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Site Infections (site + infections)
Kinds of Site Infections Selected AbstractsCOMPARISON OF INFECTION RATE USING DIFFERENT METHODS OF ASSESSMENT FOR SURVEILLANCE OF TOTAL HIP REPLACEMENT SURGICAL SITE INFECTIONSANZ JOURNAL OF SURGERY, Issue 7 2007Yoke-Fong Chiew Background: The surveillance of surgical site infections (SSI) has been undertaken in many centres worldwide to ascertain the extent of the problem and where possible, to improve the incidence rates, thereby decreasing the undesirable outcomes. The study investigates the processes and outcomes of total hip replacement SSI surveillance carried out in Dunedin Public Hospital in 2004. Methods: Two hundred and six patients were enlisted in the study and 189 primary replacements and 22 revision replacements were carried out. Four methods of diagnosis of SSI were applied: (i) clinician diagnosis; (ii) ASEPSIS score; (iii) presence of pus cells; and (iv) assessment by a clinical microbiologist. Infection rates were calculated according to the risk indexes. Results: The incidence of infections varies considerably among these four methods. The infection rates for risk index 0 were 4.35% (method 1), 2.61% (method 2), 0.87% (methods 3 and 4); and for risk indexes 1 and 2 were 4.17% (method 1), 2.08% (method 2), 1.04% (methods 3 and 4). Conclusion: There is a need for accurate infection data so that the appropriate follow-up responses, including infection control measures for total hip replacement SSI can be carried out. The preponderance of elderly patients in the study who are frequently on ,polypharmacy' regimens adds pressure to the need to obtain true infection rates. This is because when antimicrobials are prescribed to them, drug interactions, adverse effects of the antimicrobials and the selective pressure of antimicrobials causing resistances may occur. More resources and a multidisciplinary approach are required for future studies of similar nature. [source] Risk Factors for Surgical Site Infections in Older PeopleJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2006Keith S. Kaye MD OBJECTIVES: To identify risk factors for surgical site infection (SSI) in older people and to test a priori hypotheses regarding particular variables and SSI risk. DESIGN: Case-control study. SETTING: Duke University Medical Center and seven community hospitals in North Carolina and Virginia. PARTICIPANTS: Elderly patients (,65) who underwent surgery between 1991 and 2002 at the study hospitals. Cases were elderly patients with SSI; controls were elderly operative patients without SSI. Infection control practitioners prospectively identified patients. MEASUREMENTS: Data were collected retrospectively. Case patients who developed SSI were compared with control patients who did not develop SSI. RESULTS: Five hundred sixty-nine SSI cases were identified, and 589 uninfected controls were selected. In multivariate analysis, independent predictors of SSI included obesity (odds ratio (OR)=1.77, 95% confidence interval (CI)=1.34,2.32), chronic obstructive pulmonary disease (COPD) (OR=1.66, 95% CI=1.17,2.34), and a wound class classified as contaminated or dirty (OR=1.65, 95% CI=1.01,2.72). Having private insurance was associated with lower risk (OR=0.29, 95% CI=0.12,0.68). CONCLUSION: This study identified several independent predictors of SSI in older people, including comorbid conditions (COPD and obesity), perioperative variables (wound class), and socioeconomic factors (private insurance, which was associated with lower risk). The results from this study can be used to design and implement interventions for SSI prevention in high-risk older people. [source] Tame Your Bugs: Strategies to Reduce Surgical Site Infections in the Obstetric PopulationJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 2010Childbearing No abstract is available for this article. [source] Controversies in perioperative management and antimicrobial prophylaxis in urologic surgeryINTERNATIONAL JOURNAL OF UROLOGY, Issue 6 2008Shingo Yamamoto Abstract: The Japanese Urological Association (JUA) recently published guidelines for the prevention of perioperative urologic infections. Although the general remarks in the JUA guidelines are almost similar to those in guidelines previously published by the Centers for Disease Control and Prevention (CDC) and in the European Association of Urology (EAU) guidelines, their differences leave several questions that need to be answered. To clarify agreements and differences in guidelines for perioperative management in urologic interventions for development of more optimal guidelines, reports and reviews previously published were overlooked and discussed. In terms of