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Yang R, Zhang H, Chen Y, Zhang L, Chu J, Sun K, Yuan C, Tao K. Hemostatic and Ultrasound-Controlled Bactericidal Silk Fibroin Hydrogel via Integrating a Perfluorocarbon Nanoemulsion. ACS APPLIED MATERIALS & INTERFACES 2024; 16:21582-21594. [PMID: 38634578 DOI: 10.1021/acsami.4c01686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Excessive blood loss and infections are the prominent risks accounting for mortality and disability associated with acute wounds. Consequently, wound dressings should encompass adequate adhesive, hemostatic, and bactericidal attributes, yet their development remains challenging. This investigation presented the benefits of incorporating a perfluorocarbon nanoemulsion (PPP NE) into a silk-fibroin (SF)-based hydrogel. By stimulating the β-sheet conformation of the SF chains, PPP NEs drastically shortened the gelation time while augmenting the elasticity, mechanical stability, and viscosity of the hydrogel. Furthermore, the integration of PPP NEs improved hemostatic competence by boosting the affinity between cells and biomacromolecules. It also endowed the hydrogel with ultrasound-controlled bactericidal ability through the inducement of inner cavitation by perfluorocarbon and reactive oxygen species (ROS) generated by the sonosensitizer protoporphyrin. Ultimately, we employed a laparotomy bleeding model and a Staphylococcus aureus-infected trauma wound to demonstrate the first-aid efficacy. Thus, our research suggested an emulsion-incorporating strategy for managing emergency wounds.
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Affiliation(s)
- Ruihao Yang
- State Key Lab of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - Haoran Zhang
- Shanghai Key Laboratory of Veterinary Biotechnology, School of Agriculture and Biology, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - Yumo Chen
- State Key Lab of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - Linxuan Zhang
- State Key Lab of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - Jing Chu
- State Key Lab of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - Kang Sun
- State Key Lab of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - Congli Yuan
- Shanghai Key Laboratory of Veterinary Biotechnology, School of Agriculture and Biology, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - Ke Tao
- State Key Lab of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
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Sharma A, Shankar R, Yadav AK, Pratap A, Ansari MA, Srivastava V. Burden of Chronic Nonhealing Wounds: An Overview of the Worldwide Humanistic and Economic Burden to the Healthcare System. INT J LOW EXTR WOUND 2024:15347346241246339. [PMID: 38659348 DOI: 10.1177/15347346241246339] [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: 04/26/2024]
Abstract
Chronic wounds have long been a significant public health concern, but the true impact of these wounds is unknown since research designs and measuring techniques vary, leading to inconsistent estimates. The definition of a wound is a loss of epithelial continuity caused by damage to the tissue. The following conditions can cause chronic wounds: panniculitis, pyoderma gangrenosum, traumatic, neurological, metabolic, hematologic, neoplastic, or infection-related. The growing global incidence of diabetes and the aging population necessitate greater attention to chronic wounds. Regrettably, it is sad that significant healthcare institutions have overlooked wound research. The study of health-related illnesses and occurrences in particular populations, including their distribution, frequency, and determinants, and the application of this research to control health problems.
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Affiliation(s)
- Aditya Sharma
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ravi Shankar
- Department of Community Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ashish Kumar Yadav
- Centre of Biostatistics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Arvind Pratap
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Mumtaz Ahmad Ansari
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Vivek Srivastava
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Falana ROA, Ogidan OC, Fajemilehin BR. Barriers to infection prevention and control implementation in selected healthcare facilities in Nigeria. Infect Dis Now 2024; 54:104877. [PMID: 38395258 DOI: 10.1016/j.idnow.2024.104877] [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: 06/21/2023] [Revised: 12/01/2023] [Accepted: 02/20/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE While infection prevention and control are of paramount importance, up until recently an assessment of implementation challenges and performance gaps was lacking. This study explored the barriers to infection prevention and control implementation at selected healthcare facilities, the objective being to find ways to improve their programs. MATERIAL AND METHOD A qualitative approach was applied. Purposive sampling was used to select thirty-three healthcare facilities in Ekiti State, Nigeria. They were globally assessed, and an Infection Prevention and Control team, represented by the Infection Prevention and Control referent in each of the selected facilities trained the participants. Data were collected using the Key Informant Interview Guide and analyzed by means of content and thematic analyses using Atlas.ti software. RESULTS Inadequate infection prevention and control materials, poor waste management, non-compliance of patients with infection prevention and control protocols, and poor infrastructure were identified as major barriers to infection prevention and control implementation. CONCLUSION The study concluded that a number of identified factors hindering infection prevention and control implementation in healthcare facilities in Ekiti State needed to be addressed.
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Affiliation(s)
- Rachael O A Falana
- Department of Nursing Science, Obafemi Awolowo University, Osun State, Nigeria.
| | - Oluwakemi C Ogidan
- Department of Nursing Science, Ekiti State University, Ado Ekiti, Ekiti State, Nigeria
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Odada D, Shah J, Mbithi A, Shah R. Surgical site infections post cesarean section and associated risk factors: a retrospective case-control study at a tertiary hospital in Kenya. Infect Prev Pract 2024; 6:100333. [PMID: 38222856 PMCID: PMC10787233 DOI: 10.1016/j.infpip.2023.100333] [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] [Received: 09/13/2023] [Accepted: 12/06/2023] [Indexed: 01/16/2024] Open
Abstract
Background Surgical site infection is a common healthcare-associated infection that affects maternal health, yet it can be prevented or controlled. Caesarian sections are most likely to develop surgical site infections. The rates of delivery by caesarian section in reported to be higher that the acceptable rates in some healthcare facilities. Risk factors for surgical site infections can be identified and modified to reduce the occurrence of surgical site infections. This study aims to determine the risk factors that contribute to surgical site infections post caesarian section in a tertiary teaching hospital in Kenya. Methods This was a retrospective case-control (1:2 matched) study conducted between 1st November 2021 to 31st October 2022 at a tertiary hospital in Nairobi. Data was extracted on surgical site risk factors as per World Health Organization's recommended preoperative measures, for both cases and controls. Descriptive statistics was used to summarize the variables and the Chi-squared test and Fisher's Exact test were used for group comparisons. Results A total of 1,262 caesarian deliveries were performed, 2.1% (27/1262) of which developed surgical site infections post caesarian section. The risk factors identified were not significantly associated with surgical site infection development (gestational age P=0.152, body mass index P=0.615, premature rupture of membranes P=0.253, and antibiotic prophylaxis P=0.108). Conclusions There was no significant association of exposure to surgical site infection risk factors with surgical site infection despite a positive trend. Other prospective methods should also be used in addition to chart reviews to determine the level of effect each risk factor has on surgical site infection.
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Affiliation(s)
- David Odada
- Department Nursing, Aga Khan University, Nairobi, Kenya
| | - Jasmit Shah
- Department of Internal Medicine, Aga Khan University, Nairobi, Kenya
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Annastacia Mbithi
- Department of Internal Medicine, Aga Khan University, Nairobi, Kenya
| | - Reena Shah
- Department of Internal Medicine, Aga Khan University, Nairobi, Kenya
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Nakipoglu M, Tezcaner A, Contag CH, Annabi N, Ashammakhi N. Bioadhesives with Antimicrobial Properties. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2023; 35:e2300840. [PMID: 37269168 DOI: 10.1002/adma.202300840] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/10/2023] [Indexed: 06/04/2023]
Abstract
Bioadhesives with antimicrobial properties enable easier and safer treatment of wounds as compared to the traditional methods such as suturing and stapling. Composed of natural or synthetic polymers, these bioadhesives seal wounds and facilitate healing while preventing infections through the activity of locally released antimicrobial drugs, nanocomponents, or inherently antimicrobial polers. Although many different materials and strategies are employed to develop antimicrobial bioadhesives, the design of these biomaterials necessitates a prudent approach as achieving all the required properties including optimal adhesive and cohesive properties, biocompatibility, and antimicrobial activity can be challenging. Designing antimicrobial bioadhesives with tunable physical, chemical, and biological properties will shed light on the path for future advancement of bioadhesives with antimicrobial properties. In this review, the requirements and commonly used strategies for developing bioadhesives with antimicrobial properties are discussed. In particular, different methods for their synthesis and their experimental and clinical applications on a variety of organs are reviewed. Advances in the design of bioadhesives with antimicrobial properties will pave the way for a better management of wounds to increase positive clinical outcomes.
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Affiliation(s)
- Mustafa Nakipoglu
- Department of Chemical and Biomolecular Engineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Department of Engineering Sciences, School of Natural and Applied Sciences, Middle East Technical University, Ankara, 06800, Turkey
- Department of Molecular Biology and Genetics, Faculty of Sciences, Bartin University, Bartin, 74000, Turkey
| | - Ayşen Tezcaner
- Department of Engineering Sciences, School of Natural and Applied Sciences, Middle East Technical University, Ankara, 06800, Turkey
- BIOMATEN, CoE in Biomaterials & Tissue Engineering, Middle East Technical University, Ankara, 06800, Turkey
| | - Christopher H Contag
- Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, 48824, USA
- Department of Biomedical Engineering, College of Engineering, Michigan State University, East Lansing, MI, 48824, USA
| | - Nasim Annabi
- Department of Chemical and Biomolecular Engineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Nureddin Ashammakhi
- Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, 48824, USA
- Department of Biomedical Engineering, College of Engineering, Michigan State University, East Lansing, MI, 48824, USA
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
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Abbas A, Laverde R, Yap A, Stephens CQ, Samad L, Seyi-Olajide JO, Ameh EA, Ozgediz D, Lakhoo K, Bickler SW, Meara JG, Bundy D, Jamison DT, Klazura G, Sykes A, Philipo GS. Routine Pediatric Surgical Emergencies: Incidence, Morbidity, and Mortality During the 1st 8000 Days of Life-A Narrative Review. World J Surg 2023; 47:3419-3428. [PMID: 37341797 PMCID: PMC10694096 DOI: 10.1007/s00268-023-07097-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Many potentially treatable non-congenital and non-traumatic surgical conditions can occur during the first 8000 days of life and an estimated 85% of children in low- and middle-income countries (LMICs) will develop one before 15 years old. This review summarizes the common routine surgical emergencies in children from LMICs and their effects on morbidity and mortality. METHODS A narrative review was undertaken to assess the epidemiology, treatment, and outcomes of common surgical emergencies that present within the first 8000 days (or 21.9 years) of life in LMICs. Available data on pediatric surgical emergency care in LMICs were aggregated. RESULTS Outside of trauma, acute appendicitis, ileal perforation secondary to typhoid fever, and intestinal obstruction from intussusception and hernias continue to be the most common abdominal emergencies among children in LMICs. Musculoskeletal infections also contribute significantly to the surgical burden in children. These "neglected" conditions disproportionally affect children in LMICs and are due to delays in seeking care leading to late presentation and preventable complications. Pediatric surgical emergencies also necessitate heavy resource utilization in LMICs, where healthcare systems are already under strain. CONCLUSIONS Delays in care and resource limitations in LMIC healthcare systems are key contributors to the complicated and emergent presentation of pediatric surgical disease. Timely access to surgery can not only prevent long-term impairments but also preserve the impact of public health interventions and decrease costs in the overall healthcare system.
