Surgical Site Infection Rate Drops to 0% Using a Vacuum-Assisted Closure in Contaminated/ Dirty Infected Laparotomy Wounds

2017 ◽  
Vol 83 (5) ◽  
pp. 512-514 ◽  
Author(s):  
Gerardo Lozano-Balderas ◽  
Alejandro Ruiz-Velasco-Santacruz ◽  
Jose Antonio Diaz-Elizondo ◽  
Juan Antonio Gomez-Navarro ◽  
Eduardo Flores-Villalba
Keyword(s):  
Surgical Site Infection ◽  
Infection Rate ◽  
Primary Closure ◽  
Statistical Significance ◽  
Site Infection ◽  
Class Iii ◽  
Infection Rates ◽  
Vacuum Assisted Closure ◽  
Significant Difference ◽  
Delayed Closure

Wound site infections increase costs, hospital stay, morbidity, and mortality. Techniques used for wounds management after laparotomy are primary, delayed primary, and vacuum-assisted closures. The objective of this study is to compare infection rates between those techniques in contaminated and dirty/ infected wounds. Eighty-one laparotomized patients with Class III or IV surgical wounds were enrolled in a three-arm randomized prospective study. Patients were allocated to each group with the software Research Randomizer® (Urbaniak, G. C, & Plous, S., Version 4.0). Presence of infection was determined by a certified board physician according to Centers for Disease Control's Criteria for Defining a Surgical Site Infection. Twenty-seven patients received primary closure, 29 delayed primary closure, and 25 vacuum-assisted closure, with no exclusions for analysis. Surgical site infection was present in 10 (37%) patients treated with primary closure, 5 (17%) with primary delayed closure, and 0 (0%) patients receiving vacuum-assisted closure. Statistical significance was found between infection rates of the vacuum-assisted group and the other two groups. No significant difference was found between the primary and primary delayed closure groups. The infection rate in contaminated/dirty-infected laparotomy wounds decreases from 37 and 17 per cent with a primary and delayed primary closures, respectively, to 0 per cent with vacuum-assisted systems.

scholarly journals Povidone-iodine irrigation combined with Vancomycin powder lowers infection rates in pediatric deformity surgery

2021 ◽  
Author(s):  
Rolando Figueroa Roberto ◽  
Flynn Andrew Rowan ◽  
Deepak Nallur ◽  
Blythe Durbin-Johnson ◽  
Yashar Javidan ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Infection Rate ◽  
Povidone Iodine ◽  
Small Sample Size ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Small Sample ◽  
Site Infection ◽  
Infection Rates ◽  
Vancomycin Powder

Abstract Background Surgical site infection is a morbid, devastating complication after spinal procedures. Studies have investigated the effect of wound lavage with 3.5% Povidone-iodine solution or the use of intrawound Vancomycin powder. We examined the effect of Povidone-iodine irrigation, intrawound Vancomycin powder, or a combination of both agents in a tertiary care Pediatric Hospital. Methods We queried our health system database for patients undergoing spinal surgery over an eight-year span between January 2008 and June 2016 and identified patient cohorts who received no intervention, intrawound Vancomycin alone, Povidone-iodine irrigation alone, or a combination of both agents. Infection rates were determined. The effect of treatment on outcome was analyzed using a logistic regression model. Results 475 patients were identified who met study inclusion criteria. 88 non-neuromuscular patients received no intra-operative agent. The surgical site infection (SSI) rate in this group of patients was 10%. For the 194 non-neuromuscular scoliosis patients who received Povidone-iodine and Vancomycin powder, the infection rate was reduced to 0.7%. The SSI rate in the 180 non-neuromuscular patients who were treated with Vancomycin powder alone was 1.4%. 13 patients were treated with Povidone-iodine lavage only, with a small sample size precluding statistical comparison. Infection rate in the 132 neuromuscular disease patients decreased from 14 to 7% overall during this time span: while the odds ratio of infection was reduced in all neuromuscular treatment groups receiving intra-operative measures, statistical significance was not reached in any neuromuscular group studied. Conclusions A protocol using combined 3.5% weight/volume Povidone-iodine and Vancomycin powder was associated with the lowest infection rate in our non-neuromuscular patient population and should be considered as a low cost intervention in pediatric patients undergoing spinal deformity procedures. Level of evidence Level II.

