1
|
Dehghani B, DeAngelis RD, Hallman M, Karnuta JM, Minutillo GT, Alqazzaz A, Donegan DJ, Mehta S. Using Next-Generation Sequencing to Understand Infection Prevention in Surgical Treatment of Upper Extremity Fractures-A Prospective Cohort Study. J Am Acad Orthop Surg 2024; 32:e832-e838. [PMID: 39093461 DOI: 10.5435/jaaos-d-23-00703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 04/15/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION Postoperative fracture site infection can lead to notable patient morbidity, increase cost of care, and further contribute to healthcare disparities globally. Dogma suggests surgical blades as a vehicle for introducing bacteria into the surgical site; however, there is a paucity of literature to support this claim. This study uses advanced DNA sequencing to detect bacterial DNA on surgical blades used in upper extremity fracture surgeries. METHODS This was a prospective study, conducted at a high-volume level 1 trauma center. All acute, closed upper extremity fractures requiring surgical stabilization were consecutively enrolled in a prospective fashion. The primary end point was the presence of bacterial DNA on the surgical blade using next-generation sequencing (NGS). At the time of surgery, two blades were sterilely opened. One blade served as the control while the other was used for the initial skin incision. Two negative control blades were opened directly into a sterile container. Two positive control blades were used for skin incision through known infections. All samples were sent for NGS analysis. RESULTS Forty patients were enrolled in this study. The median age was 33.5 years, and 30% were female; the median body mass index was 26.52. Humerus fractures were the most common injury (N = 17, 42.5%), followed by clavicle fractures (13, 32.5%) and radius/ulna fractures (10, 25.0%). NGS analysis revealed no contamination of test blades used for skin incision. Three control blades tested positive for bacterial DNA. Negative control blades tested negative for bacterial DNA (0/2); the positive control blades resulted positive for bacterial DNA contamination (2/2). CONCLUSION Surgical blades used for skin incision in the upper extremity are not contaminated with bacterial DNA as analyzed by NGS. This finding challenges previous surgical dogma regarding surgical blade contamination and supports that the same surgical blade can safely be used for deeper dissection. LEVEL OF EVIDENCE Level II study: IRB approval-IRB#848938.
Collapse
Affiliation(s)
- Bijan Dehghani
- From the Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | | | | | | |
Collapse
|
2
|
Xiong S, Qin S, Tong L, Long Y, Luo Y, Feng Q, Peng X, Jiang M, Xiong F, Li J, Zhang Y, Zhang Z, Liu H, Cai L. The clinical use of remote parameter testing during cardiac implantable electronic devices implantation procedures: a single center, randomized, open-label, non-inferiority trial. Front Cardiovasc Med 2024; 11:1364940. [PMID: 38586175 PMCID: PMC10995217 DOI: 10.3389/fcvm.2024.1364940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/05/2024] [Indexed: 04/09/2024] Open
Abstract
Background A novel non-contact system for remote parameter testing and reprogramming offers an alternative method for assessing device parameters during cardiac implantable electronic devices (CIEDs) implantation without the need for physical contact with the manufacturer's clinical service technician. The safety and feasibility of using this system in CIEDs implantation procedures remains to be determined. Objective Evaluate the safety and feasibility of remote parameter testing in CIEDs implantation procedures. Methods A single center, randomized, open-label, non-inferiority trial (ChiCTR2200057587) was conducted to compare the two approaches for interrogating CIEDs during implantation procedures: routine interrogation performed by on-site technicians or remote interrogation performed by technicians using the 5G-Cloud Technology Platform. Patients aged ≥18 years and elected to receive CIEDs were eligible for inclusion. The primary endpoint was the completion rate of the parameter test. Safety and efficiency were evaluated in all randomly assigned participants. Results A total of 480 patients were finally enrolled and were randomly assigned to routine group (n = 240) or remote group (n = 240). The primary endpoint was achieved by 100% in both groups (P = 0.0060 for noninferiority). The parameters of sensing, threshold, and impedance regarding the right atrium, right ventricle, and left ventricle had no statistical significance between the two groups (P > 0.05). Procedure time, parameter testing time, and both duration and dose of x-ray irradiation were not significantly different between the two groups (P > 0.05). Shut-open door frequency was significantly higher in the routine group than the remote group [6.00 (4.00, 8.00) vs. 0, P < 0.0001]. Notably, no clinical or technical complications were observed in the remote group. Conclusions Remote parameter testing is safe and feasible across various devices implantation procedures. The utilization of remote parameter testing and reprogramming could represent an innovative approach to improve healthcare accessibility and unlock the full potential of secondary centers in managing CIEDs. The Registration Identification ChiCTR2200057587.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Zhen Zhang
- Correspondence: Zhen Zhang Hanxiong Liu Lin Cai
| | | | - Lin Cai
- Correspondence: Zhen Zhang Hanxiong Liu Lin Cai
| |
Collapse
|
3
|
Humphreys H, Bak A, Ridgway E, Wilson APR, Vos MC, Woodhead K, Haill C, Xuereb D, Walker JM, Bostock J, Marsden GL, Pinkney T, Kumar R, Hoffman PN. Rituals and behaviours in the operating theatre - joint guidelines of the Healthcare Infection Society and the European Society of Clinical Microbiology and Infectious Diseases. J Hosp Infect 2023; 140:165.e1-165.e28. [PMID: 37454912 DOI: 10.1016/j.jhin.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 06/05/2023] [Accepted: 06/11/2023] [Indexed: 07/18/2023]
Affiliation(s)
- H Humphreys
- Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland; Healthcare Infection Society, London, UK; ESCMID Study Group for Nosocomial Infection, Basel, Switzerland.
