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1.
J Wound Care ; 30(7): 534-542, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34256595

RESUMO

Objective: The prevalence and economic burden of wounds are growing. Any wound has the potential to become hard-to-heal and require frequent care. Clinicians need to find ways to absorb demand on services without compromising outcomes. Drivers of wound care efficiency-time-to-heal, frequency of dressing change and the incidence of complications-can be evaluated to shape future wound management. A survey of wound care was conducted by clinicians from five centres in Sweden over a one-week period, during which clinicians documented every wound once. At the time of surveying, 49% of wounds were considered to be improving, infection incidence was 11.7% and dressings were changed a mean of 2.2 times per week, with highly exuding wounds changed 6.9 times per week. The data highlighted the importance of diagnosing patient and wound characteristics in selecting treatments and organising care. Recognised gaps in diagnoses potentially identify opportunities to influence healing, complication incidence and intensity of nursing, thus reducing demand on resources. In conclusion, this survey highlights opportunities to reduce the burdens these drivers present. Through improved diagnosis and alignment to recognised care pathways, there is potential to improve patient outcomes and alleviate the strains placed upon wound care providers.


Assuntos
Bandagens , Cicatrização , Humanos , Infecção da Ferida Cirúrgica , Suécia/epidemiologia
2.
J Extra Corpor Technol ; 53(2): 130-136, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34194079

RESUMO

A decrease in the infection rates in the operating room (OR) is attributable to advances in sterile technique; heating, ventilation, and air-conditioning (HVAC) filtration; and limiting the number of people entering and leaving the OR. However, some infection complications after open heart procedures have been linked to the discharge fans of surgical equipment, most notably from the LivaNova 3T. We believe that surgical infection within the OR may also be due to other devices with internal fans. The purpose of this study was to 1) identify surgical equipment with an internal fan and see how they affect the airflow in an OR, 2) use the equipment to positively affect airflow to possibly reduce the risk of surgical site infections, and 3) bring attention to the HVAC system ability to exchange air throughout the OR. By using a fog machine and multiple camera angles, we identified the devices that have an effect on the airflow. We saw that the direction of the intake vent of specific devices can change the direction of airflow and possibly help to remove air. Last, we showed how the current HVAC air exchange rate might not be enough to remove contaminated air within the OR. Understanding intake and discharge vents for all equipment is important because sterile contamination and wound infection may be minimized or mitigated completely by simply repositioning a few devices.


Assuntos
Salas Cirúrgicas , Ventilação , Ar Condicionado , Calefação , Humanos , Infecção da Ferida Cirúrgica/prevenção & controle
3.
J Biol Regul Homeost Agents ; 35(2 Suppl. 1): 205-210, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34281318

RESUMO

After oral surgery, bacterial adhesion to suture can cause surgical site infections and delay wound healing. Microbial adherence to the suture is influenced by its physical configuration and chemical structure. The aim of this study was to compare in vivo the bacterial adhesion to two suture materials used in oral surgery: silk and monofilament expanded polytetrafluoethilene (e-PTFE). After sinus lift surgery, 15 flaps were sutured with silk (nonabsorbable, organic, braided, 4.0) and 15 were sutured with e-PTFE (nonabsorbable, synthetic, monofilament, 4.0). Seven days after surgery, bacterial adherence, in terms of percentage of the surface covered, was evaluated for each suture material by scanning electron microscope (SEM). Onto silk suture, plaque consisted of a few cocci and a higher proportion of rods and filamentous-shaped bacteria, with some mineralized plaque. Onto e-PTFE speciments, only small colonies of a few cocci or no bacteria were observed, with empty spaces between the colonies and no plaque mineralization. The surface covered by bacteria on e-PTFE specimens was significantly lower than that of silk sutures. (22.1% ±4.96% vs 54.3% ± 7.9%; P =0.0001). The results of the present study suggest that multifilament structure of silk favours a greater bacterial adherence, proliferation, and persistence, so monofilament and e- PTFE suture should be preferred in oral surgery.


