Surveillance, Auditing, and Feedback Can Reduce Surgical Site Infection Dramatically: Toward Zero Surgical Site Infection.

BACKGROUND: We evaluated the Surveillance of Surgical Site Infection (SSI), Auditing, and Feedback (SAF) effect on the rate of compliance with an SSI care bundle and measured its effectiveness in reducing the SSI rate. METHOD: A prospective cohort study from January 2014 to December 2016 was classified into three phases: pre-SAF, early-SAF, and late-SAF. Pre-operative baseline characteristics of 24,677 patients who underwent orthopedic, cardiovascular thoracic surgery (CTVS) or urologic operations were recorded. Univariable analyses of the SSI rates in the pre-SAF and post-SAF phases were performed. Percentage compliance and non-compliance with each care component were calculated. Correlation between reduction in the SSI rate and increase in compliance with the pre-operative, peri-operative, and post-operative care-bundle components was performed using the Spearman test. RESULTS: There was a significant decrease in the SSI rate in orthopedic procedures that involved surgical implantation and in mitral valve/aortic valve (MVR/AVR) cardiac operations, with a relative risk (RR) ratio of 0.19 (95% confidence interval [CI] 0.12-0.31) and 0.08 (95% CI 0.03-0.22), respectively. The SSI rate was inversely correlated with the rate of compliance with pre-operative (r = -0.738; p = 0.037), peri-operative (r = - 0.802; p = 0.017), and post-operative (r = -0.762; p = 0.028) care bundles. CONCLUSION: Implementation of the Surveillance of SSI, Auditing, and Feedback bundle had a profound beneficial effect on the SSI rate, thereby reducing healthcare costs and improving patient quality of life.

Colletotrichum keratitis: A Rare but Definite Clinical Entity.

Colletotrichum spp. is an emerging pathogen which causes a variety of human infections. Only a few cases of Colletotrichum keratitis have been reported from India. We are reporting three cases of keratitis which were caused by three different species of Colletotrichum. Two of the three patients had a history of trauma and of a previous treatment with topical antibiotics. A direct microscopic examination of the corneas of all the three patients revealed fungal elements and Colletotrichum spp. grew in the culture. Two patients responded to topical anti - fungal therapy and the ulcer regressed, while the third patient failed to respond .The third patient was referred to a higher specialty centre for Keratoplasty.