Frequency Of Surgical Site Infection Research Articles

On-Lay versus Sub-Lay Mesh Repair for Ventral Hernia: A Retrospective Cohort Study

Background: The most feared complication of hernia surgery is recurrence. There is no standard technique by which recurrence can be avoided. Objective: This study was conducted to test the hypothesis of whether the outcomes of sub-lay mesh are better than on-lay mesh repair for ventral hernias. Methods: This retrospective cohort study was conducted on patients who underwent open ventral hernia repair from 1st June 2016 - 31st April 2021. The primary outcome was recurrence and secondary outcomes were operative time, Surgical Site Infection (SSI) within 30 days, and seroma. Results: A total of 187 patients underwent ventral hernia repair and 69 were included in the study i.e. 35 in the sub-lay and 34 in the on-lay group. Both the groups were comparable for the baseline variables i.e. age, gender distribution, BMI, type of hernia, and content, with mean ± standard deviation age of 48.89 years ± 15.32 in the sub-lay and 52.7 ±12.3 in the on-lay group; however, the on-lay mesh was observed to be a preferred approach in patients with obesity or small defect <5 cms. No statistically significant difference was observed between sub-lay and on-lay groups for recurrence (2.9% vs. 5.7%, p-value 0.51), SSI (8.6% vs. 2.9%, p-value: 0.31), Mesh infection (2.9% vs. 2.9% p-value: 0.74), duration of surgery (median: 120 vs. 121 minutes, p-value 0.36) and seroma formation (2.9% vs. 2.9%, p-value 0.74), respectively. Conclusion: This study demonstrates no significant differences between sub-lay vs. on-lay mesh placement in terms of recurrence, seroma formation, and operative time; however, with the slightly higher (statistically insignificant) frequency of SSI in the sub-lay group.

Risk of Surgical Site Infection Following Open and Laparoscopic Cholecystectomy

Objective: The purpose of this research was to assess the risk for infection at the surgical site following open vs. laparoscopic cholecystectomy. Study Design: Randomized control trial Place and Duration: Data was collected from different hospitals including Department of Surgery, Khyber Teaching Hospital and Jinnah International Hospital, Abbottabad in the period from March, 2022 to August, 2022. Methods: Total 94 patients of both genders had age 18-70 years were included. We have taken informed written consent from the included patients for detailed demographics. We equally divided cases in two groups. Group I received open cholecystectomy in 47 patients and 47 patients of group II received laparoscopic cholecystectomy. Post-operative frequency of surgical site infection was compared among both groups. SPSS 23.0 was used to analyze all data. Results: In 94 included cases, 63 (67.02%) were females and 31 (32.98%) were males. Patients mean age in group I was 32.3±13.44 years while in group II mean age was 35.7±16.37 years. Diabetes, depression, hypertension and liver disease were the comorbidities among both groups. Post-operative duration of hospital stay was lower in group II 1.9±6.32 days as compared to group I 4.5±1.19 days. We found that frequency of surgical site infection in group I was higher in 12 (25.5%) cases as compared to group II in 3 (6.4%) cases. Conclusion: In this study, we found that laparoscopic cholecystectomy resulted in a lower rate of infection at the surgical site compared to open cholecystectomy. Keywords: Surgical Site Infection, Open cholecystectomy, Laparoscopic cholecystectomy

1663. Risk-benefit assessment of cefazolin use for surgical site infection prevention among patients allergic to penicillins and cephalosporins

