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Kurumboor P, Chacko S, Vipin IS, Prakash R, Pal AS. Role of single-ring oval disposable wound protecting device in preventing surgical site infection in laparoscopic colorectal resections. J Minim Access Surg 2024; 20:7-11. [PMID: 38240382 PMCID: PMC10898642 DOI: 10.4103/jmas.jmas_110_22] [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: 04/04/2022] [Revised: 06/10/2022] [Accepted: 07/10/2022] [Indexed: 11/07/2022] Open
Abstract
CONTEXT Surgical site infections (SSI) continue to be a major cause of morbidity, mortality, prolonged hospital stays and a major reason of financial burden to health-care providers and patients after major abdominal surgeries. Along with infection control practices and care bundles, additional use of devices which protect the wound from contamination is believed to decrease the burden of SSI. AIMS This study aims to assess the benefit of single-ring disposable wound protector in preventing SSI, overall complications, hospitals stay and morbidity data in laparoscopic colorectal resection. SETTINGS AND DESIGN The study design involves case-control study, retrospective. SUBJECTS AND METHODS A case-control study comparing single ring oval wound protector versus conventional wound protectors retrospectively between August 2019 and December 2021. The ease of use of the device, rate of SSI, overall complications, hospitals stay and morbidity data were analysed. STATISTICAL ANALYSIS USED The statistical analysis was performed by IBM SPSS Statistics 20 version. All Categorical Variables will be described as frequency and percentage. Continuous variables will be described as mean ± standard deviation. Continuous variables were analysed using t-test and categorical parameters using Fisher's exact test. RESULTS Of the 110 patients studied, wound Protecting devices were used in 58 patients Wound Protector Group (WPG group) and 62 patients did not use such devices (no WPG). The groups were comparable in demographic features, risk features, systemic illness, type of surgeries undertaken and the specimen extraction wound used. There was a significant decrease in the incidence of SSI (1.7% vs. 16% P ≤ 0.008) and the hospital stay (P ≤ 0.03) when WPG was used compared to the group in which it was not used. CONCLUSIONS Apart from the use of infection control practices and care bundles, the use of oval-shaped single-ring wound protector is likely to reduce SSI.
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Affiliation(s)
- Prakash Kurumboor
- Department of GI and HPB Surgery, Aster Medcity, Kochi, Kerala, India
| | - Sidharth Chacko
- Department of GI and HPB Surgery, Aster Medcity, Kochi, Kerala, India
| | - I. S. Vipin
- Department of GI and HPB Surgery, Aster Medcity, Kochi, Kerala, India
| | - Rohan Prakash
- Department of GI and HPB Surgery, Aster Medcity, Kochi, Kerala, India
| | - Ashna S. Pal
- Department of GI and HPB Surgery, Aster Medcity, Kochi, Kerala, India
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Salem HS, Sherman AE, Chen Z, Scuderi GR, Mont MA. The Utility of Perioperative Products for the Prevention of Surgical Site Infections in Total Knee Arthroplasty and Lower Extremity Arthroplasty: A Systematic Review. J Knee Surg 2022; 35:1023-1043. [PMID: 34875715 DOI: 10.1055/s-0041-1740394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Surgical site infections (SSIs) are among the most prevalent and devastating complications following lower extremity total joint arthroplasty (TJA). Strategies to reduce the rates can be divided into preoperative, perioperatives, and postoperative measures. A multicenter trial is underway to evaluate the efficacy of implementing a bundled care program for SSI prevention in lower extremity TJA including: (1) nasal decolonization; (2) surgical skin antisepsis; (3) antimicrobial incise draping; (4) temperature management; and (5) negative-pressure wound therapy for selected high-risk patients. The purposes of this systematic review were to provide a background and then to summarize the available evidence pertaining to each of these SSI-reduction strategies with special emphasis on total knee arthroplasty. A systematic review of the literature was conducted in accordance with the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. Five individual literature searches were performed to identify studies evaluating nasal decolonization temperature management, surgical skin antisepsis, antimicrobial incise draping, and negative-pressure wound therapy. The highest level of evidence reports was used in each product review, and if there were insufficient arthroplasty papers on the particular topic, then papers were further culled from the surgical specialties to form the basis for the review. There was sufficient literature to assess all of the various prophylactic and preventative techniques. All five products used in the bundled program were supported for use as prophylactic agents or for the direct reduction of SSIs in both level I and II studies. This systematic review showed that various pre-, intra-, and postoperative strategies are efficacious in decreasing the risks of SSIs following lower extremity TJA procedures. Thus, including them in the armamentarium for SSI-reduction strategies for hip and knee arthroplasty surgeons should decrease the incidence of infections. We expect that the combined use of these products in an upcoming study will support these findings and may further enhance the reduction of total knee arthroplasty SSIs in a synergistic manner.
