Reduction In Surgical Site Infection Rate Research Articles

Plastic Wound Protector vs Surgical Gauze for Surgical Site Infection Reduction in Open GI Surgery

Surgical site infections (SSIs) are prevalent hospital-acquired infections with significant patient impacts and global health care burdens. The World Health Organization recommends using wound protector devices in abdominal surgery as a preventive measure to lower the risk of SSIs despite limited evidence. To examine the efficacy of a dual-ring, plastic wound protector in lowering the SSI rate in open gastrointestinal (GI) surgery irrespective of intra-abdominal contamination levels. This multicenter, patient-blinded, parallel-arm randomized clinical trial was conducted from August 2017 to October 2022 at 13 hospitals in an academic setting. Patients undergoing open abdominal bowel surgery (eg, for bowel perforation) were eligible for inclusion. Patients were randomized 1:1 to a dual-ring, plastic wound protector to protect the incision site of the abdominal wall (experimental group) or a conventional surgical gauze (control group). The primary end point was the rate of SSI within 30 days of open GI surgery. A total of 458 patients were randomized; after 1 was excluded from the control group, 457 were included in the intention-to-treat analysis (mean [SD] age, 58.4 [12.1] years; 256 [56.0%] male; 341 [74.6%] with a clean-contaminated wound): 229 in the wound protector group and 228 in the surgical gauze group. The overall SSI rate in the intention-to-treat analysis was 15.7% (72 of 458 patients). The SSI rate for the wound protector was 10.9% (25 of 229 patients) compared with 20.5% (47 of 229 patients) with surgical gauze. The wound protector significantly reduced the risk of SSI, with a relative risk reduction (RRR) of 46.81% (95% CI, 16.64%-66.06%). The wound protector significantly decreased the SSI rate for clean-contaminated wounds (RRR, 43.75%; 95% CI, 3.75%-67.13%), particularly for superficial SSIs (RRR, 42.50%; 95% CI, 7.16%-64.39%). Length of hospital stay was similar in both groups (mean [SD], 15.2 [10.5] vs 15.3 [10.2] days), as were the overall postoperative complication rates (20.1% vs 18.8%). This randomized clinical trial found a significant reduction in SSI rates when a plastic wound protector was used during open GI surgery compared with surgical gaze, supporting the World Health Organization recommendation for use of wound protector devices in abdominal surgery. ClinicalTrials.gov Identifier: NCT03170843.

Effectiveness of Chlorhexidine and Povidone Iodine in Preventing Surgical Site Infections (SSIs) in C-Section Deliveries

Objective: To compare the effectiveness of Chlorhexidine and Povidone iodine in preventing SSIs in C-section deliveries. Methodology: The study was conducted at a medical university and hospital in Karachi, from January 2021 July 2021. A non-probability consecutive sampling technique was used to select 35 participants. The study included women aged 18 to 45 years. The efficacy of Chlorhexidine and Povidone iodine in preventing SSIs was evaluated. Two groups were randomly assigned, with Group 1 receiving Chlorhexidine gluconate and Group 2 receiving Povidone-Iodine for skin preparation. Data on various factors were recorded, and the occurrence of SSIs within ten days of cesarean delivery was assessed. Results: The study included women aged 18 to 45 years. The efficacy of Chlorhexidine and Povidine iodine in preventing SSIs was evaluated. The results showed that Chlorhexidine was effective in preventing SSIs in 94.3% of cases, while Povidone iodine was effective in 91.4% of cases. However, no significant difference was observed between the two groups. The study results were consistent with previous research showing a reduction in SSI rates with the use of Chlorhexidine or Povidone- iodine. The overall rate of SSI was lower in the Chlorhexidine group, but contextual factors and adherence to infection control practices may influence outcomes. Conclusion. This study augments existing knowledge on preventing SSIs in C-section deliveries. While both Chlorhexidine and Povidone-iodine demonstrated comparable efficacy, Chlorhexidine appeared slightly more effective in reducing SSIs. Nonetheless, the study's limitations underscore the necessity for further research in diverse healthcare settings.