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Affiliation(s)
- Alizeh Abbas
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ruth Laverde
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Ava Yap
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
| | - Caroline Q Stephens
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Lubna Samad
- Global Surgery Programs, Interactive Research & Development, Karachi, Pakistan
| | | | - Emmanuel A Ameh
- Division of Pediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria
| | - Doruk Ozgediz
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Kokila Lakhoo
- Department of Pediatric Surgery, University of Oxford and Oxford University Hospitals, Oxford, UK
| | - Stephen W Bickler
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9500 Gilman Drive #0739, La Jolla, San Diego, CA, 92093-0739, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Donald Bundy
- Global Research Consortium for School Health and Nutrition, London School of Hygiene and Tropical Medicine, London, UK
| | - Dean T Jamison
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Greg Klazura
- Loyola University Medical Center, Chicago, IL, USA
| | - Alicia Sykes
- Naval Medical Center San Diego, San Diego, CA, USA
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Alt V, Rupp M, Bärtl S, Walter N. Global management of fracture-related infections: Two different perspectives. Injury 2023; 54:111176. [PMID: 38044027 DOI: 10.1016/j.injury.2023.111176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Affiliation(s)
- Volker Alt
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg 93053, Germany.
| | - Markus Rupp
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg 93053, Germany
| | - Susanne Bärtl
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg 93053, Germany
| | - Nike Walter
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg 93053, Germany
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Mezemir R, Olayemi O, Dessie Y. Incidence, Bacterial Profile and Predictors of Surgical Site Infection After Cesarean Section in Ethiopia, A Prospective Cohort Study. Int J Womens Health 2023; 15:1547-1560. [PMID: 37854040 PMCID: PMC10581010 DOI: 10.2147/ijwh.s425632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/26/2023] [Indexed: 10/20/2023] Open
Abstract
Background Surgical site infections (SSI) after cesarean section are common in Ethiopia and result in maternal morbidity, mortality, hospitalization, and medical costs. This study aimed to determine the incidence, bacterial profile, and associated factors of surgical site infection after cesarean section (CS) in public and private referral hospitals. Methods A prospective observational cohort study was conducted on 741 pregnant women who underwent CS from July to September 2022. Women who had CS were followed up for at least 30 days. Infected wound specimens from those who had SSIs were collected and bacteriologically analyzed. The data were analyzed with SPSS version 25. The logistic regression model assessed the relationship between the independent variable and the outcome with 95% confidence interval. Results The incidence of post-cesarean surgical site infection was 11.6% (95% Cl: 9.4, 13.6). Staphylococcus aureus was the most common bacteria in CS wounds 10 (21.2%). Two to three antenatal care visits (ANC) (AOR: 3.11, 95% CI: 1.69, 5.75), delayed antenatal booking (AOR: 6.99, 95% CI: 2.09, 23.32), membrane rupture (AOR: 2.10, 95% CI: 1.04, 4.24), multiple vaginal examinations (AOR = 4.21, 95% CI: 1.35, 6.92) and public hospitals (AOR: 11.1, 95% CI: 1.48, 45, 14) were associated with increased risk of SSI after CS, in contrary shorter hospital stays (AOR = 0.37, 95% CI: 0.15, 0.91) and transversal incisions (AOR = 0.38, 95% CI: 0.15, 0.91) were associated with lower risk SSI after CS. Conclusion The incidence of SSI after CS was high. Delayed antenatal booking, two to three antenatal visits, multiple vaginal exams, membrane rupture, vertical incision, longer postoperative hospital stays, and procedures in public hospitals were associated with increased risk of SSI after CS. Therefore, intervention programs should focus on post-discharge surveillance and identification of risk to reduce and prevent SSI after CS rate.
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Affiliation(s)
- Rahel Mezemir
- Pan African University, Life and Earth Sciences Institute (Including Health and Agriculture), Ibadan, Nigeria
- St. Paul’s Hospital Millennium Medical College, School of Nursing, Addis Ababa, Ethiopia
| | - Oladapo Olayemi
- Department of Obstetrics and Gynecology, College of Medicine, Pan African University Life and Earth Sciences Institutes, University of Ibadan, Ibadan, Nigeria
| | - Yadeta Dessie
- College of Health and Medical Sciences Haramaya University, Harar, Ethiopia
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Obuh OO, Esomu EJO, Sydney RO. Suturing Dermatotraction Techniques in Closing Fasciotomy Wounds: A Systematic Review. Cureus 2023; 15:e37550. [PMID: 37197103 PMCID: PMC10184723 DOI: 10.7759/cureus.37550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 05/19/2023] Open
Abstract
A surgical patient post-fasciotomy presents a challenge to restore the cover of the muscle groups, and the use of the suturing dermatotraction techniques presents a cheap and easy means of native cover. This systematic review of case series and case-control study explored the trend of this technique, including duration of delayed primary wound closure, complications, and failure rates. A literature review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted on Medline, Embase, and Cumulative Index of Nursing and Allied Health Literature (CINAHL), yielding a combined total of 820 articles between 1946 and June 18, 2022. Human studies with suturing dermatotraction techniques were included. Sixteen (16) studies reviewed met the criteria. The basic anatomy of the dermatotraction technique involves an anchor point on the skin, a material for traction, and a suture pattern. The shoelace technique was the predominant suture pattern, with staples as skin anchor material/method and silastic vessel loops as traction sling used by 11 studies. Modifications of this method included the use of intradermal Prolene sutures and pediatric catheters. The shortest duration for skin apposition was two days, and the longest was 113 days. Complications were comparable to that of surgical wounds and thus may not be attributable to the technique itself. Studies reviewed showed that superficial and early complications were more likely than deep or delayed complications. Negative pressure wound therapy (NPWT) and skin graft salvaged a few failed closures in two studies. There are varying practices of tightening rates with reports ranging from daily to every 72 hours. The rate of tightening and disease burden may account for the wide range of reported delayed primary closure. Most of the studies reviewed closed fasciotomy wounds with this technique within an average of <10 days. It is relatively cheaper, carries a low morbidity burden, and has multiple reported success in the closure of fasciotomy wounds in this review and thus should have an increased adoption as a first approach in managing fasciotomy wounds, especially in low-income countries.
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Affiliation(s)
- Otomi O Obuh
- Plastic and Reconstructive Surgery, Surgery Interest Group of Africa, Lagos, NGA
- Surgery, Imperial College Healthcare NHS Trust, London, GBR
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Saleem Z, Ahsan U, Haseeb A, Altaf U, Batool N, Rani H, Jaffer J, Shahid F, Hussain M, Amir A, Rehman IU, Saleh U, Shabbir S, Qamar MU, Altowayan WM, Raees F, Azmat A, Imam MT, Skosana PP, Godman B. Antibiotic Utilization Patterns for Different Wound Types among Surgical Patients: Findings and Implications. Antibiotics (Basel) 2023; 12:678. [PMID: 37107040 PMCID: PMC10135394 DOI: 10.3390/antibiotics12040678] [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: 02/28/2023] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Antimicrobial prophylaxis is effective in reducing the rate of surgical site infections (SSIs) post-operatively. However, there are concerns with the extent of prophylaxis post-operatively, especially in low- and middle-income countries (LMICs). This increases antimicrobial resistance (AMR), which is a key issue in Pakistan. Consequently, we conducted an observational cross-sectional study on 583 patients undergoing surgery at a leading teaching hospital in Pakistan with respect to the choice, time and duration of antimicrobials to prevent SSIs. The identified variables included post-operative prophylactic antimicrobials given to all patients for all surgical procedures. In addition, cephalosporins were frequently used for all surgical procedures, and among these, the use of third-generation cephalosporins was common. The duration of post-operative prophylaxis was 3-4 days, appreciably longer than the suggestions of the guidelines, with most patients prescribed antimicrobials until discharge. The inappropriate choice of antimicrobials combined with prolonged post-operative antibiotic administration need to be addressed. This includes appropriate interventions, such as antimicrobial stewardship programs, which have been successful in other LMICs to improve antibiotic utilization associated with SSIs and to reduce AMR.
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Affiliation(s)
- Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahuddin Zakaria University, Multan 60800, Pakistan
| | - Umar Ahsan
- Department of Infection Prevention and Control, Alnoor Specialist Hospital, Ministry of Health, Makkah 24241, Saudi Arabia
| | - Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Ummara Altaf
- Department of Pharmacy, Ghurki Trust Teaching Hospital, Lahore 54000, Pakistan
| | - Narjis Batool
- Center of Health Systems and Safety Research, Faculty of Medicine, Health and Human Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney 2109, Australia
| | - Hira Rani
- Department of Pharmacy, Faculty of Pharmacy, University of Lahore, Lahore 54000, Pakistan
| | - Javeria Jaffer
- Department of Pharmacy, Faculty of Pharmacy, University of Lahore, Lahore 54000, Pakistan
| | - Fatima Shahid
- Department of Pharmacy, Faculty of Pharmacy, University of Lahore, Lahore 54000, Pakistan
| | - Mujahid Hussain
- Department of Pharmacy, Indus Hospital and Health Network, Karachi 75190, Pakistan
| | - Afreenish Amir
- Department of Microbiology, Armed Forces Institute of Pathology, National University of Medical Sciences, Rawalpindi 46000, Pakistan
| | - Inaam Ur Rehman
- Punjab University College of Pharmacy, Faculty of Pharmacy, University of the Punjab, Lahore 54000, Pakistan
| | - Umar Saleh
- Punjab University College of Pharmacy, Faculty of Pharmacy, University of the Punjab, Lahore 54000, Pakistan
| | - Sana Shabbir
- Punjab University College of Pharmacy, Faculty of Pharmacy, University of the Punjab, Lahore 54000, Pakistan
| | - Muhammad Usman Qamar
- Institute of Microbiology, Faculty of Life Sciences, Government College University Faisalabad, Faisalabad 38000, Pakistan
| | - Waleed Mohammad Altowayan
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraydah 52571, Saudi Arabia
| | - Fahad Raees
- Department of Medical Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Aisha Azmat
- Department of Physiology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Mohammad Tarique Imam
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdul Aziz University, Al Kharj 11942, Saudi Arabia
| | - Phumzile P. Skosana
- Department of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa
| | - Brian Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow G4 0RE, UK
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
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Forrester JD, Bekele A, Stefan AM, Tshokey T, Berndtson AE, Beyene RT, Chou J, Sawyer RG, Valenzuela JY, Rickard J. Components of Existing National Surgical Site Infection Surveillance Programs Based on a Case Series of Low- and Middle-Income Countries: Building Blocks for Success and Opportunities for Improvement. Surg Infect (Larchmt) 2023; 24:112-118. [PMID: 36629853 DOI: 10.1089/sur.2022.331] [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: 01/12/2023] Open
Abstract
Background: Surgical site infection (SSI) surveillance programs are recommended to be included in national infection prevention and control (IPC) programs, yet few exist in low- or middle-income countries (LMICs). Our goal was to identify components of surveillance in existing programs that could be replicated elsewhere and note opportunities for improvement to build awareness for other countries in the process of developing their own national surgical site infection surveillance (nSSIS) programs. Methods: We administered a survey built upon the U.S. Centers for Disease Control and Prevention's framework for surveillance system evaluation to systematically deconstruct logistical infrastructure of existing nSSIS programs in LMICs. Qualitative analyses of survey responses by thematic elements were used to identify successful surveillance system components and recognize opportunities for improvement. Results: Three respondents representing countries in Europe and Central Asia, sub-Saharan Africa, and South Asia designated as upper middle-income, lower middle-income, and low-income responded. Notable strengths described by respondents included use of local paper documentation, staggered data entry, and limited data entry fields. Opportunities for improvement included outpatient data capture, broader coverage of healthcare centers within a nation, improved audit processes, defining the denominator of number of surgical procedures, and presence of an easily accessible, free SSI surveillance training program for healthcare workers. Conclusions: Outpatient post-surgery surveillance, national coverage of healthcare facilities, and training on how to take local SSI surveillance data and integrate it within a broader nSSIS program at the national level remain areas of opportunities for countries looking to implement a nSSIS program.
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Affiliation(s)
- Joseph D Forrester
- Section of Acute Care Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - Abebe Bekele
- School of Medicine, University of Global Health Equity, Kigali, Rwanda
| | | | - Tshokey Tshokey
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Allison E Berndtson
- Department of Surgery, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California, San Diego, San Diego, California, USA
| | - Robel T Beyene
- Division of Acute Care Surgery, Vanderbilt University, Nashville, Tennessee, USA
| | - Jesse Chou
- Department of Plastic and Maxillofacial Surgery, University of Virginia, Charlottesville, Virgina, USA
| | - Robert G Sawyer
- Department of Surgery, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Julie Y Valenzuela
- Department of Surgery, Jamaica Hospital Medical Center, New York, New York, USA
| | - Jennifer Rickard
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
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Singla R, Suri V, Veeramalla S, Shafiq N, Rohilla M, Kalra J. Ensuring Compliance with Surgical Antimicrobial Prophylaxis Policy in High-Volume Resource-Limited Settings: Integrated Measures from Inception to Audit. J Gynecol Surg 2023. [DOI: 10.1089/gyn.2022.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Affiliation(s)
- Rimpi Singla
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Snigdha Veeramalla
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nusrat Shafiq
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Minakshi Rohilla
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jaswinder Kalra
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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13
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Hawkins J, Rangel UJS, Tesfaye A, Gebeyehu N, Weiser TG, Bitew S, Mammo TN, Starr N. Bridging the know-do gap in low-income surgical environments: Creating contextually appropriate training videos to promote safer surgery in Ethiopia. Surg Open Sci 2023; 11:40-44. [PMID: 36466047 PMCID: PMC9709099 DOI: 10.1016/j.sopen.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022] Open
Abstract
Although international guidelines exist for the prevention of surgical site infections, their implementation in diverse clinical contexts, especially in low and middle-income countries, is challenging due to the lack of available resources and organizational structure of facilities. The goal of this project was to develop a series of video training aids to highlight best practices in surgical infection prevention in hospitals with limited resources and to provide practical solutions to common challenges faced in these settings. Using the validated Clean Cut education framework for infection prevention developed by Lifebox, a charity devoted to improving surgical and anesthetic safety, we partnered with clinicians in one Ethiopian hospital to create six educational videos giving practical guidelines for infection prevention under resource variable conditions. These include: 1) proper use of the WHO Surgical Safety Checklist, 2) hand and skin antisepsis, 3) confirming instrument sterility, 4) maintaining the sterile field, 5) antibiotic prophylaxis, and 6) gauze counting. Gaps in available online educational materials were identified in each of the six areas. Videos were created providing setting-specific education and addressing gaps in existing materials for each of the infection prevention topics. These videos are now integrated into infection prevention curricula through Lifebox in Ethiopia and ongoing data collection to evaluate acceptability and efficacy is ongoing. Surgical education videos on infection prevention topics addressing location-specific resources and workarounds can be useful to hospitals operating in resource-limited settings for training staff and supporting quality and safety efforts in surgery.
