scholarly journals EP.TU.870Challenges of Surgical Site Infections (SSIs) and Stoma

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Jennifer Ma ◽  
Pauline Whitehouse ◽  
Malcolm McFall
Keyword(s):  
Large Bowel ◽  
Surgical Site Infections ◽  
Site Infection ◽  
Chi Square ◽  
Local Database ◽  
Health Burden ◽  
Stoma Formation ◽  
Chi Square Test ◽  
Reduced Rate ◽  
Incisional Ssis

Abstract Aims Surgical site infection (SSI) is a costly health burden and is frequently observed in patients who undergo large bowel surgeries with stoma formation. The use of PICO has been associated with reduced rate of SSI and its use is encouraged by NICE. Method We identified patients who underwent elective or emergency large bowel surgeries, between 2014-2018, using the local database collected for national SSI surveillance. PICO order forms were cross-referenced with SSI database. Analysed data is presented as percentages, and variable testing is performed using Chi Square test. Results The overall rate of SSIs was 12.7%. 6.8% of the cohort developed an incisional SSI, while 5.9% developed an organ/space SSI. The presence of stoma had a significant impact in the rate of incisional SSI (10.3% v 4.2%; p = 0.000179). Amongst all patients with PICO dressing applied, stoma formation was associated with a higher rate of incisional SSI (15.2% vs 6.9%, p = 0.042). 28.7% patients with stoma formation had PICO applied. The use of PICO in this group of patients was associated with statistically significant improvement in the rate of incisional SSI (4.4% v 8.4%; p = 0.026) but not in the rate of organ/ space SSI (2.1% v 4.5%; p = 0.18). Similar findings were not observed when considering elective and emergency cases separately. Conclusion The risk of incisional SSIs is high in patients with stoma formation, even in those who had PICO dressing fitted. Tricky fitting of PICO dressing in the presence of stoma could be one hurdle in reducing SSIs.

scholarly journals Risk of surgical site infection in patients undergoing orthopedic surgery

2011 ◽  
Vol 19 (6) ◽  
pp. 1362-1368 ◽  
Author(s):  
Flávia Falci Ercole ◽  
Lúcia Maciel Castro Franco ◽  
Tamara Gonçalves Rezende Macieira ◽  
Luísa Cristina Crespo Wenceslau ◽  
Helena Isabel Nascimento de Resende ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Descriptive Analysis ◽  
Surgical Site Infections ◽  
Incidence Rates ◽  
Site Infection ◽  
Chi Square ◽  
Historical Cohort ◽  
Surgical Site Infection Incidence ◽  
Chi Square Test

This study aimed to identify risk factors associated with surgical site infections in orthopedic surgical patients at a public hospital in Minas Gerais, Brazil, between 2005 and 2007. A historical cohort of 3,543 patients submitted to orthopedic surgical procedures. A descriptive analysis was conducted and surgical site infection incidence rates were estimated. To verify the association between infection and risk factors, the Chi-square Test was used. The strength of association of the event with the independent variables was estimated using Relative Risk, with a 95% confidence interval and p<0.05. The incidence of surgical site infection was 1.8%. Potential surgical wound contamination, clinical conditions, time and type of surgical procedure were statistically associated with infection. Identifying the association between surgical site infection and these risk factors is important and contributes to nurses’ clinical practice.

scholarly journals Nonconcordance with Surgical Site Infection Prevention Guidelines and Rates of Surgical Site Infections for General Surgical, Neurological, and Orthopedic Procedures

2011 ◽  
Vol 55 (10) ◽  
pp. 4659-4663 ◽  
Author(s):  
Barnaby Young ◽  
Tat Ming Ng ◽  
Christine Teng ◽  
Brenda Ang ◽  
Hwei Yee Tai ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Univariate Analysis ◽  
Surgical Site Infections ◽  
Orthopedic Procedures ◽  
Site Infection ◽  
Chi Square ◽  
Chi Square Test ◽  
Prevention Guidelines ◽  
Complication Of Surgery

