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Vicentini C, Ugliono E, Elhadidy HSMA, Paladini G, Cornio AR, Cussotto F, Morino M, Zotti CM. Surgical reorganization during the COVID-19 pandemic and impact on case-mix and surgical site infections: A multicenter cohort study in Italy. Health Policy 2024; 146:105113. [PMID: 38896918 DOI: 10.1016/j.healthpol.2024.105113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 02/27/2024] [Accepted: 06/12/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND The coronavirus 2019 (COVID-19) pandemic led to major disruptions in surgical activity, particularly in the first year (2020). The objective of this study was to assess the impact of surgical reorganization on surgical outcomes in Northern Italy in 2020 and 2021. METHODS A retrospective cohort study was conducted among 30 hospitals participating in the surveillance system for surgical site infections (SSIs). Abdominal surgery procedures performed between 2018 and 2021 were considered. Predicted SSI rates for 2020 and 2021 were estimated based on 2018-2019 data and compared with observed rates. Independent predictors for SSI were investigated using logistic regression, including procedure year. RESULTS 7605 procedures were included. Significant differences in case-mix were found comparing the three time periods. Observed SSI rates among all patients in 2020 were significantly lower than expected based on 2018-2019 SSI rates (p 0.0465). Patients undergoing procedures other than cancer surgery in 2020 had significantly lower odds for SSI (odds ratio, OR 0.52, 95 % confidence interval, CI 0.3-0.89, p 0.018) and patients undergoing surgery in 2021 had significantly higher odds for SSI (OR 1.49, 95 % CI 1.07-2.09, p 0.019) compared to 2018-2019. CONCLUSIONS Enhanced infection prevention and control (IPC) measures could explain the reduced SSI risk during the first pandemic year. IPC practices should continue to be reinforced beyond the pandemic context.
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Affiliation(s)
- Costanza Vicentini
- Department of Public Health and Paediatrics, University of Turin, Via Santena 5 bis, 10126, Turin, Italy.
| | - Elettra Ugliono
- Department of Surgical Sciences, University of Turin, Corso A.M. Dogliotti 14, 10126 Turin, Italy
| | | | - Giovanni Paladini
- Department of Public Health and Paediatrics, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - Alessandro Roberto Cornio
- Department of Public Health and Paediatrics, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - Federico Cussotto
- Department of Public Health and Paediatrics, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - Mario Morino
- Department of Surgical Sciences, University of Turin, Corso A.M. Dogliotti 14, 10126 Turin, Italy
| | - Carla Maria Zotti
- Department of Public Health and Paediatrics, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
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Jameie M, Ilkhani S, Pashang M, Bagheri A, Jalali A, Barkhordari K, Nosrati M, Boroumand MA, Bagheri J. Coronavirus Disease 2019 Pandemic and Reduced Surgical Site Infection After Cardiac Surgery: A Potential Blessing in Disguise. Surg Infect (Larchmt) 2024; 25:362-369. [PMID: 38700752 DOI: 10.1089/sur.2023.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
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.
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Affiliation(s)
- Mana Jameie
- Tehran Heart Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saba Ilkhani
- Department of General and Vascular Surgery, Shahid Beheshti University of Medical Sciences and Health Services, Shohada-e-Tajrish Hospital, Tehran, Iran
| | - Mina Pashang
- Tehran Heart Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Bagheri
- Tehran Heart Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Khosro Barkhordari
- Tehran Heart Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjaneh Nosrati
- Tehran Heart Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Boroumand
- Tehran Heart Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Jamshid Bagheri
- Tehran Heart Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Ciccacci F, De Santo C, Mosconi C, Orlando S, Carestia M, Guarente L, Liotta G, Palombi L, Emberti Gialloreti L. Not only COVID-19: a systematic review of anti-COVID-19 measures and their effect on healthcare-associated infections. J Hosp Infect 2024; 147:133-145. [PMID: 38423132 DOI: 10.1016/j.jhin.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) burden healthcare globally. Amid the SARS-CoV-2 pandemic, intensified infection control measures, such as mask usage and hand hygiene, were implemented. AIM To assess the efficacy of these measures in preventing HAIs among hospitalized patients. METHODS Using the PICO framework (Population, Intervention, Comparison, Outcome), the study focused on hospitalized patients and the effectiveness of anti-COVID-19 measures in preventing HAIs. A systematic review of literature published in 2020-2022 was conducted, examining interventions such as mask usage, hand hygiene, and environmental cleaning. FINDINGS This systematic review analysed 42 studies: two in 2020, 21 in 2021, and 19 in 2022. Most studies were from high-income countries (28). Most studies (30 out of 42) reported a reduction in HAIs after implementing anti-COVID-19 measures. Gastrointestinal infections and respiratory tract infections showed significant reduction, unlike bloodstream infections and urinary tract infections. Some wards, like cardiology and neurology, experienced reduced HAIs, unlike intensive care units and coronary care units. There was an increase in studies reporting no effect of hygiene measures on HAIs in 2022, eventually indicating a shift in effectiveness over time. CONCLUSION Anti-COVID-19 measures have shown selective efficacy in preventing HAIs. The study emphasizes the need for context-specific strategies and increased focus on regions with limited resources. Continued research is essential to refine infection control practices, especially in high-risk settings.
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Affiliation(s)
- F Ciccacci
- Departmental Faculty of Medicine and Surgery, Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - C De Santo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - C Mosconi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - S Orlando
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - M Carestia
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - L Guarente
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - G Liotta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - L Palombi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy; Catholic University Our Lady of Good Counsel, Tirana, Albania
| | - L Emberti Gialloreti
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Mimura T, Matsumoto G, Natori T, Ikegami S, Uehara M, Oba H, Hatakenaka T, Kamanaka T, Miyaoka Y, Kurogochi D, Fukuzawa T, Koseki M, Kanai S, Takahashi J. 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. J Hosp Infect 2024; 146:160-165. [PMID: 37301228 PMCID: PMC10250054 DOI: 10.1016/j.jhin.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/23/2023] [Accepted: 06/03/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND 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. AIM To examine the impact of the COVID-19 pandemic on the incidence of SSIs after orthopaedic surgery. METHODS 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- T Mimura
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
| | - G Matsumoto
- Department of Laboratory Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - T Natori
- Department of Laboratory Medicine, Shinshu University School of Medicine, Matsumoto, Japan; Division of Infection Control, Shinshu University Hospital, Matsumoto, Japan
| | - S Ikegami
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - M Uehara
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - H Oba
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - T Hatakenaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - T Kamanaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Y Miyaoka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - D Kurogochi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - T Fukuzawa
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - M Koseki
- Faculty of Textile Science and Technology, Shinshu University, Nagano, Japan
| | - S Kanai
- Division of Infection Control, Shinshu University Hospital, Matsumoto, Japan
| | - J Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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5
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Teymourian H, ArianNik M, Mohit B, Massoudi N. A retrospective cohort study of the impact of COVID-19 infection control measures on surgical site infections in an academic hospital setting. Int Wound J 2024; 21:e14583. [PMID: 38453147 PMCID: PMC10920026 DOI: 10.1111/iwj.14583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 12/06/2023] [Indexed: 03/09/2024] Open
Abstract
Previous studies show that both the frequency of surgeries and incidence of surgical site infections (SSIs) have been lower during the coronavirus disease 2019 (COVID-19) pandemic. This study's purpose is to analyse the possible association of the COVID-19 epidemic-related increased health measures, such as protective equipment and products, increased hand hygiene and restrictions imposed, on the incidence of SSIs in an academic medical centre. We designed a single-centre, retrospective cohort study and collected data on the frequency of surgeries and the incidence of SSIs, among patients who had surgeries pre- and post-COVID-19 pandemic. Besides the intervention and outcome variable, we sought information on patient gender, surgery type, body mass index (BMI), smoking, and type II diabetes mellitus. We used Wald 95% confidence interval (95% CI) and the p values of the odds ratio (OR) to report results. Of the N = 24 098 surgeries performed in this hospital, there were 269 patients who reported post-surgical SSIs in this hospital between March 2019 and March 2021. The OR of developing a post-surgical SSI was 0.40 (95% CI: 0.33-0.57, p < 0.05; adjusted for confounders 0.39 [95% CI: 0.30-0.52, p < 0.05]) among patients who had surgery under post-pandemic infection control measures, as compared to patients who had surgery under pre-pandemic usual care infection control measures. Our significant results conclude that an association may exist between the enhanced infection control measures used during the COVID-19 pandemic and lower incidence of SSIs we observed during this period.
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Affiliation(s)
- Houman Teymourian
- Department of Anesthesiology, Shohada Tajrish Specialty Hospital, Faculty of MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Mohsen ArianNik
- Department of Anesthesiology, Taleghani General Hospital, Faculty of MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Babak Mohit
- Sleep Disorders CenterUniversity of Maryland Medical CenterBaltimoreMarylandUSA
| | - Nilofar Massoudi
- Department of Anesthesiology, Clinical Research Development Center, Imam Hossein Educational Hospital, Faculty of MedicineShahid Beheshti University of Medical SciencesTehranIran
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6
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Strobel RM, Baehr A, Hammerich R, Schulze D, Lehmann KS, Lauscher JC, Beyer K, Otto SD, Seifarth C. Impact of Coronavirus Disease 2019 (COVID-19) Pandemic on Surgical Site Infection in Patients with Inflammatory Bowel Disease-A Monocentric, Retrospective Cohort Study. J Clin Med 2024; 13:650. [PMID: 38337344 PMCID: PMC10856376 DOI: 10.3390/jcm13030650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/12/2024] [Accepted: 01/20/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: Surgical site infections (SSIs) are a relevant problem with a 25% incidence rate after elective laparotomy due to inflammatory bowel disease (IBD). The aim of this study was to evaluate whether stricter hygienic measures during the COVID-19 pandemic influenced the rate of SSI. (2) Methods: This is a monocentric, retrospective cohort study comparing the rate of SSI in patients with bowel resection due to IBD during COVID-19 (1 March 2020-15 December 2021) to a cohort pre-COVID-19 (1 February 2015-25 May 2018). (3) Results: The rate of SSI in IBD patients with bowel resection was 25.8% during the COVID-19 pandemic compared to 31.8% pre-COVID-19 (OR 0.94; 95% CI 0.40-2.20; p = 0.881). There were seventeen (17.5%) superficial and four (4.1%) deep incisional and organ/space SSIs, respectively, during the COVID-19 pandemic (p = 0.216). There were more postoperative intra-abdominal abscesses during COVID-19 (7.2% vs. 0.9%; p = 0.021). The strictness of hygienic measures (mild, medium, strict) had no influence on the rate of SSI (p = 0.553). (4) Conclusions: Hygienic regulations in hospitals during COVID-19 did not significantly reduce the rate of SSI in patients with bowel resection due to IBD. A ban on surgery, whereby only emergency surgery was allowed, was likely to delay surgery and exacerbate the disease, which probably contributed to more SSIs and postoperative complications.
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Affiliation(s)
- Rahel Maria Strobel
- Department of General and Visceral Surgery, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany (C.S.)
| | - Amelie Baehr
- Department of General and Visceral Surgery, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany (C.S.)
| | - Ralf Hammerich
- Department of Clinical Quality and Risk Management, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Daniel Schulze
- Department of Biometry and Clinical Epidemiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Kai Siegfried Lehmann
- Department of General and Visceral Surgery, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany (C.S.)
| | - Johannes Christian Lauscher
- Department of General and Visceral Surgery, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany (C.S.)
| | - Katharina Beyer
- Department of General and Visceral Surgery, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany (C.S.)
| | - Susanne Dorothea Otto
- Department of General and Visceral Surgery, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany (C.S.)
| | - Claudia Seifarth
- Department of General and Visceral Surgery, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany (C.S.)
