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Okishio Y, Ueda K, Nasu T, Kawashima S, Kunitatsu K, Masuda M, Ichimiya M, Uyama S, Kato S. Intraoperative techniques to prevent deep incisional or organ-space surgical site infection after emergency surgery for nonappendiceal perforation peritonitis: a prospective two-center observational study. Eur J Trauma Emerg Surg 2023; 49:2215-2224. [PMID: 37300696 DOI: 10.1007/s00068-023-02301-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE The rate of surgical site infection (SSI) after surgery for secondary peritonitis is very high. This study investigated the relationship between intraoperative procedures of emergency surgery for nonappendiceal perforation peritonitis and deep incisional or organ-space SSI. METHODS This prospective, two-center observational study included patients aged ≥ 20 years who underwent emergency surgery for perforation peritonitis between April 2017 and March 2020. We compared patients with deep incisional or organ-space SSI (Group S) to patients without SSIs or with superficial incisional SSIs (Group C). Thereafter, we evaluated the association between intraoperative technical variables and deep incisional or organ-space SSI using a multivariate logistic regression model. All multivariate analyses were adjusted for potentially relevant risk factors (e.g., age, body mass index, diabetes, smoking habit, and National Nosocomial Infection Surveillance risk index). RESULTS Of the 75 participants, 14 were in Group S and 61 were in Group C. The use of a wound protector device was significantly associated with decreased odds of deep incisional or organ-space SSI (adjusted odds ratios [AOR], 0.017; 95% confidence intervals [CI] 0.0014-0.19, p = 0.0011). A 1000 ml increase in intra-abdominal lavage with normal saline was significantly associated with increased odds of deep incisional or organ-space SSI (AOR: 1.28, 95% CI 1.02-1.61, p = 0.033). CONCLUSION Wound protector devices should be used in emergency surgery for nonappendiceal perforation peritonitis. Excessive intra-abdominal lavage with normal saline for peritonitis may have unsatisfactory benefits and increases the incidence of deep incisional or organ-space SSI.
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Affiliation(s)
- Yuko Okishio
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan.
| | - Kentaro Ueda
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Toru Nasu
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
- Department of Emergency Medicine, Katsuragi Hospital, Kishiwada, Japan
| | - Shuji Kawashima
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Kosei Kunitatsu
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Mitsuru Masuda
- Department of Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Masato Ichimiya
- Department of Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Shiro Uyama
- Department of Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Seiya Kato
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
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Vicentini C, Elhadidy HSMA, Marengo N, Paladini G, Cornio AR, Zotti CM. Mortality and Case Fatality Rates Associated With Surgical Site Infections: A Retrospective Surveillance Study. Surg Infect (Larchmt) 2023; 24:734-740. [PMID: 37669111 DOI: 10.1089/sur.2023.082] [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: 09/07/2023] Open
Abstract
Background: Surgical site infections (SSIs) have been associated with increases in terms of costs, hospital stay, morbidity, and mortality. We aimed to assess trends in SSIs monitored through 10 years of surveillance activities in our region, and to describe mortality attributable to SSIs in the two most frequently monitored surgical procedures: colorectal surgery and hip arthroplasty. Methods: A retrospective cohort study was conducted among the 42 hospitals participating in the surveillance network of our region in northern Italy. All colorectal and hip arthroplasty procedures performed between January 1st, 2010, and December 31st, 2019, and monitored through the surveillance system were included in the study. Surgical site infection rates, overall mortality, case fatality rates (CFR), and mortality attributable to SSIs were evaluated overall and by year of participation in the surveillance program. Results: In total, 11,417 colon surgery and 20,804 hip arthroplasty procedures were included. Among colon surgery procedures, SSI rates decreased from 9.21% in 2010 to 5.7% in 2019. A significant decreasing trend was found for overall mortality (p = 0.008), which progressively decreased from 4.96% in 2010 to 2.96% in 2019. Among hip arthroplasty procedures, no significant trend emerged for SSI and mortality rates. Considering the 10-year period, the CFR was 6.62% and 3.7% for SSIs after colon surgery and hip arthroplasty procedures, respectively. Conclusions: The impact of SSIs on the clinical outcomes of patients undergoing surgery highlights the importance of SSI surveillance.
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Affiliation(s)
- Costanza Vicentini
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
| | | | - Noemi Marengo
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
| | - Giovanni Paladini
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
| | | | - Carla Maria Zotti
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
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Ali A, Gebretsadik D, Desta K. Incidence of surgical site infection, bacterial isolate, and their antimicrobial susceptibility pattern among patients who underwent surgery at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia. SAGE Open Med 2023; 11:20503121231172345. [PMID: 37214212 PMCID: PMC10192803 DOI: 10.1177/20503121231172345] [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: 11/29/2022] [Accepted: 04/11/2023] [Indexed: 05/24/2023] Open
Abstract
Objective Surgical site infection is the most common postoperative complication worldwide, representing a major burden for patients and health systems. The aim of the study is to determine the incidence and bacterial profile that cause surgical site infection among patients who underwent surgery in parts of Northeast Ethiopia. Methods A health facility-based cross-sectional study was conducted in Dessie Comprehensive Specialized Hospital from July 22 to October 25, 2016. A total of 338 patients from the obstetrics and gynecology and general surgical wards were included, through consecutive sampling technique. The specimens were collected aseptically on the first day when the patients had presented with clinical evidence of infection and then sent to the microbiology laboratory. The data were entered and analyzed by SPSS version 20, and the results were explained by frequency distribution in tables and figures. Results The majority of participants were female (74.3%) and more than half (61.2%) of the surgeries were performed in the gynecology and obstetrics ward. Clinically, 49 patients (14.5%) were diagnosed as developing surgical site infection, and wound swabs were taken for bacteriological study. About 41 (83.7%) swabs showed bacterial growth, indicating 12.13% overall prevalence of bacterial surgical site infection. Out of 48 bacterial isolates, more than half (56.25%) of them were Gram negative. The most frequent isolate was Staphylococcus aureus, 14 (66.67%), followed by Escherichia coli, 9 (33.33%). Out of the total bacterial isolates, 38 (79.2%) isolates were found to be multidrug resistant, and the rate of multidrug resistant was higher among Gram-negative isolates. Conclusion An average rate of surgical site infection was found to be reported and significant numbers of bacterial isolates were also detected. The highest rate of surgical site infection was reported in prostate surgery, followed by small bowel, vaginal hysterectomy, and exploratory laparotomy surgical procedures. Periodic surveillance on the incidence rate and bacterial profile along with the determination of their antibiotic susceptibility should be performed.
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Affiliation(s)
- Abdurrahman Ali
- Department of Medical Laboratory
Science, College of Medicine and Health Sciences, Wollo University, Dessie,
Ethiopia
| | - Daniel Gebretsadik
- Department of Medical Laboratory
Science, College of Medicine and Health Sciences, Wollo University, Dessie,
Ethiopia
| | - Kassu Desta
- Department of Medical Laboratory
Sciences, School of Allied Health Sciences, College of Health Science, Addis Ababa
University, Addis Ababa, Oromia, Ethiopia
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Horgan S, Saab MM, Drennan J, Keane D, Hegarty J. Healthcare professionals' knowledge and attitudes of surgical site infection and surveillance: A narrative systematic review. Nurse Educ Pract 2023; 69:103637. [PMID: 37062123 DOI: 10.1016/j.nepr.2023.103637] [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: 12/08/2022] [Revised: 03/24/2023] [Accepted: 04/04/2023] [Indexed: 04/18/2023]
Abstract
AIM This systematic review reports on healthcare professionals' knowledge and attitudes of surgical site infection and surgical site infection surveillance as well as interventions aimed at enhancing healthcare professionals' knowledge and attitudes. BACKGROUND Surgical site infection is a serious adverse outcome following surgery. Despite the presence of international guidelines, the prevention of surgical site infections remains a challenge for patients and hospitals. It is critical that healthcare professionals have sufficient knowledge on surgical site infection and on their role in implementing evidence-based prevention strategies. DESIGN This review is reported using the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines. METHODS A search was undertaken in the following databases: Academic Search Complete, CINAHL, ERIC, MEDLINE, PsycARTICLES, PsycINFO and Web of Science for studies published between January 2010 and March 2022. Studies that examined healthcare professionals' knowledge and attitudes in relation to surgical site infection, surgical site infection surveillance and risk factors for their development were included. We also included studies that examined interventions that aimed to enhance healthcare professionals' knowledge and attitude in relation to surgical site infection, surveillance, and risk factors. We also described the impact of such interventions on the incidence of surgical site infections. RESULTS A total of 26 studies were included. Results were synthesised narratively according to the review objectives. Findings from this review show that knowledge of what surgical site infection is and its prevention was poor amongst healthcare professionals, while attitudes were positive particularly in relation to healthcare professionals' role in prevention. Only three studies examined the effects of interventions on healthcare professionals' knowledge of surgical site infection and surgical site infection prevention. Of those, two used multimodal educational interventions and found statistically significant improvement in knowledge. CONCLUSIONS Overall knowledge of surgical site infection and its prevention is poor amongst healthcare professionals, while attitudes were positive particularly in relation to healthcare professionals' role in prevention. There is a need for more experimental research to evaluate interventions which aim to address healthcare professionals' knowledge and attitudes towards surgical site infection prevention and surveillance. Such studies should include all healthcare professionals involved in the care of a surgical patient. TWEETABLE ABSTRACT Knowledge and attitudes of surgical site infection prevention amongst healthcare professionals.
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Affiliation(s)
- Sinéad Horgan
- Department of Nursing and Midwifery, South/South West Hospitals Group, Erinville, Western Road, Cork, Ireland; Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland.
| | - Mohamad M Saab
- Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Jonathan Drennan
- Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Danielle Keane
- Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland
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Image-based digital post-discharge surveillance in England: measuring patient enrolment, engagement, clinician response times, surgical site infection, and carbon footprint. J Hosp Infect 2023; 133:15-22. [PMID: 36642336 DOI: 10.1016/j.jhin.2023.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Surgical site infections (SSIs) can have a significant impact on patients, their families and healthcare providers. With shortening inpatient periods, the post-discharge element of surveillance is becoming increasingly important. Proactive surveillance, including digital wound images using patient smartphones, may be an efficient alternative to traditional methods for collecting post-discharge surveillance (PDS). AIM To determine success in patient enrolment and engagement including reasons for non-response, the time for clinicians to respond to patients, SSI rates, and carbon emissions when conducting PDS using patient smartphones. METHODS An evaluation was undertaken for a one-month period (June 2022) in two adult cardiac surgery services which routinely used patient smartphones for PDS, using the secure Islacare (Isla) system. FINDINGS The initial patient response rate for Isla was 87.3%, and the majority of patients (73%) remained engaged throughout the 30-day period. There was no significant difference in age, gender, operation type or distance to hospital between Isla responders or non-responders, or if the hospital provided a photo at discharge or not. Patients using Isla had a shorter post-discharge stay (P = 0.03), although this was not attributed to the platform. Patients not owning a smartphone and a technical issue were the main barriers to participation. Overall, nine SSIs were recorded, eight through the Isla surveillance and one through a hospital transfer readmission. The carbon emission associated with the SSI ranged from 5 to 2615 kg CO2e. CONCLUSION In a real-world setting, using patient smartphones is an effective method to collect PDS, including wound images.