Impact of antibiotic-coated sutures on surgical site infections: a second-order meta-analysis.

Surgical site infections (SSIs) pose a global challenge, impacting patients and healthcare expenditures. This second-order meta-analysis endeavors to assess the efficacy of antibiotic sutures in averting SSIs by amalgamating data from various meta-studies. This research adhered to the PRISMA 2020 guidelines. The quality and comprehensiveness of the encompassed meta-analyses were assessed through the QUOROM checklist and AMSTAR techniques. The primary study overlap was evaluated via measures such as pairwise intersection heat maps, corrected covered area, and the citation matrix of evidence. The statistical power at the study-level was determined utilizing the meta-meta package. Data synthesis employed random and fixed effects models at a 95% CI. A meta-regression analysis was conducted to explore potential correlations between the CDC classification of SSIs, trial types, and the observed effect sizes in the studies. This investigation revealed a significant reduction in SSI rates due to antimicrobial-coated sutures, evidenced by a relative risk (RR) of 0.68 (95% CI: 0.59-0.76), with a prediction interval of 0.38-1.19. The analysis encompassed 18 studies with 22 meta-analyses, demonstrating a median QUOROM score of 13.6 out of 18 and an AMSTAR score of 9.1 out of 11. The presence of moderate heterogeneity was noted ( Q =106.611, I2 =54.038%), with nonrandomized controlled trials exhibiting an RR of 0.56 (95% CI: 0.39-0.80), and RCTs displaying an RR of 0.71 (95% CI: 0.63-0.81). Subgroup analysis unveiled variable RR reductions for specific surgical procedures. Antimicrobial-coated sutures offer a promising approach to mitigating SSIs risk. However, their efficacy is optimally realized when employed in conjunction with other robust practices.

Does a Presurgical Antisepsis Protocol Decrease Surgical Site Infections in Young Children?

National standards for surgical site infection (SSI) prevention for children remain elusive. Our institution developed a presurgical antisepsis protocol that included the three components of chlorhexidine gluconate bathing wipes, chlorhexidine gluconate oral rinse, and povidone-iodine nasal swab. This retrospective cohort study examined data from electronic health records to compare SSI rates before and after protocol implementation. We included children aged 2 through 11years undergoing any surgical procedure with the use of an incision in the OR (N=1,356). We did not find any difference in the occurrence of SSI before and after the protocol was implemented. Logistic regression showed that an infection present at the time of surgery was the only significant predictor of an SSI. The implementation of a presurgical antisepsis protocol was not associated with SSI rate reduction in this pediatric cohort.

Reducing Surgical Site Infections Post-Caesarean Section.

Surgical Site Infections (SSI) are one of the most common complications after a caesarean with significant morbidity. Evidence suggests that SSI rates can be reduced post caesarean by using a Leukomed® Sorbact® (Essity) bacteria binding wound dressing, thereby reducing bacterial wound colonisation. Barking, Havering & Redbridge University Hospitals NHS Trust, London, UK (BHRUT) maternity unit sought change their clinical practice by using Leukomed Sorbact and evaluate if this reduced their SSI rate, SSI readmission rate, antibiotic usage and evaluate any associated cost savings. From January 1st 2022, Mepore® (Molnlycke) wound dressings were replaced with Leukomed Sorbact for all caesareans. Retrospective and prospective audits were undertaken to compare SSI incidence pre- and post- implementation of the dressing. No changes were made to wound cleaning products, prophylactic antibiotic use or surgical technique. Wound closure technique remained the choice of the individual surgeon. Prior to this practice change, the baseline SSI rate between January-December 2021 was 6.1% and the SSI readmission rate was 1.27%. Comparative data for January-December 2022 showed a 38% reduction in SSI rates (overall SSI rate = 3.8%), a 31% reduction in readmission rate for SSI (overall rate = 0.88%), a 38% reduction in readmission bed days and a 30% reduction in antibiotic use. There was a reduction in SSI rates in all body mass index (BMI) categories. Total savings due to the reduction in SSI rates over twelve months were £234,784. The cost savings to BHRUT solely attributable to the reduction in readmissions was £49,750 or £21 per Caesarean, which will be an ongoing saving. The use of Leukomed Sorbact dressings after Caesarean resulted in improved clinical outcomes with reduced SSI and readmission rates. Investment in the new dressing was cost effective when considering bed days freed, the reduction in antibiotic usage, reduced morbidity and improved patient experience.

