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Chimenea A, Domínguez-Moreno M, Barrera-Talavera M, García-Díaz L, Antiñolo G. Maternal and Neonatal Outcomes After Ex-Utero Intrapartum Treatment for Congenital Diaphragmatic Hernia: A Case Series. Eur J Pediatr Surg 2024; 34:319-324. [PMID: 37473779 DOI: 10.1055/a-2133-8380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
INTRODUCTION Despite advances in neonatal intensive care, fetuses with congenital diaphragmatic hernia (CDH) remain to have a poor prognosis. Exclusive postnatal treatment is inadequate in patients with moderate CDH (observed than expected lung-to-head ratio [O/E LHR] 26-45%) and can lead to respiratory failure at birth, requiring extracorporeal membrane oxygenation in 75% of cases. An ex-utero intrapartum treatment (EXIT) procedure may be beneficial in these cases, improving the fetal-neonatal transition. MATERIAL AND METHODS We review all pregnancies with fetal isolated left CDH with moderate O/E LHR delivered by EXIT in our center from January 2007 to December 2022. Maternal and neonatal variables were analyzed. As primary outcomes, we included neonatal survival and mortality rates, surgical and infectious complications, uterine scar dehiscence, and blood loss during EXIT. As secondary outcomes, we studied recurrences of the diaphragmatic defect, long-term evolution, subsequent pregnancies, and mode of delivery. RESULTS A total of 14 patients were delivered by the EXIT procedure, with a neonatal survival rate of 85.7%. All these children had optimal physical and neurocognitive development and no pulmonary morbidity. We found no major complications and 7.1% of minor maternal complications. There were no cases of surgical wound infection or endometritis. The median decrease in hemoglobin during the EXIT procedure was 1.9 mg/dL, and only one case required postoperative transfusion. Two out of the 14 women became pregnant again, and both pregnancies were uneventful. CONCLUSIONS In our series, the EXIT procedure allows for adequate airway management associated with a high neonatal survival rate in patients with moderate O/E LHR CDH, with a low rate of neonatal and maternal complications.
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Affiliation(s)
- Angel Chimenea
- Department of Materno-Fetal Medicine, Genetics, and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain
- Fetal, IVF, and Reproduction Simulation Training Centre (FIRST), Seville, Spain
| | - Marta Domínguez-Moreno
- Department of Materno-Fetal Medicine, Genetics, and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain
| | - María Barrera-Talavera
- Department of Materno-Fetal Medicine, Genetics, and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain
| | - Lutgardo García-Díaz
- Department of Materno-Fetal Medicine, Genetics, and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain
- Department of Surgery, University of Seville, Seville, Spain
| | - Guillermo Antiñolo
- Department of Materno-Fetal Medicine, Genetics, and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain
- Fetal, IVF, and Reproduction Simulation Training Centre (FIRST), Seville, Spain
- Department of Surgery, University of Seville, Seville, Spain
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Seville, Spain
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Litman E, Young B, Spiel M. Novel Insights on Group B Streptococcus in Pregnancy. Clin Obstet Gynecol 2024:00003081-990000000-00164. [PMID: 38902963 DOI: 10.1097/grf.0000000000000883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Group B Streptococcus (GBS) is a frequent colonizer of the human genital and gastrointestinal tract. In pregnant or postpartum persons, colonization is often asymptomatic and can contribute to infectious morbidity in both the parturient and the newborn. The prevalence of invasive GBS disease has dramatically decreased over the past 3 decades. However, despite standardized clinical algorithms, GBS disease remains a public health concern. Our review summarizes the GBS bacteria pathophysiology, morbidity, management guidelines, and summarizes ongoing research. While novel testing and parturient vaccination are being explored, barriers exist, preventing guideline updates and widespread implementation.
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Affiliation(s)
- Ethan Litman
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA
| | - Brett Young
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA
| | - Melissa Spiel
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA
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Hill H, Wagenhäuser I, Schuller P, Diessner J, Eisenmann M, Kampmeier S, Vogel U, Wöckel A, Krone M. Establishing semi-automated infection surveillance in obstetrics and gynaecology. J Hosp Infect 2024; 146:125-133. [PMID: 38295904 DOI: 10.1016/j.jhin.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Surveillance is an acknowledged method to decrease nosocomial infections, such as surgical site infections (SSIs). Electronic healthcare records create the opportunity for automated surveillance. While approaches for different types of surgeries and indicators already exist, there are very few for obstetrics and gynaecology. AIM To analyse the sensitivity and workload reduction of semi-automated surveillance in obstetrics and gynaecology. METHODS In this retrospective, single-centre study at a 1438-bed tertiary care hospital in Germany, semi-automated SSI surveillance using the indicators 'antibiotic prescription', 'microbiological data' and 'administrative data' (diagnosis codes, readmission, post-hospitalization care) was compared with manual analysis and categorization of all patient files. Breast surgeries (BSs) conducted in 2018 and caesarean sections (CSs) that met the inclusion criteria between May 2013 and December 2019 were included. Indicators were analysed for sensitivity, number of analysed procedures needed to identify one case, and potential workload reduction in detecting SSIs in comparison with the control group. FINDINGS The reference standard showed nine SSIs in 416 BSs (2.2%). Sensitivities for the indicators 'antibiotic prescription', 'diagnosis code', 'microbiological sample taken', and the combination 'diagnosis code or microbiological sample' were 100%, 88.9%, 66.7% and 100%, respectively. The reference standard showed 54 SSIs in 3438 CSs (1.6%). Sensitivities for the indicators 'collection of microbiological samples', 'diagnosis codes', 'readmission/post-hospitalization care', and the combination of all indicators were 38.9%, 27.8%, 85.2% and 94.4%, respectively. CONCLUSIONS Semi-automated surveillance systems may reduce workload by maintaining high sensitivity depending on the type of surgery, local circumstances and thorough digitalization.
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Affiliation(s)
- H Hill
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany; Infection Control and Antimicrobial Stewardship Unit, University Hospital Würzburg, Würzburg, Germany
| | - I Wagenhäuser
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Würzburg, Würzburg, Germany; Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - P Schuller
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Würzburg, Würzburg, Germany
| | - J Diessner
- Department of Obstetrics and Gynaecology, University Hospital Würzburg, Würzburg, Germany
| | - M Eisenmann
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Würzburg, Würzburg, Germany
| | - S Kampmeier
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany; Infection Control and Antimicrobial Stewardship Unit, University Hospital Würzburg, Würzburg, Germany
| | - U Vogel
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany; Infection Control and Antimicrobial Stewardship Unit, University Hospital Würzburg, Würzburg, Germany
| | - A Wöckel
- Department of Obstetrics and Gynaecology, University Hospital Würzburg, Würzburg, Germany
| | - M Krone
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany; Infection Control and Antimicrobial Stewardship Unit, University Hospital Würzburg, Würzburg, Germany.