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Affiliation(s)
- Hytham S Salem
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York.,Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Alain E Sherman
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York
| | - Zhongming Chen
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York.,Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Giles R Scuderi
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York
| | - Michael A Mont
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York.,Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
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Arab-Zozani M, Pezeshki MZ, Khodayari-Zarnaq R, Janati A. Inappropriate Rate of Admission and Hospitalization in the Iranian Hospitals: A Systematic Review and Meta-Analysis. Value Health Reg Issues 2019; 21:105-112. [PMID: 31704488 DOI: 10.1016/j.vhri.2019.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 06/06/2019] [Accepted: 07/22/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Inappropriate admission and hospitalization are types of overuse that impose a financial burden on all health systems, especially in hospitals. OBJECTIVE To analyze the evidence on the inappropriateness of admission and hospitalization in Iranian hospitals. METHODS This study was conducted using PubMed, Embase, Scopus, and Web of Science, as well as Persian databases, including Magiran and Scientific Information Database up to May 2018. Two researchers extracted result of the included studies, independently. We used Cohen's κ statistic for measuring inter-rater agreement. The meta-analyses were conducted based on pooled effect estimates for the rate of admission and hospitalization using the DerSimonian-Laird random-effects model with 95% confidence intervals (CI). RESULTS Seventeen articles met the inclusion criteria. The inter-rater agreement was very good for abstracts and full-texts screening (κ 0.86 and 98, respectively). The overall inappropriate rate was 12.3% (95% CI, 8.4-17.5) and 11.9% (95% CI, 7.7-18.1) for admission and hospitalization, respectively. The inappropriate rate of admission was significantly higher before the Health Sector Evolution Plan (HSEP) than after HSEP (14.6%, 95% CI, 8.6-23.6 before HSEP and 10%, 95% CI, 5.5-17.3 after HSEP), and the inappropriate rate of hospitalization was significantly higher after HSEP than before HESP (9.5%, 95% CI, 5.2-16.7 before HSEP and 16.9%, 95% CI, 8.2-31.7 after HSEP). CONCLUSIONS Adoption standard measures of admission and hospitalization, treating patients in appropriate care centers, and establishing a referral system is essential to reduce the inappropriate admission and hospitalization in Iranian hospitals. Such interventions can lead to a reduction in personnel costs and workload and ultimately increase the productivity of the hospital.
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Affiliation(s)
- Morteza Arab-Zozani
- Department of Health Services Management, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran; Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Mohammad Zakaria Pezeshki
- Department of Community and Family Medicine, Social Determinants of Health Research Center, Tabriz Medical School, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rahim Khodayari-Zarnaq
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Janati
- Department of Health Services Management, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
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Wojcik BM, Han K, Peponis T, Velmahos G, Kaafarani HMA. Impact of Intra-Operative Adverse Events on the Risk of Surgical Site Infection in Abdominal Surgery. Surg Infect (Larchmt) 2019; 20:174-183. [PMID: 30657419 DOI: 10.1089/sur.2018.157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Intra-operative adverse events (iAEs) recently were shown to correlate independently with an increased risk of post-operative death, morbidity, re-admissions, and length of hospital stay. We sought to understand further the impact of iAEs on surgical site infections (SSIs) in abdominal surgical procedures and delineate which patient populations are most affected. We hypothesized that all patients with iAEs have an increased risk for SSI, especially those with pre-existing risk factors for SSI. PATIENTS AND METHODS To identify iAEs, a well-described three-step methodology was used: (1) the 2007-2012 American College of Surgeons-National Surgical Quality Improvement Program database was merged with the administrative database of our tertiary academic center, (2) the merged database was screened for iAEs in abdominal surgical procedures using the International Classification of Diseases, Ninth Revision, Clinical Modification-based Patient Safety Indicator "Accidental Puncture/Laceration," and (3) each flagged record was systematically reviewed to confirm iAE occurrence. Uni-variable and backward stepwise multi-variable analyses (adjusting for demographics, co-morbidities, type and complexity of operation) were performed to study the independent correlation between iAEs and SSIs (superficial, deep incisional, and organ-space). The correlation between iAEs and SSIs was investigated especially in patients deemed a priori at high risk for SSIs, specifically those older than age 60 and those with diabetes mellitus, obesity, cigarette smoking, steroid use, or American Society of Anesthesiologists class ≥III. RESULTS A total of 9,288 operations were included, and iAEs were detected in 183 (2.0%). Most iAEs consisted of bowel (44%) or vessel (29%) injuries and were addressed intra-operatively (92%). SSI occurred in 686 (7.4%) cases and included 331 (3.5%) superficial, 32 (0.34%) deep incisional, and 333 (3.6%) organ/space infections. iAEs were correlated independently with SSI (odds ratio [OR] = 1.67; 95% confidence interval [CI], 1.11-2.52, p = 0.013), and more severe iAEs were associated with a higher risk of infection. Analysis by SSI type revealed a significant association with organ/space SSI (OR = 1.81, 95% CI 1.07-3.05; p = 0.027), but not incisional infections. Most interestingly, the occurrence of an iAE was correlated with increased SSI rate in the low-risk but not the high-risk patient populations. Specifically, iAEs increased SSI in patients younger than 60 (OR = 2.69, 95% CI 1.55-4.67, p < 0.001), non-diabetic patients (OR = 1.64, 95% CI 1.04-2.58, p = 0.034), non-obese patients (OR = 2.9, 95% CI 1.81-4.66, p < 0.001), non-smokers (OR = 1.67, 95% CI 1.08-2.6, p = 0.022), with no steroid use (OR = 1.73, 95% CI 1.15-2.6, p < 0.008), and with ASA class <III (OR = 2.26, 95% CI 1.31-3.87, p = 0.003). CONCLUSIONS The iAEs are associated independently with increased SSIs, particularly in patients with less pre-existing risk factors for SSI. Preventing iAEs or mitigating their impact, once they occur, may help decrease the rate of SSIs.
