Total Surgical Site Infections Research Articles

Coronavirus Disease 2019 Pandemic and Reduced Surgical Site Infection After Cardiac Surgery: A Potential Blessing in Disguise.

Background: The coronavirus disease 2019 (COVID-19) pandemic has brought about drastic hygienic measures, one upside of which might be the mitigated occurrence of surgical site infection (SSI). This study investigated the association of the pandemic with SSI occurrence after cardiac surgeries. Patients and Methods: From 2014 to 2022, patients undergoing cardiac surgery were included and categorized into pre-pandemic and during-pandemic groups. Surgical site infections were classified into harvest-site, superficial sternal, and complex sternal infection. Multiple logistic regression and inverse probability weighting assessed the association of the pandemic with SSI. Results: Among a total of 26,143 patients, 793 SSIs occurred. The during-pandemic patients were younger (61.87 ± 10.58 vs. 65.64 ± 11.82) with a higher male proportion (70.1% vs. 67.4%) and a higher prevalence of all studied comorbidities/risk factors (expect cigarette smoking). Total SSI rate decreased substantially from 3.3% before COVID-19 to 1.8% afterward (p < 0.001). Inverse probability weights analyses evinced an independent association of the pandemic with a reduced risk of total (adjusted odds ratio [OR]; 0.59; 95% confidence interval [CI], 0.45-0.78), harvest-site (adjusted OR, 0.36; 95% CI, 0.19-0.70), and superficial sternal infection (adjusted OR, 0.60; 95% CI, 0.43-0.81). No significant association was observed with complex sternal site infection (adjusted OR, 1.05; 95% CI, 0.55-2.01). Multivariable regression recapitulated these findings. Conclusions: The COVID-19 pandemic independently pertained to more than a 40% reduction in SSI occurrence, particularly affecting harvest-site and superficial sternal infections. However, there remains the possibility of the implications of other known and unknown confounders on the observed association. To some extent, the decrease in SSIs after the pandemic can be justified by reinforced hygienic precautions, emphasizing the necessity of extending the adherence to these measurements into the post-COVID-19 era to maintain the status quo.

Recent evidence for subcutaneous drains to prevent surgical site infections after abdominal surgery: A systematic review and meta-analysis.

Surgical site infections (SSIs) increase mortality, hospital stays, additional medical treatment, and medical costs. Subcutaneous drains prevent SSIs in gynecological and breast surgeries; however, their clinical impact in abdominal surgery remains unclear. To investigate whether subcutaneous drains were beneficial in abdominal surgery using a systematic review and meta-analysis. The database search used PubMed, MEDLINE, and the Cochrane Library. The following inclusion criteria were set for the systematic review: (1) Randomized controlled trial studies comparing SSIs after abdominal surgery with or without subcutaneous drains; and (2) Studies that described clinical outcomes, such as SSIs, seroma formation, the length of hospital stays, and mortality. Eight studies were included in this meta-analysis. The rate of total SSIs was significantly lower in the drained group (54/771, 7.0%) than in the control group (89/759, 11.7%), particularly in gastrointestinal surgery. Furthermore, the rate of superficial SSIs was slightly lower in the drained group (31/517, 6.0%) than in the control group (49/521, 9.4%). No significant differences were observed in seroma formation between the groups. Hospital stays were shorter in the drained group than in the control group. Subcutaneous drains after abdominal surgery prevented SSIs and reduced hospital stays but did not significantly affect seroma formation. The timing of drain removal needs to be reconsidered in future studies.

Comparison of Antibiotic Coated Vicryl Vs Non-Coated Vicryl in Abdominal Fascial Closure After Laparotomy in Children

Objective: To compare the outcome of antibiotic-coated vicryl versus non-coated vicryl in abdominal fascial closure after laparotomy in children regarding surgical site infections in contaminated wounds. Material and Method: This randomized control study (NCT06129773) was conducted for one year at The Children's Hospital and University of Child Health Sciences, Lahore. According to the operational criteria, 100 patients were included in the research and randomly divided into two groups (50 patients in each Group). All patients were assessed for surgical site infection on the 3rd, 7th, and 30th postoperative days using the Southampton wound grading system. The student's t-test and Chi-square tests were applied in SPSS version 24 to interpret the associations between different variables. A P-value of &lt;0.05 was considered significant. Results: Both groups have similar demographic parameters like age and weight distribution. The mean age of the children in abdominal fascial closure with antibiotic-coated vicryl was 64.09±50.14 months, while in non-coated vicryl was 64.26± 53.45 months (p-value of 0.164). There was a male predominance in the study population, with 70 % males and 30 % females. The total surgical site infection (SSI) incidence following laparotomy was 37%. Surgical site infections occurred in 22% of patients in abdominal fascial closure with antibiotic-coated vicryl and 52% in the non-coated vicryl Group (p-value: 0.002). The hospital stay in the antibiotic-coated vicryl Group was significantly shorter than non-coated group. (4.20 versus 8.24 days. P- value: 0.001). Conclusions: The results of our study concluded that antibiotic-coated vicryl is superior to uncoated vicryl for abdominal fascial closure after laparotomy in contaminated wounds in children

