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Okishio Y, Ueda K, Nasu T, Kawashima S, Kunitatsu K, Masuda M, Ichimiya M, Uyama S, Kato S. Intraoperative techniques to prevent deep incisional or organ-space surgical site infection after emergency surgery for nonappendiceal perforation peritonitis: a prospective two-center observational study. Eur J Trauma Emerg Surg 2023; 49:2215-2224. [PMID: 37300696 DOI: 10.1007/s00068-023-02301-0] [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: 03/12/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE The rate of surgical site infection (SSI) after surgery for secondary peritonitis is very high. This study investigated the relationship between intraoperative procedures of emergency surgery for nonappendiceal perforation peritonitis and deep incisional or organ-space SSI. METHODS This prospective, two-center observational study included patients aged ≥ 20 years who underwent emergency surgery for perforation peritonitis between April 2017 and March 2020. We compared patients with deep incisional or organ-space SSI (Group S) to patients without SSIs or with superficial incisional SSIs (Group C). Thereafter, we evaluated the association between intraoperative technical variables and deep incisional or organ-space SSI using a multivariate logistic regression model. All multivariate analyses were adjusted for potentially relevant risk factors (e.g., age, body mass index, diabetes, smoking habit, and National Nosocomial Infection Surveillance risk index). RESULTS Of the 75 participants, 14 were in Group S and 61 were in Group C. The use of a wound protector device was significantly associated with decreased odds of deep incisional or organ-space SSI (adjusted odds ratios [AOR], 0.017; 95% confidence intervals [CI] 0.0014-0.19, p = 0.0011). A 1000 ml increase in intra-abdominal lavage with normal saline was significantly associated with increased odds of deep incisional or organ-space SSI (AOR: 1.28, 95% CI 1.02-1.61, p = 0.033). CONCLUSION Wound protector devices should be used in emergency surgery for nonappendiceal perforation peritonitis. Excessive intra-abdominal lavage with normal saline for peritonitis may have unsatisfactory benefits and increases the incidence of deep incisional or organ-space SSI.
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Affiliation(s)
- Yuko Okishio
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan.
| | - Kentaro Ueda
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Toru Nasu
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
- Department of Emergency Medicine, Katsuragi Hospital, Kishiwada, Japan
| | - Shuji Kawashima
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Kosei Kunitatsu
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Mitsuru Masuda
- Department of Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Masato Ichimiya
- Department of Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Shiro Uyama
- Department of Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Seiya Kato
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
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Smith D, Bhangu A. Study protocol for a cluster randomised trial of sterile glove and instrument change at the time of wound closure to reduce surgical site infection in low- and middle-income countries (CHEETAH). Trials 2022; 23:204. [PMID: 35264227 PMCID: PMC8905008 DOI: 10.1186/s13063-022-06102-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/10/2022] [Indexed: 01/22/2023] Open
Abstract
Background Surgical site infection (SSI) represents a major burden for patients, doctors, and health systems around the world. The aim of this trial is to assess whether the practice of using separate sterile gloves and instruments to close wounds at the end of surgery compared to current routine hospital practice can reduce surgical site infection at 30-days post-surgery for patients undergoing clean-contaminated, contaminated, or dirty abdominal surgery. Methods This study protocol describes a pragmatic, international, multi-centre, 2-arm, cluster randomised controlled trial, with an internal pilot. Clusters are defined as hospitals within low- and middle-income countries (LMICs) defined by the Development Assistance Committee (DAC) Official Development Assistance (ODA) list, where there are at least 4 eligible hospitals per country. Hospitals (clusters) must be in LMICs where glove and instrument change are not currently routine practice. Patients (adults and children) undergoing emergency or elective abdominal surgery for a clean-contaminated, contaminated, or dirty operation are eligible for inclusion. Before closing the abdominal wall, surgeons and the scrub nurse will change gloves and use separate, sterile instruments (intervention), versus no changing gloves or using separate, sterile instruments (standard practice, control). The primary outcome is SSI within 30 days after surgery, using the Centre for Disease Control (CDC) criteria. Secondary outcomes are SSI before point of hospital discharge, and readmission, reoperation, length of hospital stay, return to normal activities, and death up to 30-days after surgery. A 12-month internal pilot, including 12 clusters and approximately 600 participants, aims to assess adherence to allocation and follow-up of patients. The main trial is powered to detect a minimum reduction in the primary outcome from 16 to 12%. A total of 12,800 participants will be recruited from 64 clusters (hospitals) each including at least 200 participants. Discussion Change of gloves and sterile instruments prior to fascial closure in abdominal surgery is a low-cost, simple, intraoperative intervention which involves all members of the surgical and scrub team. If effective at reducing SSI, this practice could be readily implemented across all contexts. The findings of this trial will inform future guideline updates from international healthcare organisations, including the World Health Organization. Trial registration ClinicalTrials.gov NCT03980652. Registered on 9 July 2019 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06102-5.
