scholarly journals ROLE OF PREOPERATIVE ASSESSMENT OF SERUM CHOLESTEROL AND ALBUMIN IN SURGICAL SITE INFECTION.

2019 ◽  
Vol 3 (7) ◽  
Author(s):  
Dr. Kirankumar B. Sodavadiya ◽  
Dr. Sunita Singh ◽  
Dr. BK Agrawal
Keyword(s):  
Relative Risk ◽  
Surgical Site Infection ◽  
Length Of Hospital Stay ◽  
Preoperative Assessment ◽  
Albumin Level ◽  
Blood Cholesterol ◽  
Site Infection ◽  
Health Care Centre ◽  
The People ◽  
Study Population

INTRODUCTION:Surgical site infection (SSI) is defined as infection occurring in an incisional wound within 30 days of the procedure or within 1 year if a prosthesis is implanted. A few studies have reported a relationship between low serum albumin level and low cholesterol level in surgical site infection, length of hospital stay and death and is reported to be one of the major causes of morbidity and mortality among hospitalized patients. METHOD:1 year prospective cohort study was conducted in Tertiary Health care Centre, Indore. A study population of 248 patients from hospital admitted in Department of General Surgery for elective operation. RESULT:From Total Patients - 172 (69.4%) were male patients and 76 (30.6%) were female patients. The frequency of patients developed SSI in hypoalbuminemia was 25(44.6%) in number compare to n=18(10.7%) in normal and to n= 03(12.5%) in hyper albuminemia. The Relative Risk between Hypoalbuminemia and SSI is 4.17 with CI (2.46  to 7) (P = <0.001). There is a significant association between cholesterol levels and the occurrence of SSI, with majority of the people with SSI had Hypocholesterolemia and it was found to be statistically significant with Relative risk(RR=3.98, CI= 2.28 to 6.95) (P = <0.001). CONCLUSION:Low blood cholesterol and albumin level are the important factors which is usually can lead to significant decrease in this preventable post operative complications especially in a malnourished population presenting in a government setup.

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

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.

EP.TH.959Meta-analysis of temporary loop ileostomy closure during or after adjuvant chemotherapy following rectal cancer surgery: An ongoing dilemma

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shahin Hajibandeh ◽  
Shahab Hajibandeh ◽  
Pratik Bhattacharya ◽  
Reza Zakaria ◽  
Christopher Thompson ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Perioperative Complications ◽  
Loop Ileostomy ◽  
Length Of Hospital Stay ◽  
Ileostomy Closure ◽  
Site Infection ◽  
Cancer Resection

Abstract Aims To evaluate comparative outcomes of temporary loop ileostomy closure during or after adjuvant chemotherapy following rectal cancer resection. Methods We systematic searched MEDLINE; EMBASE; CINAHL; CENTRAL; the World Health Organization International Clinical Trials Registry; ClinicalTrials.gov; ISRCTN Register, and bibliographic reference lists. Overall perioperative complications, anastomotic leak, surgical site infection, ileus and length of hospital stay were the evaluated outcome parameters. Combined overall effect sizes were calculated using fixed-effect or random-effects models. Results We identified 4 studies reporting a total of 436 patients comparing outcomes of temporary loop ileostomy closure during (n = 185) or after (n = 251) adjuvant chemotherapy following colorectal cancer resection. There was no significant difference in overall perioperative complications (OR 1.39; 95% CI 0.82-2.36, p = 0.22), anastomotic leak (OR 2.80; 95% CI 0.47-16.56, p = 0.26), surgical site infection (OR 1.97; 95% CI 0.80-4.90, p = 0.14), ileus (OR 1.22; 95% CI 0.50-2.96, p = 0.66) or length of hospital stay (MD 0.02; 95% CI -0.85-0.89, p = 0.97) between two groups. Between-study heterogeneity was low in all analyses. Conclusions The meta-analysis of best, albeit limited, available evidence suggests that temporary loop ileostomy closure during adjuvant chemotherapy following rectal cancer resection may be associated with comparable outcomes to closure of ileostomy after adjuvant chemotherapy. We encourage future research to concentrate on completeness of chemotherapy and quality of life which can determine appropriateness of either approach.

scholarly journals Surgical Infections and Antibiotic Stewardship: In Need for New Directions

2019 ◽  
pp. 145749691989161 ◽  
Author(s):  
R. Andersson ◽  
K. Søreide ◽  
D. Ansari
Keyword(s):  
Surgical Site Infection ◽  
English Language ◽  
Medical Profession ◽  
Length Of Hospital Stay ◽  
Surgical Site Infections ◽  
Health Economy ◽  
Site Infection ◽  
Remote Sites ◽  
Guidelines And Recommendations ◽  
Evidence Based Guidelines