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7
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Ismaeil R, Nahas ARF, Kamarudin NB, Abubakar U, Mat-Nor MB, Mohamed MHN. Evaluation of the impact of COVID-19 pandemic on hospital-acquired infections in a tertiary hospital in Malaysia. BMC Infect Dis 2023; 23:779. [PMID: 37946158 PMCID: PMC10636815 DOI: 10.1186/s12879-023-08770-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Infection prevention measures are the gold standard for preventing the spread of hospital-acquired infections (HAIs). COVID-19 pandemic caused major disruptions in infection prevention measures, and this has implications on the rate of HAIs. This study assessed the impact of COVID-19 pandemic on the rate and the types of HAIs at Sultan Ahmed Shah Hospital. METHOD This is a retrospective cohort study that compared the rate of HAIs from April to October 2019 (pre COVID period) and April to October 2020 (during COVID period). Data was collected through the review of patients' electronic medical records. RESULTS There were a total of 578 patients included in the selected wards during the pre- and during the pandemic. Thirty-nine episodes (12.1%) of HAIs were report in the pre COVID period and 29 (11.3%) during COVID-19. In both periods, hospital-acquired pneumonia (HAP) was the most frequent HAI among the patients. There was a rise in catheter-associated bloodstream infections (CLABSI) (0.8%) and ventilator associated pneumonia (VAP) (1.1%) during the COVID-19 period. The most common bacteria were methicillin-resistant Staphylococcus aureus (MRSA) (28.2%) and Enterococcus faecalis (17.9%) in the Pre COVID-19 period, and Pseudomonas aeruginosa (27.6%) and Stenotrophomonas maltophilia (6.9%) during COVID-19. CONCLUSION Our research concluded that the rates of HAIs during the COVID-19 pandemic were not significantly impacted by the improved in-hospital infection prevention efforts to control the pandemic. There is need for further efforts to promote adherence to preventive practices.
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Affiliation(s)
- Rehab Ismaeil
- Department of Pharmacy Practice, Kulliyah of Pharmacy, International Islamic University Malaysia (IIUM), Jalan Sultan Ahmad Shah, 25200, Kuantan, Pahang, Malaysia
| | - Abdul Rahman Fata Nahas
- Department of Pharmacy Practice, Kulliyah of Pharmacy, International Islamic University Malaysia (IIUM), Jalan Sultan Ahmad Shah, 25200, Kuantan, Pahang, Malaysia
| | - Norhidayah Binti Kamarudin
- Department of Medical Microbiology, Kulliyyah of Medicine, International Islamic University Malaysia, 25200, Kuantan, Malaysia
| | - Usman Abubakar
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, 2713, Doha, Qatar.
| | - Mohamad Basri Mat-Nor
- Department of Intensive Care, Kulliyyah of Medicine, International Islamic University Malaysia, 25200, Kuantan, Malaysia
| | - Mohamad Haniki Nik Mohamed
- Department of Pharmacy Practice, Kulliyah of Pharmacy, International Islamic University Malaysia (IIUM), Jalan Sultan Ahmad Shah, 25200, Kuantan, Pahang, Malaysia.
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8
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Abubakar U, Awaisu A, Khan AH, Alam K. Impact of COVID-19 Pandemic on Healthcare-Associated Infections: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2023; 12:1600. [PMID: 37998802 PMCID: PMC10668951 DOI: 10.3390/antibiotics12111600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 11/25/2023] Open
Abstract
This study investigated how the Coronavirus Disease 2019 (COVID-19) pandemic has affected the rate of healthcare-associated infections (HAIs). PubMed, Scopus and Google Scholar were searched to identify potentially eligible studies published from December 2019 to September 2022. A random effect model was used to determine the changes in the rate of HAIs during the pandemic. Thirty-seven studies, mostly from the United States (n = 13), were included. Fifteen studies described how the pandemic affected the rate of CLABSIs and CAUTIs, and eight of them showed a significant increase in CLABSIs. The risk of CLABSIs and CDIs was 27% (pooled odds ratio [OR]: 0.73; confidence interval [CI]: 0.61-0.89; p < 0.001) and 20% (pooled OR: 1.20; CI: 1.10-1.31; p < 0.001) higher during the pandemic compared to before the COVID-19 pandemic period, respectively. However, the overall risk of HAIs was unaffected by the pandemic (pooled OR: 1.00; 95 CI: 0.80-1.24; p = 0.990). Furthermore, there were no significant changes in the risk of CAUTIs (pooled OR: 1.01; 95 CI: 0.88-1.16; p = 0.890), and SSIs (pooled OR: 1.27; CI: 0.91-1.76; p = 0.16) between the two periods. The COVID-19 pandemic had no effect on the overall risk of HAIs among hospitalized patients, but an increased risk of CLABSIs and CDI were observed during the pandemic. Therefore, more stringent infection control and prevention measures and prudent interventions to promote the rational use of antibiotics are warranted across all healthcare facilities to reduce the burden of HAIs.
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Affiliation(s)
- Usman Abubakar
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Ahmed Awaisu
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town 11800, Malaysia
| | - Khurshid Alam
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town 11800, Malaysia
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Xavier LFD, Medeiros AS, Melo MCDESF, Santos RNG, Gama ZADAS, Freitas MRDE. Improvement project to reduce surgical site infections: a retrospective cohort study. Rev Col Bras Cir 2023; 50:e20233380. [PMID: 37851758 PMCID: PMC10519693 DOI: 10.1590/0100-6991e-20233380-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 04/06/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION Surgical site infections are one of the main problems related to health care. In Brazil, they are responsible for 14 to 16% of infections related to health care. This study sought to analyze the effect of implementing a package of measures to reduce surgical site infections (SSI) in heart surgeries, kidney transplants and herniorrhaphies and to evaluate adherence to the safe surgery checklist in a university hospital. METHODS this is a retrospective cohort study with data collection in a time series for the period from 2018 to 2020. RESULTS we analyzed 222 medical records referring to the surgeries under study performed in the year 2020, in which data were collected from the patients and the care package prevention measures. SSI data and adherence to the safe surgery checklist were analyzed in the years 2018, 2019 and 2020, totaling 268, 300 and 222 procedures analyzed, respectively. CONCLUSION the study showed a significant reduction in the SSI rate with greater adherence to the protocol, which was not maintained and was influenced by the COVID-19 pandemic. Thus, the sustainability of this action represents a challenge to be overcome, in order to establish a safer environment for the patient and a better quality of service.
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Affiliation(s)
| | - Amanda Silva Medeiros
- - Universidade Federal do Rio Grande do Norte, Centro de Ciências da Saúde - Natal - RN - Brasil
| | | | | | | | - Marise Reis DE Freitas
- - Universidade Federal do Rio Grande do Norte, Departamento de Infectologia - Natal - RN - Brasil
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10
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McLoughlin LC, Perlis N, Lajkosz K, Boasie A, Esmail T, Nielson C, Lavrencic N, Jackson T, Kulkarni GS. Surgical Site Infections During the Pandemic: The Impact of the "COVID Bundle". World J Surg 2023; 47:2310-2318. [PMID: 37488332 DOI: 10.1007/s00268-023-07112-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND A reduction in surgical site infections (SSIs) has been reported in several discrete patient populations during the COVID-19 pandemic. Herein, this study evaluates the impact of the COVID-19 pandemic on SSI in a large patient cohort incorporating multiple surgical disciplines. We hypothesize that enhanced infection control and heightened awareness of such measures is analogous to an SSI care bundle, the hypothetical "COVID bundle", and may impact SSI rates. METHOD Data collected for the American College of Surgeons National Surgical Quality Improvement Program between January 1, 2015, and April 1, 2021, were retrospectively analyzed. SSI rates were compared among time-dependent patient cohorts: Cohort A (pre-pandemic, N = 24,060, 87%) and Cohort B (pandemic, N = 3698, 13%). Time series and multivariable analyses predicted pre-pandemic and pandemic SSI trends and tested for association with timing of surgery. RESULTS The overall SSI incidence was reduced in Cohort B versus Cohort A (2.8% vs. 4.5%, p < 0.001). Multivariable analysis indicated a downward SSI trend before pandemic onset (IRR 0.997, 95% CI 0.994, 1). At pandemic onset, the trend reduced by a relative factor of 39% (IRR 0.601, 95% CI 0.338, 1.069). SSI then trended upward during the pandemic (IRR 1.035, 95% CI 0.965, 1.111). SSI rates significantly trended downward in general surgical patients at pandemic onset (IRR 0.572, 95% CI 0.353, 0.928). CONCLUSION Although overall SSI incidence was reduced during the pandemic, a statistically significant decrease in the predicted SSI rate only occurred in general surgical patients at pandemic onset. This trend may suggest a positive impact of the "COVID bundle" on SSI rates in these patients.
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Affiliation(s)
- Louise Catherine McLoughlin
- Division of Surgical Oncology (Urology), Department of Surgery, University Health Network, University of Toronto, Toronto, Canada.
- Department of Urology, St. James's Hospital, Dublin 8, Ireland.
- Department of Surgery, Trinity College Dublin, Dublin, Ireland.
| | - Nathan Perlis
- Division of Surgical Oncology (Urology), Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - Katherine Lajkosz
- Division of Surgical Oncology (Urology), Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - Alexandra Boasie
- Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - Tariq Esmail
- Department of Anesthesiology and Pain Management, University Health Network, University of Toronto, Toronto, Canada
| | - Chantelle Nielson
- Department of Quality, Safety and Clinical Adoption, University of Toronto, Toronto, Canada
| | - Natalia Lavrencic
- Department of Quality, Safety and Clinical Adoption, University of Toronto, Toronto, Canada
| | - Timothy Jackson
- Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - Girish S Kulkarni
- Division of Surgical Oncology (Urology), Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
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Oy S, Saing CH, Ung M, Zahari M, Nouhak I, Kim S, Nagashima-Hayashi M, Khuon D, Koy V, Mam S, Sayasone S, Saphonn V, Yi S. Developing an infection prevention and control intervention to reduce hospital-acquired infections in Cambodia and Lao People's Democratic Republic: the HAI-PC study protocol. Front Public Health 2023; 11:1239228. [PMID: 37799162 PMCID: PMC10548876 DOI: 10.3389/fpubh.2023.1239228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/30/2023] [Indexed: 10/07/2023] Open
Abstract
Background Hospital-acquired infections (HAIs) are significant public health issues, especially in low-and middle-income countries (LMICs). Hand hygiene and low-level disinfection of equipment practices among healthcare workers are some of the essential measures to reduce HAIs. Various infection prevention and control (IPC) interventions to reduce HAI incidence have been developed. However, effective interventions have not been well developed in the LMICs context. Therefore, this protocol aims to develop, pilot, and assess the feasibility and acceptability of an IPC intervention in Cambodia and the Lao People's Democratic Republic. Methods This study will consist of four phases guided by the Medical Research Council (MRC) Framework. Three hospitals will be purposely selected - each from the district, provincial, and national levels - in each country. The gap analysis will be conducted in Phase 1 to explore IPC practices among healthcare workers at each hospital through desk reviews, direct observation of hand hygiene and low-level disinfection of equipment practices, in-depth interviews with healthcare workers, and key informant interviews with stakeholders. In Phase 2, an IPC intervention will be developed based on the results of Phase 1 and interventions selected from a systematic literature review of IPC interventions in LMICs. In Phase 3, the developed intervention will be piloted in the hospitals chosen in Phase 1. In Phase 4, the feasibility and acceptability of the developed intervention will be assessed among healthcare workers and representatives at the selected hospitals. National consultative workshops in both countries will be conducted to validate the developed intervention with the national technical working groups. Discussion The MRC Framework will be employed to develop and evaluate an intervention to reduce HAIs in two LMICs. This theoretical framework will be used to explore the factors influencing hand hygiene compliance among healthcare workers. The gap analysis results will allow us to develop a comprehensive IPC intervention to reduce HAI incidence in Cambodia and Lao People's Democratic Republic. Findings from this protocol will feed into promising IPC interventions to reduce HAI incidence in other resource-limited settings. Clinical trial registration ClinicalTrial.Gov, identifier NCT05547373.