Assuntos
Seda , Suturas , Bactérias , Aderência Bacteriana , Humanos , Infecção da Ferida Cirúrgica
4.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 43(3): 402-405, 2021 Jun 30.
Artigo em Chinês | MEDLINE | ID: mdl-34238416

RESUMO

Objective To investigate the incidence of surgical site infection(SSI)following conversion from laparoscopic to open cholecystectomy and to analyze the related risk factors. Methods The clinical data of 179 patients who had experienced conversion from laparoscopic to open cholecystectomy in Peking Union Medical College Hospital from January 2014 to August 2019 were analyzed retrospectively.Univariate and multivariate logistic regression analyses were performed to evaluate the associations between clinical variables and SSI. Results The incidence of SSI was 19.0%(34/179)after conversion from laparoscopic to open cholecystectomy.The multivariable analysis demonstrated that preoperative endoscopic retrograde cholangiopancreatography(ERCP)(OR=4.208,95% CI:1.590-11.135,P=0.004)was the only independent risk factor of SSI. Conclusions The incidence of SSI after conversion from laparoscopic to open cholecystectomy increased remarkably,especially in those who had preoperative ERCP.Preventive interventions should be taken to reduce the incidence of SSI.


Assuntos
Laparoscopia , Infecção da Ferida Cirúrgica , Colecistectomia , Humanos , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia
5.
Artigo em Alemão | MEDLINE | ID: mdl-34298568

RESUMO

The anaesthesiological care of patients in the operating room involves many activities that can lead to an infection. Hand hygiene is the most effective single measure for the prevention of nosocomial infections. Hand disinfectant dispensers should be placed within easy reach. When preparing infusions and drugs to be administered intravenously, the introduction of microorganisms cannot be completely ruled out, even if all hygienic requirements are observed. Therefore, parenterals without preservatives may only be removed immediately before administration, not several times from the same container and not for several patients. For punctures for regional anaesthesia and for the placement of vascular catheters, the highest hygiene requirements apply when long seldinger wires are used or when catheters are placed in deep tissue spaces or body cavities. The timely application of antibiotic prophylaxis is one of the most important measures in perioperative infection prevention. Indications and choice of substance should be defined in an in-house guideline. Maintaining a balanced volume, body temperature and blood sugar level contributes to the prophylaxis of surgical site infections. The preparation of an operating room after an operation must always ensure that it does not pose a risk of infection for the following patient - regardless of the pathogens with which the previous patient is infected or colonized. There is no evidence for further measures to separate so-called aseptic and septic operations or of patients with multi-resistant pathogens. In order to be able to take the necessary measures for employee protection in corona-infected patients in the operating room, it is essential to know the current infection status. For example, when a patient is handed over to the OR, a current test result should be checked and documented on the OR checklist.


Assuntos
Anestesia por Condução , Infecção Hospitalar , Higiene das Mãos , Infecção Hospitalar/prevenção & controle , Humanos , Controle de Infecções , Infecção da Ferida Cirúrgica
6.
Artigo em Alemão | MEDLINE | ID: mdl-34298570

RESUMO

The burden of surgical site infections (SSIs) is increasing. The number of surgical procedures continues to rise, and surgical patients present increasingly complex comorbidities. Half of SSIs are deemed preventable using evidence-based strategies. It is recommended for patients to bathe or shower prior to surgery. Hair should be removed only with a clipper. Shaving is strongly discouraged at all times. Antimicrobial prophylaxis should be administered only when indicated, based on guidelines, and timed correctly in order to achieve a bactericidal concentration in the tissues when the incision is made. Prophylaxis must not be continued beyond surgery. For skin preparation in the operating room an alcohol-based agent plus chlorhexidine or octenidine is recommended. During surgery, glycemic control and goal-directed fluid therapy should be implemented. Normothermia should be targeted in all patients. The perioperative use of an increased fraction of inspired oxygen may reduce the risk of SSI. Using a surgical safety checklist during a team time-out immediately before surgery reduces the incidence of SSI.