The COVID-19 pandemic and reduced surgical site infection following cardiac surgery: time to take up the baton

Abstract Background Various hygienic measures have been reinforced or newly-adopted since the start of the COVID-19 pandemic. At the same time, studies have indicated a reduction in various types of hospital-acquired infections, including surgical site infections (SSI). Purpose This study investigated the association of the pandemic with SSI following cardiac surgeries. Method From 2014 to 2022, 26143 patients undergoing cardiac surgery were included and categorized into "pre-pandemic" (n= 22015) and "during-pandemic" (n=4128) groups. SSIs were classified into harvest-site, superficial sternal, and complex sternal infection. Logistic regression (univariate and multivariable) and inverse probability weighting (IPW) assessed the association of the pandemic with SSIs. For both analyses, various known SSI-related risk factors were taken into account as covariates. Results Among the study population, 793 SSIs occurred. The "during-pandemic" patients were significantly younger (61.87±10.58 vs. 65.64 ±11.82) with a higher male proportion (70.1% vs. 67.4%) and a higher prevalence of comorbidities/risk factors (expect for cigarette smoking). Total SSI rate significantly plummeted from 3.3% before COVID-19 to 1.8% afterward (P&amp;lt;0.001) (Figure 1 and 2). IPW analyses evinced an independent association of the pandemic with a reduced risk of total (adjusted-OR: 0.59, 95% confidence interval (CI):0.45-0.78), harvest-site (adjusted-OR: 0.36, 95%CI: 0.19-0.70), and superficial sternal infection (adjusted-OR: 0.60, 95%CI: 0.43-0.81). No significant association was observed with complex sternal site infection (adjusted-OR: 1.05, 95% CI: 0.55-2.01). Multivariable regression recapitulated these findings (Figure 2). Conclusions The COVID-19 pandemic pertained to more than a 40% reduction in SSI occurrence, particularly affecting harvest-site and superficial sternal infections. To some extent, the drop in SSIs following the pandemic can be justified by reinforced hygienic precautions, emphasizing the necessity of extending reinforcement of and adherence to these measurements into the post-COVID-19 era to maintain the status quo.

The role of preoperative glycemic control in decreasing surgical site infections in lower extremity fractures

BackgroundPostoperative surgical site infections (SSIs) are an important complication to prevent in surgical treatment. Patients with diabetes mellitus (DM) have a higher risk of SSIs. Preoperative glycemic control is required. For patients with orthopedic trauma, the duration of preoperative glycemic control is limited because delaying operative treatment is difficult. However, whether preoperative glycemic control would decrease the risk of SSIs in diabetic patients with lower extremity fractures is unclear. The first aim of this study was to investigate the rate of SSIs among patients with DM who had undergone preoperative glycemic control, compared with that of patients without DM. As the secondary aim, we sought to demonstrate among patients with DM whether preoperative glycemic control would affect the development of SSIs between patients with controlled DM and patients with poorly controlled DM.MethodsIn this retrospective cohort study, 1510 patients treated surgically for lower extremity fractures were enrolled. Data collected were patient age, sex, body mass index, history of DM, development of SSIs, tobacco use, the presence of an open fracture, the period between the day of injury and the operation, the length of surgery, and blood glucose levels on admission and on the day before surgery.ResultsThe rate of total SSIs was 6.0% among patients with DM and 4.4% among patients without DM (p = 0.31). Multivariate logistic regression revealed a significant association between the development of SSIs and the presence of DM (odds ratio, 1.79; 95% confidence interval 1.01–3.19; p = 0.047). The results of the secondary study revealed that the rate of early SSIs was significantly higher in the poorly controlled DM group than in the controlled DM group (5.9% vs. 1.5%; p = 0.032). However, multivariate logistic regression revealed that control levels of DM were not significantly associated with the development of SSIs.ConclusionsEven though patients with DM had undergone preoperative glycemic control, SSIs were significantly associated with DM, especially when the patients had poorly controlled DM. This finding suggested that continuous glycemic control is important preoperatively and postoperatively to prevent SSIs.

Randomized controlled trial of olanexidine gluconate and povidone iodine for surgical site infection after gastrointestinal surgery.

