scholarly journals Successful control program to implement the appropriate antibiotic prophylaxis for cesarean section

2008 ◽  
Vol 50 (2) ◽  
pp. 79-82 ◽  
Author(s):  
Silvia Nunes Szente Fonseca ◽  
Maria Helena Sofia ◽  
Silvana Quintana ◽  
Fernanda Dos Santos Nogueira ◽  
Anna S. Levin
Keyword(s):  
Cesarean Section ◽  
Intervention Program ◽  
Antimicrobial Prophylaxis ◽  
Surgical Site Infections ◽  
Control Program ◽  
Post Discharge ◽  
Post Intervention ◽  
Successful Control ◽  
A Prospective Study ◽  
Government Reimbursement

OBJECTIVE: Describe implementation of a successful program to reduce doses (cefazolin 2 to 1 g) used for antimicrobial prophylaxis. METHODS: Evaluation of an intervention program to reduce prophylactic antimicrobial doses. The intervention included weekly staff discussions, automatic dispensation of 1g-vial of cefazolin by the pharmacy unless expressly requested by surgeon and increase in post-discharge surveillance as a strategy to reassure surgeons of the safety of the reduction. In the pre and post intervention periods, a prospective study of antimicrobial consumption and surgical site infections were measured. RESULTS: There were 5,164 and 5,204 deliveries in 2001-2002 and 2003-2004, respectively; 1,524 (29.5%) and 1,363 (26%) were cesarean sections. There was a 45% decrease in cefazolin vials used on average per cesarean section (2.29 to 1.25). Patients evaluated increased from 16% to 67% and the SSI rates in both periods were 3.34% to 2.42%, respectively. CONCLUSION: An ample intervention, including administrative and educational measures, led to high compliance with dose reduction and saved more than US$4,000 in cefazolin, considered important because government reimbursement in Brazil for cesarean section is $80.

scholarly journals The Association Between Preterm Premature Rupture of Membranes and Surgical Site Infection Following Cesarean Section

2016 ◽  
Author(s):  
Mehmet Çınar ◽  
Hakan Timur ◽  
Ali İrfan Güzel ◽  
Aytekin Tokmak ◽  
Burak Ersak ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cesarean Section ◽  
Clinical Characteristics ◽  
Positive Culture ◽  
Surgical Site Infections ◽  
Study Group ◽  
Obese Women ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Post Discharge

<p><strong>OBJECTIVE:</strong> To evaluate clinical characteristics of surgical-site infections (SSIs) following cesarean section (CS) and to identify infection rates and risk factors associated with SSIs following cesarean section. <br /><strong>STUDY DESIGN:</strong> A total of 197 patients who underwent cesarean and complicated with SSIs was evaluated during hospital stay or within 30 days following cesarean section by readmission to the hospital or by post discharge survey. The clinical characteristics, subsequent microbiological culture results and management were recorded. <br /><strong>RESULTS:</strong> There were 34 (17.25%) patients complicated with preeclampsia and 26 (13.17%) gestational diabetes mellitus (GDM) in the study group. Preterm rupture of membranes (PROM) rate was 17.31% and mean rupture period were 6.61 hours. In the study population, 66 patients had positive culture results. The most isolated microorganism was S. Aureus (n=13, 19.7%). Preeclampsia, GDM and PROM rates were statically significant high in patients with positive culture results (p&lt;0.05). There were 31 patients complicated with PROM in the study group. The rates of positive culture results were significantly increased by PROM (mean 45%, p&lt;0.05).<br /><strong>CONCLUSION:  </strong>Independent risk factors for post-cesarean SSIs are younger age, obesity, diabetes, hypertension, premature rupture of membranes. Information regarding higher rates of SSIs should be provided to obese women undergoing cesarean delivery, especially when diabetes and hypertension coexists.</p>

scholarly journals Antimicrobial prophylaxis administration after umbilical cord clamping in cesarean section and the risk of surgical site infection: a cohort study with 55,901 patients

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Rami Sommerstein ◽  
◽  
Jonas Marschall ◽  
Andrew Atkinson ◽  
Daniel Surbek ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Umbilical Cord ◽  
Multilevel Models ◽  
Antimicrobial Prophylaxis ◽  
Surgical Site Infections ◽  
Patient Characteristics ◽  
World Health ◽  
Cord Clamping ◽  
Umbilical Cord Clamping ◽  
Health Organization