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Affiliation(s)
- Jessica Hawkins
- Massachusetts General Hospital, Department of Anesthesia, United States of America
| | | | - Assefa Tesfaye
- St. Peter's Specialized Hospital, Department of Surgery, Ethiopia
| | | | - Thomas G. Weiser
- Stanford University School of Medicine, United States of America
- Stanford University, Department of Surgery, United States of America
- Lifebox Foundation, Ethiopia
| | | | | | - Nichole Starr
- Lifebox Foundation, Ethiopia
- University of California, San Francisco, Department of Surgery, United States of America
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Do HTT, Edwards H, Finlayson K. Surgical wound assessment tool: Construct validity and inter-rater reliability of a tool designed for nurses. J Clin Nurs 2023; 32:83-95. [PMID: 36494871 DOI: 10.1111/jocn.16476] [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: 03/21/2022] [Revised: 06/17/2022] [Accepted: 07/18/2022] [Indexed: 12/14/2022]
Abstract
AIMS AND OBJECTIVES To validate construct validity and inter-rater reliability of a surgical wound assessment tool. BACKGROUND Wound assessment is central to appropriate wound management. However, limited standard surgical wound assessment tools are available to assist nurses in assessing and recording progress in the healing of surgical wounds. DESIGN A prospective observational study was utilised to test the validity and reliability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline was used. METHODS Convenience sampling was used to recruit 260 patients who underwent elective or emergency surgery at a hospital in Vietnam. Exploratory factor analysis was used to examine the construct validity of the surgical wound assessment tool. Inter-rater reliability was calculated using the intraclass correlation coefficient and Cohen's kappa to determine reliability of the overall scale and identified items. RESULTS The results of the exploratory factor analysis supported a three-component structure of the surgical wound assessment tool. The intraclass correlation coefficient value of the overall scale was 0.79 (95% CI 0.67-0.89), p < .001, confirming excellent inter-rater reliability. Cohen's kappa value ranged from 0.5 to 1, demonstrating moderate to almost perfect level of agreement for individual items, except for one item on pain. CONCLUSION The surgical wound assessment tool was deemed to be acceptable, valid and reliable for monitoring the status of surgical wound healing. However, further modification and testing are needed to strengthen the tool and to determine the applicability of the tool in other populations. RELEVANCE TO CLINICAL PRACTICE The application of the SWAT would improve the assessment of surgical wounds in daily nursing practice which will promote improved postoperative wound management. It is an easy and practical tool for enhancing inter-disciplinary communication and care outcomes for all patients with surgical wounds.
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Affiliation(s)
- Hien Thi Thu Do
- Nursing Faculty, Haiduong Medical Technical University, Haiduong, Vietnam.,Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Helen Edwards
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Kathleen Finlayson
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
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Sefah IA, Denoo EY, Bangalee V, Kurdi A, Sneddon J, Godman B. Appropriateness of surgical antimicrobial prophylaxis in a teaching hospital in Ghana: findings and implications. JAC Antimicrob Resist 2022; 4:dlac102. [PMID: 36226227 PMCID: PMC9549739 DOI: 10.1093/jacamr/dlac102] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background Surgical site infections (SSIs) are among the most common infections seen in hospitalized patients in low- and middle-income countries (LMICs), accounting for up to 60% of hospital-acquired infections. Surgical antimicrobial prophylaxis (SAP) has shown to be an effective intervention for reducing SSIs and their impact. There are concerns of inappropriate use of SAP in Ghana and therefore our audit in this teaching hospital. Methods A retrospective cross sectional clinical audit of medical records of patients undergoing surgery over a 5 month duration from January to May 2021 in Ho Teaching Hospital. A data collection form was designed to collect key information including the age and gender of patients, type and duration of surgery, choice and duration of SAP. The collected data was assessed for the proportion of SAP compliance with Ghana Standard Treatment Guidelines (STGs) and any association with various patient, surgical wound and drug characteristics. Results Of the 597 medical records assessed, the mean age of patients was 35.6 ± 12.2 years with 86.8% (n = 518) female. Overall SAP compliance with the STG was 2.5% (n = 15). SAP compliance due to appropriate choice of antimicrobials was 67.0% (n = 400) and duration at 8.7% (n = 52). SAP compliance was predicted by duration of SAP (P < 0.000) and postoperative hospitalization duration (P = 0.005). Conclusions SAP compliance rate was suboptimal, principally due to a longer duration of prescription. Quality improvement measures such as education of front-line staff on guideline compliance, coupled with clinical audit and regular updates, are urgently needed to combat inappropriate prescribing and rising resistance rates.
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Affiliation(s)
- Israel Abebrese Sefah
- Corresponding author. E-mail: @IsraelSefah, @BangaleeVarsha, @Amanjkurdi6, @jacquisneddons
| | - Edinam Yawo Denoo
- School of Pharmacy, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Varsha Bangalee
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Amanj Kurdi
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK,Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | | | - Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK,Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates,Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Katabogama JB, Mpirimbanyi C, Cyuzuzo T, Muvunyi V, Urimubabo C, Rickard J. Costs Associated With Surgical Infections at a Tertiary Referral Hospital in Rwanda. J Surg Res 2022; 280:94-102. [PMID: 35964487 DOI: 10.1016/j.jss.2022.07.011] [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: 12/27/2021] [Revised: 06/04/2022] [Accepted: 07/08/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In low-income and middle-income countries, there is a high demand for surgical care, although many individuals lack access due to its affordability, availability, and accessibility. Costs are an important metric in healthcare and can influence healthcare access and outcomes. The aim of this study was to determine the financial impact of infections in acute care surgery patients and factors associated with inability to pay the hospital bill at a Rwandan referral hospital. MATERIALS AND METHODS This was a prospective observational study of acute care surgery patients at a tertiary referral hospital in Rwanda with infections. Data were collected on demographics, clinical features, hospital charges, and expenses. Factors associated with inability to pay the hospital bill were analyzed using Chi-squared and Wilcoxon rank sum tests. RESULTS Over 14 mo, 191 acute care surgery patients with infections were enrolled. Most (n = 174, 91%) patients had health insurance. Median total hospital charges were 414.24 United States Dollars (interquartile range [IQR]: 268.20, 797.48) and median patient charges were 41.53 USD (IQR: 17.15, 103.09). At discharge, 53 (28%) patients were unable to pay their hospital bill. On a univariate analysis actors associated with inability to pay the bill included transportation via ambulance, occupation as a farmer, diagnosis, complications, surgical site infection, and length of hospital stay. On a multivariable analysis, intestinal obstruction (adjusted odds ratio 4.56, 95% confidence interval 1.16, 17.95, P value 0.030) and length of hospital stay more than 7 d (adjusted odds ratio 2.95, 95% confidence interval 1.04, 8.34, P value 0.042) were associated with inability to pay the final hospital bill. CONCLUSIONS Although there is broad availability of health insurance in Rwanda, hospital charges and other expenses remain a financial burden for many patients seeking surgical care. Further innovative efforts are needed to mitigate expenses and minimize financial risk.
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Affiliation(s)
| | | | - Thierry Cyuzuzo
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
| | - Vital Muvunyi
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
| | - Christian Urimubabo
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda; Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Jennifer Rickard
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda; Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda; Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
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Khan KR, Kumari J, Haider SMW, Fawwad SBU, Kumar N, Nizar R, Kumar D, . S, Hasan M, Mumtaz H. The Prevalence and Etiology of Surgical Site Infections Following Gastrointestinal Tract Surgery: A Cross-Sectional Study From a Tertiary Care Hospital. Cureus 2022; 14:e27320. [PMID: 36044339 PMCID: PMC9411708 DOI: 10.7759/cureus.27320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/05/2022] Open
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18
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Delva S, Marseille B, Foronda CL, Solomon AY, Pfaff T, Baptiste DL. Hand hygiene practices in Caribbean and Latin American countries: An integrative review. J Clin Nurs 2022; 32:2140-2154. [PMID: 35773957 DOI: 10.1111/jocn.16415] [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: 04/12/2021] [Revised: 03/01/2022] [Accepted: 05/16/2022] [Indexed: 11/27/2022]
Abstract
AIM AND OBJECTIVE To explore what is known about knowledge, attitudes and beliefs that influence hand hygiene practices in in low- and middle-income Caribbean and Latin American countries. BACKGROUND With the emergence of infectious diseases such as the recent COVID-19 pandemic, handwashing is key to preventing communicable diseases as they disproportionately affect populations in low-income countries. While hand hygiene is known to be the single most effective method for avoiding the transmission of infection, little is known about the beliefs and practices of individuals in these regions. METHODS Following PRISMA 2020 Checklist, an integrative review of studies published from 2008-2020 was conducted (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Whittemore and Knafl's method was used to review the literature. Six databases were searched, and the Johns Hopkins Evidence Based Rating Scale was used for study appraisal. RESULTS The review yielded 18 studies conducted across Latin America. Poor handwashing practices are influenced by various factors including inadequate education and training, cultural beliefs, lack of resources and substandard government regulations. Communicable diseases and other diarrheal illnesses were highly prevalent, especially after a major disease outbreak. CONCLUSION Future post-disaster campaigns aimed at improving hand hygiene and handwashing practices should focus on beliefs and attitudes to affect behaviour change since there was a higher disease susceptibility during those times. Barriers to proper hand hygiene include false attitudes such as, washing hands only after touching bodily fluids/patient contact or not washing hands at all after open defecation. RELEVANCE TO CLINICAL PRACTICE Researchers working with populations in Latin America and the Caribbean should partner with local community health workers to improve compliance to recommended hand hygiene practices.
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Affiliation(s)
- Sabianca Delva
- Boston College Connell School of Nursing, Chestnut Hill, Massachusetts, USA
| | | | - Cynthia L Foronda
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA
| | | | - Teresa Pfaff
- Center for Global Initiatives, Department of Community-Public Health, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Diana-Lyn Baptiste
- Department of Nursing, Johns Hopkins School of Nursing, Baltimore, Maryland, USA
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19
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Lluís N, Parra J, Villodre C, Zapater P, Jalali A, Cantó M, Mena L, Ramia JM, Lluís F. Prediction of peritoneal soiling in acute appendicitis with simple clinical and laboratory data. Prospective, multicenter, cohort study of 2,645 adult patients nationwide. Int J Surg 2022; 104:106741. [PMID: 35772594 DOI: 10.1016/j.ijsu.2022.106741] [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: 03/06/2022] [Revised: 05/24/2022] [Accepted: 06/16/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND AIMS In order to facilitate the preoperative prediction of complicated appendicitis, we propose a complementary approach by selecting an endpoint defined by the intraoperative finding of peritoneal soiling (PS). METHODS Over a 6-month period, 38 centers (5% of all public hospitals) attending emergency general surgery patients on a 24-hour, 7-days a week basis, enrolled consecutive adult patients requiring appendectomy. Patients were stratified according to the absence or the finding of PS during the surgical procedure. RESULTS A total of 2645 patients were included; median age (IQR) was 35 (22-51) years, 44.3% were female. The laparoscopic approach was used in 70.8% of appendectomies. In a third of patients (31.7%), there was PS with pus around the appendix, or bowel contents, free pus, or blood in the peritoneal cavity. To develop the prediction model, 1764 patients were randomly selected for the derivation cohort and the remaining 881 patients were assigned to the validation cohort. On multivariable logistic regression analysis of all patients, two clinical variables (age, and pulse) and three laboratory variables (serum urea, serum sodium, and white blood cell count) were individually associated (P < .05) with a greater probability of having PS (Hosmer-Lemeshow chi, 1.63; P = .99; C-statistic, 0.7). Based on the multivariable regression model, both static and dynamic nomograms were developed for the prediction of PS in patients with acute appendicitis. CONCLUSIONS The entry of simple clinical and laboratory variables in the dynamic nomogram may be useful in guiding the initial management of patients with acute appendicitis in resource-limited settings.
