1
|
Yilmaz MK, Celik N, Tarabichi S, Abbaszadeh A, Parvizi J. Evidence-based Approach for Prevention of Surgical Site Infection. Hip Pelvis 2024; 36:161-167. [PMID: 39210568 PMCID: PMC11380536 DOI: 10.5371/hp.2024.36.3.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 09/04/2024] Open
Abstract
Periprosthetic joint infection (PJI) is regarded as a critical factor contributing to the failure of primary and revision total joint arthroplasty (TJA). With the increasing prevalence of TJA, a significant increase in the incidence of PJI is expected. The escalating number of cases, along with the significant economic strain imposed on healthcare systems, place emphasis on the pressing need for development of effective strategies for prevention. PJI not only affects patient outcomes but also increases mortality rates, thus its prevention is a matter of vital importance. The longer-term survival rates for PJI after total hip and knee arthroplasty correspond with or are lower than those for prevalent cancers in older adults while exceeding those for other types of cancers. Because of the multifaceted nature of infection risk, a collaborative effort among healthcare professionals is essential to implementing diverse strategies for prevention. Rigorous validation of the efficacy of emerging novel preventive techniques will be required. The combined application of these strategies can minimize the risk of infection, thus their comprehensive adoption is important. Collectively, the risk of PJI could be substantially minimized by application of a multifaceted approach implementing these strategies, leading to improvement of patient outcomes and a reduced economic burden.
Collapse
Affiliation(s)
- Mehmet Kursat Yilmaz
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
- Department of Orthopaedics and Traumatology, Istanbul Medipol University School of Medicine, Istanbul, Türkiye
| | - Nursanem Celik
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
- Istanbul Medipol University School of Medicine, Istanbul, Türkiye
| | - Saad Tarabichi
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ahmad Abbaszadeh
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Javad Parvizi
- International Joint Center, Acıbadem Maslak Hospital, Istanbul, Türkiye
| |
Collapse
|
2
|
Dehghani B, DeAngelis RD, Hallman M, Karnuta JM, Minutillo GT, Alqazzaz A, Donegan DJ, Mehta S. Using Next-Generation Sequencing to Understand Infection Prevention in Surgical Treatment of Upper Extremity Fractures-A Prospective Cohort Study. J Am Acad Orthop Surg 2024; 32:e832-e838. [PMID: 39093461 DOI: 10.5435/jaaos-d-23-00703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 04/15/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION Postoperative fracture site infection can lead to notable patient morbidity, increase cost of care, and further contribute to healthcare disparities globally. Dogma suggests surgical blades as a vehicle for introducing bacteria into the surgical site; however, there is a paucity of literature to support this claim. This study uses advanced DNA sequencing to detect bacterial DNA on surgical blades used in upper extremity fracture surgeries. METHODS This was a prospective study, conducted at a high-volume level 1 trauma center. All acute, closed upper extremity fractures requiring surgical stabilization were consecutively enrolled in a prospective fashion. The primary end point was the presence of bacterial DNA on the surgical blade using next-generation sequencing (NGS). At the time of surgery, two blades were sterilely opened. One blade served as the control while the other was used for the initial skin incision. Two negative control blades were opened directly into a sterile container. Two positive control blades were used for skin incision through known infections. All samples were sent for NGS analysis. RESULTS Forty patients were enrolled in this study. The median age was 33.5 years, and 30% were female; the median body mass index was 26.52. Humerus fractures were the most common injury (N = 17, 42.5%), followed by clavicle fractures (13, 32.5%) and radius/ulna fractures (10, 25.0%). NGS analysis revealed no contamination of test blades used for skin incision. Three control blades tested positive for bacterial DNA. Negative control blades tested negative for bacterial DNA (0/2); the positive control blades resulted positive for bacterial DNA contamination (2/2). CONCLUSION Surgical blades used for skin incision in the upper extremity are not contaminated with bacterial DNA as analyzed by NGS. This finding challenges previous surgical dogma regarding surgical blade contamination and supports that the same surgical blade can safely be used for deeper dissection. LEVEL OF EVIDENCE Level II study: IRB approval-IRB#848938.
