scholarly journals Investigation of Surgical Site Infection Outbreak Among Neurosurgical Patients

2020 ◽  
Vol 41 (S1) ◽  
pp. s306-s306
Author(s):  
Luísa Ramos ◽  
Jussara Pessoa ◽  
Leonardo Santos ◽  
Carlos Starling ◽  
Braulio Couto
Keyword(s):  
Length Of Stay ◽  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Hospital Admissions ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Site Infection ◽  
Epidemic Period ◽  
Neurosurgical Patients ◽  
London Protocol

Background: The infection control service of a private hospital in Belo Horizonte, Brazil, performs continuous surveillance of surgical patients according to the CDC NHSN protocols. In a routine analysis of the neurosurgical service, we identified a subtle increase in the incidence of surgical site infection (SSI): in 5 months (June–October 2018), 6 patients developed an SSI. From January 2017 until May 2018, there were no cases of infection in neurosurgery, which led us to suspect an outbreak. Methods: A cohort study was used to investigate the factors associated with risk of SSI. We investigated the following variables: ASA score, number of hospital admissions, age, preoperative hospital length of stay, duration of surgery, wound class, general anesthesia, emergency, trauma, prosthesis, surgical procedures, surgeon. Furthermore, 9 key steps were followed to investigate the outbreak: case definition (step 1), search for new SSI cases (step 2); confirmation of the outbreak (step 3); analysis of SSI cases by London Protocol (step 4); analysis of the cohort data (step 5); inspections in the surgical ward (step 6); qualitative and quantitative reports sent to the neurosurgical departments (step 7); continuing with active surveillance (stage 8); announcement of research findings (step 9). Results: The outbreak was confirmed: SSI incidence in the pre-epidemic period (January–May 2018) was 0 of 218 (0%); in the epidemic period (June–October 2018), SSI incidence was 6 of 94 (6.4%) (P < .001). We identified 3 SSI etiologic agents: 2 Klebsiella pneumoniae, 2 S. aureus, and 1 Serratia marcescens. It was unlikely that there was a common source for the outbreak. We identified the following risk factors: second or third hospital admissions (RR, 3.7; P = .041), and preoperative hospital length of stay: SSI patients (4.3±5.7 days) versus control patients (0.7 ± 2.1 days) (P = .048). None of the surgeons presented an SSI rate significantly different from each other. We used the London protocol to identify antibiotic prophylaxis failures in most cases. Conclusions: New cases of infections can be prevented if the length of preoperative hospital stay becomes as short as possible and, most importantly, if antibiotic prophylaxis does not fail.Funding: NoneDisclosures: None

scholarly journals 1247. Multicenter Study on Risk Factors for Surgical Site Infection After Exploratory Laparotomy

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S449-S449
Author(s):  
Túlio Alves Jeangregório Rodrigues ◽  
Guilherme Fernandes de Oliveira ◽  
Júlia G C Dias ◽  
Laís Souza Campos ◽  
Letícia Rodrigues ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Abdominal Surgery ◽  
Surgical Site Infection ◽  
Exploratory Laparotomy ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Hospital Death ◽  
Site Infection ◽  
The Impact