Assuntos
Antibacterianos , Infecção da Ferida Cirúrgica , Antibioticoprofilaxia , Humanos , Infecção da Ferida Cirúrgica/prevenção & controle
7.
Zhonghua Shao Shang Za Zhi ; 37(7): 666-667, 2021 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-34304407

RESUMO

According to a document issued by the General Office of National Health Commission, "one person, one diagnosis, and one room" is required in the process of outpatient consultation. However, the patient will need to go to another room for dressing change after the doctor checks the wound if sticking to the conventional layout of current wound repair specialist outpatient clinic in hospitals and following the regulation of "separation of diagnosis and treatment". To allow a patient walking back and forth with the exposed wounds to different clinics or going to another clinic for dressing change with the original dressing reapplied to the wound is against the regulation of nosocomial infection control and the principle of sterility. To ensure that the layout of the outpatient clinic in the wound repair outpatient department not only conforms to the principle of "one person, one diagnosis, and one room", but also meets the characteristics of the diagnosis and treatment process of chronic wounds, this paper proposes the layout of "large space and small partition" in the wound repair clinic.


Assuntos
Instituições de Assistência Ambulatorial , Bandagens , Humanos , Encaminhamento e Consulta , Infecção da Ferida Cirúrgica
8.
Trials ; 22(1): 471, 2021 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-34289893

RESUMO

BACKGROUND: Surgical site infection is the most common complication of abdominal surgery, with a global impact on patients and health systems. There are no tools to identify wound infection that are validated for use in the global setting. The overall aim of the study described in this protocol is to evaluate the feasibility and validity of a remote, digital pathway for wound assessment after hospital discharge for patients in low- and middle-income countries (LMICs). METHODS: A multi-centre, international, mixed-methods study within a trial, conducted in two stages (TALON-1 and TALON-2). TALON-1 will adapt and translate a universal reporter outcome measurement tool (Bluebelle Wound Healing Questionnaire, WHQ) for use in global surgical research (SWAT store registration: 126) that can be delivered over the telephone. TALON-2 will evaluate a remote wound assessment pathway (including trial retention) and validate the diagnostic accuracy of this adapted WHQ through a prospective cohort study embedded within two global surgery trials. Embedded community engagement and involvement activities will be used to optimise delivery and ensure culturally attuned conduct. TALON-1 and TALON-2 are designed and will be reported in accordance with best practice guidelines for adaptation and validation of outcome measures, and diagnostic test accuracy studies. DISCUSSION: Methods to identify surgical site infection after surgery for patients after hospital discharge have the potential to improve patient safety, trial retention, and research efficiency. TALON represents a large, pragmatic, international study co-designed and delivered with LMIC researchers and patients to address an important research gap in global surgery trial methodology.


Assuntos
Países em Desenvolvimento , Infecção da Ferida Cirúrgica , Estudos de Viabilidade , Humanos , Estudos Prospectivos , Infecção da Ferida Cirúrgica/diagnóstico , Inquéritos e Questionários , Telefone , Cicatrização
9.
BMC Infect Dis ; 21(1): 670, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34243725

RESUMO

OBJECTIVES: An estimated 1% of endovascular aneurysm repair (EVAR) devices become infected, carrying a high mortality rate. Surgical explantation is recommended and prognosis is guarded. This retrospective cohort analysis focuses on the role of outpatient parenteral antimicrobial therapy (OPAT) in the management of aortic vascular graft infections following EVAR. METHODS: Patients who received OPAT for aortic graft infections (AGI) following EVAR from 2014 to 2018 inclusive were identified using the OPAT database. Clinical, microbiological and radiological data were collected. Survivors were followed up for a median of 36 months (range 25-60) after first presentation with infection. Outcomes were assessed. RESULTS: Eleven cases with 20 OPAT episodes were identified: 10/11 male, median age 76 (IQR 71-81). Median time to presentation was 7 months (range 0-81 months) after EVAR. OPAT lead to a 55% reduction in length of hospital stay. One patient had graft explantation; four others had temporising measures. Eight of 11 were alive a median of 36 months after presentation with infection, having had a median of 2 re-treatments on OPAT (range 1-3). Seven of the eight survivors were on continuous suppressive oral antimicrobials; three were also intermittently on intravenous antibiotics for flares of infection. Patient/ infection outcomes were cure (1/11), improved (7/11), failure (3/11). CONCLUSION: AGI following EVAR usually presents in the first year after graft deployment. OPAT has an important peri-operative role in patients suitable for curative surgery. OPAT followed by oral suppressive antimicrobial therapy can be a feasible long-term treatment for non-curative management of AGI. Survival in our cohort was longer than expected, and OPAT was feasible despite the complexity of these infections. OPAT can avoid multiple and lengthy hospital admissions and maximise time at home and quality of life in this cohort with life-limiting infection.


