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Bolten A, Kringos DS, Spijkerman IJB, Sperna Weiland NH. The carbon footprint of the operating room related to infection prevention measures: a scoping review. J Hosp Infect 2022; 128:64-73. [PMID: 35850380 DOI: 10.1016/j.jhin.2022.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Infection prevention measures are widely used in operating rooms (ORs). However, the extent to which they are at odds with ambitions to reduce the health sector's carbon footprint remains unclear. AIM To synthesize the evidence base for the carbon footprint of commonly used infection prevention measures in the OR, namely medical devices and instruments, surgical attire and air treatment systems. METHODS A scoping review of the international scientific literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The search was performed in PubMed and Google Scholar. Articles published between 2010 and June 2021 on infection prevention measures, their impact on the health sector's carbon footprint, and risk for surgical site infections (SSIs) were included. FINDINGS Although hospitals strive to reduce their carbon footprint, many infection prevention measures result in increased emissions. Evidence suggests that the use of disposable items instead of reusable items generally increases the carbon footprint, depending on sources of electricity. Controversy exists regarding the correlation between air treatment systems, contamination and the incidence of SSIs. The literature indicates that new air treatment systems consume more energy and do not necessarily reduce SSIs compared with conventional systems. CONCLUSION Infection prevention measures in ORs can be at odds with sustainability. The use of new air treatment systems and disposable items generally leads to significant greenhouse gas emissions, and does not necessarily reduce the incidence of SSIs. Alternative infection prevention measures with less environmental impact are available. Implementation could be facilitated by embracing environmental impact as an additional dimension of quality of care, which should change current risk-based approaches for the prevention of SSIs.
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Affiliation(s)
- A Bolten
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - D S Kringos
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - I J B Spijkerman
- Department of Microbiology and Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - N H Sperna Weiland
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands; Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Centre for Sustainable Healthcare, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
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2
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de Jonge SW, Boldingh QJJ, Koch AH, Daniels L, de Vries EN, Spijkerman IJB, Ankum WM, Kerkhoffs GMMJ, Dijkgraaf MG, Hollmann MW, Boermeester MA. Timing of Preoperative Antibiotic Prophylaxis and Surgical Site Infection: TAPAS, An Observational Cohort Study. Ann Surg 2021; 274:e308-e314. [PMID: 31663971 DOI: 10.1097/sla.0000000000003634] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To test the hypothesis that surgical site infection (SSI) risk differs, after administration of surgical antibiotic prophylaxis (SAP) within 60-30 or 30-0 minutes before incision. BACKGROUND The importance of appropriate timing of SAP before surgery has long been recognized. However, available evidence is contradictive on the best timing within a 60-0 minutes time interval before incision. Here, we aim to evaluate previous contradictions with a carefully designed observational cohort. METHODS An observational cohort study was conducted in a Dutch tertiary referral center. For 2 years, consecutive patients with SAP indication undergoing general, orthopedic, or gynecologic surgery were followed for the occurrence of superficial and deep SSI as defined by the Center of Disease Control and Prevention. The association between timing of SAP and SSI was assessed using multivariable logistic regression. RESULTS After 3001 surgical procedures, 161 SSIs were detected. In 87% of the procedures, SAP was administered within 60 minutes before incision. Only antibiotics with short infusion time were used. Multivariable logistic regression indicated there was no conclusive evidence of a difference in SSI risk after SAP administration 60-30 minutes or 30-0 minutes before incision [odds ratio: 0.82; 95% confidence interval (0.57-1.19)]. CONCLUSIONS For SAP with short infusion time no clear superior timing interval within the 60-minute interval before incision could be identified in this cohort. We were unable to reproduce differences in SSI risk found in earlier studies.
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Affiliation(s)
- Stijn W de Jonge
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Quirine J J Boldingh
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Anna H Koch
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Gynaecology, Tergooi Hospital, Location Blaricum, Blaricum, the Netherlands
| | - Lidewine Daniels
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Surgery, Westfriesgasthuis, Hoorn, the Netherlands
| | - Eefje N de Vries
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Surgery, Tergooi Hospital, Hilversum, the Netherlands
| | - Ingrid J B Spijkerman
- Department of Medical Microbiology, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Wim M Ankum
- Department of Gynecologic Surgery, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marcel G Dijkgraaf
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Markus W Hollmann
- Department of Anesthesiology, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
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Koopsen J, Dekker M, Thung P, Jonges M, Vennema H, Leenstra T, Eggink D, Welkers MRA, Struijs PAA, Reusken C, van Mansfeld R, de Jong MD, Schinkel J, Spijkerman IJB. Rapid reinfection with SARS-CoV-2 variant-of-concern Alpha detected in a nurse during an outbreak at a non-covid inpatient ward: lessons learned. Antimicrob Resist Infect Control 2021; 10:137. [PMID: 34565476 PMCID: PMC8474951 DOI: 10.1186/s13756-021-01008-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/07/2021] [Indexed: 11/10/2022] Open
Abstract
We describe the lessons learned during a SARS-CoV-2 variant-of-concern Alpha outbreak investigation at a normal care unit in a university hospital in Amsterdam in December 2020. The outbreak consisted of nine nurses and two roomed-in patient family members. (attack rate 18%). One nurse tested positive with a phylogenetically distinct variant, after a documented infection 83 days prior. Three key points were taken from this investigation. First, it was controlled by adherence to existing guidelines, despite increased transmissibility of the variant. Second, viral sequencing can inform transmission cluster inference, but the epidemiological context is essential to draw appropriate conclusions. Third, reinfections with Alpha variants can occur rapidly after primary infection.