surgical site infections (SSI) in urologic surgery, consensus for open and endoscopic-instrumental procedures is still somewhat controversial, while a consensus has not yet emerged for its use in laparoscopic procedures. Further research is required to determine what is an optimal prophylactic protocol to effectively prevent both SSI and remote infections (RI). [source] Japanese guidelines for prevention of perioperative infections in urological fieldINTERNATIONAL JOURNAL OF UROLOGY, Issue 10 2007Tetsuro Matsumoto Abstract: For urologists, it is very important to master surgical indications and surgical techniques. On the other hand, the knowledge of the prevention of perioperative infections and the improvement of surgical techniques should always be considered. Although the prevention of perioperative infections in each surgical field is a very important issue, the evidence and the number of guidelines are limited. Among them, the preparation of guidelines has progressed, especially in gastrointestinal surgery. The Center for Disease Control and Prevention (CDC) proposed guidelines for the prevention of surgical site infections, which have been used worldwide. In urology, the original guidelines were different from those of general surgery, due to many endourological procedures and urine exposure in the surgical field. The Japanese Society of UTI Cooperative Study Group has thus framed these guidelines supported by The Japanese Urological Association. The guidelines consist of the following nine techniques: open surgeries, laparoscopic surgeries, transurethral resection of bladder tumor, ureterorenoscope and transurethral lithotripsy, transurethral resection of the prostate, prostate biopsy, cystourethroscope, pediatric surgeries in the urological field, and extracorporeal shock wave lithotripsy and febrile neutropenia. These are the first guidelines for the prevention of perioperative infections in the urological field in Japan. Although most of these guidelines were made using reliable evidence, there are parts without enough evidence. Therefore, if new reliable data is reported, it will be necessary for these guidelines to be revised in the future. [source] Bacteria of preoperative urinary tract infections contaminate the surgical fields and develop surgical site infections in urological operationsINTERNATIONAL JOURNAL OF UROLOGY, Issue 11 2004RYOICHI HAMASUNA Abstract Background: The risk factors for surgical site infection (SSI) following urological operations have not been clearly identified, although the presence of a preoperative urinary tract infection (UTI) is thought to be one risk factor. We studied potential risk factors to clarify when and how bacteria contaminate wounds and SSI develop. Methods: Objects of the present study were patients with SSI after open urological operations that were performed at the Department of Urology, Miyazaki Medical College Hospital, University of Miyazaki, Kiyotake, Miyazaki, Japan, during the period between June 1999 and December 2000. Endourological operations, operations on children and short operations of less than 2 h duration were excluded. Patients were screened for the presence of UTI before the operation and subcutaneous swabs for culture were collected at the end of the operation by brushing with a sterile cotton-swab just before skin closure. Results: Surgical site infections occurred in 20 of 134 patients. Bacteria from the subcutaneous swabs were detected in 15 (75.0%) of the patients with SSI. All patients received antimicrobial prophylaxis (AMP), but bacteria from the subcutaneous swabs of patients with SSI were less susceptible to the agents (20.0%). Preoperative UTI were observed in 11 (55.0%) of the patients with SSI. In these patients, four had the same species of bacteria detected from urine, swab and wound, three had the same species from swab and wound and one had the same species from urine and wound. Conclusions: Preoperative UTI was the most important risk factor for SSI following urological operations. It is most likely that the bacteria in the urine contaminated the surgical fields and the AMP resistant strains produced SSI. [source] Nosocomial infections and antimicrobial resistance in critical care medicineJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 1 2006Jennifer S. Ogeer-Gyles DVM Abstract Objective: To review the human and companion animal veterinary literature on nosocomial infections and antimicrobial drug resistance as they pertain to the critically ill patient. Data sources: Data from human and veterinary sources were reviewed using PubMed and CAB. Human data synthesis: There is a large amount of published data on nosocomially-acquired bloodstream infections, pneumonia, urinary