The Association of Diabetes and Glucose Control With Surgical-Site Infections Among Cardiothoracic Surgery Patients

2001 ◽  
Vol 22 (10) ◽  
pp. 607-612 ◽  
Author(s):  
Robert Latham ◽  
Ava D. Lancaster ◽  
Janet F. Covington ◽  
John S. Pirolo ◽  
Clarence S. Thomas
Keyword(s):  
Tertiary Care ◽  
Surgical Site Infections ◽  
Cardiothoracic Surgery ◽  
Undiagnosed Diabetes ◽  
Risk Of Infection ◽  
Case Control Studies ◽  
Chronic Complications ◽  
Preoperative Hemoglobin ◽  
Increased Risk ◽  
The Mean

AbstractObjective:To assess the importance of diabetes, diabetes control, hyperglycemia, and previously undiagnosed diabetes in the development of surgical-site infections (SSIs) among cardiothoracic surgery patients.Setting:A 540-bed tertiary-care university-affiliated hospital.Design:Prospective cohort and case-control studies.Patients:All patients having cardiothoracic surgery between November 1998 and September 1999 were eligible for participation. One thousand patients had preoperative hemoglobin Ale determinations. Seventy-four patients with SSIs were identified.Results:Diabetes (odd ratio [OR], 2.76; P<.001) and postoperative hyperglycemia (OR, 2.02; P=.007) were independently associated with development of SSIs. Among known diabetics, elevated hemoglobin Ale values were not associated with a statistically significantly increased risk of infection; the mean Ale value was 8.44% among those with infections compared with 7.80% for those without (P=.09). Forty-two (6%) of 700 patients without prior diabetes history had evidence of undiagnosed diabetes; their infection rate was comparable to that of known diabetics (3/42 [796] vs 17/300 [6%]; P=.72). An additional 30% of nondiabetics had elevated hemoglobin Ale determinations or perioperative hyperglycemia.Conclusions:Postoperative hyperglycemia and previously undiagnosed diabetes are associated with development of SSIs among cardiothoracic surgery patients. Screening for diabetes and hyperglycemia among patients having cardiothoracic surgery may be warranted to prevent postoperative and chronic complications of this metabolic abnormality.

scholarly journals Study of antimicrobial use in paediatric inpatients in a tertiary care hospital in Ahmedabad, India

2020 ◽  
Vol 8 (1) ◽  
pp. 35
Author(s):  
Hetal N. Jeeyani ◽  
Rutvik H. Parikh ◽  
Sheena Sivanandan ◽  
Harsh J. Muliya ◽  
Shivam N. Badiyani ◽  
...  
Keyword(s):  
Bacterial Resistance ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Care Hospital ◽  
Antimicrobial Drugs ◽  
Prescribing Indicators ◽  
Inappropriate Use ◽  
Increased Risk ◽  
The Mean

Background: Inappropriate use and overuse of antibiotics are important factors leading to increased bacterial resistance apart from increased risk of adverse reactions. The aim of this study was to derive antibiotic use percentage, study its pattern and compare antibiotic prescribing indicators with standard indicators.Methods: This prospective observational study was conducted from 1st August 2018 to 31st July 2019 on paediatric inpatients from 1 month to 14 years. All the relevant data was taken from the case records of patients at the time of discharge. The data included: age, sex, hospital stay, clinical diagnosis and details of antimicrobial treatment.Results: From 989 patients, 85.9% were diagnosed with infectious illness, of which 60.1% had viral and 36.7% had bacterial infection. The use of antimicrobial drugs was 42.7% and antibiotics was 40.4%. The mean number of antibiotics received was 1.13±0.31. 90% patients received single antibiotic. 88.8% drugs were prescribed by generic name and 99% drugs were prescribed from essential drug formulary. 17 different antibiotics were used out of which ceftriaxone (62.5%) was the most commonly used. Groupwise, antibiotic use was cephalosporins (68.4%), penicillin (20.2%), aminoglycosides (4.31%), fluoroquinolones (0.9%) and macrolides (0.22%). The use of higher antibiotics like vancomycin (3.86%) and carbapenems (0.68%) was quite less.Conclusions: The antibiotic use in our hospital was higher than the WHO standard but less as compared to majority of other studies. Use of cephalosporins was more and penicillin was less as compared to other studies. This suggests that there is a need of implementing antibiotic stewardship programs to enhance rational antibiotic prescribing.