| | - A Bak
- Healthcare Infection Society, London, UK
| | - E Ridgway
- Healthcare Infection Society, London, UK
| | - A P R Wilson
- Healthcare Infection Society, London, UK; University College London Hospitals, London, UK
| | - M C Vos
- ESCMID Study Group for Nosocomial Infection, Basel, Switzerland; Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - K Woodhead
- Association for Perioperative Practice, Harrogate, UK; Royal College of Nursing, London, UK
| | - C Haill
- Healthcare Infection Society, London, UK
| | - D Xuereb
- Infection Prevention Society, Seafield, UK
| | - J M Walker
- Healthcare Infection Society, London, UK; NHS Grampian, Greater Aberdeen, UK
| | - J Bostock
- Lay Member for Healthcare Infection Society, London, UK
| | - G L Marsden
- Healthcare Infection Society, London, UK; Royal College of General Practitioners, London, UK
| | - T Pinkney
- University of Birmingham, Birmingham, UK
| | - R Kumar
- Lay Member for Healthcare Infection Society, London, UK
| | | |
Collapse
|
4
|
Fann LY, Cheng CC, Chien YC, Hsu CW, Chien WC, Huang YC, Chung RJ, Huang SH, Jiang YH, Yin SH, Cheng KW, Wu YP, Hsiao SH, Hsu SY, Huang YC, Chu CM. Effect of far-infrared radiation on inhibition of colonies on packaging during storage of sterilised surgical instruments. Sci Rep 2023; 13:8490. [PMID: 37231027 DOI: 10.1038/s41598-023-35352-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 05/16/2023] [Indexed: 05/27/2023] Open
Abstract
The sterilisation of surgical instruments is a major factor in infection control in the operating room (OR). All items used in the OR must be sterile for patient safety. Therefore, the present study evaluated the effect of far-infrared radiation (FIR) on the inhibition of colonies on packaging surface during the long-term storage of sterilised surgical instruments. From September 2021 to July 2022, 68.2% of 85 packages without FIR treatment showed microbial growth after incubation at 35 °C for 30 days and at room temperature for 5 days. A total of 34 bacterial species were identified, with the number of colonies increasing over time. In total, 130 colony-forming units were observed. The main microorganisms detected were Staphylococcus spp. (35%) and Bacillus spp. (21%) , Kocuria marina and Lactobacillus spp. (14%), and mould (5%). No colonies were found in 72 packages treated with FIR in the OR. Even after sterilisation, microbial growth can occur due to movement of the packages by staff, sweeping of floors, lack of high-efficiency particulate air filtration, high humidity, and inadequate hand hygiene. Thus, safe and simple far-infrared devices that allow continuous disinfection for storage spaces, as well as temperature and humidity control, help to reduce microorganisms in the OR.
Collapse
Affiliation(s)
- Li-Yun Fann
- Department of Nursing, Taipei City Hospital, Taipei, 10684, Taiwan
- Department of Nurse-Midwifery and Women Health, National Taipei University of Nursing and Health Sciences, Taipei, 11220, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, 11490, Taiwan
| | - Chih-Chien Cheng
- Univeraity of Taipei, Taipei, 10048, Taiwan
- Department of Obstetrics/Gynecology, Taipei City Hospital, Taipei, 10341, Taiwan
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, 242062, Taiwan
| | - Yung-Chen Chien
- Department of Inspection, Taipei City Hospital, Ren-Ai Branch, Taipei, 10629, Taiwan
| | - Cheng-Wei Hsu
- Department of Nursing, Taipei City Hospital, Taipei, 10684, Taiwan
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei, 11490, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, 11490, Taiwan
- Department of Medical Research, Tri-Service General Hospital, Taipei, 11490, Taiwan
| | - Yao-Ching Huang
- School of Public Health, National Defense Medical Center, Taipei, 11490, Taiwan
- Department of Medical Research, Tri-Service General Hospital, Taipei, 11490, Taiwan
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei, 10608, Taiwan
| | - Ren-Jei Chung
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei, 10608, Taiwan
| | - Shi-Hao Huang
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei, 10608, Taiwan
| | - Ying-Hua Jiang
- Department of Nursing, Taipei City Hospital, Taipei, 10684, Taiwan
| | - Shih-Han Yin
- Department of Nursing, Taipei City Hospital, Taipei, 10684, Taiwan
| | - Kai-Wen Cheng
- Department of Nursing, Taipei City Hospital, Taipei, 10684, Taiwan
| | - Yi-Ping Wu
- Department of Nursing, Taipei City Hospital, Taipei, 10684, Taiwan
| | - Sheng-Huang Hsiao
- Department of Neurosurgery, Taipei City Hospital, Ren-Ai Branch, Taipei, 10629, Taiwan.
