Mechanisms related to inadvertent perioperative hypothermia and increased risk of surgical site infections

Abstract Background Hospital-acquired infections (HAIs) in intensive care units (ICUs) are among the avoidable morbidity and mortality causes. This study aimed at investigating the rate of ICU-acquired infections (ICU-AIs) in Iran. Methods For the purpose of this multi-center study, the rate of ICU-AIs calculated based on the data collected through Iranian nosocomial infections surveillance system and hospital information system. The data expanded based on 12 months of the year (13,632 records in terms of “hospital-ward-month”), and then, the last observation carried forward method was used to replace the missing data. Results The mean (standard deviation) age of 52,276 patients with HAIs in the ICUs was 47.37 (30.78) years. The overall rate of ICU-AIs was 96.61 per 1000 patients and 16.82 per 1000 patient-days in Iran’s hospitals. The three main HAIs in the general ICUs were ventilator-associated events (VAE), urinary tract infection (UTI), and pneumonia events & lower respiratory tract infection (PNEU & LRI) infections. The three main HAIs in the internal and surgical ICUs were VAE, UTI, and bloodstream infections/surgical site infections (BSI/SSI). The most prevalent HAIs were BSI, PNEU & LRI and eye, ear, nose, throat, or mouth (EENT) infections in the neonatal ICU and PNEU & LRI, VAE, and BSI in the PICU. Device, catheter, and ventilator-associated infections accounted for 60.96, 18.56, and 39.83% of ICU-AIs, respectively. The ventilator-associated infection rate was 26.29 per 1000 ventilator-days. Based on the Pabon Lasso model, the lowest rates of ICU-AIs (66.95 per 1000 patients and 15.19 patient-days) observed in zone III, the efficient area. Conclusions HAIs are common in the internal ICU wards. In fact, VAE and ventilator-related infections are more prevalent in Iran. HAIs in the ICUs leads to an increased risk of ICU-related mortality. Therefore, to reduce ICU-AIs, the specific and trained personnel must be responsible for the use of the devices (catheter use and ventilators), avoid over use of catheterization when possible, and remove catheters earlier.

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Preoperative cigarette smoking and short-term morbidity and mortality after cardiac surgery: a meta-analysis

Heart Asia ◽

10.1136/heartasia-2018-011069 ◽

2018 ◽

Vol 10 (2) ◽

pp. e011069 ◽

Cited By ~ 1

Author(s):

Nicholas Gregory Ross Bayfield ◽

Adrian Pannekoek ◽

David Hao Tian

Keyword(s):

Cardiac Surgery ◽

Smoking Status ◽

Meta Analysis ◽

Surgical Site Infections ◽

Neurological Complications ◽

Pulmonary Complications ◽

Morbidity And Mortality ◽

Surgical Patients ◽

Short Term ◽

Increased Risk

Currently, the choice of whether or not to electively operate on current smokers is varied among cardiothoracic surgeons. This meta-analysis aims to determine whether preoperative current versus ex-smoking status is related to short-term postoperative morbidity and mortality in cardiac surgical patients. Systematic literature searches of the PubMed, MEDLINE and Cochrane databases were carried out to identify all studies in cardiac surgery that investigated the relationship between smoking status and postoperative outcomes. Extracted data were analysed by random effects models. Primary outcomes included 30-day or in-hospital all-cause mortality and pulmonary morbidity. Overall, 13 relevant studies were identified, with 34 230 patients in current or ex-smoking subgroups. There was no difference in mortality (p=0.93). Current smokers had significantly higher risk of overall pulmonary complications (OR 1.44; 95% CI 1.27 to 1.64; p<0.001) and postoperative pneumonia (OR 1.62; 95% CI 1.27 to 2.06; p<0.001) as well as lower risk of postoperative renal complications (OR 0.82; 95% CI 0.70 to 0.96; p=0.01) compared with ex-smokers. There was a trend towards an increased risk of postoperative MI (OR 1.29; 95% CI 0.95 to 1.75; p=0.10). No difference in postoperative neurological complications (p=0.15), postoperative sternal surgical site infections (p=0.20) or postoperative length of intensive care unit stay (p=0.86) was seen. Cardiac surgical patients who are current smokers at the time of operation do not have an increased 30-day mortality risk compared with ex-smokers, although they are at significantly increased risk of postoperative pulmonary complications.

