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Smith S, Abuhassanian I, Attia J, Carroll R, Lott N, Hampton J, Gani J. Antiseptic Skin Agents to Prevent Surgical Site Infection After Clean Implant Surgery: Subgroup Analysis of the NEWSkin Prep Trial. Surg Infect (Larchmt) 2023; 24:818-822. [PMID: 37944097 DOI: 10.1089/sur.2023.250] [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] [Indexed: 11/12/2023] Open
Abstract
Background: There remains debate as to the ideal skin preparation agent to prevent surgical site infection (SSI) after clean implant surgery. This study is a subgroup analysis of all patients undergoing implant surgery in the NEWSkin prep trial. Patients and Methods: The NEWSkin prep trial is a randomized clinical trial (RCT; n = 3300) comparing the three antiseptic skin preparation agents commonly used prior to incisional surgery: chlorhexidine with alcohol (C-Alc), povidone iodine with alcohol (PI-Alc), and aqueous povidone iodine (PI-Aq). All participants who underwent clean incisional surgeries with implants from this trial were selected for analysis. The primary outcome was SSI rate; secondary outcomes were complication rates and re-admission rates. Results: A total of 712 patients in the NEWSkinPrep study underwent clean implant surgery between January 2015 and December 2018. Randomization resulted in the following distribution: C-Alc, 238; PI-Alc, 243; and PI-Aq, 231. Median age of participants was 63 years and 41% were female. Surgical site infection rates were: C-Alc, 10.13%; PI-Alc,11.52%; and PI-Aq, 11.26%. Povidone iodine with alcohol did not appear to be non-inferior to C-Alc (mean difference, 1.39%; 95% confidence interval [CI], -4.17 to 6.95) and PI-Alc was not superior to PI-Aq (mean difference, 0.27%; 95% CI, -5.45 to 5.99; p = 0.9271). There were no differences seen in secondary outcomes between groups. Conclusions: These results indicate a similarity between PI-Alc and C-Alc and that PI-Alc was not superior to PI-Aq. Because this study was not powered to assess these differences in clean cases with implants, additional studies are needed to assess these agents.
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Affiliation(s)
- Stephen Smith
- Hunter Surgical Clinical Research Unit, University of Newcastle, Newcastle, New South Wales, Australia
| | | | - John Attia
- Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Rosemary Carroll
- Hunter Surgical Clinical Research Unit, University of Newcastle, Newcastle, New South Wales, Australia
| | - Natalie Lott
- Hunter Surgical Clinical Research Unit, University of Newcastle, Newcastle, New South Wales, Australia
| | - Jacob Hampton
- John Hunter Division of Surgery, University of Newcastle, Newcastle, New South Wales, Australia
| | - Jon Gani
- Hunter Surgical Clinical Research Unit, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
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Predictors of Hospital Readmission After Motor Vehicle Crash: Prospective Cohort Study. J Trauma Nurs 2023; 30:83-91. [PMID: 36881699 DOI: 10.1097/jtn.0000000000000707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Motor vehicle crash (MVC) is a major public health problem worldwide and contributes to a large burden of death, disability, and economic loss. OBJECTIVE To identify the predictors of hospital readmission in victims of MVC within 1 year after discharge. METHODS A prospective cohort study conducted with individuals who suffered MVC admitted to a regional hospital and who were followed up for 12 months after discharge. Predictors of hospital readmission were verified by means of Poisson regression models with robust variance, using a hierarchical conceptual model. RESULTS Of the 241 patients followed up, 200 were contacted and comprised the population of this study. Of these, 50 (25.0%) reported hospital readmission during the 12-month period after discharge. It was evidenced that being male (relative risk [RR] = 0.58; 95% CI [0.36, 0.95], p = .033) was a protective factor, whereas occurrences of greater severity (RR = 1.77; 95% CI [1.03, 3.02], p = .036), not receiving pre-hospital care (RR = 2.14; 95% CI [1.24, 3.69], p = .006), the occurrence of postdischarge infection (RR = 2.14; 95% CI [1.37, 3.36], p = .001), and having access to rehabilitation treatment (RR = 1.64; 95% CI [1.03, 2.62], p≤ .001) are configured as risk factors for hospital readmission in individuals who have suffered these events. CONCLUSION It was found that gender, trauma severity, pre-hospital care, postdischarge infection, and rehabilitation treatment variables predict hospital readmission in MVC victims within 1 year after discharge.