Antiseptics used at surgical sites are vital to preventing surgical site infections (SSI). In this study, a comparative investigation of the novel antiseptics olanexidine gluconate (OG) and povidone-iodine (PI) was conducted to determine whether OG is more effective than PI against SSI after gastrointestinal surgery. This prospective, randomized, single-blind, interventional, single-center study was conducted between August 2018 and February 2021. Patients scheduled for large-scale gastrointestinal surgeries were randomized into two groups and administered OG (OG group) or PI (PI group) as preoperative antiseptics. The primary endpoint was the SSI occurrence rate within 30 days after surgery. In total, 525 patients were enrolled in this study, of whom 256 and 254 were in the OG and PI groups, respectively. The total SSI occurrence rate in the OG group (10.8%; n = 26) and the PI group (13.0%; n = 33) was not significantly different (p = 0.335). The occurrence rate of superficial incisional SSI and organ/space SSI did not significantly differ between the groups; however, that of deep incisional SSI showed a significant difference, with 0.4% (n = 1) in the OG group and 4.3% (n = 11) in the PI group (p = 0.003). OG, as a preoperative skin antiseptic, did not reduce the occurrence rate of total SSI. However, deep incisional SSI may be reduced using OG.

Impact of the COVID-19 pandemic on the incidence of surgical site infection after orthopaedic surgery: an interrupted time series analysis of the nationwide surveillance database in Japan

During the COVID-19 pandemic, hygiene awareness was increased in communities and hospitals. However, there is controversy regarding whether such circumstances affected the incidence of surgical site infections (SSIs) in the orthopaedic surgical field. To examine the impact of the COVID-19 pandemic on the incidence of SSIs after orthopaedic surgery. The medical records of patients having undergone orthopaedic surgery were extracted from the nationwide surveillance database in Japan. The primary outcomes were the monthly incidences of total SSIs, deep or organ/space SSIs, and SSIs due to meticillin-resistant Staphylococcus aureus (MRSA). Interrupted time series analysis was conducted between pre-pandemic (January 2017 to March 2020) and pandemic (April 2020 to June 2021) periods. A total of 309,341 operations were included. Interrupted time series analysis adjusted for seasonality showed no significant changes in the incidence of total SSIs (rate ratio 0.94 and 95% confidence interval 0.98-1.02), deep or organ/space SSIs (0.91, 0.72-1.15), or SSIs due to MRSA (1.07, 0.68-1.68) along with no remarkable slope changes in any parameter (1.00, 0.98-1.02; 1.00, 0.97-1.02; and 0.98, 0.93-1.03, respectively). Awareness and measures against the COVID-19 pandemic did not markedly influence the incidence of total SSIs, deep or organ/space SSIs, or SSIs due to MRSA following orthopaedic surgery in Japan.

Preoperative oral fluoroquinolone antibiotics in elective colorectal surgery to prevent surgical site infections: a systematic review and meta-analysis.

Preoperative treatment with oral neomycin combined with erythromycin or metronidazole is recommended to decrease the risk of surgical site infections (SSIs) in elective colorectal surgery. However, oral neomycin is not commercially available in Canada, and therefore it is not routinely used. Fluoroquinolones are widely available and have excellent activity against aerobic Gram-negative bacteria. The aim of this systematic review was to identify, critically appraise and summarize the evidence on the efficacy and safety of preoperative use of oral fluoroquinolone antibiotics for the prevention of SSIs in adult patients undergoing elective colorectal resection. Following Cochrane guidelines, we included English-language randomized controlled trials (RCTs) comparing oral fluoroquinolones plus routine preoperative intravenous antibiotics against intravenous antibiotics alone from MEDLINE (Ovid), Embase (Ovid), the Cochrane Central Register of Controlled Trials( Ovid) and ClinicalTrials.gov. We included 3 RCTs (1136 patients). Risk of bias was uncertain in 2 trials and high in 1 trial. Preoperative oral fluoroquinolones led to significantly decreased total SSIs (risk ratio [RR] 0.43, 95% confidence interval [CI] 0.32-0.57, I 2 = 0%), superficial incisional (RR 0.38, 95% CI 0.22-0.68, I 2 = 32%), deep incisional (RR 0.19, 95% CI 0.06-0.65, I 2 = 0%) and organ/space SSIs (RR 0.34, 95% CI 0.12-0.90, I 2 = 33%). There was also a significant reduction in anastomotic leaks (RR 0.22, 95% CI 0.06-0.87, I 2 = 0%). No antibiotic-related adverse events were reported. This review suggests that preoperative oral fluoroquinolones with intravenous antibiotics are superior to intravenous antibiotics alone for preventing SSIs after colorectal surgery. If neomycin is unavailable, oral fluoroquinolones should be considered as a reasonable alternative. Future trials are required to further compare the relative efficacy of oral antibiotic regimens.