tract infections and surgical site infections, and strategies to minimize the frequency of these infections, in human medicine. Nosocomial infections caused by multi-drug-resistant (MDR) pathogens are a leading cause of increased patient morbidity and mortality, medical treatment costs, and prolonged hospital stay. Epidemiology and risk factor analyses have shown that the major risk factor for the development of antimicrobial resistance in critically ill human patients is heavy antibiotic usage. Veterinary data synthesis: There is a paucity of information on the development of antimicrobial drug resistance and nosocomially-acquired infections in critically ill small animal veterinary patients. Mechanisms of antimicrobial drug resistance are universal, although the selection effects created by antibiotic usage may be less significant in veterinary patients. Future studies on the development of antimicrobial drug resistance in critically ill animals may benefit from research that has been conducted in humans. Conclusions: Antimicrobial use in critically ill patients selects for antimicrobial drug resistance and MDR nosocomial pathogens. The choice of antimicrobials should be prudent and based on regular surveillance studies and accurate microbiological diagnostics. Antimicrobial drug resistance is becoming an increasing problem in veterinary medicine, particularly in the critical care setting, and institution-specific strategies should be developed to prevent the emergence of MDR infections. The collation of data from tertiary-care veterinary hospitals may identify trends in antimicrobial drug resistance patterns in nosocomial pathogens and aid in formulating guidelines for antimicrobial use. [source] Effect of antibiotic prophylaxis on the risk of surgical site infection in orthotopic liver transplant,LIVER TRANSPLANTATION, Issue 6 2008Angel Asensio Surgical site infections are common bacterial infections in orthotopic liver transplantation. The purpose of this study was to determine the incidence, timing, location, and risk factors, specifically antibiotic prophylaxis, for surgical site infections. A prospective study was performed that included a population of 1222 consecutive patients (73.0% males) who underwent liver transplantation in Spanish hospitals belonging to the Red de Estudio de la Infección en el Trasplante research network. One hundred seven patients developed surgical site infections. The predominant infection sites were incisional wound (53 episodes) and peritonitis (40 episodes). The timing of the organ/space surgical site infections was slightly delayed in comparison with incisional surgical site infections. Enterococcus spp., Escherichia coli, Staphylococcus aureus, and Acinetobacter baumannii were the predominant pathogens. Choledochojejunal or hepaticojejunal reconstruction (odds ratio, 4.2; 95% confidence interval, 1.6,10.7), previous liver or kidney transplant (odds ratio, 2.6; 95% confidence interval, 1.1,6.3), and more than 4 red blood cell units transfused (odds ratio, 2.0; 95% confidence interval, 1.1,3.4) were independently associated with the development of surgical site infections. Biliary reconstruction by choledochojejunostomy or hepaticojejunostomy increases the risk of surgical site infections. Liver Transpl 14:799,805, 2008. © 2008 AASLD. [source] Prophylactic effect of clarithromycin in skin flap complications in cochlear implants surgery,THE LARYNGOSCOPE, Issue 10 2009Juan Garcia-Valdecasas MD Abstract Objectives/Hypothesis: To assess the usefulness of postoperative clarithromycin versus classical postoperative prophylaxis with occlusive dressing to prevent cochlear implant skin flap complications. Study Design: Cohort study. Methods: Surgical site infections were compared in four groups: 1) ceramic/classical postoperative cares (21 patients), 2) titanium-silicon/classical postoperative cares (75), 3) ceramic/clarithromycin (24), and 4) titanium-silicon/clarithromycin (76). Preoperative ceftriaxone was systematically used in all patients in all four groups. Patients were followed up for at least 4 months. Attributable risk and number needed to treat were calculated. Results: All infections appeared in titanium-silicon covered implants, and the risk of surgical site infection was 8.1 times higher in patients treated only with ceftriaxone and classical postoperative prophylaxis compared to those also given clarithromycin. Eleven patients needed to receive clarithromycin to avoid surgical infection. Conclusions: Long-term treatment with low-dose clarithromycin may reduce the incidence of surgical site infections. Laryngoscope, 2009 [source] Use of face masks by non-scrubbed operating room staff: a randomized controlled trialANZ JOURNAL OF SURGERY, Issue 3 2010Joan Webster Abstract Background:, Ambiguity remains about the effectiveness of wearing surgical face masks. The purpose of this study was to assess the impact on surgical site infections (SSIs) when non-scrubbed operating room staff did not wear surgical face masks. Methods:, Eight hundred twenty-seven participants undergoing elective or emergency obstetric, gynecological, general, orthopaedic, breast or urological surgery in an Australian tertiary hospital were enrolled. Complete follow-up data were available for 811 patients (98.1%). Operating room lists were randomly allocated to a ,Mask group' (all non-scrubbed staff wore a mask) or ,No Mask group' (none of the non-scrubbed staff wore masks). The primary end point, SSI was identified using in-patient surveillance; post discharge follow-up and chart reviews. The patient was followed for up to six weeks. Results:, Overall, 83 (10.2%) surgical site infections were recorded; 46/401 (11.5%) in the Masked group and 37/410 (9.0%) in the No Mask group; odds ratio (OR) 0.77 (95% confidence interval (CI) 0.49 to 1.21), p = 0.151. Independent risk factors for surgical site infection included: any pre-operative stay (adjusted odds ratio [aOR], 0.43 (95% CI, 0.20; 0.95), high BMI aOR, 0.38 (95% CI, 0.17; 0.87), and any previous surgical site infection aOR, 0.40 (95% CI, 0.17; 0.89). Conclusion:, Surgical site infection rates did not increase when non-scrubbed operating room personnel did not wear a face mask. [source] COMPARISON OF INFECTION RATE USING DIFFERENT METHODS OF ASSESSMENT FOR SURVEILLANCE OF TOTAL HIP REPLACEMENT SURGICAL SITE INFECTIONSANZ JOURNAL OF SURGERY, Issue 7 2007Yoke-Fong Chiew Background: The surveillance of surgical site infections (SSI) has been undertaken in many centres worldwide to ascertain the extent of the problem and where possible, to improve the incidence rates, thereby decreasing the undesirable outcomes. The study investigates the processes and outcomes of total hip replacement SSI surveillance carried out in Dunedin Public Hospital in 2004. Methods: Two hundred and six patients were enlisted in the study and 189 primary replacements and 22 revision replacements were carried out. Four methods of diagnosis of SSI were applied: (i) clinician diagnosis; (ii) ASEPSIS score; (iii) presence of pus cells; and (iv) assessment by a clinical microbiologist. Infection rates were calculated according to the risk indexes. Results: The incidence of infections varies considerably among these four methods. The infection rates for risk index 0 were 4.35% (method 1), 2.61% (method 2), 0.87% (methods 3 and 4); and for risk indexes 1 and 2 were 4.17% (method 1), 2.08% (method 2), 1.04% (methods 3 and 4). Conclusion: There is a need for accurate infection data so that the appropriate follow-up responses, including infection control measures for total hip replacement SSI can be carried out. The preponderance of elderly patients in the study who are frequently on ,polypharmacy' regimens adds pressure to the need to obtain true infection rates. This is because when antimicrobials are prescribed to them, drug interactions, adverse effects of the antimicrobials and the selective pressure of antimicrobials causing resistances may occur. More resources and a multidisciplinary approach are required for future studies of similar nature. [source] Postoperative surgical site infections in cardiac surgery ,an overview of preventive measuresAPMIS, Issue 9 2007BENGT GÅRDLUND Postoperative surgical site infections are a major cause of postoperative morbidity and mortality in cardiac surgery. A surgical site infection occurs when the contaminating pathogens overcome the host defense systems and an infectious process begins. Bacteria may enter the operating site either by direct contamination from the patient's skin or internal organs, through the hands and instruments of the surgical staff or by bacteria-carrying particles that float around in the operating theatre and may land in the wound. The ability to withstand the contaminating bacteria depends on both local and systemic host defense. Successful preventive strategies are multiple and must include: 1) Minimizing the bacterial contamination of the surgical site (skin preparation, operating room ventilation, scrubbing, double gloving, etc.), 2) Minimizing the consequences of virulent contaminating bacteria by antibiotic prophylaxis (adequate dose, sort, timing, duration), 3) Minimizing injury to local host defense (atraumatic surgery, no excessive electrocautery, meticulous hemostasis, etc.), and 4) Optimizing general host defense (nutrition, tobacco smoking, weight loss, etc.). Compliance with these preventive procedures must be enforced