The multimodal strategy in Surgical Site Infections control and prevention in orthopaedic patients – a 10-year retrospective observational study at a Polish hospital

Abstract INTRODUCTION Surgical site infections (SSIs) are among the most common healthcare-associated infections. They are associated with longer post-operative hospital stays, additional surgical procedures, treatment in intensive care units and higher mortality. MATERIAL AND METHODS Surgical site infections (SSIs) were detected in patients hospitalized in a 40-bed orthopaedics ward via continuous surveillance in 2009–2018. The total number of study patients was 15,678. The results were divided into two 5-year periods before and after the introduction of the SSI prevention plan. The study was conducted as part of a national Healthcare-Associated Infections Surveillance Programme, following the methodology recommended by the HAI-Net, European Centre for Disease Prevention and Control Program (ECDC). RESULTS 168 SSIs were detected in total, including 163 deep SSIs (SSI-D). The total SSI incidence rate was 1.1%, but in hip prosthesis: 1.2%, in knee prosthesis: 1.3%, for open reduction of fracture (FX): 1.3%, for close reduction of fracture (CR): 1.5%, and 0.8% for other procedures. 64% of SSI-D cases required rehospitalisation. A significantly reduction in incidence was found only after fracture reductions: FX and CR, respectively 2.1% vs. 0.7% (OR 3.1 95%CI 1.4-6.6, p<0.01) and 2.1 vs. 0.8% (OR 2.4 95%CI 1.0-5.9, p<0.05). SSI-Ds were usually caused by Gram-positive cocci, specially Staphylococcus aureus , 74 (45.7%); Enterobacteriaceae bacillis accounted for 14.1% and Gram-negative non-fermenting rods for 8.5%. CONCLUSIONS The implementated SSI prevention plan demonstrated a significant decrease from 2.1% to 0.7% in SSI-D incidence only in fracture reductions, without changes in epidemiology SSI incidence rates in other procedures. Depending on the epidemiological situation in the ward, it is worthwhile to surveillance of SSIs associated to different types of orthopaedic surgery to assess the risks and take preventive measures.

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Surgical Site Infections in orthopaedic patients – a 10-year retrospective observational study in a Polish hospital

10.21203/rs.2.17756/v1 ◽

2019 ◽

Author(s):

Małgorzata Kołpa ◽

Róża Słowik ◽

Marta Wałaszek ◽

Zdzisław Wolak ◽

Anna Rozanska ◽

...

Keyword(s):

Hip Prosthesis ◽

Knee Prosthesis ◽

Surgical Site Infections ◽

Control Program ◽

Healthcare Associated Infections ◽

Orthopaedic Patients ◽

Before And After ◽

Hospital Stays ◽

Healthcare Associated ◽

Prevention Plan

Abstract INTRODUCTION Surgical site infections (SSIs) are among the most common healthcare-associated infections. They are associated with longer post-operative hospital stays, additional surgical procedures, treatment in intensive care units and higher mortality.MATERIAL AND METHODS Surgical site infections (SSIs) were detected in patients hospitalized in a 40-bed orthopaedics ward via continuous surveillance in 2009–2018. The total number of study patients was 15,678. The results were divided into two 5-year periods before and after the introduction of the SSI prevention plan. The study was conducted as part of a national healthcare-Associated Infections surveillance programme, following the methodology recommended by the HAI-Net, European Centre for Disease Prevention and Control Program (ECDC). RESULTS 168 SSIs were detected in total, including 163 deep SSIs (SSI-D). The total SSI incidence rate was 1.1%, but in hip prosthesis: 1.2%, in knee prosthesis: 1.3%, for open reduction of fracture (FX): 1.3%, for close reduction of fracture (CR): 1.5%, and 0.8% for other procedures. 64% of SSI-D cases required rehospitalisation. A significantly reduction in incidence was found only after fracture reductions: FX and CR, respectively 2.1% vs. 0.7% (OR 3.1 95%CI 1.4-6.6, p<0.01) and 2.1 vs. 0.8% (OR 2.4 95%CI 1.0-5.9, p<0.05). SSI-Ds were usually caused by Gram-positive cocci, specially Staphylococcus aureus, 74 (45.7%); Enterobacteriaceae bacillis accounted for 14.1% and Gram-negative non-fermenting rods for 8.5%. CONCLUSIONS The implemented SSI prevention plan demonstrated a significant decrease (about 2.5-3 times) in SSI-D incidence in fracture reductions. Depending on the epidemiological situation in the ward, it is worthwhile to surveillance of SSIs associated to different types of orthopaedic surgery to assess the risks and take preventive measures.