The Role of Patient Engagement in Surgical Site Infection Reduction: A Process Improvement Project.

Surgical site infections (SSIs) are the second most common healthcare-associated infection, with prevention being a high-priority goal for all healthcare organizations. Although routine surveillance and standardized prevention protocols have long been used, patient engagement is an additional intervention that should be considered and may be beneficial in SSI prevention. To determine if the development of a standardized patient education discharge plan for management of a surgical site and/or surgical drain would contribute to a reduction in SSI rates in inpatients undergoing colorectal, plastic, or general surgery. A preintervention/postintervention design was used. Before intervention, patients and surgeons were surveyed regarding various discharge practices related to surgical incision/drain care. The intervention consisted of implementing a standardized discharge plan including standardized education and patient discharge kits. After implementation, patients were surveyed regarding discharge practices. Patient survey responses and SSI rates were compared between the preintervention and postintervention time frames. Rates of SSIs decreased across all three surgical specialties during the project period: colorectal SSIs decreased from 3.2% to 2.7%, plastics from 1.2% to 0.5%, and general from 0.86% to 0.33%. Improvements were also realized in patient survey responses to various aspects of surgical incision/drain care. Patient engagement may be an important strategy to integrate with SSI evidence-based care bundles. Active engagement of surgical patients perioperatively has the potential to improve the patient experience, which ultimately can result in improved healthcare outcomes for this population.

Routine Sterile Glove and Instrument Change at the Time of Abdominal Wound Closure to Prevent Surgical Site Infection: Reviewing the ChEETAh Trial.

"Evidence-Based Reviews in Surgery" (EBRS) was developed to foster critical appraisal skills in practicing surgeons and trainees in order that they may evaluate surgical literature and practice Evidence-based Based Surgery. EBRS virtually connects experts in clinical surgery and evidence-based methodology to collaboratively assess the strengths and weaknesses of current practice compared to the risks and benefits of new approaches to care. Since the inception of EBRS, summaries of each review have been published. The present article is a comprehensive review of the ChEETAh trial, investigating the effectiveness of routine glove and instrument change before abdominal wound closure to prevent surgical site infection (SSI). The trial was conducted in low- and middle-income countries (LMICs) and employed a cluster-randomized design. The results indicate a statistically significant reduction in SSI rates. Although the ChEETAh trial has strengths, caution is advised before implementing the intervention globally. The study's clinical relevance and cost-effectiveness need to be considered, and targeted implementation in specific patient clusters and hospitals with the necessary resources is recommended. Institutions should not only assess their unique circumstances (resources, baseline SSI rates, and use of other effective preventive measures) before implementing glove and instrument changes in their setting but also monitor their outcomes and costs should they choose in favor of implementation. Further research, including long-term effects, is suggested to refine the understanding of the intervention's implications in diverse settings.

Implementation of a Surgical Site Infection Prevention Bundle at the Time of Cesarean

Surgical site infection (SSI) prevention bundles have been associated with a reduction in SSI rates. SSI at the time of cesarean birth increases maternal morbidity and mortality, decreases patient satisfaction, and significantly increases hospital costs. Prior to implementation, there was no consistent SSI-prevention interventions.

