Reduction Of Surgical Site Infections Research Articles

The role of saline irrigation prior to wound closure in the reduction of surgical site infection. A systematic review and meta-analysis. Systematic Review Registration: PROSPERO: CRD42018082287

The role of saline irrigation prior to wound closure in the reduction of surgical site infection. A systematic review and meta-analysis. Systematic Review Registration: PROSPERO: CRD42018082287

Perioperative antimicrobial prophylaxis and prevention of hepatobiliary surgical site infections.

To characterize the microbiology of hepatobiliary surgical site infections (SSIs) and to explore the relationship between specific antimicrobial prophylaxis regimens and the development of SSIs. Retrospective matched case-control study comparing patient, procedure, and antimicrobial prophylaxis characteristics among patients undergoing a hepatobiliary surgical procedure with and without an SSI. A tertiary referral acute-care facility. Patients undergoing procedures defined as "BILI" (bile duct, liver, or pancreas surgery) using National Healthcare Safety Network (NHSN) definitions, excluding those undergoing concomitant liver transplantation, from January 2013 through June 2016 were included in the study population. The SSIs were identified through routine infection control surveillance using NHSN definitions. All patients who developed an SSI were considered cases. Controls were selected randomly matched 2:1 with cases based on fiscal quarter of the procedure. Logistic regression modeling was performed to explore variables associated with SSI, including antimicrobial prophylaxis received. Among 975 procedures, 80 (8.2%) resulted in an SSI. Most cases involved an organism nonsusceptible to standard prophylaxis regimens, including cefazolin (68.8%), cefazolin plus metronidazole (61.3%), and ampicillin-sulbactam (52.5%). In a multivariate model, antimicrobial coverage against Enterococcus spp (aOR, 0.58; 95% confidence interval [CI], 0.17-2.04; P=.40) and against Pseudomonas spp (aOR, 2.40; 95% CI, 0.56-10.29; P=.24) were not protective against the development of an SSI. The presence of a documented β-lactam allergy was significantly associated with the development of an SSI (aOR, 3.54; 95% CI, 1.36-9.19; P=.009). Although SSIs at the study institution were associated with pathogens nonsusceptible to the most commonly used prophylaxis regimens, broader-spectrum coverage was not associated with a reduction in SSIs.

Colon and rectal surgery surgical site infection reduction bundle: To improve is to change

BackgroundDespite the introduction of the Surgical Care Improvement Project, surgical site infections remain a source of morbidity. The aim of this study was to determine the value of implementing a colorectal bundle on SSI rates. MethodsBetween 2011 and 2016 a total of 1351 patients underwent colorectal operations. Patients were grouped into pre-implementation (Group A, January 1, 2011–December 31, 2012), implementation (Group B, January 1, 2013–December 31, 2014) and post-implementation (Group C, January 1, 2015–December 31, 2016). Primary endpoints were superficial SSI, deep SSI, wound separation and total SSI. ResultsAfter the bundle was implemented, there was a significant reduction in superficial (6.6%–4%, p < 0.05), deep (3.7%–1.1%, p < 0.05), and total SSI rates (10.9%–4.7%, p < 0.05). Comparing Group A to Group C there was a decrease in total SSI (9.4%–4.7%, p < 0.05). ConclusionImplementation of the bundle resulted in a reduction in overall SSI rates particularly as compliance increased. This study offers evidence that small changes can lead to significant decreases in surgical site infections.