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Humphrey T, Daniell H, Chen AF, Hollenbeck B, Talmo C, Fang CJ, Smith EL, Niu R, Melnic CM, Hosseinzadeh S, Bedair HS. Effect of the COVID-19 Pandemic on Rates of Ninety-Day Peri-Prosthetic Joint and Surgical Site Infections after Primary Total Joint Arthroplasty: A Multicenter, Retrospective Study. Surg Infect (Larchmt) 2022; 23:458-464. [PMID: 35594331 DOI: 10.1089/sur.2022.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The impact of the coronavirus 2019 (COVID-19) pandemic on the rate of primary total joint arthroplasty (TJA) peri-prosthetic joint infection (PJI) and superficial surgical site infections (SSI) is currently unknown. The purpose of this multicenter study was to evaluate any changes in the rates of 90-day PJI or 30-day SSI, including trends in microbiology of the infections, during the COVID-19 pandemic compared to the three years prior. Patients and Methods: An Institutional Review Board-approved, multicenter, retrospective study was conducted with five participating academic institutions across two healthcare systems in the northeastern United States. Primary TJA patients from the years 2017-2019 were grouped as a pre-COVID-19 pandemic cohort and patients from the year 2020 were grouped as a COVID-19 pandemic cohort. Differences in patient demographics, PJI, SSI, and microbiology between the two cohorts were assessed. Results: A total of 14,844 TJAs in the pre-COVID-19 pandemic cohort and 5,453 TJAs in the COVID-19 pandemic cohort were evaluated. There were no substantial differences of the combined 90-day PJI and 30-day superficial SSI rates between the pre-COVID-19 pandemic cohort (0.35%) compared with the COVID-19 pandemic cohort (0.26%; p = 0.303). Conclusions: This study did not find any change in the rates of 90-day PJI or 30-day superficial SSI in patients undergoing primary TJA between a pre-COVID-19 pandemic and COVID-19 pandemic cohort. Larger national database studies may identify small but substantial differences in 90-day PJI and 30-day superficial SSI rates between these two time periods. Our data may support continued efforts to maintain high compliance with hand hygiene, use of personal protective equipment, and limited hospital visitation whenever possible.
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Affiliation(s)
- Tyler Humphrey
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,Kaplan Joint Center, Newton-Wellesley Hospital, Newton, Massachusetts, USA
| | - Hayley Daniell
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian Hollenbeck
- Department of Infectious Disease, New England Baptist Hospital, Dedham, Massachusetts, USA
| | - Carl Talmo
- Department of Orthopaedic Surgery, New England Baptist Hospital, Dedham, Massachusetts, USA
| | - Christopher J Fang
- Department of Infectious Disease, New England Baptist Hospital, Dedham, Massachusetts, USA
| | - Eric L Smith
- Department of Orthopaedic Surgery, New England Baptist Hospital, Dedham, Massachusetts, USA
| | - Ruijia Niu
- Department of Orthopaedic Surgery, New England Baptist Hospital, Dedham, Massachusetts, USA
| | - Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,Kaplan Joint Center, Newton-Wellesley Hospital, Newton, Massachusetts, USA
| | - Shayan Hosseinzadeh
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,Kaplan Joint Center, Newton-Wellesley Hospital, Newton, Massachusetts, USA
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4
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Wound Closure Following Intervention for Closed Orthopedic Trauma. Injury 2022; 53:313-322. [PMID: 34865820 DOI: 10.1016/j.injury.2021.11.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/24/2021] [Indexed: 02/02/2023]
Abstract
The method of skin closure and post-operative wound management has always been important in orthopedic surgery and plays an even larger role now that surgical site infection (SSI) is a national healthcare metric for both surgeons and hospitals. Wound related issues remain some of the most feared complications following orthopedic trauma procedures and are associated with significant morbidity. In order to minimize the risk of surgical site complications, surgeons must be familiar with the physiology of wound healing as well as the patient and surgical factors affecting healing potential. The goal of all skin closure techniques is to promote rapid healing with acceptable cosmesis, all while minimizing risk of infection and dehiscence. Knowledge of the types of closure material, techniques of wound closure, surgical dressings, negative pressure wound therapy, and other local modalities is important to optimize wound healing. There is no consensus in the literature as to which closure method is superior but the available data can be used to make informed choices. Although often left to less experienced members of the surgical team, the process of wound closure and dressing the wound should not be an afterthought, and instead must be part of the surgical plan. Wounds that are in direct communication with bony fractures are particularly at risk due to local tissue trauma, resultant swelling, hematoma formation, and injured vasculature.
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Yang J, Zhang X, Liang W. A retrospective analysis of factors affecting surgical site infection in orthopaedic patients. J Int Med Res 2021; 48:300060520907776. [PMID: 32281431 PMCID: PMC7155240 DOI: 10.1177/0300060520907776] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To investigate the factors affecting surgical site infections (SSI) in patients undergoing orthopaedic surgery. Methods The electronic medical records of patients undergoing orthopaedic surgery between September 2010 and July 2018 were retrospectively retrieved and reviewed. Logistic regression analyses were used to analyse the correlation between surgery-related variables and SSI. The odds ratio (OR) and 95% confidence interval (CI) were estimated for the risk factors. Results Clinical data from 25 954 patients were reviewed and 804 (3.1%) were found to have become infected at the surgical site. Older age (≥60 years) was a risk factor (OR 2.218) and younger age (<18 years) was a protective factor (OR 0.258). Diabetes mellitus (OR 6.560) and hypertension (OR 3.991) were independent risk factors. Compared with type II incisions, type I incisions had a lower risk for SSI (OR 0.031), while type III incisions had a greater risk of SSI (OR 2.599). Compared with upper limbs and hands, the feet had a lower risk of infection, while surgery performed at the spine and joints did not increase the risk as compared with foot surgery. Conclusion Older age, hypertension, diabetes mellitus and type III incisions were risk factors for SSI following orthopaedic surgery.
