Improved Perioperative Antibiotic Use and Reduced Surgical Wound Infections Through Use of Computer Decision Analysis

1989 ◽  
Vol 10 (7) ◽  
pp. 316-320 ◽  
Author(s):  
Robert A. Larsen ◽  
R. Scott Evans ◽  
John P. Burke ◽  
Stanley L. Pestotnik ◽  
Reed M. Gardner ◽  
...  
Keyword(s):  
Antibiotic Use ◽  
Infectious Complications ◽  
First Year ◽  
Wound Infections ◽  
Infection Rates ◽  
Surgical Incision ◽  
Postoperative Wound ◽  
Prescribing Habits ◽  
Second Year ◽  
A Prospective Study

AbstractA prospective study was performed over a two-year period to determine whether computer-generated reminders of perioperative antibiotic use could improve prescribing habits and reduce postoperative wound infections. During the first year, baseline patterns of antibiotic use and postoperative infection rates were established. During the second year, computer-generated reminders regarding perioperative antibiotic use were placed in the patient's medical record prior to surgery and patterns of antibiotic use and postoperative wound infections monitored.Hospitalized patients undergoing non-emergency surgery from June to November 1985 (3,263 patients), and from June to November 1986 (3,568) were monitored with respect to indications for perioperative antibiotic use, timing of antibiotic use and postoperative infectious complications. Perioperative antibiotic use was considered advisable for 1,621 (50%) patients in the 1985 sample and for 1,830 (51%) patients in the 1986 sample. Among these patients, antibiotics were given within two hours before the surgical incision in 638 (40%) of the 1985 sample and 1,070 (58%) of the 1986 sample (p<0.001). Overall, postoperative wound infections were detected in 28 (1.8%) of 1,621 patients in 1985 compared with 16 (0.9%) of 1,830 such patients in 1986 (p<0.03).We conclude that computer-generated reminders of perioperative antibiotic use improved prescribing habits with a concurrent decline in postoperative wound infections.

scholarly journals Relation of intraoperative bile culture to the postoperative morbidity in hepatopancreatic and biliary surgeries

2019 ◽  
Vol 6 (11) ◽  
pp. 3967
Author(s):  
Sabina Nisar ◽  
Umer Jan ◽  
Ishfaq Ahmad Gilkar ◽  
Sadaf Ali Bangri ◽  
Sudershan Reddy
Keyword(s):  
Escherichia Coli ◽  
Postoperative Morbidity ◽  
Intervention Group ◽  
Wound Infections ◽  
Infection Rates ◽  
Medical Sciences ◽  
E Coli ◽  
Common Organism ◽  
Monomicrobial Infection ◽  
A Prospective Study

Background: The reported incidence of bacteria in bile is extremely variable 8%-42%. Several authors have been able to correlate the bacteria cultured from bile at operations with those subsequently causing wound infections and septicemia in postoperative period.Methods: This study was a prospective study conducted in Department of Surgical Gastroenterology at Sher-i-Kashmir Institute of Medical Sciences from July 2016 to June 2018. A total of 100 patients were included in study.Results: Mean age of the patients was 43.7±15.01, The most common organism found in our study was Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) in 33.9%, E.coli and Enterococcus faecalis 21%, The monomicrobial infection was due to E coli 11.3%, The patients with bactibilia had more of wound infection 54.8% and intra-abdominal collections 17.7%, most common organism from bile was E. coli and K. pneumonia and same organisms were also cultured from wound sites.Conclusions: The preoperative intervention group should be considered potentially infected, requires careful operative technique to avoid spillage of bile on wound surfaces to decrease infection rates and morbidity.

Perioperative Antibiotic Use in Endoscopic Endonasal Skull Base Surgery

2021 ◽  
Author(s):  
Morcos N. Nakhla ◽  
Tara J. Wu ◽  
Emmanuel G. Villalpando ◽  
Reza Kianian ◽  
Anthony P. Heaney ◽  
...  
Keyword(s):  
Surgical Repair ◽  
Antibiotic Use ◽  
Infectious Complications ◽  
Csf Leak ◽  
Infection Rates ◽  
Endoscopic Endonasal ◽  
Heavy Burden ◽  
Endoscopic Endonasal Transsphenoidal Surgery ◽  
Evidence Based Guidelines ◽  
Optimal Type