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Affiliation(s)
- Donna Smith
- NIHR Global Health Research Unit on Global Surgery, Institute of Translational Medicine, University of Birmingham, Heritage Building, Mindelsohn Way, Birmingham, B152TH, UK.
| | - Aneel Bhangu
- NIHR Global Health Research Unit on Global Surgery, Institute of Translational Medicine, University of Birmingham, Heritage Building, Mindelsohn Way, Birmingham, B152TH, UK
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Kreibich M, Siepe M, Berger T, Pingpoh C, Puiu P, Morlock J, Walter T, Kondov S, Beyersdorf F, Rylski B, Czerny M. Treatment of infectious aortic disease with bovine pericardial tube grafts. Eur J Cardiothorac Surg 2021; 60:155-161. [PMID: 33523214 DOI: 10.1093/ejcts/ezab003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/20/2020] [Accepted: 12/08/2020] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES Our aim was to evaluate the mid-term outcomes of bovine pericardial tube graft repair for infectious aortic disease in any aortic segment. METHODS Between May 2015 and July 2020, 45 patients were treated for infectious aortic disease of the native (n = 9) aorta or after (endo-)graft (n = 36) implantation with bovine pericardial tube grafts. Clinical, infectious details, outcomes and follow-up data were evaluated. RESULTS All aortic segments underwent pericardial tube graft or bifurcational replacement: the aortic root (n = 12, 27%), ascending aorta (n = 18, 40%), aortic arch (n = 7, 16%), descending aorta (n = 5, 11%), thoraco-abdominal aorta (n = 6, 13%) and abdominal aorta (n = 18, 40%) including the iliac arteries (n = 14, 31%). Organ fistulation (n = 15, 33%) was the most common underlying pathology. Seven patients (16%) expired in-hospital secondary to ongoing sepsis (n = 5, 11%), respiratory failure (n = 1, 2%) and unknown cause (n = 1, 2%). A fungal infection was predictive for in-hospital mortality (P = 0.026, odds ratio: 19.470). After a median follow-up of 11 [first quartile: 2, third quartile 26] months, 9 additional patients (20%) expired and 1 patient developed a postoperative spondylodiscitis at the level of the aortic tube graft. Hence, freedom from proven aortic graft re-infection was 98%. CONCLUSIONS Orthotopic aortic reconstruction using bovine pericardial tube grafts to treat infectious aortic disease is possible in any aortic segment. Organ fistulation is a frequently observed disease mechanism requiring concomitant treatment. Granted, the early attrition rate is substantial, but after the initial period, both survival and freedom from re-infection appear encouraging.
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Affiliation(s)
- Maximilian Kreibich
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tim Berger
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Clarence Pingpoh
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Paul Puiu
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julia Morlock
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tim Walter
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stoyan Kondov
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Vishwanath S, Pellegrini B, Parker E, Earnest A, Kalbasi S, Gartoulla P, Elder E, Farrell G, Moore C, Cooter RD, Ahern S, McNeil JJ, Hopper I. Breast Device Surgery in Australia: Early Results from the Australian Breast Device Registry. J Plast Reconstr Aesthet Surg 2021; 74:2719-2730. [PMID: 33931327 DOI: 10.1016/j.bjps.2021.03.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 03/03/2021] [Accepted: 03/13/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Australian Breast Device Registry (ABDR) is a clinical quality registry designed to monitor the performance of breast devices; and the quality and safety of breast device surgery. OBJECTIVE To report on breast device surgery characteristics across Australia. METHODS Participants were registered patients in the ABDR from 2012 to 2018. Results are described using percentages, mean and median. Revision rates were calculated using survival analysis methods. RESULTS A total of 37,603 patients were registered and had undergone reconstruction (post-cancer 15.1%, risk-reducing mastectomy 3.4% and developmental deformity 2.4%) or cosmetic augmentation (74.7%) procedures. The majority of breast implant devices were silicone filled with textured surface (reconstruction 74.0% and augmentation 64.0%). Sub-pectoral plane was the most common for both reconstruction (60.1%) and augmentation (76.6%) procedures. For reconstruction surgery, the most common surgical incision was previous mastectomy scar (44.0%) and inframammary (31.8%), and for augmentation, it was inframammary (83.4%). Intraoperative/postoperative antibiotic usage for reconstruction was 85.8% and augmentation was 89.4%. Revision incidence due to complication at 12 months post-cancer reconstruction was 5.1%, risk-reducing reconstruction 5.7% and developmental deformity implants 4.5%. Revision incidence due to complication at 12 months after augmentation procedure was 1.1%. Patient-reported outcome measures (PROMs) indicate high levels of satisfaction at 1 year for augmentation and reconstruction procedures. CONCLUSION We report on early data from the ABDR and reflect on the uptake of the registry by surgeons and patients. The registry also benefits from international collaborative approaches to addressing challenges and is committed to facilitate international post-market surveillance.
