Diagnosis and Management of Surgical Site Infections: Narrative Review

Infection of the wound after surgery is a regular occurrence. Wound infection is a complicated process that involves a molecular interplay between numerous biological processes. Wound infections are associated with a high rate of morbidity and mortality. Surgical site infections are a common surgical complication that affects approximately 3%-6% of all surgical procedures according to different studies. Surgical site infections (SSIs) cause negative consequences in patients, such as prolonged hospitalization and mortality. Each incision causes wound contamination, however there are established techniques to reduce the incidence of SSI. Improved adherence to evidence-based preventative strategies such as adequate antibiotic prophylaxis, in particular, can help to reduce the rate of SSI. The sort of procedure used determines the correct diagnosis of SSI. Early detection, on the other hand, is critical for good management of all surgical operations. Consistent antibiotic therapy, wound drainage, and, if necessary, vigorous wound debridement are all part of the treatment for SSI. Following that, wound management is determined by the location and nature of the infection. This study aims to: Diagnosis and Management of Surgical Site Infections. In this review we will be looking at surgical site infections epidemiology, etiology, diagnosis and management.

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Surgical Strategies to Promote Cutaneous Healing

Medical Sciences ◽

10.3390/medsci9020045 ◽

2021 ◽

Vol 9 (2) ◽

pp. 45

Author(s):

Ines Maria Niederstätter ◽

Jennifer Lynn Schiefer ◽

Paul Christian Fuchs

Keyword(s):

Wound Healing ◽

Wound Closure ◽

Chronic Wounds ◽

Treatment Algorithm ◽

Surgical Site Infections ◽

Repair Process ◽

Suture Technique ◽

The Body ◽

Wound Debridement ◽

Reconstructive Ladder

Usually, cutaneous wound healing does not get impeded and processes uneventfully, reaching wound closure easily. The goal of this repair process is to restore the integrity of the body surface by creating a resilient and stable scar. Surgical practice and strategies have an impact on the course of wound healing and the later appearance of the scar. By considering elementary surgical principles, such as the appropriate suture material, suture technique, and timing, optimal conditions for wound healing can be created. Wounds can be differentiated into clean wounds, clean–contaminated wounds, contaminated, and infected/dirty wounds, based on the degree of colonization or infection. Furthermore, a distinction is made between acute and chronic wounds. The latter are wounds that persist for longer than 4–6 weeks. Care should be taken to avoid surgical site infections in the management of wounds by maintaining sterile working conditions, using antimicrobial working techniques, and implementing the principles of preoperative antibiotics. Successful wound closure is influenced by wound debridement. Wound debridement removes necrotic tissue, senescent and non-migratory cells, bacteria, and foreign bodies that impede wound healing. Additionally, the reconstructive ladder is a viable and partially overlapping treatment algorithm in plastic surgery to achieve successful wound closure.

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Preparedness of pre-intern medical graduates of three universities in Sri Lanka to diagnose and manage anaphylaxis

BMC Medical Education ◽

10.1186/s12909-021-02588-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chandrani Nirmala Wijekoon ◽

Indika Wettasinghe ◽

Dinithi Fernando ◽

Arosha Sampath Dissanayake ◽

Malinda Gunawardana ◽

...

Keyword(s):