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Surgical-Site Infections Following Cesarean Section in an Estonian University Hospital: Postdischarge Surveillance and analysis of Risk Factors

Infection Control and Hospital Epidemiology ◽

10.1086/502566 ◽

2005 ◽

Vol 26 (5) ◽

pp. 449-454 ◽

Cited By ~ 37

Author(s):

Piret Mitt ◽

Katrin Lang ◽

Aira Peri ◽

Matti Maimets

Keyword(s):

Risk Factors ◽

Cesarean Section ◽

Tertiary Care ◽

Surgical Site Infections ◽

Fetal Monitoring ◽

University Hospital ◽

Cross Sectional Survey ◽

Increased Risk ◽

Multi Method Approach ◽

Method Approach

AbstractObjectives:To evaluate a multi-method approach to postdischarge surveillance of surgical-site infections (SSIs) and to identify infection rates and risk factors associated with SSI following cesarean section.Design:Cross-sectional survey.Setting:Academic tertiary-care obstetric and gynecology center with 54 beds.Patients:All women who delivered by cesarean section in Tartu University Women's Clinic during 2002.Methods:Infections were identified during hospital stay or by postdischarge survey using a combination of telephone calls, healthcare worker questionnaire, and outpatient medical records review. SSI was diagnosed according to the criteria of the Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System.Results:The multi-method approach gave a follow-up rate of 94.8%. Of 305 patients, 19 (6.2%; 95% confidence interval [CI95)], 3.8-9.6) had SSIs. Forty-two percent of these SSIs were detected during postdischarge surveillance. We found three variables associated with increased risk for developing SSI: internal fetal monitoring (odds ratio [OR], 16.6; CI95, 2.2-125.8; P = .007), chorioamnionitis (OR, 8.8; CI95, 1.1-69.6; P = .04), and surgical wound classes III and IV (OR, 3.8; CI95, 1.2-11.8; P=.02).Conclusions:The high response rate validated the effectiveness of this kind of surveillance method and was most suitable in current circumstances. A challenge exists to decrease the frequency of internal fetal monitoring and to treat chorioamnionitis as soon as possible (Infect Control Hosp Epidemiol 2005;26:449-454).

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Perioperative hypothermia and surgical site infections part 2

The Veterinary Nurse ◽

10.12968/vetn.2015.6.5.276 ◽

2015 ◽

Vol 6 (5) ◽

pp. 276-280 ◽

Cited By ~ 1

Author(s):

Alison Mann

Keyword(s):

Surgical Site Infections ◽

Perioperative Hypothermia

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Association between daptomycin susceptibility and teicoplanin resistance in Staphylococcus epidermidis

Scientific Reports ◽

10.1038/s41598-019-55149-z ◽

2019 ◽

Vol 9 (1) ◽

Author(s):

Shinichi Watanabe ◽

Yukinobu Kawakami ◽

Hiroshi Kimura ◽

Shinobu Murakami ◽

Hitoshi Miyamoto ◽

...

Keyword(s):

Staphylococcus Epidermidis ◽

Retrospective Cohort ◽

Inhibitory Concentration ◽

Surgical Site Infections ◽

University Hospital ◽

Clinicopathological Factors ◽

Common Occurrence ◽

Increased Risk ◽

History Of ◽

Multiple Analysis

AbstractStaphylococcus epidermidis infections are a common occurrence in hospitals, particularly in catheter-related bloodstream and surgical site infections and infective endocarditis. Higher daptomycin minimum inhibitory concentration (MIC) values may be associated with daptomycin treatment failure among patients with S. epidermidis infections. We therefore conducted a retrospective cohort study to determine the predictive value of daptomycin susceptibility. A retrospective study was undertaken in 1,337 patients with S. epidermidis infections. Data were collected from 1 January 2013 to 31 December 2016 at Ehime University Hospital, and included the following clinicopathological factors for evaluation: age, sex, resistance to vancomycin or teicoplanin, and history of antimicrobial therapy. Multiple analysis was performed using logistic regression to identify factors that independently and significantly affected the daptomycin resistance. Daptomycin-resistant S. epidermidis was identified in 38 (2.8%) patients. According to the multiple analysis, only higher MIC values (≥16 mg/L) for teicoplanin (P < 0.0001) were independently associated with an increased risk of developing daptomycin resistance. In conclusion, higher teicoplanin MIC values may predict resistance to daptomycin treatment in S. epidermidis infections.

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1239. Efficacy of Preoperative Chlorhexidine Gluconate and Mupirocin in the Prevention of Orthopedic Surgical Site Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1102 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S446-S446

Author(s):

Gabrielle Kahler ◽

Michael Ing

Keyword(s):

