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Horgan S, Drennan J, Andrews E, Saab MM, Hegarty J. Healthcare professionals' knowledge and attitudes towards surgical site infection and surveillance: A quasi-experimental study. Nurs Open 2024; 11:e2048. [PMID: 38268293 PMCID: PMC10697123 DOI: 10.1002/nop2.2048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 06/23/2023] [Accepted: 10/23/2023] [Indexed: 01/26/2024] Open
Abstract
AIM SSI is one of the most prevalent healthcare-associated infections and is associated with extended hospital stays, increased need for reoperation and higher hospital readmission rates. Implementing systematic SSI surveillance can reduce these adverse outcomes. Implementing a surveillance system into a hospital is a complex intervention requiring that staff involved in a patient's perioperative journey have the knowledge of SSI prevention, the data required for surveillance, an understanding of how data informs quality improvement initiatives and their role in surveillance. The aim of this study was to evaluate the impact of a complex intervention on the knowledge and attitudes of healthcare professionals towards surgical site infection (SSI), SSI prevention and surveillance in a university hospital setting. DESIGN The study used a quasi-experimental pre-test-post-test design. METHOD The impact of a complex intervention was evaluated by measuring healthcare professionals' (n = 74) knowledge of and attitudes towards SSI and surveillance. Normalisation process theory (NPT) guided the study and the development of the intervention. RESULTS There was a statistically significant increase in scores on the knowledge of SSI and prevention from pre-intervention to post-test. The knowledge of risk factors scores at post-test was significantly higher than that at pre-intervention. Overall attitudes to SSI prevention and surveillance were good both pre-intervention and post-test but there was a significant change in the attitude of participants. The findings reveal an overall positive impact of the complex intervention on the knowledge and attitude of healthcare professionals relating to SSI, SSI prevention and surveillance; however, the extent of the change varied across items measured.
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Affiliation(s)
- Sinéad Horgan
- Department of Nursing and MidwiferySouth/South West Hospitals Group, ErinvilleCorkIreland
| | - Jonathan Drennan
- School of Nursing and Midwifery, College of Medicine and HealthUniversity College CorkCorkIreland
| | - Emmet Andrews
- Department of SurgeryCork University HospitalCorkIreland
| | - Mohamad M. Saab
- School of Nursing and Midwifery, College of Medicine and HealthUniversity College CorkCorkIreland
| | - Josephine Hegarty
- School of Nursing and Midwifery, College of Medicine and HealthUniversity College CorkCorkIreland
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Horgan S, Saab MM, Drennan J, Keane D, Hegarty J. Healthcare professionals' knowledge and attitudes of surgical site infection and surveillance: A narrative systematic review. Nurse Educ Pract 2023; 69:103637. [PMID: 37062123 DOI: 10.1016/j.nepr.2023.103637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/24/2023] [Accepted: 04/04/2023] [Indexed: 04/18/2023]
Abstract
AIM This systematic review reports on healthcare professionals' knowledge and attitudes of surgical site infection and surgical site infection surveillance as well as interventions aimed at enhancing healthcare professionals' knowledge and attitudes. BACKGROUND Surgical site infection is a serious adverse outcome following surgery. Despite the presence of international guidelines, the prevention of surgical site infections remains a challenge for patients and hospitals. It is critical that healthcare professionals have sufficient knowledge on surgical site infection and on their role in implementing evidence-based prevention strategies. DESIGN This review is reported using the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines. METHODS A search was undertaken in the following databases: Academic Search Complete, CINAHL, ERIC, MEDLINE, PsycARTICLES, PsycINFO and Web of Science for studies published between January 2010 and March 2022. Studies that examined healthcare professionals' knowledge and attitudes in relation to surgical site infection, surgical site infection surveillance and risk factors for their development were included. We also included studies that examined interventions that aimed to enhance healthcare professionals' knowledge and attitude in relation to surgical site infection, surveillance, and risk factors. We also described the impact of such interventions on the incidence of surgical site infections. RESULTS A total of 26 studies were included. Results were synthesised narratively according to the review objectives. Findings from this review show that knowledge of what surgical site infection is and its prevention was poor amongst healthcare professionals, while attitudes were positive particularly in relation to healthcare professionals' role in prevention. Only three studies examined the effects of interventions on healthcare professionals' knowledge of surgical site infection and surgical site infection prevention. Of those, two used multimodal educational interventions and found statistically significant improvement in knowledge. CONCLUSIONS Overall knowledge of surgical site infection and its prevention is poor amongst healthcare professionals, while attitudes were positive particularly in relation to healthcare professionals' role in prevention. There is a need for more experimental research to evaluate interventions which aim to address healthcare professionals' knowledge and attitudes towards surgical site infection prevention and surveillance. Such studies should include all healthcare professionals involved in the care of a surgical patient. TWEETABLE ABSTRACT Knowledge and attitudes of surgical site infection prevention amongst healthcare professionals.
