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Muller-Sloof E, de Laat E, Zwanenburg P, Wijlens A, Vermeulen H, Hummelink S, Ulrich D. Exploring the definition of surgical wound dehiscence in literature: A scoping. J Tissue Viability 2024:S0965-206X(24)00142-6. [PMID: 39341772 DOI: 10.1016/j.jtv.2024.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 09/02/2024] [Accepted: 09/20/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND Surgical wound dehiscence (SWD) is interpreted differently amongst healthcare professionals due to a lack of uniformity in definitions in literature. Inconsistent defining impedes accurate diagnosis, appropriate care, intercollegiate consultation, and benchmarking. Despite the introduction of a consensus-driven definition by the World Union of Wound Healing Societies (WUWHS) in 2018, its application in literature and clinical practice remains unclear. A OBJECTIVES This scoping review aims to systematically explore the literature to identify existing SWD definitions, provide an overview, identify knowledge gaps, and extract articles that reference the WUWHS definition. METHODS This review was performed in accordance with the PRISMA-ScR guidelines and Joanna Briggs Institute Methodology for Scoping Reviews. A systematic literature search was performed through MEDLINE, EMBASE, Cochrane Library and Google Scholar. Eligibility screening and data extraction were independently performed by two researchers. RESULTS This study included 34 articles: 28 systematic reviews, two randomized clinical trials, three retrospective studies, and one book chapter. SWD was defined in different ways, such as "breakdown/disruption of the surgical wound" (n = 17), "separation/splitting apart of the wound edges" (n = 13), "gaping/re-opened wound" (n = 7), mechanical failure (n = 2), or infection (n = 1). Other studies defined SWD in relation to its depth (skin layers involved) or length over the incision, both complete and partial (n = 9). One study referenced the WUWHS definition. CONCLUSION Existing literature demonstrates a substantial variety in defining SWD, and little adoption of the WUWHS definition following its introduction in 2018. Uniform use of the definition should be considered as this will improve the quality of care.
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Affiliation(s)
- Emmy Muller-Sloof
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, P/O Box 9101, 6500 HB, Nijmegen (634), the Netherlands; Department of Vascular Surgery, Erasmus University Medical Center, Dr. Molenwaterplein 40, 3015 GD, Rotterdam (Rg219), the Netherlands.
| | - Erik de Laat
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, P/O Box 9101, 6500 HB, Nijmegen (634), the Netherlands.
| | - Pieter Zwanenburg
- Department of Ophthalmology, Rotterdam Eye Hospital, P/O Box 70030, 3000 LM, Rotterdam, the Netherlands.
| | - Anke Wijlens
- Spoedzorg Huisartsen Twente - Twentse Huisartsen Onderneming Oost Nederland, P/O Box 570, 7550 AN, Hengelo, the Netherlands.
| | - Hester Vermeulen
- Radboud Institute for Health Sciences Scientific Center for Quality of Healthcare, Radboud University Medical Center, P/O Box 9101, 6500 HB, Nijmegen, the Netherlands; HAN University Applied Sciences, Institute of Health, Kapittelweg 54, 6525 EP, Nijmegen, the Netherlands.
| | - Stefan Hummelink
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, P/O Box 9101, 6500 HB, Nijmegen (634), the Netherlands.
| | - Dietmar Ulrich
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, P/O Box 9101, 6500 HB, Nijmegen (634), the Netherlands.
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Muller-Sloof E, de Laat E, Baljé-Volkers C, Hummelink S, Vermeulen H, Ulrich D. Inter-rater reliability among healthcare professionals in assessing postoperative wound photos for the presence or absence of surgical wound dehiscence: A Pretest - Posttest study. J Tissue Viability 2024:S0965-206X(24)00106-2. [PMID: 38991899 DOI: 10.1016/j.jtv.2024.07.001] [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: 12/04/2023] [Revised: 06/18/2024] [Accepted: 07/05/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Surgical wound dehiscence (SWD) has various definitions, which complicates accurate and uniform diagnosis. To address this, the World Union Wound Healing Societies (WUWHS) presented a consensus based definition and classification for SWD (2018). AIM This quasi-experimental pretest-posttest study investigates the inter-rater reliability among healthcare professionals (HCP) and wound care professionals (WCP) when assessing wound photos on the presence or absence of SWD before and after training on the WUWHS-definition. METHODS Wound expert teams compiled a set of twenty photos (SWD+: nineteen, SWD-: one), and a video training. Subsequently, 262 healthcare professionals received the pretest link to assess wound photos. After completion, participants received the posttest link, including a (video) training on the WUWHS-definition, and reassessment of fourteen photos (SWD+: thirteen, SWD-: one). PRIMARY OUTCOMES 1) pretest-posttest inter-rater-reliability among participants in assessing photos in congruence with the WUWHS-definition 2) the impact of training on assessment scores. SECONDARY OUTCOME familiarity with the WUWHS-definition. RESULTS One hundred thirty-one participants (65 HCPs, 66 WCPs) completed both tests. The posttest inter-rater reliability among participants for correctly identifying SWD was increased from 67.6 % to 76.2 %, reaching statistical significance (p-value: 0.001; 95 % Confidence Interval [1.8-2.2]). Sub-analyses per photo showed improved SWD posttest scores in thirteen photos, while statistical significance was reached in seven photos. Thirty-three percent of participants knew the WUWHS-definition. CONCLUSION The inter-rater reliability among participants increases after training on the WUWHS-definition. The definition provides diagnostic criteria for accurate SWD diagnosis. Widespread use of the definition may improve uniformity in care for patients with SWD.
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Affiliation(s)
- Emmy Muller-Sloof
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, P/O Box 9101, 6500 HB, Nijmegen, (634), the Netherlands.
| | - Erik de Laat
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, P/O Box 9101, 6500 HB, Nijmegen, (634), the Netherlands.
| | | | - Stefan Hummelink
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, P/O Box 9101, 6500 HB, Nijmegen, (634), the Netherlands.
| | - Hester Vermeulen
- Radboud Institute for Health Sciences Scientific Center for Quality of Healthcare, Radboud University Medical Center, P/O Box 9101, 6500 HB, Nijmegen, the Netherlands; HAN University Applied Sciences, Institute of Health, Kapittelweg 54, 6525 EP, Nijmegen, the Netherlands.
| | - Dietmar Ulrich
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, P/O Box 9101, 6500 HB, Nijmegen, (634), the Netherlands.
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Edwards M, Graziadio S, Shore J, Schmitz ND, Galvain T, Danker WA, Kocaman M, Pournaras DJ, Bowley DM, Hardy KJ. Plus Sutures for preventing surgical site infection: a systematic review of clinical outcomes with economic and environmental models. BMC Surg 2023; 23:300. [PMID: 37789307 PMCID: PMC10548560 DOI: 10.1186/s12893-023-02187-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 09/07/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Surgical site infections (SSIs) represent ~ 20% of all hospital-acquired infections in surgical patients and are associated with prolonged hospital stay, admission to intensive care, and mortality. We conducted a systematic review with economic and environmental models to assess whether triclosan-coated sutures (Plus Sutures) provide benefits over non-coated sutures in the reduction of SSI risk. METHODS Searches were conducted in fifteen databases. A total of 1,991 records were retrieved. Following deduplication and screening by two independent reviewers, 31 randomized controlled trials in adults and children were included in the review. Similarity of the studies was assessed by narrative review and confirmed by quantitative assessment. A fixed effects meta-analysis of SSI incidence model including all groups of patients estimated a risk ratio of 0.71 (95% confidence interval: 0.64 to 0.79) indicating those in the Plus Sutures group had a 29% reduction in the risk of developing an SSI compared with those in the control group (p < 0.001). Safety outcomes were analysed qualitatively. RESULTS The economic model estimated the use of Plus Sutures to result in average cost savings of £13.63 per patient. Plus Sutures remained cost-saving in all subgroup analyses with cost-savings ranging between £11 (clean wounds) and £140 (non-clean wounds). The environmental impact of SSI is substantial, and the model suggests that the introduction of Plus Sutures could result in potential environmental benefits. CONCLUSIONS The evidence suggests that Plus Sutures are associated with a reduced incidence of SSI across all surgery types alongside cost savings when compared with standard sutures.
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Affiliation(s)
- M Edwards
- York Health Economics Consortium, University of York, Enterprise House, Innovation Way, York, YO10 5NQ, UK.
| | - S Graziadio
- York Health Economics Consortium, University of York, Enterprise House, Innovation Way, York, YO10 5NQ, UK
| | - J Shore
- York Health Economics Consortium, University of York, Enterprise House, Innovation Way, York, YO10 5NQ, UK
| | - N D Schmitz
- Johnson & Johnson MEDICAL GmbH, Robert-Koch-Strasse 1, 22851, Norderstedt, Germany
| | - T Galvain
- Global Health Economics, Johnson & Johnson Medical Devices, New Brunswick, NJ, USA
| | - W A Danker
- Ethicon Inc., 1000 US-202, Raritan, NJ, 08869, USA
| | - M Kocaman
- Johnson & Johnson Medical Limited, Berkshire, UK
| | - D J Pournaras
- Department of Bariatric and Metabolic Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - D M Bowley
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK
| | - K J Hardy
- Derbyshire Pathology, University Hospitals Derby and Burton NHS Trust, Royal Derby Hospital, Derby, UK
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Nicolazzo D, Rusin E, Varese A, Galassi M. Negative Pressure Wound Therapy and Traditional Dressing: An Italian Health Technology Assessment Evaluation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20032400. [PMID: 36767767 PMCID: PMC9915998 DOI: 10.3390/ijerph20032400] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/13/2023] [Accepted: 01/21/2023] [Indexed: 05/27/2023]
Abstract
This evaluation shows the main advantages related to the introduction of negative pressure wound therapy (NPWT) in Italian clinical practice for the management of incisions in vascular surgery in patients suffering from peripheral arterial disease (PAD) and at risk of postoperative complications, compared to treatment with traditional dressings. A health technology assessment (HTA) activity was conducted assuming the hospital perspective, within a 12-month time horizon. The nine EUnetHTA Core Model dimensions were deeply explored, using scientific evidence on the topic, real-life data, and healthcare professionals' perceptions. The evaluation shows that the use of NPWT has had a positive impact in terms of higher clinical effectiveness and safety profile. The process mapping highlights how NPWT allows a reduction of 2.5 hospitalization days compared with standard dressing, with the consequent benefits considering economic, organizational, and social aspects. A significant economic saving per patient emerged, with an overall optimization of the patient's clinical pathway, impacting positively on the hospital's capacity. The budget impact analysis shows that the higher number of patients treated with NPWT, the higher the economic advantages. Furthermore, assuming the patient's perspective, it would generate an overall reduction in social costs of 28%. In conclusion, the results of this study provide helpful evidence-based information to policymakers through examinations of the relative values of intervention, thus supporting the overall hospital and institutional decision-making process to define appropriate areas of investments, leading to the achievement of not only higher clinical outcomes, but also important social, economic, and organizational advantages.
