A diagnostic algorithm for the surveillance of deep surgical site infections after colorectal surgery

AbstractObjective:Surveillance of surgical site infections (SSIs) is important for infection control and is usually performed through retrospective manual chart review. The aim of this study was to develop an algorithm for the surveillance of deep SSIs based on clinical variables to enhance efficiency of surveillance.Design:Retrospective cohort study (2012–2015).Setting:A Dutch teaching hospital.Participants:We included all consecutive patients who underwent colorectal surgery excluding those with contaminated wounds at the time of surgery. All patients were evaluated for deep SSIs through manual chart review, using the Centers for Disease Control and Prevention (CDC) criteria as the reference standard.Analysis:We used logistic regression modeling to identify predictors that contributed to the estimation of diagnostic probability. Bootstrapping was applied to increase generalizability, followed by assessment of statistical performance and clinical implications.Results:In total, 1,606 patients were included, of whom 129 (8.0%) acquired a deep SSI. The final model included postoperative length of stay, wound class, readmission, reoperation, and 30-day mortality. The model achieved 68.7% specificity and 98.5% sensitivity and an area under the receiver operator characteristic (ROC) curve (AUC) of 0.950 (95% CI, 0.932–0.969). Positive and negative predictive values were 21.5% and 99.8%, respectively. Applying the algorithm resulted in a 63.4% reduction in the number of records requiring full manual review (from 1,606 to 590).Conclusions:This 5-parameter model identified 98.5% of patients with a deep SSI. The model can be used to develop semiautomatic surveillance of deep SSIs after colorectal surgery, which may further improve efficiency and quality of SSI surveillance.

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Harnessing Claims to Improve Detection of Surgical Site Infections following Hysterectomy and Colorectal Surgery

Infection Control and Hospital Epidemiology ◽

10.1086/673975 ◽

2013 ◽

Vol 34 (12) ◽

pp. 1321-1323 ◽

Cited By ~ 14

Author(s):

Alyssa R. Letourneau ◽

Michael S. Calderwood ◽

Susan S. Huang ◽

Dale W. Bratzler ◽

Allen Ma ◽

...

Keyword(s):

Colorectal Surgery ◽

Surgical Site Infection ◽

Chart Review ◽

Claims Data ◽

Surgical Site Infections ◽

Performance Characteristics ◽

Site Infection ◽

Routine Surveillance

Surgical site infection (SSI) surveillance is performed using a variety of methods with unclear performance characteristics. We used claims data to identify records for review following hysterectomy and colorectal surgery. Claims-enhanced screening identified SSIs missed by routine surveillance and could be used for targeted chart review to improve SSI detection.

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Surgical Site Infection Rates in Laparoscopic Versus Open Colorectal Surgery

The American Surgeon ◽

10.1177/000313481107701003 ◽

2011 ◽

Vol 77 (10) ◽

pp. 1290-1294 ◽

Cited By ~ 52

Author(s):

Rahim Aimaq ◽

Gabriel Akopian ◽

Howard S. Kaufman

Keyword(s):

Colorectal Surgery ◽

Surgical Site Infections ◽

Laparoscopic Group ◽

Improvement Program ◽

Chi Square ◽

Factors Associated ◽

Acs Nsqip ◽

Increase Risk ◽

Acs Nsqip Database ◽

Wound Class

The purpose of this study was to use the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to evaluate the incidence of postoperative surgical site infections (SSIs) between laparoscopic (LAP) and open colorectal surgery. The 2008 ACS-NSQIP Participant Use File was queried by Current Procedural Terminology codes for colorectal surgery cases. SSI rates were compared between groups using Pearson chi-square and Fisher exact tests. Univariate and multivariate analyses were performed to identify factors associated with the LAP approach and/or SSIs. A total of 7,755 LAP and 16,184 open cases were identified. The laparoscopic group had an SSI rate of 9.4 versus 15.7 per cent for the open group ( P < 0.0001). There was no statistical difference in the type of SSI (superficial, deep, and/or organ space) between the two groups. Although multivariate analysis identified several factors associated with SSIs of different types, LAP was the only factor found to decrease risk, whereas wound class and operative time were found to increase risk among all categories of SSIs. Despite a significantly lower incidence of postoperative SSI, only 32 per cent of colorectal surgery was performed laparoscopically in NSQIP hospitals in 2008. Wider adoption of LAP approaches for colorectal surgery should continue to reduce SSIs.

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Use of triclosan-coated suture material as prevention of surgical site infections (literature review)

Wounds and wound infections The prof B M Kostyuchenok journal ◽

10.25199/2408-9613-2021-8-2-28-32 ◽

2021 ◽

Vol 8 (2) ◽

pp. 28-32

Author(s):

S. M. Sharkov ◽

S. R. Ikhsanova

Keyword(s):

Risk Index ◽

Surgical Site Infections ◽

Infectious Complications ◽

World Health ◽

International Studies ◽

Long Time ◽

International Data ◽

Health Organization ◽

Wound Class

According to international data, the incidence of infections in the field of surgery in children and adults varies from 2.0 to 20.0 %. The occurrence of the above infections is influenced by many factors: the presence of comorbidities, ASA index, surgical wound class, NNIS risk index. Important factors include the quality of the suture. According to experts of the World Health Organization, 40.0–60.0 % of infections in the field of surgery can be prevented. The first microbiological study of suture (polyglactin 910) with triclosan was published in 2002. According to international studies, the use of a triclosan reduces the adhesion of bacteria to the suture, the viability of microbes and the release of inflammatory mediators. Triclosan actively prevents the colonization of the filament, in addition, concentrations sufficient to suppress the growth and reproduction of pathogens are maintained in the environment for a long time, resulting in the prevention of the development of infectious complications.