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Affiliation(s)
- Sinéad Horgan
- Department of Nursing and Midwifery, South/South West Hospitals Group, Erinville, Western Road, Cork, Ireland; Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland.
| | - Mohamad M Saab
- Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Jonathan Drennan
- Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Danielle Keane
- Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland
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Badia JM, Amillo Zaragüeta M, Rubio-Pérez I, Espin-Basany E, González Sánchez C, Balibrea JM. What have we learned from the surveys of the AEC, AECP and the Observatory of Infection in Surgery? Compliance with postoperative infection prevention measures and comparison with the AEC recommendations. Cir Esp 2022; 100:392-403. [PMID: 35283055 DOI: 10.1016/j.cireng.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/12/2021] [Indexed: 06/14/2023]
Abstract
Before planning improvement strategies, it is crucial to know the degree of implementation of preventative measures for postoperative infection. The aggregated results of 3 surveys carried out by the Observatory of Infection in Surgery to members of 11 associations of surgeons and perioperative nurses are presented. The questions were aimed to determine the knowledge of the scientific evidence, personal beliefs and the actual use of the main measures. Of 2295 respondents, 45.1% did not receive feedback on the infection rate of their unit. Insufficient knowledge of some of the main prevention recommendations and some disturbing rates of use were observed. The preferred strategies to improve compliance with preventive guidelines and their degree of implementation were investigated. A gap between scientific evidence and clinical practice in the prevention of infection in different surgical specialties was confirmed.
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Affiliation(s)
- Josep M Badia
- Servicio de Cirugía General, Hospital General de Granollers, Universitat Internacional de Catalunya, Granollers, Spain.
| | - Mireia Amillo Zaragüeta
- Servicio de Cirugía General, Hospital General de Granollers, Universitat Internacional de Catalunya, Granollers, Spain
| | - Inés Rubio-Pérez
- Servicio de Cirugía General, Hospital Universitario la Paz, Madrid, Spain
| | - Eloy Espin-Basany
- Servicio de Cirugía General, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | | | - José M Balibrea
- Servicio de Cirugía General, Hospital Clínic de Barcelona, Barcelona, Spain
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Badia JM, Amillo Zaragüeta M, Rubio-Pérez I, Espin-Basany E, González Sánchez C, Balibrea JM. ¿Qué hemos aprendido de las encuestas de la AEC, AECP y del Observatorio de Infección en Cirugía? Cumplimiento de las medidas de prevención de infección postoperatoria y comparación con las recomendaciones de la AEC. Cir Esp 2021. [DOI: 10.1016/j.ciresp.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gillani SW, Vippadapu P, Gulam SM. Physician-reported barriers and challenges to antibiotic prescribing in surgical prophylaxis: a structured systematic review. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmab022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Abstract
Objectives
The purpose of the study is to identify and analyse the barriers in surgical procedures where antibiotic dissipation is habitual.
Methods
Extensive literature search is carried out using different electronic databases (PubMed, Europe PMC, PLoS and Google Scholar) between January 2000 and December 2020. The articles were selected purely based on the inclusion criteria. Only qualitative and cross-sectional studies were selected to reduce the risk of bias. The JBI and AXIS checklists were used to assessed the quality of the enrolled articles. Data extractions were done by using a predesigned standardized data collection form.
Key findings
A total of 2067 articles were electronically retrieved but only 14 articles met the eligibility criteria. About 15 902 healthcare professionals (HCPs) with an average response rate of 64.7% were pooled for evidence synthesis. The majority of respondents (50%) discussed different barriers in their practice site for surgical antibiotic prophylaxis (SAP) administration. Barriers were categorized into four themes: lack of guideline availability and knowledge, lack of adherence to guidelines, lack of guideline knowledge and adherence and physician perceptions or off-label practices. A total of 723 (56.3%) out of 1282 HCPs from nine different studies reported a lack of adherence to guidelines during the perioperative process. The majority of respondents in three studies, 318 (82%) out of 386 HCPs, reported that physicians’ perceptions play a crucial role in prescribing SAP during surgeries.