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Affiliation(s)
- Jelle Koopsen
- Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mireille Dekker
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands.
| | - Philip Thung
- Department of Occupational Health and Safety, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marcel Jonges
- Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Harry Vennema
- Centre for Infectious Disease Control, WHO COVID-19 Reference Laboratory, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Tjalling Leenstra
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Dirk Eggink
- Centre for Infectious Disease Control, WHO COVID-19 Reference Laboratory, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Matthijs R A Welkers
- Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter A A Struijs
- Department of Orthopedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Chantal Reusken
- Centre for Infectious Disease Control, WHO COVID-19 Reference Laboratory, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Rosa van Mansfeld
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
| | - Menno D de Jong
- Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Janke Schinkel
- Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ingrid J B Spijkerman
- Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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van Someren Gréve F, Spijkerman IJB, Slot KM, Schultsz C, Vandertop WP. Letter: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Treatment of Pediatric Hydrocephalus: Update of the 2014 Guidelines. Neurosurgery 2021; 88:E575-E576. [PMID: 33693854 DOI: 10.1093/neuros/nyab074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 01/24/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Frank van Someren Gréve
- Department of Medical Microbiology Amsterdam University Medical Center Amsterdam, the Netherlands
| | - Ingrid J B Spijkerman
- Department of Medical Microbiology Amsterdam University Medical Center Amsterdam, the Netherlands
| | - K Mariam Slot
- Department of Neurosurgery Amsterdam University Medical Center Amsterdam, the Netherlands
| | - Constance Schultsz
- Department of Medical Microbiology Amsterdam University Medical Center Amsterdam, the Netherlands.,Department of Global Health Amsterdam Institute for Global Health and Development Amsterdam University Medical Center Amsterdam, the Netherlands
| | - W Peter Vandertop
- Department of Neurosurgery Amsterdam University Medical Center Amsterdam, the Netherlands
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Sanders FRK, Penning D, Backes M, Dingemans SA, van Dieren S, Eskes AM, Goslings JC, Kloen P, Mathôt RAA, Schep NWL, Spijkerman IJB, Schepers T. Wound infection following implant removal of foot, ankle, lower leg or patella; a protocol for a multicenter randomized controlled trial investigating the (cost-)effectiveness of 2 g of prophylactic cefazolin compared to placebo (WIFI-2 trial). BMC Surg 2021; 21:69. [PMID: 33522909 PMCID: PMC7849087 DOI: 10.1186/s12893-020-01024-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background Elective implant removal (IR) after fracture fixation is one of the most common procedures within (orthopedic) trauma surgery. The rate of surgical site infections (SSIs) in this procedure is quite high, especially below the level of the knee. Antibiotic prophylaxis is not routinely prescribed, even though it has proved to lower SSI rates in other (orthopedic) trauma surgical procedures. The primary objective is to study the effectiveness of a single intravenous dose of 2 g of cefazolin on SSIs after IR following fixation of foot, ankle and/or lower leg fractures. Methods This is a multicenter, double-blind placebo controlled trial with a superiority design, including adult patients undergoing elective implant removal after fixation of a fracture of foot, ankle, lower leg or patella. Exclusion criteria are: an active infection, current antibiotic treatment, or a medical condition contraindicating prophylaxis with cefazolin including allergy. Patients are randomized to receive a single preoperative intravenous dose of either 2 g of cefazolin or a placebo (NaCl). The primary analysis will be an intention-to-treat comparison of the proportion of patients with a SSI at 90 days after IR in both groups. Discussion If 2 g of prophylactic cefazolin proves to be both effective and cost-effective in preventing SSI, this would have implications for current guidelines. Combined with the high infection rate of IR which previous studies have shown, it would be sufficiently substantiated for guidelines to suggest protocolled use of prophylactic antibiotics in IR of foot, ankle, lower leg or patella. Trial registration Nederlands Trial Register (NTR): NL8284, registered on 9th of January 2020, https://www.trialregister.nl/trial/8284
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Affiliation(s)
- Fay R K Sanders
- Trauma Surgery, Amsterdam UMC, Loc. AMC, G4-137, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Diederick Penning
- Trauma Surgery, Amsterdam UMC, Loc. AMC, G4-137, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Manouk Backes
- Trauma Surgery, Amsterdam UMC, Loc. AMC, G4-137, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Siem A Dingemans
