Sweat Contamination Induced Surgical Site Infections After Spine Surgery: Three Case Reports and Literature Review

Abstract Background:Surgical site infection (SSI) is one of the most intractable complications following spine surgery during the early postoperative stage. Elderly (age > 70 years), body mass index > 30, smoking, diabetes mellitus, coronary artery disease, chronic obstructive pulmonary disease, anemia, low serum albumin, operation time > 3h, and perioperative blood loss > 500 ml are the common risk factors of SSI after spine surgery. However, there are few published reports about sweat contamination induced surgical site infections with Staphylococcus epidermidis up to date. Staphylococcus epidermidis is a permanent member of the normal human microbiota and has emerged as an important opportunistic pathogen in SSI. We aim to detect the influence of sweat infiltration on SSI with Staphylococcus epidermidis and effective management. Case presentation:A 73-year-old male, a 54-year-old male and a 73-year-old female were admitted to our hospital. All of them underwent posterior compression and fusion surgery with internal fixation and got surgical site infection after primary surgery. Two of them suffered moderate surgical site infection while the third patient with comorbidities suffered severe surgical site infection. Antibiotic therapy and debridement with internal fixation retained were utilized during which microbiological culture were taken. The moderate infection patients got fully recovered after debridement and primary suture while the serious one had recurrence after the first debridement, and then the second operation was performed. SSI, however, relapsed after three days. Vacuum-assisted closure (VAC) system was replaced in the third debridement. The severe patient got well recovered and discharged after displacement of VAC system. Conclusion:Sweat-contaminated is an inducement of SSI with Staphylococcus epidermidis that should attract surgeons’ attention. For mild infection, changing dressing and infrared treatment can achieve good results. For moderate infection, one debridement and primary suture are enough. For severe infection, early application of VAC system can reduce the number of debridement and achieve good clinical outcome.

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The Effectiveness of Sterile Wound Drapes in the Prevention of Surgical Site Infection in Thoracic Surgery

BioMed Research International ◽

10.1155/2019/1438793 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Kemal Karapınar ◽

Celalettin İbrahim Kocatürk

Keyword(s):

Thoracic Surgery ◽

Surgical Site Infection ◽

Operation Time ◽

Surgical Site Infections ◽

Control Group ◽

Site Infection ◽

Wound Debridement ◽

Thoracic Surgical Procedures ◽

Hospitalization Costs ◽

The Cost

Background. The rate of surgical site infections (SSIs) has decreased in parallel to advances in sterilization techniques. Such infections increase morbidity and hospitalization costs. The use of iodine-impregnated sterile wound drapes (SWDs) is recommended to prevent or reduce the incidence of these infections. However, there is a paucity of data regarding their use in thoracic surgical procedures. The aim of the present study was to evaluate the effectiveness of sterile wound drapes in the prevention of these infections and the effects on hospitalization costs. Methods. Perioperative iodine-impregnated SWDs have been used since January 2015 in the Thoracic Surgery Clinic of our hospital. A retrospective evaluation was made of patients who underwent anatomic pulmonary resection via thoracotomy with SWD in the period January 2015–2017, compared with a control group who underwent the same surgery without SWD in the 2-year period before January 2015. Factors that may have increased the risk of surgical site infection were documented and the occurrence of SSI was recorded from postoperative follow-up data. The cost analysis was performed as an important criterion to investigate the benefits of SWD. Results. Evaluation was made of 654 patients in the study group (n:380) using SWD, the operation time was significantly longer, and perioperative blood transfusion was significantly higher, whereas treatment costs (p=0.0001) and wound culture positivity (p=0.004) were significantly lower and less surgical wound debridement was performed (p=0.002). Conclusion. The findings suggest that the use of sterile wound draping in thoracic surgery procedures reduces surgical site infections and hospitalization costs.