| | - Shao-Yuan Hsu
- Department of Neurosurgery, Taipei City Hospital, Ren-Ai Branch, Taipei, 10629, Taiwan.
| | - Ying-Che Huang
- Department of Anesthesia and Critical Care Medicine, Taipei City Hospital, Ren-Ai Branch, Taipei, 10629, Taiwan.
| | - Chi-Ming Chu
- School of Public Health, National Defense Medical Center, Taipei, 11490, Taiwan.
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, 11490, Taiwan.
| |
Collapse
|
5
|
Quan X. Improving Ambulatory Surgery Environments: The Effects on Patient Preoperative Anxiety, Perception, and Noise. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2023; 16:73-88. [PMID: 36740908 DOI: 10.1177/19375867221149990] [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: 02/07/2023]
Abstract
OBJECTIVES The study aimed to comparatively evaluate three types of preoperative care environment in terms of patient experience outcomes including patient preoperative anxiety, perceived environmental qualities, and noise level. BACKGROUND Preoperative anxiety is a major healthcare problem causing delays, complications, dissatisfaction, and rising healthcare costs. The design of preoperative spaces may play an important role in reducing preoperative anxiety and improving outcomes. METHODS Anonymous questionnaire surveys were conducted with 228 patients in the three types of preoperative bays that varied in terms of bay size and the amount of hard-wall partitions between bays to compare patient self-reported anxiety and perceived environmental qualities. Sound level measurements were conducted throughout the three preoperative care units. RESULTS Female patients in the preoperative unit with largest bays and full hard-wall partitions between bays reported significantly lower levels of subjective anxiety (p's = .002, <.001) and higher levels of perceived environmental qualities on privacy, cleanliness, noise, and pleasantness (p's from <.001 to .017) than patients in the units with smaller bays and no or partial hard-wall partitions. Similar but less clear pattern was found among male patients. The lowest average noise levels were recorded in the unit with largest bays and full hard-wall partitions between bays (2.3-6.1 decibels lower than the other units). CONCLUSIONS The design of preoperative care environment may contribute to the better management of preoperative anxiety. Further efforts in research and design are needed to maximize the benefits in clinical, experiential, and financial outcomes.
Collapse
Affiliation(s)
- Xiaobo Quan
- Christopher C. Gibbs College of Architecture, University of Oklahoma, Norman, OK, USA
| |
Collapse
|
6
|
Agra PA, Agra PA, Marceliano-Alves MFV, Conceição GMSD, Assumpção SLDL, Crespo CDF, Philippi LMB, Lins RX. Effect of Ozone Gas on Removal of Airborne Particles. Eur J Dent 2022; 16:695-702. [PMID: 35436785 PMCID: PMC9507573 DOI: 10.1055/s-0041-1741375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective
Airborne particles are one of the most important factors in the spread of infectious pathogens and must be monitored in healthcare facilities. Viable particles are living microorganisms, whereas non-viable particles do not contain microorganisms but act as transport for viable particles. The effectiveness of ozone in reducing these particles in a non-controlled room and a controlled cleanroom using high-efficiency particles air (HEPA) filter was analyzed in this study.
Materials and Methods
Viable particles and non-viable particles sized 0.5 and 5 μm were quantified before and after ozonation in two different health environments: non-controlled (group 1) and controlled area, which was associated with a HEPA filtering system (group 2). Active air sampling using a MAS 100 was used to count the number of viable particles, while the number of non-viable particles/m
3
was obtained following the manufacturer's recommendations of the Lasair III 310C system.
Results
Our results of the viable particles counting were not quantifiable and analyzed using statistical tests. Both groups showed a slight tendency to reduce the number of viable particles after ozonation of the environmental air. A statistically significant reduction of non-viable 5 μm particles after ozonation was observed in both groups (G1:
p
= 0,009; G2:
p
= 0,002). Reduction in the non-viable 0.5 μm particles after ozonation was observed only in group 2, associated with the HEPA filter. In group 1, after ozonation, a significant increase in 0.5 μm particles was observed, probably due to the breaking of 5 μm particles by ozone gas. Our results suggest that ozone gas can break 5 μm particles and, when associated with a HEPA filter, increases its effectiveness in removing 0.5 μm particles.
Conclusion
Considering that 5 μm particles are important in the air transport of microorganisms, their reduction in the environment can be a relevant parameter in controlling the dissemination of infections.