- Trauma Surgery, Amsterdam UMC, Loc. AMC, G4-137, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Susan van Dieren
- Trauma Surgery, Amsterdam UMC, Loc. AMC, G4-137, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Anne M Eskes
- Trauma Surgery, Amsterdam UMC, Loc. AMC, G4-137, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - J Carel Goslings
- Trauma Surgery, OLVG, Loc. West, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - Peter Kloen
- Orthopedic Surgery, Amsterdam UMC, Loc. AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Ron A A Mathôt
- Hospital Pharmacy, Amsterdam UMC, Loc. AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Niels W L Schep
- Trauma Surgery, Maasstad Ziekenhuis, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
| | - Ingrid J B Spijkerman
- Medical Microbiology, Amsterdam UMC, Loc. AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Tim Schepers
- Trauma Surgery, Amsterdam UMC, Loc. AMC, G4-137, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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6
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Sperna Weiland NH, Traversari RAAL, Sinnige JS, van Someren Gréve F, Timmermans A, Spijkerman IJB, Ganzevoort W, Hollmann MW. Influence of room ventilation settings on aerosol clearance and distribution. Br J Anaesth 2021; 126:e49-e52. [PMID: 33190858 PMCID: PMC7584416 DOI: 10.1016/j.bja.2020.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 10/18/2020] [Accepted: 10/19/2020] [Indexed: 12/22/2022] Open
Affiliation(s)
| | | | - Jante S Sinnige
- Department of Anaesthesiology, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Anne Timmermans
- Department of Gynaecology, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Wessel Ganzevoort
- Department of Gynaecology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Markus W Hollmann
- Department of Anaesthesiology, Amsterdam UMC, Amsterdam, The Netherlands
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7
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Laan BJ, Maaskant JM, Spijkerman IJB, Borgert MJ, Godfried MH, Pasmooij BC, Opmeer BC, Vos MC, Geerlings SE. De-implementation strategy to reduce inappropriate use of intravenous and urinary catheters (RICAT): a multicentre, prospective, interrupted time-series and before and after study. Lancet Infect Dis 2020; 20:864-872. [PMID: 32151333 DOI: 10.1016/s1473-3099(19)30709-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/29/2019] [Accepted: 11/27/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Catheter-associated bloodstream infections and urinary tract infections are frequently encountered health care-associated infections. We aimed to reduce inappropriate use of catheters to reduce health care-associated infections. METHODS In this multicentre, interrupted time-series and before and after study, we introduced a de-implementation strategy with multifaceted interventions in seven hospitals in the Netherlands. Adult patients admitted to internal medicine, gastroenterology, geriatic, oncology, or pulmonology wards, and non-surgical acute admission units, and who had a (central or peripheral) venous or urinary catheter were eligible for inclusion. One of the interventions was that nurses in the participating wards attended educational meetings on appropriate catheter use. Data on catheter use were collected every 2 weeks by the primary research physician during the baseline period (7 months) and intervention period (7 months), which were separated by a 5 month transition period. The primary outcomes were percentages of short peripheral intravenous catheters and urinary catheters used inappropriately on the days of data collection. Indications for catheter use were based on international guidelines. This study is registered with Netherlands Trial Register, NL5438. FINDINGS Between Sept 1, 2016, and April 1, 2018, we screened 6157 patients for inclusion, of whom 5696 were enrolled: 2650 patients in the baseline group, and 3046 in the intervention group. Inappropriate use of peripheral intravenous catheters occurred in 366 (22·0%, 95% CI 20·0 to 24·0) of 1665 patients in the baseline group and in 275 (14·4%, 12·8 to 16·0) of 1912 patients in the intervention group (incidence rate ratio [IRR] 0·65, 95% CI 0·56 to 0·77, p<0·0001). Time-series analyses showed an absolute reduction in inappropriate use of peripheral intravenous catheters from baseline to intervention periods of 6·65% (95% CI 2·47 to 10·82, p=0·011). Inappropriate use of urinary catheters occurred in 105 (32·4%, 95% CI 27·3 to 37·8) of 324 patients in the baseline group compared with 96 (24·1%, 20·0 to 28·6) of 398 patients in the intervention group (IRR 0·74, 95% CI 0·56 to 0·98, p=0·013). Time-series analyses showed an absolute reduction in inappropriate use of urinary catheters of 6·34% (95% CI -12·46 to 25·13, p=0·524). INTERPRETATION Our de-implementation strategy reduced inappropriate use of short peripheral intravenous catheters in patients who were not in the intensive care unit. The reduction of inappropriate use of urinary catheters was substantial, yet not statistically significant in time-series analysis due to a small sample size. The strategy appears well suited for broad-scale implementation to reduce health care-associated infections. FUNDING Netherlands Organisation for Health Research and Development.