ABSTRACTSurgical site infection (SSI) is a common and preventable complication of surgery, but the relative importance of individual measures recommended by guidelines has not been determined. Elective general surgical, neurological, and orthopedic procedures requiring antibiotic prophylaxis from a 3-month period were retrospectively studied to determine concordance with SSI prevention guidelines and to identify factors which predicted the development of SSIs. A total of 216 surgeries were reviewed, with 18 SSIs (8.3%). A mean of 1.4 antibiotic prophylaxis errors per surgery were identified, with correct antibiotic type identified for 64%, antibiotic timing for 83%, supplemental antibiotic dosing for 34%, and antibiotic duration of less than 24 h for 44%. Normothermia was present in 79% of surgeries, and normoglycemia was present in 17%. Univariate analysis of the SSI rate identified four significant factors. Antibiotic prophylaxis for less than 24 h postoperatively (odds ratio [OR], 0.213; 95% confidence interval [95% CI]0.060 to 0.757) and neurosurgery (OR, 0.118; 95% CI, 0.15 to 0.903) correlated with a reduced risk of SSI. The mean number of prophylaxis errors (OR, 1.6; 95% CI, 1.02 to 2.4) and a duration of surgical drainage for more than 3 days (OR, 2.679; 95% CI, 1.009 to 7.113) predicted SSI. By multivariate analysis, errors in individual antibiotic prophylaxis measures were not significantly associated with SSI; however, the presence of more than two errors was significant (OR, 4.030; 95% CI, 1.018 to 15.96). A strong correlation was identified between the degree of concordance to SSI prevention guidelines and the SSI rate (P= 0.001, Mantel-Haenszel linear-by-linear association chi-square test).

scholarly journals Efficacy of Non-Beta-lactam Antibiotics for Prevention of Cesarean Delivery Surgical Site Infections

2019 ◽  
Vol 09 (02) ◽  
pp. e167-e171 ◽  
Author(s):  
Benjamin Harris ◽  
Maeve Hopkins ◽  
Margaret Villers ◽  
Jeremy Weber ◽  
Carl Pieper ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Cesarean Delivery ◽  
Surgical Site Infections ◽  
Type I ◽  
Site Infection ◽  
Beta Lactam ◽  
Postpartum Visit ◽  
Chi Square ◽  
Lower Odds ◽  
Logistic Regression Models

Objective To examine the association between perioperative Beta (β))-lactam versus non-β-lactam antibiotics and cesarean delivery surgical site infection (SSI). Study Design Retrospective cohort of women undergoing cesarean delivery from January 1 to December 31, 2014. All women undergoing cesarean after 34 weeks with a postpartum visit were included. Prevalence of SSI was compared between women receiving β-lactam versus non-β-lactam antibiotics. Bivariate analyses were performed using Pearson's Chi-square, Fisher's exact, or Wilcoxon's rank-sum tests. Logistic regression models were fit controlling for possible confounders. Results Of the 929 women included, 826 (89%) received β-lactam prophylaxis and 103 (11%) received a non-β-lactam. Among the 893 women who reported a non-type I (low risk) allergy, 819 (92%) received β-lactam prophylaxis. SSI occurred in 7% of women who received β-lactam antibiotics versus 15% of women who received a non-β-lactam (p = 0.004). β-Lactam prophylaxis was associated with lower odds of SSI compared with non-β-lactam antibiotics (odds ratio [OR] = 0.43; 95% confidence interval [CI] = 0.22–0.83; p = 0.01) after controlling for chorioamnionitis in labor, postlabor cesarean, endometritis, tobacco use, and body mass index (BMI). Conclusion β-Lactam perioperative prophylaxis is associated with lower odds of a cesarean delivery surgical site infection compared with non-β-lactam antibiotics.

