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Using administrative data to determine rates of surgical site infections following spinal fusion and laminectomy procedures. Am J Infect Control 2021; 49:759-763. [PMID: 33091510 DOI: 10.1016/j.ajic.2020.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Surgical site infections (SSIs) are a serious and costly post-op complication. Generating SSI rates often requires labor-intensive methods, but increasing numbers of publications reported SSI rates using administrative data. METHODS Index laminectomy and spinal fusion procedures were identified using Canadian Classification of Health Interventions (CCI) procedure codes for inpatients and outpatients in the province of Alberta, Canada between 2008 and 2015. SSIs occurring in the year postsurgery were identified using the International Classification of Diseases, 10th Revision, Canada (ICD-10-CA) diagnosis and CCI procedure codes indicative of post-op infection. Rates of SSIs and case characteristics were reported. RESULTS Over the 8-year study period, 21,222 index spinal procedures were identified of which 12,027 (56.7%) were laminectomy procedures, with 322 SSIs identified, an SSI rate of 2.7 per 100 procedures. Of the 9,195 (43.3%) fusion procedures, 298 were identified as an SSI, an SSI rate of 3.2 per 100 procedures. This study found SSI rates increased from 2008 and 2015, and rates were the highest in the 0-18 year age group. CONCLUSIONS The rates reported in this study were similar to published SSI rates using traditional surveillance methods, suggesting administrative data may be a viable method for reporting SSI rates following spinal procedures. Further work is needed to validate SSIs identified using administrative data by comparing to traditional surveillance.
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2
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Corcoran T, Kasza J, Short TG, O'Loughlin E, Chan MTV, Leslie K, Forbes A, Paech M, Myles P. Intraoperative dexamethasone does not increase the risk of postoperative wound infection: a propensity score-matched post hoc analysis of the ENIGMA-II trial (EnDEX). Br J Anaesth 2018; 118:190-199. [PMID: 28100522 DOI: 10.1093/bja/aew446] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND In a post hoc analysis of the ENIGMA-II trial, we sought to determine whether intraoperative dexamethasone was associated with adverse safety outcomes. METHODS Inverse probability weighting with estimated propensity scores was used to determine the association of dexamethasone administration with postoperative infection, quality of recovery, and adverse safety outcomes for 5499 of the 7112 non-cardiac surgery subjects enrolled in ENIGMA-II. RESULTS Dexamethasone was administered to 2178 (40%) of the 5499 subjects included in this analysis and was not associated with wound infection [189 (8.7%) vs 275 (8.3%); propensity score-adjusted relative risk (RR) 1.10; 95% confidence interval (CI) 0.89-1.34; P=0.38], severe postoperative nausea and vomiting on day 1 [242 (7.3%) vs 189 (8.7%); propensity score-adjusted RR 1.06; 95% CI 0.86-1.30; P=0.59], quality of recovery score [median 14, interquartile range (IQR) 12-15, vs median 14, IQR 12-16, P=0.10), length of stay in the postanaesthesia care unit [propensity score-adjusted median (IQR) 2.0 (1.3, 2.9) vs 1.9 (1.3, 3.1), P=0.60], or the primary outcome of the main trial. Dexamethasone administration was associated with a decrease in fever on days 1-3 [182 (8.4%) vs 488 (14.7%); RR 0.61; 95% CI 0.5-0.74; P<0.001] and shorter lengths of stay in hospital [propensity score-adjusted median (IQR) 5.0 (2.9, 8.2) vs 5.3 (3.1, 9.1), P<0.001]. Neither diabetes mellitus nor surgical wound contamination status altered these outcomes. CONCLUSION Dexamethasone administration to high-risk non-cardiac surgical patients did not increase the risk of postoperative wound infection or other adverse events up to day 30, and appears to be safe in patients either with or without diabetes mellitus. CLINICAL TRIAL REGISTRATION NCT00430989.
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Affiliation(s)
- T Corcoran
- Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Western Australia, Australia .,School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.,Western Australia Health Department, Perth, Western Australia, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - J Kasza
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - T G Short
- Department of Anaesthesia, Auckland City Hospital, Park Road, Grafton, Auckland, New Zealand
| | - E O'Loughlin
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.,Department of Anaesthesia and Pain Medicine, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - M T V Chan
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - K Leslie
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Anaesthesia, Perioperative and Pain Medicine Unit, and Department of Pharmacology and Therapeutics, University of Melbourne, Melbourne, Victoria, Australia
| | - A Forbes
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - M Paech
- Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.,School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - P Myles
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia
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Suchomel M, Brillmann M, Assadian O, Ousey KJ, Presterl E. Chlorhexidine-coated surgical gloves influence the bacterial flora of hands over a period of 3 hours. Antimicrob Resist Infect Control 2018; 7:108. [PMID: 30202521 PMCID: PMC6127898 DOI: 10.1186/s13756-018-0395-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 08/15/2018] [Indexed: 11/10/2022] Open
Abstract
Background The risk of SSI increases in the presence of foreign materials and may be caused by organisms with low pathogenicity, such as skin flora derived from hands of surgical team members in the event of a glove breach. Previously, we were able to demonstrate that a novel antimicrobial surgical glove coated chlorhexidine-digluconate as the active ingredient on its inner surface was able to suppress surgeons' hand flora during operative procedures by a magnitude of 1.7 log10 cfu/mL. Because of the clinical design of that study, we were not able to measure the full magnitude of the possible antibacterial suppression effect of antimicrobial gloves over a full 3 h period. Methods The experimental procedure followed the method for assessment of the 3-h effects of a surgical hand rub's efficacy to reduce the release of hand flora as described in the European Norm EN 12791. Healthy volunteers tested either an antimicrobial surgical glove or non-antimicrobial surgical latex gloves in a standardized laboratory-based experiment over a wear time of 3 h. Results Wearing antimicrobial surgical glove after a surgical hand rub with 60% (v/v) n-propanol resulted in the highest 3-h reduction factor of 2.67 log10. Non-antimicrobial surgical gloves demonstrated significantly lower (p ≤ 0.01) 3-h reduction factors at 1.96 log10 and 1.68 log10, respectively. Antibacterial surgical gloves are able to maintain a sustainable bacterial reduction on finger tips in a magnitude of almost 3 log10 (log10 2.67 cfu) over 3 h wear time. Conclusion It was demonstrated that wear of an antibacterial surgical glove coated with chlorhexidine-digluconate is able to suppress resident hand flora significantly over a period of 3-h.