Collapse
Affiliation(s)
- Priscilla Alvarenga Agra
- Post Graduate Program in Dentistry, Health Institute of Nova Friburgo, Federal Fluminense University, Nova Friburgo, Rio de Janeiro, Brazil
| | - Patricia Alvarenga Agra
- Immunobiological Technology Institute, Bio-Manguinhos, Oswaldo Cruz Foundation,-Rio de Janeiro, Brazil
| | | | | | | | - Celso de Farias Crespo
- Immunobiological Technology Institute, Bio-Manguinhos, Oswaldo Cruz Foundation,-Rio de Janeiro, Brazil
| | | | - Renata Ximenes Lins
- Post Graduate Program in Dentistry, Health Institute of Nova Friburgo, Federal Fluminense University, Nova Friburgo, Rio de Janeiro, Brazil
| |
Collapse
|
7
|
The Effect of Operating Room Size on Orthopaedic Surgical Site Infection Rates. J Am Acad Orthop Surg 2021; 29:1009-1016. [PMID: 33443390 DOI: 10.5435/jaaos-d-20-01022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/03/2020] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE With many preventable causes of surgical site infections (SSIs) identified, the effect of operating room (OR) size on SSI rates has not been assessed. This study investigated the effect of OR size on incidence of SSIs for orthopaedic procedures. BACKGROUND SSIs remain a common complication within the perioperative realm. Responsible for increasing length of hospitalization and costs, SSIs result in a decreased quality of life for patients. METHODS A retrospective review of 11,163 patients who underwent orthopaedic surgery-including total knee and hip arthroplasties, laminectomies, and spinal fusions-between January 2018 and January 2020 were reviewed. Total net square footage (NSF) of all ORs was recorded, and incidence of SSIs was calculated. Cases were categorized based on the size of the OR (small: 250 to 399 NSF; medium: 400 to 549 NSF; and large: 550 to 699 NSF). Chi-square analysis compared infection rates between the different OR sizes, and a binary logistic regression model identified other predictors of infection. RESULTS Overall, 137 patients (1.2%) developed an SSI. Of these infections, 16 (11.7%) occurred in small ORs, 83 (60.6%) in medium ORs, and 38 (27.7%) in large ORs. The incidence of SSIs was 0.7% in small ORs, 1.3% in medium ORs, and 1.8% in large ORs. Factors found to significantly impact SSI's included medium-sized ORs, younger patients, procedure type (fusions and emergencies/traumas), longer procedures, and higher American Society of Anesthesiologists scores (>3). CONCLUSION Our study shows that OR size in addition to various other perioperative parameters plays a role in the rate of SSIs for orthopaedic procedures. LEVEL OF EVIDENCE Retrospective Cohort Study; Level III Evidence.
Collapse
|
8
|
Giwangkancana G, Rahmi A, Indriasari, Hidayat NN. Managing surgical patients with a COVID-19 infection in the operating room: An experience from Indonesia. ACTA ACUST UNITED AC 2021; 24:100198. [PMID: 34307910 PMCID: PMC8268678 DOI: 10.1016/j.pcorm.2021.100198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/14/2021] [Accepted: 06/20/2021] [Indexed: 10/24/2022]
Abstract
Background The Coronavirus and the COVID-19 pandemic in 2020 have significantly impacted hospital care, including surgery practice. Hospitals must balance patient care, staff safety, resource availability, and medical ethics. Differences in community infection trends, national policies, availability of resources and technology, plus local circumstances may make uniform management impossible globally. This paper described the practical workflow of emergency COVID-19 surgery in a tertiary referral national hospital in Indonesia. Method This study focused on the process of preparation for COVID-19 surgery from March 2020-March 2021. We also described the available facilities in terms of equipment and human resources. Results Steps of COVID-19 surgery preparations were described, such as the setup of general and infectious triage in the emergency department, development of preoperative screening protocol for COVID-19, designation of a specialized COVID-19 operating room and surgical staff, changes in preoperative surgery and anesthesia workflow, development of checklists and postoperative monitoring on staff health. Conclusions Changes in the workflow are essential during the pandemic for safe surgery. These changes require a multidisciplinary approach, communication, and a continued willingness to adapt. We recommend local adaptation of our general workflow for emergency surgery during an epidemic or pandemic.