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Affiliation(s)
- Brandon M Wojcik
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Kelsey Han
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Thomas Peponis
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - George Velmahos
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Pieper D, Rombey T, Doerner J, Rembe JD, Zirngibl H, Zarras K, Ambe PC. The role of saline irrigation prior to wound closure in the reduction of surgical site infection: protocol for a systematic review and meta-analysis. Syst Rev 2018; 7:152. [PMID: 30286812 PMCID: PMC6172761 DOI: 10.1186/s13643-018-0813-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 09/11/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Surgical site infection describes an infectious complication of surgical wounds. This single complication is thought to occur in close to 20% of surgical cases. This complication has been described in all kinds of surgical procedure including minimally invasive procedures. Wound irrigation is frequently used as a means of reducing surgical site infection. However, there is lack of solid evidence to support routine wound irrigation. The aim of this review is to provide evidence for the efficacy of routine wound irrigation with normal saline in preventing surgical site infection. The rate of surgical site infection in cases with and without wound irrigation will be analyzed. METHODS/DESIGN Systematic literature searches will be conducted to identify all published and unpublished studies. The following databases will be searched for citations from inception to present: MEDLINE (via PubMed), Embase (via Embase), and CENTRAL (via the Cochrane library). The search strategy will be developed by the research team in collaboration with an experienced librarian and checked by a referee according to the Peer Review of Electronic Search Strategies (PRESS) guideline. A draft of the PubMed search strategy could be (irrigation[tiab] OR "Therapeutic Irrigation"[mesh] OR lavage[tiab]) AND (saline[tiab] OR "Sodium Chloride"[mesh] OR sodium chloride[tiab]) NOT ("Comment" [Publication Type] OR "Letter" [Publication Type] OR "Editorial" [Publication Type]). No time limits will be set. The reference lists of eligible articles will be hand searched. Relevant data will be extracted from eligible studies using a previously designed data extraction sheet. Relative risks will be calculated for binary outcomes and mean differences or standardized mean differences, if necessary, for continuous outcomes. For all measures, 95% confidence levels will be calculated. Both arms would be compared with regard to the rate of surgical site infection within 30 days following surgery. We will report the review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. DISCUSSION This review aims at investigating the value of routine wound irrigation using normal saline in preventing surgical site infection. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42018082287.
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Affiliation(s)
- Dawid Pieper
- Institute for Research in Operative Medicine, Chair of Surgical Research, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Tanja Rombey
- Institute for Research in Operative Medicine, Chair of Surgical Research, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Johannes Doerner
- Department of Surgery, Helios University Hospital Wuppertal, Witten/Herdecke University, Heusnerstr. 40, 42283 Wuppertal, Germany
| | - Julian-Dario Rembe
- Department of Surgery, Helios University Hospital Wuppertal, Witten/Herdecke University, Heusnerstr. 40, 42283 Wuppertal, Germany
| | - Hubert Zirngibl
- Department of Surgery, Helios University Hospital Wuppertal, Witten/Herdecke University, Heusnerstr. 40, 42283 Wuppertal, Germany
| | - Konstantinos Zarras
- Department of visceral, minimal invasive and oncologic surgery, Marienhospital Düsseldorf, Rochusstr. 2, 40479 Düsseldorf, Germany
| | - Peter C. Ambe
- Department of Surgery, Helios University Hospital Wuppertal, Witten/Herdecke University, Heusnerstr. 40, 42283 Wuppertal, Germany
- Department of visceral, minimal invasive and oncologic surgery, Marienhospital Düsseldorf, Rochusstr. 2, 40479 Düsseldorf, Germany
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Manoukian S, Stewart S, Dancer S, Graves N, Mason H, McFarland A, Robertson C, Reilly J. Estimating excess length of stay due to healthcare-associated infections: a systematic review and meta-analysis of statistical methodology. J Hosp Infect 2018; 100:222-235. [PMID: 29902486 DOI: 10.1016/j.jhin.2018.06.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/05/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Healthcare-associated infection (HCAI) affects millions of patients worldwide. HCAI is associated with increased healthcare costs, owing primarily to increased hospital length of stay (LOS) but calculating these costs is complicated due to time-dependent bias. Accurate estimation of excess LOS due to HCAI is essential to ensure that we invest in cost-effective infection prevention and control (IPC) measures. AIM To identify and review the main statistical methods that have been employed to estimate differential LOS between patients with, and without, HCAI; to highlight and discuss potential biases of all statistical approaches. METHODS A systematic review from 1997 to April 2017 was conducted in PubMed, CINAHL, ProQuest and EconLit databases. Studies were quality-assessed using an adapted Newcastle-Ottawa Scale (NOS). Methods were categorized as time-fixed or time-varying, with the former exhibiting time-dependent bias. Two examples of meta-analysis were used to illustrate how estimates of excess LOS differ between different studies. FINDINGS Ninety-two studies with estimates on excess LOS were identified. The majority of articles employed time-fixed methods (75%). Studies using time-varying methods are of higher quality according to NOS. Studies using time-fixed methods overestimate additional LOS attributable to HCAI. Undertaking meta-analysis is challenging due to a variety of study designs and reporting styles. Study differences are further magnified by heterogeneous populations, case definitions, causative organisms, and susceptibilities. CONCLUSION Methodologies have evolved over the last 20 years but there is still a significant body of evidence reliant upon time-fixed methods. Robust estimates are required to inform investment in cost-effective IPC interventions.
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Affiliation(s)
- S Manoukian
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK.