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Affiliation(s)
- Miranda Suchomel
- 1Institute for Hygiene and Applied Immunology, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - Markus Brillmann
- 1Institute for Hygiene and Applied Immunology, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - Ojan Assadian
- 2Department for Hospital Epidemiology and Infection Control, Medical University of Vienna, Vienna, Austria.,3Institute for Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK
| | - Karen J Ousey
- 3Institute for Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK
| | - Elisabeth Presterl
- 2Department for Hospital Epidemiology and Infection Control, Medical University of Vienna, Vienna, Austria
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4
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Garcia Stickney DN, Thieman Mankin KM. The impact of postdischarge surveillance on surgical site infection diagnosis. Vet Surg 2017; 47:66-73. [DOI: 10.1111/vsu.12738] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 05/23/2017] [Accepted: 07/06/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Danielle N. Garcia Stickney
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine; Texas A&M University; College Station Texas
| | - Kelley M. Thieman Mankin
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine; Texas A&M University; College Station Texas
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5
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Sganga G, Tascini C, Sozio E, Colizza S. Early recognition of methicillin-resistant Staphylococcus aureus surgical site infections using risk and protective factors identified by a group of Italian surgeons through Delphi method. World J Emerg Surg 2017; 12:25. [PMID: 28616060 PMCID: PMC5469047 DOI: 10.1186/s13017-017-0136-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 05/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surgical site infections (SSIs) constitute a major clinical problem in terms of morbidity, mortality, duration of hospital stay, and overall costs. The bacterial pathogens implicated most frequently are Streptococcus pyogenes (S. pyogenes) and Staphylococcus aureus (S. aureus). The incidence of methicillin-resistant S. aureus (MRSA) SSIs is increasing significantly. Since these infections have a significant impact on hospital budgets and patients' health, their diagnosis must be anticipated and therapy improved. The first step should be to evaluate risk factors for MRSA SSIs. METHODS Through a literature review, we identified possible major and minor risk factors for, and protective factors against MRSA SSIs. We then submitted statements on these factors to 228 Italian surgeons to determine, using the Delphi method, the degree of consensus regarding their importance. The consensus was rated as positive if >80% of the voters agreed with a statement and as negative if >80% of the voters disagreed. In other cases, no consensus was reached. RESULTS There was positive consensus that sepsis, >2 weeks of hospitalization, age >75 years, colonization by MRSA, and diabetes were major risk factors for MRSA SSIs. Other possible major risk factors, on which a consensus was not reached, e.g., prior antibiotic use, were considered minor risk factors. Other minor risk factors were identified. An adequate antibiotic prophylaxis, laparoscopic technique, and infection committee surveillance were considered protective factors against MRSA SSIs. All these factors might be used to build predictive criteria for identifying SSI due to MRSA. CONCLUSIONS In order to help to recognize and thus promptly initiate an adequate antibiotic therapy for MRSA SSIs, we designed a gradation of risk and protective factors. Validation, ideally prospective, of this score is now required. In the case of a SSI, if the risk that the infection is caused by MRSA is high, empiric antibiotic therapy should be started after debriding the wound and collecting material for culture.
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Affiliation(s)
- G. Sganga
- Istituto Clinica Chirurgica, Divisione Chirurgia Generale e del Trapianto di Fegato, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Largo Gemelli, 8, 00168 Roma, Italia
| | - C. Tascini
- Prima Divisione Malattie Infettive, Azienda Ospedaliera dei Colli, Napoli, Italia
| | - E. Sozio
- U.O. Medicina d’Urgenza Universitaria, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italia
| | - S. Colizza
- Master Sepsi in Chirurgia, Università Cattolica del Sacro Cuore, Roma, Italia
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6
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Woelber E, Schrick EJ, Gessner BD, Evans HL. Proportion of Surgical Site Infections Occurring after Hospital Discharge: A Systematic Review. Surg Infect (Larchmt) 2016; 17:510-9. [DOI: 10.1089/sur.2015.241] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Erik Woelber
- University of Washington School of Medicine, Seattle, Washington
| | - Emily J. Schrick
- University of Washington College of Arts and Sciences, Seattle, Washington
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7
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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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8
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Sganga G, Tascini C, Sozio E, Carlini M, Chirletti P, Cortese F, Gattuso R, Granone P, Pempinello C, Sartelli M, Colizza S. Focus on the prophylaxis, epidemiology and therapy of methicillin-resistant Staphylococcus aureus surgical site infections and a position paper on associated risk factors: the perspective of an Italian group of surgeons. World J Emerg Surg 2016; 11:26. [PMID: 27307786 PMCID: PMC4908758 DOI: 10.1186/s13017-016-0086-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 06/10/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aim of this research was to study the epidemiology, microbiology, prophylaxis, and antibiotic therapy of surgical site infections (SSIs), especially those caused by methicillin-resistant Staphylococcus aureus (MRSA), and identify the risk factors for these infections. In Italy SSIs occur in about 5 % of all surgical procedures. They are predominantly caused by staphylococci, and 30 % of them are diagnosed after discharge. In every surgical specialty there are specific procedures more associated with SSIs. METHODS The authors conducted a systematic review of the literature on SSIs, especially MRSA infections, and used the Delphi method to identify risk factors for these resistant infections. RESULTS Risk factors associated with MRSA SSIs identified by the Delphi method were: patients from long-term care facilities, recent hospitalization (within the preceding 30 days), Charlson score > 5 points, chronic obstructive pulmonary disease and thoracic surgery, antibiotic therapy with beta-lactams (especially cephalosporins and carbapenem) and/or quinolones in the preceding 30 days, age 75 years or older, current duration of hospitalization >16 days, and surgery with prothesis implantation. Protective factors were adequate antibiotic prophylaxis, laparoscopic surgery and the presence of an active, in-hospital surveillance program for the control of infections. MRSA therapy, especially with agents that enable the patient's rapid discharge from hospital is described. CONCLUSION The prevention, identification and treatment of SSIs, especially those caused by MRSA, should be implemented in surgical units in order to improve clinical and economic outcomes.
