Potential sources of operating room air contamination: a preliminary study

Impact of Intraoperative Hypothermia on Incidence of Infection in Implant-Based Breast Reconstruction

BACKGROUND

Infection following implant-based breast reconstruction can lead to devastating complications. Risk factors for infection include smoking, diabetes, and obesity. Intraoperative hypothermia may represent another modifiable risk factor. This study analyzed the effect of hypothermia in postmastectomy immediate implant-based reconstruction on postoperative surgical-site infection (SSI).

METHODS

This was a retrospective review of 122 patients with intraoperative hypothermia, defined as less than 35.5°C, and 106 normothermic patients who underwent postmastectomy implant-based reconstruction between 2015 and 2021. Demographics, comorbidities, smoking status, hypothermia (and its duration), and length of surgery were collected. The primary outcome was SSI. Secondary outcomes included reoperation and delayed wound healing.

RESULTS

A total of 185 patients (81%) underwent staged reconstruction with tissue expander placement and 43 patients (18.9%) had a direct-to-implant procedure. Over half (53%) of the patients experienced intraoperative hypothermia. In the hypothermic group, a higher proportion of patients had SSIs (34.4% versus 17% of normothermic patients; P < 0.05) and wound healing complications (27.9% versus 16%; P < 0.05). Intraoperative hypothermia predicted SSI (OR, 2.567; 95% CI, 1.367 to 4.818; P < 0.05) and delayed wound healing (OR, 2.023; 95% CI, 1.053 to 3.884; P < 0.05). Longer duration of hypothermia significantly correlated with SSI, with an average 103 minutes versus 77 minutes ( P < 0.05).

CONCLUSIONS

This study demonstrates that intraoperative hypothermia is a significant risk factor for postoperative infection in postmastectomy implant-based breast reconstruction. Maintaining strict normothermia during implant-based breast reconstruction procedures may improve patient outcomes by reducing the risk of postoperative infection and delayed wound healing.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Risk, II.

Eliminating sternal wound infections: Why every cardiac surgery program needs an I hate infections team

Objectives

The majority of studies examining deep sternal wound infection (DSWI) prevention focus on ameliorating 1 variable at a time. There is a paucity of data regarding the synergistic effects of combining clinical and environmental interventions. This article describes an interdisciplinary, multimodal approach to eliminate DSWIs at a large community hospital.

Methods

We developed a robust, multidisciplinary infection prevention team to evaluate and act in all phases of perioperative care to achieve a cardiac surgery DSWI rate of 0, named: the I hate infections team. The team identified opportunities for improved care and best practices and implemented changes on an ongoing basis.

Results

Patient-related interventions consisted of preoperative methicillin-resistant Staphylococcus aureus identification, individualized perioperative antibiotics, antimicrobial dosing strategies, and maintenance of normothermia. Operative-related interventions involved glycemic control, sternal adhesives, medications and hemostasis, rigid sternal fixation for high-risk patients, chlorhexidine gluconate dressings over invasive lines, and use of disposable health care equipment. Environment-related interventions included optimizing operating room ventilation and terminal cleaning, reducing airborne particle counts, and decreasing foot traffic. Together, these interventions reduced the DSWI incidence from 1.6% preintervention to 0% for 12 consecutive months after full bundle implementation.

Conclusions

A multidisciplinary team focused on eliminating DSWI identified known risk factors and implemented evidence-based interventions in each phase of care to ameliorate risk. Although the influence of each individual intervention on DSWI remains unknown, use of the bundled infection prevention approach reduced the incidence to 0 for the first 12 months after implementation.