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de Vermandois JAR, Cochetti G, Zingaro MD, Santoro A, Panciarola M, Boni A, Marsico M, Gaudio G, Paladini A, Guiggi P, Cirocchi R, Mearini E. Evaluation of Surgical Site Infection in Mini-invasive Urological Surgery. Open Med (Wars) 2019; 14:711-718. [PMID: 31572804 PMCID: PMC6749724 DOI: 10.1515/med-2019-0081] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 06/24/2019] [Indexed: 01/09/2023] Open
Abstract
Surgical Site Infection (SSI) is the most frequent source of infection in surgical patients and the second most frequent cause of hospital-acquired infection. The primary aim of this prospective study was to compare SSI occurrences between minimally invasive surgery (MIS) and open urological surgery. Secondly, perioperative outcomes were evaluated in two different approaches. A consecutive group of 60 patients undergoing urological surgery were prospectively enrolled in a single high-volume center between May and October 2018. We included procedures that were performed by minimally invasive or traditional techniques. We evaluated and compared the incidence of SSI and perioperative outcomes in terms of intraoperative bleeding, post-operative complications, postoperative pain, patient satisfaction with the analgesic treatment, time to flatus, time of oral intake and mobilization, and length of hospital stay. The two groups were homogeneous with regard to demographic data. Superficial incisional SSIs were diagnosed in 10% of cases (3/30) in the second group and 0% in the first (p<0.05); space/organ SSIs developed in 4 patients, which were diagnosed by ultrasound scan and confirmed by abdominal CT: 1 patient (3.3%) in group 1 showed an infected lymphocele, whereas 1 case of infected lymphocele and 2 cases of pelvic abscess were detected in group 2 (10%, p<0.05). All the perioperative outcomes as well as were overall complication rate favored MIS (p<0.05). The use of minimally invasive techniques in urological surgery reduced the risk of SSI by comparison with a traditional approach. In addition, MIS was associated with better perioperative outcomes and a lower overall complication rate.
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Affiliation(s)
| | - Giovanni Cochetti
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Michele Del Zingaro
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Alberto Santoro
- Department of General Surgery and Surgical Specialties "Paride Stefanini";, Sapienza University of Rome, Rome, Italy
| | - Mattia Panciarola
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Andrea Boni
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Matteo Marsico
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Gianluca Gaudio
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Alessio Paladini
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Paolo Guiggi
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Roberto Cirocchi
- Department of Digestive Surgery and Liver Unit, University of Perugia, Perugia, Italy
| | - Ettore Mearini
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
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Khaw C, Oberle AD, Lund BC, Egge J, Heintz BH, Erickson BA, Livorsi DJ. Assessment of Guideline Discordance With Antimicrobial Prophylaxis Best Practices for Common Urologic Procedures. JAMA Netw Open 2018; 1:e186248. [PMID: 30646318 PMCID: PMC6324350 DOI: 10.1001/jamanetworkopen.2018.6248] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE The American Urological Association guidelines recommend 24 or fewer hours of antimicrobial prophylaxis for most urologic procedures. Continuing antimicrobial therapy beyond 24 hours may carry more risks than advantages. OBJECTIVES To assess guideline discordance of antimicrobial prophylaxis for common urologic endoscopic procedures, and to identify opportunities for improving antimicrobial prescribing through future stewardship interventions. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study conducted manual audits of medical records of 375 patients who underwent 1 of 3 urologic procedures (transurethral resection of bladder tumor [TURBT], transurethral resection of the prostate [TURP], and ureteroscopy [URS]) at 5 Veterans Health Administration facilities from January 1, 2016, to June 30, 2017. Antimicrobial prescribing practices across the national Veterans Health Administration system were assessed using the administrative data for 29 530 records. MAIN OUTCOMES AND MEASURES Guideline discordance was assessed in the medical record review. Excessive postprocedural antimicrobial use was measured in the national administrative data analysis. RESULTS The medical records of a total of 375 patients were manually reviewed. Among the 375 patients, 366 (97.6%) were male and 9 (2.4%) were female, with a mean (SD) age of 64.2 (10.9) years and a predominantly white race/ethnicity (289 [77.1%]). In addition, 29 530 patient records in the national administrative database were assessed. Among the patient records, 28 938 (98.0%) were male and 592 (2.0%) were female with a mean (SD) age of 69.1 (10.2) years and a predominantly white race/ethnicity (23 297 [78.9%]). Among the manually reviewed medical records, periprocedural or postprocedural antimicrobial prescribing was guideline discordant in 217 patients (57.9%). Postprocedural antimicrobial agents were continued beyond 24 hours in 211 patients (56.3%) and were guideline discordant in 177 patients (83.9%), with a median (interquartile range) duration of 3 (3-5) days of unnecessary antimicrobial therapy. In the analysis of national administrative data, excessive postprocedural antimicrobial agents were prescribed in 10 988 of 29 350 patient records (37.2%), with a median (interquartile range) of 3 (2-6) excess days. For any given facility, a statistically significant correlation was observed in the frequency of postprocedural antimicrobial prescribing between any 2 procedures, indicating that facilities with higher rates of excessive use for 1 procedure also had higher rates for another procedure: TURP and TURBT (ρ = 0.719; 95% CI, 0.603-0.803; P < .001), TURP and URS (ρ = 0.629; 95% CI, 0.476-0.741; P < .001), and TURBT and URS (ρ = 0.813; 95% CI, 0.724-0.873; P < .001). CONCLUSIONS AND RELEVANCE In this study of patients who underwent common urologic procedures, the rate of guideline-discordant antimicrobial use was high mostly because of overprescribing of postprocedural antimicrobial agents; future antimicrobial stewardship interventions should target the postprocedural period.
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Affiliation(s)
| | - Anthony D. Oberle
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City
| | | | - Jason Egge
- Iowa City VA Health Care System, Iowa City
| | | | - Bradley A. Erickson
- Iowa City VA Health Care System, Iowa City
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City
| | - Daniel J. Livorsi
- Iowa City VA Health Care System, Iowa City
- Division of Infectious Diseases, University of Iowa Hospitals and Clinics, Iowa City
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Comparison of guideline recommendations for antimicrobial prophylaxis in urologic procedures: variability, lack of consensus, and contradictions. Int Urol Nephrol 2018; 50:1923-1937. [DOI: 10.1007/s11255-018-1971-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 08/18/2018] [Indexed: 10/28/2022]
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Shin B, Chung HS, Hwang EC, Jung SI, Kwon DD. Antibiotic Prophylaxis in Radical Prostatectomy: Comparison of 2-Day and More than 2-Day Prophylaxis. J Korean Med Sci 2017; 32:1009-1015. [PMID: 28480660 PMCID: PMC5426237 DOI: 10.3346/jkms.2017.32.6.1009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/04/2017] [Indexed: 11/27/2022] Open
Abstract
The efficacy of antibiotic prophylaxis in radical prostatectomy (RP) remains to be established. We retrospectively compared the occurrence of perioperative infections after RP between the 2 different antibiotic protocols. This study involved 428 cases of laparoscopic radical prostatectomy (LRP). After excluding patients who had no perioperative urine culture data, 313 consecutive patients who underwent LRP for prostate carcinoma were classified into 2 groups according to the duration of antimicrobial prophylaxis. To group 1 (153 patients), a second-generation cephalosporin was administered for less than 2 days, whilst the remaining 160 patients in group 2 were administered the drug for more than 2 days. The overall incidence of postoperative bacteriuria was 50.8%, being significantly higher in group 1 (56.9%) than in group 2 (45%). The incidence of surgical site infection (SSI) was significantly higher in group 1 (5.2%) than in group 2 (0.6%). Multivariate analysis revealed that old age, duration of antibiotics for more than 2 days, and duration of Foley catheter placement were independently associated with postoperative infectious complications (all, P < 0.05). Multivariate analysis revealed that duration of antibiotics for more than 2 days, duration of Foley catheter placement, and duration of surgical drain placement were independently associated with postoperative SSI (all, P < 0.05). The incidence of postoperative bacteriuria and SSI were higher in patients who received antibiotics for a short duration. Based on our results, we demonstrated that the outcome of postoperative infectious complications is dependent on old age, short antibiotic administration duration, and prolonged Foley catheterization. Prolonged drain placement is associated with SSI, whilst a longer duration of antibiotics use and prolonged Foley catheterization are associated with a decrease in the incidence of SSI.
