scholarly journals 1432 Simplifying Processes to Improve Rate of Surgical Site Infections

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
C Knight ◽  
P Nalwaya ◽  
R Allot ◽  
H Aly
Keyword(s):  
Average Rate ◽  
Dose Calculation ◽  
Surgical Site Infections ◽  
Antibiotic Use ◽  
Local Policy ◽  
Healthcare Associated Infection ◽  
Standard Data ◽  
Improve Compliance ◽  
Administration Time ◽  
Improve Rate

Abstract Aim Surgical site infection (SSI) is a common healthcare associated infection, complicating 10-15% of operations. These have the potential to cause significant harm to patients, prolong hospital stays and are costly to the NHS. Although the cause is multifactorial, appropriate antibiotic prophylaxis plays a role in reducing SSIs. Due to a higher-than-average rate of SSIs at ASPH, an audit was performed to review the use of antibiotics prior to surgery. Method Local antibiotic policies for surgical prophylaxis were used as the audit standard. Data was collected prospectively over a two-week period. Recovery nurses filled out a proforma identifying type of surgery, patients’ weight, antibiotics received and dose. Results 120 datasets were collected. Due to incomplete data, 113 were analysed; 81 patients required prophylactic antibiotics. The audit identified that current practice was not aligned with local policy. Where antibiotic use was indicated, all bar one patient received appropriate antibiotics. The primary issue identified was incorrect gentamicin dosing when a 5mg/kg dose based on creatine clearance was required. Gentamicin was dosed appropriately in 15 out of 49 cases, with 160mg administered in most cases regardless of policy. Conclusions Reasons underlying this are likely to be multifactorial, including ototoxicity risk, dose calculation and administration time; at present, the scheduling of theatre cases does not allow for a 30-minute gap from induction of anaesthesia to start of surgery. Working in partnership with the microbiologists we plan to create a gentamicin dose reference chart for display in all anaesthetic rooms to simplify dosing and improve compliance.

The impact of a multimodel approach to designing a new orthopedic department

2020 ◽  
pp. 1-6
Author(s):  
Elad Keren ◽  
Abraham Borer ◽  
Lior Nesher ◽  
Tali Shafat ◽  
Rivka Yosipovich ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Antibiotic Stewardship ◽  
Infection Prevention ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Antibiotic Use ◽  
Prevention Measures ◽  
Orthopedic Department ◽  
Before And After ◽  
The Impact

Abstract Objective: To determine whether a multifaceted approach effectively influenced antibiotic use in an orthopedics department. Design: Retrospective cohort study comparing the readmission rate and antibiotic use before and after an intervention. Setting: A 1,000-bed, tertiary-care, university hospital. Patients: Adult patients admitted to the orthopedics department between January 2015 and December 2018. Methods: During the preintervention period (2015–2016), 1 general orthopedic department was in operation. In the postintervention period (2017–2018), 2 separate departments were created: one designated for elective “clean” surgeries and another that included a “complicated wound” unit. A multifaceted strategy including infection prevention measures and introducing antibiotic stewardship practices was implemented. Admission rates, hand hygiene practice compliance, surgical site infections, and antibiotic treatment before versus after the intervention were analyzed. Results: The number of admissions and hospitalization days in the 2 periods did not change. Seven-day readmissions per annual quarter decreased significantly from the preintervention period (median, 7 days; interquartile range [IQR], 6–9) to the postintervention period (median, 4 days; IQR, 2–7; P = .038). Hand hygiene compliance increased and surgical site infections decreased in the postintervention period. Although total antibiotic use was not reduced, there was a significant change in the breakdown of the different antibiotic classes used before and after the intervention: increased use of narrow-spectrum β-lactams (P < .001) and decreased use of β-lactamase inhibitors (P < .001), third-generation cephalosporins (P = .044), and clindamycin (P < .001). Conclusions: Restructuring the orthopedics department facilitated better infection prevention measures accompanied by antibiotic stewardship implementation, resulting in a decreased use of broad-spectrum antibiotics and a significant reduction in readmission rates.

