A CLINICAL STUDY ON FACTORS RESPONSIBLE FOR SURGICAL SITE INFECTIONS FOLLOWING EMERGENCY NONTRAUMATIC ABDOMINAL OPERATIONS

This study aims at nding out the common organisms responsible for surgical site infections following emergency non - traumatic abdominal operations and their sensitivity patterns of the microorganisms were ascertained. Determination of factors responsible for infections to reduce the infection rate and thereby reduce the morbidity and mortality. The patients admitted to various surgical wards in KIMS General Hospital, who are operated for emergency non -traumatic abdominal operations are included in this study. A proforma for study of all consecutive patients of emergency non-traumatic abdominal operations will be used. Culture and sensitivity of the organism at the surgical site infection are documented. Various statistical and epidemiological parameters used will be are mean and standard deviation. It was revealed that, overall surgical site infection rate was17.14 per cent. It was observed that among the various host factors studied age, sex, and educational status of the patients were not statistically signicant, but presence of comorbidity played a signicant role in causing SSI. Among the perioperative / environmental factors category of operations, types of incisions, and delay to initiate operation did not play signicant role, but duration of operation and degree of wound contamination played statistically signicant role. It can be concluded from the ndings of the study that microorganisms that are normal inhabitants of our body are mainly responsible for surgical site infection (SSI). Various host factors like malnutrition, obesity, patients’ knowledge about hygiene, presence of co- morbidity etc. coupled with environmental factors such as condition of the wounds, delay to initiate operation, duration of operation, prolonged exposure of peritoneal cavity to environment, prophylactic use of antibiotics and factors associated with surgery like type of incision, type of operation greatly contribute to occurrences of SSI. So, quality of surgical care including immediate assessment of patients, resuscitative measures, adequate preparation of patients and aseptic environment are important for control of SSI.

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Factors predicting surgical site infection after clean contaminated surgery

International Surgery Journal ◽

10.18203/2349-2902.isj20175915 ◽

2017 ◽

Vol 5 (1) ◽

pp. 300

Author(s):

Ranjith Mannarakkal ◽

Mohammed Suaib ◽

Abidali Karatparambil ◽

Abhijith N. Das

Keyword(s):

Risk Factors ◽

Surgical Site Infection ◽

Prolonged Exposure ◽

Surgical Site Infections ◽

Prophylactic Antibiotics ◽

Site Infection ◽

E Coli ◽

Co Morbidity ◽

Abdominal Operations ◽

Clean Contaminated

Background: The infection of a wound is defined as the invasion of organisms through tissues following a breakdown of local and systemic host defences, leading to cellulitis, lymphangitis, abscess and bacteraemia. Southampton criteria and the centers for disease control and prevention criteria for the diagnosis of surgical site infections are used now for severity assessment. There is still controversy existing on the multifactorial causal relationship.Methods: Longitudinal Observational study with nonrandom purposive sampling carried out in the patients in OT, Casuality, ICU and Wards, in our hospital having clean contaminated abdominal operations for one-year period starting from November 2015 determine the factors responsible for surgical site infections following clean contaminated abdominal operations with prophylactic antibiotics(n=150).Results: Diabetes mellitus (odds ratio of 1.9) and emergency procedure (12.6%) were the most important risk factors for development of SSI. E. Coli (45%, n= 9) was the most common organism. Midline incision (n=6/22 = 27.27%) showed highest rate. Other high-risk factors are obesity, malnutrition, anemia, old age and prolonged duration of surgeries.Conclusions: Various host factors like malnutrition, obesity, patients knowledge about hygiene, presence of co-morbidity etc. coupled with environmental factors such as condition of the wounds, delay to initiate operation, duration of operation, prolonged exposure of peritoneal cavity to environment, prophylactic use of antibiotics and factors associated with surgery like type of incision, type of operation and experience of operating surgeon greatly contribute to occurrences of SSI. So, quality of surgical care including immediate assessment of patients, resuscitative measures, adequate preparation of patients and aseptic environment are important for control of SSI. Moreover, in absence of highly advanced surgical amenities, preoperative resuscitative units, modern operation theatre facilities and sophisticated sterilization procedure it is necessary to use prophylactic antibiotics to encounter the various types of micro-organisms responsible for surgical site infection, particularly E. coli.

