gauze dressing as about 40% of the study group with NPWT showed muscle weakness and evidence of dehiscence and 46.7% of the control group with the traditional dressing showed muscle weakness and dehiscence. SO, the prophylactic use of NPWT in contaminated wound is effective in reducing the SSI, but there is no effect on muscle weakness and wound dehiscence.

Prospective Observational Study Of Surgical Site Infections In Obstetrics And Gynaecological Operations In Teaching Hospital

Background: Surgical site infections (SSI) are defined as infections occurring upto 30 days after surgery or (upto one year in patients receiving implants) and affecting either the incision or deep tissue at the operative site. SSIs are potential complications associated with any type of surgical procedure. Even though SSIs are among the most preventable hospital acquired infections, they still symbolize a significant burden in terms of patient’s morbidity and mortality leading to prolonged hospital stay and increase the patient susceptibility to other nosocomial infections affecting the financial condition of patients. Risk factors for SSIs are grouped as patient related, preoperative or pre pregnancy, intraoperative or intrapartum, and postoperative. SSI causes a substantial risk to patients and financial loses for health system because the multi-factorial causes achieving a measurable and sustained reduction in SSIs. In this context it becomes important to determine the prevalence of SSI, assess the magnitude of problem and provide a rationale to set priorities in infection control in the hospitals. Materials and Methods: The present prospective observational study was conducted on 200 patients in the Department of Obstetrics and gynaecology, at Dr B R Ambedkar Medical College and Hospital for a period of 12 months. Prior to the initiation of the study, Ethical and Research Committee clearance was obtained from Institutional Ethical Committee. Results: There was a significant statistical difference in the incidence of SSIs basing on the body mass index of subjects (pvalue:<0.001). SSI incidence was high in morbidly obese subjects. There was a highly significant statistical difference in the incidence of SSIs basing on the history of previous surgeries of subjects (p-value: <0.0001). SSI incidence was low in subjects with no history of previous surgeries. There was a highly significant statistical difference in the incidence of SSIs basing on the type of surgery (p-value: 0.48). SSI incidence was high in caesarean and low in tubectomy surgeries. There was a significant no statistical difference in the incidence of SSIs basing on the type of incision (p-value: 0.70). There was a highly significant statistical difference in the incidence of SSIs basing on the methods of skin closure (p-value: 0.002). SSI incidence was high in mattress method of skin closure and low in subcuticular method of skin closure. There was a highly significant statistical difference in the incidence of SSIs basing on the class of wound (p-value: 0.00001). SSI incidence was high in dirty wounds and low in clean wounds of skin closure. Conclusion: Although several preoperative risk factors (e.g., age, morbid obesity, ability to pursue a minimally invasive approach, type of gynaecologic surgery, type of incision, methods of skin closure, class of wound) may not be within the surgeon’s control, several evidence based interventions can limit the incidence of SSIs.

The Effect of Fascial Closure With Triclosan-Coated Sutures on the Incidence of Abdominal Wall Dehiscence: An Individual Participant Data Meta-Analysis.

Wound closure with triclosan-coated sutures (TCS) appears to reduce the risk of surgical site infection (SSI). Because there is a strong association between postoperative SSI and the development of acute abdominal wall dehiscence (AWD) after laparotomy, we hypothesized that the use of TCS for wound closure after laparotomy may also reduce the risk of AWD. The MEDLINE, Embase, and CENTRAL databases were searched from their inception to 01 November 2022. Randomized trials that compared the use of TCS with identical but uncoated sutures for fascial closure were eligible if they could provide individual participant data (IPD) on AWD. From these trials, we only included in the analysis those subjects who underwent open abdominal surgery. The primary outcome was the incidence of AWD within 30days postoperatively, requiring emergency reoperation. The certainty of evidence was assessed using the GRADE methodology (PROSPERO: CRD42019121173. We identified twelve eligible trials. Eight studies shared IPD. The incidence of AWD within 30 days after surgery was 27/1,565 (1.7%) in the TCS group vs. 40/1,430 (2.8%) in the control group (Relative Risk: 0.70 [95% confidence interval (CI) 0.44-1.11, I 2 = 0%, τ2 = 0.00]). The certainty of evidence was moderate after downgrading for imprecision. The incidence of incisional SSI was 163/1,576 (10.3%) vs. 198/1,439 (13.8%), RR 0.80 (95% CI 0.67-0.97). We found no conclusive evidence to support the use of triclosan-coated sutures for the prevention of acute abdominal wall dehiscence after laparotomy. In these selected studies, a significant reduction in incisional SSI was observed.