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Development of a Multidisciplinary Aerodigestive Program: An Institutional Experience

Children ◽

10.3390/children8070535 ◽

2021 ◽

Vol 8 (7) ◽

pp. 535

Author(s):

Seung Kim ◽

Mireu Park ◽

Eunyoung Kim ◽

Ga Eun Kim ◽

Jae Hwa Jung ◽

...

Keyword(s):

Quality Of Life ◽

Chart Review ◽

Retrospective Chart Review ◽

Multidisciplinary Management ◽

Neurologic Disease ◽

Institutional Experience ◽

Swallowing Difficulty ◽

The Common ◽

Chronic Comorbidities

We share our experience on the implementation of a multidisciplinary aerodigestive program comprising an aerodigestive team (ADT) so as to evaluate its feasibility. We performed a retrospective chart review of the patients discussed at the monthly ADT meetings and analyzed the data. A total of 98 children were referred to the ADT during the study period. The number of cases increased steadily from 3.5 cases per month in 2019 to 8.5 cases per month in 2020. The median age of patients was 34.5 months, and 55% were male. Among the chronic comorbidities, neurologic disease was the most common (85%), followed by respiratory (36%) and cardiac (13%) disorders. The common reasons for consultation were suspected aspiration (56%), respiratory difficulty (44%), drooling/stertor (30%), regurgitation/vomiting (18%), and feeding/swallowing difficulty (17%). Following discussions, 58 patients received active interventions, including fundoplication, gastrostomy, laryngomicrosurgery, tracheostomy, and primary dilatation of the airway. According to the questionnaire of the caregiver, the majority agreed that the main symptoms and quality of life of patients had improved (88%), reducing the burden on caregivers (77%). Aerodigestive programs may provide comprehensive and multidisciplinary management for children with complex airway and digestive tract disorders.

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Evaluation of HiCrome KPC Agar for the Screening of Carbapenem-Resistant Enterobacterales Colonization in the ICU Setting of a Tertiary Care Hospital

Journal of Laboratory Physicians ◽

10.1055/s-0041-1732494 ◽

2021 ◽

Author(s):

Ashoka Mahapatra ◽

K Nikitha ◽

Sutapa Rath ◽

Bijayini Behera ◽

Kavita Gupta

Keyword(s):

Tertiary Care ◽

High Sensitivity ◽

Care Hospital ◽

Predictive Values ◽

Klebsiella Pneumoniae Carbapenemase ◽

Carbapenem Resistant ◽

Rectal Swabs ◽

Control And Prevention ◽

Indian Setting ◽

Sensitivity Specificity

Abstract Background Spread of carbapenem-resistant Enterobacterales (CRE) is a significant concern in intensive care unit (ICU) settings. Approaches to routine screening for CRE colonization in all ICU patients vary depending on institutional epidemiology and resources. The present study was aimed to evaluate the performance of HiCrome Klebsiella pneumoniae carbapenemase (KPC) agar for the detection of CRE colonization in ICU settings taking the Centers for Disease Control and Prevention (CDC) recommended method as reference. Methods Two-hundred and eighty rectal swabs (duplicate) from 140 patients were subjected to CRE detection in HiCrome KPC agar and MacConkey agar (CDC criteria). Results Using CDC method, total 41 CRE isolates were recovered comprising of 29 E scherichia coli, 11 Klebsiella, and 1 Enterobacter spp. On the other hand, 49 isolates of CRE recovered from 140 rectal swabs using HiCrome KPC agar, out of which 33 were E. coli, 15 Klebsiella, and 1 Enterobacter sp. Statistical Analysis Sensitivity, specificity, negative, and positive predictive values of CRE screening by HiCrome KPC agar were found to be 100% (91.4–100), 91.9% (84.8–95.8), 83.6% (70.9–91.4), and 100% (95.9–100), respectively, taking the CDC recommended method as reference. Conclusion HiCrome KPC agar has high sensitivity in screening CRE colonization. Further studies are needed to establish its applicability for detecting the predominant circulating carbapenemases in the Indian setting.

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Mycobacterium chimaera infections among cardiothoracic surgery patients associated with heater-cooler devices—Kansas and California, 2019

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.396 ◽

2021 ◽

pp. 1-6

Author(s):

Kerui Xu ◽

Lauren E. Finn ◽

Robert L. Geist ◽

Christopher Prestel ◽

Heather Moulton-Meissner ◽

...