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Affiliation(s)
- G. Sganga
- />Istituto Clinica Chirurgica, Divisione Chirurgia Generale e Trapianti d’Organo, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - C. Tascini
- />U.O. Malattie Infettive, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - E. Sozio
- />U.O. Medicina d’Urgenza Universitaria, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - M. Carlini
- />Chirurgia generale Ospedale Sant’Eugenio di Roma, Rome, Italy
| | - P. Chirletti
- />Dipartimento di Chirurgia Università La Sapienza, Policlinico Umberto I, Rome, Italy
| | - F. Cortese
- />UOC Chirurgia di Urgenza Ospedale San Filippo Neri, Rome, Italy
| | - R. Gattuso
- />Dipartimento di Chirurgia Generale e Trapianti d’Organo, UOC Chirurgia Vascolare, Università La Sapienza, Policlinico Umberto I, Rome, Italy
| | - P. Granone
- />Istituto Patologia Chirurgia, Unità Operativa Complessa Chirurgia Toracica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - C. Pempinello
- />Ortopedia e Traumatologia dell’Ospedale S. Gennaro ASL Napoli 1 Centro, Naples, Italy
| | - M. Sartelli
- />U.O Chirurgia Generale Ospedale di Macerata, Macerata, Italy
| | - S. Colizza
- />Master Sepsi in Chirurgia, Università Cattolica, Rome, Italy
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9
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Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update. Infect Control Hosp Epidemiol 2016; 35 Suppl 2:S66-88. [DOI: 10.1017/s0899823x00193869] [Citation(s) in RCA: 184] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their surgical site infection (SSI) prevention efforts. This document updates “Strategies to Prevent Surgical Site Infections in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
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10
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Barbadoro P, Marmorale C, Recanatini C, Mazzarini G, Pellegrini I, D'Errico MM, Prospero E. May the drain be a way in for microbes in surgical infections? Am J Infect Control 2016; 44:283-8. [PMID: 26717874 DOI: 10.1016/j.ajic.2015.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 10/06/2015] [Accepted: 10/07/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND Surgical site infection (SSI) is among the most frequent hospital-acquired infections occurring in surgical patients and leads to increased morbidity, mortality, and costs. We aimed to identify risk factors for SSI in patients undergoing surgical procedures, with a particular attention to the use of drains. METHODS This study includes all patients undergoing abdominal surgical procedures in 2 surgical wards in a teaching hospital in central Italy. Collected data included patient's demographic and clinical characteristics, procedure characteristics, administration of perioperative antibiotic prophylaxis, and microorganism isolated. The outcome of interest was SSI. FINDINGS A total of 872 abdominal surgery procedures were surveyed during the study period. Drains were placed in 37.0% of cases. SSI rate was 6.4% globally and 13.6% among the patients with drains, versus 2.4% in those without a drain (P < .001). In 72.1% of cases antibiotic prophylaxis was administered. The logistic regression analysis (P < .001) shown insertion of a drain (odds ratio [OR], 5.14; 95% confidence interval [CI], 2.63-10.08), prolonged surgery (OR, 1.98; 95% CI, 1.09-3.59), and American Society of Anesthesiologists score equal to 3 (OR, 6.13; 95% CI, 2.33-16.11) as independent risk factors for SSI, whereas antibiotic prophylaxis was protective (OR, 0.53; 95% CI, 0.29-0.99). CONCLUSION This study revealed surgical drains as a risk factor for SSI, pointing out the need of a clearer understanding of drain role in the dynamics of SSI occurrence, with the purpose of decreasing infection risk through targeted preventive interventions.
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An evaluation of surgical site infection surveillance methods for colon surgery and hysterectomy in Colorado hospitals. Infect Control Hosp Epidemiol 2015; 36:353-5. [PMID: 25695179 DOI: 10.1017/ice.2014.54] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Surgical site infection (SSI) surveillance techniques for colon surgery and hysterectomy among Colorado infection preventionists were characterized through an online survey. Considerable variation was found in SSI surveillance practices, specifically varying use of triggers for SSI review, including laboratory values, healthcare personnel communication, and postoperative visits.
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Zarate R, Birnbaum D. Postdischarge Surgical Site Infection Surveillance Practices in Washington Acute Care Hospitals. Infect Control Hosp Epidemiol 2015; 33:87-9. [DOI: 10.1086/663339] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Little is known about postdischarge surveillance practices currently in place among American hospitals. This survey describes practices used by acute care hospitals covered by Washington State's legislated mandate for public reporting of surgical site infections. While the vast majority of facilities use multiple techniques, wide variation in practices was discovered.Infect Control Hosp Epidemiol 2012;33(1):8
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Turk R, Singh A, Weese JS. Prospective surgical site infection surveillance in dogs. Vet Surg 2014; 44:2-8. [PMID: 25196800 DOI: 10.1111/j.1532-950x.2014.12267.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 07/06/2014] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To 1) describe the incidence of surgical site infections (SSI) in dogs undergoing surgery at the Ontario Veterinary College Health Sciences Centre; 2) describe and compare procedure-specific SSI rates; and 3) identify factors associated with development of SSI. STUDY DESIGN Prospective, cohort study ANIMALS Dogs (n = 846) undergoing surgery during 45 weeks (September 2010-July 2011). METHODS Follow-up telephone conversation with dog owners was performed 30 days postoperatively, with additional 1-year follow-up performed for cases with surgical implants. A standardized questionnaire was administered to detect and characterize SSI. RESULTS SSI were identified in 26 (3.0%) dogs; 11 (42%) were classified as superficial SSI, whereas 13 were deep, and 2 were organ/space. Of the confirmed SSI, only 17 (65%) were documented in the medical records. Hypotension (P = .011), class of surgery (P = .029), and use of an implant (P = .001) increased the risk of SSI. Microbial cultures were submitted for 19 cases (73%) and of those, 74% were staphylococci. CONCLUSIONS SSI can result in devastating consequences in dogs and understanding risk factors is critical to target prevention practices. Whereas some risk factors such as hypotension are modifiable, others such as class of surgery are not. When possible, active surveillance should be used as part of a hospital infection control program.