Abstract Background Prosthetic joint infection (PJI) is a devastating complication following knee and hip arthroplasty. Perioperative antibiotics are routinely used in an effort to decrease the risk of surgical site infections (SSI), including superficial skin infections and deep PJI. The American Academy of Orthopedic Surgeons recommend cefazolin as standard of care for SSI prophylaxis. However, non-beta-lactams are often used in patients labeled as allergic to penicillins or cephalosporins due to concern of increased hypersensitivity reactions (HSR). Methods This study examined the frequency of SSI and HSR after receipt of perioperative cefazolin compared to clindamycin and/or vancomycin (C/V) within adult patients labeled as allergic to penicillins or cephalosporins. Patients were included if they underwent primary total hip or knee replacement surgery between January 2020 and July 2021 within the University of Colorado Health system. The outcome of SSI was assessed up to 90 days after surgery. The outcome of HSR was assessed up to 60 minutes after the conclusion of surgery. Results The cohort included 1,128 patients (cefazolin, n=809; C/V, n=319). Baseline characteristics were similar between groups except the proportion of patients with a history of immediate allergy symptoms was greater in the C/V group (59.6%) compared to the cefazolin group (35.8%). The frequency of SSI was lower in the cefazolin group compared to the C/V group (0.9% vs. 3.8%, p < .01). The cefazolin group included 7 SSI, consisting of 6 superficial SSI and 1 deep PJI. The C/V group included 12 SSI, consisting of 6 superficial SSI and 6 deep PJI. HSR were not significantly different between patients receiving cefazolin vs. C/V (0.2% vs. 1.3%, p=.06). HSR in the cefazolin group consisted of skin involvement (n=1) and self-reported allergy in post-operative window (n=1). Both patients had a non-descript history of penicillin allergy. HSR in the C/V group consisted of skin involvement (n=2) and hemodynamic instability (n=2). Three of the four patients had a history of immediate cephalosporin allergy. Conclusion Among penicillin or cephalosporin allergic patients, the use of cefazolin was associated with a lower frequency of PJI without an increase in HSR during surgery. Disclosures All Authors: No reported disclosures.

988. Risk of surgical site infection and Clostridioides difficile infection after perioperative clindamycin in patients labeled penicillin and/or cephalosporin allergic

Abstract Background Perioperative antibiotics reduce surgical site infections after hip and knee arthroplasty. Clindamycin is routinely used as a perioperative antibiotic in patients with beta-lactam allergy labels instead of first-line antibiotics like cefazolin. The purpose of this study is to assess the risk of adverse outcomes associated with the use of clindamycin to prevent surgical site infections (SSI) after total joint arthroplasty. Methods This retrospective review included adult patients labeled as allergic to penicillin or cephalosporin antibiotics, who underwent a primary total hip and/or knee arthroplasty between January 2020 through July 2021, and received perioperative antibiotics. The outcomes of SSI and Clostridioides difficile infection (CDI) within 90 days was compared between patients receiving perioperative clindamycin vs. non-clindamycin antibiotics. Results A total of 1,121 surgical procedures in 1,047 patients were included. The frequency of SSI for the cohort was 1.6% and CDI was 0.4%. SSI occurred more frequently in the clindamycin group than in the non-clindamycin group (4.3% vs 0.7%, p< .01). The average duration from surgery to SSI was 22.7 ± 11.6 days in the clindamycin group and 24.8 ± 11.1 days in the non-clindamycin group. The frequency of CDI occurrence was greater in the clindamycin group than the non-clindamycin group (1.1% vs. 0.1%, p=.05). The average duration from surgery to CDI was 32.6 + 26.6 days in the clindamycin group and 4.6 days in the non-clindamycin group. Multivariable logistic regression identified clindamycin-containing perioperative antibiotic regimens (odds ratio (OR) 5.5) and opioid use prior to surgery (OR 8.7) as risk factors for 90-day surgical site infection. Staphylococcus aureus was the cultured pathogen in 9 of the 17 SSIs. Conclusion This study found a significantly higher frequency of SSI and CDI when clindamycin-based regimens are used perioperatively for primary hip and knee arthroplasty. These results are likely related to decreased activity of clindamycin against Staphylococcus aureus and greater alterations of the microbiome in comparison to beta-lactams. Disclosures All Authors: No reported disclosures.