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Affiliation(s)
- Bosung Shin
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Ho Seok Chung
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Seung Il Jung
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea.
| | - Dong Deuk Kwon
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
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Haifler M, Mor Y, Dotan Z, Ramon J, Zilberman DE. Prophylactic antibiotic treatment following laparoscopic robot-assisted radical prostatectomy for the prevention of catheter-associated urinary tract infections: did the AUA guidelines make a difference? J Robot Surg 2016; 11:367-371. [DOI: 10.1007/s11701-016-0667-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 12/05/2016] [Indexed: 10/20/2022]
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[Antibiotic prophylaxis in urology]. Urologia 2014; 81:209-17. [PMID: 25532466 DOI: 10.5301/uro.5000098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2014] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Antibiotic prophylaxis (AP) is used to minimize infectious complications resulting from interventions. Due to high rates of development of bacterial resistance and side effects, the use of antibiotics must be weighed on the basis of high levels of evidence. The main endpoints of urology AP are the prevention of symptomatic urogenital infections, urosepsis and wound infections. The purpose of this review is to bring objectives, principles and recommendations on urology AP according to the latest scientific evidence. METHODS We carried out a systematic search of MEDLINE, EMBASE and the Cochrane Library using keywords such as AP, prophylaxis, antibiotics, urological surgery, urogenital surgery and the names of the urologic procedures. The results of studies on the AP for each procedure were classified according to the levels of evidence and grades of recommendation from the European Association of Urology. RESULTS There are a number of good quality studies on AP about endoscopic resection of the prostate (TURP), urodynamic studies and transrectal prostate biopsies (trPB). The majority of the studies about other procedures have several limitations (sample size, consistency of definitions, statistics and trial design). Lack of consistency in the definitions of infectious complications does not allow comparison between different studies. CONCLUSIONS The AP is evidence-based is indicated only for TURP and trPB. It is desirable to perform randomized, prospective and controlled trials in order to rationalize the use of antibiotics, improve the cost/benefit ratio and reduce bacterial antibiotic resistances.
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Abstract
There are specific indications in urological procedures [transurethral resection of the prostate (TURP), transurethral resection of the bladder (TURB), endoscopic procedures, and all interventions classified as contaminated or dirty] requiring antibiotic prophylaxis. Most postoperative infections are caused by enterococci of the Gram-positive strains and Enterobacteriaceae of the Gram-negative ones. As reported by the European Center for Disease Prevention and Control (ECDC), there are increasing numbers of antibiotic-resistant pathogens. Most Enterococcus faecium strains are ampicillin-resistant and the Enterobacteriaceae have a high prevalence of extended-spectrum beta-lactamase (ESBL) producers, for which the cephalosporins and penicillins are not drugs of choice. In recent years, there are also increasing numbers of Gram-negative strains that are able to produce carbapenemases and for which the only therapeutic options are gentamicin, tigecycline and colistin. An alternative to these drugs, from a prophylactic point of view, is fosfomycin, an old antibiotic that maintains bactericidal activity against both enterococci and multidrug-resistant Enterobacteriaceae. Available in an oral formulation as trometamol salt, fosfomycin reaches high plasma and urine concentrations, and is therefore a possible alternative to other drugs both for therapy and urological prophylaxis.
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Hwang EC, Jung SI, Kwon DD, Lee G, Bae JH, Na YG, Min SK, Son H, Lee SJ, Chung JM, Chung H, Cho IR, Kim YH, Kim TH, Chang IH. A prospective Korean multicenter study for infectious complications in patients undergoing prostate surgery: risk factors and efficacy of antibiotic prophylaxis. J Korean Med Sci 2014; 29:1271-7. [PMID: 25246747 PMCID: PMC4168182 DOI: 10.3346/jkms.2014.29.9.1271] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 05/27/2014] [Indexed: 11/20/2022] Open
Abstract
This multicenter study was undertaken to determine the efficacy of antibiotic prophylaxis and identify the risk factors for infectious complications after prostate surgery in Korean patients. A total of 424 patients who underwent surgery of the prostate were reviewed. All patients underwent urinalysis and urine culture preoperatively and postoperatively. Efficacy of antibiotic prophylaxis and risk factors for infectious complications were investigated. Infectious complications were observed in 34.9% of all patients. Factors independently associated with infectious complications were diabetes mellitus (adjusted OR, 1.99; 95% CI, 1.09-3.65, P=0.025) and operation time (adjusted OR, 1.08; 95% CI, 1.03-1.13, P=0.004). Clinicians should be aware of the high risk of infectious complications in patients with diabetes and those who undergo a prolonged operation time. Neither the type nor duration of prophylactic antibiotics resulted in differences in infectious complications.