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Study of efficacy of short course peri-operative antibiotics in clean contaminated surgeries

International Surgery Journal ◽

10.18203/2349-2902.isj20173207 ◽

2017 ◽

Vol 4 (8) ◽

pp. 2455

Author(s):

Shivakumar C. R. ◽

Mohammad Fazelul Rahman Shoeb ◽

Anil Reddy Pinate

Keyword(s):

Surgical Site Infection ◽

Infection Rate ◽

Surgical Site Infections ◽

Cost Effective ◽

Site Infection ◽

Medical Sciences ◽

Short Course ◽

Perioperative Antibiotics ◽

Clean Contaminated ◽

Hospital Acquired

Background: Surgical site infection is a one of the most common postoperative complication and causes significant postoperative morbidity and mortality. WHO described Hospital acquired infections as one of the major infectious diseases having huge economic impact. Perioperative antibiotics constitute the bulk of antimicrobial consumption in any hospital. We need to adapt the policies that decrease the incidence of postoperative wound infection.Methods: Patients undergoing elective surgeries for clean contaminated cases for various causes from 15th May 2014 to 15th June 2017 under Surgical 1st Unit of District hospital Gulbarga (Affiliated to Gulbarga Institute of Medical Sciences, Gulbarga) are included in our study. During this period, a total of 216 patients participated, of which 145 were males and 71 were females. Patients received two doses of perioperative antibiotics, first dose before surgery and second dose after surgery, 12 hours apart during this period.Results: In this study, surgical site infection rate is 2.3% in clean-contaminated surgeries.Conclusions: The findings indicate that a short course of perioperative antibiotics where in first dose is given 30 minutes to one hour before surgery and second dose is given 12 hours after surgery are sufficient and efficacious as infection rate is acceptable (1%-3%).Infection rate in our study was 2.3%. It is cost-effective as well for prevention of surgical site infections in clean-contaminated surgeries in Indian surgical setup.

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An observational study of incidence of surgical site infections in gastrointestinal surgeries

International Surgery Journal ◽

10.18203/2349-2902.isj20214751 ◽

2021 ◽

Vol 8 (12) ◽

pp. 3595

Author(s):

Jenishkumar Vijaykumar Modi ◽

Darshit Kalaria

Keyword(s):

Risk Factors ◽

Observational Study ◽

Surgical Site Infection ◽

Infection Rate ◽

Surgical Site Infections ◽

Site Infection ◽

Infection Rates ◽

Surgical Site Infection Rate ◽

Long Time ◽

Surgery Department

Background: This study analysed the incidence of surgical site infections in gastrointestinal surgeries and its risk factors. so this study helped us in reducing surgical site infection by avoiding or minimizing that risk factors.Methods: The present study was conducted at general surgery department, SMIMER, Surat. An observational study of 400 cases that have undergone abdominal surgery in SMIMER hospital and were followed up from the day of operation to 30 days after discharge was done.Results: The overall infection rate for a total of the 400 cases was 17.25%. The incidence rate in this study was well within the infection rates of 2.8% to 17% seen in other studies. Different studies from India at different places have shown the SSI (surgical site infection) rate to vary from 6.09% to 38.7%.Conclusions: Our study reveals that though SSIs have been widely studied since a long time, they still remain as one of the most important causes of morbidity and mortality in surgically treated patients.

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Quality improvement initiative: Preventative Surgical Site Infection Protocol in Vascular Surgery

Vascular ◽

10.1177/1708538117719155 ◽

2017 ◽

Vol 26 (1) ◽

pp. 47-53 ◽

Cited By ~ 5

Author(s):

David Parizh ◽

Enrico Ascher ◽

Syed Ali Raza Rizvi ◽

Anil Hingorani ◽

Michael Amaturo ◽

...

Keyword(s):

Quality Improvement ◽

Vascular Surgery ◽

Surgical Site Infection ◽

Infection Rate ◽

Surgical Site Infections ◽

Quality Improvement Initiative ◽

Site Infection ◽

Surgical Site Infection Rate ◽

Patient Demographics ◽

Revascularization Procedures

Objective A quality improvement initiative was employed to decrease single institution surgical site infection rate in open lower extremity revascularization procedures. Summary background data: In an attempt to lower patient morbidity, we developed and implemented the Preventative Surgical Site Infection Protocol in Vascular Surgery. Surgical site infections lead to prolonged hospital stays, adjunctive procedure, and additive costs. We employed targeted interventions to address the common risk factors that predispose patients to post-operative complications. Methods Retrospective review was performed between 2012 and 2016 for all surgical site infections after revascularization procedures of the lower extremity. A quality improvement protocol was initiated in January 2015. Primary outcome was the assessment of surgical site infection rate reduction in the pre-protocol vs. post-protocol era. Secondary outcomes evaluated patient demographics, closure method, perioperative antibiotic coverage, and management outcomes. Results Implementation of the protocol decreased the surgical site infection rate from 6.4% to 1.6% p = 0.0137). Patient demographics and comorbidities were assessed and failed to demonstrate a statistically significant difference among the infection and no-infection groups. Wound closure with monocryl suture vs. staple proved to be associated with decreased surgical site infection rate ( p < 0.005). Conclusions Preventative measures, in the form of a standardized protocol, to decrease surgical site infections in the vascular surgery population are effective and necessary. Our data suggest that there may be benefit in the incorporation of MRSA and Gram-negative coverage as part of the Surgical Care Improvement Project perioperative guidelines.