Implementation Strategies to Reduce Gynecological Surgical Site Infections

Surgical site infection (SSI) is a widespread issue that raises expenditures, duration of hospital visits, readmissions, but also death. This original study objective was to compare the SSI incidence prior to and after the introduction of the BIs as well as to assess the intervention's effectiveness in decreasing the relative SSI incidence. Method.This study was carried out at Department of Gynecology in Hayatabad Medical Complex, Peshawar, Pakistan from January 2021 to October 2021. Following 30 days following surgery, the prevalence of SSIs was studied. Of the 850 participants with GM who were diagnosed, 630 had laparotomies prior to (PRE) and 220 following (POST) the installation of BI. Result The most frequent suggestion was OC. There was a substantial decrease in the SSI frequency between OC laparotomies, including those without BR (PRE 11% (45/395) vs. POST 4.3% (7/162); RRR 81.7%; OR 0.14, 95% CI 0.06-0.52; p value less than 0.002) also those through BR (Pre 67.3% (31/46) against Post 14.2% (2/14; RRR 86.7%; OR 0.06, 95% CI 0.02–0.57; p = 0.003). the total SSI incidence within UC decreased from 25.8% (47/182) to 15.3% (6/39; RRR 48%; OR 0.46, 95% CI 0.17-1.34; p = 0.133). Overall SSI rates among CC decreased from 17.6% (6/34) to 0 (0/15). Conclusion Most commonly, conventional bundles of implementation interventions are used in SSI prevention. The rate of SSI in GM significantly decreased once BI was implemented. Keywords: Surgical site infection, laparotomies, gynecological cancers, gynecology oncologist.

Decreasing the Rate of Surgical Site Infection after Colon Surgery: Does Adding Antibiotic to Wound Irrigation Before Skin Closure Decrease the Rate of Wound Infection?

Introduction: Surgical site infection (SSI) is a common complication of colorectal surgery. Despite bundles of care that have decreased the rate, SSIs are still common. Irrigation solutions can be used in an attempt to minimize SSI risk before closure. The aim of this study is to access the effect of irrigation with antibiotic solution compared with saline in reducing the rate of SSI. Methods: This is retrospective study included patients who underwent emergency or elective colon surgery between 2017 and 2021. In this study group, antibiotic solution (Bacitracin or Gentamicin) mixed with saline was used to irrigate the peritoneal cavity and wound before closure, and this was compared with the control group (saline alone). Multivariable logistic regression was used to compare the rates of SSI between the groups. Results: Baseline characteristics and preoperative co-morbidities were similar between the groups. The SSI rate was 7% (9/129) in antibiotic irrigation group compared with 5.1% (7/137) in saline group. BMI (Kg/m2) (OR=1.12 [1.03-1.21], p = 0.003), operation time (minutes) (OR=1.006 [1.0008-1.012], p = 0.02), dirty (infected) wound (OR=8.24 [1.5-44.4], p = 0.01) and use of suture for skin closure (OR=4.65 [1.3-15.45], p = 0.01) were associated with higher risk of developing SSI. Conclusion: SSI continues to serve as a major source of morbidity for colorectal surgery patients in both the emergent and elective settings. In this study, antibiotic irrigation was not associated with a decrease in the rate of SSI. Minimizing the frequency of SSI will impact patient outcomes, cost savings, and quality measures.

Frequency of Surgical Site Infection in Emergency Appendicectomy for Complicated Appendicitis

Objective: To find out the frequency of surgical site infections in emergency appendectomy for complicated appendicitis Method: This cross-sectional study was conducted at Khyber Teaching Hospital, MTI, Peshawar from November 20, 2021 to August 12, 2022. We included 131 patients, who had undergone emergency appendectomy for complicated appendicitis. The sampling technique was consecutive non-probability sampling. Confidence interval of 95% and 7% margin of error were considered. The patients with complicated appendicitis on appendicect-omy were included in the study. Demographic data (age, gender), history of active smoking or diabetes mellitus at admission, procedure duration, appendicitis-type according to surgical findings (grossly inflamed, gangrenous, perforated), BMI were noted. All the data were collected on a proforma (Annex 1). SPSS software (version 23.0) was used for data analysis. Results: Out of 131 patients, 88 (67.2%) were males and 43 (32.8%) were females with mean age of 33±2.3 years and mean BMI of 26±5. Frequency of surgical site infections among clean, clean-contaminated, contaminated, and dirty wound infections were 5/17 (29%), 20/67 (30%), 13/30 (43%), and 8/17 (49%) respectively. The overall frequency of surgical site infection was 46/131 (35%). Out of these 46 cases, 25 (54.3%) were superficial SSIs, 14 (30.4%) were deep SSIs and 07 (15.2%) were deep/space occupying SSIs. Conclusion: In our study, the frequency of surgical site infections is 35% which is higher compared to other studies conducted. So proper preoperative and postoperative cares should be taken to decrease the frequency or incidence of surgical site infection in the department.

