Surgical Site Infections In Cardiac Surgery Research Articles

Surgical Site Infection Prevention Strategies in Cardiac Surgery: A Systematic Review

Background: Cardiac surgery becomes one of surgical procedure that has potential for develop several complications including surgical site infection (SSI). Despite the case is still very common, SSI can be regarded as the most preventable, especially when the treatment approach used, because there are many risk factors associated with the target. This systematic review aims to assess the effectiveness of interventions strategies used to reduce the incident of SSI in cardiac surgery. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines provide a standardized framework for conducting and reporting systematic reviews. A comprehensive search was conducted across major electronic databases, The following database were PubMed, Scopus and ProQuest. The inclusion criteria were clinical and a randomized control trial published between 2018 to 2023. The primary outcome measure was SSI rates. Results: The studies encompassed diverse perioperative intervention strategies, such as pre operative nasal ointment, pre operative showering and shaving, chlorhexidine mouthwash, and negative pressure therapy. In total, 436.762 articles regarding SSI prevention strategies in cardiac surgery were found in this study. However, around 7 articles that were met with the criteria of this study. Conclusion: Actions to reduce the incidence of SSI are carried out at all perioperative stages. The action taken was modifying the intervention and also using additional therapy carried out by health workers.

Impact of some intraoperative factors on wound infection in cardiac surgery

Relevanc. Surgical Site Infection (SSI) after open heart surgery is a significant problem in clinical, social, and economic aspect which causes the need to identification of the preferred procedures for successful prevention of the SSI.Objectives. To determine risk of the SSI in cardiac surgery depending on complexity of intervention, using of cardiopulmonary bypass (CBP) and use of both internal mammary arteries (IMA).Methods. Prospective observations study from 2010 to 2019 in cardiac surgery department of the Ural Institute of Cardiology, where in total 4993 open heart surgery procedures were consecutively performed. All SSI cases were recorded up to 90 days after surgery. The analysis was performed to identify risk of cardiopulmonary bypass (CPB), bilateral IMA grafting and combined procedures on the risk of the postoperative wound infection.Results. During the investigation period, total 220 cases of the SSI (4,5%) have been registered of the 4993 patients undergoing open heart surgery. It included 42 cases of deep sternal infection (0,9%) and 178 cases of superficial infection (3,6%). The main pathogen identified was Staphylococcus epidermidis (56,4%). During the hospital period, 151 cases (66,5%) of SSI have been detected, with the median time to detection of the complication 6 days. The relative mortality risk in deep sternal infection group was 4,4 times higher than in the group without SSI (HR 4,6, 95 % CI 1,5-13,9, p=0,003624). CABG increases the relative risk of SSI in compare with non-CABG procedures (OR 3,086169; 95%CI 1,281 – 7,437), while the complexity of the operation (combined versus isolated interventions) does not significantly increase the risk (OR 0.972283; 95% CI: 0.696 - 1.359). The incidence of SSI in the group of in situ BIMA grafting was 8.8%, significantly increasing the likelihood of the SSI in compare to those with SIMA (OR 2.167983, 95% CI 1.463 - 3.212; p =0,000057). CBP significantly increases the risk of postoperative wound infections (OR 1.523890, 95% CI 1.149 - 2.022, p = 0.001742).Conclusions. Refusal of cardiopulmonary bypass, simultaneous procedures and bilateral coronary artery bypass does not allow completely to avoid postoperative wound infections. Nevertheless, the technical features of the preparations and use of grafts, including skeletonization, prevention of coagulation and the preference for sequential composite CABG, can reduce the risk associated with the type of the open heart surgery.

Surgical Site Infection Prevention Bundle in Cardiac Surgery.

BackgroundSurgical site infections (SSI) are among the most prevalent infections in healthcare institutions, attributing a risk of death which varies from 33% to 77% and a 2- to 11-fold increase in risk of death. Patients submitted to cardiac surgery are more susceptible to SSI, accounting for 3.5% to 21% of SSI. The mortality rate attributable to these causes is as high as 25%. Prevention of SSI in cardiac surgery is based on a bundle of preventive measures, which focus on modifiable risks.ObjectiveThe objective of this study was to identify SSI risk factors in clean cardiac surgery.MethodsA retrospective cohort study analyzed 1,846 medical records from patients who underwent clean cardiac surgery. Fisher’s exact test was used for bivariate comparison, and Poisson regression was used for independent analysis of SSI risk, considering a significance level of p < 0.05.ResultsThe results of the study comprised a multivariate analysis. The variables that were associated with the diagnosis of SSI were: surgical risk index (OR: 2.575; CI: 1.224-5.416), obesity (OR: 2.068; CI: 1.457-2.936), diabetes mellitus (OR: 1,678; CI: 1.168-2.409), and blood glucose level (OR: 1.004; CI: 1.001-1.007).ConclusionsThis study evidenced that complete adherence to the bundle was not associated with a reduction in the risk of surgical infections. Diabetes mellitus, obesity, and surgical risk index assessment were, however, identified to increase association and consequently risk of SSI in cardiac surgery.