Role of Layer by Layer Irrigation by Povidone Iodine during Closure of Potentially Contaminated Wounds in Reduction of Surgical Site Infection

Background: surgical site infection (SSI) is the infections occurring up to 30 days after surgery that affect the incision, deep tissue at the operation site or involve the organs or body space. Infection at the surgical site remains the second most common adverse event occurring to hospitalized patients and a major source of morbidity following surgical procedures. Aim of the Work: this study was done to assess the role of irrigation of partially contaminated wounds by povidone iodine in reduction of surgical site infection. Patients and Methods: this descriptive prospective study was carried out on 100 patients of potentially contaminated wounds at El-Hussein University Hospital and others, Patients divided into two groups A&B each group consisted of fifty patients, Group A: their wounds irrigated layer by layer with povidone iodine during closure, Group B: their wounds closed without irrigation with povidone iodine. Results: total number of cases with SSI in our study is twenty cases 20% of the total count. In group A there was nine cases two of them showed pus formation. While, in group B there was eleven cases eight of them undergo pus formation. Conclusion: from our study we concluded that The irrigation of the subcuta­neous tissue during closure of potentially (clean) contaminated wounds layer by layer by povidone-iodine 10% solution did not significantly reduces the surgical site infection percentage but significantly reduced the forma­tion of pus within the infected wound cavity and thus reducing the severity of surgical site infection.

Role of Layer by Layer Irrigation by Povidone Iodine during Closure of Potentially Contaminated Wounds in Reduction of Surgical Site Infection

Background: surgical site infection (SSI) is the infections occurring up to 30 days after surgery that affect the incision, deep tissue at the operation site or involve the organs or body space. Infection at the surgical site remains the second most common adverse event occurring to hospitalized patients and a major source of morbidity following surgical procedures. Aim of the Work: this study was done to assess the role of irrigation of partially contaminated wounds by povidone iodine in reduction of surgical site infection. Patients and Methods: this descriptive prospective study was carried out on 100 patients of potentially contaminated wounds at El-Hussein University Hospital and others, Patients divided into two groups A&B each group consisted of fifty patients, Group A: their wounds irrigated layer by layer with povidone iodine during closure, Group B: their wounds closed without irrigation with povidone iodine. Results: total number of cases with SSI in our study is twenty cases 20% of the total count. In group A there was nine cases two of them showed pus formation. While, in group B there was eleven cases eight of them undergo pus formation. Conclusion: from our study we concluded that The irrigation of the subcuta­neous tissue during closure of potentially (clean) contaminated wounds layer by layer by povidone-iodine 10% solution did not significantly reduces the surgical site infection percentage but significantly reduced the forma­tion of pus within the infected wound cavity and thus reducing the severity of surgical site infection.

ROSSINI 2: Reduction of surgical site infection using several novel interventions. A multi-arm, multi-stage trial delivered by trainee collaborative research networks

ROSSINI 2: Reduction of surgical site infection using several novel interventions. A multi-arm, multi-stage trial delivered by trainee collaborative research networks

Single use negative pressure dressing for reduction in surgical site infection following emergency laparotomy (SUNRRISE)

Single use negative pressure dressing for reduction in surgical site infection following emergency laparotomy (SUNRRISE)

Exploring an optimal risk adjustment model for public reporting of cesarean section surgical site infections.

Public report of surgical site infections (SSI) rates has been an important component of SSI reduction strategies, and risk adjustment is needed before SSI rates are publicly reported. Improving the risk adjustment model facilitates meaningful comparison in the public reporting of SSIs. This research aimed to explore an optimal risk adjustment model for the public reporting of cesarean section (CS) SSI. Information on 2506 cases of CS performed at T hospital, a tertiary general hospital located in the W City of H Province in China, from 01 January 2013 to 31 December 2014 was collected. The data were used to construct the multivariate risk adjustment models of CS SSI through logistic and Poisson stepwise regression. The c-index was used to compare the predictive power between the new logistic regression and the National Nosocomial Infections Surveillance (NNIS) risk index model. Pearson goodness-of-fit was determined to compare the goodness-of-fit between the new Poisson regression and the NNIS risk index model. The two new regression models were also compared. The logistic and Poisson regression models included two patient-related risk factors, namely, BMI (OR=1.085, P=0.006; RR=1.081, P=0.006) and ASA score (OR=1.522, P=0.044; RR=1.501, P=0.047). The c-index of the logistic regression model (0.628) was higher than that of the NNIS risk index model (0.600). The goodness-of-fit of the Poisson regression model (0.946) was better than that of the NNIS risk index model (0.851). The logistic and Poisson regression risk models are better than the NNIS risk index model, implying that a multifactorial risk adjustment model is needed for the public reporting of CS SSI. The advantage of logistic regression model is that the predictive power of model can be evaluated by c-index, however, Poisson regression may offer more advantages on model accuracy than logistic regression does when the infection rate decreases.