| | - S Stewart
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
| | - S Dancer
- Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire, UK
| | - N Graves
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - H Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
| | - A McFarland
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
| | - C Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - J Reilly
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
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Brandt C, Sohr D, Behnke M, Daschner F, Rüden H, Gastmeier P. Reduction of Surgical Site Infection Rates Associated With Active Surveillance. Infect Control Hosp Epidemiol 2016; 27:1347-51. [PMID: 17152033 DOI: 10.1086/509843] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2005] [Accepted: 11/10/2005] [Indexed: 11/03/2022]
Abstract
Objective.To evaluate whether surgical site infection (SSI) rates decrease in surgical departments as a result of performing active SSI surveillance.Design.Retrospective multiple logistic regression analyses.Setting.A group of 130 surgical departments of German hospitals participating in the Krankenhaus Infektions Surveillance System (KISS).Methods.Data for 19 categories of operative procedures performed between January 1997 and June 2004 were included (119,114 operations). Active SSI surveillance was performed according to National Nosocomial Infections Surveillance system (NNIS) methods and definitions. Departments' SSI rates were calculated individually for each year of surveillance and for each operative procedure category, taking into account when the individual departments had begun their surveillance activities. Multiple logistic regression analyses on a single operation basis were carried out with stepwise variable selection to predict outcomes for patients with SSI. The variables included were as follows: the department's year of participation, NNIS risk index variables, patients' age and sex, and the hospitals' structural characteristics, such as yearly operation frequency, number of beds, and academic status.Results.For 14 of 19 operative procedure categories analyzed, there was a tendency toward lower SSI rates that was associated with increasing duration of SSI surveillance. In multiple logistic regression analyses of pooled data for all operative procedures, the departments' participation in the surveillance system was a significant independent protective factor. Compared with the surveillance year 1, the SSI risk decreased in year 2 (odds ratio, 0.84; 95% confidence interval, 0.77-0.93) and in year 3 (odds ratio, 0.75; 95% confidence interval, 0.68-0.82), and there was no change in year 4.Conclusion.The SSI incidence was reduced by one quarter as a result of the surveillance-induced infection control efforts, which indicates the usefulness of a voluntary surveillance system.
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Affiliation(s)
- C Brandt
- Institut fūr Hygiene und Umweltmedizin, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Gastmeier P. Postdischarge Surveillance for Surgical Site Infection: The Continuing Challenge. Infect Control Hosp Epidemiol 2016; 27:1287-90. [PMID: 17152024 DOI: 10.1086/509000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2006] [Accepted: 09/09/2006] [Indexed: 12/30/2022]
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Herwaldt LA, Cullen JJ, Scholz D, French P, Zimmerman MB, Pfaller MA, Wenzel RP, Perl TM. A Prospective Study of Outcomes, Healthcare Resource Utilization, and Costs Associated With Postoperative Nosocomial Infections. Infect Control Hosp Epidemiol 2016; 27:1291-8. [PMID: 17152025 DOI: 10.1086/509827] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2005] [Accepted: 06/14/2006] [Indexed: 01/08/2023]
Abstract
Objective.We evaluated 4 important outcomes associated with postoperative nosocomial infection: costs, mortality, excess length of stay, and utilization of healthcare resources.Design.The outcomes for patients who underwent general, cardiothoracic, and neurosurgical operations were recorded during a previous clinical trial. Multivariable analyses including significant covariates were conducted to determine whether nosocomial infection significantly affected the outcomes.Setting.A large tertiary care medical center and an affiliated Veterans Affairs Medical Center.Patients.A total of 3,864 surgical patients.Results.The overall nosocomial infection rate was 11.3%. Important covariates included age, Karnofsky score, McCabe and Jackson classification of the severity of underlying disease, National Nosocomial Infection Surveillance system risk index, and number of comorbidities. After accounting for covariates, nosocomial infection was associated with increased postoperative length of stay, increased costs, increased hospital readmission rate, and increased use of antimicrobial agents in the outpatient setting. Nosocomial infection was not associated independently with a significantly increased risk of death in this surgical population.Conclusion.Postoperative nosocomial infection was associated with increased costs of care and with increased utilization of medical resources. To accurately assess the effects of nosocomial infections, one must take into account important covariates. Surgeons seeking to decrease the cost of care and resource utilization must identify ways to decrease the rate of postoperative nosocomial infection.
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Affiliation(s)
- Loreen A Herwaldt
- Department of Internal Medicine, University of Iowa College of Public Health, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.
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Singh A, Bartsch SM, Muder RR, Lee BY. An Economic Model: Value of Antimicrobial-Coated Sutures to Society, Hospitals, and Third-Party Payers in Preventing Abdominal Surgical Site Infections. Infect Control Hosp Epidemiol 2016; 35:1013-20. [DOI: 10.1086/677163] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundWhile the persistence of high surgical site infection (SSI) rates has prompted the advent of more expensive sutures that are coated with antimicrobial agents to prevent SSIs, the economic value of such sutures has yet to be determined.MethodsUsing TreeAge Pro, we developed a decision analytic model to determine the cost-effectiveness of using antimicrobial sutures in abdominal incisions from the hospital, third-party payer, and societal perspectives. Sensitivity analyses systematically varied the risk of developing an SSI (range, 5%–20%), the cost of triclosan-coated sutures (range, $5–$25/inch), and triclosan-coated suture efficacy in preventing infection (range, 5%–50%) to highlight the range of costs associated with using such sutures.ResultsTriclosan-coated sutures saved $4,109–$13,975 (hospital perspective), $4,133–$14,297 (third-party payer perspective), and $40,127–$53,244 (societal perspective) per SSI prevented, when a surgery had a 15% SSI risk, depending on their efficacy. If the SSI risk was no more than 5% and the efficacy in preventing SSIs was no more than 10%, triclosan-coated sutures resulted in extra expenditure for hospitals and third-party payers (resulting in extra costs of $1,626 and $1,071 per SSI prevented for hospitals and third-party payers, respectively; SSI risk, 5%; efficacy, 10%).ConclusionsOur results suggest that switching to triclosan-coated sutures from the uncoated sutures can both prevent SSIs and save substantial costs for hospitals, third-party payers, and society, as long as efficacy in preventing SSIs is at least 10% and SSI risk is at least 10%.