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The Use of Vacuum Dressings for Dead Space Management in Deep Surgical Site Infections Allows Implant and Bone Graft Retention

Global Spine Journal ◽

10.1177/2192568217696694 ◽

2017 ◽

Vol 7 (8) ◽

pp. 756-761 ◽

Cited By ~ 2

Author(s):

James P. Watt ◽

Robert N. Dunn

Keyword(s):

Surgical Site Infection ◽

Bone Graft ◽

Spine Surgery ◽

Surgical Site Infections ◽

Lumbar Spine Surgery ◽

Causative Organism ◽

Site Infection ◽

Space Management ◽

Acute Wound ◽

Deep Surgical Site Infection

Study Design: Retrospective, descriptive study. Objectives: Managing early surgical site infection following elective lumbar spine surgery remains a challenge with controversy regarding retention of instrumentation and bone graft. Wound closure may also pose considerable challenges. We aim to report on our method of managing deep surgical site infections complicating elective spine surgery with surgeon assembled deep vacuum dressings. Identification of causative organisms with their sensitivities was a secondary objective. Methods: Patients were identified from a prospectively maintained, single-surgeon database from 2003-2015. Patients who had an infective or trauma related diagnosis, cervical procedures, and were younger than 18 years were excluded. Records were reviewed to identify bacteriology, laboratory tests performed, antibiotics administered, and type and frequency of surgical management. One thousand two hundred twenty patients qualified for inclusion, with 19 identified as having developed acute wound sepsis. Results: All patients had surgical debridement on the day of presentation and the majority of wounds were managed with a vacuum dressing. In all but 1 patient was instrumentation retained. Specimens for culture were taken at each debridement and antibiotics changed accordingly. Patients received a minimum 6 weeks of antibiotics. Conclusions: The management of deep surgical site infection is labor intensive and frustrating for both surgeon and patient due to the unexpected prolonged admission. Management goals are identification and eradication of the causative organism with subsequent healing of the surgical wound. This process is enhanced with the use of negative-suction dressings made from theatre stock replaced at regular intervals and allows retention of bone graft and instrumentation in the majority of cases.

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Basics of Surgical-Site Infection Surveillance

Infection Control and Hospital Epidemiology ◽

10.1086/647694 ◽

1997 ◽

Vol 18 (09) ◽

pp. 659-668 ◽

Cited By ~ 33

Author(s):

Marie-Claude Roy ◽

Trish M. Perl

Keyword(s):

Surgical Site Infection ◽

Hospital Costs ◽

Surgical Site Infections ◽

Surveillance Program ◽

Site Infection ◽

Infection Rates ◽

The Third ◽

Infection Surveillance ◽

Surveillance Programs ◽

Substantial Morbidity

AbstractSurgical-site infections, the third most common class of nosocomial infections, cause substantial morbidity and mortality and increase hospital costs. Surveillance programs can lead to reductions in surgical-site infection rates of 35% to 50%. Herein, we will discuss the practical aspects of implementing a hospital-based surveillance program for surgical-site infections. We will review surveillance methods, patient populations that should be screened, and interventions that could reduce infection rates.

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Microbiology Characteristics and Risk Factors of Surgical Site Infection in Limb Fractures: a Single-center Retrospective Study

10.21203/rs.3.rs-251699/v1 ◽

2021 ◽

Author(s):

Junchao Luo ◽

Xinji Chen ◽

Yin Zhang ◽

Yu Tong ◽

Senbo Zhu ◽

...

Keyword(s):

Risk Factors ◽

Surgical Site Infection ◽

Internal Fixation ◽

Surgical Site Infections ◽

High Energy ◽

Fracture Site ◽

Coagulase Negative Staphylococcus ◽

Site Infection ◽

Preventative Measures ◽

Limb Fractures

Abstract Background: Limb fractures were becoming more common, and internal fixation increased the risk of surgical site infection. The purpose of this study was to identified risk factors for surgical site infection and the factors that affected the microbiological characteristics.Material and methods: Data from patients with limb fractures who received internal fixation between January 2010 and January 2020 were included. Univariate and multivariate logistic analyses were performed to determine independent risk factors.Results: A total of 4479 patients were identified and 187 (4.18%) patients developed surgical site infections (SSI). Staphylococcus aureus (25.1%) was the most common bacteria, followed by Coagulase negative Staphylococcus (18.8%) and Acinetobacter baumannii (12.0%). Multiple regression analysis revealed that low total protein (OR, 4.066; 95% CI, 1.217-13.583) and high white blood cell count (OR, 3.133; 95% CI, 1.291-7.605) were risk factors for gram-negative bacteria infection. Five risk factors were identified to be independently associated with the development of SSIs, including current smoking (OR, 2.923; 95% CI, 1.294-6.599), high-energy injury (OR, 2.816; 95% CI, 1.368-5.799), femoral fracture, tibia and fibula fracture, vascular injury at the fracture site (OR, 10.284; 95% CI, 2.506-42.199), skin contusin at the fracture site (OR, 3.348; 95% CI, 1.304-8.574), hypohemoglobin (OR, 2.991; 95% CI, 1.422-6.292).Conclusion: Preoperative preventative measures should be taken in patients at high risk to reduce the incidence of SSIs.