Reduction of Surgical Site Infections With the Implementation of Vaginal Preparation Before Cesarean Births

As one of the most common surgical procedures performed today, cesarean births constitute 32% of all births in the United States. Cesarean births increase concerns for infections, because 5%–10% of cesarean births result in a surgical site infection (SSI). Many protocols and bundles have been created to decrease these complications. The implementation of a vaginal preparation procedure before cesarean births is one such intervention.

EPOP-119 - What a Difference Physician Engagement Can Make!

Background: Sustainable reductions in Peripheral Vascular Bypass (PVBY) surgical site infections (SSIs) require physician engagement. The Agency for Healthcare Research and Quality's (AHRQ) Comprehensive Unit-based Safety Program (CUSP) encourages teamwork and communication. Previous efforts to reduce vascular SSI focused on nursing initiatives and data sharing, and were unsuccessful. This study demonstrates that teamwork and physician engagement can achieve a sustainable reduction in PVBY SSI.

Influences of clinical experience in the quantification of morphometric sarcopaenia: a cohort study.

Influences of clinical experience in the quantification of morphometric sarcopaenia: a cohort study.

Does Addition of Tobramycin Powder Reduce Infection Rates After Spine Surgery?

Study Design:Retrospective chart review.Objectives:To evaluate the efficacy of tobramycin and vancomycin powder in reducing surgical site infections in posterior lumbar instrumented fusion.Methods:A multicenter, electronic database search was conducted for all patients who underwent posterior instrumented lumbar fusions.Results:The addition of vancomycin powder decreased postoperative infections from an incidence of 5.7% down to a rate of 2.0%. This difference was statistically significant (P = .018). The addition of tobramycin powder to the wound in addition to vancomycin further decreased the infection rate down to 1.8%. The postoperative infection rate was statistically significant (P = .041) when compared with the no-powder group. However, the difference was not statistically significant (P = 1.00) when compared with vancomycin alone. There was also a trend toward gram-negative organisms with the addition of more antibiotic powder. In the control group, for example, the organisms cultured were 66% methicillin-sensitive Staphylococcus aureus and 33% gram-negative organisms. In the vancomycin group, 30% of the organisms cultured were Staphylococcus aureus and 60% gram-negative organisms. In the vancomycin and tobramycin powder group, 100% of the organisms cultured were gram-negative.Conclusions:There is a reduction in surgical site infections with addition of antibiotic powder to the wound prior to closure. However, the reduction in the infection rate was not as great with the addition of tobramycin powder to vancomycin alone and there was a noticeable change in the spectrum of organism cultured with this addition. Clinicians should consider the risk-to-benefit ratio in each case when deciding to use antibiotic powder.

Reduction in surgical site infection with suprafascial intrawound application of vancomycin powder in instrumented posterior spinal fusion: a retrospective case-control study.