Impact of Medicaid expansion on diagnosis and management of patients with testicular cancer.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 551-551
Author(s):  
Xinglei Shen ◽  
Mindi TenNapel
Keyword(s):  
Testicular Cancer ◽  
Stage I ◽  
Stage Iii ◽  
Medicaid Expansion ◽  
Chi Square ◽  
Medicaid Enrollment ◽  
Chi Square Test ◽  
Reduced Rate ◽  
New Diagnosis ◽  
Insured Patients

551 Background: One crucial aspect of the Affordable Care Act is the optional Medicaid expansion, which started in 2014. Patients with testicular cancer may derive particular benefit from Medicaid expansion due to demographics overlap. We hypothesize that Medicaid expansion would improve outcome in these patients. Methods: We reviewed the Surveillance Epidemiology and End Results (SEER) database for testicular cancer diagnosed from 2010 to 2014. Among the SEER regions, we separated in to states that did (CA, CT, HI, IA, KY, MI, NJ, NM, WA) or did not (AK, GA, LA, UT) undertake expansion. Medicaid data from CMMS were used to measure the degree of Medicaid expansion (EXP). Data from 2010-2013 was used as baseline, and 2014 as the effect of EXP. Chi-square test was used to compare between groups. Results: We identified 12731 cases of testicular cancer from 2010 to 2014. Within SEER regions, overall Medicaid enrollment increased by 30.4% from 2013 to 2014 in the EXP states, and by 8.4% in non-EXP states. Expansion did not affect incidence of testicular cancer. In the EXP states, Medicaid coverage for testicular cancer increased from 14.8% to 19.4% in 2014 (p < 0.001) and uninsured decreased from 8.7% to 4.3% (p < 0.001). In non-EXP states, coverage with Medicaid (9.7% to 8.8%, p = 0.60) and uninsured (13.6% to 12.9%, p = 0.68) did not change. Within individual states, we noted a linear correlation between % increase in Medicaid enrollment and % decrease in uninsured cases (R = 0.58). Among Medicaid patients in EXP states, stage I cases increased (52% to 60%), stage III cases decreased (27% to 20%). There was no change among insured patients (70.6% to 73.3% for stage I, and 10.9% to 9.1% for stage III). In contrast, in non-EXP states, Medicaid patients had decrease in stage I and increase in stage III cases. Medicaid patients had higher rates of no treatment and lower rates of lymph node assessment for stage II NSGCT compared to insured patients, but this did not vary with EXP. Conclusions: Medicaid expansion reduced rate of uninsured for patients with new diagnosis of testicular cancer. There was a shift to earlier stage of diagnosis in Medicaid patients, but no apparent effect yet on management. Future studies will focus on change over time and effect on survival.

scholarly journals Surgical Site Infections (SSI) and factors associated in a private tertiary care teaching hospital in Raichur, Karnataka, India

2018 ◽  
Vol 5 (8) ◽  
pp. 2899
Author(s):  
Prashanta Swami Pujar ◽  
K. B. Phuleker ◽  
Nagaraj Bhalki
Keyword(s):  
Risk Factors ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Research Centre ◽  
Chi Square ◽  
College Hospital ◽  
Factors Associated ◽  
Duration Of Surgery ◽  
Chi Square Test ◽  
A Prospective Study

Background: Prevention of Surgical site infection (SSI) remains a focus of attention because wound infections continue to be a major source of expense, morbidity, and even mortality. Three quarters of deaths of surgical patients with SSIs are attributed to nosocomial infections, nearly all of which are organ/space infections. The objective of the present study was to estimate the incidence of SSI and to study the various risk factors associated with SSI.Methods: This is a prospective study of 180 eligible cases eligible subjects, who underwent various surgeries in the department of General Surgery after applying inclusion and exclusion criteria. The study conducted at the Navodaya Medical College Hospital and Research Centre, Raichur. The tenure for the study was April 2017 to June 2017. Data was collected using pretested proforma. Data was analysed using SPSS version 16. Chi -square test and multiple logistic regression was applied to know the association between various risk factors and occurrence of SSI.Results: Among 180 patients 33 (18.33%) developed surgical site infections (SSI). Among 33 SSIs 25 (75.76%) were grade 3 and 8 (24.24%) were grade 4 infections. SSIs were found more commonly among patients over 50 years, diabetics, HIV infected patients, patients with longer duration of surgery and associations with these factors were found statistically significant.Conclusions: The incidence rate of SSI was quite high, and its end results will have a greater impact on patients as well as on healthcare systems. Prevention of SSI requires multipronged approach targeting both patient related and procedure related risk factors in pre- operative, intra-operative, and post-operative period.

