CORR Insights®: Do Adhesive Drapes Have an Effect on Infection Rates in Orthopaedic Surgery? A Systematic Review and Meta-analysis

Background: Compliance with handwashing in busy healthcare facilities, such as intensive care units (ICUs), is suboptimal and alcohol hand-rub preparations have been suggested to improve compliance. There is no evidence on the comparative effectiveness between handwash and hand-rub strategies. This systematic review was to assess the effectiveness of handwash versus hand-rub strategies for preventing nosocomial infection in ICUs. Methods Studies conducted in ICUs and indexed in PubMed comparing the clinical effectiveness and adverse events between handwash and hand-rub groups were included in a systematic review. The primary outcome was nosocomial infection rates. Secondary outcomes included microbial counts on healthcare providers’ hands, mortality rates, patient/hospital cost of treatment of healthcare-associated infections (HCAIs), length of ICU/hospital stays, and adverse events. Studies were independently screened and data extracted by at least two authors. Meta-analyses of risk ratios (RR), incidence rate ratios (IRR), odds ratios (OR) and mean differences (MD), were conducted using the RevMan 5.3 software. Results: Seven studies published between 1992-2009 and involving a total of 11,663 patients were included. Five studies (10,981 patients) contributed data to the ICU acquired nosocomial infection rates. The pooled IRR was 0.71 (95% CI 0.61, 0.82; I2 = 94%). On sensitivity analysis, pooled IRR was 0.39 (95% CI 0.32, 0.48; 4 studies; 8,247 patients; I2 = 0%) in favour of hand rub. The pooled OR for mortality was 0.95 (95% CI 0.78, 1.61; 4 studies; 3,475 patients; I2 = 39%). The pooled MD for length of hospital stay was -0.74 (95% CI -2.83, 1.34; 3 studies; 741 patients; I2 = 0%). The pooled OR for an undesirable skin effect was 0.37 (95% CI 0.23, 0.60; 3 studies;1504 patients; I2 = 0%) in favour of hand rub. Overall quality of evidence was low. Conclusion: Hand rub appeared more effective when compared to handwash in ICUs.

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Role of pulsed-xenon ultraviolet light in reducing healthcare-associated infections: a systematic review and meta-analysis

Epidemiology and Infection ◽

10.1017/s095026882000148x ◽

2020 ◽

Vol 148 ◽

Author(s):

Zhenhong Dong ◽

Na Zhou ◽

Guijuan Liu ◽

Li Zhao

Keyword(s):

Systematic Review ◽

Ultraviolet Light ◽

Meta Analysis ◽

Pooled Analysis ◽

Current Evidence ◽

Healthcare Associated Infections ◽

Infection Rates ◽

Healthcare Settings ◽

Meta Regression Analysis ◽

Healthcare Associated

Abstract Pulsed-xenon-ultraviolet light (PX-UVL) is increasingly used as a supplemental disinfection method in healthcare settings. We undertook a systematic search of the literature through several databases and conducted a meta-analysis to evaluate the efficacy of PX-UVL in reducing healthcare-associated infections. Eleven studies were included in the systematic review and nine in the meta-analysis. Pooled analysis of seven studies with before-after data indicated a statistically significant reduction of Clostridium difficile infection (CDI) rates with the use of the PX-UVL (incidence rate ratio (IRR): 0.73, 95% CI 0.57–0.94, I2 = 72%, P = 0.01), and four studies reported a reduction of risk of methicillin-resistant Staphylococcus aureus (MRSA) infections (IRR: 0.79, 95% CI 0.64–0.98, I2 = 35%, P = 0.03). However, a further four trials found no significant reduction in vancomycin-resistant enterococci (VRE) infection rates (IRR: 0.80, 95% CI 0.63–1.01, I2 = 60%, P = 0.06). The results for CDI and MRSA proved unstable on sensitivity analysis. Meta-regression analysis did not demonstrate any influence of study duration or intervention duration on CDI rates. We conclude that the use of PX-UVL, in addition to standard disinfection protocols, may help to reduce the incidence of CDI and MRSA but not VRE infection rates. However, the quality of evidence is not high, with unstable results and wide confidence intervals, and further high-quality studies are required to supplement the current evidence.