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Gibson A, Tevis S, Kennedy G. Readmission after delayed diagnosis of surgical site infection: a focus on prevention using the American College of Surgeons National Surgical Quality Improvement Program. Am J Surg 2014; 207:832-9. [PMID: 24119885 PMCID: PMC4811594 DOI: 10.1016/j.amjsurg.2013.05.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 05/24/2013] [Accepted: 05/30/2013] [Indexed: 01/03/2023]
Abstract
BACKGROUND Surgical site infection (SSI) is a costly complication leading to increased resource use and patient morbidity. We hypothesized that postdischarge SSI results in a high rate of preventable readmissions. METHODS We used our institutional American College of Surgeons National Surgical Quality Improvement Program database to identify patients undergoing general surgery procedures from 2006 to 2011. RESULTS SSIs developed in 10% of the 3,663 patients who underwent an inpatient general surgical procedure. SSI was diagnosed after discharge in 48% of patients. Patients with a diagnosis of SSI after discharge were less likely to have a history of smoking (15% vs 28%, P = .001), chronic obstructive pulmonary disease (3% vs 9%, P = .015), congestive heart failure (0% vs 3%, P = .03), or sepsis within 48 hours preoperatively (17% vs 32%, P = .001) compared with patients diagnosed before discharge. Over 50% of the patients diagnosed with SSI after discharge required readmission. CONCLUSIONS A diagnosis of SSI after discharge is associated with a high readmission rate despite occurring in healthier patients. We propose discharge teaching improvements and a wound surveillance clinic within the first week may result in a decreased readmission rate.
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Affiliation(s)
- Angela Gibson
- Department of Surgery, University of Wisconsin, H4/3 Clinical Sciences Center, 600 Highland Avenue, Madison, WI 53792, USA
| | - Sarah Tevis
- Department of Surgery, University of Wisconsin, H4/3 Clinical Sciences Center, 600 Highland Avenue, Madison, WI 53792, USA
| | - Gregory Kennedy
- Department of Surgery, University of Wisconsin, H4/3 Clinical Sciences Center, 600 Highland Avenue, Madison, WI 53792, USA.
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Anderson DJ, Podgorny K, Berríos-Torres SI, Bratzler DW, Dellinger EP, Greene L, Nyquist AC, Saiman L, Yokoe DS, Maragakis LL, Kaye KS. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014; 35:605-27. [PMID: 24799638 PMCID: PMC4267723 DOI: 10.1086/676022] [Citation(s) in RCA: 555] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their surgical site infection (SSI) prevention efforts. This document updates “Strategies to Prevent Surgical Site Infections in Acute Care Hospitals,”1 published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.2
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Affiliation(s)
| | | | | | - Dale W. Bratzler
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | | | - Linda Greene
- Highland Hospital and University of Rochester Medical Center, Rochester, New York
| | - Ann-Christine Nyquist
- Children’s Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado
| | - Lisa Saiman
- Columbia University Medical Center, New York, New York
| | - Deborah S. Yokoe
- Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Keith S. Kaye
- Detroit Medical Center and Wayne State University, Detroit, Michigan
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Gomes AEB, Cavalcante RDS, Pavan ÉCP, Freitas EDS, Fortaleza CMCB. Predictive factors of post-discharge surgical site infections among patients from a teaching hospital. Rev Soc Bras Med Trop 2014. [DOI: 10.1590/0037-8682-0069-2013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Post-discharge surgical site infections after uncomplicated elective colorectal surgery: impact and risk factors. The experience of the VINCat Program. J Hosp Infect 2014; 86:127-32. [DOI: 10.1016/j.jhin.2013.11.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 11/03/2013] [Indexed: 11/23/2022]
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Randomized controlled trial to reduce bacterial colonization of surgical drains after breast and axillary operations. Ann Surg 2013; 258:240-7. [PMID: 23518704 DOI: 10.1097/sla.0b013e31828c0b85] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether bacterial colonization of drains can be reduced by local antiseptic interventions. BACKGROUND Drains are a potential source of bacterial entry into surgical wounds and may contribute to surgical site infection after breast surgery. METHODS After institutional review board approval, patients undergoing total mastectomy and/or axillary lymph node dissection were randomized to standard drain care (control) or drain antisepsis (treated). Standard drain care comprised twice daily cleansing with alcohol swabs. Antisepsis drain care included (1) a chlorhexidine disc at the drain exit site and (2) irrigation of the drain bulb twice daily with dilute sodium hypochlorite (Dakin's) solution. Culture results of drain fluid and tubing were compared between control and antisepsis groups. RESULTS Overall, 100 patients with 125 drains completed the study with 48 patients (58 drains) in the control group and 52 patients (67 drains) in the antisepsis group. Cultures of drain bulb fluid at 1 week were positive (1+ or greater growth) in 66% (38/58) of control drains compared with 21% (14/67) of antisepsis drains (P = 0.0001). Drain tubing cultures demonstrated more than 50 colony-forming units in 19% (8/43) of control drains versus 0% (0/53) of treated drains (P = 0.004). Surgical site infection was diagnosed in 6 patients (6%)--5 patients in the control group and 1 patient in the antisepsis group (P = 0.06). CONCLUSIONS Simple and inexpensive local antiseptic interventions with a chlorhexidine disc and hypochlorite solution reduce bacterial colonization of drains. Based on these data, further study of drain antisepsis and its potential impact on surgical site infection rate is warranted (ClinicalTrials.gov Identifier: NCT01286168).
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Løwer HL, Eriksen HM, Aavitsland P, Skjeldestad FE. Methodology of the Norwegian Surveillance System for Healthcare-Associated Infections: the value of a mandatory system, automated data collection, and active postdischarge surveillance. Am J Infect Control 2013; 41:591-6. [PMID: 23318091 DOI: 10.1016/j.ajic.2012.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 08/29/2012] [Accepted: 09/04/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Surveillance is a primary component of systems for the prevention of health care-associated infections (HCAI). Feedback to surgeons from these surveillance systems may reduce rates of surgical site infections (SSIs) by approximately 20%. OBJECTIVE Our objective was to describe the Norwegian Surveillance System for Healthcare-Associated Infections' (NOIS) module for SSI (NOIS-SSI) and to evaluate the completeness of hospital participation, the effectiveness of automated data collection, and the added value of follow-up after hospital discharge during 2005 to 2009. METHODS NOIS was introduced by regulation in 2005. Hospital participation is described through adherence to the mandatory requirements and participation in the voluntary aspects of the system. Automated data collection is evaluated through the completeness of reporting of explanatory and administrative variables. The impact of active postdischarge surveillance is assessed through the completeness of follow-up and the proportion of infections detected after hospital discharge. RESULTS The system has achieved 95% (52/55) hospital participation, with 65% (34/52) of the hospitals submitting more data than the required minimum. The completeness of patient and procedure-related background data is satisfactory, with 23.3% (5,079/21,772) of the records having at least 1 missing value. The completeness of 30-day follow-up of patients is 90.7% (19,747/21,772), and 81% (765/948) of the infections were detected after discharge from hospital. CONCLUSION Implementation of a new surveillance system for SSI has been successful evaluated through hospital participation, the completeness of reporting of explanatory and administrative variables, and the completeness of postdischarge follow-up. Important success factors are a mandatory system, automated data-harvesting systems in hospitals, and active postdischarge surveillance.
