scholarly journals Prophylaxis of Surgical Site Infection in Cranial Surgery with Vancomycin Powder Application into Wound

2019 ◽  
Vol 23 (3) ◽  
pp. 205-210
Author(s):  
SAMI UR REHMAN ◽  
RIFFAT ULLAH KHAN ◽  
GHAYUR ABBAS ◽  
USAMA BIN ZUBAIR ◽  
KAMRAN KHAN ◽  
...  
Keyword(s):  
Treatment Group ◽  
Surgical Site Infection ◽  
Control Group ◽  
P Value ◽  
Site Infection ◽  
Significant Difference ◽  
Routine Prophylaxis ◽  
Vancomycin Powder ◽  
Vancomycin Group ◽  
Lost To Follow Up

Objective: To see the effect of application of Vancomycin powder directly into the subgaleal space in reducing the postoperative surgical site infections.Materials and Methods: All the patients who underwent consecutive elective craniotomies from April 2017 to May 2018 Dept of Neurosurgery, szabmu, PIMS, Islamabad. The control group received the standard routine prophylaxis according to the hospital protocols, whereas the treatment group, in addition to the standard prophylaxis, received Vancomycin powder in the surgical wound in addition to the standard routine prophylaxis. Results: 182 patients were enrolled in the study, 91 allocated to each the control and treatment group (Vancomycin). Six patients were lost to follow up. There were 90 patients in the control group and 86 patients in the treatment (Vancomycin) group. Both the groups were almost statistically similar. In the control group, 34.09% (n = 60) were male and 17.04% (n = 30) were female. In the treatment group, 29.54% (n = 52) were male and 19.31% (n = 34) were female. The overall rate of surgical site infection (SSI) was 3.97% (7 out of 176 cases). A statistically significant difference found in infection rate between the treatment group, 0% (0 out of 86 cases) and the control group, 7.77% (7 out of 90 cases) with the p value of 0.002. Conclusions: The use of topical Vancomycin powder in surgical wounds may significantly reduce the incidence of infection in patients undergoing elective craniotomies. It is a promising means of preventing devastating and harmful postoperative wound infections.

Intrawound Low-dose Vancomycin (250 mg) Powder has Lower Risk of Wound Dehiscence than Higher Doses in Spine Surgeries

2021 ◽  
pp. 46
Author(s):  
Ahmed Sonbol
Keyword(s):  
Surgical Site Infection ◽  
Low Dose ◽  
Wound Dehiscence ◽  
High Dose ◽  
Site Infection ◽  
Systemic Complications ◽  
Significant Difference ◽  
Vancomycin Powder ◽  
Vancomycin Group ◽  
Higher Doses

Introduction: Surgical site infection post spinal surgery is a known complication which can be serious and may require aggressive intervention. Intrawound vancomycin powder application is an evolving method to prevent such complication. Although it has very low systemic complications, wound dehiscence with negative culture is reported in the literature. The aim of this study was to find the risk of wound dehiscence with low-dose intrawound vancomycin in comparison to 1 gr and its effectiveness in prevention of surgical site infection. Methodology: A chart review of all patients who underwent posterior thoracic, lumbar or sacral spine surgeries from December 2009 to September 2016 in a single center was done. Patients were categorized into three groups. First, patients who did not receive any intrawound vancomycin; second, patients who received high-dose vancomycin (1 gr); and third, patients who received low-dose vancomycin (250 mg). Additionally, patients’ demographic information, clinical data, and surgical variables were collected. Primary outcome was the presence of wound dehiscence or surgical site infection. Result: In total, 391 patients were included in this study, of which 56 (14.3%) received high-dose intrawound vancomycin, 126 (32.2%) received low dose, and 209 (53.5%) did not receive any. The overall incidence of wound dehiscence was 6.14% (24 out of 391 patients). Wound dehiscence was statistically and significantly higher (p = 0.039) in the high-dose vancomycin group in comparison to the patients who received low dose. The overall incidence of postoperative infection was 2.05% (eight patients). There was no statistically significant difference between the groups. Conclusion: The use of intrawound low-dose vancomycin (250 mg) has less wound dehiscence in comparison with other higher standard doses. Further trials are needed to evaluate the effectiveness of this dose in preventing postoperative infections.

