Effect of Antimicrobial Prophylaxis on the Incidence of Infections in Clean Surgical Wounds in Hospitals Undergoing Renovation

2006 ◽  
Vol 27 (12) ◽  
pp. 1372-1376 ◽  
Author(s):  
Osvaldo Iribarren ◽  
Miguel Araujo
Keyword(s):  
Relative Risk ◽  
Confidence Interval ◽  
Surgical Site Infection ◽  
Antimicrobial Prophylaxis ◽  
Control Group ◽  
Site Infection ◽  
Double Blind ◽  
Prophylaxis Group ◽  
Surgical Wounds ◽  
American Society

Objective. To measure the effect of cephazolin prophylaxis on the rate of surgical site infection among patients with clean surgical wounds, categorized by risk group, in a hospital undergoing renovation. Design. Randomized, double-blind clinical trial. Setting. Saint Paul General Hospital, Coquimbo, Chile, during a period when it was undergoing significant interior remodeling. Patients. General surgery patients who received antibiotic prophylaxis before clean wound surgery between March 2003 and May 2004 and a matched control group of patients who did not receive such prophylaxis. Results. A total of 303 patients participated in the study. The rate of infection among patients with an American Society of Anesthesiologists (ASA) classification of 1 in the prophylaxis group was 7.3%, whereas among ASA 1 patients in a no-prophylaxis control group it was 10.3% (P = .40). In the prophylaxis group, the ASA 2 and ASA 3 patients combined had an infection rate of 10.5%, whereas in the no-prophylaxis group these patients had a rate of 30.0% (relative risk, 0.33 [95% confidence interval, 0.58-0.96]; P = .03). Both the ASA 2 and ASA 3 patients were protected from infection by prophylaxis; these patients had 1.7 and 2.2 times, respectively, more risk of developing a surgical site infection than did ASA 1 patients after a clean surgical procedure, but the ASA 2 and ASA 3 patients who did not receive prophylaxis had 4.3 and 4.8 times, respectively, greater risk of infection (relative risk, 0.91 [95% confidence interval, 0.83-0.99]; P = .02). Prophylaxis significantly reduced the rate of infection in the ASA 2 and ASA 3 groups. Conclusions. We recommend the use of antimicrobial prophylaxis with cephalosporins in ASA 2 and ASA 3 patients undergoing clean wound surgery during a period when significant renovations are being performed in the hospital.

A meta-analysis of spinal surgical site infection and vancomycin powder

2014 ◽  
Vol 21 (6) ◽  
pp. 974-983 ◽  
Author(s):  
Nickalus R. Khan ◽  
Clinton J. Thompson ◽  
Michael DeCuypere ◽  
Jonathan M. Angotti ◽  
Erick Kalobwe ◽  
...  
Keyword(s):  
Relative Risk ◽  
Surgical Site Infection ◽  
Risk Reduction ◽  
Spine Surgery ◽  
Spinal Surgery ◽  
Meta Analysis ◽  
Control Group ◽  
Number Needed To Treat ◽  
Site Infection ◽  
Vancomycin Powder

Object Surgical site infection (SSI) is a serious and costly complication of spinal surgery. There have been several conflicting reports on the use of intrawound vancomycin powder in decreasing SSI in spine surgery. The purpose of this study is to answer the question: “Does intrawound vancomycin powder reduce the rate of SSIs in spine surgery?” Methods A comprehensive search of multiple electronic databases and bibliographies was conducted to identify clinical studies that evaluated the rates of SSI with and without the use of intrawound vancomycin powder in spine surgery. Independent reviewers extracted data and graded the quality of each paper that met inclusion criteria. A random effects meta-analysis was then performed. Results The search identified 9 retrospective cohort studies (Level III evidence) and 1 randomized controlled trial (Level II evidence). There were 2574 cases and 106 infections in the control group (4.1%) and 2518 cases and 33 infections (1.3%) in the treatment group, yielding a pooled absolute risk reduction and relative risk reduction of 2.8% and 68%, respectively. The meta-analysis revealed the use of vancomycin powder to be protective in preventing SSI (relative risk = 0.34, 95% confidence interval 0.17–0.66, p = 0.021). The number needed to treat to prevent 1 SSI was 36. A subgroup analysis found that patients who had implants had a reduced risk of SSI with vancomycin powder (p = 0.023), compared with those who had noninstrumented spinal operations (p = 0.226). Conclusions This meta-analysis suggests that the use of vancomycin powder may be protective against SSI in open spinal surgery; however, the exact population in which it should be used is not clear. This benefit may be most appreciated in higher-risk populations or in facilities with a high baseline rate of infection.