Abstract Background Improved evidence-based guidelines on the optimal type and duration of antibiotics for patients undergoing endoscopic endonasal transsphenoidal surgery (EETS) are needed. We analyze the infectious complications among a large cohort of EETS patients undergoing a standardized regimen of cefazolin for 24 hours, followed by cephalexin for 7 days after surgery (clindamycin if penicillin/cephalosporin allergic). Methods A retrospective review of 132 EETS patients from 2018 to 2020 was conducted. Patient, tumor, and surgical characteristics were collected, along with infection rates. Multivariate logistic regression determined the variable(s) independently associated with infectious outcomes. Results Nearly all patients (99%) received postoperative antibiotics with 78% receiving cefazolin, 17% receiving cephalexin, 3% receiving clindamycin, and 2% receiving other antibiotics. Fifty-three patients (40%) had an intraoperative cerebrospinal fluid (CSF) leak, and three patients (2%) developed a postoperative CSF leak requiring surgical repair. Within 30 days, no patients developed meningitis. Five patients (4%) developed sinusitis, two patients (3%) developed pneumonia, and one patient (1%) developed cellulitis at a peripheral intravenous line. Two patients (2%) developed an allergy to cephalexin, requiring conservative management. After adjustment for comorbidities and operative factors, presence of postoperative infectious complications was independently associated with increased LOS (β = 3.7 days; p = 0.001). Conclusion Compared with reported findings in the literature, we report low rates of infectious complications and antibiotic intolerance, despite presence of a heavy burden of comorbidities and high intraoperative CSF leak rates among our cohort. These findings support our standardized 7-day perioperative antibiotic regimen.

scholarly journals Automatic Artificial Hair Implant: Safety and Efficacy in Androgenetic Alopecia. A Prospective Study with a Highly Biocompatible Fiber

2018 ◽  
Vol 6 (1) ◽  
pp. 38-42 ◽  
Author(s):  
Amr Abdel - Hakim Rateb Said ◽  
Bogdan Morad Albzour ◽  
Mariangela Santiago ◽  
Manjul Agrawal ◽  
Miriam Rovesti ◽  
...  
Keyword(s):  
Systemic Treatment ◽  
Polyamide Fibre ◽  
Androgenetic Alopecia ◽  
First Year ◽  
Clinical Safety ◽  
Safety And Efficacy ◽  
Operative Care ◽  
Covered Area ◽  
Second Year ◽  
A Prospective Study

AIM: A multi - centre two years the long prospective open clinical study was conducted in five countries located in four different continents from May 2015 to evaluate the clinical safety and efficacy of Automatic Biofibre hair implant in male and female androgenetic alopecia. Biofibre®is a CE/TGA certified medical grade polyamide fibre suitable for implantation.MATERIAL AND METHODS: A total of 213 patients were enrolled in the study. Patients were assessed pre -operatively by Hamilton scale grading and the percentage of scalp covered by hair. All the patients underwent Biofibre hair implantation by a standardised surgical technique followed by adequate post-operative care. Efficacy of the implant was evaluated by surgeons and patients bimonthly for the first year and trimonthly during the second year. Any adverse effects were recorded during these visits.RESULTS: At the completion of the study period, a total of 194 patients concluded the trial and the results were statistically evaluated. Both Hamilton scale grading and covered area percent improved at the end of the study, and subjective and objective evaluations revealed satisfactory results. Side effects were reported in only 18 cases (9.27%) which were easily controlled by either topical or systemic treatment in 8 to 10 days.CONCLUSION: Overall a successful result was noticed in 97.94% of patients with great psychological satisfaction.

Postoperative Wound Infections Following Cardiac Surgery: Significance of Contaminated Cases Performed in the Preceding 48 Hours

1984 ◽  
Vol 5 (8) ◽  
pp. 371-377 ◽  
Author(s):  
Malkanthie I. deSilva ◽  
J. Peter Rissing
Keyword(s):  
Cardiac Surgery ◽  
Operative Time ◽  
Surgical Wound Infection ◽  
Wound Infections ◽  
Open Heart ◽  
Surgical Wound ◽  
Infection Rates ◽  
Postoperative Wound ◽  
Handling System ◽  
Prolonged Operative Time

AbstractPostoperative wound infections following open heart cardiac surgery increased markedly after hospital relocation (7 of 77 v; 4 of 320; p = .0007). Of the multiple identified risk factors, significant patient and procedural association included prolonged operative time of infected patients (384 minutes ± 115 SD v 318 ± 67, p = .025) and operation in a room used within the previous 48 hours for a contaminated case (4/7 infected v 10/67 not infected; p = .023). Several defects were discovered in the air handling system. After appropriate changes, the infection rate decreased in the next 12 months (1 of 109; p < .02). Other concurrent surgical wound infection rates remained unchanged suggesting that defective air handling may have impacted only on the open heart cardiac surgery patients. Preceding contaminated surgery and prolonged operative time were associated with postoperative wound infections in cardiac surgery.

scholarly journals Preoperative Endoscopic Biliary Stenting Before Pancreaticoduodenectomy: Does Timing Matter?

