scholarly journals Povidone-iodine irrigation combined with Vancomycin powder lowers infection rates in pediatric deformity surgery

2021 ◽  
Author(s):  
Rolando Figueroa Roberto ◽  
Flynn Andrew Rowan ◽  
Deepak Nallur ◽  
Blythe Durbin-Johnson ◽  
Yashar Javidan ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Infection Rate ◽  
Povidone Iodine ◽  
Small Sample Size ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Small Sample ◽  
Site Infection ◽  
Infection Rates ◽  
Vancomycin Powder

Abstract Background Surgical site infection is a morbid, devastating complication after spinal procedures. Studies have investigated the effect of wound lavage with 3.5% Povidone-iodine solution or the use of intrawound Vancomycin powder. We examined the effect of Povidone-iodine irrigation, intrawound Vancomycin powder, or a combination of both agents in a tertiary care Pediatric Hospital. Methods We queried our health system database for patients undergoing spinal surgery over an eight-year span between January 2008 and June 2016 and identified patient cohorts who received no intervention, intrawound Vancomycin alone, Povidone-iodine irrigation alone, or a combination of both agents. Infection rates were determined. The effect of treatment on outcome was analyzed using a logistic regression model. Results 475 patients were identified who met study inclusion criteria. 88 non-neuromuscular patients received no intra-operative agent. The surgical site infection (SSI) rate in this group of patients was 10%. For the 194 non-neuromuscular scoliosis patients who received Povidone-iodine and Vancomycin powder, the infection rate was reduced to 0.7%. The SSI rate in the 180 non-neuromuscular patients who were treated with Vancomycin powder alone was 1.4%. 13 patients were treated with Povidone-iodine lavage only, with a small sample size precluding statistical comparison. Infection rate in the 132 neuromuscular disease patients decreased from 14 to 7% overall during this time span: while the odds ratio of infection was reduced in all neuromuscular treatment groups receiving intra-operative measures, statistical significance was not reached in any neuromuscular group studied. Conclusions A protocol using combined 3.5% weight/volume Povidone-iodine and Vancomycin powder was associated with the lowest infection rate in our non-neuromuscular patient population and should be considered as a low cost intervention in pediatric patients undergoing spinal deformity procedures. Level of evidence Level II.

Surgical Site Infection Rate Drops to 0% Using a Vacuum-Assisted Closure in Contaminated/ Dirty Infected Laparotomy Wounds

2017 ◽  
Vol 83 (5) ◽  
pp. 512-514 ◽  
Author(s):  
Gerardo Lozano-Balderas ◽  
Alejandro Ruiz-Velasco-Santacruz ◽  
Jose Antonio Diaz-Elizondo ◽  
Juan Antonio Gomez-Navarro ◽  
Eduardo Flores-Villalba
Keyword(s):  
Surgical Site Infection ◽  
Infection Rate ◽  
Primary Closure ◽  
Statistical Significance ◽  
Site Infection ◽  
Class Iii ◽  
Infection Rates ◽  
Vacuum Assisted Closure ◽  
Significant Difference ◽  
Delayed Closure

Wound site infections increase costs, hospital stay, morbidity, and mortality. Techniques used for wounds management after laparotomy are primary, delayed primary, and vacuum-assisted closures. The objective of this study is to compare infection rates between those techniques in contaminated and dirty/ infected wounds. Eighty-one laparotomized patients with Class III or IV surgical wounds were enrolled in a three-arm randomized prospective study. Patients were allocated to each group with the software Research Randomizer® (Urbaniak, G. C, & Plous, S., Version 4.0). Presence of infection was determined by a certified board physician according to Centers for Disease Control's Criteria for Defining a Surgical Site Infection. Twenty-seven patients received primary closure, 29 delayed primary closure, and 25 vacuum-assisted closure, with no exclusions for analysis. Surgical site infection was present in 10 (37%) patients treated with primary closure, 5 (17%) with primary delayed closure, and 0 (0%) patients receiving vacuum-assisted closure. Statistical significance was found between infection rates of the vacuum-assisted group and the other two groups. No significant difference was found between the primary and primary delayed closure groups. The infection rate in contaminated/dirty-infected laparotomy wounds decreases from 37 and 17 per cent with a primary and delayed primary closures, respectively, to 0 per cent with vacuum-assisted systems.

