Surgical Wound Classification and Surgical Site Infections in the Orthopaedic Patient

Abstrak Penggunaan antibiotik profilaksis bedah yang tidak tepat dapat meningkatkan risiko terjadinya Infeksi Luka Operasi (ILO) dan resistensi obat. Penelitian ini bertujuan untuk menilai ketepatan penggunaan antibiotik profilaksis bedah pada bedah bersih di rumah sakit (RS) di Jakarta. Penelitian ini merupakan studi potong lintang di sebuah RS pemerintah di Jakarta. Data yang diambil berasal dari rekam medis pasien dewasa yang menjalani pembedahan dengan kriteria kelas luka bedah bersih. Data diambil pada periode 1 Januari hingga 31 Desember 2013. Analisis data dilakukan secara deskriptif berdasarkan pedoman penggunaan antibiotik baik nasional maupun internasional. Hasil penelitian menunjukkan 837 pasien menjalani bedah bersih pada periode tersebut. Bedah yang banyak dilakukan adalah bedah abdominal (30%) dan thorak-non kardiak (23,5%) dan lebih dari 96% merupakan bedah elektif. Jenis antibiotik yang paling banyak digunakan adalah siprofloksasin (56,5%). Keseluruhan kesesuaian antibiotik profilaksis adalah 27,7% tepat indikasi prosedur bedah dan hanya 0,5% yang tepat obat. Sebagai kesimpulan, ketepatan penggunaaan antibiotik profilasis di salah satu RS di Jakarta masih rendah. Penggunaan antibiotik yang tepat dapat menurunkan risiko ILO dan mengurangi biaya pengobatan dengan mengurangi peresepan yang tidak perlu dan durasi penggunaan antibiotik. Kata kunci: antibiotik, bedah bersih, ketepatan, profilaksis Abstract Inappropriate use of surgical prophylactic antibiotics can increase the risk of Surgical Site Infections (SSI) and drug resistance. This study aimed to assess the appropriateness use of surgical prophylactic antibiotics in clean surgery wounds in a hospital in Jakarta. This cross-sectional study was conducted at a government hospital in Jakarta. Data were collected from medical records of adult patients undergoing surgery with clean surgical wound criteria from January 1 to December 31, 2013. Data were analyzed descriptively based on guidelines for antibiotics use both nationally and internationally. The result showed 837 patients classified into the clean surgical wound during this period. The most common surgeries were abdominal surgery (39%) and non-cardiac thoracic (23.5%) and more than 96% were elective surgeries. The overall antibiotic prophylactic appropriateness showed 27.7% in surgical procedures and only 0.5% in choice of antibiotics. In conclusion, the appropriateness of surgery antibiotics prophylactic use in one of the hospitals in Jakarta was still low. Appropriate use of antibiotics can reduce the risk of SSI and cost treatment by reducing unnecessary prescribing and duration of antibiotics use. Keywords: antibiotic, appropriate, prophylactic, clean surgery

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CDC Definitions of Nosocomial Surgical Site Infections, 1992: A Modification of CDC Definitions of Surgical Wound Infections

Infection Control and Hospital Epidemiology ◽

10.1086/646436 ◽

1992 ◽

Vol 13 (10) ◽

pp. 606-608 ◽

Cited By ~ 366

Author(s):

Teresa C. Horan ◽

Robert P. Gaynes ◽

William J. Martone ◽

William R. Jarvis ◽

T. Grace Emori

Keyword(s):

Surgical Site Infections ◽

Wound Infections ◽

Surgical Wound

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Validation of Surgical Wound Classification in the Operating Room

Infection Control and Hospital Epidemiology ◽

10.1086/646730 ◽

1993 ◽

Vol 14 (5) ◽

pp. 255-259 ◽

Cited By ~ 3

Author(s):

Denise M. Cardo ◽

Pamela S. Falk ◽

C. Glen Mayhall

Keyword(s):

Operating Room ◽

Surgical Wound ◽

Wound Classification

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Retrospective Study of Infection Rate in Small Animal Surgery – of UBASMV Timișoara (2007-2017)

Bulletin of University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca Veterinary Medicine ◽

10.15835/buasvmcn-vm:2018.0037 ◽

2018 ◽

Vol 75 (2) ◽

pp. 231

Author(s):

Cornel IGNA ◽

Daniel BUMB ◽

Bogdan SICOE ◽

Larisa SCHUSZLER ◽

Cristian ZAHA

Keyword(s):

Antimicrobial Prophylaxis ◽

Companion Animals ◽

Small Animal ◽

Surgical Site Infections ◽

Important Concern ◽

Baseline Information ◽

Wound Classification ◽

Animal Surgery ◽

Clean Contaminated ◽

Surgical Clinic

Surgical site infections (SSIs) remain an important concern in veterinary practice. The purpose of this work was to determine the SSIs rate in the Surgery Clinic of the Faculty of Veterinary Medicine, Timișoara and to correlate SSIs incidence with surgical wound classification by degree of contamination and with the use of antimicrobial prophylaxis and / or applied therapy. Records of all animals operated on between 2007 and 2017 were closely checked for development of postoperative wound infection and were reviewed. The rate of surgical site infection was 0.77%, and by categories was 0.70% in clean surgeries, 0.15% in clean-contaminated surgeries, 1.76% in contaminated surgeries, and 1.08% in infected surgeries. Baseline information for SSIs surveillance in our surgical clinic and for comparison with other studies was defined. SSIs frequency in companion animals in our service is comparable with the frequency observed in another studies.