Collapse
Affiliation(s)
- Gezy Giwangkancana
- Department of Anesthesiology and Intensive Care, Faculty of Medicine Universitas Padjadjaran - Dr. Hasan Sadikin National Referral Hospital Bandung Indonesia
| | - Alia Rahmi
- Department of Nursing, Dr. Hasan Sadikin National Referral Hospital Bandung Indonesia
| | - Indriasari
- Department of Anesthesiology and Intensive Care, Faculty of Medicine Universitas Padjadjaran - Dr. Hasan Sadikin National Referral Hospital Bandung Indonesia
| | - Nucki Nursjamsi Hidayat
- Department of Orthopaedics and Traumatology, Faculty of Medicine Universitas Padjadjaran - Dr. Hasan Sadikin National Referral Hospital Bandung Indonesia
| |
Collapse
|
9
|
Aganovic A, Cao G, Fecer T, Ljungqvist B, Lytsy B, Radtke A, Reinmüller B, Traversari R. Ventilation design conditions associated with airborne bacteria levels within the wound area during surgical procedures: a systematic review. J Hosp Infect 2021; 113:85-95. [PMID: 33930488 DOI: 10.1016/j.jhin.2021.04.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Without confirmation of the ventilation design conditions (typology and airflow rate), the common practice of identifying unidirectional airflow (UDAF) systems as equivalent to ultra-clean air ventilation systems may be misleading, but also any claims about the ineffectiveness of UDAF systems should be doubted. The aim of this review was to assess and compare ventilation system design conditions for which ultra-clean air (mean <10 cfu/m3) within 50 cm from the wound has been reported. Six medical databases were systematically searched to identify and select studies reporting intraoperative airborne levels expressed as cfu/m3 close to the wound site, and ventilation system design conditions. Available data on confounding factors such as the number of persons present in the operating room, number of door openings, and clothing material were also included. Predictors for achieving mean airborne bacteria levels within <10 cfu/m3 were identified using a penalized multivariate logistic regression model. Twelve studies met the eligibility criteria and were included for analysis. UDAF systems considered had significantly higher air volume flows compared with turbulent ventilation (TV) systems considered. Ultra-clean environments were reported in all UDAF-ventilated (N = 7) rooms compared with four of 11 operating rooms equipped with TV. On multivariate analysis, the total number of air exchange rates (P=0.019; odds ratio (OR) 95% confidence interval (CI): 0.66-0.96) and type of clothing material (P=0.031; OR 95% CI: 0.01-0.71) were significantly associated with achieving mean levels of airborne bacteria <10 cfu/m3. High-volume UDAF systems complying with DIN 1946-4:2008 standards for the airflow rate and ceiling diffuser size unconditionally achieve ultra-clean air close to the wound site. In conclusion, the studied articles demonstrate that high-volume UDAF systems perform as ultra-clean air systems and are superior to TV systems in reducing airborne bacteria levels close to the wound site.
Collapse
Affiliation(s)
- A Aganovic
- Department of Automation and Process Engineering, The Arctic University of Norway, Norway.
| | - G Cao
- Department of Energy and Process Engineering, Norwegian University of Science and Technology - NTNU, Norway
| | - T Fecer
- Department of Computer Aided Engineering and Computer Science, Faculty of Civil Engineering, Brno University of Technology, Czech Republic
| | - B Ljungqvist
- Department of Civil and Environmental Engineering, Chalmers University of Technology, Sweden
| | - B Lytsy
- Department of Medical Sciences, Clinical Microbiology, Uppsala University, Sweden
| | - A Radtke
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Norway
| | - B Reinmüller
- Department of Civil and Environmental Engineering, Chalmers University of Technology, Sweden
| | - R Traversari
- Netherlands Organization for Applied Scientific Research, Netherlands
| |
Collapse
|
10
|
Yıldırım G, Kılıç H, Karakaş HM. The antimicrobial efficacy of shielded ultraviolet germicidal irradiation in CT rooms with intense human circulation. ACTA ACUST UNITED AC 2021; 27:293-301. [PMID: 33517253 DOI: 10.5152/dir.2021.20688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Computed tomography (CT) premises are one of the strategic points in the spread of hospital-acquired infections. Ultraviolet germicidal irradiation (UVGI) is an effective method that could potentially be used to purify the ambient air in them. However, it cannot be directly used in the presence of humans and, therefore, it is not operationally suitable in such units with continuous human circulation. Newer devices have been developed to purify air with more efficient and shielded UV-C sources. This study aims to assess the microbial air contamination in CT scanning rooms and investigates the efficacy and technical considerations of shielded UV-C arrays. METHODS Two shielded UVGI systems, each equipped with 15 Watt UV-C LED arrays, were tested in a very busy CT unit. Initially, a pilot study was performed to determine ambient microorganisms under routine conditions before UVGI installation, followed by three basic scenarios of UVGI use under normal and abnormal conditions: A, UVGI, with both air-conditioning (AC) and ventilation on; B, UVGI, with AC on and ventilation off; C, UVGI, with both AC and ventilation off. Ambient air was sampled in various time points before and after the initialization of UV irradiation and analyzed for colony formation. RESULTS The mean total colony count in the pilot study was 1360±450 CFU/m3. Pre-UVGI colony count was 3510 CFU/m3 for Scenario A, ~10000 CFU/m3 for Scenario B and 990 CFU/m3 for Scenario C. Thirty minutes after UVGI, total colony counts in all three scenarios dropped to 30 to 70 CFU/m3. Under normal operating conditions and UVGI, the mean colony count was found as 21.4±13.5 CFU/m3 and the average efficacy of the UVGI was found as 99.39%. CONCLUSION This study identified substantial microbial air contamination in CT scanning rooms during normal and abnormal operating conditions. UV-C LED arrays effectively eliminate these microbiological contaminants. This effect is also observed under abnormal operating conditions where no other means of ventilation or air conditioning exists.