Conclusion
This study concluded that the barriers within the practice site play a decisive role in SAP optimization and therefore all HCPs are recommended to maintain local/standard guidelines and adhere to them while prescribing SAP.
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Affiliation(s)
- Syed Wasif Gillani
- Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University, Ajman, UAE
| | - Prasanna Vippadapu
- Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University, Ajman, UAE
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Assessment of the Risk and Economic Burden of Surgical Site Infection Following Colorectal Surgery Using a US Longitudinal Database: Is There a Role for Innovative Antimicrobial Wound Closure Technology to Reduce the Risk of Infection? Dis Colon Rectum 2020; 63:1628-1638. [PMID: 33109910 PMCID: PMC7774813 DOI: 10.1097/dcr.0000000000001799] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Colorectal surgical procedures place substantial burden on health care systems because of the high complication risk, of surgical site infections in particular. The risk of surgical site infection after colorectal surgery is one of the highest of any surgical specialty. OBJECTIVE The purpose of this study was to determine the incidence, cost of infections after colorectal surgery, and potential economic benefit of using antimicrobial wound closure to improve patient outcomes. DESIGN Retrospective observational cohort analysis and probabilistic cost analysis were performed. SETTINGS The analysis utilized a database for colorectal patients in the United States between 2014 and 2018. PATIENTS A total of 107,665 patients who underwent colorectal surgery were included in the analysis. MAIN OUTCOME MEASURES Rate of infection was together with identified between 3 and 180 days postoperatively, infection risk factors, infection costs over 24 months postoperatively by payer type (commercial payers and Medicare), and potential costs avoided per patient by using an evidence-based innovative wound closure technology. RESULTS Surgical site infections were diagnosed postoperatively in 23.9% of patients (4.0% superficial incisional and 19.9% deep incisional/organ space). Risk factors significantly increased risk of deep incisional/organ-space infection and included several patient comorbidities, age, payer type, and admission type. After 12 months, adjusted increased costs associated with infections ranged from $36,429 to $144,809 for commercial payers and $17,551 to $102,280 for Medicare, depending on surgical site infection type. Adjusted incremental costs continued to increase over a 24-month study period for both payers. Use of antimicrobial wound closure for colorectal surgery is projected to significantly reduce median payer costs by $809 to $1170 per patient compared with traditional wound closure. LIMITATIONS The inherent biases associated with retrospective databases limited this study. CONCLUSIONS Surgical site infection cost burden was found to be higher than previously reported, with payer costs escalating over a 24-month postoperative period. Cost analysis results for adopting antimicrobial wound closure aligns with previous evidence-based studies, suggesting a fiscal benefit for its use as a component of a comprehensive evidence-based surgical care bundle for reducing the risk of infection. See Video Abstract at http://links.lww.com/DCR/B358. EVALUACIÓN DEL RIESGO Y LA CARGA ECONÓMICA DE LA INFECCIÓN DEL SITIO QUIRÚRGICO DESPUÉS DE UNA CIRUGÍA COLORRECTAL UTILIZANDO UNA BASE DE DATOS LONGITUDINAL DE EE.UU.: ¿EXISTE UN PAPEL PARA LA TECNOLOGÍA INNOVADORA DE CIERRE DE HERIDAS ANTIMICROBIANAS PARA REDUCIR EL RIESGO DE INFECCIÓN?: Los procedimientos quirúrgicos colorrectales suponen una carga considerable para los sistemas de salud debido al alto riesgo de complicaciones, particularmente las infecciones del sitio quirúrgico. El riesgo de infección posoperatoria del sitio quirúrgico colorrectal es uno de los más altos de cualquier especialidad quirúrgica.El propósito de este estudio fue determinar la incidencia, el costo de las infecciones después de la cirugía colorrectal y el beneficio económico potencial del uso del cierre de la herida con antimicrobianos para mejorar los resultados de los pacientes.Análisis retrospectivo de cohorte observacional y análisis de costo probabilístico.El análisis utilizó la base de datos para pacientes colorrectales en los Estados Unidos entre 2014 y 2018.Un total de 107,665 pacientes sometidos a cirugía colorrectal.Se identificó una tasa de infección entre 3 y 180 días