Collapse
Affiliation(s)
- Bijan Dehghani
- From the Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | | | | | | |
Collapse
|
3
|
Gradisnik L, Bunc G, Ravnik J, Velnar T. Enhancing Surgical Safety: Microbiological Air Control in Operating Theatres at University Medical Centre Maribor. Diagnostics (Basel) 2024; 14:1054. [PMID: 38786351 PMCID: PMC11120459 DOI: 10.3390/diagnostics14101054] [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: 04/14/2024] [Revised: 05/10/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND the aim of the study was to assess microbiological air quality in operating theatres by determining the level of microbiological contamination of the air and critical surfaces using the passive air sampling method and compliance of the operating theatre staff with infection control measures. MATERIALS AND METHODS The prospective study was conducted in the surgical block of the University Medical Centre Maribor. For two months continuously, ten operating theatres were assessed for microbial contamination of air and surfaces during quiet and active times of the day. A passive air sampling method with Petri dishes on an agar specially adapted for this purpose (plate count agar) was used. In addition, ten surgical procedures were observed to assess staff compliance with recommended practises. RESULTS Air samples met microbiological standards in all operating theatres. In both sampling sessions of the day (quiet and active periods), microbial contamination of the air was always within the limit of 10 CFU/m3. The average number of bacterial colonies was zero to two during quiet phases and one to four during active phases. Approximately 60% of the isolates from the operating theatres belonged mainly to the genus Staphylococcus: S. epidermidis (36% of the isolates), S. hominis (17.5%) and S. haemolyticus (5.5%). The rest were identified as Streptococcus anginosus (23%) and Bacillus sp. (18%). Pathogenic bacteria and moulds were not present. In regard to staff compliance with good surgical practise, the former varied by behaviour and function, with non-compliance in pre-operative skin preparation and operating theatre congestion being notable. The cleanliness of the environment was satisfactory. CONCLUSIONS Microbiological air control is extremely important for the safety and success of both surgical and postoperative practises. In spite of good results obtained in the study, further improvements in surgical staff compliance with good surgical practise are essential to reduce surgical site infections.
Collapse
Affiliation(s)
| | - Gorazd Bunc
- Department of Neurosurgery, University Medical Centre Maribor, 2000 Maribor, Slovenia; (G.B.); (J.R.)
| | - Janez Ravnik
- Department of Neurosurgery, University Medical Centre Maribor, 2000 Maribor, Slovenia; (G.B.); (J.R.)
| | - Tomaz Velnar
- Department of Neurosurgery, University Medical Centre Maribor, 2000 Maribor, Slovenia; (G.B.); (J.R.)
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- AMEU-ECM Maribor, 2000 Maribor, Slovenia
| |
Collapse
|
4
|
Albertini P, Mainardi P, Bagattini M, Lombardi A, Riccio P, Ragosta M, Pennino F, Bruzzese D, Triassi M. Risk Influence of Some Environmental and Behavioral Factors on Air Contamination in the Operating Room: An Experimental Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6592. [PMID: 37623177 PMCID: PMC10454192 DOI: 10.3390/ijerph20166592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/31/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
Air contamination in operating rooms (ORs) depends on the conditions of the room and on activities therein performed. Methodologies of air quality assessment in ORs are often inadequately described in the scientific literature, and the time required for a change in status in air quality is never taken into account. The purpose of this study was to determine the influence of the state and the presence of human operators on air quality by implementing a precise measurement protocol that also took into account the time required for changes in the room to affect air pollution. As the main indicators of air pollution, bacterial load and concentration of airborne dust were measured. The results showed that: the use of surgical masks by operators in the OR did not significantly affect bacterial load within a distance of 2 m; keeping OR doors open did not induce a significant increase in bacterial load and of 5 μm particles while 10 μm particles concentration was positively affected; and air pollution measured with open doors was not significantly different from that due to the presence of two staff members, whether or not they were wearing masks. The results clarified the role of some factors on air pollution in ORs.