255. CURRENT STATUS IN POSTOPERATIVE SHORT-TERM OUTCOMES OF ESOPHAGEAL RECONSTRUCTION USING THE GASTRIC TUBE AND FREE JEJUNUM FOR CERVICAL ESOPHAGEAL CANCER

Abstract Cervical esophageal cancer is rare of esophageal cancers. Therefore, there is currently no survey for a large cohort of postoperative short-term outcomes. The gastric tube or the free jejunum are the two major reconstructed organs in esophageal reconstruction after esophagectomy for cervical esophageal cancer. This study aimed to clarify the current status of esophageal reconstruction by reconstructed organ after esophagectomy for cervical esophageal cancer, especially postoperative morbidities and mortality. Based on the Japan National Clinical Database, 807 surgically treated cases of cervical esophageal cancer between January 1, 2016, and December 31, 2019, were enrolled. Clinical outcomes were compared between the gastric tube group and the free jejunum group. The frequency of surgical site infection in organ space, anastomotic leakage, pneumonia, empyema, and chylothorax was significantly higher in the gastric tube group (10.0%, 17.9%, 16.7%, 2.0%, and 3.3%, respectively) than in the free jejunum group (2.9%, 6.7%, 11.1%, 0.0%, and 0.3%, respectively) (p = <0.001, <0.001, 0.029, 0.008 and 0.005, respectively). Significantly more patients in the gastric tube group required long-term hospitalization over 90 days (p = 0.039). Although these two major reconstructed organs are often not oncologically selectable, our results suggested that the free jejunum reconstruction after esophagectomy for cervical esophageal cancer may be more desirable when confined resection of the cervical esophagus was oncologically acceptable.

The Comparison Of The Frequency Of Surgical Site Infections in patients With Primary Closure Vs Delayed Primary Closure In Contaminated Abdominal surgeries

Aim: To compare the frequency of surgical site infections in patients with primary closure versus delayed primary closure in contaminated abdominal surgeries. Study duration: 7th August 2020 to 6th February 2021 Study design & setting: Randomized controlled trial in the Department of Surgery, Bahawal Victoria Hospital, Bahawalpur. Methods: A sample size of eighty two patients presented with the complaint of contaminated abdomen surgical procedures of any gender between the age of 20-60 years have been The calculated sample size was eighty two i.e. forty one in each group with 5% level of significance, the surgical site infections in patients with major closure as 42.5% and with delayed closure as 17.5%. Sampling technique was Non-probability, consecutive sampling. All subjects presented with contaminated stomach surgical procedures as per operational definitions and age twenty to sixty years have been included in the study. The patients with malignant ascites was excluded from the study. Patients with records of penetrating/blunt stomach injuries, with persistent steroid use i.e. >1 month and patients with persistent renal failure Results: The age of women mean in group A was 37.68±7.37 years and in group B was 36.44 ± 8.12 years. Majority of the subjects were forty eight (58.54%) have been between twenty to forty years of age. Out of eighty two patients, fifty seven (69.51%) have been men and 25 (30.49%). The surgical site contamination in group A (primary closure) as eleven (26.83%) and in Group B (delayed primary closure) as four (9.76%) respectively with p-value of 0.046. Conclusion: Therefore it is concluded that frequency of surgical site infections is much less in patients with delayed major closure in contaminated abdomen surgeries as in compare to main closure. Keywords: Surgical site infections, delayed primary closure, Prolene.