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Affiliation(s)
| | | | - Alessandra Varese
- A.O.U Città dalla Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Margherita Galassi
- Istituto Nazionale per lo Studio e la Cura dei Tumori, 20133 Milan, Italy
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Gillani SW, Vippadapu P, Gulam SM. Physician-reported barriers and challenges to antibiotic prescribing in surgical prophylaxis: a structured systematic review. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmab022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Abstract
Objectives
The purpose of the study is to identify and analyse the barriers in surgical procedures where antibiotic dissipation is habitual.
Methods
Extensive literature search is carried out using different electronic databases (PubMed, Europe PMC, PLoS and Google Scholar) between January 2000 and December 2020. The articles were selected purely based on the inclusion criteria. Only qualitative and cross-sectional studies were selected to reduce the risk of bias. The JBI and AXIS checklists were used to assessed the quality of the enrolled articles. Data extractions were done by using a predesigned standardized data collection form.
Key findings
A total of 2067 articles were electronically retrieved but only 14 articles met the eligibility criteria. About 15 902 healthcare professionals (HCPs) with an average response rate of 64.7% were pooled for evidence synthesis. The majority of respondents (50%) discussed different barriers in their practice site for surgical antibiotic prophylaxis (SAP) administration. Barriers were categorized into four themes: lack of guideline availability and knowledge, lack of adherence to guidelines, lack of guideline knowledge and adherence and physician perceptions or off-label practices. A total of 723 (56.3%) out of 1282 HCPs from nine different studies reported a lack of adherence to guidelines during the perioperative process. The majority of respondents in three studies, 318 (82%) out of 386 HCPs, reported that physicians’ perceptions play a crucial role in prescribing SAP during surgeries.
Conclusion
This study concluded that the barriers within the practice site play a decisive role in SAP optimization and therefore all HCPs are recommended to maintain local/standard guidelines and adhere to them while prescribing SAP.
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Affiliation(s)
- Syed Wasif Gillani
- Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University, Ajman, UAE
| | - Prasanna Vippadapu
- Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University, Ajman, UAE
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Bekiari A, Pappas-Gogos G, Dimopoulos D, Priavali E, Gartzonika K, Glantzounis GK. Surgical site infection in a Greek general surgery department: who is at most risk? J Wound Care 2021; 30:268-274. [PMID: 33856911 DOI: 10.12968/jowc.2021.30.4.268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Surgical site infections (SSIs) are associated with protracted hospitalisation, antibiotics administration, and increased morbidity and mortality. This work investigated the incidence rate of SSIs in the Department of General Surgery at the University Hospital of Ioannina, Greece, the associated risk factors and pathogens responsible. METHOD In this prospective cohort study, patients who underwent elective procedures under general anaesthesia were enrolled. Risk factors monitored included age, sex, body mass index, smoking, alcohol consumption, preoperative length of stay, chemoprophylaxis, intensive care unit (ICU) stay, American Society of Anesthesiology (ASA) score, and the National Nosocomial Infections Surveillance System (NNIS) basic SSI risk index. RESULTS Of the 1058 enrolled patients, 80 (7.6%) developed SSIs. Of the total cohort, 62.5% of patients received chemoprophylaxis for >24 hours. A total of 20 different pathogens, each with multiple strains (n=108 in total), were identified, 53 (49.5%) Gram-negative rods, 46 (42%) Gram-positive cocci, and nine (8.4%) fungi (Candida spp.). Escherichia coli was the prevalent microorganism (24.3%). SSI-related risk factors, as defined by univariate analysis, included: ICU stay, ASA score >2 (p<0.001), NNIS score >0, and wound classes II, III, and IV. Also, serum albumin levels <3.5g/dl were associated with increased rate of SSIs. The multivariate model identified an NNIS score of >0 and wound classes II, III, and IV as independent SSI-related risk factors. CONCLUSION This study showed high SSI rates. Several factors were associated with increased SSI rates, as well as overuse of prophylactic antibiotics. The results of the present study could be a starting point for the introduction of a system for recording and actively monitoring SSIs in Greek hospitals, and implementation of specific guidelines according to risk factors.
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Affiliation(s)
- Anna Bekiari
- Department of Surgery, University Hospital of Ioannina and School of Medicine, University of Ioannina, Greece
| | - George Pappas-Gogos
- Department of Surgery, University Hospital of Ioannina and School of Medicine, University of Ioannina, Greece
| | - Dimitrios Dimopoulos
- Department of Medical Physics, School of Medicine, University of Ioannina, Greece
| | - Efthalia Priavali
- Department of Microbiology, University Hospital of Ioannina and School of Medicine, University of Ioannina, Greece
| | - Konstantina Gartzonika
- Department of Microbiology, University Hospital of Ioannina and School of Medicine, University of Ioannina, Greece
| | - Georgios K Glantzounis
- Department of Surgery, University Hospital of Ioannina and School of Medicine, University of Ioannina, Greece
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Barker CJ, Marriot A, Khan M, Oswald T, Tingle SJ, Partington PF, Carluke I, Reed MR. Hip aspiration culture: analysing data from a single operator series investigating periprosthetic joint infection. J Bone Jt Infect 2021; 6:165-170. [PMID: 34084706 PMCID: PMC8137858 DOI: 10.5194/jbji-6-165-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 04/09/2021] [Indexed: 01/29/2023] Open
Abstract
Introduction:
We undertook this study to know the sensitivity, specificity and post-test
probabilities of hip aspiration when diagnosing periprosthetic hip infections. We also examined “dry tap” (injection with saline and
aspiration) results and aspiration volumes.
Methods:
This is a retrospective cohort study of patients aspirated for suspected
periprosthetic joint infection between July 2012 and October 2016. All aspirations were carried out by one trained surgical care practitioner
(SCP). All aspirations followed an aseptic technique and fluoroscopic guidance. Aspiration was compared to tissue biopsy taken at revision.
Aspiration volumes were analysed for comparison.
Results:
Between January 2012 and September 2016, 461 hip aspirations were performed
by our SCP. Of these 125 progressed to revision. We calculated sensitivity
59 % (confidence interval (CI) 35 %–82 %) and specificity 94 % (CI
89 %–98 %). Pre-test probability for our cohort was 0.14. Positive post-test
probability was 0.59 and negative post-test probability 0.06. Aspiration
volume for infected (n=17) and non-infected (n=108) joints was compared
and showed no significant difference. Dry taps were experienced five times; in each instance the dry tap agreed with the biopsy result.
Conclusions:
Our data show that hip aspiration culture is a highly specific investigation
for diagnosing infection but that it is not sensitive. Aspiration volume
showed no significant difference between infected and non-infected groups.
Each time a joint was infiltrated with saline to achieve a result, the result matched tissue sampling.
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Affiliation(s)
| | - Alan Marriot
- Northumbria Healthcare NHS Foundation Trust, Cramlington, NE23 6NZ, UK
| | - Munir Khan
- Northumbria Healthcare NHS Foundation trust, Cramlington, NE23 6NZ, UK
| | - Tamsin Oswald
- Northumbria Healthcare NHS Foundation Trust, Cramlington, NE23 6NZ, UK
| | - Samuel J Tingle
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK
| | - Paul F Partington
- Northumbria Healthcare NHS Foundation Trust, Cramlington, NE23 6NZ, UK
| | - Ian Carluke
- Northumbria Healthcare NHS Foundation Trust, Cramlington, NE23 6NZ, UK
| | - Mike R Reed
- Northumbria Healthcare NHS Foundation Trust, Cramlington, NE23 6NZ, UK
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Craxford S, Marson BA, Oderuth E, Nightingale J, Agrawal Y, Ollivere B. Methicillin-resistant Staphylococcus aureus in hip fracture. Bone Joint J 2021; 103-B:170-177. [PMID: 33380201 DOI: 10.1302/0301-620x.103b1.bjj-2020-0659.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Infection after surgery increases treatment costs and is associated with increased mortality. Hip fracture patients have historically had high rates of methicillin-resistant Staphylococcus aureus (MRSA) colonization and surgical site infection (SSI). This paper reports the impact of routine MRSA screening and the "cleanyourhands" campaign on rates of MRSA SSI and patient outcome. METHODS A total of 13,503 patients who presented with a hip fracture over 17 years formed the study population. Multivariable logistic regression was performed to determine risk factors for MRSA and SSI. Autoregressive integrated moving average (ARIMA) modelling adjusted for temporal trends in rates of MRSA. Kaplan-Meier estimators were generated to assess for changes in mortality. RESULTS In all, 6,189 patients were identified before the introduction of screening and 7,314 in the post-screening cohort. MRSA infection fell from 69 cases to 15 in the post-screening cohort (p < 0.001). The ARIMA confirmed a significant reduction in MRSA SSI post-screening (p = 0.043) but no significant impact after hand hygiene alone (p = 0.121). Overall SSI fell (2.4% to 1.5%), however deep infection increased slightly (0.89% to 1.06%). ARIMA showed neither intervention affected overall SSI ("cleanyourhands" -0.172% (95% confidence interval (CI) -0.39% to 0.21); p = 0.122, screening -0.113% per year, (95% CI -0.34 to 0.12); p = 0.373). One-year mortality after deep SSI was unchanged after screening (50% vs 45%; p = 0.415). Only warfarinization (OR 3.616 (95% CI 1.366 to 9.569); p = 0.010) and screening (OR 0.189 (95% CI 0.086 to 0.414); p < 0.001) were significant covariables for developing MRSA SSI. CONCLUSION While screening and decolonization may reduce MRSA-associated SSI, the benefit to patient outcome remains unclear. Overall deep SSI remains an unsolved problem that has seen little improvement over time. Preventing other hospital-associated infections should not be forgotten in the fight against MRSA. Cite this article: Bone Joint J 2021;103-B(1):170-177.
