Effect of duration of pre-operative admission on surgical site infection in major abdominal surgeries: an observational study

Background: Surgical site infection (SSI) are second most common cause of mortality in surgical patient, situation has been further complicated by emergence of drug resistant strains. The importance of preventing surgical site infections is well recognized since they lead to increased morbidity, prolonged hospital stays, need for readmission, high end antibiotic treatment and re-surgery. The study was done to see if incidence of SSI is decreased with decreased pre-operative admission time. Others factors associated with SSI were analysed including the microbiological spectrum.Methods: The study was an analytical, observational, case control study. Sixty (60) cases each of gynaecology and obstetrical post-operative patients who developed SSI within 30 days were taken as cases and who did not develop SSI were taken as controls and preoperative admission time was analysed in both cases and controls to observe if risk of surgical site infections decreases due to decreased exposure to nosocomial pathogens when the pre-operative admission time was less than 48 hours.Results: Author found that there was statistically significant difference in the time between surgery and admission in the gynaecological surgeries with p value 0.023, as compared to the obstetrics surgeries where there was no statistically significant difference. Common organism isolated was E. coli sensitive to gentamicin.Conclusions: From this study, it seems to be a good policy to evaluate the patient on OPD basis and admit them about 24 to 48 hours prior to the surgery rather them keeping them admitted for prolonged duration in wards for diagnostic evaluation. This prevents nosocomial contamination in the patient’s skin flora thereby preventing SSI. This practice not only conserves the hospital resources but also makes the patient turn over faster. Further this might in the long run reduce the antibiotic resistant hospital flora.

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Does Skin Preparation Influence Surgical Site Infection in Laparotomy Wounds: Comparative Evaluation of Preoperative Skin Preparation With 4% Chlorhexidine With 5% Povidone Iodine in Laparotomy Wounds: A Prospective Trial

European Journal of Medical and Health Sciences ◽

10.24018/ejmed.2020.2.4.415 ◽

2020 ◽

Vol 2 (4) ◽

Author(s):

Ravindran Chirukandath ◽

Manoj P. Elangovan ◽

Agil B. ◽

Reshma A. Cheedhamadathil ◽

Ayana M. Dev ◽

...

Keyword(s):

Surgical Site Infection ◽

Povidone Iodine ◽

Prospective Trial ◽

Surgical Site Infections ◽

P Value ◽

Site Infection ◽

Related Complication ◽

Skin Preparation ◽

Emergency Procedures ◽

Significant Difference

Introduction: Surgical site infection is a dangerous condition causing a heavy burden on the patient and social health system. Surgical site infections are among the most common hospital acquired infections comprising 14 to 16% of inpatient infections. There are various factors predisposing the infections and many of them are patient related or disease related. The use of pre-operative skin preparation by effective antiseptic plays an important role in reducing postoperative wound infections. There are several kinds of antiseptics available for preoperative skin preparation; however povidone iodine and spirit are commonly used in clinical practice. Materials and Methods: This study compared the incidence of surgical site infections within 7 days of postoperative period in laparotomy wounds prepared using 4% Chlorhexidine and those prepared with 5% Povidone iodine for pre-laparotomy skin preparation. Results: This study compared 128, 4% Chlorhexidine prepared patients and 109, 5% Povidone iodine prepared patients undergoing various elective n = 114 and emergency procedures n = 123. The overall SSI rates in 7 days in the whole group were 13.44 %. The SSI rates on the 4% Chlorhexidine group were 10.16% and 5% povidone iodine group were 17.27% and it was statically significant with a p value of p = 0.00413 showing significant reduction in the 4% Chlorhexidine group. The study also compared the SSI rates in elective and emergency procedures in both groups with significant difference in emergency procedures. More variables are also compared between the groups and results were analyzed. Conclusion: This study shows the use of Chlorhexidine 4% reduces the morbidity of one of the most common wound related complication in laparotomy patients in all categories of laparotomy wounds.