Impact of intrawound vancomycin powder on prevention of surgical site infection after posterior spinal surgery

2021 ◽  
pp. 1-9
Author(s):  
Hiroki Ushirozako ◽  
Tomohiko Hasegawa ◽  
Yu Yamato ◽  
Go Yoshida ◽  
Tatsuya Yasuda ◽  
...  
Keyword(s):  
Propensity Score ◽  
Spinal Surgery ◽  
Control Group ◽  
Control Groups ◽  
Propensity Score Model ◽  
Significant Difference ◽  
Surgical Data ◽  
Vancomycin Powder ◽  
Vancomycin Group ◽  
And Control

OBJECTIVESurgical site infection (SSI) after posterior spinal surgery is one of the severe complications that may occur despite administration of prophylactic antibiotics and the use of intraoperative aseptic precautions. The use of intrawound vancomycin powder for SSI prevention is still controversial, with a lack of high-quality and large-scale studies. The purpose of this retrospective study using a propensity score–matched analysis was to clarify whether intrawound vancomycin powder prevents SSI occurrence after spinal surgery.METHODSThe authors analyzed 1261 adult patients who underwent posterior spinal surgery between 2010 and 2018 (mean age 62.3 years; 506 men, 755 women; follow-up period at least 1 year). Baseline and surgical data were assessed. After a preliminary analysis, a propensity score model was established with adjustments for age, sex, type of disease, and previously reported risk factors for SSI. The SSI rates were compared between patients with intrawound vancomycin powder treatment (vancomycin group) and those without (control group).RESULTSIn a preliminary analysis of 1261 unmatched patients (623 patients in the vancomycin group and 638 patients in the control group), there were significant differences between the groups in age (p = 0.041), body mass index (p = 0.013), American Society of Anesthesiologists classification (p < 0.001), malnutrition (p = 0.001), revision status (p < 0.001), use of steroids (p = 0.019), use of anticoagulation (p = 0.033), length of surgery (p = 0.003), estimated blood loss (p < 0.001), and use of instrumentation (p < 0.001). There was no significant difference in SSI rates between the vancomycin and control groups (21 SSIs [3.4%] vs 33 SSIs [5.2%]; OR 0.640, 95% CI 0.368–1.111; p = 0.114). Using a one-to-one propensity score–matched analysis, 444 pairs of patients from the vancomycin and control groups were selected. There was no significant difference in the baseline and surgical data, except for height (p = 0.046), between both groups. The C-statistic for the propensity score model was 0.702. In the score-matched analysis, 12 (2.7%) and 24 (5.4%) patients in the vancomycin and control groups, respectively, developed SSIs (OR 0.486, 95% CI 0.243–0.972; p = 0.041). There were no systemic complications related to the use of vancomycin.CONCLUSIONSThe current study showed that intrawound vancomycin powder was useful in reducing the risk of SSI after posterior spinal surgery by half, without adverse events. Intrawound vancomycin powder use is a safe and effective procedure for SSI prevention.

Effectiveness of sustained natural apophyseal glides in females with cervicogenic headache: A randomized controlled trial

2021 ◽  
pp. 1-7
Author(s):  
Muhammad Kashif ◽  
Nosheen Manzoor ◽  
Rimsha Safdar ◽  
Hafsa Khan ◽  
Maryam Farooq ◽  
...  
Keyword(s):  
Treatment Group ◽  
Controlled Trial ◽  
Neck Disability Index ◽  
Placebo Treatment ◽  
Cervicogenic Headache ◽  
Control Group ◽  
P Value ◽  
Head Positioning ◽  
Significant Difference ◽  
Neck Disability