Abstract Background The World Health Organization (WHO) recommends administration of surgical antimicrobial prophylaxis (SAP) in cesarean section prior to incision to prevent surgical site infections (SSI). This study aimed to determine whether SAP administration following cord clamping confers an increased SSI risk to the mother. Methods Study design: Cohort. Setting: 75 participating Swiss hospitals, from 2009 to 2018. Participants: A total of 55,901 patients were analyzed. Main outcome measures: We assessed the association between SAP administration relative to incision and clamping and the SSI rate, using generalized linear multilevel models, adjusted for patient characteristics, procedural variables, and health-care system factors. Results SAP was administered before incision in 26′405 patients (47.2%) and after clamping in 29,496 patients (52.8%). Overall 846 SSIs were documented, of which 379 (1.6% [95% CI, 1.4–1.8%]) occurred before incision and 449 (1.7% [1.5–1.9%]) after clamping (p = 0.759). The adjusted odds ratio for SAP administration after clamping was not significantly associated with an increased SSI rate (1.14, 95% CI 0.96–1.36; p = 0.144) when compared to before incision. Supplementary and subgroup analyses supported these main results. Conclusions This study did not confirm an increased SSI risk for the mother in cesarean section if SAP is given after umbilical cord clamping compared to before incision.

scholarly journals Surgical site infection following cesarean section in a general hospital in Kuwait: trends and risk factors

2019 ◽  
Vol 147 ◽  
Author(s):  
W. Alfouzan ◽  
M. Al Fadhli ◽  
N. Abdo ◽  
W. Alali ◽  
R. Dhar
Keyword(s):  
Risk Factors ◽  
Cesarean Section ◽  
Prophylactic Antibiotic ◽  
Surgical Site Infections ◽  
Prophylactic Antibiotics ◽  
Drug Resistant ◽  
Surgical Morbidity ◽  
Antibiotic Policy ◽  
Infection Surveillance ◽  
A Prospective Study

Abstract Surgical site infections (SSI) are a significant cause of post-surgical morbidity and mortality. The objectives of this study were to determine the prevalence of SSI and identify risk factors for infections following cesarean section (CS). A prospective study of SSI after CS was carried out from January 2014 to December 2016 using the methodology of the American National Nosocomial Infection Surveillance System. Suspected SSIs were confirmed clinically by the surgeon, and or, by culture. Seven thousand two hundred thirty five CS were performed with an overall SSI prevalence of 2.1%, increasing from 1.7% in 2014 to 2.95% in 2016 (P = 0.010). Of 152 cases of SSI, the prevalence of infection was 46.7% in women ⩽30 years and 53.3% in women >30 years (P = 0.119). Of 148 culture samples from as many women, 112 (75.7%) yielded growth of microorganisms with 42 (37.5%) of isolates being multi-drug resistant (MDR). Women who did not receive prophylactic antibiotics (35.5%) developed SSI more often than those who did (P < 0.0001). These findings suggest that emergency CS and inappropriate antibiotic prophylaxis are risk factors for developing SSI. In the light of the emergence of MDR bacteria there is a need to implement revised prophylactic antibiotic policy as part of antimicrobial stewardship to decrease SSI rates.

Clinical Teaching Competences of Nursing Demonstrators at Faculty of Nursing Post Intervention program

2018 ◽  
Vol 14 (1) ◽  
pp. 32-55
Author(s):  
Zohor El said: ◽  
Fouda Shaban: ◽  
Samar Ghadery ◽  
Om ebrahiem Elmelegy
Keyword(s):  
Intervention Program ◽  
Clinical Teaching ◽  
Post Intervention

scholarly journals Administrative Coding Methods Impact Surgical Site Infection Rates

2020 ◽  
Vol 41 (S1) ◽  
pp. s111-s112
Author(s):  
Mohammed Alsuhaibani ◽  
Mohammed Alzunitan ◽  
Kyle Jenn ◽  
Daniel Diekema ◽  
Michael Edmond ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Surgical Procedures ◽  
Hip Prosthesis ◽  
Knee Prosthesis ◽  
Surgical Site Infections ◽  
Fold Increase ◽  
Abdominal Hysterectomy ◽  
Absolute Difference ◽  
Coding Method ◽  
The Impact

