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Watson F, Wilks SA, Keevil CW, Chewins J. Evaluating the environmental microbiota across four National Health Service hospitals within England. J Hosp Infect 2023; 131:203-212. [PMID: 36343745 DOI: 10.1016/j.jhin.2022.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
Hospital surfaces contaminated with microbial soiling, such as dry surface biofilms (DSBs), can act as a reservoir for pathogenic micro-organisms, and inhibit their detection and removal during routine cleaning. Studies have recognized that such increases in bioburden can hinder the impact of disinfectants and mask the detection of potential pathogens. Cleanliness within healthcare settings is often determined through routine culture-based analysis, whereby surfaces that exhibit >2.5 colony-forming units (CFU) per cm2 pose a risk to patient health; therefore, any underestimation could have detrimental effects. This study quantified microbial growth on high-touch surfaces in four hospitals in England over 19 months. This was achieved using environmental swabs to sample a variety of surfaces within close proximity of the patient, and plating these on to non-specific low nutrient detection agar. The presence of DSBs on surfaces physically removed from the environment was confirmed using real-time imaging through episcopic differential interference contrast microscopy combined with epifluorescence. Approximately two-thirds of surfaces tested exceeded the limit for cleanliness (median 2230 CFU/cm2), whilst 83% of surfaces imaged with BacLight LIVE/DEAD staining confirmed traces of biofilm. Differences in infection control methods, such as choice of surface disinfectants and cleaning personnel, were not reflected in the microbial variation observed and resulting risk to patients. This highlights a potential limitation in the effectiveness of the current standards for all hospital cleaning, and further development using representative clinical data is required to overcome this limitation.
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Affiliation(s)
- F Watson
- School of Biological Sciences, University of Southampton, Southampton, UK; Bioquell UK Ltd, Andover, UK
| | - S A Wilks
- School of Health Sciences, University of Southampton, Southampton, UK
| | - C W Keevil
- School of Biological Sciences, University of Southampton, Southampton, UK
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2
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Bosco R, Cevenini G, Gambelli S, Nante N, Messina G. Improvement and standardization of disinfection in Hospital Theatre with UV-C technology. J Hosp Infect 2022; 128:19-25. [PMID: 35820555 DOI: 10.1016/j.jhin.2022.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The level of disinfection between operating sessions is important to prevent cross-contamination risk in Operating Theatres (OTs). The aim was to assess the difference in microbial contamination between different disinfection levels (DLs), before T(0) and after T(1) application of a UVC Device (UVC-D). METHODS A cross-sectional study was conducted between December 2019 and August 2020 in a Clinic. Three DLs: no disinfection after surgery (DL0), after in-between cleaning (DL1), and after terminal cleaning (DL2), were compared to assess the reduction of microbial presence before T(0) and after T(1), the use of UVC-D that was used for 5-3 minutes per bedside. 260 Petri dishes (PD), divided into a preliminary phase followed by a probabilistic model-driven experiment, were used in 3 OTs, and Colony Forming Units (CFU) were counted. The Mann-Whitney test was performed in the preliminary phase to establish UVC exposure time. Using the probabilistic model, we calculated descriptive statistics and % and log10 reduction. The MANOVA analysis for repeated measure was performed to verify the 95% statistical difference between T(0) and T(1), combined with the DLs and different OTs. RESULTS The Mann-Whitney showed no CFU difference between 3-5 minutes of UVC exposure time; the MANOVA test for showed no significant difference between DLs in T(0)-T(1) CFU reduction with a mean CFU reduction of 72% (CI95% 61.7 - 84.9%) regardless of the DL applied before. CONCLUSION UVC-D enhanced environmental disinfection under any initial conditions. In concert with sainting procedures improves and standardizes the level of environmental hygiene.
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Affiliation(s)
- R Bosco
- Post Graduate School in Public Health, Department of Molecular and Developmental Medicine, University of Siena, Italy, MD
| | - G Cevenini
- Department of Medical Biotechnologies, University of Siena, Italy, EngD
| | - S Gambelli
- Rugani Hospital Monteriggioni, Siena, Italy, MD
| | - N Nante
- Department of Molecular and Developmental Medicine, University of Siena, Italy MD
| | - G Messina
- Department of Molecular and Developmental Medicine, University of Siena, Italy MD.
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Hajong R, Newme K, Nath CK, Moirangthem T, Dhal MR, Pala S. Role of serum C-reactive protein and interleukin-6 as a predictor of intra-abdominal and surgical site infections after elective abdominal surgery. J Family Med Prim Care 2021; 10:403-406. [PMID: 34017761 PMCID: PMC8132759 DOI: 10.4103/jfmpc.jfmpc_1191_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/08/2020] [Accepted: 12/01/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction: Infections after surgeries considerably increase patients' hospital stay, thereby prolonging patients' early return to productive life. At the same time, the cost of hospitalization also increases. Therefore, if objective tests can predict infections before it actually happens, then more preventive measures in the form of upgrading antibiotics can be taken which might prevent patients from developing serious infections and thereby reduce morbidity and mortality of surgery. Material and Methods: It was a prospective cross sectional study to assess the efficacy of acute phase reactants C-reactive protein (CRP) and interleukin 6 (IL 6) in predicting infections in patients undergoing routine general surgical operations. A total of 74 patients were included in the study. Laparoscopic surgical procedures were not included in the study to maintain uniformity in the procedures. Data so collected were analyzed by using SPSS version 22. Results: A total of 27 patients developed wound infections postoperatively. The mean rise in the levels of CRP and IL 6 was higher in those patients who developed postoperative wound infections. The positive predictive value and negative predictive value was found to be better with IL 6 than with CRP. Conclusion: It may be concluded that a serial estimation of CRP and IL 6 postoperatively can predict infections and may be utilized routinely in general surgical practice.