Assuntos
Anti-Infecciosos/uso terapêutico , Infecção da Ferida Cirúrgica/tratamento farmacológico , Enxerto Vascular/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/cirurgia , Estudos de Coortes , Feminino , Humanos , Infusões Parenterais , Tempo de Internação , Masculino , Pacientes Ambulatoriais , Qualidade de Vida , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/etiologia
10.
Medicine (Baltimore) ; 100(25): e26393, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160421

RESUMO

ABSTRACT: Rhinoplasty in children has raised concerns about its safety in the pediatric population. There is scarcity of evidence describing outcomes and surgical techniques performed in pediatric rhinoplasty. We analyzed post-operative complications and cartilage preferences between plastic surgeons and otolaryngologists.Data was collected through the Pediatric National Surgical Improvement Program from 2012 to 2017. Current Procedure Terminology codes were used for data extraction. Patients were grouped according to type of rhinoplasty procedures (primary, secondary, and cleft rhinoplasty). A comparison between plastic surgeons and otolaryngologists was made in each group in terms of postoperative complications. Additionally, a sub-group analysis based on cartilage graft preferences was performed.During the study period, a total of 1839 patients underwent rhinoplasty procedures; plastic surgeons performed 1438 (78.2%) cases and otolaryngologists performed 401 (21.8%) cases. After analyzing each group, no significant differences were noted in terms of wound dehiscence, surgical site infection, readmission, or reoperation. Subgroup analysis revealed that plastic surgeons prefer using rib and ear cartilage, while otolaryngologists prefer septal and ear cartilage.The analysis of 1839 pediatric patients undergoing three types of rhinoplasty procedures showed similar postoperative outcomes, but different cartilage graft utilization between plastic surgeons and otolaryngologists.


Assuntos
Rinoplastia/efeitos adversos , Deiscência da Ferida Operatória/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Adolescente , Criança , Pré-Escolar , Cartilagem Costal/transplante , Cartilagem da Orelha/transplante , Feminino , Humanos , Lactente , Masculino , Cartilagens Nasais/transplante , Otorrinolaringologistas/estatística & dados numéricos , Otolaringologia/métodos , Otolaringologia/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Rinoplastia/métodos , Rinoplastia/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Cirurgia Plástica/métodos , Cirurgia Plástica/estatística & dados numéricos , Deiscência da Ferida Operatória/etiologia , Infecção da Ferida Cirúrgica/etiologia , Resultado do Tratamento
11.
West Afr J Med ; 38(6): 566-570, 2021 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-34180209

RESUMO

BACKGROUND: The role of prophylactic antibiotics in mesh repair of inguinal hernia is controversial and often based on institutional policies. Surgical site infection rate from earlier studies in Nigeria justifies the continued use of prophylactic antibiotics during hernia repair. With increased use of antibiotics comes the challenge of antibiotic resistance and toxicity. The use of antimicrobial coated suture may help avoid these challenges but its efficacy needs to be tested. OBJECTIVE: To compare Triclosan coated suture with intravenous antibiotics for the repair of inguinal hernia with mesh. METHODS: Patients with uncomplicated inguinal hernia undergoing mesh repair were randomized to either have intravenous antibiotics administered for prophylaxis or to have wound closure with Triclosan coated Vicryl 2/0 suture. Post operatively, wound infection rates were compared between the two groups. Follow up was for 1 year. RESULTS: We studied 49 patients with 59 hernias with a mean age of 53 years. Hernias were solitary in 75% of cases, the majority of which were right sided, while 25% were bilateral. There were 25 patients with 32 hernias in the Intravenous antibiotic group (Group A) and 24 patients with 27 hernias in the Triclosan suture group (Group B). Wound grades were similar between the two groups with one patient in the Triclosan group confirmed to have wound infection (4.2%) and none in the Intravenous antibiotics group (p=0.27). Wound infection was of the superficial type which resolved with wound care within 1 month. CONCLUSION: Triclosan coated suture may be safely used as an alternative to intravenous antibiotics for the mesh repair of inguinal hernia. Further studies are required to validate this finding.