Collapse
Affiliation(s)
- Prospero Albertini
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy; (P.A.); (P.M.); (M.B.); (A.L.); (D.B.); (M.T.)
| | - Pierangela Mainardi
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy; (P.A.); (P.M.); (M.B.); (A.L.); (D.B.); (M.T.)
| | - Maria Bagattini
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy; (P.A.); (P.M.); (M.B.); (A.L.); (D.B.); (M.T.)
| | - Annalisa Lombardi
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy; (P.A.); (P.M.); (M.B.); (A.L.); (D.B.); (M.T.)
| | - Patrizia Riccio
- Department of Molecular Medicine and Medical Biotechnology, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy;
| | - Maria Ragosta
- School of Engineering, University of Basilicata, V.le dell’Ateneo Lucano N° 10, 85100 Potenza, Italy;
| | - Francesca Pennino
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy; (P.A.); (P.M.); (M.B.); (A.L.); (D.B.); (M.T.)
| | - Dario Bruzzese
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy; (P.A.); (P.M.); (M.B.); (A.L.); (D.B.); (M.T.)
| | - Maria Triassi
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy; (P.A.); (P.M.); (M.B.); (A.L.); (D.B.); (M.T.)
| |
Collapse
|
5
|
Dai W, Fang F. Pre-Admission Use of Chlorhexidine-Impregnated Gauze for Skin Preparation Reduces the Incidence of Peri-Prosthetic Joint Infection after Primary Total Knee Arthroplasty: A Prospective Cohort with Retrospective Controls. Surg Infect (Larchmt) 2022; 23:717-721. [PMID: 36067078 DOI: 10.1089/sur.2022.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Peri-prosthetic joint infection (PJI) has long been a devastating complication after total knee arthroplasty (TKA), with native skin flora always identified as the causative agents. The aim of this study was to investigate the efficacy of pre-admission use of chlorhexidine-impregnated gauze for pre-operative skin preparation on infection rates after primary TKA surgeries. Patients and Methods: Patients undergoing TKAs performed from January 2017 until January 2021 were prospectively recruited. The experimental group included patients who used chlorhexidine-impregnated gauze the evening before surgery for skin preparation. These patients were compared with a retrospective cohort of TKAs performed during the previous four years without this step as control group. During a one-year follow-up, complications including PJI and superficial infections were collected as the primary outcomes for analysis. Results: A total of 1,218 TKAs in the experimental group and 1,033 TKAs in the control group were included in the study. A total of seven (0.6%) cases of PJI were identified in the experimental group, whereas 16 (1.5%) cases were diagnosed in the control group; a significant difference was detected (χ2 = 5.245; p = 0.022). Eighteen (1.5%) cases of superficial infection were identified in the experimental group, and 28 (2.7%) cases were observed in the control group; a significant difference was found between groups (χ2 = 4.243; p = 0.039). No significant differences were found on other wound-related complications. Conclusions: Pre-admission use of chlorhexidine-impregnated gauze for skin preparation was found to be an effective practice in reducing the incidence of PJI after TKA procedures, which has the potential of being utilized for patients undergoing TKA surgeries.
Collapse
Affiliation(s)
- Wei Dai
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Orthopedic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fang Fang
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
6
|
Matic D, Cheng JS, Gauthier O, Harder Y, Lettieri SC, Chatterjee S, Chen M, Volgas D. Generation of Cross-Specialty Consensus Statements on Soft Tissue Management via a Modified Delphi Method. World J Surg 2022; 46:2174-2188. [PMID: 35831713 PMCID: PMC9334401 DOI: 10.1007/s00268-022-06627-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Soft tissue management (STM) training programs for surgeons are largely tradition based, and substantial differences exist among different surgical specialties. The lack of comprehensive and systematic clinical evidence on how surgical techniques and implants affect soft tissue healing makes it difficult to develop evidence-based curricula. As a curriculum development group (CDG), we set out to find common grounds in the form of a set of consensus statements to serve as the basis for surgical soft tissue education. METHODS Following a backward planning process and Kern's six-step approach, the group selected 13 topics to build a cross-specialty STM curriculum. A set of statements based on the curriculum topics were generated by the CDG through discussions and a literature review of three topics. A modified Delphi process including one round of pilot voting through a face-to-face CDG meeting and two rounds of web-based survey involving 22 panelists were utilized for the generation of consensus statements. RESULTS Seventy-one statements were evaluated, and 56 statements reached the 80% consensus for "can be taught as is." CONCLUSIONS Using a modified Delphi method, a set of cross-specialty consensus statements on soft tissue management were generated. These consensus statements can be used as a foundation for multi-specialty surgical education. Similar methods that combine expert experience and clinical evidence can be used to develop specialty-specific consensus on soft tissue handling.