scholarly journals The effect of triclosan-coated sutures on the rate of surgical site infection after hip and knee arthroplasty: a double-blind randomized controlled trial of 2546 patients

2018 ◽  
Vol 100-B (3) ◽  
pp. 296-302 ◽  
Author(s):  
A. P. Sprowson† ◽  
C. Jensen ◽  
N. Parsons ◽  
P. Partington ◽  
K. Emmerson ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Knee Arthroplasty ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
Site Infection ◽  
Double Blind ◽  
Suture Group ◽  
Double Blinded ◽  
Complication Of Surgery

AimsSurgical site infection (SSI) is a common complication of surgery with an incidence of about 1% in the United Kingdom. Sutures can lead to the development of a SSI, as micro-organisms can colonize the suture as it is implanted. Triclosan-coated sutures, being antimicrobical, were developed to reduce the rate of SSI. Our aim was to assess whether triclosan-coated sutures cause a reduction in SSIs following arthroplasty of the hip and knee.Patients and MethodsThis two-arm, parallel, double-blinded study involved 2546 patients undergoing elective total hip (THA) and total knee arthroplasty (TKA) at three hospitals. A total of 1323 were quasi-randomized to a standard suture group, and 1223 being quasi-randomized to the triclosan-coated suture group. The primary endpoint was the rate of SSI at 30 days postoperatively.ResultsThe baseline characteristics of age, gender and comorbidities were well matched in the two groups. The rates of superficial SSI were 0.8% in the control group and 0.7% in the intervention group (p = 0.651), and when deep and superficial SSIs were combined the rates were 2.5% and 1.8 (p = 0.266). The length of stay in hospital and the rates of medical complications did not differ significantly between the groups (p = 1.000).ConclusionThis trial provided no evidence that the use of triclosan-coated sutures at THA and TKA leads to a reduction in the rate of SSI. Cite this article: Bone Joint J 2018;100-B:296–302.

scholarly journals Impact of choice of skin preparation solution in cardiac surgery on rate of surgical site infection: a propensity score matched analysis

2017 ◽  
Vol 19 (1) ◽  
pp. 16-21 ◽  
Author(s):  
Shahzad G Raja ◽  
Melissa Rochon ◽  
Clair Mullins ◽  
Carlos Morais ◽  
Antonios Kourliouros ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Relative Risk ◽  
Propensity Score ◽  
Confidence Interval ◽  
Surgical Site Infection ◽  
Povidone Iodine ◽  
Chlorhexidine Gluconate ◽  
Site Infection ◽  
Skin Preparation ◽  
Significant Superiority

Background: Antiseptic skin preparations containing chlorhexidine gluconate and povidone iodine are routinely used to reduce the risk of surgical site infection (SSI). This study assesses the efficacy of two alcohol-based solutions, 2% chlorhexidine-alcohol and 10% povidone iodine-alcohol, on the incidence of cardiac SSI. Methods: A total of 738 consecutive patients undergoing cardiac surgery had skin preparation with 2% chlorhexidine gluconate in 70% isopropanol (ChloraPrep, BD Ltd, UK) were propensity matched to 738 patients with skin prepared with 10% povidone–iodine in 30% industrial methylated spirit (Videne Alcoholic Tincture, Ecolab Ltd, UK). Continuous, prospective SSI surveillance data were collected for all these patients. A retrospective analysis of prospectively collected perioperative data was performed. Results: The overall rate of SSI was similar in the chlorhexidine–alcohol and povidone–iodine–alcohol groups (3.3% versus 3.8%; P = 0.14; relative risk [RR] = 0.98; 95% confidence interval [CI] = 0.52–1.78). Superficial (1.2% versus 1.8%; P = 0.18; RR = 0.97; 95% CI = 0.48–1.80) and deep incisional (1.2% versus 1.6%; P = 0.24) SSI rates were also similar with 10% povidone–iodine–alcohol being marginally more effective against organ-space infections (0.8% versus 0.4%; P = 0.05; RR = 0.38; 95% CI = 0.20–1.01). Conclusion: Our analysis confirms that alcohol-based skin preparation in cardiac surgery with povidone–iodine reduces the incidence of organ-space infections with no significant superiority in preventing incisional SSI compared with chlorhexidine-alcohol.