Risk Factors for Surgical Site Infection Following Cesarean Delivery

Background and Aim: Obstetrics' most common surgery is the cesarean section. The most common cause of hospitalization is surgical site infection, which increases morbidity and mortality. Postpartum infection is most commonly caused by cesarean section. The present study aimed to determine the several risk factors for surgical site infections after caesarean birth. Patients and Methods: This case-control study was conducted on 874 women underwent cesarean section in the department of Obstetrics and Gynecology at Moulvi Ameer Shah Memorial Hospital, Peshawar from January 2022 to September 2022. Patients were categorized into study group and control. A case is a patient who developed surgical site infections (SSI) after undergoing cesarean section surgery, while a control is a patient who had the procedure before or after SSI wasn't developed. Using the bivariate and multivariate logistic regression methods, infections on the patients were detected based on physical examination, laboratory reports, and post-operative follow-ups. Data analysis was done in SPSS version 28. Results: Of the total 874 cesarean cases, the prevalence of surgical site infection after cesarean section was 84 (9.6%). The age wise distribution of cases with SSI were as follows: 12 (14.3%) in 15-25 years, 62 (73.8%) in 26-35 years, and 7 (8.3%) in &gt;35 years. Among 84 cases, the incidence of superficial type and deep incisional type was 80 (95.2%) and 4 (4.8%) respectively. The incidence of SSI diagnosis within 10 and after 10 postoperative days were 57 (67.9%) and 27 (32.1%) respectively. Among SSI diagnosed cases, the prevalence of normal, overweight, and obese patients were 16 (19%), 40 (47.7%), and 28 (33.3%) respectively. The prevalence of primipara was 72% (n=60) in SSI group. Out of total SSI cases, the incidence of primary and repeated CS was 74 (88.1%) and 10 (11.9%) respectively. In the SSI group, 45.2% (n = 38) out of total cases had medical complications like hypertension, diabetes, anemia, hypothyroidism, autoimmune diseases like scleroderma and SLE, and fever. Conclusion: The present study concluded that the prevalence of surgical site infection after cesarean section was 9.6%. The chances of surgical site infection after cesarean section increase as one gets older, obese, suffers medical complications while pregnant, goes into labor during a cesarean section, and has more than five PV examinations. Obstetricians should take precautions to avoid preventable risk factors. Keywords: Surgical site infection, Risk factors, Cesarean section

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.

Antimicrobial Stewardship in Total Joint Arthroplasty: Outcomes of a Collaborative Program Implementation.

Antimicrobial stewardship has been cited as a crucial component of orthopaedic surgical care; however, limited high-quality data exist to guide antibiotic use across the total joint arthroplasty continuum. Antimicrobial stewardship program (ASP) implementation and evaluation is needed in this space. We pursued a prospective, sequential cohort study of an interprofessional ASP for total joint arthroplasty (TJA) formed in late 2017 at the study institution. Twelve total evidence-based recommendations for protocol change were issued, with 11 accepted and implemented across three project phases spanning March 2018 to December 2019. The primary study outcome was the rate of optimal preoperative intravenous antibiotic selection as assessed for Baseline versus Postintervention time periods. Secondary outcomes included individual antibiotic utilization rates. Descriptive statistics were pursued for institutional surgical site infection (SSI) and postoperative acute kidney injury (AKI) rates across the affected time frame. A cost-benefit analysis of the ASP was estimated from the institutional perspective. The rate of optimal preoperative antibiotic selection increased from 64.9% in the Baseline Period (February 2018, n = 57) to 95.4% in the Postimplementation period (June 2018 to December 2019, n = 1,220) (P < 0.001). The rates of second-line preoperative antibiotics and total perioperative antibiotic exposures decreased. Total SSI and AKI rates in primary elective TJA seemed to decrease from calendar year 2018 to 2019 (deep SSI 1.00% to 0.22%, superficial SSI 0.66% to 0.00%, and AKI 1.97% to 1.03%). The institution realized an estimated $197,050 cost savings per 1000 TJA procedures. A comprehensive ASP for TJA was associated with an increased use of optimal preoperative antibiotic selection, decreased total antibiotic exposures, and cost savings, without apparent detriment to SSI or AKI rates.

Reducing surgical site infections after colectomy: bundle item compliance, process, and outlier identification.

