scholarly journals Evaluation of Surgical Site Infections and Analysis of Risk Factors

ANKEM Dergisi ◽  
2020 ◽  
Author(s):  
Özgür Dağlı ◽  
Fatma Tosun ◽  
Arife Kılıç

Surgical site infections (SSI) extend the patient’s length of stay, causing unnecessary complications and increase mortality, morbidity and cost. In each hospital, these infections take place in hospital infection surveillance and show changes specific to hospitals. In this study, the files of 402 patients; hospitalized between 2016 and 2018 in the surgical clinics of the Health Sciences University Bursa High Specialization Training and Research Hospital were analyzed retrospectively in terms of SSI, patient profile, length of stay, underlying diseases, risk factors and causative microorganisms. In the study, patients in gynecology and obstetrics, pediatric surgery, cardiovascular surgery, orthopedics, general surgery, urology, and neurosurgery services were included in the surgeries that were followed up on the basis of the procedures in accordance with the decisions of the infection control committee. The most frequently isolated microorganisms in SSI were coagulase negative staphylococci (14.7 %) Escherichia coli (11.7 %), Staphylococcus aureus (6 %) Klebsiella spp. (7 %) and Pseudomonas spp. (3.5 %), while the rate of culture negative SSI cases was determined as (41.5 %). In statistical analysis; presence of a foreign body prosthesis, coronary artery disease, diabetes mellitus, hypertension, hemodialysis, H2 receptor antagonist use, chest tube, peripheral artery catheter, central venous catheter, nasogastric catheter, surgical drain, transfusion, urinary catheter, peripheral venous catheter, mechanical ventilation and endotracheal intubation were statistically significant in the development of SSI. In the analyzes on length of stay, it was found that the length of stay significantly increased as the depth increased in the SSI classification. Identifying risk factors for SSI is critical to reduce the incidence of SSI and identify high-risk patient populations that may require more surveillance for postoperative infection and to develop quality improvement strategies and infection control interventions.

2021 ◽  
pp. 112972982110150
Author(s):  
Ya-mei Chen ◽  
Xiao-wen Fan ◽  
Ming-hong Liu ◽  
Jie Wang ◽  
Yi-qun Yang ◽  
...  

Purpose: The objective of this study was to determine the independent risk factors associated with peripheral venous catheter (PVC) failure and develop a model that can predict PVC failure. Methods: This prospective, multicenter cohort study was carried out in nine tertiary hospitals in Suzhou, China between December 2017 and February 2018. Adult patients undergoing first-time insertion of a PVC were observed from catheter insertion to removal. Logistic regression was used to identify the independent risk factors predicting PVC failure. Results: This study included 5345 patients. The PVC failure rate was 54.05% ( n = 2889/5345), and the most common causes of PVC failure were phlebitis (16.3%) and infiltration/extravasation (13.8%). On multivariate analysis, age (45–59 years: OR, 1.295; 95% CI, 1.074–1.561; 60–74 years: OR, 1.375; 95% CI, 1.143–1.654; ⩾75 years: OR, 1.676; 95% CI, 1.355–2.073); department (surgery OR, 1.229; 95% CI, 1.062–1.423; emergency internal/surgical ward OR, 1.451; 95% CI, 1.082–1.945); history of venous puncture in the last week (OR, 1.298, 95% CI 1.130–1.491); insertion site, number of puncture attempts, irritant fluid infusion, daily infusion time, daily infusion volume, and type of sealing liquid were independent predictors of PVC failure. Receiver operating characteristic curve analysis indicated that a logistic regression model constructed using these variables had moderate accuracy for the prediction of PVC failure (area under the curve, 0.781). The Hosmer-Lemeshow goodness of fit test demonstrated that the model was correctly specified (χ2 = 2.514, p = 0.961). Conclusion: This study should raise awareness among healthcare providers of the risk factors for PVC failure. We recommend that healthcare providers use vascular access device selection tools to select a clinically appropriate device and for the timely detection of complications, and have a list of drugs classified as irritants or vesicants so they can monitor patients receiving fluid infusions containing these drugs more frequently.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
F Gori ◽  
N Vonci ◽  
A Tinturini ◽  
C Basagni ◽  
G Messina ◽  
...  