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Surgical-site infections in emergency abdominal paediatric surgeries at a tertiary-care hospital in Pakistan

Journal of the Pakistan Medical Association ◽

10.47391/jpma.1107 ◽

2020 ◽

pp. 1-9

Author(s):

Ali Faisal Saleem ◽

Huma Faiz Halepota ◽

Hasaan Omar ◽

Areeba Zain ◽

Muhammad Arif Mateen Khan

Keyword(s):

Abdominal Surgery ◽

Surgical Site Infection ◽

Tertiary Care ◽

Stable Condition ◽

University Hospital ◽

P Value ◽

Care Hospital ◽

Site Infection ◽

Significant Difference ◽

Pathogen Occurrence

Abstract A retrospective chart review was carried out in children (neonates to 18 years) who underwent acute surgical abdominal exploration during 2012-2016 at the Aga Khan University Hospital, Karachi, to evaluate the post-operative surgical site infection rates in emergency paediatric abdominal surgery. Incidence of surgical site infection (SSI) was estimated. P-value was calculated, chi-square and non-parametric tests were performed by comparing pre-surgical and post-surgical procedure pathogen occurrence and pre-procedure wound status. Pathogen occurrence related to time-trend of 98 paediatric patients who underwent emergency abdominal surgery was plotted. Of the 94 who were discharged in stable condition, it was found that there was no significant difference between pre- and post-surgical pathogens. Escherichia coli (n=10) was found to be the most common pathogen. Contaminated wounds were associated with higher SSI (p=0.036, OR 1.95 95% CI 0.7-5.4). Continuous...

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Role of subcutaneous suction drain in reducing surgical site infections after emergency laparotomy

International Surgery Journal ◽

10.18203/2349-2902.isj20173141 ◽

2017 ◽

Vol 4 (8) ◽

pp. 2717

Author(s):

Poonam Gupta ◽

Rajesh Kumar

Keyword(s):

Surgical Site Infection ◽

Significant Role ◽

Surgical Site Infections ◽

P Value ◽

Emergency Laparotomy ◽

Emergency Setting ◽

Site Infection ◽

Randomised Study ◽

Suction Drain ◽

Drain Group

Background: One of important morbidity postoperatively is surgical site infection and the important cause is collection of blood and serous fluids which can get infected and this factor is even more important in emergency laparotomies. our prospective randomised study compares the incidence of surgical site infection in post emergency abdominal surgical wounds with subcutaneous suction drains versus those in whom drain was not placed.Methods: A prospective interventional study of 100 subjects done in department of surgery at rural tertiary centre. on the basis of exclusion and inclusion criteria patient were randomly selected for cases (with post-operative suction drain) and controls. subcutaneous drain in emergency setting play significant role in reducing the incidence of surgical site infection which is significant statistically.Results: 24% of patients in drain group develop surgical site infections. 50% of patients in non-drain group develop infection. Incidence of infection in drain group was lower than the no drain group (p value 0.05) and was statistically significant.Conclusions: Subcutaneous drain in emergency laparotomy play significant role in reducing the incidence of surgical site infection

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Magnitude of Surgical Site Infection and Its Associated Factors Among Patients Who Underwent a Surgical Procedure at Debre Tabor General Hospital, Northwest Ethiopia

10.21203/rs.3.rs-123625/v1 ◽

2020 ◽

Author(s):

Mequanint Bezie Walelign ◽

Tadesse Wuletaw Demissie ◽

Abaynew Honelign Desalegn

Keyword(s):

Surgical Site Infection ◽

General Hospital ◽

Surgical Procedure ◽

Surgical Site Infections ◽

Northwest Ethiopia ◽

P Value ◽

Age Group ◽

Site Infection ◽

Co Morbidity ◽

Debre Tabor

Abstract Background: Surgical site infections are the commonest nosocomial infections and responsible for considerable morbidity and mortality as well as increased hospitalizations and treatment cost related to surgical operations. The aim of this study was to determine the magnitude and factors associated with surgical site infections at the surgical ward of Debre Tabor General Hospital, Northwest Ethiopia.Method: Institution based cross-sectional study was conducted on patients who underwent a surgical procedure at Debre Tabor General Hospital in 2020. The sample size was determined using the single population proportion formula. Data were entered and analyzed using SPSS version 21 software. Bivariate and multivariate logistic regressions analysis were employed. The odds ratio and its 95% confidence interval were taken to test the association between the dependent and independent variables. A P-value of less than 0.05 will be considered statistically significant.Result: In this study, a total of 191 patients have participated in the study yielding a response rate of 100%. The mean age of the respondents was 2.5 (SD ±0.68) years. The most age group 115(60.2%) resides at the age group greater than 40 years. More than one half(62.3) of the surgical clients were females. Most of the clients were farmers(32.5%) and unable to read and write(41.9) based on the occupation. The magnitude of surgical site infection in this study was found to be 11.5% (95% CI: 7.8%, 15.9%). The factors existence of comorbidity and antibiotic prophylaxis was given were found to be significantly associated with the magnitude of surgical site infection.Conclusion: The magnitude of surgical site infection in this study was high. Proper management of patients with co-morbidity especially those with diabetes mellitus, proper administration of anesthesia, and delivering intravenous antimicrobial prophylaxis before surgery as ordered would significantly reduce the incidence of surgical site infection.