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Estimating extra length of stay due to healthcare-associated infections before and after implementation of a hospital-wide infection control program

PLoS ONE ◽

10.1371/journal.pone.0217159 ◽

2019 ◽

Vol 14 (5) ◽

pp. e0217159 ◽

Cited By ~ 2

Author(s):

Habibollah Arefian ◽

Stefan Hagel ◽

Dagmar Fischer ◽

André Scherag ◽

Frank Martin Brunkhorst ◽

...

Keyword(s):

Length Of Stay ◽

Infection Control ◽

Control Program ◽

Healthcare Associated Infections ◽

Infection Control Program ◽

Before And After ◽

Healthcare Associated

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Incidence of Surgical Site Infections in Multicenter Study—Implications for Surveillance Practice and Organization

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18105374 ◽

2021 ◽

Vol 18 (10) ◽

pp. 5374

Author(s):

Anna Różańska ◽

Jerzy Rosiński ◽

Andrzej Jarynowski ◽

Katarzyna Baranowska-Tateno ◽

Małgorzata Siewierska ◽

...

Keyword(s):

Surgical Site Infections ◽

Weather Conditions ◽

Incidence Rates ◽

Healthcare Associated Infections ◽

Country Level ◽

Significant Difference ◽

Surveillance Practice ◽

Healthcare Associated ◽

Hospital Acquired ◽

And Control

Introduction: WHO core components of healthcare-associated infections (HAIs) prevention and control include their surveillance system. In Poland, there are no widespread multi-center infection surveillance networks based on continuous, targeted, active methodology. One of the most important form of HAIs are surgical site infections (SSIs). The aim of this study was to analyze the incidence of SSIs, in the context of seasonal differentiation. Seasonal differentiation could be connected with weather conditions, but it also can be affected by personnel absence due to holidays and furlough. The second aspect may influence organization of work and increased absenteeism may contribute to lowering the quality of patient care. Healthcare associated infections are the phenomenon which can be especially affected by such factors. Methods: The data used originate from the targeted, active surveillance reports obtained from the six years period, based on the ECDC recommendations. Results: Highest incidence rates of SSIs were found after operations performed in June and August, equal to 1.8% and 1.5% respectively and the lowest in October was 0.8%. These differences were statistically significant: for June incidence: OR 1.6, 95% CI 1.03–2.5, p = 0.015. Another approach showed a significant difference between the level of incidence in the period from November to January together with from June to August (1.35%), comparing to the rest of the year (1.05%). Also the rates of enterococcal and Enterobacterales infections were significantly higher for the period comprising months from November till January and from June to August. In Poland these are periods of increased number of absences associated with summer, national and religious holidays. Conclusions: Our results show that the short-term surveillance data limited to several days or months are not sufficient to obtain a valuable description of the epidemiological situation due to HAI. Efforts should be undertaken in order to implement wide net of hospital acquired infections, including SSI on the country level.

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Administrative Coding Methods Impact Surgical Site Infection Rates

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.616 ◽

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

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Longitudinal Trends in All Healthcare-Associated Infections through Comprehensive Hospital-wide Surveillance and Infection Control Measures over the Past 12 Years: Substantial Burden of Healthcare-Associated Infections Outside of Intensive Care Units and “Other” Types of Infection

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2015.142 ◽

2015 ◽

Vol 36 (10) ◽

pp. 1139-1147 ◽

Cited By ~ 14

Author(s):

Hajime Kanamori ◽

David J. Weber ◽

Lauren M. DiBiase ◽

Emily E. Sickbert-Bennett ◽

Rebecca Brooks ◽

...

