Incidence of Surgical Site Infection After Spine Surgery: What Is the Impact of the Definition of Infection?

Abstract Introduction Open abdominal surgery confers potentially greater risk of surgical site infections, and local evidence suggests use of drains can reduce this. Our objectives were: Assessing local rates and risk factors of infections and if use of drains can reduce the rates of infections. Method Retrospectively looking from 01/01/2018 to 31/12/2018, at patients following laparotomy or open cholecystectomy. Data collection on demographics, smoking/alcohol status, heart, respiratory or renal disease or diabetes, steroid use and CEPOD status, as well as use of drain and the outcome of infection using inpatient and online patient records. Results 84 patients included, 25 had drains inserted. There were 13 documented cases of surgical site infection, all of whom had no drain post-op. Other parameters shown to be most prevalent in the patients with a surgical site infection include being current/ex-smoker (8/13), having heart disease (9/13), and elective procedures. Conclusions Aiming to reduce the risk of surgical site infections can improve morbidity and potentially mortality outcomes. Our audit data showed that there appears to be a benefit of inserting intra-abdominal or subcutaneous drains. We will create a standard operating procedure of all patient to receive drains post-op and then re-audit to assess the impact this has on infection rates.

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Surgical Site Infection Following Caesarean Section by Acinetobacter Species: A Report from a Hyperendemic Setting in the Brazilian Amazon Region

Microorganisms ◽

10.3390/microorganisms9040743 ◽

2021 ◽

Vol 9 (4) ◽

pp. 743

Author(s):

Blenda Gonçalves Cabral ◽

Danielle Murici Brasiliense ◽

Ismari Perini Furlaneto ◽

Yan Corrêa Rodrigues ◽

Karla Valéria Batista Lima

Keyword(s):

Caesarean Section ◽

Surgical Site Infection ◽

Carbapenem Resistance ◽

Brazilian Amazon ◽

Amazon Region ◽

Site Infection ◽

Acinetobacter Species ◽

Brazilian Amazon Region ◽

Acinetobacter Spp ◽

The Impact

Surgical site infection (SSI) following caesarean section is associated with increased morbidity, mortality, and significant health care costs. This study evaluated the epidemiological, clinical, and microbiological features of Acinetobacter spp. in women with SSIs who have undergone caesarean section at a referral hospital in the Brazilian Amazon region. This study included 69 women with post-caesarean SSI by Acinetobacter spp. admitted to the hospital between January 2012 and May 2015. The 69 Acinetobacter isolates were subjected to molecular species identification, antimicrobial susceptibility testing, detection of carbapenemase-encoding genes, and genotyping. The main complications of post-caesarean SSI by Acinetobacter were inadequate and prolonged antibiotic therapy, sepsis, prolonged hospitalization, and re-suture procedures. A. baumannii, A. nosocomialis and A. colistiniresistens species were identified among the isolates. Carbapenem resistance was associated with OXA-23-producing A. baumannii isolates and IMP-1-producing A. nosocomialis isolate. Patients with multidrug-resistant A. baumannii infection showed worse clinical courses. Dissemination of persistent epidemic clones was observed, and the main clonal complexes (CC) for A. baumannii were CC231 and CC236 (Oxford scheme) and CC1 and CC15 (Pasteur scheme). This is the first report of a long-term Acinetobacter spp. outbreak in women who underwent caesarean section at a Brazilian hospital. This study demonstrates the impact of multidrug resistance on the clinical course of post-caesarean infections.

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The impact of copper impregnated wound dressings on surgical site infection following caesarean section: A double blind randomised controlled study

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2018.08.534 ◽

2019 ◽

Vol 234 ◽

pp. e171 ◽

Cited By ~ 1

Author(s):

Linda Arendsen ◽

Ranee Thakar ◽

Abdul Sultan

Keyword(s):

Caesarean Section ◽

Surgical Site Infection ◽

Wound Dressings ◽

Controlled Study ◽

Site Infection ◽

Double Blind ◽

Randomised Controlled Study ◽

Randomised Controlled ◽

The Impact

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Risk factors for unavoidable removal of instrumentation after surgical site infection of spine surgery

Medicine ◽

10.1097/md.0000000000005118 ◽

2016 ◽

Vol 95 (43) ◽

pp. e5118 ◽

Cited By ~ 9

Author(s):

Hiroyuki Tominaga ◽

Takao Setoguchi ◽

Hideki Kawamura ◽

Ichiro Kawamura ◽

Satoshi Nagano ◽

...

Keyword(s):

Risk Factors ◽

Surgical Site Infection ◽

Spine Surgery ◽

Site Infection

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Preoperative Prevention of Surgical-Site Infection in Spine Surgery

Orthopaedic Nursing ◽

10.1097/nor.0000000000000786 ◽

2021 ◽

Vol 40 (5) ◽

pp. 276-280

Author(s):

Lauren M. Franker ◽

Molly Pretet ◽

Barbara Douglas ◽

Kristin Simmons ◽

Amber Wilson ◽

...