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Copanitsanou P, Santy-Tomlinson J. The nurses' role in the diagnosis and surveillance of orthopaedic surgical site infections. Int J Orthop Trauma Nurs 2020; 41:100818. [PMID: 33339751 DOI: 10.1016/j.ijotn.2020.100818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Aktuerk D, Ali J, Badran A, Balmforth D, Bleetman D, Brown C, Suelo-Calanao R, Cartwright J, Casey L, Chiwera L, Fudulu D, Garner M, Gradinariu G, Harky A, Hussain A, Hutton S, Kew E, Loubani M, Mani K, Martin J, Rochon M, Moawad N, Mohamed S, Muretti M, Murphy G, Olivieri G, Paglinawan I, Quijano-Campos J, Rizzo V, Robertson S, Rogers L, Roman M, Salmon K, Sanders J, Talukder S, Tanner J, Vaja R, Zientara A, Green S, Miles R, Lamagni T, Harrington P. National survey of variations in practice in the prevention of surgical site infections in adult cardiac surgery, United Kingdom and Republic of Ireland. J Hosp Infect 2020; 106:812-819. [DOI: 10.1016/j.jhin.2020.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/11/2020] [Indexed: 11/25/2022]
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Masters J, Metcalfe D, Ha JS, Judge A, Costa ML. Surgical site infection after hip fracture surgery: a systematic review and meta-analysis of studies published in the UK. Bone Joint Res 2020; 9:554-562. [PMID: 32922764 PMCID: PMC7469514 DOI: 10.1302/2046-3758.99.bjr-2020-0023.r1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aims This study explores the reported rate of surgical site infection (SSI) after hip fracture surgery in published studies concerning patients treated in the UK. Methods Studies were included if they reported on SSI after any type of surgical treatment for hip fracture. Each study required a minimum of 30 days follow-up and 100 patients. Meta-analysis was undertaken using a random effects model. Heterogeneity was expressed using the I2 statistic. Risk of bias was assessed using a modified Newcastle-Ottawa Scale (NOS) system. Results There were 20 studies reporting data from 88,615 patients. Most were retrospective cohort studies from single centres. The pooled incidence was 2.1% (95% confidence interval (CI) 1.54% to 2.62%) across ‘all types’ of hip fracture surgery. When analyzed by operation type, the SSI incidences were: hemiarthroplasty 2.87% (95% CI 1.99% to 3.75%) and sliding hip screw 1.35% (95% CI 0.78% to 1.93%). There was considerable variation in definition of infection used, as well as considerable risk of bias, particularly as few studies actively screened participants for SSI. Conclusion Synthesis of published estimates of infection yield a rate higher than that seen in national surveillance procedures. Biases noted in all studies would trend towards an underestimate, largely due to inadequate follow-up.
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Affiliation(s)
- James Masters
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David Metcalfe
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Joon Soo Ha
- The Royal College of Surgeons of England, London, UK
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew L Costa
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Pagamisse AF, Tanner J, Poveda VDB. Post-discharge surveillance of surgical site infections in teaching hospitals in Brazil. Rev Esc Enferm USP 2020; 54:e03542. [PMID: 32187309 DOI: 10.1590/s1980-220x2018038203542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 04/11/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Understanding the reality of surgical site infections post-discharge surveillance in Brazilian teaching hospitals. METHOD A cross-sectional study conducted by sending an online questionnaire to nurses from the Hospital Infection Control Committee of Brazilian teaching hospitals registered in the National Registry of Health Establishments. RESULTS Of the 193 teaching hospitals in Brazil, eight declined to take part as they did not conduct post-discharge surveillance and 36 did not respond. Twenty five of the remaining 149 hospitals provided detailed responses and 96% of responding institutions performed surgical site infection surveillance during hospitalization; active search (29.3%) was the main method, while 84% reported performing post-discharge surveillance mainly by telephone (42.8%). Both surveillance actions have nurses as the main responsible professionals. CONCLUSION Nurses play a prominent role in surgical site infection identification/screening actions, and active search during hospitalization allied with post-discharge surveillance by telephone were the preferred methods.
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Affiliation(s)
| | - Judith Tanner
- School of Nursing, University of Nottingham, Nottingham, United Kingdom
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Leaper D, Rochon M, Pinkney T, Edmiston CE. Guidelines for the prevention of surgical site infection: an update from NICE. Infect Prev Pract 2019; 1:100026. [PMID: 34368683 PMCID: PMC8336317 DOI: 10.1016/j.infpip.2019.100026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/11/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- David Leaper
- Department of Surgery, University of Newcastle upon Tyne, Department of Clinical Sciences, University of Huddersfield, UK
- Corresponding author.
| | - Melissa Rochon
- Quality & Safety Lead for Surveillance, Royal Brompton & Harefield NHS FT, UK
| | - Thomas Pinkney
- George Drexler & Royal College of Surgeons, University of Birmingham, University Hospitals Birmingham, UK
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Iskandar K, Sartelli M, Tabbal M, Ansaloni L, Baiocchi GL, Catena F, Coccolini F, Haque M, Labricciosa FM, Moghabghab A, Pagani L, Hanna PA, Roques C, Salameh P, Molinier L. Highlighting the gaps in quantifying the economic burden of surgical site infections associated with antimicrobial-resistant bacteria. World J Emerg Surg 2019; 14:50. [PMID: 31832084 PMCID: PMC6868735 DOI: 10.1186/s13017-019-0266-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/20/2019] [Indexed: 12/14/2022] Open
Abstract
Antibiotics are the pillar of surgery from prophylaxis to treatment; any failure is potentially a leading cause for increased morbidity and mortality. Robust data on the burden of SSI especially those due to antimicrobial resistance (AMR) show variable rates between countries and geographical regions but accurate estimates of the incidence of surgical site infections (SSI) due to AMR and its related global economic impact are yet to be determined. Quantifying the burden of SSI treatment is an incentive to sensitize governments, healthcare systems, and the society to invest in quality improvement and sustainable development. However in the absence of a unified epidemiologically sound infection definition of SSI and a well-designed global surveillance system, the end result is a lack of accurate and reliable data that limits the comparability of estimates between countries and the possibility of tracking changes to inform healthcare professionals about the appropriateness of implemented infection prevention and control strategies. This review aims to highlight the reported gaps in surveillance methods, epidemiologic data, and evidence-based SSI prevention practices and in the methodologies undertaken for the evaluation of the economic burden of SSI associated with AMR bacteria. If efforts to tackle this problem are taken in isolation without a global alliance and data is still lacking generalizability and comparability, we may see the future as a race between the global research efforts for the advancement in surgery and the global alarming reports of the increased incidence of antimicrobial-resistant pathogens threatening to undermine any achievement.
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Affiliation(s)
- Katia Iskandar
- INSERM, UMR 1027, Université Paul Sabatier Toulouse III, Toulouse, France
- Epidemiologie Clinique et Toxicologie, INSPECT-LB: Institut National de Sante Publique, Beirut, Lebanon
| | | | - Marwan Tabbal
- Department of Surgery, Clinique du Levant Hospital, Beirut, Lebanon
| | - Luca Ansaloni
- Department of Surgery, Bufalini Hospital, Cesena, Italy
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Fausto Catena
- Department of Emergency Surgery, Parma MaggioreHospital, Parma, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Surgery, Cisanello University Hospital, Pisa, Italy
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, UniversitiPertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | | | - Ayad Moghabghab
- Department of Anesthesiology and Reanimation, Lebanese Canadian Hospital, Beirut, Lebanon
| | - Leonardo Pagani
- Infectious Diseases Unit, Bolzano Central Hospital, Bolzano, Italy
| | | | - Christine Roques
- Laboratoire de Génie Chimique (UMR 5503), Département Bioprocédés et Systèmes Microbiens, Université de Toulouse, Université Paul Sabatier, Toulouse, France
| | - Pascale Salameh
- Epidemiologie Clinique et Toxicologie, INSPECT-LB: Institut National de Sante Publique, Beirut, Lebanon
- Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Laurent Molinier
- Département d’Information Médicale, Centre Hospitalier Universitaire, Toulouse, F-31000 France
- INSERM, UMR 1027, Université Paul Sabatier Toulouse III, Toulouse, France
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Jeffery S, Leaper D, Armstrong D, Lantis J. Using negative pressure wound therapy to prevent surgical site infection. J Wound Care 2019; 27:S5-S13. [PMID: 29509094 DOI: 10.12968/jowc.2018.27.sup3.s5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
It is estimated that, at the very least, 5% of patients who undergo surgery develop a surgical site infection (SSI). There has been much interest in the use of negative pressure wound therapy (NPWT) as a prophylactic treatment to reduce the risk of SSI. Evidence suggests it can accelerate healing times, reduce both the length of hospital stay and the frequency of dressing changes, and improve patients' quality of life. The efficacy of traditional and portable NPWT systems is similar. However, the latter has an advantage in that it increases patient mobility and does not hinder individuals from carrying out activities of daily living. There are also economic data suggesting that portable NPWT devices are associated with long-term cost savings.
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Affiliation(s)
- Steven Jeffery
- Consultant Burns and Plastic Surgeon, Professor of Wound Study, Birmingham City University, UK
| | - David Leaper
- Emeritus Professor of Surgery, University of Newcastle upon Tyne, Emeritus Professor of Clinical Sciences, University of Huddersfield and Visiting Professor, Imperial College, London, UK
| | - David Armstrong
- Professor of Surgery and Director, Southwestern Academic Limb Salvage Alliance (SALSA), Keck School of Medicine, University of Southern California, US
| | - John Lantis
- Vice Chairman, Department of Surgery, Chief of Vascular and Endovascular Surgery, Mount Sinai St Luke's and West Hospitals, Professor of Surgery, Icahn School of Medicine, USA
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16
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Matsuda S, Ikawa F, Ohba H, Yoshiyama M, Hidaka T, Kurisu K, Miyamoto S, Date I, Nakase H. Questionnaire Survey Regarding Prevention of Surgical Site Infection after Neurosurgery in Japan: Focus on Perioperative Management and Administration of Surgical Antibiotic Prophylaxis. Neurol Med Chir (Tokyo) 2019; 59:197-203. [PMID: 31068545 PMCID: PMC6580046 DOI: 10.2176/nmc.oa.2018-0328] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Various guidelines regarding surgical site infection (SSI) have recently been established. However, perioperative management of the wound and use of antibiotics have never been standardized completely in departments of neurosurgery in Japan. This survey investigated current perioperative management and administration of surgical antibiotic prophylaxis (SAP) and compared with guidelines intended to reduce SSI associated with neurosurgery in Japan. Questionnaires were distributed to members of the conference on Neurosurgical Techniques and Tools and the Japan Society of Aesthetic Neurosurgery via internet. The questionnaires asked about methods of perioperative management. A total of 255 members returned answers to the questionnaires. The questionnaires revealed that partial or no removal of the hair and hair shampooing at the day before surgery were performed in 96.1% and 88.1% of each institute following the World Health Organization (WHO) guidelines. Use of SAP at just before, during, and after surgery were 65.0%, 86.2%, and 63.0%, respectively. The postoperative period of use of intravenous SAP prolonged beyond 24 h in 80.0% against the recommendation of WHO. Perioperative management of wounds and use of SAP varies in institutes in Japan and some procedures were far different from the WHO guidelines. Japanese neurosurgeons should notice the prolonged SAP and comply with the WHO guidelines.