Collapse
Affiliation(s)
- Damir Matic
- Division of Plastic and Reconstructive Surgery, Department of Surgery, London Health Science Center, Victoria Hospital, Western University, 800 Commissioners Rd E, London, ON N6A5W9 Canada
| | - Joseph S. Cheng
- Department of Neurosurgery, University of Cincinnati College of Medicine, P.O. Box 670515, Cincinnati, OH 45267-0515 USA
| | - Olivier Gauthier
- Department of Small Animal Surgery and Anesthesia, Food Science and Engineering, ONIRIS Nantes-Atlantic College of Veterinary Medicine, Site de la Chantrerie, 101 route de Gachet - CS 40706, 44307 Nantes cedex 3, France
| | - Yves Harder
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale Di Lugano, Sede Ospedale Italiano, Ente Ospedaliero Cantonale (EOC), Via Capelli, CH-6962 Viganello - Lugano, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana (USI), Via Buffi 13, 6900 Lugano, Switzerland
| | | | - Sandipan Chatterjee
- AO Education Institute, AO Foundation, Stettbachstrasse 6, 8600 Dübendorf, Switzerland
| | - Maio Chen
- AO Innovation Translation Center, AO Foundation, Clavadelerstrasse 8, 7270 Davos, Switzerland
| | - David Volgas
- Department of Orthopaedic Surgery, University of Missouri – Columbia, 3800 S National Ave Suite 600, Springfield, MO 65807 USA
| |
Collapse
|
7
|
Hovis JP, Moore-Lotridge SN, Mansour A, Gibson BH, Weikert DR, Desai MJ, Gebhart SS, Schoenecker JG, Lee DH. Sterility of Miniature C-arm Fluoroscopy in Hand and Upper Extremity Surgery. J Hand Microsurg 2022; 14:153-159. [PMID: 35983289 PMCID: PMC9381171 DOI: 10.1055/s-0040-1714434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Previous studies have demonstrated that sterile equipment is frequently contaminated intraoperatively, yet the incidence of miniature c-arm (MCA) contamination in hand and upper extremity surgery is unclear. To examine this incidence, a prospective study of MCA sterility in hand and upper extremity cases was performed in a hospital main operating room (MOR) ( n = 13) or an ambulatory surgery center operating room (AOR) ( n = 16) at a single tertiary care center. Case length, MCA usage parameters, and sterility of the MCA through the case were examined. We found that MOR surgical times trended toward significance ( p = 0.055) and that MOR MCAs had significantly more contamination prior to draping than AOR MCAs ( p < 0.001). In MORs and AORs, 46.2 and 37.5% of MCAs respectively were contaminated intraoperatively. In MORs and AORs, 85.7 and 80% of noncontaminated cases, respectively, used the above hand- table technique, while 50 and 83.3% of contaminated MOR and AOR cases, respectively, used a below hand-table technique. Similar CPT codes were noted in both settings. Thus, a high-rate of MCA intraoperative contamination occurs in both settings. MCA placement below the hand-table may impact intraoperative contamination, even to distant MCA areas. Regular sterilization of equipment and awareness of these possible risk factors could lower bacterial burden.