OBJECTIVE Recent studies have demonstrated the efficacy of subfascial intrawound application of vancomycin powder in spine surgery in reducing the rate of surgical site infections (SSIs). However, to date no study has evaluated the efficacy and safety of suprafascial application of vancomycin powder in spine surgery. The purpose of this study was to quantify the rate of SSIs after open instrumented posterior spinal fusion with and without application of suprafascial vancomycin powder and to evaluate the rate of vancomycin powder-related local adverse effects. METHODS The authors conducted a single-center retrospective case-control study of adult patients undergoing open instrumented posterior fusion of the cervical, thoracic, or lumbar spine performed by a single surgeon from January 2010 through December 2016. In March 2013, routine application of 1 g of suprafascial vancomycin powder was started for all cases in addition to standard systemic antibiotic prophylaxis. Baseline demographics and operative data as well as the SSI rates were compared between the study groups. The incidence of vancomycin powder-related adverse effects was analyzed. RESULTS A total of 515 patients (268 in the untreated group and 247 in the treated group) were included in the study. The mean age was significantly higher in the treated group than in the untreated group (58.4 vs 54.4 years, p < 0.01). Operative variables were similar between the study groups. Patients receiving vancomycin powder had a significantly lower infection rate (5.6% in the untreated group vs 0% in the treated group, p < 0.001). No vancomycin powder-related adverse effects were identified in the treated group. CONCLUSIONS Routine application of suprafascial intrawound vancomycin powder in addition to systemic antibiotic prophylaxis is an easy-to-use, safe, and effective strategy for preventing SSIs after instrumented posterior spinal fusion. Suprafascial application of vancomycin powder could be a valuable alternative to previously reported subfascial distribution, minimizing the risk of local adverse drug reactions.

Bouffant vs Skull Cap and Impact on Surgical Site Infection: Does Operating Room Headwear Really Matter?

The American College of Surgeons guidelines indicate that skull caps are acceptable, and the Association of Perioperative Registered Nurses recommends bouffant caps. However, no scientific evidence has shown a significant advantage in surgical site infection (SSI) reduction with either cap. The objective of this study was to determine the influence of surgical cap choice on SSIs. Data from a previously published prospective randomized trial on the impact of hair clipping on SSIs were analyzed. Patients were grouped by the attending surgeons' preferred cap choice into either bouffant or skull cap groups. Overall, 1,543 patients were included in the trial. Attending surgeons wore bouffant caps in 39% and skull caps in 61% of cases. Prevalence of diabetes and tobacco use were similar between the groups. Bouffant caps were used in 71% of colon/intestinal cases, 42% of hernia/other cases, 40% of biliary cases, and only 1% of foregut cases. Overall, SSIs occurred in 8% and 5% of cases with a bouffant and skull cap, respectively (p= 0.016); with 6% vs 4% classified as superficial (p= 0.041), 0.8% vs 0.2% classified as deep (p= 0.12), and 1% vs 0.9% classified as organ space (p= 0.79); however, when adjusting for the type of operation, no significant differences in SSI rates were observed for skull caps vs bouffant caps. Attending surgeon preference for bouffant vs skull cap does not significantly impact SSI rates after accounting for surgical procedure type. Future guidelines should consider these clinical outcomes data and surgeon preference should dictate operating room headwear.

Success of a Colorectal Surgical Site Infection Prevention Bundle in a Multihospital System.

Surgical site infections, readmissions, and extended hospital stays are risks for patients undergoing colon surgeries. These procedures are often urgent, and patients may have multiple comorbidities. Preoperative and postoperative steps to reduce the number of complications provide substantial benefits clinically, economically, and psychologically. We used a multidisciplinary, collaborative approach to identify best practices when developing and implementing a standardized approach to the management of patients undergoing elective colon surgery. Interventions included nutrition supplements and preoperative and postoperative protocols. Our management project showed a 74.6% reduction in readmissions, a 22.73% reduction in length of stay, an 85% reduction in colon surgical site infections measured by incidence (84.5% reduction) and standard infection ratio (54.55% reduction), and 95% compliance with the use of both order sets during an 18-month period. Applying standardized order sets for assessing and addressing patient comorbidities before colorectal surgery can result in a substantial and sustainable reduction in complications.

Intra-Operative Inspired Fraction of Oxygen and the Risk of Surgical Site Infections in Patients with Type 1 Surgical Incisions.