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Affiliation(s)
- Sreymom Oy
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Chan Hang Saing
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Mengieng Ung
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Marina Zahari
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Inthavong Nouhak
- Department of International Program for Health in the Tropics, Lao Tropical and Public Health Institute, Vientiane, Lao People’s Democratic Republic
| | - Sothea Kim
- University of Health Sciences, Phnom Penh, Cambodia
| | - Michiko Nagashima-Hayashi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Dyna Khuon
- University of Health Sciences, Phnom Penh, Cambodia
| | - Virya Koy
- Department of Hospital Services, Ministry of Health, Phnom Penh, Cambodia
| | - Sovatha Mam
- University of Health Sciences, Phnom Penh, Cambodia
| | - Somphou Sayasone
- Department of International Program for Health in the Tropics, Lao Tropical and Public Health Institute, Vientiane, Lao People’s Democratic Republic
| | | | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, CA, United States
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12
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Gorgas E, Klepacz H, Dowling S, Ramcharan R, Hoesel L, Walker J, Curtiss WJ. Reusing personal protective equipment (PPE) did not increase surgical site infection in trauma surgical patients during the COVID-19 pandemic: A retrospective cohort study in Michigan Trauma Centers. Am J Infect Control 2023; 51:996-998. [PMID: 36584900 PMCID: PMC9794391 DOI: 10.1016/j.ajic.2022.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/17/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Reuse of personal protective equipment (PPE), masks more specifically, during the COVID-19 pandemic was common. The primary objective of this study was to compare pre-pandemic surgical site infection (SSI) rates prior to reuse of PPE, to pandemic SSI rates after reuse of PPE in trauma surgical patients. METHODS A retrospective cohort analysis collected from the Michigan Trauma Quality Improvement Program database was performed. The pre-COVID cohort was from March 1, 2019 to December 31, 2019 and post-COVID cohort was March 1, 2020 to December 31,2020. Descriptive statistics were used to assess differences between variables in each cohort. RESULTS Nearly half (49.8%) of our cohort (n = 48,987) was in the post-COVID group. There was no significant difference in frequency of operative intervention between groups (p > .05). There was no significant increase (p > .05) between pre- and post-COVID cohorts for superficial, deep, or organ space SSI when reuse of masks was common. CONCLUSION Reuse of PPE did not lead to an increase in SSI in surgical patients. These findings are consistent with previous studies, but the first to be described in the trauma surgical patient population. Studies such as this may help inform further discussion regarding PPE usage as we continue to emerge from the current pandemic with the continuous threat of future pandemics.
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Affiliation(s)
- Evan Gorgas
- Department of Trauma, Acute, and Critical Care Surgery, Trinity Health, Ann Arbor, MI.
| | - Heather Klepacz
- Department of Trauma, Acute, and Critical Care Surgery, Trinity Health, Ann Arbor, MI
| | - Shawn Dowling
- Department of Trauma, Acute, and Critical Care Surgery, Trinity Health, Ann Arbor, MI
| | - Roger Ramcharan
- Department of Trauma, Acute, and Critical Care Surgery, Trinity Health, Ann Arbor, MI
| | - Laszlo Hoesel
- Department of Trauma, Acute, and Critical Care Surgery, Trinity Health, Ann Arbor, MI
| | - Jeffrey Walker
- Department of Trauma, Acute, and Critical Care Surgery, Trinity Health, Ann Arbor, MI
| | - William J Curtiss
- Department of Trauma, Acute, and Critical Care Surgery, Trinity Health, Ann Arbor, MI
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13
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Bolikas E, Astrinaki E, Panagiotaki E, Vitsaxaki E, Saplamidou S, Drositis I, Stafylaki D, Chamilos G, Gikas A, Kofteridis DP, Kritsotakis EI. Impact of SARS-CoV-2 Preventive Measures against Healthcare-Associated Infections from Antibiotic-Resistant ESKAPEE Pathogens: A Two-Center, Natural Quasi-Experimental Study in Greece. Antibiotics (Basel) 2023; 12:1088. [PMID: 37508184 PMCID: PMC10376605 DOI: 10.3390/antibiotics12071088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
The COVID-19 pandemic led to unprecedented stress on healthcare systems worldwide, forming settings of concern for increasing antimicrobial resistance. We investigated the impact of SARS-CoV-2 preventive measures against healthcare-associated infections (HAIs) from antibiotic-resistant bacteria in two tertiary-care hospitals. We compared infection rates between March 2019 and February 2020 (pre-intervention period) and March 2020 and February 2021 (COVID-19 intervention period) from drug-resistant ESKAPEE bacteria (methicillin-resistant Staphylococcus aureus; vancomycin-resistant Enterococci; carbapenem-resistant Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species and Escherichia coli). Over 24 months, 586 drug-resistant ESKAPEE HAIs occurred in 439 patients (0.3% of 179,629 inpatients) with a mean age of 63 years, with 43% being treated in intensive care units (ICUs), and having a 45% inpatient mortality rate. Interrupted time series analysis revealed increasing infection rates before the intervention that were sharply interrupted by abrupt drops for most pathogens and henceforth remained stable in the ICUs but progressively increased in ordinary wards. In the ICUs, the pooled infection rate was 44% lower over the intervention period compared to the pre-intervention period (incidence rate ratio (IRR) 0.56, 95%CI 0.41-0.75, p < 0.001). Pooled infection rates in the wards were slightly higher over the COVID-19 period (IRR 1.12, 95%CI 0.87-1.45, p = 0.368). The findings confirmed the ancillary beneficial impact of the enhanced bundle of transmission-based precautions adopted against SARS-CoV-2 in rapidly constraining antimicrobial-resistant HAIs in two Greek hospitals.
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Affiliation(s)
- Emmanouil Bolikas
- Laboratory of Biostatistics, School of Medicine, University of Crete, 71003 Heraklion, Greece
- Infection Control Committee, Venizeleio-Pananeio General Hospital, 71409 Heraklion, Greece
| | - Eirini Astrinaki
- Infection Control Committee, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Evangelia Panagiotaki
- Infection Control Committee, Venizeleio-Pananeio General Hospital, 71409 Heraklion, Greece
- Department of Clinical Microbiology, Venizeleio-Pananeio General Hospital, 71409 Heraklion, Greece
| | - Efsevia Vitsaxaki
- Infection Control Committee, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Stamatina Saplamidou
- Infection Control Committee, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Ioannis Drositis
- Infection Control Committee, Venizeleio-Pananeio General Hospital, 71409 Heraklion, Greece
- Department of Medical Oncology, Venizeleio-Pananeio General Hospital, 71409 Heraklion, Greece
| | - Dimitra Stafylaki
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Georgios Chamilos
- Infection Control Committee, University Hospital of Heraklion, 71110 Heraklion, Greece
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Achilleas Gikas
- Infection Control Committee, University Hospital of Heraklion, 71110 Heraklion, Greece
- Department of Internal Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Diamantis P Kofteridis
- Infection Control Committee, University Hospital of Heraklion, 71110 Heraklion, Greece
- Department of Internal Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Evangelos I Kritsotakis
- Laboratory of Biostatistics, School of Medicine, University of Crete, 71003 Heraklion, Greece
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14
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Ju JW, You J, Hong H, Kang CK, Kim WH, Lee HJ. Impact of Enhanced in-Hospital Infection Prevention During the COVID-19 Pandemic on Postoperative Pneumonia in Older Surgical Patients. Int J Gen Med 2023; 16:1943-1951. [PMID: 37251284 PMCID: PMC10224724 DOI: 10.2147/ijgm.s411502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/19/2023] [Indexed: 05/31/2023] Open
Abstract
Purpose We aimed to investigate the impact of enhanced in-hospital infection prevention during the coronavirus disease 2019 (COVID-19) pandemic on postoperative pneumonia in older surgical patients. Patients and Methods We retrospectively reviewed the electronic medical records of consecutive patients ≥70 years who underwent elective surgery between 2017 and 2021 at our institution. All perioperative variables were retrieved from the electronic medical records. The primary outcome was new-onset postoperative pneumonia during the hospitalization period. Since February 2020, our institution implemented a series of policies to enhance infection prevention, hence patients were divided into groups according to whether they underwent surgery before or during the COVID-19 pandemic. An interrupted time series analysis was performed to evaluate the difference between pre- and post-intervention slopes of the primary outcome. Results Among the 29,387 patients included in the study, 10,547 patients underwent surgery during the COVID-19 pandemic. Although there was a decreasing trend of the monthly incidence rate of postoperative pneumonia compared to before the COVID-19 pandemic, there was no statistical significance in the trend (slope before COVID-19 period: β-coefficient, -0.007; 95% CI, -0.022 to 0.007). Conclusion Our study revealed that enhanced in-hospital infection prevention implemented to manage the COVID-19 pandemic did not significantly affect the decreasing trend of postoperative pneumonia at our institution.
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Affiliation(s)
- Jae-Woo Ju
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jiwon You
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyunsook Hong
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Won Ho Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho-Jin Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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15
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Alaidaroos OA, Almuhaydib MN, Alhossan MA, Aldossari AN, Fallatta MO, Alotaibi SM, Alowid FK, Salem AA, Alsaygh KA, Alshammary HS. Unexpected Benefits of Coronavirus Disease 2019: Impact of Coronavirus Disease 2019 Pandemic on Surgical Site Infection: A Systematic Review and Meta-Analysis. Surg Infect (Larchmt) 2023; 24:119-130. [PMID: 36847343 DOI: 10.1089/sur.2022.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Background: We aimed to summarize and synthesize the current evidence regarding the indirect impact of the coronavirus disease 2019 (COVID-19) pandemic and its associated measures on the surgical site infection (SSI) rate compared with the pre-pandemic period. Methods: A computerized search was conducted on MEDLINE via PubMed, Web of Science, and Scopus using the relevant keywords. Two-stage screening and data extraction were done. The National Institutes of Health (NIH) tools were used for the quality assessment. The Review Manager 5.4.1 program was used for the analysis. Results: Sixteen articles (n = 157,426 patients) were included. The COVID-19 pandemic and lockdown were associated with reduced risk of SSIs after surgery (odds ratio [OR], 0.65; 95% confidence interval [CI], 0.56-0.75; p < 0.00001) and (OR, 0.49; 95% CI, 0.29-0.84; p = 0.009), respectively. There was no significant reduction in the SSIs rate after applying the extended use of masks (OR, 0.73; 95% CI, 0.30-1.73; p = 0.47). A reduction in the superficial SSI rate during the COVID-19 pandemic compared with the pre-COVID-19 pandemic period was observed (OR, 0.58; 95% CI, 0.45-0.75; p < 0.0001). Conclusions: The current evidence suggests that the COVID-19 pandemic may have some unexpected benefits, including improved infection control protocols, which resulted in reduced SSI rates, especially superficial SSIs. In contrast to extended mask use, the lockdown was associated with reduced rates of SSIs.
