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Bansal VV, Kamath Y, Waghmare S, Khajanchi MU, Roy N. Feasibility of tele-visits after elective ventral hernia surgery: Experience from an Indian tertiary care center. Surgery 2024:S0039-6060(24)00073-4. [PMID: 38503605 DOI: 10.1016/j.surg.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/04/2024] [Accepted: 02/07/2024] [Indexed: 03/21/2024]
Affiliation(s)
- Varun V Bansal
- Department of General Surgery, Seth G.S Medical College & K.E.M Hospital, Mumbai, India. http://www.twitter.com/Varun_VBSurg
| | - Yash Kamath
- Department of General Surgery, Seth G.S Medical College & K.E.M Hospital, Mumbai, India
| | - Sahil Waghmare
- Department of General Surgery, Seth G.S Medical College & K.E.M Hospital, Mumbai, India
| | - Monty U Khajanchi
- Department of General Surgery, Seth G.S Medical College & K.E.M Hospital, Mumbai, India
| | - Nobhojit Roy
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
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Gupta AK, Vyas A. Use of chitosan wound dressing for the treatment of surgical site infection: a case report. J Wound Care 2023; 32:S4-S8. [PMID: 36930280 DOI: 10.12968/jowc.2023.32.sup3.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Surgical site infections (SSIs) are treated using topical antiseptics and systemic antibiotics, but some cases are unresponsive to such regimens. This case study reports the effective healing of an SSI by a chitosan wound dressing (MaxioCel; Axio Biosolutions Private Limited, India) in a 63-year-old female patient. The patient presented with an infected, hard-to-heal wound in the abdominal region, developed after a hernia surgery, and was initially treated with standard procedures. However, due to the continuous progression of infection, a highly absorbent, bioactive microfibre dressing was selected for the treatment and was continued for two months with alternate-day dressing changes. After 60 days of treatment, wound healing was observed, along with remission from the infection, as well as reduction in exudate level and pain. The use of chitosan wound dressing in management of hard-to-heal infected wounds provides efficient remission of SSI and a faster healing rate.
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Affiliation(s)
- Alok Kumar Gupta
- Minimal Access Surgery and General Surgery, Max Hospital, Gurugram, Haryana, India, 122001
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Lai J, Li Q, He Y, Zou S, Bai X, Rastogi S. Glycemic Control Regimens in the Prevention of Surgical Site Infections: A Meta-Analysis of Randomized Clinical Trials. Front Surg 2022; 9:855409. [PMID: 35402490 PMCID: PMC8990940 DOI: 10.3389/fsurg.2022.855409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/18/2022] [Indexed: 01/04/2023] Open
Abstract
Background Increased risk of surgical site infections (SSIs) caused by hyperglycemia makes it necessary to follow perioperative glucose lowering strategies to reduce postoperative complications. A meta-analysis was conducted to understand the efficacy of intensive vs. conventional blood glucose lowering regimens on the incidence of SSIs and hypoglycemia from various randomized controlled studies (RCTs). Materials and Methods A systematic literature review was conducted using MEDLINE and Central databases for RCTs that involved intensive (lower blood glucose target levels) vs. conventional (higher blood glucose target levels) strategies in patients undergoing various types of surgeries. The primary outcomes were SSIs or postoperative wound infections. Hypoglycemia and mortality outcomes were also studied. A random-effects model was used to calculate the pooled risk ratio (RR), and subgroup analyses were performed. Results A total of 29 RCTs were included in the meta-analysis with the information from 14,126 patients. A reduction in overall incidence of SSIs was found (RR 0.63, 0.50-0.80, p = 0.0002, I 2= 56%). Subgroup analyses showed that intensive insulin regimens decreased the risk of SSIs in patients with diabetes, in cardiac and abdominal surgical procedures, and during the intraoperative and postoperative phases of surgery. However, the risk of hypoglycemia and mortality was increased in the intensive group compared to the conventional group. Conclusion The results of the meta-analysis provide support for the use of intensive insulin regimens during the perioperative phase for decreasing the incidence of SSIs in certain patient populations and surgical categories.
