Cheetah - Sterile Glove and Clean Instrument Change at the Time of Wound Closure to Reduce Surgical Site Infection

Objective: Identify nursing interventions that contribute to the reduction of surgical site infections in potentially contaminated surgeries. Methods: Integrative review, carried out in four databases. There were 5,888 articles published in the period from January 2008 to July 2018, in English, Portuguese and Spanish, from which nine articles were selected after final analysis. Results: The nursing interventions appeared according to the perioperative periods: preoperative (55.55%), intraoperative (33.33%), postoperative (66.66%), being associated with: antibiotic therapy, trichotomy, alcoholic chlorhexidine bathing, hand hygiene, sterile glove/wear/ package change for fascia and skin closure, degermination, antisepsis, surgical classification, surgical time, care with dressings and drains, temperature and blood glucose control, patient education, discharge and post-hospital discharge orientation. Conclusions: Nursing interventions were identified in each perioperative period, proving to be essential for the qualification of nursing care and effective in reducing surgical site infection in potentially contaminated surgeries.

Download Full-text

Comparison of 2-octyl cyanoacrylate skin adhesive and interrupted polypropylene sutures for wound closure in total ankle arthroplasty

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02791-x ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Gun-Woo Lee ◽

Woo Kyoung Kwak ◽

Keun-Bae Lee

Keyword(s):

Patient Satisfaction ◽

Surgical Site Infection ◽

Wound Closure ◽

Wound Dehiscence ◽

Wound Complications ◽

Site Infection ◽

Ankle Arthroplasty ◽

Suture Group ◽

Allergic Contact ◽

Polypropylene Sutures

Abstract Background Adhesive skin materials have increasingly been used in orthopedic surgery. We aimed to compare the efficacy and safety of skin adhesive (2-octyl cyanoacrylate and polymer mesh, Dermabond Prineo) and interrupted polypropylene sutures for wound closure in patients undergoing total ankle arthroplasty (TAA). Methods We prospectively enrolled 107 consecutive patients (108 ankles) undergoing TAA and divided them into two groups: skin adhesive group (36 ankles) and suture group (72 ankles). The primary outcome assessment included wound complications and patient satisfaction for wound cosmesis. The secondary outcome assessment included duration of surgery, length of hospital stay, and the Ankle Osteoarthritis Scale (AOS) pain and disability score. Results There was one case of allergic contact dermatitis, three cases of wound dehiscence, and one case of superficial surgical site infection in the skin adhesive group. Among them, one case each with allergic contact dermatitis and wound dehiscence finally progressed to deep surgical site infection. Three cases of wound dehiscence were also reported in the suture group; however, there was no case of surgical site infection. Patient satisfaction for wound cosmesis was significantly higher in the skin adhesive group than in the suture group (p = 0.001). There was no statistically significant difference between the groups in terms of secondary outcomes (p > 0.05). Conclusions Although the use of Dermabond Prineo showed better patient satisfaction for wound cosmesis, it showed significantly high wound complication rates and no other clinical benefits compared to interrupted polypropylene suture in TAA. Our results suggest that awareness of the possibility of wound complications is necessary when Dermabond Prineo is used in TAA.

Download Full-text

Bluebelle pilot randomised controlled trial of three wound dressing strategies to reduce surgical site infection in primary surgical wounds

BMJ Open ◽

10.1136/bmjopen-2019-030615 ◽

2020 ◽

Vol 10 (1) ◽

pp. e030615 ◽

Cited By ~ 1

Author(s):

Jane Blazeby

Keyword(s):

Randomised Controlled Trial ◽

Surgical Site Infection ◽

Wound Closure ◽

Controlled Trial ◽

Response Rates ◽

Secondary Outcome ◽

Site Infection ◽

Main Trial ◽

Surgical Wounds ◽

Randomised Controlled

ObjectiveSurgical site infection (SSI) affects up to 25% of primary surgical wounds. Dressing strategies may influence SSI risk. The Bluebelle study assessed the feasibility of a multicentre randomised controlled trial (RCT) to evaluate the effectiveness and cost-effectiveness of different dressing strategies to reduce SSI in primary surgical wounds.DesignA pilot, factorial RCT.SettingFive UK hospitals.ParticipantsAdults undergoing abdominal surgery with a primary surgical wound.InterventionsParticipants were randomised to ‘simple dressing’, ‘glue-as-a-dressing’ or ‘no dressing’, and to the time at which the treatment allocation was disclosed to the surgeon (disclosure time, before or after wound closure).Primary and secondary outcome measuresFeasibility outcomes focused on recruitment, adherence to randomised allocations, reference assessment of SSI and response rates to participant-completed and observer-completed questionnaires to assess SSI (proposed primary outcome for main trial), wound experience and symptoms, and quality of life (EQ-5D-5L).ResultsBetween March and November 2016, 1115 patients were screened; 699 (73.4%) were eligible and approached, 415 (59.4%) consented and 394 (35.3%) were randomised (simple dressing=133, glue=129 and ‘no dressing’=132). Non-adherence to dressing allocation was 2% (3/133), 6% (8/129) and 15% (20/132), respectively. Adherence to disclosure time was 99% and 86% before and after wound closure, respectively. The overall rate of SSI (reference assessment) was 18.1% (51/281). Response rates to the Wound Healing Questionnaire and other questionnaires ranged from >90% at 4 days to 68% at 4–8 weeks.ConclusionsA definitive RCT of dressing strategies including ‘no dressing’ is feasible. Further work is needed to optimise questionnaire response rates.Trial registration number49328913; Pre-results.

