Impact of using triclosan-antibacterial sutures on incidence of surgical site infection

Background

Surgical site infection is a common complication of surgery. Its morbidities range from delayed healing to systemic sepsis. It has impact on the economy and health care resources.

Methods

This study was a prospective, randomized, double-blinded, controlled multicenter study aimed to compare triclosan-coated polyglactin 910 sutures with polyglactin 910 sutures for the reduction of surgical site infections. This article details the results from the Cairo University center. A total of 450 patients who had undergone different surgical procedures were enrolled; 230 were enrolled in the study group and 220 were enrolled in the control group.

Results

The study group and the control group were comparable regarding risk factors for surgical site infection. Surgical site infection incidence was 7% in the study group and 15% in the control group (P = .011). The mean extended stay as a result of infection was 3.71 days, with an average cost $91 US per day.

Conclusions

Use of the triclosan-coated polyglactin 910 antimicrobial suture lead to reduction of surgical site infection and has an impact on saving health care resources. The triclosan-coated polyglactin 910 antimicrobial suture could save $1,517,727 yearly in this single center.     

The impact of prophylactic intraoperative vancomycin powder on microbial profile,antibiotic regimen,length of stay,and reoperation rate in elective spine surgery

Background Context

There is growing concern that the microbial profile of surgical site infection (SSI) in the setting of prophylactic vancomycin powder may favor more resistant and uncommon organisms.

术前硬膜外激素注射是否增加腰椎术后手术部位感染风险的Meta分析

目的 :通过Meta分析明确术前腰椎硬膜外激素注射(lumbar epidural steroid injection,LESI)是否增加后续腰椎手术术后手术部位感染(surgical site infection,SSI)风险。方法:检索Pubmed、Embase、Cochran Trail数据库,检索时间均是从建库到2018年7月。筛选出比较腰椎术前行LESI及未行LESI患者术后90d内SSI发生率的对照研究,各研究的观察(暴露)组为接受LESI并后续相同节段行首次腰椎手术,对照(非暴露)组为未行LESI而于相同节段行首次腰椎手术。各组病例数均大于100,随访时间至少90d。评价指标为术后90d内SSI发生率。依据LESI注射距后续腰椎手术时间分亚组(1个月内,1～3个月,3～6个月,6～12个月),合并SSI比值比(OR)。使用Newcastle-Ottawa Quality Scale(NOS)评分评价纳入研究质量。分别行亚组分析探讨异质性,敏感性分析测定合并结果稳定性,Egger′s回归检测发表偏倚。结果:共5篇文献纳入研究,其中4篇为回顾性病例对照研究,1篇为回顾性队列研究,研究质量NOS评分均在6分以上。共纳入225801例患者,其中暴露组38452例,对照组187349例。经Meta分析,术前1个月内行LESI,暴露组与对照组术后90d内SSI发生率比较OR=2.15(95%CI,1.30～3.55),P0.05;术前1～3个月行LESI,暴露组与对照组术后90d内SSI发生率比较OR=1.54(95%CI,1.36～1.74),P0.05;术前3～6个月行LESI,暴露组与对照组术后90d内SSI发生率比较OR=1.09(95%CI,0.94～1.26),P0.05;术前6～12个月行LESI,暴露组与对照组术后90d内SSI发生率比较OR=1.30(95%CI,0.88～1.93),P0.05。Meta分析亚组分析证实基线资料不匹配为显著异质性来源,敏感性分析证实Meta分析结果稳定,发表偏倚检测提示未见发表偏倚。结论:术前3个月内行LESI显著增加后续腰椎手术术后90d内SSI风险。     

Implementation of a methicillin-resistant Staphylococcus aureus (MRSA) prevention bundle results in decreased MRSA surgical site infections

Background

Methicillin-resistant Staphylococcus aureus (MRSA) surgical site infections (SSIs) increase morbidity and mortality. We examined the impact of the MRSA bundle on SSIs.

Methods

Data regarding the implementation of the MRSA bundle from 2007 to 2008 were obtained, including admission and discharge MRSA screenings, overall MRSA infections, and cardiac and orthopedic SSIs. Chi-square was used for all comparisons.

