95. Impact of Penetrating Trauma on Surgical Site Infection Standardized Infection Ratio (SIR) for Colon Procedures

Background Colon surgery (COLO) is one of the focus areas for the the Centers for Medicare and Medicaid Services (CMS) Hospital Inpatient Quality Reporting (IQR) Program. Standardized criteria from the National Healthcare Surveillance Network (NSHN) are used to define surgical site infections (SSI) and to assess and weight standardized risk variables, so that all organizations can be judged to the same standard. Performance is compared though use of a standardized infection ratio (SIR), which is the observed number of infections, divided by the “predicted” number of infections, given the number and type of surgeries performed. Methods A retrospective review of medical records and NHSN documentation was conducted for 778 COLO procedures that were performed at a large academic and level 1 trauma center between January 2019 and December 2020. Initial review of the data showed that the increases in SIR were primarily concentrated in trauma patients with intestinal injury and fecal spillage. SIR for adult procedures were calculated using the NHSN Complex 30-Day SSI Data for IQR Report model, which the metric used by the CMS IQR. The CDC NHSN Statistics Calculator was used to compare SIR for procedures coded as trauma and non-trauma. As a proxy for patients with penetrating trauma, SIR for patients coded as trauma who had a surgical wound class noted as dirty was compared to SIR for patients coded as trauma with surgical wound class coded as contaminated or clean-contaminated. Results For the CMS model, there was a statistically significant difference (p = 0.0003) between SIR for trauma (SIR = 3.451) and non-trauma (SIR = 1.071) procedures. There was also a statistically significant difference (p=0.0014) between trauma procedures with dirty surgical wound class (SIR = 6.608), compared to those with wounds categorized as contaminated or clean-contaminated (SIR = 2.235). NHSN Adult Complex 30 Days SIR comparison for COLO SSI with and without trauma NHSN Adult Complex 30 Days SIR comparison for trauma COLO procedures with dirty wound class description, against COLO procedures with wound class described as clean or clean-contaminated Conclusion Risk factors currently included in the model for COLO SSI may not adequately account for the increased risk from penetrating trauma with fecal spillage. Trauma and wound class should be added to the CMS IQR risk model for SIR. Disclosures Kelley M. Boston, MPH, CIC, CPHQ, FAPIC, Infection Prevention & Management Associates (Employee, Shareholder) Luis Ostrosky-Zeichner, MD, Amplyx (Consultant)Cidara (Consultant)F2G (Consultant)Gilead (Grant/Research Support, Speaker's Bureau)Pfizer (Scientific Research Study Investigator, Speaker's Bureau)Scynexis (Grant/Research Support, Scientific Research Study Investigator)Viracor (Consultant)

Use of triclosan-coated suture material as prevention of surgical site infections (literature review)

According to international data, the incidence of infections in the field of surgery in children and adults varies from 2.0 to 20.0 %. The occurrence of the above infections is influenced by many factors: the presence of comorbidities, ASA index, surgical wound class, NNIS risk index. Important factors include the quality of the suture. According to experts of the World Health Organization, 40.0–60.0 % of infections in the field of surgery can be prevented. The first microbiological study of suture (polyglactin 910) with triclosan was published in 2002. According to international studies, the use of a triclosan reduces the adhesion of bacteria to the suture, the viability of microbes and the release of inflammatory mediators. Triclosan actively prevents the colonization of the filament, in addition, concentrations sufficient to suppress the growth and reproduction of pathogens are maintained in the environment for a long time, resulting in the prevention of the development of infectious complications.