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Surgical Site Infections in Spine Surgery: Preoperative Prevention Strategies to Minimize Risk

Global Spine Journal ◽

10.1177/2192568217752130 ◽

2018 ◽

Vol 8 (4_suppl) ◽

pp. 31S-36S ◽

Cited By ~ 10

Author(s):

Nicholas T. Spina ◽

Ilyas S. Aleem ◽

Ahmad Nassr ◽

Brandon D. Lawrence

Keyword(s):

Surgical Site Infection ◽

Spine Surgery ◽

Critical Role ◽

Blood Glucose Control ◽

Surgical Site Infections ◽

Site Infection ◽

Preventive Strategies ◽

Review Of The Literature ◽

Prevention Strategies ◽

Hospital System

Study Design: Literature review. Objectives: A review of the literature identifying preoperative risk factors for developing surgical site infections after spine surgery and discussion of the preventive strategies to minimize risks. Methods: A review of the literature and synthesis of the data to provide an updated review on the preoperative management of surgical site infection. Results: Preoperative prevention strategies of reducing surgical site infections in spine surgery remains a challenging problem. Careful mitigation of modifiable patient comorbidities, blood glucose control, smoking, obesity, and screening for pathologic microorganisms is paramount to reduce this risk. Individualized antibiotic regimens, skin preparation, and hand hygiene also play a critical role in surgical site infection prevention. Conclusions: This review of the literature discusses the preoperative preventive strategies and risk management techniques of surgical site infections in spine surgery. Significant decreases in surgical site infections after spine surgery have been noted over the past decade due to increased awareness and implementation of the prevention strategies described in this article. However, it is important to recognize that prevention of surgical site infection requires a system-wide approach that includes the hospital system, the surgeon, and the patient. Continued efforts should focus on system-wide implementation programs including careful patient selection, individualized antibiotic treatment algorithms, identification of pathologic organisms, and preoperative decolonization programs to further prevent surgical site infections and optimize patient outcomes.

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GAMBARAN KEJADIAN INFEKSI LUKA OPERASI (ILO) PASCA BEDAH ABDOMEN DI RSUD ABDUL WAHAB SJAHRANIE SAMARINDA

Jurnal Kebidanan Mutiara Mahakam ◽

10.36998/jkmm.v8i1.68 ◽

2020 ◽

Vol 8 (1) ◽

pp. 21-37

Author(s):