Background: Surveillance for surgical site infections (SSI) is recommended by the CDC. Currently, colon and abdominal hysterectomy SSI rates are publicly available and impact hospital reimbursement. However, the CDC NHSN allows surgical procedures to be abstracted based on International Classification of Diseases, Tenth Revision (ICD-10) or current procedural terminology (CPT) codes. We assessed the impact of using ICD and/or CPT codes on the number of cases abstracted and SSI rates. Methods: We retrieved administrative codes (ICD and/or CPT) for procedures performed at the University of Iowa Hospitals & Clinics over 1 year: October 2018–September 2019. We included 10 procedure types: colon, hysterectomy, cesarean section, breast, cardiac, craniotomy, spinal fusion, laminectomy, hip prosthesis, and knee prosthesis surgeries. We then calculated the number of procedures that would be abstracted if we used different permutations in administration codes: (1) ICD codes only, (2) CPT codes only, (3) both ICD and CPT codes, and (4) at least 1 code from either ICD or CPT. We then calculated the impact on SSI rates based on any of the 4 coding permutations. Results: In total, 9,583 surgical procedures and 180 SSIs were detected during the study period using the fourth method (ICD or CPT codes). Denominators varied according to procedure type and coding method used. The number of procedures abstracted for breast surgery had a >10-fold difference if reported based on ICD only versus ICD or CPT codes (104 vs 1,109). Hip prosthesis had the lowest variation (638 vs 767). For SSI rates, cesarean section showed almost a 3-fold increment (2.6% when using ICD only to 7.32% with both ICD & CPT), whereas abdominal hysterectomy showed nearly a 2-fold increase (1.14% when using CPT only to 2.22% with both ICD & CPT codes). However, SSI rates remained fairly similar for craniotomy (0.14% absolute difference), hip prosthesis (0.24% absolute difference), and colon (0.09% absolute difference) despite differences in the number of abstracted procedures and coding methods. Conclusions: Denominators and SSI rates vary depending on the coding method used. Variations in the number of procedures abstracted and their subsequent impact on SSI rates were not predictable. Variations in coding methods used by hospitals could impact interhospital comparisons and benchmarking, potentially leading to disparities in public reporting and hospital penalties.Funding: NoneDisclosures: None

scholarly journals Trends in orthopaedic antimicrobial prophylaxis in the UK between 2005 and 2011

2013 ◽  
Vol 95 (7) ◽  
pp. 495-502 ◽  
Author(s):  
RS Aujla ◽  
DJ Bryson ◽  
A Gulihar ◽  
GJ Taylor
Keyword(s):  
Orthopaedic Surgery ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Elective Surgery ◽  
Antimicrobial Prophylaxis ◽  
Trauma Surgery ◽  
Surgical Site Infections ◽  
Freedom Of Information ◽  
Infection Rates ◽  
Freedom Of Information Act ◽  
The Uk

Introduction Antimicrobial prophylaxis remains the most powerful tool used to reduce infection rates in orthopaedics but the choice of antibiotic is complex. The aim of this study was to examine trends in antimicrobial prophylaxis in orthopaedic surgery involving the insertion of metalwork between 2005 and 2011. Methods Two questionnaires (one in 2008 and one in 2011) were sent to all National Health Service trusts in the UK using the Freedom of Information Act. Results In total, 87% of trusts that perform orthopaedic surgery responded. The use of cefuroxime more than halved between 2005 and 2011 from 80% to 36% and 78% to 26% in elective surgery and trauma surgery respectively. Combination therapy with flucloxacillin and gentamicin rose from 1% to 32% in elective and 1% to 34% in trauma surgery. Other increasingly popular regimes include teicoplanin and gentamicin (1% to 10% in elective, 1% to 6% in trauma) and co-amoxiclav (3% to 8% in elective, 4% to 14% in trauma). The majority of changes occurred between 2008 and 2010. Over half (56%) of the trusts stated that Clostridium difficile was the main reason for changing regimes. Conclusions In 2008 a systematic review involving 11,343 participants failed to show a difference in surgical site infections when comparing different antimicrobial prophylaxis regimes in orthopaedic surgery. Concerns over C difficile and methicillin resistant Staphylococcus aureus have influenced antimicrobial regimes in both trauma and elective surgery. Teicoplanin would be an appropriate choice for antimicrobial prophylaxis in both trauma and elective units but this is not reflected in its current level of popularity.