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Blackham AU, Farrah JP, McCoy TP, Schmidt BS, Shen P. Prevention of surgical site infections in high-risk patients with laparotomy incisions using negative-pressure therapy. Am J Surg 2013; 205:647-54. [DOI: 10.1016/j.amjsurg.2012.06.007] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 05/16/2012] [Accepted: 06/07/2012] [Indexed: 01/04/2023]
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O'Connell RL, Rusby JE. Efficacy of prophylactic antibiotic administration for breast cancer surgery in overweight or obese patients: research highlight. Gland Surg 2013; 2:107-9. [PMID: 25083467 DOI: 10.3978/j.issn.2227-684x.2013.05.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 05/24/2013] [Indexed: 11/14/2022]
Abstract
The rate of surgical site infection (SSI) after breast surgery is higher than expected for a 'clean procedure'. There is currently no consensus on the use of antibiotics, and as a result there is variation in use. An infection may compromise cosmesis and delay the start of adjuvant therapy. This research highlight reviews a recent paper by Gulluoglu and colleagues investigating the use of antibiotics in overweight and obese patients undergoing breast cancer surgery and also reviews the current literature on this important topic.
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Affiliation(s)
- Rachel L O'Connell
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Down Road, Sutton, Surrey, SM2 5PT, UK
| | - Jennifer E Rusby
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Down Road, Sutton, Surrey, SM2 5PT, UK
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Omar AA, Al-Mousa HH. Surgical site infection complicating breast cancer surgery in kuwait. ISRN PREVENTIVE MEDICINE 2013; 2013:295783. [PMID: 24967132 PMCID: PMC4062853 DOI: 10.5402/2013/295783] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 11/15/2012] [Indexed: 11/23/2022]
Abstract
Background and Objectives. Surgical site infection (SSI) is the most common postoperative complication associated with breast cancer surgery. The present investigation aimed to determine the SSI rate after breast cancer surgeries and the causative microorganisms. Patients and Methods. All patients who underwent breast surgery in Kuwait Cancer Control Center as a treatment for breast cancer from January 2009-December 2010 were prospectively followed for the development of SSI. Indirect detection was used to identify SSIs through medical record to review and discussion with the treating surgeons. Results. The number of operations was 438. Females represented 434 (99.1%) cases while males constituted only 4 (0.9%) cases. SSIs were diagnosed after 10 operations, all for female cases. Most of the SSIs (8 cases; 80%) were detected after patients were discharged, during outpatient followup. Out of those 5/8; (62.5%) were readmitted for management of SSI. Nine patients (90%) received systemic antibiotic therapy for management of their wound infection. The SSI rate was 2.3%. The main causative organism was Staphylococcus aureus (S. aureus) which was responsible for 40% of infections. Gram negative bacteria were isolated from 40% of the cases. Conclusion. SSI is an important complication following breast cancer surgery. Microbiological diagnosis is an essential tool for proper management of such patients.
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Affiliation(s)
- Abeer A Omar
- Infection Control Department, Kuwait Cancer Control Center and Infection Control Directorate, Ministry of Health, Kuwait ; Department of Microbiology, High Institute of Public Health, Alexandria University, Egypt
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Teija-Kaisa A, Eija M, Marja S, Outi L. Risk factors for surgical site infection in breast surgery. J Clin Nurs 2012; 22:948-57. [PMID: 23121264 DOI: 10.1111/jocn.12009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2012] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To study risks of surgical site infection in breast surgery. The objectives were to measure the association of postoperative infection with patient- and procedure-related factors. BACKGROUND The infection rate in breast surgery is expected to be low but it varies a lot. The variation is recommended to be assessed by measuring procedure-related factors. DESIGN A retrospective chart review of 982 breast surgery patients was completed. METHODS The data on patient demographics, procedure types, patient and surgery-related factors were collected. A multivariate logistic regression model for all breast operations (n=982), lumpectomies (n=700) and mastectomies (n=282) was performed. RESULTS The infection rate was 6.7%. In a multivariate logistic regression model for all operations, a contaminated or dirty wound, high American Society of Anesthesiologists score, high body mass index, use of surgical drains and re-operation predicted increased infection risk. In lumpectomies high body mass index and use of surgical drains predicted increased risk. In mastectomies, the significant predictor was re-operation. CONCLUSIONS The surgical site infection rate was high. In addition to the two classical risks (high wound class and anaesthesia risk), high body mass index, re-operation and use of surgical drain increased the infection risk among all patients. RELEVANCE TO CLINICAL PRACTICE In breast surgery careful assessment, documentation and adherence to aseptic practices are important with all patients. Patients with heavy weight need special attention. The need for antimicrobial prophylaxis in re-operations and the need of surgical drains in lumpectomies are important to consider carefully.
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Affiliation(s)
- Aholaakko Teija-Kaisa
- University of Helsinki Medical Faculty, Helsinki and Principal Lecturer, Laurea University of Applied Sciences, Vantaa, Finland.