The glitz and glamour randomized trial: the effect of fingernail polish on post-caesarean surgical site infection

Current surgical scrub guidelines suggest that fingernail polish should not be worn by healthcare providers despite collective evidence not demonstrating a relationship between fingernail polish and surgical-site infection (SSI). The purpose of this study was to determine the effect of surgical staff wearing nail polish on the incidence of SSI after caesarean delivery. In this calendar block-randomised clinical trial, surgical staff were assigned to wear nail polish or to have unpainted nails for alternating two-week periods. The primary outcome was surgical site infection within 6 weeks of caesarean delivery. There were 372 patients in the nail polish arm and 465 in the polish-free arm. The rate of SSIs was not significantly different between the nail polish arm and the polish-free arm (1.3% vs 2.8% p = .155). We found the rate of SSI following caesarean delivery is not significantly affected by surgical staff wearing fingernail polish. Impact Statement What is already known on this subject? Current surgical scrub guidelines state that fingernail polish should not be worn by healthcare providers even though the collective evidence has not been able to show the relationship between fingernail polish and surgical site infection. Previous studies have only used bacterial colony count after handwashing as a primary endpoint. The evidence they provide for developing scrub guidelines have been contradictory and inconclusive. What do the results of this study add? To better inform surgical scrub guidelines, evidence is needed that evaluates the effect of fingernail polish on clinically significant endpoints. Our study, Glitz & Glamour, examined 885 non-emergent Caesarian sections using a calendar-block schedule to determine if wearing nail polish had an impact on rates of surgical site infection. What are the implications of these findings for clinical practice and/or further research? Results suggested that fingernail polish had no difference on frequency of surgical site infections, and neither condition of the polish (chipped vs. freshly applied) nor the type of polish (gel vs. regular) had any impact either.

Comparative Risk of Surgical Site Infection With Open Cholecystectomy Vs Laparoscopic Cholecystectomy

OBJECTIVES: This study aimed to compare the risk of surgical site infection with open vs laparoscopic cholecystectomy. METHODOLOGY: This randomized control trial was done at the Department of Surgery, Hayatabad Medical Complex, Peshawar, for 12 months from 11/5/2018 to 11/5/2019. 116 patients were recruited for this study, 58 for each group randomly allocated to a group by lottery method and concealed Allocation. Patients in Group A underwent laparoscopic cholecystectomy, while patients in group B underwent open cholecystectomy. According to ward protocol, post-operative analgesia & antibiotics were given to patients in both groups. Expert consultant general surgeons did all the evaluation & procedures; all the patients were followed up to 30 days after the procedure & any surgical site infections, if found, were noted. RESULTS: The mean age was 36 years ± 12.19 SD and 38 years ± 11.88 SD in laparoscopic and open cholecystectomy, respectively. In laparoscopic cholecystectomy, 28% of patients were male, and 72% of patients were female, while in open cholecystectomy, 29% of patients were male, and 71% of patients were female. 07% of laparoscopic and 26% of open cholecystectomy patients had surgical site infections. CONCLUSION: Our study concludes that the frequency of surgical site infection was found less in laparoscopic cholecystectomy than in open cholecystectomy.

Are postoperative antibiotics required after orthognathic surgery?

The aim of this study was to investigate and compare the frequency of surgical site infection (SSI) between orthognathic patients who received only intraoperative antibiotics and patients who received intraoperative antibiotics plus postoperative antibiotics. A retrospective study was performed of patients treated by a single surgeon over the years 2006–2012 and 2016–2019. The primary predictor variable was antibiotic exposure. The control group received no postoperative prophylactic antibiotics. The study group received postoperative antibiotics. Both groups received prophylactic intraoperative antibiotics and performed postoperative chlorhexidine rinses. The primary outcome was SSI frequency. Univariate, bivariate, and multiple logistic regression analyses were performed; statistical significance was set at P ≤ 0.05. The sample comprised 333 patients. Their mean age was 30.7 ± 11.8 years. The study group included 129 patients (38.7%); the control group included 204 patients (61.3%). The frequency of SSI was 17.1% in the study group and 26.5% in the control group (P = 0.048). In the multivariable logistic regression, only alcohol consumption was significantly associated with an increased risk of SSI (odds ratio 2.46, 95% confidence interval 1.36–4.44; P = 0.003). In patients undergoing orthognathic surgery, postoperative antibiotic exposure in addition to intraoperative prophylaxis approached but was not statistically significant for a decreased risk of SSI (P = 0.067).

Evaluation of factors associated with surgical site infection in equine proximal interphalangeal joint arthrodesis: 54 cases (2010-2019).