Collapse
Affiliation(s)
- James P. Hovis
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Stephanie N. Moore-Lotridge
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Ashton Mansour
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Breanne H.Y. Gibson
- Department of Pharmacology, Vanderbilt University, Robinson Research, Nashville, Tennessee, United States
| | - Douglas R. Weikert
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Mihir J. Desai
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Sandra S. Gebhart
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Jonathan G. Schoenecker
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Department of Pharmacology, Vanderbilt University, Robinson Research, Nashville, Tennessee, United States
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Donald H. Lee
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| |
Collapse
|
8
|
Hendricks W, Mecca J, Rahimi M, Rojo MR, Von Ballmoos MCW, McFall RG, Haddad P, Berczeli MT, Sinha K, Barnes RG, Peden EK, Lumsden AB, MacGillivray TE, Corr SJ. Evaluation of a Novel System for RFID Intraoperative Cardiovascular Analytics. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2022; 10:1900309. [PMID: 35992372 PMCID: PMC9384959 DOI: 10.1109/jtehm.2022.3196832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/27/2022] [Accepted: 07/27/2022] [Indexed: 11/23/2022]
Abstract
Objective: To evaluate a novel technology for real time tracking of RF-Identified (RFID) surgical tools (Biotic System), providing intraoperative data analytics during simulated cardiovascular procedures. Ineffective asset management in the Operating Room (OR) leads to inefficient utilization of resources and contributes to prolonged operative times and increased costs. Analysis of captured data can assist in quantifying instrument utilization, procedure flow, performance and prevention of retained instruments. Methods & Results: Five surgeons performed thirteen simulated surgical cases on three human cadavers. Procedures included (i) two abdominal aortic aneurysm (AAA) repairs, (ii) three carotid endarterectomies (CE), (iii) two femoropopliteal (fem-pop) bypasses, (iv) thoracic aortic aneurysm repair, (v) coronary artery bypass graft, (vi) aortic valve replacement, (vii) ascending aortic aneurysm repair, (viii) heart transplants, and (ix) mitral valve replacement. For each case an average of 139 surgical instruments were RFID-tagged and tracked intraoperatively. Data was captured and analyzed retrospectively. Of the 139 instruments tracked across each of the 13 cases, 55 instruments (39.5%) were actually used, demonstrating a high level of redundancy. For repeat cases (i.e. CE/AAA/fem-pop): (i) average instrument usage was 41 ± 3.6 (8.8% variation) for CE (n=3); (ii) average instrument usage was 69 ± 4.0 (5.8% variation) for AAA (n=2); and (iii) average instrument usage was 48 ± 2.5 (5.3% variation) for fem- pop (n=2). Results also showed a reduction in end-of-procedure instrument counting times of 58-87%. Conclusions: We report on a method for collecting intraoperative data analytics regarding instrument usage via RFID technology. This system will help refine instrument selection, quantitate instrument utilization and prevent inadvertent retention in a patient. This should help increase efficiency in packaging and sterilization and let surgeons make objective decisions in the composition of surgical trays. Clinical and Translational Impact Statement—Intraoperative analytics of surgical tools and associated equipment may ultimately lead to safer more efficient surgeries that increase patient outcomes while decreasing the cost of care.
Collapse
Affiliation(s)
| | | | - Maham Rahimi
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Manuel R Rojo
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA
| | | | - Ross G. McFall
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Paul Haddad
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Marton T. Berczeli
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Kavya Sinha
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Rebecca G. Barnes
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Eric K. Peden
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Alan B. Lumsden
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA
| | | | - Stuart J. Corr
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA
| |
Collapse
|
9
|
The Effect of Operating Room Size on Orthopaedic Surgical Site Infection Rates. J Am Acad Orthop Surg 2021; 29:1009-1016. [PMID: 33443390 DOI: 10.5435/jaaos-d-20-01022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/03/2020] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE With many preventable causes of surgical site infections (SSIs) identified, the effect of operating room (OR) size on SSI rates has not been assessed. This study investigated the effect of OR size on incidence of SSIs for orthopaedic procedures. BACKGROUND SSIs remain a common complication within the perioperative realm. Responsible for increasing length of hospitalization and costs, SSIs result in a decreased quality of life for patients. METHODS A retrospective review of 11,163 patients who underwent orthopaedic surgery-including total knee and hip arthroplasties, laminectomies, and spinal fusions-between January 2018 and January 2020 were reviewed. Total net square footage (NSF) of all ORs was recorded, and incidence of SSIs was calculated. Cases were categorized based on the size of the OR (small: 250 to 399 NSF; medium: 400 to 549 NSF; and large: 550 to 699 NSF). Chi-square analysis compared infection rates between the different OR sizes, and a binary logistic regression model identified other predictors of infection. RESULTS Overall, 137 patients (1.2%) developed an SSI. Of these infections, 16 (11.7%) occurred in small ORs, 83 (60.6%) in medium ORs, and 38 (27.7%) in large ORs. The incidence of SSIs was 0.7% in small ORs, 1.3% in medium ORs, and 1.8% in large ORs. Factors found to significantly impact SSI's included medium-sized ORs, younger patients, procedure type (fusions and emergencies/traumas), longer procedures, and higher American Society of Anesthesiologists scores (>3). CONCLUSION Our study shows that OR size in addition to various other perioperative parameters plays a role in the rate of SSIs for orthopaedic procedures. LEVEL OF EVIDENCE Retrospective Cohort Study; Level III Evidence.