Background and Aims: Patients undergoing surgery are prone to infections, either at the site of surgery (superficial or organ-space) or at remote sites (e.g. pneumonia or urinary tract). Surgical site infections are associated with substantial morbidity and mortality, increased length of hospital stay and represent a huge burden to the health economy across all healthcare systems. Here we discuss recent advances and challenges in the field of surgical site infections. Material and Methods: Review of pertinent English language literature. Results: Numerous guidelines and recommendations have been published in order to prevent surgical site infections. Compliance with these evidence-based guidelines vary and has not resulted in any major decrease in the surgical site infection rate. To date, most efforts to reduce surgical site infection have focused on the role of the surgeon, but a more comprehensive approach is necessary. Conclusion: Surgical site infections need to be addressed in a structured way, including checklists, audits, monitoring, and measurements. All stakeholders, including the medical profession, the society, and the patient, need to work together to reduce surgical site infections. Most surgical site infections are preventable—and we need a paradigm shift to tackle the problem.

scholarly journals The application of evidence-based bundle approach to reduce surgical site infection in geriatric hip fracture patients: A single centre experience

2020 ◽  
Vol 27 (2) ◽  
pp. 133-141
Author(s):  
Chow Chun Lok ◽  
Chan Pak Hin Alexander ◽  
Hung Yuk Wah ◽  
Fan Jason Chi Ho
Keyword(s):  
Hip Fracture ◽  
Surgical Site Infection ◽  
Prophylactic Antibiotic ◽  
Length Of Hospital Stay ◽  
High Rate ◽  
Adhesive Tape ◽  
Site Infection ◽  
Intervention Programme ◽  
Community Healthcare ◽  
Geriatric Hip Fracture

Introduction: Surgical site infection (SSI) is associated with increased morbidity and mortality, prolongation on length of hospital stay and cost of community healthcare. In 2010 and 2012, our centre experienced an unexpectedly high rate of SSI in geriatric hip fracture patients with hemiarthroplasty done. A multifaceted intervention programme – ‘bundle approach’ – consisting of preoperative microbiological screening, perioperative measures and postoperative wound care was implemented. Method: Preoperative methicillin-resistant Staphylococcus aureus (MRSA) screening was implemented. Intravenous vancomycin was given as prophylactic antibiotic of choice in those patients with positive MRSA screening. All patients will be bathed with chlorhexidine lotion 1 day before operation or on the day of operation. Standardized protocol of surgical site disinfection was implemented: a stringent first stage povidone-iodine disinfection, second stage waterproof extremity draping and sterile plastic sheet wrapping of non-surgical region and third stage ChloraPrep, followed by circumferential iodophor-impregnated plastic adhesive drape (‘Ioban’) covering the hip and thigh region. The surgical wound was dressed with Aquacel adhesive tape after wound closure. Results: The total numbers of infected cases were 17 from 2008 to 2012 and 9 from 2013 to 2018 (first quarter). The rates of infection were 7.02% from 2008 to 2012 and 3.16% from 2013 to 2018 (first quarter). There was a statistically significant reduction in the number of infected cases of hemiarthroplasty after the implementation of bundle approach ( p = 0.0411). Discussion: The bundle approach showed to achieve an effective and sustained decrease in SSI for the geriatric hip fracture patients.

Surgical site infection risk following cesarean deliveries covered by Medicaid or private insurance

2019 ◽  
Vol 40 (6) ◽  
pp. 639-648 ◽  
Author(s):  
Sarah H. Yi ◽  
Kiran M. Perkins ◽  
Sophia V. Kazakova ◽  
Kelly M. Hatfield ◽  
David G. Kleinbaum ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Cesarean Delivery ◽  
Private Insurance ◽  
Site Infection ◽  
Cesarean Deliveries ◽  
Need To Evaluate ◽  
Study Population ◽  
Facility Level ◽  
Primary Payer

AbstractObjective:To compare risk of surgical site infection (SSI) following cesarean delivery between women covered by Medicaid and private health insurance.Study design:Retrospective cohort.Study population:Cesarean deliveries covered by Medicaid or private insurance and reported to the National Healthcare Safety Network (NHSN) and state inpatient discharge databases by hospitals in California (2011–2013).Methods:Deliveries reported to NHSN and state inpatient discharge databases were linked to identify SSIs in the 30 days following cesarean delivery, primary payer, and patient and procedure characteristics. Additional hospital-level characteristics were obtained from public databases. Relative risk of SSI by primary payer primary payer was assessed using multivariable logistic regression adjusting for patient, procedure, and hospital characteristics, accounting for facility-level clustering.Results:Of 291,757 cesarean deliveries included, 48% were covered by Medicaid. SSIs were detected following 1,055 deliveries covered by Medicaid (0.75%) and 955 deliveries covered by private insurance (0.63%) (unadjusted odds ratio, 1.2; 95% confidence interval [CI], 1.1–1.3; P < .0001). The adjusted odds of SSI following cesarean deliveries covered by Medicaid was 1.4 (95% CI, 1.2–1.6; P < .0001) times the odds of those covered by private insurance.Conclusions:In this, the largest and only multicenter study to investigate SSI risk following cesarean delivery by primary payer, Medicaid-insured women had a higher risk of infection than privately insured women. These findings suggest the need to evaluate and better characterize the quality of maternal healthcare for and needs of women covered by Medicaid to inform targeted infection prevention and policy.