Keyword(s):

Intensive Care ◽

Tract Infection ◽

Intensive Care Units ◽

Linear Models ◽

Infection Type ◽

Tertiary Care ◽

Surgical Site Infections ◽

Control Measures ◽

Healthcare Associated Infections ◽

Healthcare Associated

OBJECTIVETargeted surveillance has focused on device-associated infections and surgical site infections (SSIs) and is often limited to healthcare-associated infections (HAIs) in high-risk areas. Longitudinal trends in all HAIs, including other types of HAIs, and HAIs outside of intensive care units (ICUs) remain unclear. We examined the incidences of all HAIs using comprehensive hospital-wide surveillance over a 12-year period (2001–2012).METHODSThis retrospective observational study was conducted at the University of North Carolina (UNC) Hospitals, a tertiary care academic facility. All HAIs, including 5 major infections with 14 specific infection sites as defined using CDC criteria, were ascertained through comprehensive hospital-wide surveillance. Generalized linear models were used to examine the incidence rate difference by infection type over time.RESULTSA total of 16,579 HAIs included 6,397 cases in ICUs and 10,182 cases outside ICUs. The incidence of overall HAIs decreased significantly hospital-wide (−3.4 infections per 1,000 patient days), in ICUs (−8.4 infections per 1,000 patient days), and in non-ICU settings (−1.9 infections per 1,000 patient days). The incidences of bloodstream infection, urinary tract infection, and pneumonia in hospital-wide settings decreased significantly, but the incidences of SSI and lower respiratory tract infection remained unchanged. The incidence of Clostridium difficile infection (CDI) increased remarkably. The outcomes were estimated to include 700 overall HAIs prevented, 40 lives saved, and cost savings in excess of $10 million.CONCLUSIONSWe demonstrated success in reducing overall HAIs over a 12-year period. Our data underscore the necessity for surveillance and infection prevention interventions outside of the ICUs, for non–device-associated HAIs, and for CDI.Infect Control Hosp Epidemiol 2015;36(10):1139–1147

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Impact of Healthcare-Associated Infections Connected to Medical Devices—An Update

Microorganisms ◽

10.3390/microorganisms9112332 ◽

2021 ◽

Vol 9 (11) ◽

pp. 2332

Author(s):

Nitin Chandra Teja Dadi ◽

Barbora Radochová ◽

Jarmila Vargová ◽

Helena Bujdáková

Keyword(s):

Medical Devices ◽

Surgical Site Infections ◽

Central Line ◽

Ventilator Associated Pneumonia ◽

Healthcare Associated Infections ◽

Care Bundles ◽

Planktonic Form ◽

Novel Approaches ◽

Healthcare Associated ◽

The Impact

Healthcare-associated infections (HAIs) are caused by nosocomial pathogens. HAIs have an immense impact not only on developing countries but also on highly developed parts of world. They are predominantly device-associated infections that are caused by the planktonic form of microorganisms as well as those organized in biofilms. This review elucidates the impact of HAIs, focusing on device-associated infections such as central line-associated bloodstream infection including catheter infection, catheter-associated urinary tract infection, ventilator-associated pneumonia, and surgical site infections. The most relevant microorganisms are mentioned in terms of their frequency of infection on medical devices. Standard care bundles, conventional therapy, and novel approaches against device-associated infections are briefly mentioned as well. This review concisely summarizes relevant and up-to-date information on HAIs and HAI-associated microorganisms and also provides a description of several useful approaches for tackling HAIs.

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Costs of ambulatory pediatric healthcare-associated infections: Central-line–associated bloodstream infection (CLABSIs), catheter-associated urinary tract infection (CAUTIs), and surgical site infections (SSIs)

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.305 ◽

2020 ◽

Vol 41 (11) ◽

pp. 1292-1297

Author(s):

Michael L. Rinke ◽

Suzette O. Oyeku ◽

William J. H. Ford ◽

Moonseong Heo ◽

Lisa Saiman ◽

...