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Affiliation(s)
- Ranendra Hajong
- Department of General Surgery, NEIGRIHMS, Shillong, Meghalaya, India
| | | | - Chandan Kr Nath
- Department of Biochemistry, NEIGRIHMS, Shillong, Meghalaya, India
| | | | | | - Star Pala
- Department of Community Medicine, NEIGRIHMS, Shillong, Meghalaya, India
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Shadmehr MB, Alaeen Z, Baniasadi S. Adherence to American Society of Health‐System Pharmacists guidelines for antibiotic prophylaxis in thoracic surgery: a prospective observational study. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2020. [DOI: 10.1002/jppr.1557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Mohammad Behgam Shadmehr
- Tracheal Diseases Research Center National Research Institute of Tuberculosis and Lung Diseases Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Zeinab Alaeen
- Department of Clinical Pharmacy Faculty of Pharmacy Pharmaceutical Sciences Branch Islamic Azad University Tehran Iran
| | - Shadi Baniasadi
- Tracheal Diseases Research Center National Research Institute of Tuberculosis and Lung Diseases Shahid Beheshti University of Medical Sciences Tehran Iran
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Giraldi G, Montesano M, Napoli C, Frati P, La Russa R, Santurro A, Scopetti M, Orsi GB. Healthcare-Associated Infections Due to Multidrug-Resistant Organisms: a Surveillance Study on Extra Hospital Stay and Direct Costs. Curr Pharm Biotechnol 2020; 20:643-652. [PMID: 30961489 DOI: 10.2174/1389201020666190408095811] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/27/2018] [Accepted: 12/15/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND The increasing antimicrobial resistance poses a challenge to surveillance systems and raises concerns about the impact of multidrug-resistant organisms on patient safety. OBJECTIVE The study aimed to estimate extra hospital stay and economic burden of infections due to alert organisms - mostly multidrug-resistant - in a teaching hospital. METHODS The present retrospective matched cohort study was conducted based on the analysis of hospital admissions at Sant'Andrea Teaching Hospital in Rome from April to December 2015. Extra hospital stay was the difference in the length of stay between each case and control. All the patients developing an infection due to an alert organism were considered cases, all others were eligible as controls. The costs of LOS were evaluated by multiplying the extra stay with the hospital daily cost. RESULTS Overall, 122 patients developed an infection due to alert organisms and were all matched with controls. The attributable extra stay was of 2,291 days (mean 18.8; median 19.0) with a significantly increased hospitalization in intensive care units (21.2 days), bloodstream infections (52.5 days), and infections due to Gram-negative bacteria (mean 29.2 days; median 32.6 days). Applying the single day hospital cost, the overall additional expenditure was 11,549 euro per patient. The average additional cost of antibiotic drugs for the treatment of infections was about 1,200 euro per patient. CONCLUSION The present study presents an accurate mapping of the clinical and economic impact of infections attributable to alert organisms demonstrating that infections due to multidrug-resistant organisms are associated with higher mortality, longer hospital stays, and increased costs. Article Highlights Box: The increasing antimicrobial resistance poses a challenge for surveillance systems and raises concerns about the impact of multidrug-resistant organisms on patient safety. • Healthcare-associated infections (HAIs) have historically been recognized as a significant public health problem requiring close surveillance. • Despite several and reliable findings have been achieved on clinical issues, our knowledge on the economic impact of healthcare-associated infections due to multidrug-resistant organisms needs to be widened. • Estimating the cost of infections due to multidrug-resistant organisms in terms of extra hospital stay and economic burden is complex, and the financial impact varies across different health systems. • Evaluations of social and economic implications of hospital infections play an increasingly important role in the implementation of surveillance systems. • The costs of infection prevention and control programs and dedicated personnel are relatively low and self-sustainable when efficient.
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Affiliation(s)
- Guglielmo Giraldi
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
| | | | - Christian Napoli
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Raffaele La Russa
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Alessandro Santurro
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Scopetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Giovanni B Orsi
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
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Efficacy and safety of two post-operative drains: results of a prospectively randomized clinical study in breast cancer patients after breast conserving surgery. Arch Gynecol Obstet 2019; 300:1687-1692. [PMID: 31686184 DOI: 10.1007/s00404-019-05360-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 10/25/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of two post-operative drains in breast cancer patients after breast conserving surgery. METHODS This was a prospectively randomized comparative study of two drains investigated in breast cancer patients after breast conserving therapy. The Redon drain ends in a tip with 28 double perforations while the Quadrain drain features 4 flexible flaps of about 0.15 m length. The drains cost 0.28 € and 3.54 €, respectively. Primary target parameter was the duration of the drains staying in the surgical site. Secondary target parameters were pain post-surgery, seroma volume, final cosmetic result and surgical site infections. RESULTS A total of 88 patients were randomized, 47 and 41 received the Redon drain and the Quadrain drain, respectively. The mean duration of the drains staying in the surgical site was not different between the Redon and the Quadrain drain, 42.6 h (± 25.8 h) and 50.1 h (± 28.5 h), respectively (p = 0.1959). The post-operative pain score, seroma size, cosmetic result and surgical site infections were not different for both systems. CONCLUSION The Redon drain and the new Quadrain drain were not significantly different with respect to duration in the surgical site, post-operative pain, seroma volume and cosmetic result.
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Longobardi P, Hoxha K, Bennett MH. Is there a role for hyperbaric oxygen therapy in the treatment of refractory wounds of rare etiology? Diving Hyperb Med 2019; 49:216-224. [PMID: 31523797 DOI: 10.28920/dhm49.3.216-224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 05/01/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Delayed wound healing indicates wounds that have failed to respond to more than 4-6 weeks of comprehensive wound care. Wounds with delayed healing are a major source of morbidity and a major cost to hospital and community healthcare providers. Hyperbaric oxygen therapy (HBOT) is a treatment designed to increase the supply of oxygen to wounds and has been applied to a variety of wound types. This article reviews the place of HBOT in the treatment of non-healing vasculitic, calcific uremic arteriolopathy (CUA), livedoid vasculopathy (LV), pyoderma gangrenosum (PG) ulcers. METHODS We searched electronic databases for research and review studies focused on HBOT for the treatment of delayed healing ulcers with rare etiologies. We excluded HBOT for ulcers reviewed elsewhere. RESULTS We included a total of three case series and four case reports including 63 participants. Most were related to severe, non-healing ulcers in patients with vasculitis, CUA, LV, and PG. There was some evidence that HBOT may improve the healing rate of wounds by increasing nitric oxide (NO) levels and the number of endothelial progenitor cells in the wounds. HBOT may also improve pain in these ulcers. CONCLUSION We recommend the establishment of comprehensive and detailed wound care registries to rapidly collect prospective data on the use of HBOT for these problem wounds. There is a strong case for appropriately powered, multi-centre randomized trials to establish the true efficacy and cost-effectiveness of HBOT especially for vasculitis ulcers that have not improved following immunosuppressive therapy.