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Marrone M, Caricato P, Mele F, Leonardelli M, Duma S, Gorini E, Stellacci A, Bavaro DF, Diella L, Saracino A, Dell'Erba A, Tafuri S. Analysis of Italian requests for compensation in cases of responsibility for healthcare-related infections: A retrospective study. Front Public Health 2023; 10:1078719. [PMID: 36684913 PMCID: PMC9849901 DOI: 10.3389/fpubh.2022.1078719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/14/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction The aim of this study was to examine the type of compensation claims for alleged medical malpractice in the field of healthcare-related infections in Italy. Methods It was analyzed which was the most frequent clinical context, the characteristics of the disputes established, which were the alleged damages most often complained of, which were the possibly censurable behaviors of the health professionals, and which were the reasons for acceptance or rejection of the request for compensation. Results In 90.2%, the issue questioned regarded surgical site infections. The most common pathogens involved were coagulase-negative Staphylococci (34.1%) and Staphylococcus aureus (24.4%). The lack or non-adherence to protocols of prophylaxis and/or prevention of healthcare-related infections was the most reported cause of acceptance of the request of compensation. Discussion According to our data, a stronger effort should be made in terms of risk management perspective in order to ensure the develop and application of protocols for prevention of Gram-positive healthcare-related infections and strengthen infection control and antimicrobial stewardship programs.
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Affiliation(s)
- Maricla Marrone
- Section of Legal Medicine, Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Pierluigi Caricato
- Section of Legal Medicine, Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Federica Mele
- Section of Legal Medicine, Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Mirko Leonardelli
- Section of Legal Medicine, Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Stefano Duma
- Section of Legal Medicine, Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Ettore Gorini
- Attorney of Supreme Court, Department of Economics and Finance, Aldo Moro University of Bari, Bari, Italy
| | - Alessandra Stellacci
- Section of Legal Medicine, Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Davide Fiore Bavaro
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, Aldo Moro University of Bari, Bari, Italy
| | - Lucia Diella
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, Aldo Moro University of Bari, Bari, Italy
| | - Annalisa Saracino
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, Aldo Moro University of Bari, Bari, Italy
| | - Alessandro Dell'Erba
- Section of Legal Medicine, Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Silvio Tafuri
- Section of Public Health, Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Bari, Italy
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Wilcox MH, Dryden M. Update on the epidemiology of healthcare-acquired bacterial infections: focus on complicated skin and skin structure infections. J Antimicrob Chemother 2021; 76:iv2-iv8. [PMID: 34849996 PMCID: PMC8632754 DOI: 10.1093/jac/dkab350] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Healthcare-associated infections (HCAIs) are a threat to patient safety and cause substantial medical and economic burden in acute care and long-term care facilities. Risk factors for HCAIs include patient characteristics, the type of care and the setting. Local surveillance data and microbiological characterization are crucial tools for guiding antimicrobial treatment and informing efforts to reduce the incidence of HCAI. Skin and soft tissue infections, including superficial and deep incisional surgical site infections, are among the most frequent HCAIs. Other skin and soft tissue infections associated with healthcare settings include vascular access site infections, infected burns and traumas, and decubitus ulcer infections.
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Affiliation(s)
- Mark H Wilcox
- Department of Medical Microbiology, Leeds Teaching Hospitals & University of Leeds, Leeds, UK
| | - Matthew Dryden
- Hampshire Hospitals NHS Foundation Trust, Winchester, UK
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Bekiari A, Pappas-Gogos G, Dimopoulos D, Priavali E, Gartzonika K, Glantzounis GK. Surgical site infection in a Greek general surgery department: who is at most risk? J Wound Care 2021; 30:268-274. [PMID: 33856911 DOI: 10.12968/jowc.2021.30.4.268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Surgical site infections (SSIs) are associated with protracted hospitalisation, antibiotics administration, and increased morbidity and mortality. This work investigated the incidence rate of SSIs in the Department of General Surgery at the University Hospital of Ioannina, Greece, the associated risk factors and pathogens responsible. METHOD In this prospective cohort study, patients who underwent elective procedures under general anaesthesia were enrolled. Risk factors monitored included age, sex, body mass index, smoking, alcohol consumption, preoperative length of stay, chemoprophylaxis, intensive care unit (ICU) stay, American Society of Anesthesiology (ASA) score, and the National Nosocomial Infections Surveillance System (NNIS) basic SSI risk index. RESULTS Of the 1058 enrolled patients, 80 (7.6%) developed SSIs. Of the total cohort, 62.5% of patients received chemoprophylaxis for >24 hours. A total of 20 different pathogens, each with multiple strains (n=108 in total), were identified, 53 (49.5%) Gram-negative rods, 46 (42%) Gram-positive cocci, and nine (8.4%) fungi (Candida spp.). Escherichia coli was the prevalent microorganism (24.3%). SSI-related risk factors, as defined by univariate analysis, included: ICU stay, ASA score >2 (p<0.001), NNIS score >0, and wound classes II, III, and IV. Also, serum albumin levels <3.5g/dl were associated with increased rate of SSIs. The multivariate model identified an NNIS score of >0 and wound classes II, III, and IV as independent SSI-related risk factors. CONCLUSION This study showed high SSI rates. Several factors were associated with increased SSI rates, as well as overuse of prophylactic antibiotics. The results of the present study could be a starting point for the introduction of a system for recording and actively monitoring SSIs in Greek hospitals, and implementation of specific guidelines according to risk factors.
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Affiliation(s)
- Anna Bekiari
- Department of Surgery, University Hospital of Ioannina and School of Medicine, University of Ioannina, Greece
| | - George Pappas-Gogos
- Department of Surgery, University Hospital of Ioannina and School of Medicine, University of Ioannina, Greece
| | - Dimitrios Dimopoulos
- Department of Medical Physics, School of Medicine, University of Ioannina, Greece
| | - Efthalia Priavali
- Department of Microbiology, University Hospital of Ioannina and School of Medicine, University of Ioannina, Greece
| | - Konstantina Gartzonika
- Department of Microbiology, University Hospital of Ioannina and School of Medicine, University of Ioannina, Greece
| | - Georgios K Glantzounis
- Department of Surgery, University Hospital of Ioannina and School of Medicine, University of Ioannina, Greece
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Morita S, Tsuruta M, Okabayashi K, Ishida T, Shigeta K, Seishima R, Itano O, Hasegawa H, Kitagawa Y. Impact of intraoperative hypocapnia on postoperative complications in laparoscopic surgery for colorectal cancer. Surg Today 2021; 52:278-286. [PMID: 34185158 DOI: 10.1007/s00595-021-02315-4] [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: 11/28/2020] [Accepted: 05/12/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE In laparoscopic surgery (LS) for colorectal cancer (CRC), the relationship between intraoperative end-tidal carbon dioxide concentration (EtCO2) and surgery-related complications remains unexplored. This study assessed the impact of intraoperative EtCO2 on postoperative complications in LS for CRC. METHODS In total, 909 patients who underwent LS for CRC were enrolled. Hypocapnia and hypercapnia were defined as EtCO2 < 35 mmHg and > 40 mmHg, respectively, and the relationships between hypocapnia or hypercapnia duration and postoperative complications were analyzed. RESULTS The median (range) durations of hypocapnia and hypercapnia were 2.0 (0-8.3) h and 0.3 (0-5.8) h, respectively. Complications were observed in 208 cases (23.0%), which included 37 (4.1%) instances of anastomotic leakage and 86 (9.5%) of superficial surgical site infection (SSI). While the hypercapnia duration was not associated with the short-term outcomes, prolonged hypocapnia was significantly correlated with complications (p = 0.02), specifically superficial SSI (p = 0.005). Multivariate analyses adjusted for confounding factors confirmed that hypocapnia prolongation was an independent risk factor for postoperative superficial SSI [OR 1.19; 95% confidence interval (Cl) 1.03-1.36, p = 0.01]. CONCLUSION Intraoperative hypocapnia may be a risk factor for postoperative complications, in particular superficial SSI, in LS for CRC.
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Affiliation(s)
- Satoru Morita
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masashi Tsuruta
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. .,Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare Narita Hospital, Chiba, Japan.
| | - Koji Okabayashi
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takashi Ishida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | - Kohei Shigeta
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Ryo Seishima
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Osamu Itano
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | - Hirotoshi Hasegawa
- Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Storey A, MacDonald B, Rahman MA. The association between preoperative length of hospital stay and deep sternal wound infection: A scoping review. Aust Crit Care 2021; 34:620-633. [PMID: 33750649 DOI: 10.1016/j.aucc.2020.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/10/2020] [Accepted: 12/13/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Deep sternal wound infection (DSWI) is a serious complication of cardiac surgery, associated with a significantly longer hospital stay, an increased mortality, and an almost doubling of treatment costs. The preoperative length of hospital stay has been suggested in a small number of studies as a modifiable risk factor yet is not included in surgical site infection prevention guidelines. The aim of this scoping review was to review the existing evidence on the association between preoperative length of hospital stay and DSWI, and to identify established risk factors for DSWI. METHODS A literature search of six electronic databases yielded 2297 results. Titles concerning risk factors for DSWI, sternal or surgical wound infection, or poststernotomy complications were included. Abstracts relating to preoperative length of stay as a risk factor for DSWI proceeded to full article review. Articles regarding paediatric surgery, DSWI management or unavailable in English were excluded. RESULTS The review identified 11 observational cohort studies. DSWI prevalence was between 0.9% and 6.8%. Preoperative length of stay ranged from 0-15.5 days and was found to be associated with DSWI in all studies. Preoperative length of stay and DSWI were inconsistently defined. Other risk factors for DSWI included diabetes, obesity, respiratory disease, heart failure, renal impairment, complex surgery, and reoperation (p < 0.05). CONCLUSION In this scoping review, an association between preoperative length of stay and the development of DSWI following cardiac surgery was identified. Thus, preoperative length of stay as a modifiable risk factor for DSWI should be considered for inclusion in cardiothoracic surgical infection prevention guidelines.