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Affiliation(s)
- Swarna Vishwanath
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Breanna Pellegrini
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Emily Parker
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Arul Earnest
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Saeid Kalbasi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Pragya Gartoulla
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Elisabeth Elder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Westmead Breast Cancer Institute, Australia; University of Sydney, Sydney, Australia; Breast Surgeons of Australia & New Zealand, Australia
| | - Gillian Farrell
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Cabrini Hospital - Brighton, Australia; Peter McCallum Cancer Centre, Melbourne, Australia; Australian Society of Plastic Surgeons, Australia
| | - Colin Moore
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Australasian College of Cosmetic Surgery, Australia
| | - Rodney D Cooter
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ingrid Hopper
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
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Chakfé N, Diener H, Lejay A, Assadian O, Berard X, Caillon J, Fourneau I, Glaudemans AWJM, Koncar I, Lindholt J, Melissano G, Saleem BR, Senneville E, Slart RHJA, Szeberin Z, Venermo M, Vermassen F, Wyss TR, de Borst GJ, Bastos Gonçalves F, Kakkos SK, Kolh P, Tulamo R, Vega de Ceniga M, von Allmen RS, van den Berg JC, Debus ES, Koelemay MJW, Linares-Palomino JP, Moneta GL, Ricco JB, Wanhainen A. Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections. Eur J Vasc Endovasc Surg 2020; 59:339-384. [PMID: 32035742 DOI: 10.1016/j.ejvs.2019.10.016] [Citation(s) in RCA: 272] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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General Assembly, Prevention, Operating Room - Surgical Attire: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S117-S125. [PMID: 30348561 DOI: 10.1016/j.arth.2018.09.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Kim K, Zhu M, Munro JT, Young SW. Glove change to reduce the risk of surgical site infection or prosthetic joint infection in arthroplasty surgeries: a systematic review. ANZ J Surg 2018; 89:1009-1015. [DOI: 10.1111/ans.14936] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 10/01/2018] [Accepted: 10/04/2018] [Indexed: 01/11/2023]
Affiliation(s)
- Katy Kim
- Department of OrthopaedicsNorth Shore Hospital Auckland New Zealand
| | - Mark Zhu
- Department of OrthopaedicsAuckland Hospital Auckland New Zealand
| | - Jacob T. Munro
- Department of OrthopaedicsAuckland Hospital Auckland New Zealand
| | - Simon W. Young
- Department of OrthopaedicsNorth Shore Hospital Auckland New Zealand
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Li X, Li M, Li J, Gong W, Sun Y, Tang J, Yao X, Wang X. Glove perforation and contamination in fracture fixation surgeries. Am J Infect Control 2017; 45:458-460. [PMID: 27769705 DOI: 10.1016/j.ajic.2016.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 07/06/2016] [Accepted: 07/06/2016] [Indexed: 11/25/2022]
Abstract
The aim of the present study was to investigate glove contamination and perforation rate during traumatic orthopedic surgeries and evaluate the factors affecting glove contamination and perforation. There were significant differences in glove contamination among different surgery stages. In terms of contamination and perforation, there were significant differences between surgeons and assistants (ie, scrub-nurses).