Improvement of operating room air quality and sustained reduction of surgical site infections in an orthopedic specialty hospital

Surgical site infection (SSI) rates can be impacted by air quality, and a high-efficiency particulate air and ultraviolet air recirculation system (HUAIRS) has been shown to improve operating room air quality. This study examined the impact of HUAIRS devices on SSI rates when used at an orthopedic specialty hospital. HUAIRS devices were used intraoperatively at the facility. Total particle counts before and after HUAIRS implementation were compared. SSI rates for nervous system procedures or for all procedures at the facility were also compared for the 2.5-year periods before and after implementing HUAIRS devices. Over 30,000 consecutive procedures were performed from 2017 to 2022. The overall SSI rate at the facility was 0.45% before implementing HUAIRS devices compared to 0.22% (P<0.001) after. The SSI rate following nervous system procedures was 2.06% before implementing HUAIRS devices versus 0.29% (P<.001) after. Total particle counts were also significantly lower after implementing HUAIRS devices. Implementation of HUAIRS devices at an orthopedic specialty hospital is associated with significant reductions in SSI rates and intraoperative air contamination levels. These data support the need to further investigate intraoperative air quality interventions for the reduction in SSI rates.

PreciSSIon: a collaborative initiative to reduce surgical site infections after elective colorectal surgery

Surgical site infections (SSIs) are common after colorectal surgery, but most hospitals do not know their SSI rates. Approximately half of SSIs occur after discharge, and postdischarge surveillance is needed for accurate measurement. Perioperative care bundles are known to reduce SSI rates. PreciSSion is a collaboration between seven hospitals in the West of England. To establish reliable SSI measurement after elective colorectal surgery using 30-day patient-reported outcome measures, and to implement an evidence-based four-point care bundle that had already demonstrated a reduction in the SSI rate in a local hospital. The bundle included: 2% chlorhexidine skin preparation, a second dose of antibiotic after 4h, use of a dual-ring wound protector, and use of antibacterial sutures for abdominal wall closure. The 30-day patient-reported SSI rate was determined using the Public Health England questionnaire, and response rates were recorded. The baseline SSI rate was measured from November 2019 to May 2020, and continued after implementation of the care bundle until March 2021. Bundle compliance was also measured. The average questionnaire response rate was 81%, and average compliance was 92%, 96%, 79% and 85% for each element of the bundle. The baseline SSI rate was 8-30%. Six of seven hospitals reduced their SSI rate, and the regional average SSI rate almost halved from 18% (1447 patients) to 9.5% (1247 patients). A care bundle developed in a single hospital can be adopted in other hospitals, and a 50% reduction in SSI rate after elective colorectal surgery can be replicated in other hospitals within 18 months.

A prospective, randomized assessment of a novel, local antibiotic releasing platform for the prevention of superficial and deep surgical site infections

BackgroundDespite significant advances in infection control guidelines and practices, surgical site infections (SSIs) remain a substantial cause of morbidity, prolonged hospitalization, and mortality among patients having both elective and emergent surgeries. D-PLEX100 is a novel, antibiotic-eluting polymer–lipid matrix that supplies a high, local concentration of doxycycline for the prevention of superficial and deep SSIs. The aim of our study was to evaluate the safety and efficacy of D-PLEX in addition to standard of care (SOC) in preventing superficial and deep surgical site infections for patients undergoing elective colorectal surgery.MethodsFrom October 10, 2018 to October 6, 2019, as part of a Phase 2 clinical trial, we randomly assigned 202 patients who had scheduled elective colorectal surgery to receive either standard of care SSI prophylaxis or D-PLEX100 in addition to standard of care. The primary objective was to assess the efficacy of D-PLEX100 in superficial and deep SSI reduction, as measured by the incidence of SSIs within 30 days, as adjudicated by both an individual assessor and a three-person endpoint adjudication committee, all of whom were blinded to study-group assignments. Safety was assessed by the stratification and incidence of treatment-emergent adverse events.ResultsOne hundred and seventy-nine patients were evaluated in the per protocol population, 88 in the intervention arm [51 males, 37 females, median age (64.0 range: 19–92) years] and 91 in the control arm [57 males, 34 females, median age 64.5 (range: 21–88) years]. The SSI rate within 30 day post-index surgery revealed a 64% relative risk reduction in SSI rate in the D-PLEX100 plus standard of care (SOC) group [n = 7/88 (8%)] vs SOC alone [n = 20/91 (22%)]; p = 0.0115. There was no significant difference in treatment-emergent adverse events.ConclusionsD-PLEX100 application leads to a statistically significant reduction in superficial and deep surgical site infections in this colorectal clinical model without any associated increase in adverse events.