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Affiliation(s)
- Annmarie Storey
- Alfred Heart & Lung, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004, Australia; School of Nursing and Midwifery, La Trobe University, Plenty Rd & Kingsbury Dr, Bundoora, Melbourne, VIC 3086, Australia.
| | - Brendan MacDonald
- Alfred Heart & Lung, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004, Australia; Ward 2.2, Box Hill Hospital, Eastern Health, 8 Arnold St, Box Hill, Melbourne, Victoria, 3128, Australia
| | - Muhammad Aziz Rahman
- School of Health, Federation University Australia, Berwick, Melbourne, VIC 3806, Australia; Australian Institute of Primary Care and Ageing, La Trobe University, Melbourne, VIC 3086, Australia.
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11
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Caputo D, Coppola A, Farolfi T, La Vaccara V, Angeletti S, Cascone C, Ciccozzi M, Coppola R. The use of an implemented infection prevention bundle reduces the incidence of surgical site infections after colorectal surgery: a retrospective single center analysis. Updates Surg 2021; 73:2113-2124. [PMID: 33400250 DOI: 10.1007/s13304-020-00960-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/23/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surgical-site infections (SSIs) represent the most common complications after colorectal surgery (CS). Role of preoperative administration of oral antibiotic prophylaxis (OAP) and mechanical bowel preparation (MBP), alone or in combination, in the prevention of SSIs after CS is debated. Aim of this study was to assess the effect of the introduction of an Implemented Infection Prevention Bundle (IIPB) in preventing SSIs in CS. METHODS A group of 251 patients (Group 1) who underwent CS receiving only preoperative intravenous antibiotic prophylaxis (IAP) was compared to a Group of 107 patients (Group 2) who also received the IIPB. The IIPB consisted of the combination of oral administrations of three doses of Rifaximin 400 mg and MBP the day before surgery and in the administration of a cleansing enema the day of the surgical procedure. RESULTS At the univariate analysis, Group 2 showed significant lower rates of wound infection (WI) (2.8% vs. 9.9%; p = 0.021) and anastomotic leakage (AL) (2.8% vs. 14.7%; p = 0.001) with shorter hospital stay (5 vs. 6 days; p < 0.0001). The probability of postoperative AL was lower in Group 2; patients in this Group resulted protected from AL; a statistically significant Odds ratio of 0.16 (CI 0.05-0.55 p = 0.0034) was found. In diabetic patients, that were at higher risk of WI (OR 3.53, CI 1.49-8.35 p = 0.002), despite having any impact on anastomotic dehiscence, the use of IIPB significantly reduced the rate of WI (0% vs 28.1%; p = 0.01). CONCLUSION The use of an IIPB significantly reduces rates of SSIs and post-operative hospital stay after CS.
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Affiliation(s)
- Damiano Caputo
- Department of Surgery, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Alessandro Coppola
- Department of Surgery, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Tommaso Farolfi
- Department of Surgery, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy.
| | - Vincenzo La Vaccara
- Department of Surgery, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Chiara Cascone
- Department of Surgery, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistic and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Roberto Coppola
- Department of Surgery, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
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12
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López Barrachina R, de la Cruz Tabares E, Guzmán Collado IDLT. Incidence of surgical site infection in colon surgery according to RENAVE methodology: Prospective study 2017–2019. ACTA ACUST UNITED AC 2021. [DOI: 10.1016/j.cireng.2020.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Microbial Monitoring as a Tool for Preventing Infectious Risk in the Operating Room: Results of 10 Years of Activity. ATMOSPHERE 2020. [DOI: 10.3390/atmos12010019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Environmental microbial contamination in the operating room (OR) can favour contamination of the surgical wound, posing the risk of infection of the surgical site. Thus, environmental monitoring is a useful tool for assessing environmental health and the effectiveness and efficiency of the measures adopted to control the risk of infection in the OR. This work aimed to analyse the long term environmental quality of 18 ORs throughout Sardinia, Italy, through the quantitative and qualitative characterisation of the microbial flora present in the air and on surfaces, in order to evaluate the trend over time, including in relation to any control measures adopted. The results of the sampling carried out in the period from January 2010 to December 2019 have been extrapolated from the archive-database of the Laboratory of the Hygiene and Control of Hospital Infections Unit of the University Hospital in Sassari. During the period in question, 188 air evaluations were carried out, both in empty rooms and during surgery, and 872 surface samples were taken. When the air was monitored, it emerged that significant contamination was detectable in a reduced number of examinations and a limited number of rooms. Microbial load values higher than the reference values may have been mainly determined by sub-optimal operation/maintenance of the air conditioning system. Surface testing showed a good level of sanitisation, given the low percentage of non-compliant values detected. The possibility of having data available on environmental quality is a useful educational and training tool both for those responsible for sanitisation procedures and the surgical team, in order to increase awareness of the effects of a lack of compliance with behavioural standards.
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14
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Monzani R, Barbera G, Restelli U, Galeone C, Petrini F. Protocol Implementation for Normothermia in Surgery Settings in Italy: Budget-Impact Analysis. Risk Manag Healthc Policy 2020; 13:2347-2356. [PMID: 33154686 PMCID: PMC7608003 DOI: 10.2147/rmhp.s267923] [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: 06/16/2020] [Accepted: 10/01/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Hypothermia is a well-known risk of the perioperative period and considered a preventable effect of anesthesia care. Nevertheless, it is not fully controlled, causing a number of adverse outcomes following surgical operations and thus increasing length of stay in hospital and treatment costs. The aim of this study was to assess the budget impact (BI) of the implementation of proactive strategies to prevent inadvertent perioperative hypothermia (IPH) in surgical patients in Italy, as recommended by international guidelines and by a good clinical practice (GCP) guideline of the Italian Society of Anesthesia, Analgesia, Reanimation, and Intensive Care. Methods BI was calculated over a 3-year period from the perspective of the Italian National Health Service (NHS). Model inputs were extracted from national literature when available and otherwise from international sources. The reference analytic model was based on the cost-effectiveness analysis of the National Institute for Health and Care Excellence clinical guidance 65. Estimates were based on assessments made about current malpractice in Italy and on a hypothesis of how future practice might change by implementing the GCP. Model output included overall BI results, variations in the number of warmed patients, medical-device average costs and use of mix. Results The base-case estimate quantified a decrease of 35% in extra days of hospital stay due to IPH and a net BI of –€60.92 million. Conclusion Increasing protocol adoption for preventing IPH would lead to both clinical advantages and significant savings for the NHS. Its large diffusion in Italian hospitals is thus desirable.
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Affiliation(s)
- Roberta Monzani
- Day Hospital Chirurgico, IRCCS Humanitas Research Hospital Rozzano, Rozzano, Italy
| | | | - Umberto Restelli
- Centre for Health Economics, Social and Health Care Management Carlo Cattaneo University, Castellanza, Italy.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Carlotta Galeone
- Bicocca Applied Statistics Center (B-ASC), Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Flavia Petrini
- Anestesia, Rianimazione e Terapia Intensiva, Università Gabriele d'Annunzio - ASL 2 Abruzzo, Chieti, Italy
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15
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Pelullo CP, Pepe A, Napolitano F, Coppola N, Di Giuseppe G. Perioperative Antibiotic Prophylaxis: Knowledge and Attitudes among Resident Physicians in Italy. Antibiotics (Basel) 2020; 9:E357. [PMID: 32630396 PMCID: PMC7345233 DOI: 10.3390/antibiotics9060357] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 12/16/2022] Open
Abstract
The aim of this study is to evaluate knowledge and attitudes on the perioperative antibiotic prophylaxis (PAP) among surgery and anesthesiology resident physicians in Italy. A Web-based national survey of Italian surgery and anesthesiology resident physicians was conducted between March 2018 and January 2019. Participants completed a questionnaire and three case vignettes for each specialty. Of the 1282 resident physicians selected, 466 completed the online questionnaire for a response rate of 36.3%. More than half of the sample were female (52.9%), and the mean age was 30 years. A total of 36.3% of the participants had an adequate knowledge score about PAP. Multiple logistic regression analysis showed that resident physicians in general surgery compared to those in anesthesiology, those who agreed that PAP must be performed within 60 min before surgical incision, and those who were aware regarding the availability about the availability of national guidelines on PAP, were significantly more likely to have adequate knowledge about PAP. Moreover, 14% of participants were very concerned that patients may contract surgical site infections during hospitalization. These findings should be useful to promote educational intervention specifically targeted for surgery and anesthesiology resident physicians organizing training course on PAP, to improve the correct antibiotic use and to prevent healthcare-associated infections.
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Affiliation(s)
- Concetta Paola Pelullo
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80135 Naples, Italy; (C.P.P.); (A.P.); (F.N.)
| | - Angela Pepe
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80135 Naples, Italy; (C.P.P.); (A.P.); (F.N.)
| | - Francesco Napolitano
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80135 Naples, Italy; (C.P.P.); (A.P.); (F.N.)
| | - Nicola Coppola
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Gabriella Di Giuseppe
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80135 Naples, Italy; (C.P.P.); (A.P.); (F.N.)
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16
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López Barrachina R, de la Cruz Tabares E, Guzmán Collado IDLT. Incidence of surgical site infection in colon surgery according to RENAVE methodology: Prospective study 2017-2019. Cir Esp 2020; 99:34-40. [PMID: 32532474 DOI: 10.1016/j.ciresp.2020.05.008] [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: 01/15/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Navarra Hospital Complex has renovated its healthcare-associated infections surveillance and control methods meeting the requirements of the Spanish National Epidemiologic Surveillance Network. Surgical site infections are one of the most relevant adverse outcomes, being the colon surgery one of the mandatory monitored procedures. This system will ease, not only the yearly estimation of the hospital surgical infection rates, but also its comparison at national and European levels. METHODS 416 patients underwent surgery between 2017 and 2019. Clinical variables were gathered during the patient hospitalization and up to 30days from surgery, stratifying the cases by their NHSN (National Health Safety Network) surgical infection risk index. A univariant descriptive analysis was performed and outcome indicators were estimated. RESULTS The cumulative incidence was 10.6%, with 44 cases. The rates were higher among the high-risk subgroups: 25.0% and 42.9%, respectively, for NSHN index categories2 and3. CONCLUSIONS The incidence was similar to the ones found in other studies carried out in analogous conditions. However, the methodologic variability makes it difficult to compare results.