WP5.10 - Improving documentation of Surgical Site Infection Reduction Bundle (SSIRB) use in emergency laparotomies

Abstract Aims Surgical site infections (SSI) are associated with significant morbidity and mortality, substantial costs for hospitals due to increased length of stays, intensive care admissions and hospital re-admissions. NICE and the WHO support evidence based SSI reduction bundles (SSIRB). An evidence based SSIRB consisting of eight steps was implemented in the Surgical Emergency Unit (SEU) of a large teaching hospital to reduce SSI rates after emergency laparotomies. An audit was undertaken to assess documentation of SSIRB use. Methods The first audit cycle evaluated SEU laparotomies in January 2022 (n=31). The operation notes in patients’ electronic records were reviewed to extract SSIRB use. The intervention involved altering the electronic operation note to include a section on SSIRB use, which occurred in October 2022. The surgical team were educated about the importance of documenting SSIRB use and the updated operation note. A re-audit was completed for April 2023 (n=21). Results The first cycle showed that SSIRB documentation was poor (ranging from 0% to 55% for each step). After the operation note was updated, documentation of SSIRB use improved significantly for five of the eight steps. 48% of operation notes used the SSIRB section and documentation was higher for these laparotomies. Conclusions Documentation of SSIRB use improved after the intervention. Trusts are obliged to report accurate post-operative SSI rates. Improved documentation allows evaluation of SSIRB use compliance, enabling SSIRB steps with low compliance to be targeted. A high compliance rate to a SSIRB will reduce SSI rates, ultimately benefiting both patients and trusts.

Multifunctional hernia repair biopatch: Development, characterization, in vitro and in vivo evaluation

Incisional hernia, a prevalent postoperative complication, is characterized by the protrusion of organs or tissues through damaged abdominal wall. Predisposing factors for hernias include obesity, wound infections, immunosuppression, and comorbidities. However, hernia patches currently in use, including the commercial polypropylene (PP) patch, still have limitations in providing the mechanical and biological properties necessary for abdominal wall regeneration. In this study, three dimensional (3D) printing and coaxial electrospinning methods were combined to create a multifunctional double layered hernia repair biopatch to overcome these limitations. The double-layer design of the biopatch serves a multifunctional role in addressing incisional hernia models, with 3D printed ciprofloxacin (CIP) loaded polycaprolactone (PCL)/gelatin (Ge) scaffold (3DCIP) layer and coaxially electrospun PCL/Ge/κ-carrageenan (κ-C) nanofiber (NF) layers. While 3DCIP layers provides temporary mechanical reinforcement to the damaged abdominal wall, prevention of adhesions to internal organs, and reduction of surgical site infections, NF layer serves as tissue regeneration and fast wound healing. The developed multifunctional hernia biopatches underwent comprehensive physical and chemical characterization, followed by in vitro and in vivo evaluations. These evaluations included comparisons with a commercial PP patch, which was used as the control in the experiments. The study successfully fabricated multifunctional hernia biopatches with excellent antibacterial properties, high mechanical robustness, and strong biocompatibility.