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Affiliation(s)
| | | | - Mashari Ahmed Alhossan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulkarem Naif Aldossari
- College of Medicine, Najran University, Najran, Saudi Arabia.,Emergency Department, King Khalid Hospital, Najran, Saudi Arabia
| | - Mawadda Omar Fallatta
- College of Medicine, Umm Al Qura University, Makkah, Saudi Arabia.,General Surgery Department, Althaghr Hospital, Jeddah, Saudi Arabia
| | | | - Fay Khalid Alowid
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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16
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D'Oria M, Veraldi GF, Mastrorilli D, Mezzetto L, Calvagna C, Taglialavoro J, Bassini S, Griselli F, Grosso L, Carere A, D'Andrea A, Lepidi S. Association Between the Lockdown for SARS-CoV-2 (COVID-19) and Reduced Surgical Site Infections after Vascular Exposure in the Groin at Two Italian Academic Hospitals. Ann Vasc Surg 2023; 89:60-67. [PMID: 36404473 PMCID: PMC9613778 DOI: 10.1016/j.avsg.2022.09.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND The aim of this study was to evaluate whether the scrupulous hygiene rules and the restriction of contacts during the lockdown owing to the COVID-19 pandemic affected the rate and severity of surgical site infections (SSI) after vascular exposure in the groin at two Italian University Hospitals. METHODS Starting from March 2020, strict hygiene measures for protection of health care workers (HCW) and patients from COVID-19 infection were implemented, and partly lifted in July 2020. The main exposure for analysis purposes was the period in which patients were operated. Accordingly, study subjects were divided into two groups for subsequent comparisons (preCOVID-19 era: March-June 2018-2019 versus COVID-19 era: March-June 2020). The primary endpoint was the occurrence of superficial and/or deep SSI within 30 days after surgery. The Centers for Disease Control and Prevention definitions were used to classify superficial and deep SSI. RESULTS A total of 194 consecutive patients who underwent vascular exposure in the groin were retrospectively analyzed. Of those, 60 underwent surgery from April 1, 2018 to June 30 of the same year; 83 from April 1, 2019 to June 30 of the same year; and 51 from April 1, 2020 to June 30 of the same year. The mean age of the study cohort was 75 years and 140 (72%) were males. Patients who were operated in the COVID-19 era were less likely to develop SSI (10% vs. 28%; P = 0.008), including both deep SSI (4% vs. 13%; P = 0.04) and superficial SSI (6% vs. 15%; P = 0.05). After multivariate adjustments, being operated in the COVID-19 era was found to be a negative predictor for development of an SSI (odds ratio [OR] = 0.31; 95% confidence interval [CI] = 0.09-0.76; P < 0.001) or deep SSI (OR = 0.21; 95% CI = 0.03-0.98; P < 0.001). Operative time was also found as independent predictor for the development of deep SSI (OR = 1.21; 95%CI = 1.21-1.52; P = 0.02). Using binary logistic regression, there were no independent predictors of superficial SSI that could be identified. CONCLUSIONS Vascular exposure in the groin carries a non-negligible risk of SSI. In this study, we provided important insights that are simple and easily viable precautions (such as the universal use of surgical masks both for patients and health care professionals during wound care, the widespread diffusion of hand sanitizers, and the reduction of the number of visitors in the surgical wards) could be promising and safe tools for SSI risk reduction.
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Affiliation(s)
- Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy,Correspondence to: Mario D'Oria, MD, Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Strada di Fiume 447, 34149, Trieste, Italy
| | - Gian Franco Veraldi
- Department of Vascular Surgery, University Hospital and Trust of Verona, Italy
| | - Davide Mastrorilli
- Department of Vascular Surgery, University Hospital and Trust of Verona, Italy
| | - Luca Mezzetto
- Department of Vascular Surgery, University Hospital and Trust of Verona, Italy
| | - Cristiano Calvagna
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Jacopo Taglialavoro
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Silvia Bassini
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Filippo Griselli
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Lorenzo Grosso
- Department of Vascular Surgery, University Hospital and Trust of Verona, Italy
| | - Andrea Carere
- Faculty of Medicine, University of Trieste Medical School, Italy
| | - Alessia D'Andrea
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
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Gasch O, Badia-Cebada L, Carmezim J, Vaqué M, Pomar V, Moreno E, Marrón A, Jiménez-Martínez E, García-Quesada MJ, Garcia-Alarcón X, Domènech D, Càmara J, Andrés M, Peñafiel J, Porrón R, Limón E, Calbo E, Pujol M. Effects of the COVID-19 Pandemic on Incidence and Epidemiology of Catheter-Related Bacteremia, Spain. Emerg Infect Dis 2022; 28:2181-2189. [PMID: 36191608 PMCID: PMC9622263 DOI: 10.3201/eid2811.220547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We compared hospital-acquired catheter-related bacteremia (CRB) episodes diagnosed at acute care hospitals in Catalonia, Spain, during the COVID-19 pandemic in 2020 with those detected during 2007–2019. We compared the annual observed and predicted CRB rates by using the negative binomial regression model and calculated stratified annual root mean squared errors. A total of 10,030 episodes were diagnosed during 2007–2020. During 2020, the observed CRB incidence rate was 0.29/103 patient-days, whereas the predicted CRB rate was 0.14/103 patient-days. The root mean squared error was 0.153. Thus, a substantial increase in hospital-acquired CRB cases was observed during the COVID-19 pandemic in 2020 compared with the rate predicted from 2007–2019. The incidence rate was expected to increase by 1.07 (95% CI 1–1.15) for every 1,000 COVID-19–related hospital admissions. We recommend maintaining all CRB prevention efforts regardless of the coexistence of other challenges, such as the COVID-19 pandemic.
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18
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Iness AN, Abaricia JO, Sawadogo W, Iness CM, Duesberg M, Cyrus J, Prasad V. The Effect of Hospital Visitor Policies on Patients, Their Visitors, and Health Care Providers During the COVID-19 Pandemic: A Systematic Review. Am J Med 2022; 135:1158-1167.e3. [PMID: 35472383 PMCID: PMC9035621 DOI: 10.1016/j.amjmed.2022.04.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 11/19/2022]
Abstract
Health care policymaking during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has questioned the precedent of restricting hospital visitors. We aimed to synthesize available data describing the resulting impact on patient, family/visitor, and health care provider well-being. We systematically reviewed articles from the World Health Organization COVID-19 Global Literature on Coronavirus Disease Database published between December 2019 through April 2021. Included studies focused on hospitalized patients and reported 1 or more prespecified main or secondary outcome (coronavirus disease 2019 [COVID-19] disease transmission, global well-being, mortality, morbidity, or health care resource utilization). Two authors independently extracted data into a standardized form with a third author resolving discrepancies. A total of 1153 abstracts were screened, and 26 final full-text articles were included. Ten studies were qualitative, with 7 cohort studies, and no randomized controlled trials. Critically ill patients were the most represented (12 out of 26 studies). Blanket hospital visitor policies were associated with failure to address the unique needs of patients, their visitors, and health care providers in various clinical environments. Overall, a patient-centered, thoughtful, and nuanced approach to hospital visitor policies is likely to benefit all stakeholders while minimizing potential harms.
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Affiliation(s)
- Audra N Iness
- Division of Hematology, Oncology and Palliative Care, Massey Cancer Center, Virginia Commonwealth University, Richmond, Va; Department of Pediatrics, Baylor College of Medicine, Houston, Tex.
| | - Jefferson O Abaricia
- Department of Bioengineering, College of Engineering, Virginia Commonwealth University, Richmond, Va
| | - Wendemi Sawadogo
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Va
| | - Caleb M Iness
- School of Medicine, California Northstate University, Elk Grove, Calif
| | - Max Duesberg
- School of Medicine, California Northstate University, Elk Grove, Calif
| | - John Cyrus
- Health Sciences Library, Research and Education Department, Virginia Commonwealth University, Richmond, Va
| | - Vinay Prasad
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco
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19
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Cheng Y, Chen Y, Hou X, Yu J, Wen H, Dai J, Zheng Y. Development of a Nomogram for Predicting Surgical Site Infection in Patients with Resected Lung Neoplasm Undergoing Minimally Invasive Surgery. Surg Infect (Larchmt) 2022; 23:754-762. [PMID: 36149679 DOI: 10.1089/sur.2022.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Predictive models are necessary to target high-risk populations and provide precision interventions for patients with lung neoplasm who suffer from surgical site infections (SSI). Patients and Methods: This case control study included patients with lung neoplasm who underwent minimally invasive surgeries (MIS). Logistic regression was used to generate the prediction model of SSI, and a nomogram was created. A receiver operator characteristic (ROC) curve was used to examine the predictive value of the model. Results: A total of 151 patients with SSI were included, and 604 patients were randomly selected among the patients without SSI (ratio 4:1). Male gender (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.57-4.15; p < 0.001), age >60 years (OR, 2.10; 95% CI, 1.29-3.44, p = 0.003), operation time >60 minutes (all categories, p < 0.05), treatments for diabetes mellitus (OR, 2.96; 95% CI, 1.75-4.98l; p < 0.001), and best forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC; OR, 0.96; 95% CI, 0.94-0.99; p = 0.008) were independently associated with SSI. The model based on these variables showed an area under the curve (AUC) of 0.813 for predicting SSI. Conclusions: A nomogram predictive model was successfully established for predicting SSI in patients receiving MIS, with good predictive value.
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Affiliation(s)
- Yuejia Cheng
- Department of Medical Administration, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yong Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xumin Hou
- Department of Hospital President, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jianguang Yu
- Department of Pharmacy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Haini Wen
- Department of Pharmacy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jinjie Dai
- Department of Medical Administration, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yue Zheng
- Department of Medical Administration, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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20
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Smith BB, Bosch W, O'Horo JC, Girardo ME, Bolton PB, Murray AW, Hirte IL, Singbartl K, Martin DP. Surgical Site Infections During the Covid-19 Era: A Retrospective, Multicenter Analysis. Am J Infect Control 2022; 51:607-611. [PMID: 36162605 PMCID: PMC9500048 DOI: 10.1016/j.ajic.2022.09.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/28/2022]
Abstract
Background Surgical site infections (SSIs) are an undesired perioperative outcome. Recent studies have shown increases in hospital acquired infections during the coronavirus disease 2019 (COVID-19) pandemic. The objective of this study was to evaluate postoperative SSIs in the COVID-19-era compared to a historical cohort at a large, multicenter, academic institution. Methods A retrospective review of all patients who underwent National Health and Safety Network (NHSN) inpatient surgical procedures between January 1, 2018 and December 31, 2020. Patients from the COVID-19-era (March-December 2020) were compared and matched 1:1 with historical controls (2018/2019) utilizing the standardized infection ratio (SIR) to detect difference. Results/Discussion During the study period, 29,904 patients underwent NHSN procedures at our institution. When patients from the matched cohort (2018/2019) were compared to the COVID-19-era cohort (2020), a decreased risk of SSI was observed following colorectal surgery (RR = 0.94, 95% CI [0.65, 1.37], P = .76), hysterectomy (RR = 0.88, 95% CI [0.39, 1.99], P = .75), and knee prothesis surgery (RR = 0.95, 95% CI [0.52, 1.74], P = .88), though not statistically significant. An increased risk of SSI was observed following hip prosthesis surgery (RR 1.09, 95% CI [0.68, 1.75], P = .72), though not statistically significant. Conclusions The risk of SSI in patients who underwent NHSN inpatient surgical procedures in 2020 with perioperative COVID-19 precautions was not significantly different when compared to matched controls at our large, multicenter, academic institution.