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Affiliation(s)
- Ruth López Barrachina
- Servicio de Medicina Preventiva e Higiene Hospitalaria, Complejo Hospitalario de Navarra, Pamplona, España.
| | - Enrique de la Cruz Tabares
- Servicio de Medicina Preventiva e Higiene Hospitalaria, Complejo Hospitalario de Navarra, Pamplona, España
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17
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Sartelli M, Pagani L, Iannazzo S, Moro ML, Viale P, Pan A, Ansaloni L, Coccolini F, D’Errico MM, Agreiter I, Amadio Nespola G, Barchiesi F, Benigni V, Binazzi R, Cappanera S, Chiodera A, Cola V, Corsi D, Cortese F, Crapis M, Cristini F, D’Arpino A, De Simone B, Di Bella S, Di Marzo F, Donati A, Elisei D, Fantoni M, Ferrari A, Foghetti D, Francisci D, Gattuso G, Giacometti A, Gesuelli GC, Marmorale C, Martini E, Meledandri M, Murri R, Padrini D, Palmieri D, Pauri P, Rebagliati C, Ricchizzi E, Sambri V, Schimizzi AM, Siquini W, Scoccia L, Scoppettuolo G, Sganga G, Storti N, Tavio M, Toccafondi G, Tumietto F, Viaggi B, Vivarelli M, Tranà C, Raso M, Labricciosa FM, Dhingra S, Catena F. A proposal for a comprehensive approach to infections across the surgical pathway. World J Emerg Surg 2020; 15:13. [PMID: 32070390 PMCID: PMC7029591 DOI: 10.1186/s13017-020-00295-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/10/2020] [Indexed: 02/08/2023] Open
Abstract
Despite evidence supporting the effectiveness of best practices in infection prevention and management, many healthcare workers fail to implement them and evidence-based practices tend to be underused in routine practice. Prevention and management of infections across the surgical pathway should always focus on collaboration among all healthcare workers sharing knowledge of best practices. To clarify key issues in the prevention and management of infections across the surgical pathway, a multidisciplinary task force of experts convened in Ancona, Italy, on May 31, 2019, for a national meeting. This document represents the executive summary of the final statements approved by the expert panel.
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Affiliation(s)
- Massimo Sartelli
- Department of Surgery, Macerata Hospital, ASUR Marche, Macerata, Italy
| | - Leonardo Pagani
- Infectious Diseases Unit, Bolzano Central Hospital, Bolzano, Italy
| | | | - Maria Luisa Moro
- Regional Agency for Health and Social Care, Emilia-Romagna Region–ASSR, Bologna, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, S. Orsola-Malpighi Hospital, “Alma Mater Studiorum”-University of Bologna, Bologna, Italy
| | - Angelo Pan
- Infectious Diseases, ASST di Cremona, Cremona, Italy
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Federico Coccolini
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Marcello Mario D’Errico
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Iris Agreiter
- Bone Marrow Transplant Unit, Denis Burkitt, St. James’s Hospital, Dublin, Ireland
| | | | - Francesco Barchiesi
- Infectious Diseases Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Valeria Benigni
- Clinical Administration, Senigallia Hospital, ASUR Marche, Senigallia, AN Italy
| | | | - Stefano Cappanera
- Infectious Diseases Clinic, Department of Medicine, “S. Maria” Hospital, Terni, University of Perugia, Perugia, Italy
| | | | - Valentina Cola
- Department of Hospital Pharmacy, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Daniela Corsi
- Department of Anesthesiology and Intensive Care Unit, Civitanova Marche Hospital, ASUR Marche, Civitanova Marche, MC Italy
| | - Francesco Cortese
- Emergency Surgery and Trauma Care Unit, San Filippo Neri Hospital, Rome, Italy
| | - Massimo Crapis
- Infectious Diseases Unit, Pordenone Hospital, Pordenone, Friuli-Venezia Giulia Italy
| | | | - Alessandro D’Arpino
- Hospital Pharmacy Unit, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Belinda De Simone
- Operative Unit of General Surgery, Azienda USL IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Stefano Di Bella
- Infectious Diseases Department, Trieste University Hospital, Trieste, Italy
| | | | - Abele Donati
- Department of Anesthesiology and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Daniele Elisei
- Department of Anesthesiology and Intensive Care Unit, Macerata Hospital, ASUR Marche, Macerata, Italy
| | - Massimo Fantoni
- Department of Infectious Diseases, Fondazione Policlinico A. Gemelli IRCCS, Istituto di Clinica delle Malattie Infettive, Università Cattolica S. Cuore, Rome, Italy
| | - Anna Ferrari
- Department of Critical Care Medicine Unit, San Filippo Neri Hospital, Rome, Italy
| | - Domitilla Foghetti
- Department of Surgery, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | | | - Gianni Gattuso
- Infectious Diseases Unit, Carlo Poma Hospital, Mantua, Italy
| | - Andrea Giacometti
- Infectious Diseases Clinic, Department of Biological Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | | | - Cristina Marmorale
- Department of Surgery, Marche Polytechnic University of Marche Region, Ancona, Italy
| | - Enrica Martini
- Hospital Hygiene Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | | | - Rita Murri
- Department of Infectious Diseases, Fondazione Policlinico A. Gemelli IRCCS, Istituto di Clinica delle Malattie Infettive, Università Cattolica S. Cuore, Rome, Italy
| | - Daniela Padrini
- Clinical Administration Santa Maria Annunziata Hospital, USL Toscana Centro, Florence, Italy
| | | | - Paola Pauri
- Unit of Microbiology and Virology, Senigallia Hospital, Senigallia, AN Italy
| | | | - Enrico Ricchizzi
- Regional Agency for Health and Social Care, Emilia-Romagna Region–ASSR, Bologna, Italy
| | - Vittorio Sambri
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
- Unit of Microbiology, The Great Romagna Area Hub Laboratory, Pievesestina, Cesena, Italy
| | | | - Walter Siquini
- Department of Surgery, Macerata Hospital, ASUR Marche, Macerata, Italy
| | - Loredana Scoccia
- Unit of Hospital Pharmacy, Macerata Hospital, ASUR Marche, Macerata, Italy
| | - Giancarlo Scoppettuolo
- Infectious Diseases Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gabriele Sganga
- Division of Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Marcello Tavio
- Infectious Diseases Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - Giulio Toccafondi
- Clinical Risk Management and Patient Safety Center, Tuscany Region, Florence, Italy
| | - Fabio Tumietto
- Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, S. Orsola-Malpighi Hospital, “Alma Mater Studiorum”-University of Bologna, Bologna, Italy
| | - Bruno Viaggi
- Department of Anesthesiology, Neuro Intensive Care Unit, Florence Careggi University Hospital, Florence, Italy
| | - Marco Vivarelli
- Unit of Hepato-Pancreato-Biliary and Transplant Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Cristian Tranà
- Department of Surgery, Macerata Hospital, ASUR Marche, Macerata, Italy
| | | | | | - Sameer Dhingra
- Faculty of Medical Sciences, School of Pharmacy, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Fausto Catena
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
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Danwang C, Bigna JJ, Tochie JN, Mbonda A, Mbanga CM, Nzalie RNT, Guifo ML, Essomba A. Global incidence of surgical site infection after appendectomy: a systematic review and meta-analysis. BMJ Open 2020; 10:e034266. [PMID: 32075838 PMCID: PMC7045165 DOI: 10.1136/bmjopen-2019-034266] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Although surgical site infection (SSI) is one of the most studied healthcare-associated infections, the global burden of SSI after appendectomy remains unknown. OBJECTIVE We estimated the incidence of SSI after appendectomy at global and regional levels. DESIGN Systematic review and meta-analysis. PARTICIPANTS Appendectomy patients. DATA SOURCES EMBASE, PubMed and Web of Science were searched, with no language restrictions, to identify observational studies and clinical trials published between 1 January 2000 and 30 December 2018 and reporting on the incidence of SSI after appendectomy. A random-effect model meta-analysis served to obtain the pooled incidence of SSI after appendectomy. RESULTS In total, 226 studies (729 434 participants from 49 countries) were included in the meta-analysis. With regard to methodological quality, 59 (26.1%) studies had low risk of bias, 147 (65.0%) had moderate risk of bias and 20 (8.8%) had high risk of bias. We found an overall incidence of SSI of 7.0 per 100 appendectomies (95% prediction interval: 1.0-17.6), varying from 0 to 37.4 per 100 appendectomies. A subgroup analysis to identify sources of heterogeneity showed that the incidence varied from 5.8 in Europe to 12.6 per 100 appendectomies in Africa (p<0.0001). The incidence of SSI after appendectomy increased when the level of income decreased, from 6.2 in high-income countries to 11.1 per 100 appendectomies in low-income countries (p=0.015). Open appendectomy (11.0 per 100 surgical procedures) was found to have a higher incidence of SSI compared with laparoscopy (4.6 per 100 appendectomies) (p=0.0002). CONCLUSION This study suggests a high burden of SSI after appendectomy in some regions (especially Africa) and in low-income countries. Strategies are needed to implement and disseminate the WHO guidelines to decrease the burden of SSI after appendectomy in these regions. PROSPERO REGISTRATION NUMBER CRD42017075257.
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Affiliation(s)
- Celestin Danwang
- Epidemiology and Biostatistics Unit, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Bruxelles, Belgium
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Jean Joel Bigna
- Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | - Joel Noutakdie Tochie
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Aimé Mbonda
- Department of General Medicine, Djohong District Hospital, Djohong, Cameroon
| | - Clarence Mvalo Mbanga
- Department of General Medicine, Mankon Sub-Divisional Hospital, Bamenda, North West Region, Cameroon
| | - Rolf Nyah Tuku Nzalie
- Department of General Medicine, Ngong District Hospital, Ngong, North Region, Cameroon
| | - Marc Leroy Guifo
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Arthur Essomba
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
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Gagliotti C, Buttazzi R, Ricciardi A, Ricchizzi E, Lanciotti G, Moro M. Use of health databases to deal with underreporting of surgical site infections due to suboptimal post-discharge follow-up. J Hosp Infect 2020; 104:239-242. [DOI: 10.1016/j.jhin.2019.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/09/2019] [Indexed: 10/26/2022]
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Surgical antimicrobial prophylaxis prescribing practices and impact on infection risk: Results from a multicenter surveillance study in Italy (2012-2017). Am J Infect Control 2019; 47:1426-1430. [PMID: 31400885 DOI: 10.1016/j.ajic.2019.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/15/2019] [Accepted: 07/15/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Italy is one of the largest consumers of broad-spectrum agents (BSAs) in Europe. This study evaluated surgical antimicrobial prophylaxis (SAP) compliance with the Italian national guidelines and its impact on surgical site infection (SSI) risk. METHODS A prospective study was conducted in 42 hospitals participating in the national surveillance system for SSIs. SAP compliance was evaluated considering antibiotic choice, duration of administration, and timing of first dose. Trends in the consumption of 5 BSAs were also evaluated. RESULTS Between 2012 and 2017, 24,861 surgical procedures were monitored. The risk ratios (RRs) for appropriate SAP increased by 22% each year, and significant increasing trends over time were found for overall compliance, timing, and duration. Adequate antibiotic choice and duration of administration were associated with a significantly reduced SSI risk (RR = 0.57; 95% confidence interval [CI], 0.5-0.65 vs RR = 0.51; 95% CI, 0.45-0.57, respectively), and overall compliance was associated with a RR of 0.65 (95% CI, 0.59-0.72). CONCLUSIONS These findings suggest that appropriate narrow-spectrum agents could be more effective than BSAs in preventing SSIs. Interventions to improve SAP compliance with guidelines could significantly contribute to reducing antimicrobial resistance by reducing SSIs and promoting more prudent use of antimicrobials.