Collagen implant with gentamicin sulphate reduces surgical site infection in vascular surgery: A prospective cohort study

Introduction: Surgical site infection (SSI) is a common complication after vascular surgery. It may cause exposure of the underlying prosthesis causing graft infection, which may require the removal of the vascular graft, increasing amputation and mortality risks. Graft contamination usually occurs during operative procedure or by direct spread from an infected wound. It is therefore advisable to a strong effort in reducing SSI. Topic antibiotics have not been fully studied in vascular surgery, but collagen implant with gentamicin sulphate has shown to reduce SSI in cardiac surgery, orthopaedics, and general surgery procedures. Methods: Sixty (60) non-diabetic and non-obese patients with lower limb ischaemia with indication for femoropopliteal PTFE prosthetic bypass were allocated into 2 groups of 30 patients. A collagen implant impregnated with gentamicin sulphate (Collatamp®) was applied in the groin incision adjacent to the prosthesis in one group, and the other was a control group. The same surgical team operated all patients. Szilagyi classification was used. Results: There was no SSI (0% – 0/30) in the collagen implant with gentamicin sulphate group, contrasting with 6 cases (20% – 6/30) of SSI (grade I and II) in the control group (p = 0.024). In-hospital day's data shows a significant difference between the two groups (p = 0.004) with a mean of 5.66 days for implant group and 8.10 days for control group. There was no SSI grade III. Conclusion: Collagen implant with gentamicin sulphate (Collatamp®) reduces SSI in the groin incision in ischaemic patients submitted to femoropopliteal PTFE prosthetic bypass. Days of hospitalization are also reduced. Decreasing SSI rate and in-hospital days, this implant may also reduce health care costs. Because this is a small pilot study, a multicentre RCT is necessary for validation.

Gender-Specific Differences in Surgical Site Infections: An Analysis of 438,050 Surgical Procedures from the German National Nosocomial Infections Surveillance System

Background: Surgical site infections (SSI) are among the most frequent healthcare-associated infections. They impose a substantial burden with increased morbidity and exceeding healthcare costs. Risk factors such as age, diabetes, and smoking status are commonly accounted for in the literature, but few studies address gender differences. Methods: Data from the German Nosocomial Infections Surveillance System (Krankenhaus-Infektions-Surveillance-System (KISS)) from 2005 to 2010 were analysed for cardiac, vascular, visceral, and orthopaedic surgery, with a total of 438,050 surgical procedures and 8,639 SSI. Rates of SSI and isolated pathogens were analysed for gender. Results: Women had a lower rate of SSI (SSI/100 procedures) in abdominal surgery than men (2.92 vs. 4.37; p < 0.001). No gender-specific differences were found in orthopaedic and vascular surgery, while women had a higher risk for SSI in cardiac surgery (5.50 vs. 3.02; p < 0.001). Isolated pathogens showed differences for sensitive Staphylococcus aureus and Pseudomonas aeruginosa, which were more frequent in women (both p = 0.007), while coagulase-negative staphylococci occurred more often in men (18.8 vs. 14.0%; p < 0.001). Conclusion: Gender differences in SSI exist and are procedure-specific. The underlying mechanisms need to be further elucidated so that targeted measures for the prevention of SSI can be developed.

A retrospective non-randomized study on the impact of INTEGUSEAL, a preoperative microbial skin sealant, on the rate of surgical site infections after cardiac surgery

Surgical site infection (SSI) remains a serious potential complication after cardiac surgery. This study evaluated the impact of a cyanoacrylate microbial skin sealant (INTEGUSEAL) on the rate of SSI in cardiac surgery patients. Between January 2006 and July 2008, 580 patients underwent cardiac surgery by a single surgeon (PMD). Standard preoperative skin preparation was performed in 280 patients (control group), and 300 patients (microbial skin sealant group) received microbial skin sealant in addition to standard preoperative preparation. Patient characteristics and preoperative and combined pre/intraoperative risk scores were evaluated. The primary study endpoint was freedom from SSI within 30 days. Both groups were established in a 15-month period. Carotid artery disease, diabetes mellitus, congestive heart failure, previous cardiac surgery, and bilateral internal mammary artery use were significantly more common in the skin sealant group. Preoperative risk scores for the development of SSI in the two groups were similar. In the skin sealant group, the combined operative risk score for SSI was significantly higher (9.8±4.0 vs. 8.7±3.7; p<0.001) nevertheless the incidence of SSI was significantly lower (2.3% vs. 6.8%; p=0.011) than in the control group. Changing a surgeon's standard preoperative practice by including a microbial skin sealant pretreatment significantly reduced the rate of SSI.