después de la operación, los factores de riesgo de infección, los costos de infección durante 24 meses posteriores a la operación por tipo de pagador (pagadores comerciales y Medicare), y los costos potenciales evitados por paciente utilizando una tecnología innovadora de cierre de heridas basada en evidencias.Infecciones del sitio quirúrgico, diagnosticadas postoperatoriamente en el 23,9% de los pacientes (4,0% incisional superficial y 19,9% incisional profunda / espacio orgánico). Los factores de riesgo aumentaron significativamente el riesgo de infección profunda por incisión / espacio orgánico e incluyeron comorbilidades selectivas del paciente, edad, tipo de pagador y tipo de admisión. Después de 12 meses, el aumento de los costos asociados con las infecciones varió de $ 36,429 a $ 144,809 para los pagadores comerciales y de $ 17,551 a $ 102,280 para Medicare, según el tipo de infección del sitio quirúrgico. Los costos incrementales ajustados continuaron aumentando durante un período de estudio de 24 meses para ambos pagadores. Se prevé que el uso del cierre antimicrobiano de la herida para la cirugía colorrectal reducirá significativamente los costos medios del pagador en $ 809- $ 1,170 por paciente en comparación con el cierre tradicional de la herida.Los sesgos inherentes asociados a las bases de datos retrospectivas limitaron este estudio.Se encontró que la carga del costo de la infección del sitio quirúrgico es mayor que la reportada previamente, y los costos del pagador aumentaron durante un período postoperatorio de 24 meses. Los resultados del análisis de costos para la adopción del cierre de heridas antimicrobianas se alinean con estudios previos basados en evidencia, lo que sugiere un beneficio fiscal para su uso como componente de un paquete integral de atención quirúrgica basada en evidencia para reducir el riesgo de infección. Consulte Video Resumen en http://links.lww.com/DCR/B358.
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Badia JM, Rubio-Pérez I, López-Menéndez J, Diez C, Al-Raies Bolaños B, Ocaña-Guaita J, Meijome XM, Chamorro-Pons M, Calderón-Nájera R, Ortega-Pérez G, Paredes-Esteban R, Sánchez-Viguera C, Vilallonga R, Picardo AL, Bravo-Brañas E, Espin E, Balibrea JM. The persistent breach between evidence and practice in the prevention of surgical site infection. Qualitative study. Int J Surg 2020; 82:231-239. [PMID: 32877754 DOI: 10.1016/j.ijsu.2020.08.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/20/2020] [Accepted: 08/11/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Despite the dissemination of guidelines for surgical site infection (SSI) prevention, a gap between the theoretical measures and their compliance persists. Accurate estimates of the implementation of preventative measures is crucial before planning dissemination strategies. METHODS A web-based survey was distributed to members of 11 Associations of operative nurses and surgeons. Questions aimed to determine their awareness of evidence, personal beliefs and actual use of the main preventative measures. RESULTS Of 1105 responders, 50.5% receive no feed-back of their SSI rate. Responders show a moderate rate of awareness of the recommendations about not removing hair, hair clipping, skin antisepsis with alcoholic solutions, and normothermia. Antibiotic prophylaxis is given for more than 24 h by 18.8% of respondents. Screening for S. aureus is performed by 27.6%. Hair removal by shaving is used by 16.6% of responders. The most common antiseptic solutions are alcoholic chlorhexidine (57.2%) and aqueous povidone (23.3%). 62.8% of surgeons allow the solution to air dry before applying surgical drapes. Adhesive drapes in the surgical field are used routinely in 33.4% of cases. Perioperative normothermia, glucose control and hyperoxia are used in 84.3%, 65.9% and 23.3% of cases. Antimicrobial sutures and negative pressure therapy are used by 20.2% and 43.5% of teams, respectively. Prior to closing the incision, 83.9% replace surgical instruments always or selectively. Wound irrigation before closing is used in 78.1% of cases, mostly with saline. Check-lists, standardized orders, surveillance, feed-back and educational programs were rated most highly by respondents as a means to improve compliance with preventative guidelines, but few of these strategies were in place at their institutions. CONCLUSION Gaps in the translation of evidence into practice remain in the prevention of SSI among different surgical specialities. Several areas for improvement have been identified, as some core prevention measures are not in common use.