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Brahmbhatt RD, Huebner M, Scow JS, Harmsen WS, Boughey JC, Harris AM, Goede D, Jakub JW, Hieken TJ, Degnim AC. National practice patterns in preoperative and postoperative antibiotic prophylaxis in breast procedures requiring drains: survey of the American Society of Breast Surgeons. Ann Surg Oncol 2012; 19:3205-11. [PMID: 22766988 PMCID: PMC3934495 DOI: 10.1245/s10434-012-2477-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Indexed: 01/01/2023]
Abstract
BACKGROUND To assess national practice patterns regarding use of perioperative antibiotics by surgeons performing breast operations requiring drainage tubes. METHODS The members of the American Society of Breast Surgeons (ASBrS) were surveyed regarding use of perioperative antibiotics for breast operations requiring drains, with or without immediate tissue expander or implant reconstruction. RESULTS Of 2,857 ASBrS members contacted, 917 (32 %) responded; all self-identified as surgeons. Of 905 evaluable respondents, most described themselves as general surgeons (46 %) or breast surgeons (46 %). For cases in which drains are anticipated, most respondents (86 %) reported routine use of preoperative prophylactic antibiotics, with 99 % selecting cephalosporins. Use of antibiotic >24 h postoperatively varied by whether or not reconstruction was performed. In nonreconstruction cases, the majority (76 %) reported "never/almost never" prescribing antibiotics beyond the 24-h postoperative period, but 16 % reported "always/almost always." In reconstruction cases, the majority (58 %) reported routine antibiotic use beyond 24 h, and the primary driver of the decision to use antibiotics was reported to be the plastic surgeon (83 %). Among those reporting use at >24 h, the duration recommended for nonreconstruction cases was "up to 1 week" in 38 % and "until drains removed" in 39 %; this was similar for reconstruction cases. CONCLUSIONS Cephalosporins are utilized uniformly as preoperative antibiotic prophylaxis in breast operations requiring drains. However, use of postoperative antibiotic prophylaxis is strongly dependent on the presence of immediate breast reconstruction. Consensus is lacking on the role of postoperative antibiotic prophylaxis in breast operations utilizing drains.
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Affiliation(s)
| | - Marianne Huebner
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | | | - W. Scott Harmsen
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | | | | | - Donna Goede
- Survey Research Center, Mayo Clinic, Rochester, MN
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Degnim AC, Throckmorton AD, Boostrom SY, Boughey JC, Holifield A, Baddour LM, Hoskin TL. Surgical site infection after breast surgery: impact of 2010 CDC reporting guidelines. Ann Surg Oncol 2012; 19:4099-103. [PMID: 22732837 DOI: 10.1245/s10434-012-2448-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Reported surgical site infection (SSI) rates after breast operations ranges 0.8-26 % in the literature. The aims of the present study were to characterize SSI after breast/axillary operations and determine the impact on the SSI rate of the 2010 Centers for Disease Control and Prevention (CDC) reporting guidelines that now specifically exclude cellulitis. METHODS Retrospective chart review identified 368 patients with 449 operated sides between July 2004 and June 2006. SSI was defined by CDC criteria: purulent drainage (category 1), positive aseptically collected culture (category 2), signs of inflammation with opening of incision and absence of negative culture (category 3), and physician diagnosis of infection (category 4). The impact of excluding cellulitis was assessed. RESULTS Prior CDC reporting guidelines revealed that among 368 patients, 32 (8.7 %) experienced SSI in 33 (7.3 %) of 449 operated sides. Of these, 11 (33 %) met CDC criteria 1-3, while 22 (67 %) met CDC criterion 4. Excluding cellulitis cases per 2010 CDC SSI reporting guidelines eliminates 21 of the 22 infections previously meeting CDC criterion 4. Under the new reporting guidelines, the SSI rate is 12 (2.7 %) of 449 operated sides. SSI rates varied by procedure, but these differences were not statistically significant. CONCLUSIONS Cellulitis after breast and axillary surgery is much more common than other criteria for SSI, and SSI rates are reduced almost threefold if cellulitis cases are excluded. Recently revised CDC reporting guidelines may result in underestimates of the clinical burden of SSI after breast/axillary surgery.
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Affiliation(s)
- Amy C Degnim
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA.
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Gerbier-Colomban S, Bourjault M, Cêtre JC, Baulieux J, Metzger MH. Evaluation study of different strategies for detecting surgical site infections using the hospital information system at Lyon University Hospital, France. Ann Surg 2012; 255:896-900. [PMID: 22415422 DOI: 10.1097/sla.0b013e31824e6f4f] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To evaluate different strategies for detecting surgical site infections (SSIs) using different sources (notification by the surgeon, bacteriological results, antibiotic prescription, and discharge diagnosis codes). BACKGROUND Surveillance plays a role in reducing the risks of SSIs but the performance of case reports by surgeons is insufficient. Indirect methods of SSI detection are an alternative to increase the quality of surveillance. METHODS A retrospective cohort study of 446 patients operated consecutively during the first half of 2007 was set up in a 56-bed general surgery unit in Lyon University Hospital, France. Patients were followed up 30 days after intervention. Different methods of detection were established by combining different data sources. The sensitivity and specificity of these methods were calculated by using, as reference method, the manual review of the medical records. RESULTS The sensitivity and specificity of SSI detection were, respectively, 18.4% (95% confidence interval [CI]: 7.9-31.6) and 100% for surgeon notification; 63.2% (95% CI: 47.3-78.9) and 95.1% (95% CI: 92.9-97.1) for detection based on positive cultures; 68.4% (95% CI: 52.6-81.6) and 87.5% (95% CI: 84.3-90.7) using antibiotic prescription; 26.3% (95% CI: 13.2-42.1) and 99.5% (95% CI: 98.8-100) using discharge diagnosis codes. By combining the latter 3 sources, the sensitivity increased at 86.8% (95% CI: 76.3-97.4) and the specificity was lowered at 85.5% (95% CI: 82.1-89.0). CONCLUSIONS SSI detection based on the combination of data extracted automatically from the hospital information system performed well. This strategy has been implemented gradually in Lyon University Hospital.
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Affiliation(s)
- Solweig Gerbier-Colomban
- Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Unité d'hygiène et d'épidémiologie, Lyon, France.