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Bashir A, Sørensen P. Evaluation of intraoperative glove change in prevention of postoperative cerebrospinal fluid shunt infections, and the predictors of shunt infection. Br J Neurosurg 2016; 31:452-458. [PMID: 27626705 DOI: 10.1080/02688697.2016.1229745] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND We have previously suggested that surgical gloves could be a possible means for transferring microorganisms from skin flora to shunt material during surgery. The objectives of this study were to examine (1) whether the rate of shunt infections was reduced after introducing intraoperative glove change before handling the shunt material; (2) clinical presentation of shunt infections, microbiological data, and treatment management; and (3) predictors of shunt infections. METHODS A retrospective study of 432 shunt operations in 295 adults was undertaken over a 7-year period. Study population consisted of two groups: Group A without intraoperative glove change (2003-2006), and Group B with change of the outer pair of the initial double gloves before handling the shunt material (2006-2009). The results were compared at 6- and 12-month postoperatively. A binary logistic regression was performed to determine predictors of shunt infections. RESULTS Overall, 46 (10.6%) infection episodes occurred in 40 (13.6%) patients. Main symptoms were fever, abdominal pain and altered mental status. Propionibacterium acnes was the frequently isolated microorganism, followed by Staphylococcus species. The infection rate was reduced only moderately from 11.8% in Group A to 9.8% in Group B (p = .472). Patients with subarachnoid haemorrhage were more likely to experience shunt infections (17.9%), compared to patients with normal pressure hydrocephalus (5.9%). An increased likelihood of shunt infections for the increased number of subsequent shunt revisions (p = .030) and a trend towards prior history of shunt infections (p = .118) was seen. After adjusting for various covariates, a decreased likelihood of shunt infections for intraoperative glove change was seen at 6-month follow-up for first-time shunt insertion (p = .050). CONCLUSION Intraoperative glove change does not significantly reduce the risk of shunt infection. However, it seems to reduce the infection rate within 6 months in patients undergoing first-time shunt insertion only.
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Affiliation(s)
- Asma Bashir
- a Department of Neurosurgery , University Hospital of Aalborg , Hobrovej , Aalborg , Denmark
| | - Preben Sørensen
- a Department of Neurosurgery , University Hospital of Aalborg , Hobrovej , Aalborg , Denmark
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Yaldiz C, Yaldiz M, Ceylan N, Kacira OK, Ceylan D, Kacira T, Kizilcay G, Tanriverdi T. Retrospective, Demographic, and Clinical Investigation of the Causes of Postoperative Infection in Patients With Lumbar Spinal Stenosis Who Underwent Posterior Stabilization. Medicine (Baltimore) 2015; 94:e1177. [PMID: 26200620 PMCID: PMC4602987 DOI: 10.1097/md.0000000000001177] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Owing to the increasing population of elderly patients, a large number of patients with degenerative spondylosis are currently being surgically treated. Although basic measures for decreasing postoperative surgical infections (PSIs) are considered, it still remains among the leading causes of morbidity and mortality. The aim of this retrospective analysis is to present possible causes leading to PSI in patients who underwent surgery for lumbar degenerative spondylosis and highlight how it can be avoided to decrease morbidity and mortality. The study included 540 patients who underwent posterior stabilization due to degenerative lumbar stenosis between January 2013 and January 2014. The data before and after surgery was retrieved from the hospital charts. Patients with degenerative lumbar stenosis who were operated upon in this study had >2 levels of laminectomy and facetectomy. For this reason, posterior stabilization was performed for all the patients included in this study. Determining the causes of postoperative infection (PI) following spinal surgeries performed with instrumentation is a struggle. Seventeen different parameters that may be related to PI were evaluated in this study. The presence of systemic diseases, unknown glove perforations, and perioperative blood transfusions were among the parameters that increased the prevalence of PI. Alternatively, prolene sutures, double-layered gloves, and the use of rifampicin Sv (RIS) decreased the incidence of PI. Although the presence of systemic diseases, unnoticed glove perforations, and perioperative blood transfusions increased PIs, prolene suture material, double-layered gloves, and the use of RIS decreased PIs.