Sepriani indriati Azis ◽

P.M.T. Mangalindung Ompusunggu ◽

Hadi Irawiraman

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Abdominal Surgery ◽

Surgical Site Infection ◽

Staphylococcus Epidermidis ◽

Surgical Site Infections ◽

Prophylactic Antibiotics ◽

Site Infection ◽

Surgical Wound ◽

Duration Of Surgery

Infeksi luka operasi (ILO) adalah infeksi pada bagian tubuh yang terpapar oleh ahli bedah saat prosedur invasive. ILO merupakan salah satu infeksi nosokomial yang paling umum dan paling dapat dicegah diantara infeksi nosokomial lainnya, namun kejadian infeksi luka operasi terutama pada bedah abdomen masih menunjukkan beban yang signifikan. Faktor resiko infeksi luka operasi meliputi usia tua, jenis luka operasi, penyakit penyerta seperti diabetes mellitus, pemberian antibiotik profilaksis yang tidak adekuat, status gizi pasien seperti obesitas dan malnutrisi serta durasi operasi yang panjang. Penelitian ini bertujuan untuk mengetahui gambaran kejadian infeksi luka operasi pasca bedah abdomen di RSUD Abdul Wahab Sjahranie Samarinda. Metode penelitian ini adalah penelitian deskriptif laboratorik. Data penelitian diambil dari swab luka operasi dan data rekam medik pada 40 pasien pasca bedah abdomen yang melakukan pergantian perban pertama kali serta memenuhi kriteria inklusi dan eksklusi. Hasil penelitian menunjukkan 30 orang (75%) pasien mendapatkan infeksi luka operasi. Mayoritas pasien terinfeksi berusia diatas 40 tahun, yaitu pada 15 pasien (37,5%). Sebagian besar pasien terinfeksi mendapatkan luka bersih terkontaminasi, yaitu 23 pasien (57,5%). Mayoritas pasien terinfeksi yaitu 27 pasien (67,5%) tidak memiliki penyakit penyerta. Bakteri gram positif, yaitu Staphylococcus epidermidis merupakan bakteri penginfeksi terbanyak yang teridentifikasi pada 10 orang (33,3%) pasien. Seluruh pasien terinfeksi, yaitu 30 pasien (75%) mendapatkan antibiotik profilaksis. Mayoritas pasien terinfeksi memiliki status gizi normal, yaitu 17 orang (42,5%), dan kejadian infeksi lebih banyak terjadi pada pasien dengan durasi <120 menit, yaitu 20 orang (50%) pasien. Kata Kunci : Infeksi Luka Operasi, ILO, Bedah Abdomen, Faktor Resiko Infeksi Luka Operasi Surgical site infection (SSI) is an infection at the part of the body that was exposed by a surgeon during an invasive procedure. SSI is one of the most common and most preventable nosocomial infection among other nosocomial infections, but the incidence of surgical site infections especially in abdominal surgery still shows a significant burden. Risk factors of surgical site infections include old age, type of surgical wound, comorbidities such as diabetes mellitus, inadequate prophylactic antibiotics, nutritional statuses such as obesity and malnutrition and long duration of surgery. This study aimed to explain an overview of the incidence of postoperative abdominal wound infection in Abdul Wahab Sjahranie General Hospital, Samarinda. This research method was a laboratory descriptive study. The research data was taken from surgical wound swabs and medical record data of 40 post-abdominal surgery patients who made the bandage changes for the first time and met the inclusion and exclusion criteria. The results showed 30 patients (75%) had surgical site infections. The highest percentage of infected patients aged over 40 years, i.e. in 15 people (37.5%). Most of the infected patients had clean contaminated wounds, i.e. in 23 patients (57.5%). The majority of infected patients did not have concomitant diseases, i.e. 27 people (67.5%). Gram-positive bacteria, specifically Staphylococcus epidermidis was the most infectious bacteria identified in 10 patients (33.3%). All infected patients, i.e. 30 patients (75%) received prophylactic antibiotics. The highest frequencies of infected patients had normal nutritional status, i.e.17 patients(42.5%), and the incidence of infection was more common in patients with duration <120 minutes, i.e. 20 patients (50%). Keywords : Surgical Site Infection, SSI, Abdominal Surgery, Risk Factors

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Surgical Site Infection in a Tertiary Care Teaching Hospital

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i47b33193 ◽

2021 ◽

pp. 853-859

Author(s):

V. Kartthick ◽

P. B. Sudarshan

Keyword(s):

Surgical Site Infection ◽

Nosocomial Infections ◽

Tertiary Care ◽

Operation Time ◽

Surgical Site Infections ◽

Site Infection ◽

Mortality And Morbidity ◽

Emergency Procedures ◽

Elective Surgical Procedures ◽

Surgical Wounds

Introduction: Surgical site infections [SSIs] are the Third most common nosocomial infections, According to the National Nosocomial Infections Surveillance, patients who are hospitalized account for 15 to 18 percent of all nosocomial infections .increased mortality and morbidity rates associated with Surgery. Surgical wounds are divided into four categories: clean, clean-contaminated, contaminated and dirty wounds. Materials and Methods: This was a retrospective study, done throughout for two years period, from June 2018 to May 2020 .785 patients underwent surgery in the Dept. of General Surgery in Saveetha Medical College and Hospital, Thandalam. Were taken as part of this study. Elective surgical procedures were performed on 495 patients. And 290 were taken to the hospital for emergency treatment. An in-depth examination of these cases was conducted, taking into account the date of admission, clinical features, history, types of surgery [emergency or elective], pre-operative preparation, drain used, and its type and postoperative findings. Results: Surgical Site Infections were found in 58 cases out of 785 surgeries. In elective clean and contaminated patients, the overall postoperative SSI rate is 4.34 percent of all cases, whereas emergency cases account for 12.41 percent. According to the research, that the most prevalent type of surgical site infection is superficial surgical site infection accounting for 72.1 percent of all SSIs in elective cases and 61.11 percent in emergency cases, and deep surgical site infection accounting for 23.25 percent of elective cases and 30.55 percent of emergency cases. Conclusion: The most common bacteria found in elective surgical wounds are E. coli. Proteus mirabilis is the most prevalent organism isolated from emergency surgical wounds. A shift in the pre-operative period antibiotics may even diminish the occurrence. Pre-existing medical conditions like diabetes mellitus wound type, operation time, emergency procedures, and wound contamination all had a significant impact on the development of surgical site infection.