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Affiliation(s)
- Jing Lai
- Department of Nursing, The First People's Hospital of Longquanyi District, Chengdu, China
| | - Qihong Li
- Department of Internal Medicine, Yantai Qishan Hospital, Yantai, China
| | - Ying He
- Department of Science and Teaching, The First People's Hospital of Longquanyi District, Chengdu, China
| | - Shiyue Zou
- Department of Endocrinology, The First People's Hospital of Longquanyi District, Chengdu, China
| | - Xiaodong Bai
- Department of Outpatient, China Medical University, Shenyang, China
| | - Sanjay Rastogi
- Department of OMFS, Regional Dental College, Guwahati, India
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Harish R, Kazi FN, Sharma JVP. Efficacy of Subcutaneous Closed Suction Drain in Reduction of Postoperative Surgical Site Infection. Surg J (N Y) 2021; 7:e275-e280. [PMID: 34660890 PMCID: PMC8510787 DOI: 10.1055/s-0041-1735900] [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: 05/04/2021] [Accepted: 07/22/2021] [Indexed: 12/03/2022] Open
Abstract
Background
Surgical site infections (SSIs) are the infections of wound after an invasive operative approach. It remains to be a major morbidity for patients undergoing surgeries although there have been tremendous improvements in the surgical techniques.
Different interventions to suppress the selective serotonin reuptake inhibitors have been proposed. Many of them have been routinely used by surgeons like minimizing shaving, hand washing, and preoperative antibiotics and these are well accepted. Drains are used in major abdominal surgeries, hernia repairs, breast surgeries reducing collections in closed areas.
1
Hematoma, serous fluid, and dead space in surgical incision wounds raise the risk of infection as they serve as the platform for microbial growth. Studies have proved that the usage of subcutaneous drains has lowered the chances of infection.
Results
The patients in the case group had lower incidence of SSI compared with the control group. The patients in the case group had subcutaneous drain which drained any collection that developed in the subcutaneous space. When the incidence of SSI was compared between the emergency cases and elective cases, the emergency cases showed higher propensity for SSI and increased rate for patients who had co-morbidities like diabetes mellitus, hypertension, etc. The most common organism isolated from the SSI was found to be
Escherichia coli
. It was also noted that the mean number of days of hospital stay was comparatively higher for the patients who developed SSI compared with patients who did not develop SSI.
Conclusion
Thus the presence of SSI adds morbidity to the patient and the patients who undergo major surgeries are likely to develop SSI postoperatively. The presence of subcutaneous closed suction drain helps in reducing the SSI to a certain extent.
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Affiliation(s)
- R Harish
- Department of General Surgery, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
| | - Farah Naaz Kazi
- Department of General Surgery, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
| | - J V Pranav Sharma
- Department of General Surgery, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
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Behera HS, Chayani N, Bal M, Khuntia HK, Pati S, Das S, Ranjit M. Identification of population of bacteria from culture negative surgical site infection patients using molecular tool. BMC Surg 2021; 21:28. [PMID: 33413260 PMCID: PMC7788737 DOI: 10.1186/s12893-020-01016-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 12/15/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Managing surgical site infections, with negative culture report in routine diagnosis is a common dilemma in microbiology accounting more than 30% worldwide. The present study attempted to identify the presence of bacterial spp. if any in wound aspirates/swabs of culture negative surgical site infections of hospitalised patients using molecular tools. METHODS Ninety-seven patients with post-operative SSI whose wound swabs/aspirate were negative in the conventional aerobic culture after 72 h of incubation were analysed by 16S rRNA gene specific broad range PCR. The amplified DNA fragments were sequenced by Sanger DNA sequencing method and homology of the sequence were matched using NCBI BLAST (NCBI, USA) RESULTS: Of the 97 patients, 16S rRNA based broad range PCR assay could identify the presence of bacterial pathogen in 53(54.63%) cases, of which 29 isolates were supposed to be of viable but non-culturable bacteria (VBNC), 07 were of obligatory anaerobes and 13 were of unculturable bacteria, 04 were with poly bacterial infections. CONCLUSIONS Our study highlights the usefulness of PCR assay in detecting the presence of any VBNC, anaerobes and unculturable bacteria in SSI patients regardless of how well the bacteria may or may not grow in culture. Measures should be taken to use anaerobic culture system and PCR diagnosis along with conventional culture to detect the VBNC and unculturable bacteria where Gram stain is positive for better patient care.