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Affiliation(s)
- N Lluís
- Hepatobiliary and Pancreas Surgery, Department of Surgical Oncology, Miami Cancer Institute, Miami, FL, USA
| | - J Parra
- Department of Surgery, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | - C Villodre
- Department of Surgery, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain.
| | - P Zapater
- Department of Clinical Pharmacology, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | - A Jalali
- School of Mathematical Sciences, University College Cork, Cork, Ireland
| | - M Cantó
- Computing, BomhardIP, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | - L Mena
- Department of Clinical Documentation, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | - J M Ramia
- Department of Surgery, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | - F Lluís
- Department of Surgery, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
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20
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Wound infection and subsequent port-site hernia following laparoscopic appendectomy: A case report and surveillance data analysis. Int J Surg Case Rep 2022; 95:107235. [PMID: 35636213 PMCID: PMC9157466 DOI: 10.1016/j.ijscr.2022.107235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/14/2022] [Accepted: 05/18/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Non-operative antibiotic therapy is now considered as an alternative to surgery for acute appendicitis (AA). This is in part due to the reported surgical complication rates. We report a patient who developed wound infection and port site hernia following a laparoscopic appendectomy, analyze our post-operative wound infection rates, and discuss the treatment options for AA globally. Presentation of case We report a 40-year-old woman who developed a wound infection and subsequent port site hernia following laparoscopic appendectomy (LA) and analyze surgical site infection (SSI) and readmission rates for patients who underwent LA at our medical center. Analysis of our surveillance data demonstrated that 15/865 (1.7%) patients developed SSIs and 7/15 (47%) of these patients had positive wound cultures. Patients who developed SSIs were more likely to be male (80% vs 20%; P = 0.03), be older (43.0 vs 34.0; P = 0.04), have higher surgical wound classification scores (66.7% vs 38.2%; P = 0.009), and have longer operative times (82 vs 62 min; P = 0.003). The overall readmission rate was 2.8%. Discussion We report a lower SSI rate after LA than usually reported. Surgical site infection following LA is rare and may be challenging to diagnose early. Additional complications such as port-site hernia may also be encountered in this setting. Conclusion This data should inform both physicians and surgeons who must consider the expected complication rates associated with surgery for AA globally. We report a surgical site infection rate of 1.7% for laparoscopic appendectomy. Wound infection rates are lower for laparoscopic than for open appendectomy. Laparoscopic port-site infection may be followed by port-site hernias. Globally the laparoscopic approach is favored for appendectomy.
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Sartelli M, Labricciosa FM, Coccolini F, Coimbra R, Abu-Zidan FM, Ansaloni L, Al-Hasan MN, Ansari S, Barie PS, Caínzos MA, Ceresoli M, Chiarugi M, Claridge JA, Cicuttin E, Dellinger EP, Fry DE, Guirao X, Hardcastle TC, Hecker A, Leppäniemi AK, Litvin A, Marwah S, Maseda E, Mazuski JE, Memish ZA, Kirkpatrick AW, Pagani L, Podda M, Rasa HK, Sakakushev BE, Sawyer RG, Tumietto F, Xiao Y, Aboubreeg WF, Adamou H, Akhmeteli L, Akin E, Alberio MG, Alconchel F, Magagi IA, Araúz AB, Argenio G, Atanasov BC, Atici SD, Awad SS, Baili E, Bains L, Bala M, Baraket O, Baral S, Belskii VA, Benboubker M, Ben-Ishay O, Bordoni P, Boumédiène A, Brisinda G, Cavazzuti L, Chandy SJ, Chiarello MM, Cillara N, Clarizia G, Cocuz ME, Cocuz IG, Conti L, Coppola R, Cui Y, Czepiel J, D'Acapito F, Damaskos D, Das K, De Simone B, Delibegovic S, Demetrashvili Z, Detanac DS, Dhingra S, Di Bella S, Dimitrov EN, Dogjani A, D'Oria M, Dumitru IM, Elmangory MM, Enciu O, Fantoni M, Filipescu D, Fleres F, Foghetti D, Fransvea P, Gachabayov M, Galeiras R, Gattuso G, Ghannam WM, Ghisetti V, Giraudo G, Gonfa KB, Gonullu E, Hamad YTEY, Hecker M, Isik A, Ismail N, Ismail A, Jain SA, Kanj SS, Kapoor G, Karaiskos I, Kavalakat AJ, Kenig J, Khamis F, Khokha V, Kiguba R, Kim JI, Kobe Y, Kok KYY, Kovacevic BM, Kryvoruchko IA, Kuriyama A, Landaluce-Olavarria A, Lasithiotakis K, Lohsiriwat V, Lostoridis E, Luppi D, Vega GMM, Maegele M, Marinis A, Martines G, Martínez-Pérez A, Massalou D, Mesina C, Metan G, Miranda-Novales MG, Mishra SK, Mohamed MIH, Mohamedahmed AYY, Mora-Guzmán I, Mulita F, Musina AM, Navsaria PH, Negoi I, Nita GE, O'Connor DB, Ordoñez CA, Pantalone D, Panyko A, Papadopoulos A, Pararas N, Pata F, Patel T, Pellino G, Perra T, Perrone G, Pesce A, Pintar T, Popivanov GI, Porcu A, Quiodettis MA, Rahim R, Mitul AR, Reichert M, Rems M, Campbell GYR, Rocha-Pereira N, Rodrigues G, Villamil GER, Rossi S, Sall I, Kafil HS, Sasia D, Seni J, Seretis C, Serradilla-Martín M, Shelat VG, Siribumrungwong B, Slavchev M, Solaini L, Tan BK, Tarasconi A, Tartaglia D, Toma EA, Tomadze G, Toro A, Tovani-Palone MR, van Goor H, Vasilescu A, Vereczkei A, Veroux M, Weckmann SA, Widmer LW, Yahya A, Zachariah SK, Zakaria AD, Zubareva N, Zuidema WP, Di Carlo I, Cortese F, Baiocchi GL, Maier RV, Catena F. It is time to define an organizational model for the prevention and management of infections along the surgical pathway: a worldwide cross-sectional survey. World J Emerg Surg 2022; 17:17. [PMID: 35300731 PMCID: PMC8928018 DOI: 10.1186/s13017-022-00420-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/28/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The objectives of the study were to investigate the organizational characteristics of acute care facilities worldwide in preventing and managing infections in surgery; assess participants' perception regarding infection prevention and control (IPC) measures, antibiotic prescribing practices, and source control; describe awareness about the global burden of antimicrobial resistance (AMR) and IPC measures; and determine the role of the Coronavirus Disease 2019 pandemic on said awareness. METHODS A cross-sectional web-based survey was conducted contacting 1432 health care workers (HCWs) belonging to a mailing list provided by the Global Alliance for Infections in Surgery. The self-administered questionnaire was developed by a multidisciplinary team. The survey was open from May 22, 2021, and June 22, 2021. Three reminders were sent, after 7, 14, and 21 days. RESULTS Three hundred four respondents from 72 countries returned a questionnaire, with an overall response rate of 21.2%. Respectively, 90.4% and 68.8% of participants stated their hospital had a multidisciplinary IPC team or a multidisciplinary antimicrobial stewardship team. Local protocols for antimicrobial therapy of surgical infections and protocols for surgical antibiotic prophylaxis were present in 76.6% and 90.8% of hospitals, respectively. In 23.4% and 24.0% of hospitals no surveillance systems for surgical site infections and no monitoring systems of used antimicrobials were implemented. Patient and family involvement in IPC management was considered to be slightly or not important in their hospital by the majority of respondents (65.1%). Awareness of the global burden of AMR among HCWs was considered very important or important by 54.6% of participants. The COVID-19 pandemic was considered by 80.3% of respondents as a very important or important factor in raising HCWs awareness of the IPC programs in their hospital. Based on the survey results, the authors developed 15 statements for several questions regarding the prevention and management of infections in surgery. The statements may be the starting point for designing future evidence-based recommendations. CONCLUSION Adequacy of prevention and management of infections in acute care facilities depends on HCWs behaviours and on the organizational characteristics of acute health care facilities to support best practices and promote behavioural change. Patient involvement in the implementation of IPC is still little considered. A debate on how operationalising a fundamental change to IPC, from being solely the HCWs responsibility to one that involves a collaborative relationship between HCWs and patients, should be opened.
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Affiliation(s)
| | | | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Raul Coimbra
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, Riverside, USA
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Luca Ansaloni
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Majdi N Al-Hasan
- Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, USA
| | - Shamshul Ansari
- Department of Microbiology, Chitwan Medical College and Teaching Hospital, Bharatpur, Chitwan, Nepal
| | - Philip S Barie
- Department of Surgery, Weill Cornell Medicine, New York, USA
| | | | - Marco Ceresoli
- Department of General and Emergency Surgery, Milano-Bicocca University, School of Medicine and Surgery, Milan, Italy
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Jeffrey A Claridge
- MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Enrico Cicuttin
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | | | - Donald E Fry
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Xavier Guirao
- Surgical Endocrine Head and Neck Unit, Department of General Surgery, Parc Tauli, Hospital Universitari, Sabadell, Spain
| | - Timothy Craig Hardcastle
- Trauma and Burn Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Andreas Hecker
- Department of Surgery, University Hospital of Giessen, Giessen, Germany
| | - Ari K Leppäniemi
- Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Andrey Litvin
- Department of Surgical Disciplines, Immanuel Kant Baltic Federal University, Regional Clinic Hospital, Kaliningrad, Russia
| | - Sanjay Marwah
- Department of Surgery, BDS Post-Graduate Institute of Medical Sciences, Rohtak, India
| | - Emilio Maseda
- Surgical Critical Care, Department of Anesthesia, Hospital Valdecilla, Santander, Spain
| | - John E Mazuski
- Department of Surgery, Washington University in Saint Louis, Saint Louis, USA
| | - Ziad Ahmed Memish
- Research and Innovation Center, King Saud Medical City, College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Andrew W Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, Canada
| | - Leonardo Pagani
- Antimicrobial Stewardship Program, Bolzano Central Hospital, Bolzano, Italy
| | - Mauro Podda
- Department of Emergency Surgery, Cagliari University Hospital "D. Casula", AOU Cagliari, Cagliari, Italy
| | | | - Boris E Sakakushev
- General Surgery, UMHAT St George Plovdiv, RIMU/Research Institute at Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Robert G Sawyer
- Department of Surgery, Homer Stryker, M.D., School of Medicine, Western Michigan University, Kalamazoo, USA
| | - Fabio Tumietto
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Yonghong Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | | | | | - Lali Akhmeteli
- Department of Surgery, TSMU First University Clinic, Tbilisi, Georgia
| | - Emrah Akin
- Department of Surgery, Sakarya University Educational and Research Hospital, Sakarya, Turkey
| | | | - Felipe Alconchel
- Department of Surgery and Transplantation, Virgen de La Arrixaca University Hospital, El Palmar, Spain
| | | | - Ana Belén Araúz
- Infectious Diseases Unit, Hospital Santo Tomás, Panama City, Panama
| | - Giulio Argenio
- Emergency Surgery Unit, AOU San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy
| | - Boyko C Atanasov
- Department of Surgery, UMHAT Eurohospital Plovdiv, RIMU/Research Institute at Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Semra Demirli Atici
- Department of Surgery, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Selmy Sabry Awad
- Department of Trauma and Acute Care Surgery, Mansoura University Hospital, Mansoura University, Mansoura, Egypt
| | - Efstratia Baili
- Second Department of Surgery, IASO General Hospital, Athens, Greece
| | - Lovenish Bains
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Miklosh Bala
- Department of Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Oussama Baraket
- Department of Surgery, Department of Surgery, Bizerte Hospital, Tunis El Manar University, Tunis, Tunisia
| | - Suman Baral
- Department of Surgery, Dirghayu Pokhara Hospital, Pokhara, Nepal
| | - Vladislav A Belskii
- Department of Anesthesiology and Intensive Care, Privolzhskiy District Medical Center, Nizhny Novgorod, Russia
| | - Moussa Benboubker
- HAIs Control Committee, HASSAN II University Hospital Fez, Fez, Morocco
| | - Offir Ben-Ishay
- Department of Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Pierpaolo Bordoni
- Department of Surgery, ASST Valtellina e Alto Lario, Sondrio Hospital, Sondrio, Italy
| | | | - Giuseppe Brisinda
- Medical and Surgical Sciences Department, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Laura Cavazzuti
- Medical Directorate, Arcispedale Santa Maria Nuova Hospital, Local Health Authority-IRCSS of Reggio Emilia, Reggio Emilia, Italy
| | - Sujith J Chandy
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, India
| | - Maria Michela Chiarello
- Department of Surgery, Ospedale San Giovanni di Dio, Azienda Sanitaria Provinciale, Crotone, Italy
| | - Nicola Cillara
- Department of Surgery, PO Santissima Trinità ASSL Cagliari, Cagliari, Italy
| | - Guglielmo Clarizia
- Department of Surgery, ASST Valtellina e Alto Lario, Sondrio Hospital, Sondrio, Italy
| | - Maria-Elena Cocuz
- Faculty of Medicine, University Transilvania of Brasov, Brasov, Romania
| | - Iuliu Gabriel Cocuz