Results

A significant decrease in MRSA transmission from a 5.8 to 3.0 per 1,000 bed-days (P < .05) was found after implementation of the MRSA bundle. Overall MRSA nosocomial infections decreased from 2.0 to 1.0 per 1,000 bed-days (P = .016). There was a statistically significant decrease in overall SSIs (P < .05), with a 65% decrease in orthopaedic MRSA SSIs and 1% decrease in cardiac MRSA SSIs.

Conclusion

Our data demonstrate that successful implementation of the MRSA bundle significantly decreases MRSA transmission between patients, the overall number of nosocomial MRSA infections, and MRSA SSIs.     

外周血淋巴细胞总数在颈椎术后感染早期诊断中的应用价值

目的 :探讨外周血中淋巴细胞总数在颈椎术后手术部位感染(surgical site infection,SSI)早期诊断中的应用价值。方法:回顾性分析复旦大学附属华山医院脊柱外科2001年1月~2015年10月收治的颈椎术后SSI患者18例(浅表切口感染7例,深部切口感染11例),以及性别、年龄、症状及手术方式相同的术后未感染患者47例。所有研究对象术前及术后3d检测并分析体温、外周血中白细胞总数、中性粒细胞总数、淋巴细胞总数、红细胞沉降率(erythrocyte sedimentation rate,ESR)及C-反应蛋白(C-reactive protein,CRP)等参数。绘制术后3d工作特征曲线(ROC曲线),并计算各项参数曲线下面积(AUC);同时,使用约登指数分析各项参数的最佳临界值。采用SPSS 12.0统计软件对测量数据进行统计分析。结果:术前,仅深部切口感染患者的淋巴细胞总数较非感染患者出现显著减少(P=0.01)。术后3d,浅表切口感染与深部切口感染患者的淋巴细胞总数均较术后未感染患者出现明显下降(P=0.02);除此之外,仅深部切口感染患者的CRP及ESR值较未感染患者出现异常升高(P=0.00)。根据术后3d的ROC曲线,仅淋巴细胞总数(P=0.00)与CRP(P=0.01)对颈椎术后SSI具有诊断价值。相较于CRP(0.71),淋巴细胞总数的AUC值(0.97)明显较大。同时,淋巴细胞总数的约登指数(0.944;临界值1.31×109/L)也明显大于CRP(0.424;临界值14.7mg/L)。结论 :颈椎术后围手术期淋巴细胞总数的异常减少与颈椎术后SSI的产生存在明显的相关性。术后早期,检测外周血中淋巴细胞总数有助于早期诊断颈椎术后SSI,为预防及尽早针对性应用抗生素治疗颈椎术后SSI提供可靠依据。     

稀碘伏溶液浸泡术野对降低术后脊柱手术切口感染风险的效果

目的 :评价在脊柱手术关闭切口前使用稀碘伏溶液浸泡术野对降低术后切口感染的效果。方法 :搜集从2010年1月~2014年12月由我院骨科同一术者实施手术的患者资料,排除其中椎体成形手术、原发感染手术、Halo头环固定术、椎间孔镜手术及内固定取出手术。共计纳入706例满足条件的脊柱手术患者作为观察对象。对照组为2010年1月~2012年12月进行的311例脊柱手术患者,在关闭切口前使用1000~1500ml生理盐水冲洗术野。观察组为2013年1月~2014年12月进行的395例脊柱手术患者,在关闭切口前使用1%的稀碘伏溶液浸泡术野2min后用生理盐水冲洗一遍。观察术后两组患者切口感染发生情况,并对两组变量和感染率进行统计学分析。结果:观察组和对照组患者在年龄、性别、BMI指数、贫血人数、低蛋白血症人数、糖尿病人数、手术入路、节段涉及、术中失血量、术中输血量等指标上没有统计学差异(P0.05)。对照组311例患者中9例(2.9%)发生了术后切口感染,2例(0.6%)为表浅切口感染,7例(2.3%)为深部切口感染;观察组395例患者中仅1例(0.2%)发生切口感染,为浅表切口感染。两组患者在总切口感染率(P=0.009)和深部切口感染率(P=0.009)上有统计学差异。单因素分析结果显示是否使用稀碘伏溶液浸泡是影响术后感染的重要因素。结论:在脊柱手术关闭切口前使用稀碘伏溶液浸泡术野是一种有效、简单、廉价、值得推荐的能降低术后切口感染风险的方法。但其更确切的效果以及最佳的标准化操作方法有待更大规模、证据等级更高的研究予以揭示。     