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Affiliation(s)
- Pasquale Longobardi
- Corresponding author: Dr Pasquale Longobardi, Chief Medical Director, Centro Iperbarico, via Augusto Torre 3, 48124 Ravenna, Italy, .,Centro Iperbarico (Hyperbaric Medicine and Wound Care Centre), Ravenna, Italy
| | - Klarida Hoxha
- Centro Iperbarico (Hyperbaric Medicine and Wound Care Centre), Ravenna, Italy
| | - Michael H Bennett
- Department of Anaesthesia, University of New South Wales, Sydney, Australia
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Ezzelarab MH, Nouh O, Ahmed AN, Anany MG, Rachidi NGE, Salem AS. A Randomized Control Trial Comparing Transparent Film Dressings and Conventional Occlusive Dressings for Elective Surgical Procedures. Open Access Maced J Med Sci 2019; 7:2844-2850. [PMID: 31844447 PMCID: PMC6901868 DOI: 10.3889/oamjms.2019.809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 07/21/2019] [Accepted: 07/22/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND: Surgical site infection is one of the major health-care-associated problems causing substantial morbidity and mortality and constituting a financial burden on hospitals as well. The wound management is one of the crucial evidence-based strategies in the reduction of surgical site infection rates AIM: To study the impact of standardisation of transparent semipermeable dressing procedure on the rate of surgical site infection in comparison with conventional dressing in clean and clean-contaminated surgeries. METHODS: The study included 100 patients who were admitted to surgical wards in Cairo university hospitals, for clean and clean-contaminated operations, in the period from February 2017 to August 2017. Immunocompromised and uncontrolled diabetic patients were excluded. Patients were randomly allocated into two groups; in the first group, patients wounds were covered using transparent semipermeable dressing, while the second group patients’ wounds were covered using conventional occlusive gauze dressing. Patients were followed up for criteria of infection every other day during the first week then at two weeks, three weeks and four weeks. RESULTS: In clean and clean-contaminated operations, the transparent dressing group showed a significantly lesser rate of surgical site infection at (2%), compared with the conventional occlusive gauze dressing group with a surgical site infection rate of (14%) (p-value of 0.02). CONCLUSION: The transparent semipermeable dressing is effective in reducing surgical site infection rate in clean and clean-contaminated operations.
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Affiliation(s)
| | - Omar Nouh
- Plastic and Reconstructive Surgery, Cairo University, Cairo, Egypt
| | | | - Mervat Gaber Anany
- Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Surgical site infection risk following cesarean deliveries covered by Medicaid or private insurance. Infect Control Hosp Epidemiol 2019; 40:639-648. [DOI: 10.1017/ice.2019.66] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjective:To compare risk of surgical site infection (SSI) following cesarean delivery between women covered by Medicaid and private health insurance.Study design:Retrospective cohort.Study population:Cesarean deliveries covered by Medicaid or private insurance and reported to the National Healthcare Safety Network (NHSN) and state inpatient discharge databases by hospitals in California (2011–2013).Methods:Deliveries reported to NHSN and state inpatient discharge databases were linked to identify SSIs in the 30 days following cesarean delivery, primary payer, and patient and procedure characteristics. Additional hospital-level characteristics were obtained from public databases. Relative risk of SSI by primary payer primary payer was assessed using multivariable logistic regression adjusting for patient, procedure, and hospital characteristics, accounting for facility-level clustering.Results:Of 291,757 cesarean deliveries included, 48% were covered by Medicaid. SSIs were detected following 1,055 deliveries covered by Medicaid (0.75%) and 955 deliveries covered by private insurance (0.63%) (unadjusted odds ratio, 1.2; 95% confidence interval [CI], 1.1–1.3; P < .0001). The adjusted odds of SSI following cesarean deliveries covered by Medicaid was 1.4 (95% CI, 1.2–1.6; P < .0001) times the odds of those covered by private insurance.Conclusions:In this, the largest and only multicenter study to investigate SSI risk following cesarean delivery by primary payer, Medicaid-insured women had a higher risk of infection than privately insured women. These findings suggest the need to evaluate and better characterize the quality of maternal healthcare for and needs of women covered by Medicaid to inform targeted infection prevention and policy.
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Nair V, Sahni AK, Sharma D, Grover N, Shankar S, Chakravarty A, Patrikar S, Methe K, Jaiswal SS, Dalal SS, Kapur A, Verma R, Prakash J, Gupta A, Bhansali A, Batura D, Rao GG, Joshi DP, Chopra BK. Point prevalence & risk factor assessment for hospital-acquired infections in a tertiary care hospital in Pune, India. Indian J Med Res 2018; 145:824-832. [PMID: 29067985 PMCID: PMC5674553 DOI: 10.4103/ijmr.ijmr_1167_15] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background & objectives: Hospital-acquired infections (HAIs) are a major challenge to patient safety and have serious public health implications by changing the quality of life of patients and sometimes causing disability or even death. The true burden of HAI remains unknown, particularly in developing countries. The objective of this study was to estimate point prevalence of HAI and study the associated risk factors in a tertiary care hospital in Pune, India. Methods: A series of four cross-sectional point prevalence surveys were carried out between March and August 2014. Data of each patient admitted were collected using a structured data entry form. Centers for Disease Control and Prevention guidelines were used to identify and diagnose patients with HAI. Results: Overall prevalence of HAI was 3.76 per cent. Surgical Intensive Care Unit (ICU) (25%), medical ICU (20%), burns ward (20%) and paediatric ward (12.17%) were identified to have significant association with HAI. Prolonged hospital stay [odds ratio (OR=2.81), mechanical ventilation (OR=18.57), use of urinary catheter (OR=7.89) and exposure to central air-conditioning (OR=8.59) had higher odds of acquiring HAI (P<0.05). Interpretation & conclusions: HAI prevalence showed a progressive reduction over successive rounds of survey. Conscious effort needs to be taken by all concerned to reduce the duration of hospital stay. Use of medical devices should be minimized and used judiciously. Healthcare infection control should be a priority of every healthcare provider. Such surveys should be done in different healthcare settings to plan a response to reducing HAI.