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Affiliation(s)
- Bart J Laan
- Infectious Diseases, Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
| | - Jolanda M Maaskant
- Clinical Epidemiology, Biostatistics, and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ingrid J B Spijkerman
- Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Marjon J Borgert
- Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Mieke H Godfried
- Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Berend C Pasmooij
- Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Brent C Opmeer
- Clinical Research Unit, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Margreet C Vos
- Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Suzanne E Geerlings
- Infectious Diseases, Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Govaert GAM, Termaat MF, Glaudemans AWJM, Geurts JAP, de Jong T, de Jong VM, Joosse P, Kooijmans H, Overbosch J, Scheper H, Spijkerman IJB. [Diagnosis and treatment of fracture-related infections]. Ned Tijdschr Geneeskd 2019; 163:D3178. [PMID: 31050271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Fracture-related infection (FRI) is a serious complication after fracture care and can lead to severe morbidity with loss of quality of life, a significant increase in medical expenses and loss of participation in work and social life. Early recognition, adequate surgical debridement, deep uncontaminated tissue cultures with (if indicated) soft tissue reconstruction and fracture stabilization followed by antibiotic therapy are the cornerstones of the successful management of FRI. Recently, in 2018, the AO/EBJIS consensus definition for FRI was published and both national and international working groups are being assembled and provide guidelines and tools for the care of patients with FRI. This paper is a synopsis of the Dutch guideline on FRI (2018), illustrated by a clinical case, and is aiming to provide an overview of the current knowledge on diagnosis and treatment of this disease.
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Affiliation(s)
| | | | - A W J M Glaudemans
- Universitair Medisch Centrum Groningen, Rijksuniversiteit Groningen, Medical Imaging Center, afd. Nucleaire en Moleculaire Beeldvorming
| | - J A P Geurts
- Maastricht Universitair Medisch Centrum, afd. Orthopedie
| | - T de Jong
- Erasmus Medisch Centrum, afd. Plastische en Reconstructieve Chirurgie, Rotterdam
| | - V M de Jong
- Amsterdam Universitaire Medische Centra, locatie AMC, Trauma Unit
| | - P Joosse
- Noordwest Ziekenhuisgroep, afd. Chirurgie, Noordwest Ziekenhuisgroep, Alkmaar en Rode Kruis Ziekenhuis, afd. Chirurgie, Beverwijk
| | - H Kooijmans
- Kennisinstituut Federatie Medisch Specialisten, Utrecht
| | - J Overbosch
- Universitair Medisch Centrum Groningen, Rijksuniversiteit Groningen, afd. Radiologie
| | - H Scheper
- Afdeling Infectieziekten Leids Universitair Medisch Centrum, Leiden
| | - I J B Spijkerman
- Amsterdam Universitaire Medische Centra, locatie AMC, afd. Medische Microbiologie
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Laan BJ, Spijkerman IJB, Godfried MH, Pasmooij BC, Borgert MJ, Maaskant JM, Opmeer BC, Vos MC, Geerlings SE. 1530. De-implementation Strategy to Reduce the Inappropriate Use of Urinary and Intravenous CATheters: the RICAT Study. Open Forum Infect Dis 2018. [PMCID: PMC6253397 DOI: 10.1093/ofid/ofy210.1359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Catheter-associated urinary tract infection (UTI) and catheter-associated bloodstream infection (BSI) are common healthcare-associated infections (HAI). Therefore, catheters should only be used if indicated. However, based on the literature up to 65% of the urinary catheters and 56% of the peripheral intravenous catheters have an inappropriate indication. So, an efficient way to reduce HAIs is to avoid unnecessary use of catheters. Our quality improvement project aims to reduce unnecessary use of catheters. Methods In a multicenter, interrupted time series study, several interventions to avoid inappropriate use of catheters were carried out in internal medicine and nonsurgical subspecialty wards in seven hospitals in the Netherlands. The indications for catheter use were based on (inter)national guidelines. The primary endpoint is the percentage of inappropriate indications on the day of data collection. Secondary endpoints are catheter-associated infections, length of hospital stay and mortality. Data were collected once per 2 weeks during baseline (7 months) and post-intervention (7 months). Preliminary analyses compared incidence rates before and after the intervention. Results Data were obtained from 5,691 observed patients. The rate of inappropriate use of urinary catheters decreased from 32.1 to 23.7% (incidence rate ratio 0.74, 95% CI 0.58–0.94, P = 0.013), and inappropriate use of peripheral intravenous catheters decreased from 22.0 to 15.2% (incidence rate ratio 0.69, 95% CI 0.60–0.80, P < 0.001). The overall urinary and intravenous catheter use was stable, resp. 12.2% (n = 324) to 12.5% (n = 380) and 62.8% (n = 1,665) to 62.1% (n = 1,887). Most inappropriate indications were due to prolonged catheter use. The indications which expire frequently are”Accurate measurements of urinary output in critically ill patients’ for urinary and”IV fluids and antibiotic therapy’ for intravenous catheters. Subsequent analyses will take into account the interrupted time series design, and evaluate catheter-associated UTI and BSI rates. ![]()
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Conclusion Our de-implementation strategy reduces unnecessary use of urinary and intravenous catheters in non-ICUs. It is important to increase awareness for inappropriate use of catheters. Disclosures S. E. Geerlings, Nordic Pharma: Consultant and Fosfomycin iv, consulting fee.