Keyword(s):

Urinary Tract ◽

Ambulatory Surgery ◽

Bloodstream Infections ◽

Surgical Site Infections ◽

Central Line ◽

Healthcare Associated Infections ◽

Retrospective Case ◽

Additional Costs ◽

Tract Infections ◽

Healthcare Associated

AbstractObjective:Ambulatory healthcare-associated infections (HAIs) occur frequently in children and are associated with morbidity. Less is known about ambulatory HAI costs. This study estimated additional costs associated with pediatric ambulatory central-line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTI), and surgical site infections (SSIs) following ambulatory surgery.Design:Retrospective case-control study.Setting:Four academic medical centers.Patients:Children aged 0–22 years seen between 2010 and 2015 and at risk for HAI as identified by electronic queries.Methods:Chart review adjudicated HAIs. Charges were obtained for patients with HAIs and matched controls 30 days before HAI, on the day of, and 30 days after HAI. Charges were converted to costs and 2015 USD. Mixed-effects linear regression was used to estimate the difference-in-differences of HAI case versus control costs in 2 models: unrecorded charge values considered missing and a sensitivity analysis with unrecorded charge considered $0.Results:Our search identified 177 patients with ambulatory CLABSIs, 53 with ambulatory CAUTIs, and 26 with SSIs following ambulatory surgery who were matched with 382, 110, and 75 controls, respectively. Additional cost associated with an ambulatory CLABSI was $5,684 (95% confidence interval [CI], $1,005–$10,362) and $6,502 (95% CI, $2,261–$10,744) in the 2 models; cost associated with a CAUTI was $6,660 (95% CI, $1,055, $12,145) and $2,661 (95% CI, −$431 to $5,753); cost associated with an SSI following ambulatory surgery at 1 institution only was $6,370 (95% CI, $4,022–$8,719).Conclusions:Ambulatory HAI in pediatric patients are associated with significant additional costs. Further work is needed to reduce ambulatory HAIs.

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Healthcare resources attributable to methicillin-resistant Staphylococcus aureus orthopedic surgical site infections

Scientific Reports ◽

10.1038/s41598-020-74070-4 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Haruhisa Fukuda ◽

Daisuke Sato ◽

Tetsuya Iwamoto ◽

Koji Yamada ◽

Kazuhiko Matsushita

Keyword(s):

Staphylococcus Aureus ◽

Hip Prosthesis ◽

Knee Prosthesis ◽

Surgical Site Infections ◽

Healthcare Resource Utilization ◽

Prevention Measures ◽

Healthcare Resources ◽

Methicillin Resistant ◽

Japanese Residents ◽

Almost All

Abstract The number of orthopedic surgeries is increasing as populations steadily age, but surgical site infection (SSI) rates remain relatively consistent. This study aimed to quantify the healthcare resources attributable to methicillin-resistant Staphylococcus aureus (MRSA) SSIs in orthopedic surgical patients. The analysis was conducted using a national claims database comprising data from almost all Japanese residents. We examined patients who underwent any of the following surgeries between April 2012 and March 2018: amputation (AMP), spinal fusion (FUSN), open reduction of fracture (FX), hip prosthesis (HPRO), knee prosthesis (KPRO), and laminectomy (LAM). Propensity score matching was performed to identify non-SSI control patients, and generalized estimating equations were used to estimate the differences in outcomes between the case and control groups. The numbers of MRSA SSI cases (infection rates) ranged from 64 (0.03%) to 1,152 (2.33%). MRSA SSI-attributable increases in healthcare expenditure ranged from $11,630 ($21,151 vs. $9,521) for LAM to $35,693 ($50,122 vs. $14,429) for FX, and increases in hospital stay ranged from 40.6 days (59.2 vs. 18.6) for LAM to 89.5 days (122.0 vs. 32.5) for FX. In conclusion, MRSA SSIs contribute to substantial increases in healthcare resource utilization, emphasizing the need to implement effective infection prevention measures for orthopedic surgeries.