Surgical Site Infection in a Tertiary Neonatal Surgery Centre

2018 ◽  
Vol 29 (03) ◽  
pp. 260-265 ◽  
Author(s):  
Adiam Woldemicael ◽  
Sarah Bradley ◽  
Caroline Pardy ◽  
Justin Richards ◽  
Paolo Trerotoli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Model ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Logistic Regression Model ◽  
Length Of Hospital Stay ◽  
Neonatal Surgery ◽  
Site Infection ◽  
Increased Risk

Introduction Surgical site infection (SSI) is a key performance indicator to assess the quality of surgical care. Incidence and risk factors for SSI in neonatal surgery are lacking in the literature. Aim To define the incidence of SSI and possible risk factors in a tertiary neonatal surgery centre. Materials and Methods This is a prospective cohort study of all the neonates who underwent abdominal and thoracic surgery between March 2012 and October 2016. The variables analyzed were gender, gestational age, birth weight, age at surgery, preoperative stay in neonatal intensive care unit, type of surgery, length of stay, and microorganisms isolated from the wounds. Statistical analysis was done with chi-square, Student's t- or Mann–Whitney U-tests. A logistic regression model was used to evaluate determinants of risk for SSI; variables were analyzed both with univariate and multivariate models. For the length of hospital stay, a logistic regression model was performed with independent variables. Results A total of 244 neonates underwent 319 surgical procedures. The overall incidence of SSIs was 43/319 (13.5%). The only statistical differences between neonates with and without SSI were preoperative stay (<4 days vs. ≥4 days, p < 0.01) and length of hospital stay (<30 days vs. ≥30 days, p < 0.01). A pre-operative stay longer than 4 days was associated with almost three times increased risk of SSI (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.05–8.34, p = 0.0407). Gastrointestinal procedures were associated with more than ten times the risk of SSI compared with other procedures (OR 10.17, 95% CI 3.82–27.10, p < 0.0001). Gastroschisis closure and necrotizing enterocolitis (NEC) laparotomies had the highest incidence SSI (54% and 62%, respectively). The risk of longer length of hospital stay after SSI was more than three times higher (OR = 3.36, 95%CI 1.63–6.94, p = 0.001). Conclusion This is the first article benchmarking the incidence of SSI in neonatal surgery in the United Kingdom. A preoperative stay ≥4 days and gastrointestinal procedures were independent risk factors for SSI. More research is needed to develop strategies to reduce SSI in selected neonatal procedures.

A meta-analysis of spinal surgical site infection and vancomycin powder

2014 ◽  
Vol 21 (6) ◽  
pp. 974-983 ◽  
Author(s):  
Nickalus R. Khan ◽  
Clinton J. Thompson ◽  
Michael DeCuypere ◽  
Jonathan M. Angotti ◽  
Erick Kalobwe ◽  
...  
Keyword(s):  
Relative Risk ◽  
Surgical Site Infection ◽  
Risk Reduction ◽  
Spine Surgery ◽  
Spinal Surgery ◽  
Meta Analysis ◽  
Control Group ◽  
Number Needed To Treat ◽  
Site Infection ◽  
Vancomycin Powder

Object Surgical site infection (SSI) is a serious and costly complication of spinal surgery. There have been several conflicting reports on the use of intrawound vancomycin powder in decreasing SSI in spine surgery. The purpose of this study is to answer the question: “Does intrawound vancomycin powder reduce the rate of SSIs in spine surgery?” Methods A comprehensive search of multiple electronic databases and bibliographies was conducted to identify clinical studies that evaluated the rates of SSI with and without the use of intrawound vancomycin powder in spine surgery. Independent reviewers extracted data and graded the quality of each paper that met inclusion criteria. A random effects meta-analysis was then performed. Results The search identified 9 retrospective cohort studies (Level III evidence) and 1 randomized controlled trial (Level II evidence). There were 2574 cases and 106 infections in the control group (4.1%) and 2518 cases and 33 infections (1.3%) in the treatment group, yielding a pooled absolute risk reduction and relative risk reduction of 2.8% and 68%, respectively. The meta-analysis revealed the use of vancomycin powder to be protective in preventing SSI (relative risk = 0.34, 95% confidence interval 0.17–0.66, p = 0.021). The number needed to treat to prevent 1 SSI was 36. A subgroup analysis found that patients who had implants had a reduced risk of SSI with vancomycin powder (p = 0.023), compared with those who had noninstrumented spinal operations (p = 0.226). Conclusions This meta-analysis suggests that the use of vancomycin powder may be protective against SSI in open spinal surgery; however, the exact population in which it should be used is not clear. This benefit may be most appreciated in higher-risk populations or in facilities with a high baseline rate of infection.