The impact of bowel preparation on surgical site infection rates in gynecologic oncology surgery, post-hoc analysis from a randomized controlled trial (550)

<b>Objectives:</b> To determine the relationship between oral antibiotic bowel preparation (OABP) and mechanical bowel preparation (MBP) with respect to surgical site infection (SSI) rates in patients with gynecologic cancer undergoing colorectal surgery. <b>Methods:</b> A post-hoc analysis was performed using data from a randomized controlled trial investigating the use of negative pressure wound therapy after laparotomy. Patients with presumed malignancy requiring laparotomy were enrolled from March 2016 to August 2019. For this analysis, we only included cases with confirmed gynecologic malignancy, undergoing gynecologic oncology surgeries that also required colorectal resections. The primary outcome was SSI within 30 (±5) days of surgery. Univariate and multivariable analyses with stepwise model selection for SSI were performed. <b>Results:</b> The cohort included 161 surgeries requiring one or more colorectal resections. Of these, 15 (9%) had no bowel preparation, 39 (24%) had OABP only, and 107 (67%) had OABP+MBP. There was no case in which MBP was used alone. The overall SSI rate was 19% (<i>n</i>=31) and varied significantly by bowel preparation type: 53% (<i>n</i>=8) in the no-preparation group, 21% (<i>n</i>=8) in the OABP alone group, and 14% (<i>n</i>=15) in the OABP+MBP group (p=0.003). The difference between OABP and OABP+MBP was non-significant (p=0.44). The median length of stay was nine days (range: 6-12) for patients with no preparation, six days (range: 5-8) in the OABP group, and seven days (range: 6-10) in the OABP+MBP group (p=0.045). The overall complication rate was 34% (<i>n</i>=54) and did not vary significantly by bowel preparation type: 53% (<i>n</i>=8) no preparation, 28% (<i>n</i>=11) OABP alone, 33% (<i>n</i>=35) OABP+MBP (p=0.23). The overall anastomotic leak rate was 1.2% (<i>n</i>=2), with one case occurring in the no bowel preparation cohort (6.7%), one in the OABP cohort (2.6%), and none in the OABP+MBP cohort. Univariate logistic regression found that OABP was associated with a decreased risk of SSI (odds ratio [OR]: 0.23, 95% CI: 0.06-0.80) compared with no bowel preparation; OABP+MBP was also associated with a decreased risk of SSI (OR: 0.14, 95% CI: 0.04-0.45) compared with no bowel preparation (p=0.004). On multivariate analysis, the use of a bowel preparation demonstrated a significant impact on SSI rates (p=0.004) when accounting for preoperative hemoglobin, partial thromboplastin time, and bowel resection type. <b>Conclusions:</b> The use of OABP is associated with a reduction in SSI rates. Adoption of bowel preparation prior to gynecologic oncology surgeries with anticipated colorectal resection reduces the risk of SSI. While the use of MBP alone has been abandoned, further investigation is needed to determine whether OABP is sufficient or whether OABP+MBP should be recommended.