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Affiliation(s)
- Jun Yang
- Department of Orthopaedics and Traumatology, Yuxi Municipal Hospital of Traditional Chinese Medicine, Yuxi, Yunnan Province, China
| | - Xiangmin Zhang
- Department of Orthopaedics and Traumatology, Yuxi Municipal Hospital of Traditional Chinese Medicine, Yuxi, Yunnan Province, China
| | - Wangbo Liang
- Department of Orthopaedics and Traumatology, Yuxi Municipal Hospital of Traditional Chinese Medicine, Yuxi, Yunnan Province, China
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Do HTT, Finlayson K, Edwards H. Surgical wound assessment in Vietnam: a think-aloud technique and interview analysis. J Wound Care 2020; 29:S4-S13. [PMID: 32279617 DOI: 10.12968/jowc.2020.29.sup4.s4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To identify the key components of a surgical wound assessment tool that nurses in Vietnam could use when conducting a surgical wound assessment. The study also explored Vietnamese nurses' perceptions of current practices in surgical wound assessment and assessed their requirements for a surgical wound assessment tool. METHOD Registered nurses from surgical wards in a Vietnamese hospital were invited to participate in this descriptive, qualitative study. A combination of the think-aloud technique and semi-structured interviews was undertaken. Transcribed responses were analysed using inductive content analysis to indicate how Vietnamese nurses undertook wound assessment and the data they collected. RESULTS A total of 13 nurses took part. Data from both the think-aloud process and interviews indicated that nurses evaluated surgical wounds based on their experience and observation without using standard guidelines. Some components, such as wound edge, periwound skin, exudate volume and signs of infection, were identified by the nurses. Other wound characteristics, such as wound site, wound bed, exudate and pain, and risk factors were less frequently collected. Nurses expressed their need for a tool with comprehensive content, precise terms, user-friendly language and a scoring system to facilitate their wound assessment. CONCLUSION Hospitals in Vietnam need a standard tool to help nurses improve surgical wound assessment in daily nursing practice, and to enhance multidisciplinary communication and patient care.
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Affiliation(s)
- Hien Thi Thu Do
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,Nursing department, Haiduong Medical Technical University, Vietnam
| | - Kathleen Finlayson
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Helen Edwards
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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Copanitsanou P, Kechagias VA, Grivas TB, Wilson P. Use of ASEPSIS scoring method for the assessment of surgical wound infections in a Greek orthopaedic department. Int J Orthop Trauma Nurs 2018; 30:3-7. [PMID: 29887237 DOI: 10.1016/j.ijotn.2018.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/18/2018] [Accepted: 03/27/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND In Greece there is no systematic assessment of surgical wounds with the use of a validated instrument, while the ASEPSIS scoring method has been widely used internationally. AIM To examine the frequency of wound infections and their correlations both with patient background factors, as well as surgery factors, with the use of ASEPSIS. METHODS In this prospective, observational study, participants undergoing orthopaedic surgeries in a large hospital in Greece were assessed during hospitalisation and the first month after discharge using the ASEPSIS wound assessment tool. The principles of the Declaration of Helsinki were applied. Non-parametric statistical analyses were performed using SPSS 20.0. RESULTS In total, 111 patients participated; nearly half (49.5%) had a total ASEPSIS score of "0". Almost 3 out of 4 patients (76.6%) had an ASEPSIS score under or equal to "10" (satisfactory healing) and only 3.6% had a minor or severe surgical wound infection. The ASEPSIS score was only positively correlated to longer surgery duration and longer postoperative stay. DISCUSSION The frequency of surgical wound infections in orthopaedic patients in Greece is comparable to that described in the literature. ASEPSIS could be used for assessing patients and as a performance indicator in Greek orthopaedic departments.
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Affiliation(s)
- Panagiota Copanitsanou
- General Hospital of Piraeus "Tzaneio", National and Kapodistrian University of Athens, Athens, Greece.
| | | | - Theodoros B Grivas
- General Hospital of Piraeus "Tzaneio", Head of the Department of Orthopaedics and Traumatology, Greece
| | - Peter Wilson
- Department of Microbiology, University College London Hospitals, London, UK
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Paiva L, Monteiro DAT, Pompeo DA, Ciol MA, Dantas RAS, Rossi LA. Readmissions due to traffic accidents at a general hospital. Rev Lat Am Enfermagem 2017; 23:693-9. [PMID: 26444172 PMCID: PMC4623733 DOI: 10.1590/0104-1169.0242.2623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: to verify the occurrence and the causes of hospital readmissions within a year
after discharge from hospitalizations due to traffic accidents. Methods: victims of multiple traumas due to traffic accidents were included, who were
admitted to an Intensive Care Unit. Sociodemographic data, accident circumstances,
body regions affected and cause of readmission were collected from the patient
histories. Results: among the 109 victims of traffic accidents, the majority were young and adult
men. Most hospitalizations due to accidents involved motorcycle drivers (56.9%).