Collapse
Affiliation(s)
- Gülşah Yıldırım
- Department of Radiology, University of Health Sciences, Istanbul Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey
| | - Haluk Kılıç
- Department of Medical Microbiology, University of Health Sciences, Istanbul Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey
| | - Hakkı Muammer Karakaş
- Department of Radiology, University of Health Sciences, Istanbul Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey
| |
Collapse
|
11
|
Anderson RL, Lipps JA, Pritchard CL, Venkatachalam AM, Olson DM. An operating room audit to examine for patterns of staff entry/exit: pattern sequencing as a method of traffic reduction. J Infect Prev 2020; 22:69-74. [PMID: 33859724 DOI: 10.1177/1757177420967079] [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] [Received: 06/05/2020] [Accepted: 09/13/2020] [Indexed: 11/16/2022] Open
Abstract
Background Surgical site infections (SSIs) are estimated at over 16,000 annually and cost hospitals an estimated $1.6 billion per year. Therefore, most operating rooms (ORs) seek methods to reduce the risk of SSI, especially during the intraoperative period. Prior work has established a link between excess traffic through the OR and increased microbial counts, which create a higher risk for SSIs. Aim/Objectives To identify patterns of staff entry into the OR to further reduce the risk of SSIs after total joint arthroplasties. Methods Researchers directly observed 31 total joint arthroplasties, recording every instance the door to the OR suite opened and the personnel, reason for opening and timing during surgical incision. Researchers then utilised the sequential data analysis to search for patterns. Results Despite expected patterns in staff movement during the patterned surgery, researchers found no significant patterns to staff movement during total joint arthroplasty. Discussion This study's results suggest purposeful education targeted to circulating registered nurses could induce purposeful creation of traffic flow patterns to further decrease traffic and risk of SSI. Conclusion There is no singular pattern to entering and exiting the OR during surgery. Thus, a single-solution approach is not recommended.
Collapse
Affiliation(s)
| | - Jodi A Lipps
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | - DaiWai M Olson
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
12
|
Risk factors for surgical site infections in abdominal surgeries in Ghana: emphasis on the impact of operating rooms door openings. Epidemiol Infect 2020; 148:e147. [PMID: 32605670 PMCID: PMC7398855 DOI: 10.1017/s0950268820001454] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Major surgery carried out in low- and middle-income countries is associated with a high risk of surgical site infections (SSI), but knowledge is limited regarding contributory factors to such infections. This study explores factors related to patients developing an SSI in a teaching hospital in Ghana. A prospective cohort study of patients undergoing abdominal surgical procedures was conducted at Korle Bu Teaching Hospital. Patient characteristics, procedures and environmental characteristics were recorded. A 30-day daily surveillance was used to diagnose SSI, and Poisson regression analysis was used to test for association of SSI and risk factors; survival was determined by proportional hazard regression methods. We included 358 patients of which 58 (16.2%; 95% CI 12.7-20.4%) developed an SSI. The median number of door openings during an operation was 79, with 81% being unnecessary. Door openings greater than 100 during an operation (P = 0.028) significantly increased a patient's risk of developing an SSI. Such patients tended to have an elevated mortality risk (hazard ratio 2.67; 95% CI 0.75-9.45, P = 0.128). We conclude that changing behaviour and practices in operating rooms is a key strategy to reduce SSI risk.
Collapse
|
13
|
Anis HK, Curtis GL, Klika AK, Piuzzi NS, Otiso J, Richter SS, Barsoum WK, Higuera CA. In-Room Ultraviolet Air Filtration Units Reduce Airborne Particles During Total Joint Arthroplasty. J Orthop Res 2020; 38:431-437. [PMID: 31441105 DOI: 10.1002/jor.24453] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 08/07/2019] [Indexed: 02/04/2023]
Abstract
Reducing airborne bioburden in total joint arthroplasty (TJA) is of critical importance. The efficacy of crystalline ultraviolet-C (C-UVC) filtration in reducing bioburden in a dynamic operating room (OR) environment has not been evaluated. We assessed whether C-UVC filtration reduced (i) total particle counts (TPC); (ii) viable particle counts (VPC); and (iii) colony-forming units (CFUs). Fifty primary TJA cases were performed in a positive-pressure OR; 25 cases with the C-UVC unit and 25 cases without. The air was sampled by a particle counter and an impact air sampler to measure particle counts and CFUs, respectively. To compare TPC, VPC, and CFU/m3 between groups, independent t tests and multivariate regression, adjusted for number of OR staff and door openings, were performed. The C-UVC group had significantly lower TPC (2.6 × 106 vs. 4.7 × 106 particles, p = 0.001) and VPC (18,605 vs. 27,516 particles, p = 0.001). There were fewer CFUs in the C-UVC group (10.9 CFU/m3 vs. 13.7 CFU/m3 , p = 0.163). Multivariate analysis identified C-UVC filtration as a significant predictor of decreased TPC (β = -0.44, p = 0.002) and VPC (β = -0.47, p = 0.001) after accounting for door openings and number of OR staff. The reduction in CFUs was not significant on multivariate analysis. In this prospective pilot study, a C-UVC air disinfection and recirculation unit led to a significant reduction in both TPC and VPC and a non-significant reduction in CFU. Statement of clinical significance: Further studies are needed to investigate the effects of C-UVC filtration units on surgical-site infection rates. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:431-437, 2020.