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Vicentini C, Dalmasso P, Politano G, Furmenti MF, Quattrocolo F, Zotti CM. Surgical Site Infections in Italy, 2009–2015: Incidence, Trends, and Impact of Surveillance Duration on Infection Risk. Surg Infect (Larchmt) 2019; 20:504-509. [DOI: 10.1089/sur.2018.298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Costanza Vicentini
- Department of Public Health and Paediatrics, Università di Torino, Torino, Italy
| | - Paola Dalmasso
- Department of Public Health and Paediatrics, Università di Torino, Torino, Italy
| | - Gianfranco Politano
- Control and Computer Engineering Department, Politecnico di Torino, Torino, Italy
| | | | | | - Carla Maria Zotti
- Department of Public Health and Paediatrics, Università di Torino, Torino, Italy
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Mathur P, Mittal S, Trikha V, Lohiya A, Khurana S, Katyal S, Bhardwaj N, Sagar S, Kumar S, Malhotra R, Walia K. Protocol for developing a surveillance system for surgical site infections. Indian J Med Microbiol 2019; 37:318-325. [PMID: 32003328 DOI: 10.4103/ijmm.ijmm_19_446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Purpose Healthcare-associated infections (HCAIs/ HAIs) are the most common adverse occurrences during health care delivery. Across the globe, millions of patients are affected by HAIs annually, with a higher burden and impact in developing nations. a major lacuna in planning preventing protocols is the absence of National Surveillance Systems in most low-middle income countries, which also prevents allocation of resources to the high-priority areas. Among all the HAIs, there is a huge global burden of SSIs, in terms of morbidity, prolonged hospital stays, increased antimicrobial treatment as well as attributable mortality. Method This manuscript details the process of establishment of an SSI surveillance protocol at a level-1 trauma centre in North India. Result and Conclusion Surveillance is an essential tool to reduce this burden. It is also an important primary step in recognizing problems and priorities, and it plays a crucial role in identifying risk factors for SSI and to be able to target modifiable risk factors. Therefore, it is imperative to establish reliable systems for surveillance of HAIs, to regularly estimate the actual burden of HAIs, and to use these data for developing indigenous preventive measures, tailored to the country's priorities.
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Affiliation(s)
- Purva Mathur
- Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Samarth Mittal
- Department of Orthopedics, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Trikha
- Department of Orthopedics, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Ayush Lohiya
- Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Surbhi Khurana
- Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Sonal Katyal
- Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Nidhi Bhardwaj
- Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Sagar
- Division of Trauma Surgery, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Subodh Kumar
- Division of Trauma Surgery, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Malhotra
- Department of Orthopedics, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Kamini Walia
- Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
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Ansari S, Hassan M, Barry HD, Bhatti TA, Hussain SZM, Jabeen S, Fareed S. Risk Factors Associated with Surgical Site Infections: A Retrospective Report from a Developing Country. Cureus 2019; 11:e4801. [PMID: 31396469 PMCID: PMC6679712 DOI: 10.7759/cureus.4801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/30/2019] [Indexed: 11/24/2022] Open
Abstract
Introduction Any infection occurring at the site of a surgical incision superficially or deep within the fascia, within 30 days of a surgical procedure is termed as a surgical site infection (SSI). Due to limited resources, non-adherence to infection control guidelines and substandard sterilization practices, the incidence is higher in developing countries. The aim of this study is to estimate the incidence of surgical site infections in general surgeries at a tertiary care hospital in Pakistan and identify the predisposing risk factors. Methods This was a retrospective analysis that included all surgical records from June 1, 2018, to December 31, 2018. After exclusion, 882 records were included. The incidence of SSI and predisposing risk factors were noted. Data were entered and analyzed using SPSS v. 22.0 (IBM Corp, Armonk, NY, US). Results The incidence of SSI was 8.84% (n=78). SSIs were more common in older participants (11.4% vs. 6.4%; p=0.009), in patients with more than 24 hour of preoperative hospital stay (11.2% vs. 64%; p=0.013), in procedures of longer duration (1.53 ± 0.35 vs 2.57 ± 0.17; p<0.0001), and in emergency surgeries (19.2% vs. 7.5%; p=0.0001). The combined incidence of SSIs in American Society of Anesthesiologists (ASA) index III and above was 37 (47.4%) and that in I and II was 41 (52.6%) (p<0.00001). Conclusion This study has revealed a very high incidence of surgical site infections. These infections are more common in elderly patients, patients undergoing emergency surgeries, those with longer preoperative hospital stay and longer surgical duration, and patients with a high ASA index.
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Affiliation(s)
- Shahbaz Ansari
- Internal Medicine, Jinnah Postgraduate Medical Center, Karachi, PAK
| | | | - Habiba D Barry
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | | | | | - Shah Jabeen
- Physiology, Liaquat College of Medicine and Dentistry, Karachi, PAK
| | - Sundus Fareed
- Internal Medicine, Civil Hospital Karachi, Karachi, PAK
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Napolitano F, Tomassoni D, Cascone D, Di Giuseppe G. Evaluation of hospital readmissions for surgical site infections in Italy. Eur J Public Health 2019; 28:421-425. [PMID: 29206920 DOI: 10.1093/eurpub/ckx205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background The objectives of this investigation are to assess the prevalence of hospital readmissions for surgical site infections (SSIs) in patients aged ≥18 in Italy and to describe the clinical characteristics of these patients and evaluate the possible association with readmission for SSIs. Methods A retrospective epidemiological study was conducted between January and May 2015 considering a sample of patients aged ≥18 years admitted to the surgical wards of two hospitals in Naples and undergoing surgery in the year 2014. Results 3.8% of patients had been readmitted and 28.8% of them were readmitted to hospital due to SSIs. The multiple logistic regression model showed that readmissions for SSIs were significantly more common in smokers (odds ratio [OR] = 3.14; 95% confidence interval [CI] = 1.13-8.69), in patients with immunosuppression status (OR = 8.28; 95% CI = 1.76-38.87), in patients with low serum albumin (OR = 3.07; 95% CI = 1.05-9.01) and in patients who had undergone a surgical procedure classified as contaminated (OR = 10:44; 95% CI = 3.11-35.01) compared with those that had undergone a surgical procedure classified as clean. Conclusions The results point to the need that hospital infection prevention strategies are implemented in order to reduce morbidity and mortality for patients. Moreover, the measures taken to prevent infections would lead to a reduction in health spending since almost one third of readmissions to the hospital in our study were due to SSIs.
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Affiliation(s)
- Francesco Napolitano
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Davide Tomassoni
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Diana Cascone
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Gabriella Di Giuseppe
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
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Chungsiriwattana W, Sangkhathat S, Kongkamol C, Suwalak N, Phainuphong P, Komet O, Darayon R. Decreasing Trend of Surgical Site Infections among Surgical Patients in a University Hospital in Thailand after an Active Surveillance Program. Surg Infect (Larchmt) 2019; 20:382-389. [PMID: 30801228 DOI: 10.1089/sur.2018.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Reports from high-quality healthcare systems have shown that active surveillance and management of factors associated with surgical site infection (SSI) decreased the incidence and improved overall outcomes. Methods: This study aimed to appraise the incidence trend of SSIs during the 10-year period between 2007 and 2016 in a university hospital in a middle-income country, focusing on six high-risk and high-volume procedures. The study also examined factors associated with SSIs and their impact on surgical outcomes. Results: A total of 10,139 procedures in 9,661 cases were reviewed. The overall incidence of SSI was 2.98%. The incidence increased substantially with increasing risk score according to the National Nosocomial Infection Surveillance (NNIS) system risk score. The incidence trend decreased over time during the 10-year period studied. The procedures with the highest SSI incidence were craniotomy, colonic surgery, and cholecystectomy, which were also the three procedures that had standardized infection ratios (SIR) higher than 1.0 in all risk score categories. Univariable analysis found that diabetes mellitus was the only risk factor associated with SSI (odds ratio [OR] 1.81, 95% confidence interval [CI] 1.2-2.73). The majority of the positive cultures were gram-negative bacteria (45%) and 49% of all reported organisms were drug resistant. There were two important consequences of the infections: length of hospitalization increased substantially from 13 days to 24 days (p < 0.01) and patients with SSI had more than three times higher mortality rate (7% compared with 1.9%, p < 0.001). Conclusion: With active surveillance, the incidence of SSIs decreased to less than 2.0% over the 10-year study period. More intensive surveillance should implemented for operations with high SIR and cases with diabetes mellitus.