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Incidence of Surgical Site Infections after Thyroid and Parathyroid Surgery: No Role for Antimicrobial Prophylaxis

The American Surgeon ◽

10.1177/000313481808400638 ◽

2018 ◽

Vol 84 (6) ◽

pp. 897-901 ◽

Cited By ~ 1

Author(s):

Marina Moskalenko ◽

Megumi Asai ◽

Karen Beem ◽

Todd A. Pezzi ◽

Cynthia L. Brophy ◽

...

Keyword(s):

Quality Improvement ◽

Antimicrobial Prophylaxis ◽

Surgical Site Infections ◽

Quality Improvement Program ◽

Parathyroid Surgery ◽

Improvement Program ◽

Skin Preparation ◽

Surgical Quality ◽

Patient Demographics ◽

Wound Classification

To better define the value of antimicrobial prophylaxis (AMP) and antiseptic skin preparation (ASP) in thyroid and parathyroid surgery, we examined the rate of surgical site infections (SSIs) with and without AMP. Retrospective analysis was performed using the National Surgical Quality Improvement Program database at a single institution. Patients undergoing thyroid or parathyroid surgery with data entered into the National Surgical Quality Improvement Program database at our institution between November 2007 and June 2015 were studied, including patient demographics, wound classification, other risk factors for SSI, and wound outcome. Charts were retrospectively reviewed for AMP, ASP, and use of drains. Of the 534 patients who underwent thyroid (n = 358) or parathyroid (n = 176) surgery, 58 (10.9%) were diabetic, 54 (10.1%) used tobacco, and 14 (2.6%) were on steroids. Most wounds were classified as “clean” (99.6%). Betadine was used for ASP in 96 per cent. AMP was given to 141 patients (26%) using cefazolin, vancomycin, or clindamycin. The remaining 393 patients (74%) received no AMP. Zero infections occurred in the group who did not receive AMP. One (0.7%) superficial, nonpurulent SSI occurred in the group that received AMP which was not statistically significantly different (P = 0.319). The rates of SSI after thyroid and parathyroid surgery are extremely low, around two per 1000 cases, and do not decrease with AMP. Therefore, AMP is not necessary in thyroid and parathyroid surgery and should be avoided to reduce costs, adverse reactions, and antibiotic resistance.

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Adaptation of the CDC Surgical Wound Classification System for Orthopaedic Trauma Surgery

Journal of Orthopaedic Trauma ◽

10.1097/bot.0000000000002269 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

John A. Scolaro ◽

Julie Agel ◽

Meir. Marmor ◽

Jarrod Dumpe ◽

Matt Karam ◽

...

Keyword(s):

Classification System ◽

Trauma Surgery ◽

Orthopaedic Trauma ◽

Surgical Wound ◽

Wound Classification

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Effect of surgical wound classification on biologic graft performance in complex hernia repair: An experimental study

Surgery ◽

10.1016/j.surg.2012.08.064 ◽

2013 ◽

Vol 153 (4) ◽

pp. 481-492 ◽

Cited By ~ 24

Author(s):

Karem C. Harth ◽

Jeffrey A. Blatnik ◽

James M. Anderson ◽

Michael R. Jacobs ◽

Farhad Zeinali ◽

...

Keyword(s):

Experimental Study ◽

Hernia Repair ◽

Surgical Wound ◽

Biologic Graft ◽

Wound Classification

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Negative Pressure Incision Management System in the Prevention of Groin Wound Infection in Vascular Surgery Patients

Surgery Research and Practice ◽

10.1155/2015/303560 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 4

Author(s):

Jan H. Koetje ◽

Karsten D. Ottink ◽

Iris Feenstra ◽

Wilbert M. Fritschy

Keyword(s):

Vascular Surgery ◽

Negative Pressure ◽

Surgical Site Infections ◽

Surgical Patients ◽

Management Systems ◽

Wound Infections ◽

Site Infection ◽

Surgical Wound ◽

Postoperative Wound ◽

Emergency Procedures

Objectives. Groin wounds following vascular surgery are highly susceptible to healing disturbances, with reported site infections reaching 30%. Negative pressure incision management systems (NPIMS) are believed to positively influence the prevention of surgical wound-healing disturbances (WHD) and surgical site infections (SSI). NPIMS placed directly after closure of the surgical wound is thought to result in fewer infections; we analysed its effect on postoperative wound infections in patients after vascular surgery via the groin.Methods. From May 2012 to March 2013 we included 90 surgical patients; 40 received a NPIMS. All patients with WHDs were labelled and subanalysed for surgical site infection in case of positive microbiological culture. These infections were graded according to Szilagyi. Number of WHDs and SSIs were compared across cohorts.Results. Patient and perioperative characteristics were equal, except for a significantly higher number of emergency procedures among non-NPIMS patients. We found no significant differences in number of WHDs, SSIs, or Szilagyi grades between the two cohorts.Conclusion. The equal number of SSIs across cohorts showed that NPIMS could not reduce the number of surgical site infections after vascular groin surgery.

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