Challenges in reporting surgical site infections to the national surgical site infection surveillance and suggestions for improvement

IntroductionMandatory orthopaedic surgical site infection (SSI) data in England are used as a benchmark to compare infection rates between participating hospitals. According to the national guidelines, trusts are required to submit their data for at least one quarter of the year but they are free to report for all quarters. Owing to this ambiguity, there is a concern about robust reporting across trusts and therefore the accuracy of these data. There is also concern about the accuracy of collection methods. The aim of this five-year retrospective study was to assess the accuracy of SSI reporting at two hospitals in South East England under the same trust.MethodsA retrospective review was carried out of five years of electronic medical records, microbiology data and readmission data of all patients who underwent hip and knee replacement surgery at these hospitals. These data were validated with the data submitted to Public Health England (PHE) and any discrepancy between the two was noted.ResultsA significant difference was found in the SSI rates reported by the surveillance staff and our retrospective method.ConclusionsOur study confirms the findings of a national survey, which raised concerns about the quality of SSI reporting and the usefulness of PHE SSI data for benchmarking purposes. To our knowledge, there are no previously published studies that have looked at the accuracy of the English orthopaedic SSI surveillance. In the light of our findings, there is an urgent need for external validation studies to identify the extent of the problem in the surveillance scheme. The governing bodies should also issue clear guidelines for reporting SSIs to maintain homogeneity and to present the true incidence of SSI. We suggest some measures that we have instituted to address these inadequacies that have led to significant improvements in reporting at our trust.     

腰椎术后手术部位深部感染的诊断与治疗

目的 :探讨腰椎术后手术部位深部感染的诊断与治疗方法。方法 :回顾性分析2012年1月~2017年7月我院骨科收治的14例腰椎术后深部感染患者的临床资料、诊疗方法、随访结果。其中男性9例,女性5例,平均年龄53.0±13.1岁(19~73岁);早期感染(30d)13例,迟发感染(≥30d)1例;应用内固定物13例,未应用内固定物1例。患者出现感染征象后,立即留取标本送检并经验性静脉应用抗生素,随后根据细菌培养结果与病情变化调整抗生素种类,待主要炎症指标正常后改为口服抗生素。12例单纯抗生素治疗后病情未见改善者,予全麻下彻底清创;其中4例清创术后采用对口持续灌洗引流,另8例清创术后采用VSD负压引流,随访观察治疗效果。结果:本组共7例患者细菌培养结果阳性,其中单一细菌感染6例,混合感染1例。所有患者均应用抗生素治疗;静脉抗生素使用时间平均39.7±13.2d(24~77d),口服抗生素使用时间平均32.9±3.1d(28~38d)。13例内固定置入术后感染患者中11例内固定物得以保留,2例因多次清创无效后移除部分内固定物。14例患者均逐渐好转、最终治愈出院,平均住院时间51.4±13.1d。所有患者经平均32.4±18.6个月(4~67个月)随访,至末次随访时未见感染复发,且均主诉满意。结论:抗生素治疗、外科彻底清创是腰椎术后深部感染的有效治疗手段;对于有内固定物者,早期感染获得积极治疗后可保留内固定。     