Healthcare-Associated Infection in Italy Annual Point-Prevalence Surveys, 2002–2004

2009 ◽  
Vol 30 (7) ◽  
pp. 659-665 ◽  
Author(s):  
Simone Lanini ◽  
William R. Jarvis ◽  
Emanuele Nicastri ◽  
Gaetano Privitera ◽  
Giovanni Gesu ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Univariate Analysis ◽  
National Health System ◽  
Bloodstream Infections ◽  
Surgical Site Infections ◽  
Point Prevalence ◽  
Healthcare Associated Infection ◽  
Tract Infections ◽  
Healthcare Associated

Objective.Healthcare-associated infections (HAIs) are an important cause of morbidity and mortality worldwide. During the period from 2002 through 2004, a group of Italian hospitals was recruited to conduct HAI point-prevalence surveys.Design.Three point-prevalence surveys.Methods.A total of 9,609 patients were surveyed.Results.The overall frequency of HAI was 6.7% (645 infections among the 9,609 surveyed patients). The most frequent HAIs were lower respiratory tract infections, which accounted for 35.8% (231 of 645 HAIs) of all HAIs, followed by urinary tract infections (152 [23.6%] of 645 HAIs), bloodstream infections (90 [14.0%] of 645 HAIs), and surgical site infections (79 [12.2%] of 645 HAIs). In both multivariate and univariate analysis, invasive procedures, duration of stay, chemotherapy, trauma, coma, and the location of the hospital were all factors statistically significantly associated with the occurrence of an HAL Enterobacteriaceae were the most common isolates recovered in medical and surgical wards, whereas gram-negative aerobic bacilli were the most common isolates recovered in intensive care units. Approximately one-half of all of the patients surveyed were receiving antibiotics at the time of our study; the most used antibiotic classes were fluoroquinolones in medical wards, cephalosporins in surgical wards, and penicillins and glycopeptides in intensive care units.Conclusion.Our study emphasizes the need for implementing further HAI surveillance to provide the National Health System with proper tools to prevent and manage infection in hospitalized patients.

Common Organisms Responsible for Healthcare-associated Infection (HCAI)

2019 ◽  
Author(s):  
George Jacob ◽  
Martina N. Cummins
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Local Policy ◽  
Healthcare Associated Infection ◽  
Beta Lactam ◽  
Beta Lactam Antibiotics ◽  
Patient Admissions ◽  
Before And After ◽  
Control And Prevention ◽  
Infectious Waste

MRSA are S. aureus which become methicillin resistant by the acquisition of the mec A gene which is on a mobile chromosomal determinant called staphylococcal cassette chromosome mec (SCC mec). The mec A gene encodes for a penicillin- binding protein (PBP2a) which has a low affinity for isoxazolyl-penicillins (MICs to oxacillin/ meticillin ≥ 4μg/ ml) and is resistant to all classes of beta-lactam antibiotics. Current Department of Health (DOH) guidance (2014) recommends that mandatory MRSA screening be streamlined to include only: ● All patient admissions to high- risk units; ● Healthcare workers; and ● All patients previously identified as colonized or infected with MRSA. The guidance also advises Trusts to follow local risk assessment policies to identify other potential high- risk units or units with a history of high endemicity of MRSA; and The guidance also recommends regular auditing of compliance with MRSA screening policy. The 2006 guideline for the control and prevention of MRSA in healthcare facilities recommends the following four measures. ● Isolation MRSA- positive patients should be nursed in a single room or if none is available, cohorting into a bay after risk assessment. Patient movement, and the number of staff and visitors looking after the patient, should be minimized. ● Hand hygiene and use of personal protective equipment (PPE) All staff and visitors should decontaminate their hands with soap and water/or an alcohol rub before and after contact with the patient or their immediate surroundings. Single-use disposable gloves and aprons/non- permeable gowns should be used by staff and visitors if there is a risk of contamination with body fluids. ● Disposal of waste and laundry All waste from colonized/ infected patients should be placed in the infectious waste stream. All linen and bedding from patients colonized/infected with MRSA should be considered as contaminated and processed as infected linen. ● Cleaning and decontamination The patient’s room should be cleaned/disinfected daily with an appropriate detergent/disinfectant as per local policy. On discharge of the patient, the room needs to be terminally cleaned before it is reused. All patient equipment should either be single-patient use or be cleaned, disinfected, and sterilized.