Sri Lanka ◽

Early Recognition ◽

Correct Diagnosis ◽

Cross Sectional Study ◽

Intravenous Route ◽

Cross Sectional ◽

Diagnosis And Management ◽

Medical Graduates ◽

Self Confidence ◽

Case Diagnosis

Abstract Background Early recognition and the optimal management of anaphylaxis saves lives but studies from different countries have demonstrated gaps in knowledge and practices between healthcare workers. There is a paucity of such data from Sri Lanka. We assessed knowledge, perception and self-confidence in the diagnosis and management of anaphylaxis amongst pre-intern medical graduates who would soon become first-contact doctors attending emergencies. Methods This cross-sectional study included pre-interns who graduated with Bachelor of Medicine, Bachelor of Surgery (MBBS) degrees in 2019 from three Sri Lankan universities with differing undergraduate curricula. Using consecutive sampling data were collected within four months of the final-MBBS examinations with a self-administered questionnaire and the answers on case diagnosis and management were used as the basis of outcome scores. Results 385 participants responded (response rate: 91.5%). 16.4% correctly identified all anaphylaxis triggers. Only 7.3% correctly diagnosed all ten case scenarios and 34.5% all seven cases of anaphylaxis. 98.2 and 97.9% correctly identified 1:1000 adrenaline as the first-line treatment and the intramuscular route. 9.9% would preferentially but incorrectly use the intravenous route if access was available. Only 79.2 and 55.6% knew the correct adult and paediatric doses of adrenaline and 50% agreed that follow-up care was needed. The mean scores for case diagnosis and management of anaphylaxis were 7.7/10 ± 1.4 and 16.9/20 ± 1.9, respectively. Multiple linear regression indicated that the final MBBS results classification (class of degree or no class indicated) was a positive predictor of case diagnosis score [class vs no class: B = 0.662 (95% CI 0.347–0.978), p < 0.001] and being a graduate of University 2 [B = 1.568 (95% CI 1.182–1.953), p < 0.001] and passing with a class at final MBBS [B = 0.716 (95% CI 0.319–1.113), p < 0.001] were positive predictors of management score. Self confidence in diagnosing and managing anaphylaxis were rated as 79.7 and 62.1% and there was a positive correlation between knowledge and perception scores and self-confidence (case-diagnosis: rpb = 0.111, p = 0.03; management: rpb = 0.164, p = 0.001). Conclusions Knowledge, perception and self confidence in the diagnosis and management of anaphylaxis was sub optimal amongst pre-interns and we identified areas that need improvement. A higher MBBS qualification classification was a predictor for correct diagnosis and management and confidence in diagnosis and management positively correlated with knowledge and perception scores. Further and enhanced educational and training strategies are needed for this life threatening emergency condition.

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EN BLOC RESECTION OF BLADDER TUMOR(EBRT) USING MONOPOLAR CAUTERY; A TERTIARY HOSPITAL EXPERIENCE.

10.36106/ijar/8300518 ◽

2021 ◽

pp. 15-16

Author(s):

Neeraj Agarwal ◽

Bhuwan kumar ◽

Prashant Gupta ◽

Govind Sharma ◽

Shivam Priyadarshi

Keyword(s):

Bladder Cancer ◽

Correct Diagnosis ◽

En Bloc Resection ◽

Tertiary Hospital ◽

Complete Resection ◽

High Rate ◽

Severe Bleeding ◽

Detrusor Muscle ◽

Bladder Tumors ◽

En Bloc

Bladder cancer is a growing health problem with the second most common urological malignancy. It accounts for around 7% of a new cancer diagnosis. Tobacco smoking is the most important risk factor accounting for around 50% of cases. Tobacco smokes contain aromatic amines and polycyclic hydrocarbons which are excreted through kidneys. The goal of transurethral biopsy in NMIBC(non-muscle invasive bladder cancer) is to make the correct diagnosis and completely remove all visible lesions which can be either resected piecemeal or en bloc. The presence of detrusor muscle in the specimen is an important factor for planning treatment and prognosis. Here we share our experience of EBRT using monopolar cautery describing the feasibility, safety, and adequacy of the procedure in the management of small urinary bladder tumors. The study was conducted in the Department of Urology, SMS Medical College, and attached hospitals. All the patients with clinical NMIBC during study duration were admitted and a total of 25 patients above the age of 18yrs, having papillary bladder tumors less than 3 cm were included in the study. Complete resection by the en bloc technique was achieved in all 25 cases with no requirement of conversion to conventional TURBT. Our study also shows the presence of detrusor muscle in 22 specimens out of 25. And only two patients developed severe bleeding which needed a blood transfusion. Thus, ERBT using monopolar cautery is safe and feasible for the complete resection of NMIBCs with a high rate of detrusor-positive specimens in the selected patient population.