Assuntos
Hérnia Inguinal , Triclosan , Antibioticoprofilaxia , Humanos , Pessoa de Meia-Idade , Nigéria , Projetos Piloto , Telas Cirúrgicas , Infecção da Ferida Cirúrgica , Suturas
12.
Rev Bras Ginecol Obstet ; 43(5): 374-376, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34182581

RESUMO

OBJECTIVE: To analyze effects of the COVID-19 pandemic on the consumption of personal protective equipment and products (PPEP), as well as the frequency of surgical site infection (SSI) among non-COVID-19 patients submitted to cesarean sections. METHODS: A retrospective study was conducted in a maternity unity of a public teaching hospital which was not part of the reference service for COVID-19 treatment. It compared PPEP consumption and the occurrence of SSI after cesarean sections in monthly periods before and after the occurrence of the first case of COVID-19 in Porto Alegre, state of Rio Grande do Sul, Brazil. Personal protective equipment and products consumption was measured as units of masks, gloves, gowns, and caps, and use of alcohol-based products or soap for hand sanitation as ml/patient/day. The SSI index was calculated as the proportion of cases of SSI over the number of cesarean sections performed monthly during the study period. RESULTS: There was an increase in all measured items of PPEP, with consumption of disposable masks with a median of 1,450 units in the pre-COVID period, and of 2550 in the post-COVID period (a 75.9% increase). A decrease of 49% in SSI was detected, with a median of 1.74 in the pre-COVID period and of 0.89 in the post-COVID period. CONCLUSION: The increase in consumption of PPEP could be a result of safer practices adopted by healthcare workers with the advent of COVID-19, of which the following reduction in the occurrence of SSI could be a direct consequence. Despite the severity of the crisis, one could state that extreme situations can lead to valuable reflections and opportunities for improvement.


Assuntos
COVID-19 , Cesárea , Higienizadores de Mão , Equipamento de Proteção Individual/estatística & dados numéricos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle , COVID-19/prevenção & controle , Feminino , Pessoal de Saúde , Humanos , Gravidez , Estudos Retrospectivos
13.
BMJ Open ; 11(6): e051374, 2021 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-34135056

RESUMO

INTRODUCTION: Surgical site infection (SSI) is one of the most common complications after gastrointestinal surgery, with a reported incidence of approximately 10%-25%, which is higher than the rates after other types of surgery. Intraoperative wound irrigation (IOWI) is a simple intervention for SSI prevention, and recent studies have reported that IOWI with aqueous povidone-iodine (PVP-I) is significantly more effective at reducing the incidence of SSI than saline. However, the evidence level of previous trials evaluating the efficacy of aqueous PVP-I solution for preventing SSI has been low. METHODS AND ANALYSES: We propose a single-institute, prospective, randomised, blinded-endpoint trial to assess the superiority of IOWI with aqueous 10% PVP-I solution compared with normal saline for reducing SSI in clean-contaminated wounds after elective gastrointestinal surgery. In the study group, IOWI with 40 mL of aqueous 10% PVP-I solution is performed for 1 min before skin suture, and in the control group, IOWI with 100 mL of saline is performed for 1 min before skin suture. We hypothesise that IOWI with aqueous 10% PVP-I solution will achieve a 50% reduction in the incidence of SSIs. The target number of cases is set at 950. The primary outcome is the incidence of incisional SSI up to postoperative day 30 and will be analysed in the modified intention-to-treat set. ETHICS AND DISSEMINATION: This trial was designed and is being conducted by Saitama Medical Center, Jichi Medical University, with approval from the Bioethics Committee for Clinical Research, Saitama Medical Center, Jichi Medical University. Participant recruitment began in June 2019. The final results will be reported in international peer-reviewed journals immediately after trial completion. TRIAL REGISTRATION NUMBER: UMIN000036889.