Treatment Protocol ◽

Retrospective Chart Review ◽

Surgical Site Infections ◽

The United States ◽

Chlorhexidine Gluconate ◽

Orthopedic Procedures ◽

Causative Organism ◽

Infection Rates ◽

Chi Square ◽

Increased Risk

Abstract Background Surgical site infections (SSIs) affect 1–5% of patients undergoing surgical procedures in the United States each year and have a mortality rate of up to 75%. We sought to assess the efficacy of a bundled preoperative decolonization treatment protocol to prevent SSIs in hip, knee, or spine procedures. Methods A retrospective chart review was conducted for 2224 adult patients undergoing spine, knee, or hip procedures performed at the JL Pettis Memorial VAMC from October 1, 2010 to December 31, 2018. NHSN/CDC criteria were utilized. The study included spine surgeries with or without new hardware, but only hip and knee surgeries with new hardware. Procedures with an infection present at the time of surgery (PATOS) were excluded. A pre-operative methicillin-resistant Staphylococcus aureus (MRSA) nares screen was performed. Patients treated were given mupirocin (MPN) to apply to their nares and 4% chlorhexidine gluconate (CHG) to wash all skin prior to the procedure. Patients undergoing emergent procedures received CHG without MPN. The intention to treat model and chi-square test were utilized. The primary endpoints were the infection rates in both the untreated and treated groups. Secondary endpoints included the MRSA screening result, SSI class, causative organism(s), and the surgical site. Results A total of 2,112 procedures were included in the study. Thirty-three (1.56%) procedures met NHSN/CDC criteria for SSI. Of the 1,754 (83.0%) procedures given decolonization treatment with MPN and/or CHG, 22 (1.25%) developed an SSI. Of the 358 procedures not receiving treatment, 11 (3.07%) developed an SSI. Conclusion Patients given decolonization treatment had a lower infection rate compared with those who were not treated (1.25% vs. 3.07%, P = 0.0115). Even though the decrease in infection rates were most significant for hip procedures, the overall trend favored the use of a preoperative decolonization treatment protocol for all of the orthopedic procedures studied (Table 1). Current barriers include patient compliance and correct use of decolonization agents, which may affect the actual efficacy of decolonization treatment. A possible confounder was the known increased risk of SSIs in emergent procedures. Disclosures All authors: No reported disclosures.

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Myomectomy during cesarean section

Serbian Journal of Anesthesia and Intensive Therapy ◽

10.5937/sjait2104073s ◽

2021 ◽

Vol 43 (3-4) ◽

pp. 73-80

Author(s):

Radmila Sparić ◽

Đina Tomašević ◽

Mladen Anđić ◽

Miljan Pupovac ◽

Aleksandra Pavić ◽

...

Keyword(s):

Caesarean Section ◽

Cesarean Section ◽

Perioperative Complications ◽

Uterine Fibroids ◽

Surgical Site Infections ◽

Reproductive Age ◽

Benign Tumors ◽

Uterine Torsion ◽

Perioperative Bleeding ◽

Increased Risk

Myomas (fibroids, leiomyomas) are the most common benign tumors of genital organs in women of reproductive age and represent a significant problem in women's health care. The frequency of cesarean section is higher in women with uterine fibroids. Absolute indications for myomectomy during caesarean section are: fibroids that prevent hysterotomy during caesarean section, impede uterine incision suture, hamper safe fetal extraction and cause uterine torsion. Relative indications for myomectomy during caesarean section are: subserous and pedunculated fibroids, anterior uterine wall fibroids, fibroids that can cause immediate perioperative, and puerperal complications, the patient's desire, fibroids that can cause complications in subsequent pregnancies, and fibroids that can be enucleated without additional hysterotomy. Myomectomy during caesarean section is a complex surgical procedure, associated with the possibility of considerable complications, and defining their actual frequency and risk factors for their occurrence requires further research. Myomectomy during caesarean section is associated with an increased risk of perioperative bleeding. Other perioperative complications of myomectomy during cesarean section are: disseminated intravascular coagulation, paralytic ileus, surgical site infections, sepsis, postoperative febrile morbidity, increased incidence of blood transfusions, and prolonged hospitalization.

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Postoperative infections: a preventable calamity

10.31219/osf.io/s26r3 ◽

2021 ◽

Author(s):

Qasim Mehmood ◽

Arisha Nawaz ◽

Priyanka Chahal ◽

Dattatreya Mukherjee

Keyword(s):

Surgical Complication ◽

Operative Procedure ◽

Surgical Site Infections ◽

Body Part ◽

Adhesive Tape ◽

Joint Tissue ◽

Surgical Wounds ◽

Increased Risk ◽

Prolonged Hospital ◽

Healthcare Associated

This is a Commentary, Surgical wounds generally heal by primary closure during which the wound edges are brought together, and is assisted by the use of sutures, stitches, staples, adhesive tape, or glue. Some of surgical wounds are more difficult to heal due to their anatomical position or an increased risk of infections [1]. When the surgical wound is not healed properly it leads to complications which include surgical site infections, dehiscence, and development of seromas or hematomas [2]. The infection appears in a wound created by a surgical or post-operative procedure of any cavity, bone, joint, tissue or prosthesis involved. The organisms involved in the infection are generally endogenous to the patient and come from the skin or any body part that has been opened. It is the most common post surgical complication, with increased morbidity and mortality. In general surgery, reported rates of post surgical complications range from 6% to 44%. These infections are a common type of healthcare associated infections and frequent complication of hospitalization. They are responsible for prolonged hospital stay, increased admissions in intensive care units, readmission in hospitals after surgery, increased surgery costs, and delays to adjuvant systemic therapy [3,5]. The increased morbidity and costs associated with these postoperative complications motivate healthcare professionals to be vigilant in recognizing risk factors arising from patient comorbidities or circumstances of surgery.

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