scholarly journals 1181. Significant Reduction of Non-Ventilator Hospital-Acquired Pneumonia (HAP) with a Prevention Bundle and Clinical and Leadership Feedback in a Large Integrated Healthcare System

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S423-S423
Author(s):  
Sejal Naik ◽  
Cristine Lacerna ◽  
Yulia Kevorkova ◽  
Jessica Galin ◽  
Donna Patey ◽  
...  
Keyword(s):  
Healthcare System ◽  
Oral Care ◽  
Antibiotic Use ◽  
Altered Mental Status ◽  
Feeding Tube ◽  
Healthcare Associated Infection ◽  
Integrated Healthcare ◽  
Benzodiazepine Use ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Abstract Background Non-Ventilator Hospital-acquired Pneumonia (HAP) is a prevalent healthcare-associated infection with mortality of 21%. HAP prevention literature is scant. We developed a definition enabling accurate surveillance to support this effort and implemented a prevention bundle based on available literature and characteristics of our high-performing centers. Methods Kaiser Permanente Northern California is an integrated healthcare system providing care for 4.4 million patients at 21 medical centers. Discharge diagnoses of HAP cases were reviewed for accuracy and factors permitting programmatic confirmation. A natural language extraction program identified new and persisting imaging findings, providing specificity. No other surveillance factors added specificity. Surgery, altered mental status, sedation, albumin <3 g/dl and tube feedings were identified as predictive risks. Seven interventions became part of a new pneumonia prevention order set for automatically identified high-risk patients: aggressive mobilization, upright posture for meals, swallowing evaluation before feeding, sedation restriction, elevated head of bed, oral care and feeding tube care. The project was fully implemented in 2015. Results Results were reported by 1,000 admissions and by 100,000 members served, to address a rapidly growing population. HAP decreased from 5.92 to 1.79/1000 admissions and 24.57 to 6.49/100,000 members and HAP case mortality remained stable (18–19%) while overall HAP mortality decreased from 1.05 to 0.34/1000 admissions (4.37 to 1.24 /100,000 members) (Figure 1 and 2). Carbapenem, quinolone, aminoglycoside and vancomycin use all decreased significantly (Figure 3). Benzodiazepine use decreased from 10.4% of all inpatient-days in 2014 to 8.8% of inpatient-days in 2016. Conclusion HAP rates, mortality and broad-spectrum antibiotic use were all reduced significantly, despite the absence of clinical practice guidelines or strong supportive literature for guidance. Some interventions had limited support, but most augmented basic nursing care. None had risks of adverse consequences. This supports the need to examine practices to improve care despite absent literature and even more so supports a need to study these difficult nebulous areas of care. Disclosures All authors: No reported disclosures.

Efficacy of Negative Pressure Wound Treatment in Preventing Surgical Site Infections after Whipple Procedures

2017 ◽  
Vol 83 (10) ◽  
pp. 1166-1169 ◽  
Author(s):  
Ryan Gupta ◽  
Geoffrey C. Darby ◽  
David K. Imagawa
Keyword(s):  
Negative Pressure ◽  
Average Rate ◽  
Surgical Site Infections ◽  
Whipple Procedure ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Tube Placement ◽  
Wound Treatment ◽  
Improvement Program ◽  
Significant Difference