Predictors of surgical site infection in dirty urological surgery

Objectives:   Risk factors for surgical site infection (SSI) following urologic dirty operations have not been clearly identified. This study was conducted to describe incidence, potential risk factors and common causative pathogens of the SSI in such operations.
Methods:   Medical records of patients who had undergone simple nephrectomy or lumbotomy for suppurative renal infection at our institutions from 1999 to 2006 were retrospectively evaluated. The following data were retrieved: presence of SSI, demographic data, laboratory findings, comorbidities, microbiological data, type of renal suppuration, type of urological surgery and antibiotic regimen. Risk factors for SSI were evaluated using the multiple logistic regression model.
Results:   Sixty-five patients (mean age 55.6 ± 13.1 years) were eligible for data analysis. In 20 of them (30.8%) a SSI was identified. The most common isolated pathogens were gram-negative bacteria. At univariate logistic regression analysis risk factors significantly associated with SSI included: presence of emphysematous infection, hypoalbuminemia, number of predisposing conditions, emergency operations, isolation of Enterobacteriaceae, positive pus culture. The use of trimethoprim/sulfamethoxazole was associated with a decreased risk for SSI. Multiple logistic model identified only the emergency operations and isolated Enterobacteriaceae as independent predictors of SSI (odds ratio [OR] = 11.1) (95% confidence interval [CI] = 3.0–40.8) and OR = 3.9 (1.0–14.8), respectively.
Conclusions:   Patients with suppurative renal infections are submitted to life-saving emergency surgery. Urological surgeons should keep in mind that this carries a high risk for subsequent SSI. Effective preventive measures in these circumstance cannot be identified. Further research in this area is necessary to clarify this issue.     

Predicting length of stay after shoulder arthroplasty

Background/HypothesisThe annual volume of shoulder arthroplasty (SA) in the United States has increased more than 400% from 1993 to 2008 and is projected to increase an additional 300% from 2008 to 2030. The purpose of this study was to develop and internally validate a preoperative predictive nomogram for length of stay (LOS) after SA. We hypothesized that patient-specific covariates are responsible for increased LOS after SA. If sufficiently accurate, such a nomogram would be valuable for defining which patients would qualify for outpatient SA.MethodsA systematic review of the literature was performed to identify patient variables responsible for increased LOS defined as ≥ 2 days. Patient data were collected from 234 consecutive SA cases performed between 2010 and 2016 at a single tertiary healthcare center by six orthopedic surgeons. The cohort was separated into two groups: short LOS (≤1 day; n = 98) and extended LOS (≥2 days; n = 136). Logistic regression coefficients were used to construct an LOS nomogram that was internally validated by the bootstrapping method. A receiver operating characteristic curve plot determined the discriminative ability of the nomogram. Generalizability was assessed using external validation with a new data set of 193 records prospectively collected from 2016 to 2018.ResultsUnivariate analysis demonstrated that female sex, cancer history, anticoagulation and oral hypoglycemic agents, undergoing humeral head replacement for fracture, and discharge to a facility were significant predictors for an LOS ≥2 days. The following patient covariates were found to be significant in the development of the nomogram: age, female sex, procedure type, disease-modifying antirheumatic drugs (DMARDs), renal dysfunction, and diabetes drugs. The prediction accuracy of this model was good (area under the curve of the receiver operating characteristic curve plot of 0.793). External validation of the model reported an area under the curve of 0.664.ConclusionPatients most suitable for expedited postoperative stay are healthy middle-aged males that are not on diabetic medications or DMARDs, have no renal disease, and undergo resurfacing, total SA, or reverse total SA. This nomogram may be an additional clinical decision-making tool for effectively preparing for postoperative care and decreasing LOS for an episode of care, subsequently reducing the total cost of care. Future work would focus on undertaking a prospective multicenter study involving institutions that perform a high annual volume of SAs.Level of evidenceLevel III; Retrospective Cohort Study     

Surgical attire,practices and their perception in the prevention of surgical site infection

IntroductionClean surgical scrubs, surgical gowns and headgear are worn by operative teams to decrease bacterial contamination and lower surgical site infection (SSI) rates.MethodsA detailed review was undertaken of peer-reviewed publications and other sources of material in the English language over the last 50 years included.ResultsSurgical scrubs should be clean and made of tightly woven material. Studies investigating single-use gowns and drapes versus reusable gowns report conflicting evidence. Double gloving may reduce SSI rates in procedures where no antibiotic prophylaxis was administered. Bacterial contamination of the operative field has been shown to be decreased by the wearing of surgical headgear by the operating team.ConclusionsFurther consideration and better trials are required to determine the impact of different theatre clothing on SSI rates.     