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Do Intra-Articular Steroid Injections Increase Infection Rates in Subsequent Arthroplasty? A Systematic Review and Meta-Analysis of Comparative Studies

The Journal of Arthroplasty ◽

10.1016/j.arth.2014.07.013 ◽

2014 ◽

Vol 29 (11) ◽

pp. 2175-2180 ◽

Cited By ~ 31

Author(s):

Charalambos P. Charalambous ◽

Apostolos D. Prodromidis ◽

Tariq A. Kwaees

Keyword(s):

Systematic Review ◽

Comparative Studies ◽

Meta Analysis ◽

Infection Rates ◽

Steroid Injections

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Low-dose ketamine in painful orthopaedic surgery: a systematic review and meta-analysis

British Journal of Anaesthesia ◽

10.1016/j.bja.2019.05.043 ◽

2019 ◽

Vol 123 (3) ◽

pp. 325-334 ◽

Cited By ~ 9

Author(s):

J. Mark Riddell ◽

John M. Trummel ◽

Igho J. Onakpoya

Keyword(s):

Systematic Review ◽

Orthopaedic Surgery ◽

Low Dose ◽

Meta Analysis

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Efficacy of antimicrobial coated orthopaedic implants on the prevention of periprosthetic infections: a systematic review and meta-analysis

Journal of Bone and Joint Infection ◽

10.7150/jbji.44839 ◽

2020 ◽

Vol 5 (4) ◽

pp. 212-222 ◽

Cited By ~ 1

Author(s):

Olga D. Savvidou ◽

Angelos Kaspiris ◽

Ioannis Trikoupis ◽

George Kakouratos ◽

Stavros Goumenos ◽

...

Keyword(s):

Systematic Review ◽

Antimicrobial Agents ◽

Meta Analysis ◽

Titanium Implants ◽

Silver Coating ◽

Orthopaedic Implant ◽

Infection Rates ◽

Implant Surface ◽

Coated Implant ◽

Periprosthetic Infections

Abstract. Introduction: Implant-associated infections are a major problem in orthopaedic surgery. Local delivery systems of antimicrobial agents on the implant surface have attracted great interest recently. The purpose of this study was to identify antimicrobial coatings currently used in clinical practice, examining their safety and effectiveness in reducing post-operative infection rates.Materials and Methods: A systematic review was conducted in four databases (Medline, Embase, Cochrane, Cinahl) according to the Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) guidelines up to December 2019, using the key words “orthopaedic implant coated”, “coated implant infection”, “silver coating ” and “antibiotic coating”.Results: Seven articles involving 1307 patients (561 with coated implants and 746 controls who were not) comparing the incidence of periprosthetic infections after the application of internal fracture fixation, total arthroplasties and endoprostheses were evaluated. Three different coating technologies were identified: gentamicin coating for tibia nail and total arthroplasties; silver technology and povidone-iodine coating for tumour endoprostheses and titanium implants. Meta-analysis demonstrated that patients who were treated with antimicrobial coated implants presented lower infection rates compared to controls over the seven studies (Q = 6.1232, I2 = 0.00, 95% CI: 1.717 to 4.986, OR: 2.926, Z= 3.949, p<0.001). Subgroup statistical analysis revealed that each coating technique was effective in the prevention of periprosthetic infections (Q = 9.2606, I2 = 78.40%, 95% CI: 1.401 to 4.070, OR: 2.388, Z= 3.200, p<0.001).Conclusion: All technologies were reported to have good biocompatibility and were effective in the reduction of post-operative peri-prosthetic infection rates.

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