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Affiliation(s)
| | - Surasak Sangkhathat
- 1 Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Chanon Kongkamol
- 2 Occupational Medicine Unit, Department of Family Medicine and Preventive Medicine Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Nonglak Suwalak
- 3 Infection Control Unit, Songklanagarind Hospital, Hat Yai, Songkhla, Thailand
| | | | - Ornanong Komet
- 3 Infection Control Unit, Songklanagarind Hospital, Hat Yai, Songkhla, Thailand
| | - Rungtip Darayon
- 3 Infection Control Unit, Songklanagarind Hospital, Hat Yai, Songkhla, Thailand
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Implementation strategies to reduce surgical site infections: A systematic review. Infect Control Hosp Epidemiol 2019; 40:287-300. [PMID: 30786946 DOI: 10.1017/ice.2018.355] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Surgical site infections (SSIs) portend high patient morbidity and mortality. Although evidence-based clinical interventions can reduce SSIs, they are not reliably delivered in practice, and data are limited on the best approach to improve adherence. OBJECTIVE To summarize implementation strategies aimed at improving adherence to evidence-based interventions that reduce SSIs. DESIGN Systematic reviewMethods:We searched PubMed, Embase, CINAHL, the Cochrane Library, the WHO Regional databases, AFROLIB, and Africa-Wide for studies published between January 1990 and December 2015. The Effective Practice and Organization Care (EPOC) criteria were used to identify an acceptable-quality study design. We used structured forms to extract data on implementation strategies and grouped them into an implementation model called the "Four Es" framework (ie, engage, educate, execute, and evaluate). RESULTS In total, 125 studies met our inclusion criteria, but only 8 studies met the EPOC criteria, which limited our ability to identify best practices. Most studies used multifaceted strategies to improve adherence with evidence-based interventions. Engagement strategies included multidisciplinary work and strong leadership involvement. Education strategies included various approaches to introduce evidence-based practices to clinicians and patients. Execution strategies standardized the interventions into simple tasks to facilitate uptake. Evaluation strategies assessed adherence with evidence-based interventions and patient outcomes, providing feedback of performance to providers. CONCLUSIONS Multifaceted implementation strategies represent the most common approach to facilitating the adoption of evidence-based practices. We believe that this summary of implementation strategies complements existing clinical guidelines and may accelerate efforts to reduce SSIs.
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Surgical site infection surveillance for elective primary total hip and knee arthroplasty in Winnipeg, Manitoba, Canada. Am J Infect Control 2019; 47:157-163. [PMID: 30274885 DOI: 10.1016/j.ajic.2018.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Surgical site infections (SSIs) increase morbidity and mortality after primary hip and knee arthroplasty. We evaluated a surveillance program that tracked risk factors associated with infection after primary hip and knee arthroplasty in the Winnipeg Regional Health Authority. METHODS Surveillance data from April 2010 to March 2015 were reviewed for all 12,636 primary hip or knee arthroplasties, including 1-year follow-up. Procedures were evaluated in earlier (April 2010 to December 2012) and later periods (January 2013 to March 2015). Risk factors for postoperative infection were evaluated. RESULTS There were 154 SSIs in 12,636 operations (1.22%) (earlier, 98 infections in 6,613 operations [1.48%]; later, 56 infections in 6,023 operations [0.93%]). The frequency of primary hip arthroplasty deep infection decreased from earlier to later periods; the frequency of primary knee arthroplasty infection was similar between the time periods. Independent risk factors associated with increased SSI risk included higher body mass index. SSI frequency was inversely associated with maintaining immediate postoperative temperature between 36°C and 38°C and surgery in the later period. CONCLUSIONS Surveillance was effective in decreasing the frequency of deep infection after primary total hip arthroplasties but not after knee arthroplasties. Surveillance of orthopedic surgery with feedback of SSI rates to the front-line staff may result in improvement in surgical outcomes.
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Sono T, Fujibayashi S, Izeki M, Shimizu Y, Masamoto K, Morizane K, Otsuki B, Tanida S, Nagao M, Ichiyama S, Matsuda S. Decreased rate of surgical site infection after spinal surgery with instrumentation using bundled approach including surveillance and intrawound vancomycin application. Medicine (Baltimore) 2018; 97:e12010. [PMID: 30142843 PMCID: PMC6112973 DOI: 10.1097/md.0000000000012010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Surgical site infections (SSIs) increase the risk of mortality, postsurgery, extend hospital stay, and increase the costs of healthcare. Our aim in this study was to evaluate the effectiveness of a multidisciplinary, evidence-based, surveillance program combined with intrawound application of vancomycin in lowering the incidence rate of SSI after spinal surgery with instrumentation.We conducted a retrospective analysis of 637 patients who underwent spinal fusion with instrumentation in our institution at 3 different time periods: prior to our surveillance program (control group), surveillance only (surveillance group 1), and surveillance combined with intrawound vancomycin application (surveillance group 2). The following covariates were considered in the evaluation of between-group differences in SSI rate: sex, age, surgical site, National Nosocomial Infection Surveillance (NNIS) risk index, American Society of Anesthesiologists (ASA) physical status classification, and other health comorbidities. The causative organism in cases of SSI was confirmed in all cases.The rate of SSI was significantly lower in the surveillance group 2 (1.4%) than in the control group (4.6%; P = .04). On multivariate logistic regression analysis, steroid use (adjusted odd's ratio (OR), 6.06; 95% confidence interval (CI), 1.45-23.6) and operative time (adjusted OR.1.01; 95% CI, 1.00-1.01) were identified as independent risk factors of SSI. Staphylococcus species and Propionibacterium acnes were the principal causative organisms.A bundled approach that includes surveillance and intrawound application of vancomycin is an effective strategy to lower the risk of SSI after spinal fusion with instrumentation. The use of steroid and longer operative time are risk factors of SSI.Our findings support the implementation of a program of surveillance, combined with intrawound vancomycin application, to reduce the incidence rate of SSIs in spinal surgery.
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Affiliation(s)
- Takashi Sono
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto
| | - Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto
| | - Masanori Izeki
- Department of Orthopaedic Surgery, Medical Research Institute, Kitano Hospital, Osaka
| | - Yu Shimizu
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto
| | - Kazutaka Masamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto
| | - Kazuaki Morizane
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto
| | - Bungo Otsuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto
| | - Shimei Tanida
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto
| | - Miki Nagao
- Department of Infection Control and Prevention/Infection Control Team, Kyoto University Hospital, Japan
| | - Satoshi Ichiyama
- Department of Infection Control and Prevention/Infection Control Team, Kyoto University Hospital, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto
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Application of antimicrobial drugs in perioperative surgical incision. Ann Clin Microbiol Antimicrob 2018; 17:2. [PMID: 29397046 PMCID: PMC5797388 DOI: 10.1186/s12941-018-0254-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/19/2018] [Indexed: 01/10/2023] Open
Abstract
Infection in surgical incision often results in poor wound healing, and one of the main factors for wound infection is the use of antimicrobial agents. Rational use of antibiotics is one of the key factors to prevent incision infection in general surgery. The number of current clinical studies on antibiotic use before and during surgery is greater than that of systematic studies on antibiotic use after surgery. For the rational use of antibiotics and improvement of wound healing rate, researchers around the world have gradually focused on the use of antibiotics after surgery. Despite the familiarity on the concept of “rational use of antibiotics”, few clear and systematic studies were conducted to elucidate the effect of different antibiotics on wound healing. Therefore, this review focuses on the use of different types of antimicrobial agents in surgical wounds.
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Surveillance of Environmental and Procedural Measures of Infection Control in the Operating Theatre Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 15:ijerph15010046. [PMID: 29283367 PMCID: PMC5800145 DOI: 10.3390/ijerph15010046] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 12/19/2017] [Accepted: 12/27/2017] [Indexed: 12/22/2022]
Abstract
The microbiological contamination of operating theatres and the lack of adherence to best practices by surgical staff represent some of the factors affecting Surgical Site Infections (SSIs). The aim of the present study was to assess the microbiological quality of operating settings and the staff compliance to the SSI evidence-based control measures. Ten operating rooms were examined for microbiological contamination of air and surfaces, after cleaning procedures, in “at rest” conditions. Furthermore, 10 surgical operations were monitored to assess staff compliance to the recommended practices. None of the air samples exceeded microbiological reference standards and only six of the 200 surface samples (3.0%) were slightly above recommended levels. Potentially pathogenic bacteria and moulds were never detected. Staff compliance to best practices varied depending on the type of behaviour investigated and the role of the operator. The major not compliant behaviours were: pre-operative skin antisepsis, crowding of the operating room and hand hygiene of the anaesthetist. The good environmental microbiological quality observed is indicative of the efficacy of the cleaning-sanitization procedures adopted. The major critical point was staff compliance to recommended practices. Awareness campaigns are therefore necessary, aimed at improving the organisation of work so as to facilitate compliance to operative protocols.
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Carvalho RLRD, Campos CC, Franco LMDC, Rocha ADM, Ercole FF. Incidence and risk factors for surgical site infection in general surgeries. Rev Lat Am Enfermagem 2017; 25:e2848. [PMID: 29211190 PMCID: PMC5738868 DOI: 10.1590/1518-8345.1502.2848] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 10/28/2016] [Indexed: 11/24/2022] Open
Abstract
Objective: to estimate the incidence of surgical site infection in general surgeries at a
large Brazilian hospital while identifying risk factors and prevalent
microorganisms. Method: non-concurrent cohort study with 16,882 information of patients undergoing general
surgery from 2008 to 2011. Data were analyzed by descriptive, bivariate and
multivariate analysis. Results: the incidence of surgical site infection was 3.4%. The risk factors associated
with surgical site infection were: length of preoperative hospital stay more than
24 hours; duration of surgery in hours; wound class clean-contaminated,
contaminated and dirty/infected; and ASA index classified into ASA II, III and
IV/V. Staphyloccocus aureus and Escherichia coli
were identified. Conclusion: the incidence was lower than that found in the national studies on general
surgeries. These risk factors corroborate those presented by the National
Nosocomial Infection Surveillance System Risk Index, by the addition of the length
of preoperative hospital stay. The identification of the actual incidence of
surgical site infection in general surgeries and associated risk factors may
support the actions of the health team in order to minimize the complications
caused by surgical site infection.
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Affiliation(s)
- Rafael Lima Rodrigues de Carvalho
- Doctoral student, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil. Professor, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Camila Cláudia Campos
- Doctoral student, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil. Professor, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Adelaide De Mattia Rocha
- PhD, Associate Professor, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Flávia Falci Ercole
- PhD, Associate Professor, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Effectiveness of national and subnational infection prevention and control interventions in high-income and upper-middle-income countries: a systematic review. THE LANCET. INFECTIOUS DISEASES 2017; 18:e159-e171. [PMID: 29100898 DOI: 10.1016/s1473-3099(17)30479-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 07/14/2017] [Accepted: 07/25/2017] [Indexed: 11/20/2022]
Abstract
Evidence-based guidance for national infection prevention and control (IPC) programmes is needed to support national and global capacity building to reduce health-care-associated infection and antimicrobial resistance. In this systematic review we investigate evidence on the effectiveness of IPC interventions implemented at national or subnational levels to inform the development of WHO guidelines on the core components of national IPC programmes. We searched CENTRAL, CINAHL, Embase, MEDLINE, and WHO IRIS databases for publications between Jan 1, 2000, and April 19, 2017. 29 studies that met the eligibility criteria (ie, economic evaluations, cluster-randomised trials, non-randomised trials, controlled before-and-after studies, and interrupted time-series studies exploring the effective of these interventions) were categorised according to intervention type: multimodal, care bundles, policies, and surveillance, monitoring, and feedback. Evidence of effectiveness was found in all categories but the best quality evidence was on multimodal interventions and surveillance, monitoring, and feedback. We call for improvements in study design, reporting of research, and quality of evidence particularly from low-income countries, to strengthen the uptake and international relevance of IPC interventions.