2020 ◽  
pp. 155335062097588
Author(s):  
Abu Bakar Hafeez Bhatti ◽  
Roshni Z. Jafri ◽  
Muhammed Kashif Khan ◽  
Faisal Saud Dar
Keyword(s):  
Wound Infection ◽  
Wound Infections ◽  
Infection Rates ◽  
Biliary Stenting ◽  
Postoperative Wound ◽  
Group 4 ◽  
Significant Difference ◽  
The Impact ◽  
Surgery Duration

Background. The role of preoperative biliary stenting (PBS) before pancreaticoduodenectomy (PD) in patients with obstructive jaundice is debatable. The objective of the current study was to assess PD outcomes after upfront surgery or PBS and determine the impact of stent to surgery duration on PD outcomes. Methods. We reviewed patients who underwent PD between 2011 and 2019. Patients were grouped based on whether they underwent upfront surgery (n = 67) or PBS (n = 66). We further assessed outcomes based on stent to surgery duration. Results. There was no significant difference in 30-day mortality (3% vs. 2.9%, P = 1), 90-day mortality (7.5% vs. 4.4%, P = .4), and Grade B-C pancreatic fistula rates (7.5% vs. 4.4%, P = .4) in the PBS and upfront surgery groups, respectively. A significant increase in wound infections (22.7% vs. 7.4%, P = .01) and readmissions (10.6% vs. 0, P = .006) was seen in the PBS group. The highest rate of wound infection was seen when stent to surgery duration was 4-6 weeks (41.6%). The wound infection rates in the upfront surgery group, high-risk PBS group (4-6 weeks), and low-risk PBS group were 5/67(7.4%), 5/12(41.6%), and 7/36(19.4%), respectively ( P = .008). Conclusions. PBS increases postoperative wound infections when compared with upfront surgery. Patients operated between 4 and 6 weeks after stenting have the highest rate of wound infection.

scholarly journals Knowledge, Attitude and Practice on Antibiotic Use among Medical Students

2020 ◽  
Vol 8 (1) ◽  
pp. 23-33
Author(s):  
Lokeshwar Chaurasia ◽  
Sanjay Chaudhary ◽  
Gita Paudel ◽  
Jitendra Kumar Singh
Keyword(s):  
Medical Students ◽  
Bacterial Resistance ◽  
Antibiotic Use ◽  
First Year ◽  
Undergraduate Medical Students ◽  
Medical College ◽  
Attitude And Practice ◽  
Significant Difference ◽  
Second Year ◽  
Knowledge Attitude And Practice

Background and Objectives: Bacterial resistance has reached an alarming proportion in developing countries because of various reasons like indiscriminate use of antibiotics and its availability as over the counter (OTC) drugs. This study is to get an overview of students understanding of antibiotics and to compare the knowledge, attitude and practice (KAP) on antibiotic use among undergraduate medical students. Material and methods: This was a descriptive cross-sectional study conducted among undergraduate medical students of Janaki Medical College. A structured and customized self-administered questionnaire was used to collect data on socio-demographic and knowledge, attitude and practice (KAP) regarding antibiotic use of medical students. Data were analyzed using SPSS version 20. P < 0.05 was considered statistically significant. Results: Out of 183 undergraduate medical students from first, second and third year of Janaki medical College, 115 (62.8%) were male and 68 (37.2%) were female. Among medical students, mean rank of knowledge on antibiotic use among first year (mean rank = 89.36) and second year (mean rank = 87.50) was lower compared to third year (mean rank = 97.78). The mean rank for attitude among first year (mean rank = 87.75) and second year (mean rank = 94.38) was lower compared to third year (mean rank = 94.56). Likewise, practice of antibiotic use was low among first year (mean rank = 61.27) and second year (mean rank = 105.91) compared to third year students (mean rank = 115.19). There is significant difference of mean rank for the practice (p<0.0001) but not for knowledge and attitude on antibiotic use among the students studying in different years. Conclusion: This study showed varying level of knowledge, attitude and practice on antibiotics use among undergraduate medical students of first, second and third year, suggesting that continuous educational intervention on rational use of antibiotic should be made mandatory in the all the academic years of undergraduate medical curriculum, for promoting judicious use of antibiotics, minimizing self-medication and impacts of antibiotic resistance, and for rational antibiotics prescription by future doctors.