scholarly journals Standardising intraoperative irrigation with 0.05% chlorhexidine gluconate in caesarean delivery to reduce surgical site infections: A single institution experience

2019 ◽  
Vol 30 (1-2) ◽  
pp. 24-33
Author(s):  
Theresa Mangold ◽  
Erin Kinzel Hamilton ◽  
Helen Boehm Johnson ◽  
Rene Perez
Keyword(s):  
Treatment Group ◽  
Surgical Site Infection ◽  
Infection Rate ◽  
Caesarean Delivery ◽  
Chlorhexidine Gluconate ◽  
Control Group ◽  
Antibiotic Administration ◽  
Site Infection ◽  
Infection Rates ◽  
The Impact

Background Surgical site infection is a significant cause of morbidity and mortality following caesarean delivery. Objective To determine whether standardising intraoperative irrigation with 0.05% chlorhexidine gluconate during caesarean delivery could decrease infection rates. Methods This was a process improvement project involving 742 women, 343 of whom received low-pressured 0.05% chlorhexidine gluconate irrigation during caesarean delivery over a one-year period. Infection rates were compared with a standard-of-care control group (399 women) undergoing caesarean delivery the preceding year. Results The treatment group infection rate met the study goal by achieving a lower infection rate than the control group, though this was not statistically significant. A significant interaction effect between irrigation with 0.05% chlorhexidine gluconate and antibiotic administration time existed, such that infection occurrence in the treatment group was not dependent on antibiotic timing, as opposed to the control group infection occurrence, which was dependent on antibiotic timing. Conclusion Intraoperative irrigation with 0.05% chlorhexidine gluconate during caesarean delivery did not statistically significantly reduce the rate of infections. It did render the impact of antibiotic administration timing irrelevant in prevention of surgical site infection. This suggests a role for 0.05% chlorhexidine gluconate irrigation in mitigating infection risk whether antibiotic prophylaxis timing is suboptimal or ideal.

scholarly journals An observational study of incidence of surgical site infections in gastrointestinal surgeries

2021 ◽  
Vol 8 (12) ◽  
pp. 3595
Author(s):  
Jenishkumar Vijaykumar Modi ◽  
Darshit Kalaria
Keyword(s):  
Risk Factors ◽  
Observational Study ◽  
Surgical Site Infection ◽  
Infection Rate ◽  
Surgical Site Infections ◽  
Site Infection ◽  
Infection Rates ◽  
Surgical Site Infection Rate ◽  
Long Time ◽  
Surgery Department

Background: This study analysed the incidence of surgical site infections in gastrointestinal surgeries and its risk factors. so this study helped us in reducing surgical site infection by avoiding or minimizing that risk factors.Methods: The present study was conducted at general surgery department, SMIMER, Surat. An observational study of 400 cases that have undergone abdominal surgery in SMIMER hospital and were followed up from the day of operation to 30 days after discharge was done.Results: The overall infection rate for a total of the 400 cases was 17.25%. The incidence rate in this study was well within the infection rates of 2.8% to 17% seen in other studies. Different studies from India at different places have shown the SSI (surgical site infection) rate to vary from 6.09% to 38.7%.Conclusions: Our study reveals that though SSIs have been widely studied since a long time, they still remain as one of the most important causes of morbidity and mortality in surgically treated patients.

scholarly journals 891. Is Post-discharge Surveillance of Surgical Patients Really Worth It? Results Observed in Three Years of a Multicenter Study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S479-S481
Author(s):  
Rafaela Tonholli Pinho ◽  
Luciana Coelho Tanure ◽  
Joice Ribeiro Lopes ◽  
Bárbara Caldeira Pires ◽  
Flávio Henrique Batista de Souza ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Infection Rate ◽  
Tertiary Care ◽  
Patient Discharge ◽  
Surgical Patient ◽  
Surveillance Program ◽  
Site Infection ◽  
Infection Rates ◽  
Post Discharge ◽  
Belo Horizonte