Download Full-text

Pyoderma Gangrenosum after Cardiac Surgery

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0041-1735960 ◽

2021 ◽

Author(s):

Asen Petrov ◽

Utz Kappert ◽

Torsten Schmidt ◽

Klaus Ehrhard Matschke ◽

Manuel Wilbring

Keyword(s):

Cardiac Surgery ◽

Surgical Site Infection ◽

Pyoderma Gangrenosum ◽

Severe Pain ◽

Wound Closure ◽

Clinical Presentation ◽

Correct Diagnosis ◽

Rapid Progression ◽

Site Infection ◽

Case Mortality

Abstract Background Pyoderma gangrenosum after cardiac surgery is a rare, noninfectious ulcerating skin disease mimicking sternal wound infection. Methods A systematic search of literature for pyoderma gangrenosum complicating cases of cardiac surgery was conducted between September 1985 and September 2020 on PubMed and Cochrane databases. A systematic review and detailed overview of clinical presentation, diagnostic, treatment, and outcome is provided. Results A total of 15 studies enclosing 15 patients suffering from pyoderma gangrenosum following cardiac surgery were identified. Onset of symptoms was observed after a median of 5 days. Patients were predominantly male (81.3%) with a median age of 64 years. Typical clinical presentation mimicked sternal site infection, mainly by means of mediastinitis. Specific signs were rapid progression, erythematous to violaceous color of the wound border, accompanied by unspecific symptoms including fever, malaise, and severe pain. Additionally, pathergy (development of ulcers at the sites of minor cutaneous trauma) was reported frequently. Biopsy is mandatory with a cutaneous neutrophilic inflammation confirming the diagnosis. Initial treatment mostly (75.0% of reported cases) was misled, addressing suspicion of surgical site infection. After correct diagnosis, the treatment was switched to an immunosuppressive therapy. Full sternal wound closure took between 5 weeks and 5 months. Reported case mortality was 12.5% in actually low-risk surgeries. Conclusion Despite pyoderma gangrenosum has typical signs, it remains an exclusion diagnosis. The treatment is completely opposite to the main differential diagnosis—the typical surgical site infection. Knowledge about diagnosis and treatment is essential in the context of avoiding fatal mistreatment.

Download Full-text

Systematic review of the use of cyanoacrylate glue in addition to standard wound closure in the prevention of surgical site infection

International Wound Journal ◽

10.1111/iwj.13044 ◽

2018 ◽

Vol 16 (2) ◽

pp. 387-393

Author(s):

Matthew Machin ◽

Chen Liu ◽

Alex Coupland ◽

Alun Huw Davies ◽

Ankur Thapar

Keyword(s):

Systematic Review ◽

Surgical Site Infection ◽

Wound Closure ◽

Site Infection ◽

Cyanoacrylate Glue

Download Full-text

Impact of using triclosan-impregnated sutures on incidence of surgical site infection: a real world Indian study

International Surgery Journal ◽

10.18203/2349-2902.isj20180369 ◽

2018 ◽

Vol 5 (2) ◽

pp. 647

Author(s):

Shivpreet Singh Samra ◽

Vijay Jagad ◽

Munish Mahajan ◽

M. S. Randhawa ◽

Chetna Trehan

Keyword(s):

Surgical Site Infection ◽

Real World ◽

Wound Closure ◽

Single Case ◽

Wide Spectrum ◽

Bacterial Colonization ◽

Surgical Care ◽

Site Infection ◽

Indian Study ◽

Core Measures

Background: Surgical Site Infection is an index of health care system of any hospital. Surgical material is a risk factor for SSI that can be easily changed. One of such measures is the use of antimicrobial suture technology which involves the impregnation of synthetic, absorbable, polymeric sutures with the antiseptic, Triclosan. Triclosan-coated sutures inhibit bacterial colonization of wide-spectrum of pathogens. This study was designed to assess the efficacy of triclosan coated sutures in reducing incidence of surgical site infection in Indian population.Methods: This is a retrospective ‘real-world’ study of 150 patients who underwent surgery and wound closure with triclosan-coated suture from May 2015 to December 2015 at Hospital, Mohali. Incidence of SSI was recorded, and nature of wound was categorized. Data was subject to descriptive analysis.Results: 99.3% of wounds sutured with triclosan coated sutures did not have surgical site infection. The single case of SSI encountered was categorized as superficial-incisional. All the evaluated cases were categorized as ‘clean’ at the time of discharge.Conclusions: Triclosan-coated sutures were responsible for the reported reduction in SSI, particularly in adult patients with clean wounds. This study justifies that in addition to the mandated core measures of surgical care, adjunctive evidence-based interventions such as Triclosan-coated sutures should be considered in the comprehensive effort to decrease risk of surgical site infection and improve outcome at both patient and institutional levels.

Download Full-text