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Delli Carpini G, Giannella L, Di Giuseppe J, Fioretti M, Franconi I, Gatti L, Sabbatini K, Montanari M, Marconi C, Tafuri E, Tibaldi L, Fichera M, Pizzagalli D, Ciavattini A. Inter-rater agreement of CDC criteria and ASEPSIS score in assessing surgical site infections after cesarean section: a prospective observational study. Front Surg 2023; 10:1123193. [PMID: 37675248 PMCID: PMC10477579 DOI: 10.3389/fsurg.2023.1123193] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 08/07/2023] [Indexed: 09/08/2023] Open
Abstract
Objective To assess and compare the inter-rater agreement of the CDC criteria and the ASEPSIS score in identifying surgical site infections after cesarean section. Methods Prospective observational study including 110 patients subjected to a cesarean section at our institution. Surgical wounds were managed according to standard care and were photographed on the third, seventh, and thirtieth postoperative day or during any evaluation in case of complications. Three expert surgeons reviewed the prospectively gathered data and photographs and classified each wound using CDC criteria and the ASEPSIS score. The inter-rater agreements of CDC criteria and ASEPSIS score were determined with Krippendorff's Alpha with linear weights and compared with a confidence interval approach. Results The weighted α coefficient for CDC criteria was 0.587 (95%CI, 0.411-0.763, p < 0.001, "moderate" agreement according to Altman's interpretation of weighted agreement coefficient), while the weighted α coefficient for the ASEPSIS score was 0.856 (95%CI, 0.733-0.980, p < 0.001, "very good" agreement). Conclusion ASEPSIS score presents a "very good" inter-rater agreement for surgical site infections identification after cesarean, resulting in a more objective method than CDC criteria ("moderate" inter-rater agreement). ASEPSIS score could represent an objective tool for managing and monitoring surgical site infections after cesarean section, also by photographic evaluation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Andrea Ciavattini
- Obstetrics and Gynecologic Section, Department of Odontostomatological and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
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Boulanger V, Poirier É, MacLaurin A, Quach C. Divergences between healthcare-associated infection administrative data and active surveillance data in Canada. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2022; 48:4-16. [PMID: 35273464 PMCID: PMC8856828 DOI: 10.14745/ccdr.v48i01a02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Although Canada has both a national active surveillance system and administrative data for the passive surveillance of healthcare-associated infections (HAI), both have identified strengths and weaknesses in their data collection and reporting. Active and passive surveillance work independently, resulting in results that diverge at times. To understand the divergences between administrative health data and active surveillance data, a scoping review was performed. METHOD Medline, Embase and Cumulative Index to Nursing and Allied Health Literature along with grey literature were searched for studies in English and French that evaluated the use of administrative data, alone or in comparison with traditional surveillance, in Canada between 1995 and November 2, 2020. After extracting relevant information from selected articles, a descriptive summary of findings was provided with suggestions for the improvement of surveillance systems to optimize the overall data quality. RESULTS Sixteen articles met the inclusion criteria, including twelve observational studies and four systematic reviews. Studies showed that using a single source of administrative data was not accurate for HAI surveillance when compared with traditional active surveillance; however, combining different sources of data or combining administrative with active surveillance data improved accuracy. Electronic surveillance systems can also enhance surveillance by improving the ability to detect potential HAIs. CONCLUSION Although active surveillance of HAIs produced the most accurate results and remains the gold-standard, the integration between active and passive surveillance data can be optimized. Administrative data can be used to enhance traditional active surveillance. Future studies are needed to evaluate the feasibility and benefits of potential solutions presented for the use of administrative data for HAI surveillance and reporting in Canada.
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Affiliation(s)
- Virginie Boulanger
- Département de microbiologie, infectiologie et immunologie, Faculté de médecine, Université de Montréal, Montréal, QC
- Centre de recherche – CHU Sainte-Justine, Montréal, QC
| | - Étienne Poirier
- Département de microbiologie, infectiologie et immunologie, Faculté de médecine, Université de Montréal, Montréal, QC
- Centre de recherche – CHU Sainte-Justine, Montréal, QC
| | | | - Caroline Quach
- Département de microbiologie, infectiologie et immunologie, Faculté de médecine, Université de Montréal, Montréal, QC
- Centre de recherche – CHU Sainte-Justine, Montréal, QC
- Département clinique de médecine de laboratoire, CHU Sainte-Justine, Montréal, QC
- Prévention et contrôle des infections, Département de pédiatrie, CHU Sainte-Justine, Montréal, QC
- Correspondence:
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Ousey K, Blackburn J, Stephenson J, Southern T. Incidence and Risk Factors for Surgical Site Infection following Emergency Cesarean Section: A Retrospective Case-Control Study. Adv Skin Wound Care 2021; 34:482-487. [PMID: 34415252 DOI: 10.1097/01.asw.0000767368.20398.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the incidence, risk, and associated factors that contribute to an acquired surgical site infection (SSI) after emergency cesarean section (CS). METHODS This retrospective case-control study was conducted in an acute district general hospital in England with 206 patients (101 SSI patients and 105 non-SSI patients) who had an emergency CS in 2017. Grade of surgeon, smoking status, preoperative vaginal swab status (positive or negative), diabetes status, age, body mass index, membrane rupture to delivery interval, and length of surgery were recorded. Risk factors were identified using simple and multiple logistic regression. RESULTS Body mass index was significantly associated with SSI (odds ratio, 1.17; 95% confidence interval, 1.11 to 1.24; P < .001). Further, substantive nonsignificant associations were recorded between SSI and patient age and vaginal swab status. CONCLUSIONS Body mass index was the only significant risk factor for the development of an SSI after emergency CS, possibly because of the impact of excessive adipose tissue on the immune system and reduced effectiveness of antibiotics. Diabetes status, patient age, and preoperative vaginal swab status were not significantly associated with SSI. Improved guidelines and strategies for managing at-risk patients would enable clinicians to reduce the risk of SSI development. The importance of wound management including frequent wound cleaning, appropriate dressings, dressing changes, and education is highlighted. Future research on larger samples should be conducted to validate these findings.
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Affiliation(s)
- Karen Ousey
- At the University of Huddersfield, United Kingdom, Karen Ousey, PhD, FRSB, RGN, FHEA, CMgr, MCMI, is Professor of Skin Integrity and Director, Institute of Skin Integrity and Infection Prevention; Joanna Blackburn, PhD, is Research Fellow, Institute of Skin Integrity and Infection Prevention; John Stephenson, PhD, is Senior Lecturer, School of Human and Health Sciences; and Tom Southern, MS, is Master's Student, School of Human and Health Sciences. The authors have disclosed no financial relationships related to this article. Submitted October 6, 2020; accepted in revised form November 5, 2020
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Narice BF, Almeida JR, Farrell T, Madhuvrata P. Impact of changing gloves during cesarean section on postoperative infective complications: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2021; 100:1581-1594. [PMID: 33871059 DOI: 10.1111/aogs.14161] [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] [Received: 11/29/2020] [Revised: 03/22/2021] [Accepted: 04/10/2021] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The cesarean section rate around the world, currently estimated at 21.1%, continues to increase. Women who undergo a cesarean section sustain a seven- to ten-fold greater risk of infective morbidity compared with those who deliver vaginally. MATERIAL AND METHODS We aimed to assess the impact of changing gloves intraoperatively on post-cesarean section infective morbidity (PROSPERO CRD42018110529). MEDLINE, Scopus, Web of Science, CINAHL, WHO Global Index Medicus, and Cochrane Central were searched for randomized controlled trials until June 2020. Published randomized controlled trials that evaluated the effects of glove changing during cesarean section on infective complications were considered eligible for the review. Two reviewers independently selected studies, assessed the risk of bias, and extracted data about interventions and adverse maternal outcomes. Dichotomous variables were presented and included in the meta-analyses as risk ratios (RR) with 95% confidence intervals (CI). The quality of evidence was assessed using the GRADE approach in alignment with the recommendations from the Cochrane Review Group. RESULTS We identified seven randomized controlled trials reporting data over 1948 women. Changing gloves during a cesarean section was associated with a statistically significantly lower incidence of wound infective complications (RR 0.41, 95% CI 0.26-0.65, p < 0.0001; GRADE moderate quality evidence). This intervention seemed to be effective only if performed after delivery of the placenta. No significant difference was seen in the incidence of endometritis (RR 0.96, 95% CI 0.78-1.20, p = 0.74; GRADE moderate quality evidence) and/or febrile morbidity (RR 0.73, 95% CI 0.30-1.81, p = 0.50; GRADE moderate quality evidence), regardless of the timing of the intervention. CONCLUSIONS Changing gloves after delivery of the placenta during a cesarean section is associated with a significant reduction in the incidence of post-surgical wound complications compared with keeping the same gloves throughout the whole surgery. However, an adequately powered study to assess the limitations and cost-effectiveness of the intervention is needed before this recommendation can be translated into current clinical practice.
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Affiliation(s)
- Brenda F Narice
- Academic Unit of Reproductive and Developmental Medicine, Jessop Wing, University of Sheffield, Sheffield, UK
| | - Joana R Almeida
- Department of Obstetrics and Gynaecology, Jessop Wing, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Tom Farrell
- Women's Wellness & Research center, Hamad Medical Corporation, Doha, Qatar
| | - Priya Madhuvrata
- Department of Obstetrics and Gynaecology, Jessop Wing, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
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Martin E, Beckmann M, Blythe R, Merollini K, Graves N. Adherence to best practice: Preventing surgical site infection following caesarean section in Australia. Aust N Z J Obstet Gynaecol 2021; 61:728-734. [PMID: 33843068 DOI: 10.1111/ajo.13347] [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: 12/03/2020] [Accepted: 03/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Surgical site infection (SSI) following caesarean section is a serious but underreported problem with an estimated incidence of 5-9%. It is essential to identify adherence to established prevention strategies to reduce the incidence rate. AIMS The aims of this study were to quantify unwarranted variation from evidence-based practice on the prevention of SSI at caesarean section in Australia; and to identify predictors of not implementing an existing infection prevention bundle: pre-incision antibiotic prophylaxis, vaginal preparation and spontaneous placenta removal. MATERIALS AND METHODS An online cross-sectional survey of obstetricians and obstetric Diplomates was conducted in 2016. The primary outcome was adherence to an existing infection prevention bundle, with demographic and clinical variables predicting adherence through multivariable binary logistic regression. RESULTS Forty-nine percent of respondents (response rate 39.6%) reported implementing zero or only one element of the infection prevention bundle. The types of respondents most likely to have poor adherence were Diplomates (adjusted odds ratio (aOR) 2.58), obstetricians practising in private hospitals (aOR 3.34), those usually practising in public and private hospitals (aOR 2.23), and those not usually implementing a surgical safety checklist (aOR 3.77). CONCLUSIONS Adherence to best practice at caesarean section is low among many Australian obstetricians. Infection control practitioners and obstetricians need to collaboratively implement surgical safety checklists at caesarean section, and monitor implementation using process key performance indicators, and audit and feedback. These strategies will reduce unwarranted variation from evidence-based infection control practice.