The purpose of this study was to implement a checklist monitoring system and identify critical surgical checklist items associated with post-colectomy surgical site infections (SSI). The relationship between checklist compliance, infection rates, and identification of non-compliant surgeons was explored. National Health Safety Network (NHSN) data were imported annually to establish baseline incidence of post-colectomy SSI from 2016 to 2019. A colectomy checklist was used to monitor compliance for 1694 random colectomies (1274 elective; 420 emergency). Reports were generated monthly to profile system, hospital, surgeon-specific infection, and checklist compliance rates. Checklist compliance improved in elective and emergent colectomies to > 90% for all items except oral antibiotic and mechanical bowel prep in elective cases. Annualized total SSI and organ space infection rates in elective cases decreased by 33% and 45%, respectively. Elective and emergency SSI's were reduced for Superficial Incisional Primary (SIP), Deep Incisional Primary (DIP), and Intra-Abdominal Abscess (IAB) by 66%, 60.4%, and 78.3%, respectively. Checklist compliance between low (< 3%) and high (> 3%) infection rate surgeons demonstrated significantly lower utilization of oral antibiotic prep (p < 0.03) and mechanical bowel prep (p < 0.02) in high infection rate surgeons. Surgeons compliant with colectomy checklists decreased elective and emergency colectomy infection rates. Ceiling compliance rates > 95% for bundle items are suggested to achieve optimal reductions in SSIs and efforts should be focused on surgeons with NHSN infection rates > 3%. Oral antibiotic prep and mechanical bowel prep compliance rates in elective colectomy appeared to differentiate high infection rate surgeons from low infection rate surgeons.

Skin and mucous membranes colonisation with Staphylococcus aureus or MRSA as a risk factor for surgical site infections in elective Caesarean Section

The purpose of this study was to determine if skin and mucous membrane colonisation with Staphylococcus aureus (S. aureus) and methicillin-resistant Staphylococcus aureus (MRSA) increases the incidence of surgical site infection (SSI) post-elective Caesarean Sections. A prospective study was conducted at a major centre in Jordan, involving 127 patients who underwent elective Caesarean Section surgeries during 2019. Participants were screened for skin and mucous membranes colonisation for S. aureus preoperatively and were followed for 90 days for any signs of SSI. The screening sites were on three parts of the patients’ bodies; nose, throat, and groyne. The total SSI incidence was 18.9%. Among participants with SSI; 66.7% had a superficial infection and 33.3% had deep tissue infection. Skin and mucous membrane colonisation was positive in 42 participants (33.1%) in one of the three screening sites. Participants with positive skin and mucous membrane colonisation were found to have SSI incidence 2.43 times more than the non-colonised participants (Fisher’s Exact test = 3.832, p = .05, CI: 0.098–6.02). Participants with S. aureus skin and mucous membranes colonisation were significantly 2.94 times with more SSI incidence than those who were not colonised (Fisher’s Exact test = 5.485, p = .02, CI: 1.164–7.439). Skin and mucous membrane colonisation was found to increase the incidence of SSI. More attention should be performed to screen for skin and mucous membranes colonisation and subsequent selective skin decolonisation to decrease SSI incidence. IMPACT STATEMENT What is already known on this subject? Surgical site infection (SSI) is a challenge that increases the costs of health care. Surgical site infection is associated with high costs mainly due to the increase in the length of hospital stay. Skin screening for S. aureus or MRSA colonisation was found to be important for selective skin decolonisation using appropriate antiseptic preparation and preoperative antibiotic prophylaxis. What do the results of this study add? The incidence of SSI in the colonised group was found to be 2.43 times higher than in the non-colonised group. What are the implications of these findings for clinical practice and/or further research? Screening for colonisation and subsequent selective skin decolonisation should be a part of SSI prevention policies.

Clinical Relevance of Closed-Incision Negative Pressure Therapy (ciNPT) for SSI-Risk Reduction in Vascular Surgery Through a Groin Incision