SURGICAL SITE INFECTION IN OBG - PRE AND POST COVID -19 PANDEMIC -A COMPARATIVE STUDY

Introduction: Methods:Surgical site infection (SSI) accounts for major morbidity in post-operative patients. An observational study was carried st out in a tertiary health centre in Kerala, India, where SSI Rates were analyzed for a period of 24 months prior and 24 months after January 2020 (1 case of COVID-19) based on patient records. A drastic reduction in SSI rates was noted in post covid period in Gynaecological casesResults: (2.44%, p=0.004). Signicant reduction in SSI was also noted in Elective LSCS (0.70%, p=0.004) and Emergency LSCS cases (1.51%, p=0.039). Conclusion: The practice of wearing N-95 masks and frequent hand washing can be continued to reduce SSI rates in OBG wards.

Use of Topical Vancomycin Powder to Reduce Surgical Site Infections after Deep Brain Stimulation Surgery: UCSF Experience and Meta-Analysis

Objective: Surgical site infection (SSI) is the most common serious complication of deep brain stimulation (DBS) implantation surgery. Here, we report a single-surgeon experience on the efficacy of topical, intrawound vancomycin powder (VP) in reducing SSI for DBS surgery and present the first systematic review and meta-analysis examining the effect of topical vancomycin on SSI in patients after DBS surgery. Methods: For the retrospective review, all unique patients undergoing DBS surgery at UCSF for new hardware implantation or internal pulse generator (IPG) replacement by a single surgeon from September 2013 to March 2019, with at least 1 year of follow-up data, were included. For the meta-analysis, we included all primary studies that compared SSIs with and without application of topical vancomycin in DBS surgeries. Results: 368 unique patients met inclusion criteria; 195 patients received topical VP (VP group) and 173 did not (control). 99/195 patients in the VP group underwent new DBS implantation and 96/195 had IPG replacement. 71/173 patients in the control group had new DBS implantation and 102/173 had IPG replacement. There were 10 total cases of SSI: 4 patients from the VP group (3 new implants and 1 IPG replacement) and 6 patients from the control group (3 new implants and 3 IPG replacements), resulting in SSI rates of 2.1 and 3.5%, respectively (p value = 0.337). Including our retrospective analysis, 6 studies met inclusion criteria for the systematic review and meta-analysis. In the 4 studies that examined primary DBS implants, 479 total patients received topical VP and 436 did not; mean odds ratio for SSI with topical vancomycin was 0.802 (95% confidence interval [CI] 0.175–3.678). Across the 5 studies that examined IPG implantations or replacements, 606 total patients received topical VP while 1,173 patients did not; mean odds ratio for SSI with topical vancomycin was 0.492 (95% CI 0.164–1.475). In either case, topical VP application did not significantly decrease risk of SSI. Conclusion: Surgical infections after DBS surgery are uncommon events, with studies demonstrating mixed results on whether topical vancomycin reduces this risk. Our single-institution retrospective analysis and systematic review of prior studies both demonstrated no significant SSI rate reduction with topical VP. This is likely due to low baseline SSI rates, resulting in a small effect size for prevention. Given the cost-effectiveness, simplicity, and low risk, topical, intrawound VP remains a treatment option to further reduce risk of SSI, particularly in settings with higher baseline infection rates.

Evaluation of Adjunctive Azithromycin Prophylaxis in Women Undergoing Cesarean Delivery in a Setting With Low Baseline Incidence of Surgical Site Infection.

The purpose of this quality improvement study was to determine the effect of adding azithromycin to standard antibiotic prophylaxis on the rates surgical site infection (SSI) in women undergoing both elective and non-elective cesarean deliveries at our centre. A before-and-after quality improvement study was conducted at the Regina General Hospital in Regina, Saskatchewan. Data collected from 989 women who had a caesarean delivery between June 1, 2016 and June 30, 2017 were compared with those from 1033 women who had a caesarean delivery between August 1, 2017 and July 31, 2018, after the introduction of adjunctive azithromycin prophylaxis. The primary outcome measure was the change in the incidence of SSI up to 30 days following surgery. Secondary outcome measures included timing of azithromycin prophylaxis and the number of women who did not receive azithromycin. Surgical site infection rates decreased from 3.5% to 2.9% after adjunctive azithromycin prophylaxis was introduced. The absolute reduction in SSIs of 0.6% was not statistically significant (P = 0.42). There were no differences in SSI rates between the elective and non-elective subgroups. Adding azithromycin to the standard antibiotic prophylaxis for cesarean delivery showed no statistically significant reduction in SSI rates in a population with low baseline rates of SSI.