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Mihaljevic AL, Schirren R, Müller TC, Kehl V, Friess H, Kleeff J. Postoperative negative-pressure incision therapy following open colorectal surgery (Poniy): study protocol for a randomized controlled trial. Trials 2015; 16:471. [PMID: 26482031 PMCID: PMC4617637 DOI: 10.1186/s13063-015-0995-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 10/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postoperative surgical site infections cause substantial morbidity, prolonged hospitalization, costs and even mortality, and remain one of the most frequent surgical complications. In prospective trials with adequate follow-up, more than 20 % of patients undergoing elective colorectal surgery are affected and methods to reduce surgical site infections are urgently needed. Negative-pressure incision therapy is a novel intervention that holds promise to reduce postoperative wound infection rates, but has not yet been rigorously tested in a randomized controlled trial. METHODS/DESIGN The aim is to investigate whether the postoperative application of a negative-pressure incision therapy device for 5-7 days reduces the rate of surgical site infections following open elective colorectal surgery by 50 %. This is a randomized, controlled, observer-blinded multicentre clinical trial with two parallel study groups. The primary outcome measure will be the rate of surgical site infections within 30 days postoperatively. Surgical site infections are defined according to criteria of the US Centers for Disease Control and Prevention. Statistical analysis of the primary endpoint measure will be based on the intention-to-treat population. The global level of significance is set at 5 % (two-sided) and the sample size (n = 170 per group) is determined to assure a power of 80 %. DISCUSSION The Poniy trial will explore whether the rate of surgical site infections can be reduced by the application of a negative-pressure incision therapy device in patients undergoing open elective colorectal surgery. Its pragmatic design guarantees high external validity and clinical relevance. TRIAL REGISTRATION Deutsches Register Klinischer Studien DRKS00006199 .
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Affiliation(s)
- André L Mihaljevic
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München and CHIR-Net Munich, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - Rebekka Schirren
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München and CHIR-Net Munich, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - Tara C Müller
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München and CHIR-Net Munich, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - Victoria Kehl
- Institute for Medical Statistics and Epidemiology, Klinikum rechts der Isar, Technische Universtität München, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München and CHIR-Net Munich, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - Jörg Kleeff
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München and CHIR-Net Munich, Ismaningerstrasse 22, 81675, Munich, Germany. .,Current affiliation: The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Prescot Street, Liverpool L7 8XP, UK. .,Department of General-, Visceral- and Pediatric Surgery, University Hospital Düsseldorf, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany.
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Kleeff J, Erkan M, Jäger C, Menacher M, Gebhardt F, Hartel M. Umbilical Microflora, Antiseptic Skin Preparation, and Surgical Site Infection in Abdominal Surgery. Surg Infect (Larchmt) 2015; 16:450-4. [DOI: 10.1089/sur.2014.163] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Jörg Kleeff
- Department of Surgery, Technische Universität München, Munich, Germany
| | - Mert Erkan
- Department of Surgery, Technische Universität München, Munich, Germany
| | - Carsten Jäger
- Department of Surgery, Technische Universität München, Munich, Germany
| | | | - Friedemann Gebhardt
- Institute of Medical Microbiology and Immunology, Technische Universität München, Munich, Germany
| | - Mark Hartel
- Department of Surgery, Technische Universität München, Munich, Germany
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Wound edge protectors in open abdominal surgery to reduce surgical site infections: a systematic review and meta-analysis. PLoS One 2015; 10:e0121187. [PMID: 25816365 PMCID: PMC4376627 DOI: 10.1371/journal.pone.0121187] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 01/28/2015] [Indexed: 11/26/2022] Open
Abstract
Importance Surgical site infections remain one of the most frequent complications following abdominal surgery and cause substantial costs, morbidity and mortality. Objective To assess the effectiveness of wound edge protectors in open abdominal surgery in reducing surgical site infections. Evidence Review A systematic literature search was conducted according to a prespecified review protocol in a variety of data-bases combined with hand-searches for randomized controlled trials on wound edge protectors in patients undergoing laparotomy. A qualitative and quantitative analysis of included trials was conducted. Findings We identified 16 randomized controlled trials including 3695 patients investigating wound edge protectors published between 1972 and 2014. Critical appraisal uncovered a number of methodological flaws, predominantly in the older trials. Wound edge protectors significantly reduced the rate of surgical site infections (risk ratio 0.65; 95%CI, 0.51–0.83; p = 0.0007; I2 = 52%). The results were robust in a number of sensitivity analyses. A similar effect size was found in the subgroup of patients undergoing colorectal surgery (risk ratio 0.65; 95%CI, 0.44–0.97; p = 0.04; I2 = 56%). Of the two common types of wound protectors double ring devices were found to exhibit a greater protective effect (risk ratio 0.29; 95%CI, 0.15–0.55) than single-ring devices (risk ratio 0.71; 95%CI, 0.54–0.92), but this might largely be due to the lower quality of available data for double-ring devices. Exploratory subgroup analyses for the degree of contamination showed a larger protective effect in contaminated cases (0.44; 95%CI, 0.28–0.67; p = 0.0002, I2 = 23%) than in clean-contaminated surgeries (0.72, 95%CI, 0.57–0.91; p = 0.005; I2 = 46%) and a strong effect on the reduction of superficial surgical site infections (risk ratio 0.45; 95%CI, 0.24–0.82; p = 0.001; I2 = 72%). Conclusions and Relevance Wound edge protectors significantly reduce the rate of surgical site infections in open abdominal surgery. Further trials are needed to explore their effectiveness in different risk constellations.