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Affiliation(s)
- Velu Nair
- Department of Internal Medicine, Armed Forces Medical College, Pune, India
| | - A K Sahni
- Department of Microbiology, Armed Forces Medical College, Pune, India
| | - Dinesh Sharma
- Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - Naveen Grover
- Department of Microbiology, Armed Forces Medical College, Pune, India
| | - S Shankar
- Department of Internal Medicine, Armed Forces Medical College, Pune, India
| | - A Chakravarty
- Department of Hospital Administration, Armed Forces Medical College, Pune, India
| | - Seema Patrikar
- Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - Kailas Methe
- Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - S S Jaiswal
- Department of Surgery, Armed Forces Medical College, Pune, India
| | - S S Dalal
- Department of Paediatrics, Armed Forces Medical College, Pune, India
| | - Anupam Kapur
- Department of Obstetrics and Gynaecology, Armed Forces Medical College, Pune, India
| | - Rajesh Verma
- Department of Dermatology, Armed Forces Medical College, Pune, India
| | - Jyoti Prakash
- Department of Psychiatry, Armed Forces Medical College, Pune, India
| | - Ashutosh Gupta
- Department of Ophthalmology, Armed Forces Medical College, Pune, India
| | - Anvita Bhansali
- Department of Otorhinolaryngology, Armed Forces Medical College, Pune, India
| | - Deepak Batura
- Department of Urology, Armed Forces Medical College, Pune, India
| | - G Gopal Rao
- Department of Microbiology, Armed Forces Medical College, Pune, India
| | - D P Joshi
- Department of Urology, Armed Forces Medical College, Pune, India
| | - B K Chopra
- Department of Orthopaedics, Armed Forces Medical College, Pune, India
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Prospero E, Cavicchi A, Bacelli S, Barbadoro P, Tantucci L, D'Errico MM. Surveillance for Surgical Site Infection After Hospital Discharge: A Surgical Procedure–Specific Perspective. Infect Control Hosp Epidemiol 2016; 27:1313-7. [PMID: 17152028 DOI: 10.1086/509838] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Accepted: 05/22/2006] [Indexed: 02/02/2023]
Abstract
Objective.To estimate the rate of surgical site infection (SSI) occurring after hospital discharge, to evaluate whether limiting surveillance to inpatients underestimates the true rate of SSI, and to select surgical procedures that should be included in a postdischarge surveillance program.Design.Prospective surveillance study.Setting.A surgical ward at a university teaching hospital in Italy.Patients.A total of 264 surgical patients were included in the study.Results.The global SSI rate was 10.6% (28 patients); 17 (60.2%) of patients with an SSI developed the infection after hospital discharge. The overall mean length of postoperative stay (±SD) for patients who acquired a postdischarge SSI was 4.9 ± 3.7 days, and SSI was diagnosed a mean duration (±SD) of 11.5 ± 4.5 days after surgery. Among procedures with postdischarge SSIs, those classified by the National Nosocomial Infections Surveillance system (NNIS) as herniorrhaphy, mastectomy, other endocrine system, and other integumentary system were associated with a mean postoperative stay that was less than the mean time between the operation and the onset of SSI. Four (36%) of in-hospital SSIs occurred after procedures with an NNIS risk index of 0, and 7 (64%) occurred after procedures with an NNIS risk index of 1 or higher. Of the 17 SSIs diagnosed after discharge, 14 procedures (82%) had an NNIS risk index of 0, compared with 3 procedures (18%) with an NNIS risk index of 1 or higher.Conclusions.Our results revealed an increased risk of postdischarge SSI after some types of surgical procedures and suggest that there is an important need to change from generalized to NNIS operative category-directed postdischarge surveillance, at least for procedures locally considered to be high-risk.
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Affiliation(s)
- E Prospero
- Department Infectious Disease and Public Health, Universita Politecnica Marche, Ancona, Italy.
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Marchi M, Pan A, Gagliotti C, Morsillo F, Parenti M, Resi D, Moro ML. The Italian national surgical site infection surveillance programme and its positive impact, 2009 to 2011. Euro Surveill 2014; 19. [DOI: 10.2807/1560-7917.es2014.19.21.20815] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- M Marchi
- Area Rischio Infettivo, Agenzia Sanitaria e Sociale Regionale dell’Emilia-Romagna (Infectious risk area, Health and Social Regional Agency of Emilia-Romagna), Bologna, Italy
- These authors contributed equally to this work
| | - A Pan
- These authors contributed equally to this work
- Infectious and Tropical Disease Unit, Istituti Ospitalieri di Cremona, Cremona, Italy
- Area Rischio Infettivo, Agenzia Sanitaria e Sociale Regionale dell’Emilia-Romagna (Infectious risk area, Health and Social Regional Agency of Emilia-Romagna), Bologna, Italy
| | - C Gagliotti
- Area Rischio Infettivo, Agenzia Sanitaria e Sociale Regionale dell’Emilia-Romagna (Infectious risk area, Health and Social Regional Agency of Emilia-Romagna), Bologna, Italy
| | - F Morsillo
- Area Rischio Infettivo, Agenzia Sanitaria e Sociale Regionale dell’Emilia-Romagna (Infectious risk area, Health and Social Regional Agency of Emilia-Romagna), Bologna, Italy
| | - M Parenti
- Area Rischio Infettivo, Agenzia Sanitaria e Sociale Regionale dell’Emilia-Romagna (Infectious risk area, Health and Social Regional Agency of Emilia-Romagna), Bologna, Italy
| | - D Resi
- Area Rischio Infettivo, Agenzia Sanitaria e Sociale Regionale dell’Emilia-Romagna (Infectious risk area, Health and Social Regional Agency of Emilia-Romagna), Bologna, Italy
- Dipartimento di Sanità Pubblica, Azienda Unitaria Sanitaria Locale (Department of Public Health, Local Health Agency), Ravenna, Italy
| | - M L Moro
- Area Rischio Infettivo, Agenzia Sanitaria e Sociale Regionale dell’Emilia-Romagna (Infectious risk area, Health and Social Regional Agency of Emilia-Romagna), Bologna, Italy
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Kattipattanapong W, Isaradisaikul S, Hanprasertpong C. Surgical Site Infections in Ear Surgery. Otolaryngol Head Neck Surg 2013; 148:469-74. [DOI: 10.1177/0194599812472297] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective (1) To compare the rate of surgical site infections in ear surgery between groups with and without hair removal and (2) to study factors associated with surgical site infections. Study Design A preliminary, randomized, controlled trial. Setting University hospital. Subjects and Methods The study was conducted in a group of 136 patients who underwent surgery for external or middle ear disease via the post-auricular approach at Chiang Mai University Hospital from May 2010 to May 2011. Demographic data, surgical site infection within 30 days postoperatively, and associated factors were recorded. Results Fifty-eight cases were men and 78 cases women. Demographic data between the 2 groups were compared. Age, gender, the side of operated ear, types of anesthesia, emergency or elective setting, body mass index, history of alcohol and/or tobacco use, underlying diseases, operative time, and the length of hospital stay revealed no significant differences. A postoperative surgical site infection developed in 5 patients: 3 in the group with hair removal (4.5%) and 2 in the group without hair removal (2.8%) ( P value = 0.674, Fisher’s exact test). All infected cases had undergone mastoidectomy. Conclusions Surgical site infection rates between the 2 groups (with and without hair removal) demonstrated no difference. Hair removal prior to ear surgery via post-auricular incision had no effect on the rate of surgical site infection.