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Affiliation(s)
- Bradford B Smith
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 E. Mayo Blvd; Phoenix, AZ 85054.
| | - Wendelyn Bosch
- Division of Infectious Diseases, Mayo Clinic, 4500 San Pablo Rd; Jacksonville, FL 32224
| | - John C O'Horo
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, 200 1(st) St. SW; Rochester, MN 55905; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 1st St. SW; Rochester, MN 55905
| | - Marlene E Girardo
- Department of Quantitative Health Sciences, Mayo Clinic, 5777 E. Mayo Blvd; Phoenix, AZ 85054
| | - Patrick B Bolton
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 E. Mayo Blvd; Phoenix, AZ 85054
| | - Andrew W Murray
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 E. Mayo Blvd; Phoenix, AZ 85054
| | - Ingrid L Hirte
- Mayo Clinic Alix School of Medicine, 13400 E. Shea Blvd. Scottsdale, AZ 85259
| | - Kai Singbartl
- Division of Critical Care Medicine, Mayo Clinic, 5777 E. Mayo Blvd; Phoenix, AZ 85054
| | - David P Martin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 1st St. SW; Rochester, MN 55905
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21
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Surgical site infections in patients undergoing breast oncological surgery during the lockdown: An unexpected lesson from the COVID-19 pandemic. G Chir 2022; 42:e02. [PMID: 35936027 PMCID: PMC9323553 DOI: 10.1097/ia9.0000000000000003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/24/2022] [Indexed: 01/19/2023]
Abstract
Background The present study aims to evaluate how the measures to contain the SARS-CoV-2 spreading affected the surgical site infections (SSIs) rate in patients who underwent nondeferrable breast cancer surgery (BCS). Methods This study is a retrospective analysis of prospectively collected data from a consecutive series of patients underwent nondeferrable BCS in a regional Italian Covid-free hub during two different period: March to April 2020 (pandemic cohort [PC]) and March till April 2019 (control cohort [CC]). SSIs were defined according to the criteria established by the Center for disease control and prevention (CDC) and additional treatment, serous discharge, erythema, purulent exudate, separation of deep tissues, isolation of bacteria, and stay (ASEPSIS) scoring systems. Results One hundred ninety-nine patients were included in the present study: 100 and 99 patients who underwent nondeferrable BCS from March to April 2020 (PC) and from March to April 2019 (CC), respectively. The overall SSIs rate in this series was 9.1% according to CDC criteria and 6.5% according to ASEPSIS criteria. The SSIs incidence decreased during the pandemic period. Moreover, the SSIs rate according to ASEPSIS criteria was statistically lower in the PC than in the CC. We observed significant evidence of higher SSIs, both in terms of CDC and ASEPSIS score, in patients having undergone breast reconstruction compared with patients not undergoing immediate reconstruction. Conclusions The restrictive measures issued during the lockdown period seemed to lower the SSIs rates in patients undergoing nondeferrable BCS.
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22
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Felser S, Sewtz C, Kriesen U, Kragl B, Hamann T, Bock F, Strüder DF, Schafmayer C, Dräger DL, Junghanss C. Relatives Experience More Psychological Distress Due to COVID-19 Pandemic-Related Visitation Restrictions Than In-Patients. Front Public Health 2022; 10:862978. [PMID: 35910882 PMCID: PMC9326244 DOI: 10.3389/fpubh.2022.862978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background The COVID-19 pandemic led to visiting restrictions (VRs) of patients in hospitals. Social contacts between patients' relatives play an important role in convalescence. Isolation may cause new psychological comorbidity. The present study investigated the psychological distress of VR in in-patients and their relatives. Methods From April 1, 2020 to May 20, 2020, 313 in-patients (≥14 years) of the University Medical Center Rostock were interviewed by questionnaires and 51 relatives by phone. Subjective psychological distress was assessed by a distress thermometer [0 (not at all)−100 (extreme)]. The study also investigated stressors due to VR, psychological distress in dependence on demographic or disease-related data, currently used communication channels and desired alternatives and support. Results Relatives were more psychologically distressed by VR than in-patients (59 ± 34 vs. 38 ± 30, p = 0.002). Loss of direct physical contact and facial expressions/gestures resulted in the most distress. Psychological distress due to VR was independent of demographics and indicates small positive correlations with the severity of physical restriction and the general psychological distress of in-patients. The most frequent ways of communication were via phone and social media. Frequently requested alternatives for patients were other interlocutors and free phone/tablet use, for relatives visiting rooms with partitions. Conclusion VRs are a stressor for patients and their relatives. The establishment of visiting rooms with partitions and the free use of phones/tablets could reduce the additional distress.
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Affiliation(s)
- Sabine Felser
- Hematology, Oncology, Palliative Medicine, Department of Internal Medicine, Clinic III, University Hospital Rostock, Rostock, Germany
- *Correspondence: Sabine Felser
| | - Corinna Sewtz
- Hematology, Oncology, Palliative Medicine, Department of Internal Medicine, Clinic III, University Hospital Rostock, Rostock, Germany
| | - Ursula Kriesen
- Hematology, Oncology, Palliative Medicine, Department of Internal Medicine, Clinic III, University Hospital Rostock, Rostock, Germany
| | - Brigitte Kragl
- Hematology, Oncology, Palliative Medicine, Department of Internal Medicine, Clinic III, University Hospital Rostock, Rostock, Germany
| | - Till Hamann
- Department of Neurology, University Hospital Rostock, Rostock, Germany
| | - Felix Bock
- Department of Radiation Oncology, University Hospital Rostock, Rostock, Germany
| | - Daniel Fabian Strüder
- Head and Neck Surgery “Otto Koerner”, Department of Otorhinolaryngology, University Hospital Rostock, Rostock, Germany
| | - Clemens Schafmayer
- Department of General Surgery, University Hospital Rostock, Rostock, Germany
| | | | - Christian Junghanss
- Hematology, Oncology, Palliative Medicine, Department of Internal Medicine, Clinic III, University Hospital Rostock, Rostock, Germany
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23
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Losurdo P, Mastronardi M, de Manzini N, Bortul M. Survival and long-term surgical outcomes after colorectal surgery: are there any gender-related differences? Updates Surg 2022; 74:1337-1343. [PMID: 35810269 PMCID: PMC9338158 DOI: 10.1007/s13304-022-01323-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/20/2022] [Indexed: 02/07/2023]
Abstract
Colorectal cancer (CRC) incidence and mortality seems to be lower in women than in men. The present study aims to evaluate the impact of gender on CRC diagnosis, treatment, and survival. This is a retrospective cohort study based on a single-center dataset of CRC patients from the University Hospital of Trieste (Italy). Data of 1796 consecutive CRC patients referred to our center from November 11th, 2004, to December 31st, 2017, were analyzed. Right-sided carcinomas are more frequent in women than in men; furthermore, women had a lower surgical complication rate. Men showed a higher 5- and 10-year mortality. This survival benefit for women was observed independently of the tumor localization. The 5-year hazard ratio (HR) for women vs men was 0.776 (p 0.003), and after 10-year 0.816 (p 0.017). Regarding the disease-free survival (DFS), 5 and 10-year HR was 0.759 (p 0.034) and 0.788 (p 0.07), respectively. On multivariable analysis, respecting tumor localization, the odds of female gender were higher than man with right colon disease. Male gender was more independently associated with age at the surgery time. Women survival advantage was higher than men, except for patients older than 80. Surgical outcome and survival after CRC surgical treatment seem to be gender related. For this reason, gender could play an important role in CRC diagnosis and therapy, allowing an earlier diagnosis in women.
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Affiliation(s)
- Pasquale Losurdo
- Surgical Clinic Unit, Division of General Surgery, Department of Medical and Surgical Sciences, Hospital of Cattinara, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Manuela Mastronardi
- Surgical Clinic Unit, Division of General Surgery, Department of Medical and Surgical Sciences, Hospital of Cattinara, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Nicolò de Manzini
- Surgical Clinic Unit, Division of General Surgery, Department of Medical and Surgical Sciences, Hospital of Cattinara, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Marina Bortul
- Surgical Clinic Unit, Division of General Surgery, Department of Medical and Surgical Sciences, Hospital of Cattinara, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
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24
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ABD EL AZIZ MA, CALINI G, ABDALLA S, SAEED HA, LOVELY JK, D’ANGELO ALD, BEHM KT, MATHIS KL, LARSON DW. Acute social isolation and postoperative surgical outcomes. Lessons learned from COVID-19 pandemic. Minerva Surg 2022; 77:348-353. [DOI: 10.23736/s2724-5691.21.09243-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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25
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Humphrey T, Daniell H, Chen AF, Hollenbeck B, Talmo C, Fang CJ, Smith EL, Niu R, Melnic CM, Hosseinzadeh S, Bedair HS. Effect of the COVID-19 Pandemic on Rates of Ninety-Day Peri-Prosthetic Joint and Surgical Site Infections after Primary Total Joint Arthroplasty: A Multicenter, Retrospective Study. Surg Infect (Larchmt) 2022; 23:458-464. [PMID: 35594331 DOI: 10.1089/sur.2022.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The impact of the coronavirus 2019 (COVID-19) pandemic on the rate of primary total joint arthroplasty (TJA) peri-prosthetic joint infection (PJI) and superficial surgical site infections (SSI) is currently unknown. The purpose of this multicenter study was to evaluate any changes in the rates of 90-day PJI or 30-day SSI, including trends in microbiology of the infections, during the COVID-19 pandemic compared to the three years prior. Patients and Methods: An Institutional Review Board-approved, multicenter, retrospective study was conducted with five participating academic institutions across two healthcare systems in the northeastern United States. Primary TJA patients from the years 2017-2019 were grouped as a pre-COVID-19 pandemic cohort and patients from the year 2020 were grouped as a COVID-19 pandemic cohort. Differences in patient demographics, PJI, SSI, and microbiology between the two cohorts were assessed. Results: A total of 14,844 TJAs in the pre-COVID-19 pandemic cohort and 5,453 TJAs in the COVID-19 pandemic cohort were evaluated. There were no substantial differences of the combined 90-day PJI and 30-day superficial SSI rates between the pre-COVID-19 pandemic cohort (0.35%) compared with the COVID-19 pandemic cohort (0.26%; p = 0.303). Conclusions: This study did not find any change in the rates of 90-day PJI or 30-day superficial SSI in patients undergoing primary TJA between a pre-COVID-19 pandemic and COVID-19 pandemic cohort. Larger national database studies may identify small but substantial differences in 90-day PJI and 30-day superficial SSI rates between these two time periods. Our data may support continued efforts to maintain high compliance with hand hygiene, use of personal protective equipment, and limited hospital visitation whenever possible.