BackgroundThe frequency of surgical site infection (SSI) following orthopaedic implant placement in horses has been reported but not compared with respect to specific antibiotic protocols administered.ObjectivesTo determine factors associated with SSI in horses undergoing proximal interphalangeal joint (PIPJ) arthrodesis including perioperative antibiotic protocols.MethodsRecords were evaluated (2010–2019), and horses undergoing PIPJ arthrodesis were identified. Patient signalment, supervising surgeon, reason for surgery, limb, implants placed, anaesthetic time, duration casting/coaptation postoperatively, antibiotic regimen and incidence/onset SSI were recorded. Bayesian and frequentist logistic regressions were used to estimate the contribution of covariates to infection occurrence.ResultsFifty‐four PIPJ arthrodeses were performed. SSI occurred in 2/54 (3.7%) on day 15,30. Arthrodesis was performed most commonly for osteoarthritis (33/54, 61.1%), fracture (11/54, 20.4%), and subluxation (5/54, 9.3%). Perioperative systemic antibiotics were administered 1–3 days (15/54, 27.8%) or > 3 days (39/54, 72.2%). Antibiotic protocols included cefazolin/gentamicin (20/54, 37%), cefazolin/gentamicin/doxycycline (14/54, 25.9%) and potassium penicillin/gentamicin (10/54, 18.5%). Regional limb perfusion was performed preoperatively 31/54 (57.4%) and postoperatively 7/54 (13%). Survival to dismissal was 98.1% (53/54 horses) with one horse euthanized due to support limb laminitis. No association was identified between antibiotic selection or duration (1–3 vs. > 3 days), pre‐operative regional antibiotic perfusion, intraoperative antibiotic lavage or anaesthetic time (< or > 3 h) and SSI; however, modelling was complicated by quasi‐complete or complete separation of the data. Bayesian analysis (but not frequentist analysis) indicated an association between post‐operative regional antibiotic perfusion and SSI. Limitations include the retrospective nature of data collection and the low rate of infection overall.ConclusionsThe prevalence of SSI in this population was lower than that in previous reports of equine orthopaedic internal fixation. There was no difference in SSI rate in cases administered systemic antibiotics for 1–3 days or >3 days, or for those horses that did or did not receive preoperative regional antibiotic perfusion.

Posterior tibial artery flap versus radial forearm flap in oral cavity reconstruction and donor site morbidity

The repair of soft tissue defects after oral cavity cancer resection is challenging. The aim of this study was to compare the outcomes and donor site morbidity of the radial forearm free flap (RFF) and posterior tibial artery perforator flap (PTAF) for oral cavity reconstruction after cancer ablation. All patients who underwent oral cavity reconstruction with a RFF or PTAF between January 2017 and December 2019 were included retrospectively in this study. All flaps were harvested with a long adipofascial extension. The donor site defects were closed with a triangular full-thickness skin graft harvested adjacent to the flap. Flap outcomes and donor site complications were recorded and compared. The study included 145 patients; 30 underwent reconstruction with a RFF and 115 with a PTAF. No significant difference between the PTAF and RFF was observed concerning the flap survival rate (98.3% vs 96.7%), flap harvest time (53.39 vs 49.28 min), hospital stay (12.3 vs 15.2 days), or subjective functional and cosmetic outcomes. The PTAF showed a larger vascular calibre (P < 0.05), greater flap thickness (P = 0.002), and lower frequency of surgical site infection (P = 0.055) when compared to the RFF. No significant difference was observed between the pre- and postoperative ranges of ankle and wrist movements. The PTAF is an excellent alternative to the RFF for the repair of oral cavity defects, with the additional advantages of a well-hidden scar on the lower extremity, larger vascular calibre, and lower frequencies of postoperative donor site morbidities.

