Prevention of Surgical Site Infection in Abdominal Surgery. A Critical Review of the Evidence

Abstract Background Surgical site infection is the most common complication of abdominal surgery, with a global impact on patients and health systems. There are no tools to identify wound infection that are validated for use in the global setting. The overall aim of the study described in this protocol is to evaluate the feasibility and validity of a remote, digital pathway for wound assessment after hospital discharge for patients in low- and middle-income countries (LMICs). Methods A multi-centre, international, mixed-methods study within a trial, conducted in two stages (TALON-1 and TALON-2). TALON-1 will adapt and translate a universal reporter outcome measurement tool (Bluebelle Wound Healing Questionnaire, WHQ) for use in global surgical research (SWAT store registration: 126) that can be delivered over the telephone. TALON-2 will evaluate a remote wound assessment pathway (including trial retention) and validate the diagnostic accuracy of this adapted WHQ through a prospective cohort study embedded within two global surgery trials. Embedded community engagement and involvement activities will be used to optimise delivery and ensure culturally attuned conduct. TALON-1 and TALON-2 are designed and will be reported in accordance with best practice guidelines for adaptation and validation of outcome measures, and diagnostic test accuracy studies. Discussion Methods to identify surgical site infection after surgery for patients after hospital discharge have the potential to improve patient safety, trial retention, and research efficiency. TALON represents a large, pragmatic, international study co-designed and delivered with LMIC researchers and patients to address an important research gap in global surgery trial methodology.

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ANTIBIOPROPHYLAXIS AND ANTIBIOTHERAPY IN ABDOMINAL SURGERY – SHORT REVIEW

Romanian Journal of Clinical Research ◽

10.33695/rjcr.v2i1.23 ◽

2019 ◽

Vol 2 (1) ◽

pp. 37-40

Author(s):

Marina Leontescu ◽

Octavian Andronic ◽

Dan Nicolae Păduraru ◽

Alexandra Bolocan ◽

Daniel Ion

Keyword(s):

Gastrointestinal Tract ◽

Abdominal Surgery ◽

Surgical Site Infection ◽

Short Review ◽

Gastric Surgery ◽

Infectious Complications ◽

Antibiotic Administration ◽

Site Infection ◽

Intestinal Anastomoses ◽

First And Second Generation

Surgical site infection (SSI) represents a concerning for all surgeons because both the unfavorable impact on health care costs and risk factors that increase the durations of wound healing and SSI rate. A review of PubMed, Scopus and Google Scholar has been made. The keywords used were related to surgical site infection prevetion. SSIs have a raised incidence in abdominal surgery because of the fact that many types of bacterias live in the gastrointestinal tract and during a surgical procedure some may escape and cause an infection. There is a high risk of postoperatory infections in gastric surgery due to intestinal anastomoses which are predisposed to leakage. In hernia repair surgery there is a higher rate of SSIs than expected for a clean procedure, and one risk factor may be represented by the prosthetic device used. On the other hand, in laparoscopic cholecystectomy, there is a very low risk of SSI and antibioprophylaxis is not recommended. But the most contaminated procedure with the highest risk of infectious complications is colorectal surgery, which requieres a combination of antibiotics because of the numerous types of microorganism. Abdominal surgery comprises different techniques and involves most elements of the gastrointestinal tract. Some procedures need antibiotic prophylaxis and in others antibiotic administration is even prohibited. The most effective antibiotics are first and second-generation cephalosporins.

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Circular pOlyethylene drape in preVEntion of suRgical site infection (COVER Trial): Study protocol of a randomized controlled trial

10.21203/rs.2.120/v1 ◽

2018 ◽

Author(s):

Ri Na Yoo ◽

Hyung Jin Kim ◽

Jae Im Lee ◽

Won-Kyung Kang ◽

Bong-Hyeon Kye ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Abdominal Surgery ◽

Surgical Site Infection ◽

Controlled Trial ◽

Dropout Rate ◽

Site Infection ◽

Gi Tract ◽

Randomized Controlled ◽

Wound Protector ◽

Open Abdominal Surgery

Abstract Background: Surgical site infection (SSI) after abdominal surgery is still a significant morbidity associated with an increased socioeconomic burden and poor quality of life. SSI prevalence rates as high as 40% in cases of fecal contamination have been reported; however, current methods to reduce SSI are limited to elective abdominal surgery. Further evaluation of preventive measures for reducing SSI is necessary. Methods/design: The COVER trial investigates whether the application of a dual-ring circular plastic wound protector reduces the rate of SSI in patients undergoing open abdominal surgery related to the gastrointestinal (GI) tract, regardless of the type of wound classified by the Center for Disease Control (CDC). The COVER trial is a multicenter, randomized controlled clinical trial with two parallel arms – one using a wound protector and the other using conventional surgical dressing gauze. The primary outcome will measure the rate of SSI in two groups. Statistical analysis of the primary end point will be based on the intention-to-treat population. The sample size is determined to achieve a study power of 80% at 95% 2-sided confidence limits. Considering a dropout rate of up to 5%, a total of 458 patients, 229 patients in each group, will be enrolled in this study. Discussion: The COVER trial will provide high-quality evidence for using a circular polyethylene drape in open abdominal surgery for the GI tract in all types of wound. The design of the trial will deliver high external validity and clinical significance. Trial registration: The trial protocol was registered at ClinicalTrials.gov (NCT 03170843) on May 31, 2017. https://clinicaltrials.gov/ct2/show/NCT03170843?term=NCT+03170843&rank=1 Keywords: Circular polyethylene drape, Abdominal surgery, Gastrointestinal tract, Surgical site infection, Randomized controlled trial