Surgical-Site Infections Following Cesarean Section in an Estonian University Hospital: Postdischarge Surveillance and analysis of Risk Factors

2005 ◽  
Vol 26 (5) ◽  
pp. 449-454 ◽  
Author(s):  
Piret Mitt ◽  
Katrin Lang ◽  
Aira Peri ◽  
Matti Maimets
Keyword(s):  
Risk Factors ◽  
Cesarean Section ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Fetal Monitoring ◽  
University Hospital ◽  
Cross Sectional Survey ◽  
Increased Risk ◽  
Multi Method Approach ◽  
Method Approach

AbstractObjectives:To evaluate a multi-method approach to postdischarge surveillance of surgical-site infections (SSIs) and to identify infection rates and risk factors associated with SSI following cesarean section.Design:Cross-sectional survey.Setting:Academic tertiary-care obstetric and gynecology center with 54 beds.Patients:All women who delivered by cesarean section in Tartu University Women's Clinic during 2002.Methods:Infections were identified during hospital stay or by postdischarge survey using a combination of telephone calls, healthcare worker questionnaire, and outpatient medical records review. SSI was diagnosed according to the criteria of the Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System.Results:The multi-method approach gave a follow-up rate of 94.8%. Of 305 patients, 19 (6.2%; 95% confidence interval [CI95)], 3.8-9.6) had SSIs. Forty-two percent of these SSIs were detected during postdischarge surveillance. We found three variables associated with increased risk for developing SSI: internal fetal monitoring (odds ratio [OR], 16.6; CI95, 2.2-125.8; P = .007), chorioamnionitis (OR, 8.8; CI95, 1.1-69.6; P = .04), and surgical wound classes III and IV (OR, 3.8; CI95, 1.2-11.8; P=.02).Conclusions:The high response rate validated the effectiveness of this kind of surveillance method and was most suitable in current circumstances. A challenge exists to decrease the frequency of internal fetal monitoring and to treat chorioamnionitis as soon as possible (Infect Control Hosp Epidemiol 2005;26:449-454).

Assessment of Catheter-Associated Infection Risk with the Hickman Right Atrial Catheter

1984 ◽  
Vol 5 (5) ◽  
pp. 226-230 ◽  
Author(s):  
Peter C. Fuchs ◽  
Marie E. Gustafson ◽  
James T. King ◽  
Patrick T. Goodall
Keyword(s):  
Parenteral Nutrition ◽  
Antibiotic Therapy ◽  
Cancer Chemotherapy ◽  
Infection Risk ◽  
Right Atrial ◽  
Risk Of Infection ◽  
Primary Indication ◽  
Increased Risk ◽  
Atrial Catheter ◽  
The Mean

AbstractOne hundred fifty Hickman right atrial catheters were inserted into 143 patients and were followed prospectively until removal. Primary indications for their use were: cancer chemotherapy (45), parenteral nutrition (35), antibiotic therapy (63), and miscellaneous (7). The overall catheter-associated infection rate was 12.0%. Since the mean duration of catheterization was 125 days, the infection/duration rate was 1.0/1,000 days of use. The risk of infection differed significantly according to the primary indication for catheterization: parenteral nutrition > antibiotic therapy > cancer chemotherapy. The increased risk of catheter-associated infection attributable to duration of catheterization was additive, and the per day risk of such infections remained constant regardless of duration. Nearly two-thirds of patients were discharged home with catheters in place, without adversely affecting infection risk.

scholarly journals 1234. Mental Models of Surgical Site Infection Prevention Among Surgical Technicians and Nurses

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S444-S445
Author(s):  
Aurora E Pop-Vicas ◽  
Amanda Young ◽  
Mary-Jo Knobloch ◽  
Nasia Safdar
Keyword(s):  
Behavior Change ◽  
Focus Groups ◽  
Mental Models ◽  
Wound Care ◽  
Care Center ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Post Discharge ◽  
Sterile Technique ◽  
Increased Risk