- Pathophysiology Department, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, George Emil Palade of Targu Mures, Targu Mures, Romania
| | - Luigi Conti
- Department of Surgery, Ospedale G. Da Saliceto, AUSL Piacenza, Piacenza, Italy
| | | | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | - Jacek Czepiel
- Department of Infectious and Tropical Diseases, Jagiellonian University Medical College, Krakaw, Poland
| | - Fabrizio D'Acapito
- Department of Surgery, Forlì Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | | | - Koray Das
- Department of Surgery, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
| | - Belinda De Simone
- Emergency and Metabolic Minimally Invasive Surgery, Poissy-Saint-Germain-en-Laye Hospital, Yvelines, France
| | - Samir Delibegovic
- Department of Surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Zaza Demetrashvili
- Department of Surgery, Kipshidze Central University Hospital, Tbilisi, Georgia
| | - Dzemail S Detanac
- Department of Surgery, General Hospital Novi Pazar, Novi Pazar, Serbia
| | - Sameer Dhingra
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur, Bihar, India
| | - Stefano Di Bella
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Trieste, Italy
| | - Evgeni N Dimitrov
- Department of Surgical Diseases, University Hospital "Prof. Dr. Stoyan Kirkovich", Stara Zagora, Bulgaria
| | - Agron Dogjani
- Department of Surgery, University of Medicine of Tirana, Tirana, Albania
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste, Trieste, Italy
| | | | | | - Octavian Enciu
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Massimo Fantoni
- Dipartimento Di Scienze Di Laboratorio E Infettivologiche, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Daniela Filipescu
- Cardiac Anaesthesia and Intensive Care 2, Emergency Institute of Cardiovascular Diseases, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Francesco Fleres
- Department of Surgery, ASST Valtellina e Alto Lario, Sondrio Hospital, Sondrio, Italy
| | | | - Pietro Fransvea
- Medical and Surgical Sciences Department, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Mahir Gachabayov
- Department of Abdominal Surgery, Vladimir City Emergency Hospital, Vladimir, Russia
| | - Rita Galeiras
- Critical Care Unit, Complexo Hospitalario Universitario, La Coruna, Spain
| | - Gianni Gattuso
- Department of Infectious Diseases, Carlo Poma" Hospital ASST, Mantova, Italy
| | - Wagih M Ghannam
- Department of Surgery, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Valeria Ghisetti
- Laboratory of Microbiology and Virology, Amedeo di Savoia Hospital and ASL Città di Torino, Turin, Italy
| | - Giorgio Giraudo
- Department of Surgery, Aso Santa Croce e Carle, Cuneo, Italy
| | - Kebebe Bekele Gonfa
- Department of Surgery, Madda Walabu University Goba Referral Hospital, Bala-Robe, Ethiopia
| | - Emre Gonullu
- Department of Surgery, Sakarya University, Adapazarı, Turkey
| | | | - Matthias Hecker
- Medical Clinic II, University Hospital Giessen, Glessen, Germany
| | - Arda Isik
- Department of Surgery, Istanbul Medeniyet University, Istanbul, Turkey
| | - Nizar Ismail
- Trauma and Orthopaedics, Stoke Mandeville Hospital, Aylesbury, UK
| | - Azzain Ismail
- Trauma and Orthopaedics Woodend Hospital, Aberdeen, UK
| | | | - Souha S Kanj
- Infectious Diseases Division, American University of Beirut Medical Center, Beirut, Lebanon
| | - Garima Kapoor
- Department of Microbiology, Gandhi Medical College, Bhopal, India
| | - Ilias Karaiskos
- 1St Department of Internal Medicine-Infectious Diseases, Hygeia Hospital, Marousi, Greece
| | - Alfie J Kavalakat
- Department of Surgery, Jubilee Mission Medical College and RI, Thrissur, India
| | - Jakub Kenig
- Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Faryal Khamis
- Infectious Diseases and Internal Medicine Department, Royal Hospital, Muscat, Oman
| | - Vladimir Khokha
- Department of Emergency Surgery, City Hospital, Mozyr, Belarus
| | - Ronald Kiguba
- Pharmacology and Therapeutics, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jae Il Kim
- Department of Surgery, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Yoshiro Kobe
- Department of Surgery, Chiba Emergency Medical Center, Chiba, Japan
| | - Kenneth Yuh Yen Kok
- Discipline of Medicine, Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Brunei Darussalam University, Darussalam, Brunei
| | | | | | - Akira Kuriyama
- Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, Japan
| | | | | | - Varut Lohsiriwat
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Davide Luppi
- Department of Surgery, ASMN IRCCS, Reggio Emilia, Italy
| | - Gustavo Miguel Machain Vega
- General Surgery, Universidad Nacional de Asunción-Facultad de Ciencias Medicas, Hospital de Clínicas, Asuncion, Paraguay
| | - Marc Maegele
- Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, Cologne, Germany
| | | | - Gennaro Martines
- Department of Surgery, Azienda Ospedaliero Universitaria Policlinico, Bari, Italy
| | - Aleix Martínez-Pérez
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Damien Massalou
- Acute Care Surgery, Centre Hospitalier Universitaire de Nice, Nice University Hospital, Nice, France
| | - Cristian Mesina
- Department of Surgery, Emergency County Hospital of Craiova, Craiova, Romania
| | - Gökhan Metan
- Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - María Guadalupe Miranda-Novales
- Infectious Diseases Department, Paediatric Hospital, Analysis and Synthesis Research Unit, Social Security Mexican Institute, Mexico City, Mexico
| | - Shyam Kumar Mishra
- Clinical Microbiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | | | | | - Ismael Mora-Guzmán
- Department of Surgery, Hospital General La Mancha Centro, Alcazar de San Juan, Spain
| | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Rio, Greece
| | - Ana-Maria Musina
- Department of Surgery, University of Medicine and Pharmacy Grigore T Popa, Iasi, Romania
| | - Pradeep H Navsaria
- Trauma Centre, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Ionut Negoi
- Department of Surgery, Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | | | | | - Desiré Pantalone
- Emergency Surgery Department, AOU Careggi-Università di Firenze, Florence, Italy
| | - Arpád Panyko
- IVth Department of Surgery, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | | | - Nikolaos Pararas
- Surgical Department, Dr. Sulaiman Al Habib Hospital, Alfaisal University, Riyadh, Saudi Arabia
| | - Francesco Pata
- Department of Surgery, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy
| | - Tapan Patel
- Department of Surgery, Baroda Medical College, Vadodara, India
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Teresa Perra
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Azienda Ospedaliero Universitaria di Sassari, Sassari, Italy
| | - Gennaro Perrone
- Department of Emergency Surgery, Parma University Hospital, Parma, Italy
| | - Antonio Pesce
- Department of Surgery, Azienda USL of Ferrara-University of Ferrara, Ferrara, Italy
| | - Tadeja Pintar
- Abdominal Surgery Department, UMC Ljubljana, Ljubljana, Slovenia
| | | | - Alberto Porcu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Azienda Ospedaliero Universitaria di Sassari, Sassari, Italy
| | | | - Razrim Rahim
- Department of Surgery, Universiti Sains Islam Malaysia, Nilai, Malaysia
| | - Ashrarur Rahman Mitul
- Unit of Pediatric Surgery, Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh
| | - Martin Reichert
- Department of Surgery, University Hospital of Giessen, Giessen, Germany
| | - Miran Rems
- Department for General and Abdominal Surgery, General Hospital Jesenice, Jesenice, Slovenia
| | | | | | - Gabriel Rodrigues
- Department of Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Gustavo Eduardo Roncancio Villamil
- Department of Medicine, Division of Infectious Diseases, Universidad Pontificia Bolivariana, Medellín, Colombia
- Research Group on Cardiovascular and Pulmonary Diseases, Clínica Cardio VID, Medellín, Colombia
| | - Stefano Rossi
- Emergency Surgery Department, San Filippo Neri Hospital, Rome, Italy
| | - Ibrahima Sall
- Department of Surgery, Military Teaching Hospital, Hôpital Principal de Dakar, Dakar, Senegal
| | - Hossein Samadi Kafil
- Drug Applied Research Center, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Diego Sasia
- Department of Surgery, Aso Santa Croce e Carle, Cuneo, Italy
| | - Jeremiah Seni
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | | | - Mario Serradilla-Martín
- Department of Surgery, Instituto de Investigación Sanitaria Aragón, Miguel Servet University Hospital, Zaragoza, Spain
| | - Vishal G Shelat
- Department of Surgery, Tan Tock Seng Hospital, Novena, Singapore
| | | | - Mihail Slavchev
- Department of Surgery, University Hospital Eurohospital, Plovdiv, Bulgaria
| | - Leonardo Solaini
- Department of Medical and Surgical Sciences, University of Bologna, Forlì, Italy
| | - Boun Kim Tan
- Infection Prevention and Control Unit, Centre des Massues, French Red Cross, Lyon, France
| | - Antonio Tarasconi
- Department of Emergency Surgery, Parma University Hospital, Parma, Italy
| | - Dario Tartaglia
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Elena Adelina Toma
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Gia Tomadze
- Department of Surgery, Tbilisi State Medical University, Tbilisi, Georgia
| | - Adriana Toro
- Department of General Surgery, E. Muscatello Augusta Hospital, Augusta, Italy
| | - Marcos Roberto Tovani-Palone
- Department of Pathology and Legal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alin Vasilescu
- Department of Surgery, St. Spiridon University Hospital "Grigore T Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Andras Vereczkei
- Department of Surgery, Medical Center University of Pécs, Pécs, Hungary
| | - Massimiliano Veroux
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
| | | | - Lukas Werner Widmer
- Department of Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland
| | | | - Sanoop K Zachariah
- Department of Surgery, Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala, India
| | - Andee Dzulkarnaen Zakaria
- Department of Surgery, School of Medical Sciences and University Hospital Sains Malaysia, Sains Malaysia University, Penang, Malaysia
| | - Nadezhda Zubareva
- Department of General Surgery, Perm State Medical University N.a. Academician E.A. Wagner, Perm, Russia
| | - Wietse P Zuidema
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Isidoro Di Carlo
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
| | - Francesco Cortese
- Emergency Surgery Department, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - Gian Luca Baiocchi
- Department of Surgery, AAST Cremona, Cremona, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Ronald V Maier
- Harborview Medical Center, Department of Surgery, University of Washington, Seattle, WA, USA
| | - Fausto Catena
- Department of Surgery, Bufalini" Hospital, Cesena, Italy
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Bayissa BB, Miressa F, Abulkadir A, Fekadu G. Predictors of complicated appendicitis among patients presented to public referral hospitals in Harari region, Eastern Ethiopia: a case-control study. SURGERY IN PRACTICE AND SCIENCE 2022. [DOI: 10.1016/j.sipas.2022.100072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Ernest EC, Hellar A, Varallo J, Tibyehabwa L, Bertram MM, Fitzgerald L, Katoto A, Mshana S, Simba D, Gwitaba K, Boddu R, Alidina S, Giiti G, Kihunrwa A, Balandya B, Urassa D, Hussein Y, Damien C, Wackenreuter B, Barash D, Morrison M, Reynolds C, Christensen A, Makuwani A. Reducing surgical site infections and mortality among obstetric surgical patients in Tanzania: a pre-evaluation and postevaluation of a multicomponent safe surgery intervention. BMJ Glob Health 2021; 6:e006788. [PMID: 34876458 PMCID: PMC8655579 DOI: 10.1136/bmjgh-2021-006788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/01/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Despite ongoing maternal health interventions, maternal deaths in Tanzania remain high. One of the main causes of maternal mortality includes postoperative infections. Surgical site infection (SSI) rates are higher in low/middle-income countries (LMICs), such as Tanzania, compared with high-income countries. We evaluated the impact of a multicomponent safe surgery intervention in Tanzania, hypothesising it would (1) increase adherence to safety practices, such as the WHO Surgical Safety Checklist (SSC), (2) reduce SSI rates following caesarean section (CS) and (3) reduce CS-related perioperative mortality rates (POMRs). METHODS We conducted a pre-cross-sectional/post-cross-sectional study design to evaluate WHO SSC utilisation, SSI rates and CS-related POMR before and 18 months after implementation. Our interventions included training of inter-professional surgical teams, promoting use of the WHO SSC and introducing an infection prevention (IP) bundle for all CS patients. We assessed use of WHO SSC and SSI rates through random sampling of 279 individual CS patient files. We reviewed registers and ward round reports to obtain the number of CS performed and CS-related deaths. We compared proportions of individuals with a characteristic of interest during pre-implementation and post implementation using the two-proportion z-test at p≤0.05 using STATA V.15. RESULTS The SSC utilisation rate for CS increased from 3.7% (5 out of 136) to 95.1% (136 out of 143) with p<0.001. Likewise, the proportion of women with SSI after CS reduced from 14% during baseline to 1% (p=0.002). The change in SSI rate after the implementation of the safe surgery interventions is statistically significant (p<0.001). The CS-related POMR decreased by 38.5% (p=0.6) after the implementation of safe surgery interventions. CONCLUSION Our findings show that our intervention led to improved utilisation of the WHO SSC, reduced SSIs and a drop in CS-related POMR. We recommend replication of the interventions in other LMICs.