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Value-based purchasing may unfairly penalize specialty centers performing combined liver–colon multivisceral resections

Journal of Patient Safety and Risk Management ◽

10.1177/2516043518790654 ◽

2018 ◽

Vol 23 (4) ◽

pp. 143-148

Author(s):

Ira L Leeds ◽

Peter J Pronovost ◽

J Matthew Austin ◽

Elliott R Haut

Keyword(s):

Linear Regression ◽

Surgical Site Infection ◽

Infection Rate ◽

Risk Adjustment ◽

Surgical Site Infections ◽

Multivisceral Resection ◽

Colon Surgery ◽

Site Infection ◽

Surgical Site Infection Rate ◽

Value Based Purchasing

Background Some of the measures in value-based purchasing programs may be flawed due to inadequate risk adjustment. The purpose of this study was to examine the effect of the surgical casemix on surgical site infection rates using combined colectomy–hepatectomy resections as a test case. Methods We identified all adult patients undergoing elective colon surgery (2007–2013) in the National Inpatient Sample. We defined patients with a concurrent liver resection as “multivisceral resections.” Cases from each hospital were pooled by hospital identifier. The association between surgical site infection rate and the proportion of multivisceral resections performed was compared statistically. Findings were further tested for independence against hospital-level characteristics similar to risk-adjusted surgical site infection rate reporting. Results We identified 1014 hospitals performing 127,646 colon surgeries including 1168 (0.9%) multivisceral resections. The overall surgical site infection rate for multivisceral resection was 11.3% versus 1.6% for colectomy-only resections (p < 0.001). Simple linear regression demonstrated a 2.3% increase in a hospital’s surgical site infection rate for each 1% increase in the proportion of multivisceral resections performed. Multivariable linear regression demonstrated a preserved association. Conclusion A hospital’s rate of surgical site infections is positively associated with the proportion of multivisceral resections performed. Value-based purchasing programs should assess readily available data for further risk-adjustment inclusion.

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Magnitude of Surgical Site Infection and Its Associated Factors Among Patients Who Underwent a Surgical Procedure at Debre Tabor General Hospital, Northwest Ethiopia

10.21203/rs.3.rs-123625/v1 ◽

2020 ◽

Author(s):

Mequanint Bezie Walelign ◽

Tadesse Wuletaw Demissie ◽

Abaynew Honelign Desalegn

Keyword(s):

Surgical Site Infection ◽

General Hospital ◽

Surgical Procedure ◽

Surgical Site Infections ◽

Northwest Ethiopia ◽

P Value ◽

Age Group ◽

Site Infection ◽

Co Morbidity ◽

Debre Tabor

Abstract Background: Surgical site infections are the commonest nosocomial infections and responsible for considerable morbidity and mortality as well as increased hospitalizations and treatment cost related to surgical operations. The aim of this study was to determine the magnitude and factors associated with surgical site infections at the surgical ward of Debre Tabor General Hospital, Northwest Ethiopia.Method: Institution based cross-sectional study was conducted on patients who underwent a surgical procedure at Debre Tabor General Hospital in 2020. The sample size was determined using the single population proportion formula. Data were entered and analyzed using SPSS version 21 software. Bivariate and multivariate logistic regressions analysis were employed. The odds ratio and its 95% confidence interval were taken to test the association between the dependent and independent variables. A P-value of less than 0.05 will be considered statistically significant.Result: In this study, a total of 191 patients have participated in the study yielding a response rate of 100%. The mean age of the respondents was 2.5 (SD ±0.68) years. The most age group 115(60.2%) resides at the age group greater than 40 years. More than one half(62.3) of the surgical clients were females. Most of the clients were farmers(32.5%) and unable to read and write(41.9) based on the occupation. The magnitude of surgical site infection in this study was found to be 11.5% (95% CI: 7.8%, 15.9%). The factors existence of comorbidity and antibiotic prophylaxis was given were found to be significantly associated with the magnitude of surgical site infection.Conclusion: The magnitude of surgical site infection in this study was high. Proper management of patients with co-morbidity especially those with diabetes mellitus, proper administration of anesthesia, and delivering intravenous antimicrobial prophylaxis before surgery as ordered would significantly reduce the incidence of surgical site infection.