Abstract Background Surgical site infections (SSIs) can account for 25% of all nosocomial infections and contribute significantly to the economic burden resulting from infectious complications. To control this problem, an active surveillance program with the feedback of SSI rates to surgeons can reduce subsequent rates by up to 40%, since 19% to 65% of these infections are diagnosed after patient discharge. However, there is no standard method for conducting surveillance outside the hospital and the best methodology is still unknown. For many hospitals, SSI surveillance has three main objectives: to feedback surgeons with their SSI rates; to evaluate SSI rates over time, identifying outbreaks; and to compare data among different institutions. This study aims to answer the crucial question: is surveillance after patient discharge worthwhile? Methods Prospective surveillance according to the National Healthcare Safety Network (NHSN) protocol of the Centers for Disease Control and Prevention (CDC) at Hospital Lifecenter, Hospital Madre Teresa and Hospital Universitário Ciências Médicas, tertiary care centers, which serve the metropolitan area of Belo Horizonte, Brazil. The data were collected between Jan/2017 and Dec/2019. Results In almost three years of study, the infection rate data were calculated with and without surveillance. The monthly analysis by clinic showed that the inclusion of post-discharge patients in the computed rates increases its value, but not significantly. Of 22.009 patients analyzed, in Lifecenter Hospital, 229(1%) had SSI. This percentage refers to the infection rate with the post-discharge survey, while the rate of surgical infection without vigilance corresponds to 202(0,9%) (Table 1). The surveillance for Madre Teresa, those numbers were: 29.770, 382(1,3%) and 351(1,2%), respectively (Table 2). In Hospital Universitário Ciências Médicas: 20.286, 447 (2,2%) and 215(1,1%) (Table 3). Table 1 - Surgical site infection: data with and without post-discharge surveillance. Hospital Lifecenter (Jan/ 2017 to Jul/2019): month-by-month analysis. Table 2 - Surgical site infection: data with and without post-discharge surveillance. Hospital Madre Teresa (Jan/ 2017 to Dec/2019): month-by-month analysis. Table 3 - Surgical site infection: data with and without post-discharge surveillance. Hospital Universitário Ciências Médicas (Jan/ 2017 to Dec/2019): month-by-month analysis. Conclusion SSI post-discharge surveillance is indicated only for specific procedures. However, once the endemic curve with the infection rate did not change with the inclusion of post-discharge SSI, the study strongly suggests that surveillance after the discharge of the surgical patient is not necessary. Graph 1 - Surgical site infection: rates with and without post-discharge surveillance. Hospital Lifecenter (Jan/2017 to Jul/2019): endemic curve. Graph 2 - Surgical site infection: rates with and without post-discharge surveillance. Hospital Madre Teresa (Jan/2017 to Jul/2019): endemic curve. Graph 3 - Surgical site infection: rate with and without post-discharge surveillance. Hospital Universitário Ciências Médicas (Jan/2017 to Jul/2019): endemic curve. Disclosures All Authors: No reported disclosures

scholarly journals Oral health and incidence of nosocomial infection and mortality in patients undergoing elective cardiac surgery

2021 ◽  
Vol 10 (5) ◽  
pp. e14910514658
Author(s):  
Gabriela Margraf Gehring ◽  
Mario Augusto Cray da Costa ◽  
Renan Bordini Cardoso ◽  
Ana Carolina Mello Fontoura de Souza ◽  
Marcelo Carlos Bortoluzzi
Keyword(s):  
Cardiac Surgery ◽  
Oral Health ◽  
Nosocomial Infection ◽  
Surgical Site Infection ◽  
Statistical Significance ◽  
Oral Disease ◽  
Hospital Death ◽  
Site Infection ◽  
Elective Cardiac Surgery ◽  
Significant Difference

Objective: To analyze the relationship between oral disease and the risk of developing hospital pneumonia, mediastinitis, endocarditis, surgical site infection and hospital death in patients undergoing elective cardiac surgery. Assess which risk factors would be related to the risk of nosocomial infection and death after cardiac surgery. Methodology: It was an analytical, observational, prospective study, carried out from January to December 2018. The study included 46 patients candidates for elective cardiac surgery and evaluated as to the type of heart disease, type of surgery, associated comorbidities, age, NYHA classification, BMI, ICU stay days, oral health assessment by a dental surgeon, occurrence of infection and hospital death. The analysis was done through analysis of absolute and relative frequencies, estimation of odds ratios, chi-square test and Mann-Whitney test. Results: Of the 46 patients analyzed, 11 (23.9%) of them had hospital infections and 4 (8.7%) died, there was no statistically significant difference in the variables studied with the occurrence of infection or death. The heterogeneity of the findings in the oral evaluation that ranged from edentulous patients with partial or total dentures, partial edentulous with or without prosthesis and varying degrees of oral disease that ranged from gingivitis, periodontitis to abscesses. The prostheses had varying degrees of conservation and hygiene. This great variability of findings may have implied no statistical significance in the variables. Conclusion: There was no statistical difference in the occurrence of hospital pneumonia, mediastinitis, endocarditis, surgical site infection and hospital death according to the patients' oral health condition.