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Affiliation(s)
- Woraya Kattipattanapong
- Department of Otolaryngology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Suwicha Isaradisaikul
- Department of Otolaryngology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Charuk Hanprasertpong
- Department of Otolaryngology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Hautemanière A, Florentin A, Hunter PR, Bresler L, Hartemann P. Screening for surgical nosocomial infections by crossing databases. J Infect Public Health 2012; 6:89-97. [PMID: 23537821 DOI: 10.1016/j.jiph.2012.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 06/27/2012] [Accepted: 08/09/2012] [Indexed: 10/27/2022] Open
Abstract
UNLABELLED Surgical site infection (SSI) is a major cause of morbidity and mortality, and they are the third cause of nosocomial infections. It has been shown that surveillance can reduce the rate of these infections because the publication of the results that introduce a interrogation on her surgical pratices. However, surveillance requires considerable medical resources. Our objective is to validate a computer algorithm that uses microbiological results and the results of a C-reactive protein (CRP) assay and granulocyte count to detect SSIs. MATERIALS AND METHODS All patients who underwent colorectal surgery between the 1st of January and the 30th of June 2009 were included. Administrative, surgical and microbiological data and the appearance of neutrophilia and CRP after surgery and during hospitalization were collected. The algorithm uses four biological variables: CRP, neutrophils, and the bacterium found on the positive sample. The CRP and neutrophil variables were coded in 0 or 1. CRP was coded as 1 if the sample was below 5mg/l at the time of the operation and increased to more than 60mg/l in the 30 days immediately after post-operation. Neutrophils were coded as 1 if the sample was normal at the time of the operation and increased to more than 12,000cells/mm(3) in the 30 days immediately after post-operation. The "type of sample" and "bacterium" variables were coded in categories. For the type of sample, we coded 3 if the sampling site was related to the surgical site, 2 if the sampling site was potentially linked to the surgical site, 1 if the sampling site was not directly or indirectly related to the surgical site and 0 if there was no sample. Regarding the bacteria, we coded 3 for bacteria found in over 5% of SSIs, 2 for bacteria found in 2-5% of SSIs, 1 for bacteria found in less than 2% of SSIs and 0 if there were no bacteria. The algorithm calculates a score from 1 to 5. RESULTS Our study included 195 operations, out of which it was possible to study 168. Following the operations, we found neutrophilia above 12,000cells/mm(3) in 41.5% of cases and CRP above 60mg/l in 64.6% of cases. Thirty-seven operations (22%) were complicated by an SSI. The positive predictive values and the negative predictive values in our algorithm were 74.07% and 87.94%, respectively, and the number of records that remain to be investigated is 27 out of 168. CONCLUSIONS Linking databases from bacteriology and biology with those containing the hospital records of surgical procedures is a simple method for identifying surgical nosocomial infections.
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Affiliation(s)
- Alexis Hautemanière
- Service Hygiène, Centre Hospitalier Universitaire de Nancy, rue du Morvan, 54511 Vandoeuvre les Nancy Cedex, France.
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Teija-Kaisa A, Eija M, Marja S, Outi L. Risk factors for surgical site infection in breast surgery. J Clin Nurs 2012; 22:948-57. [PMID: 23121264 DOI: 10.1111/jocn.12009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2012] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To study risks of surgical site infection in breast surgery. The objectives were to measure the association of postoperative infection with patient- and procedure-related factors. BACKGROUND The infection rate in breast surgery is expected to be low but it varies a lot. The variation is recommended to be assessed by measuring procedure-related factors. DESIGN A retrospective chart review of 982 breast surgery patients was completed. METHODS The data on patient demographics, procedure types, patient and surgery-related factors were collected. A multivariate logistic regression model for all breast operations (n=982), lumpectomies (n=700) and mastectomies (n=282) was performed. RESULTS The infection rate was 6.7%. In a multivariate logistic regression model for all operations, a contaminated or dirty wound, high American Society of Anesthesiologists score, high body mass index, use of surgical drains and re-operation predicted increased infection risk. In lumpectomies high body mass index and use of surgical drains predicted increased risk. In mastectomies, the significant predictor was re-operation. CONCLUSIONS The surgical site infection rate was high. In addition to the two classical risks (high wound class and anaesthesia risk), high body mass index, re-operation and use of surgical drain increased the infection risk among all patients. RELEVANCE TO CLINICAL PRACTICE In breast surgery careful assessment, documentation and adherence to aseptic practices are important with all patients. Patients with heavy weight need special attention. The need for antimicrobial prophylaxis in re-operations and the need of surgical drains in lumpectomies are important to consider carefully.
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Affiliation(s)
- Aholaakko Teija-Kaisa
- University of Helsinki Medical Faculty, Helsinki and Principal Lecturer, Laurea University of Applied Sciences, Vantaa, Finland.
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Biscione FM, Couto RC, Pedrosa TMG. Performance, revision, and extension of the National Nosocomial Infections Surveillance system's risk index in Brazilian hospitals. Infect Control Hosp Epidemiol 2012; 33:124-34. [PMID: 22227981 DOI: 10.1086/663702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the benefit of using procedure-specific alternative cutoff points for National Nosocomial Infections Surveillance (NNIS) risk index variables and of extending surgical site infection (SSI) risk prediction models with a postdischarge surveillance indicator. DESIGN Open, retrospective, validation cohort study. SETTING Five private, nonuniversity Brazilian hospitals. PATIENTS Consecutive inpatients operated on between January 1993 and May 2006 (other operations of the genitourinary system [n = 20,723], integumentary system [n = 12,408], or musculoskeletal system [n = 15,714] and abdominal hysterectomy [n = 11,847]). METHODS For each procedure category, development and validation samples were defined nonrandomly. In the development samples, alternative SSI prognostic scores were constructed using logistic regression: (i) alternative NNIS scores used NNIS risk index covariates and cutoff points but locally derived SSI risk strata and rates, (ii) revised scores used procedure-specific alternative cutoff points, and (iii) extended scores expanded revised scores with a postdischarge surveillance indicator. Performances were compared in the validation samples using calibration, discrimination, and overall performance measures. RESULTS The NNIS risk index showed low discrimination, inadequate calibration, and predictions with high variability. The most consistent advantage of alternative NNIS scores was regarding calibration (prevalence and dispersion components). Revised scores performed slightly better than the NNIS risk index for most procedures and measures, mainly in calibration. Extended scores clearly performed better than the NNIS risk index, irrespective of the measure or operative procedure. CONCLUSIONS Locally derived SSI risk strata and rates improved the NNIS risk index's calibration. Alternative cutoff points further improved the specification of the intrinsic SSI risk component. Controlling for incomplete postdischarge SSI surveillance provided consistently more accurate SSI risk adjustment.
