Preventing surgical site infection: conclusions from experts at EWMA

Opinion Leaders ◽

Site Infection ◽

Infection Rates ◽

Key Opinion Leaders

In an Essity-sponsored symposium, titled ‘Surgical site infection rates still high? We need to do more,’ key opinion leaders discussed the importance of identifying, preventing and treating surgical site infections (SSI). Fatima Bibi summarises the main points presented at EWMA 2019.

58 Use of Abdominal Wall or Sucutaneous Drain to Reduce the Risk of Surgical Site Infections

British Journal of Surgery ◽

10.1093/bjs/znab134.356 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

H Mistry ◽

B Woolner ◽

A John

Keyword(s):

Surgical Site Infection ◽

Open Cholecystectomy ◽

Standard Operating Procedure ◽

Site Infection ◽

Infection Rates ◽

Local Evidence ◽

Audit Data ◽

The Impact ◽

To Receive

Abstract Introduction Open abdominal surgery confers potentially greater risk of surgical site infections, and local evidence suggests use of drains can reduce this. Our objectives were: Assessing local rates and risk factors of infections and if use of drains can reduce the rates of infections. Method Retrospectively looking from 01/01/2018 to 31/12/2018, at patients following laparotomy or open cholecystectomy. Data collection on demographics, smoking/alcohol status, heart, respiratory or renal disease or diabetes, steroid use and CEPOD status, as well as use of drain and the outcome of infection using inpatient and online patient records. Results 84 patients included, 25 had drains inserted. There were 13 documented cases of surgical site infection, all of whom had no drain post-op. Other parameters shown to be most prevalent in the patients with a surgical site infection include being current/ex-smoker (8/13), having heart disease (9/13), and elective procedures. Conclusions Aiming to reduce the risk of surgical site infections can improve morbidity and potentially mortality outcomes. Our audit data showed that there appears to be a benefit of inserting intra-abdominal or subcutaneous drains. We will create a standard operating procedure of all patient to receive drains post-op and then re-audit to assess the impact this has on infection rates.

Reduction in Surgical Antibiotic Prophylaxis Expenditure and the Rate of Surgical Site Infection by Means of a Protocol That Controls the Use of Prophylaxis

10.1017/s0195941700075305 ◽

2006 ◽

Vol 27 (12) ◽

pp. 1358-1365 ◽

Cited By ~ 2

Author(s):

Marisa I. Gómez ◽

Silvia I. Acosta-Gnass ◽

Luisa Mosqueda-Barboza ◽

Juan A Basualdo

Keyword(s):

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Final Stage ◽

Antimicrobial Prophylaxis ◽

Surgical Antimicrobial Prophylaxis

Site Infection ◽

Infection Rates ◽

Prospective Survey ◽

Surgical Antibiotic Prophylaxis ◽

Objective.To evaluate the effectiveness of an intervention based on training and the use of a protocol with an automatic stop of antimicrobial prophylaxis to improve hospital compliance with surgical antibiotic prophylaxis guidelines.Design.An interventional study with a before-after trial was conducted in 3 stages: a 3-year initial stage (January 1999 to December 2001), during which a descriptive-prospective survey was performed to evaluate surgical antimicrobial prophylaxis and surgical site infections; a 6-month second stage (January to June 2002), during which an educational intervention was performed regarding the routine use of a surgical antimicrobial prophylaxis request form that included an automatic stop of prophylaxis (the “automatic-stop prophylaxis form”); and a 3-year final stage (July 2002 to June 2005), during which a descriptive-prospective survey of surgical antimicrobial prophylaxis and surgical site infections was again performed.Setting.An 88-bed teaching hospital in Entre Ríos, Argentina.Patients.A total of 3,496 patients who underwent surgery were included in the first stage of the study and 3,982 were included in the final stage.Results.Comparison of the first stage of the study with the final stage revealed that antimicrobial prophylaxis was given at the appropriate time to 55% and 88% of patients, respectively (relative risk [RR], 0.27 [95% confidence interval {CI}, 0.25-0.30]; P < .01); the antimicrobial regimen was adequate in 74% and 87% of patients, respectively (RR, 0.50 [95% CI, 0.45-0.55]; P < .01); duration of the prophylaxis was adequate in 44% and 55% of patients, respectively (RR, 0.80 [95% CI, 0.77-0.84]; P < .01); and the surgical site infection rates were 3.2% and 1.9%, respectively (RR, 0.59 [95% CI, 0.44-0.79]; P < .01). Antimicrobial expenditure was US$10,678.66 per 1,000 patient-days during the first stage and US$7,686.05 per 1,000 patient-days during the final stage (RR, 0.87 [95% CI, 0.86-0.89]; P<.01).Conclusion.The intervention based on training and application of a protocol with an automatic stop of prophylaxis favored compliance with the hospital's current surgical antibiotic prophylaxis guidelines before the intervention, achieving significant reductions of surgical site infection rates and substantial savings for the healthcare system.

