Collaboration with an infection control team for patients with infection after spine surgery

Kobayashi, K. et al. American Journal of Infection Control. Published online: 22 February 2017

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Highlights: 

  • The risk of infection after spine surgery has increased due to aging of society.
  • An infection control team (ICT) manages infected cases at our hospital.
  • The ICT guided use of antibiotics in 30 cases and investigated infection in 10.
  • The bacteria detection rate was 88% (35/40 patients) in cases treated by the ICT.
  • Early assistance from the ICT is a key to preventing onset of MRSA infection.

Read the full abstract here

Barriers, perceptions, and adherence: Hand hygiene in the operating room and endoscopy suite

Pederson, L. et al. American Journal of Infection Control. Published online: 8 February 2017

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Highlights: 

  • Barriers and perceptions of nonsurgical scrubbed hand hygiene were examined.
  • Hand hygiene role modeling by health care workers is poor.
  • Self-awareness of hand hygiene practices is inadequate.

Read the full abstract here

Azithromycin Prophylaxis for Cesarean Delivery

Rothaus, C. The New England Journal of Medicine. Published online: September 29th 2016

Cesarean delivery is the most common major surgical procedure and is associated with a rate of surgical-site infection (including endometritis and wound infection) that is 5 to 10 times the rate for vaginal delivery. Tita et al. assessed whether the addition of azithromycin to standard antibiotic prophylaxis before skin incision would reduce the incidence of infection after cesarean section among women who were undergoing nonelective cesarean delivery during labor or after membrane rupture. In this new Original Article involving women who received standard antibiotic prophylaxis for nonelective cesarean section, the risk of infection after surgery was lower with the addition of azithromycin than with placebo.

Clinical Pearl

• How does pregnancy-associated infection rank as a cause of maternal death in the United States?

Globally, pregnancy-associated infection is a major cause of maternal death and is the fourth most common cause in the United States.

Clinical Pearl

• How often do postoperative infections occur after nonelective cesarean delivery?

Despite routine use of antibiotic prophylaxis (commonly, a cephalosporin given before skin incision), infection after cesarean section remains an important concern, particularly among women who undergo nonelective procedures (i.e., unscheduled cesarean section during labor, after membrane rupture, or for maternal or fetal emergencies). As many as 60 to 70% of all cesarean deliveries are nonelective; postoperative infections occur in up to 12% of women undergoing nonelective cesarean delivery with standard preincision prophylaxis.#

Read the full Now@NEJM Blog post here

Read the original research article here

Cardiac surgery, nosocomial infection, and the built environment

Sommerstein, R. et al.Journal of Hospital Infection. Published online: 10 May 2016

Heater‒cooler units (HCUs) have received considerable attention from an infection prevention viewpoint in the last two years, as their water reservoir has been linked to healthcare-associated outbreaks. Ten cases of Mycobacterium chimaera infection associated with contaminated HCUs have been described in the literature and the suspected transmission pathway by air was recently substantiated.2,3 Götting et al. now report on the difficulties of physically separating the HCU in order to divert contaminated HCU exhaust air from the surgical field and how they relied on non-fermenters as surrogate micro-organism ‒ despite their unknown significance.

Read the abstract here

Surgical site infections surveillance

Public Health England has published Surgical site infections in NHS hospitals in England 2014/15. This annual report covers surgical site infection (SSI) data collected by NHS hospitals and independent sector NHS treatment centres.  Data includes information on the number of operations performed, data quality, benchmarks, trends and risk factors. SSIs are also recorded by surgical category for each NHS Trusts in England.

Significant decrease in the incidence of orthopedic MRSA SSIs

  • A prevention bundle was implemented for orthopedic MRSA SSIs.
  • The bundle reinforced contact precaution and AMP stewardship.
  • The MRSA SSI rate correlated negatively with cefazolin AUD.
  • Prolonged AMP may increase the risk of MRSA SSI.
  • The bundle was associated with the decrease in the incidence of MRSA SSIs.