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Minimization of Negative Impact of Well Cementing on Productive Horizons by Utilization of Swellable Packers

10.2118/208510-ms ◽

2021 ◽

Author(s):

Mykhaylo Paduchak ◽

Viktor Dudzych ◽

Anatolii Boiko

Keyword(s):

Negative Impact ◽

Differential Pressure ◽

High Rate ◽

Donets Basin ◽

Technical Solution ◽

Negative Consequences ◽

Well Completion ◽

Stable Production ◽

Geological Conditions ◽

Gas Tight

Abstract Avoiding of negative impact of slurry contact with productive sections by utilization of swellable pakers well completion systems as a key solution for depleted reservoirs. Results are compared to previously used classic well completion method with production casing cementing The new method of the well completion is based on a long period and many wells operations within Svyrydivske field in Dnipro-Donets Basin (here and after DDB). Precise selection of hybrid, oil and water based elastomers and correct placement in the appropriate hole zones for water and sectional isolation together with oil based mud utilization during drilling have provided stable production in depleted reservoirs and have minimized negative consequences from water filtration. The results achieved and the well completion method are described in detail to allow readers to replicate all results in a comparable geological conditions in DDB. Current well completion method has a couple of outstanding results achieved: –well integrity barrier is based on sufficient differential pressure provided by swellable packers;–reliable long term water isolation of all detected water contained intervals;–the production sections are not polluted by slurry filtrated water;–increased production rate comparing to cemented wells;–no risks of slurry loss during well cementing. This technology has been successfully implemented in both vertical and deviated wells on 4.5″ (114.3 mm) casing OD, in the interval 5100-5450 meters, bottom hole temperature 120-135°C. The differential pressure provided by swellable packer is up to 10,000 PSI (68.9 MPa). Fluid reactive packers are ready to expand and isolate highly cavernous hole sections and keep differential pressure sustainably. To achieve the best results with this well completion method, it is also important to use reliable gas tight casing connections and know precise reservoir characteristics. That is why the technology is recommended to be customized for well known brownfield reservoirs with high rate of depletion. The main benefit of the well completion method is a proved and safe technical solution for mainly depleted deep gas and condensate deposits in DDB (Ukraine) with sensitive economics

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Scoping study into wound management nurse practitioner models of practice

Australian Health Review ◽

10.1071/ah14040 ◽

2015 ◽

Vol 39 (2) ◽

pp. 220 ◽

Cited By ~ 3

Author(s):

Michelle A. Gibb ◽

Helen E. Edwards ◽

Glenn E. Gardner

Keyword(s):