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Affiliation(s)
- Fernando Martín Biscione
- Health Sciences and Tropical Medicine Postgraduate Course, Minas Gerais Federal University School of Medicine, Belo Horizonte, Minas Gerais, Brazil
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Knapp AG, Kamepalli RK, Martone WJ, Yankelev S. Prospective, non-comparative study of daptomycin for the treatment of superficial and deep incisional surgical site infections. Surg Infect (Larchmt) 2011; 12:113-8. [PMID: 21348765 DOI: 10.1089/sur.2008.106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Skin infections, including surgical site infections (SSIs), usually involve gram-positive pathogens and continue to be a leading cause of morbidity and death among hospital patients. The increasing prevalence of methicillin-resistant Staphylococcus aureus and other resistant strains accentuates the need for effective and safe therapies for such infections. This exploratory study evaluated the efficacy and safety of daptomycin in patients with gram-positive SSI according to wound classification. METHODS Eligible patients had an SSI with onset < 30 days after surgery, positive gram stain or culture at least three days before daptomycin therapy began, and three or more clinical signs and symptoms of infection. The incisional SSI was classified as superficial or deep according to the U.S. Centers for Disease Control and Prevention criteria. Patients with organ-space infections were excluded, as were those with major concomitant infections, foreign material in the incision that could not be removed, previous systemic antimicrobial therapy, or creatinine clearance < 30 mL/min. Daptomycin 4 mg/kg was administered intravenously once daily for 7-14 days. The primary efficacy endpoint was clinical response at the end of daptomycin therapy, and the safety assessment was based on adverse events (AEs). RESULTS Sixty-nine patients were enrolled, 60 of whom were evaluable for efficacy. Extremity wounds predominated among superficial incisional SSIs (n = 30), whereas abdominal wounds predominated among deep SSIs (n = 30). Patients with deep incisional SSI were more likely to be young, male, white, and febrile and to weigh more than patients with superficial SSIs. The overall clinical success rate was 92% (95% confidence interval [CI] 82-97%); the success rate was 100% in superficial incisional SSI and 83% in deep SSI (17% difference; 95% CI 0-33%). Staphylococcus aureus (28/36 methicillin-resistant) was the pathogen isolated most frequently. In 10 patients who were febrile at baseline, the median time to defervescence was five days, and the mean duration of treatment in the series was 11.2 days. Daptomycin was well tolerated. In most patients, AEs were mild or moderate in intensity; in two patients (one superficial, one deep), daptomycin was discontinued because of AEs. CONCLUSIONS The results of this exploratory study of SSI are consistent with those of previous studies of daptomycin in the treatment of diverse complicated skin and skin-structure infections, and suggest that wound classification should be treated as an important covariate in future studies of daptomycin and other antibiotics.
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Affiliation(s)
- Andrew G Knapp
- Cubist Pharmaceuticals Inc, Lexington, Massachusetts 02421, USA.
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Di Leo A, Piffer S, Ricci F, Manzi A, Poggi E, Porretto V, Fambri P, Piccini G, Patrizia T, Fabbri L, Busetti R. Surgical Site Infections in an Italian Surgical Ward: A Prospective Study. Surg Infect (Larchmt) 2009; 10:533-8. [DOI: 10.1089/sur.2009.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Alberto Di Leo
- Unit of General Surgery, APSS of Trento, Alto Garda e Ledro Hospital, Arco (TN), Italy
| | - Silvano Piffer
- Department of Epidemiology, APSS of Trento, Trento, Italy
| | - Francesco Ricci
- Unit of General Surgery, APSS of Trento, Alto Garda e Ledro Hospital, Arco (TN), Italy
| | - Alberto Manzi
- Unit of General Surgery, APSS of Trento, Alto Garda e Ledro Hospital, Arco (TN), Italy
| | - Elena Poggi
- Unit of General Surgery, APSS of Trento, Alto Garda e Ledro Hospital, Arco (TN), Italy
| | - Vincenzo Porretto
- Unit of General Surgery, APSS of Trento, Alto Garda e Ledro Hospital, Arco (TN), Italy
| | - Paolo Fambri
- Unit of General Surgery, APSS of Trento, Alto Garda e Ledro Hospital, Arco (TN), Italy
| | - Giannina Piccini
- Hospital Health Direction, APSS of Trento, Alto Garda e Ledro Hospital, Arco (TN), Italy
| | - Trentini Patrizia
- Hospital Health Direction, APSS of Trento, Alto Garda e Ledro Hospital, Arco (TN), Italy
| | - Luca Fabbri
- Hospital Health Direction, APSS of Trento, Alto Garda e Ledro Hospital, Arco (TN), Italy
| | - Rosanna Busetti
- Laboratory of Clinical Pathology, APSS of Trento, Alto Garda e Ledro Hospital, Arco (TN), Italy
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Sen CK, Gordillo GM, Roy S, Kirsner R, Lambert L, Hunt TK, Gottrup F, Gurtner GC, Longaker MT. Human skin wounds: a major and snowballing threat to public health and the economy. Wound Repair Regen 2009; 17:763-71. [PMID: 19903300 PMCID: PMC2810192 DOI: 10.1111/j.1524-475x.2009.00543.x] [Citation(s) in RCA: 1797] [Impact Index Per Article: 119.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
ABSTRACT In the United States, chronic wounds affect 6.5 million patients. An estimated excess of US$25 billion is spent annually on treatment of chronic wounds and the burden is rapidly growing due to increasing health care costs, an aging population and a sharp rise in the incidence of diabetes and obesity worldwide. The annual wound care products market is projected to reach $15.3 billion by 2010. Chronic wounds are rarely seen in individuals who are otherwise healthy. In fact, chronic wound patients frequently suffer from "highly branded" diseases such as diabetes and obesity. This seems to have overshadowed the significance of wounds per se as a major health problem. For example, NIH's Research Portfolio Online Reporting Tool (RePORT; http://report.nih.gov/), directed at providing access to estimates of funding for various disease conditions does list several rare diseases but does not list wounds. Forty million inpatient surgical procedures were performed in the United States in 2000, followed closely by 31.5 million outpatient surgeries. The need for post-surgical wound care is sharply on the rise. Emergency wound care in an acute setting has major significance not only in a war setting but also in homeland preparedness against natural disasters as well as against terrorism attacks. An additional burden of wound healing is the problem of skin scarring, a $12 billion annual market. The immense economic and social impact of wounds in our society calls for allocation of a higher level of attention and resources to understand biological mechanisms underlying cutaneous wound complications.