Vascular surgery, especially lower limb revascularization surgery, has one of the highest rates of surgical complications, predominantly surgical site infections (SSI). Resulting in a significant burden of additional costs due to longer hospital stays, re-admissions and re-interventions, mainly attributable to deep incisional SSIs. Closed incisional negative pressure therapy (ciNPT) is a relatively new strategy in the postoperative management surgical wounds, aiming to reduce surgical wound complications. When discussing the clinical relevance of ciNPT, it is crucial to take into account the outcome of therapy as well as the additional costs related to ciNPT. Since, the additional costs must be justified by an associated decrease in the morbidity and costs associated with groin wound complications, which are particularly attributable to deep incisional SSIs. The current literature evaluating the beneficial effect of ciNPT in groin incisional vascular surgery, predominantly focusses on the decrease in superficial SSIs. Whereas this study aims to address and discuss the clinical relevance of ciNPT over conventional wound dressings, by separately evaluating and comparing the incidence of superficial and deep SSIs and their related re-admissions and re-interventions. In this single center prospective cohort study performed in a non-academic hospital in The Netherlands, 59 consecutive patients (67 incisions) were included between January and October 2019. All underwent elective vascular surgery with groin (access) incisions for either lower limb revascularization surgery or abdominal aortic aneurysm surgery. The study group was treated with six days ciNPT (PREVENA Incision Management System; KCI/3M, San Antonio, TX, USA) and matched for equal comparison to a historical retrospectively analysed cohort of 54 consecutive patients (60 incisions), all of whom have undergone elective vascular surgery for equal indications with groin (access) incisions in our center between January and October 2018. The standard-care group was treated following standard surgical wound care protocol with conventional surgical self-adhesive plaster (10×15cm, Mepore, Mölnlycke Health Care AB, Gothenburg, Sweden). Study groups were comparable at baseline, except for Body Mass Index (BMI), which was significantly higher in the ciNPT-group (P =.021). No significant differences for formation of seroma, hematoma, as well as wound dehiscence and SSIs were found between both groups. Groin SSIs were seen in 12.1% of the patients in the ciNPT-group and in 13.0% in the Standard-care group (OR 0.80, CI ((0.26, 2.48)), deep SSI contributed for 4 out of 7 patients of total SSIs in the ciNPT-group and for 2 out of 7 patients in the standard of care group (P-value >0.05). Analysis for incidence of hospital re-admission and re-intervention in both study groups showed no significant difference. Subset analysis in both study groups for SSIs differentiated in superficial and deep SSIs showed that only deep SSIs resulted in re-interventions. Based on the findings in the population of our single center study, we conclude that routine use of ciNPT was not effective in reducing groin wound complications, and therefore could not replicate the promising findings from some previous studies. Furthermore, we did not find a reduction in the incidence of deep SSIs, which comprise the highest morbidity and costs. Considering our findings as well as the associated additional expenses related to ciNPT, it might be superfluous at this stage to use ciNPT as the new standard of post-operative groin incision care for all lower limb revascularization and abdominal aortic aneurysm surgeries. In our opinion further research is warranted for establishing a risk-factor based model for determination of the indication of ciNPT. To be able to achieve a more substantiated decision for utilizing ciNPT compared to standard surgical wound care in groin incisional vascular surgical interventions.

Chlorhexidine\u2013alcohol versus povidone\u2013iodine as preoperative skin antisepsis for prevention of surgical site infection in cesarean delivery\u2014a pilot randomized control trial

ObjectivesTo compare the efficacy of chlorhexidine–alcohol and povidone–iodine as preoperative antiseptic skin preparation for prevention of surgical site infection (SSI) after cesarean delivery (CD).Materials and methodsA total of 311 eligible women who underwent CS were recruited in the study after fulfilling all the eligibility and exclusion criteria. Patients were randomized into two groups (153 in chlorhexidine–alcohol group and 158 in povidone–iodine group) by a computer-generated randomization table. Patients were followed for a period of 30 days in postoperative period to monitor for SSI.ResultsThe rate of SSI in the chlorhexidine–alcohol group is 5.4% and that of the povidone–iodine group is 8.6%. E. coli, K. pneumoniae, and Acinetobacter baumannii were the most common organisms isolated. E. coli was found in 9.5% of the total SSI cases.ConclusionsThe study found that the patients who received chlorhexidine–alcohol as skin antiseptic had less chance of developing SSI than those who received povidone–iodine; however, it did not reach a statistical significance.Trial registrationClinical Trials Registry of India CTRI/2018/05/014294. Registered on May 31, 2018

A comparison of surgical site infections following total hip replacement and total knee replacement surgeries identified by Infection Prevention and Control and the National Surgical Quality Improvement Program in Alberta, Canada.

To understand how the different data collections methods of the Alberta Health Services Infection Prevention and Control Program (IPC) and the National Surgical Quality Improvement Program (NSQIP) are affecting reported rates of surgical site infections (SSIs) following total hip replacements (THRs) and total knee replacements (TKRs). Retrospective cohort study. Four hospitals in Alberta, Canada. Those with THR or TKR surgeries between September 1, 2015, and March 31, 2018. Demographic information, complex SSIs reported by IPC and NSQIP were compared and then IPC and NSQIP data were matched with percent agreement and Cohen's κ calculated. Statistical analysis was performed for age, gender and complex SSIs. A P value <.05 was considered significant. In total, 7,549 IPC and 2,037 NSQIP patients were compared. The complex SSI rate for NSQIP was higher compared to IPC (THR: 1.19 vs 0.68 [P = .147]; TKR: 0.92 vs 0.80 [P = .682]). After matching, 7 SSIs were identified by both IPC and NSQIP; 3 were identified only by IPC, and 12 were identified only by NSQIP (positive agreement, 0.48; negative agreement, 1.0; κ = 0.48). Different approaches to monitor SSIs may lead to different results and trending patterns. NSQIP reports total SSI rates that are consistently higher than IPC. If systems are compared at any point in time, confidence on the data may be eroded. Stakeholders need to be aware of these variations and education provided to facilitate an understanding of differences and a consistent approach to SSI surveillance monitoring over time.