Getting It Right First Time: the national survey of surgical site infection rates in NHS trusts in England

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2019.0064 ◽

2019 ◽

Vol 101 (7) ◽

pp. 463-471

Author(s):

JLC Wong ◽

CWY Ho ◽

G Scott ◽

JT Machin ◽

TWR Briggs ◽

...

Keyword(s):

Surgical Site Infection ◽

National Survey ◽

Financial Burden ◽

Paediatric Surgery ◽

Site Infection ◽

Infection Rates ◽

Infection Surveillance ◽

Surgical Units ◽

First Time

Introduction Surgical site infections are associated with increased morbidity and mortality in patients. The Getting It Right First Time surgical site infection programme set up a national survey to review surgical site infection rates in surgical units in England. The objectives were for frontline clinicians to assess the rates of infection following selected procedures, to examine the risk of significant complications and to review current practice in the prevention of surgical site infection. Methods A national survey was launched in April 2017 to assess surgical site infections within 13 specialties: breast surgery, cardiothoracic surgery, cranial neurosurgery, ear, nose and throat surgery, general surgery, obstetrics and gynaecology, ophthalmology, oral and maxillofacial surgery, orthopaedic surgery, paediatric surgery, spinal surgery, urology and vascular surgery. All participating trusts prospectively identified and collected supporting information on surgical site infections diagnosed within the six-month study period. Results Data were received from 95 NHS trusts. A total of 1807 surgical site infection cases were reported. There were variations in rates reported by trusts across specialties and procedures. Reoperations were reported in 36.2% of all identified cases, and surgical site infections are associated with a delayed discharge rate of 34.1% in our survey. Conclusion The Getting It Right First Time surgical site infection programme has introduced a different approach to infection surveillance in England. Results of the survey has demonstrated variation in surgical site infection rates among surgical units, raised the importance in addressing these issues for better patient outcomes and to reduce the financial burden on the NHS. Much work remains to be done to improve surgical site infection surveillance across surgical units and trusts in England.

MRSA – ‘Bug-Bear’ of a Surgical Practice: Reducing the Incidence of MRSA Surgical Site Infections

Annals of The Royal College of Surgeons of England ◽

10.1308/003588406x94841 ◽

2006 ◽

Vol 88 (2) ◽

pp. 222-223 ◽

Cited By ~ 14

Author(s):

Andrea Guyot ◽

Graham Layer

Keyword(s):

Staphylococcus Aureus ◽

Surgical Site Infection ◽

Orthopaedic Surgery ◽

Methicillin Resistant Staphylococcus Aureus ◽

Site Infection ◽

Infection Rates ◽

Methicillin Resistant ◽

Surgical Practice ◽

Department Of Health

Adverse publicity (the ‘superbug') has demonstrated that the problem of MRSA (methicillin-resistant Staphylococcus aureus) is prevalent in many of the country's most prestigious hospitals. The results of the mandatory UK Department of Health (DH) surveillance for early surgical site infections in orthopaedic surgery (SSIS) have been published recently for the period April 2004 to March 2005 when 41,242 operations were studied (< http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsStatistic > 28 October 2005). Infection rates were generally and gratifyingly low but 48% of surgical site infections were caused by Staph. aureus and of those 68% were MRSA. The following article will discuss the aetiology and prevention of MRSA surgical site infection.

Reduction in Surgical Antibiotic Prophylaxis Expenditure and the Rate of Surgical Site Infection by Means of a Protocol That Controls the Use of Prophylaxis

10.1086/509845 ◽

2006 ◽

Vol 27 (12) ◽

pp. 1358-1365 ◽

Cited By ~ 23

Author(s):

Marisa I. Gómez ◽

Silvia I. Acosta-Gnass ◽

Luisa Mosqueda-Barboza ◽

Juan A Basualdo

Keyword(s):