Surgical site infections (SSIs) occur at an average rate of 21.1 per cent after Whipple procedures per NSQIP data. In the setting of adherence to standard National Surgery Quality Improvement Program (NSQIP) Hepatopancreatobiliary recommendations including wound protector use and glove change before closing, this study seeks to evaluate the efficacy of using negative pressure wound treatment (NPWT) over closed incision sites after a Whipple procedure to prevent SSI formation. We retrospectively examined consecutive patients from January 2014 to July 2016 who met criteria of completing Whipple procedures with full primary incision closure performed by a single surgeon at a single institution. Sixty-one patients were included in the study between two cohorts: traditional dressing (TD) (n = 36) and NPWT dressing (n = 25). There was a statistically significant difference (P = 0.01) in SSI formation between the TD cohort (n = 15, SSI rate = 0.41) and the NPWT cohort (n = 3, SSI rate = 0.12). The adjusted odds ratio (OR) of SSI formation was significant for NPWT use [OR = 0.15, P = 0.036] and for hospital length of stay [OR = 1.21, P = 0.024]. Operative length, operative blood loss, units of perioperative blood transfusion, intraoperative gastrojejunal tube placement, preoperative stent placement, and postoperative antibiotic duration did not significantly impact SSI formation (P > 0.05).

scholarly journals Assessment of Prophylactic Antibiotic Use in Patients with Surgical Site Infections

2013 ◽  
Vol 48 (7) ◽  
pp. 560-567 ◽  
Author(s):  
Whitney J. Goede ◽  
Jenna K. Lovely ◽  
Rodney L. Thompson ◽  
Robert R. Cima
Keyword(s):  
Antimicrobial Prophylaxis ◽  
Prophylactic Antibiotic ◽  
Surgical Care ◽  
Control Unit ◽  
Surgical Site Infections ◽  
Perioperative Period ◽  
Antibiotic Use ◽  
Infection Prevention And Control ◽  
Improvement Project ◽  
Antibiotic Selection

Background Surgical site infections (SSIs) are the leading cause of hospital-acquired infections and are associated with substantial health care costs, with increased morbidity and death. The Surgical Care Improvement Project (SCIP) contains standards that are nationally reported with the aim of improving patient outcomes after surgery. Our institution's standards for antimicrobial prophylaxis in the perioperative period are more stringent than these measures and may be considered “beyond SCIP.” The 4 elements of appropriate antimicrobial prophylaxis are timing, antibiotic selection, dosing, and intraoperative redosing. Objective To quantify antimicrobial SSI prophylaxis compliance in accordance with institutional standards and to identify potential opportunities for improvement. Methods Patients aged 18 years or older were included if they had an SSI between January 1, 2009, and June 30, 2010, according to the database maintained prospectively by the Infection Prevention and Control Unit. Adherence to our institution's practice standards was assessed through analysis of antibiotics administered—timing in relation to the incision, closure, and tourniquet inflation times for the procedure and antibiotic selection, dose, and redosing. Results Overall noncompliance with all 4 elements of antimicrobial prophylaxis was 75.4% among the 760 cases. Repeat dosing had the greatest noncompliance (45.1%); antibiotic selection had the lowest incidence of noncompliance (10.8%). Conclusions Noncompliance existed in each element of antimicrobial SSI prophylaxis, with antibiotic redosing leading in noncompliance. With the implementation of tools to assist the surgical team in following institutional standards, noncompliance will likely decline and additional research opportunities will exist.

scholarly journals Impact of national policies on the microbial aetiology of surgical site infections in acute NHS hospitals in England: analysis of trends between 2000 and 2013 using multi-centre prospective cohort data

2016 ◽  
Vol 145 (5) ◽  
pp. 957-969 ◽  
Author(s):  
S. ELGOHARI ◽  
J. WILSON ◽  
A. SAEI ◽  
E. A. SHERIDAN ◽  
T. LAMAGNI
Keyword(s):  
Mixed Model ◽  
Linear Mixed Model ◽  
Surgical Site Infections ◽  
Antibiotic Use ◽  
Study Data ◽  
Causative Organism ◽  
Case Definitions ◽  
Standard Case ◽  
Healthcare Associated ◽  
Increasing Trends