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Prophylaxis of Surgical Site Infection in Cranial Surgery with Vancomycin Powder Application into Wound

Pakistan Journal Of Neurological Surgery ◽

10.36552/pjns.v23i3.351 ◽

2019 ◽

Vol 23 (3) ◽

pp. 205-210

Author(s):

SAMI UR REHMAN ◽

RIFFAT ULLAH KHAN ◽

GHAYUR ABBAS ◽

USAMA BIN ZUBAIR ◽

KAMRAN KHAN ◽

...

Keyword(s):

Treatment Group ◽

Surgical Site Infection ◽

Control Group ◽

P Value ◽

Site Infection ◽

Significant Difference ◽

Routine Prophylaxis ◽

Vancomycin Powder ◽

Vancomycin Group ◽

Lost To Follow Up

Objective: To see the effect of application of Vancomycin powder directly into the subgaleal space in reducing the postoperative surgical site infections.Materials and Methods: All the patients who underwent consecutive elective craniotomies from April 2017 to May 2018 Dept of Neurosurgery, szabmu, PIMS, Islamabad. The control group received the standard routine prophylaxis according to the hospital protocols, whereas the treatment group, in addition to the standard prophylaxis, received Vancomycin powder in the surgical wound in addition to the standard routine prophylaxis. Results: 182 patients were enrolled in the study, 91 allocated to each the control and treatment group (Vancomycin). Six patients were lost to follow up. There were 90 patients in the control group and 86 patients in the treatment (Vancomycin) group. Both the groups were almost statistically similar. In the control group, 34.09% (n = 60) were male and 17.04% (n = 30) were female. In the treatment group, 29.54% (n = 52) were male and 19.31% (n = 34) were female. The overall rate of surgical site infection (SSI) was 3.97% (7 out of 176 cases). A statistically significant difference found in infection rate between the treatment group, 0% (0 out of 86 cases) and the control group, 7.77% (7 out of 90 cases) with the p value of 0.002. Conclusions: The use of topical Vancomycin powder in surgical wounds may significantly reduce the incidence of infection in patients undergoing elective craniotomies. It is a promising means of preventing devastating and harmful postoperative wound infections.

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Prevalence of surgical site infections and their sensitivity patterns in elective abdominal surgeries in King George Hospital, Visakhapatnam

International Surgery Journal ◽

10.18203/2349-2902.isj20202830 ◽

2020 ◽

Vol 7 (7) ◽

pp. 2247

Author(s):

Pratha Anantha Ramani ◽

Simhadri Uday Kiran ◽

Murali Manohar Deevi ◽

Ginni Vijay Sainath Reddy ◽

Ginjupalli Saichand ◽

...

Keyword(s):

Risk Factors ◽

Surgical Site Infection ◽

Surgical Site Infections ◽

Wound Dressings ◽

Site Infection ◽

Antibiotic Resistant ◽

Clean Contaminated ◽

King George Hospital ◽

A Prospective Study ◽

Prolonged Hospital

Background: Surgical site infections are one of the most common complications in the postoperative period leading to increased morbidity, prolonged hospital stay and reduced quality of life. The present study aims to identify the incidence of surgical site infection (SSI), risk factors, causative organisms, and their sensitivity patterns in patients who have undergone elective abdominal surgeries.Methods: A prospective study containing 200 patients who have undergone elective abdominal surgeries from May 2018 to January 2020 were evaluated. A thorough history was taken in all the patients. A detailed clinical examination and routine investigations were done. Parameters such as body mass index (BMI), diabetic status, type of surgery, wound grading, culture, and sensitivity patterns were considered. The patients underwent treatment based on their investigatory reports.Results: In the present study, 54 patients developed surgical site infection, and among them, 22 are diabetics. Only ten patients with normal BMI developed SSI, whereas the other 44 patients who developed SSI had abnormal BMI. The incidence of SSI was higher in clean-contaminated surgeries comprising up to 89% of cases. Staphylococcus aureus was the most commonly isolated organism, and cefoperazone plus sulbactam was the most sensitive on antibiogram.Conclusions: The surgical site infections are on rising trend due to the emergence of antibiotic-resistant microorganisms. Treatment of the underlying risk factors, regular wound dressings, and antibiotics, according to sensitivity patterns, are the mainstay.