Abstract Background Surgical site infections (SSI) are common and costly. Institutions have implemented complex prevention bundles to reduce SSI, but adherence remains challenging. Understanding clinicians’ mental models related to SSI prevention can help develop strategies to improve adherence. Methods We conducted focus groups with surgical clinicians at a tertiary care center. We used constructs from behavior change theories to analyze responses and identify relevant themes for SSI prevention. Results We had 19 participants (10 nurses, 9 surgical technicians) in 4 focus groups. We found the following SSI prevention challenges: (1) emphasis on rapid patient turnover, which impairs ability to complete all required infection control tasks; (2) OR crowding and traffic, with increased risk to sterile technique breaks; (3) poor compliance with OR attire, including wearing scrubs outside of the hospital; (4) inadequate OR cleaning between cases; (5) lack of emphasis on post-discharge wound care instructions. The following beliefs were commonly expressed: (1) belief that some SSI are inevitable, due to increased complexity and duration of surgical procedures in a referral center; (2) perceived lack of knowledge and training on OR sterile technique among medical and nursing students; (3) perceived incorrect techniques for applying skin preps among surgical residents, and, occasionally, attendings; (4) fear and hesitancy to bring up OR irregularities if individual involved is perceived as having a “difficult personality,” irrespective of social hierarchy; (5) feeling overwhelmed by too many requirements for SSI prevention, which frequently change; (6) belief that some policies originate from outside influences and are not relevant to frontline clinicians; (7) frustration to receiving SSI performance feedback that is not individualized and lacks actionable items; (8) feeling “blamed” for having SSI without knowing “how to fix it”; (9) belief that training rigor and dedication to patient care have decreased over time, and are lax among younger generations. Representative quotes categorized according to behavior change constructs are shown in Table 1. Conclusion Addressing clinicians’ perceptions of SSI prevention may help improve adherence to the process and reduce SSI incidence. Disclosures All authors: No reported disclosures.

scholarly journals Risk of Complications in Spine Surgery: A Prospective Study

2015 ◽  
Vol 9 (1) ◽  
pp. 20-25 ◽  
Author(s):  
Rodolfo Casimiro Reis ◽  
Matheus Fernandes de Oliveira ◽  
José Marcus Rotta ◽  
Ricardo Vieira Botelho
Keyword(s):  
Risk Factors ◽  
Prospective Study ◽  
Spine Surgery ◽  
Absolute Risk ◽  
Surgical Site Infections ◽  
Spine Instrumentation ◽  
Increased Risk ◽  
The Mean ◽  
A Prospective Study ◽  
Epidemiological Characteristics

Purpose : Complications are the chief concern of patients and physicians when considering spine surgery. The authors seek to assess the incidence of complications in patients undergoing spine surgery and identify risk factors for their occurrence. Methods : Prospective study of patients undergoing spine surgery from 1 February 2013 to 1 February 2014. Epidemiological characteristics and complications during the surgical hospitalization were recorded and analyzed. Results : The sample comprised 95 patients (mean age, 59 years). Overall, 23% of patients were obese (BMI =30). The mean BMI was 25.9. Approximately 53% of patients had comorbidities. Complications occurred in 23% of cases; surgical site infections were the most common (9%). There were no significant differences between patients who did and did not develop complications in terms of age (60.6 vs 59.9 years, p = 0.71), sex (56% female vs 54% female, p = 0.59), BMI (26.6 vs 27.2, p = 0.40), or presence of comorbidities (52% vs 52.8%, p = 0.87). The risk of complications was higher among patients submitted to spine instrumentation than those submitted to non-instrumented surgery (33% vs 22%), p=0.8. Conclusion : Just over one-quarter of patients in the sample developed complications. In this study, age, BMI, comorbidities were not associated with increased risk of complications after spine surgery. The use of instrumentation increased the absolute risk of complications.

scholarly journals Risk of burnout among emergency physicians at a tertiary care centre in Saudi Arabia

2014 ◽  
Vol 3 (4) ◽  
pp. 20 ◽  
Author(s):  
Abdulmohsen Alsaawi ◽  
Khaled Alrajhi ◽  
Saad Albaiz ◽  
Mohammed Alsultan ◽  
Majid Alsalamah ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
High Risk ◽  
Human Services ◽  
Tertiary Care ◽  
Maslach Burnout Inventory ◽  
Emergency Physicians ◽  
Risk Zone ◽  
Increased Risk ◽  
Study Results ◽  
The Mean

Background: Emergency Medicine physicians are shown to be at increased risk of burnout. In this study, we aimed to assess the risk of burnout among emergency physicians working at one of the largest Emergency Departments in Saudi Arabia. Methods: This is an observational, cross-sectional study based on a structured questionnaire Maslach Burnout Inventory- Human Services Survey (MBI-HSS), which has been previously tested and validated extensively. The study targeted all physicians in the Emergency Department (ED) at a tertiary medical center in Riyadh. A total of 72 emergency physicians were included in the study. Results: Overall, 53 (74%) out of 72 subjects filled the questionnaire. Out of the 53 respondents, 45 (85%) were males and eight (15%) females. The years of practice experience ranged from six months to 24 years, with a median of seven years. Burnout Inventory-Human Services Survey subscale results: Emotional Exhaustion (EE): The mean EE score was 2.72 (SD 1.28), with 21 participants (40%) in the high-risk zone. Depersonalization (DP): The mean DP score was 1.86 (SD 1.31), with 21 participants (40%) in the high-risk zone. Personal Accomplishment (PA): The mean PA score was 4.5 (SD 0.9), with 17 participants (32%) in the high-risk zone. Conclusion: Our results are consistent with previous literature in showing that emergency physicians are at a moderate to high risk of burnout. Decision makers should take serious steps to address the threat, in order to minimize the risk of burnout and its impact on physicians as well as the patient they care for.