Keyword(s):

Surgical Site Infection ◽

Spine Surgery ◽

Site Infection

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Postoperative Surgical Site Infection After Spine Surgery: An Update From the Scoliosis Research Society (SRS) Morbidity and Mortality Database*

Spine Deformity ◽

10.1016/j.jspd.2018.04.004 ◽

2018 ◽

Vol 6 (6) ◽

pp. 634-643 ◽

Cited By ~ 7

Author(s):

Jamal N. Shillingford ◽

Joseph L. Laratta ◽

Hemant Reddy ◽

Alex Ha ◽

Ronald A. Lehman ◽

...

Keyword(s):

Surgical Site Infection ◽

Spine Surgery ◽

Research Society ◽

Morbidity And Mortality ◽

Site Infection ◽

Scoliosis Research Society

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Chlorhexidine Showers are Associated With a Reduction in Surgical Site Infection Following Spine Surgery: An Analysis of 4266 Consecutive Surgeries

Neurosurgery ◽

10.1093/neuros/nyy568 ◽

2018 ◽

Vol 85 (6) ◽

pp. 817-826 ◽

Cited By ~ 8

Author(s):

Andrew K Chan ◽

Simon G Ammanuel ◽

Alvin Y Chan ◽

Taemin Oh ◽

Henry C Skrehot ◽

...

Keyword(s):

Multivariate Analysis ◽

Surgical Site Infection ◽

Spine Surgery ◽

Subgroup Analysis ◽

Spinal Surgery ◽

Site Infection ◽

Safe Patient Care ◽

Significant Difference ◽

Additional Costs ◽

Procedure Type

Abstract BACKGROUND Surgical site infection (SSI) is a common complication following spinal surgery. Prevention is critical to maintaining safe patient care and reducing additional costs associated with treatment. OBJECTIVE To determine the efficacy of preoperative chlorhexidine (CHG) showers on SSI rates following fusion and nonfusion spine surgery. METHODS A mandatory preoperative CHG shower protocol was implemented at our institution in November 2013. A cohort comparison of 4266 consecutive patients assessed differences in SSI rates for the pre- and postimplementation periods. Subgroup analysis was performed on the type of spinal surgery (eg, fusion vs nonfusion). Data represent all spine surgeries performed between April 2012 and April 2016. RESULTS The overall mean SSI rate was 0.4%. There was no significant difference between the pre- (0.7%) and postimplementation periods (0.2%; P = .08). Subgroup analysis stratified by procedure type showed that the SSI rate for the nonfusion patients was significantly lower in the post- (0.1%) than the preimplementation group (0.7%; P = .02). There was no significant difference between SSI rates for the pre- (0.8%) and postimplementation groups (0.3%) for the fusion cohort (P = .21). In multivariate analysis, the implementation of preoperative CHG showers were associated with significantly decreased odds of SSI (odds ratio = 0.15, 95% confidence interval [0.03-0.55], P < .01). CONCLUSION This is the largest study investigating the efficacy of preoperative CHG showers on SSI following spinal surgery. In adjusted multivariate analysis, CHG showering was associated with a significant decrease in SSI following spinal surgery.

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Standardising intraoperative irrigation with 0.05% chlorhexidine gluconate in caesarean delivery to reduce surgical site infections: A single institution experience

Journal of Perioperative Practice ◽

10.1177/1750458919850727 ◽

2019 ◽

Vol 30 (1-2) ◽

pp. 24-33

Author(s):

Theresa Mangold ◽

Erin Kinzel Hamilton ◽

Helen Boehm Johnson ◽

Rene Perez

Keyword(s):

Treatment Group ◽

Surgical Site Infection ◽

Infection Rate ◽

Caesarean Delivery ◽

Chlorhexidine Gluconate ◽

Control Group ◽

Antibiotic Administration ◽

Site Infection ◽

Infection Rates ◽

The Impact

Background Surgical site infection is a significant cause of morbidity and mortality following caesarean delivery. Objective To determine whether standardising intraoperative irrigation with 0.05% chlorhexidine gluconate during caesarean delivery could decrease infection rates. Methods This was a process improvement project involving 742 women, 343 of whom received low-pressured 0.05% chlorhexidine gluconate irrigation during caesarean delivery over a one-year period. Infection rates were compared with a standard-of-care control group (399 women) undergoing caesarean delivery the preceding year. Results The treatment group infection rate met the study goal by achieving a lower infection rate than the control group, though this was not statistically significant. A significant interaction effect between irrigation with 0.05% chlorhexidine gluconate and antibiotic administration time existed, such that infection occurrence in the treatment group was not dependent on antibiotic timing, as opposed to the control group infection occurrence, which was dependent on antibiotic timing. Conclusion Intraoperative irrigation with 0.05% chlorhexidine gluconate during caesarean delivery did not statistically significantly reduce the rate of infections. It did render the impact of antibiotic administration timing irrelevant in prevention of surgical site infection. This suggests a role for 0.05% chlorhexidine gluconate irrigation in mitigating infection risk whether antibiotic prophylaxis timing is suboptimal or ideal.

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