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Surgical Site Infection after Gastrointestinal and Hepatobiliary Surgeries- A Retrospective Evaluation from a Single Center of Western India

10.20944/preprints202005.0317.v1 ◽

2020 ◽

Author(s):

Bhavin B. Vasavada ◽

Hardik Patel

Keyword(s):

Multivariate Analysis ◽

Surgical Site Infection ◽

Hospital Stay ◽

Univariate Analysis ◽

Surgical Site Infections ◽

Western India ◽

Site Infection ◽

Prolonged Hospital Stay ◽

Hepatobiliary Surgery ◽

Prolonged Hospital

Aim: Aim of our study to evaluate various factors responsible for surgical site infection after gastrointestinal and hepatobiliary surgeries. Material and Methods: Patient who underwent gastrointestinal and hepatobiliary surgery in our department were evaluated retrospectively. Various factors associated with surgical site infection were evaluated using univariate and multivariate analysis. Surgical site infection was defined as any culture positive discharge from the wound within 30 days of surgery.Statistical analysis was done using SPSS version 23. Results: We evaluated total 331 patients operated between April 2018 to March 2020. 14 patients were lost to follow up after discharge and before completing post operative day 30. 18 patients expired before 30 days without developing SSI and were excluded from the study as per exclusion criteria. 299 patient included in the study. Total 20 patients developed surgical site infection. It showed SSI rate in our study population was 6.68%. On univariate analysis prolonged hospital stay, more blood product used, higher cdc grade of surgery, higher ASA grade, more operative time, open surgeries,colorectal and HPB surgeries were associated with surgical site infections. On multivariate analysis only prolonged hospital stay independently predicted Surgical Site Infectins. (p=0.014,0dds ratio 1.223, 95% confidence interal 1.042-1.435). Conclusion: Prolonged hospital stay independently predicts surgical site infections after gastrointestinal and hepatobiliary surgery.

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Superficial surgical site infections following stone and non-stone bile duct surgery- A comparative analysis

Northern International Medical College Journal ◽

10.3329/nimcj.v11i2.54061 ◽

2021 ◽

Vol 11 (2) ◽

pp. 458-462

Author(s):

Chishti Tanhar Bakth Choudhury ◽

BH Nazma Yasmeen ◽

Manir Hossain Khan ◽

AHM Towhidul Alam ◽

Shirin Akhter

Keyword(s):

Bile Duct ◽

Surgical Site Infection ◽

Wound Infection ◽

Surgical Site Infections ◽

Stone Disease ◽

P Value ◽

Site Infection ◽

Causative Agents ◽

Group A ◽

Group B

Background : Superficial surgical site infection (SSSI) is a vital issue after biliary surgery. Surgical site infections remain a major cause of illness in the post-operative period. Objectives : The purpose of the present study was to compare the number of wound infection and the causative organism of surgical site infection of patient of stone and non-stone bile duct surgery. Methodology : This cross-sectional study was carried out in the Department of Surgery at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from May 2017 to April 2018 for a period of 12 months. Patients presented with biliary disease of stone and non-stone variety were selected as study population. Patients were divided into 2 groups designated as group A and group B. Patients with the biliary stone disease were enrolled in group A and the biliary nonstone disease patients were in the group B. Patients were followed up in the postoperative period up to 2 weeks to find out the incidence of wound infection and its risk factors, causative agents, and some other variables. Certain variables were closely monitored to find the postoperative outcome as these variables were standard parameters in assessment of the outcome of the study. Results : A total number of 50 patients were recruited for this study of which 25 patients were enrolled in group A and the 25 patients were enrolled in group B. Mean age was 42.48 ± 17.21 years in group A and 40.04 ± 21.37 years in group B. The difference was not statistically significant ( p=0.659). Males were predominant in both groups. Male female ratio was 1.77:1 and 1.08:1 in group A and group B respectively. Inflammatory evidence of gall bladder with pericholecystic collection was found in 5 (20%) and 6 (24%) patients in group A and group B. There was evidence of cholangitis in 8 (32%) and 4 (16%) patients in group A and group B respectively. Evidence of inflammation at the wound site, was found in 14 (56%) patients in group A and 7 (28%) patients in group B. There was statistically significant difference between these 2 groups in the incidence of superficial surgical site infection, ( p value is 0.045). Regarding per operative collected bile, we found E. Coli in 4 cases in group A and 3 cases in group B ( p value is 0.408). Klebsiella spp. was found in 1 patient in group A. Wound swab C/S identified E. Coli in 1 patient in group A. Staph aureus was found in 1 and 2 patients in group A and group B respectively ( p value is nonsignificant). Conclusion : In conclusion, there is a difference in the incidence of occurrence of surgical site infection and causative agents after stone and non-stone bile duct surgery. Stone disease has increased chance of wound infection than nonstone disease of bile ducts. Northern International Medical College Journal Vol.11 (2) Jan 2020: 458-462