Abstract Background The extended length of stay (LoS) is one of the main causes of hospital infections (HAI), followed by an increase in antibiotics consumption. The final step is the development of multiresistant microorganisms, with a consequent increase in costs for the national healthcare system. Aim of this study is to evaluate the prevalence of HAI and to analyze ATB consumption in a teaching hospital Methods Between 17-21 June 2019 the infection control team collected the clinical records of 425 patients to perform a point of prevalence analysis (PPA). Eligible patients were hospitalized in surgical and medical wards of the teaching Hospital (615 beds) in Siena, Italy. For each patients according to guidelines of European Centers for Disease Control and Prevention (ECDC 4.2) we searched for evidence of HAI and for all indication of ATB consumption. Data were processed using Stata12 Results Overall 425 patients have been analyzed (48.24% female), mean age was 60.88 (SD 26.11) years, mean LoS 8.37 (min 1 max 86) days. Patients were admitted mostly in General Medicine wards (48.94%); 34% underwent surgery. 63.8% of patients had Peripheral Venous Catheter, 20% Central Venous Catheter and 31.06% Urinary Catheter. Twenty-nine HAI were discovered (PPA 6.82%); the higher prevalence (19.23%) was in Intensive Care Unit. LoS (OR:1.07;IC95%1.04-1.1) and devices (OR:2.17;IC95%1.39-3.37) were the two variables that significantly influenced the infection risk. Forty-six percent of all patients received ATB, the most used were third generation Cephalosporines (26,18%), followed by Penicillines (24,73%). The main use was to treat community infections (62.12%), followed by medical prophylaxis (30.81%) Conclusions PPA of HAI was 6.82%, comparable to 2017 national PPA (6.5%); prolonged LoS is probably the main cause of this result. Our analysis showed that ATB consumption was quite high, in agreement with the Italian prevalence (44.9%), but the percentage of medical prophylaxis was still high. Key messages The way to achieve the health care infection control is still long, the length of the hospitalization could be a field to be improved. High consumption of antibiotics for prophylaxis is still the main point to fight in the battle against the multiresistant microorganisms.


2018 ◽  
Vol 5 (3) ◽  
pp. 668 ◽  
Author(s):  
Satish Kumar Dalai ◽  
Sanghamitra Padhi ◽  
Abhishek Padhi ◽  
Banojini Parida

Background: Peripheral venous catheter related blood stream infections (PVC-BSI) are a common cause of morbidity and mortality in hospitals. Most of the catheter related blood stream infections occurs due to lack of proper aseptic measures. This study points out the risk factors microbial profile and antimicrobial susceptibility of isolates associated with PVC-BSI. The common organisms causing Catheter related BSI are Staphylococcus aureus (41.1%), and Klebsiella species (17.6%) followed by CONS and Enterococcus species. Objective of present study was to isolate and identify the organisms causing PCV-BSI, perform antimicrobial sensitivity testing of isolated organisms and to identify the associated risk factors and preventive measures that should be used.Methods: The study was conducted over a period of one year from August 2015 to July 2016 in the Department of Microbiology. Study group comprised of all the patients with peripheral venous catheterization who developed signs and symptoms of septicemia after 48 hrs of insertion of PVC. These patients were followed up from the time of catheterization till discharge. Peripheral venous catheter tip was collected under aseptic condition along with peripheral blood samples from a site other than the catheterized one. Samples were collected from patients at any point of time who developed signs and symptoms of septicemia after 48 hrs of catheter insertion. The length of time for which the PVC was in place was recorded.Results: In total, 87 cases were included in the study with mean catheter duration of 4.8 days accounting for 418 catheter days. Out of these 87 cases, 17 cases developed PVC-BSI (19.5%) and 34 cases developed colonization (24.1%). Staphylococcus species (41.1%) was the most common isolate.Conclusions: PVC-BSI has a significant role in hospital acquired infections and more studies are needed to establish this.


2010 ◽  
Vol 31 (4) ◽  
pp. 395-401 ◽  
Author(s):  
Christine Geffers ◽  
Anne Gastmeier ◽  
Frank Schwab ◽  
Katrin Groneberg ◽  
Henning Rüden ◽  
...  

