Fewer Early Surgical Site Infections After Hip Fracture and Lessons Learned From the Safe Hands Project: A Five-Year Longitudinal Study of 3,553 Patients

Abstract Background: Surgical site infection after acute hip fracture surgery is a devastating complication associated with increased suffering and mortality. The aim of the study was to investigate early SSI, sepsis, pneumonia and urinary tract infections over five years, before and after the implementation of the Safe Hands project.Methods: This was a single-centre observational study with a five-year longitudinal design, investigating the effects of an infection-prevention intervention targeting the clinical care pathway of individuals with acute hip fracture. Statistical analyses were based on routinely collected patient outcome data comprising 3,553 patients. The study conforms to the criteria of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).Results: The incidence of early SSIs decreased from 2.5% in years 1-2 to 1.1% in years 4-5. Similar results were observed for sepsis (2.7% to 1.3%) and urinary tract infections (14.2% to 4.2%). The multivariable regression shows that, for every observed year, the odds of early SSIs decreased. Male gender, procedure time, sepsis and preoperative skin damage increased the odds significantly.Conclusions Our preventive bundle, based on partnership between researchers, managers and clinicians and a strong commitment to change from the involved professions, appear to be effective in reducing the frequency of potentially devastating SSIs and other HAIs after hip fractures surgery. The use of external and internal facilitators was crucial to enable individual and organisational learning and overcoming barriers to improvements.Trial registration: Clinical Trials.gov ID: NCT02983136 Registered 6 December 2016 - Retrospectively registered.

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A clinical care pathway to improve the acute care of patients with glioma.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.30_suppl.217 ◽

2014 ◽

Vol 32 (30_suppl) ◽

pp. 217-217

Author(s):

Natalie Riblet ◽

Jennifer Snide ◽

Evelyn Schlosser ◽

David Nalepinski ◽

Lanelle Jalowiec ◽

...

Keyword(s):

Urinary Tract ◽

Acute Care ◽

Urinary Tract Infections ◽

Best Practice ◽

Care Pathway ◽

Clinical Care ◽

Performance Outcomes ◽

Care Pathways ◽

Improvement Interventions ◽

Tract Infections

217 Background: Gliomas account for nearly 80% of primary malignant brain tumors and are associated with poor survival. Developing clinical care pathways to ensure that patients receive coordinated, comprehensive and timely care may result in improved outcomes and patient satisfaction. Methods: A quality improvement (QI) project was chartered to improve the care provided to patients with glioma. A multidisciplinary team was convened and met weekly and then monthly from Feb 2013 – April 2014. Twenty best practice measures were identified from the literature. Using a Plan-Do-Study-Act framework, the team brainstormed and implemented various improvement interventions between Oct 2013 and Feb 2014. Statistical process control charts were used to evaluate progress. A dashboard of quality measures was generated to allow for ongoing reporting. Results: Retrospective data was available for 12 best practice measures; 6 of which could be abstracted from electronic medical records. Eight measures were not part of the current system of care. The baseline population consisted of 98 patients with gliomas. Review of their records suggested wide variation in performance, with compliance ranging from 30% to 100%. Unanticipated opportunities for improvement included a high proportion of outpatient falls (7%) and urinary tract infections (10%). The team hypothesized that lack of standardization in the current process may contribute to less-than-ideal performance. After implementing improvement interventions, the records of 19 consecutive patients with glioma were reviewed. The proportion of patients meeting criteria for 12 practice measures modestly improved (65% pre QI-work; 78% post-QI work). There were no additional cases of urinary tract infections. Barriers to pathway development included difficulties with transforming manual measures into electronic data sets and accounting for portions of care that occurred at outside facilities. Updated outcomes will be presented. Conclusions: Creating evidence based clinical care pathways for addressing the acute care needs of patients with glioma is important. There are many challenges, however, to developing sustainable systems for measuring and reporting performance outcomes overtime.

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TWOC around the clock: a multimodal approach to improving catheter care

Journal of Infection Prevention ◽

10.1177/1757177416668584 ◽

2016 ◽

Vol 18 (2) ◽

pp. 57-64 ◽

Cited By ~ 3

Author(s):

Carolyn H Dawson ◽

Melanie Gallo ◽

Kate Prevc

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Care Pathway ◽

Care Bundle ◽

Care Group ◽

Multimodal Approach ◽

Prevalence Survey ◽

Tract Infections ◽

Catheter Care

Background: Urinary tract infections (UTI) are the second-largest group of healthcare-associated infections (HCAI). The Saving Lives Urinary Catheter Care Bundle was introduced to reduce catheter-associated urinary tract infections (CAUTI). In response, we implemented a catheter care group to examine ways to improve catheter care in an acute hospital NHS Trust. Methods: We adopted a multimodal approach, revolving around four components: (1) Catheter Care Pathway; (2) HOUDINI checklist; (3) catheter magnets; and (4) use of bladder ultrasound scanners. Results: The yearly CAUTI prevalence survey showed an annual reduction in CAUTI from 2012–2013 to 2014–2015 (3.5% to 2.4%). Evaluations of the multimodal approach have highlighted limitations, leading to priorities being established around provision of tools, education, and use of measurement and feedback. Conclusions: Our multimodal approach demonstrates CAUTI rate improvements are achievable, directly benefiting patients. However, long-term maintenance of multimodal components is required to ensure sustained benefit. Engagement and accountability have emerged as significant challenges to the effectiveness and longevity of the catheter care group. We suggest greater emphasis on such challenges if long-term national or international improvement is to be achieved.