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A Perioperative Systems Design to Improve Intraoperative Glucose Monitoring Is Associated with a Reduction in Surgical Site Infections in a Diabetic Patient Population

Anesthesiology ◽

10.1097/aln.0000000000001516 ◽

2017 ◽

Vol 126 (3) ◽

pp. 431-440 ◽

Cited By ~ 25

Author(s):

Jesse M. Ehrenfeld ◽

Jonathan P. Wanderer ◽

Maxim Terekhov ◽

Brian S. Rothman ◽

Warren S. Sandberg

Keyword(s):

Surgical Site Infection ◽

Infection Rate ◽

Glucose Monitoring ◽

Surgical Site Infections ◽

Interrupted Time Series ◽

Glucose Measurement ◽

Diabetic Patients ◽

Site Infection ◽

Surgical Site Infection Rate

Abstract Background Diabetic patients receiving insulin should have periodic intraoperative glucose measurement. The authors conducted a care redesign effort to improve intraoperative glucose monitoring. Methods With approval from Vanderbilt University Human Research Protection Program (Nashville, Tennessee), the authors created an automatic system to identify diabetic patients, detect insulin administration, check for recent glucose measurement, and remind clinicians to check intraoperative glucose. Interrupted time series and propensity score matching were used to quantify pre- and postintervention impact on outcomes. Chi-square/likelihood ratio tests were used to compare surgical site infections at patient follow-up. Results The authors analyzed 15,895 cases (3,994 preintervention and 11,901 postintervention; similar patient characteristics between groups). Intraoperative glucose monitoring rose from 61.6 to 87.3% in cases after intervention (P = 0.0001). Recovery room entry hyperglycemia (fraction of initial postoperative glucose readings greater than 250) fell from 11.0 to 7.2% after intervention (P = 0.0019), while hypoglycemia (fraction of initial postoperative glucose readings less than 75) was unchanged (0.6 vs. 0.9%; P = 0.2155). Eighty-seven percent of patients had follow-up care. After intervention the unadjusted surgical site infection rate fell from 1.5 to 1.0% (P = 0.0061), a 55.4% relative risk reduction. Interrupted time series analysis confirmed a statistically significant surgical site infection rate reduction (P = 0.01). Propensity score matching to adjust for confounders generated a cohort of 7,604 well-matched patients and confirmed a statistically significant surgical site infection rate reduction (P = 0.02). Conclusions Anesthesiologists add healthcare value by improving perioperative systems. The authors leveraged the one-time cost of programming to improve reliability of intraoperative glucose management and observed improved glucose monitoring, increased insulin administration, reduced recovery room hyperglycemia, and fewer surgical site infections. Their analysis is limited by its applied quasiexperimental design.

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Magnitude of Surgical Site Infection and its Associated Factors among Patients who Underwent a Surgical Procedure at Debre Tabor General Hospital, Northwest Ethiopia

10.21203/rs.3.rs-136000/v1 ◽

2020 ◽

Author(s):

Mequanint Bezie Walelign ◽

Tadesse Wuletaw Demissie ◽

Abaynew Honelign Dessalegn

Keyword(s):