Objective.To describe the relationship between the use of central and peripheral venous catheters and the risk of nosocomial, primary, laboratory-confirmed bloodstream infection (BSI) for neonates with a birth weight less than 1,500 g (very-low-birth-weight [VLBW] infants).Methods.Cox proportional hazard regression analysis with time-dependent variable was used to determine the risk factors for the occurrence of BSI in a cohort of VLBW infants. We analyzed previously collected surveillance data from the German national nosocomial surveillance system for VLBW infants. All VLBW infants in 22 participating neonatal departments who had a complete daily record of patient information were included.Results.Of 2,126 VLBW infants, 261 (12.3%) developed a BSI. The incidence density for BSI was 3.3 per 1,000 patient-days. The multivariate analysis identified the following significant independent risk factors for BSI: lower birth weight (hazard ratio [HR], 1.1–2.2), vaginal delivery (HR, 1.5), central venous catheter use (HR, 6.2) or peripheral venous catheter use (HR, 6.0) within 2 days before developing BSI, and the individual departments (HR, 0.0–4.6).Conclusions.After adjusting for other risk factors, use of peripheral venous catheter and use of central venous catheter were significantly related to occurrence of BSI in VLBW infants.


2006 ◽  
Vol 27 (7) ◽  
pp. 709-715 ◽  
Author(s):  
Juan Francisco Casanova ◽  
Rafael Herruzo ◽  
Jesús Díez

Objectives.To assess the appropriateness of using the indices developed by the Study on the Efficacy of Nosocomial Infection Control (SENIC) and the National Nosocomial Infections Surveillance (NNIS) project to determine risk factors for surgical site infection (SSI) in children and, if not appropriate, to explore the factors related to SSI in children so these factors could be used in a risk index for pediatric patients.Design.Cohort study during more than 4 years.Setting.La Paz University Hospital, a national reference center that serves Health Area 5 of Madrid, Spain, which has approximately 500,000 inhabitants.Patients.Convenience sample consisting of the 3,646 children admitted for surgery who had a postsurgical stay of more than 2 days.Results.A model with 8 predictive factors (degree of surgical contamination; duration of surgery; type of surgery; use of a peripheral venous catheter, central venous catheter, or urinary catheter; number of diagnoses; and SSI exposition time) was created. Its relation to the SSI rate was better than that of the SENIC or NNIS indices. Its sensitivity, specificity, and area under the receiver–operating characteristic curve were higher than that of the SENIC index.Conclusions.The model that we created seems to be more adequate for predicting SSI and evaluating pediatric patients' intrinsic risk than the SENIC and NNIS indices.


2020 ◽  
pp. 112972982091725
Author(s):  
Víctor Daniel Rosenthal ◽  
Ider Bat-Erdene ◽  
Debkishore Gupta ◽  
Prasad Rajhans ◽  
Sheila Nainan Myatra ◽  
...  

Background: Short-term peripheral venous catheter–associated bloodstream infection rates have not been systematically studied in Asian countries, and data on peripheral venous catheter–associated bloodstream infections incidence by number of short-term peripheral venous catheter days are not available. Methods: Prospective, surveillance study on peripheral venous catheter–associated bloodstream infections conducted from 1 September 2013 to 31 May 2019 in 262 intensive care units, members of the International Nosocomial Infection Control Consortium, from 78 hospitals in 32 cities of 8 countries in the South-East Asia Region: China, India, Malaysia, Mongolia, Nepal, Philippines, Thailand, and Vietnam. For this research, we applied definition and criteria of the CDC NHSN, methodology of the INICC, and software named INICC Surveillance Online System. Results: We followed 83,295 intensive care unit patients for 369,371 bed-days and 376,492 peripheral venous catheter-days. We identified 999 peripheral venous catheter–associated bloodstream infections, amounting to a rate of 2.65/1000 peripheral venous catheter-days. Mortality in patients with peripheral venous catheter but without peripheral venous catheter–associated bloodstream infections was 4.53% and 12.21% in patients with peripheral venous catheter–associated bloodstream infections. The mean length of stay in patients with peripheral venous catheter but without peripheral venous catheter–associated bloodstream infections was 4.40 days and 7.11 days in patients with peripheral venous catheter and peripheral venous catheter–associated bloodstream infections. The microorganism profile showed 67.1% were Gram-negative bacteria: Escherichia coli (22.9%), Klebsiella spp (10.7%), Pseudomonas aeruginosa (5.3%), Enterobacter spp. (4.5%), and others (23.7%). The predominant Gram-positive bacteria were Staphylococcus aureus (11.4%). Conclusions: Infection prevention programs must be implemented to reduce the incidence of peripheral venous catheter–associated bloodstream infections.