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Cataldo MA, Granata G, Petrosillo N. Antibacterial Prophylaxis for Surgical Site Infection in the Elderly: Practical Application. Drugs Aging 2017; 34:489-498. [PMID: 28589466 DOI: 10.1007/s40266-017-0471-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Surgical site infections are among the most common healthcare-associated infections and are linked with increased length of hospitalization, re-admission, mortality and significant financial burden. Risk factors for the occurrence of surgical site infections include variables related to the surgical procedure as well as host factors. Increasing age is associated with the occurrence of surgical site infections. The aim of this review is to give an update on the antibiotic prophylaxis for surgical site infection in elderly people. We focused on specific issues and practical applications, such as the importance of targeting the antimicrobial agent to the susceptibility pattern of colonizing flora in selected cases and the need for dosage modifications.
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Affiliation(s)
- Maria Adriana Cataldo
- Clinical Department, National Institute for Infectious Diseases "Lazzaro Spallanzani", via Portuense 292, 00149, Rome, Italy
| | - Guido Granata
- Clinical Department, National Institute for Infectious Diseases "Lazzaro Spallanzani", via Portuense 292, 00149, Rome, Italy
| | - Nicola Petrosillo
- Clinical Department, National Institute for Infectious Diseases "Lazzaro Spallanzani", via Portuense 292, 00149, Rome, Italy.
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Abstract
Surgical site infection (SSI) continues to be a global health problem that causes increased morbidity and mortality, especially in developing countries. This study aimed to determine the prevalence of SSI, the microbial pathogens, and their resistance patterns, as well as to identify risk factors associated with this infection at a Saudi tertiary care hospital. This cross-sectional observational study involved all patients who had undergone surgery and who stayed in the hospital for at least 48 hours during a 1-year period. SSI was diagnosed using the guidelines of the US Centers for Disease Control and Prevention. A total of 2160 patients were included, and the overall SSI rate was 10.2%. Malignancy [odds ratio (OR) = 1.63], duration of operation (OR = 1.41), high American Society of Anesthesiologists score (OR = 1.8), and clean-contaminated (OR = 1.5) and contaminated (OR = 3.2) operations were found to be statistically significant risk factors for SSI. The most frequently isolated microorganisms were Acinetobacter spp (31.5%), Escherichia coli (25.5%), and Pseudomonas spp (17.9%). This study further illustrates the burden of SSI in a typical hospital situation in developing countries. Our findings highlight the urgent need to develop a consistent national surveillance program for SSI, with accurate feedback of appropriate data to help surgeons control and reduce the SSI rates in developing countries.
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Sganga G, Tascini C, Sozio E, Colizza S. Early recognition of methicillin-resistant Staphylococcus aureus surgical site infections using risk and protective factors identified by a group of Italian surgeons through Delphi method. World J Emerg Surg 2017; 12:25. [PMID: 28616060 PMCID: PMC5469047 DOI: 10.1186/s13017-017-0136-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 05/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surgical site infections (SSIs) constitute a major clinical problem in terms of morbidity, mortality, duration of hospital stay, and overall costs. The bacterial pathogens implicated most frequently are Streptococcus pyogenes (S. pyogenes) and Staphylococcus aureus (S. aureus). The incidence of methicillin-resistant S. aureus (MRSA) SSIs is increasing significantly. Since these infections have a significant impact on hospital budgets and patients' health, their diagnosis must be anticipated and therapy improved. The first step should be to evaluate risk factors for MRSA SSIs. METHODS Through a literature review, we identified possible major and minor risk factors for, and protective factors against MRSA SSIs. We then submitted statements on these factors to 228 Italian surgeons to determine, using the Delphi method, the degree of consensus regarding their importance. The consensus was rated as positive if >80% of the voters agreed with a statement and as negative if >80% of the voters disagreed. In other cases, no consensus was reached. RESULTS There was positive consensus that sepsis, >2 weeks of hospitalization, age >75 years, colonization by MRSA, and diabetes were major risk factors for MRSA SSIs. Other possible major risk factors, on which a consensus was not reached, e.g., prior antibiotic use, were considered minor risk factors. Other minor risk factors were identified. An adequate antibiotic prophylaxis, laparoscopic technique, and infection committee surveillance were considered protective factors against MRSA SSIs. All these factors might be used to build predictive criteria for identifying SSI due to MRSA. CONCLUSIONS In order to help to recognize and thus promptly initiate an adequate antibiotic therapy for MRSA SSIs, we designed a gradation of risk and protective factors. Validation, ideally prospective, of this score is now required. In the case of a SSI, if the risk that the infection is caused by MRSA is high, empiric antibiotic therapy should be started after debriding the wound and collecting material for culture.
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Affiliation(s)
- G. Sganga
- Istituto Clinica Chirurgica, Divisione Chirurgia Generale e del Trapianto di Fegato, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Largo Gemelli, 8, 00168 Roma, Italia
| | - C. Tascini
- Prima Divisione Malattie Infettive, Azienda Ospedaliera dei Colli, Napoli, Italia
| | - E. Sozio
- U.O. Medicina d’Urgenza Universitaria, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italia
| | - S. Colizza
- Master Sepsi in Chirurgia, Università Cattolica del Sacro Cuore, Roma, Italia
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Bert F, Giacomelli S, Amprino V, Pieve G, Ceresetti D, Testa M, Zotti CM. The "bundle" approach to reduce the surgical site infection rate. J Eval Clin Pract 2017; 23:642-647. [PMID: 28145067 DOI: 10.1111/jep.12694] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/25/2016] [Accepted: 11/25/2016] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES In Italy, since 2008, the surveillance of surgical site infections (SSIs) has been conducted following ECDC recommendations, according to the protocol of the National System of Surveillance of Surgical Site Infections. In 2009, in Piedmont region, where the study was conducted, it was introduced a survey of a "bundle" for every patient under SSIs surveillance. The bundle includes 5 items: infection risk index calculation, preoperative shower, trichotomy, antibiotic prophylaxis, and body temperature control. The aim of this study is the evaluation of the incidence rate of the SSIs in relation to the implementation of the bundle from January 1st to December 31st, 2012. METHOD This study is an observational study (retrospective cohort). The regional surveillance system collected 3314 surgical operations during the year 2012 from 37 hospitals. The represented surgical categories were hip prosthetic surgery (HPRO: 1992 cases) and colon surgery (COLO: 1322 cases). The bundle was implemented in 1114 and 671 operations, respectively. Univariate and multivariate analysis were conducted stratifying the sample for hip surgery and colorectal surgery, with the purpose to identify an association between the implementation of the bundle and a decrease of the rate of SSIs. RESULTS From the analysis, the bundle resulted as a protective factor for the infection risk in colon surgery (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.38-0.78). The main risk factors were American Society of Anesthesiologists score ≥ 3 (OR, 1.57; 95% CI, 1.10-2.24) and contamination class ≥ 3 (OR, 2.02; 95% CI, 1.37-2.97). In the hip surgery, the application of the bundle was not statistically associated to a decrease of the risk of infection. CONCLUSION The use of surgical bundle seems to reduce significantly the SSIs rate in the colon surgery.
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Affiliation(s)
- Fabrizio Bert
- Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy
| | - Sebastian Giacomelli
- Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy
| | - Viola Amprino
- Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy
| | - Giulio Pieve
- Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy
| | - Daniela Ceresetti
- Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy
| | - Marco Testa
- Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy
| | - Carla M Zotti
- Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy
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Shah PM, Evans HL, Harrigan A, Sawyer RG, Friel CM, Hedrick TL. Wound Concerns and Healthcare Consumption of Resources after Colorectal Surgery: An Opportunity for Innovation? Surg Infect (Larchmt) 2017; 18:634-640. [PMID: 28486022 DOI: 10.1089/sur.2017.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Significant portions of patients undergoing colorectal surgical procedures have minor incision disturbances, yet very few meet definitions for surgical site infection (SSI). We sought to investigate the natural history of incision disturbances with a focus on the patient experience and resource utilization. We hypothesize that patients who have an incision disturbance consume frequent healthcare resources in the post-operative period despite the fact that most never receive a diagnosis of SSI. METHODS A 24-month prospective observational study was undertaken at an academic institution. Patients undergoing elective colorectal operation by two board-certified colorectal surgeons were followed prospectively for 90 days. Incisions were photographed serially and clinically characterized beginning as early as post-operative day two and at follow-up visits. The primary outcome was patient concern for an incision disturbance. Three surgeons reviewed clinical data and photographs to determine the presence of an incisional surgical infection, and diagnosis required agreement from two of three surgeons. RESULTS There were 171 patients included; 31 (15%) sought evaluation from a healthcare provider for concerns related to their incision including 46 telephone calls, six emergency department visits, seven primary care visits, 10 home health and 40 surgical clinic visits. Incision erythema and drainage were the most common sources of patient concern. Mean body mass index was higher in patients with concern for incision disturbances (34 vs. 28 kg/m2, p < 0.0001). Ultimately, 8% (14/171) received a diagnosis of SSI by study criteria while only 2% (4/171) were captured as having an SSI by the institutional National Surgical Quality Improvement Program database (p < 0.0001). CONCLUSIONS Patients undergoing colorectal surgical procedures commonly are concerned with post-operative incision disturbance, yet few are associated with a diagnosis of SSI, and in-person evaluation yields frequent utilization of healthcare resources. This presents an opportunity for secure electronic communication with the surgical team and the patient to potentially reduce consumption of healthcare resources.