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Affiliation(s)
- Elizabeth Martin
- Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Michael Beckmann
- Mothers, Babies and Women's Health, Mater Hospital Brisbane, Brisbane, Queensland, Australia
| | - Robin Blythe
- Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Katharina Merollini
- Sunshine Coast Health Institute, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
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Cabral BG, Brasiliense DM, Furlaneto IP, Rodrigues YC, Lima KVB. Surgical Site Infection Following Caesarean Section by Acinetobacter Species: A Report from a Hyperendemic Setting in the Brazilian Amazon Region. Microorganisms 2021; 9:microorganisms9040743. [PMID: 33918140 PMCID: PMC8067217 DOI: 10.3390/microorganisms9040743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 12/31/2022] Open
Abstract
Surgical site infection (SSI) following caesarean section is associated with increased morbidity, mortality, and significant health care costs. This study evaluated the epidemiological, clinical, and microbiological features of Acinetobacter spp. in women with SSIs who have undergone caesarean section at a referral hospital in the Brazilian Amazon region. This study included 69 women with post-caesarean SSI by Acinetobacter spp. admitted to the hospital between January 2012 and May 2015. The 69 Acinetobacter isolates were subjected to molecular species identification, antimicrobial susceptibility testing, detection of carbapenemase-encoding genes, and genotyping. The main complications of post-caesarean SSI by Acinetobacter were inadequate and prolonged antibiotic therapy, sepsis, prolonged hospitalization, and re-suture procedures. A. baumannii, A. nosocomialis and A. colistiniresistens species were identified among the isolates. Carbapenem resistance was associated with OXA-23-producing A. baumannii isolates and IMP-1-producing A. nosocomialis isolate. Patients with multidrug-resistant A. baumannii infection showed worse clinical courses. Dissemination of persistent epidemic clones was observed, and the main clonal complexes (CC) for A. baumannii were CC231 and CC236 (Oxford scheme) and CC1 and CC15 (Pasteur scheme). This is the first report of a long-term Acinetobacter spp. outbreak in women who underwent caesarean section at a Brazilian hospital. This study demonstrates the impact of multidrug resistance on the clinical course of post-caesarean infections.
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Affiliation(s)
- Blenda Gonçalves Cabral
- Parasitic Biology in the Amazon Region, Center of Biological and Health Sciences, State University of Pará, Belém 66087-662, PA, Brazil; (B.G.C.); (Y.C.R.); (K.V.B.L.)
| | - Danielle Murici Brasiliense
- Bacteriology and Mycology Section, Evandro Chagas Institute, Ananindeua 67030-000, PA, Brazil
- Correspondence: ; Tel.: +55-9132-1421-16
| | | | - Yan Corrêa Rodrigues
- Parasitic Biology in the Amazon Region, Center of Biological and Health Sciences, State University of Pará, Belém 66087-662, PA, Brazil; (B.G.C.); (Y.C.R.); (K.V.B.L.)
| | - Karla Valéria Batista Lima
- Parasitic Biology in the Amazon Region, Center of Biological and Health Sciences, State University of Pará, Belém 66087-662, PA, Brazil; (B.G.C.); (Y.C.R.); (K.V.B.L.)
- Bacteriology and Mycology Section, Evandro Chagas Institute, Ananindeua 67030-000, PA, Brazil
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Niv Y, Kuniavsky M, Bronshtein O, Goldschmidt N, Hanhart S, Levine D, Mahalla H. Quality Indicators for Prevention of Infection in the Surgical Site: The Israeli National Program for Quality Indicators Experience. Qual Manag Health Care 2021; 30:81-86. [PMID: 33783421 DOI: 10.1097/qmh.0000000000000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES The Israeli National Program for Quality Indicators (INPQ) sets as its primary goal to promote high-quality health care within selected core areas in the Israeli health system. Surgical site infection is one of the most common types of acquired infections. The INPQ supports 3 distinct indicators concerning suitable antibiotic treatment in colorectal surgery, cesarean sections, and surgery for femoral neck fractures. METHODS We measured the number of patients who received prophylactic antibiotics, beginning an hour before the first cut and stopping after 24 hours in 1 of the 3 operations, according to the International Classification of Diseases, Ninth Revision (ICD-9) codes. Goals for success have been established annually according to the results of the previous year. Data computed for each operation included socioeconomic status, dates of hospitalization and release, date of death, date of birth, gender, date of operation, time of beginning and end of the operation, and time of beginning and end of anesthesia. RESULTS Within 3 to 5 years, we achieved a significant increase in appropriate prophylactic antibiotic use from 78% to 85%, 78% to 95%, and 66% to 88% for colorectal surgery (n = 9404), cesarean sections (n = 141 362), and femoral joint operations (n = 30 728), respectively. The mortality rate was lower, 1.85% versus 0.55% in patients who received proper antibiotic therapy (odds ratio [OR] = 3.141; 95% confidence interval [CI], 1.829-5.394, P < .0001), 0.031% versus 0.006% (OR = 6.741; 95% CI, 1.879-21.187; P = .003), and 5.59% versus 4.51% (OR = 1.253; 95% CI, 1.091-1.439; P = .001), respectively. CONCLUSION Prophylactic antibiotic treatment is strongly recommended by medical guidelines. The experience of the INPQ supports this approach. We demonstrate a significant lower mortality rate in patients who have been properly treated.
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Affiliation(s)
- Yaron Niv
- The Israeli National Program for Quality Indicators, Ministry of Health, Jerusalem, Israel
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Sandy-Hodgetts K, Parsons R, Norman R, Fear MW, Wood FM, White SW. Effectiveness of negative pressure wound therapy in the prevention of surgical wound complications in the cesarean section at-risk population: a parallel group randomised multicentre trial-the CYGNUS protocol. BMJ Open 2020; 10:e035727. [PMID: 33077559 PMCID: PMC7574944 DOI: 10.1136/bmjopen-2019-035727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Caesarean delivery is steadily becoming one of the more common surgical procedures in Australia with over 100 000 caesarean sections performed each year. Over the last 10 years in Australia, the caesarean section rate has increased from 28% in 2003 to 33% in 2013. On the international stage, the Australian caesarean delivery rates are higher than the average for the Organisation for Economic Co-operation and Development, Australia ranked as 8 out of 33 and is second to the USA. Postoperative surgical site infections (SSIs) and wound complications are the most common and costly event following a caesarean section. Globally, complication rates following a caesarean delivery vary from 4.9% to 9.8%. Complications such as infection and wound breakdown affect the postpartum mother's health and well-being, and contribute to healthcare costs for clinical management that often spans the acute, community and primary healthcare settings. Published level one studies using advanced wound dressings in the identified 'at-risk' population prior to surgery for prophylactic intervention are yet to be forthcoming. METHODS AND ANALYSIS A parallel group randomised control trial of 448 patients will be conducted across two metropolitan hospitals in Perth, Western Australia, which provide obstetric and midwifery services. We will recruit pregnant women in the last trimester, prior to their admission into the healthcare facility for delivery of their child. We will use a computer-generated block sequence to randomise the 448 participants to either the interventional (negative pressure wound therapy (NPWT) dressing, n=224) or comparator arm (non-NPWT dressing, n=224). The primary outcome measure is the occurrence of surgical wound dehiscence (SSWD) or SSI. The Centres for Disease Control reporting definition of either superficial or deep infection at 30 days will be used as the outcome measure definition. SWD will be classified as per the World Union of Wound Healing Societies grading system (grade I-IV). We will assess recruitment rate, and adherence to intervention and follow-up. We will assess the potential effectiveness of NPWT in the prevention of postpartum surgical wound complications at three time points during the study; postoperative days 5, 14 and 30, after which the participant will be closed out of the trial. We will use statistical methods to determine efficacy, and risk stratification will be conducted to determine the SWD risk profile of the participant. Follow-up at day 30 will assess superficial and deep infection, and wound dehiscence (grade I-IV) and the core outcome data set for wound complications. This study will collect health-related quality of life (European Quality of Life 5-Dimensions 5-Level Scale), mortality and late complications such as further surgery with a cost analysis conducted. The primary analysis will be by intention-to-treat. This clinical trial protocol follows the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) and the Consolidated Standards of Reporting Trials guidelines. ETHICS AND DISSEMINATION Ethics approval was obtained through St John of God Health Care (HREC1409), Western Australia Department of Health King Edward Memorial Hospital (HREC3111). Study findings will be published in peer-reviewed journals and presented at international conferences. We used the SPIRIT checklist when writing our study protocol. TRIAL REGISTRATION NUMBER Australian and New Zealand Clinical Trials Registry (ACTRN12618002006224p).