Preventing Surgical Site Infections and Colorectal Surgery: Creating an Interdisciplinary Culture of Safety and Excellence

<i>Background</i>: Surgical site infections (SSI) are an undesirable surgical complication that leads to negative patient and system outcomes. SSI risk correlates with various intrinsic (patient) and extrinsic (system) factors. Colorectal surgeries are especially susceptible. In 2013, the incidence of postoperative colorectal SSI rates was noted to be elevated at our institution with respect to national benchmarks. We developed and implemented an evidence based Colorectal Bundle (CRB) as our targeted intervention to reduce SSI. <i>Methods</i>: A multidisciplinary team was formed to develop and implement a CRB. The bundle was created using interventions established in the literature while also accounting for institutional biases. After a period of implementation, data was then analyzed using baseline and post implementation statistics. Additionally, infection rates were compared to national expected incidences using two national programs, the NSQIP and NHSN. Bundle compliance was encouraged over time to achieve sustained results. <i>Results</i>: We performed a total of 519 colorectal surgeries over a span of two and a half years and limited our infection rate to only 12 cases (2.3%). This was a significant reduction in SSI rates (RR 0.28, p < 0.001) and according to NSQIP, placed our system in the top decile with respect to SSI incidence. <i>Conclusions</i>: Implementation of our CRB resulted in a sustained decrease in SSI rates with respect to colorectal surgeries. We hope this manuscript can serve as a recipe for change. We highlight steps that were crucial to the success of our CRB from inception onward. We believe these key elements include the presence of a surgical champion, multi departmental buy-in, and continued compliance leading to a culture of excellence.

The impact of copper impregnated wound dressings on surgical site infection following caesarean section: a double blind randomised controlled study

ObjectiveTo investigate the effect of copper impregnated wound dressings on the surgical site infection (SSI) rate following caesarean section (CS). DesignSingle centre double blind randomised controlled trial. ParticipantsWomen aged 18 years or over who had a CS. InterventionsAll women were randomised to receive either a copper-oxide impregnated wound dressing (study group) or a non-copper wound dressing (control group). Main outcome measuresThe primary study outcome was the incidence of SSI within a 30-day period from CS, assessed via a telephone questionnaire. Secondary outcomes were length of hospital stay, and readmission rate. Results324 women were enrolled in the study of whom 159 were randomised to the study group and 165 to the control group. The follow up rate was 97.5%. A total of 78 women (24.1%) developed an SSI within 30 days following CS; 29 (18.2%) in the study group and 49 (29.7%) controls (P = 0.037, relative risk reduction (RRR) of 38.7%). The incidence of superficial/deep SSI was not significantly different (24.2% vs. 17.6%, P = 0.257), however a significant relative risk reduction of 80.3% for Organ/Space SSI was observed in the study group (12.7% vs. 2.5%, P = 0.002). Length of hospital stay, and readmission rate did not vary significantly between groups. ConclusionsThis is the first study to demonstrate a significant reduction in SSI rates following CS with the use of copper impregnated wound dressings. The high SSI rate confirms the importance of new strategies to reduce the infection rate. Copper is a natural remedy which could potentially reduce hospital acquired infections without the use of antibiotics and its associated risks of antibiotic resistance.

