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At least 73 records · Page 4Linked to original sources
PubMed2003

Antiseptic wound ventilation with a gas diffuser: a new intraoperative method to prevent surgical wound infection?

Postoperative wound infections are often a result of peri-operative contamination by Staphylococcus aureus. With a new insufflation device, a gas diffuser, it has become possible to establish a local micro-environment of almost 100% carbon dioxide in an open surgical wound. The device enables ventilation of the wound with an antiseptic agent, which in gaseous form can be delivered as a low uniform dose to all parts of the wound. The use of carbon dioxide (CO2) as a carrier gas eliminates possible inflammability of an antiseptic agent and helps to concentrate it to the site of interest by gravity. Using the above delivery system we have demonstrated the antibacterial effect of gaseous ethanol on S. aureus inoculated on sterile filter disks and blood agar plates, respectively. Ethanol is a very potent antiseptic agent with known properties, which makes it suitable for testing the maximal decontamination level. On filter disks, CO2 carrying vapour from a 95% ethanol solution decreased the number of colony-forming units after 5 min of exposure (P=0.04), and killed all bacteria within 10-15 min (P<0.001). In the presence of organic material, i.e. on exposed blood agar plates, the colony size decreased with exposure time, and no colonies were detected after 60 min of exposure (P<0.001). Antiseptic gas derived from 70% ethanol solution was less effective than that from 95% ethanol (P<0.001). CO2 humidified with water did not have a significant effect on number or size of the colonies. Our findings suggest that intraoperative wound antisepsis with a gas mixture of CO2 and an antiseptic agent delivered with a gas diffuser, may be a simple method to reduce the risk of postoperative wound infection.

Administration, Cutaneous↗
PubMed1983

[Topical use of antibiotics for preventing wound infection in general surgery].

A group of 463 general surgery patients received topical applications of lincomycin and gentamycin, which significantly reduced the incidence of infected wounds compared to the untreated control group. This confirmed the prophylactic efficacy of topical antibiotic treatment which is also less dangerous than parenteral administration.

Administration, Topical↗
PubMed1987

The impact of postdischarge infection on surgical wound infection rates.

We undertook a study of postdischarge infections to assess the reliability of a surgical wound surveillance program in a 930-bed teaching hospital. During a six-month period, a subset of operations performed each day was randomly selected and patients interviewed by telephone one month postsurgery using a standard set of questions. The infection rate for all patients contacted directly postdischarge was 5.4%, whereas the surgical wound infection rate determined for all procedures through the standard hospital program was 1.5%. For day-surgery patients, who are not routinely followed in the hospital surveillance program, 8 (7.8%) of 103 patients contacted had infection. Thus, the overall surgical infection rate determined in this study was over three times higher than that calculated using standard surveillance. A reliable method for identifying postdischarge wound infections is necessary to ensure accurate surgical wound infection rates.

Follow-Up Studies↗
PubMed1993

Sternal wound infections.

Sternal wound infections are a major cause of morbidity and mortality in patients undergoing cardiac surgery. They occur in 1% to 3% of patients who undergo open-heart surgery and carry a 20% to 40% mortality rate. Sternal infections can range from minor, superficial infections to open mediastinitis with invasion of the sternum, heart, and great vessels. Staphylococcus species are responsible for the majority of sternal infections, but environmental sources can cause infections by other organisms. The common signs and symptoms of mediastinitis are fever, leukocytosis, sternal instability, drainage, and pain. Several risk factors exist for sternal wound infection, with bilateral internal mammary artery bypass grafting in diabetic patients being the most common. Treatment entails surgical debridement with either closed irrigation, open-wound packing, or muscle or omental flap procedures, as well as antibiotic therapy. Some simple procedures help limit the development of sternal infections in certain patients.

Combined Modality Therapy↗
PubMed1992

The use of the Body Mass Index in studies of abdominal wound infection.

Abdominal wound infection rates were significantly related to obesity, as measured by Body Mass Index, in two large clinical trials of prophylactic antibiotics in at-risk abdominal surgery. Obesity is a risk factor that should be taken into account in any study in which wound infection is an outcome measure.

Abdomen↗
PubMed1985

Treatment of wound infections.

Postoperative wound infections and infections linked to various traumatic and thermal injuries all contribute to patient morbidity and mortality, as well as to increased hospital costs. Standard practices of wound management include debridement of devitalized tissue, drainage, irrigation, and loose packing of the open wound. Antibiotics are usually effective as adjuncts to these procedures and to host resistance. Their choice, whenever possible, should be based on cultures of fresh pus (anaerobes must be obtained by airless syringe) to select an agent active against implicated pathogens. In rapidly developing infections, the choice must often be based on known probabilities until culture results are available. Specific management techniques are indicated for postoperative wounds, where brief prophylactic treatment may be needed. Traumatic wounds may require combination antibiotic therapy, and possible lack of immunity to tetanus should be considered. Most burn wound infections tend to be nosocomial; topical antiseptic agents often control burn infections while preventing the emergence of resistant bacteria.