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Affiliation(s)
- Tyler Humphrey
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,Kaplan Joint Center, Newton-Wellesley Hospital, Newton, Massachusetts, USA
| | - Hayley Daniell
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian Hollenbeck
- Department of Infectious Disease, New England Baptist Hospital, Dedham, Massachusetts, USA
| | - Carl Talmo
- Department of Orthopaedic Surgery, New England Baptist Hospital, Dedham, Massachusetts, USA
| | - Christopher J Fang
- Department of Infectious Disease, New England Baptist Hospital, Dedham, Massachusetts, USA
| | - Eric L Smith
- Department of Orthopaedic Surgery, New England Baptist Hospital, Dedham, Massachusetts, USA
| | - Ruijia Niu
- Department of Orthopaedic Surgery, New England Baptist Hospital, Dedham, Massachusetts, USA
| | - Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,Kaplan Joint Center, Newton-Wellesley Hospital, Newton, Massachusetts, USA
| | - Shayan Hosseinzadeh
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,Kaplan Joint Center, Newton-Wellesley Hospital, Newton, Massachusetts, USA
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26
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So ACP, Karampera C, Khan M, Russell B, Moss C, Monroy-Iglesias MJ, Thillai K, Josephs DH, Pintus E, Rudman S, Van Hemelrijck M, Dolly S, Enting D. Safe provision of systemic anti-cancer treatment for urological cancer patients during COVID-19: a tertiary centre experience in the first wave of COVID-19. BMC Urol 2022; 22:71. [PMID: 35488333 PMCID: PMC9051846 DOI: 10.1186/s12894-022-01023-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 04/12/2022] [Indexed: 12/04/2022] Open
Abstract
Background Safe provision of systemic anti-cancer treatment (SACT) during the COVID-19 pandemic remains an ongoing concern amongst clinicians. Methods Retrospective analysis on uro-oncology patients who continued or started SACT between 1st March and 31st May 2020 during the pandemic (with 2019 as a comparator). Results 441 patients received SACT in 2020 (292 prostate, 101 renal, 38 urothelial, 10 testicular) compared to 518 patients in 2019 (340 prostate, 121 renal, 42 urothelial, 15 testicular). In 2020, there were 75.00% fewer patients with stage 3 cancers receiving SACT (p < 0.0001) and 94.44% fewer patients receiving radical treatment (p = 0.00194). The number of patients started on a new line of SACT was similar between both years (118 in 2019 vs 102 in 2020; p = 0.898) but with 53.45% fewer patients started on chemotherapy in 2020 (p < 0.001). Overall, 5 patients tested positive for COVID-19 (one asymptomatic, one mild, two moderate, one severe resulting in death). Compared to 2019, 30-day mortality was similar (1.69% in 2019 vs 0.98% in 2020; p = 0.649) whereas 6-month mortality was lower (9.32% in 2019 vs 1.96% in 2020; p = 0.0209) in 2020. Conclusion This study suggests that delivery of SACT to uro-oncology patients during COVID-19 pandemic may be safe in high-incidence areas with appropriate risk-reduction strategies. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-022-01023-6.
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Affiliation(s)
- Alfred Chung Pui So
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - Christina Karampera
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - Muhammad Khan
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - Beth Russell
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, SE1 9RT, UK
| | - Charlotte Moss
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, SE1 9RT, UK
| | - Maria J Monroy-Iglesias
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, SE1 9RT, UK
| | - Kiruthikah Thillai
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - Debra Hannah Josephs
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - Elias Pintus
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - Sarah Rudman
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, SE1 9RT, UK
| | - Saoirse Dolly
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - Deborah Enting
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK.
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27
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Tham N, Fazio T, Johnson D, Skandarajah A, Hayes IP. Hospital Acquired Infections in Surgical Patients: Impact of COVID-19-Related Infection Prevention Measures. World J Surg 2022; 46:1249-1258. [PMID: 35384475 PMCID: PMC8985564 DOI: 10.1007/s00268-022-06539-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 01/08/2023]
Abstract
Background Hospital acquired infections are common, costly, and potentially preventable adverse events. This study aimed to determine the effect of the COVID-19 pandemic-related escalation in infection prevention and control measures on the incidence of hospital acquired infection in surgical patients in a low COVID-19 environment in Australia. Method This was a retrospective cohort study in a tertiary institution. All patients undergoing a surgical procedure from 1 April 2020 to 30 June 2020 (COVID-19 pandemic period) were compared to patients pre-pandemic (1 April 2019–30 June 2019). The primary outcome investigated was odds of overall hospital acquired infection. The secondary outcome was patterns of involved microorganisms. Univariable and multivariable logistic regression analysis was performed to assess odds of hospital acquired infection. Results There were 5945 admission episodes included in this study, 224 (6.6%) episodes had hospital acquired infections in 2019 and 179 (7.1%) in 2020. Univariable logistic regression analysis demonstrated no evidence of change in odds of having a hospital acquired infection between cohorts (OR 1.08, 95% CI 0.88–1.33, P = 0.434). The multivariable regression analysis adjusting for potentially confounding co-variables also demonstrated no evidence of change in odds of hospital acquired infection (OR 0.93, 95% CI 0.74–1.16, P = 0.530). Conclusion Increased infection prevention and control measures did not affect the incidence of hospital acquired infection in surgical patients in our institution, suggesting that there may be a plateau effect with these measures in a system with a pre-existing high baseline of practice. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-022-06539-4.
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Affiliation(s)
- Nicole Tham
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Parkville, VIC, Australia. .,Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, VIC, Australia. .,Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia.
| | - Timothy Fazio
- Department of General Medicine and Infectious Diseases, The Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.,Health Intelligence Unit, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Douglas Johnson
- Department of General Medicine and Infectious Diseases, The Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Anita Skandarajah
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, VIC, Australia.,Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Ian P Hayes
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Parkville, VIC, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, VIC, Australia.,Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
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28
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Mohammadi A, Khatami F, Azimbeik Z, Khajavi A, Aloosh M, Aghamir SMK. Hospital-acquired infections in a tertiary hospital in Iran before and during the COVID-19 pandemic. Wien Med Wochenschr 2022; 172:220-226. [PMID: 35254565 PMCID: PMC8900468 DOI: 10.1007/s10354-022-00918-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/24/2022] [Indexed: 12/01/2022]
Abstract
Infection prevention protocols are the accepted standard to control nosocomial infections. These protective measures intensified after the coronavirus 2019 (COVID-19) pandemic to reduce the risk of viral transmission. It is the rationale that this practice reduces nosocomial infections. We evaluated the impact of these protective measures on nosocomial infections in our center with more than 20,000 records of annual patient admission. In a retrospective study, we evaluated the incidence of nosocomial infections in Sina hospital for 9 months (April–December 2020) during the COVID-19 period and compared it with the 8 months in the pre-COVID period (April–November 2019). Despite decreasing the number of admissions during the COVID era (hospitalizations showed a reduction of 43.79%), the total hospital nosocomial infections remained unchanged; 4.73% in the pre-COVID period versus 4.78% during the COVID period. During the COVID period the infection percentages increased in the cardiovascular care unit (p-value = 0.002) and intensive care units (p-value = 0.045), and declined in cardiology (p-value = 0.046) and neurology (p-value = 0.019) wards. This study showed that intensifying the infection prevention protocols is important in decreasing the nosocomial infections in some wards (cardiology and neurology). Still, we saw increased nosocomial infection in some wards, e.g., the intensive care unit (ICU) and coronary care unit (CCU). Thus, enhanced infection prevention protocols implemented in hospitals to prevent the spread of a pandemic infection may not always decrease rates of other hospital-acquired infections during a pandemic. Due to limited resources, transfer of staff, and staff shortage due to quarantine measures may prohibit improved prevention procedures from effectively controlling nosocomial infections.
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Affiliation(s)
- Abdolreza Mohammadi
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Khatami
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Azimbeik
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Khajavi
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Aloosh
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
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29
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The Impacts of COVID-19 on Healthcare Quality in Tertiary Medical Centers-A Retrospective Study on Data from Taiwan Clinical Performance Indicators System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042278. [PMID: 35206466 PMCID: PMC8871675 DOI: 10.3390/ijerph19042278] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 01/27/2023]
Abstract
To date, COVID-19 is by far the most impactful contagious disease of the 21st century and it has had a devastating effect on public health in countries around the globe. Elective medical services have declined markedly since the outbreak of the COVID-19 pandemic. Few studies have compared changes in healthcare quality before and during the outbreak of COVID-19 in Eastern Asian countries. We aimed to explore the impacts of COVID-19 on healthcare quality among medical centers in Taiwan. This was a retrospective study that collected anonymized data from the Taiwan Clinical Performance Indicator system, which was founded by the Joint Commission of Taiwan, an organization to promote, execute, and certify the nation’s healthcare quality policies. We explored quality indicators reported by more than three-quarters of medical centers in Taiwan from January 2019 to December 2020. The year 2019 was defined as the baseline period and 2020 was defined as the period after the start of the outbreak of COVID-19. Quality indicators from different regions were analyzed. Unscheduled returns of emergency patients within 72 h of their discharge, unscheduled returns of hospitalized patients within 14 days of their discharge, and unscheduled returns of surgical patients to the operating room during hospitalization all declined during the COVID-19 outbreak. Interestingly, the proportion of acute ischemic stroke patients receiving intravenous tissue-type plasminogen activator (IV-tPA) increased during outbreak of COVID-19. There were significant regional variations in healthcare quality indicators among medical centers in northern and middle/southern Taiwan. The outbreak of COVID-19 changed different patterns of healthcare systems. Although healthcare quality seemed to improve, further investigation is warranted to better understand whether those who were in need of returning to the emergency room or hospital were reluctant or were prevented from travel by the shelter-in-place policy.
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Gopal K, Krishna N, Jose R, Biju SSC, Pichandi JS, Varma PK. Effects of the COVID-19 Pandemic on Cardiac Surgery Practice and Outcomes. J Chest Surg 2022; 55:61-68. [PMID: 35115424 PMCID: PMC8824652 DOI: 10.5090/jcs.21.125] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/22/2021] [Accepted: 12/13/2021] [Indexed: 01/04/2023] Open
Abstract
Background While the coronavirus disease 2019 (COVID-19) pandemic has affected all aspects of health care, its impact on cardiac surgical practice and outcomes is yet to be determined. We compared the outcomes of our cardiac surgical practice from the past year during the pandemic to those in a similar pre-pandemic period. Methods Retrospective data were collected from 307 patients who were involved in all adult cardiac surgical procedures performed between March 2020 and February 2021, which was considered the pandemic period, at Amrita Institute of Medical Sciences, India. These were compared with data from the 1-year period between March 2019 and February 2020. During that earlier period, 491 patients underwent surgery, and the surgical outcomes were assessed. Outpatient visit data were also collected to evaluate the effect of COVID-19 on outpatient follow-up visits. Results A 37% decrease in surgical case volume was observed during the study period. No difference was found in operative mortality between the 2 time periods (3.3% vs. 2.6%, p=0.383). Overall postoperative complications were less frequent during this period, at 23% compared to 38% the previous year (p<0.001). Conclusion The COVID-19 pandemic caused a dramatic decrease in surgical volume and outpatient medical follow-up. However, the pandemic and its attendant social restrictions did not yield a significant change in the surgical outcomes of our patients. Hence, it is reasonable to continue cardiac surgical care during global health crises, and this can be done with good results.