Surgical Site Infection (SSI) Surveillance Program for Mastectomy in the Department of Surgery of the University of the Philippines-Philippine General Hospital

Background. Mastectomy is a common surgical procedure done worldwide. Surgical site infection (SSI) is a common healthcare-associated infection. Mastectomy SSIs are frequently under-reported.&#x0D; Objectives. The study aimed to determine the incidence of SSI among mastectomy cases of the Department of Surgery, University of the Philippines – Philippine General Hospital (UP-PGH) during one year of full implementation of the Surgical Site Infection Surveillance Program and evaluate the program’s surveillance follow-up rate.&#x0D; Methods. This study was an observational practice audit research that included all adult patients who underwent a mastectomy in UP-PGH from January 1, 2018, to January 31, 2019, when the SSI Surveillance Program was fully implemented. SSI was monitored and assessed during the patient’s hospital stay, on the day of hospital discharge, and at 30 days (± 2 days) after surgery, either during an outpatient visit or via phone call by a nurse navigator. SSI frequency for mastectomy was computed both during the in-hospital stay and at 30 days after surgery. Surveillance follow-up rate, defined as the proportion of patients who could follow-up up to 30 days after surgery, was determined.&#x0D; Results. The 30-day SSI rate for mastectomy was 6.8% (19/279). All 279 patients were followed up to 30 days after surgery. Of the 279 patients, 277 (99.3%) were through clinic visits, one was through phone calls, and one was still admitted to the hospital.&#x0D; Conclusion. Full implementation of the SSI Surveillance Program for mastectomy in UP-PGH for one year showed a higher SSI rate than in published international literature. The program had a complete 30-day patient follow-up, contributing to more accurate SSI reporting. Implementing an SSI surveillance program with standardized protocols, dedicated personnel, patient education component, and the analysis of the information derived from such programs can improve an institution's quality of surgical care.

Outcome on Surgical Site Infections for the Closure of Abdominal Incisions in General Surgery

Objective: To determine the frequency of surgical site infections according to the closure of abdominal incisions (skin staplers versus suture stitches) in General Surgery at Liaquat University of Medical and Health Sciences (LUMHS). Material and Method: This cross-section comparative study was conducted at the Department of General Surgery at LUMHS. The study was conducted for one year from January 2021 to December 2021. All the patients aged more than 12 years, both genders and who had undergone abdominal surgeries were included. Patients were divided into two groups group A and group B as per closure of the abdominal incisions. Patients in group A underwent staplers wound closure and patients in group B underwent wound closure by suture stitches. Patients were assessed for postoperative surgical site infection during hospital stay. All the data were collected via self-made study proforma. SPSS version 26 was used for the purpose of data analysis. Stratification with respect to the effect modifiers was done and a p-value &lt; 0.05 was taken as significant. Results: In this study, a total of 41 cases were comparatively studied regarding surgical site infections as to the type of wound closure. The average age of the stapler’s patients’ group was 36.70+6.22 years and the average age of the suture patients’ group was 42.47+5.09 years. Males were most common in both groups without a significant difference (p-929), while average duration of closure was significantly lower in stapler group as compared to suture group (p-0.001). Of all, 12 cases had wound infection, particularly as 4 cases had infection grade I, 5 cases had grade II infection and 2 cases had grade III infection. Although frequency of surgical site infection was statistically insignificant (p-0.223). Conclusion: The wound closure skin stapler’s method was observed to be effective in terms of short duration, while the frequency of surgical site infection was higher in stapler closure but statistically insignificant as per both techniques. Keywords: Wound infection, stapler, suture, effectiveness

Postoperative surveillance for surgical site infections (SSIs) after open appendectomy in a tertiary care hospital of district Peshawar, Pakistan.

Objective: To discover the frequency of surgical site infections (SSIs) for acute appendicitis following the open appendectomy. Study Design: Cross Sectional study. Setting: Department of Surgery, Khyber Teaching Hospital, Peshawar. Period: January 2021 to June 2021. Material &amp; Methods: In this research, overall, 287 patients were examined and scrutinized. After obtaining the informed consent and detailed history, all the patients considered of having appendicitis were placed on the next OT list. Typical pre-operative measures were followed. In all cases, a single qualified general surgeon carried out all the surgeries. Once the surgeries were completed, standard post-operative protocols were maintained for all patients which included antibiotics like ciprofloxacin 500mg BD+ Flagyl 400mg/100ml TDS, analgesics (like diclofenac 50 mg TDS) and wound dressings for 24 hours. Results: In the current study, the average age was 33 years with a standard deviation (SD) ±9.81. Fifty six (56%) percent of the research participants were males, while 44% were females. The duration of surgery was 45 minutes on average with SD±5.94. Mean BMI was 25 Kg/m2 with SD±4.77. Twenty percent (20%) of patients did not use proper medicine while 80% patients had used proper medicine. Seventy-nine (79%) percent of patients had wound care but 21% of patients did not have wound care. Moreover, 18% of patients had SSI and 82% of patients did not have SSI. Conclusion: We concluded from our study that the frequency of surgical site infections (SSIs) was around 18% after the open appendectomy for acute appendicitis.