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Affiliation(s)
- Can Yaldiz
- From the Departmant of Neurosurgery (CY, DC, TK, GK); Departmant of Dermatology (MY); Departmant of Internal Medicine (NC); Departmant of Radiology (OKK), Sakarya University Training and Research Hospital, Sakarya; and Department of Neurosurgery (TT), Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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Beldame J, Lagrave B, Lievain L, Lefebvre B, Frebourg N, Dujardin F. Surgical glove bacterial contamination and perforation during total hip arthroplasty implantation: when gloves should be changed. Orthop Traumatol Surg Res 2012; 98:432-40. [PMID: 22578871 DOI: 10.1016/j.otsr.2011.10.015] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Revised: 10/21/2011] [Accepted: 10/25/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Double gloving is recommended in orthopedic surgery, notably in total hip arthroplasties (THA) to prevent contamination of the surgical site. HYPOTHESIS Systematic glove changes during the key phases of hip prosthesis implantation reduce the frequency of occult perforations and bacterial loading of glove surfaces. PATIENTS AND METHODS During 29 THA implantation procedures, we evaluated the bacterial contamination of the outer glove surface and its perforation rate. Contaminations were sought by placing the gloved fingertips on blood geloses (incubation, 48 h at 37°C), and perforations were sought using a water test (NF EN 455-1). RESULTS One intervention was excluded from the study because an initial contamination was detected, leaving 28 cases analyzed. Fifteen interventions (53.6%) presented contaminated geloses (26 contaminated glove changes for 3.38% of the gloves used). These contaminations were found on the gloves of all of the gloved personnel, with no distinction as to the right or left side. Thirty-eight percent of the contaminations occurred during joint reduction, whereas the other surgical stages grouped 15-26% of the contaminations (P<0.05). Twenty-nine bacteria were identified: 62% coagulase-negative staphylococci (16% of which were methicillin-resistant). Twenty-eight perforations were identified (3.5% of the gloves used), 67.8% of which were located on the operator and 64.3% on the dominant side. Eighty percent of the perforations occurred during the "surgical incision" and the "cup and stem implantation" stages (respectively, 5.0% and 5.5% of the gloves used during the surgical time) (P<0.05), without being associated with an increased risk of bacterial contamination. At the 12-month clinical follow-up, no infectious complications were found. On the gloves worn by the 20 surgical team members contaminated during these 28 surgical procedures, replacing contaminated gloves with new sterile gloves rendered all the bacteriological samples of the subsequent surgical stages negative in 16 cases (80%). DISCUSSION Increasing the number of outer glove renewals, notably during certain surgical stages at risk for contamination (prosthesis reduction) or perforation (surgical incision/femoral cementing) can reduce the risk of contamination and perforation. The bacteria isolated suggest a cutaneous origin. Regularly changing gloves has resulted in a sterile state in 80% of cases. LEVEL OF EVIDENCE AND TYPE OF STUDY: Level III prospective diagnostic study.
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Affiliation(s)
- J Beldame
- Department of Orthopaedic Surgery, Rouen Teaching Hospital Center, 1, rue de Germont, 76031 Rouen cedex, France.
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The use of synthetic mesh in vaginal prolapse surgery: a survey of Dutch urogynaecologists. Eur J Obstet Gynecol Reprod Biol 2012; 162:113-5. [DOI: 10.1016/j.ejogrb.2012.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 01/13/2012] [Accepted: 02/09/2012] [Indexed: 11/22/2022]
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Lorenz U, Schäfer T, Ohlsen K, Tiurbe GC, Bühler C, Germer CT, Kellersmann R. In vivo detection of Staphylococcus aureus in biofilm on vascular prostheses using non-invasive biophotonic imaging. Eur J Vasc Endovasc Surg 2010; 41:68-75. [PMID: 20943422 DOI: 10.1016/j.ejvs.2010.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 09/06/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Biophotonic imaging was compared to standard enumeration method both for counting Staphylococcus aureus in biofilm and bacterial susceptibility tests of different graft materials. DESIGN Prospective, randomized, controlled animal study. MATERIAL AND METHODS Five types of vascular grafts were placed subcutaneously in 35 mice and challenged with bioluminescent S. aureus. The mice were divided into equal groups as follows: group A (polyester), group B (polytetrafluoroethylene), group C and D (two types of silver acetate-coated polyester) and group E (bovine pericardium). Controls were given only the bacteria. The bioluminescence signal of S. aureus, able to predict number of viable bacteria in biofilm without any manipulation, was measured at different time points. Five days postinfection, regular cultures of adherent bacteria on grafts were obtained. Comparative analyses between bioluminescence activity and culture enumeration were performed. RESULTS The number of viable bacteria on silver-coated prostheses was the slightest, indicating superior bacterial resistance. The density of bacteria on polytetrafluoroethylene and polyester was comparable, with a non-significant advantage for polytetrafluoroethylene. Moreover, bioluminescence detected the number of viable S. aureus in biofilm more exactly compared to enumeration of bacteria. CONCLUSION Bioluminescence imaging can be considered a useful tool to characterize susceptibility of any graft material to bacterial biofilm prior to implantation.