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A Probiotic-Based Sanitation System for the Reduction of Healthcare Associated Infections and Antimicrobial Resistances: A Budget Impact Analysis

Pathogens ◽

10.3390/pathogens9060502 ◽

2020 ◽

Vol 9 (6) ◽

pp. 502

Author(s):

Rosanna Tarricone ◽

Carla Rognoni ◽

Luca Arnoldo ◽

Sante Mazzacane ◽

Elisabetta Caselli

Keyword(s):

Antibiotic Resistance ◽

Impact Analysis ◽

Budget Impact ◽

Incidence Rates ◽

Budget Impact Analysis ◽

Healthcare Associated Infections ◽

Chemical Cleaning ◽

Hospital Perspective ◽

Sanitation Systems ◽

Healthcare Associated

Healthcare associated infections (HAIs) and antibiotic resistance have high social and economic burdens. Healthcare environments play an important role in the transmission of HAIs. The Probiotic Cleaning Hygiene System (PCHS) has been shown to decrease hospital surface pathogens up to 90% vs. conventional chemical cleaning (CCC). This study compares PCHS to CCC as to reduction of HAIs and their severity, related antibiotic resistances, and costs. Incidence rates of HAIs/antibiotic resistances were estimated from a previously conducted multicenter pre-post (6 months CCC + 6 months PCHS) intervention study, after applying the propensity score matching technique. A budget impact analysis compared the current scenario of use of CCC with future scenarios considering increasing utilization of PCHS, from 5% to 50% in the next five years, from a hospital perspective in Italy. The cumulative incidence of HAI was 4.6% and 2.4% (p < 0.0001) for CCC (N = 4160) and PCHS (N = 4160) (OR = 0.47, CI 95% 0.37–0.60), with severe HAIs of 1.57% vs. 1% and antibiotic resistances of 1.13% vs. 0.53%, respectively. Increased use of PCHS over CCC in Italian internal medicine/geriatrics and neurology departments in the next 5 years is expected to avert at least about 31,000 HAIs and 8500 antibiotic resistances, and save at least 14 million euros, of which 11.6 for the treatment of resistant HAIs. Innovative, environmentally sustainable sanitation systems, like PCHS, might substantially reduce antibiotic resistance and increase protection of health worldwide.

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Estimating the Proportion of Healthcare-Associated Infections That Are Reasonably Preventable and the Related Mortality and Costs

Infection Control and Hospital Epidemiology ◽

10.1086/657912 ◽

2011 ◽

Vol 32 (2) ◽

pp. 101-114 ◽

Cited By ~ 496

Author(s):

Craig A. Umscheid ◽

Matthew D. Mitchell ◽

Jalpa A. Doshi ◽

Rajender Agarwal ◽

Kendal Williams ◽

...

Keyword(s):

Systematic Review ◽

Bloodstream Infections ◽

Surgical Site Infections ◽

Current Evidence ◽

Annual Number ◽

Evidence Based ◽

Healthcare Associated Infections ◽

Tract Infections ◽

Healthcare Associated ◽

Related Mortality

Objective.To estimate the proportion of healthcare-associated infections (HAIs) in US hospitals that are “reasonably preventable,” along with their related mortality and costs.Methods.To estimate preventability of catheter-associated bloodstream infections (CABSIs), catheter-associated urinary tract infections (CAUTIs), surgical site infections (SSIs), and ventilator-associated pneumonia (VAP), we used a federally sponsored systematic review of interventions to reduce HAIs. Ranges of preventability included the lowest and highest risk reductions reported by US studies of “moderate” to “good” quality published in the last 10 years. We used the most recently published national data to determine the annual incidence of HAIs and associated mortality. To estimate incremental cost of HAIs, we performed a systematic review, which included costs from studies in general US patient populations. To calculate ranges for the annual number of preventable infections and deaths and annual costs, we multiplied our infection, mortality, and cost figures with our ranges of preventability for each HAI.Results.AS many as 65%–70% of cases of CABSI and CAUTI and 55% of cases of VAP and SSI may be preventable with current evidence-based strategies. CAUTI may be the most preventable HAI. CABSI has the highest number of preventable deaths, followed by VAP. CABSI also has the highest cost impact; costs due to preventable cases of VAP, CAUTI, and SSI are likely less.Conclusions.Our findings suggest that 100% prevention of HAIs may not be attainable with current evidence-based prevention strategies; however, comprehensive implementation of such strategies could prevent hundreds of thousands of HAIs and save tens of thousands of lives and billions of dollars.

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