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Affiliation(s)
- Shingo Matsuda
- Department of Neurosurgery, Shimane Prefectural Central Hospital
| | - Fusao Ikawa
- Department of Neurosurgery, Shimane Prefectural Central Hospital
| | - Hideo Ohba
- Department of Neurosurgery, Shimane Prefectural Central Hospital
| | | | - Toshikazu Hidaka
- Department of Neurosurgery, Shimane Prefectural Central Hospital
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | | | - Isao Date
- Department of Neurological Surgery, Graduate School of Medicine, Okayama University
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Wong J, Ho C, Scott G, Machin JT, Briggs T. Getting It Right First Time: the national survey of surgical site infection rates in NHS trusts in England. Ann R Coll Surg Engl 2019; 101:463-471. [PMID: 31155919 DOI: 10.1308/rcsann.2019.0064] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Surgical site infections are associated with increased morbidity and mortality in patients. The Getting It Right First Time surgical site infection programme set up a national survey to review surgical site infection rates in surgical units in England. The objectives were for frontline clinicians to assess the rates of infection following selected procedures, to examine the risk of significant complications and to review current practice in the prevention of surgical site infection. METHODS A national survey was launched in April 2017 to assess surgical site infections within 13 specialties: breast surgery, cardiothoracic surgery, cranial neurosurgery, ear, nose and throat surgery, general surgery, obstetrics and gynaecology, ophthalmology, oral and maxillofacial surgery, orthopaedic surgery, paediatric surgery, spinal surgery, urology and vascular surgery. All participating trusts prospectively identified and collected supporting information on surgical site infections diagnosed within the six-month study period. RESULTS Data were received from 95 NHS trusts. A total of 1807 surgical site infection cases were reported. There were variations in rates reported by trusts across specialties and procedures. Reoperations were reported in 36.2% of all identified cases, and surgical site infections are associated with a delayed discharge rate of 34.1% in our survey. CONCLUSION The Getting It Right First Time surgical site infection programme has introduced a different approach to infection surveillance in England. Results of the survey has demonstrated variation in surgical site infection rates among surgical units, raised the importance in addressing these issues for better patient outcomes and to reduce the financial burden on the NHS. Much work remains to be done to improve surgical site infection surveillance across surgical units and trusts in England.
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Affiliation(s)
- Jlc Wong
- Getting It Right First Time, Royal National Orthopaedic Hospital NHS Trust and NHS Improvement, Brockley Hill, Stanmore, UK
| | - Cwy Ho
- Getting It Right First Time, Royal National Orthopaedic Hospital NHS Trust and NHS Improvement, Brockley Hill, Stanmore, UK
| | - G Scott
- Getting It Right First Time, Royal National Orthopaedic Hospital NHS Trust and NHS Improvement, Brockley Hill, Stanmore, UK
| | - J T Machin
- Getting It Right First Time, Royal National Orthopaedic Hospital NHS Trust and NHS Improvement, Brockley Hill, Stanmore, UK
| | - Twr Briggs
- Getting It Right First Time, Royal National Orthopaedic Hospital NHS Trust and NHS Improvement, Brockley Hill, Stanmore, UK
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18
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Prevention of Postoperative Wound Infections. PREVENTION AND CONTROL OF INFECTIONS IN HOSPITALS 2019. [PMCID: PMC7122543 DOI: 10.1007/978-3-319-99921-0_33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Surgery creates most hospital infections, injuries, accidents, invalidity and death in the global healthcare system. The number of surgically treated patients per year is high and increasing. Surgical site infection (SSI) is dependent on type of operation and may occur in 5–20% after surgery, triggers 7–11 extra postoperative days in hospitals and results in 2–11 times higher risk of death than comparable, noninfected patients. Up to 60% of SSI can be prevented. Prevention of postoperative wound infection is done by good general hygiene, operative sterility and effective barriers against transmission of infections, before, during and after surgery. A basic support by hospital leaders, knowledge and skill of the surgical teams, enough resources, excellent treatment of the complete patient admission and monitoring patients after discharge may lead to significant reduction of SSIs, lower death rates and a less expensive health system.
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Validation of the Bluebelle Wound Healing Questionnaire for assessment of surgical-site infection in closed primary wounds after hospital discharge. Br J Surg 2018; 106:226-235. [PMID: 30556594 PMCID: PMC6457211 DOI: 10.1002/bjs.11008] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/13/2018] [Accepted: 09/05/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Accurate assessment of surgical-site infection (SSI) is crucial for surveillance and research. Self-reporting patient measures are needed because current SSI tools are limited for assessing patients after leaving hospital. The Bluebelle Wound Healing Questionnaire (WHQ) was developed for patient or observer completion; this study tested its acceptability, scale structure, reliability and validity in patients with closed primary wounds after abdominal surgery. METHODS Patients completed the WHQ (self-assessment) within 30 days after leaving hospital and returned it by post. Healthcare professionals completed the WHQ (observer assessment) by telephone or face-to-face. Questionnaire response rates and patient acceptability were assessed. Factor analysis and Cronbach's α examined scale structure and internal consistency. Test-retest and self- versus observer reliability assessments were performed. Sensitivity and specificity for SSI discrimination against a face-to-face reference diagnosis (using Centers for Disease Control and Prevention criteria) were examined. RESULTS Some 561 of 792 self-assessments (70·8 per cent) and 597 of 791 observer assessments (75·5 per cent) were completed, with few missing data or problems reported. Data supported a single-scale structure with strong internal consistency (α greater than 0·8). Reliability between test-retest and self- versus observer assessments was good (κ 0·6 or above for the majority of items). Sensitivity and specificity for SSI discrimination was high (area under the receiver operating characteristic (ROC) curve 0·91). CONCLUSION The Bluebelle WHQ is acceptable, reliable and valid with a single-scale structure for postdischarge patient or observer assessment of SSI in closed primary wounds.
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Busscher HJ, Alt V, van der Mei HC, Fagette PH, Zimmerli W, Moriarty TF, Parvizi J, Schmidmaier G, Raschke MJ, Gehrke T, Bayston R, Baddour LM, Winterton LC, Darouiche RO, Grainger DW. A Trans-Atlantic Perspective on Stagnation in Clinical Translation of Antimicrobial Strategies for the Control of Biomaterial-Implant-Associated Infection. ACS Biomater Sci Eng 2018; 5:402-406. [PMID: 30775431 PMCID: PMC6373985 DOI: 10.1021/acsbiomaterials.8b01071] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/01/2018] [Indexed: 12/31/2022]
Abstract
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Current regulatory
requirements impede clinical translation and
market introduction of many new antimicrobial combination implants
and devices, causing unnecessary patient suffering, doctor frustration,
and costs to healthcare payers. Regulatory requirements of antimicrobial
combination implants and devices should be thoroughly revisited and
their approval allowed based on enrichment of benefit demonstrations
from high-risk patient groups and populations or device components
to facilitate their clinical translation. Biomaterial implant and
devices equipped with antimicrobial strategies and approved based
on enrichment claims should be mandatorily enrolled in global registry
studies supervised by regulatory agencies for a minimum five-year
period or until statistically validated evidence for noninferiority
or superiority of claims is demonstrated. With these recommendations,
this trans-Atlantic consortium of academicians and clinicians takes
its responsibility to actively seek to relieve the factors that stagnate
downward clinical translation and availability of antimicrobial combination
implants and devices. Improved dialogue between the various key players
involved in the current translational blockade, which include patients,
academicians and doctors, policymakers, regulatory agencies, manufacturers,
and healthcare payers, is urgently needed.
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Affiliation(s)
- Henk J Busscher
- University of Groningen and University Medical Center Groningen, Department of Biomedical Engineering, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Volker Alt
- Department of Trauma Surgery, University Hospital Giessen-Marburg, Rudolf-Buchheim strasse 7, 35392 Giessen, Germany
| | - Henny C van der Mei
- University of Groningen and University Medical Center Groningen, Department of Biomedical Engineering, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Paul H Fagette
- University of Groningen and University Medical Center Groningen, Department of Biomedical Engineering, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Werner Zimmerli
- Basel University Medical Clinic, Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland
| | - T Fintan Moriarty
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos Platz, Switzerland
| | - Javad Parvizi
- Department of Orthopedic Surgery, Rothman Institute at Jefferson, Thomas Jefferson University, Center City Philadelphia, 925 Chestnut Street, Fifth Floor, Philadelphia, Pennsylvania 19107, United States
| | - Gerhard Schmidmaier
- Department of Orthopedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Michael J Raschke
- Department of Trauma, Hand, and Reconstructive Surgery, University of Muenster, Albert-Schweizer-Campus, D-48149 Muenster, Germany
| | - Thorsten Gehrke
- Department of Orthopedic Joint Surgery and Endoprosthetics, HELIOS ENDO-Clinic, Holstenstrasse 2, 22767 Hamburg, Germany
| | - Roger Bayston
- School of Medicine, Queens Medical Center, University of Nottingham, Nottingham NG7 2UH, U.K
| | - Larry M Baddour
- Divisions of Infectious Diseases and Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, United States
| | - Lynn C Winterton
- Better Vision Group, LLC, 808 Sandy Trail, Keller, Texas 76248, United States
| | - Rabih O Darouiche
- Departments of Medicine, Surgery and PM&R, Baylor College of Medicine 1333 Moursund Avenue, Houston, Texas 77030, United States
| | - David W Grainger
- Departments of Bioengineering, Pharmaceutics, and Pharmaceutical Chemistry, University of Utah, 30 South 2000 East, Salt Lake City, Utah 84112-5820, United States
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21
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Troughton R, Birgand G, Johnson A, Naylor N, Gharbi M, Aylin P, Hopkins S, Jaffer U, Holmes A. Mapping national surveillance of surgical site infections in England: needs and priorities. J Hosp Infect 2018; 100:378-385. [DOI: 10.1016/j.jhin.2018.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/06/2018] [Indexed: 10/14/2022]
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22
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Chiwera L, Wigglesworth N, McCoskery C, Lucchese G, Newsholme W. Reducing adult cardiac surgical site infections and the economic impact of using multidisciplinary collaboration. J Hosp Infect 2018; 100:428-436. [DOI: 10.1016/j.jhin.2018.03.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 03/22/2018] [Indexed: 12/22/2022]
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Gray J, Oppenheim B, Mahida N. The Journal of Hospital Infection - a history of infection prevention and control in 100 volumes. J Hosp Infect 2018; 100:1-8. [PMID: 30173875 DOI: 10.1016/j.jhin.2018.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 07/04/2018] [Indexed: 02/04/2023]
Affiliation(s)
- J Gray
- Journal of Hospital Infection, London, UK.