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THE EFFECT OF PERIOPERATIVE AND PROPHYLACTIC ANTIBIOTICS AGAINST THE INCIDENCE OF UTI AND SURGICAL SITE INFECTIONS AFTER HYPOSPADIAS SURGERY

Indonesian Journal of Urology ◽

10.32421/juri.v24i1.270 ◽

2017 ◽

Vol 24 (1) ◽

Author(s):

Raditya Kusuma ◽

Johan Renaldo ◽

Tarmono Djojodimedjo ◽

Sunaryo Hardjowijoto

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Prophylactic Antibiotic ◽

Surgical Site Infections ◽

Prophylactic Antibiotics ◽

Repair Operation ◽

Significant Difference ◽

Perioperative Antibiotics ◽

Tract Infections ◽

Hypospadias Surgery

Objective: The aim of this study is to analyze the effect of perioperative and prophylactic antibiotics against the incidence of urinary tract infections (UTI) and surgical site infections (SSI) after hypospadias surgery (hypospadias repair operation). Materials & Methods: This study is an observational study of explanation with 24 hypospadias patients (2 groups) during the period of October 2015 to February 2016. Samples were divided into two groups, 12 patients received prophylactic antibiotics and 12 patients received perioperative antibiotics (random sampling). Inclusion criteria included patients with glandular hypospadias to proximal penile hypospadias, aged 6 months until 15 years and underwent hypospadias surgery with one surgical technique namely Tubularized Incised Plate (TIP). The examination of urine culture and evaluation of the wounds were performed on day 4, 10, and 20 day after surgery to determine the incidence of urinary tract infections and surgical site infections. Results: There is no significant difference in the incidence of UTI on on day 4, 10 and 20 in perioperative group and prophylaxis group with p=0.282 and p=0.500 at day 4 and 10 (p>0.05). There is no significant difference in the incidence of SSI on day 4, 10 and 20 in the group of perioperative antibiotic and prophylactic antibiotic with p=0.680 and p=0.217 at day 4 and 10 (p>0.05). Conclusion: There is no effect of the prophylactic antibiotic as well as perioperative antibiotic treatment on the incidence of UTI and SSI

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2147. Human Infections due to Actinotignum Species: A 5-Year Retrospective Review at Mayo Clinic Rochester, Minnesota

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1827 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S727-S728

Author(s):

Sadia Syed ◽

Muhammad R Sohail

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Mayo Clinic ◽

Joint Infection ◽

Positive Culture ◽

Surgical Site Infections ◽

Clinical Microbiology Laboratory ◽

Joint Infections ◽

Tract Infections ◽

Human Infections

Abstract Background We aim to investigate the incidence, clinical presentation, management, and outcome of infections due to Actinotignum species observed at Mayo Clinic Rochester over the last 5 years. Methods We searched the clinical microbiology laboratory database to identify isolates of Actinotignum spp. from all body sites between January 1, 2014 and December 31, 2018. Results Fifty-four patients with positive culture with Actinotignum were identified. Mean age was 67 years and 27 (50%) had an underlying urogenital condition. Actinotignum was isolated in 26 urine cultures, 6 blood cultures, 12 abscess fluid cultures, and 10 bone/joint tissue cultures (Table 1). Fifteen (28%) specimens were monomicrobial while 39 (72%) were polymicrobial. Recovery from urine cultures was interpreted as colonization in 11 (20%) cases. Of the 54 patients with positive cultures, 43 patients had Actinotignum-associated clinical infection; 15 (35%) with urinary tract infections (11 with cystitis and 4 with pyelonephritis), 12 (28%) with abscesses (skin, intraabdominal, and surgical site infections), 10 (23%) with bone/joint infection, and 6 (14%) with bacteremia (Table 2). Most frequently isolated species was A. schaalii (n = 40); followed by 2 cases of A. sanguinis. Susceptibility testing (n = 40) showed that all stains were susceptible to penicillin (MIC< = 0.5), 36% were susceptible to clindamycin (MIC < = 2) and 10% susceptible to metronidazole (MIC < = 8). There was no recurrence of Actinotignum-related infections in any of the treated cases. Two patients with bone/joint infection underwent repeat surgical intervention due to worsening infection while on antibiotic treatment prior to resolution of infection. There was 1 death in a patient with bacteremia (polymicrobial) who had presented with a massive stroke (Table 3). Conclusion A. schaalii was most commonly associated with urinary tract infections followed by abscesses and bone/joint infections in elderly population. Majority of the infections were polymicrobial. All tested isolated were susceptible to penicillin; however, resistance was frequent for clindamycin and metronidazole. All appropriately treated patients had resolution of infection without recurrence from Actinotignum, except for one patient with bacteremia who died from massive stroke Disclosures All authors: No reported disclosures.