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Mueller TC, Loos M, Haller B, Mihaljevic AL, Nitsche U, Wilhelm D, Friess H, Kleeff J, Bader FG. Intra-operative wound irrigation to reduce surgical site infections after abdominal surgery: a systematic review and meta-analysis. Langenbecks Arch Surg 2015; 400:167-81. [PMID: 25681239 DOI: 10.1007/s00423-015-1279-x] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 02/01/2015] [Indexed: 02/08/2023]
Abstract
PURPOSE Surgical site infection (SSI) remains to be one of the most frequent infectious complications following abdominal surgery. Prophylactic intra-operative wound irrigation (IOWI) before skin closure has been proposed to reduce bacterial wound contamination and the risk of SSI. However, current recommendations on its use are conflicting especially concerning antibiotic and antiseptic solutions because of their potential tissue toxicity and enhancement of bacterial drug resistances. METHODS To analyze the existing evidence for the effect of IOWI with topical antibiotics, povidone-iodine (PVP-I) solutions or saline on the incidence of SSI following open abdominal surgery, a systematic review and meta-analysis of randomized controlled trials (RCTs) was carried out according to the recommendations of the Cochrane Collaboration. RESULTS Forty-one RCTs reporting primary data of over 9000 patients were analyzed. Meta-analysis on the effect of IOWI with any solution compared to no irrigation revealed a significant benefit in the reduction of SSI rates (OR = 0.54, 95 % confidence Interval (CI) [0.42; 0.69], p < 0.0001). Subgroup analyses showed that this effect was strongest in colorectal surgery and that IOWI with antibiotic solutions had a stronger effect than irrigation with PVP-I or saline. However, all of the included trials were at considerable risk of bias according to the quality assessment. CONCLUSION These results suggest that IOWI before skin closure represents a pragmatic and economical approach to reduce postoperative SSI after abdominal surgery and that antibiotic solutions seem to be more effective than PVP-I solutions or simple saline, and it might be worth to re-evaluate their use for specific indications.
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Affiliation(s)
- Tara C Mueller
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany,
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Brandt C, Hansen S, Sohr D, Daschner F, Rüden H, Gastmeier P. Finding a Method for Optimizing Risk Adjustment When Comparing Surgical-Site Infection Rates. Infect Control Hosp Epidemiol 2015; 25:313-8. [PMID: 15108729 DOI: 10.1086/502398] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AbstractObjective:To investigate whether stratification of the risk of developing a surgical-site infection (SSI) is improved when a logistic regression model is used to weight the risk factors for each procedure category individually instead of the modified NNIS System risk index.Design and Setting:The German Nosocomial Infection Surveillance System, based on NNIS System methodology, has 273 acute care surgical departments participating voluntarily. Data on 9 procedure categories were included (214,271 operations).Methods:For each of the procedure categories, the significant risk factors from the available data (NNIS System risk index variables of ASA score, wound class, duration of operation, and endoscope use, as well as gender and age) were identified by multiple logistic regression analyses with stepwise variable selection. The area under the receiver operating characteristic (ROC) curve resulting from these analyses was used to evaluate the predictive power of logistic regression models.Results:For most procedures, at least two of the three variables contributing to the NNIS System risk index were shown to be independent risk factors (appendectomy, knee arthroscopy, cholecystectomy, colon surgery, herniorrhaphy, hip prosthesis, knee prosthesis, and vascular surgery). The predictive power of logistic regression models (including age and gender, when appropriate) was low (between 0.55 and 0.71) and for most procedures only slightly better than that of the NNIS System risk index.Conclusion:Without the inclusion of additional procedure-specific variables, logistic regression models do not improve the comparison of SSI rates from various hospitals.
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Affiliation(s)
- Christian Brandt
- Institut für Hygiene und Umweltmedizin, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Gikas A, Roumbelaki M, Pediaditis J, Nikolaidis P, Levidiotou S, Kartali S, Kioumis J, Maltezos E, Metalidis S, Anevlavis E, Haliotis G, Kolibiris H, Tselentis Y. Prevalence of Nosocomial Infections After Surgery in Greek Hospitals: Results of Two Nationwide Surveys. Infect Control Hosp Epidemiol 2015; 25:319-24. [PMID: 15108730 DOI: 10.1086/502399] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AbstractObjective:To determine the frequency and type of nosocomial infections (NIs) (especially surgical-site infections [SSIs]), risk factors, and the type and duration of antibiotic use among surgical patients in Greek hospitals.Design:Two point-prevalence studies.Setting:Fourteen Greek hospitals.Patients:Those in the hospitals during two prevalence surveys undergoing surgery during their stay.Results:In the 1999 survey, 129 of 1,037 surgical patients had developed 148 NIs (14.3%). A total of 1,093 operations were registered, and 49 SSIs (4.5%) were found. In the 2000 survey, 82 of 868 surgical patients had developed 88 NIs (10.1%). A total of 902 operations were registered, and 38 SSIs were detected (4.2%). The median length of stay (LOS) for surgical patients without SSI was 10.0 days (range, 1-19 days); for patients who developed SSI it was 30 days (range, 1-52 days; P < .001). The median LOS prior to surgery for patients without SSI was 1 day (range, 0-4 days); for patients who developed SSI it was 3 days (range, 0-7.5 days; P < .001). Among 30 possible risk factors studied, wound class, LOS prior to surgery, and central venous catheterization were independent predictors of SSI. Median durations of prophylactic antibiotic therapy were 4 days (range, 1-14 days) and 6 days (range, 1-16 days) in the 1999 and 2000 surveys, respectively.Conclusion:Surgical patients in Greek hospitals suffered higher rates of SSI than did surgical patients in other developed countries while prophylactic antibiotics were used excessively.