Applying Machine Learning Across Sites: External Validation of a Surgical Site Infection Detection Algorithm

Surgical complications have tremendous consequences and costs. Complication detection is important for quality improvement, but traditional manual chart review is burdensome. Automated mechanisms are needed to make this more efficient. To understand the generalizability of a machine learning algorithm between sites, automated surgical site infection (SSI) detection algorithms developed at one center were tested at another distinct center. NSQIP patients had electronic health record (EHR) data extracted at one center (University of Minnesota Medical Center, Site A) over a 4-year period for model development and internal validation, and at a second center (University of California San Francisco, Site B) over a subsequent 2-year period for external validation. Models for automated NSQIP SSI detection of superficial, organ space, and total SSI within 30 days postoperatively were validated using area under the curve (AUC) scores and corresponding 95% confidence intervals. For the 8,883 patients (Site A) and 1,473 patients (Site B), AUC scores were not statistically different for any outcome including superficial (external 0.804, internal [0.784, 0.874] AUC); organ/space (external 0.905, internal [0.867, 0.941] AUC); and total (external 0.855, internal [0.854, 0.908] AUC) SSI. False negative rates decreased with increasing case review volume and would be amenable to a strategy in which cases with low predicted probabilities of SSI could be excluded from chart review. Our findings demonstrated that SSI detection machine learning algorithms developed at 1 site were generalizable to another institution. SSI detection models are practically applicable to accelerate and focus chart review.

Surgical site infections in the COVID-19 era: a comparative cohort study

Background. The COVID-19 pandemic has put an important strain on the healthcare system all over the world. Several strategies to mitigate its impact have been proposed, with the sole purpose to prioritize the finite resources in different healthcare settings, in order to still provide qualitative medical services. As a result, elective surgeries, even for oncologic patients, were postponed or even cancelled, if the patient’s healthcare safety could not be maintained. Surgical site infections (SSIs), as defined by the Centers for Disease Control and Prevention (CDC), are a well-known cause of patient morbidity and of increased healthcare costs. Objectives. To assess the rate and impact of SSIs during the COVID-19 pandemic (the year 2020) compared to the rate during 2019 and to identify the prevention bundle to reduce their incidence in an important academic tertiary center in Romania. Materials and method. We performed a cohort study on operated patients in both obstetrics and gynecology departments, in a third-level maternity unit, the “Filantropia” Clinical Hospital of Obstetrics and Gynecology, Bucharest, regarding the prevalence of surgical site infections during one year of COVID-19 pandemic (2020) versus the prevalence and impact of the previous year (2019). This is an observational cohort retrospective study, analyzing the period from the 1st of January 2019 to the 31st of December 2019 and from the 1st of January 2020 to the 31st of December 2020, with the aim to evaluate the influence of highly surveillance and perioperative guidelines followed during the COVID-19 pandemic and to compare it to the regulations and guidelines followed during 2019. Results. Taking into account both gynecological interventions and caesarean sections, 6998 interventions were performed (3641 in 2019 and 3357 in 2020), with no significant difference regarding patients’ demographics. The number of operations performed were different, with fewer caesarean sections in 2020 (2061) compared to 2273 in 2019. Also, fewer operations for malignancies such as ovarian or endometrial cancers and laparoscopic procedures were performed in 2020 compared to 2019, due to difficulties in maintaining the patients’ and medical personnel safety. No significant difference rates were observed regarding postoperative complications or the length of stay. However, the total SSI complication rate was reduced in 2020 (1.22%) compared to the previous year (1.92%) due to the introduction of higher surveillance protocols and to medical personnel theoretical and hands-on education. Discussion. Risk factors, such as high Body Mass Index, increased blood glucose levels, smoking status, immunodeficiency or MRSA status, have an important role in facilitating the SSIs. Considering the epidemiological context, a reduced referral to medical services during pandemic, excluding emergencies, led to fewer surgeries performed in the gynecology department, fewer caesarean sections and to a total SSI rate decreased compared to 2019. Thus, understanding the multiple factors involved in the pathology, the importance of a responsible care and the existence of a record of these cases may help diminish the rate, especially during pandemic. Conclusions. Beside challenges faced during the pandemic period, we continued to perform surgical procedures with timely planning and meticulous care, keeping a low rate of SSIs (1.22%). The use of standardized protocols and a bundle of preventive strategies may be of great help in the better control of this type of infections.