Frequency of Surgical Site Infection after Open Appendectomy using Antimicrobial Sutures

Frequency of Surgical Site Infection after Open Appendectomy using Antimicrobial Sutures

Cryopreservation of autologous bone flaps following decompressive craniectomy: A new method reduced positive cultures without increase in post-cranioplasty infection rate

IntroductionCranioplasty (CP) after decompressive craniectomy (DC) is a common neurosurgical procedure. Implementation of European Union (EU) directives recommending bacterial cultures before cryopreservation, lead to increased number of autologous bone flaps being discarded due to positive cultures. A new method for handling bone flaps prior to cryopreservation, including the use of pulsed lavage, was developed. Research questionThe aim was to evaluate the effect of a new method on proportion of positive bacterial cultures and surgical site infection (SSI) following CP surgery. Material and methodsSixty-one bone flaps from 53 consecutive DC surgery patients were retrospectively included and the study period was divided into before and after method implementation. Patient demographics, laboratory and culture results, type of CP and occurrence of SSI were analyzed. ResultsTwenty-six and 18 bone flaps were available for analysis during the first and second period, respectively. The proportion of positive bacterial cultures was higher in the first period compared to the second (n ​= ​9(35%) vs 0(0%); p ​= ​0.001), and thus the use of custom made implants was considerably higher in the first study period (p ​= ​0.001). There was no difference in the frequency of post-cranioplasty SSI between the first and second study period (n ​= ​3 (11.5%) vs 1 (4.8%), p ​= ​0.408). Discussion and conclusionThe new method for handling bone flaps resulted in a lower frequency of positive bacterial cultures, without increased frequency of post-cranioplasty SSI, thus demonstrating it is safe to use, allows compliance with the EU-directives, and may reduce unnecessary discarding of bone flaps.

Postcaeserean Surgical Site Infection at a Tertiary Care Centre in Southern Rajasthan, India

Introduction: Surgical Site Infection (SSI) is one of the most common complications of postcaeserean section, which is mainly associated with increase morbidity and mortality. This is also an important cause of prolonged hospital stay, patient dissatisfaction and higher treatment cost. There is very limited data available on the incidence, outcome and clinical spectrum of postcaeserean SSI from Southern Rajasthan. Aim: The aim was to find out the frequency of SSI and variables contributing to it in women who have a caesarean section in a tertiary care centre in Rajasthan, India. Materials and Methods: This was a prospective observational study conducted over a duration of six months from June 2019 to November 2019 at SHKBM, Jhalawar Hospital and Medical College, Jhalawar, Rajasthan, India. All the women who developed postcaeserean SSI during hospital stay or within 30 days following surgery were included in the study. Demographic data and all the potential risk factors were noted. Pus samples from the infected wound were sent for culture and sensitivity. Data was presented as frequencies and percentages. Statistical Package for Social Sciences software (SPSS) version 26.0 and Epi Info Software were used for the statistical analysis. Results: A total of 1157 cases underwent caeserean section during study period, among them 53 cases had postcaeserean SSI, which gives an incidence rate of 4.5%. In present study, majority of women belonged to 21-25 years of age group 33 (62.26%), 31 (58.49%) cases were unbooked, 47 (88.67%) of SSI was seen in emergency caeserean section, and 48 (90.56%) of SSI cases had pfannenstiel incision. Anaemia (81.13%), hypertensive disorder (13.2%) and urinary tract infection (3.77%) were associated medical risk factors for SSI. There were other obstetrics and intraoperative risk factors found to be associated with postcaeserean SSI, out of them previous caesarean section was most common (56.6%). Klebsiella was the most common organism isolated. Conclusion: Infrequent antenatal visits, emergency caeserean sections, anaemia and history of previous caeserean section are the most common risk factors for SSI.