Abstract Background Exploratory laparotomy surgery is abdominal operations not involving the gastrointestinal tract or biliary system. The objective of our study is to answer three questions: (a) What is the risk of surgical site infection (SSI) after exploratory abdominal surgery? (b) What is the impact of SSI in the hospital length of stay and hospital mortality? (c) What are risk factors for SSI after exploratory abdominal surgery? Methods A retrospective cohort study assessed meningitis and risk factors in patients undergoing exploratory laparotomy between January 2013 and December 2017 from 12 hospitals at Belo Horizonte, Brazil. Data were gathered by standardized methods defined by the National Healthcare Safety Network (NHSN)/CDC procedure-associated protocols for routine SSI surveillance. 26 preoperative and operative categorical and continuous variables were evaluated by univariate and multivariate analysis (logistic regression). Outcome variables: Surgical site infection (SSI), hospital death, hospital length of stay. Variables were analyzed using Epi Info and applying statistical two-tailed test hypothesis with significance level of 5%. Results A sample of 6,591 patients submitted to exploratory laparotomy was analyzed (SSI risk = 4.3%): Hospital length of stay in noninfected patients (days): mean = 16, median = 6, std. dev. = 30; hospital stay in infected patients: mean = 32, median = 22, std. dev. = 30 (P < 0.001). The mortality rate in patients without infection was 14% while hospital death of infected patients was 20% (P = 0.009). Main risk factors for SSI: ügeneral anesthesia (SSI = 4.9%, relative risk – RR = 2.8, P < 0.001); preoperative hospital length of stay more than 4 days (SSI=3.9%, RR=1.8, P = 0.003); wound class contaminated or dirty (SSI = 5.4%, RR = 1.5, P = 0.002); duration of procedure higher than 3 hours (SSI = 7.1%, RR = 2.1, P < 0.001); after trauma laparotomy (SSI = 7.8%, RR = 1.9, P = 0.001). Conclusion We identified patients at high risk of surgical site infection after exploratory laparotomy: trauma patients from contaminated or dirty wound surgery, submitted to a procedure with general anesthesia that last more than 3 hours have 13% SSI. Patients without any of these four risk factors have only 1.2% SSI. Disclosures All authors: No reported disclosures.

Surgical Site Infection After Pediatric Cardiothoracic Surgery

2016 ◽  
Vol 8 (1) ◽  
pp. 7-12 ◽  
Author(s):  
Anthony A. Sochet ◽  
Alexander M. Cartron ◽  
Aoibhinn Nyhan ◽  
Michael C. Spaeder ◽  
Xiaoyan Song ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Surgical Site Infection ◽  
Heart Surgery ◽  
Hospital Costs ◽  
Congenital Heart Surgery ◽  
Hospital Length ◽  
Cardiothoracic Surgery ◽  
Hospital Length Of Stay ◽  
Published Data ◽  
Site Infection

Background: Surgical site infection (SSI) occurs in 0.25% to 6% of children after cardiothoracic surgery (CTS). There are no published data regarding the financial impact of SSI after pediatric CTS. We sought to determine the attributable hospital cost and length of stay associated with SSI in children after CTS. Methods: We performed a retrospective, matched cohort study in a 26-bed cardiac intensive care unit (CICU) from January 2010 through December 2013. Cases with SSI were identified retrospectively and individually matched to controls 2:1 by age, gender, Risk Adjustment for Congenital Heart Surgery score, Society of Thoracic Surgeons–European Association for Cardiothoracic Surgery category, and primary cardiac diagnosis and procedure. Results: Of the 981 cases performed during the study period, 12 with SSI were identified. There were no differences in demographics, clinical characteristics, or intraoperative data. Median total hospital costs were higher in participants with SSI as compared to controls (US$219,573 vs US$82,623, P < .01). Children with SSI had longer median CICU length of stay (9 vs 3 days, P < .01), hospital length of stay (18 vs 8.5 days, P < .01), and duration of mechanical ventilation (2 vs 1 day, P < .01) and vasoactive administration (4.5 vs 1 day, P < .01). Conclusions: Children with SSI after CTS have an associated increase in hospital costs of US$136,950/case and hospital length of stay of 9.5 days/case. The economic burden posed by SSI stress the importance of infection control surveillance, exhaustive preventative measures, and identification of modifiable risk factors.

Shorter Duration of Femoral-Popliteal Bypass Is Associated with Decreased Surgical Site Infection and Shorter Hospital Length of Stay

2012 ◽  
Vol 215 (4) ◽  
pp. 512-518 ◽  
Author(s):  
Tze-Woei Tan ◽  
Jeffrey A. Kalish ◽  
Naomi M. Hamburg ◽  
Denis Rybin ◽  
Gheorghe Doros ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Surgical Site Infection ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Site Infection

Survival trends in palliative care patients with cancer: A Mayo Clinic 5-year review