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Hafez S, Saied T, Hasan E, Elnawasany M, Ahmad E, Lloyd L, El-Shobary W, House B, Talaat M. Incidence and modifiable risk factors of surveillance of surgical site infections in Egypt: a prospective study. Am J Infect Control 2012; 40:426-30. [PMID: 21943830 DOI: 10.1016/j.ajic.2011.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Revised: 07/04/2011] [Accepted: 07/05/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Surgical site infections (SSIs) contribute significantly to patient morbidity and mortality and exhaust health care system resources. The main objectives of the study were to describe the incidence rates of SSIs among patients undergoing urologic or cardiothoracic surgeries, the associated risk factors, and the common causative etiologies found at Alexandria University Hospital in Egypt. METHODS A prospective active surveillance study for patients undergoing urologic and cardiothoracic surgeries was implemented from July 2009 to December 2010. Patients were inspected daily for developing SSIs and with a 30-day postoperative follow-up. Wound swabs were obtained from patients who had clinical signs suggestive of infection. Swabs were cultured for bacterial identification and tested for antimicrobial sensitivity. Standard Centers for Disease Control and Prevention National Health Safety Network case definitions were used. RESULTS SSIs occurred in 187 (17%) of patients with complete follow-up (n = 1,062), of which 106 (57%) occurred in-hospital and 81 (43%) occurred after discharge. Higher SSI rates were observed in cardiothoracic surgeries (23.3%), compared with urologic surgeries (9%) (P < .001). A stepwise logistic model identified an increased risk of SSI for those who underwent cardiothoracic surgeries (odds ratio [OR], 4.7; 95% confidence interval [CI], 2.2-11.1), those aged >45 years (OR, 2.32; 95% CI, 1.35-4.01), increased duration of hospital stay before (OR, 1.03; 95% CI, 1.01-1.05) and after (OR, 1.07; 95% CI, 1.04-1.09) surgery, antibiotics ≤24 hours before surgery (OR, 2.54; 95% CI, 1.63-3.94), and dirty wounds (OR, 4.09; 95% CI, 1.60-10.43). CONCLUSIONS Measures to reduce the high rates of SSI need to be instituted through a multidisciplinary effort including infection control education and specific SSI prevention activities at Alexandria University Hospital.
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Perioperative antibiotic prophylaxis: improved compliance and impact on infection rates. Epidemiol Infect 2010; 139:1326-31. [DOI: 10.1017/s0950268810002505] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
SUMMARYThe aims of this study were to determine adherence to the perioperative antibiotic prophylaxis (PAP) protocol used at a large Italian teaching hospital during a 6-year period, to assess the variables associated with inappropriate administration, and to measure the impact on surgical site infection (SSI) rates. There were 28 621 patients surveyed of which 74·6% received PAP. An improvement in adherence to the PAP protocol was registered for 58·8% of patients. Significant risk factors were an American Society of Anesthesiologists (ASA) score ⩾2 [odds ratios (OR) from 1·28 (95% confidence interval (CI) 1·19–1·37) to 1·87 (95% CI 1·43–2·44)], prolonged duration of surgery (OR 1·68, 95% CI 1·56–1·82) and urgent surgery (OR 2·16, 95% CI 1·96–2·37). During the study period, a significant reduction in SSIs rates was detected. We concluded that the global reduction of inadequate PAP administration signifies the efficacy of a multidisciplinary quality improvement initiative on antimicrobial utilization, and this is supported by the observed reduction of the SSI rate.
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West J, Khan Y, Murray DM, Stevenson KB. Assessing specific secondary ICD-9-CM codes as potential predictors of surgical site infections. Am J Infect Control 2010; 38:701-5. [PMID: 20579771 DOI: 10.1016/j.ajic.2010.03.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Revised: 03/22/2010] [Accepted: 03/23/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Public reporting and reduced Medicare payments because of health care-associated infections have resulted in the consideration of administrative discharge codes as markers of health care-associated infections. This study aims to determine whether specific secondary ICD-9-CM infection codes linked to cases from a large data set of surgical procedures are predictors of surgical site infections (SSIs). METHODS All patients undergoing 1 of 9 surgical procedures from January 1, 2005, through December 31, 2005, at a large academic medical center and who were assigned a secondary ICD-9-CM infection code at discharge were eligible for study inclusion. All cases were reviewed to determine the presence of SSIs. Logistic regression was used to determine which secondary codes were predictors of SSIs. RESULTS Among 75 secondary infection codes applied at discharge to 454 patients, only 1 code (998.59) appeared to be reliably associated with SSIs. Two other general infection codes (996.63 and 996.67) and 1 specific infection code (320.3) may also have utility. CONCLUSION Administrative coding data do not perform well to identify SSIs. Some general secondary infection codes, however, may have the potential to be utilized in screening algorithms of electronic health data to assist in SSI surveillance.
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Daneman N, Lu H, Redelmeier DA. Discharge after discharge: predicting surgical site infections after patients leave hospital. J Hosp Infect 2010; 75:188-94. [PMID: 20435375 DOI: 10.1016/j.jhin.2010.01.029] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Accepted: 01/21/2010] [Indexed: 12/21/2022]
Abstract
In this population-based retrospective cohort study, we examined the frequency, severity, and prediction of post-discharge surgical site infections (SSIs). We evaluated all patients admitted for their first elective surgical procedure in Ontario, Canada, between 1 April 2002 and 31 March 2008. Procedure and patient characteristics were derived from linked hospital, emergency room and physician claims databases within Canada's universal healthcare system. The 30 day risk of SSI was derived from the initial hospital admission, outpatient consultations, return emergency room visits and readmissions. The cohort included 622 683 patients, of whom 84 081 (13.5%) were diagnosed with SSI, and more than half (48 725) were diagnosed post-discharge. Post-discharge infections were associated with an increased risk of reoperation (odds ratio: 2.28; 95% confidence interval: 2.11-2.48), return emergency room visit (9.08; 8.89-9.27), and readmission (6.16; 5.98-6.35). The most common risk index predicted incremental increases in the risk of in-hospital SSI, but did not predict increases in the risk of post-discharge infection. Patients with post-discharge infections had baseline characteristics more akin to uninfected patients than patients with in-hospital infections. Predictors of post-discharge infection included shorter procedure duration, shorter length of stay, rural residence, alcoholism, diabetes and obesity. Post-discharge SSIs are frequent, severe, scattered over time and location, and hard to predict using common risk indices. They represent an important hidden burden in our healthcare system.