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Affiliation(s)
- Kirun Gopal
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Center, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Neethu Krishna
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Center, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Rajesh Jose
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Center, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Surya Sree Chitra Biju
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Center, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Jaya Suriya Pichandi
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Center, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Praveen Kerala Varma
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Center, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
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König S, Pellissier V, Hohenstein S, Leiner J, Hindricks G, Meier-Hellmann A, Kuhlen R, Bollmann A. A Comparative Analysis of In-Hospital Mortality per Disease Groups in Germany Before and During the COVID-19 Pandemic From 2016 to 2020. JAMA Netw Open 2022; 5:e2148649. [PMID: 35166779 PMCID: PMC8848198 DOI: 10.1001/jamanetworkopen.2021.48649] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Throughout the ongoing SARS-CoV-2 pandemic, it has been critical to understand not only the viral disease itself but also its implications for the overall health care system. Reports about excess mortality in this regard have mostly focused on overall death counts during specific pandemic phases. OBJECTIVE To investigate hospitalization rates and compare in-hospital mortality rates with absolute mortality incidences across a broad spectrum of diseases, comparing 2020 data with those of prepandemic years. DESIGN, SETTING, AND PARTICIPANTS Retrospective, cross-sectional, multicentric analysis of administrative data from 5 821 757 inpatients admitted from January 1, 2016, to December 31, 2020, to 87 German Helios primary to tertiary care hospitals. EXPOSURES Exposure to SARS-CoV-2. MAIN OUTCOMES AND MEASURES Administrative data were analyzed from January 1, 2016, to March 31, 2021, as a consecutive sample for all inpatients. Disease groups were defined according to International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10; German modification) encoded main discharge diagnoses. Incidence rate ratios (IRRs) for hospital admissions and hospital mortality counts, as well as relative mortality risks (RMRs) comparing 2016-2019 with 2020 (exposure to the SARS-CoV-2 pandemic), were calculated with Poisson regression with log-link function. RESULTS Data were examined for 5 821 757 inpatients (mean [SD] age, 56.4 [25.3] years; 51.5% women), including 125 807 in-hospital deaths. Incidence rate ratios for hospital admissions were associated with a significant reduction for all investigated disease groups (IRR, 0.82; 95% CI, 0.79-0.86; P < .001). After adjusting for age, sex, the Elixhauser Comorbidity Index score, and SARS-CoV-2 infections, RMRs were associated with an increase in infectious diseases (RMR, 1.28; 95% CI, 1.21-1.34; P < .001), musculoskeletal diseases (RMR, 1.19; 95% CI, 1.04-1.36; P = .009), and respiratory diseases (RMR, 1.09; 95% CI, 1.05-1.14; P < .001) but not for the total cohort (RMR, 1.00; 95% CI, 0.99-1.02; P = .66). Regarding in-hospital mortality, IRR was associated with an increase within the ICD-10 chapter of respiratory diseases (IRR, 1.28; 95% CI, 1.13-1.46; P < .001) in comparing 2020 with 2016-2019, in contrast to being associated with a reduction in IRRs for the overall cohort and several other subgroups. After exclusion of patients with SARS-CoV-2 infections, IRRs were associated with a reduction in absolute in-hospital mortality for the overall cohort (IRR, 0.78; 95% CI, 0.72-0.84; P < .001) and the subgroup of respiratory diseases (IRR, 0.83; 95% CI, 0.74-0.92; P < .001). CONCLUSIONS AND RELEVANCE This cross-sectional study of inpatients from a multicentric German database suggests that absolute in-hospital mortality for 2020 across disease groups was not higher compared with previous years. Higher IRRs of in-hospital deaths observed in patients with respiratory diseases were likely associated with individuals with SARS-CoV-2 infections.
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Affiliation(s)
- Sebastian König
- Department of Electrophysiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
- Leipzig Heart Institute, Leipzig, Germany
| | | | | | | | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
- Leipzig Heart Institute, Leipzig, Germany
| | | | | | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
- Leipzig Heart Institute, Leipzig, Germany
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Gaspari R, Spinazzola G, Teofili L, Avolio AW, Fiori B, Maresca GM, Spanu T, Nicolotti N, De Pascale G, Antonelli M. Protective effect of SARS-CoV-2 preventive measures against ESKAPE and Escherichia coli infections. Eur J Clin Invest 2021; 51:e13687. [PMID: 34599600 PMCID: PMC8646464 DOI: 10.1111/eci.13687] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND/OBJECTIVES We investigated whether behavioral precautions adopted during Coronavirus disease (COVID-19) pandemic also influenced the spreading and multidrug resistance (MDR) of ESKAPEEc (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii [AB], Pseudomonas aeruginosa, Enterobacter spp and Escherichia Coli, [EC]) among Intensive Care Unit (ICU) patients. SUBJECTS/METHODS We performed a single-center retrospective study in adult patients admitted to our COVID-19-free surgical ICU. Only patients staying in ICU for more than 48 hours were included. The ESKAPEEc infections recorded during the COVID-19 period (June 1, 2020 - February 28, 2021) and in the corresponding pre-pandemic period (June 1, 2019 - February 28, 2020) were compared. An interrupted time series analysis was performed to rule out possible confounders. RESULTS Overall, 173 patients in the COVID-19 period and 132 in the pre-COVID-19 period were investigated. The ESKAPEEc infections were documented in 23 (13.3%) and 35 (26.5%) patients in the pandemic and the pre-pandemic periods, respectively (p = 0.005). Demographics, diagnosis, comorbidities, type of surgery, Simplified Acute Physiology Score II, length of mechanical ventilation, hospital and ICU length of stay, ICU death rate, and 28-day hospital mortality were similar in the two groups. In comparison with the pre-pandemic period, no AB was recorded during COVID-19 period, (p = 0.017), while extended-spectrum beta-lactamase-producing EC infections significantly decreased (p = 0.017). Overall, the ESKAPEEc isolates during pandemic less frequently exhibited multidrug-resistant (p = 0.014). CONCLUSIONS These findings suggest that a robust adherence to hygiene measures together with human contact restrictions in a COVID-19 free ICU might also restrain the transmission of ESKAPEEc pathogens.
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Affiliation(s)
- Rita Gaspari
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giorgia Spinazzola
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Luciana Teofili
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Dipartimento di Scienze radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Alfonso W Avolio
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Barbara Fiori
- Dipartimento di Scienze di laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Gian M Maresca
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Teresa Spanu
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Roma, Italy.,Dipartimento di Scienze di laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Nicola Nicolotti
- Direzione Sanitaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Gennaro De Pascale
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Massimo Antonelli
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Roma, Italy
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Chacón-Quesada T, Rohde V, von der Brelie C. Less surgical site infections in neurosurgery during COVID-19 times-one potential benefit of the pandemic? Neurosurg Rev 2021; 44:3421-3425. [PMID: 33674981 PMCID: PMC7935474 DOI: 10.1007/s10143-021-01513-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/08/2021] [Accepted: 02/22/2021] [Indexed: 01/28/2023]
Abstract
Hygiene measures were intensified when the COVID-19 pandemic began. Patient contacts were limited to a minimum. Visitors were either not allowed for a certain period or limited for the rest of the time. The hospital staff began to wear masks and gloves continuously. Clinical examinations and routine wound controls were also performed under intensified hygiene standards. These circumstances result in a limitation of direct physical interactions between the nursing staff, the physicians and the patients. We analyzed to what extent the intensification of hygiene measures affects the rate of surgical site infections (SSI) after neurosurgical procedures. The rate of SSI during the 6-month interval after the beginning of COVID-19 measures was compared with the SSI rate before. The numbers of the period before COVID-19 were analyzed as mean values resulting from the analysis of two separate time periods each consisting of 6 months. The spectrum of surgical procedures was compared. Patient-related risk factors for SSIs were noted. Microorganisms were analyzed. We focused on SSIs occurring at a maximum of 60 days after the primary surgery. Overall, in the two respective 6-month periods before COVID-19, a mean of 1379 patients was surgically treated in our institution. After the beginning of COVID-19 (starting from 04/2020) our surgical numbers dropped by 101, resulting in a total number of 1278 patients being operated after 03/2020 until 09/2020. The SSI rate was 3.6% (03/2019-09/2019, 50 SSIs) and 2.2% (09/2019-03/2020, 29 SSIs), resulting in a mean of 2.9% before COVID-19 began. After the beginning of COVID-19 hygiene measures, this rate dropped to 1.4% (16 SSIs) resembling a significant reduction (p=0.003). Risk factors for the development of SSI were present in 81.3% of all patients. Pre- and post-COVID-19 patient groups had similar baseline characteristics. The same holds true when comparing the percentage of cranial and spinal procedures pre- and post-COVID-19 (p=0.91). Comparing the numbers (p=0.28) and the species (p=0.85) of microorganisms (MO) causing SSI, we found a similar distribution. Despite equal demographics and characteristics of SSI, the rate of SSI dropped substantially. This argues for an effective reduction of postoperative SSI resulting from the implementation of strict hygiene measures being established after the beginning of the COVID-19 pandemic. We therefore advocate continuing with strict and intensive hygiene measures in the future.
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Affiliation(s)
- T Chacón-Quesada
- Department of Neurosurgery, Georg August University of Göttingen, Göttingen, Germany
| | - V Rohde
- Department of Neurosurgery, Georg August University of Göttingen, Göttingen, Germany
| | - C von der Brelie
- Department of Neurosurgery, Georg August University of Göttingen, Göttingen, Germany.
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Mitra M, Ghosh A, Pal R, Basu M. Prevention of hospital-acquired infections: A construct during Covid-19 pandemic. J Family Med Prim Care 2021; 10:3348-3354. [PMID: 34760756 PMCID: PMC8565103 DOI: 10.4103/jfmpc.jfmpc_742_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/07/2021] [Accepted: 07/10/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction: Hospital-acquired infection (HAI) rates were reported to have declined in healthcare settings during the Covid-19 pandemic. Needless to mention that HAI is of paramount interest and relevance to a primary care physician who need to care from womb to tomb inside pandemic. Objectives: This study was conducted to find the impact of Covid-19 pandemic on the four parameters of HAIs, namely, catheter-associated urinary tract infections (CAUTI), central-line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia (VAP) and surgical site infections (SSIs) with hand hygiene compliance rates among healthcare workers. Materials and Methods: This retrospective data mining was undertaken in a 700 bed multispecialty teaching hospital in the Eastern India which was a Government of Bihar approved speciality Covid Care Hospital. Data from the monthly routine infection control monitoring and surveillance activities was collated from January 2019 to December 2020. Control charts with upper and lower control limit set at mean ± 1 SD were used to monitor monthly trends of HAIs. Results: The CAUTI rates reduced by 28.01%; the CLABSI rates declined by 37.61%, the SSI rates reduced by 62.39%, while the highest VAP rates were reported in November 2019 (1.9 per 1000 ventilator days). The hand hygiene compliance rates from January 2019 to December 2020 among different healthcare staffs showed a sharply rising trend. Conclusion: Covid-19 pandemic highlighted paramount importance regarding compliance to hand hygiene and implementation of standard infection control practices as recommended by World Health Organisation and Centres for Diseases Control and Prevention (CDC), which can drastically reduce range of HAIs.