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Affiliation(s)
- Himanshu Sekhar Behera
- ICMR-Regional Medical Research Centre, Bhubaneswar, 751023, Odisha, India. .,Department of Molecular Epidemiology, ICMR-Regional Medical Research Centre, Bhubaneswar, 751023, India.
| | - Nirupama Chayani
- Department of Microbiology, SCB Medical College and Hospital, Cuttack, 753003, India
| | - Madhusmita Bal
- Department of Parasite Immunology, ICMR-Regional Medical Research Centre, Bhubaneswar, 751023, India
| | - Hemant Kumar Khuntia
- Department of Molecular Epidemiology, ICMR-Regional Medical Research Centre, Bhubaneswar, 751023, India
| | - Sanghamitra Pati
- Department of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar, India
| | - Sashibhusan Das
- Department of Molecular Epidemiology, ICMR-Regional Medical Research Centre, Bhubaneswar, 751023, India
| | - Manoranjan Ranjit
- ICMR-Regional Medical Research Centre, Bhubaneswar, 751023, Odisha, India. .,Department of Molecular Epidemiology, ICMR-Regional Medical Research Centre, Bhubaneswar, 751023, India.
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Khan F, Chaudhary B, Sultan A, Ahmad M, Alvi Y, Shah MS, Khan HM. Qualitative Thematic Analysis of Knowledge and Practices of Surgical Antimicrobial Prophylaxis at a Tertiary Care Teaching Hospital. Surg Infect (Larchmt) 2020; 22:434-441. [PMID: 33944586 DOI: 10.1089/sur.2020.181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Surgical antimicrobial prophylaxis (SAP) refers to the utilization of antibiotic agents for the prevention of surgical site infections (SSI), to prevent SSI-associated morbidity and mortality, reduce duration and cost of healthcare, and cause minimal adverse drug effects. The adherence rate among surgeons for the available international and national guidelines and optimal practice remains considerably low in many hospitals, especially in developing countries. The objective of this study was to assess the knowledge and compliance rate for SAP guidelines among various surgical specialties and those involved in providing SAP. Methods: An institution-based exploratory, multi-specialty, collective, mixed method approach (qualitative and quantitative) was used to assess the knowledge and compliance rate for SAP guidelines among the consultants and residents of surgical specialties. Quantitative analysis was performed using a pre-tested questionnaire. For qualitative analysis, focus group discussions were conducted. Thematic analysis was conducted by the Theoretical Domains Framework (TDF) and the Capabilities, Opportunities, Motivation and Behaviour (COM-B) model. Results: Twenty-eight focus groups and 16 paired interviews were undertaken. On thematic analysis six significant themes were noted and mapped to the COM-B model, and subthemes mapped to the relevant TDF domains in a combined framework. Key themes recognized were: (1) solitary focus on surgical skills; (2) following the hierarchy is more important than guideline compliance; (3) doubts and overcautious attitude of surgeons hinders appropriate SAP prescribing; (4) non-availability in-hospital supply of antimicrobial agents; (5) patient characteristics and type of surgery play a role in prescribing SAP; and (6) lack of national and local guidelines. Conclusions: The knowledge and attitudes of surgeons toward appropriate SAP prescribing are crucial factors for execution of guidelines. Including them in policy making decisions can help in strong execution of the same.
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Affiliation(s)
- Fatima Khan
- Department of Microbiology, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh, India
| | - Bhanu Chaudhary
- 7th Semester, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh, India
| | - Asfia Sultan
- Department of Microbiology, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh, India
| | - Manzoor Ahmad
- Department of Surgery, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh, India
| | - Yasir Alvi
- Department of Community Medicine, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh, India
| | - Mohammad Salman Shah
- Department of Community Medicine, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh, India
| | - Haris M Khan
- Department of Microbiology, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh, India
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