Compare the Frequency of Surgical Site Infections in Patients Undergoing Hip Surgery with Closed Suction Drain Placed At Surgical Site and Without Drain

2021 ◽  
Vol 15 (9) ◽  
pp. 2844-2847
Author(s):  
Saghir Ahmed ◽  
Fida Ahmed Baloch ◽  
Irshad Ahmed ◽  
Irfan Ahmed ◽  
Bilal Elahi ◽  
...  
Keyword(s):  
Hip Arthroplasty ◽  
Surgical Site Infections ◽  
Hip Surgery ◽  
P Value ◽  
Trochanteric Fractures ◽  
Chi Square ◽  
Closed Suction ◽  
Suction Drain ◽  
Closed Suction Drain ◽  
Chi Square Test

Introduction: Hip trauma is a debilitating event that leads to a major limitation in patient’s functional ability. The incidence of hip fractures increases with advancing age and are more common in old age individuals. Closed-suction drainage has been routinely used in total hip arthroplasty to prevent hematoma formation and surgical site infections (SSI). Objective: To compare the frequency of surgical site infections in patients undergoing hip surgery with closed suction drain placed at surgical site and without drain. Study Design: Randomized controlled trial. Place and Duration: The study was completed at department of Orthopedic Surgery Unit III, Bolan Medical College Hospital Quetta, Pakistan. The duration of study was from 1-April-2016 to 31-October-2017. Subjects and Methods: A total number of 176 patients who underwent hip arthroplasty were included in this study. Group A (n=88) patients underwent hip surgery with placement of drain and Group B patients underwent hip surgery without the placement of drains. Data analysis was carried out using SPSS v20.0. Chi-square test was applied to compare surgical site infections in drain group and without drain group. Effect modifiers were controlled by stratification. Post stratification Chi-square test was applied taking P-value <0.05 as significant. Results: The mean age of patients in this study was 42.26 (SD 9.86) years. There were 135 males (76.7%) patients in this study and 41 (23.3%) female patients. The mean duration of fracture was 39.41 (SD 7.74) days. There were 63 (35.8%) patients who presented with greater/lesser trochanteric fractures, 64 (36.4%) presented with sub-trochanteric fractures and 49 (27.8%) were presented with inter-trochanteric fractures. SSIs occurred in 7 patients in whom drain was inserted after surgery and in only 2 patients in whom drain was not inserted (p-value 0.08). There was no effect of confounder variables on the occurrence of SSIs. Conclusion: The risk of surgical site infections is same in patients undergoing hip surgery with closed suction drain placed at surgical site and without drain. Keywords: Hip fractures, Hip arthroplasty, Closed suction drains, Surgical site infections.

Influence of Climate on the Incidence of Peritoneal Dialysis-Related Peritonitis

2003 ◽  
Vol 23 (6) ◽  
pp. 580-586 ◽  
Author(s):  
Cheuk-Chun Szeto ◽  
Kai-Ming Chow ◽  
Teresa Yuk-Hwa Wong ◽  
Chi-Bon Leung ◽  
Philip Kam-Tao Li
Keyword(s):  
Peritoneal Dialysis ◽  
Seasonal Variation ◽  
Odds Ratio ◽  
Site Infection ◽  
Exit Site ◽  
Chi Square ◽  
Exit Site Infection ◽  
Dialysis Unit ◽  
Significant Seasonal Variation ◽  
Chi Square Test