scholarly journals Predicting of poor outcomes in COVID-19 patients: Experience from an Argentinean hospital

2021 ◽  
Vol 3 (4) ◽  
pp. 316-325
Author(s):  
Maximiliano Gabriel Castro ◽  
◽  
María José Sadonio ◽  
Aida Agustina Castillo Landaburo ◽  
Gisel Cuevas ◽  
...  
Keyword(s):  
Public Hospital ◽  
Care Center ◽  
Invasive Mechanical Ventilation ◽  
Tertiary Care ◽  
Santa Fe ◽  
Increased Risk ◽  
All Cause Mortality ◽  
The Mean ◽  
Poor Outcomes ◽  
Patients Experience

Introduction: The pressure over health systems caused by the COVID-19 pandemic brought about the need to develop tools that would allow for the identification of those patients that require immediate attention. Our objective was to identify clinical and biochemical predictors of poor outcomes (PO) in a cohort of patients hospitalized due to COVID-19 in an Argentinean public hospital. Methods: Prospective cohort study conducted from March 3rd, 2020 to February 16th, 2021 in a tertiary care center in Santa Fe, Argentina. Clinical and biochemical characteristics of patients with COVID-19 pneumonia admitted consecutively were analyzed in order to identify predictors of a composite of poor outcomes (PO) -all-cause mortality and/or need for invasive mechanical ventilation. Results: 421 patients were included. The mean age was 56.13 ± 15.05 years. 57.0% were males. 79.7% presented at least one comorbidity. 27.7% (n=116) presented PO. In the multivariate analysis, a higher 4C-score and a higher LDH, as well as a lower SatO2/FiO2, were associated with a higher risk of PO. No variable reached an AUC of 0.800 in the ROC analysis. 4C-score presented a numerically higher AUC (0.766 IC 95% 0.715-0.817). Conclusions: Each point that the 4C-score increases, the risk of PO rises by 28%. Also, for every 100-units increase in LDH or 50-units decrease in SatO2/FiO2 at admission, there is a 20% increased risk of PO.

scholarly journals Association of gestational age, Apgar score and neonatal outcomes in newborns with meconium stained amniotic fluid

2019 ◽  
Vol 6 (4) ◽  
pp. 1563
Author(s):  
Preeti Garg ◽  
Devendra Barua ◽  
Shruti Saxena
Keyword(s):  
Amniotic Fluid ◽  
Gestational Age ◽  
Apgar Score ◽  
Tertiary Care ◽  
Neonatal Outcomes ◽  
Control Group ◽  
Study Group ◽  
Increased Risk ◽  
The Mean ◽  
Meconium Stained Amniotic Fluid

Background: Infants born with meconium stained fluid are at increased risk of fetal hypoxia, evidenced by increased rates of abnormalities indicated by fetal monitoring in labor, low neonatal Apgar scores, and fetal deaths. The study is conducted to determine association of gestational age, Apgar score and neonatal outcomes in newborn born with meconium stained amniotic fluid in tertiary care centre of central India.Methods: The study was conducted over a period of 2 years from January 2012 to January 2014 in Department of Pediatrics, Sri Aurobindo Medical College and Hospital, Indore, Madhya Pradesh, India. One hundred newborns with meconium stained amniotic fluid (study group) and one hundred newborns with clear amniotic fluids (control group) were studied in this period. Gestational age, Apgar score and neonatal outcomes were compared among two groups.Results: The mean gestational age in study group was 38.89±1.14 weeks and in control group was 38.59±0.99 weeks. The mean Apgar score at 1 min was 5.80±1.59 in study group and in the control group was 7.86±0.35. 32 babies in meconium stained liquor had hypoxia of which 11 had respiratory distress, 11 required mechanical ventilation (MAS 08, sepsis 03), 2 newborns had HIE stage 2 and 5 patients died. The above findings suggest higher gestational age, lower Apgar score and poor neonatal outcomes are associated with meconium stained liquor.Conclusions: The study depicts significant co-relation with higher gestational age, lower Apgar at 1 and 5 minutes and poor neonatal outcome in babies with meconium stained amniotic fluid.