Collapse
|
10
|
Parent M. OR Traffic and Surgical Site Infections: A Quality Improvement Project. AORN J 2021; 113:379-388. [PMID: 33788226 DOI: 10.1002/aorn.13355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/08/2020] [Indexed: 11/07/2022]
Abstract
Operating rooms are dynamic places with a lot of movement and people working as a concerted team. Operating room traffic can be necessary (eg, retrieving an unusual supply) or unnecessary (eg, a social visit). This quality improvement project aimed to reduce the amount of OR traffic to only necessary traffic and reduce the surgical site infection rates for the orthopedic ORs in a northern California community hospital. There were three principle interventions: door signs discouraging traffic, staff member relief in batches, and preference card review for accuracy. During the six-week post-intervention period, there were no reported surgical site infections for orthopedic procedures, and the standardized infection ratio decreased from 1.75 to 0 in 10 weeks. Operating room traffic decreased after implementation by 46.9%. The number of door openings per minute decreased from 1.96 per minute to 1.04 per minute at the project's conclusion. Staff members' awareness of OR traffic increased.
Collapse
|
11
|
Giwangkancana G, Rahmi A, Indriasari, Hidayat NN. Managing surgical patients with a COVID-19 infection in the operating room: An experience from Indonesia. ACTA ACUST UNITED AC 2021; 24:100198. [PMID: 34307910 PMCID: PMC8268678 DOI: 10.1016/j.pcorm.2021.100198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/14/2021] [Accepted: 06/20/2021] [Indexed: 10/24/2022]
Abstract
Background The Coronavirus and the COVID-19 pandemic in 2020 have significantly impacted hospital care, including surgery practice. Hospitals must balance patient care, staff safety, resource availability, and medical ethics. Differences in community infection trends, national policies, availability of resources and technology, plus local circumstances may make uniform management impossible globally. This paper described the practical workflow of emergency COVID-19 surgery in a tertiary referral national hospital in Indonesia. Method This study focused on the process of preparation for COVID-19 surgery from March 2020-March 2021. We also described the available facilities in terms of equipment and human resources. Results Steps of COVID-19 surgery preparations were described, such as the setup of general and infectious triage in the emergency department, development of preoperative screening protocol for COVID-19, designation of a specialized COVID-19 operating room and surgical staff, changes in preoperative surgery and anesthesia workflow, development of checklists and postoperative monitoring on staff health. Conclusions Changes in the workflow are essential during the pandemic for safe surgery. These changes require a multidisciplinary approach, communication, and a continued willingness to adapt. We recommend local adaptation of our general workflow for emergency surgery during an epidemic or pandemic.