Patient Outcomes ◽

Nurse Practitioner ◽

Survey Methodology ◽

Response Rate ◽

Wound Management ◽

Scoping Study ◽

Wound Debridement ◽

Australian Context ◽

Practice Parameters ◽

Baseline Information

Objectives The primary objective of this research was to investigate wound management nurse practitioner (WMNP) models of service for the purposes of identifying parameters of practice and how patient outcomes are measured. Methods A scoping study was conducted with all authorised WMNPs in Australia from October to December 2012 using survey methodology. A questionnaire was developed to obtain data on the role and practice parameters of authorised WMNPs in Australia. The tool comprised seven sections and included a total of 59 questions. The questionnaire was distributed to all members of the WMNP Online Peer Review Group, to which it was anticipated the majority of WMNPs belonged. Results Twenty-one WMNPs responded (response rate 87%), with the results based on a subset of respondents who stated that, at the time of the questionnaire, they were employed as a WMNP, therefore yielding a response rate of 71% (n = 15). Most respondents (93%; n = 14) were employed in the public sector, with an average of 64 occasions of service per month. The typical length of a new case consultation was 60 min, with 32 min for follow ups. The most frequently performed activity was wound photography (83%; n = 12), patient, family or carer education (75%; n = 12), Doppler ankle–brachial pressure index assessment (58%; n = 12), conservative sharp wound debridement (58%; n = 12) and counselling (50%; n = 12). The most routinely prescribed medications were local anaesthetics (25%; n = 12) and oral antibiotics (25%; n = 12). Data were routinely collected by 91% of respondents on service-related and wound-related parameters to monitor patient outcomes, to justify and improve health services provided. Conclusion This study yielded important baseline information on this professional group, including data on patient problems managed, the types of interventions implemented, the resources used to accomplish outcomes and how outcomes are measured. What is known about the topic? The nurse practitioner (NP) is an established and legitimised entity of health service in Australia, with NPs in a range of specialities. To date, there is a paucity of research on the role and practice parameters of WMNP in the Australian context. What does this paper add? This paper provides important baseline information on WMNP models of practice in the Australian context, including data on patient problems managed, the types of interventions implemented, the resources used to accomplish outcomes and how outcomes are currently measured. This information will help inform the development of WMNP roles and highlights potential areas of evaluation for WMNP models of care. What are the implications for practitioners? Measurement of outcomes is essential to demonstrate efficacy of NP service. Yet, there is no way currently to measure these outcomes for WMNP service. Nationally consistent data collection on processes of care and patient outcomes supports ongoing development of the WMNP role.

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Risk factors for incisional surgical site infections in elective surgery for colorectal cancer: focus on intraoperative meticulous wound management

Surgery Today ◽

10.1007/s00595-013-0677-3 ◽

2013 ◽

Vol 44 (7) ◽

pp. 1242-1252 ◽

Cited By ~ 17

Author(s):

Keita Itatsu ◽

Gen Sugawara ◽

Yuji Kaneoka ◽

Takehito Kato ◽

Eiji Takeuchi ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Elective Surgery ◽

Surgical Site Infections ◽

Wound Management

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Diagnostic statements: a linguistic analysis of how clinicians communicate diagnosis

Diagnosis ◽

10.1515/dx-2021-0086 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Maria R. Dahm ◽

Carmel Crock

Keyword(s):

Diagnostic Accuracy ◽

Correct Diagnosis ◽

Linguistic Analysis ◽

Diagnostic Error ◽

The Other ◽

Personal Knowledge ◽

History Taking ◽

High Stakes ◽

Diagnosis And Management

Abstract Objectives To investigate from a linguistic perspective how clinicians deliver diagnosis to patients, and how these statements relate to diagnostic accuracy. Methods To identify temporal and discursive features in diagnostic statements, we analysed 16 video-recorded interactions collected during a practice high-stakes exam for internationally trained clinicians (25% female, n=4) to gain accreditation to practice in Australia. We recorded time spent on history-taking, examination, diagnosis and management. We extracted and deductively analysed types of diagnostic statements informed by literature. Results Half of the participants arrived at the correct diagnosis, while the other half misdiagnosed the patient. On average, clinicians who made a diagnostic error took 30 s less in history-taking and 30 s more in providing diagnosis than clinicians with correct diagnosis. The majority of diagnostic statements were evidentialised (describing specific observations (n=24) or alluding to diagnostic processes (n=7)), personal knowledge or judgement (n=8), generalisations (n=6) and assertions (n=4). Clinicians who misdiagnosed provided more specific observations (n=14) than those who diagnosed correctly (n=9). Conclusions Interactions where there is a diagnostic error, had shorter history-taking periods, longer diagnostic statements and featured more evidence. Time spent on history-taking and diagnosis, and use of evidentialised diagnostic statements may be indicators for diagnostic accuracy.