Collapse
Affiliation(s)
- Hiba K Anis
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave/A41, Cleveland, Ohio, 44114
| | - Gannon L Curtis
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, Michigan
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave/A41, Cleveland, Ohio, 44114
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave/A41, Cleveland, Ohio, 44114
| | - Joshua Otiso
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave/A41, Cleveland, Ohio, 44114
| | - Sandra S Richter
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave/A41, Cleveland, Ohio, 44114
| | - Wael K Barsoum
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Carlos A Higuera
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida
| |
Collapse
|
14
|
Stauning MA, Bediako-Bowan A, Bjerrum S, Andersen LP, Andreu-Sánchez S, Labi AK, Kurtzhals JAL, Marvig RL, Opintan JA. Genetic relationship between bacteria isolated from intraoperative air samples and surgical site infections at a major teaching hospital in Ghana. J Hosp Infect 2019; 104:309-320. [PMID: 31738985 DOI: 10.1016/j.jhin.2019.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 10/28/2019] [Accepted: 11/11/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND In low- and middle-income countries (LMICs) the rate of surgical site infections (SSI) is high, leading to negative patient outcomes and excess healthcare costs. A causal relationship between airborne bacteria in the operating room and SSI has not been established, at a molecular or genetic level. We studied the relationship between intraoperative airborne bacteria and bacteria causing SSI in an LMIC. METHODS Active air sampling using a portable impactor was performed during clean or clean-contaminated elective surgical procedures. Active patient follow-up consisting of phone calls and clinical examinations was performed 3, 14 and 30 days after surgery. Bacterial isolates recovered from SSI and air samples were compared by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF) identification, ribotyping, whole genome sequencing (WGS), and metagenomic analysis. RESULTS Of 128 included patients, 116 (91%) completed follow-up and 11 (9%) developed SSI. Known pathogenic bacteria were isolated from intraoperative air samples in all cases with SSI. A match between air and SSI isolates was found by MALDI-TOF in eight cases. Matching ribotypes were found in six cases and in one case both WGS and metagenomic analysis showed identity between air- and SSI-isolates. CONCLUSION The study showed high levels of intraoperative airborne bacteria, an SSI-rate of 9% and a genetic link between intraoperative airborne bacteria and bacteria isolated from SSIs. This indicates the need for awareness of intraoperative air quality in LMICs.
Collapse
Affiliation(s)
- M A Stauning
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - A Bediako-Bowan
- Department of Surgery, School of Medicine and Dentistry, University of Ghana, Accra, Ghana; Department of Surgery, Korle-Bu Teaching Hospital, Accra, Ghana; Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark; Statens Serum Institut, Copenhagen, Denmark
| | - S Bjerrum
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - L P Andersen
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - S Andreu-Sánchez
- Centre for Genomic Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - A-K Labi
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark; Department of Microbiology, Korle-Bu Teaching Hospital, Accra, Ghana
| | - J A L Kurtzhals
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.
| | - R L Marvig
- Centre for Genomic Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - J A Opintan
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| |
Collapse
|
15
|
Traversari A, van Heumen S, Hoksbergen A. Effect of using ceiling-mounted systems for imaging in hybrid operating rooms on the level of colony-forming units during surgery. J Hosp Infect 2019; 103:e61-e67. [DOI: 10.1016/j.jhin.2018.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 10/16/2018] [Indexed: 11/26/2022]
|
16
|
Ji C, Zhu Y, Liu S, Li J, Zhang F, Chen W, Zhang Y. Incidence and risk of surgical site infection after adult femoral neck fractures treated by surgery: A retrospective case-control study. Medicine (Baltimore) 2019; 98:e14882. [PMID: 30882697 PMCID: PMC6426521 DOI: 10.1097/md.0000000000014882] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Surgical site infections (SSI) are devastating complications after surgery for femoral neck fractures. There are a lot of literature have shown a strong association between diabetic patients and SSI. This study aimed to identify diabetes as an independent risk factor of SSI, focusing on femoral neck fractures, and to investigate the other potential risk factors for SSI.We retrospectively collected data from patients who underwent surgery for femoral neck fractures through the medical record management system at a single level 1 hospital between January 2015 and June 2016. Demographic and clinical patient factors and characteristics of SSI were recorded. The case group was defined as patients with SSI and the control group was defined as patients without SSI. Univariate and multivariate analyses were performed to determine the risk factors for SSI.Data were provided for 692 patients, among whom 26 had SSI, representing an incidence rate of 3.67%. In the SSI group, 24 (3.47%) patients had superficial infection and 2 (0.29%) had deep infection. On multivariate analysis, diabetes (P < .001) was determined an independent risk factor of SSI, so were surgery performed between May and September (P = .04), body mass index (P = .031), corticosteroid therapy (P = .003), anemia (P = .041), and low preoperative hemoglobin levels.Our results suggest that clinicians should recognize patients with these factors, particularly diabetes. And taking management optimally in the preoperative period will prevent the SSI after femoral neck fracture.