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Affiliation(s)
- U Lorenz
- Section of Vascular and Endovascular Surgery, Department of General, Visceral, Vascular & Paediatric Surgery, University Clinic of Wuerzburg, Oberdürrbacher Str. 6, 97080 Wuerzburg, Germany.
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Stewart AH, Eyers PS, Earnshaw JJ. Prevention of infection in peripheral arterial reconstruction: A systematic review and meta-analysis. J Vasc Surg 2007; 46:148-55. [PMID: 17606135 DOI: 10.1016/j.jvs.2007.02.065] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Accepted: 02/27/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis was to determine the effectiveness of perioperative strategies to prevent infection in patients undergoing peripheral arterial reconstruction. METHODS All randomized controlled trials (RCTs) evaluating measures intended to reduce or prevent infection in arterial surgery were identified through searches of the Cochrane Peripheral Vascular Diseases Group specialized trials register, the Cochrane Central Register of Controlled Trials (CENTRAL), and reference lists of relevant articles. Two authors independently selected and assessed the quality of included trials. Relative risk (RR) was used as a measure of effect for each dichotomous outcome. RESULTS The study included 34 RCTs. Of these, 22 were trials of prophylactic systemic antibiotics, 3 of rifampicin-bonded grafts, 3 of preoperative skin antisepsis, 2 of suction wound drainage, 2 of minimally invasive in situ bypass techniques, and individual trials of intraoperative glove change and wound closure techniques. Wound infection or early graft infection outcomes were recorded in all trials. Only two trials, both of rifampicin bonding, followed up graft infection outcomes to 2 years. Prophylactic systemic antibiotics reduced the risk of wound infection (RR, 0.25; 95% confidence interval [CI], 0.17 to 0.38) and early graft infection in a fixed-effect model (RR, 0.31; 95% CI, 0.11 to 0.85, P = .02). Antibiotic prophylaxis for >24 hours appeared to be of no added benefit (RR, 1.28; 95% CI, 0.82 to 1.98). There was no evidence that prophylactic rifampicin bonding to Dacron grafts reduced graft infection at 1 month (RR, 0.63; 95% CI, 0.27 to 1.49), or 2 years (RR, 1.05; 95% CI, 0.46 to 2.40). There was no evidence of a beneficial or detrimental effect on rates of wound infection with suction groin wound drainage (RR, 0.96; 95% CI, 0.50 to 1.86) or from preoperative bathing with antiseptic agents compared with unmedicated bathing (RR, 0.97; 95% CI, 0.70 to 1.36). CONCLUSIONS There is clear evidence of the benefit of prophylactic broad-spectrum antibiotics for vascular reconstruction. Many other interventions intended to reduce the risk of infection in arterial reconstruction lack evidence of effectiveness.
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Affiliation(s)
- Andrew H Stewart
- Department of Vascular Surgery, Gloucestershire Royal Hospital, Great Western Road, Gloucester, United Kingdom
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Muralidhar B, Anwar SM, Handa AI, Peto TEA, Bowler ICJW. Prevalence of MRSA in Emergency and Elective Patients Admitted to a Vascular Surgical Unit: Implications for Antibiotic Prophylaxis. Eur J Vasc Endovasc Surg 2006; 32:402-7. [PMID: 16716610 DOI: 10.1016/j.ejvs.2006.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2005] [Accepted: 03/26/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES MATERIALS AND METHODS 200 consecutive emergency/transfer and 150 consecutive elective patients admitted between April 2004 and January 2005, were studied. Data was obtained from departmental Morbidity and Mortality records and the computerised laboratory medicine information system. RESULTS 261 (75%) of the 350 patients were screened for MRSA on admission (target 100%). The proportions of emergency/transfer and elective patients screened were similar (78% and 72% respectively). The prevalence of MRSA carriage detected by admission screening in emergency/transfer patients 30/153 (20%), was significantly higher (p<0.0001) than in elective patients 2/108 (2%). A simple decision analysis model suggests that gentamicin should be used when the prevalence of MRSA reaches 10% and vancomycin when the prevalence reaches 50%. CONCLUSIONS The high prevalence of MRSA colonisation in emergency/transfer patients has important implications for pre-operative antibiotic prophylaxis.