scholarly journals Decreased calorie and protein intake is a risk factor for infection and prolonged length of stay in surgical patients: A prospective cohort study

2016 ◽  
Vol 29 (3) ◽  
pp. 307-316 ◽  
Author(s):  
Michelli Cristina Silva de ASSIS ◽  
Carla Rosane de Moraes SILVEIRA ◽  
Mariur Gomes BEGHETTO ◽  
Elza Daniel de MELLO
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Tertiary Care ◽  
Nutritional Therapy ◽  
University Hospital ◽  
Risk Of Infection ◽  
Prolonged Length ◽  
Increased Risk

ABSTRACT Objective The aim was to assess whether postoperative calorie and protein intakes increase the risk of infection and prolonged length of stay in a tertiary care university hospital in Southern Brazil. Methods This is a prospective cohort study approved by the hospital's Research Ethics Committee. The sample consisted of adult patients undergoing elective surgery. The exclusion criteria included patients who could not undergo nutritional assessment and those with a planned hospital stay of fewer than 72 hours. Nutritional status was assessed on admission and every seven days thereafter until hospital discharge or death. Demographic and clinical data, as well as information regarding independent and outcome variables, were collected from the patient's records. Food intake assessment was conducted by researchers six times a week. Calorie and protein intakes were considered adequate if equal to or greater than 75% of the prescribed amount, and length of stay was considered prolonged when above the average for specialty and type of surgery. Data was analyzed using Poisson regression. Results Of the 519 study patients, 16.2% had adequate nutritional therapy. Most of these patients were men with ischemic heart disease and acquired immunodeficiency syndrome. After adjusting for confounders, inadequate nutritional therapy increased risk of infection by 121.0% (RR=2.21; 95%CI=1.01-4.86) and risk of prolonged length of stay by 89.0% (RR=1.89; 95%CI=1.01-3.53). Conclusion Most patients did not have adequate nutritional therapy. Those with inadequate nutritional therapy had a higher risk of infection and longer length of stay.

Risk Factors for Surgical-Site Infections Following Cesarean Section

2001 ◽  
Vol 22 (10) ◽  
pp. 613-617 ◽  
Author(s):  
Carol A. Killian ◽  
Eileen M. Graffunder ◽  
Timothy J. Vinciguerra ◽  
Richard A. Venezia
Keyword(s):  
Risk Factors ◽  
Cesarean Section ◽  
Antibiotic Prophylaxis ◽  
Multiple Logistic Regression Analysis ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Cesarean Sections ◽  
Increased Risk ◽  
Active Labor ◽  
Prenatal Visits

AbstractObjective:To identify risk factors associated with surgical-site infections (SSIs) following cesarean sections.Design:Prospective cohort study.Setting:High-risk obstetrics and neonatal tertiary-care center in upstate New York.Patients:Population-based sample of 765 patients who underwent cesarean sections at our facility during 6-month periods each year from 1996 through 1998.Methods:Prospective surgical-site surveillance was conducted using methodology of the National Nosocomial Infections Surveillance System. Infections were identified during admission, within 30 days following the cesarean section, by read-mission to the hospital or by a postdischarge survey.Results:Multiple logistic-regression analysis identified four factors independently associated with an increased risk of SSI following cesarean section: absence of antibiotic prophylaxis (odds ratio [OR], 2.63; 95% confidence interval [CI95], 1.50-4.6; P=.008); surgery time (OR, 1.01; CI95, 1.00-1.02; P=.04); <7 prenatal visits (OR, 3.99; CI95, 1.74-9.15; P=.001); and hours of ruptured membranes (OR, 1.02; CI95,1.01-1.03; P=.04).Patients given antibiotic prophylaxis had significantly lower infection rates than patients who did not receive antibiotic prophylaxis (F=02), whether or not active labor or ruptured membranes were present.Conclusion:Among the variables identified as risk factors for SSI, only two have the possibility to be changed through interventions. Antibiotic prophylaxis would benefit all cesarean patients regardless of active labor or ruptured membranes and would decrease morbidity and length of stay. Women's healthcare professionals also must continue to encourage pregnant women to start prenatal visits early in the pregnancy and to maintain scheduled visits throughout the pregnancy to prevent perinatal complications, including postoperative infection.

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