The causes of the return to the hospital were: need to continue the surgical
treatment (63.2%), surgical site infection (26.3%) and fall related to the
physical sequelae of the trauma (10.5%). The rehospitalization rate corresponded
to 174/1,000 people/year. Conclusion: the hospital readmission rate in the study population is similar to the rates
found in other studies. Victims of severe limb traumas need multiple surgical
procedures, lengthier hospitalizations and extended rehabilitation.
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Affiliation(s)
- Luciana Paiva
- Universidade Federal do Triângulo Mineiro, Uberaba, MG, BR
| | | | - Daniele Alcalá Pompeo
- Departamento de Enfermagem Especializada, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, BR
| | | | | | - Lídia Aparecida Rossi
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, BR
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Kok TWK, Agrawal N, Sathappan SS, Chen WK. Risk factors for early implant-related surgical site infection. J Orthop Surg (Hong Kong) 2016; 24:72-6. [PMID: 27122517 DOI: 10.1177/230949901602400117] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To identify the risk factors and microbes associated with early implant-related surgical site infection (SSI). METHODS Records of 193 implant-related SSIs secondary to primary orthopaedic surgery were reviewed. Early and late SSI was defined as infection diagnosed within and after 3 months of surgery, respectively. RESULTS Of the 193 implant-related SSIs, 29 were superficial incisional, 127 were deep incisional, and 37 were organ/space-related. 144 (90%) out of 160 SSIs used cefazolin in their prophylactic antibiotic regimen. In univariate analysis, early SSI was associated with diabetes mellitus, American Society of Anesthesiologists (ASA) score of >2, emergency procedures, and lack of antibiotic prophylaxis. In multivariable analysis, early SSI was associated with an ASA score of >2 (p=0.016). CONCLUSION It is important to cross-check ASA score with co-morbidities to reduce early SSIs. Peri-operative optimisation and antibiotic prophylaxis should be administered prior to surgery. Appropriate modification of antibiotic prophylaxis should be considered.
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Affiliation(s)
- T W K Kok
- Department of Orthpaedic Surgery, Tan Tock Seng Hospital, Singapore
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Marwa JM, Ngayomela IH, Seni J, Mshana SE. Cefepime versus Ceftriaxone for perioperative systemic antibiotic prophylaxis in elective orthopedic surgery at Bugando Medical Centre Mwanza, Tanzania: a randomized clinical study. BMC Pharmacol Toxicol 2015; 16:42. [PMID: 26699529 PMCID: PMC4690262 DOI: 10.1186/s40360-015-0039-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 11/18/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Antimicrobial prophylaxis reduces the incidence of postoperative wound infections especially among patients undergoing orthopedics surgery. However, there is dearth of information on the clinical effectiveness, spectrum limitations and practical contextual information on third and fourth generation cephalosporins. The aim of this study was to evaluate the efficacy and safety of cefepime and ceftriaxone as peri-operative systemic antimicrobial prophylaxis in elective orthopedic surgery in our center. METHODS This study was a prospective, randomized, open label comparative clinical study of patients undergoing elective orthopedic procedures at the Bugando Medical Centre (BMC) between June 2014 and February 2015. Two hundred thirty participants were enrolled in the study and randomly assigned into Ceftriaxone regimen (group A) or Cefepime regimen (group B). Participants in ceftriaxone or cefepime group received 50 mg/kg up to 2 g single dose perioperative intravenous infusion at least 30 min before incision. Both groups were followed for 30 days using a Center for Disease Control superficial surgical site infection criterion for the outcome. A two-tailed margin of equivalence was set at 5% analyzed on the intent to treat. RESULTS All 230 participants were subjected to final analysis with no patient being lost to follow-up. Superficial surgical site infection occurred in 5 out of 117 (4.3%, 0.6 to 7.9 at 95% CI) patients receiving cefepime compared to 3 out of 113 (2.7%, 0.3 to 5.6 at 95% CI) among patients receiving ceftriaxone regimen. The absolute difference of 1.6% (95% Confidence Interval: -6.3 to 3.1), equivocally lies outside the 5% statistically significant margin of presumed clinical equivalence. CONCLUSION The difference between cefepime and ceftriaxone in preventing SSIs following elective clean orthopedic surgery was not statistically significant. TRIAL REGISTRATION Pan African Clinical Trial Registry: PACTR201406000803420.