BACKGROUND: Cervicogenic headache (CGH) is a common condition that results in significant disability. To treat this dysfunction, Mulligan described sustained natural apophyseal gliders (SNAGs) as a manual therapy approach. However, only inconclusive short-term evidence exists for treating CGH with SNAGs. OBJECTIVE: The present study aims to investigate the effect of SNAGs in the treatment of CGH. METHODS: Fourty female patients ranging from 20 to 40 years with CGH were randomly assigned to two groups: 20 in a treatment group and 20 in a control group. SNAGs were applied to the treatment group while the control group received placebo treatment. Both groups received their respective treatment for 20 minutes, alternately three times per week, for a total of 12 times in four weeks. The outcome measures were the Neck Disability Index (NDI) and the Visual Analogue Scale (VAS). Participants were assessed at baseline and at the end of each week. The data was analyzed using SPSS version 20. Independent t-testing was used to reveal changes between groups. One-way ANOVA was used to determine changes within groups. The level of significance was P< 0.05. RESULTS: Twenty participants (100%) in the treatment group and 17 (85%) in the control group had a history of headache aggravation with active movements or passive head positioning. There was no significant difference at baseline (p> 0.05), indicating that both groups were homogeneous at the time of recruitment. The p value (p< 0.05) showed a significant difference in pain and level of disability at three and four weeks (p< 0.05) in patients treated with SNAGs. However, the cervical range of motion (ROM) showed a statistically significant improvement in flexion and extension in the treatment group (p< 0.05) while there was no significant improvement in side flexion and rotation ROM in both groups (p> 0.05). CONCLUSION: This study found that SNAGs were effective in reducing pain and neck disability and improved ROM in females with CGH.

scholarly journals Standardising intraoperative irrigation with 0.05% chlorhexidine gluconate in caesarean delivery to reduce surgical site infections: A single institution experience

2019 ◽  
Vol 30 (1-2) ◽  
pp. 24-33
Author(s):  
Theresa Mangold ◽  
Erin Kinzel Hamilton ◽  
Helen Boehm Johnson ◽  
Rene Perez
Keyword(s):  
Treatment Group ◽  
Surgical Site Infection ◽  
Infection Rate ◽  
Caesarean Delivery ◽  
Chlorhexidine Gluconate ◽  
Control Group ◽  
Antibiotic Administration ◽  
Site Infection ◽  
Infection Rates ◽  
The Impact

Background Surgical site infection is a significant cause of morbidity and mortality following caesarean delivery. Objective To determine whether standardising intraoperative irrigation with 0.05% chlorhexidine gluconate during caesarean delivery could decrease infection rates. Methods This was a process improvement project involving 742 women, 343 of whom received low-pressured 0.05% chlorhexidine gluconate irrigation during caesarean delivery over a one-year period. Infection rates were compared with a standard-of-care control group (399 women) undergoing caesarean delivery the preceding year. Results The treatment group infection rate met the study goal by achieving a lower infection rate than the control group, though this was not statistically significant. A significant interaction effect between irrigation with 0.05% chlorhexidine gluconate and antibiotic administration time existed, such that infection occurrence in the treatment group was not dependent on antibiotic timing, as opposed to the control group infection occurrence, which was dependent on antibiotic timing. Conclusion Intraoperative irrigation with 0.05% chlorhexidine gluconate during caesarean delivery did not statistically significantly reduce the rate of infections. It did render the impact of antibiotic administration timing irrelevant in prevention of surgical site infection. This suggests a role for 0.05% chlorhexidine gluconate irrigation in mitigating infection risk whether antibiotic prophylaxis timing is suboptimal or ideal.

scholarly journals A meta-analysis of the local application of vancomycin powder to prevent surgical site infection after spinal surgeries

2020 ◽  
Vol 48 (7) ◽  
pp. 030006052092005
Author(s):  
Shuo Shan ◽  
Laiyong Tu ◽  
Wenfei Gu ◽  
Kahaer Aikenmu ◽  
Jiang Zhao
Keyword(s):  
Surgical Site Infection ◽  
Meta Analysis ◽  
Local Application ◽  
Site Infection ◽  
China National Knowledge Infrastructure ◽  
Knowledge Infrastructure ◽  
Mesh Terms ◽  
Vancomycin Powder ◽  
Vancomycin Group ◽  
And Control

