Incidence of surgical site infections in the departments of orthopedics and traumatology

BACKGROUND/AIM: Besides infections of urinary tract and pneumonias, as well as blood infections, surgical site infections (SSI) represent one of the most common localization of hospital infections. The aim of this study was to determine the incidence of SSI in the departments of orthopedics and traumatology as well as the SSI incidence in relation to the ASA score, surgical site contamination class and NNIS index. METHODS: A prospective cohort study followed daily all the surgical patients hospitalized over 48 hours in the Institute for Orthopedic Surgery and Traumatology, Clinical Center of Serbia, as well as 30 days after the discharge, during the period betwen February 1 to July 31, 2002. The patients were examined and their diagnoses made according to the definition of hospital infections, i.e. upon clinical and/or laboratory analyses, using concurrently the ASA score, surgical site contamination class and NNIS index. RESULTS: Out of 227 surgical patients, 60 were diagnosed with SSI during their hospitalization, while 3 of the patients developed SSI after the discharge. The incidence of SSI was 22.7% (95% CI = 17.8-27.6). In the patients with good health condition, i.e. ASA < or = 2, the incidence of SSI was 18.3% (43/235) and in those with ASA > 2, it was 47.6% (20/42) (chi2 = 17.4; p < 0.001). The incidence of SSI was 13.5% (25/185) in the clean wounds, 11.6% (5/43) in purely contaminated, while it was much higher in the contaminated 65.5%; (19/29) and soiled 70.0%; (14/20) wounds (chi2 = 67.6; p < 0.001). The incidence of SSI in relation to NNIS was 8.1% (13/161) in the patients with score 0, then 36.4% (32/88) in the patients with score 1, and 64.3% (18/28) in the patients with the scores 2 and 3 (chi2 = 57.3; p < 0.001). The patients with SSI stayed in the departments of orthopedics and traumatology approximately 1.8 times longer than the patients without SSI (t = 5.3; DF = 275; p < 0.0019. CONCLUSION: It is important to emphasize the need for constant epidemiological surveillance of SSI and the implementation of preventive measures in Serbia.     

Nosocomial infections in the intensive care units

BACKGROUND/AIM: The risk for nosocomial infections (NIs) is 5-10 times higher in patients hospitalized in the Intensive Care Units (ICUs) than in patients staying in other wards. The higher incidence rates of NIs in the ICUs may be explained by the fact that the patients in the ICUs have more severe underlying disease, and are exposed to the invasive diagnostic and therapeutical procedures. The unreasonable use of antibiotics leads to the selection of multiresistant agents, which have been increasingly recorded as the NIs causative agents. The aim of this study was to investigate the characteristics of NIs in the ICUs in the period January-June 2005. METHODS: The study of incidence was performed in accordance with the methodology of the Centers for Diseases and Prevention. Any infections in the patients hospitalized in the ICUs in the period from January to June 2005 were registered. The results both from medical documentation and from the direct contacts with the medical personnel were analyzed. The samples were tested using standard methods in the microbiological laboratory. RESULTS: The incidence rates of NIs patients ranged from 1.5 to 40.8, and the incidence rates of infections were 1.5 to 65.6 per 1 000 patient's days. Out of the total number of NIs, urinary infections accounted for 44.6%, blood infections for 37.6%, and surgical site infections for 16.9%. CONCLUSION: The most frequent cause of nosocomial urinary infections was Klebsiella, of nosocomial sepsis--coagulase--negative staphylococci, and of surgical site infections--Staphylococcus aureus.     

The prevention of hospital infections in therapeutic gastroenterology departments]

The article studies the possibilities and conditions of the origin and factors that contribute to the proliferation of inpatient infections (I.I.) in therapeutic gastroenterologic units. The following risk factors of I.I. contamination and proliferation were disclosed: violation of sterilization methods, damaging of mucosa during invasive examinations, weak organism resistance of patients, etc. Measures for I.I. prophylaxis are proposed.     

组织工程与创伤医学

组织工程是近年来逐渐发展起来的一项新型医疗技术。其基本原理是应用细胞生物学和工程学的原理，将体外培养扩增后具有生物学活力及特定功能的细胞与可降解生物支架材料复合，在体内或体外再造组织或器官，用以修复或改善损伤组织或器官的结构与功能，最终形成有活力的正常组织或器官，达到真正意义上的生物学重建。     

Epidemiology and traumatology of injuries in soccer

A prospective investigation of soccer injuries among 123 players participating at various competition levels was undertaken in a Danish soccer club. The injury incidence during games was highest at division level (18.5/1000 hours) and lowest at series level (11.9/1000 hours), whereas the distribution of the incidences during practice was reversed. The youth section (16 to 18 years) had incidences that could be compared to the highest senior level. The lower extremity was involved in 84% of the injuries, including 34% of overuse injuries. Ankle sprains were most common (36%) and equally found at all levels, whereas half of all overuse injuries were seen among division players. Contact injuries during tackling occurred most often in lower series and youths (45%). Players participating at high levels had only 30% of the injuries during tackling and 54% during running. More than half of 20 knee injuries were caused by tackling. Thirty-five percent of injured players were absent from soccer for more than 1 month; 28% had complaints 12 months after the end of the season with knee injuries the most serious. The study shows that the injury incidence, the pattern of injury, and the traumatology varied between players participating at different levels of soccer competition.     

Epidemiology and traumatology of injuries in track athletes

During one year 4398 injured athletes were treated at the casualty wards of Aarhus, Denmark; 156 were practicing track and field disciplines. In the same period 54 track athletes of a Danish sport club were followed in order to register any lesion incurred during sports activity. Thirty-one athletes (57%) had 35 injuries, giving an injury incidence of 1.8 per 1000 hours of practice. At follow-up after 1 year, 13% of all athletes still had complaints, and none of them had returned to former sports activity. Jumpers had overuse symptoms correlated to take-off, and sprains or fractures related to downstrokes. Runners had a higher risk of overuse injuries than jumpers, especially involving the Achilles tendon and the plantar aponeurosis. Young athletes had a higher injury incidence per time than older participants; and women had higher injury risk than men.