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Final Stage ◽

Antimicrobial Prophylaxis ◽

Surgical Antimicrobial Prophylaxis

Site Infection ◽

Infection Rates ◽

Prospective Survey ◽

Surgical Antibiotic Prophylaxis ◽

Objective.To evaluate the effectiveness of an intervention based on training and the use of a protocol with an automatic stop of antimicrobial prophylaxis to improve hospital compliance with surgical antibiotic prophylaxis guidelines.Design.An interventional study with a before-after trial was conducted in 3 stages: a 3-year initial stage (January 1999 to December 2001), during which a descriptive-prospective survey was performed to evaluate surgical antimicrobial prophylaxis and surgical site infections; a 6-month second stage (January to June 2002), during which an educational intervention was performed regarding the routine use of a surgical antimicrobial prophylaxis request form that included an automatic stop of prophylaxis (the “automatic-stop prophylaxis form”); and a 3-year final stage (July 2002 to June 2005), during which a descriptive-prospective survey of surgical antimicrobial prophylaxis and surgical site infections was again performed.Setting.An 88-bed teaching hospital in Entre Ríos, Argentina.Patients.A total of 3,496 patients who underwent surgery were included in the first stage of the study and 3,982 were included in the final stage.Results.Comparison of the first stage of the study with the final stage revealed that antimicrobial prophylaxis was given at the appropriate time to 55% and 88% of patients, respectively (relative risk [RR], 0.27 [95% confidence interval {CI}, 0.25-0.30];P< .01); the antimicrobial regimen was adequate in 74% and 87% of patients, respectively (RR, 0.50 [95% CI, 0.45-0.55];P< .01); duration of the prophylaxis was adequate in 44% and 55% of patients, respectively (RR, 0.80 [95% CI, 0.77-0.84];P< .01); and the surgical site infection rates were 3.2% and 1.9%, respectively (RR, 0.59 [95% CI, 0.44-0.79];P< .01). Antimicrobial expenditure was US$10,678.66 per 1,000 patient-days during the first stage and US$7,686.05 per 1,000 patient-days during the final stage (RR, 0.87 [95% CI, 0.86-0.89];P<.01).Conclusion.The intervention based on training and application of a protocol with an automatic stop of prophylaxis favored compliance with the hospital's current surgical antibiotic prophylaxis guidelines before the intervention, achieving significant reductions of surgical site infection rates and substantial savings for the healthcare system.

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

International Surgery Journal ◽

10.18203/2349-2902.isj20214751 ◽

2021 ◽

Vol 8 (12) ◽

pp. 3595

Author(s):

Jenishkumar Vijaykumar Modi ◽

Darshit Kalaria

Keyword(s):

Risk Factors ◽

Observational Study ◽

Surgical Site Infection ◽

Infection Rate ◽

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.

Impact of Postdischarge Surveillance on Surgical-Site Infection Rates for Coronary Artery Bypass Procedures

10.1086/502076 ◽

2002 ◽

Vol 23 (7) ◽

pp. 364-367 ◽

Cited By ~ 47

Author(s):

Joan L Avato ◽

Kwan Kew Lai

Keyword(s):

Coronary Artery ◽

Surgical Site Infection ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Risk Index ◽

Site Infection ◽

Infection Rates ◽

Surgical Site Infection Rate ◽

Harvest Site

Objective:To assess the influence of postdischarge infection surveillance on risk-adjusted surgical-site infection rates for coronary artery bypass graft (CABG) procedures.Design:Prospective surveillance of surgical-site infections after CABG.Setting:Tertiary-care referral hospital.Methods:Data on surgical-site infections were collected for 1,324 CABG procedures during 27 months. They were risk adjusted and analyzed according to the surgical surveillance protocol of the National Nosocomial Infections Surveillance (NNIS) System of the Centers for Disease Control and Prevention, with and without postdischarge data.Results:Data were available for 96% of the patients. Of the 88 surgical-site infections, 28% were identified prior to discharge and 72% postdischarge. More chest than harvest-site infections were identified (46% vs 11%) prior to discharge, and more harvest-site than chest infections were identified in the outpatient setting (42% vs 14%). The surgical-site infection rate for patients stratified under risk index 1, calculated without postdischarge surveillance, was 2.9%; when compared with that of the NNIS System, the P value was .29. When postdischarge surveillance was included, the surgical-site infection rate was 4.9% and statistically significant when compared with that of the NNIS System (P = .007). For patients stratified under risk index 2, the rates with and without postdischarge surveillance were 11.7% and 10.0%, respectively; when compared with the NNIS System rates, the P values were .000008 and .0006, respectively.Conclusions:Only 28% of the surgical-site infections would have been detected if surveillance had been limited to hospital stay. Postdischarge surveillance identified more surgical-site infections among risk index 1 patients. Hospitals with comprehensive postdischarge surveillance after CABG procedures are likely to record higher surgical-site infection rates than those that do not perform such surveillance.