2000 ◽  
Vol 21 (5) ◽  
pp. 311-318 ◽  
Author(s):  
Eveline L.P.E. Geubbels ◽  
A. Joke Mintjes-de Groot ◽  
Jan Maarten J. van den Berg ◽  
Annette S. de Boer

AbstractObjectives:To describe the results of the first year of the Dutch national surveillance of surgical-site infections (SSIs) and risk factors, which aims to implement a standardized surveillance system in a network of Dutch hospitals, to collect comparable data on SSIs to serve as a reference, and to provide a basic infrastructure for further intervention research.Design:Prospective multicenter cohort study.Setting:Acute-care hospitals in The Netherlands from June 1996 to May 1997.Results:38 hospitals participated, with a slight overrepresentation of larger hospitals. Following a total of 18,063 operations, 562 SSIs occurred, of which 198 were deep. Multivariate analysis of pooled procedures shows that age, preoperative length of stay, wound contamination class, anesthesia score, and duration of surgery were independent risk factors for SSI. When analyzed by procedure, the relative importance of these risk factors changed. Bacteriological documentation was available for 56% of the SSIs; 35% of all isolates were Staphylococcus aureus. Multiple regression analysis computed the mean extra postoperative length of stay associated with SSI to be 8.2 days.Conclusion:The first year of national surveillance has shown that it is feasible to collect comparable data on SSI, which are already used for education, policy, and decision making in the network of participating hospitals. This gives room to effectuate the next aim, namely to use the network as an infrastructure for intervention research. Multivariate analysis shows that feedback on a procedure-specific level is important.


2020 ◽  
Vol 41 (5) ◽  
pp. 553-563 ◽  
Author(s):  
Víctor Daniel Rosenthal ◽  
Ider Bat-Erdene ◽  
Debkishore Gupta ◽  
Souad Belkebir ◽  
Prasad Rajhans ◽  
...  

AbstractBackground:Short-term peripheral venous catheter–related bloodstream infection (PVCR-BSI) rates have not been systematically studied in resource-limited countries, and data on their incidence by number of device days are not available.Methods:Prospective, surveillance study on PVCR-BSI conducted from September 1, 2013, to May 31, 2019, in 727 intensive care units (ICUs), by members of the International Nosocomial Infection Control Consortium (INICC), from 268 hospitals in 141 cities of 42 countries of Africa, the Americas, Eastern Mediterranean, Europe, South East Asia, and Western Pacific regions. For this research, we applied definition and criteria of the CDC NHSN, methodology of the INICC, and software named INICC Surveillance Online System.Results:We followed 149,609 ICU patients for 731,135 bed days and 743,508 short-term peripheral venous catheter (PVC) days. We identified 1,789 PVCR-BSIs for an overall rate of 2.41 per 1,000 PVC days. Mortality in patients with PVC but without PVCR-BSI was 6.67%, and mortality was 18% in patients with PVC and PVCR-BSI. The length of stay of patients with PVC but without PVCR-BSI was 4.83 days, and the length of stay was 9.85 days in patients with PVC and PVCR-BSI. Among these infections, the microorganism profile showed 58% gram-negative bacteria: Escherichia coli (16%), Klebsiella spp (11%), Pseudomonas aeruginosa (6%), Enterobacter spp (4%), and others (20%) including Serratia marcescens. Staphylococcus aureus were the predominant gram-positive bacteria (12%).Conclusions:PVCR-BSI rates in INICC ICUs were much higher than rates published from industrialized countries. Infection prevention programs must be implemented to reduce the incidence of PVCR-BSIs in resource-limited countries.


2001 ◽  
Vol 22 (08) ◽  
pp. 485-492 ◽  
Author(s):  
Dao Nguyen ◽  
William Bruce MacLeod ◽  
Dae Cam Phung ◽  
Quyet Thang Cong ◽  
Viet Hung Nguyen ◽  
...  