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1247. Multicenter Study on Risk Factors for Surgical Site Infection After Exploratory Laparotomy

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1110 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S449-S449

Author(s):

Túlio Alves Jeangregório Rodrigues ◽

Guilherme Fernandes de Oliveira ◽

Júlia G C Dias ◽

Laís Souza Campos ◽

Letícia Rodrigues ◽

...

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Abdominal Surgery ◽

Surgical Site Infection ◽

Exploratory Laparotomy ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Hospital Death ◽

Site Infection ◽

The Impact

Abstract Background Exploratory laparotomy surgery is abdominal operations not involving the gastrointestinal tract or biliary system. The objective of our study is to answer three questions: (a) What is the risk of surgical site infection (SSI) after exploratory abdominal surgery? (b) What is the impact of SSI in the hospital length of stay and hospital mortality? (c) What are risk factors for SSI after exploratory abdominal surgery? Methods A retrospective cohort study assessed meningitis and risk factors in patients undergoing exploratory laparotomy between January 2013 and December 2017 from 12 hospitals at Belo Horizonte, Brazil. Data were gathered by standardized methods defined by the National Healthcare Safety Network (NHSN)/CDC procedure-associated protocols for routine SSI surveillance. 26 preoperative and operative categorical and continuous variables were evaluated by univariate and multivariate analysis (logistic regression). Outcome variables: Surgical site infection (SSI), hospital death, hospital length of stay. Variables were analyzed using Epi Info and applying statistical two-tailed test hypothesis with significance level of 5%. Results A sample of 6,591 patients submitted to exploratory laparotomy was analyzed (SSI risk = 4.3%): Hospital length of stay in noninfected patients (days): mean = 16, median = 6, std. dev. = 30; hospital stay in infected patients: mean = 32, median = 22, std. dev. = 30 (P < 0.001). The mortality rate in patients without infection was 14% while hospital death of infected patients was 20% (P = 0.009). Main risk factors for SSI: ügeneral anesthesia (SSI = 4.9%, relative risk – RR = 2.8, P < 0.001); preoperative hospital length of stay more than 4 days (SSI=3.9%, RR=1.8, P = 0.003); wound class contaminated or dirty (SSI = 5.4%, RR = 1.5, P = 0.002); duration of procedure higher than 3 hours (SSI = 7.1%, RR = 2.1, P < 0.001); after trauma laparotomy (SSI = 7.8%, RR = 1.9, P = 0.001). Conclusion We identified patients at high risk of surgical site infection after exploratory laparotomy: trauma patients from contaminated or dirty wound surgery, submitted to a procedure with general anesthesia that last more than 3 hours have 13% SSI. Patients without any of these four risk factors have only 1.2% SSI. Disclosures All authors: No reported disclosures.

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Surgical-site infections in emergency abdominal paediatric surgeries at a tertiary-care hospital in Pakistan

Journal of the Pakistan Medical Association ◽

10.47391/jpma.1107 ◽

2020 ◽

pp. 1-9

Author(s):

Ali Faisal Saleem ◽

Huma Faiz Halepota ◽

Hasaan Omar ◽

Areeba Zain ◽

Muhammad Arif Mateen Khan

Keyword(s):

Abdominal Surgery ◽

Surgical Site Infection ◽

Tertiary Care ◽

Stable Condition ◽

University Hospital ◽

P Value ◽

Care Hospital ◽

Site Infection ◽

Significant Difference ◽

Pathogen Occurrence

Abstract A retrospective chart review was carried out in children (neonates to 18 years) who underwent acute surgical abdominal exploration during 2012-2016 at the Aga Khan University Hospital, Karachi, to evaluate the post-operative surgical site infection rates in emergency paediatric abdominal surgery. Incidence of surgical site infection (SSI) was estimated. P-value was calculated, chi-square and non-parametric tests were performed by comparing pre-surgical and post-surgical procedure pathogen occurrence and pre-procedure wound status. Pathogen occurrence related to time-trend of 98 paediatric patients who underwent emergency abdominal surgery was plotted. Of the 94 who were discharged in stable condition, it was found that there was no significant difference between pre- and post-surgical pathogens. Escherichia coli (n=10) was found to be the most common pathogen. Contaminated wounds were associated with higher SSI (p=0.036, OR 1.95 95% CI 0.7-5.4). Continuous...

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