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Prolonged Hospital Stay is Associated with Increase Surgical Site Infection, Gastrointestinal and Hepatobiliary Surgery – A propensity Matched Analysis

10.20944/preprints202009.0356.v1 ◽

2020 ◽

Author(s):

Bhavin Vasavada ◽

Hardik Patel

Keyword(s):

Surgical Site Infection ◽

Hospital Stay ◽

Malignant Disease ◽

Surgical Site Infections ◽

Site Infection ◽

Prolonged Hospital Stay ◽

Hepatobiliary Surgery ◽

Small Intestinal ◽

Prolonged Hospital ◽

Upper Gastrointestinal

Aims: Primary AIM of the study was to evaluate effect of prolonged hospital stay on Surgical site infections We also evaluated effect of prolonged hospital stay on overall morbidity in Gastrointestinal and Hepatobiliary Surgery as secondary outcome. Methods: We retrospectively analysed all the patients who underwent gastrointestinal and hepatobiliary surgery between April 2017 to March 2020. On our analysis we found mean hospital stay in patient who did not develop SSI and/or morbidity was 4 days (Total hospital stay) vs 6 days who developed morbidity (hospital stay before diagnosis of SSI or diagnosis or morbid event). Based on this to avoid selection bias, we did 1:1 propensity score analysis between patients who had 4 or less than hospital stay vs patients who had 5 or more hospital stay before diagnosis of surgical site infection and/or morbid event. We took all the preoperative and intraoperative factors like Age, sex, malignant disease, ASA score, CDC grade of surgery, open or laparoscopic surgery, HPB surgeries, colorectal surgeries, Upper Gastrointestinal surgeries and small intestinal surgeries as covariates. We used nearest neighbor matching protocol with a calipher of 0.2. Cases were not reusable after matching. Statistical analysis was done using SPSS version 23. Results: We included 348 patients operated between April 2017 and March 2020 in our analysis. After 1:1 propensity score matching 58 patients included in study arm (prevent hospital stay more than 4 days) and 56 patients in control arm. Both groups were comparable with regard to Age, Sex, Surgery for malignant disease, ASA score, CDC grade of surgery, HPB surgeries, Small intestinal surgeries, Colorectal surgeries, upper gastrointestinal surgeries, intraoperative blood product requirement, intraoperative hypotension or any other event, operative time. Prolonged hospital stay (> 4 days) was significantly associated with surgical site infections (p<0.0001), morbidity (p=0.001). Open surgeries were associated with prolonged hospital stay. (p=0.032). Conclusion: Prolonged Hospital stay is associated with increase surgical site infection and morbidity in Gastrointestinal and Hepatobiliary Surgery.

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Nurses' Knowledge and Practice Towards Prevention of Surgical Site Infection

International Journal of Service Management and Sustainability ◽

10.24191/ijsms.v6i1.12875 ◽

2021 ◽

Vol 6 (1) ◽

pp. 1

Author(s):

Fatimah Sham ◽

Nur Azira Abdul Raji ◽

Mohd Fitri Omar ◽

Zulkarnain Hasan ◽

Muhammad Khairi Patahorahman ◽

...

Keyword(s):

Surgical Site Infection ◽

Good Practice ◽

Public Hospitals ◽

Control Measures ◽

Good Knowledge ◽

P Value ◽

Site Infection ◽

Significant Difference ◽

Knowledge And Practice ◽

Nurses Knowledge

Surgical Site Infection (SIS) is a common healthcare-associated infection that significantly impacts patient safety and financial losses for health systems. Enhancing nurses' knowledge and practice is an essential component in the prevention of the spread of infection. The study aims to assess the knowledge and practice of preventing surgical site infection among nurses. A cross-sectional study was conducted among 306 nurses in two public hospitals in Malaysia. Data were obtained from selfadministered questionnaires and analyzed using the IBM Statistical Packages for Social Science (SPSS) Window Version 23. This study revealed that 85.3 % of nurses had good knowledge, and 97.7 % had good practice regarding SSI prevention. However, there was no significant difference between the nurses' knowledge and practice towards Prevention SSI (x2: 1.10; p-value: 0.28). There was a statistically significant association between working unit/ward and the total knowledge score (x2:24.51; p-value: 0.01). Nurses who worked in the Operation Theatre were found to have higher percentage of good knowledge (n: 108; 35.3%). It can be concluded that the nurses had good knowledge and practice regarding surgical site infection. Successful strategies of infection control measures were the well-structured guidelines, continuing education programs, adequate supervision, good support, and regular basis of the necessary consumables and supplies.

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