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Affiliation(s)
- Bart J Laan
- Department of Infectious Diseases, Academic Medical Centre, Amsterdam, Netherlands
| | | | | | | | | | | | - Brent C Opmeer
- Clinical Research Unit, Academic Medical Centre of the University of Amsterdam, Amsterdam, Netherlands
| | - Margreet C Vos
- Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Suzanne E Geerlings
- Department of Infectious Diseases, Academic Medical Centre, Amsterdam, Netherlands
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10
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Backes M, Dingemans SA, Dijkgraaf MGW, van den Berg HR, van Dijkman B, Hoogendoorn JM, Joosse P, Ritchie ED, Roerdink WH, Schots JPM, Sosef NL, Spijkerman IJB, Twigt BA, van der Veen AH, van Veen RN, Vermeulen J, Vos DI, Winkelhagen J, Goslings JC, Schepers T. Effect of Antibiotic Prophylaxis on Surgical Site Infections Following Removal of Orthopedic Implants Used for Treatment of Foot, Ankle, and Lower Leg Fractures: A Randomized Clinical Trial. JAMA 2017; 318:2438-2445. [PMID: 29279933 PMCID: PMC5820713 DOI: 10.1001/jama.2017.19343] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
IMPORTANCE Following clean (class I, not contaminated) surgical procedures, the rate of surgical site infection (SSI) should be less than approximately 2%. However, an infection rate of 12.2% has been reported following removal of orthopedic implants used for treatment of fractures below the knee. OBJECTIVE To evaluate the effect of a single dose of preoperative antibiotic prophylaxis on the incidence of SSIs following removal of orthopedic implants used for treatment of fractures below the knee. DESIGN, SETTING, AND PARTICIPANTS Multicenter, double-blind, randomized clinical trial including 500 patients aged 18 to 75 years with previous surgical treatment for fractures below the knee who were undergoing removal of orthopedic implants from 19 hospitals (17 teaching and 2 academic) in the Netherlands (November 2014-September 2016), with a follow-up of 6 months (final follow-up, March 28, 2017). Exclusion criteria were an active infection or fistula, antibiotic treatment, reimplantation of osteosynthesis material in the same session, allergy for cephalosporins, known kidney disease, immunosuppressant use, or pregnancy. INTERVENTIONS A single preoperative intravenous dose of 1000 mg of cefazolin (cefazolin group, n = 228) or sodium chloride (0.9%; saline group, n = 242). MAIN OUTCOMES AND MEASURES Primary outcome was SSI within 30 days as measured by the criteria from the US Centers for Disease Control and Prevention. Secondary outcome measures were functional outcome, health-related quality of life, and patient satisfaction. RESULTS Among 477 randomized patients (mean age, 44 years [SD, 15]; women, 274 [57%]; median time from orthopedic implant placement, 11 months [interquartile range, 7-16]), 470 patients completed the study. Sixty-six patients developed an SSI (14.0%): 30 patients (13.2%) in the cefazolin group vs 36 in the saline group (14.9%) (absolute risk difference, -1.7 [95% CI, -8.0 to 4.6], P = .60). CONCLUSIONS AND RELEVANCE Among patients undergoing surgery for removal of orthopedic implants used for treatment of fractures below the knee, a single preoperative dose of intravenous cefazolin compared with saline did not reduce the risk of surgical site infection within 30 days following implant removal. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02225821.