886. Impact of Type of Surgical Management on the Incidence of Recurrent Surgical Site Infections Following Hip and Knee replacements in Calgary, Alberta

BackgroundRecurrent surgical site infections (SSIs) are associated with decreased quality of life for patients and increased economic burden to healthcare systems. Positive cultures at reimplantation and patient co-morbidities have been shown to increase the risk of recurrent SSI in hip and knee surgical site infections. Two-stage exchange has been considered for the most appropriate surgical management for these SSI’s, however, it is unclear whether the type of revision arthroplasty and pathogen of the first SSI impacts recurrence rates.MethodsA retrospective review of prospectively collected data on all complex SSIs following primary hip and knee arthroplasties between April 1 2012 and March 31, 2019, in Calgary, Alberta was performed. Patients were followed for two years post-index arthroplasty to determine initial management of first complex SSI (Debridement, antibiotics and implant retention (DAIR) vs DAIR+liner exchange vs one-stage vs two-stage), rate of recurrent complex SSI, and microbiological data for first and subsequent SSI’s.ResultsOf the 142 complex SSIs, 95 (66.9%) were managed with DAIR and liner exchange, 25 (17.6%) were managed with DAIR, 13 (9.1%) with one-stage and 8 (5.6%) with two-stage procedures. The recurrence rate was 19/95 (20%) for DAIR and liner, 8/25 (32%) for DAIR alone, 2/13 (15%) with one stage, and 3/8 (37.5%) with two-stage. There was no significant difference in recurrence rates of complex SSI when stratified by surgical management. Of the pathogens, Staphylococcus aureus (S.aureus) (including methicillin-resistant S. aureus (MRSA)) accounted for 35.2% of total first SSI and 50% of recurrences. A significantly higher proportion of S.aureus infections (including MRSA) ended up with a recurrent infection compared to all other pathogens (p=0.045). Of the 32 recurrences, 28.1% were due to the same pathogen as the initial SSI.ConclusionS.aureus was the most common pathogen causing initial and recurrent SSIs. This reinforces that S.aureus complex SSIs would likely benefit from early recognition and aggressive treatment. Recurrence of SSI was not impacted by type of revision arthroplasty. This study is limited by a small sample size. These findings contribute to the paucity of literature in this area and suggest a need for expansion to larger populations.Disclosures All Authors: No reported disclosures

Reporting Surgical Site Infections (SSIs) Using Different Surveillance Systems— Complexity of Infection Matters

Background: In Alberta, Canada, surgical site infections (SSIs) following total hip (THR) and knee replacements (TKR) are reported using 2 data sources: infection prevention and control (IPC), which surveys all THR and TKR using NHSN definitions and the Canadian International Classification of Disease, Tenth Revision (ICD-10-CA) codes, and the National Surgical Quality Improvement Program (NSQIP), which uses a systematic sampling process that involves an 8-day cycle schedule, modified NHSN definitions and current procedural terminology (CPT) codes. We compared the similarities and discrepancies in THR/TKR SSI reporting. Methods: A retrospective multisite cohort study of IPC and NSQIP THR/TKR SSI data at 4 hospitals was performed. SSI data were collected between September 1, 2015, and March 31, 2018. Demographic information and complex and total SSIs reported by IPC and NSQIP were compared for both THR and TKR surgeries. To determine whether both data sources reported similar trends over time, total SSIs by quarter were compared. Univariate analyses using a t test for age and the χ2 test for gender for complex SSIs and total SSIs was performed. The Pearson correlation and the Shapiro-Wilk test were used to assess the THR and TKR trends between the 2 data sources. A P value of &lt;.05 was considered significant. Results: Following the removal of duplicates and missing data, 7,549 IPC and 2,037 NSQIP patients, respectively, were compared. Age, gender, and other demographic parameters were not significantly different. Total THR and TKR SSIs per 100 procedures using NSQIP data were significantly higher than the same rates using IPC data: THR, 2.25 versus 0.92 (P &lt; .05) and TKR, 3.43 versus 1.26 (P &lt; .05). Both IPC and NSQIP data indicated increasing total THR SSI rates over time, but with different magnitudes (r = 0.658). For total TKR SSI, the IPC rate decreased, whereas the NSQIP rate increased over the same period (r = 0.374). When superficial SSIs were excluded, the rates reported between IPC and NSQIP data by hospital and by procedure type were more comparable, with trends toward higher rates reported by NSQIP for THR than for TKR: THR, 1.19 versus 0.68 (P = 0.15) and TKR, 0.92 versus 0.80 (P = .68). Conclusions: Different approaches used to monitor SSIs following surgeries may lead to different results and trend patterns. NSQIP reports total SSI rates that are significantly higher than the IPC Alberta orthopedic population predominantly as a result of increased identification of superficial SSIs. Because the diagnosis of superficial SSIs may be less reliable, SSI reporting should focus on complex infections.Funding: NoneDisclosures: None