Pursestring Closure versus Conventional Primary Closure Following Stoma Reversal to Reduce Surgical Site Infection Rate

2015 ◽  
Vol 58 (8) ◽  
pp. 808-815 ◽  
Author(s):  
Meng-Chiao Hsieh ◽  
Liang-Tseng Kuo ◽  
Ching-Chi Chi ◽  
Wen-Shih Huang ◽  
Chih-Chien Chin
Keyword(s):  
Surgical Site Infection ◽  
Infection Rate ◽  
Primary Closure ◽  
Site Infection ◽  
Surgical Site Infection Rate ◽  
Stoma Reversal

Clinical outcome of V-Y flap with latissimus dorsi and gluteal advancement for treatment of large thoracolumbar myelomeningocele defects: a comparative study

2019 ◽  
Vol 24 (1) ◽  
pp. 75-84
Author(s):  
Mohammad Sadegh Masoudi ◽  
Mohammad Ali Hoghoughi ◽  
Fariborz Ghaffarpasand ◽  
Shekoofeh Yaghmaei ◽  
Maryam Azadegan ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Comparative Study ◽  
Surgical Site Infection ◽  
Latissimus Dorsi ◽  
Primary Closure ◽  
Wound Dehiscence ◽  
Site Infection ◽  
Gluteal Muscle ◽  
Operative Duration ◽  
Csf Leakage

OBJECTIVESurgical repair and closure of myelomeningocele (MMC) defects are important and vital, as the mortality rate is as high as 65%–70% in untreated patients. Closure of large MMC defects is challenging for pediatric neurosurgeons and plastic surgeons. The aim of the current study is to report the operative characteristics and outcome of a series of Iranian patients with large MMC defects utilizing the V-Y flap and with latissimus dorsi or gluteal muscle advancement.METHODSThis comparative study was conducted during a 4-year period from September 2013 to October 2017 in the pediatric neurosurgery department of Shiraz Namazi Hospital, Southern Iran. The authors included 24 patients with large MMC defects who underwent surgery utilizing the bilateral V-Y flap and latissimus dorsi and gluteal muscle advancement. They also retrospectively included 19 patients with similar age, sex, and defect size who underwent surgery using the primary or delayed closure techniques at their center. At least 2 years of follow-up was conducted. The frequency of leakage, necrosis, dehiscence, systemic infection (sepsis, pneumonia), need for ventriculoperitoneal shunt insertion, and mortality was compared between the 2 groups.RESULTSThe bilateral V-Y flap with muscle advancement was associated with a significantly longer operative duration (p < 0.001) than the primary closure group. Those undergoing bilateral V-Y flaps with muscle advancement had significantly lower rates of surgical site infection (p = 0.038), wound dehiscence (p = 0.013), and postoperative CSF leakage (p = 0.030) than those undergoing primary repair. The bilateral V-Y flap with muscle advancement was also associated with a lower mortality rate (p = 0.038; OR 5.09 [95% CI 1.12–23.1]) than primary closure. In patients undergoing bilateral V-Y flap and muscle advancement, a longer operative duration was significantly associated with mortality (p = 0.008). In addition, surgical site infection (p = 0.032), wound dehiscence (p = 0.011), and postoperative leakage (p = 0.011) were predictors of mortality. Neonatal sepsis (p = 0.002) and postoperative NEC (p = 0.011) were among other predictors of mortality in this group.CONCLUSIONSThe bilateral V-Y flap with latissimus dorsi or gluteal advancement is a safe and effective surgical approach for covering large MMC defects and is associated with lower rates of surgical site infection, dehiscence, CSF leakage, and mortality. Further studies are required to elucidate the long-term outcomes.

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