Impact of bodyweight-adjusted antimicrobial prophylaxis on surgical-site infection rates

Background Antimicrobial prophylaxis (AMP) adjustment according to bodyweight to prevent surgical-site infections (SSI) is controversial. The impact of weight-adjusted AMP dosing on SSI rates was investigated here. Methods Results from a first study of patients undergoing visceral, vascular or trauma operations, and receiving standard AMP, enabled retrospective evaluation of the impact of bodyweight and BMI on SSI rates, and identification of patients eligible for weight-adjusted AMP. In a subsequent observational prospective study, patients weighing at least 80 kg were assigned to receive double-dose AMP. Risk factors for SSI, including ASA classification, duration and type of surgery, wound class, diabetes, weight in kilograms, BMI, age, and AMP dose, were evaluated in multivariable analysis. Results In the first study (3508 patients), bodyweight and BMI significantly correlated with higher rates of all SSI subclasses (both P < 0.001). An 80-kg cut-off identified patients receiving single-dose AMP who were at higher risk of SSI. In the prospective study (2161 patients), 546 patients weighing 80 kg or more who received only single-dose AMP had higher rates of all SSI types than a group of 1615 who received double-dose AMP (odds ratio (OR) 4.40, 95 per cent c.i. 3.18 to 6.23; P < 0.001). In multivariable analysis including 5021 patients from both cohorts, bodyweight (OR 1.01, 1.00 to 1.02; P = 0.008), BMI (OR 1.01, 1.00 to 1.02; P = 0.007) and double-dose AMP (OR 0.33, 0.23 to 0.46; P < 0.001) among other variables were independently associated with SSI rates. Conclusion Double-dose AMP decreases SSI rates in patients weighing 80 kg or more.

Surgical Antibiotic Prophylaxis Use and Surgical Site Infection Pattern in Dessie Referral Hospital, Dessie, Northeast of Ethiopia

Background. Surgical site infections are the third (14%-16%) most frequent cause of nosocomial infections among hospitalized patients. They still form a large health problem and result in increased antibiotic usage, increased associated costs, and prolonged hospitalization and contribute to increased patient morbidity and mortality. Therefore, studies on surgical site infections and surgical antibiotic prophylaxis contribute to identifying surgical site infection rate and risk factor associated with it as well as for identifying the gap in surgical antibiotic prophylaxis practice. Objective. To assess surgical antibiotic prophylaxis practice and surgical site infection among surgical patients. Method. A hospital-based prospective observational study was conducted in 68 patients who underwent major surgery in Dessie Referral Hospital adult surgical wards between March 24 and April 25/2017. Descriptive and logistic regression analyses were performed to determine infection rate and risk factors for surgical site infections. Result. Assessment of 68 patients who underwent major surgery revealed an overall surgical site infection rate of 23.4%. Prophylactic antibiotics were administered for 59 operations; of these, 33 (48.6%) had inappropriate timing of administration. A combination of ceftriaxone and metronidazole 28 (47.46%) was frequently used. Factors associated with surgical site infection were wound class, patient comorbid condition, duration of the procedure, the timing of administration, and omitting prophylaxis use. Conclusion. This study indicated a higher rate of surgical site infection and also revealed that wound class, preexisting medical condition, prolonged duration of surgery, omitting of prophylaxis use, and inappropriate timing of administration were highly associated with surgical site infection.

Novel Technique to Reduce the Incidence of SSI after Colorectal Surgery

SSI is a leading cause of morbidity and increases health-care cost after colorectal operations. It is a key hospital-level patient safety indicator. Previous literature has identified perioperative risk factors associated with SSI and interventions to decrease rate of infection. The purpose of this study was to evaluate the impact of blowhole closure on the rate of superficial and deep SSI. The ACS-NSQIP database was queried for patients undergoing colectomy at the University of Kentucky from 2013 to 2016. Retrospective chart review was performed to gather demographic data and perioperative variables. Wounds left open and packed were excluded. Rates of postoperative SSI were measured between the groups. One thousand eighty-three patients undergoing elective and emergent colectomy were reviewed. Nine hundred and forty-five had closed incision and 138 had blowhole closure. Patient characteristics between the groups were well matched. Patients with a blowhole closure were more likely to have an open procedure ( P = 0.037) and a higher wound class ( P < 0.001). The rate of superficial and deep SSI was 9.1 per cent in patients with a closed incision and 5.1 per cent in patients with blowhole closure ( P = 0.142). With adjustment for approach and wound class, blowhole closure decreased the incidence of SSI ( P = 0.04). There was no significant difference in morbidity or mortality. Patients undergoing elective and emergent colectomy had decreased incidence of SSI when blowhole closure was used. Given that it does not increase resource usage and its technical ease, blowhole closure should become the standard method of surgical wound closure.