scholarly journals 891. Is Post-discharge Surveillance of Surgical Patients Really Worth It? Results Observed in Three Years of a Multicenter Study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S479-S481
Author(s):  
Rafaela Tonholli Pinho ◽  
Luciana Coelho Tanure ◽  
Joice Ribeiro Lopes ◽  
Bárbara Caldeira Pires ◽  
Flávio Henrique Batista de Souza ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Infection Rate ◽  
Tertiary Care ◽  
Patient Discharge ◽  
Surgical Patient ◽  
Surveillance Program ◽  
Site Infection ◽  
Infection Rates ◽  
Post Discharge ◽  
Belo Horizonte

Abstract Background Surgical site infections (SSIs) can account for 25% of all nosocomial infections and contribute significantly to the economic burden resulting from infectious complications. To control this problem, an active surveillance program with the feedback of SSI rates to surgeons can reduce subsequent rates by up to 40%, since 19% to 65% of these infections are diagnosed after patient discharge. However, there is no standard method for conducting surveillance outside the hospital and the best methodology is still unknown. For many hospitals, SSI surveillance has three main objectives: to feedback surgeons with their SSI rates; to evaluate SSI rates over time, identifying outbreaks; and to compare data among different institutions. This study aims to answer the crucial question: is surveillance after patient discharge worthwhile? Methods Prospective surveillance according to the National Healthcare Safety Network (NHSN) protocol of the Centers for Disease Control and Prevention (CDC) at Hospital Lifecenter, Hospital Madre Teresa and Hospital Universitário Ciências Médicas, tertiary care centers, which serve the metropolitan area of Belo Horizonte, Brazil. The data were collected between Jan/2017 and Dec/2019. Results In almost three years of study, the infection rate data were calculated with and without surveillance. The monthly analysis by clinic showed that the inclusion of post-discharge patients in the computed rates increases its value, but not significantly. Of 22.009 patients analyzed, in Lifecenter Hospital, 229(1%) had SSI. This percentage refers to the infection rate with the post-discharge survey, while the rate of surgical infection without vigilance corresponds to 202(0,9%) (Table 1). The surveillance for Madre Teresa, those numbers were: 29.770, 382(1,3%) and 351(1,2%), respectively (Table 2). In Hospital Universitário Ciências Médicas: 20.286, 447 (2,2%) and 215(1,1%) (Table 3). Table 1 - Surgical site infection: data with and without post-discharge surveillance. Hospital Lifecenter (Jan/ 2017 to Jul/2019): month-by-month analysis. Table 2 - Surgical site infection: data with and without post-discharge surveillance. Hospital Madre Teresa (Jan/ 2017 to Dec/2019): month-by-month analysis. Table 3 - Surgical site infection: data with and without post-discharge surveillance. Hospital Universitário Ciências Médicas (Jan/ 2017 to Dec/2019): month-by-month analysis. Conclusion SSI post-discharge surveillance is indicated only for specific procedures. However, once the endemic curve with the infection rate did not change with the inclusion of post-discharge SSI, the study strongly suggests that surveillance after the discharge of the surgical patient is not necessary. Graph 1 - Surgical site infection: rates with and without post-discharge surveillance. Hospital Lifecenter (Jan/2017 to Jul/2019): endemic curve. Graph 2 - Surgical site infection: rates with and without post-discharge surveillance. Hospital Madre Teresa (Jan/2017 to Jul/2019): endemic curve. Graph 3 - Surgical site infection: rate with and without post-discharge surveillance. Hospital Universitário Ciências Médicas (Jan/2017 to Jul/2019): endemic curve. Disclosures All Authors: No reported disclosures

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

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.