| | | | - N Mahida
- Journal of Hospital Infection, London, UK
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Masters JPM, Achten J, Cook J, Dritsaki M, Sansom L, Costa ML. Randomised controlled feasibility trial of standard wound management versus negative-pressure wound therapy in the treatment of adult patients having surgical incisions for hip fractures. BMJ Open 2018; 8:e020632. [PMID: 29654039 PMCID: PMC5898317 DOI: 10.1136/bmjopen-2017-020632] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Deep wound infection is a catastrophic complication after hip fracture surgery. However, current understanding of infection rates in this population is limited. Many technologies such as incisional negative-pressure wound therapy (NPWT) show promise in reducing the rate of infection. This trial is a feasibility study looking to establish a value estimated with a greater precision of the rate of deep infection after hip fracture treatment in patients treated with NPWT versus standard dressing following hip fracture surgery. METHODS AND ANALYSIS A randomised controlled trial of 464 patients will be run across multiple centres. It is embedded in the World Hip Trauma Evaluation cohort study. Any patient over the age of 65 years having surgery for hip fracture is eligible unless they are being treated with percutaneous screw fixation. A web-based randomisation sequence will stratify patients by centre. Patients will be allocated to either NPWT or standard care on a 1:1 basis. The primary outcome measure is the Centre for Disease Control definition of deep infection at 30 days. Follow-up at 4 months will also assess deep infection and the core outcome dataset for hip fractures. This includes health-related quality of life (EQ-5D-5L), mobility, mortality and late complications such as further surgery. The primary analysis will be intention to treat. ETHICS AND DISSEMINATION Oxford C Research Ethics Committee granted ethical approval on 28/04/2017, 17/SC/0207. The results of this study will be reported in a peer-reviewed publication and inform the design of a future full-scale trial. TRIAL REGISTRATION NUMBER ISRCTN55305726.
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Affiliation(s)
- James P M Masters
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Juul Achten
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Jonathan Cook
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Melina Dritsaki
- Oxford Clinical Trial Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Lucy Sansom
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Matthew L Costa
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
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Taylor JS, Marten CA, Potts KA, Cloutier LM, Cain KE, Fenton SL, Tatum TN, James DA, Myers KN, Hubbs CA, Burzawa JK, Vachhani S, Nick AM, Meyer LA, Graviss LS, Ware KM, Park AK, Aloia TA, Bodurka DC, Levenback CF, Schmeler KM. What Is the Real Rate of Surgical Site Infection? J Oncol Pract 2017; 12:e878-e883. [PMID: 27460495 DOI: 10.1200/jop.2016.011759] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Surgical site infections (SSIs) are associated with patient morbidity and increased health care costs. Although several national organizations including the University HealthSystem Consortium (UHC), the National Surgical Quality Improvement Program (NSQIP), and the National Healthcare Safety Network (NHSN) monitor SSI, there is no standard reporting methodology. METHODS We queried the UHC, NSQIP, and NHSN databases from July 2012 to June 2014 for SSI after gynecologic surgery at our institution. Each organization uses different definitions and inclusion and exclusion criteria for SSI. The rate of SSI was also obtained from chart review from April 1 to June 30, 2014. SSI was classified as superficial, deep, or organ space infection. The rates reported by the agencies were compared with the rates obtained by chart review using Fisher's exact test. RESULTS Overall SSI rates for the databases were as follows: UHC, 1.5%; NSQIP, 8.8%; and NHSN, 2.8% (P < .001). The individual databases had wide variation in the rate of deep infection (UHC, 0.7%; NSQIP, 4.7%; NHSN, 1.3%; P < .001) and organ space infection (UHC, 0.4%; NSQIP, 4.4%; NHSN, 1.4%; P < .001). In agreement with the variation in reporting methodology, only 19 cases (24.4%) were included in more than one database and only one case was included in all three databases (1.3%). CONCLUSION There is discordance among national reporting agencies tracking SSI. Adopting standardized metrics across agencies could improve consistency and accuracy in assessing SSI rates.
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Affiliation(s)
- Jolyn S Taylor
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Claire A Marten
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Lynn M Cloutier
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Shauna L Fenton
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tara N Tatum
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Deepthi A James
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Keith N Myers
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cheryl A Hubbs
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Shital Vachhani
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Alpa M Nick
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Larissa A Meyer
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Linda S Graviss
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kathy M Ware
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anne K Park
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Thomas A Aloia
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Diane C Bodurka
- The University of Texas MD Anderson Cancer Center, Houston, TX
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26
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Vaishya R, Agarwal AK, Rawat SK, Singh H, Vijay V. Is Single-stage Revision Safe Following Infected Total Knee Arthroplasty? A Critical Review. Cureus 2017; 9:e1629. [PMID: 29104837 PMCID: PMC5662166 DOI: 10.7759/cureus.1629] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 08/30/2017] [Indexed: 01/22/2023] Open
Abstract
With the improvement in outcomes and modern prosthesis design, total knee arthroplasty (TKA) has now become a commonly performed surgery. It is postulated that a total of 2-5% of the primary and revision TKA becomes infected every year, requiring a revision procedure which to date is the conventional two-stage revision. The diagnosis and treatment of these periprosthetic infections is a major and challenging task, as it requires precise identification of the pathogen, meticulous debridement, and postoperative rehabilitation. To date, there have been very few studies in existing literature comparing the outcomes of single-stage versus two-stage procedure in infected TKA. The aim of the review was to provide the clinicians an insight into the outcome of the single-stage procedure compared to two-stage procedures and to suggest ways to improve the results further. In the following critical review, a total of 669 cases that underwent either a single or two-stage revision for infected TKA were studied. The postoperative functional scores were comparable in most studies during the early postoperative period. Our data supports the use of a single-stage revision surgery in infected TKA as an alternative to a conventional two-stage procedure. However, larger prospective and multicentric trials are required to validate our findings.
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Affiliation(s)
- Raju Vaishya
- Department of Orthopedics, Indraprastha Apollo Hospital, New Delhi
| | | | - Sudheer K Rawat
- Department of Orthopedics, Indraprastha Apollo Hospital, New Delhi
| | - Harsh Singh
- Department of Orthopedics, Indraprastha Apollo Hospital, New Delhi
| | - Vipul Vijay
- Department of Orthopedics, Indraprastha Apollo Hospital, New Delhi
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Leaper D, Wilson P, Assadian O, Edmiston C, Kiernan M, Miller A, Bond-Smith G, Yap J. The role of antimicrobial sutures in preventing surgical site infection. Ann R Coll Surg Engl 2017; 99:439-443. [PMID: 28660816 PMCID: PMC5696981 DOI: 10.1308/rcsann.2017.0071] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2017] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Healthcare associated infections (HCAIs) are falling following widespread and enforced introduction of guidelines, particularly those that have addressed antibiotic resistant pathogens such as methicillin resistant Staphylococcus aureus or emergent pathogens such as Clostridium difficile, but no such decline has been seen in the incidence of surgical site infection (SSI), either in the UK, the EU or the US. SSI is one of the HCAIs, which are all avoidable complications of a surgical patient's pathway through both nosocomial and community care. METHODS This report is based on a meeting held at The Royal College of Surgeons of England on 21 July 2016. Using PubMed, members of the panel reviewed the current use of antiseptics and antimicrobial sutures in their specialties to prevent SSI. FINDINGS The group agreed that wider use of antiseptics in surgical practice may help in reducing reliance on antibiotics in infection prevention and control, especially in the perioperative period of open elective colorectal, hepatobiliary and cardiac operative procedures. The wider use of antiseptics includes preoperative showering, promotion of hand hygiene, (including the appropriate use of surgical gloves), preoperative skin preparation (including management of hair removal), antimicrobial sutures and the management of dehisced surgical wounds after infection. The meeting placed emphasis on the level I evidence that supports the use of antimicrobial sutures, particularly in surgical procedures after which the SSI rate is high (colorectal and hepatobiliary surgery) or when a SSI can be life threatening even when the rate of SSI is low (cardiac surgery).