through regular reviews of performance. Non-compliance with hygiene routines is often due to ignorance and poor planning. Education of personnel in these issues is a continuous process. [source] Benchmarks and control charts for surgical site infectionsBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 7 2000T. L. Gustafson Background Although benchmarks and control charts are basic quality improvement tools, few surgeons use them to monitor surgical site infection (SSI). Obstacles to widespread acceptance include: (1) small denominators, (2) complexities of adjusting for patient risk and (3) scepticism about their true purpose (cost cutting, surgical privilege determination or improving outcomes). Methods The application of benchmark charts (using US national SSI rates as limits) and control charts (using facility rates as limits) was studied in 51 hospitals submitting data to the AICE National Database Initiative. SSI rates were risk adjusted by calculating a new statistic, the standardized infection ratio (SIR), based on the risk index suggested by the Centers for Disease Control National Nosocomial Infection Surveillance Study. Fourteen different types of control chart were examined and 115 suspiciously high or low monthly rates were flagged. Participating hospital epidemiologists investigated and classified each flag as ,a real problem' (potentially preventable) or ,not a problem' (beyond the control of personnel at this facility). Results None of the standard, widely recommended, control charts studied showed practical value for identifying either preventable rate increases or outbreaks (clusters due to a single organism). On the other hand, several types of risk-adjusted control chart based on the SIR correctly identified most true opportunities for improvement. Sensitivity, specificity and receiver,operator characteristic (ROC) analysis revealed that the XmR chart of monthly SIRs would be useful in hospitals with smaller surgical volumes (ROC area = 0·732, P = 0·001). For larger hospitals, the most sensitive and robust SIR chart for real-time monitoring of surgical infections was the mXmR chart (ROC area = 0·753, P = 0·0005). © 2000 British Journal of Surgery Society Ltd [source] Performance indicators and the public reporting of healthcare-associated infection ratesCLINICAL MICROBIOLOGY AND INFECTION, Issue 10 2008H. Humphreys Abstract Surveillance of healthcare-associated infections (HCAIs) makes evident the importance of the quality of patient care, and the increasing demand for public reporting of HCAI surveillance data and related quality indicators is thus not surprising. However, there is little evidence that public reporting results in improved patient care. Debate continues about which HCAI-related indicators are the best measures of performance and thus the most appropriate for public reporting. Suitable indicators should allow improvements leading to better patient outcomes, and should be comparable among hospitals and countries. Appropriate examples include central vascular catheter infections, surgical prophylaxis and surgical site infections. [source] Multiple synchronous colonic anastomoses: are they safe?COLORECTAL DISEASE, Issue 2 2010S. D. Holubar Abstract Objective, To evaluate short-term outcomes after construction of synchronous colonic anastomoses without fecal diversion. Method, Using a prospective procedural database, all adult general surgery patients who underwent two synchronous segmental colon resections and anastomoses without ostomy at our institution from 1992,2007 were identified. Demographics, operative techniques, and 30-day outcomes are reported. Results are number (percent) of patients or median (interquartile range). Results, Over 15 years, 69 patients underwent double colonic anastomoses [40 males, age 63 (45,76) years, BMI 25.3 (22.9,28.7) kg/m2]. Multiple colonic anastomoses were performed in one of every 201 colectomies during the study period (0.5%). The operation was an emergency in two (3%) cases; most cases were clean-contaminated 56 (81%). Ten (17%) cases were laparoscopic-assisted with a 44% conversion rate. Length of stay was seven (5,10) days. Overall 30-day morbidity was 36% including nine (13%) surgical site infections, two (2.9%) intra-abdominal abscesses requiring percutaneous drainage, and one (1.4%) wound dehiscence. There were no anastomotic leaks or fistulas, and two patients (2.9%) died within 30 days from pulmonary sepsis and complications from a distal anastomotic hemorrhage, respectively. Conclusions, Synchronous colon anastomoses without fecal diversion do not appear to be associated with an increased risk of complications and can be safely constructed in selected patients. [source] | ||||||||||