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Affiliation(s)
- Manouk Backes
- Trauma Unit, Department of Surgery, Academic Medical Center Amsterdam, the Netherlands
| | - Siem A. Dingemans
- Trauma Unit, Department of Surgery, Academic Medical Center Amsterdam, the Netherlands
| | | | | | | | | | - Pieter Joosse
- Department of Surgery, Medical Center Alkmaar Alkmaar, the Netherlands
| | - Ewan D. Ritchie
- Department of Surgery, Alrijne Hospital Leiderdorp, the Netherlands
| | | | | | - Nico L. Sosef
- Department of Surgery, Spaarne Gasthuis Hoofddorp, the Netherlands
| | | | - Bas A. Twigt
- Department of Surgery, BovenIJ Hospital Amsterdam, the Netherlands
| | | | - Ruben N. van Veen
- Department of Surgery, Onze Lieve Vrouwe Gasthuis West Amsterdam, the Netherlands
| | - Jefrey Vermeulen
- Department of Surgery, Spaarne Gasthuis Haarlem, the Netherlands
| | - Dagmar I. Vos
- Department of Surgery, Amphia Hospital Breda, the Netherlands
| | | | - J. Carel Goslings
- Trauma Unit, Department of Surgery, Academic Medical Center Amsterdam, the Netherlands
| | - Tim Schepers
- Trauma Unit, Department of Surgery, Academic Medical Center Amsterdam, the Netherlands
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Laan BJ, Spijkerman IJB, Godfried MH, Pasmooij BC, Maaskant JM, Borgert MJ, Opmeer BC, Vos MC, Geerlings SE. De-implementation strategy to Reduce the Inappropriate use of urinary and intravenous CATheters: study protocol for the RICAT-study. BMC Infect Dis 2017; 17:53. [PMID: 28068924 PMCID: PMC5223587 DOI: 10.1186/s12879-016-2154-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 12/22/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Urinary and (peripheral and central) intravenous catheters are widely used in hospitalized patients. However, up to 56% of the catheters do not have an appropriate indication and some serious complications with the use of these catheters can occur. The main objective of our quality improvement project is to reduce the use of catheters without an appropriate indication by 25-50%, and to evaluate the affecting factors of our de-implementation strategy. METHODS In a multicenter, prospective interrupted time series analysis, several interventions to avoid inappropriate use of catheters will be conducted in seven hospitals in the Netherlands. Firstly, we will define a list of appropriate indications for urinary and (peripheral and central) intravenous catheters, which will restrict the use of catheters and urge catheter removal when the indication is no longer appropriate. Secondly, after the baseline measurements, the intervention will take place, which consists of a kick-off meeting, including a competitive feedback report of the baseline measurements, and education of healthcare workers and patients. Additional strategies based on the baseline data and local conditions are optional. The primary endpoint is the percentage of catheters with an inappropriate indication on the day of data collection before and after the de-implementation strategy. Secondary endpoints are catheter-related infections or other complications, catheter re-insertion rate, length of hospital (and ICU) stay and mortality. In addition, the cost-effectiveness of the de-implementation strategy will be calculated. DISCUSSION This study aims to reduce the use of urinary and intravenous catheters with an inappropriate indication, and as a result reduce the catheter-related complications. If (cost-) effective it provides a tool for a nationwide approach to reduce catheter-related infections and other complications. TRIAL REGISTRATION Dutch trial registry: NTR6015 . Registered 9 August 2016.