Objective The use of peritoneal dialysis has expanded in many developing subtropical countries; however, the role of climatic factors in dialysis-related peritonitis has not been studied in detail. Design Retrospective study. Setting A single regional dialysis unit in a university teaching hospital. Patients We reviewed all cases of dialysis-related peritonitis treated in our dialysis unit from January 1995 to December 2001. Information was collected on demographic data, microbiologic etiology, associated catheter exit-site infection, and clinical response. Results In 24 059 patient-months of follow-up, 1344 episodes of peritonitis were recorded. There were significantly more peritonitis episodes in July and August [odds ratio 1.17, 95% confidence interval (CI) 1.03 – 1.32], and fewer peritonitis episodes in December (odds ratio 0.79, 95% CI 0.61 – 0.98). There was also a trend of more peritonitis in March (odds ratio 1.18, 95% CI 0.97 – 1.41), but the difference was not statistically significant. When the incidence of peritonitis caused by individual bacterial species was further analyzed, we found a significant seasonal variation in the rate of peritonitis caused by gram-negative bacteria, except Pseudomonas (overall chi-square test, p = 0.002). A similar trend of seasonal variation was also observed in gram-positive peritonitis, but the result was not statistically significant. There was significant seasonal variation in the rate of peritonitis that had coexisting exit-site infection (overall chi-square test, p = 0.02), with peak incidence in July. However, the proportion of peritonitis that had coexisting exit-site infection did not have significant seasonal variation. There was significant correlation between monthly peritonitis rate and average humidity ( r = –0.346, p < 0.002) and temperature ( r = –0.264, p = 0.015). Conclusions There is substantial seasonal variation in the incidence of dialysis-related peritonitis, with peak incidence in the months that are hot and humid. Keeping a cool and dry living environment may help to reduce peritonitis in peritoneal dialysis patients in tropical countries.

scholarly journals Perioperative Hyperglycemia as a Risk Factor for Early Surgical-Site Infection in Stable Trauma Patients in Orthopedic Unit

2020 ◽  
Vol 18 (2) ◽  
Author(s):  
Mohd Darulnizam bin Othman ◽  
Ahmad Fadzli Sulong
Keyword(s):  
Surgical Site Infection ◽  
Length Of Hospital Stay ◽  
Diabetic Patients ◽  
Trauma Patients ◽  
Site Infection ◽  
Chi Square ◽  
Co Morbidity ◽  
Chi Square Test ◽  
Orthopaedic Injuries ◽  
Admission Glucose

Introduction: Perioperative hyperglycemia resulted from known diabetes mellitus, occult diabetes or stressed-induced hyperglycemia. It is associated with increasing risk of surgical-site infection (SSI). This research is to evaluate relationship between perioperative hyperglycemia and early SSI in stable trauma patients with orthopaedic injuries.  Materials and method: We conducted an observational cohort study in Hospital Sultanah Nur Zahirah, Kuala Terengganu over 15 months. We included patients 18 years and older with operative orthopaedic injuries and excluded those with steroid use, multisystem injuries, critically ill or unstable and patients with perioperative infection. Demographics, medical comorbidities, body mass index, type of fracture, HbA1c level in diabetic patients and length of hospital stay were recorded. Fingerprick glucose values were obtained twice daily. Hyperglycemic index (HGI), an area under the glucose curve above the normal range divided by the length of stay, were calculated. Perioperative hyperglycemia was defined by HGI greater than 1.76. SSI was defined by gross purulence or positive intraoperative culture at reoperation within 30 days. The categorical data were analysed using chi square test while continuous data were analysed using T-test.  Results: Total of 90 patients, 15-diabetic and 75 non-diabetic. 10 diabetic and 1 non-diabetic patients were hyperglycemic (p=0.001). Perioperative hyperglycemia was associated with mean age 54.3 year old, having 1 or more co-morbidity or mean admission glucose 13.1 mmol/L (p=0.001). There were 12 early SSI giving infection rate 13.3%. Early SSI was associated with HGI 1.76 and more (p=0.001), patients             with 1 or more co-morbidity (p=0.006), mean admission glucose of 9.63 mmol/L (p=0.001). Conclusion: Our study showed perioperative hyperglycemia in stable trauma patients with orthopaedic injuries were associated with SSI. More patients are needed to find association of other variables and more studies are required in determining the acceptable glucose level and optimal treatment of perioperative hyperglycemia in stable trauma patients.