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Affiliation(s)
- Manasij Mitra
- Department of Anesthesiology, MGM Medical College and LSK Hospital, Kishanganj, Bihar, India
| | - Amrita Ghosh
- Department of Biochemistry, Medical College and Hospital, 88 College Street, Kolkata, West Bengal, India
| | - Ranabir Pal
- Department of Community Medicine, MGM Medical College and LSK Hospital, Kishanganj, Bihar, India
| | - Maitraye Basu
- Department of Biochemistry, MGM Medical College and LSK Hospital, Kishanganj, Bihar, India
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Pantvaidya G, Joshi S, Nayak P, Kannan S, DeSouza A, Poddar P, Prakash G, Vijaykumaran P, Nair D, Vaish R, Patkar S, Niyogi D, Joshi P, Chaudhari V, Singh V, Mathews S, Pramesh CS, Badwe RA, Puri A. Surgical Site Infections in patients undergoing major oncological surgery during the COVID-19 paNdemic (SCION): A propensity-matched analysis. J Surg Oncol 2021; 125:327-335. [PMID: 34729779 PMCID: PMC8661874 DOI: 10.1002/jso.26738] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 10/23/2021] [Indexed: 11/10/2022]
Abstract
Background and Objectives There are reports of outcomes of elective major cancer surgery during the COVID‐19 pandemic. We evaluated if reinforcement of hand hygiene, universal masking, and distancing as a part of pandemic precautions led to a decrease in the incidence of surgical site infections (SSIs) in major oncologic resections. Methods Propensity score matching using the nearest neighbor algorithm was performed on 3123 patients over seven covariates (age, comorbidities, surgery duration, prior treatment, disease stage, reconstruction, and surgical wound type) yielding 2614 matched (pre‐COVID 1612 and COVID 1002) patients. Conditional logistic regression was used to identify if SSI incidence was lower amongst patients operated during the pandemic. Results There was a 4.2% (p = 0.006) decrease in SSI in patients operated during the pandemic. On multivariate regression, surgery during the COVID‐19 period (odds ratio [OR] = 0.77; 95% confidence interval [CI] = 0.61–0.98; p = 0.03), prior chemoradiation (OR = 2.46; CI = 1.45–4.17; p < 0.001), duration of surgery >4 h (OR = 2.17; 95%CI = 1.55–3.05; p < 0.001) and clean contaminated wounds (OR = 2.50; 95% CI = 1.09–2.18; p = 0.012) were significantly associated with SSI. Conclusion Increased compliance with hand hygiene, near‐universal mask usage, and social distancing during the COVID‐19 pandemic possibly led to a 23% decreased odds of SSI in major oncologic resections. Extending these low‐cost interventions in the post‐pandemic era can decrease morbidity associated with SSI in cancer surgery.
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Affiliation(s)
- Gouri Pantvaidya
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Shalaka Joshi
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Prakash Nayak
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Sadhana Kannan
- Clinical Research Secreteriat, Advanced Centre for Treatment, Research and Education in Cancer, Mumbai, India
| | - Ashwin DeSouza
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Pabashi Poddar
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Gagan Prakash
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Preeti Vijaykumaran
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Deepa Nair
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Richa Vaish
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Shraddha Patkar
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Devayani Niyogi
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Poonam Joshi
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Vikram Chaudhari
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Vikas Singh
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Saumya Mathews
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - C S Pramesh
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Rajendra A Badwe
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Ajay Puri
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
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Risk of surgical site infection in hand trauma, and the impact of the SARS-CoV-2 pandemic: A cohort study. J Plast Reconstr Aesthet Surg 2021; 74:3080-3086. [PMID: 34303636 PMCID: PMC8259108 DOI: 10.1016/j.bjps.2021.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/27/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Despite the ubiquity of hand trauma, there remains insufficient published data to reliably inform these patients of surgical site infection (SSI) risk. We describe the risk of SSI in a single-centre cohort of patients with hand trauma, with an analysis of the impact of the coronavirus disease-2019 (COVID-19) pandemic. METHODS Retrospective data collection of consecutive patients who underwent surgery for hand and wrist trauma in a single plastic surgery centre over two, three-month periods. Demographic, injury and operative details, alongside prophylactic antibiotic use, were recorded. Burn injuries and wounds infected at presentation were excluded. Presence of SSI at 30 days (90 days if a surgical implant was used) was assessed. RESULTS Overall, 556 patients - 'Pre-COVID-19' (n = 310) and 'During COVID-19' (n = 246) - were included. Risk of SSI was 3.6% in the aggregated cohort. Female patients were more likely to develop an SSI, even when adjusted for their greater prevalence of bite aetiologies (adj OR 2.5; 95% CI, 1.00-6.37 and p < 0.05). The absolute risk of SSI in the 'Pre-COVID-19' group was 2.3% and 5.3% in the 'During COVID-19' group. The relative risk of developing an SSI in the 'During COVID-19' group was 2.34 (95% CI, 0.95-5.78 and p = 0.06). Baseline characteristics were equivalent between the two groups. CONCLUSION The risk of SSI in hand trauma is the same as the nationally estimated risk for all surgeries; 3-5%. Changes in presentation and practice associated with the first wave of the COVID-19 pandemic did not appear to alter the risk of SSI in patients undergoing surgery for hand trauma.
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Unterfrauner I, Hruby LA, Jans P, Steinwender L, Farshad M, Uçkay I. Impact of a total lockdown for pandemic SARS-CoV-2 (Covid-19) on deep surgical site infections and other complications after orthopedic surgery: a retrospective analysis. Antimicrob Resist Infect Control 2021; 10:112. [PMID: 34332632 PMCID: PMC8325206 DOI: 10.1186/s13756-021-00982-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/16/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND A total lockdown for pandemic SARS-CoV-2 (Covid-19) entailed a restriction of elective orthopedic surgeries in Switzerland. While access to the hospital and human contacts were limited, hygiene measures were intensified. The objective was to investigate the impact of those strict public health guidelines on the rate of intra-hospital, deep surgical site infections (SSI), wound healing disorders and non-infectious postoperative complications after orthopedic surgery during the first Covid-19 lockdown. METHODS In a single-center study, patients with orthopedic surgery during the first Covid-19 lockdown from March 16, 2020 to April 26, 2020 were compared to cohorts that underwent orthopedic intervention in the pre- and post-lockdown periods of six months each. Besides the implementation of substantial public health measures (promotion of respiratory etiquette and hand hygiene), no additional infection control bundles have been implemented. RESULTS 5791 patients were included in this study. In multivariate Cox regression analyses adjusting for the large case-mix, the lockdown was unrelated to SSI (hazard ratio (HR) 1.6; 95% confidence interval (CI) 0.6-4.8), wound healing disorders (HR 0.7; 95% CI 0.1-5.7) or other non-infectious postoperative complications (HR 0.7, 95% CI 0.3-1.5) after a median follow-up of seven months. CONCLUSION The risks for SSI, wound healing disorders and other complications in orthopedic surgery were not influenced by the extended public health measures of the total Covid-19 lockdown. Trial registration BASEC 2020-02646 (Cantonal Ethics Commission Zurich). LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Ines Unterfrauner
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
- Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Laura A. Hruby
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Peter Jans
- Medical Informatics Service, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Ludwig Steinwender
- Infection Control, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Ilker Uçkay
- Infection Control, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
- Unit of Clinical and Applied Research, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
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38
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Tavanaei R, Ahmadi P, Yazdani KO, Zali A, Oraee-Yazdani S. The Impact of the Coronavirus Disease 2019 Pandemic on Neurosurgical Practice and Feasibility of Safe Resumption of Elective Procedures During this Era in a Large Referral Center in Tehran, Iran: An Unmatched Case-Control Study. World Neurosurg 2021; 154:e370-e381. [PMID: 34284156 PMCID: PMC8285939 DOI: 10.1016/j.wneu.2021.07.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/09/2021] [Indexed: 12/23/2022]
Abstract
Objective The coronavirus disease 2019 (COVID-19) pandemic has considerably affected surgical practice. The present study aimed to investigate the effects of the pandemic on neurosurgical practice and the safety of the resumption of elective procedures through implementing screening protocols in a high-volume academic public center in Iran, as one of the countries severely affected by the pandemic. Methods This unmatched case-control study compared 2 populations of patients who underwent neurosurgical procedures between June 1, 2019 and September 1, 2019 and the same period in 2020. In the prospective part of the study, patients who underwent elective procedures were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection postoperatively to evaluate the viability of our screening protocol. Results Elective and emergency procedures showed significant reduction during the pandemic (59.4%, n = 168 vs. 71.3%, n = 380) and increase (28.7%, n = 153 vs. 40.6%, n = 115, respectively; P = 0.003). The proportional distribution of neurosurgical categories remained unchanged during the pandemic. Poisson regression showed that the reduction in total daily admissions and some categories, including spine, trauma, oncology, and infection were significantly correlated with the pandemic. Among patients who underwent elective procedures, 0 (0.0%) and 26 (16.25%) had positive test results on days 30 and 60 postoperatively, respectively. Overall mortality was comparable between the pre–COVID-19 and COVID-19 periods, yet patients with concurrent SARS-CoV-2 infection showed substantially higher mortality (65%). Conclusions By implementing safety and screening protocols with proper resource allocation, the emergency care capacity can be maintained and the risk minimized of hospital-acquired SARS-CoV-2 infection, complications, and mortality among neurosurgical patients during the pandemic. Similarly, for elective procedures, according to available resources, hospital beds can be allocated for patients with a higher risk of delayed hospitalization and those who are concerned about the risk of hospital-acquired infection can be reassured.
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Affiliation(s)
- Roozbeh Tavanaei
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pooria Ahmadi
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kaveh Oraii Yazdani
- Department of Cardiovascular Diseases, Zahedan University of Medical Science, Zahedan, Iran
| | - Alireza Zali
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Oraee-Yazdani
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Advantages of, and Adaptations to, Enhanced Recovery Protocols for Perioperative Care during the COVID-19 Pandemic. J Minim Invasive Gynecol 2020; 28:481-489. [PMID: 33359742 PMCID: PMC7833787 DOI: 10.1016/j.jmig.2020.12.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 11/20/2022]
Abstract
Objective This review formulates the rationale for using enhanced recovery protocols (ERPs) to standardize and optimize perioperative care during this high-risk time to minimize poor outcomes owing to provider, patient, and system vulnerabilities. Data Sources n/a Methods of Study Selection A literature review using key Medical Subject Headings terms was performed—according to methods described by the Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines—on studies that described enhanced recovery and coronavirus disease (COVID-19). Tabulation, Integration, and Results Modifications to our existing ERPs related to the COVID-19 pandemic should include new accommodations for patient education, preoperative COVID-19 testing, prehabilitation, and intraoperative infection as well as thromboembolism risk reduction. Conclusion ERPs are evidence-based, best practice guidelines applied across the perioperative continuum to mitigate surgical stress, decrease complications, and accelerate recovery. These benefits are part of the high-value–care equation needed to solve the clinical, operational, and financial challenges of the current COVID-19 pandemic. The factors driving outcomes on ERPs, such as the provision of minimally invasive surgery, warrant careful consideration. Tracking patient outcomes and improving care in response to outcomes data are key to the success of clinical care protocols such as ERPs. Numerous emerging clinical registries and reporting systems have been activated to provide outcomes data on the impact of COVID-19. This will inform and change surgical practice as well as provide opportunity to learn if the advantages that surgeons, patients, and the healthcare system might gain from using ERPs during a pandemic are meaningful.
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