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Affiliation(s)
| | | | | | | | | | | | - Adam Katoto
- JHPIEGO, Dar es Salaam, Tanzania, United Republic of
| | - Stella Mshana
- JHPIEGO, Dar es Salaam, Tanzania, United Republic of
| | - Dorcas Simba
- JHPIEGO, Dar es Salaam, Tanzania, United Republic of
| | | | - Rohini Boddu
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Shehnaz Alidina
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Geofrey Giiti
- Department of Surgery, Catholic University of Health and Allied Sciences Bugando, Mwanza, Tanzania, United Republic of
| | - Albert Kihunrwa
- Department of Obstetrics and Gynaecology, Bugando Medical Centre, Mwanza, Tanzania, United Republic of
| | - Belinda Balandya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - David Urassa
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Yahya Hussein
- President Office Regional Authority and Local Government, Dar es Salaam, Tanzania, United Republic of
| | - Caroline Damien
- Ministry of Health Community Development Gender Elderly and Children, Dar es Salaam, Tanzania, United Republic of
| | | | - David Barash
- Developing Health Globally, GE Foundation, Fairfield, Connecticut, USA
| | - Melissa Morrison
- The ELMA Philanthropies Services (U.S.), New York, New York, USA
| | | | | | - Ahmed Makuwani
- Ministry of Health Community Development Gender Elderly and Children, Dar es Salaam, Tanzania, United Republic of
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Sibindi C, Mushambwe T, Mageza A, Socci A. Population characteristics, outcomes, and centerwide insights of the Zimbabwe national experience with the SIGN intramedullary nail (2013-2020). INTERNATIONAL ORTHOPAEDICS 2021; 46:89-96. [PMID: 34424393 DOI: 10.1007/s00264-021-05167-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE SIGN Fracture international is a non-profit organization that provides intramedullary nails to SIGN centres at no cost for intra-operative fracture fixation in exchange for cases being uploaded to the SIGN Online Surgical Database (SOSD). The SIGN program was introduced in Zimbabwe in 2013 and had expanded to nine hospitals at the end of 2020. This study aimed to evaluate the population characteristics and clinical outcomes of patients who received the SIGN nail in Zimbabwe as well as intranational trends across SIGN centres. METHODS We conducted a retrospective review of the SOSD for all cases carried out in Zimbabwe between 2013 and 2020. RESULTS A total of 1764 patients received operative fixation over the period. The majority were young (36.83 ± 15.13) years and male (74%). The average time to surgery was 22 ± 20.5 days with over 69% of patients getting surgery after more than ten days. Femur fracture fixation (72%) was the most common procedure with road traffic accidents (RTAs) being the most common cause of fractures (73%). The majority of patients had no follow-up (61%). Of patients with follow-up, 4% reported infection, 2% deformity, and 78% with healing X-rays. There were large differences in volume of patients at different centres with no significant trends in outcomes. CONCLUSION The SIGN program allows for safe surgery in Zimbabwe. There are large intranational differences of no particular trend across SIGN centres which may be improved through more intranational knowledge sharing. Improved follow-up would allow for more insights to be gleaned from the database.
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Affiliation(s)
- Cosmas Sibindi
- Department of Orthopedics, Yale School of Medicine, 47 College Street, New Haven, CT, 06510, USA.
| | - Tafadzwa Mushambwe
- Parirenyatwa Group of Hospitals, University of Zimbabwe, Mazowe Street, 103 Baines Avenue, Avenues, Harare, Zimbabwe
| | - Akimu Mageza
- Parirenyatwa Group of Hospitals, University of Zimbabwe, Mazowe Street, 103 Baines Avenue, Avenues, Harare, Zimbabwe
| | - Adrienne Socci
- Department of Orthopedics, Yale School of Medicine, 47 College Street, New Haven, CT, 06510, USA
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25
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Jin J, Akau Ola S, Yip CH, Nthumba P, Ameh EA, de Jonge S, Mehes M, Waiqanabete HI, Henry J, Hill A. The Impact of Quality Improvement Interventions in Improving Surgical Infections and Mortality in Low and Middle-Income Countries: A Systematic Review and Meta-Analysis. World J Surg 2021; 45:2993-3006. [PMID: 34218314 DOI: 10.1007/s00268-021-06208-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Morbidity and mortality in surgical systems in low- and middle-income countries (LMICs) remain high compared to high-income countries. Quality improvement processes, interventions, and structure are essential in the effort to improve peri-operative outcomes. METHODS A systematic review and meta-analysis of interventional studies assessing quality improvement processes, interventions, and structure in developing country surgical systems was conducted according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they were conducted in an LMIC, occurred in a surgical setting, and measured the effect of an implementation and its impact. The primary outcome was mortality, and secondary outcomes were rates of rates of hospital-acquired infection (HAI) and surgical site infections (SSI). Prospero Registration: CRD42020171542. RESULT Of 38,273 search results, 31 studies were included in a qualitative synthesis, and 28 articles were included in a meta-analysis. Implementation of multimodal bundled interventions reduced the incidence of HAI by a relative risk (RR) of 0.39 (95%CI 0.26 to 0.59), the effect of hand hygiene interventions on HAIs showed a non-significant effect of RR of 0.69 (0.46-1.05). The WHO Safe Surgery Checklist reduced mortality by RR 0.68 (0.49 to 0.95) and SSI by RR 0.50 (0.33 to 0.63) and antimicrobial stewardship interventions reduced SSI by RR 0.67 (0.48-0.93). CONCLUSION There is evidence that a number of quality improvement processes, interventions and structural changes can improve mortality, HAI and SSI outcomes in the peri-operative setting in LMICs.
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Affiliation(s)
- James Jin
- Department of Surgery, The University of Auckland, Auckland, 1010, New Zealand
| | - Salesi Akau Ola
- Surgery, Fiji National University, samabula fiji Lakeba Street Samabula, Suva, Fiji
| | - Cheng-Har Yip
- Surgery, University of Malaya, Subang Jaya Medical Centre, 50603, Kuala Lumpur, Malaysia
| | - Peter Nthumba
- AIC Kijabe Hospital Surgery, Kijabe Road Kijabe Lari Kiambu KE, Kijabe, Kenya
| | - Emmanuel A Ameh
- Division of Paediatric Surgery, Northcentral University, 8667 E Hartford Dr Ste 100, Scottsdale, AZ, 85255, USA
| | - Stijn de Jonge
- Department of Surgery, Amsterdam UMC Locatie AMC, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
| | | | | | - Jaymie Henry
- Department of Surgery, Florida Atlantic University, Boca Raton, USA.
| | - Andrew Hill
- Department of Surgery, University of Auckland, Auckland, 1010, New Zealand
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Evaluation of the Clinical Use of Ceftriaxone among In-Patients in Selected Health Facilities in Uganda. Antibiotics (Basel) 2021; 10:antibiotics10070779. [PMID: 34202391 PMCID: PMC8300672 DOI: 10.3390/antibiotics10070779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/14/2021] [Accepted: 05/19/2021] [Indexed: 11/25/2022] Open
Abstract
Ceftriaxone has a high propensity for misuse because of its high rate of utilization. In this study, we aimed at assessing the appropriateness of the clinical utilization of ceftriaxone in nine health facilities in Uganda. Using the World Health Organization (WHO) Drug Use Evaluation indicators, we reviewed a systematic sample of 885 patients’ treatment records selected over a three (3)-month period. Our results showed that prescriptions were written mostly by medical officers at 53.3% (470/882). Ceftriaxone was prescribed mainly for surgical prophylaxis at 25.3% (154/609), respiratory tract infections at 17% (104/609), and sepsis at 11% (67/609), as well as for non-recommended indications such as malaria at 7% (43/609) and anemia at 8% (49/609). Ceftriaxone was mostly prescribed once daily (92.3%; 817/885), as a 2 g dose (50.1%; 443/885), and for 5 days (41%; 363/885). The average score of inappropriate use of ceftriaxone in the eight indicators was 32.1%. Only 58.3% (516/885) of the ceftriaxone doses prescribed were administered to completion. Complete blood count and culture and sensitivity testing rates were 38.8% (343/885) and 1.13% (10/885), respectively. Over 85.4% (756/885) of the patients improved and were discharged. Factors associated with appropriate ceftriaxone use were gender, pregnancy status, days of hospitalization, health facility level of care, health facility type, and type of prescriber.
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Inclusion of Children's Surgery in National Surgical Plans and Child Health Programmes: the need and roadmap from Global Initiative for Children's Surgery. Pediatr Surg Int 2021; 37:529-537. [PMID: 33399928 DOI: 10.1007/s00383-020-04813-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 12/11/2022]
Abstract
About 1.7 billion children and adolescents, mostly in low- and middle-income countries (LMICs) lack access to surgical care. While some of these countries have developed surgical plans and others are in the process of developing theirs, children's surgery has not received the much-needed specific emphasis and focus in these plans. With the significant burden of children's surgical conditions especially in low- and middle-income countries, universal health coverage and the United Nations' (UN) Sustainable Development Goals (SDG) will not be achieved without deliberate efforts to scale up access to children's surgical care. Inclusion of children's surgery in National Surgical Obstetric and Anaesthesia Plans (NSOAPs) can be done using the Global Initiative for Children's Surgery (GICS)-modified Children's Surgical Assessment Tool (CSAT) tool for baseline assessment and the Optimal Resources for Children Surgical Care (OReCS) as a foundational tool for implementation.
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Paquet-Côté PA, Alejaldre L, Lapointe Verreault C, Gobeil SMC, Lamoureux R, Bédard L, Normandeau CO, Lemay-St-Denis C, Pelletier JN, Voyer N. Development of sulfahydantoin derivatives as β-lactamase inhibitors. Bioorg Med Chem Lett 2021; 35:127781. [PMID: 33422604 DOI: 10.1016/j.bmcl.2021.127781] [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: 12/07/2020] [Revised: 01/01/2021] [Accepted: 01/04/2021] [Indexed: 11/16/2022]
Abstract
Sulfahydantoin-based molecules may provide a means to counteract antibiotic resistance, which is on the rise. These molecules may act as inhibitors of β-lactamase enzymes, which are key in some resistance mechanisms. In this paper, we report on the synthesis of 6 novel sulfahydantoin derivatives by the key reaction of chlorosulfonyl isocyanate to form α-amino acid derived sulfamides, and their cyclization into sulfahydantoins. The synthesis is rapid and provides the target compounds in 8 steps. We investigated their potential as β-lactamase inhibitors using two common Class A β-lactamases, TEM-1 and the prevalent extended-spectrum TEM-15. Two compounds, 3 and 6, show substantial inhibition of the β-lactamases with IC50 values between 130 and 510 μM and inferred Ki values between 32 and 55 μM.
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Affiliation(s)
| | - Lorea Alejaldre
- Département de biochimie and PROTEO, Université de Montréal, Montréal H3C 3J7, Canada
| | | | - Sophie M C Gobeil
- Département de biochimie and PROTEO, Université de Montréal, Montréal H3C 3J7, Canada
| | - Rosalie Lamoureux
- Département de Chimie and PROTEO, Université Laval, 1045 avenue de la Médecine, Québec G1V 0A6, Canada
| | - Laurie Bédard
- Département de Chimie and PROTEO, Université Laval, 1045 avenue de la Médecine, Québec G1V 0A6, Canada
| | | | | | - Joelle N Pelletier
- Département de biochimie and PROTEO, Université de Montréal, Montréal H3C 3J7, Canada; Département de chimie, Université de Montréal, Montréal H3C 3J7, Canada
| | - Normand Voyer
- Département de Chimie and PROTEO, Université Laval, 1045 avenue de la Médecine, Québec G1V 0A6, Canada.