scholarly journals Scaling Up Quality Improvement for Surgical Teams (QIST) - avoiding surgical site infection and anaemia at the time of surgery: protocol for a cluster randomised controlled trial

2019 ◽  
Author(s):  
Ashley B Scrimshire ◽  
Alison Booth ◽  
Caroline Fairhurst ◽  
Win Tadd ◽  
Annie Laverty ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Surgical Site Infection ◽  
Controlled Trial ◽  
Length Of Hospital Stay ◽  
Learning System ◽  
Health Improvement ◽  
Routine Practice ◽  
Site Infection ◽  
Usual Practice ◽  
Surgery Patient

Abstract Background: Measures shown to improve outcomes for patients often fail to be adopted into routine practice in the NHS. The Institute for Health Improvement Breakthrough Series Collaborative (BSC) model is designed to support implementation at scale. This trial aims to assess the effectiveness and cost-effectivenessof quality improvement collaboratives based on the BSC method for introducing service improvements at scale in the NHS. Methods: Forty Trusts will be randomised (1:1) to introduce one of two protocols already shown to improve outcomes in patients undergoing elective total hip and knee replacement surgery. The intervention is improvement collaboratives based on the BSC model, a learning system that brings together a large number of teams to seek improvement focused on a proven intervention. Collaboratives aim to deliver at scale, maximise local engagement and leadership and are designed to build capacity, enable learning and prepare for sustainability. Collaboratives involve learning sessions, action periods, and a summative congress. Trusts will be supported to introduce either: decolonisation for MSSA to reduce post-operative infection (QIST:Infection), or an anaemia optimisation programme to reduce peri-operative blood transfusions (QIST:Anaemia). Trusts will continue with their usual practice for whichever protocol they are not introducing. Anonymised data related to both infection and anaemia outcomes for patients undergoing hip or knee arthroplasty at all sites will mean the two groups act as controls for each other. The primary outcome for the QIST: Infection collaborative is deep MSSA surgical site infection within 90 days of surgery, and for the QIST: Anaemia collaborative is blood transfusion within 7 days of surgery. Patient-level secondary outcomes include length of hospital stay and re-admission, which will also inform the economic costings. Qualitative interviews will evaluate the support provided to teams. Discussion: The scale of this trial brings considerable challenges and potential barriers to delivery. Anticipated challenges relate to recruiting and sustaining up to 40 organisations, each with their own culture and context. This complex project with multiple stakeholders across a large geography will be managed by experienced senior-level project leaders with a proven track record in advanced project management. The team will ensure effective project governance and communications.

scholarly journals LAPAROSOPIC ASSISTED RIGHT HEMICOLECTOMY

2015 ◽  
Vol 22 (08) ◽  
pp. 1020-1023
Author(s):  
Jahangir Sarwar Khan ◽  
Muhammad Salman Shafique
Keyword(s):  
Surgical Site Infection ◽  
Hospital Stay ◽  
Oral Intake ◽  
Length Of Hospital Stay ◽  
Right Hemicolectomy ◽  
Site Infection ◽  
Carcinoma Colon ◽  
Duration Of Operation ◽  
Age Range ◽  
Surgical Unit

Objective: Experience with Laparosopic assisted Right Hemicolectomy ispresented. Study Design: Prospective study. Setting: Surgical Unit-I, Holy Family Hospital,Rawalpindi, Pakistan. Period: 2010 to 2014. Materials and Methods: 20 patients underwentlaparosopic assisted right hemicolectomy. Duration of operation, postoperative pain, durationof post operative analgesia, frequency of surgical site infection and length of hospital stay werenoted. Results: There were 13 male and 7 female patients with the age range of 25-70 years(45±11years). Eleven (11) patients were suffering from carcinoma colon wheras nine (09)were suffering from Tuberculosis. Mean operative time was about 92 minutes. Only four opiodinjections were required as post-operative analgesia. Oral intake was started after 24 hours. Themean length of hospital stay was 5.5 days with no case of surgical site infection. Conclusion:Laparoscopic assisted right hemicolectomy is a safe and viable option in our setup.

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