Assuntos
Anti-Infecciosos Locais , Procedimentos Cirúrgicos do Sistema Digestório , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Humanos , Povidona-Iodo , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Solução Salina , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle
14.
Wiad Lek ; 74(4): 934-939, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34156007

RESUMO

OBJECTIVE: The aim: To obtain the first national estimates of the current prevalence rate of SSI after CSEC and antimicrobial resistance of causing pathogens in Ukraine. PATIENTS AND METHODS: Materials and methods: We performed a retrospective multhicentre cogort study based surveillance data was conducted from May 2017 to December 2019. The study population consisted of all women who had a cesarean section in 11 regional women hospitals of Ukraine. Definitions of SSI after cesarean section were used from the CDC/ NHSN. RESULTS: Results: A total of 2 326 CSEC operations and 14.7% SSI were identified within 30 days of the operation. Of these, 44.4% were superficial incisional SSI, 28.9% were deep incisional SSI, and 26.6% were organ/space SSI, 25.7% of which were classed as endometritis. Of all cases 70.5% of infections were detected post discharge. The most commonly identifed pathogen were Staphylococcus aureus (23.5%), Escherichiacoli (20%), Coagulase-negative staphylococci (8.1%), Enterococcus spp. (7.7%), Pseudomonasaeruginosa (7.7%), Enterobacter spp. (6.4%), and Streptococcus spp. (5.6%). The overall proportion of extended spectrum beta-lactamase (ESBL) production among Enterobacteriaceae was 18.3% and of methicillin-resistance in S. aureus(MRSA) 13.9%. Resistance to third-generation cephalosporins was observed in 15.2% E.coli and 7.9% Klebsiellapneumoniae isolates. Carbapenem resistance was identified in 7.3% of P.aeruginosa isolates. CONCLUSION: Conclusions: The results of this study revealed high rates of SSI after CSEC and most causing pathogens were associated with resistant to antibiotic stranis. This knowledge is essential to develop targeted strategies to surveillance and reduce the incidence of postoperative infections.


Assuntos
Staphylococcus aureus , Infecção da Ferida Cirúrgica , Assistência ao Convalescente , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Cesárea/efeitos adversos , Farmacorresistência Bacteriana , Feminino , Humanos , Alta do Paciente , Gravidez , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Ucrânia
15.
Artigo em Inglês | MEDLINE | ID: mdl-34070095

RESUMO

INTRODUCTION: WHO core components of healthcare-associated infections (HAIs) prevention and control include their surveillance system. In Poland, there are no widespread multi-center infection surveillance networks based on continuous, targeted, active methodology. One of the most important form of HAIs are surgical site infections (SSIs). The aim of this study was to analyze the incidence of SSIs, in the context of seasonal differentiation. Seasonal differentiation could be connected with weather conditions, but it also can be affected by personnel absence due to holidays and furlough. The second aspect may influence organization of work and increased absenteeism may contribute to lowering the quality of patient care. Healthcare associated infections are the phenomenon which can be especially affected by such factors. METHODS: The data used originate from the targeted, active surveillance reports obtained from the six years period, based on the ECDC recommendations. RESULTS: Highest incidence rates of SSIs were found after operations performed in June and August, equal to 1.8% and 1.5% respectively and the lowest in October was 0.8%. These differences were statistically significant: for June incidence: OR 1.6, 95% CI 1.03-2.5, p = 0.015. Another approach showed a significant difference between the level of incidence in the period from November to January together with from June to August (1.35%), comparing to the rest of the year (1.05%). Also the rates of enterococcal and Enterobacterales infections were significantly higher for the period comprising months from November till January and from June to August. In Poland these are periods of increased number of absences associated with summer, national and religious holidays. CONCLUSIONS: Our results show that the short-term surveillance data limited to several days or months are not sufficient to obtain a valuable description of the epidemiological situation due to HAI. Efforts should be undertaken in order to implement wide net of hospital acquired infections, including SSI on the country level.