Surgical Site Infection ◽

General Hospital ◽

Surgical Procedure ◽

Surgical Site Infections ◽

Northwest Ethiopia ◽

P Value ◽

Age Group ◽

Site Infection ◽

Co Morbidity ◽

Debre Tabor

Abstract Background: Surgical site infections are commonest nosocomial infections and responsible for considerable morbidity and mortality as well as increased hospitalizations and treatment cost related to surgical operations.Objective: The aim of this study was to determine the magnitude and factors associated with surgical site infections at surgical ward of Debre Tabor General Hospital, Northwest Ethiopia.Method: Institution based cross sectional study was conducted on patients who underwent a surgical procedure at Debre Tabor General Hospital in 2020. The sample size was determined using single population proportion formula. Data were entered and analyzed using SPSS version 21 software. Bivariate and multivariate logistic regressions analysis were employed. Odds ratio and its 95% confidence interval were taken to test the association between the dependent and independent variables. P-value of less than 0.05 will be considered as statistically significant. Result: In this study, a total of 191 patients have participated in the study yielding a response rate of 100%. The mean age of the respondents was 2.5 (SD ±0.68) years. The most age group 115(60.2%) resides at the age group greater than 40 years. More than one half(62.3) of the surgical clients were females. Most of the clients were farmers(32.5%) and un able to read and write(41.9) based on the occupation. The magnitude of surgical site infection in this study was found to be 11.5% (95% CI: 7.8%, 15.9%).The factors existance of comorbidity and antibiotic prophylaxis given were found to be significantly assoiated with magnitude of surgical site infection.Conclusion: The magnitude of surgical site infection in this study was high. Proper management of patients with co-morbidity especially those with diabetes mellitus, proper administration of anesthesia and delivering intravenous antimicrobial prophylaxis before surgery as ordered would significantly reduce the incidence of surgical site infection.

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Enhancing recovery: Joining the Improving Surgical Care and Recovery programme to decrease colorectal surgical site infections

Journal of Perioperative Practice ◽

10.1177/1750458920962029 ◽

2021 ◽

pp. 175045892096202

Author(s):

Bernadette Boalt-Watson ◽

Cherif Boutros

Keyword(s):

Length Of Stay ◽

Surgical Site Infection ◽

Infection Rate ◽

Mechanical Bowel Preparation ◽

Surgical Care ◽

Surgical Site Infections ◽

The United States ◽

Surgical Patients ◽

Site Infection ◽

Surgical Site Infection Rate

Aim Surgical site infections after colorectal surgery are a clinical and financial challenge in healthcare. The purpose of this project was to decrease the rate of surgical site infections in colorectal surgical patients in a community hospital with an academic cancer centre in the United States of America. Method The Quality Improvement Department obtained data to measure the hospital’s performance with colorectal surgical patients. The data examined the surgical site infection rate and the length of stay. A multidisciplinary team was established to implement protocols to improve compliance. Results More than 200 patients received a colorectal surgical resection at the hospital. The implemented protocols decreased both the surgical site infection rate and the length of stay (9.1–0% and median 6–4 days respectively). Discussion Challenges with implementation of the Improving Surgical Care and Recovery programme, in a community setting, are discussed. The challenges were worked through collaboratively to achieve the best outcomes for the patients. Conclusion The interdisciplinary committee used evidence-based practices to enhance the care of the colorectal patients. Some of the protocols that emerged were: patient education, pain medication, mechanical bowel preparation and antibiotics, as well as early alimentation. The protocols are discussed in Tables 1 to 4.

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Surgical Antibiotic Prophylaxis Use and Surgical Site Infection Pattern in Dessie Referral Hospital, Dessie, Northeast of Ethiopia

BioMed Research International ◽

10.1155/2020/1695683 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Desye Misganaw ◽

Bedilu Linger ◽

Atinkut Abesha

Keyword(s):

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Infection Rate ◽

Surgical Site Infections ◽

Major Surgery ◽

Site Infection ◽

Surgical Site Infection Rate ◽

Surgical Antibiotic Prophylaxis ◽

Wound Class ◽

Dessie Referral Hospital

Background. Surgical site infections are the third (14%-16%) most frequent cause of nosocomial infections among hospitalized patients. They still form a large health problem and result in increased antibiotic usage, increased associated costs, and prolonged hospitalization and contribute to increased patient morbidity and mortality. Therefore, studies on surgical site infections and surgical antibiotic prophylaxis contribute to identifying surgical site infection rate and risk factor associated with it as well as for identifying the gap in surgical antibiotic prophylaxis practice. Objective. To assess surgical antibiotic prophylaxis practice and surgical site infection among surgical patients. Method. A hospital-based prospective observational study was conducted in 68 patients who underwent major surgery in Dessie Referral Hospital adult surgical wards between March 24 and April 25/2017. Descriptive and logistic regression analyses were performed to determine infection rate and risk factors for surgical site infections. Result. Assessment of 68 patients who underwent major surgery revealed an overall surgical site infection rate of 23.4%. Prophylactic antibiotics were administered for 59 operations; of these, 33 (48.6%) had inappropriate timing of administration. A combination of ceftriaxone and metronidazole 28 (47.46%) was frequently used. Factors associated with surgical site infection were wound class, patient comorbid condition, duration of the procedure, the timing of administration, and omitting prophylaxis use. Conclusion. This study indicated a higher rate of surgical site infection and also revealed that wound class, preexisting medical condition, prolonged duration of surgery, omitting of prophylaxis use, and inappropriate timing of administration were highly associated with surgical site infection.

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