Full reference:Kawamura, H et al.A bundle that includes active surveillance, contact precaution for carriers, and cefazolin-based antimicrobial prophylaxis prevents methicillin-resistant Staphylococcus aureus infections in clean orthopedic surgery. American Journal of Infection Control. Available online 30 October 2015

 

Model for Improvement reduced surgical site infections

An improvement collaborative implemented a care bundle to reduce surgical site infections amongst children. Over a two year period they used the Model for Improvement to develop and implement change. Organisations were encouraged to adopt all or part of the bundle. Support was provided through webinars, discussion boards, targeted messages to leaders and in-person training. Within six months, 97% of organisations were using the bundle reliably. There was a 21% reduction in surgical site infection rates, from an average of 2.5 per 100 procedures to 1.8 per 100 procedures. The reduction was sustained over the 15 month follow-up period.

Schaffzin JK, et al. Surgical site infection reduction by the Solutions for Patient Safety Hospital Engagement Network. Pediatrics. Nov;136(5)1353-60 2015.

A multifaceted prevention program to reduce infection after cesarean section: Interventions assessed using an intensive postdischarge surveillance system

American Journal of Infection Control: August 1, 2015 Volume 43, Issue 8, Pages 805–809

Background
We assessed the effects of the components of a multifaceted and evidence-based caesarean-section surgical site infection (SSI) prevention program on the SSI rate after cesarean section using a postdischarge surveillance (PDS) system.

Methods
Multiple prevention interventions were serially implemented. SSI case finding was undertaken through active inpatient surveillance and intensive PDS using a standardized form at the 6-week postdischarge visit. SSI diagnosis was made using the Centers for Disease Control and Prevention standardized criteria. All cesarean deliveries between July 2007 and December 2012 were included. Changes in SSI rate were analyzed using segmented regression analysis.

Results
Nine thousand four hundred forty-two cesarean sections were assessed during the study period. PDS forms were completed for 7,985 women (85%). SSI was detected in 451 cases (5.6%): 91% were superficial, 9% were deep/organ-space infections. The SSI rate decreased incrementally from 8.2% at baseline to 4.1%; significant decreases were observed after optimizing antibiotic prophylaxis timing, using a surgical safety checklist, and enhancing prenatal education to discourage prehospital self-removal of hair. Nonelective surgeries or those undertaken after >12 hours of rupture of membranes had a significantly higher rate compared with those without either risk factor (6.3% vs 3.2%; P < .001).

Conclusions
A multifaceted SSI prevention strategy, with periodic feedback of data, led to a significant reduction in SSI rates after cesarean section.

via A multifaceted prevention program to reduce infection after cesarean section: Interventions assessed using an intensive postdischarge surveillance system – American Journal of Infection Control.

Wearing two sets of gloves reduces contamination in surgery

A simple intervention such as wearing double gloves and removing the outer layer after touching the patient during surgery can reduce contamination. This study tested, in a simulated environment, whether anaesthetists wearing two pairs of gloves reduced contamination in surgery. The outer set of gloves was removed immediately after placing a tube into the airway. In half of the 22 simulation sessions personnel wore a single pair of gloves and in the other half they wore two sets of gloves. Before the simulation, the lips and inside of the mouth of the mannequin were coated with a fluorescent gel to represent a pathogen. After the simulation, an observer examined 40 different sites to determine whether the ‘pathogen’ was transferred to the patient or the patient’s environment. There was a significant reduction in the rate of contamination with double gloves. Single gloves were associated with an average of 20 contaminated sites compared to five with double gloves.

Reference: Birnbach DJ, Rosen LF, Fitzpatrick M, Carling P, Arheart KL, Munoz-Price LS. Double gloves: a randomized trial to evaluate a simple strategy to reduce contamination in the operating room. Anesthesia and Analgesia. 2015 Mar;120(4):848-852