Assuntos
Infecção Hospitalar , Infecção da Ferida Cirúrgica , Infecção Hospitalar/epidemiologia , Humanos , Incidência , Controle de Infecções , Polônia/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia
16.
Spine (Phila Pa 1976) ; 46(14): 923-930, 2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-34160370

RESUMO

STUDY DESIGN: Retrospective study using prospectively collected data. OBJECTIVE: This study aimed to investigate the effect of alternative antimicrobial prophylaxis agents on surgical site infections (SSIs) after spine surgery. SUMMARY OF BACKGROUND DATA: Although the use of alternative antimicrobial prophylaxis agents might have a negative effect on SSI prevention, their association with SSI risk in spine surgery remains unclear. METHODS: We used the registry data of consecutive patients undergoing spine surgery from April 2017 to January 2020 in four institutions participating in the University of Tokyo Spine Group. Before March 2019, all institutions used cefazolin for antimicrobial prophylaxis. After March 2019, the institutions used broad-spectrum beta-lactam agents as an alternative due to a cefazolin shortage in Japan. RESULTS: Among the 3841 enrolled patients (2289 males), 2024 received cefazolin and 1117 received alternative agents. The risk of reoperation for deep SSI within 30 days of spine surgery was significantly higher in the alternative antimicrobial prophylaxis agent group (adjusted odds ratio [aOR] 1.96; 95% confidence interval [CI], 1.15-3.35; P = 0.014). In subgroup analyses, the SSI risk was significantly higher in the thoracolumbar surgery group (aOR 1.98; 95% CI, 1.06-3.73; P = 0.03). A nonsignificant consistent trend was found in all other subgroups: posterior decompression (aOR 1.91; 95% CI, 0.86-4.21; P = 0.11); posterior fixation (aOR 2.05; 95% CI, 0.99-4.24; P = 0.05); and cervical spine surgery (aOR 2.30; 95% CI, 0.82-6.46; P = 0.11). CONCLUSION: Alternative antimicrobial prophylaxis agents increased the risk of reoperation for SSI after spine surgery compared with cefazolin. Our study supports the current practice of using first-generation cephalosporins as first-line antimicrobial prophylaxis agents in spine surgery as recommended in multiple guidelines.Level of Evidence: 3.


Assuntos
Antibacterianos/provisão & distribuição , Cefazolina/provisão & distribuição , Coluna Vertebral/cirurgia , Infecção da Ferida Cirúrgica , Antibacterianos/uso terapêutico , Antibioticoprofilaxia/estatística & dados numéricos , Cefazolina/uso terapêutico , Humanos , Japão , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/epidemiologia
17.
J Wound Care ; 30(6): 449-453, 2021 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-34121434

RESUMO

The use of negative pressure wound therapy (NPWT) in surgical wound healing by secondary intention is well known. Its use in healing dehisced vascular bypass wounds is contraindicated by manufacturers due to exposed vasculature and risk of bleeding. There is an increasing body of knowledge to support the use of NPWT in vascular wounds in order to prevent graft excision and the need for flap closure. This paper reports the use of two different approaches using NPWT to heal dehisced, infected vascular groin bypass wounds in two patients. Both patients had lower limb bypass using Dacron (Vascutek Ltd., UK) grafts and subsequently became infected, dehisced and required debridement. Following debridement, graft was visible in the wound bed and NPWT was applied to facilitate healing. Case one had polyurethane (black) foam and a layer of petroleum-impregnated cellulose acetate mesh to prevent adherence to the graft. Case two had polyvinyl alcohol (white) (PVA) foam applied to the wound. The PVA foam was used in Case two due to pain at dressing changes. Negative pressure was initially -25mmHg but increased gradually to -125mmHg and -150mmHg, respectively, the therapeutic pressure for the respective foams. Dressings were changed every 48-72 hours and infection treated with antibiotics as appropriate. After eight days and 28 days of NPWT, respectively, graft was no longer visible. No significant bleeding was noted. These two case studies would suggest that, with precautions taken to protect the vasculature, the use of NPWT in healing dehisced vascular groin wounds is an appropriate treatment.