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Affiliation(s)
- N Daneman
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
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Rosenthal R, Weber WP, Marti WR, Misteli H, Reck S, Dangel M, Oertli D, Widmer AF. Surveillance of surgical site infections by surgeons: biased underreporting or useful epidemiological data? J Hosp Infect 2010; 75:178-82. [PMID: 20227139 DOI: 10.1016/j.jhin.2009.10.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2009] [Accepted: 10/12/2009] [Indexed: 11/17/2022]
Abstract
Surgical site infections (SSIs) significantly increase post-operative morbidity and mortality. SSI surveillance is an established monitoring tool and reduces SSI rates. The purpose of this study was to compare prospective in-hospital SSI surveillance (I) by the surgical staff and (II) additionally by an infection control team (ICT). The reference method (III) was defined by data generated by the surgical team, supplemented by the ICT and completed by post-discharge surveillance with a post-operative follow-up of one year representing the sum of all available resources. During 24 months, all consecutive inpatient procedures (N=6283) were prospectively recorded by the surgical staff until patients' discharge (I). SSI rates were compared with the surveillance performed by the ICT (II) and with the reference method (III). The overall SSI rate (reference method) was 4.7% (N=293), of which 187 (63.8%) were detected in-hospital and 106 (36.2%) after discharge. (I) The surgical staff detected 91/187 (48.7%) of in-hospital SSIs [91/293 (31.0%) of the reference], (II) the ICT an additional 96/187 (51.3%) during hospitalisation [96/293 (32.8%) of the reference]. Further cross-checking as performed in the visceral surgery department increased the surgeons' detection rate (I) to 59/105 (56.2%) of in-hospital SSIs [59/147 (40.1%) of the reference]. SSI surveillance by the surgical staff detects almost half of all in-hospital SSIs and has the potential to increase the detection rate by simple interventions such as cross-checking. Such a relatively inexpensive surveillance system is an option for hospitals without an ICT or for low risk surgical procedures. Moreover, trends in SSI rates can easily be detected, allowing early intervention.
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Affiliation(s)
- R Rosenthal
- Department of Surgery, Basel University Hospital, Switzerland
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Di Leo A, Piffer S, Ricci F, Manzi A, Poggi E, Porretto V, Fambri P, Piccini G, Patrizia T, Fabbri L, Busetti R. Surgical Site Infections in an Italian Surgical Ward: A Prospective Study. Surg Infect (Larchmt) 2009; 10:533-8. [DOI: 10.1089/sur.2009.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Alberto Di Leo
- Unit of General Surgery, APSS of Trento, Alto Garda e Ledro Hospital, Arco (TN), Italy
| | - Silvano Piffer
- Department of Epidemiology, APSS of Trento, Trento, Italy
| | - Francesco Ricci
- Unit of General Surgery, APSS of Trento, Alto Garda e Ledro Hospital, Arco (TN), Italy
| | - Alberto Manzi
- Unit of General Surgery, APSS of Trento, Alto Garda e Ledro Hospital, Arco (TN), Italy
| | - Elena Poggi
- Unit of General Surgery, APSS of Trento, Alto Garda e Ledro Hospital, Arco (TN), Italy
| | - Vincenzo Porretto
- Unit of General Surgery, APSS of Trento, Alto Garda e Ledro Hospital, Arco (TN), Italy
| | - Paolo Fambri
- Unit of General Surgery, APSS of Trento, Alto Garda e Ledro Hospital, Arco (TN), Italy
| | - Giannina Piccini
- Hospital Health Direction, APSS of Trento, Alto Garda e Ledro Hospital, Arco (TN), Italy
| | - Trentini Patrizia
- Hospital Health Direction, APSS of Trento, Alto Garda e Ledro Hospital, Arco (TN), Italy
| | - Luca Fabbri
- Hospital Health Direction, APSS of Trento, Alto Garda e Ledro Hospital, Arco (TN), Italy
| | - Rosanna Busetti
- Laboratory of Clinical Pathology, APSS of Trento, Alto Garda e Ledro Hospital, Arco (TN), Italy
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Cruickshank M, Ferguson J, Bull A. Reducing harm to patients from health care associated infection: the role of surveillance. Chapter 3: Surgical site infection – an abridged version. ACTA ACUST UNITED AC 2009. [DOI: 10.1071/hi09912] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Young J, Stevenson KB. Real-time surveillance and decision support: Optimizing infection control and antimicrobial choices at the point of care. Am J Infect Control 2008. [DOI: 10.1016/j.ajic.2007.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Petrosillo N, Drapeau CMJ, Nicastri E, Martini L, Ippolito G, Moro ML. Surgical site infections in Italian Hospitals: a prospective multicenter study. BMC Infect Dis 2008; 8:34. [PMID: 18328101 PMCID: PMC2311314 DOI: 10.1186/1471-2334-8-34] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Accepted: 03/07/2008] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Surgical site infections (SSI) remain a major clinical problem in terms of morbidity, mortality, and hospital costs. Nearly 60% of SSI diagnosis occur in the postdischarge period. However, literature provides little information on risk factors associated to in-hospital and postdischarge SSI occurrence. A national prospective multicenter study was conducted with the aim of assessing the incidence of both in-hospital and postdisharge SSI, and the associated risk factors. METHODS In 2002, a one-month, prospective national multicenter surveillance study was conducted in General and Gynecological units of 48 Italian hospitals. Case ascertainment of SSI was carried out using standardized surveillance methodology. To assess potential risk factors for SSI we used a conditional logistic regression model. We also reported the odds ratios of in-hospital and postdischarge SSI. RESULTS SSI occurred in 241 (5.2%) of 4,665 patients, of which 148 (61.4%) during in-hospital, and 93 (38.6%) during postdischarge period. Of 93 postdischarge SSI, sixty-two (66.7%) and 31 (33.3%) were detected through telephone interview and questionnaire survey, respectively. Higher SSI incidence rates were observed in colon surgery (18.9%), gastric surgery (13.6%), and appendectomy (8.6%). If considering risk factors for SSI, at multivariate analysis we found that emergency interventions, NNIS risk score, pre-operative hospital stay, and use of drains were significantly associated with SSI occurrence. Moreover, risk factors for total SSI were also associated to in-hospital SSI. Additionally, only NNIS, pre-operative hospital stay, use of drains, and antibiotic prophylaxis were associated with postdischarge SSI. CONCLUSION Our study provided information on risk factors for SSI in a large population in general surgery setting in Italy. Standardized postdischarge surveillance detected 38.6% of all SSI. We also compared risk factors for in-hospital and postdischarge SSI, thus providing additional information to that of the current available literature. Finally, a large amount of postdischarge SSI were detected through telephone interview. The evaluation of the cost-effectiveness of the telephone interview as a postdischarge surveillance method could be an issue for further research.
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Affiliation(s)
- Nicola Petrosillo
- 2nd Infectious Diseases Division, National Institute for Infectious Diseases L, Spallanzani, Via Portuense, 292-00149 Rome, Italy.
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Tattevin P, Patrat-Delon S, Le Ho H. Postoperative central nervous system infection after neurosurgical procedures: the bride is too beautiful. Clin Infect Dis 2007; 45:1248; author reply 1248-9. [PMID: 17918099 DOI: 10.1086/522278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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