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Affiliation(s)
- Chandan K Sen
- Department of Surgery, The Ohio State University Comprehensive Wound Center, Columbus, Ohio 43210, USA.
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Posnett J, Gottrup F, Lundgren H, Saal G. The resource impact of wounds on health-care providers in Europe. J Wound Care 2009; 18:154-161. [PMID: 19349935 DOI: 10.12968/jowc.2009.18.4.41607] [Citation(s) in RCA: 226] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Most of the literature focuses on the resources required to manage particular wound types, rather than the cost of wounds to health-care organisations. Until this information is available, wound care is unlikely to be a management priority.
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Rodríguez-Baño J, del Toro MD, Lupión C, Suárez AI, Silva L, Nieto I, Muniain MA. [Arthroplasty-related infection: incidence, risk factors, clinical features, and outcome]. Enferm Infecc Microbiol Clin 2009; 26:614-20. [PMID: 19100191 DOI: 10.1016/s0213-005x(08)75277-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION There is little information about the overall incidence, risk factors, and clinical management of arthroplasty-related infection in Spain. METHODS The incidence of surgical site infection (SSI) in hip and knee arthroplasty from 2001 to 2005 was determined. Risk factors for SSI were investigated in 435 patients using multivariate logistic regression analysis. Clinical features and treatment were examined in a cohort of 58 consecutive patients with joint arthroplasty infection. RESULTS The percentages of SSI in hip and knee arthroplasty stratified according to the National Nosocomial Infection Surveillance (NNIS) index were 1.86% and 1.62% (NNIS=0), 3.72% and 2.02% (NNIS=1), and 7.20% and 6.71% (NNIS=2-3), respectively. The risk factors identified for developing SSI included secondary arthroplasty, duration of urinary catheterization, and hip arthroplasty. Fifty percent of patients with arthroplasty infection had type I (early) or III (hematogenous) infection. Gram-positive cocci were the most frequent causes. Initial therapy consisted in debridement with preservation of the prosthesis (10 patients) or removal of the prosthesis (40 patients); surgery was not performed in 8 patients. After one year of follow up, 39 patients (67%) were considered cured, 12 (21%) had a recurrence or were under chronic suppressive antimicrobial therapy, and 7 (12%) had died. CONCLUSIONS The incidence of SSI in our center is similar to that of other Spanish hospitals, but is higher than the notified incidence in the NNIS system. A modifiable risk factor (urinary catheterization) has been identified. Greater consensus for the management of these patients is desirable.
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Affiliation(s)
- Jesús Rodríguez-Baño
- Sección de Enfermedades Infecciosas, Hospital Universitario Virgen Macarena, Sevilla, Spain.
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Roumbelaki M, Kritsotakis EI, Tsioutis C, Tzilepi P, Gikas A. Surveillance of surgical site infections at a tertiary care hospital in Greece: incidence, risk factors, microbiology, and impact. Am J Infect Control 2008; 36:732-8. [PMID: 18834729 DOI: 10.1016/j.ajic.2007.11.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Revised: 11/14/2007] [Accepted: 11/19/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND In this first attempt to implement a standardized surveillance system of surgical site infections (SSI) in a Greek hospital, our objective was to identify areas for improvement by comparing main epidemiologic and microbiologic features of SSI with international data. METHODS The National Nosocomial Infections Surveillance (NNIS) system protocols were employed to prospectively collect data for patients in 8 surgical wards who underwent surgery during a 9-month period. SSI rates were benchmarked with international data using standardized infection ratios. Risk factors were evaluated by multivariate logistic regression. RESULTS A total of 129 SSI was identified in 2420 operations (5.3%), of which 47.3% developed after discharge. SSI rates were higher for 2 of 20 operation categories compared with Spanish and Italian data and for 12 of 20 categories compared with NNIS data. Gram-positive microorganisms accounted for 52.1% of SSI isolates, and Enterococci were predominant. Alarming resistance patterns for Enterococcus faecium and Acinetobacter baumannii were recorded. Potentially modifiable risk factors for SSI included multiple procedures, extended duration of operation, and antibiotic prophylaxis. SSI was associated with prolongation of postoperative stay but not with mortality. CONCLUSION Comparisons of surveillance data in our hospital with international benchmarks provided useful information for infection control interventions to reduce the incidence of SSI.
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Burnichon G, Liétard C, L’Azou D, Coutté MB, Le Gall G, Baron R, Besson G, Lejeune B. Résultats d’une surveillance des infections du site opératoire en neurochirurgie, octobre 1998–janvier 2003. Neurochirurgie 2007; 53:470-6. [DOI: 10.1016/j.neuchi.2007.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2006] [Accepted: 08/09/2007] [Indexed: 10/22/2022]
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Manniën J, van den Hof S, Brandt C, Behnke M, Wille JC, Gastmeier P. Comparison of the National Surgical Site Infection surveillance data between The Netherlands and Germany: PREZIES versus KISS. J Hosp Infect 2007; 66:224-31. [PMID: 17512635 DOI: 10.1016/j.jhin.2007.03.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Accepted: 03/23/2007] [Indexed: 11/25/2022]
Abstract
As there has been increasing interest in comparing surgical site infection (SSI) rates between countries, we compared the SSI surveillance data for The Netherlands ('PREZIES') and Germany ('KISS'). Both surveillance systems have comparable protocols with many similar risk factors, including SSI definitions developed by the Centers for Disease Control and Prevention and optional postdischarge surveillance. Nine surgical procedure categories from several specialities were included, the reporting of which were similar, with respect to content and with enough data for proper comparison. Differences for the SSI data were found between PREZIES and KISS for duration of surgery, wound contamination class, American Society of Anesthesiologists physical status classification and the postoperative duration of hospitalization. A significantly higher superficial SSI rate was found for seven surgical procedures according to PREZIES and a higher deep SSI rate for five procedures. When considering only deep SSI during hospitalization, the differences in SSI rates were much smaller. Differences in intensity of postdischarge surveillance led to 34% of SSI being detected after discharge for PREZIES and 21% for KISS. In conclusion, even though similar infection surveillance protocols are used in The Netherlands and Germany, differences occurred in the implementation. Comparisons between countries are most reliable if only deep SSIs during hospitalization are taken into account, since these SSI are not affected by postdischarge surveillance and the diagnostic sensitivity for deep SSI is probably more alike between countries than for superficial SSI.