SUMMARYOur study aimed to evaluate changes in the epidemiology of pathogens causing surgical site infections (SSIs) in England between 2000 and 2013 in the context of intensified national interventions to reduce healthcare-associated infections introduced since 2006. National prospective surveillance data on target surgical procedures were used for this study. Data on causative organism were available for 72% of inpatient-detected SSIs meeting the standard case definitions for superficial, deep and organ-space infections (9767/13 531) which were analysed for trends. A multivariable logistic linear mixed model with hospital random effects was fitted to evaluate trends by pathogen. Staphylococcus aureus was the predominant cause of SSI between 2000 (41%) and 2009 (24%), decreasing from 2006 onwards reaching 16% in 2013. Data for 2005–2013 showed that the odds of SSI caused by S. aureus decreased significantly by 14% per year [adjusted odds ratio (aOR) 0·86, 95% confidence interval (CI) 0·83–0·89] driven by significant decreases in methicillin-resistant S. aureus (MRSA) (aOR 0·71, 95% CI 0·68–0·75). However a small significant increase in methicillin-sensitive S. aureus was identified (aOR 1·06, 95% CI 1·02–1·10). Enterobacteriaceae were stable during 2000–2007 (12% of cases overall), increasing from 2008 (18%) onwards, being present in 25% of cases in 2013; the model supported these increasing trends during 2007–2013 (aOR 1·12, 95% CI 1·07–1·18). The decreasing trends in S. aureus SSIs from 2006 and the increases in Enterobacteriaceae SSIs from 2008 may be related to intensified national efforts targeted at reducing MRSA bacteraemia combined with changes in antibiotic use aimed at controlling C. difficile infections.

scholarly journals The impact of coronavirus disease 2019 (COVID-19) on healthcare-associated infections in 2020: A summary of data reported to the National Healthcare Safety Network

2021 ◽  
pp. 1-14 ◽  
Author(s):  
Lindsey M. Weiner-Lastinger ◽  
Vaishnavi Pattabiraman ◽  
Rebecca Y. Konnor ◽  
Prachi R. Patel ◽  
Emily Wong ◽  
...  
Keyword(s):  
State Level ◽  
Bloodstream Infections ◽  
Surgical Site Infections ◽  
Infection Prevention And Control ◽  
Healthcare Associated Infection ◽  
National Healthcare ◽  
National Healthcare Safety Network ◽  
Tract Infections ◽  
Healthcare Associated ◽  
The Impact

Abstract Objectives: To determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on healthcare-associated infection (HAI) incidence in US hospitals, national- and state-level standardized infection ratios (SIRs) were calculated for each quarter in 2020 and compared to those from 2019. Methods: Central–line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated events (VAEs), select surgical site infections, and Clostridioides difficile and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia laboratory-identified events reported to the National Healthcare Safety Network for 2019 and 2020 by acute-care hospitals were analyzed. SIRs were calculated for each HAI and quarter by dividing the number of reported infections by the number of predicted infections, calculated using 2015 national baseline data. Percentage changes between 2019 and 2020 SIRs were calculated. Supporting analyses, such as an assessment of device utilization in 2020 compared to 2019, were also performed. Results: Significant increases in the national SIRs for CLABSI, CAUTI, VAE, and MRSA bacteremia were observed in 2020. Changes in the SIR varied by quarter and state. The largest increase was observed for CLABSI, and significant increases in VAE incidence and ventilator utilization were seen across all 4 quarters of 2020. Conclusions: This report provides a national view of the increases in HAI incidence in 2020. These data highlight the need to return to conventional infection prevention and control practices and build resiliency in these programs to withstand future pandemics.

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