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9592-9592
Author(s):  
A. H. Kamal ◽  
K. M. Swetz ◽  
H. Liu ◽  
S. R. Ruegg ◽  
E. C. Carey ◽  
...  
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Median Time ◽  
Mayo Clinic ◽  
Hospital Admissions ◽  
Cox Model ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Care Plan ◽  
Palliative Care Consultation

9592 Background: Palliative care (PC) is an essential part of the continuum of care for cancer (CA) patients (pts). Little is known about the aggregate characteristics and survival of pts receiving inpatient palliative care consultation (PCC). Methods: We reviewed data prospectively collected on patients seen by the Palliative Care Inpatient Consult Service at Mayo Clinic - Rochester from 2003–2008. Demographics, consult characteristics, and survival were analyzed. Kaplan-Meier survival curves and a Cox model of survival were produced. Results: 1794 total patients were seen over the five year period. Cancer is the most common primary diagnosis (47%). Growth in annual PCC has risen dramatically (113 in 2003 vs. 414 in 2007) despite stable total hospital admissions. Patient are predominantly men (52% vs. 48%, p=0.02); median age is 76. General medicine, medical cardiology, and medical intensive care unit services refer most often. Most frequent issues addressed are goals of care, dismissal planning, and pain control (29%, 19%, 17%). PCC in actively dying pts have increased with 27% of all non-operating room, non-trauma in-hospital deaths being seen. Although CA pts have the highest median survival after PCC vs. other diagnoses (17 days, p = 0.018), we observed a five-year trend of decreasing survival from admission to death and PCC to death. Median time from admission to death in CA pts is 36 days in 2003 and 19 days in 2008 (p<0.01). Median time from PCC to death is 33 versus 11.5 days (p<0.01). Despite this, median hospital length of stay and time from PCC to discharge have remained fixed at 8 and 2.5 days, respectively. A Cox model of survival to discharge and <6 months survival (hospice eligibility) shows hospital length of stay, time from consult to discharge, and dismissal location from hospital are all prognostic factors. Conclusions: Survival window for PC intervention for CA pts is lessening. With the trend of shorter survival after PCC, PC professionals have little over two days to implement a comprehensive, ongoing care plan. This highlights the importance of earlier outpatient palliative care involvement with advanced cancer patients and families. No significant financial relationships to disclose.

scholarly journals Post-vaccination COVID-19: A case-control study and genomic analysis of 119 breakthrough infections in partially vaccinated individuals

2021 ◽  
Author(s):  
Ioannis Baltas ◽  
Florencia A T Boshier ◽  
Charlotte A Williams ◽  
Nadua Bayzid ◽  
Marius Cotic ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Admissions ◽  
Genomic Analysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Escape Mutation ◽  
Number Needed To Treat ◽  
Sequencing Analysis ◽  
Full Genome Sequencing ◽  
Post Vaccination

Abstract Background Post-vaccination infections challenge the control of the COVID-19 pandemic. Methods We matched 119 cases of post-vaccination SARS-CoV-2 infection with BNT162b2 mRNA, or ChAdOx1 nCOV-19, to 476 unvaccinated patients with COVID-19 (Sept 2020-March 2021), according to age and sex. Differences in 60-day all-cause mortality, hospital admission, and hospital length of stay were evaluated. Phylogenetic, single nucleotide polymorphism (SNP) and minority variant allele (MVA) full genome sequencing analysis was performed. Results 116/119 cases developed COVID-19 post first vaccination dose (median 14 days, IQR 9 – 24 days). Overall, 13/119 (10∙9%) cases and 158/476 (33∙2%) controls died (p&lt;0.001), corresponding to 4∙5 number needed to treat (NNT). Multivariably, vaccination was associated with 69∙3% (95%CI 45∙8 – 82∙6) relative risk (RR) reduction in mortality. Similar results were seen in subgroup analysis for patients with infection onset ≥14 days after first vaccination (RR reduction 65∙1%, 95%CI 27∙2 – 83∙2, NNT 4∙5), and across vaccine subgroups (BNT162b2: RR reduction 66%, 95%CI 34∙9 – 82∙2, NNT 4∙7, ChAdOx1: RR reduction 78∙4%, 95%CI 30∙4 – 93∙3, NNT 4∙1). Hospital admissions (OR 0∙80, 95%CI 0∙51 – 1∙28), and length of stay (-1∙89 days, 95%CI -4∙57 – 0∙78) were lower for cases, while Ct values were higher (30∙8 versus 28∙8, p = 0.053). B.1.1.7 was the predominant lineage in cases (100/108, 92.6%) and controls (341/446, 76.5%). Genomic analysis identified one post-vaccination case harboring the E484K vaccine escape mutation (B.1.525 lineage). Conclusions Previous vaccination reduces mortality when B.1.1.7 is the predominant lineage. No significant lineage-specific genomic changes during phylogenetic, SNP and MVA analysis were detected.