Collapse
Affiliation(s)
- Gezy Giwangkancana
- Department of Anesthesiology and Intensive Care, Faculty of Medicine Universitas Padjadjaran - Dr. Hasan Sadikin National Referral Hospital Bandung Indonesia
| | - Alia Rahmi
- Department of Nursing, Dr. Hasan Sadikin National Referral Hospital Bandung Indonesia
| | - Indriasari
- Department of Anesthesiology and Intensive Care, Faculty of Medicine Universitas Padjadjaran - Dr. Hasan Sadikin National Referral Hospital Bandung Indonesia
| | - Nucki Nursjamsi Hidayat
- Department of Orthopaedics and Traumatology, Faculty of Medicine Universitas Padjadjaran - Dr. Hasan Sadikin National Referral Hospital Bandung Indonesia
| |
Collapse
|
12
|
Montiel V, Pérez-Prieto D, Perelli S, Monllau JC. Fellows and Observers Are Not a Problem for Infection in the Operating Rooms of Teaching Centers. Trop Med Infect Dis 2021; 6:43. [PMID: 33807317 PMCID: PMC8103268 DOI: 10.3390/tropicalmed6020043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/20/2021] [Accepted: 03/23/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The aim of the present study was to determine whether the risk of complications increases with the number of people in the operating room (OR). Several studies have stated that an increased number of people in the OR increases not only the risk of infection but also the risk of intraoperative complications due to distractions during the surgery. MATERIALS AND METHODS This retrospective study included all patients who had surgery between January 2017 and January 2018 in an OR with the usual surgical team and three or more observers. Patient demographic data, surgical details (duration of the surgery, the surgery being open or arthroscopic, and whether a graft was used), and intraoperative and postoperative complications were recorded. RESULTS A total of 165 surgeries were recorded, with a mean operating time of 70 min (40% open surgeries, 37% arthroscopic surgeries, and 23% combined open and arthroscopic procedures). The main intraoperative complications were vessel damage, nerve damage, premature cement setting, and leg-length discrepancy, with 1 case each. The main postoperative complications were rigidity (8 cases), unexplained pain (11 cases), failed meniscal suturing (3 cases), a postoperative stress fracture (1 case), correction loss in osteotomy (1 case), and wound problems not related to infection (1 case). There were no cases of infection. DISCUSSION The present study shows that the complication rate when having observers in the OR is comparable to the reported data. The key to avoiding complications is for everyone to comply with basic OR behavior.
Collapse
Affiliation(s)
- Verónica Montiel
- Orthopedic Surgery and Traumatology Department, Clínica Universidad de Navarra, Av. Pio XII, 36, 31008 Pamplona, Navarra, Spain;
| | - Daniel Pérez-Prieto
- Orthopedic Surgery and Traumatology Department, Hospital del Mar, Passeig Marítim de la Barceloneta, 25, 29, 08003 Barcelona, Cataluña, Spain; (S.P.); (J.C.M.)
- Hospital Universitari Dexeus- Grupo Quirónsalud, Carrer de Sabino Arana, 5, 19, 08028 Barcelona, Cataluña, Spain
| | - Simone Perelli
- Orthopedic Surgery and Traumatology Department, Hospital del Mar, Passeig Marítim de la Barceloneta, 25, 29, 08003 Barcelona, Cataluña, Spain; (S.P.); (J.C.M.)
- Hospital Universitari Dexeus- Grupo Quirónsalud, Carrer de Sabino Arana, 5, 19, 08028 Barcelona, Cataluña, Spain
| | - Joan Carles Monllau
- Orthopedic Surgery and Traumatology Department, Hospital del Mar, Passeig Marítim de la Barceloneta, 25, 29, 08003 Barcelona, Cataluña, Spain; (S.P.); (J.C.M.)
- Hospital Universitari Dexeus- Grupo Quirónsalud, Carrer de Sabino Arana, 5, 19, 08028 Barcelona, Cataluña, Spain
| |
Collapse
|
13
|
Gursan O, Celtik M, Yanik B, Husemoglu RB, Havitcioglu H. Three-Dimensionally-Printed Joint-Preserving Prosthetic Reconstruction of Massive Bone Defects After Malignant Tumor Resection of the Proximal Tibia. Cureus 2021; 13:e13784. [PMID: 33842159 PMCID: PMC8032040 DOI: 10.7759/cureus.13784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Joint-preserving prosthetic reconstruction for massive bone defects has the potential to be a new and revolutionary treatment option. In this paper, we discuss the case of a 30-year-old female patient who presented with pain and swelling around the knee for three months. The patient underwent this procedure. Postoperative patient satisfaction, pain scores, and range of motion results were found to be promising. We believe that this method has the potential to be the next stage in the quest for better treatment options for this condition.