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Affiliation(s)
- Josep M Badia
- Department of Surgery, Hospital General de Granollers, Avinguda Francesc Ribas 1, 08402, Spain; Universitat Internacional de Catalunya, Barcelona, Spain.
| | - Inés Rubio-Pérez
- Department of Surgery, Hospital Universitario La Paz, Paseo de La Castellana, 261, 28046, Madrid, Spain.
| | - José López-Menéndez
- Department of Cardiac Surgery, Hospital Universitario Ramón y Cajal, Ctra. de Colmenar Viejo Km. 9, 100, 28034, Madrid, Spain.
| | - Cecilia Diez
- Surgical Area, Hospital Universitari Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain.
| | - Bader Al-Raies Bolaños
- Department of Vascular Surgery, Hospital de Manises, Av. de La Generalitat Valenciana, 50, 46940, Manises, Valencia, Spain.
| | - Julia Ocaña-Guaita
- Department of Vascular Surgery, Hospital Ramón y Cajal, Ctra. de Colmenar Viejo Km. 9, 100, 28034, Madrid, Spain.
| | - Xose M Meijome
- Gerencia de Asistencia Sanitaria Del Bierzo, León, Gerencia de Asistencia Sanitaria Del Bierzo, Nursing and Healthcare Research Unit, C/ El Medio, 1, 24400, Ponferrada, León, Spain.
| | - Manuel Chamorro-Pons
- Department of Oral and Maxillofacial Surgery, Hospital Ruber Juan Bravo, Calle de Juan Bravo, 49, 28006, Madrid, Spain.
| | - Ramón Calderón-Nájera
- Department of Aesthetic, Plastic and Reconstructive Surgery, Hospital Ruber Internacional, Calle de La Masó, 38 28034, Madrid, Spain.
| | - Gloria Ortega-Pérez
- Department of Surgical Oncology, MD Anderson Cancer Center, Calle de Arturo Soria, 270, 28033, Madrid, Spain.
| | - Rosa Paredes-Esteban
- Unidad de Cirugía Pediátrica, Hospital Universitario Reina Sofía, Av. Menendez Pidal, S/n, 14004, Córdoba, Spain.
| | - Cristina Sánchez-Viguera
- Servicio de Neurocirugía, Hospital Regional Universitario de Málaga, Av. de Carlos Haya, 84, 29010, Málaga, Spain.
| | - Ramon Vilallonga
- Endocrine-Metabolic and Bariatric Surgery Unit, Hospital Universitari Vall D'Hebrón, Passeig de La Vall D'Hebron, 119, 08035, Barcelona, Spain.
| | - Antonio L Picardo
- Endocrine-Metabolic and Bariatric Surgery Unit, HM Montepríncipe, Avenida de Montepríncipe Nº 25, 28660, Boadilla Del Monte, Madrid, Spain.
| | - Elena Bravo-Brañas
- Department of Aesthetic, Plastic and Reconstructive Surgery, Hospital Universitario La Paz, Paseo de La Castellana, 261, 28046, Madrid, Spain.
| | - Eloy Espin
- Department of Surgery, Hospital Universitari Vall D'Hebrón, Passeig de La Vall D'Hebron, 119, 08035, Barcelona, Spain.
| | - José M Balibrea
- Department of Surgery, Hospital Clínic de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain.
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Andersson R, Søreide K, Ansari D. Surgical Infections and Antibiotic Stewardship: In Need for New Directions. Scand J Surg 2019; 110:110-112. [PMID: 31826717 DOI: 10.1177/1457496919891617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND AIMS Patients undergoing surgery are prone to infections, either at the site of surgery (superficial or organ-space) or at remote sites (e.g. pneumonia or urinary tract). Surgical site infections are associated with substantial morbidity and mortality, increased length of hospital stay and represent a huge burden to the health economy across all healthcare systems. Here we discuss recent advances and challenges in the field of surgical site infections. MATERIAL AND METHODS Review of pertinent English language literature. RESULTS Numerous guidelines and recommendations have been published in order to prevent surgical site infections. Compliance with these evidence-based guidelines vary and has not resulted in any major decrease in the surgical site infection rate. To date, most efforts to reduce surgical site infection have focused on the role of the surgeon, but a more comprehensive approach is necessary. CONCLUSION Surgical site infections need to be addressed in a structured way, including checklists, audits, monitoring, and measurements. All stakeholders, including the medical profession, the society, and the patient, need to work together to reduce surgical site infections. Most surgical site infections are preventable-and we need a paradigm shift to tackle the problem.