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Affiliation(s)
- Joel M Marwa
- Department of Surgery, Catholic University of Health and Allied Sciences, Box 1464, Mwanza, Tanzania.
| | - Isidor H Ngayomela
- Department of Trauma and Orthopedics, Bugando Medical Centre, Box 1370, Mwanza, Tanzania.
| | - Jeremiah Seni
- Department of Microbiology/Immunology, Catholic University of Health and Allied Sciences (CUHAS), P.O. BOX 1464, Mwanza, Tanzania.
| | - Stephen E Mshana
- Department of Microbiology/Immunology, Catholic University of Health and Allied Sciences (CUHAS), P.O. BOX 1464, Mwanza, Tanzania.
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Surgical site infections, occurrence, and risk factors, before and after an alcohol-based handrub intervention in a general surgical department in a rural hospital in Ujjain, India. Am J Infect Control 2015; 43:1184-9. [PMID: 26231549 DOI: 10.1016/j.ajic.2015.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 06/05/2015] [Accepted: 06/08/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND This study set out to determine occurrence of and risk factors for surgical site infections (SSIs) before and after implementation of an alcohol-based handrub (ABHR) intervention in general surgery wards in a rural, tertiary care hospital in India. METHODS Patients who underwent surgery between October 2010 and August 2011 (preintervention period) or September 2011 and August 2013 (intervention period) in the department of surgery were included. ABHR was introduced in September 2011. SSI was defined as per the Centers for Disease Control and Prevention guidelines. Comparison of SSI rate between the 2 periods was performed using analysis of variance. Risk factors were determined using multiple logistic regression models. RESULTS Incidence of SSI was 5% (36/720) and 6.5% (103/1,581) respectively, showing nonsignificant difference (P = .5735). The risk factor common for SSI in both periods was the duration of surgery (OR = 2.6 vs OR = 1.96, pre- and intervention periods, respectively). Risk factors in the intervention period were being a woman (OR = 2.18), renal disease (OR = 3.61), diabetes (OR = 4.43), smoking (OR = 2.14), preoperative hospitalization (<3 vs >15 days; OR = 3.22), and previous hospitalization (OR = 3.5). Compared with other studies, the amount of ABHR used in our study was low. CONCLUSION The amount of ABHR used might not be sufficient to interrupt the chain of contamination of microorganisms; therefore, continuation of the intervention and surveillance is recommended.
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Ling ML, Apisarnthanarak A, Madriaga G. The Burden of Healthcare-Associated Infections in Southeast Asia: A Systematic Literature Review and Meta-analysis. Clin Infect Dis 2015; 60:1690-9. [DOI: 10.1093/cid/civ095] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 02/01/2015] [Indexed: 11/13/2022] Open
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Le TAT, Dibley MJ, Vo VN, Archibald L, Jarvis WR, Sohn AH. Reduction in Surgical Site Infections in Neurosurgical Patients Associated With a Bedside Hand Hygiene Program in Vietnam. Infect Control Hosp Epidemiol 2015; 28:583-8. [PMID: 17464919 DOI: 10.1086/516661] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2006] [Accepted: 08/22/2006] [Indexed: 02/05/2023]
Abstract
Objective.
We conducted an intervention study to assess the impact of the use of an alcohol-chlorhexidine-based hand sanitizer on surgical site infection (SSI) rates among neurosurgical patients in Ho Chi Minh City, Vietnam.
Design.
A quasi-experimental study with an untreated control group and assessment of neurosurgical patients admitted to 2 neurosurgical wards at Cho Ray Hospital between July 11 and August 15, 2000 (before the intervention), and July 14 and August 18, 2001 (after the intervention). A hand sanitizer with 70% isopropyl alcohol and 0.5% Chlorhexidine gluconate was introduced, and healthcare workers were trained in its use on ward A in September 2000. No intervention was made in ward B. Centers for Disease Control and Prevention definitions of SSI were used. Patient SSI data were collected on standardized forms and were analyzed using Stata software (Stata).
Results.
A total of 786 patients were enrolled: 377 in the period before intervention (156 in ward A and 221 in ward B) and 409 in the period after intervention (159 in ward A and 250 in ward B). On ward A after the intervention, the SSI rate was reduced by 54% (from 8.3% to 3.8%; P = .09), and more than half of superficial SSIs were eliminated (7 of 13 vs 0 of 6 in ward B; P = .007). On ward B, the SSI rate increased by 22% (from 7.2% to 9.2%; P = .8). In patients without SSI, the median postoperative length of stay and the duration of antimicrobial use were reduced on ward A (both from 8 to 6 days; P <.001) but not on ward B.
Conclusions.
Our study demonstrates that introduction of a hand sanitizer can both reduce SSI rates in neurosurgical patients, with particular impact on superficial SSIs, and reduce the overall postoperative length of stay and the duration of antimicrobial use. Hand hygiene programs in developing countries are likely to reduce SSI rates and improve patient outcomes.
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Affiliation(s)
- Thi Anh Thu Le
- Infection Control Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam.