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Zorrilla-Vaca A, Marmolejo-Posso D, Caballero-Lozada AF, Miño-Bernal JF. Sterility and Infection Prevention Standards for Anesthesiologists in LMICs: Preventing Infections and Antimicrobial Resistance. CURRENT ANESTHESIOLOGY REPORTS 2021. [DOI: 10.1007/s40140-021-00441-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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30
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Muvunyi V, Mpirimbanyi C, Katabogama JB, Cyuzuzo T, Nkubana T, Mugema JB, Musoni E, Urimubabo C, Rickard J. Community- and Hospital-Acquired Infections in Surgical patients at a Tertiary Referral Hospital in Rwanda. World J Surg 2021; 44:3290-3298. [PMID: 32535645 DOI: 10.1007/s00268-020-05634-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) are increasing in globally. The aim of this study was to compare community-acquired infections (CAIs) and hospital-acquired infections (HAIs) and determine the rate of third-generation cephalosporin resistance and ESBL-PE at a tertiary referral hospital in Rwanda. METHODS This was a cross-sectional study of Rwandan acute care surgery patients with infection. Samples were processed for culture and susceptibility patterns using Kirby-Bauer disk diffusion method. Third-generation cephalosporin resistance and ESBL-PE were compared in patients with CAI versus HAI. RESULTS Over 14 months, 220 samples were collected from 191 patients: 116 (62%) patients had CAI, 59 (32%) had HAI, and 12 (6%) had both CAI and HAI. Most (n = 178, 94%) patients were started on antibiotics with third-generation cephalosporins (ceftriaxone n = 109, 57%; cefotaxime n = 52, 27%) and metronidazole (n = 155, 81%) commonly given. Commonly isolated organisms included Escherichia coli (n = 62, 42%), Staphylococcus aureus (n = 27, 18%), and Klebsiella spp. (n = 22, 15%). Overall, 67 of 113 isolates tested had resistance to third-generation cephalosporins, with higher resistance seen in HAI compared with CAI (74% vs 46%, p value = 0.002). Overall, 47 of 89 (53%) isolates were ESBL-PE with higher rates in HAI compared with CAI (73% vs 38%, p value = 0.001). CONCLUSIONS There is broad and prolonged use of third-generation cephalosporins despite high resistance rates. ESBL-PE are high in Rwandan surgical patients with higher rates in HAI compared with CAIs. Infection prevention practices and antibiotic stewardship are critical to reduce infection rates with resistant organisms in a low-resource setting.
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Affiliation(s)
- Vital Muvunyi
- Department of Surgery, University of Rwanda, Kigali, Rwanda
| | - Christophe Mpirimbanyi
- Department of Surgery, University of Rwanda, Kigali, Rwanda.,Department of Surgery, Kibungo Referral Hospital, Kibungo, Rwanda
| | | | | | - Theoneste Nkubana
- Clinical Laboratory, University Teaching Hospital of Kigali, Kigali, Rwanda
| | | | - Emile Musoni
- Clinical Laboratory, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Christian Urimubabo
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Jennifer Rickard
- Department of Surgery, University of Rwanda, Kigali, Rwanda. .,Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda. .,Department of Surgery, University of Minnesota, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA.
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31
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Mwita JC, Ogunleye OO, Olalekan A, Kalungia AC, Kurdi A, Saleem Z, Sneddon J, Godman B. Key Issues Surrounding Appropriate Antibiotic Use for Prevention of Surgical Site Infections in Low- and Middle-Income Countries: A Narrative Review and the Implications. Int J Gen Med 2021; 14:515-530. [PMID: 33633461 PMCID: PMC7901404 DOI: 10.2147/ijgm.s253216] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/07/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There is a concern with the growing use of antimicrobials across countries increasing antimicrobial resistance (AMR) rates. A key area within hospitals is their use for the prevention of surgical site infections (SSI) with concerns with timing of the first dose, which can appreciably impact on effectiveness, as well as duration with extended prophylaxis common among low- and middle-income countries (LMICs). This is a concern as extended duration increases utilization rates and AMR as well as adverse events. Consequently, there is a need to document issues of timing and duration of surgical antibiotic prophylaxis (SAP) among LMICs together with potential ways forward to address current concerns. METHODS Narrative review of timings and duration of SAP among LMICs combined with publications documenting successful approaches to improve SAP to provide future direction to all key stakeholder groups. RESULTS There were documented concerns with the timing of the first dose of antibiotics, with appropriate timing as low as 6.7% in Egypt, although as high as 81.9% in Turkey. There was also an extensive duration of SAP, ranging from long duration times in all patients in a study in Nigeria with a mean of 8.7 days and 97% of patients in Egypt to 42.9% of patients in Pakistan and 35% in Turkey. Successful interventions to improve SAP typically involved multiple approaches including education of all key stakeholder groups, monitoring of usage against agreed guidelines,as well as quality targets. Multiple approaches typically improved timing and duration as well as reduced costs. For instance, in one study appropriateness increased from 30.1% to 91.4%, prolonged duration reduced to 5.7% of patients, and mean costs of antibiotics decreased 11-fold. CONCLUSION There are considerable concerns with the timing and duration of SAP among LMICs. Multiple interventions among LMICs can address this providing future directions.
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Affiliation(s)
- Julius C Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Lagos, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Adesola Olalekan
- Department of Medical Laboratory Science, University of Lagos, Lagos, Nigeria
- Centre for Genomics of Non-Diseases and Personalized Healthcare (CGNPH), University of Lagos, Lagos, Nigeria
| | | | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | | | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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Alidina S, Chatterjee P, Zanial N, Alreja SS, Balira R, Barash D, Ernest E, Giiti GC, Maina E, Mazhiqi A, Mushi R, Reynolds C, Sydlowski M, Tinuga F, Maongezi S, Meara JG, Kapologwe NA, Barringer E, Cainer M, Citron I, DiMeo A, Fitzgerald L, Ghandour H, Gruendl M, Hellar A, Jumbam DT, Katoto A, Kelly L, Kisakye S, Kuchukhidze S, Lama TN, Menon G, Mshana S, Reynolds C, Segirinya H, Simba D, Smith V, Staffa SJ, Strader C, Tibyehabwa L, Troxel A, Varallo J, Wurdeman T, Zurakowski D. Improving surgical quality in low-income and middle-income countries: why do some health facilities perform better than others? BMJ Qual Saf 2021; 30:937-949. [PMID: 33547219 PMCID: PMC8606467 DOI: 10.1136/bmjqs-2020-011795] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/15/2020] [Accepted: 01/18/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Evidence on heterogeneity in outcomes of surgical quality interventions in low-income and middle-income countries is limited. We explored factors driving performance in the Safe Surgery 2020 intervention in Tanzania's Lake Zone to distil implementation lessons for low-resource settings. METHODS We identified higher (n=3) and lower (n=3) performers from quantitative data on improvement from 14 safety and teamwork and communication indicators at 0 and 12 months from 10 intervention facilities, using a positive deviance framework. From 72 key informant interviews with surgical providers across facilities at 1, 6 and 12 months, we used a grounded theory approach to identify practices of higher and lower performers. RESULTS Performance experiences of higher and lower performers differed on the following themes: (1) preintervention context, (2) engagement with Safe Surgery 2020 interventions, (3) teamwork and communication orientation, (4) collective learning orientation, (5) role of leadership, and (6) perceived impact of Safe Surgery 2020 and beyond. Higher performers had a culture of teamwork which helped them capitalise on Safe Surgery 2020 to improve surgical ecosystems holistically on safety practices, teamwork and communication. Lower performers prioritised overhauling safety practices and began considering organisational cultural changes much later. Thus, while also improving, lower performers prioritised different goals and trailed higher performers on the change continuum. CONCLUSION Future interventions should be tailored to facility context and invest in strengthening teamwork, communication and collective learning and facilitate leadership engagement to build a receptive climate for successful implementation of safe surgery interventions.
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Affiliation(s)
- Shehnaz Alidina
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Pritha Chatterjee
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA.,Department of Social and Behavioral Sciences, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Noor Zanial
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Sakshie Sanjay Alreja
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Rebecca Balira
- Department of Epidemiology, National Institute for Medical Research Mwanza Research Centre, Mwanza, Tanzania
| | | | - Edwin Ernest
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania
| | | | | | - Adelina Mazhiqi
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Rahma Mushi
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Cheri Reynolds
- Department of Global Health, Assist International, Ripon, California, USA
| | - Meaghan Sydlowski
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Florian Tinuga
- Department of Health, Social Welfare and Nutrition Service, President's Office - Regional Administration and Local Government, Dodoma, Tanzania
| | - Sarah Maongezi
- Department of Adult Non-Communicable Diseases, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ntuli A Kapologwe
- Department of Health, Social Welfare and Nutrition Service, President's Office - Regional Administration and Local Government, Dodoma, Tanzania
| | - Erin Barringer
- Dalberg Advisors, Dalberg Group, New York, New York, USA
| | - Monica Cainer
- Department of Global Health, Assist International, Ripon, California, USA
| | - Isabelle Citron
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Amanda DiMeo
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | | | - Hiba Ghandour
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Magdalena Gruendl
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | | | - Desmond T Jumbam
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Adam Katoto
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania
| | - Lauren Kelly
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Steve Kisakye
- Dalberg Implement, Dalberg Group, Dar es Salaam, Tanzania
| | - Salome Kuchukhidze
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Tenzing N Lama
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Gopal Menon
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Stella Mshana
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania
| | - Chase Reynolds
- Department of Global Health, Assist International, Ripon, California, USA
| | | | - Dorcas Simba
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania
| | - Victoria Smith
- Department of Global Health, Assist International, Ripon, California, USA
| | - Steven J Staffa
- Departments of Anesthesiology and Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Christopher Strader
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | | | - Alena Troxel
- Safe Surgery 2020 Project, Jhpiego, Baltimore, Maryland, USA
| | - John Varallo
- Safe Surgery 2020 Project, Jhpiego, Baltimore, Maryland, USA
| | - Taylor Wurdeman
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - David Zurakowski
- Departments of Anesthesiology and Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
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Tarrant C, Colman AM, Jenkins DR, Chattoe-Brown E, Perera N, Mehtar S, Nakkawita WD, Bolscher M, Krockow EM. Drivers of Broad-Spectrum Antibiotic Overuse across Diverse Hospital Contexts-A Qualitative Study of Prescribers in the UK, Sri Lanka and South Africa. Antibiotics (Basel) 2021; 10:94. [PMID: 33477994 PMCID: PMC7835907 DOI: 10.3390/antibiotics10010094] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/08/2021] [Accepted: 01/18/2021] [Indexed: 01/02/2023] Open
Abstract
Antimicrobial stewardship programs focus on reducing overuse of broad-spectrum antibiotics (BSAs), primarily through interventions to change prescribing behavior. This study aims to identify multi-level influences on BSA overuse across diverse high and low income, and public and private, healthcare contexts. Semi-structured interviews were conducted with 46 prescribers from hospitals in the UK, Sri Lanka, and South Africa, including public and private providers. Interviews explored decision making about prescribing BSAs, drivers of the use of BSAs, and benefits of BSAs to various stakeholders, and were analyzed using a constant comparative approach. Analysis identified drivers of BSA overuse at the individual, social and structural levels. Structural drivers of overuse varied significantly across contexts and included: system-level factors generating tensions with stewardship goals; limited material resources within hospitals; and patient poverty, lack of infrastructure and resources in local communities. Antimicrobial stewardship needs to encompass efforts to reduce the reliance on BSAs as a solution to context-specific structural conditions.
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Affiliation(s)
- Carolyn Tarrant
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Andrew M. Colman
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester LE1 7RH, UK; (A.M.C.); (E.M.K.)
| | - David R. Jenkins
- Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK; (D.R.J.); (N.P.)
| | - Edmund Chattoe-Brown
- School of Media, Communication and Sociology, University of Leicester, Leicester LE1 7JA, UK;
| | - Nelun Perera
- Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK; (D.R.J.); (N.P.)
| | - Shaheen Mehtar
- Tygerberg Academic Hospital and Faculty of Health Sciences, Stellenbosch University, Cape Town 7505, South Africa; (S.M.); (M.B.)
| | - W.M.I. Dilini Nakkawita
- Department of Clinical Microbiology, Faculty of Medicine, General Sir John Kotelawala Defence University, Dehiwala-Mount Lavinia 10390, Sri Lanka;
| | - Michele Bolscher
- Tygerberg Academic Hospital and Faculty of Health Sciences, Stellenbosch University, Cape Town 7505, South Africa; (S.M.); (M.B.)
| | - Eva M. Krockow
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester LE1 7RH, UK; (A.M.C.); (E.M.K.)
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Point-of-Care Ultrasound: Applications in Low- and Middle-Income Countries. CURRENT ANESTHESIOLOGY REPORTS 2021; 11:69-75. [PMID: 33424456 PMCID: PMC7785781 DOI: 10.1007/s40140-020-00429-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 01/31/2023]
Abstract
Purpose of Review This review highlights the applications of point-of-care ultrasound in low- and middle-income countries and shows the diversity of ultrasound in the diagnosis and management of patients. Recent Findings There is a paucity of data on point-of-care ultrasound in anesthesiology in low- and middle-income countries. However, research has shown that point-of-care ultrasound can effectively help manage infectious diseases, as well as abdominal and pulmonary pathologies. Summary Point-of-care ultrasound is a low-cost imaging modality that can be used for the diagnosis and management of diseases that affect low- and middle-income countries. There is limited data on the use of ultrasound in anesthesiology, which provides clinicians and researchers opportunity to study its use during the perioperative period.