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Affiliation(s)
- R Andersson
- Department of Surgery, Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
| | - K Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - D Ansari
- Department of Surgery, Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
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Badia JM, Casey AL, Rubio-Pérez I, Arroyo-García N, Espin E, Biondo S, Balibrea JM. Awareness of Practice and Comparison with Best Evidence in Surgical Site Infection Prevention in Colorectal Surgery. Surg Infect (Larchmt) 2019; 21:218-226. [PMID: 31724910 PMCID: PMC7099413 DOI: 10.1089/sur.2019.203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: The use of mechanical bowel preparation and prophylaxis with oral antimicrobial agents can prevent surgical site infection (SSI) in colorectal surgical procedures, but routine adoption of these and other practices by surgeons has been limited. The aim of this study was to determine the actual practice and surgeon beliefs about preventative measures in elective colorectal operations and to compare them with established recommendations. Methods: Web-based survey was sent to colorectal surgeons assessing knowledge, beliefs, and practices regarding the use of preventative measures for SSI. Results: Of 355 surgeons, 33% had no feedback of SSI rate; 60% believed in evidence for normothermia, wound edge protection, and use of alcohol solution, and reported use of these strategies. There was a discrepancy in the assumed evidence and use of hyperoxia, glove replacement after anastomosis, surgical tools replacement, and saline surgical site lavage. Most of respondents believe that oral antibiotic prophylaxis diminishes infection, but is indicated only by one third of them. Few surgeons believe in MBP, but many actually use it. Most surgeons believe that there is a discrepancy between published guidelines and actual clinical practice. As proper means to implement guidelines, checklists, standardized orders, surveillance, feedback of SSI rates, and educational programs are rated most highly by surgeons, but few of these are in place at their institutions. Conclusions: Gaps in the translation of evidence into practice remain in the prevention of SSI in colorectal surgical procedures. Several areas for improvement have been identified. Specific implementation strategies should be addressed in colorectal units.
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Affiliation(s)
- Josep M Badia
- Department of Surgery, Hospital General de Granollers, Barcelona, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain
| | - Anna L Casey
- Department of Clinical Microbiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Inés Rubio-Pérez
- Department of Surgery, Hospital Universitario la Paz, Madrid, Spain
| | | | - Eloy Espin
- Department of Surgery, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - Sebastiano Biondo
- Department of Surgery, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain
| | - José M Balibrea
- Department of Surgery, Hospital Clínic de Barcelona, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain
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Bruyere F, Pilatz A, Boehm A, Pradere B, Wagenlehner F, Vallee M. Associated measures to antibiotic prophylaxis in urology. World J Urol 2019; 38:9-15. [DOI: 10.1007/s00345-019-02854-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/15/2019] [Indexed: 01/20/2023] Open
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Vos RJ, Van Putte BP, Kloppenburg GTL. Prevention of deep sternal wound infection in cardiac surgery: a literature review. J Hosp Infect 2018; 100:411-420. [PMID: 29885873 DOI: 10.1016/j.jhin.2018.05.026] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 05/31/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Deep sternal wound infection (DSWI) is a dreaded complication of cardiac surgery with considerable consequences in terms of mortality, morbidity and treatment costs. In addition to standard surgical site infection prevention guidelines, multiple specific measures in the prevention of DSWI have been developed and evaluated in the past decades. This review focuses on these specific measures to prevent DSWI. METHODS An extensive literature search was performed to assess interventions in the prevention of DSWI. Articles describing results of a randomized controlled trial were categorized by type of intervention. Results were yielded and, if possible, pooled. RESULTS From a total of 743 articles found, 48 randomized controlled trials were selected. Studies were divided into 12 categories, containing pre-, peri- and postoperative preventive measures. Specific measures shown to be effective were: antibiotic prophylaxis with a first-generation cephalosporin for at least 24 h, application of local gentamicin before chest closure, sternal closure with figure-of-eight steel wires, and postoperative chest support using a corset or vest. CONCLUSION This study identified several measures that prevent DSWI after cardiac surgery that are not frequently applied in current practice. It is recommended that the guidelines on prevention of surgical site infection in cardiac surgery should be updated.