Whether the fraction of inspired oxygen (FIO2) influences the risk of surgical site infection (SSI) is controversial. The World Health Organization and the World Federation of Societies of Anesthesiologists offer conflicting recommendations. In this study, we evaluate simultaneously three different definitions of FIO2 exposure and the risk of SSI in a large surgical population. Patients with clean (type 1) surgical incisions who developed superficial and deep organ/space SSI within 30 days after surgery from January 2003 through December 2012 in five surgical specialties were matched to specialty-specific controls. Fraction of inspired oxygen exposure was defined as (1) nadir FIO2, (2) percentage of operative time with FIO2 greater than 50%, and (3) cumulative hyperoxia exposure, calculated as the area under the curve (AUC) of FIO2 by time for the duration in which FIO2 greater than 50%. Stratified univariable and multivariable logistic regression models tested associations between FIO2 and SSI. One thousand two hundred fifty cases of SSI were matched to 3,248 controls. Increased oxygen exposure, by any of the three measures, was not associated with the outcome of any SSI in a multivariable logistic regression model. Elevated body mass index (BMI; 35+ vs. <25, odds ratio [OR] 1.78, 95% confidence interval [CI] 1.43-2.24), surgical duration (250+ min vs. <100 min, OR 1.93, 95% CI 1.48-2.52), diabetes mellitus (OR 1.37, 95% CI 1.13-1.65), peripheral vascular disease (OR 1.52, 95% CI 1.10-2.10), and liver cirrhosis (OR 2.48, 95% CI 1.53-4.02) were statistically significantly associated with greater odds of any SSI. Surgical sub-group analyses found higher intra-operative oxygen exposure was associated with higher odds of SSI in the neurosurgical and spine populations. Increased intra-operative inspired fraction of oxygen was not associated with a reduction in SSI. These findings do not support the practice of increasing FIO2 for the purpose of SSI reduction in patients with clean surgical incisions.

Effect of a single prophylactic preoperative oral antibiotic dose on surgical site infection following complex dermatological procedures on the nose and ear: a prospective, randomised, controlled, double-blinded trial

ObjectivesThere is limited published research studying the effect of antibiotic prophylaxis on surgical site infection (SSI) in dermatological surgery, and there is no consensus for its use in higher-risk cases....

Multidisciplinary, perioperative care bundle decreases surgical site infection in patients undergoing synchronous colorectal/liver resection

Background: Surgical site infections (SSIs) are a major cause of morbidity, mortality, and healthcare costs. Patients undergoing synchronous colorectal/liver resection are at especially high risk. This study measures the effects of a multidisciplinary, SSI reduction project in metastatic colorectal cancer patients undergoing synchronous colorectal/liver resection. Methods: Consecutive patients undergoing synchronous colorectal/liver resections at Memorial Sloan Kettering Cancer Center from 2011 to 2016 (n = 424) were included in the study. The intervention, implemented on Nov 1, 2013, included 13 total preoperative, intraoperative, and postoperative care components. The primary endpoint was SSI (both superficial/deep and organ space). Secondary endpoints were hospital length of stay (LOS) and 30-day readmission rate. Analysis was performed with Wilcoxon Rank Sum and Fisher’s Exact tests and multivariate logistic regression. Results: Overall, superficial/deep, and organ space SSI decreased by 60.5% (34.2% v 13.5%, p < 0.001), 80.6% (13.4% v 2.6%, p < 0.001), and 47.6% (20.8% v 10.9%, p < 0.008) after implementing the intervention, respectively (Table). Median LOS decreased from 9 (IQR 4-60) to 8 days (4–48) (p < 0.001), and 30-day readmission rates did not change (18.6% v 20.7%, p = 0.6). Operative duration, smoking, wound classification and implementation of the care bundle (intervention) predicted SSI. Smoking, wound classification and implementation of the care bundle were independently associated with SSI. Conclusion: In patients undergoing combined colorectal/liver resection, implementation of a multidisciplinary care bundle was associated with a 61% reduction in SSI and modest reduction in LOS. Rates of all types of SSI improved, but greatest advance was noted in superficial/deep SSI. Future multidisciplinary strategies should target deep organ space infection.TableSummary of primary and secondary study endpointsPre-intervention cohortPost-intervention cohortp valueN231193N/AOverall SSI79 (34.2%)26 (13.5%)<0.001Superficial/deep infection31 (13.4%)5 (2.6%)<0.001Organ space infection48 (20.8%)21 (10.9%)0.008LOS (days, range)9 (4-60)8 (4-48)<.00130 day readmission rate43 (18.6%)40 (20.7%)0.62 Open table in a new tab

The effect of triclosan-coated sutures on the rate of surgical site infection after hip and knee arthroplasty: a double-blind randomized controlled trial of 2546 patients.