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Affiliation(s)
- Puja M Shah
- Department of Surgery, University of Virginia , Charlottesville, Virginia
| | - Heather L Evans
- Department of Surgery, University of Virginia , Charlottesville, Virginia
| | - Amy Harrigan
- Department of Surgery, University of Virginia , Charlottesville, Virginia
| | - Robert G Sawyer
- Department of Surgery, University of Virginia , Charlottesville, Virginia
| | - Charles M Friel
- Department of Surgery, University of Virginia , Charlottesville, Virginia
| | - Traci L Hedrick
- Department of Surgery, University of Virginia , Charlottesville, Virginia
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Impact of nosocomial infections surveillance on nosocomial infection rates: A systematic review. Int J Surg 2017; 42:164-169. [PMID: 28476543 DOI: 10.1016/j.ijsu.2017.04.065] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 04/18/2017] [Accepted: 04/30/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND According to previously studies, nosocomial infections (NIs) surveillance could effectively reduce infection rates. As NIs surveillance systems have been implemented in some hospitals for several years, their impact on NIs need to be explored. Therefore, the purpose of this review is to evaluate the tendency of NI rates during the surveillance period and the impact of surveillance on NI rates. METHODS A systematic literature search of the PubMed database to identify papers that evaluated effect of surveillance on NIs, all kinds of NIs occurred during hospitalization or discharged were included. Exclude articles investigated the surveillance combined with other infection control measures. RESULTS Twenty-five articles were included. NI rates had different levels of reduction during surveillance period, the reduction were not limited by state, department, surveillance system, and NI type. Continuous surveillance had a positive impact on NI, OR/RR were ranged from 0.43 to 0.95. CONCLUSION Participation in NI surveillance is associated with reducing infection rates, though RCTs need to further prove the effective role of surveillance. Hospitals may consider to perform NIs surveillance systems according to its own conditions.
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Woelber E, Schrick EJ, Gessner BD, Evans HL. Proportion of Surgical Site Infections Occurring after Hospital Discharge: A Systematic Review. Surg Infect (Larchmt) 2016; 17:510-9. [DOI: 10.1089/sur.2015.241] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Erik Woelber
- University of Washington School of Medicine, Seattle, Washington
| | - Emily J. Schrick
- University of Washington College of Arts and Sciences, Seattle, Washington
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Smit LC, Bruins MJ, Patijn GA, Ruijs GJHM. Infectious Complications after Major Abdominal Cancer Surgery: In Search of Improvable Risk Factors. Surg Infect (Larchmt) 2016; 17:683-693. [PMID: 27483132 DOI: 10.1089/sur.2016.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Major resections for esophageal, gastric, hepatic, pancreatic, and colorectal cancer continue to be associated with a high peri-operative morbidity of up to 30%-40%. To a large extent, this morbidity is caused by infectious complications that add up to a considerable burden to patients and hospital costs. The objective of this large retrospective cross-sectional study was to determine independent patient and operation-related risk factors for infectious complications after major abdominal cancer operations to elucidate how infection rates can be reduced and improve health-care quality. PATIENTS AND METHODS In 1,389 cancer patients who underwent a major resection procedure between 2009 and 2013, infectious complications and their independent determinants were analyzed by multivariable logistic regression (p < 0.05). RESULTS Male gender was a risk factor for infections in general, whereas patients ≥65 y (odds ratio [OR] 1.75; p = 0.008), urinary tract infection (OR 0.51; p = 0.004), American Society of Anesthesiologists score (OR 1.55; p = 0.004), overall (OR 1.70; p = 0.037), vascular (OR 1.59; p = 0.020), and neurologic comorbidity (OR 2.22; p = 0.001) were associated significantly with pneumonia. Intra-abdominal drainage (OR 1.41; p = 0.024) and a duration of surgery of ≥180 min (OR 1.85; p = 0.001) were risk factors for surgical site infections. Total parenteral nutrition was significantly associated with intravascular catheter-induced infections (OR 18.09; p < 0.001) and sepsis (OR 6.69; p < 0.001). CONCLUSIONS In this study, several independent risk factors for infectious complications in major abdominal cancer operations were identified, providing opportunities for further reducing peri-operative infections. General awareness and focus on preventing infectious complications may have a significant impact on health-care outcomes and costs.
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Affiliation(s)
- Linda C Smit
- 1 Laboratory of Clinical Microbiology and Infectious Diseases , Isala, Zwolle, The Netherlands
| | - Marjan J Bruins
- 1 Laboratory of Clinical Microbiology and Infectious Diseases , Isala, Zwolle, The Netherlands
| | - Gijs A Patijn
- 2 Department of Surgery, Isala, Zwolle, The Netherlands
| | - Gijs J H M Ruijs
- 1 Laboratory of Clinical Microbiology and Infectious Diseases , Isala, Zwolle, The Netherlands
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Sganga G, Tascini C, Sozio E, Carlini M, Chirletti P, Cortese F, Gattuso R, Granone P, Pempinello C, Sartelli M, Colizza S. Focus on the prophylaxis, epidemiology and therapy of methicillin-resistant Staphylococcus aureus surgical site infections and a position paper on associated risk factors: the perspective of an Italian group of surgeons. World J Emerg Surg 2016; 11:26. [PMID: 27307786 PMCID: PMC4908758 DOI: 10.1186/s13017-016-0086-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 06/10/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aim of this research was to study the epidemiology, microbiology, prophylaxis, and antibiotic therapy of surgical site infections (SSIs), especially those caused by methicillin-resistant Staphylococcus aureus (MRSA), and identify the risk factors for these infections. In Italy SSIs occur in about 5 % of all surgical procedures. They are predominantly caused by staphylococci, and 30 % of them are diagnosed after discharge. In every surgical specialty there are specific procedures more associated with SSIs. METHODS The authors conducted a systematic review of the literature on SSIs, especially MRSA infections, and used the Delphi method to identify risk factors for these resistant infections. RESULTS Risk factors associated with MRSA SSIs identified by the Delphi method were: patients from long-term care facilities, recent hospitalization (within the preceding 30 days), Charlson score > 5 points, chronic obstructive pulmonary disease and thoracic surgery, antibiotic therapy with beta-lactams (especially cephalosporins and carbapenem) and/or quinolones in the preceding 30 days, age 75 years or older, current duration of hospitalization >16 days, and surgery with prothesis implantation. Protective factors were adequate antibiotic prophylaxis, laparoscopic surgery and the presence of an active, in-hospital surveillance program for the control of infections. MRSA therapy, especially with agents that enable the patient's rapid discharge from hospital is described. CONCLUSION The prevention, identification and treatment of SSIs, especially those caused by MRSA, should be implemented in surgical units in order to improve clinical and economic outcomes.
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Affiliation(s)
- G. Sganga
- />Istituto Clinica Chirurgica, Divisione Chirurgia Generale e Trapianti d’Organo, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - C. Tascini
- />U.O. Malattie Infettive, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - E. Sozio
- />U.O. Medicina d’Urgenza Universitaria, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - M. Carlini
- />Chirurgia generale Ospedale Sant’Eugenio di Roma, Rome, Italy
| | - P. Chirletti
- />Dipartimento di Chirurgia Università La Sapienza, Policlinico Umberto I, Rome, Italy
| | - F. Cortese
- />UOC Chirurgia di Urgenza Ospedale San Filippo Neri, Rome, Italy
| | - R. Gattuso
- />Dipartimento di Chirurgia Generale e Trapianti d’Organo, UOC Chirurgia Vascolare, Università La Sapienza, Policlinico Umberto I, Rome, Italy
| | - P. Granone
- />Istituto Patologia Chirurgia, Unità Operativa Complessa Chirurgia Toracica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - C. Pempinello
- />Ortopedia e Traumatologia dell’Ospedale S. Gennaro ASL Napoli 1 Centro, Naples, Italy
| | - M. Sartelli
- />U.O Chirurgia Generale Ospedale di Macerata, Macerata, Italy
| | - S. Colizza
- />Master Sepsi in Chirurgia, Università Cattolica, Rome, Italy
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Tacconelli E, Müller NF, Lemmen S, Mutters NT, Hagel S, Meyer E. Infection Risk in Sterile Operative Procedures. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:271-8. [PMID: 27159141 PMCID: PMC4985522 DOI: 10.3238/arztebl.2016.0271] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 01/18/2016] [Accepted: 01/18/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND The main objective of hospital hygiene and infection prevention is to protect patients from preventable nosocomial infections. It was recently stated that the proper goal should be for zero infection rates in sterile surgical procedures. In this article, we attempt to determine whether this demand is supported by the available literature. METHODS We systematically searched the Medline and EMBASE databases for studies published in the last 10 years on the efficacy of infection control measures and carried out a meta-analysis according to the PRISMA tool. We used the following search terms: "aseptic surgery," "intervention," "surgical site infection," "nosocomial infection," "intervention," and "prevention." RESULTS 2277 articles were retrieved, of which 204 were acquired in full text and analyzed. The quantitative analysis included 7 prospective cohort studies on the reduction of nosocomial infection rates after aseptic surgery. The measures used included training sessions, antibiotic prophylaxis, and operative-site disinfection and cleaning techniques. These interventions succeeded in reducing postoperative wound infections (relative risk (RR] 0.99 [0.98; 1.00]). Subgroup analyses on antibiotic prophylaxis (RR 0.99 [0.98; 1.01]) and noncontrolled trials (RR 0.97 [0.92; 1.02]) revealed small, insignificant effects. CONCLUSION A multimodal approach with the participation of specialists from various disciplines can further reduce the rate of postoperative infection. A reduction to zero is not realistic and is not supported by available evidence.
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Affiliation(s)
- Evelina Tacconelli
- German Center for Infection Research (DZIF), Department of Internal Medicine I, Medical University Hospital Tübingen
| | - Niklas F. Müller
- Division of Gastroenterology and Rheumatology, Department of. Internal Medicine, Neurology and Dermatology, University Hospital of Leipzig
| | - Sebastian Lemmen
- Central Department of Hospital Hygiene and Infectiology, Aachen University Hospital
| | - Nico T. Mutters
- Heidelberg University Hospital, Department of Infectious Diseases, Medical Microbiology and Hygiene
| | - Stefan Hagel
- Center for Infectious Diseases and Infection Control, Jena University Hospital
| | - Elisabeth Meyer
- Institute of Hygiene and Environmental Medicine, Charité—Universitätsmedizin Berlin
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Pujol Rojo M, Shaw Perujo E. [Surveillance of surgical site infections. What is the best way?]. Enferm Infecc Microbiol Clin 2014; 32:477-8. [PMID: 25200212 DOI: 10.1016/j.eimc.2014.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 07/18/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Miquel Pujol Rojo
- Servicio de Enfermedades Infecciosas, Hospital Universitario de Bellvitge, L'Hospitalet del Llobregat, Barcelona, España; Secretario del Programa VINCat.
| | - Evelyn Shaw Perujo
- Servicio de Enfermedades Infecciosas, Hospital Universitario de Bellvitge, L'Hospitalet del Llobregat, Barcelona, España; Red Española de Investigación en Patología Infecciosa
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