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Elbur AI, Yousif MA, El Sayed ASA, Abdel-Rahman ME. Misuse of prophylactic antibiotics and prevalence of postoperative wound infection in obstetrics and gynecology department in a Sudanese hospital. Health (London) 2014. [DOI: 10.4236/health.2014.62025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mihaljevic AL, Michalski CW, Erkan M, Reiser-Erkan C, Jäger C, Schuster T, Schuhmacher C, Kleeff J, Friess H. Standard abdominal wound edge protection with surgical dressings vs coverage with a sterile circular polyethylene drape for prevention of surgical site infections (BaFO): study protocol for a randomized controlled trial. Trials 2012; 13:57. [PMID: 22587425 PMCID: PMC3533734 DOI: 10.1186/1745-6215-13-57] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 03/09/2012] [Indexed: 11/10/2022] Open
Abstract
Background Postoperative surgical site infections cause substantial morbidity, prolonged hospitalization, costs and even mortality and remain one of the most frequent surgical complications. Approximately 14% to 30% of all patients undergoing elective open abdominal surgery are affected and methods to reduce surgical site infection rates warrant further investigation and evaluation in randomized controlled trials. Methods/design To investigate whether the application of a circular plastic wound protector reduces the rate of surgical site infections in general and visceral surgical patients that undergo midline or transverse laparotomy by 50%. BaFO is a randomized, controlled, patient-blinded and observer-blinded multicenter clinical trial with two parallel surgical groups. The primary outcome measure will be the rate of surgical site infections within 45 days postoperative assessed according to the definition of the Center for Disease Control. Statistical analysis of the primary endpoint will be based on the intention-to-treat population. The global level of significance is set at 5% (2 sided) and sample size (n = 258 per group) is determined to assure a power of 80% with a planned interim analysis for the primary endpoint after the inclusion of 340 patients. Discussion The BaFO trial will explore if the rate of surgical site infections can be reduced by a single, simple, inexpensive intervention in patients undergoing open elective abdominal surgery. Its pragmatic design guarantees high external validity and clinical relevance. Trial registration http://www.clinicaltrials.gov NCT01181206. Date of registration: 11 August 2010; date of first patient randomized: 8 September 2010
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Affiliation(s)
- André L Mihaljevic
- Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
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Byrne C, Hazlerigg A, Khan W, Smitham P. The role of perioperative care in reducing rates of methicillin resistant Staphylococcus aureus. J Perioper Pract 2012; 21:410-7. [PMID: 22263319 DOI: 10.1177/175045891102101202] [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]
Abstract
Methicillin resistant Staphylococcus aureus (MRSA) is defined as any strain of Staphylococcus aureus resistant to beta-lactam antibiotics, including the penicillins and cephalosporins. Over the past ten years the UK has seen a dramatic increase in MRSA prevalence in healthcare facilities and the community, with an estimated 30-50% of healthy adults thought to be colonised with MRSA. Surgical patients are among those at highest risk. With potential sequelae including septicaemia, septic shock, septic arthritis, osteomyelitis, meningitis, pneumonia or endocarditis, it is vital that all care facilities have up to date evidence-based guidelines to tackle this problem. The purpose of this review is to highlight the current evidence supporting some of the key perioperative measures which may be implemented in preventing MRSA.
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Fukuda H, Lee J, Imanaka Y. Variations in analytical methodology for estimating costs of hospital-acquired infections: a systematic review. J Hosp Infect 2010; 77:93-105. [PMID: 21145131 DOI: 10.1016/j.jhin.2010.10.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 10/08/2010] [Indexed: 11/30/2022]
Abstract
Quantifying the additional costs of hospital-acquired infections (COHAI) is essential for developing cost-effective infection control measures. The methodological approaches to estimate these costs include case reviews, matched comparisons and regression analyses. The choice of cost estimation methodologies can affect the accuracy of the resulting estimates, however, with regression analyses generally able to avoid the bias pitfalls of the other methods. The objective of this study was to elucidate the distributions and trends in cost estimation methodologies in published studies that have produced COHAI estimates. We conducted systematic searches of peer-reviewed publications that produced cost estimates attributable to hospital-acquired infection in MEDLINE from 1980 to 2006. Shifts in methodologies at 10-year intervals were analysed using Fisher's exact test. The most frequent method of COHAI estimation methodology was multiple matched comparisons (59.6%), followed by regression models (25.8%), and case reviews (7.9%). There were significant increases in studies that used regression models and decreases in matched comparisons through the 1980s, 1990s and post-2000 (P = 0.033). Whereas regression analyses have become more frequently used for COHAI estimations in recent years, matched comparisons are still used in more than half of COHAI estimation studies. Researchers need to be more discerning in the selection of methodologies for their analyses, and comparative analyses are needed to identify more accurate estimation methods. This review provides a resource for analysts to overview the distribution, trends, advantages and pitfalls of the various existing COHAI estimation methodologies.
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Affiliation(s)
- H Fukuda
- Institute for Health Economics and Policy, Tokyo, Japan
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Präambel zum Kapitel D, Hygienemanagement, der Richtlinie für Krankenhaushygiene und Infektionsprävention. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2009; 52:949-50. [DOI: 10.1007/s00103-009-0930-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sakong P, Lee JS, Lee EJ, Ko KP, Kim CH, Kim Y, Kim YI. [Association between the pattern of prophylactic antibiotic use and surgical site infection rate for major surgeries in Korea]. J Prev Med Public Health 2009; 42:12-20. [PMID: 19229120 DOI: 10.3961/jpmph.2009.42.1.12] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The purpose of this study was to analyze the association between the pattern of prophylactic antibiotic use (PAU) and the surgical site infection (SSI) rate for major surgeries in Korea. METHODS We retrospectively reviewed the medical records of patients who underwent cardiac, colon and gastric surgery, hysterectomies and hip/knee replacements at 20 hospitals, and inclusive of over 500 beds. We randomly sampled 60 cases per surgery type for patients discharged between September and November, 2006. A total fo 2,924 cases were included in our analysis. Cox's proportional hazard analysis was conducted to evaluate the association between the pattern of PAU and SSI rate. RESULTS The proportion of patients who received their first prophylactic antibiotics (PA) 1 hour before incision was 65.5%, who received inappropriate PAs was 80.8%, and the proportion of patients whose PA was discontinued within 24 hours of surgery was 0.5%. The average duration of PAU after surgery was 9 days. The relative risk (RR) of SSI in patients who received their first PA more than 1 hour before incision was significantly higher than for those who received it within 1 hour prior to incision (RR=8.20, 95% CI=4.81-13.99). Inappropriate PA selection increased SSI rate, albeit with marginal significance (RR=1.97, 95% CI=0.96-4.03). Also, prolonged PAU following surgery had no effect on SSI rate. CONCLUSIONS These results suggest that the pattern of PAU in the surgeries examined was not appropriate. Errors in the timing of PAU and of PA selection increase SSI rate. SSI rate remained unaltered following prolonged PAU after surgery.