Incidence of Surgical Site Infection Associated with Robotic Surgery

2010 ◽  
Vol 31 (8) ◽  
pp. 822-827 ◽  
Author(s):  
Elizabeth D. Hermsen ◽  
Tim Hinze ◽  
Harlan Sayles ◽  
Lee Sholtz ◽  
Mark E. Rupp
Keyword(s):  
Surgical Site Infection ◽  
Open Surgery ◽  
Small Sample Size ◽  
Academic Medical Center ◽  
Small Sample ◽  
Site Infection ◽  
National Data ◽  
Robot Assisted ◽  
Surgical Duration ◽  
Robot Assisted Surgery

Objective.Robot-assisted surgery is minimally invasive and associated with less blood loss and shorter recovery time than open surgery. We aimed to determine the duration of robot-assisted surgical procedures and the incidence of postoperative surgical site infection (SSI) and to compare our data with the SSI incidence for open procedures according to national data.Design.Retrospective cohort study.Setting.A 689-bed academic medical center.Patients.All patients who underwent a surgical procedure with use of a robotic surgical system during the period from 2000-2007.Methods.SSIs were defined and procedure types were classified according to National Healthcare Safety Network criteria. National data for comparison were from 1992-2004. Because of small sample size, procedures were grouped according to surgical site or wound classification.Results.Sixteen SSIs developed after 273 robot-assisted procedures (5.9%). The mean surgical duration was 333.6 minutes. Patients who developed SSI had longer mean surgical duration than did patients who did not (558 vs 318 minutes; P<.001). The prostate and genitourinary group had 5.74 SSIs per 100 robot-assisted procedures (95% confidence interval [CI], 2.81–11.37), compared with 0.85 SSIs per 100 open procedures from national data. The gynecologic group had 10.00 SSIs per 100 procedures (95% CI, 2.79–30.10), compared with 1.72 SSIs per 100 open procedures. The colon and herniorrhaphy groups had 33.33 SSIs per 100 procedures (95% CI, 9.68–70.00) and 37.50 SSIs per 100 procedures (95% CI, 13.68–69.43), respectively, compared with 5.88 and 1.62 SSIs per 100 open procedures from national data. Patients with a clean-contaminated wound developed 6.1 SSIs per 100 procedures (95% CI, 3.5–10.3), compared with 2.59 SSIs per 100 open procedures. No significant differences in SSI rates were found for other groups.Conclusions.Increased incidence of SSI after some types of robot-assisted surgery compared with traditional open surgery may be related to the learning curve associated with use of the robot.

scholarly journals Radiological Analysis of Frontal Cells and its Association with Frontal Sinus Mucosal Disease: A Tertiary Care Hospital Based Study

2019 ◽  
Vol 27 (1) ◽  
pp. 1-7
Author(s):  
Bikash Lal Shrestha ◽  
Sameer Karmacharya
Keyword(s):  
Frontal Sinus ◽  
Small Sample Size ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Small Sample ◽  
Care Hospital ◽  
Prospective Longitudinal Study ◽  
Mucosal Disease ◽  
Complex Anatomy ◽  
Prospective Longitudinal

Introduction The frontal sinus and frontal recess both have complex anatomy causing difficulty during endoscopic sinus surgeries. The term frontal cells is currently used to describe a group of anterior ethmoidal cells classified by Kuhn et al into 4 types. Though there are precise descriptions, the frequency of frontal sinus cells (FSCs) varies widely in the literature. The presence of FSCs is responsible for a narrowing of the frontal sinus outflow tract which subsequently causes a partial obstruction of drainage and aeration of the frontal sinus. Our main aim is to the see the distribution of different frontal cells in Nepali population and relation with frontal sinus mucosal disease.   Materials and Methods This prospective, longitudinal study performed in 110 consecutive patients who underwent CT scan of nose and paranasal sinuses. The frontal cells and agger nasi cells were identified and association between the frontal cells and agger nasi cells with frontal sinus mucosal disease was analyzed with chi square test.   Results The agger nasi was present in 83.63% CT scans whereas frontal cells were distributed in 61.82% CT (computed tomogram) scans. There was not statistical significance and any association between the frontal cells and agger nasi cells with frontal sinus mucosal disease.   Conclusion The frontal cells and agger nasi cells distribution in Nepalese population, even though in small sample size, is similar with other studies in the literature. There is also non association of either frontal cells or agger nasi cells with frontal sinus mucosal disease.

scholarly journals An observational study of incidence of surgical site infections in gastrointestinal surgeries

2021 ◽  
Vol 8 (12) ◽  
pp. 3595
Author(s):  
Jenishkumar Vijaykumar Modi ◽  
Darshit Kalaria
Keyword(s):  
Risk Factors ◽  
Observational Study ◽  
Surgical Site Infection ◽  
Infection Rate ◽  
Surgical Site Infections ◽  
Site Infection ◽  
Infection Rates ◽  
Surgical Site Infection Rate ◽  
Long Time ◽  
Surgery Department