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Affiliation(s)
- R J Vos
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands; Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, The Netherlands.
| | - B P Van Putte
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands; Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - G T L Kloppenburg
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
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A survey to identify the breach between evidence and practice in the prevention of surgical infection: Time to take action. Int J Surg 2018; 54:290-297. [DOI: 10.1016/j.ijsu.2018.04.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/15/2018] [Accepted: 04/23/2018] [Indexed: 01/11/2023]
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Baniasadi S, Alaeen Z, Behgam Shadmehr M. Surgical Antibiotic Prophylaxis: A Descriptive Study among Thoracic Surgeons. TANAFFOS 2016; 15:154-159. [PMID: 28210280 PMCID: PMC5304959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Surgical site infections (SSIs) are common complications following surgeries and increase mortality, morbidity and healthcare costs. The use of antimicrobial prophylaxis is an effective measure to prevent development of SSIs. This study aimed to evaluate the current use of prophylactic antibiotics in thoracic surgeries in Iran. MATERIALS AND METHODS A descriptive study was conducted among thoracic surgeons in order to assess their knowledge, attitude and practice (KAP) about surgical antibiotic prophylaxis (SAP). A four-section multiple-choice questionnaire was designed and hand-delivered to registered thoracic surgeons. The surgeons' answers were considered correct when they were in accordance to the American Society of Health-System Pharmacist (ASHP) guidelines. RESULTS Seventy thoracic surgeons were requested to participate in this study and their response rate was 71.4%. Thirty-five (70%) surgeons had good knowledge about appropriate SAP. However, less than half of the respondents were aware of appropriate SAP in case of Ig E-mediated reaction to penicillin and risk of Gram-negative infections. The surgeon's attitude score about the need for local and national guidelines for SAP was 78% and 90%, respectively. Accordance of the physician's practice with ASHP guidelines regarding timing of the first dosage of SAP was acceptable while correct administration of an intraoperative dose was 40% in agreement with the guideline. CONCLUSION Although thoracic surgeons had a good attitude towards antibiotic prophylaxis guidelines, their knowledge and practice should be improved for proper administration of SAP.
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Affiliation(s)
- Shadi Baniasadi
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zeinab Alaeen
- Pharmaceutical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Mohammad Behgam Shadmehr
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran,,Correspondence to: Shadmehr MB, Address: Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Masih Daneshvari Hospital, Daarabad, Niavaran, Tehran, Iran. Email address:
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Cameron M, Jones S, Adedeji O. Antibiotic prophylaxis audit and questionnaire study: Traffic Light Poster improves adherence to protocol in gastrointestinal surgery. Int J Surg 2015; 19:112-5. [DOI: 10.1016/j.ijsu.2015.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/24/2015] [Accepted: 05/06/2015] [Indexed: 01/22/2023]
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Swaminathan AK, Berkowitz R, Baker A, Spyres M. Do emergency medicine residents receive appropriate video laryngoscopy training? A survey to compare the utilization of video laryngoscopy devices in emergency medicine residency programs and community emergency departments. J Emerg Med 2015; 48:613-9. [PMID: 25648052 DOI: 10.1016/j.jemermed.2014.12.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 10/30/2014] [Accepted: 12/21/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Video laryngoscopy (VL) has emerged as a critical tool in the "difficult airway" armamentarium of emergency physicians. The resultant increase in the types of available VL devices has made Emergency Medicine Residency (EMR) training in VL increasingly challenging. Additionally, the prevalence of VL devices in the community is unknown. Because Emergency Medicine (EM) residents go on to work in diverse settings, many in non-EMR emergency departments (EDs), it is preferable that they receive training on the airway modalities they will encounter in practice. OBJECTIVE To compare the prevalence and type of VL devices in EMR programs to non-EMR EDs. METHODS This was a survey study conducted from July 2012 to October 2012 of Accreditation Council for Graduate Medical Education-accredited, MD EMR programs in the United States and non-EMR EDs in New York State. A chi-squared test was performed to determine whether the difference in VL prevalence was significant. RESULTS There were 158 EMR programs and 132 non-EMR EDs surveyed; 97.8% of EMR and 84.3% of non-EMR EDs reported having some form of VL in their departments. The difference in proportion of EMR vs. non-EMR EDs that have VL was χ(2) = 13 (p < 0.001). The Glidescope® device (Verathon Medical, Bothell, WA) was present in 87.7% of EMR programs and 79.3% of non-EMR EDs. CONCLUSIONS The majority of EMR programs trained residents in VL. The Glidescope device was used most frequently. Non-EMR EDs in New York State had a lower presence of VL devices, with the Glidescope device again being the most common. These results demonstrate that VL is pervasive in both practice environments.