Collapse
Affiliation(s)
- Chenni Ji
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei
| | - Yanbin Zhu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei
| | - Song Liu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei
| | - Jia Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei
| | - Fei Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei
| | - Wei Chen
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei
| | - Yingze Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei
- Chinese Academy of Engineering, Beijing, P.R. China
| |
Collapse
|
17
|
Alizo G, Onayemi A, Sciarretta JD, Davis JM. Operating Room Foot Traffic: A Risk Factor for Surgical Site Infections. Surg Infect (Larchmt) 2019; 20:146-150. [DOI: 10.1089/sur.2018.248] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Georgina Alizo
- Grand Strand Medical Center, Myrtle Beach, South Carolina
| | - Ayolola Onayemi
- Palisades Medical Center, Hackensack University Medical Center, North Bergen, New Jersey
| | | | - John Mihran Davis
- Palisades Medical Center, Hackensack University Medical Center, North Bergen, New Jersey
| |
Collapse
|
18
|
DiBartola AC, Barron C, Smith S, Quatman-Yates C, Chaudhari AMW, Scharschmidt TJ, Moffatt-Bruce SD, Quatman CE. Decreasing Room Traffic in Orthopedic Surgery: A Quality Improvement Initiative. Am J Med Qual 2019; 34:561-568. [PMID: 30654622 DOI: 10.1177/1062860618821180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Operating room (OR) traffic and door openings increase potential for air contamination in the OR and create distractions for surgical teams. A multidisciplinary intervention was developed among OR staff, surgical staff, vendors, radiology, and anesthesia and approved by the hospital system's patient and quality safety department for implementation. Interventions included education, OR signage, and team-based accountability and behavioral interventions. After interventions were implemented, a second prospective, observational data collection was performed and compared to preintervention OR traffic. A total of 35 cases were observed over the 3-month period in the preintervention group; 42 cases were observed in the postintervention group. Average door openings per minute decreased by 22% (P = .0011) after intervention. All surgical groups excluding anesthesia had significant reductions in OR traffic following the intervention. Behavioral interventions that focus on education, awareness, and efficiency strategies can decrease overall OR traffic for orthopedic cases.
Collapse
Affiliation(s)
| | | | - Scott Smith
- The Ohio State University College of Medicine, Columbus, OH
| | | | | | - Thomas J Scharschmidt
- The Ohio State University, Wexner Medical Center, Columbus, OH.,The Ohio State University College of Medicine, Columbus, OH
| | - Susan D Moffatt-Bruce
- The Ohio State University, Wexner Medical Center, Columbus, OH.,The Ohio State University College of Medicine, Columbus, OH
| | | |
Collapse
|
19
|
Multi-centre point-prevalence survey of hospital-acquired infections in Ghana. J Hosp Infect 2018; 101:60-68. [PMID: 29730140 DOI: 10.1016/j.jhin.2018.04.019] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/26/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is a paucity of data describing hospital-acquired infections (HAIs) in Africa. OBJECTIVE To describe the prevalence and distribution of HAIs in acute care hospitals in Ghana. METHODS Between September and December 2016, point-prevalence surveys were conducted in participating hospitals using protocols of the European Centre for Disease Prevention and Control. Medical records of eligible inpatients at or before 8am on the survey date were reviewed to identify HAIs present at the time of the survey. FINDINGS Ten hospitals were surveyed, representing 32.9% of all acute care beds in government hospitals. Of 2107 inpatients surveyed, 184 HAIs were identified among 172 patients, corresponding to an overall prevalence of 8.2%. The prevalence values in hospitals ranged from 3.5% to 14.4%, with higher proportions of infections in secondary and tertiary care facilities. The most common HAIs were surgical site infections (32.6%), bloodstream infections (19.5%), urinary tract infections (18.5%) and respiratory tract infections (16.3%). Device-associated infections accounted for 7.1% of HAIs. For 12.5% of HAIs, a micro-organism was reported; the most commonly isolated micro-organism was Escherichia coli. Approximately 61% of all patients surveyed were on antibiotics; 89.5% of patients with an HAI received at least one antimicrobial agent on the survey date. The strongest independent predictors for HAI were the presence of an invasive device before onset of infection and duration of hospital stay. CONCLUSION A low HAI burden was found compared with findings from other low- and middle-income countries.
Collapse
|