Objective This study aimed to systematically analyze the effectiveness and safety of the local application of vancomycin powder to prevent surgical site infection (SSI) after spinal surgeries and provide guidance for clinical practice. Methods Two researchers independently searched PubMed, Web of Science, Elsevier, and China National Knowledge Infrastructure using the MeSH terms “spinal surgery,” “vancomycin,” “local,” “topical,” “prophylactic,” “surgical site infection,” and “SSI” to identify studies published between January 2010 and January 2020 on the local application of vancomycin powder for preventing SSI after spinal surgeries. The outcome assessment indicators were analyzed using RevMan 5.3 software. Results Three randomized controlled trials, two prospective studies, and 26 retrospective studies were included in the current research. The results of the meta-analysis revealed significant differences between the vancomycin and control groups (non-vancomycin group) concerning the incidence of SSI (risk ratio = 0.39, 95% confidence interval = 0.28–0.55, Z = 5.46), indicating that local application of vancomycin powder can significantly reduce the incidence of SSI. Conclusion Local application of vancomycin powder is an effective and safe method to prevent SSI after spinal surgeries.

Surgical-site infections in emergency abdominal paediatric surgeries at a tertiary-care hospital in Pakistan

2020 ◽  
pp. 1-9
Author(s):  
Ali Faisal Saleem ◽  
Huma Faiz Halepota ◽  
Hasaan Omar ◽  
Areeba Zain ◽  
Muhammad Arif Mateen Khan
Keyword(s):  
Abdominal Surgery ◽  
Surgical Site Infection ◽  
Tertiary Care ◽  
Stable Condition ◽  
University Hospital ◽  
P Value ◽  
Care Hospital ◽  
Site Infection ◽  
Significant Difference ◽  
Pathogen Occurrence

Abstract A retrospective chart review was carried out in children (neonates to 18 years) who underwent acute surgical abdominal exploration during 2012-2016 at the Aga Khan University Hospital, Karachi, to evaluate the post-operative surgical site infection rates in emergency paediatric abdominal surgery. Incidence of surgical site infection (SSI) was estimated. P-value was calculated, chi-square and non-parametric tests were performed by comparing pre-surgical and post-surgical procedure pathogen occurrence and pre-procedure wound status. Pathogen occurrence related to time-trend of 98 paediatric patients who underwent emergency abdominal surgery was plotted. Of the 94 who were discharged in stable condition, it was found that there was no significant difference between pre- and post-surgical pathogens. Escherichia coli (n=10) was found to be the most common pathogen. Contaminated wounds were associated with higher SSI (p=0.036, OR 1.95 95% CI 0.7-5.4). Continuous...  

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 Effect of Giving Mahkota Dewa Fruits (Phaleria Macrocarpa) Extract to Epithelialization In Incision Wound of White Rats (Rattus Norvegicus)

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Idola Perdana Sulistyoning Suharto
Keyword(s):  
Treatment Group ◽  
Rattus Norvegicus ◽  
Male Rats ◽  
Control Group ◽  
P Value ◽  
Control Group Design ◽  
White Rats ◽  
Significant Difference ◽  
Phaleria Macrocarpa ◽  
Incision Wound

The research purpose was to analysis effect of giving mahkota dewa fruits (Phaleria macrocarpa) extract to epithelialization in incision wound of white rats (Rattus norvegicus). The method was randomized posted-only control group design. There were 30 male rats (Rattus norvegicus) grouped on control and treatment group. Control group divided into three groups (KK1, KK2, KK3) and also treatment group divided into three groups (KP1, KP2, KP3). Control group just given CMC 1% peroral without mahkota dewa fruits extract, the treatment group given mahkota dewa fruits extract 22.5 mg/kg body weight. The data was analyzed by Kruskall Wallis. Based on Kruskall Wallis test, obtained result that there was a significant difference (p<0.05) epithelialization variable with p value p = 0.000 between control and treatment group. And based on One-way Anova test, obtained result that there was a significant difference (p<0.05) with p value p =0.000 between control and treatment group. The conclusion of this research was giving mahkota dewa fruits (Phaleria macrocarpa) extract can increase epithelialization in incision wound of white rats (Rattus norvegicus). Keywords : Mahkota Dewa Fruits (Phaleria Macrocarpa) Extract, Epithelialization, Incision Wound 

scholarly journals INTERVENSI EMOTIONAL FREEDOM TECHNIQUE (EFT) UNTUK MENGURANGI NYERI POST OPERASI SECTIO CAESARIA (SC)