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Affiliation(s)
- Anand Kumar Swaminathan
- Department of Emergency Medicine, New York University School of Medicine/Bellevue Hospital, New York, New York
| | - Rachel Berkowitz
- Department of Emergency Medicine, New York University School of Medicine/Bellevue Hospital, New York, New York
| | - Annalee Baker
- Department of Emergency Medicine, New York University School of Medicine/Bellevue Hospital, New York, New York
| | - Meghan Spyres
- Department of Emergency Medicine, New York University School of Medicine/Bellevue Hospital, New York, New York
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Abstract
Surgical site infections are a major contributor to morbidity and mortality in postsurgical care. Risk for surgical site infection is multifactorial and includes a host of microbial, patient-related, and procedure-related factors. Prevention of surgical infection relies on optimization of patient factors and use of a variety of evidence-based pharmacologic and nonpharmacologic measures. At the forefront of these measures is antimicrobial prophylaxis, which has been shown to be effective at reducing risk of surgical site infection. As guidelines for prevention of surgical site infection become increasingly complex and nuanced, surgical infection outcomes are increasing tied to quality outcome and performances measures.
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Affiliation(s)
- Pang Y Young
- Division of General Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 8440-112 Street Northwest, Edmonton, Alberta T6G 2B7, Canada
| | - Rachel G Khadaroo
- Division of General Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 8440-112 Street Northwest, Edmonton, Alberta T6G 2B7, Canada; Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8440-112 Street Northwest, Edmonton, Alberta T6G 2B7, Canada.
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A prospective evaluation of missed injuries in trauma patients, before and after formalising the trauma tertiary survey. World J Surg 2014; 38:222-32. [PMID: 24081533 PMCID: PMC3889299 DOI: 10.1007/s00268-013-2226-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective This study prospectively evaluated in-hospital and postdischarge missed injury rates in admitted trauma patients, before and after the formalisation of a trauma tertiary survey (TTS) procedure.
Methods Prospective before-and-after cohort study. TTS were formalised in a single regional level II trauma hospital in November 2009. All multitrauma patients admitted between March–October 2009 (preformalisation of TTS) and December 2009–September 2010 (post-) were assessed for missed injury, classified into three types: Type I, in-hospital, (injury missed at initial assessment, detected within 24 h); Type II, in-hospital (detected in hospital after 24 h, missed at initial assessment and by TTS); Type III, postdischarge (detected after hospital discharge). Secondary outcome measures included TTS performance rates and functional outcomes at 1 and 6 months.
Results A total of 487 trauma patients were included (pre-: n = 235; post-: n = 252). In-hospital missed injury rate (Types I and II combined) was similar for both groups (3.8 vs. 4.8 %, P = 0.61), as were postdischarge missed injury rates (Type III) at 1 month (13.7 vs. 11.5 %, P = 0.43), and 6 months (3.8 vs. 3.3 %, P = 0.84) after discharge. TTS performance was substantially higher in the post-group (27 vs. 42 %, P < 0.001). Functional outcomes for both cohorts were similar at 1 and 6 months follow-up. Conclusions This is the first study to evaluate missed injury rates after hospital discharge and demonstrated cumulative missed injury rates >15 %. Some of these injuries were clinically relevant. Although TTS performance was significantly improved by formalising the process (from 27 to 42 %), this did not decrease missed injury rates.
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Calbo E, Álvarez-Rocha L, Gudiol F, Pasquau J. A review of the factors influencing antimicrobial prescribing. Enferm Infecc Microbiol Clin 2013; 31 Suppl 4:12-5. [DOI: 10.1016/s0213-005x(13)70127-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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