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Cheng K, Li J, Kong Q, Wang C, Ye N, Xia G. Risk factors for surgical site infection in a teaching hospital: a prospective study of 1,138 patients. Patient Prefer Adherence 2015; 9:1171-7. [PMID: 26316722 PMCID: PMC4542557 DOI: 10.2147/ppa.s86153] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The purpose of this study was to identify risk factors for surgical site infection (SSI) in a teaching hospital. METHODS A prospective study was initiated to investigate risk factors for SSI at a university-affiliated tertiary care center from July 2013 to December 2014. The chi-square test for categorical variables was used to determine the significance of association, whereas the multivariate logistic regression model was used to examine independent risk factors for SSI. RESULTS A total of 1,138 patients met the inclusion criteria, in whom 36 cases of infection occurred during the hospitalization period and two cases occurred after discharge. Univariate analysis showed that SSI was associated with the type of operation, wound classification, volume of blood loss, blood transfusion, American Society of Anesthesiology score before surgery, risk index, duration of surgery, diabetes, cancer, gastrointestinal catheter, urinary catheter, postoperative drainage, and preprocedural white blood cell count. Multivariate analysis identified six independent parameters correlating with the occurrence of SSI: diabetes (odds ratio [OR] 6.400; 95% confidence interval [CI] 2.582-15.866; P=0.000); cancer (OR 2.427; 95% CI 1.028-5.732; P=0.043); preprocedural white blood cell count more than 10×10(9)/L (OR 6.988; CI 3.165-15.425; P=0.000); wound classification (clean contaminated [OR: 7.893; CI: 2.244-27.762; P=0.001]; contaminated [OR: 7.031; CI: 1.652-29.922; P=0.008]; dirty [OR: 48.778; CI: 5.418-439.164; P=0.001]); operative duration more than 120 minutes (OR 4.289; CI 1.773-10.378; P=0.001); and postoperative drainage (OR 3.957; CI 1.422-11.008; P=0.008). CONCLUSION Our data suggest that all these risk factors could be regarded as potential indicators of SSI and that relevant preventive measures should be taken to reduce SSI and improve patient outcomes.
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Affiliation(s)
- Keping Cheng
- Department of Infection Control, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu Province, People’s Republic of China
- Correspondence: Keping Cheng, Department of Infection Control, Zhongda Hospital, School of Medicine, Southeast University, Gulou district of Nanjing 210009, People’s Republic of China, Tel +86 25 8327 2069, Email
| | - Jiawei Li
- Department of Infection Control, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Qingfang Kong
- Department of Infection Control, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Changxian Wang
- Department of Infection Control, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Nanyuan Ye
- Department of Infection Control, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Guohua Xia
- Department of Infection Control, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu Province, People’s Republic of China
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Lonjon G, Dauzac C, Fourniols E, Guigui P, Bonnomet F, Bonnevialle P. Early surgical site infections in adult spinal trauma: a prospective, multicentre study of infection rates and risk factors. Orthop Traumatol Surg Res 2012; 98:788-94. [PMID: 23044465 DOI: 10.1016/j.otsr.2012.07.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 07/23/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Spine surgery is known to have a high risk of surgical site infection (SSI). Multiple studies have looked into the risk factors and incidence of SSI during elective surgery, but only two retrospective studies have specifically evaluated SSI during surgery following spine trauma. MATERIALS AND METHODS This work was based on a prospective cohort study that included all the patients operated on for spinal trauma at 13 French hospitals over a three-month period. The main endpoint was the occurrence of a SSI during the three-month period. Patients with multiple trauma or open fractures were excluded from the study. RESULTS Of the 169 patients re-examined after a minimum of three months, six had had an acute SSI (3.55%). The following factors were significantly related to a SSI: age, ASA score, diabetes, procedure duration, delay elapsed between accident and procedure, number of levels fused, bleeding and prolonged presence of urinary catheter. DISCUSSION Our results were consistent with the published infection rates of 2 to 10%. The risk factors identified have all been described in previous studies on elective spine surgery. LEVEL OF EVIDENCE Level IV, prospective cohort study.