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Deka S, Kalita D, Mahanta P, Baruah D. High Prevalence of Antibiotic-Resistant Gram-Negative Bacteria Causing Surgical Site Infection in a Tertiary Care Hospital of Northeast India. Cureus 2020; 12:e12208. [PMID: 33489616 PMCID: PMC7815295 DOI: 10.7759/cureus.12208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 01/23/2023] Open
Abstract
Background and objective Surgical site infections (SSI) are the most common healthcare-associated infections in low- and middle-income countries associated with substantial morbidity and mortality and impose heavy demands on healthcare resources. We aimed to study the microbiological profile of SSI pathogens and their antibiotic-resistant patterns in a tertiary care teaching hospital serving mostly rural population Methods A prospective, hospital-based cross-sectional study on pathogen profile and drug resistance was conducted from January 2015 to December 2016. Study subjects were the patients who developed signs of SSI after undergoing surgical procedures at three surgical wards (General Surgery, Orthopedics, and Obstetrics & Gynecology). The selection of the patients was based on CDC Module. Standard bacteriological methods were applied for isolation of pathogens and antibiotic-susceptibility testing based on CLSI (Clinical Laboratory Standard Institute) guidelines. Results Out of 518 enrolled subjects, 197 showed growth after aerobic culture yielding 228 pathogen isolates; 12.2% of samples showed polymicrobial growth. Escherichia coli (22.4%) and Klebsiella species (20.6%) were the predominant isolated bacteria followed by Staphylococcus species (18.4%), Pseudomonas species (12.3%), and Enterococcus species (6.6%). Gram-negative bacteria (GNB) were highly resistant to ampicillin (90.1%) and cefazolin (85.9%). High resistance was also observed to mainstay drugs like ceftriaxone (48.4%), cefepime (61%), amoxycillin-clavulanic acid (43.4%), and ciprofloxacin/levofloxacin (37.7%). Among the Gram-positive cocci, Staphylococcus aureus showed 85-96% resistance to penicillin and 65-74% to ampicillin. But GPCs were relatively less resistant to quinolones (16-18%) and macrolides (21.5%). S. aureus was 100% sensitive to vancomycin and clindamycin but vancomycin-resistant Enterococci was encountered in 3/15 (20%) isolates. Conclusion GNBs were responsible for more than two-thirds of aerobic-culture positive SSI and showed high resistance to the commonly used antibiotics thus leaving clinicians with few choices. This necessitates periodic surveillance of causative organisms and their antibiotic-susceptibility pattern to help in formulating hospital antibiotic policy. The antibiotic stewardship program is yet to be adopted in our hospital.
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Affiliation(s)
- Sangeeta Deka
- Medical Microbiology, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, IND
- Medical Microbiology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Deepjyoti Kalita
- Microbiology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Putul Mahanta
- Forensic Medicine, Assam Medical College and Hospital, Dibrugarh, IND
| | - Dipankar Baruah
- Pathology, Fakhruddin Ali Ahmed Medical College, Barpeta, IND
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Improving sterile processing practices in Cambodian healthcare facilities. Infect Prev Pract 2020; 2:100101. [PMID: 34368729 PMCID: PMC8336156 DOI: 10.1016/j.infpip.2020.100101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/26/2020] [Indexed: 11/22/2022] Open
Abstract
Background Sterile processing practices in low-resource countries contribute to greater post-operative infection rates compared to high-resource countries. Provision of a sterile processing training program in Tanzania and Ethiopia demonstrated statistically significant improvements in sterile processing practice, a key requisite for safe surgical care. Aim To determine if a sterile processing program in a South East Asia country would result in improved conditions and practice in urban and rural healthcare facilities. Methods In 2019, a mixed-methods study was conducted with two cohorts in Cambodia, involving a total of eight healthcare facilities and 43 healthcare workers. Quantitative data were collected using a sterile processing assessment tool and a multiple-choice test pre- and post-training. Qualitative data in the form of interviews were obtained several months post-training. Findings Test results showed statistically significant and sustained effect of training over a four-six month period, as well as a large positive effect on SP knowledge in both cohorts. Analysis of hospital assessment data revealed an aggregate improvement of 36% in sterile processing benchmarks. While all participants reported increased knowledge and confidence (quantitative), rural participants conveyed a lack of support (qualitative) to implement practice changes. Conclusion The training course produced improvements in both rural and urban facilities. Findings highlight the importance of informing administrators of the rationale for needed improvements, ensuring funding is available to implement recommendations, and for governments to hold administrators accountable for improvements aligning with universally recommended sterile processing standards.
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Khan FU, Fang Y, Khan Z, Khan FU, Malik ZI, Ahmed N, Khan AH, Rehman A. Occurrence, associated risk factors, and treatment of surgical site infections in Pakistan. EUR J INFLAMM 2020. [DOI: 10.1177/2058739220960547] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Globally, surgical site infections are one of the common infections which lead to a large amount of mortality and morbidity in postsurgical care. The risk for surgical site infection is multidimensional which includes mainly; patient, surgery, and hospital-related factors. This study is aimed to determine the burden of SSIs along with contributed risk factors. A prospective observational cross-sectional study was conducted in one of the largest public-sector hospitals in Pakistan. A total of 412 patients were recruited in the study with full consent and monitored for 30 days after surgery with direct and indirect surveillance. Overall, in seven different surgical procedures the incidence (29.8%) rate of SSI was observed; in appendectomy ( n = 17, 4.1%), exploratory laparotomy ( n = 51, 12.6%), laparoscopic cholecystectomy ( n = 12, 2.90%), mesh repair ( n = 17, 4.01%), thyroidectomy (5, 1.2%), transurethral resection of the prostate ( n = 11, 2.6%), and transurethral resection of the bladder (10, 2.4%). The average SSI rate in every single procedure was about 18 (4.27%) per surgical procedure out of 123 (29.85%) SSI cases. Types of SSI identified were superficial, deep incisional and organ/space ( n = 76, 18.4%, n = 23, 5.5%, and n = 24, 5.7%). Incidence of SSIs during admission, at readmission, and post-surveillance cases were ( n = 50, 12.1%, n = 25, 6.0% and n = 48, 11.6%). Associated risk factors found contributed to the incidence of SSI ( p < 0.05). Pre-operative ( n = 348, 84.5%) and 6 (1.5%) surgical patients did not received the post-operative antibiotics. The P. aeruginosa ( n = 15, 12.1%) and S. aureus (13, 10.5%). Cefoperazone and sulbactam were the most prescribed antibiotics. Associated risk factors and treatment outcomes of surgical patients have a direct association with the incidence of SSI. Hospital-based antimicrobial stewardship, implementation of surgical guidelines, patient care, and education are needed to develop at wards level in hospitals.
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Affiliation(s)
- Faiz Ullah Khan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Health Science Centre, Xi’an Jiaotong University, China
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Health Science Centre, Xi’an Jiaotong University, China
| | - Zakir Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
- Department of Pharmacology, Institute of Health Sciences, Cukurova University, Adana, Turkey
| | - Farman Ullah Khan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Health Science Centre, Xi’an Jiaotong University, China
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Zafar Iqbal Malik
- Shaheed Zulfiqar Ali Bhutto Medical University, and General Surgical Wards, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Naveed Ahmed
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Amir Hayat Khan
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden Penang, Malaysia
| | - Asim.ur. Rehman
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
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Sartelli M, C. Hardcastle T, Catena F, Chichom-Mefire A, Coccolini F, Dhingra S, Haque M, Hodonou A, Iskandar K, Labricciosa FM, Marmorale C, Sall I, Pagani L. Antibiotic Use in Low and Middle-Income Countries and the Challenges of Antimicrobial Resistance in Surgery. Antibiotics (Basel) 2020; 9:E497. [PMID: 32784880 PMCID: PMC7459633 DOI: 10.3390/antibiotics9080497] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 12/13/2022] Open
Abstract
Antimicrobial resistance (AMR) is a phenomenon resulting from the natural evolution of microbes. Nonetheless, human activities accelerate the pace at which microorganisms develop and spread resistance. AMR is a complex and multidimensional problem, threatening not only human and animal health, but also regional, national, and global security, and the economy. Inappropriate use of antibiotics, and poor infection prevention and control strategies are contributing to the emergence and dissemination of AMR. All healthcare providers play an important role in preventing the occurrence and spread of AMR. The organization of healthcare systems, availability of diagnostic testing and appropriate antibiotics, infection prevention and control practices, along with prescribing practices (such as over-the-counter availability of antibiotics) differs markedly between high-income countries and low and middle-income countries (LMICs). These differences may affect the implementation of antibiotic prescribing practices in these settings. The strategy to reduce the global burden of AMR includes, among other aspects, an in-depth modification of the use of existing and future antibiotics in all aspects of medical practice. The Global Alliance for Infections in Surgery has instituted an interdisciplinary working group including healthcare professionals from different countries with different backgrounds to assess the need for implementing education and increasing awareness about correct antibiotic prescribing practices across the surgical pathways. This article discusses aspects specific to LMICs, where pre-existing factors make surgeons' compliance with best practices even more important.
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Affiliation(s)
| | - Timothy C. Hardcastle
- Trauma Service, Inkosi Albert Luthuli Central Hospital and Department of Surgery, Nelson R. Mandela School of Clinical Medicine, Durban 4058, South Africa;
| | - Fausto Catena
- Department of Emergency Surgery, Parma Maggiore Hospital, 43126 Parma, Italy;
| | - Alain Chichom-Mefire
- Department of Surgery and Obs/Gyn, Faculty of Health Sciences University of Buea, Buea P.O. Box 63, South West Province, Cameroon;
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Cisanello University Hospital, 56100 Pisa, Italy;
| | - Sameer Dhingra
- School of Pharmacy, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Eric Williams Medical Sciences Complex, Uriah Butler Highway, Champ Fleurs 33178, Trinidad and Tobago;
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur 57000, Malaysia;
| | - Adrien Hodonou
- Department of General Surgery, Regional Hospital Borgou, Faculty of Medicine, University of Parakou, Parakou P.O. Box 123, Benin;
| | - Katia Iskandar
- Department of Pharmacy, Lebanese, International University, Beirut 1106, Lebanon;
| | | | - Cristina Marmorale
- Department of Surgery, Università Politecnica delle Marche, 60126 Ancona, Italy;
| | - Ibrahima Sall
- General Surgery Department, Military Teaching Hospital, Dakar 3006, Senegal;
| | - Leonardo Pagani
- Infectious Diseases Unit, Bolzano Central Hospital, 39100 Bolzano, Italy;
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Khatri R, Sawyer R. Global Perspectives in Controversies Related to the Management of Intra-Abdominal Infections. Surg Infect (Larchmt) 2020; 21:626-633. [PMID: 32543289 DOI: 10.1089/sur.2020.174] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Intra-abdominal infections (IAI) remain a substantial cause of worldwide morbidity, mortality, and healthcare cost burden. The World Surgical Infection Society (WSIS) was organized to help improve global outcomes from surgical infections. An initial project for the WSIS was to assess how surgeons treat common IAI in their regions. Methods: A 10-item questionnaire was distributed to members of four surgical societies dedicated to the study of surgical infections. Questions were related to common treatment decisions in the management of IAI, with the intention of identifying differences and potential controversies in patient care. Responses were analyzed by comparing percentages with 95% confidence intervals. Results: Globally, management was relatively similar for peritoneal irrigation (most commonly with saline or other crystalloid: China, 83.2% ± 5.8%; North America, 93.2% ± 6.4%; Europe, 85.7% ± 25.9%; and Latin America, 71.8% ± 6.9%). More varied responses were seen for the management of specific disease states; for instance, for cholangitis, endoscopic retrograde cholangiopancreatic interventions were more common in North America (83.1% ± 9.6%) and less common in China (28.1% ± 7.0%). For appendiceal abscesses, percutaneous drainage and antibiotic treatment was most common in North America (93.2% ± 6.4%) and least common in Latin America (19.6% ± 6.1%). Additionally, the management of fascial and wound closures were different by region. Vacuum-assisted wound closure after fascial closure was utilized commonly in North America (32.2% ± 11.9%), Europe (28.6% ± 33.5%), and Latin America (27.6% ± 6.9%), however, was less commonly utilized in China (9.9% ± 4.4%), where there was higher rate of primary skin closure (85.7% ± 5.4%). Conclusion: Through its partnership with other surgical infection societies, the WSIS aims to develop evidence-based guidelines for more consistent pattern of IAI management globally. Delving further into why their practices differ may help improve worldwide outcomes.
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Affiliation(s)
- Richa Khatri
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA
| | - Robert Sawyer
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA
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