scholarly journals A comparative study on surgical site infections after primary closure and delayed primary closure in clean contaminated laparotomy cases

2019 ◽  
Vol 6 (3) ◽  
pp. 989
Author(s):  
T. J. Pauly ◽  
T. V. Haridas ◽  
E. Manoj Prabhakar ◽  
Roshjo Roshan
Keyword(s):  
Surgical Site Infection ◽  
Primary Closure ◽  
Surgical Site Infections ◽  
P Value ◽  
Skin Closure ◽  
Site Infection ◽  
Chi Square ◽  
Delayed Primary Closure ◽  
Laparotomy Wound ◽  
Clean Contaminated

Background: Surgical site infection is a significant cause of post operative morbidity. Timing of skin closure following a surgery and its relation to incidence of infection has been studied. The debate whether primary or delayed primary closure have been around for a long time. The aim of this study is to compare the rate of infection in a laparotomy wound in clean contaminated laparotomy cases after primary and delayed primary closure.Methods: 132 patients who underwent laparotomy for clean contaminated were selected. Of this primary closure of the skin was done in 66 cases and delayed primary closure at 48 hours were done in the other 66 patients. Wounds were followed up till post op day 7. The results between two groups were compared using chi square test.Results: two out of 66 cases developed SSI in the delayed primary sutured group whereas 8 out of 66 cases developed SSI in primary suturing group. The results were compared using chi square test and the chi square statistic was 3.8951 and the p value is 0.048428 (<0.05) proving the result significant.Conclusions: The incidence of surgical site infection in laparotomy wound after a primary closure was higher compared to delayed primary closure in clean contaminated laparotomy wounds and the difference is significant based on statistical evaluation.

scholarly journals COMPARATIVE ANALYSIS OF OCCLUSIVE DRESSING AND OPEN WOUND TREATMENT IN PREVENTION OF SURGICAL SITE INFECTIONS

2019 ◽  
Vol 7 (9) ◽  
pp. 88-91
Author(s):  
Arvind Srivastava ◽  
Prakshi Solanki
Keyword(s):  
Invasive Procedure ◽  
Surgical Site Infections ◽  
Wound Treatment ◽  
Nursing Time ◽  
Open Wound ◽  
Chi Square ◽  
Occlusive Dressing ◽  
Occlusive Dressings ◽  
Chi Square Test ◽  
Open Wound Treatment

Surgical site infections (SSIs) are defined as infections of the tissues, organs, or spaces exposed by surgeons during performance of an invasive procedure. Motivation/Background: A lot of expense both with regards to nursing time and dressing material costs is invested in prevention of SSI using occlusive surgical incision site dressing. But to what extent is this beneficial over open wound treatment? In the present study, we have compared the incidence of SSIs in surgical wounds treated with occlusive dressings versus those treated with open wound treatment to find out the same. Method: The study was conducted on 860 patients of General Surgery wards. Patients were categorized under two groups of cases where (1) Dressing was opened after 24 hours and then only open wound treatment by cleaning with Betadine 12 hourly was done till stitch removal and (2) Dressing was opened after 48 hours and then again after every 2 days occlusive dressing was done until stitch removal. Result: A Chi-Square Test was performed to understand if Occlusive dressings have an added advantage over Open Wound Treatment in prevention of SSIs. Conclusion: Occlusive Dressings have no added advantage over Open Wound Treatment in the prevention of SSIs and hence Open wound treatment can be taken as an alternative for occlusive dressings.

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