Assuntos
Tratamento de Ferimentos com Pressão Negativa , Infecção da Ferida Cirúrgica/terapia , Cicatrização , Idoso , Bandagens , Feminino , Humanos , Masculino , Transplante de Pele , Resultado do Tratamento
18.
J Wound Care ; 30(6): 476-481, 2021 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-34121438

RESUMO

OBJECTIVE: A surgical approach to the treatment of spinal defects and disorders has become more common because of the medical and technological advancements achieved in the last decade. This rising trend in spinal surgeries is associated with adverse events, most notably wound complications. From its introduction, negative pressure wound therapy (NPWT) has proved to be essential in the management of complex wounds and in speeding up wound recovery. The aim of this study is to investigate the use of incisional NPWT in patients undergoing spinal surgery and its role in the prevention of wound complications. METHOD: This study is a retrospective medical chart review conducted on patients who underwent spinal surgery and received incisional vacuum therapy as part of their treatment. The apparatus was applied intraoperatively following the spinal surgery for all patients included in this study. All surgical procedures were conducted between September 2019 and May 2020. Data entry and analysis were performed between September and October 2020. RESULTS: A total of five patients' records were reviewed. In our healthcare centre, three patients developed seroma, one developed haematoma, four required revision surgery and one patient required re-operation. There was no wound dehiscence and none of the wounds became infected. Mean length of hospital stay was 11.2 days (standard deviation (SD): 9.5 days) and mean operation time was 333 minutes (SD: 86.4 minutes). CONCLUSION: There is a scarcity of data on the role of incisional vacuum therapy in the prevention of wound complications associated with spine surgeries. Our study showed promising results for the use of incisional NPWT in the management of spinal wounds. Further research is required in order to enhance wound care by exploiting this potentially beneficial approach.


Assuntos
Tratamento de Ferimentos com Pressão Negativa , Coluna Vertebral/cirurgia , Infecção da Ferida Cirúrgica/terapia , Cicatrização , Adulto , Idoso , Feminino , Hematoma , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Seroma , Deiscência da Ferida Operatória , Infecção da Ferida Cirúrgica/prevenção & controle , Resultado do Tratamento
19.
J Ayub Med Coll Abbottabad ; 33(2): 311-314, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34137551

RESUMO

BACKGROUND: Laparoscopy is considered to be a good diagnostic and surgical way to replace open surgeries in all surgical fields. As it is a least invasive method, with advantages for patients and all associated with medical care. There is a significant increase in the use of laparoscopic surgery in gynecology. This study was done to compare the frequency of operative complications of direct trocar access versus Veress needle insertion technique for initial peritoneal entry in patients undergoing gynecological laparoscopic surgery. METHODS: This Randomized Controlled Trial was conducted at the Department of Obstetrics & Gynecology, Lahore General Hospital, Lahore from 26-12-2019 to 25-6-2020. Four hundred consecutive patients were enrolled and divided randomly into two groups by blocked randomization. Direct trocar insertion (DTI) technique was used for initial peritoneal access in group A and Veress needle (VNI) was inserted first for peritoneal access in group B. RESULTS: The mean age of the patients in DTI group was 35.76±8.38 years whereas that in VNI group was 35.85±8.38 years. In DTI group there were 8(4%) patients with extra-peritoneal insufflation and in VNI group there were 19(9.5%) patients with extra-peritoneal insufflation. There were 8(4%) patients in DTI group with Omental injury and VNI group there were 13(6.5%) patients with Omental injury. In DTI group there were 7(3.5%) patients with port-site infection compared to 15(7.5%) in VNI group. CONCLUSIONS: According to findings the rate of complications observed with VNI, DTI can be a preferred procedure for gynecological surgeries.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Laparoscopia/métodos , Agulhas , Peritônio/cirurgia , Instrumentos Cirúrgicos , Adulto , Feminino , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia/instrumentação , Hospitais Gerais , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/instrumentação , Omento/lesões , Complicações Pós-Operatórias , Infecção da Ferida Cirúrgica/etiologia
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