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Affiliation(s)
- J Manniën
- Netherlands Centre for Infectious Disease Control, National Institute for Public Health and the Environment, The Netherlands.
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Kusachi S, Sumiyama Y, Arima Y, Yoshida Y, Tanaka H, Nakamura Y, Nagao J, Saida Y, Watanabe M, Watanabe R, Sato J. Success of countermeasures against respiratory infection after digestive surgery by strict blood and fluid resuscitation. J Infect Chemother 2007; 13:172-6. [PMID: 17593504 DOI: 10.1007/s10156-007-0514-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2007] [Accepted: 02/19/2007] [Indexed: 10/23/2022]
Abstract
This prospective controlled study included 5859 cases of digestive surgery from September 1987 to August 2002. The study was divided into six 2.5-year periods, A-F. During and after period B, cefazolin was used for surgery of the esophagus, stomach, and gall bladder, and cefotiam for colon resection, hepatectomy, and pancreatectomy. During period A, total parenteral nutrition (TPN) was administered for 6 (+/-4.6) days before surgery, on average. During and after period B, TPN was confined to patients who were incapable of oral intake. During thoracic esophageal cancer surgery, frozen plasma was administered at 10 ml/h, colloid osmotic pressure was maintained, and water was prevented from accumulating in the third space. Mechanical respiratory support was not needed during or after period B. The incidence rate of respiratory infection decreased to 1.7% during period A, and to 0.7%-1.1% during and after period B. During and after period B, in particular, early respiratory infection cases after surgery decreased significantly to 0.1%-0.3%. In period A, among the respiratory infectious bacteria isolated, MRSA was the most frequent, followed by Pseudomonas aeruginosa. After period B, P. aeruginosa was the most frequent bacterium isolated. Over all periods, there was no significant difference in resistant ratios in P. aeruginosa. Because of consistent infusion management during the perioperative period, artificial breathing became unnecessary and, as a result, the prevalence of early respiratory infection decreased significantly.
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Affiliation(s)
- Shinya Kusachi
- Third Department of Surgery, Toho University Medical Center, Ohashi Hospital, 2-17-6 Ohashi, Meguro-ku, Tokyo 153-8515, Japan.
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Kasatpibal N, Jamulitrat S, Chongsuvivatwong V, Nørgaard M, Sørensen HT. Impact of surgeon-specific feedback on surgical site infection rates in Thailand. J Hosp Infect 2006; 63:148-55. [PMID: 16632074 DOI: 10.1016/j.jhin.2006.01.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2005] [Accepted: 01/20/2006] [Indexed: 11/18/2022]
Abstract
Data on surgeon-specific feedback on surgical site infection (SSI) rates are not currently available in Thailand. The authors conducted a before and after study among patients undergoing surgery in seven Thai hospitals to examine whether a feedback system to surgeons could reduce SSI rates. After a six-month surveillance period, surgeons were provided with their own SSI rates and standardized infection ratios (SIRs). The criteria of the National Nosocomial Infection Surveillance (NNIS) system were used to determine SSI rates, and the SSI rates were compared with the NNIS report in terms of the SIR. To compare the SIR before and after intervention, the SIR ratio was calculated and logistic regression analysis was used to estimate the relative impact of surgeon-specific feedback, adjusting for patient sex, patient age, degree of wound contamination, American Society of Anesthesiologists' score, duration of operation, type of operation, use and duration of antibiotic prophylaxis, and length of pre-operative stay. After confidential feedback to surgeons for six months, SSI rates and the SIR remained unchanged. The SSI rate in the pre-intervention period was 1.7 infections/100 operations and the corresponding SIR was 0.8 [95% confidence intervals (CI)=0.6-0.9]. In the post-intervention period, the SSI rate was 1.8 infections/100 operations, with a corresponding SIR of 0.8 (95%CI=0.7-0.9). The SIR ratio was 1.0. The relative risk of SSI after surgeon-specific feedback suggested that this intervention had no effect (adjusted relative risk=1.02, 95%CI=0.77-1.35). Feedback to surgeons on their SSI rates did not reduce the rates of such infections in Thailand.
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Affiliation(s)
- N Kasatpibal
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
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Suka M, Yoshida K, Takezawa J. A practical tool to assess the incidence of nosocomial infection in Japanese intensive care units: the Japanese Nosocomial Infection Surveillance System. J Hosp Infect 2006; 63:179-84. [PMID: 16621142 DOI: 10.1016/j.jhin.2005.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2005] [Accepted: 12/21/2005] [Indexed: 10/24/2022]
Abstract
SUMMARY Infection control professionals have the means to calculate infection rates in their hospitals but not to assess them. They require a practical tool that enables them to compare observed infection rates with external standards. Based on the data obtained from the intensive care unit (ICU) component of the Japanese Nosocomial Infection Surveillance (JANIS) system, a spreadsheet was developed to calculate a standardized infection ratio (SIR) as a risk-adjusted indicator. Out of the factors associated with the development of nosocomial infections in a multi-variate analysis, the following three factors were selected for stratification: APACHE II score (0-10, 11-20, 21+), operation (yes, no) and ventilator use (user, non-user). Infection rates in 2001 were determined (per 1000 patient-days), stratified by the three factors, as a benchmark. The spreadsheet was designed to calculate SIRs on the basis of the Japanese benchmark infection rates using Microsoft Excel software. The user of the spreadsheet should input the number of observed nosocomial infections and patient-days by APACHE II score, operation and ventilator use. When applied to eight Japanese ICUs, the spreadsheet revealed relative differences and temporal changes in the incidence of nosocomial infections within these ICUs.
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Affiliation(s)
- M Suka
- Department of Preventive Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
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