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Affiliation(s)
- D Leaper
- University of Newcastle upon Tyne , UK
| | - P Wilson
- University College of London Hospitals NHS Foundation Trust , UK
| | | | | | | | - A Miller
- University Hospitals of Leicester NHS Trust , UK
| | | | - J Yap
- Barts Health NHS Trust , UK
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Jenks PJ, Bennett S, Haill CF, Keenan J. National surveillance of surgical site infection: response to Lamagni et al. J Hosp Infect 2017. [PMID: 28641976 DOI: 10.1016/j.jhin.2017.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- P J Jenks
- Department of Microbiology and Infection Prevention, Derriford Hospital, Plymouth, UK.
| | - S Bennett
- Department of Microbiology and Infection Prevention, Derriford Hospital, Plymouth, UK
| | - C F Haill
- Department of Microbiology and Infection Prevention, Derriford Hospital, Plymouth, UK
| | - J Keenan
- Control and Orthopaedic Surgery, Derriford Hospital, Plymouth, UK
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Jenks P, Bennett S, Haill C, Keenan J. National surveillance of surgical site infection. J Hosp Infect 2017; 96:20-21. [DOI: 10.1016/j.jhin.2017.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/07/2017] [Indexed: 11/30/2022]
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Gomila A, Badia JM, Carratalà J, Serra-Aracil X, Shaw E, Diaz-Brito V, Castro A, Espejo E, Nicolás C, Piriz M, Brugués M, Obradors J, Lérida A, Cuquet J, Limón E, Gudiol F, Pujol M. Current outcomes and predictors of treatment failure in patients with surgical site infection after elective colorectal surgery. A multicentre prospective cohort study. J Infect 2017; 74:555-563. [PMID: 28315721 DOI: 10.1016/j.jinf.2017.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/27/2017] [Accepted: 03/08/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To determine current outcomes and predictors of treatment failure among patients with surgical site infection (SSI) after colorectal surgery. METHODS A multicentre observational prospective cohort study of adults undergoing elective colorectal surgery in 10 Spanish hospitals (2011-2014). Treatment failure was defined as persistence of signs/symptoms of SSI or death at 30 days post-surgery. RESULTS Of 3701 patients, 669 (18.1%) developed SSI; 336 (9.1%) were organ-space infections. Among patients with organ-space SSI, 81.2% required source control: 60.4% reoperation and 20.8% percutaneous/transrectal drainage. Overall treatment failure rate was 21.7%: 9% in incisional SSIs and 34.2% in organ-space SSIs (p < 0.001). Median length of stay was 15 days (IQR 9-22) for incisional SSIs and 24 days (IQR 17-35) for organ-space SSIs (p < 0.001). One hundred and twenty-seven patients (19%) required readmission and 35 patients died (5.2%). Risk factors for treatment failure among patients with organ-space SSI were age ≥65 years (OR 1.83, 95% CI: 1.07-1.83), laparoscopy (OR 1.7, 95% CI: 1.06-2.77), and reoperation (OR 2.8, 95% CI: 1.7-4.6). CONCLUSIONS Rates of SSI and treatment failure in organ-space SSI after elective colorectal surgery are notably high. Careful attention should be paid to older patients with previous laparoscopy requiring reoperation for organ-space SSI, so that treatment failure can be identified early.
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Affiliation(s)
- Aina Gomila
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; VINCat Program, Spain.
| | - Josep Ma Badia
- Department of General Surgery, Hospital General de Granollers, Universitat Internacional de Catalunya, Barcelona, Spain; VINCat Program, Spain.
| | - Jordi Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; VINCat Program, Spain; University of Barcelona, Barcelona, Spain.
| | - Xavier Serra-Aracil
- Department of Surgery and Infection Control Team, Corporació Sanitària Parc Taulí, Barcelona, Spain; VINCat Program, Spain.
| | - Evelyn Shaw
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; VINCat Program, Spain.
| | - Vicens Diaz-Brito
- Department of Infectious Diseases, Parc Sanitari Sant Joan de Déu de Sant Boi, Barcelona, Spain.
| | - Antoni Castro
- Department of Internal Medicine, Hospital Universitari Sant Joan de Reus, Tarragona, Spain; VINCat Program, Spain.
| | - Elena Espejo
- Department of Infectious Diseases, Consorci Sanitari de Terrassa, Barcelona, Spain; VINCat Program, Spain.
| | - Carmen Nicolás
- Department of Infectious Diseases, Hospital Universitari Mútua de Terrassa, Barcelona, Spain; VINCat Program, Spain.
| | - Marta Piriz
- Department of Surgery and Infection Control Team, Corporació Sanitària Parc Taulí, Barcelona, Spain; VINCat Program, Spain.
| | - Montserrat Brugués
- Department of Internal Medicine, Consorci Sanitari de l'Anoia, Barcelona, Spain; VINCat Program, Spain.
| | - Josefina Obradors
- Department of Internal Medicine, Fundació Althaia, Barcelona, Spain; VINCat Program, Spain.
| | - Ana Lérida
- Department of Internal Medicine, Hospital de Viladecans, Barcelona, Spain; VINCat Program, Spain.
| | - Jordi Cuquet
- Department of General Surgery, Hospital General de Granollers, Universitat Internacional de Catalunya, Barcelona, Spain; VINCat Program, Spain.
| | | | - Francesc Gudiol
- VINCat Program, Spain; University of Barcelona, Barcelona, Spain.
| | - Miquel Pujol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; VINCat Program, Spain.
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Tissingh EK, Sudlow A, Jones A, Nolan JF. Orthopaedic surgical site infection surveillance in NHS England: national audit of current practice. Bone Joint J 2017; 99-B:171-174. [PMID: 28148657 DOI: 10.1302/0301-620x.99b2.bjj-2016-0420.r1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 10/05/2016] [Indexed: 11/05/2022]
Abstract
AIMS The importance of accurate identification and reporting of surgical site infection (SSI) is well recognised but poorly defined. Public Health England (PHE) mandated collection of orthopaedic SSI data in 2004. Data submission is required in one of four categories (hip prosthesis, knee prosthesis, repair of neck of femur, reduction of long bone fracture) for one quarter per year. Trusts are encouraged to carry out post-discharge surveillance but this is not mandatory. Recent papers in the orthopaedic literature have highlighted the importance of SSI surveillance and the heterogeneity of surveillance methods. However, details of current orthopaedic SSI surveillance practice has not been described or quantified. PATIENTS AND METHODS All 147 NHS trusts in England were audited using a structured questionnaire. Data was collected in the following categories: data collection; data submission to PHE; definitions used; resource constraints; post-discharge surveillance and SSI rates in the four PHE categories. The response rate was 87.7%. RESULTS Variation in practice was clear in all categories in terms of methods and timings of data collection and data submission. There was little agreement on SSI definitions. At least six different definitions were used, some trusts using more than one definition. Post-discharge surveillance was carried out by 62% of respondents but there was again variation in both the methods and staff used. More than half of the respondents felt that SSI surveillance in their unit was limited by resource constraints. SSI rates ranged from 0% to 10%. CONCLUSION This paper quantifies the heterogeneity of SSI surveillance in England. It highlights the importance of adequate resourcing and the unreliability of relying on voluntary data collection and submission. Conformity of definitions and methods are recommended to enable meaningful SSI data to be collated. Cite this article: Bone Joint J 2017;99-B:171-4.
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Affiliation(s)
- E K Tissingh
- Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK
| | - A Sudlow
- Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK
| | - A Jones
- Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK
| | - J F Nolan
- Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK
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Leaper DJ, Edmiston CE, Holy CE. Meta-analysis of the potential economic impact following introduction of absorbable antimicrobial sutures. Br J Surg 2017; 104:e134-e144. [PMID: 28093728 DOI: 10.1002/bjs.10443] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/03/2016] [Accepted: 11/03/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Despite several randomized trials, systematic reviews and meta-analyses that have demonstrated the effectiveness of antimicrobial (triclosan-coated or -impregnated) sutures (TCS), the clinical and economic impact of using these sutures compared with conventional non-antimicrobial-coated absorbable sutures (NCS) remains poorly documented. METHODS An independent systematic review and meta-analysis of all published evidence from January 2005 to September 2016 comparing TCS with NCS was conducted. Surgical-site infection (SSI) was the primary outcome. The results of the meta-analysis were used in a decision-tree deterministic and stochastic cost model, using the National Health Service (NHS England)-based cost of inpatient admissions for infections and differential costs of TCS versus NCS. RESULTS Thirty-four studies were included in the final assessment from an initial 163 identified citations; 20 of 34 studies were randomized, and 17 of 34 reported blinding of physicians and assessors. Using a random-effects model, the odds ratio for SSI in the TCS compared with NCS control groups was statistically significant (odds ratio 0·61, 95 per cent c.i. 0·52 to 0·73; P < 0·001). There was significant heterogeneity (I2 = 49 per cent). Using random-effects event estimates of SSI for TCS and NCS for each individual wound type, the mean savings per surgical procedure from using antimicrobial sutures were significant: £91·25 (90 per cent c.i. 49·62 to 142·76) (€105·09 (57·15 to 164·41); exchange rate 15 November 2016) across all wound types. CONCLUSION The reviewed literature suggested that antimicrobial sutures may result in significant savings across various surgical wound types.