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Affiliation(s)
- Kylie Sandy-Hodgetts
- Skin Integrity Research Institute, School of Biomedical Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Richard Parsons
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University Faculty of Health Sciences, Perth, Western Australia, Australia
| | - Richard Norman
- School of Public Health, Curtin University Faculty of Health Sciences, Perth, Western Australia, Australia
| | - Mark W Fear
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Fiona M Wood
- Fiona Stanley and Princess Margaret Hospitals, Burns Service of Western Australia, Perth, Western Australia, Australia
| | - Scott W White
- Department of Obstetrics and Gynaecology, The University of Western Australia Faculty of Health and Medical Sciences, Perth, Western Australia, Australia
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
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Wloch C, Van Hoek AJ, Green N, Conneely J, Harrington P, Sheridan E, Wilson J, Lamagni T. Cost-benefit analysis of surveillance for surgical site infection following caesarean section. BMJ Open 2020; 10:e036919. [PMID: 32690746 PMCID: PMC7375637 DOI: 10.1136/bmjopen-2020-036919] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To estimate the economic burden to the health service of surgical site infection following caesarean section and to identify potential savings achievable through implementation of a surveillance programme. DESIGN Economic model to evaluate the costs and benefits of surveillance from community and hospital healthcare providers' perspective. SETTING England. PARTICIPANTS Women undergoing caesarean section in National Health Service hospitals. MAIN OUTCOME MEASURE Costs attributable to treatment and management of surgical site infection following caesarean section. RESULTS The costs (2010) for a hospital carrying out 800 caesarean sections a year based on infection risk of 9.6% were estimated at £18 914 (95% CI 11 521 to 29 499) with 28% accounted for by community care (£5370). With inflation to 2019 prices, this equates to an estimated cost of £5.0 m for all caesarean sections performed annually in England 2018-2019, approximately £1866 and £93 per infection managed in hospital and community, respectively. The cost of surveillance for a hospital for one calendar quarter was estimated as £3747 (2010 costs). Modelling a decrease in risk of infection of 30%, 20% or 10% between successive surveillance periods indicated that a variable intermittent surveillance strategy achieved higher or similar net savings than continuous surveillance. Breakeven was reached sooner with the variable surveillance strategy than continuous surveillance when the baseline risk of infection was 10% or 15% and smaller loses with a baseline risk of 5%. CONCLUSION Surveillance of surgical site infections after caesarean section with feedback of data to surgical teams offers a potentially effective means to reduce infection risk, improve patient experience and save money for the health service.
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Affiliation(s)
- Catherine Wloch
- Healthcare Associated Infection and Antimicrobial Resistance, Public Health England, London, UK
| | - Albert Jan Van Hoek
- Immunisation, Hepatitis, and Blood Safety, Public Health England, London, UK
| | - Nathan Green
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Joanna Conneely
- Healthcare Associated Infection and Antimicrobial Resistance, Public Health England, London, UK
| | - Pauline Harrington
- Healthcare Associated Infection and Antimicrobial Resistance, Public Health England, London, UK
| | - Elizabeth Sheridan
- Healthcare Associated Infection and Antimicrobial Resistance, Public Health England, London, UK
| | - Jennie Wilson
- Richard Wells Research Centre, University of West London, London, UK
| | - Theresa Lamagni
- Healthcare Associated Infection and Antimicrobial Resistance, Public Health England, London, UK
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Eley VA, Christensen R, Ryan R, Jackson D, Parker SL, Smith M, van Zundert AA, Wallis SC, Lipman J, Roberts JA. Prophylactic Cefazolin Dosing in Women With Body Mass Index >35 kg·m−2 Undergoing Cesarean Delivery: A Pharmacokinetic Study of Plasma and Interstitial Fluid. Anesth Analg 2020; 131:199-207. [DOI: 10.1213/ane.0000000000004766] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Tan PC, Rohani E, Lim M, Win ST, Omar SZ. A randomised trial of caesarean wound coverage: exposed versus dressed. BJOG 2020; 127:1250-1258. [PMID: 32202035 DOI: 10.1111/1471-0528.16228] [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] [Accepted: 03/17/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the superficial surgical site infection (SSI) rate to 28 days and patient satisfaction with wound coverage management when their transverse suprapubic caesarean wound is left exposed compared with dressed after skin closure. DESIGN Randomised trial. SETTING University Hospital, Malaysia: April 2016-October 2016. POPULATION 331 women delivered by caesarean section. METHOD Participants were randomised to leaving their wound entirely exposed (n = 165) or dressed (n = 166) with a low adhesive dressing (next day removal). MAIN OUTCOME MEASURES Primary outcomes were superficial SSI rate (assessed by provider inspection up to hospital discharge and telephone questionnaires on days 14 and 28) and patient satisfaction with wound coverage management before hospital discharge. RESULTS The superficial SSI rates were 2/153 (1.3%) versus 5/157 (3.2%) (relative risk [RR] 0.4, 95% CI 0.1-2.1; P = 0.45) and patient satisfaction with wound management was 7 [5-8] versus 7 [5-8] (P = 0.81) in exposed compared with dressed study groups, respectively. In the wound-exposed patients, stated preference for wound exposure significantly increased from 35.5 to 57.5%, whereas in the wound-dressed patients, the stated preference for a dressed wound fell from 48.5 to 34.4% when assessed at recruitment (pre-randomisation) to day 28. There were no significant differences in inpatient additional dressing or gauze use for wound care, post-hospital discharge self-reported wound issues of infection, antibiotics, redness and inflammation, swollen, painful, and fluid leakage to day 28 across trial groups. CONCLUSION The trial is underpowered as SSI rates were lower than expected. Nevertheless, leaving caesarean wounds exposed does not appear to have detrimental effects, provided patient counselling to manage expectations is undertaken. TWEETABLE ABSTRACT An exposed compared with a dressed caesarean wound has a similar superficial surgical site infection rate, patient satisfaction and appearance.
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Affiliation(s)
- P C Tan
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - E Rohani
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - McK Lim
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - S T Win
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - S Z Omar
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Stryja J, Sandy-Hodgetts K, Collier M, Moser C, Ousey K, Probst S, Wilson J, Xuereb D. PREVENTION AND MANAGEMENT ACROSS HEALTH-CARE SECTORS. J Wound Care 2020; 29:S1-S72. [DOI: 10.12968/jowc.2020.29.sup2b.s1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Jan Stryja
- Vascular Surgeon, Centre of vascular and miniinvasive surgery, Hospital Podlesi, Trinec, The Czech Republic. Salvatella Ltd., Centre of non-healing wounds treatment, Podiatric outpatients’ department, Trinec, The Czech Republic
| | - Kylie Sandy-Hodgetts
- Senior Research Fellow – Senior Lecturer, Faculty of Medicine, School of Biomedical Sciences, University of Western Australia, Director, Skin Integrity Clinical Trials Unit, University of Western Australia
| | - Mark Collier
- Nurse Consultant and Associate Lecturer – Tissue Viability, Independent – formerly at the United Lincolnshire Hospitals NHS Trust, c/o Pilgrim Hospital, Sibsey Road, Boston, Lincolnshire, PE21 9Q
| | - Claus Moser
- Clinical microbiologist, Rigshospitalet, Department of Clinical Microbiology, Copenhagen, Denmark
| | - Karen Ousey
- Professor of Skin Integrity, University of Huddersfield. Institute of Skin Integrity and Infection Prevention, Huddersfield, UK
| | - Sebastian Probst
- Professor of wound care, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Jennie Wilson
- Professor of Healthcare Epidemiology, University of West London, College of Nursing, Midwifery and Healthcare, London, UK
| | - Deborah Xuereb
- Senior Infection Prevention & infection Control Nurse, Mater Dei Hospital, Msida, Malta
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Douville SE, Callaway LK, Amoako A, Roberts JA, Eley VA. Reducing post-caesarean delivery surgical site infections: a narrative review. Int J Obstet Anesth 2019; 42:76-86. [PMID: 31606251 DOI: 10.1016/j.ijoa.2019.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/22/2019] [Accepted: 08/28/2019] [Indexed: 01/15/2023]
Abstract
Surgical site infection complicates 1-10% of caesarean deliveries. With the rate of caesarean delivery increasing, it is important to identify effective measures of preventing surgical site infection and to consider their impact on maternal and neonatal outcomes. Compelling evidence supports the use of prophylactic antibiotics, prior to skin incision, to reduce surgical site infection. However, there remain international variations in terms of the recommended agent, dose and body weight-adjusted dosing. Advances in wound dressings are an evolving area of interest and surgical technique can influence outcomes. This narrative review explores pharmacological and non-pharmacological methods of preventing surgical site infection following caesarean delivery.
