Surveillance for surgical site infections in orthopedic trauma surgeries at an Indian hospital

Microbiological Profile and Outcome of Surgical Site Infections Following Orthopedic Surgeries in a Tertiary Care Hospital

Surgical site infections (SSIs) are one of the most common adverse events that occur in hospitalized patients undergoing surgical procedures or in outpatient surgical measures, regardless of the advances in preventive procedures. SSI may lead to disastrous consequences in orthopedic practice as it may involve the joints and bones and is extremely difficult to get rid of the infection. The present study was designed to evaluate the rates, risk factors, microbiological profiles, and outcomes of SSIs following orthopedic procedures in patients admitted to a tertiary care hospital in Eastern India during the study period of September 2022 to March 2024. A total of 1327 patients who underwent orthopedic surgeries were followed up for the development of SSI, among whom 105 (7.9%) developed SSI, making an incidence rate of 7.9%. The incidence of SSI in different surgeries was 9.5% (34/359) in closed reduction with fixation, 8.5% (65/766) in open reduction with internal fixation, 4.4% (3/69) in hip arthroplasty, and 2.3% (3/133) in knee arthroplasty. Maximum (27.6%) patients having SSI were of the age group of 20-29 years, and 87.62% were males. The habit of smoking was found to be highly statistically significant. The common gram-positive organisms isolated were Staphylococcus aureus and Enterococcus species, which were mostly sensitive to vancomycin, linezolid, teicoplanin, and tigecycline. The common gram-negative organisms isolated were Klebsiella pneumoniae, Pseudomonas species, Escherichia coli, and Acinetobacter species, many of which were multidrug-resistant organisms and were sensitive to amikacin, amoxicillin-clavulanate, and ceftriaxone.

Surveillance for surgical site infections developed during hospital stay & after discharge: A multicentric study

Background & objectives Surgical site infections (SSIs) are among the most prevalent healthcare-associated infections (HCAIs). They cause significant morbidity, leading to excess health expenditures and increased length of hospital stay. Despite a high population burden, data on post-discharge SSIs is lacking from low-and middle-income countries (LMICs). There is no existing surveillance system of SSIs in India that covers the post-discharge period. Therefore, we proposed a multicentric analysis to estimate the proportion and identify the risk factors associated with SSIs occurring during hospital stay and after discharge. Methods SSI Surveillance was conducted in three hospitals in different parts of India according to the Centers for Disease Control and Prevention (CDC) guidelines (30 days-6 months). An indigenous database was developed for data entry and analysis. Logistic regression analysis was performed to test for an association between SSI and potential risk factors. Results A total of 161 out of 3090 patients acquired SSI, resulting in a 5.2 per cent SSI incidence. Debridement surgery, which was carried out with either an amputation, open reduction internal fixation surgery (ORIF), or closed reduction internal fixation (CRIF) surgery, had the highest SSI rate (54.2%). Clean, polluted wound class and surgeries lasting longer than 120 minutes were substantially linked to an increased risk of SSI. Interpretation & conclusions Post-discharge surveillance helped with the detection of 66 per cent of SSI cases. Combination surgeries were seen to increase the risk of SSIs in patients.

Dialkyl Carbamoyl Chloride (DACC)-Impregnated Dressings for the Prevention of Surgical Site Infections: Experience From a Multi-disciplinary Study in India

Background Surgical site infections (SSIs) represent a significant burden in healthcare, commonly occurring after surgical procedures and leading to prolonged recovery times and increased healthcare costs. Traditional antimicrobial dressings pose risks such as antimicrobial resistance. This study aimed to evaluate the safety and clinical efficacy of dialkyl carbamoyl chloride (DACC)-impregnated dressings, which use a purely physical mechanism to prevent bacterial contamination, in patients undergoing orthopaedic or gastrointestinal surgeries. Methods This prospective, multicentre observational study was conducted after ethical committee approval across four centres in India, involving 106 patients (71 orthopaedic and 35 gastrointestinal) who received DACC-impregnated dressings. Dressings were applied immediately post-surgery and assessed over 30 days for the incidence of superficial or deep SSI. Additional evaluations included pain measured using visual analogue scale (VAS), dressing adhesion, patient satisfaction, and healthcare provider feedback. Statistical analyses included descriptive statistics and comparisons between time points using the Wilcoxon and Kruskal-Wallis tests, with a significance level set at p<0.05. Results Among the 106 patients, two (1.9%) cases of SSI were reported, both in orthopaedic patients. The dressings maintained at least 50% adhesion in 98.1% of cases. Pain levels using VAS averaged 3.9 (SD=2.6) at follow-up one and 2.8 (SD=2.8) at follow-up two. Patient satisfaction was high, with 73.5% reporting improved pain experiences during dressing changes compared to previous dressings. Healthcare professionals rated the handling of dressings as excellent in 89% of cases. Conclusion DACC-impregnated dressings demonstrated effectiveness in reducing SSIs in postoperative care for orthopaedic and gastrointestinal surgeries. The dressings were well-tolerated by patients and preferred by healthcare providers due to ease of use and high adherence. These findings support DACC-impregnated dressings as a safe and effective alternative for SSI prevention, particularly beneficial in reducing the risks associated with antimicrobial resistance. Further studies with larger sample sizes and controlled designs are recommended to validate these findings.

Factors Contributing to Surgical Site Infections: A Comprehensive Systematic Review of Etiology and Risk Factors

Surgical site infections persist as a substantial concern within the realm of hospital-acquired infections. This enduring issue is further compounded by the mounting challenge of antibiotic resistance, a surge in surgical interventions, and the presence of comorbidities among patients. Thus, a comprehensive exploration of all discernible risk factors, as well as proactive preventive and prophylactic strategies, becomes imperative. Moreover, the prevalence of multidrug-resistant microorganisms has reached alarming proportions. Consequently, there is an acute need to investigate and scrutinize all potential therapeutic interventions to counter this burgeoning threat. Consequently, the primary objective of this review is to meticulously assess the origins and risk elements intertwined with surgical site infections across a diverse spectrum of surgical procedures. As the medical landscape continues to evolve, this critical analysis seeks to provide a nuanced understanding of the multi-faceted factors contributing to surgical site infections, with the overarching aim of facilitating more effective management and mitigation strategies. By exploring these dimensions comprehensively, we endeavor to enhance patient safety and the quality of surgical care in this era of evolving healthcare challenges.