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Affiliation(s)
- Bart J Laan
- Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Ingrid J B Spijkerman
- Department of Medical Microbiology, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Mieke H Godfried
- Department of Internal Medicine, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Berend C Pasmooij
- Department of Internal Medicine, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jolanda M Maaskant
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Medical Faculty, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Marjon J Borgert
- Department of Internal Medicine, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Brent C Opmeer
- Clinical Research Unit, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Suzanne E Geerlings
- Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Ammerlaan HSM, Kluytmans JAJW, Berkhout H, Buiting A, de Brauwer EIGB, van den Broek PJ, van Gelderen P, Leenders S(ACAP, Ott A, Richter C, Spanjaard L, Spijkerman IJB, van Tiel FH, Voorn GP, Wulf MWH, van Zeijl J, Troelstra A, Bonten MJM, van de Berg CMF, Bosman J, Bremer A, Bril W, Commeren D, van Essen G, Gigengack-Baars A, van Kasteren MME, Lommerse EJM, Mascini E, Renders NHM, van Rijen M, Schellekens J, Smeets E, Sprangers T, Vandenbroucke-Grauls CMJE, Verbon A, Verduin K, Wagenvoort JHT, van Wijngaarden P. Eradication of carriage with methicillin-resistant Staphylococcus aureus: effectiveness of a national guideline. J Antimicrob Chemother 2011; 66:2409-17. [DOI: 10.1093/jac/dkr243] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Heidi S. M. Ammerlaan
- Department of Medical Microbiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Jan A. J. W. Kluytmans
- Department of Medical Microbiology and Infection Control, VUmc Medical University, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Laboratory for Microbiology and Infection Control, Amphia Hospital Breda, Molengracht 21, 4818 CK Breda, The Netherlands
| | - Hanneke Berkhout
- Department of Medical Microbiology, Immunology and Hygiene and Infection Prevention, VieCuri Medical Centre, Tegelseweg 210, 5912 BL Venlo, The Netherlands
| | - Anton Buiting
- Department of Medical Microbiology, St Elisabeth Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands
| | - Els I. G. B. de Brauwer
- Department of Medical Microbiology, Atrium Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands
| | - Peterhans J. van den Broek
- Department of Infectious Diseases, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Paula van Gelderen
- Department of Medical Microbiology and Infection Control, VUmc Medical University, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | | | - Alewijn Ott
- Laboratory for Infectious Diseases, Van Ketwich Verschuurlaan 92, 9721 SW Groningen, The Netherlands
| | - Clemens Richter
- Department of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands
| | - Lodewijk Spanjaard
- Department of Medical Microbiology and Centre for Infection and Immunity Amsterdam, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Ingrid J. B. Spijkerman
- Department of Medical Microbiology and Infection Control, VUmc Medical University, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Frank H. van Tiel
- Department of Medical Microbiology, Academic Hospital Maastricht, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - G. Paul Voorn
- Department of Medical Microbiology and Immunology, St Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
| | - Mireille W. H. Wulf
- PAMM Laboratory for Medical Microbiology, De Run 6250, 5504 DL Veldhoven, The Netherlands
| | - Jan van Zeijl
- Izore, Centre Infectious Diseases Friesland, Jelsumerstraat 6, 8917 EN Leeuwarden, The Netherlands
| | - Annet Troelstra
- Department of Medical Microbiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Marc J. M. Bonten
- Department of Medical Microbiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- Julius Centre for Healthcare Science and First line Medicine, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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13
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Ammerlaan HSM, Kluytmans JAJW, Berkhout H, Buiting A, de Brauwer EIGB, van den Broek PJ, van Gelderen P, Leenders S(ACAP, Ott A, Richter C, Spanjaard L, Spijkerman IJB, van Tiel FH, Voorn GP, Wulf MWH, van Zeijl J, Troelstra A, Bonten MJM, van de Berg CMF, Bosman J, Bremer A, Bril W, Commeren D, van Essen G, Gigengack-Baars A, van Kasteren MME, Lommerse EJM, Mascini E, Renders NHM, van Rijen M, Schellekens J, Smeets E, Sprangers T, Vandenbroucke-Grauls CMJE, Verbon A, Verduin K, Wagenvoort JHT, van Wijngaarden P. Eradication of carriage with methicillin-resistant Staphylococcus aureus: determinants of treatment failure. J Antimicrob Chemother 2011; 66:2418-24. [DOI: 10.1093/jac/dkr250] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Heidi S. M. Ammerlaan
- Department of Medical Microbiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Jan A. J. W. Kluytmans
- Department of Medical Microbiology and Infection Control, VUmc Medical University, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Laboratory for Microbiology and Infection Control, Amphia Hospital Breda, Molengracht 21, 4818 CK Breda, The Netherlands
| | - Hanneke Berkhout
- Department of Medical Microbiology, Immunology and Hygiene and Infection Prevention, VieCuri Medical Centre, Tegelseweg 210, 5912 BL Venlo, The Netherlands
| | - Anton Buiting
- Department of Medical Microbiology, St Elisabeth Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands
| | - Els I. G. B. de Brauwer
- Department of Medical Microbiology, Atrium Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands
| | - Peterhans J. van den Broek
- Department of Infectious Diseases, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Paula van Gelderen
- Department of Medical Microbiology and Infection Control, VUmc Medical University, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | | | - Alewijn Ott
- Laboratory for Infectious Diseases, Van Ketwich Verschuurlaan 92, 9721 SW Groningen, The Netherlands
| | - Clemens Richter
- Department of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands
| | - Lodewijk Spanjaard
- Department of Medical Microbiology and Centre for Infection and Immunity Amsterdam, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Ingrid J. B. Spijkerman
- Department of Medical Microbiology and Infection Control, VUmc Medical University, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Frank H. van Tiel
- Department of Medical Microbiology, Academic Hospital Maastricht, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - G. Paul Voorn
- Department of Medical Microbiology and Immunology, St Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
| | - Mireille W. H. Wulf
- PAMM Laboratory for Medical Microbiology, De Run 6250, 5504 DL Veldhoven, The Netherlands
| | - Jan van Zeijl
- Izore, Centre Infectious Diseases Friesland, Jelsumerstraat 6, 8917 EN Leeuwarden, The Netherlands
| | - Annet Troelstra
- Department of Medical Microbiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Marc J. M. Bonten
- Department of Medical Microbiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- Julius Centre for Healthcare science and First line Medicine, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Vaessen N, Verweij JJ, Spijkerman IJB, van Hoek B, van Lieshout L. Fatal disseminated toxoplasmosis after liver transplantation: improved and early diagnosis by PCR. Neth J Med 2007; 65:222-3. [PMID: 17587652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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Spijkerman IJB, van Doorn LJ, Janssen MHW, Wijkmans CJ, Bilkert-Mooiman MAJ, Coutinho RA, Weers-Pothoff G. Hepatitis B virus transmission from a surgeon to patients during high-risk as well as low-risk procedures: unnoticed transmissions over a 4-year period. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.2000.01544-41.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Background
Three cases of reported acute hepatitis B virus (HBV) led to the identification of a chronically HBV-infected surgeon, with a high viral load, who was a non-responder after vaccination.