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Affiliation(s)
- Pilyong Sakong
- Department of Health Policy and Management, Seoul National University College of Medicine
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Operating room ventilation with laminar airflow shows no protective effect on the surgical site infection rate in orthopedic and abdominal surgery. Ann Surg 2008; 248:695-700. [PMID: 18948793 DOI: 10.1097/sla.0b013e31818b757d] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate whether operating room (OR) ventilation with (vertical) laminar airflow impacts on surgical site infection (SSI) rates. DESIGN Retrospective cohort-study based on routine surveillance data. PATIENTS AND METHODS Sixty-three surgical departments participating voluntarily in the German national nosocomial infections surveillance system "KISS" were included (a total of 99,230 operations). Active SSI surveillance was performed according to the methods and definitions given by the US National Nosocomial Infection Surveillance system. Surgical departments were stratified according to type of OR ventilation used: (1) turbulent ventilation with high-efficiency particulate air-filtered air, and (2) HEPA-filtered (vertical) laminar airflow ventilation. Multivariate analyses were performed by the generalized estimating equations method to control for the following variables as possible confounders: (a) Patient-based: wound contamination class, ASA score, operation duration, patients' age and gender, endoscopic operation; (b) Hospital-based: the number of beds in the hospital, its academic status, operation frequency, and long-term participation in KISS. RESULTS The risk for severe SSI after hip prosthesis implantation was significantly higher using laminar airflow OR ventilation (1.63 < 1.06; 2.52>), as compared with turbulent ventilation. The adjusted odds ratios for the other operative procedures analyzed were: knee prosthesis 1.76 < 0.80, 3.85>; appendectomy 1.52 < 0.91, 2.53>; cholecystectomy 1.37 < 0.63, 2.97>; colon surgery 0.85 < 0.49, 1.49>; and herniorrhaphy 1.48 < 0.67; 3.25>. CONCLUSIONS Unexpectedly, in this analysis, which controlled for many patient and hospital-based confounders, OR ventilation with laminar airflow showed no benefit and was even associated with a significantly higher risk for severe SSI after hip prosthesis.
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Brümmer S, Sohr D, Rüden H, Gastmeier P. [Surgical site infection rates using a laparoscopic approach: results of the German national nosocomial infections surveillance system]. Chirurg 2008; 78:910-4. [PMID: 17492262 DOI: 10.1007/s00104-007-1353-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Our aim was to assess the impact of laparoscopy on surgical site infections. METHODS An analysis was performed using the data of the German national nosocomial infections surveillance system (Krankenhaus-Infektions-Surveillance-Systems, KISS) collected during the period from January 2001 to June 2006. Univariate and multivariate analyses were used to investigate the influence of age, gender, ASA score, duration of surgery, wound contamination class and surgical technique. RESULTS AND CONCLUSIONS A total of 18,249 appendectomies, 32,912 herniorrhaphies, 42,949 cholecystectomies and 19,523 colon operations were analysed. The overall surgical site infection rate was significantly higher (2.6-fold) for the open approach compared to laparoscopically performed appendectomies. For herniorrhaphies, cholecystectomies and colon operations the corresponding odds ratios were 3.40, 3.22 and 1.20 respectively. Whenever possible a laparoscopic approach should be used.
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Affiliation(s)
- S Brümmer
- Nationales Referenzzentrum (NRZ) für nosokomiale Infektionen, Berlin, Deutschland.
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Wicke C, Schilling D, Feyerabend S, Königsrainer A, Stenzl A. Pathophysiologie der Wundheilung und modernes Wundmanagement im urologischen Kontext. Urologe A 2007; 46:1721-32; quiz 1733-4. [DOI: 10.1007/s00120-007-1593-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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[Prevention of postoperative surgical wound infection: recommendations of the Hospital Hygiene and Infection Prevention Committee of the Robert Koch Institute]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2007; 50:377-93. [PMID: 17340231 DOI: 10.1007/s00103-007-0167-0] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Abstract
Surgical site infections can be traced to discrepancies in one specific hospital department: the operating suite. Therefore, prevention is often viewed as resting completely on the surgeon. However, the source of micro-organisms responsible for surgical site infections can be endogenous or exogenous. Most infections are believed to be the former, i.e. caused by micro-organisms already resident in the patient's body. Therefore the surgeon can be regarded as suspect only in exceptional cases and usually himself a victim. Prevention is possible not only for exogenous surgical site infection but also many endogenous infections. A multicenter surveillance of infection rates at 130 operative departments participating for at least 4 years in the German National Nosocomial Infection Surveillance System was conducted. A significant 25% reduction in the 3rd year was observed compared with patients who underwent surgery within the 1st year of participation. However, surgeons alone cannot achieve such a decrease, and a team approach is required under most circumstances.
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Affiliation(s)
- P Gastmeier
- Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover.
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