Reducing abdominal hysterectomy surgical site infections: A multidisciplinary quality initiative

To investigate abdominal hysterectomy surgical site infection (SSI) rates before and after implementation of an SSI care bundle. An SSI bundle for abdominal hysterectomies was introduced in our hospital in April 2014 to reduce the SSI rate. The practices were divided into bundle elements around preoperative, intraoperative, and postoperative care. We conducted a retrospective cohort study around implementation of the SSI care bundle. Women were included if they underwent abdominal hysterectomy between 2012 and 2015. They were then divided into 2 study groups: prebundle and postbundle. The primary study outcome was SSI rate. The superficial SSI rate was the secondary outcome. The overall SSI rate was 6.18% in the prebundle group, with a median monthly SSI rate of 7.03%. After bundle implementation, the overall SSI rate declined to 2.51% (P = .02). The reduction remained significant after multivariate analysis (adjusted odds ratio 0.38; 95% confidence interval 0.15-0.88; P = .03) indicating a 62% reduction in SSI postbundle as compared to prebundle.When comparing rates based on infection classification, superficial SSIs declined significantly from 3.73% in the prebundle group to 0.90% in the postbundle group (P = 0.02). Patient demographics and pre-existing medical conditions were similar pre- and postbundle. Compliance with bundle elements was high. A significant reduction in SSI rate in abdominal hysterectomies was seen following implementation of an infection prevention bundle.

The use of oral antibiotics and mechanical bowel preparation in elective colorectal resection for the reduction of surgical site infection.

Surgical site infection (SSI) is a major cause of morbidity worldwide following elective colorectal resection, affecting up to 20% of patients 1, 2, 3. Reduction in SSI rates requires a multi‐faceted approach 4 and can be achieved with the use of SSI reduction bundles 5. Such bundles include prophylactic intravenous antibiotics 6 which represent an undisputed standard of care 4. They do not include the use of mechanical bowel preparation (MBP) alone which is not recommended in elective colonic resection to reduce SSI 7, 8, 9, although may offer an advantage in elective rectal resection 10. A long‐standing area of controversy is the use of mechanical bowel preparation and oral antibiotics (MOAB) prior to elective colorectal resection 11, 12. Marked differences exist between clinicians worldwide 13. Recent guidelines from the American Society of Colon and Rectal Surgeons strongly recommend the use of MOAB in elective colorectal resection to reduce SSI 14, 15. Other international bodies have recognized the increasing body of evidence and altered their recommendations in a more conservative manner but stopped short of endorsing this practice because of the lack of Level 1 evidence 16. This paper summarizes the arguments for and against the use of MOAB in elective colorectal resection, highlighting the areas of controversy and evidence gaps, and provides pragmatic suggestions for colorectal practice (Fig. ​(Fig.11). Open in a separate window Figure 1 Arguments for and against the use of mechanical bowel preparation and oral antibiotics in elective colorectal resection. MOAB, mechanical bowel preparation and oral antibiotics; MIS, minimally invasive surgery; ERAS, enhanced recovery after surgery; BMI, body mass index; SSI, surgical site infection; ABx, antibiotics; CDI, Clostridium difficile infection; QI, quality improvement.

Impact of a surgical site infection bundle on cesarean delivery infection rates

This study investigated cesarean delivery surgical site infection (SSI) rates before and after implementation of a SSI care bundle. A SSI bundle for cesareans was introduced in our hospital in April 2014 to reduce the SSI rate. The practices were divided into bundle elements that reflected preoperative, intraoperative, and postoperative care. We conducted a retrospective cohort study to evaluate implementation of the SSI care bundle. Women were included if they had a gestational age of at least 23 0/7 weeks and delivered a liveborn neonate(s) between 2012 and 2015. They were then divided into 2 study groups: pre-bundle and post-bundle. The primary study outcome was SSI rate. Secondary outcomes included comorbidities, perioperative factors, and SSI classification. The overall incidence of cesarean SSIs during the study time period was 1.89 (76 SSIs in 4014 cesarean deliveries). The pre-bundle mean was 2.44 and decreased to 1.1 following implementation of the SSI bundle (P = .013). This represents a 221% reduction in the SSI rate. Patient demographics and pre-existing medical conditions were similar pre- and post-bundle. Compliance with bundle elements was high. A significant reduction in SSI rate in cesarean deliveries was seen following implementation of an infection prevention bundle.