Keyword(s):

Operating Room ◽

Environmental Samples ◽

Chart Review ◽

Whole Genome ◽

Environmental Isolates ◽

Outbreak Strain ◽

Medical Chart Review ◽

The Us ◽

Control And Prevention ◽

Cleaning And Disinfection

Abstract Background: In 2015, an international outbreak of Mycobacterium chimaera infections among patients undergoing cardiothoracic surgeries was associated with exposure to contaminated LivaNova 3T heater-cooler devices (HCDs). From June 2017 to October 2020, the Centers for Disease Control and Prevention was notified of 18 patients with M. chimaera infections who had undergone cardiothoracic surgeries at 2 hospitals in Kansas (14 patients) and California (4 patients); 17 had exposure to 3T HCDs. Whole-genome sequencing of the clinical and environmental isolates matched the global outbreak strain identified in 2015. Methods: Investigations were conducted at each hospital to determine the cause of ongoing infections. Investigative methods included query of microbiologic records to identify additional cases, medical chart review, observations of operating room setup, HCD use and maintenance practices, and collection of HCD and environmental samples. Results: Onsite observations identified deviations in the positioning and maintenance of the 3T HCDs from the US Food and Drug Administration (FDA) recommendations and the manufacturer’s updated cleaning and disinfection protocols. Additionally, most 3T HCDs had not undergone the recommended vacuum and sealing upgrades by the manufacturer to decrease the dispersal of M. chimaera–containing aerosols into the operating room, despite hospital requests to the manufacturer. Conclusions: These findings highlight the need for continued awareness of the risk of M. chimaera infections associated with 3T HCDs, even if the devices are newly manufactured. Hospitals should maintain vigilance in adhering to FDA recommendations and the manufacturer’s protocols and in identifying patients with potential M. chimaera infections with exposure to these devices.

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Efficacy of Internal Neurolysis for Trigeminal Neuralgia without Vascular Compression

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0041-1723809 ◽

2021 ◽

Author(s):

Ming-Wu Li ◽

Xiao-feng Jiang ◽

Chaoshi Niu

Keyword(s):

Pain Relief ◽

Trigeminal Neuralgia ◽

Chart Review ◽

Vascular Compression ◽

Internal Neurolysis ◽

Facial Numbness ◽

Relief Rate

Abstract Background and Objective Trigeminal neuralgia is a common neurologic disease that seriously impacts a patient's quality of life. We retrospectively investigated the efficacy and safety of internal neurolysis (nerve combing) for trigeminal neuralgia without vascular compression. Patients and Methods This study was a retrospective review of all patients with trigeminal neuralgia who were admitted between January 2014 and February 2019. A subgroup of 36 patients had no vascular compression at surgery and underwent internal neurolysis. Chart review and postoperative follow-up were performed to assess the overall outcomes of internal neurolysis. Results Thirty-six patients were identified, with a mean age of 44.89 ± 7.90 (rang: 31–65) years and a disease duration of 5.19 ± 2.61 years. The immediate postoperative pain relief (Barrow Neurological Institute [BNI] pain score of I or II) rate was 100%. The medium- to long-term pain relief rate was 91.7%. Three patients experienced recurrence. Facial numbness was the primary postoperative complication. Four patients with a score of III on the BNI numbness scale immediately after surgery had marked improvement at 6 months. No serious complications occurred. Conclusion Internal neurolysis is a safe and effective treatment for trigeminal neuralgia without vascular compression or clear responsible vessels.

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The impact of Radiotherapy on Swallowing and Speech in Patients who Undergo total Laryngectomy

Otolaryngology ◽

10.1016/j.otohns.2008.08.023 ◽

2008 ◽

Vol 139 (6) ◽

pp. 792-797 ◽

Cited By ~ 21

Author(s):

Carmen de Casso ◽

Nicholas J. Slevin ◽

Jarrod J. Homer

Keyword(s):

Total Laryngectomy ◽

Chart Review ◽

Detrimental Effect ◽

Definitive Treatment ◽

Soft Diet ◽

Carcinoma Of The Larynx ◽

Voice Development ◽

The Impact ◽

Single Modality

Objectives Quality of life studies have shown no detrimental effect with radiotherapy (RT) in patients who have a total laryngectomy. We wished to determine the effect of RT (initial or postoperative) specifically on the swallowing and voice function in patients treated by total laryngectomy (TL) for carcinoma of the larynx. Design Multicenter chart review. Setting Multicenter study in the Greater Manchester and Lancashire area. Participants A total of 121 postlaryngectomy patients all of whom had completed definitive treatment at least 6 months before this study. Twenty-six patients had total laryngectomy as a single modality treatment and 95 had total laryngectomy and radiotherapy. Main Outcome Measures Swallowing (solid food, soft diet or fluid/PEG) and voice development. Results Swallowing was better in the group who had no radiotherapy ( P = 0.0037). There was no difference in voice function between the two groups. We also demonstrated that females had a worse swallowing outcome ( P = 0.0101), as did advanced nodal stage ( P = 0.001). Conclusions RT adversely affects the swallowing results but not the speech results after TL when given either as initial treatment or postoperatively. This should be kept in mind in the decision-making process in the treatment of patients with carcinoma of the larynx.

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