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Bacteria of Preoperative Urinary Tract Infections Contaminate the Surgical Fields and Develop Surgical Site Infections in Urological Operations

The Journal of Urology ◽

10.1097/01.ju.0000186934.19864.74 ◽

2005 ◽

Vol 174 (6) ◽

pp. 2244-2244 ◽

Cited By ~ 1

Author(s):

Richard E. Berger

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Surgical Site Infections ◽

Tract Infections

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The effect of education of nurses on preventing catheter-associated urinary tract infections in patients who undergo hip fracture surgery

Journal of Clinical Nursing ◽

10.1111/jocn.14160 ◽

2018 ◽

Vol 27 (5-6) ◽

pp. e1078-e1088 ◽

Cited By ~ 2

Author(s):

Ezgi Seyhan Ak ◽

Ayfer Özbaş

Keyword(s):

Urinary Tract ◽

Hip Fracture ◽

Urinary Tract Infections ◽

Hip Fracture Surgery ◽

Tract Infections ◽

Fracture Surgery

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Bacteria of preoperative urinary tract infections contaminate the surgical fields and develop surgical site infections in urological operations

International Journal of Urology ◽

10.1111/j.1442-2042.2004.00941.x ◽

2004 ◽

Vol 11 (11) ◽

pp. 941-947 ◽

Cited By ~ 29

Author(s):

RYOICHI HAMASUNA ◽

HIRONORI BETSUNOH ◽

TETSUYA SUEYOSHI ◽

KAZUMICHI YAKUSHIJI ◽

HIROMASA TSUKINO ◽

...

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Surgical Site Infections ◽

Tract Infections

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Multidrug-Resistant Microorganisms Associated with Urinary Tract Infections Following Orthopaedic Patients: A Laboratory-Based Analysis of 5239 Patients

10.21203/rs.3.rs-64767/v1 ◽

2020 ◽

Author(s):

Grzegorz Ziółkowski ◽

Iwona Pawłowska ◽

Michał Stasiowski ◽

Estera Jachowicz ◽

Tomasz Bielecki

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Surgical Site Infections ◽

Incidence Density ◽

Utilization Rate ◽

Microbiological Analysis ◽

Gram Negative ◽

Orthopaedic Patients ◽

Tract Infections ◽

Orthopedic Patients

Abstract Background: The risk of healthcare associated infections (HAI) in surgical wards remains closely related to the type of surgery and procedures performed on patients. They also condition the risk of various, apart from the most common, surgical site infections, forms of clinical infections, especially urinary tract infections (UTIs). Their occurrence in orthopedic patients is most often – in about 70%-80%, associated with the use of the bladder catheter in the perioperative period. The aim of this study was the epidemiological and microbiological analysis of UTIs following orthopedic patients, especially MDR in 2013-2015.Methods: The study was conducted in 38-bed Department of Orthopedic-Traumatic Surgery in Sosnowiec, Poland. 5 239 patients surgery included in the study, the urinary catheter utilization rate was 30.7 %. Laboratory based study using the UTI definition of the HAI-Net program, MDR was defined as resistant to at least one antibiotic from 2< antibiotics groups. The results were analyzed using the statistical package PQStat ver. 1.6.0.428 using the chi-square test (chi ^ 2) or Fisher's exact test.Results The UTI incidence was 3.2% (168 cases), CA-UTI incidence density was 9.6/1 000 catheter-days. The highest risk of UTI was found in patients aged 75 years and older. Gram-negative flora prevailed among microorganisms: 76.1%. Predominantly isolated Enterobacterales were: Escherichia coli, Klebsiella pneumoniae. Isolated microorganisms were fully sensitive to carbapenems. Gram-negative bacilli showed the lowest sensitivity to extended substrate spectrum penicillins and fluoroquinolones: 37-64%, trimethoprim-sulfamethoxazole: 50%; MDR prevalence: 24.4%.Conclusions The presented data indicate that UTI incidence is a significant problem in studied population, as well as antimicrobialresistance, especially to quinolones and extended spectrum cephalosporins, as first-line therapy remains a major challenge. To reduce the problem of high UTI incidence and MDR prevalence, the priority should be the reduction of UTI risk – which exceeded the expected values.

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