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Affiliation(s)
- D J Leaper
- Faculty of Medical Sciences, University of Newcastle upon Tyne, Newcastle upon Tyne, and Department of Clinical Sciences, Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK
| | - C E Edmiston
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - C E Holy
- Johnson & Johnson Epidemiology and Health Informatics - Medical Devices, New Brunswick, New Jersey, USA
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Grammatico-Guillon L, Baron S, Gaborit C, Rusch E, Astagneau P. Quality Assessment of Hospital Discharge Database for Routine Surveillance of Hip and Knee Arthroplasty–Related Infections. Infect Control Hosp Epidemiol 2016; 35:646-51. [DOI: 10.1086/676423] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective.Surgical site infection (SSI) surveillance represents a key method of nosocomial infection control programs worldwide. However, most SSI surveillance systems are considered to be poorly cost effective regarding human and economic resources required for data collection and patient follow up. This study aims to assess the efficacy of using hospital discharge databases (HDDs) as a routine surveillance system for detecting hip or knee arthroplasty–related infections (HKAIs).Methods.A case-control study was conducted among patients hospitalized in the Centre region of France between 2008 and 2010. HKAI cases were extracted from the HDD with various algorithms based on the International Classification of Diseases, Tenth Revision, and procedure codes. The control subjects were patients with hip or knee arthroplasty (HKA) without infection selected at random from the HDD during the study period. The gold standard was medical chart review. Sensitivity (Se), specificity (Spe), positive predictive value (PPV), and negative predictive value (NPV) were calculated to evaluate the efficacy of the surveillance system.Results.Among 18,265 hospital stays for HKA, corresponding to 17,388 patients, medical reports were checked for 1,010 hospital stays (989 patients). We identified 530 cases in total (incidence rate, 1% [95% confidence interval (CI), 0.4%–1.6%), and 333 cases were detected by routine surveillance. As compared with 480 controls, Se was 98%, Spe was 71%, PPV was 63%, and NPV was 99%. Using a more specific case definition, based on a sample of 681 hospital stays, Se was 97%, Spe was 95%, PPV was 87%, and NPV was 98%.Conclusions.This study demonstrates the potential of HDD as a tool for routine SSI surveillance after low-risk surgery, under conditions of having an appropriate algorithm for selecting infections.Infect Control Hosp Epidemiol 2014;35(6):646–651
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Kunutsor SK, Whitehouse MR, Lenguerrand E, Blom AW, Beswick AD. Re-Infection Outcomes Following One- And Two-Stage Surgical Revision of Infected Knee Prosthesis: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0151537. [PMID: 26967645 PMCID: PMC4788419 DOI: 10.1371/journal.pone.0151537] [Citation(s) in RCA: 172] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 02/28/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Periprosthetic joint infection (PJI) is a serious complication of total knee arthroplasty. Two-stage revision is the most widely used technique and considered as the most effective for treating periprosthetic knee infection. The one-stage revision strategy is an emerging alternative option, however, its performance in comparison to the two-stage strategy is unclear. We therefore sought to ask if there was a difference in re-infection rates and other clinical outcomes when comparing the one-stage to the two-stage revision strategy. OBJECTIVE Our first objective was to compare re-infection (new and recurrent infections) rates for one- and two-stage revision surgery for periprosthetic knee infection. Our second objective was to compare between the two revision strategies, clinical outcomes as measured by postoperative Knee Society Knee score, Knee Society Function score, Hospital for Special Surgery knee score, WOMAC score, and range of motion. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, EMBASE, Web of Science, Cochrane Library, reference lists of relevant studies to August 2015, and correspondence with investigators. STUDY SELECTION Longitudinal (prospective or retrospective cohort) studies conducted in generally unselected patients with periprosthetic knee infection treated exclusively by one- or two-stage revision and with re-infection outcomes reported within two years of revision surgery. No clinical trials comparing both revision strategies were identified. REVIEW METHODS Two independent investigators extracted data and discrepancies were resolved by consensus with a third investigator. Re-infection rates from 10 one-stage studies (423 participants) and 108 two-stage studies (5,129 participants) were meta-analysed using random-effect models after arcsine transformation. RESULTS The rate (95% confidence intervals) of re-infection was 7.6% (3.4-13.1) in one-stage studies. The corresponding re-infection rate for two-stage revision was 8.8% (7.2-10.6). In subgroup analyses, re-infection rates remained generally similar for several study-level and clinically relevant characteristics. Postoperative clinical outcomes of knee scores and range of motion were similar for both revision strategies. LIMITATIONS Potential bias owing to the limited number of one-stage revision studies and inability to explore heterogeneity in greater detail. CONCLUSIONS Available evidence from aggregate published data suggest the one-stage revision strategy may be as effective as the two-stage revision strategy in treating infected knee prostheses in generally unselected patients. Further investigation is warranted. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2015: CRD42015017327.
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Affiliation(s)
- Setor K. Kunutsor
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Southmead Road, Bristol, BS10 5NB, United Kingdom
| | - Michael R. Whitehouse
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Southmead Road, Bristol, BS10 5NB, United Kingdom
| | - Erik Lenguerrand
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Southmead Road, Bristol, BS10 5NB, United Kingdom
| | - Ashley W. Blom
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Southmead Road, Bristol, BS10 5NB, United Kingdom
| | - Andrew D. Beswick
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Southmead Road, Bristol, BS10 5NB, United Kingdom
| | - INFORM Team
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Southmead Road, Bristol, BS10 5NB, United Kingdom
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Pressure ulcer and wounds reporting in NHS hospitals in England part 1: Audit of monitoring systems. J Tissue Viability 2016; 25:3-15. [DOI: 10.1016/j.jtv.2015.11.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/23/2015] [Accepted: 11/12/2015] [Indexed: 11/19/2022]
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An evaluation of surgical site infection surveillance methods for colon surgery and hysterectomy in Colorado hospitals. Infect Control Hosp Epidemiol 2015; 36:353-5. [PMID: 25695179 DOI: 10.1017/ice.2014.54] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Surgical site infection (SSI) surveillance techniques for colon surgery and hysterectomy among Colorado infection preventionists were characterized through an online survey. Considerable variation was found in SSI surveillance practices, specifically varying use of triggers for SSI review, including laboratory values, healthcare personnel communication, and postoperative visits.
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Pressure ulcer and wounds reporting in NHS hospitals in England part 2: Survey of monitoring systems. J Tissue Viability 2015; 25:16-25. [PMID: 26774821 DOI: 10.1016/j.jtv.2015.11.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/23/2015] [Accepted: 11/12/2015] [Indexed: 11/20/2022]
Abstract
This is the second of a two related papers describing work undertaken to compare and contrast Pressure Ulcer (PU) monitoring systems across NHS in-patient facilities in England. The work comprised 1) a PU/Wound Audit (PUWA) and 2) a survey of PU monitoring systems. This second paper focusses on the survey which explores differences in the implementation of PU adverse event monitoring systems in 24 NHS hospital Trusts in England. The survey questionnaire comprised 41 items incorporating single and multiple response options and free-text items and was completed by the PUWA Trust lead in liaison with key people in the organisation. All 24 (100%) Trusts returned the questionnaire, with high levels of data completeness (99.1%). The questionnaire results showed variation between Trusts in relation to the recording of PUs and their reporting as part of NHS prevalence and incident monitoring systems and to Trust boards and healthcare commissioners including the inclusion (or not) of device ulcers, unstageable ulcers, Deep Tissue Injury, combined PUs/Incontinence Associated Dermatitis, category ≥ 1 ulcers or category ≥ 2 ulcers, inherited ulcers, acquired ulcers, avoidable and unavoidable ulcers and the definition of Present On Admission. These fundamental differences in reporting preclude Trust to Trust comparisons of PU prevalence and incident reporting and monitoring systems due to variation in local application and data collection methods. The results of this work and the PUWA led to the development of recommendations for PU monitoring practice, many of which are internationally relevant.
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Hickson CJ, Metcalfe D, Elgohari S, Oswald T, Masters JP, Rymaszewska M, Reed MR, Sprowson AP. Prophylactic antibiotics in elective hip and knee arthroplasty: an analysis of organisms reported to cause infections and National survey of clinical practice. Bone Joint Res 2015; 4:181-9. [PMID: 26585304 PMCID: PMC4664867 DOI: 10.1302/2046-3758.411.2000432] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objectives We wanted to investigate regional variations in the organisms
reported to be causing peri-prosthetic infections and to report
on prophylaxis regimens currently in use across England. Methods Analysis of data routinely collected by Public Health England’s
(PHE) national surgical site infection database on elective primary
hip and knee arthroplasty procedures between April 2010 and March
2013 to investigate regional variations in causative organisms.
A separate national survey of 145 hospital Trusts (groups of hospitals
under local management) in England routinely performing primary
hip and/or knee arthroplasty was carried out by standard email questionnaire. Results Analysis of 189 858 elective primary hip and knee arthroplasty
procedures and 1116 surgical site infections found statistically
significant variations for some causative organism between regions.
There was a 100% response rate to the prophylaxis questionnaire
that showed substantial variation between individual trust guidelines.
A number of regimens currently in use are inconsistent with the
best available evidence. Conclusions The approach towards antibiotic prophylaxis in elective arthroplasty
nationwide reveals substantial variation without clear justification.
Only seven causative organisms are responsible for 89% of infections
affecting primary hip and knee arthroplasty, which cannot justify
such widespread variation between prophylactic antibiotic policies. Cite this article: Bone Joint Res 2015;4:181–189.
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Affiliation(s)
- C J Hickson
- Leicester Royal Infirmary, Infirmary square, Leicester, LE1 5WW, UK
| | - D Metcalfe
- Harvard Medical School, One Brigham Circle, Boston, Massachusetts, 02115, USA
| | - S Elgohari
- Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - T Oswald
- Northumbria Healthcare NHS Foundation Trust, Woodhorn Lane, Ashington, Northumberland, NE63 9JJ, UK
| | - J P Masters
- Warwick Orthopaedics, Clinical Sciences Building, University Hospital Coventry and Warwickshire, Coventry, CV2 2DX, UK
| | - M Rymaszewska
- Wansbeck Hospital, Woodhorn Ln, Ashington, Northumberland NE63 9JJ, UK
| | - M R Reed
- Newcastle University and Northumbria Healthcare NHS Foundation Trust, Woodhorn Lane, Ashington, Northumberland, NE63 9JJ, UK
| | - A P Sprowson
- University of Warwick and University Hospitals Coventry and Warwickshire, Clinical Sciences Building, Coventry, CV2 2DX, UK
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Is hospital information system relevant to detect surgical site infection? Findings from a prospective surveillance study in posterior instrumented spinal surgery. Orthop Traumatol Surg Res 2015; 101:845-9. [PMID: 26526092 DOI: 10.1016/j.otsr.2015.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 06/07/2015] [Accepted: 08/27/2015] [Indexed: 02/02/2023]
Abstract
OBJECT Spinal instrumentation has a high rate of surgical site infection (SSI), but results greatly vary depending on surveillance methodology, surgical procedures, or quality of follow-up. Our aim was to study true incidence of SSI in spinal surgery by significant data collection, and to compare it with the results obtained through the hospital information system. METHODS This work is a single center prospective cohort study that included all patients consecutively operated on for spinal instrumentation by posterior approach over a six-month period regardless the etiology. For all patients, a "high definition" prospective method of surveillance was performed by the infection control (IC) department during at least 12 months after surgery. Results were then compared with findings from automatic surveillance though the hospital information system (HIS). RESULTS One hundred and fifty-four patients were included. We found no hardly difference between "high definition" and automatic surveillance through the HIS, even if HIS tended to under-estimate the infection rate: rate of surgical site infection was 2.60% and gross SSI incidence rate via the hospital information system was 1.95%. Smoking and alcohol consumption were significantly related to a SSI. CONCLUSION Our SSI rates to reflect the true incidence of infectious complications in posterior instrumented adult spinal surgery in our hospital and these results were consistent with the lower levels of published infection rate. In-house surveillance by surgeons only is insufficiently sensitive. Further studies with more patients and a longer inclusion time are needed to conclude if SSI case detection through the HIS could be a relevant and effective alternative method.