Predictors of Surgical site infections among patients undergoing open urological surgery at a Tertiary hospital, Tanzania: A cross sectional study

Background Surgical site infection (SSI) is one of the major hospital acquired infections highly associated with prolonged hospitalization, morbidity and mortality. In open urological surgeries, little is known on magnitude and factors associated with development of SSI. Methods and Materials This was a cross-sectional prospective observational study performed between August 2015 and March 2016 at Muhimbili National hospital (MNH), Dar es Salaam, Tanzania. All patients who underwent open urological surgery and met inclusion criteria were consecutively enrolled, and followed up for 30 days. Patients´ and operative characteristics were recorded using standard structured questionnaires. Wound/ pus swabs were collected from patients with clinical evidence of SSI for bacteriological processing. Data analysis was performed using SPSS version 20. Results Of 182 patients who underwent open urological surgery, 22% developed SSI. Pre-operative urinary tract infection (aOR 9.73, 95%CI 3.93-24.09, p<0.001) and contaminated wound class (aOR 24.997, 95%CI 2.58-242.42, p = 0.005) were independent predictors for development of SSI. Shaving within 30 hrs before surgical procedure was found to be protective for developing SSI (aOR 0.26, 95%CI 0.09-0.79, p = 0.02). Escherichia coli (20/40) was the most predominant pathogen in SSI followed by Klebsiella pneumoniae (7/40) and S. aureus (6/40). Gram-negative bacteria were highly resistant to ceftriaxone, gentamicin, amoxicillin-clavulanic acid and trimethoprim-sulfamethoxazole. Conclusion SSI was high in open urological interventions. Pre-operative urinary tract infection and contaminated wound class predicted SSI. Bacteria causing SSI were highly resistant to commonly used antibiotics.

A diagnostic algorithm for the surveillance of deep surgical site infections after colorectal surgery

Objective:Surveillance of surgical site infections (SSIs) is important for infection control and is usually performed through retrospective manual chart review. The aim of this study was to develop an algorithm for the surveillance of deep SSIs based on clinical variables to enhance efficiency of surveillance.Design:Retrospective cohort study (2012–2015).Setting:A Dutch teaching hospital.Participants:We included all consecutive patients who underwent colorectal surgery excluding those with contaminated wounds at the time of surgery. All patients were evaluated for deep SSIs through manual chart review, using the Centers for Disease Control and Prevention (CDC) criteria as the reference standard.Analysis:We used logistic regression modeling to identify predictors that contributed to the estimation of diagnostic probability. Bootstrapping was applied to increase generalizability, followed by assessment of statistical performance and clinical implications.Results:In total, 1,606 patients were included, of whom 129 (8.0%) acquired a deep SSI. The final model included postoperative length of stay, wound class, readmission, reoperation, and 30-day mortality. The model achieved 68.7% specificity and 98.5% sensitivity and an area under the receiver operator characteristic (ROC) curve (AUC) of 0.950 (95% CI, 0.932–0.969). Positive and negative predictive values were 21.5% and 99.8%, respectively. Applying the algorithm resulted in a 63.4% reduction in the number of records requiring full manual review (from 1,606 to 590).Conclusions:This 5-parameter model identified 98.5% of patients with a deep SSI. The model can be used to develop semiautomatic surveillance of deep SSIs after colorectal surgery, which may further improve efficiency and quality of SSI surveillance.