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Timing of Wound Excision

Standards for the Management of Open Fractures ◽

10.1093/med/9780198849360.003.0002 ◽

2020 ◽

pp. 11-14

Keyword(s):

Surgical Site Infections ◽

Current Data ◽

Human Studies ◽

Bacterial Burden ◽

Wound Debridement ◽

The Past ◽

Severity Of Injury ◽

Wound Excision ◽

The Subject ◽

Intense Debate

The aim of wound excision is to remove contaminating debris and all devitalised tissue. This should reduce both the bacterial burden and available substrate for microbial colonisation, resulting in fewer deep surgical site infections. In turn, this will lead to improved patient outcomes. The timing of wound excision has been the subject of intense debate. In the past, guidelines have favoured wound excision within 6 hours based on historical animal and human studies. Current data suggest that timing of wound debridement should be determined by the degree of contamination and severity of injury.

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Oxygen-ozone therapy in arthroplasty infections

Ozone Therapy ◽

10.4081/ozone.2019.8187 ◽

2019 ◽

Vol 4 (1) ◽

Author(s):

Alessandra Vittoria De Lisi ◽

Marianno Franzini ◽

Giovanni Ricevuti

Keyword(s):

Antibiotic Resistance ◽

Health System ◽

National Health ◽

National Health System ◽

Surgical Site Infections ◽

Negative Consequences ◽

Ozone Therapy ◽

National Guidelines ◽

Duration Of Hospitalization ◽

The Individual

The prevention of surgical site infections is a priority within the objectives of the National Health System. The negative consequences of postoperative infections (morbidity, duration of hospitalization, mortality) are particularly serious events for the individual patient and for the community, given both the welfare resources needed to treat them, and the continued growth of the phenomenon of antibiotic resistance. In a global health context in which evidence-based medicine has established itself, all medical interventions must be reconsidered in the light of what can be inferred from the literature evaluated according to strict methodological criteria, all the more so when the evidence is available and unanimously shared. The future objective will be to introduce in the national guidelines a protocol involving the use of ozone therapy alongside antibiotic therapy, both in the prevention and treatment of infections, to avoid the emergence of antibiotic resistance and thus reduce the expenditure of the national health system.

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The Effectiveness of Sterile Wound Drapes in the Prevention of Surgical Site Infection in Thoracic Surgery

BioMed Research International ◽

10.1155/2019/1438793 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Kemal Karapınar ◽

Celalettin İbrahim Kocatürk

Keyword(s):

Thoracic Surgery ◽

Surgical Site Infection ◽

Operation Time ◽

Surgical Site Infections ◽

Control Group ◽

Site Infection ◽

Wound Debridement ◽

Thoracic Surgical Procedures ◽

Hospitalization Costs ◽

The Cost

Background. The rate of surgical site infections (SSIs) has decreased in parallel to advances in sterilization techniques. Such infections increase morbidity and hospitalization costs. The use of iodine-impregnated sterile wound drapes (SWDs) is recommended to prevent or reduce the incidence of these infections. However, there is a paucity of data regarding their use in thoracic surgical procedures. The aim of the present study was to evaluate the effectiveness of sterile wound drapes in the prevention of these infections and the effects on hospitalization costs. Methods. Perioperative iodine-impregnated SWDs have been used since January 2015 in the Thoracic Surgery Clinic of our hospital. A retrospective evaluation was made of patients who underwent anatomic pulmonary resection via thoracotomy with SWD in the period January 2015–2017, compared with a control group who underwent the same surgery without SWD in the 2-year period before January 2015. Factors that may have increased the risk of surgical site infection were documented and the occurrence of SSI was recorded from postoperative follow-up data. The cost analysis was performed as an important criterion to investigate the benefits of SWD. Results. Evaluation was made of 654 patients in the study group (n:380) using SWD, the operation time was significantly longer, and perioperative blood transfusion was significantly higher, whereas treatment costs (p=0.0001) and wound culture positivity (p=0.004) were significantly lower and less surgical wound debridement was performed (p=0.002). Conclusion. The findings suggest that the use of sterile wound draping in thoracic surgery procedures reduces surgical site infections and hospitalization costs.

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