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Abstract
In England and Wales more than 175 000 hip and knee arthroplasties were performed in 2012. There continues to be a steady increase in the demand for joint arthroplasty because of population demographics and improving survivorship. Inevitably though the absolute number of periprosthetic infections will probably increase with severe consequences on healthcare provision. The Department of Health and the Health Protection Agency in United Kingdom established a Surgical Site Infection surveillance service (SSISS) in 1997 to undertake surveillance of surgical site infections. In 2004 mandatory reporting was introduced for one quarter of each year. There has been a wide variation in reporting rates with variable engagement with the process. The aim of this article is to improve surgeon awareness of the process and emphasise the importance of engaging with SSISS to improve the quality and type of data submitted. In Exeter we have been improving our practice by engaging with SSISS. Orthopaedic surgeons need to take ownership of the data that are submitted to ensure these are accurate and comprehensive. Cite this article: Bone Joint J 2015;97-B:1170–4.
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Affiliation(s)
- A. Patel
- Royal Stoke University Hospital, Newcastle
Road, Stoke on Trent, Staffordshire, ST4
6QG, UK
| | - G. Pavlou
- Wrightington Wigan and Leigh NHS Trust
Wrightington Hospital, Hall Lane, Appley
Bridge, Wigan WN6 9EP, UK
| | - R. A. Ahmad
- Princess Elizabeth Orthopaedic Centre, Royal
Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
| | - A. Toms
- Exeter Knee Reconstruction Unit, Barrack
Road, Exeter, EX2 5DW, UK
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Singh S, Davies J, Sabou S, Shrivastava R, Reddy S. Challenges in reporting surgical site infections to the national surgical site infection surveillance and suggestions for improvement. Ann R Coll Surg Engl 2015; 97:460-5. [PMID: 26320763 PMCID: PMC5126250 DOI: 10.1308/rcsann.2015.0027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Mandatory orthopaedic surgical site infection (SSI) data in England are used as a benchmark to compare infection rates between participating hospitals. According to the national guidelines, trusts are required to submit their data for at least one quarter of the year but they are free to report for all quarters. Owing to this ambiguity, there is a concern about robust reporting across trusts and therefore the accuracy of these data. There is also concern about the accuracy of collection methods. The aim of this five-year retrospective study was to assess the accuracy of SSI reporting at two hospitals in South East England under the same trust. METHODS A retrospective review was carried out of five years of electronic medical records, microbiology data and readmission data of all patients who underwent hip and knee replacement surgery at these hospitals. These data were validated with the data submitted to Public Health England (PHE) and any discrepancy between the two was noted. RESULTS A significant difference was found in the SSI rates reported by the surveillance staff and our retrospective method. CONCLUSIONS Our study confirms the findings of a national survey, which raised concerns about the quality of SSI reporting and the usefulness of PHE SSI data for benchmarking purposes. To our knowledge, there are no previously published studies that have looked at the accuracy of the English orthopaedic SSI surveillance. In the light of our findings, there is an urgent need for external validation studies to identify the extent of the problem in the surveillance scheme. The governing bodies should also issue clear guidelines for reporting SSIs to maintain homogeneity and to present the true incidence of SSI. We suggest some measures that we have instituted to address these inadequacies that have led to significant improvements in reporting at our trust.
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Affiliation(s)
- S Singh
- East Kent Hospitals University NHS Foundation Trust, UK
| | - J Davies
- East Kent Hospitals University NHS Foundation Trust, UK
| | - S Sabou
- East Kent Hospitals University NHS Foundation Trust, UK
| | - R Shrivastava
- East Kent Hospitals University NHS Foundation Trust, UK
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Affiliation(s)
- J. Parvizi
- The Rothman Institute, 925 Chestnut
St, Philadelphia,
PA 19107, USA
| | - F. S. Haddad
- The Bone & Joint Journal, 22 Buckingham Street, London, WC2N 6ET, UK
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Davies BM, Jones A, Patel HC. Surgical-site infection surveillance in cranial neurosurgery. Br J Neurosurg 2015; 30:35-7. [DOI: 10.3109/02688697.2015.1071321] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Surgical Site Infection After Primary Hip and Knee Arthroplasty: A Cohort Study Using a Hospital Database. Infect Control Hosp Epidemiol 2015; 36:1198-207. [DOI: 10.1017/ice.2015.148] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUNDHip or knee arthroplasty infection (HKAI) leads to heavy medical consequences even if rare.OBJECTIVETo assess the routine use of a hospital discharge detection algorithm of prosthetic joint infection as a novel additional tool for surveillance.METHODSA historic 5-year cohort study was built using a hospital database of people undergoing a first hip or knee arthroplasty in 1 French region (2.5 million inhabitants, 39 private and public hospitals): 32,678 patients with arthroplasty code plus corresponding prosthetic material code were tagged. HKAI occurrence was then tracked in the follow-up on the basis of a previously validated algorithm using International Statistical Classification of Disease, Tenth Revision, codes as well as the surgical procedures coded. HKAI density incidence was estimated during the follow-up (up to 4 years after surgery); risk factors were analyzed using Cox regression.RESULTSA total of 604 HKAI patients were identified: 1-year HKAI incidence was1.31%, and density incidence was 2.2/100 person-years in hip and 2.5/100 person-years in knee. HKAI occurred within the first 30 days after surgery for 30% but more than 1 year after replacement for 29%. Patients aged 75 years or older, male, or having liver diseases, alcohol abuse, or ulcer sore had higher risk of infection. The inpatient case fatality in HKAI patients was 11.4%.CONCLUSIONSThe hospital database method used to measure occurrence and risk factors of prosthetic joint infection helped to survey HKAI and could optimize healthcare delivery.Infect Control Hosp Epidemiol 2015;36(10):1198–1207
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Leaper DJ, Tanner J, Kiernan M, Assadian O, Edmiston CE. Surgical site infection: poor compliance with guidelines and care bundles. Int Wound J 2015; 12:357-62. [PMID: 24612792 PMCID: PMC7950697 DOI: 10.1111/iwj.12243] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 01/27/2014] [Indexed: 11/28/2022] Open
Abstract
Surgical site infections (SSIs) are probably the most preventable of the health care-associated infections. Despite the widespread international introduction of level I evidence-based guidelines for the prevention of SSIs, such as that of the National Institute for Clinical Excellence (NICE) in the UK and the surgical care improvement project (SCIP) of the USA, SSI rates have not measurably fallen. The care bundle approach is an accepted method of packaging best, evidence-based measures into routine care for all patients and, common to many guidelines for the prevention of SSI, includes methods for preoperative removal of hair (where appropriate), rational antibiotic prophylaxis, avoidance of perioperative hypothermia, management of perioperative blood glucose and effective skin preparation. Reasons for poor compliance with care bundles are not clear and have not matched the wide uptake and perceived benefit of the WHO 'Safe Surgery Saves Lives' checklist. Recommendations include the need for further research and continuous updating of guidelines; comprehensive surveillance, using validated definitions that facilitate benchmarking of anonymised surgeon-specific SSI rates; assurance that incorporation of checklists and care bundles has taken place; the development of effective communication strategies for all health care providers and those who commission services and comprehensive information for patients.
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Affiliation(s)
- David J Leaper
- School of Applied Sciences, University of Huddersfield, Huddersfield, UK
| | - Judith Tanner
- Clinical Nursing Research, DeMontfort University, Leicester, UK
| | - Martin Kiernan
- Prevention and Control of Infection, Southport and Ormskirk Hospitals NHS Trust, Southport, UK
| | - Ojan Assadian
- Department of Hospital Hygiene, Medical University of Vienna, Vienna, Austria
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Park SJ, Lee KY, Park JW, Lee JG, Choi HJ, Chun HK, Kang JG. A preliminary study for the development of indices and the current state of surgical site infections (SSIs) in Korea: the Korean Surgical Site Infection Surveillance (KOSSIS) program. Ann Surg Treat Res 2015; 88:119-25. [PMID: 25741490 PMCID: PMC4347042 DOI: 10.4174/astr.2015.88.3.119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 12/03/2014] [Accepted: 12/09/2014] [Indexed: 11/30/2022] Open
Abstract
Purpose We aimed to develop an effective system for surgical site infection (SSI) surveillance and examine the current domestic state of SSIs for common abdominal surgeries in Korea. Methods The Korean Surgical Site Infection Surveillance (KOSSIS) program was developed as an SSI surveillance system. A prospective multicenter study in nine university-affiliated or general hospitals was conducted for patients who underwent gastrectomy, cholecystectomy, appendectomy, colectomy, or proctectomy between August 16 and September 30 in 2012. Patients were monitored for up to 30 days by combining direct observation and a postdischarge surgeon survey. Data on SSIs were prospectively collected with KOSSIS secretarial support according to a common protocol. Operation-specific SSI rates were stratified according to risk factors and compared with data from the Korean Nosocomial Infections Surveillance System (KONIS) and National Healthcare Safety Network. A focus group interview was conducted with participating hospitals for feedback. Results A total of 1,088 operations were monitored: 207 gastrectomies, 318 cholecystectomies, 270 appendectomies, 197 colectomies, and 96 proctectomies. Operation-specific SSI rates determined by the KOSSIS program were substantially higher than those found in KONIS (7.73% [95% confidence interval, 4.5%-12.3%] vs. 3.4% for gastrectomies, 10.15% [95% confidence interval, 6.1%-15.2%] vs. 4.0% for colectomy, and 13.5% [95% confidence interval, 7.4%-22.0%] vs. 4.2% for proctectomy). Conclusion Despite a short surveillance period and heterogenous group of hospitals, our results suggest that KOSSIS could be a useful program to enhance SSI surveillance in Korea.
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Affiliation(s)
- Sun Jin Park
- Department of Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Kil Yeon Lee
- Department of Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Ji Won Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Gil Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Jung Choi
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hee Kyung Chun
- Department of Infection Control, Kyung Hee University Medical Center, Seoul, Korea
| | - Jung Gu Kang
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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Koek MB, Wille JC, Isken MR, Voss A, van Benthem BH. Post-discharge surveillance (PDS) for surgical site infections: a good method is more important than a long duration. Euro Surveill 2015; 20. [DOI: 10.2807/1560-7917.es2015.20.8.21042] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- M B Koek
- Department of Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
| | - J C Wille
- Department of Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
| | - M R Isken
- Medical Microbiology & Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - A Voss
- Medical Microbiology & Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
- Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - B H van Benthem
- Department of Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
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Grammatico-Guillon L, Rusch E, Astagneau P. Surveillance of prosthetic joint infections: international overview and new insights for hospital databases. J Hosp Infect 2015; 89:90-8. [DOI: 10.1016/j.jhin.2013.09.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 09/23/2013] [Indexed: 10/26/2022]
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