2018 ◽  
Vol 1 (1) ◽  
pp. 53
Author(s):  
Lutfatul Latifah ◽  
Dian Ramawati
Keyword(s):  
Treatment Group ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Pain Scale ◽  
Control Group ◽  
P Value ◽  
Control Group Design ◽  
Significant Difference ◽  
Before And After ◽  
Mother And Child

Introduction: Every woman who undergo Sectio Caesaria (SC) surgery for delivery their babies often complain about pain after the surgery and it become very distrubing. The effect of the pain cause mobilisation limitation, interrupting bonding attachment between mother and child, and postponning breastfeeding inititation. This study conduct EFT or tapping as the pain management in women post SC surgery.The aim of this study is to identify the effect of EFT or tapping for reducing pain after SC surgery. Methods: Quasy experimental with pre-post non randomized control group design was used in this study. The data been colleted using Numeric Rating Scale (NRS) to measure the pain in participants before and after EFT or tapping treatment. The number of participants was 30 mothers with 15 women in control and treatment group respectively. The t-test was used to analize the effect of the EFT. Results: The mean of pain scale before treatment in control group was 5.20 dan 6.20 for the treatment group. The pain scale after treatment in control group was 5.00 and 4.27 in treatment group. There was a significant difference between the reducing pain scale in treatment group with p value = 0,000 (α = 0.05). Discussion: EFT or tapping can be one of many non farmacologic treatment as complementer therapy to reduce pain after SC surgery. Keywords: post SC pain, EFT, pain scale decline, non farmacologic therapy

scholarly journals Effect of duration of pre-operative admission on surgical site infection in major abdominal surgeries: an observational study

2019 ◽  
Vol 8 (6) ◽  
pp. 2306
Author(s):  
Alka Shantiprakash Gupta ◽  
Arthika Shetty
Keyword(s):  
Surgical Site Infection ◽  
Surgical Site Infections ◽  
Surgical Patient ◽  
P Value ◽  
Site Infection ◽  
Admission Time ◽  
Long Run ◽  
Skin Flora ◽  
Significant Difference ◽  
Prolonged Hospital

Background: Surgical site infection (SSI) are second most common cause of mortality in surgical patient, situation has been further complicated by emergence of drug resistant strains. The importance of preventing surgical site infections is well recognized since they lead to increased morbidity, prolonged hospital stays, need for readmission, high end antibiotic treatment and re-surgery. The study was done to see if   incidence of SSI is decreased with decreased pre-operative admission time. Others factors associated with SSI were analysed including the microbiological spectrum.Methods: The study was an analytical, observational, case control study. Sixty (60) cases each of gynaecology and obstetrical post-operative patients who developed SSI within 30 days were taken as cases and who did not develop SSI were taken as controls and preoperative admission time was analysed in both cases and controls to observe if risk of surgical site infections decreases due to decreased exposure to nosocomial pathogens when the pre-operative admission time was less than 48 hours.Results: Author found that there was statistically significant difference in the time between surgery and admission in the gynaecological surgeries with p value 0.023, as compared to the obstetrics surgeries where there was no statistically significant difference. Common organism isolated was E. coli sensitive to gentamicin.Conclusions: From this study, it seems to be a good policy to evaluate the patient on OPD basis and admit them about 24 to 48 hours prior to the surgery rather them keeping them admitted for prolonged duration in wards for diagnostic evaluation. This prevents nosocomial contamination in the patient’s skin flora thereby preventing SSI. This practice not only conserves the hospital resources but also makes the patient turn over faster. Further this might in the long run reduce the antibiotic resistant hospital flora.

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