Pediatric burn-trauma patients have increased length of stay compared to trauma-only patients: A propensity matched analysis

BackgroundTrauma is the leading cause of mortality in children. Burn injury involves intensive resources, especially in pediatric patients. We hypothesized that among pediatric trauma patients, combined burn-trauma (BT) patients have increased length of stay (LOS) and mortality compared to trauma-only (T) patients.MethodsThe Pediatric Trauma Quality Improvement Program (2014–2016) was queried and BT patients were 1:2 propensity-score-matched to T patients based on age, gender, hypotension on admission, injury type and severity.Results93 BT patients were matched to 186 T patients. There were no differences in matched characteristics. BT patients had a longer median LOS (4 vs 2 days, p < 0.001) with no difference in mortality (1.1% vs 1.1%, p = 1.00), intensive care unit (ICU) LOS (3 vs 3 days, p = 0.55), or complications including decubitus ulcer (0% vs 1.1%, p = 0.32), deep vein thrombosis (0% vs 0.5%, p = 0.48), extremity compartment syndrome (1.1% vs 0%, p = 0.16), and urinary tract infection (1.1% vs 1.1%, p = 1.00).ConclusionPediatric BT patients had twice the LOS compared to a matched group of pediatric T patients. There was no difference between the cohorts in ICU LOS, complications or mortality rate. When evaluating risk-stratified quality metrics such as LOS, concomitant burn injury should be incorporated.     

Colon and rectal surgery surgical site infection reduction bundle: To improve is to change

Background

Despite the introduction of the Surgical Care Improvement Project, surgical site infections remain a source of morbidity. The aim of this study was to determine the value of implementing a colorectal bundle on SSI rates.

Post-discharge surgical site infection surveillance in a hospital in Brazil

The current study suggests the need for routine post-discharge surveillance to improve reliability on surgical site infection incidence rates. Surveillance only during hospitalization may not provide precise data on the incidence of surgical site infection, underestimating a true postoperative infection rate.     

Healthcare associated infection: novel strategies and antimicrobial implants to prevent surgical site infection

This report is based on a Hygienist Panel Meeting held at St Anne''s Manor, Wokingham on 24–25 June 2009. The panel agreed that greater use should be made of antiseptics to reduce reliance on antibiotics with their associated risk of antibiotic resistance. When choosing an antiseptic for clinical use, the Biocompatibility Index, which considers both the microbiocidal activity and any cytotoxic effects of an antiseptic agent, was considered to be a useful tool. The need for longer and more proactive post-discharge surveillance of surgical patients was also agreed to be a priority, especially given the current growth of day-case surgery. The introduction of surgical safety checklists, such as the World Health Organization''s Safe Surgery Saves Lives initiative, is a useful contribution to improving safety and prevention of SSIs and should be used universally. Considering sutures as ‘implants’, with a hard or non-shedding surface to which micro-organisms can form biofilm and cause surgical site infections, was felt to be a useful concept.     

胰十二指肠切除术后手术部位感染的危险因素分析

目的 分析引起胰十二指肠切除术（PD）后手术部位感染（SSI）的危险因素。
方法 回顾性分析2015年1月至2018年12月择期行PD 1 688例患者的临床资料,男1 047例,女641例,年龄18~87岁,BMI 14~40 kg/m²,ASA Ⅰ—Ⅲ级。记录性别、年龄、BMI、ASA分级、术前合并症、术前检验结果、影像学资料、麻醉时间、手术时间、手术方式、麻醉用药、患者术后去向等。根据术后是否发生SSI将患者分为两组：感染组（n=301）和非感染组（n=1 387）。采用单因素与多因素Logistic回归分析PD术后发生SSI的危险因素。
结果 单因素分析结果显示,感染组BMI、丙氨酸氨基转移酶＞100 U/L的比例、血清白蛋白、白细胞计数及术后进入ICU的比例均明显高于非感染组（P＜0.05）,手术时间以及麻醉时间明显长于非感染组（P＜0.05）。多因素Logistic回归分析结果显示,BMI (每增加1 kg/m²,OR=1.075, 95%CI 1.034~1.118,P＜0.001)、术前丙氨酸氨基转移酶水平＞100 U/L (OR=1.317, 95%CI 1.013~1.707, P=0.039)、术前白细胞计数＞10×10⁹/L (OR=1.920, 95%CI 1.160~3.089, P=0.009)及术后进入ICU (OR=2.317, 95%CI 1.796~2.994, P＜0.001)是PD术后SSI发生的独立危险因素。
结论 BMI每增加1 kg/m²、术前白细胞>10×10⁹/L、丙氨酸氨基转移酶水平>100 U/L以及术后进入ICU是胰十二指肠切除术后发生手术部位感染的危险因素。     