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Surgical Site Infections - A Hospital Havoc: Retrospective Study of Surgical Site Infections in Tertiary Health Care Centre in North East India

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol03-i01/09 ◽

2018 ◽

Vol 3 (01) ◽

Author(s):

V Singh ◽

A B Khyriem, W V Lyngdoh ◽

C J Lyngdoh

Keyword(s):

Surgical Site Infection ◽

Multiple Drug Resistance ◽

Surgical Site Infections ◽

Multidrug Resistant ◽

Multiple Drug ◽

Site Infection ◽

Retrospective Case ◽

Acinetobacter Baumanii ◽

Health Care Centre ◽

North East

Objectives - Surgical site infections (SSI) has turn out to be a major problem even in hospital with most modern facilities and standard protocols of pre -operative preparation and antibiotic prophylaxis. Objective of this study is to know the prevalence of surgical site infection among the postoperative patients and to identify the relationship between SSI and etiological pathogens along with their antimicrobial susceptibility at North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong. Methods - A retrospective case study conducted at NEIGRIHMS, among patients admitted to the surgical departments during the period between January 1st and December 31st 2016. Swabs from the surgical sites were collected under sterile conditions and standard bacteriological tests were performed for identification and appropriate statistical methods were employed to look for association between SSI and etiological pathogens. Results - Out of the 1284 samples included in the study, 192 samples showed evidence of SSI yielding an infection rate of 14.9%. The most commonly isolated bacteria were: Escherichia coli, Acinetobacter baumanii and Staphylococcus aureus, of the gram negative isolates 6.2% were multidrug resistant of which 19% were carbapenem resistant. Conclusion - SSI with multiple drug resistance strains and polymicrobial etiology reflects therapeutic failure. The outcome of the SSI surveillance in our hospital revealed that in order to decrease the incidence of SSI we would have to: a) incorporate a proper antibiotic stewardship b) conduct periodic surveillance to keep a check on SSI d) educate medical staffs regarding the prevention of surgical site infection.

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58 Use of Abdominal Wall or Sucutaneous Drain to Reduce the Risk of Surgical Site Infections

British Journal of Surgery ◽

10.1093/bjs/znab134.356 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

H Mistry ◽

B Woolner ◽

A John

Keyword(s):

Surgical Site Infection ◽

Open Cholecystectomy ◽

Surgical Site Infections ◽

Standard Operating Procedure ◽

Site Infection ◽

Infection Rates ◽

Local Evidence ◽

Audit Data ◽

The Impact ◽

To Receive

Abstract Introduction Open abdominal surgery confers potentially greater risk of surgical site infections, and local evidence suggests use of drains can reduce this. Our objectives were: Assessing local rates and risk factors of infections and if use of drains can reduce the rates of infections. Method Retrospectively looking from 01/01/2018 to 31/12/2018, at patients following laparotomy or open cholecystectomy. Data collection on demographics, smoking/alcohol status, heart, respiratory or renal disease or diabetes, steroid use and CEPOD status, as well as use of drain and the outcome of infection using inpatient and online patient records. Results 84 patients included, 25 had drains inserted. There were 13 documented cases of surgical site infection, all of whom had no drain post-op. Other parameters shown to be most prevalent in the patients with a surgical site infection include being current/ex-smoker (8/13), having heart disease (9/13), and elective procedures. Conclusions Aiming to reduce the risk of surgical site infections can improve morbidity and potentially mortality outcomes. Our audit data showed that there appears to be a benefit of inserting intra-abdominal or subcutaneous drains. We will create a standard operating procedure of all patient to receive drains post-op and then re-audit to assess the impact this has on infection rates.

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