Collapse
Affiliation(s)
- Onur Gursan
- Department of Orthopedics and Traumatology, Dokuz Eylül University, Izmir, TUR
| | - Mustafa Celtik
- Department of Orthopedics and Traumatology, Dokuz Eylül University, Izmir, TUR
| | - Berkay Yanik
- Department of Orthopedics and Traumatology, Dokuz Eylül University, Izmir, TUR
| | | | - Hasan Havitcioglu
- Department of Orthopedics and Traumatology, Dokuz Eylül University, Izmir, TUR
| |
Collapse
|
14
|
Zeidan A, Abdelgelil HT, Edwin E, Alqarni D. Apple Siri as communication conduit during COVID-19: between inside and outside the OR. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 7:274-275. [PMID: 35516820 PMCID: PMC8936690 DOI: 10.1136/bmjstel-2020-000740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/18/2020] [Indexed: 12/03/2022]
Affiliation(s)
- Ahed Zeidan
- Anaesthesia, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | | | - Edward Edwin
- Anaesthesia, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | - Dhafer Alqarni
- Anaesthesia, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| |
Collapse
|
15
|
Heffernan DS, Evans HL, Huston JM, Claridge JA, Blake DP, May AK, Beilman GS, Barie PS, Kaplan LJ. Surgical Infection Society Guidance for Operative and Peri-Operative Care of Adult Patients Infected by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Surg Infect (Larchmt) 2020; 21:301-308. [DOI: 10.1089/sur.2020.101] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Daithi S. Heffernan
- Department of Surgery, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA
- Division of Trauma and Surgical Critical Care, Department of Surgery, Brown University/Rhode Island Hospital, Providence, Rhode Island, USA
| | - Heather L. Evans
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jared M. Huston
- Departments of Surgery and Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Jeffrey A. Claridge
- Division of Trauma, Critical Care, Burns & Acute Care Surgery, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - David P. Blake
- Department of Surgery, Division of Trauma/Surgical Critical Care, Inova Medical Group, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
- Department of Surgery, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, Maryland, USA
| | - Addison K. May
- Division of Acute Care Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Greg S. Beilman
- Division of General Surgery/Critical Care Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Philip S. Barie
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York, USA
- Division of Medical Ethics, Weill Cornell Medicine, New York, New York, USA
| | - Lewis J. Kaplan
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Society of Critical Care Medicine, Mount Prospect, Illinois, USA
| |
Collapse
|
16
|
Salmons HI, Lendner M, Divi SN, Dworkin M, McKenzie J, Tarazona D, Gala Z, Lendner Y, Woods B, Kaye D, Savage J, Kepler C, Kurd M, Hsu V, Radcliff K, Rihn J, Anderson G, Hilibrand A, Vaccaro A, Schroeder G. Effects of Operating Room Size on Surgical Site Infection Following Lumbar Fusion Surgery. Int J Spine Surg 2019; 13:423-428. [PMID: 31741831 DOI: 10.14444/6057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Surgical site infections (SSIs) represent a devastating complication after spine surgery. Many factors have been identified, but the influence of operating room (OR) size on infection rate has not been assessed. Methods Two thousand five hundred and twenty-three patients who underwent open lumbar spine fusion at a single institution between 2010 and 2016 were included. Patients were dichotomized into large versus small groups based on OR volume. Bivariate logistic regression and a final multivariate model following a multicollinearity check were used to calculate odds of infection for all variables. Results A total of 63 patients (2.5%) developed SSIs with 46 (73%) in the larger OR group and 17 (27%) in the smaller OR group. The rate of SSIs in larger ORs was 3.02% compared with 1.81% in smaller ORs. Significant parameters impacting SSI in bivariate analysis included an earlier year of surgery, BMI > 30, more comorbidities, more levels decompressed and fused, smoking, and larger OR volumes. Multivariate analysis identified BMI > 30, Elixhauser scores, smoking, and increasing levels decompressed as significant predictors. Topical vancomycin was found to significantly decrease rate of infection in both analyses. Conclusions OR size (large versus small) was ultimately not a significant predictor of infection related to rates of SSIs, although it did show a clinical trend toward significance, suggesting association. Future prospective analysis is warranted. Level of Evidence 3.
Collapse
Affiliation(s)
- Harold I Salmons
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Mayan Lendner
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Srikanth N Divi
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Myles Dworkin
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - James McKenzie
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Daniel Tarazona
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Zachary Gala
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Yovel Lendner
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Barrett Woods
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - David Kaye
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jason Savage
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Christopher Kepler
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Mark Kurd
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Victor Hsu
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Kris Radcliff
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jeff Rihn
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Greg Anderson
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Alan Hilibrand
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Alex Vaccaro
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Gregory Schroeder
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| |
Collapse
|