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Affiliation(s)
- Eu Chang Hwang
- Department of Urology, Chonnam National University, Hwasun, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Seung Il Jung
- Department of Urology, Chonnam National University, Hwasun, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Dong Deuk Kwon
- Department of Urology, Chonnam National University, Hwasun, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Gilho Lee
- Department of Urology, Dankook University, College of Medicine, Cheonan, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Jae Hyun Bae
- Department of Urology, Korea University, College of Medicine, Seoul, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Yong Gil Na
- Department of Urology, Chungnam National University, College of Medicine, Daejeon, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Seung Ki Min
- Department of Urology, National Police Hospital, Seoul, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Hwancheol Son
- Department of Urology, Seoul National University, College of Medicine, Seoul, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Sun Ju Lee
- Department of Urology, Kyung Hee University, School of Medicine, Seoul, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Jae Min Chung
- Department of Urology, Kosin University, College of Medicine, Busan, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Hong Chung
- Department of Urology, Konkuk University, School of Medicine, Chungju, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - In Rae Cho
- Department of Urology, Inje University, College of Medicine, Busan, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Young Ho Kim
- Department of Urology, Soon Chun Hyang University, College of Medicine, Bucheon, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Tae-Hyoung Kim
- Department of Urology, Chung-Ang University, College of Medicine, Seoul, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - In Ho Chang
- Department of Urology, Chung-Ang University, College of Medicine, Seoul, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
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Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt) 2013; 14:73-156. [PMID: 23461695 DOI: 10.1089/sur.2013.9999] [Citation(s) in RCA: 705] [Impact Index Per Article: 64.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Dale W Bratzler
- College of Public Health, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma 73126-0901, USA.
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Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013; 70:195-283. [DOI: 10.2146/ajhp120568] [Citation(s) in RCA: 1364] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Grabe M. Antibiotic prophylaxis in urological surgery, a European viewpoint. Int J Antimicrob Agents 2011; 38 Suppl:58-63. [DOI: 10.1016/j.ijantimicag.2011.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Tollefson MK, Frank I, Gettman MT. Robotic-assisted Radical Prostatectomy Decreases the Incidence and Morbidity of Surgical Site Infections. Urology 2011; 78:827-31. [DOI: 10.1016/j.urology.2011.05.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 05/20/2011] [Accepted: 05/24/2011] [Indexed: 12/15/2022]
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[Incidence of nosocomial infection in open prostate surgery]. Actas Urol Esp 2011; 35:266-71. [PMID: 21474203 DOI: 10.1016/j.acuro.2011.01.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 01/26/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To know the rate of nosocomial infections in open prostate surgery and to assess the application of pre-surgery preparation and preoperative antibiotic prophylaxis protocols at three public hospitals in the Autonomous Community of Madrid. MATERIALS AND METHODS Prospective observational and multicentre study, including all the patients operated on at the services monitored and admitted for more than 48 hours between 1 January and 31 December 2009. They were monitored from admittance until their discharge. RESULTS The rate of hospital infection observed was 3.38%. The most frequent infection was surgical localization, with an incidence rate of 2.77% (superficial=1.23%; deep=0.31%; organ-space=1.23%). The percentage of appropriate surgical prophylaxis, both in the indication and in the selection of antibiotics, initiation and duration, with respect to all those patients that received it, was 47.42%. According to the data obtained from their clinical records, the percentage of patients in which the pre-surgery preparation protocol was correctly complied with, was 92%. CONCLUSIONS The results obtained in this multicentre study can serve not only as a reference to other public hospitals, but they are also comparable to other international monitoring systems. Monitoring and controlling infections associated with healthcare must be a key aspect in Patient Care and Safety programmes.
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