scholarly journals MP44: TEC4Home heart failure: using home telemonitoring to decrease ED readmissions and clinical flow

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S56-S57
Author(s):  
H. Novak Lauscher ◽  
K. Ho ◽  
J. L. Cordeiro ◽  
A. Bhullar ◽  
R. Abu Laban ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Hospital Admissions ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Total Hospital ◽  
Home Telemonitoring ◽  
Patient Health ◽  
Ed Visits ◽  
Improve Patient

Introduction: Patients with Heart failure (HF) experience frequent decompensation necessitating multiple emergency department (ED) visits and hospitalizations. If patients are able to receive timely interventions and optimize self-management, recurrent ED visits may be reduced. In this feasibility study, we piloted the application of home telemonitoring to support the discharge of HF patients from hospital to home. We hypothesized that TEC4Home would decrease ED revisits and hospital admissions and improve patient health outcomes. Methods: Upon discharge from the ED or hospital, patients with HF received a blood pressure cuff, weight scale, pulse oximeter, and a touchscreen tablet. Participants submitted measurements and answered questions on the tablet about their HF symptoms daily for 60 days. Data were reviewed by a monitoring nurse. From November 2016 to July 2017, 69 participants were recruited from Vancouver General Hospital (VGH), St. Pauls Hospital (SPH) and Kelowna General Hospital (KGH). Participants completed pre-surveys at enrollement and post-surveys 30 days after monitoring finished. Administrative data related to ED visits and hospital admissions were reviewed. Interviews were conducted with the monitoring nurses to assess the impact of monitoring on patient health outcomes. Results: A preliminary analysis was conducted on a subsample of participants (n=22) enrolled across all 3 sites by March 31, 2017. At VGH and SPH (n=14), 25% fewer patients required an ED visit in the post-survey reporting compared to pre-survey. During the monitoring period, the monitoring nurse observed seven likely avoided ED admissions due to early intervention. In total, admissions were reduced by 20% and total hospital length of stay reduced by 69%. At KGH (n=8), 43% fewer patients required an ED visit in the post-survey reporting compared to the pre-survey. Hospital admissions were reduced by 20% and total hospital length of stay reduced by 50%. Overall, TEC4Home participants from all sites showed a significant improvement in health-related quality of life and in self-care behaviour pre- to 90 days post-monitoring. A full analysis of the 69 patients will be complete in February 2018. Conclusion: Preliminary findings indicate that home telemonitoring for HF patients can decrease ED revisits and improve patient experience. The length of stay data may also suggest the potential for early discharge of ED patients with home telemonitoring to avoid or reduce hospitalization. A stepped-wedge randomized controlled trial of TEC4Home in 22 BC communities will be conducted in 2018 to generate evidence and scale up the service in urban, regional and rural communities. This work is submitted on behalf of the TEC4Home Healthcare Innovation Community.

scholarly journals 904. Surgical Site Infection After Bariatric Surgery: a Small Risk that Defines Life and Death of Patients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S486-S486
Author(s):  
Lucca G Giarola ◽  
Carlos Ernesto Ferreira Starling ◽  
Braulio Roberto Gonçalves Marinho Couto ◽  
Handerson Dias Duarte de Carvalho
Keyword(s):  
Bariatric Surgery ◽  
Logistic Regression ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Hospital Death ◽  
Site Infection ◽  
Belo Horizonte