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Affiliation(s)
- G Lonjon
- Orthopaedic Surgery Department, Beaujon Hospital, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
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16
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Infirmity and injury complexity are risk factors for surgical-site infection after operative fracture care. Clin Orthop Relat Res 2011; 469:2621-30. [PMID: 21161736 PMCID: PMC3148392 DOI: 10.1007/s11999-010-1737-2] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 11/29/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND Orthopaedic surgical-site infections prolong hospital stays, double rehospitalization rates, and increase healthcare costs. Additionally, patients with orthopaedic surgical-site infections (SSI) have substantially greater physical limitations and reductions in their health-related quality of life. However, the risk factors for SSI after operative fracture care are unclear. QUESTIONS/PURPOSE We determined the incidence and quantified modifiable and nonmodifiable risk factors for SSIs in patients with orthopaedic trauma undergoing surgery. PATIENTS AND METHODS We retrospectively indentified, from our prospective trauma database and billing records, 1611 patients who underwent 1783 trauma-related procedures between 2006 and 2008. Medical records were reviewed and demographics, surgery-specific data, and whether the patients had an SSI were recorded. We determined which if any variables predicted SSI. RESULTS Six factors independently predicted SSI: (1) the use of a drain, OR 2.3, 95% CI (1.3-3.8); (2) number of operations OR 3.4, 95% CI (2.0-6.0); (3) diabetes, OR 2.1, 95% CI (1.2-3.8); (4) congestive heart failure (CHF), OR 2.8, 95% CI (1.3-6.5); (5) site of injury tibial shaft/plateau, OR 2.3, 95% CI (1.3-4.2); and (6) site of injury, elbow, OR 2.2, 95% CI (1.1-4.7). CONCLUSION The risk factors for SSIs after skeletal trauma are most strongly determined by nonmodifiable factors: patient infirmity (diabetes and heart failure) and injury complexity (site of injury, number of operations, use of a drain). LEVEL OF EVIDENCE Level II, prognostic study. See the Guideline for Authors for a complete description of levels of evidence.
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Hadadi A, Zehtab MJ, Babagolzadeh H, Ashraf H. Contributing risk factors for orthopedic device related infections in sina hospital, tehran, iran. IRANIAN RED CRESCENT MEDICAL JOURNAL 2011; 13:117-22. [PMID: 22737445 PMCID: PMC3371915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 08/20/2010] [Accepted: 08/28/2010] [Indexed: 11/01/2022]
Abstract
BACKGROUND In spite of decreasing incidence of orthopedic device-related infections to 1%, nowadays, device-related infection still remains a diagnostic, therapeutic and cost-related problem. The objective of this study is to evaluate the contributing risk factors for orthopedic device-related infections in Sina Hospital, Tehran, Iran. METHODS Three hundred and thirty patients who underwent orthopedic device implantation from 2002-2006 were enrolled; among them, 110 patients were complicated with infection. Descriptive and logistic regression analyses were performed to determine the risk factors for device related infections. RESULTS Patients with infection were older compared to those without infection. The Staphylococcus aureus was the commonest organism. A correlation was observed between wound infection and external fixation, an underlying health condition, and addiction which were independent risk factors for a device related infection. CONCLUSION Orthopedic device-related infection puts a great financial burden on patients and hospital resources and could lead to morbidity and mortality in patients. So, appropriate pre and postoperative wound care for dirty wounds, especially when external fixators are used, and in patients with poor conditions or addiction should be done with more caution.
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Affiliation(s)
- A Hadadi
- Department of Infectious Disease, Research Development Center, Sina Hospital, Iranian Research Center for HIV/AIDS, Tehran University of Medical Sciences, Tehran, Iran,Correspondence: Azar Hadadi, MD, Associate Professor of Infectious Diseases, Research Development Center, Sina Hospital, Iranian Research Center for HIV/AIDS, Tehran University of Medical Sciences, Tehran, Iran. Tel.: +98-21-66716546, Fax: +98-21-66716546, E-mail:
| | - M J Zehtab
- Department of Orthopedic Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - H Babagolzadeh
- General Practitioner, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - H Ashraf
- Department of Cardiology, Research and Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Allegranzi B, Bagheri Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L, Pittet D. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet 2011; 377:228-41. [PMID: 21146207 DOI: 10.1016/s0140-6736(10)61458-4] [Citation(s) in RCA: 1263] [Impact Index Per Article: 97.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Health-care-associated infection is the most frequent result of unsafe patient care worldwide, but few data are available from the developing world. We aimed to assess the epidemiology of endemic health-care-associated infection in developing countries. METHODS We searched electronic databases and reference lists of relevant papers for articles published 1995-2008. Studies containing full or partial data from developing countries related to infection prevalence or incidence-including overall health-care-associated infection and major infection sites, and their microbiological cause-were selected. We classified studies as low-quality or high-quality according to predefined criteria. Data were pooled for analysis. FINDINGS Of 271 selected articles, 220 were included in the final analysis. Limited data were retrieved from some regions and many countries were not represented. 118 (54%) studies were low quality. In general, infection frequencies reported in high-quality studies were greater than those from low-quality studies. Prevalence of health-care-associated infection (pooled prevalence in high-quality studies, 15·5 per 100 patients [95% CI 12·6-18·9]) was much higher than proportions reported from Europe and the USA. Pooled overall health-care-associated infection density in adult intensive-care units was 47·9 per 1000 patient-days (95% CI 36·7-59·1), at least three times as high as densities reported from the USA. Surgical-site infection was the leading infection in hospitals (pooled cumulative incidence 5·6 per 100 surgical procedures), strikingly higher than proportions recorded in developed countries. Gram-negative bacilli represented the most common nosocomial isolates. Apart from meticillin resistance, noted in 158 of 290 (54%) Staphylococcus aureus isolates (in eight studies), very few articles reported antimicrobial resistance. INTERPRETATION The burden of health-care-associated infection in developing countries is high. Our findings indicate a need to improve surveillance and infection-control practices. FUNDING World Health Organization.