The Effect of Participating in a Surgical Site Infection (SSI) Surveillance Network on the Time Trend of SSI Rates: A Systematic Review

2017 ◽  
Vol 38 (11) ◽  
pp. 1364-1366 ◽  
Author(s):  
Mohamed Abbas ◽  
Ermira Tartari ◽  
Benedetta Allegranzi ◽  
Didier Pittet ◽  
Stephan Harbarth
Keyword(s):  
Systematic Review ◽  
Relative Risk ◽  
Literature Review ◽  
Confidence Interval ◽  
Surgical Site Infection ◽  
Systematic Literature Review ◽  
Time Trend ◽  
Site Infection ◽  
Short Term ◽  
Surveillance Network

This systematic literature review reveals that participating in a surgical site infection (SSI) surveillance network is associated with short-term reductions in SSI rates: relative risk [RR] for year 2, 0.80 (95% confidence interval [CI], 0.79–0.82); year 3 RR, 0.92 (95% CI, 0.90–0.94); year 4 RR, 0.98 (95% CI, 0.96–1.00).Infect Control Hosp Epidemiol 2017;38:1364–1366

Influence of early postoperative showering in undressed surgical wound for better clinical outcome

2019 ◽  
Vol 30 (6) ◽  
pp. 163-169
Author(s):  
Anuradha Jayathilake ◽  
Jayaweera Arachchige Asela Sampath Jayaweera ◽  
Wikum Widuranga Kumbukgolla ◽  
Sudheera Herath
Keyword(s):  
Surgical Site Infection ◽  
Tap Water ◽  
Tendon Repair ◽  
Control Group ◽  
Site Infection ◽  
Surgical Wound ◽  
Breast Lump ◽  
Surgical Wounds ◽  
Clean Environment ◽  
Clean Contaminated

Surgeons instruct the patients to avoid postoperative bathing and dress the wounds until the sutures are removed. All wounds were sutured at the end of surgery and kept undressed. Participants received a tap water body bath where the water covered the wound after 24h of surgery. The control group were asked not to wet the dressed surgical site until wound inspection on days 3 and 5. The patients were followed up in the surgery clinic on days 14 and 30 after surgery, when age, sex and type of surgery-matched controls’ surgical site infection was significantly high in clean/contaminated and contaminated appendicectomy, breast lump excision, inguinal herniotomy and tendon repair surgeries. In contaminated appendicectomy, clean/contaminated and contaminated herniotomies postsurgical infections other than surgical site infection were significantly low in test groups. Early mobilisation, keeping the surgical wounds moist and providing a clean environment are suitable to minimise the surgical wound and other associated infections.

scholarly journals Pregnancy Outcome Following Gestational Exposure to Fluoroquinolones: a Multicenter Prospective Controlled Study

1998 ◽  
Vol 42 (6) ◽  
pp. 1336-1339 ◽  
Author(s):  
Ronen Loebstein ◽  
Antonio Addis ◽  
Elaine Ho ◽  
Roseann Andreou ◽  
Suzanne Sage ◽  
...  
Keyword(s):  
Relative Risk ◽  
Confidence Interval ◽  
Pregnancy Outcome ◽  
Bacterial Resistance ◽  
Antimicrobial Agents ◽  
In Utero ◽  
Controlled Study ◽  
Control Group ◽  
Increased Risk ◽  
Clinically Significant

ABSTRACT Concerns regarding the teratogenicity of fluoroquinolones have resulted in their restricted use during gestation. This is despite an increasing need for their use due to emerging bacterial resistance. The objectives of the present investigation were to evaluate pregnancy and fetal outcomes following maternal exposure to fluoroquinolones and to examine whether in utero exposure to quinolones is associated with clinically significant musculoskeletal dysfunctions. We prospectively enrolled and followed up 200 women exposed to fluoroquinolones (norfloxacin, ciprofloxacin, ofloxacin) during gestation. Pregnancy outcome was compared with that for 200 controls matched for age and for smoking and alcohol consumption habits. Controls were exposed to nonteratogenic, nonembryotoxic antimicrobial agents matched by indication, duration of therapy (±3 days), and trimester of exposure. Rates of major congenital malformations did not differ between the group exposed to quinolones in the first trimester (2.2%) and the control group (2.6%) (relative risk, 0.85; 95% confidence interval, 0.21 to 3.49). Women treated with quinolones had a tendency for an increased rate of therapeutic abortions compared with the rate among women exposed to nonteratogens (relative risk, 4.50; 95% confidence interval, 0.98 to 20.57), resulting in lower live-birth rates (86 versus 94%; P = 0.02). The rates of spontaneous abortions, fetal distress, and prematurity and the birth weight did not differ between the groups. Gross motor developmental milestone achievements did not differ between the children of the mothers in the two groups. We concluded that the use of fluoroquinolones during embryogenesis is not associated with an increased risk of major malformations. There were no clinically significant musculoskeletal dysfunctions in children exposed to fluoroquinolones in utero. The higher rate of therapeutic abortions observed in quinolone-exposed women compared to that for their controls may be secondary to the misperception of a major risk related to quinolone use during pregnancy.

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