Methods
A retrospective cohort study was conducted on 1564 patients operated on by this surgeon over a 4-year period.
Results
Forty-nine patients (3·1 per cent) were positive for HBV markers. Based on HBV DNA sequencing and epidemiological data, transmission from the surgeon was confirmed in eight, probable in two, possible in 18 and excluded in 21 patients. One case of secondary transmission was identified from a patient to his wife, who died, presumably from fulminant hepatitis. A case–control study identified the duration of operation, the potential risk of the surgical procedure and the occurrence of complications during or after surgery as significant risk factors for HBV infection. At least eight of the 28 patients were infected during low-risk procedures.
Conclusion
Transmission from surgeons to patients at a low rate can remain unnoticed for a long period of time. Prevention requires a more stringent strategy for vaccination and testing of surgeons. It also requires revision of policies allowing HBV-infected surgeons to perform presumed ‘low-risk’ procedures.
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Affiliation(s)
- I J B Spijkerman
- Division of Public Health and Environment, Amsterdam, The Netherlands
| | | | - M H W Janssen
- Laboratory of Medical Microbiology, Bosch Medicentrum, Den Bosch, The Netherlands
| | | | | | - R A Coutinho
- Division of Public Health and Environment, Amsterdam, The Netherlands
| | - G Weers-Pothoff
- Laboratory of Medical Microbiology, Bosch Medicentrum, Den Bosch, The Netherlands
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Spijkerman IJB, van Doorn LJ, Janssen MHW, Wijkmans CJ, Bilkert-Mooiman MAJ, Coutinho RA, Weers-Pothoff G. Transmission of hepatitis B virus from a surgeon to his patients during high-risk and low-risk surgical procedures during 4 years. Infect Control Hosp Epidemiol 2002; 23:306-12. [PMID: 12083233 DOI: 10.1086/502056] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE We investigated cases of acute hepatitis B in The Netherlands that were linked to the same general surgeon who was infected with hepatitis B virus (HBV). DESIGN A retrospective cohort study was conducted of 1,564 patients operated on by the surgeon. Patients were tested for serologic HBV markers. A case-control study was performed to identify risk factors. RESULTS The surgeon tested positive for hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) with a high viral load. He was a known nonresponder after HBV vaccination and had apparently been infected for more than 10 years. Forty-nine patients (3.1%) were positive for HBV markers. Transmission of HBV from the surgeon was confirmed in 8 patients, probable in 2, and possible in 18. In the remaining 21 patients, the surgeon was not implicated. Two patients had a chronic HBV infection. One case of secondary transmission from a patient to his wife was identified. HBV DNA sequences from the surgeon were completely identical to sequences from 7 of the 28 patients and from the case of secondary transmission. The duration of the operation and the occurrence of complications during or after surgery were identified as independent risk factors. Although the risk of HBV infection during high-risk procedures was 7 times higher than that during low-risk procedures, at least 8 (28.6%) of the 28 patients were infected during low-risk procedures. CONCLUSIONS Transmission of HBV from surgeons to patients at a low rate can remain unnoticed for a long period of time. Prevention requires a more stringent strategy for vaccination and testing of surgeons and optimization of infectious disease surveillance. Policies allowing HBV-infected surgeons to perform presumably low-risk procedures should be reconsidered.
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Affiliation(s)
- Ingrid J B Spijkerman
- Division of Public Health and Environment, Municipal Health Service, Amsterdam, The Netherlands
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