AbstractObjective:To determine the incidence of, and risk factors for, surgical-site infections (SSIs).Design:Prospective observational study of all patients undergoing surgery during a 3-month period.Setting:Two urban hospitals in Hanoi, Vietnam.Patients:All 697 patients admitted for emergent and elective surgery.Methods:Data were collected on all patients undergoing surgery during a 3-month period at each hospital. We stratified the data by type of surgery, wound class, and Study on the Efficacy of Nosocomial Infection Control (SENIC) risk index. The analysis was done with the data sets from each hospital separately and with the combined data. The risk factors for SSI were identified using a logistic-regression model.Results:During the period of observation, 10.9% of 697 patients had SSI. The SSI rate was 8.3% for clean wounds, 8.6% for clean-contaminated, 12.2% for contaminated, and 43.9% for dirty wounds. The lowest rate of SSI (2.4%) was found in obstetric-gynecologic procedures and the highest rate (33.3%) in cardiothoracic operations. Using the SENIC risk index, the incidence of SSI in low-risk patients was 5.1%; for medium-risk patients, 13.5%, and high-risk patients, 24.2%. In a logistic-regression model, abdominal surgery (odds ratio [OR], 4.46;P<.01) and wound class IV (OR, 5.67;P<.01) were significant predictors of SSI. All patients were treated with prolonged courses of perioperative antibiotics. Overall infection control practices were poor as a result of deficient facilities, limited surgical instruments, and a lack of proper supplies for wound care and personal hygiene.Conclusions:There was a higher incidence of SSI in low-risk patients in Vietnam compared with developed countries. Excessive reliance on antimicrobial therapy as a means to limit SSI places patients at higher risk of adverse effects from treatment and also may contribute to worsening problems with antimicrobial resistance. Establishment of an infection control program with guidelines for antimicrobial use should improve the use of prophylactic antibiotics and attention to proper surgical and wound-care techniques. These interventions also should reduce the incidence of SSI and its associated morbidity and costs.


2021 ◽  
Vol 11 (33) ◽  
pp. 280-290
Author(s):  
Natália Da Conceição Andrade Monteiro ◽  
Eric Rosa Pereira ◽  
Fernanda Dos Anjos de Oliveira ◽  
Cecília Maria Izidoro Pinto ◽  
Graciele Oroski Paes

Revisão integrativa de literatura, objetivo foi verificar evidências científicas na literatura sobre os eventos adversos relacionados à prática de manutenção dos cateteres venosos periféricos. Critérios de inclusão: artigos publicados em português, espanhol ou inglês, nos últimos 7 anos (período de 2013 a 2019), população adulta maior de 18 anos com cateter venoso periférico, no contexto hospitalar. Foram encontrados 382 artigos e 12 atenderam aos critérios. Os EA mais citados foram flebite (92%). Os fatores de risco relacionados com a ocorrência de EA foram o local de inserção do cateter e tempo de permanência. Concluímos que a prática de enfermagem na manutenção dos CVP como sendo importante pilar na mitigação e prevenção desses eventos. Recomendam-se novos estudos de comparação, avaliando tempo de permanência em diferentes regiões anatômicas e presença de eventos adversos.Descritores: Eventos Adversos, Cateterismo Venoso Periférico, Segurança do Paciente, Enfermagem. Adverse events related to the use of peripheral venous catheters: integrative reviewAbstract: Integrative literature review, the objective was to verify scientific evidence in the literature about adverse events related to the practice of maintaining peripheral venous catheters. Inclusion criteria: articles published in Portuguese, Spanish or English, in the last 7 years (period from 2013 to 2019), adult population over 18 years old with peripheral venous catheter, in the hospital context. 382 articles were found and 12 met the criteria. The most cited AEs were phlebitis (92%). The risk factors related to the occurrence of AE were the location of the catheter insertion and the length of stay. We concluded that nursing practice in maintaining CVP as an important pillar in the mitigation and prevention of these events. Further comparison studies are recommended, assessing length of stay in different anatomical regions and the presence of adverse events.Descriptors: Adverse Events, Peripheral Venous Catheterization, Patient Safety, Nursing. Eventos adversos relacionados con el uso de catéteres venosos periféricos: revisión integradoraResumen: Revisión integral de la literatura, el objetivo fue verificar la evidencia científica en la literatura sobre los eventos adversos relacionados con la práctica de mantener catéteres venosos periféricos. Criterios de inclusión: artículos publicados en portugués, español o inglés, en los últimos 7 años (período de 2013 a 2019), población adulta mayor de 18 años con catéter venoso periférico, en el contexto hospitalario. Se encontraron 382 artículos y 12 cumplieron los criterios. Los EA más citados fueron flebitis (92%). Los factores de riesgo relacionados con la aparición de EA fueron la ubicación de la inserción del catéter y la duración de la estadía. Concluimos que la práctica de enfermería en el mantenimiento de la CVP como un pilar importante en la mitigación y prevención de estos eventos. Se recomiendan más estudios de comparación, que evalúen la duración de la estadía en diferentes regiones anatómicas y la presencia de eventos adversos.Descriptores: Eventos Adversos, Cateterismo Venoso Periférico, Seguridad del Paciente, Enfermería.


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