Background: This study analysed the incidence of surgical site infections in gastrointestinal surgeries and its risk factors. so this study helped us in reducing surgical site infection by avoiding or minimizing that risk factors.Methods: The present study was conducted at general surgery department, SMIMER, Surat. An observational study of 400 cases that have undergone abdominal surgery in SMIMER hospital and were followed up from the day of operation to 30 days after discharge was done.Results: The overall infection rate for a total of the 400 cases was 17.25%. The incidence rate in this study was well within the infection rates of 2.8% to 17% seen in other studies. Different studies from India at different places have shown the SSI (surgical site infection) rate to vary from 6.09% to 38.7%.Conclusions: Our study reveals that though SSIs have been widely studied since a long time, they still remain as one of the most important causes of morbidity and mortality in surgically treated patients.

scholarly journals Chlorhexidine-alcohol versus Povidone-Iodine-alcohol for surgical site antisepsis in caesarean section

2019 ◽  
Vol 8 (4) ◽  
pp. 1359
Author(s):  
Vishnu Priya Kesani ◽  
Sruthi Talasila ◽  
Sheela S. R.
Keyword(s):  
Caesarean Section ◽  
Surgical Site Infection ◽  
Povidone Iodine ◽  
Care Center ◽  
Tertiary Care ◽  
Site Infection ◽  
Healthcare Associated Infection ◽  
Skin Antisepsis ◽  
Control And Prevention ◽  
Healthcare Associated

Background: Caesarean section is one of the most common procedures performed. Recent studies found that surgical-site infection (SSI) was the most common healthcare-associated infection. Authors hypothesized that optimization of preoperative skin antisepsis may decrease postoperative infections. The objective was to establish the efficacy of chlorhexidine-based antiseptic protocol versus povidone-iodine protocol in reducing SSI for patients undergoing caesarean deliveries.Methods: This is a randomized prospective study conducted from April 2017 to September 2017 at a tertiary care center in India. Women who underwent caesarean sections were allocated into either group. Enrolled patients were randomly assigned to have the surgical site painted with chlorhexidine-alcohol preparation or painted with a solution of 10% povidone-iodine and then with surgical spirit. The outcomes were any SSI occurring within a week or during the 30 day follow up period of the surgery including any of: superficial or deep surgical site infection, or endometritis, according to Centers for Disease Control and Prevention definitions.Results: A total of 560 subjects (273 in the chlorhexidine group and 287 in the iodine group) qualified for the study. The number of surgical-site infection was significantly lower in the chlorhexidine group than in the iodine group (6.95% vs. 14.28%; P=0.005). Chlorhexidine–alcohol was significantly more protective than iodine-alcohol against both superficial incisional infections (5.49% vs. 10.10%, P=0.03) and deep incisional infections (1.46% vs. 4.18%, P=0.04).Conclusions: This study highlighted that Chlorhexidine-alcohol provided superior skin antisepsis in comparison to povidone iodine-alcohol.

scholarly journals Exploration of epidemiologic profile and strategic prevention framework for surgical site infection rates in a tertiary care hospital of Bhopal city

2018 ◽  
Vol 5 (2) ◽  
pp. 784
Author(s):  
Vidit Goyal ◽  
Rituja Kaushal
Keyword(s):  
Surgical Site Infection ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Care Hospital ◽  
Site Infection ◽  
Infection Rates ◽  
Routine Surveillance ◽  
Epidemiologic Profile ◽  
Hospital Acquired

Background: Post-operative surgical site infections are deadlock for any successful surgery. This exigency triggers draining of extra resources for management of the quagmire. Methods: This prospective direct surveillance study based on incidence design was undertaken to gauge and estimate the nature of propensity of various surgical site infections in a tertiary care hospital over a period of twelve months. Results: Calculated cumulative SSI rate for the year 2016 was found to be 4.32%. Conclusions: It was concluded that a multidisciplinary approach integrating periodic training sessions on infection control, checklists based routine surveillance & following some benchmark etc. are the linchpin in controlling hospital acquired infections including surgical site infection rates in any clinical setting.

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