Analysis of risk factors for surgical site infection and postoperative recurrence following inguinal and femoral hernia surgery in adults

ObjectiveWe aimed to evaluate the causes of complications following surgery for inguinal and femoral hernia, using surgical site infection (SSI) and recurrence rate as indicators of outcomes to consider appropriate treatments.MethodsWe retrospectively assessed the medical histories of 1,098 patients with adult inguinal and femoral hernias who underwent herniorrhaphy between July 2010 and March 2019. Using SSI and recurrence rate as indicators of outcomes, we statistically assessed the influence of preoperative and operative conditions on surgical outcomes.ResultsThe occurrence of postoperative SSI was significantly more frequent in patients who experienced a long surgical duration, excessive blood loss, and incarceration; underwent emergency surgery and bowel resection; and in whom no mesh sheet insertion was performed. There was no correlation between mesh use and SSI in cases that did not require emergency incarceration repair. For cases involving hernia incarceration, the use of a mesh sheet was avoided to prevent potential infection, which could explain the high incidence of SSI in cases where mesh was not used. The hernia may have recurred due to technical issues during the procedure, as well as failure to ligate the hernia sac.ConclusionsSelecting the appropriate surgical method for hernia repair may reduce the incidence of SSI. If manual reduction of inguinal hernias is not possible, an appropriate surgical procedure should be determined based on laparoscopic findings in facilities where laparoscopic hernia surgeries are frequently performed. Moreover, in cases without infection and bowel resection, mesh use may be beneficial. Recurrence can be prevented by ligating the hernia sac during surgery and solving relevant technical problems.     

Predicting surgical site infection after spine surgery: a validated model using a prospective surgical registry

Background contextThe impact of surgical site infection (SSI) is substantial. Although previous study has determined relative risk and odds ratio (OR) values to quantify risk factors, these values may be difficult to translate to the patient during counseling of surgical options. Ideally, a model that predicts absolute risk of SSI, rather than relative risk or OR values, would greatly enhance the discussion of safety of spine surgery. To date, there is no risk stratification model that specifically predicts the risk of medical complication.PurposeThe purpose of this study was to create and validate a predictive model for the risk of SSI after spine surgery.Study designThis study performs a multivariate analysis of SSI after spine surgery using a large prospective surgical registry. Using the results of this analysis, this study will then create and validate a predictive model for SSI after spine surgery.Patient sampleThe patient sample is from a high-quality surgical registry from our two institutions with prospectively collected, detailed demographic, comorbidity, and complication data.Outcome measuresAn SSI that required return to the operating room for surgical debridement.Materials and methodsUsing a prospectively collected surgical registry of more than 1,532 patients with extensive demographic, comorbidity, surgical, and complication details recorded for 2 years after the surgery, we identified several risk factors for SSI after multivariate analysis. Using the beta coefficients from those regression analyses, we created a model to predict the occurrence of SSI after spine surgery. We split our data into two subsets for internal and cross-validation of our model. We created a predictive model based on our beta coefficients from our multivariate analysis.ResultsThe final predictive model for SSI had a receiver-operator curve characteristic of 0.72, considered to be a fair measure. The final model has been uploaded for use on SpineSage.com.ConclusionsWe present a validated model for predicting SSI after spine surgery. The value in this model is that it gives the user an absolute percent likelihood of SSI after spine surgery based on the patient's comorbidity profile and invasiveness of surgery. Patients are far more likely to understand an absolute percentage, rather than relative risk and confidence interval values. A model such as this is of paramount importance in counseling patients and enhancing the safety of spine surgery. In addition, a tool such as this can be of great use particularly as health care trends toward pay for performance, quality metrics (such as SSI), and risk adjustment. To facilitate the use of this model, we have created a Web site (SpineSage.com) where users can enter patient data to determine likelihood for SSI.