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Affiliation(s)
- B Muralidhar
- Nuffield Department of Surgery, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
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Abstract
BACKGROUND Arterial reconstructions with prosthetic graft materials or vein are susceptible to infection with a resultant high patient mortality and risk of limb loss. To reduce the risk of infection effective perioperative measures are essential. OBJECTIVES To determine the effectiveness of perioperative strategies to prevent infection in patients undergoing peripheral arterial reconstruction. SEARCH STRATEGY We searched the Cochrane Peripheral Vascular Diseases Group trials register (last searched May 2006) and the Cochrane Central Register of Controlled Trials (CENTRAL) (last searched Issue 2, 2006), and reference lists of relevant articles. SELECTION CRITERIA All randomised controlled trials (RCTs) evaluating measures intended to reduce or prevent infection in arterial surgery. DATA COLLECTION AND ANALYSIS AS and PSE independently selected and assessed the quality of included trials. Relative risk was used as a measure of effect for each dichotomous outcome. MAIN RESULTS Thirty-five RCTs were included. Of these, 23 were trials of prophylactic systemic antibiotics, three of rifampicin-bonded grafts, three of preoperative skin antisepsis, two of suction wound drainage, two of minimally invasive in situ bypass techniques, and individual trials of intraoperative glove change and wound closure techniques. Wound infection or early graft infection outcomes were recorded in all trials. Only two trials, both of rifampicin bonding, followed up graft infection outcomes to two years. Trials of antibiotics versus placebo were of highest quality with six double-blind studies of the ten included. Prophylactic systemic antibiotics reduced the risk of wound infection (Relative Risk (RR) 0.25, 95% Confidence Interval (CI) 0.17 to 0.38) and early graft infection in a fixed-effect model (RR 0.31, 95% CI 0.11 to 0.85, P = 0.02). Antibiotic prophylaxis for greater than 24 hours appears to be of no added benefit (RR 1.28, 95% CI 0.82 to 1.98). There was no evidence that prophylactic rifampicin bonding to dacron grafts reduced graft infection at either one month (RR 0.63, 95% CI 0.27 to 1.49) or two years (RR 1.05, 95% CI 0.46 to 2.40). There was no evidence of a beneficial or detrimental effect on rates of wound infection with suction groin-wound drainage (RR 0.96 95% CI 0.50 to 1.86) or of any benefit from a preoperative bathing or shower regimen with antiseptic agents over unmedicated bathing (RR 0.97, 95% CI 0.70 to 1.36). AUTHORS' CONCLUSIONS There is clear evidence of the benefits of prophylactic broad spectrum antibiotics. Many other interventions intended to reduce the risk of infection in arterial reconstruction lack evidence of effectiveness.
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Affiliation(s)
- A Stewart
- Dolphin House, Department of Vascular Surgery, Bristol Royal Infirmary, Bristol, UK BS2 8HW.
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Al-Maiyah M, Bajwa A, Mackenney P, Port A, Gregg PJ, Hill D, Finn P. Glove perforation and contamination in primary total hip arthroplasty. ACTA ACUST UNITED AC 2005; 87:556-9. [PMID: 15795210 DOI: 10.1302/0301-620x.87b4.15744] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We conducted a randomised, controlled trial to determine whether changing gloves at specified intervals can reduce the incidence of glove perforation and contamination in total hip arthroplasty. A total of 50 patients were included in the study. In the study group (25 patients), gloves were changed at 20-minute intervals or prior to cementation. In the control group (25 patients), gloves were changed prior to cementation. In addition, gloves were changed in both groups whenever there was a visible puncture. Only outer gloves were investigated. Contamination was tested by impression of gloved fingers on blood agar and culture plates were subsequently incubated at 37°C for 48 hours. The number of colonies and types of organisms were recorded. Glove perforation was assessed using the water test. The incidence of perforation and contamination was significantly lower in the study group compared with the control group. Changing gloves at regular intervals is an effective way to decrease the incidence of glove perforation and bacterial contamination during total hip arthroplasty.
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Affiliation(s)
- M Al-Maiyah
- Department of Orthopaedics, School of Health, University of Teeside, Middlesbrough TS1 3BA, UK.
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Scientific surgery. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.2000.01483.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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