Deep Brain Stimulation-Related Infections: Analysis of Rates, Timing, and Seasonality

Neurosurgery ◽  
2017 ◽  
Vol 83 (3) ◽  
pp. 540-547 ◽  
Author(s):  
Fran A Hardaway ◽  
Ahmed M Raslan ◽  
Kim J Burchiel
Keyword(s):  
Deep Brain Stimulation ◽  
Infection Rate ◽  
Brain Stimulation ◽  
Infectious Complications ◽  
First Year ◽  
Infection Rates ◽  
Chi Square ◽  
Seasonal Basis ◽  
Deep Brain

Abstract BACKGROUND Infection is one of the most common complications of deep brain stimulation (DBS). Long-term infection rates beyond the immediate postoperative period are rarely evaluated. OBJECTIVE To study short- and long-term DBS-related infection rates; to evaluate any potential seasonality associated with DBS-related infections. METHODS We retrospectively reviewed all DBS surgeries performed in a 5-yr period at 1 hospital by a single surgeon. Infection rates and clinical characteristics were analyzed. Postoperative “infections” were defined as occurring within 6 mo of implantation of DBS hardware, while “erosions” were defined as transcutaneous exposure of hardware at ≥6 mo after implantation. Based on the date of surgery preceding an infection, rates of infection were calculated on a monthly and seasonal basis and compared using Chi square and logistic regression analyses. RESULTS A total of 443 patients underwent 592 operations; 311 patients underwent primary DBS placement with 632 electrodes. Primary DBS placement infection incidence was 2.6%. DBS procedure infection and infection rate by electrode were 2.9% and 3.2%, respectively. Infectious complications presented later than 6 mo postoperatively in 38% of infected patients Summer (July-September) infection rate was significantly higher than other seasons (P = .002). The odds ratio of an infection related to a surgery performed in August was found to be 4.15 compared to other months (P = .021). CONCLUSION There is a persistent risk of DBS infection and erosion beyond the first year of DBS implantation. Start of the academic year was associated with increased infection rate at our institution.

An inevitable crisis? From first to second year in counsellor training

2020 ◽  
Vol 5 (1) ◽  
pp. 74-89
Author(s):  
Hugh Crago
Keyword(s):  
Right Hemisphere ◽  
Training Programme ◽  
First Year ◽  
Training Experience ◽  
Counsellor Training ◽  
Student Dropout ◽  
Second Year ◽  
Neurological Research ◽  
First Year Of Life ◽  
And Control

In a seminal 1973 paper, Robert Clark described the very different “cultures” of the first and second year students in a four year clinical psychology PhD programme. The author applies Clark’s template to his own experiences as trainee or trainer in five different counsellor education programmes, one in the US and four in Australia. Each of the programmes, to varying degrees, demonstrates key features of the pattern identified by Clark, where the first year is “therapeutic” and other-oriented, the second is “professional” and self-focused. The author concludes that all the surveyed programmes exhibited some level of “second year crisis”, in which a significant number of students felt abandoned, dissatisfied, or rebellious. The author extends and refines Clark’s developmental analogy (first year = childhood; second year = adolescence) to reflect recent neurological research, in particular, the shift from a right hemisphere-dominant first year of life, prioritising affiliative needs, to a left hemisphere-dominant second year, prioritising autonomy and control. This shift is paralleled later by a more gradual move from a protective, supportive childhood to necessary, but sometimes conflictual, individuation in adolescence. The first two years of a counsellor training programme broadly echo this process, a process exacerbated by the second year internship/placement, in which students must “leave home” and adjust to unfamiliar, potentially less nurturing, authority figures. Finally, the author suggests introducing more rigorous “academic holding” into the first year, and greater attention to “therapeutic holding” of dissident students in the second, hopefully decreasing student dropout, and achieving a better balanced training experience.

Implementation of the Second-year course in an Engineering Professional Spine

2018 ◽  
Author(s):  
Umar Iqbal ◽  
Deena Salem ◽  
David Strong
Keyword(s):  
Learning Outcomes ◽  
Research University ◽  
Engineering Students ◽  
Employability Skills ◽  
First Year ◽  
Computer Engineering ◽  
Core Courses ◽  
Second Year ◽  
First Time ◽  
Academic Year

The objective of this paper is to document the experience of developing and implementing a second-year course in an engineering professional spine that was developed in a first-tier research university and relies on project-based core courses. The main objective of this spine is to develop the students’ cognitive and employability skills that will allow them to stand out from the crowd of other engineering graduates.The spine was developed and delivered for the first time in the academic year 2010-2011 for first-year general engineering students. In the year 2011-2012, those students joined different programs, and accordingly the second-year course was tailored to align with the different programs’ learning outcomes. This paper discusses the development and implementation of the course in the Electrical and Computer Engineering (ECE) department.

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