Abstract TP241: Race-ethnic Differentials Time and Acute Stroke Emergency Presentation: The ASPIRE Study

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Bernadette Boden-Albala ◽  
Dorothy F Edwards ◽  
Jeffrey J Wing ◽  
Shauna S Clair ◽  
Stephen Fernandez ◽  
...  
Keyword(s):  
Black Women ◽  
Acute Stroke ◽  
Intervention Program ◽  
Arrival Time ◽  
Proportional Hazards ◽  
Ethnic Disparities ◽  
Cox Proportional Hazards ◽  
Urban Setting ◽  
Intervention Period ◽  
Post Intervention

BACKGROUND: There is sparse data about the nature of race-ethnic disparities in the acute stroke setting including differentials in stroke preparedness. The aim of this analysis was to explore race-ethnic differentials in time to arrival for acute stroke in a racial and ethnically diverse urban setting. METHODS: ASPIRE is a multi-dimensional intervention program (community, hospital, and EMS) for acute stroke preparedness targeted to increase IV tPA utilization in underserved black communities in the DC metro area. We prospectively identified stroke admissions and EMS utilization including acute stroke arrival time parameters for the 6 month pre and post intervention periods. Cox proportional hazards models were used to examine predictors of arrival time. Proportionality of the hazards was checked. RESULTS: In the 6 month pre-intervention period, data was collected on 943 stroke cases; 53% female; 74% black; mean age 67 yrs. Of the subjects from the pre-intervention period with arrival times less than 48 hrs, the median arrival time to the emergency department (ED) was 9 hours; 20% presented under 3 hours. In multivariable Cox PH models, subjects were 38% more likely to arrive earlier if they had arrived by EMS (HR: 1.38, 95%CI: 1.21-1.58). Black subjects were 25% less likely to arrive earlier (HR: 0.75, 95%CI: 0.60-0.93), but this effect was dampened over time (p=0.03). The model included the interaction between black race and time and adjusted for insurance status, risk factors (hypertension and diabetes), gender, age and prior stroke. Ina gender by race analysis, there was a trend towards black women being less likely to arrive earlier to the ED (HR 0.78, 95% CI 0.6 -1.0). However, overall, there was no race-ethnic interaction with arrival by EMS. CONCLUSIONS: Contrary to the perceived perception by the community suggesting there is a disparity in EMS utilization by the black DC community, we found no overall significant racial difference in EMS utilization for acute stroke. While there was a trend towards delayed overall arrival in black females, this was independent of EMS utilization.

scholarly journals An educational intervention program on knowledge about oral hygiene measures

2014 ◽  
Vol 13 (4) ◽  
pp. 421-426
Author(s):  
Farzana Karim ◽  
Jahanara Begum
Keyword(s):  
Health Education ◽  
Educational Intervention ◽  
Oral Hygiene ◽  
Intervention Program ◽  
Family Income ◽  
Medical Science ◽  
Harmful Effect ◽  
Group Method ◽  
Post Intervention ◽  
Hygiene Measures

Background: Health education is a process of transmission of knowledge and skills necessary for improvement in quality of life. Objectives: The purpose of this quasi-experimental study was to evaluate the oral hygiene related knowledge among the population in a selected community before and after health education. Materials and Methods: A total of 106 respondents were taken purposively at South Pirerbag of Dhaka city. Baseline data were collected by pre-tested structured questionnaire. An educational intervention program was conducted by dividing the respondents into seven groups, 15 in each group; method was group discussion and lecture; poster, model of teeth and brush were the aids. Post intervention data were collected by the same questionnaire. Results: Among the respondents, 61.32% were male and 38.68% were female, mean age was 46.25 years, 35.85% had primary level education, monthly family income was Tk 5000-10000 in 66.98%. Before intervention 64.15% told that teeth should be cleaned twice daily, 62.26% told teeth should be cleaned by brush and paste and 2.83% told teeth should be cleaned after breakfast and night; whereas after intervention the result was 91.51%, 85.85% and 67.93% respectively. Before intervention 66.98% stated that tobacco is hazardous to health but 32.4% have no idea about the type of diseases that occur due to tobacco; whereas after intervention 89.62% told that tobacco is hazardous to health and most of them had idea about harmful effect of tobacco. Conclusion: Educational intervention program is effective to improve the knowledge of the respondents about oral hygiene. DOI: http://dx.doi.org/10.3329/bjms.v13i4.20589 Bangladesh Journal of Medical Science Vol.13(4) 2014 p.421-426

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