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Affiliation(s)
- S E Douville
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - L K Callaway
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia; Department of Obstetrics and Gynaecology/Obstetric Medicine, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - A Amoako
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia; Department of Obstetrics and Gynaecology/Obstetric Medicine, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - J A Roberts
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia; University of Queensland Centre for Clinical Research, The University of Queensland, Herston, Queensland, Australia; Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Herston, Queensland, Australia; Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France; Department of Pharmacy and Intensive Care Medicine, The Royal Brisbane and Women's Hospital, Herston, Qld, Australia
| | - V A Eley
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia; Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
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Molla M, Temesgen K, Seyoum T, Melkamu M. Surgical site infection and associated factors among women underwent cesarean delivery in Debretabor General Hospital, Northwest Ethiopia: hospital based cross sectional study. BMC Pregnancy Childbirth 2019; 19:317. [PMID: 31464598 PMCID: PMC6716814 DOI: 10.1186/s12884-019-2442-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/30/2019] [Indexed: 01/22/2023] Open
Abstract
Background Cesarean section rates have been increasing dramatically during the past three decades and surgical site infections are becoming a leading cause of morbidity and mortality among women undergoing cesarean deliveries. However there is lack of sound evidence on both the magnitude of the problem and the associated factors in developing countries including Ethiopia. The purpose of this study was to assess proportion of surgical site infection and associated factors among women undergoing cesarean delivery in Debretabor General Hospital. Methods An institution based cross sectional study was conducted from May to December / 2017. All women delivered by cesarean section in Debretabor General Hospital during data collection period were our study population. Data were collected using Pre-tested, semi-structured questionnaire/ data extraction tool and post discharge phone follow up and analyzed using SPSS version 20. Logistic regression model was used to determine the association of independent variables with the outcome variable and odds ratios with 95% confidence interval were used to estimate the strength of the association. Results Proportion of surgical site infection among cesarean deliveries was about 8% (95%Cl: 5.4, 11.6). Pregnancy induced hypertension (AOR = 4.75, 95%CI: 1.62, 13.92), chorioaminitis (AOR = 4.37, 95%CI: 1.53, 12.50), midline skin incision (AOR = 5.19, 95% CI: 1.87, 14.37 and post-operative hemoglobin less than 11 g/deciliter (AOR = 5.28, 95%CI: 1.97, 14.18) were significantly associated with surgical site infection. Conclusions Pregnancy induced hypertension, chorioaminitis, midline skin incision and post-operative hemoglobin of less than 11 g/deciliter were independent factors associated with surgical site infection. Cesarean deliveries with concomitant pregnancy induced hypertension, chorioaminitis and post-operative anemia needs special care and follow up until surgical site infection is ruled out. It is also advisable to reduce generous midline skin incision and better replaced with pfannensteil incision.
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Affiliation(s)
- Mihretu Molla
- Department of Midwifery College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Kiber Temesgen
- Department of Midwifery College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Seyoum
- Department of Midwifery College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mengstu Melkamu
- Department of Midwifery College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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The Use of Copper as an Antimicrobial Agent in Health Care, Including Obstetrics and Gynecology. Clin Microbiol Rev 2019; 32:32/4/e00125-18. [PMID: 31413046 DOI: 10.1128/cmr.00125-18] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Health care-associated infections (HAIs) are a global problem associated with significant morbidity and mortality. Controlling the spread of antimicrobial-resistant bacteria is a major public health challenge, and antimicrobial resistance has become one of the most important global problems in current times. The antimicrobial effect of copper has been known for centuries, and ongoing research is being conducted on the use of copper-coated hard and soft surfaces for reduction of microbial contamination and, subsequently, reduction of HAIs. This review provides an overview of the historical and current evidence of the antimicrobial and wound-healing properties of copper and explores its possible utility in obstetrics and gynecology.
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19
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Collin SM, Shetty N, Guy R, Nyaga VN, Bull A, Richards MJ, van der Kooi TI, Koek MB, De Almeida M, Roberts SA, Lamagni T. Group B Streptococcus in surgical site and non-invasive bacterial infections worldwide: A systematic review and meta-analysis. Int J Infect Dis 2019; 83:116-129. [DOI: 10.1016/j.ijid.2019.04.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 12/15/2022] Open
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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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21
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Future priorities of acute hospitals for surgical site infection surveillance in England. J Hosp Infect 2018; 100:371-377. [DOI: 10.1016/j.jhin.2018.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 06/19/2018] [Indexed: 11/23/2022]
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22
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Sprowson AP, Jensen C, Parsons N, Partington P, Emmerson K, Carluke I, Asaad S, Pratt R, Muller S, Ahmed I, Reed MR. The effect of triclosan-coated sutures on the rate of surgical site infection after hip and knee arthroplasty: a double-blind randomized controlled trial of 2546 patients. Bone Joint J 2018; 100-B:296-302. [PMID: 29589500 PMCID: PMC6427932 DOI: 10.1302/0301-620x.100b3.bjj-2017-0247.r1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Aims Surgical site infection (SSI) is a common complication of surgery with an incidence of about 1% in the United Kingdom. Sutures can lead to the development of a SSI, as micro-organisms can colonize the suture as it is implanted. Triclosan-coated sutures, being antimicrobical, were developed to reduce the rate of SSI. Our aim was to assess whether triclosan-coated sutures cause a reduction in SSIs following arthroplasty of the hip and knee. Patients and Methods This two-arm, parallel, double-blinded study involved 2546 patients undergoing elective total hip (THA) and total knee arthroplasty (TKA) at three hospitals. A total of 1323 were quasi-randomized to a standard suture group, and 1223 being quasi-randomized to the triclosan-coated suture group. The primary endpoint was the rate of SSI at 30 days postoperatively. Results The baseline characteristics of age, gender and comorbidities were well matched in the two groups. The rates of superficial SSI were 0.8% in the control group and 0.7% in the intervention group (p = 0.651), and when deep and superficial SSIs were combined the rates were 2.5% and 1.8 (p = 0.266). The length of stay in hospital and the rates of medical complications did not differ significantly between the groups (p = 1.000). Conclusion This trial provided no evidence that the use of triclosan-coated sutures at THA and TKA leads to a reduction in the rate of SSI. Cite this article: Bone Joint J 2018;100-B:296-302.