Exploration of epidemiologic profile and strategic prevention framework for surgical site infection rates in a tertiary care hospital of Bhopal city

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20180269 ◽

2018 ◽

Vol 5 (2) ◽

pp. 784

Author(s):

Vidit Goyal ◽

Rituja Kaushal

Keyword(s):

Surgical Site Infection ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Site Infection ◽

Infection Rates ◽

Routine Surveillance ◽

Epidemiologic Profile ◽

Hospital Acquired

Background: Post-operative surgical site infections are deadlock for any successful surgery. This exigency triggers draining of extra resources for management of the quagmire. Methods: This prospective direct surveillance study based on incidence design was undertaken to gauge and estimate the nature of propensity of various surgical site infections in a tertiary care hospital over a period of twelve months. Results: Calculated cumulative SSI rate for the year 2016 was found to be 4.32%. Conclusions: It was concluded that a multidisciplinary approach integrating periodic training sessions on infection control, checklists based routine surveillance & following some benchmark etc. are the linchpin in controlling hospital acquired infections including surgical site infection rates in any clinical setting.

Alexis Wound Retractor for Radical Cystectomy: A Safe and Effective Method for Retraction

Advances in Urology ◽

10.1155/2018/8727301 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Ajaydeep S. Sidhu ◽

Eric Marten ◽

Nikita Bodoukhin ◽

George Wayne ◽

Elizabeth Nagoda ◽

...

Keyword(s):

Surgical Site Infection ◽

Radical Cystectomy ◽

Retrospective Chart Review ◽

Site Infection ◽

Infection Rates ◽

Multicenter Studies ◽

Operative Outcomes ◽

Wound Retractor ◽

Open Radical Cystectomy

Surgical site infection rates remain a common postoperative problem that continues to affect patients undergoing urologic surgery. Our study seeks to evaluate the difference in surgical site infection rates in patients undergoing open radical cystectomy when comparing the Bookwalter vs. the Alexis wound retractors. After institutional review board approval, we performed a retrospective chart review from February 2010 through August 2017 of patients undergoing open radical cystectomy with urinary diversion for bladder cancer. We then stratified the groups according to whether or not the surgery was performed with the Alexis or standard Bookwalter retractor. Baseline characteristics and operative outcomes were then compared between the two groups, with the main measure being incidence of surgical site infection as defined by the CDC. We evaluated those presenting with surgical site infections within or greater than 30 postoperatively. Of 237 patients who underwent radical cystectomy with either the Alexis or Bookwalter retractor, 168 patients were eligible to be included in our analysis. There was no statistical difference noted regarding surgical site infections (SSIs) between the two groups; however, the trend was in favor of the Alexis (3%) vs. the Bookwalter (11%) at less than 30 days surgery. The Alexis wound retractor likely poses an advantage in reducing the incidence in surgical site infections in patients undergoing radical cystectomy; however, multicenter studies with larger sample sizes are suggested for further elucidation.

Effects of Preoperative Skin Preparation on Postoperative Wound Infection Rates A Prospective Study of 3 Skin Preparation Protocols

10.1086/605926 ◽

2009 ◽

Vol 30 (10) ◽

pp. 964-971 ◽

Cited By ~ 153

Author(s):

Brian R. Swenson ◽

Traci L. Hedrick ◽

Rosemarie Metzger ◽

Hugo Bonatti ◽

Timothy L. Pruett ◽

...

Keyword(s):

Surgical Site Infection ◽

General Surgery ◽

Isopropyl Alcohol ◽

Povidone Iodine ◽

Site Infection ◽

Infection Rates ◽

Skin Preparation ◽

Improvement Project ◽

Period 2

Objective.To compare the effects of different skin preparation solutions on surgical-site infection rates.Design.Three skin preparations were compared by means of a sequential implementation Design. Each agent was adopted as the preferred modality for a 6-month period for all general surgery cases. Period 1 used a povidone-iodine scrub-paint combination (Betadine) with an isopropyl alcohol application between these steps, period 2 used 2% Chlorhexidine and 70% isopropyl alcohol (ChloraPrep), and period 3 used iodine povacrylex in isopropyl alcohol (DuraPrep). Surgical-site infections were tracked for 30 days as part of ongoing data collection for the National Surgical Quality Improvement Project initiative. The primary outcome was the overall rate of surgical-site infection by 6-month period performed in an intent-to-treat manner.Setting.Single large academic medical center.Patients.All adult general surgery patients.Results.The study comprised 3,209 operations. The lowest infection rate was seen in period 3, with iodine povacrylex in isopropyl alcohol as the preferred preparation method (3.9%, compared with 6.4% for period 1 and 7.1% for period 2; P = .002). In subgroup analysis, no difference in outcomes was seen between patients prepared with povidone-iodine scrub-paint and those prepared with iodine povacrylex in isopropyl alcohol, but patients in both these groups had significantly lower surgical-site infection rates, compared with rates for patients prepared with 2% Chlorhexidine and 70% isopropyl alcohol (4.8% vs 8.2%; P = .001).Conclusions.Skin preparation solution is an important factor in the prevention of surgical-site infections. Iodophor-based compounds may be superior to Chlorhexidine for this purpose in general surgery patients.