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Uçkay I, Harbarth S, Peter R, Lew D, Hoffmeyer P, Pittet D. Preventing surgical site infections. Expert Rev Anti Infect Ther 2010; 8:657-70. [PMID: 20521894 DOI: 10.1586/eri.10.41] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The risk of surgical site infection (SSI) is approximately 1-3% for elective clean surgery. Apart from patient endogenous factors, the role of external risk factors in the pathogenesis of SSI is well recognized. However, among the many measures to prevent SSI, only some are based on strong evidence, for example, adequate perioperative administration of prophylactic antibiotics, and there is insufficient evidence to show whether one method is superior to any other. This highlights the need for a multimodal approach involving active post-discharge surveillance, as well as measures at every step of the care process, ranging from the operating theater to postoperative care. Multicenter or supranational intervention programs based on evidence-based guidelines, 'bundles' or safety checklists are likely to be beneficial on a global scale. Although theoretically reducible to zero, the maximal realistic extent by which SSI can be decreased remains unknown.
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Affiliation(s)
- Ilker Uçkay
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland
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20
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Diabetes associated with increased surgical site infections in spinal arthrodesis. Clin Orthop Relat Res 2009; 467:1670-3. [PMID: 19225851 PMCID: PMC2690748 DOI: 10.1007/s11999-009-0740-y] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Accepted: 01/28/2009] [Indexed: 01/31/2023]
Abstract
UNLABELLED Diabetes mellitus (DM) is a major risk factor for surgical site infection (SSI). Spinal surgeries are also associated with an increased risk of SSI. To confirm previous reports we evaluated the association of DM with spine infection in 195 patients who underwent elective posterior instrumented lumbar arthrodesis over a 5-year period: 30 with DM and 165 without. Other known risk factors for SSI in spinal surgery were examined: age, gender, tobacco use, body mass index, American Society of Anesthesiologists (ASA) class, intraoperative antibiotic redosing, surgical time, bone allograft use, estimated blood loss (EBL), and drain use. The adjusted relative risk of having DM for developing SSI was 4.10 (95% C.I. = 1.37-12.32). Other factors did not appear as risk factors for SSI. The data confirm DM is a risk factor for surgical site infections in spinal arthrodesis surgery. LEVEL OF EVIDENCE Level II, prognostic study (retrospective study).
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Maksimović J, Marković-Denić L, Bumbasirević M, Marinković J, Vlajinac H. Surgical site infections in orthopedic patients: prospective cohort study. Croat Med J 2008; 49:58-65. [PMID: 18293458 DOI: 10.3325/cmj.2008.1.58] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM To estimate the incidence rate and risk factors of surgical site infections in the orthopedic wards in a major teaching hospital in Serbia. METHODS A 6-month prospective cohort study, with 30 days of patient follow-up after surgery, was conducted at the teaching hospital in Belgrade. We collected patients' basic demographic data and data on underlying disease status, surgical procedures, preoperative preparation of patients, and antibiotic prophylaxis. The National Nosocomial Infections Surveillance (NNIS) risk index was computed for each patient. Descriptive and logistic regression analyses were performed to determine risk factors for surgical site infections. RESULTS Assessment of 277 patients after operation revealed surgical site infection in 63 patients. In 3 (4.8%) of them, surgical site infections were detected after hospital discharge. The overall incidence rate of surgical site infections was 22.7% (95% confidence interval [95% CI], 17.5-29.1). The incidence increased from 13.2% in clean wounds to 70.0% in dirty wounds. The rates of surgical site infection for the NNIS risk index classes 0 to 3 were 8.1% (13 of 161), 36.4% (32 of 88), 63.0% (17 of 27), and 100% (1 of 1) (P<0.001; chi2 test). Multivariate logistic regression analysis identified the following independent risk factors for surgical site infections: greater number of persons in the operating room (odds ratio [OR], 1.28; 95% CI, 1.02-1.60), contaminated or dirty wounds (OR, 12.09; 95% CI, 5.56-26.28), and American Society of Anesthesiologists' (ASA) score >2 (OR, 3.47; 95% CI, 1.51-7.95). In patients who were shaved with a razor, the period of 12 or more hours between shaving and intervention was also an independent risk factor (OR, 2.77; 95% CI, 1.22-6.28). CONCLUSION There is a high incidence of surgical site infections in orthopedic patients in Serbia in comparison with developed countries and some developing countries. Points for intervention could be reduction of personnel during surgery, better treatment of wounds, decreasing ASA score, and reduction of the time between surgical site shaving and the intervention.
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Affiliation(s)
- Jadranka Maksimović
- Ljiljana Markovic-Denic, Institute of Epidemiology, School of Medicine, Visegradska 26, 11000 Belgrade, Serbia,
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