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Affiliation(s)
- A. P. Sprowson
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - C. Jensen
- Wansbeck General Hospital, Woodhorn Lane, Northumberland NE63 9JJ, UK
| | - N. Parsons
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - P. Partington
- Wansbeck General Hospital, Woodhorn Lane, Northumberland NE63 9JJ, UK
| | - K. Emmerson
- Wansbeck General Hospital, Woodhorn Lane, Northumberland NE63 9JJ, UK
| | - I. Carluke
- Wansbeck General Hospital, Woodhorn Lane, Northumberland NE63 9JJ, UK
| | - S. Asaad
- Wansbeck General Hospital, Woodhorn Lane, Northumberland NE63 9JJ, UK
| | - R. Pratt
- Wansbeck General Hospital, Woodhorn Lane, Northumberland NE63 9JJ, UK
| | - S. Muller
- Wansbeck General Hospital, Woodhorn Lane, Northumberland NE63 9JJ, UK
| | - I. Ahmed
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - M. R. Reed
- Wansbeck General Hospital, Woodhorn Lane, Northumberland NE63 9JJ, UK
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Sprowson† AP, Jensen C, Ahmed I, Parsons N, Partington P, Emmerson K, Carluke I, Asaad S, Pratt R, Muller S, Reed MR. Infographic: Triclosan-coated sutures and surgical site infections after hip and knee arthroplasty. Bone Joint J 2018; 100-B:294-295. [DOI: 10.1302/0301-620x.100b3.bjj-2018-0099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- A. P. Sprowson†
- University Hospital Coventry and Warwickshire, Clifford Bridge
Road, Coventry CV2 2DX, UK
| | - C. Jensen
- Wansbeck General Hospital, Woodhorn
Lane, Northumberland NE63 9JJ, UK
| | - I. Ahmed
- University Hospital Coventry and Warwickshire, Clifford Bridge
Road, Coventry CV2 2DX, UK
| | - N. Parsons
- University Hospital Coventry and Warwickshire, Clifford Bridge
Road, Coventry CV2 2DX, UK
| | - P. Partington
- Wansbeck General Hospital, Woodhorn
Lane, Northumberland NE63 9JJ, UK
| | - K. Emmerson
- Wansbeck General Hospital, Woodhorn
Lane, Northumberland NE63 9JJ, UK
| | - I. Carluke
- Wansbeck General Hospital, Woodhorn
Lane, Northumberland NE63 9JJ, UK
| | - S. Asaad
- Wansbeck General Hospital, Woodhorn
Lane, Northumberland NE63 9JJ, UK
| | - R. Pratt
- Wansbeck General Hospital, Woodhorn
Lane, Northumberland NE63 9JJ, UK
| | - S. Muller
- Wansbeck General Hospital, Woodhorn
Lane, Northumberland NE63 9JJ, UK
| | - M. R. Reed
- Wansbeck General Hospital, Woodhorn
Lane, Northumberland NE63 9JJ, UK
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Martin EK, Beckmann MM, Barnsbee LN, Halton KA, Merollini KMD, Graves N. Best practice perioperative strategies and surgical techniques for preventing caesarean section surgical site infections: a systematic review of reviews and meta-analyses. BJOG 2018; 125:956-964. [DOI: 10.1111/1471-0528.15125] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2017] [Indexed: 12/16/2022]
Affiliation(s)
- EK Martin
- Institute of Health and Biomedical Innovation; Queensland University of Technology; Brisbane QLD Australia
| | - MM Beckmann
- Mater Health Services; Brisbane QLD Australia
| | - LN Barnsbee
- Institute of Health and Biomedical Innovation; Queensland University of Technology; Brisbane QLD Australia
| | - KA Halton
- Institute of Health and Biomedical Innovation; Queensland University of Technology; Brisbane QLD Australia
| | - KMD Merollini
- Faculty of Science, Health, Education and Engineering; University of the Sunshine Coast; Maroochydore QLD Australia
| | - N Graves
- Institute of Health and Biomedical Innovation; Queensland University of Technology; Brisbane QLD Australia
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Macefield RC, Reeves BC, Milne TK, Nicholson A, Blencowe NS, Calvert M, Avery KNL, Messenger DE, Bamford R, Pinkney TD, Blazeby JM. Development of a single, practical measure of surgical site infection (SSI) for patient report or observer completion. J Infect Prev 2017; 18:170-179. [PMID: 28989524 PMCID: PMC5495441 DOI: 10.1177/1757177416689724] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 12/14/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Surgical site infections (SSIs) are the third most common hospital-associated infection and can lead to significant patient morbidity and healthcare costs. Identification of SSIs is key to surveillance and research but reliable assessment is challenging, particularly after hospital discharge when most SSIs present. Existing SSI measurement tools have limitations and their suitability for post-discharge surveillance is uncertain. AIMS This study aimed to develop a single measure to identify SSI after hospital discharge, suitable for patient or observer completion. METHODS A three-phase mixed methods study was undertaken: Phase 1, an analysis of existing tools and semi-structured interviews with patients and professionals to establish the content of the measure; Phase 2, development of questionnaire items suitable for patients and professionals; Phase 3, pre-testing the single measure to assess acceptability and understanding to both stakeholder groups. Interviews and pre-testing took place over 12 months in 2014-2015 with patients and professionals from five specialties recruited from two UK hospital Trusts. FINDINGS Analyses of existing tools and interviews identified 19 important domains for assessing SSIs. Domains were developed into provisional questionnaire items. Pre-testing and iterative revision resulted in a final version with 16 items that were understood and easily completed by patients and observers (healthcare professionals). CONCLUSION A single patient and observer measure for post-discharge SSI assessment has been developed. Further testing of the validity, reliability and accuracy of the measure is underway.
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Affiliation(s)
| | | | - Thomas K Milne
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Natalie S Blencowe
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Severn and Peninsula Audit and Research Collaborative for Surgeons (SPARCS), UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kerry NL Avery
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - David E Messenger
- Severn and Peninsula Audit and Research Collaborative for Surgeons (SPARCS), UK
| | - Richard Bamford
- Severn and Peninsula Audit and Research Collaborative for Surgeons (SPARCS), UK
| | - Thomas D Pinkney
- Academic Department of Surgery, Queen Elizabeth Hospital, University of Birmingham, UK
| | - Jane M Blazeby
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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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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Young CN, Ng KYB, Webb V, Vidow S, Parasuraman R, Umranikar S. Negative pressure wound therapy aids recovery following surgical debridement due to severe bacterial cellulitis with abdominal abscess post-cesarean: A case report (CARE-Compliant). Medicine (Baltimore) 2016; 95:e5397. [PMID: 27977577 PMCID: PMC5268023 DOI: 10.1097/md.0000000000005397] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Bacterial cellulitis post-Cesarean section is rare. Negative pressure wound therapy (NPWT) is widely used in various medical specialities; its effectiveness in obstetrics however remains the topic of debate-used predominantly as an adjunct to secondary intention specific to high-risk patient groups. Its application in the treatment of actively infected wounds post-Cesarean is not well documented. Here, we document NPWT in the treatment of an unusually severe case of bacterial cellulitis with abdominal abscess postpartum. We provide a unique photographic timeline of wound progression following major surgical debridement, documenting the effectiveness of 2 different NPWT systems (RENASYS GO and PICO, Smith & Nephew). We report problems encountered using these NPWT systems and "ad-hoc" solutions to improve efficacy and patient experience.A 34-year-old primiparous Caucasian female with no prior history or risk factors for infection and a normal body mass index (BMI) presented with severe abdominal pain, swelling, and extensive abdominal redness 7 days postemergency Cesarean section. Examination revealed extensive cellulitis with associated abdominal abscess. Staphylococcus aureus was identified in wound exudates and extensive surgical debridement undertaken day 11 postnatally due to continued febrile episodes and clinical deterioration, despite aggressive intravenous antibiotic therapy. Occlusive NPWT dressings were applied for a period of 3 weeks before discharge, as well as a further 5 weeks postdischarge into the community.NPWT was well tolerated and efficacious in infection clearance and wound healing during bacterial cellulitis. Wound healing averaged 1 cm per week before NPWT withdrawal; cessation of NPWT before full wound closure resulted in significantly reduced healing rate, increased purulent discharges, and skin irritation, highlighting the efficacy of NPWT. Five-month follow-up in the clinic found the wound to be fully healed with no additional scarring beyond the boundaries of the original Cesarean incision. The patient was pleased with treatment outcomes, reporting no lasting pain or discomfort from the scar. CONCLUSIONS This report represents the first documented use of NPWT to aid healing of an actively infected, open wound following extensive surgical debridement 10 days post-Cesarean section, confirming both the efficacy and tolerability of NPWT for the treatment of severe bacterial cellulitis in obstetric debridement.
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Affiliation(s)
- Christopher N.J. Young
- Department of Molecular Medicine, School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Ka Ying Bonnie Ng
- Department of Obstetrics and Gynaecology, Princess Anne Hospital, Southampton, UK
| | - Vanessa Webb
- Department of Obstetrics and Gynaecology, Princess Anne Hospital, Southampton, UK
| | - Sarah Vidow
- Department of Obstetrics and Gynaecology, Princess Anne Hospital, Southampton, UK
| | | | - Sameer Umranikar
- Department of Obstetrics and Gynaecology, Princess Anne Hospital, Southampton, UK
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Stanirowski PJ, Kociszewska A, Cendrowski K, Sawicki W. Dialkylcarbamoyl chloride-impregnated dressing for the prevention of surgical site infection in women undergoing cesarean section: a pilot study. Arch Med Sci 2016; 12:1036-1042. [PMID: 27695495 PMCID: PMC5016568 DOI: 10.5114/aoms.2015.47654] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 11/22/2014] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Incisional surgical site infections (SSIs) occur in approximately 1.8-9.2% of patients undergoing cesarean section (CS) and contribute to prolonged hospitalization time and increased treatment costs. Dressings impregnated with dialkylcarbamoyl chloride (DACC) are an innovative approach to wound treatment based on a solely physical mechanism of action, and therefore can be used safely and without time restrictions in women during the puerperal and lactation period. MATERIAL AND METHODS A single-blinded randomized, controlled pilot study was conducted at the Mazovian Bródno Hospital, a tertiary care hospital, between December 2013 and March 2014, and it evaluated the presence of superficial and deep SSIs in patients during the first 14 days after a CS. Patients were randomly allocated to receive treatment with either a DACC dressing or a standard surgical dressing. RESULTS One hundred and forty-two patients after planned or emergency CS were enrolled in the study. No significant differences between the groups were observed with regard to patients' basic demographic and perioperative characteristics. The rate of superficial and deep SSIs was 2.8% in the group of patients who received a DACC dressing compared to 9.8% in the group with a standard surgical dressing (p = 0.08). Patients with SSIs who received a standard surgical dressing required systemic antibiotic therapy significantly more frequently (p = 0.03). Based on the logistic regression model developed, the pre-pregnancy body mass index was the only statistically significant risk factor for SSI (p = 0.015). CONCLUSIONS The results of the pilot study indicate a decreasing tendency of the SSI rate in patients after a CS who received DACC impregnated dressings.