Abstract Background Surgical site infection (SSI) in bariatric surgery can lead to devastating outcomes such as peritonitis, sepsis, septic shock and organ space infection. The objective of our study is to answer four questions: a) What is the SSI risk after bariatric surgery? b) What are the risk factors for SSI after bariatric surgery? c) What are the main outcomes to SSI in bariatric surgery? d) What are the main bacteria responsible for SSI in bariatric surgery? Methods A retrospective cohort study assessed 8,672 patients undergoing bariatric surgery between 2014/Jan and 2018/Dec from two hospitals at Belo Horizonte, Brazil. Data were gathered by standardized methods defined by the National Healthcare Safety Network (NHSN)/CDC procedure-associated protocols for routine SSI surveillance. Outcome: SSI, hospital death and total length of hospital stay. 20 preoperative and operative variables were evaluated by univariate and multivariate analysis (logistic regression). Results 77 SSI were diagnosed (risk = 0.9% [C.I.95% = 0.7%;1.1%]). Mortality rate in patients, without infection was only 0.03% (3/8,589) while hospital death of infected patients was 4% (3/77; RR = 112; p&lt; 0.001). Hospital length of stay in non-infected patients (days): mean = 2, std.dev.= 0.9; hospital stay in infected patients: mean = 7, std. dev. = 15.6 (p&lt; 0.001). Two main factors associated with SSI after bariatric surgery were identified by logistic regression: duration of procedure (hours), OR = 1.4;p=0.001, and laparoscopy procedure, OR = 0.3;p=0.020. From 77 SSIs, in 28 (36%) we identified 34 etiologic agents. The majority of SSI (59%) was caused by species of Streptococcus (32%), Klebsiella (15%), and Enterobacter (12%). Conclusion SSI is rare after bariatric surgery, however, when it happens, it’s a disaster for the patient. The incidence of SSI can be reduced significantly when laparoscopy procedure is used and the surgeon is able to perform a rapid surgery. Disclosures All Authors: No reported disclosures

scholarly journals Impact of COVID-19 Outbreak on the Emergency Presentation of Acute Appendicitis

2020 ◽  
Vol 86 (11) ◽  
pp. 1508-1512
Author(s):  
Mariana Kumaira Fonseca ◽  
Eduardo N. Trindade ◽  
Omero P. Costa Filho ◽  
Miguel P. Nácul ◽  
Artur P. Seabra
Keyword(s):  
Postoperative Complications ◽  
Length Of Stay ◽  
Acute Appendicitis ◽  
Symptom Onset ◽  
Hospital Admissions ◽  
Average Length ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Time Interval ◽  
Emergency Presentation

Background The global crisis resulting from the coronavirus pandemic has imposed a large burden on health systems worldwide. Nonetheless, acute abdominal surgical emergencies are major causes for nontrauma-related hospital admissions and their incidences were expected to remain unchanged. Surprisingly, a significant decrease in volume and a higher proportion of complicated cases are being observed worldwide. Methods The present study assesses the local impact of the coronavirus pandemic on the emergency presentation of acute appendicitis in a Brazilian hospital. A retrospective analysis was conducted on patients undergoing emergency surgery for the clinically suspected diagnosis of acute appendicitis during the 2-month period of March and April 2020 and the same time interval in the previous year. Data on demographics, timing of symptom onset and hospital presentation, intraoperative details, postoperative complications, hospital length of stay, and histological examination of the specimen were retrieved from individual registries. Results The number of appendectomies during the pandemic was 36, which represents a 56% reduction compared to the 82 patients operated during the same period in 2019. The average time of symptom onset to hospital arrival was significantly higher in 2020 (40.6 vs. 28.2 hours, P = .02). The classification of appendicitis revealed a significant higher proportion of complicated cases than the previous year (33.3% vs. 15.2%, P = .04). The rate of postoperative complications and the average length of stay were not statistically different between the groups. Conclusion Further assessment of patients’ concerns and systematic monitoring of emergency presentations are expected to help us understand and adequately address this issue.

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