International study finds 1 in 8 patients have an infection following common procedures

A worldwide study which studied the incidence of surgical site infection (SSI) in over 12,000 patients who had gastro-intestinal surgery, across 66 countries has been published in The Lancet. The researchers quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. The findings of the prospective, international study included 1 in 8 patients experiencing infection post-operation for common procedures such as appendix removal.  In more than 20% of cases, patients developed infections which antibiotics should have protected them from

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Abstract 
Background Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries throughout the world.
Methods This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries
were stratified into high-income, middle-income, and low-income groups according to the UN’s Human Development Index (HDI).  The primary outcome measure was  the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models.

Findings Between Jan 4, 2016, and July 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries).
In total, 1538 (12·3%) patients  had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI.
The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries.

Interpretation Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance.

The full text article can be downloaded from The Lancet 

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Risk factors for development of surgical site infections among liver transplantation recipients

Surgical site infection (SSI) is an important complication in the postoperative period of recipients of liver transplantation | American Journal of Infection Control

Highlights: 

  • There is a little research about surgical site infection in liver transplantation.
  • Liver transplant recipients are exposed to different risk factors for SSI.
  • There is no consensus in literature about risk factor for SSI among LT recipients.

Full reference: Oliveira, R.A. et al. (2017) Risk factors for development of surgical site infections among liver transplantation recipients: An integrative literature review. American Journal of Infection Control | Available online: 6th July 2017

 

Patient engagement with surgical site infection prevention

Tartari E, et al. (2017) Patient engagement with surgical site infection prevention: an expert panel perspective. Antimicrobial Resistance & Infection Control | Published online: 12 May 2017

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Despite remarkable developments in the use of surgical techniques, ergonomic advancements in the operating room, and implementation of bundles, surgical site infections (SSIs) remain a substantial burden, associated with increased morbidity, mortality and healthcare costs.

National and international recommendations to prevent SSIs have been published, including recent guidelines by the World Health Organization, but implementation into clinical practice remains an unresolved issue. SSI improvement programs require an integrative approach with measures taken during the pre-, intra- and postoperative care from the numerous stakeholders involved.

The current SSI prevention strategies have focused mainly on the role of healthcare workers (HCWs) and procedure related risk factors. The importance and influence of patient participation is becoming an increasingly important concept and advocated as a means to improve patient safety. Novel interventions supporting an active participative role within SSI prevention programs have not been assessed. Empowering patients with information they require to engage in the process of SSI prevention could play a major role for the implementation of recommendations.

Based on available scientific evidence, a panel of experts evaluated options for patient involvement in order to provide pragmatic recommendations for pre-, intra- and postoperative activities for the prevention of SSIs. Recommendations were based on existing guidelines and expert opinion. As a result, 9 recommendations for the surgical patient are presented here, including a practice brief in the form of a patient information leaflet. HCWs can use this information to educate patients and allow patient engagement.

Read the full article here

The impact of surgical site infection on healthcare costs and patient outcomes

Badia, J.M. et al. The Journal of hospital Infection | Published online: 8 March 2017

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Background: Surgical site infections (SSIs) are associated with increased morbidity and mortality. Furthermore, SSIs constitute a financial burden and negatively impact on patient quality of life (QoL).

Conclusion: Disparate reporting of SSIs makes direct cost comparisons difficult, however this review indicated that SSIs are extremely costly. Thus, rigorous procedures must be implemented to minimise SSIs. More economic and QoL studies are required to make accurate cost estimates and understand the true burden of SSIs.

Read the full abstract here

An audit of Caesarean section surgical site infections with single-use negative pressure wound therapy

Searle, R. & Myers, D. The Journal of Hospital Infection. Published online: February 28, 2017

This article reports audit data from the introduction of a new single-use negative pressure wound therapy system (PICO) for Caesarean section (CS) patients with high body mass index (BMI) in four hospitals in the UK and Ireland. PICO was used on closed surgical incisions following CS in 399 patients with BMI≥35. 36/399 patients (9.0%) developed signs of SSI, a rate lower than a previously reported incidence of 19.3% in a similar population. The readmission incidence was 0.8%. Therefore the use of PICO on closed surgical incisions may be associated with low incidence of SSI and readmission in this high-risk group.

Read the abstract here

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

NICE guideline update – Surgical site infections: prevention and treatment

Surveillance report 2017 – Surgical site infections: prevention and treatment (2008) | NICE guideline CG74

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Surveillance decision: We will plan an update of the guideline on prevention and treatment of surgical site infections. The update will focus on:

  • nasal decontamination of Staphylococcus aureus
  • choice of preoperative skin antiseptics
  • application of intraoperative topical antiseptics/antimicrobials before wound closure
  • type of suture.

We will consider intraoperative perfusion and hydration, and intraoperative blood glucose control in a new guideline on perioperative care. Recommendations in the surgical site infection guideline will be withdrawn on publication of new recommendations in the perioperative care guideline.

Read the full update here