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Affiliation(s)
- Paweł J Stanirowski
- Department of Obstetrics, Gynecology and Oncology, Second Faculty of Medicine, Medical University of Warsaw, Mazovian Bródno Hospital, Warsaw, Poland
| | - Anna Kociszewska
- Department of Obstetrics, Gynecology and Oncology, Second Faculty of Medicine, Medical University of Warsaw, Mazovian Bródno Hospital, Warsaw, Poland
| | - Krzysztof Cendrowski
- Department of Obstetrics, Gynecology and Oncology, Second Faculty of Medicine, Medical University of Warsaw, Mazovian Bródno Hospital, Warsaw, Poland
| | - Włodzimierz Sawicki
- Department of Obstetrics, Gynecology and Oncology, Second Faculty of Medicine, Medical University of Warsaw, Mazovian Bródno Hospital, Warsaw, Poland
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Woelber E, Schrick EJ, Gessner BD, Evans HL. Proportion of Surgical Site Infections Occurring after Hospital Discharge: A Systematic Review. Surg Infect (Larchmt) 2016; 17:510-9. [DOI: 10.1089/sur.2015.241] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Erik Woelber
- University of Washington School of Medicine, Seattle, Washington
| | - Emily J. Schrick
- University of Washington College of Arts and Sciences, Seattle, Washington
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De Nardo P, Gentilotti E, Nguhuni B, Vairo F, Chaula Z, Nicastri E, Nassoro MM, Bevilacqua N, Ismail A, Savoldi A, Zumla A, Ippolito G. Post-caesarean section surgical site infections at a Tanzanian tertiary hospital: a prospective observational study. J Hosp Infect 2016; 93:355-9. [PMID: 27125664 DOI: 10.1016/j.jhin.2016.02.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/19/2016] [Indexed: 11/18/2022]
Abstract
Few data are available on the determinants and characteristics of post-caesarean section (CS) surgical site infections (SSIs) in resource-limited settings. We conducted a prospective observational cohort study to evaluate the rates, determinants, and microbiological characteristics of post-CS SSI at the Dodoma Regional Referral Hospital (DRRH) Gynaecology and Obstetrics Department in Tanzania. Spanning a three-month period, all pregnant women who underwent CS were enrolled and followed up for 30 days. SSI following CS occurred in 224 (48%) women. Only 10 (2.1%) women received pre-incision antibiotic prophylaxis. Urgent intervention is needed to prevent and control infections and contain the rising rate of post-CS SSI at the DRRH.
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Affiliation(s)
- P De Nardo
- Resource Centre for Infectious Diseases, Dodoma Regional Referral Hospital, Dodoma, Tanzania; 'Lazzaro Spallanzani' National Institute for Infectious Diseases-IRCCS, Rome, Italy.
| | - E Gentilotti
- Resource Centre for Infectious Diseases, Dodoma Regional Referral Hospital, Dodoma, Tanzania; Department of Infectious Diseases, Tor Vergata University Hospital, Rome, Italy
| | - B Nguhuni
- Resource Centre for Infectious Diseases, Dodoma Regional Referral Hospital, Dodoma, Tanzania; 'Lazzaro Spallanzani' National Institute for Infectious Diseases-IRCCS, Rome, Italy
| | - F Vairo
- 'Lazzaro Spallanzani' National Institute for Infectious Diseases-IRCCS, Rome, Italy
| | - Z Chaula
- Resource Centre for Infectious Diseases, Dodoma Regional Referral Hospital, Dodoma, Tanzania
| | - E Nicastri
- 'Lazzaro Spallanzani' National Institute for Infectious Diseases-IRCCS, Rome, Italy
| | - M M Nassoro
- Resource Centre for Infectious Diseases, Dodoma Regional Referral Hospital, Dodoma, Tanzania
| | - N Bevilacqua
- 'Lazzaro Spallanzani' National Institute for Infectious Diseases-IRCCS, Rome, Italy
| | - A Ismail
- University of Dodoma - UDOM, Department of Statistics, Dodoma, Tanzania
| | - A Savoldi
- Resource Centre for Infectious Diseases, Dodoma Regional Referral Hospital, Dodoma, Tanzania; Department of Health Sciences, Clinic of Infectious Diseases, 'San Paolo' Hospital, University of Milan, Milan, Italy
| | - A Zumla
- Division of Infection and Immunity, University College London, London, UK; NIHR Biomedical Research Centre at UCL Hospitals NHS Foundation Trust, London, UK
| | - G Ippolito
- 'Lazzaro Spallanzani' National Institute for Infectious Diseases-IRCCS, Rome, Italy
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Russo PL, Cheng AC, Richards M, Graves N, Hall L. Healthcare-associated infections in Australia: time for national surveillance. AUST HEALTH REV 2016; 39:37-43. [PMID: 25362241 DOI: 10.1071/ah14037] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 08/22/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Healthcare-associated infection (HAI) surveillance programs are critical for infection prevention. Australia does not have a comprehensive national HAI surveillance program. The purpose of this paper is to provide an overview of established international and Australian statewide HAI surveillance programs and recommend a pathway for the development of a national HAI surveillance program in Australia. METHODS This study examined existing HAI surveillance programs through a literature review, a review of HAI surveillance program documentation, such as websites, surveillance manuals and data reports and direct contact with program representatives. RESULTS Evidence from international programs demonstrates national HAI surveillance reduces the incidence of HAIs. However, the current status of HAI surveillance activity in Australian states is disparate, variation between programs is not well understood, and the quality of data currently used to compose national HAI rates is uncertain. CONCLUSIONS There is a need to develop a well-structured, evidence-based national HAI program in Australia to meet the increasing demand for validated reliable national HAI data. Such a program could be leveraged off the work of existing Australian and international programs.
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Affiliation(s)
- Philip L Russo
- Institute of Health & Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Qld 4059, Australia.
| | - Allen C Cheng
- Infectious Diseases Epidemiology Unit, Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Prahran, Vic. 3181, Australia. Email
| | - Michael Richards
- Faculty of Medicine, Dentistry and Health, University of Melbourne, Vic. 3010, Australia. Email
| | - Nicholas Graves
- Institute of Health & Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Qld 4059, Australia.
| | - Lisa Hall
- Institute of Health & Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Qld 4059, Australia.
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Stanirowski PJ, Bizoń M, Cendrowski K, Sawicki W. Randomized Controlled Trial Evaluating Dialkylcarbamoyl Chloride Impregnated Dressings for the Prevention of Surgical Site Infections in Adult Women Undergoing Cesarean Section. Surg Infect (Larchmt) 2016; 17:427-35. [PMID: 26891115 PMCID: PMC4960475 DOI: 10.1089/sur.2015.223] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: Surgical site infections (SSI) occur in 1.8%–9.2% of women undergoing cesarean section (CS) and lead to greater morbidity rates and increased treatment costs. The aim of the study was to evaluate the efficacy and cost-effectiveness of dialkylcarbamoyl chloride (DACC) impregnated dressings to prevent SSI in women subject to CS. Methods: Randomized, controlled trial was conducted at the Mazovian Bródno Hospital, a tertiary care center performing approximately 1300 deliveries per year, between June 2014 and April 2015. Patients were randomly allocated to receive either DACC impregnated dressing or standard surgical dressing (SSD) following skin closure. In order to analyze cost-effectiveness of the selected dressings in the group of patients who developed SSI, the costs of ambulatory visits, additional hospitalization, nursing care, and systemic antibiotic therapy were assessed. Independent risk factors for SSI were determined by multivariable logistic regression. Results: Five hundred and forty-three women undergoing elective or emergency CS were enrolled. The SSI rates in the DACC and SSD groups were 1.8% and 5.2%, respectively (p = 0.04). The total cost of SSI prophylaxis and treatment was greater in the control group as compared with the study group (5775 EUR vs. 1065 EUR, respectively). Independent risk factors for SSI included higher pre-pregnancy body mass index (adjusted odds ratio [aOR] = 1.08; [95% confidence interval [CI]: 1.0–1.2]; p < 0.05), smoking in pregnancy (aOR = 5.34; [95% CI: 1.6–15.4]; p < 0.01), and SSD application (aOR = 2.94; [95% CI: 1.1–9.3]; p < 0.05). Conclusion: The study confirmed the efficacy and cost-effectiveness of DACC impregnated dressings in SSI prevention among women undergoing CS.