A Perioperative Quality Improvement Program for Cesarean Delivery in Ethiopia

Infections and complications following cesarean delivery are a significant source of maternal mortality in Ethiopia. To study the effectiveness of a program to strengthen compliance with perioperative standards and reduce postoperative complications following cesarean delivery. This stepped-wedge cluster randomized clinical trial included patients undergoing cesarean delivery from August 24, 2021, to January 31, 2023, at 9 hospitals organized into 5 clusters in Ethiopia. Clean Cut, a multimodal surgical quality improvement program that includes process-mapping 6 perioperative standards and creating site-specific, systems-level improvements. The control period was the period before implementation of the intervention. The primary end point was surgical site infection rate, and secondary end points were maternal mortality and perinatal mortality and a composite outcome of infections and both mortality outcomes. All were assessed at 30 days postoperatively in the intervention and control groups, adjusting for clustering and demographics. Compliance with standards and the relationship between compliance and outcomes were also compared between the 2 arms. Among 9755 women undergoing cesarean delivery, 5099 deliveries (52.3%) occurred during the control period (2722 emergency cases [53.4%]) and 4656 (47.7%) during the intervention period (2346 emergency cases [50.4%]). Mean (SD) patient age was 27.04 (0.05) years. Thirty-day follow-up was completed for 5153 patients (52.8%). No significant reduction in infection rates was detected after the intervention (OR, 0.84; 95% CI, 0.55-1.27; P = .40). Intraoperative infection prevention standards improved significantly in the intervention arm vs control arm for compliance with at least 5 of the 6 standards (odds ratio [OR], 2.95; 95% CI, 2.40-3.62; P < .001). Regardless of trial arm, high compliance was associated with reduced odds of maternal (OR, 0.32; 95% CI, 0.11-0.93; P = .04) and perinatal (OR, 0.64; 95% CI, 0.47-0.89; P = .008) mortality. In this stepped-wedge cluster randomized clinical trial of patients undergoing cesarean delivery, no significant reductions in surgical site infections were observed. However, compliance with perioperative standards improved following the intervention. ClinicalTrials.gov Identifier: NCT04812522; Pan-African Clinical Trials Registry Identifier: PACTR202108717887402.

Association of negative pressure wound therapyand surgical site infections in patients undergoing cytoreductive surgery: An entropy balanced analysis.

Surgical site infections (SSIs) after cytoreductive surgery (CRS) ± hyperthermic intraperitoneal chemotherapy (HIPEC) are a major cause of potentially avoidable morbidity. We explored the association of negative pressure wound therapy (NPWT) with SSI in patients undergoing CRS/HIPEC. Retrospective analysis of consecutive patients undergoing CRS/HIPEC for non-gynecologic cancers. Exposure was the receipt of NPWT versus traditional skin closure. Primary outcome was SSI within 90 days of surgery. We performed multivariable logistic regression (before and after entropy balancing) to evaluate the association of exposure with outcomes. A total of 251 patients were included, of which 43 (17%) received NPWT and 26 (10.4%) developed SSIs. Baseline demographics and clinicopathologic characteristics were similar between the two groups with some exceptions: Patients who received NPWT had a higher Peritoneal Carcinomatosis Index (median 19 vs. 11, p = 0.002) and operative time (10 vs. 8.2 h, p = 0.003) but were less likely to undergo HIPEC (84% vs. 95%, p < 0.05). After entropy balancing, on multivariable logistic regression, NPWT was not associated with 90-day SSI (odds ratio = 0.90; 95% confidence interval = 0.21-3.80; p = 0.89). NPWT was not associated with a reduction in SSIs. These findings prompt a reevaluation of the routine use of NPWT in CRS/HIPEC.

Perioperative Supplemental Oxygen for the Prevention of Surgical Site Infection After Cesarean Section: A Systematic Review of Existing Literature.

Initial systematic reviews demonstrated the reduction of surgical site infection (SSI) following perioperative oxygen supplementation. SSI among colorectal surgeries was reduced by more than 50% with high-flow oxygen. However, recent randomized trials are coming up with conflicting results. The objective of this review was to comprehend whether the application of perioperative supplemental oxygen decreased the hazard of SSI following cesarean delivery.The initial search identified 95 studies. After screening title and abstracts 59 studies were included, and 33 studies were found to be relevant after checking eligibility. After a careful analysis, five articles were found fit for this systematic review. Extracted information included study design and methodology, the cumulative incidence of post-cesarean SSI following supplemental oxygen, the odds ratio, and associated variability for all factors considered in univariate and/or multivariate analysis. The cumulative incidence of the standard care group and supplemental oxygen group were comparable in all five studies with statistically significant differences. The secondary outcomes such as hospital readmission, wound separation, and intravenous antibiotics were similar in both groups as stated in the two studies. The rate of SSI in diabetics was 6.9% and 14.4% in the standard care group and supplemental oxygen group, respectively, as analyzed in a study. An increase in intra-operative blood loss was found to be the major risk factor leading to SSI. In one of the studies, Caucasian race, increased basal metabolic index, and prolonged surgery were associated with increased risk of SSI. There was no difference in neonatal umbilical artery pH resulting from supplemental oxygen during cesarean.The available literature is quite sufficient to prove that supplemental oxygen offers no added benefit in reducing post-cesarean SSI. Hence, we do not recommend its use for this purpose.