AimsSurgical site infection (SSI) is a common complication of surgery with an incidence of about 1% in the United Kingdom. Sutures can lead to the development of a SSI, as micro-organisms can colonize the suture as it is implanted. Triclosan-coated sutures, being antimicrobical, were developed to reduce the rate of SSI. Our aim was to assess whether triclosan-coated sutures cause a reduction in SSIs following arthroplasty of the hip and knee.Patients and MethodsThis two-arm, parallel, double-blinded study involved 2546 patients undergoing elective total hip (THA) and total knee arthroplasty (TKA) at three hospitals. A total of 1323 were quasi-randomized to a standard suture group, and 1223 being quasi-randomized to the triclosan-coated suture group. The primary endpoint was the rate of SSI at 30 days postoperatively.ResultsThe baseline characteristics of age, gender and comorbidities were well matched in the two groups. The rates of superficial SSI were 0.8% in the control group and 0.7% in the intervention group (p = 0.651), and when deep and superficial SSIs were combined the rates were 2.5% and 1.8 (p = 0.266). The length of stay in hospital and the rates of medical complications did not differ significantly between the groups (p = 1.000).ConclusionThis trial provided no evidence that the use of triclosan-coated sutures at THA and TKA leads to a reduction in the rate of SSI.Cite this article: Bone Joint J 2018;100-B:296–302.

Is surgical antibiotic prophylaxis necessary for pediatric orchiopexy?

Surgeons frequently use surgical antibiotic prophylaxis (SAP), despite limited evidence to support its efficacy. Potential adverse events associated with antibiotic use include allergic reaction (including anaphylaxis), Clostridium difficile infection, and selecting for resistant bacteria. Surgical site infections (SSI) are very rare in patients undergoing clean pediatric urologic procedures. Current guidelines are unclear about the efficacy of surgical antibiotic prophylaxis for prevention of SSI in the pediatric population. It was hypothesized that children who received SAP prior to orchiopexy would have no reduction in surgical site infection (SSI) risk but an increased risk of antibiotic-associated adverse events. A retrospective cohort study was conducted of all males aged between 30 days and 18 years who underwent an orchiopexy (ICD-9 CM 62.5) in an ambulatory or observation setting from 2004 to 2015 using the Pediatric Health Information System database. Inpatients and those with concomitant procedures were excluded. Chi-squared or Fisher's exact tests were used to determine the association between SAP and allergic reaction (defined as a charge for epinephrine or ICD-9 diagnosis code for allergic reaction on the date of surgery) and any of the following within 30 days: SSI, hospital readmission or any repeat hospital encounter. Mixed effects logistic regression was performed, controlling for age, race, and insurance, and clustering of similar practice patterns by hospital. A total of 71,767 patients were included: median age was 4.6 years, 61.4% were white, and 49.3% had public insurance; 33.5% received SAP. Of these participants, 996/71,767 (1.4%) had a perioperative allergic reaction and <0.1% were diagnosed with an SSI. On mixed effects logistic regression, those who received SAP had 1.2 times the odds of a perioperative allergic reaction compared with those who did not receive SAP (P=0.005). Surgical antibiotic prophylaxis was not associated with decreased rates of SSI, lower hospital readmission, nor a lower chance of a repeat encounter within 30 days. In patients undergoing orchiopexy, it was found that SAP did not reduce the risk of postoperative SSI, readmissions, or hospital visits. Patients who received SAP had significantly increased odds of perioperative allergic reaction. This demonstrated that the risks of SAP outweigh the benefits in children undergoing orchiopexy.