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Affiliation(s)
- Paweł Jan Stanirowski
- Department of Obstetrics, Gynecology, and Oncology, II Faculty of Medicine, Medical University of Warsaw , Mazovian Bródno Hospital, Warsaw, Poland
| | - Magdalena Bizoń
- Department of Obstetrics, Gynecology, and Oncology, II Faculty of Medicine, Medical University of Warsaw , Mazovian Bródno Hospital, Warsaw, Poland
| | - Krzysztof Cendrowski
- Department of Obstetrics, Gynecology, and Oncology, II Faculty of Medicine, Medical University of Warsaw , Mazovian Bródno Hospital, Warsaw, Poland
| | - Włodzimierz Sawicki
- Department of Obstetrics, Gynecology, and Oncology, II Faculty of Medicine, Medical University of Warsaw , Mazovian Bródno Hospital, Warsaw, Poland
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Cesarean section surgical site infections in sub-Saharan Africa: a multi-country study from Medecins Sans Frontieres. World J Surg 2015; 39:350-5. [PMID: 25358418 PMCID: PMC4300431 DOI: 10.1007/s00268-014-2840-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Surgical site infections (SSI) are a significant cause of post-surgical morbidity and mortality and can be an indicator of surgical quality. The objectives of this study were to measure post-operative SSI after cesarean section (CS) at four sites in three sub-Saharan African countries and to describe the associated risk factors in order to improved quality of care in low and middle income surgical programs. Methods This study included data from four emergency obstetric programs supported by Medecins sans Frontieres, from Burundi, the Democratic Republic of Congo (DRC), and Sierra Leone. Women undergoing from August 1 2010 to January 31 2011 were included. CS post-operative SSI data were prospectively collected. Logistic regression was used to model SSI risk factors. Findings In total, 1,276 women underwent CS. The incidence of SSI was 7.3 % (range 1.7–10.4 %). 93 % of SSI were superficial. The median length of stay of women without SSI was 7 days (range 3–63 days) compared to 21 days (range 5–51 days) in those with SSI (p < 0.001). In multivariate analysis, younger age, premature rupture of the membranes, and neonatal death were associated with an increased risk of SSI, while antenatal hemorrhage and the Lubutu, DRC project site were associated with a lower risk of developing an SSI. Conclusions This study demonstrates that surgery can be performed with a low incidence of SSI, a proxy for surgical safety, in sub-Saharan Africa. Protocols such as perioperative antibiotics and basic infrastructure such as clean water and sterilization can be achieved. Simple data collection tools will assist policymakers with monitoring and evaluation as well as quality control assurance of surgical programs in low and middle income countries.
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Hung HW, Yang PY, Yan YH, Jou HJ, Lu MC, Wu SC. Increased postpartum maternal complications after cesarean section compared with vaginal delivery in 225 304 Taiwanese women. J Matern Fetal Neonatal Med 2015; 29:1665-72. [DOI: 10.3109/14767058.2015.1059806] [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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Tuffaha HW, Gillespie BM, Chaboyer W, Gordon LG, Scuffham PA. Cost-utility analysis of negative pressure wound therapy in high-risk cesarean section wounds. J Surg Res 2015; 195:612-22. [DOI: 10.1016/j.jss.2015.02.008] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 01/14/2015] [Accepted: 02/06/2015] [Indexed: 11/16/2022]
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Gregor M, Paterová P, Buchta V, Ketřánek J, Špaček J. Healthcare-associated infections in gynecology and obstetrics at a university hospital in the Czech Republic. Int J Gynaecol Obstet 2014; 126:240-3. [PMID: 24890744 DOI: 10.1016/j.ijgo.2014.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 02/05/2014] [Accepted: 04/30/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine the spectrum of etiology and the incidence of healthcare-associated infections (HAIs) among gynecologic and obstetric patients. METHODS In a descriptive survey, data were analyzed from in-patients at the Department of Gynecology and Obstetrics, University Hospital and Faculty of Medicine in Hradec Králové, Czech Republic, between January 2007 and December 2011. RESULTS Among 21 937 patients treated during the study period, there were 189 (0.86%) cases of HAI. Gynecologic patients had a higher incidence of HAIs (1.31%) compared with pregnant women (0.60%). The incidence of HAI was 0.13% after laparoscopic surgery, 0.63% after a minor gynecologic intervention, and 3.73% after major surgery. Vaginal delivery (0.36%) represented a low risk of HAI. Compared with vaginal delivery, the incidence of HAI increased twofold for planned cesarean delivery (0.64%), and tenfold for emergency cesarean delivery (3.63%). The majority of causative microorganisms (72.7%) were susceptible to penicillin antibiotics. None of the patients died as a result of HAI. CONCLUSION The incidence of HAIs at a university hospital in the Czech Republic was very low. Antibiotic resistance was only a minor problem, and the incidence of multiresistant strains was rare.
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Affiliation(s)
- Miroslav Gregor
- Department of Gynecology and Obstetrics, University Hospital and Faculty of Medicine in Hradec Králové, Hradec Králové, Czech Republic.
| | - Pavla Paterová
- Department of Clinical Microbiology, University Hospital and Faculty of Medicine in Hradec Králové, Hradec Králové, Czech Republic
| | - Vladimír Buchta
- Department of Clinical Microbiology, University Hospital and Faculty of Medicine in Hradec Králové, Hradec Králové, Czech Republic
| | - Jan Ketřánek
- Department of Gynecology and Obstetrics, University Hospital and Faculty of Medicine in Hradec Králové, Hradec Králové, Czech Republic
| | - Jiří Špaček
- Department of Gynecology and Obstetrics, University Hospital and Faculty of Medicine in Hradec Králové, Hradec Králové, Czech Republic
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Wilson J. Surgical site infection: the principles and practice of surveillance: Part 2: analysing and interpreting data. J Infect Prev 2013. [DOI: 10.1177/1757177413507620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In Part 1 of this two-part series on surveillance of surgical site infection (SSI) the principles of surveillance methodology and the role of surveillance in reducing the risk of infection were discussed. This second part focuses on the analysis and interpretation SSI surveillance data, the challenges this presents and of some of the solutions. The risk of SSI is conventionally expressed as the percentage of operations that develop SSI. However, this metric is strongly dependant on the length of post-operative stay, since infections take several days to become apparent and are difficult to identify after discharge. Comparisons based on more severe infections detected in inpatients or those readmitted with SSI are more likely to provide reliable data for inter-hospital comparisons. The precision of the estimated rates and adjustment for intrinsic risk factors are important considerations, although ultimately mechanisms for discriminating significantly higher rates merely indicate a problem requiring further investigation rather than definitive evidence of poor practice.
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Affiliation(s)
- Jennie Wilson
- Institute of Practice, Interdisciplinary Research and Enterprise, University of West London, London
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38
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Bratzler DW. Editorial commentary: accountability for surgical site infections: will the playing field be level? Clin Infect Dis 2013; 57:1289-91. [PMID: 23912847 DOI: 10.1093/cid/cit518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Dale W Bratzler
- College of Medicine and College of Public Health, Oklahoma University Health Sciences Center, Oklahoma City
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Itatsu K, Sugawara G, Kaneoka Y, Kato T, Takeuchi E, Kanai M, Hasegawa H, Arai T, Yokoyama Y, Nagino M. Risk factors for incisional surgical site infections in elective surgery for colorectal cancer: focus on intraoperative meticulous wound management. Surg Today 2013; 44:1242-52. [DOI: 10.1007/s00595-013-0677-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 06/14/2013] [Indexed: 12/12/2022]
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40
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Lamagni T, Wilson J, Wloch C, Elgohari S, Harrington P, Johnson A. Improving patient safety through surgical site infection surveillance: response to Tanner et al. J Hosp Infect 2013; 84:269-70. [PMID: 23731826 DOI: 10.1016/j.jhin.2013.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 02/15/2013] [Indexed: 11/24/2022]
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