Anti-Bacterial Agents↗
PubMed1988

Antibody response to outer-membrane antigens of Pseudomonas aeruginosa in human burn wound infection.

There is little information about the local and systemic antibody response to surface antigens of bacteria growing in situ in infected lesions in man. In this study, Pseudomonas aeruginosa was obtained directly from the infected wounds of two patients with burns and studied without subculture. Outer-membrane proteins (OMPs) were investigated and compared with those of cells cultivated in the laboratory, with the aim of selecting defined growth conditions to give surface antigens more closely resembling those found in vivo. Several high-mol. wt (77,000-101,000) proteins were expressed in the outer membranes of the bacteria from the patients and could be phenotypically induced by cultivating the same isolate in iron-depleted conditions in vitro. Other major OMPs (D, E, F, G and H) were also observed in cells taken from the lesions. Immunoblotting demonstrated that proteins D and E were recognised by different classes of immunoglobulins in the sera of both patients as was flagellar antigen present in the outer-membrane preparation of the P. aeruginosa from patient 1. Iron-regulated membrane proteins (IRMPs) were similarly detected, but more strongly by IgM from patient 1. Furthermore, a marked antibody response to IRMPs was noted at the site of infection. Bands of a similar intensity were seen after absorption of the sera with lipopolysaccharide (LPS) purified from the infecting strain. This indicated that the response observed was directed against OMPs (including IRMPs) and not against contaminating LPS.

Antibodies, Bacterial↗
PubMed2006

Reduction in wound infection rates by wound surveillance with postdischarge follow-up and feedback.

BACKGROUND: Surgical wound surveillance with postdischarge follow-up is rarely done in the UK as it is seen as expensive. The aim of this study was to determine whether employing a dedicated team was effective and reduced costs. METHODS: Infection data were collected prospectively with postdischarge follow-up at 2-3 months, and fed back to surgeons. Wound infection was defined using both ASEPSIS wound scoring and criteria of the US Centers for Disease Control (CDC) definitions. RESULTS: Over 4 years, 15 548 patient episodes were included. Postdischarge surveillance data were available for 79.9 per cent of the 15 154 records of patients who survived. There was a significant reduction in the rate of wound infection between the first and fourth years by ASEPSIS and CDC definitions: odds ratio 0.77 (95 per cent confidence interval (c.i.) 0.64 to 0.92) and 0.69 (95 per cent c.i. 0.57 to 0.83), respectively. The proportion of infections fell significantly in orthopaedic, cardiac and thoracic surgery. The annual budget for wound surveillance was pound 91,600. Changes in infection rates contributed pound 347,491 to the reduction in cost among the patients surveyed. CONCLUSION: Wound surveillance was associated with a reduction in rates of wound infection within 4 years. The cost reduction as a result of fewer infections exceeded the cost of surveillance after 2 years.

Cost-Benefit Analysis↗
PubMed1990

[Free skin flap for wound infection].

Since 1979, free skin flaps (FSF) have been used for repairing infected wounds in 32 cases with the sequence of 31 cases succeeded and 1 case failed. Among them, 27 cases (84%) were I stage healing and 4 cases (12.5%) were II stage healing. The patients whose infectious surface of wound with exposure of bone, articulation and tendon can not repair with skin grafting or near skin flap were chosen to have this operation. However, the blood vessels in the surface of wound which can be supplied to anastomosis were also necessary. The most important thing for the operation was determination of the opportunity making out the major bacteria infected and debridement entirely. The bigger the blood vessel calibre of FSF selected, the better the surface of wound healing. In this group, 4 cases appeared crisis of blood vessels. Whether it is associated with inflammation of wound is discussed.

Adolescent↗
PubMed1982

[Wound infection and its treatment. In general and abdominal surgery].

The treatment of infected wounds follows the well-known principles of septic surgery: incision, drainage and perhaps irrigation. The prevention of infection is particularly important: a short clinical stay in preparation for the operation, observing the rules of hygiene, and an atraumatic surgical technique. Prophylactic antibiotics are indicated in surgery of the colon. In manifest peritonitis the source of infection must be eliminated. Drainage of the free abdominal cavity as well as intra- and postoperative peritoneal irrigation are of questionable value.

Abdomen↗
PubMed1992

Postoperative wound infections following myocutaneous flap surgery in spinal injury patients.

Severe pressure ulcers in patients with spinal cord injury are frequently treated by using musculocutaneous (m-c) flap surgery. There have been few studies of the use of perioperative antibiotics to prevent postoperative infection in this setting. We reviewed 74 m-c flap surgeries in 53 patients (41 male and 12 female) from October 1989 for one year. The sites involved were ischial (31), sacral (24), trochanteric (18), deltoid (2), olecranon (1) and posterior thigh (1). An antibiotic was usually administered perioperatively for 5 days. Patients were followed for a median of 30 (8-96) weeks. Postoperative infections occurred at a median of 12 (4-25) days in 6 of 74 (8%) surgeries. The organisms cultured from the 6 infected wounds were: Bacteroides sp. (4), Proteus mirabilis (2), E. coli (2), MRSA (2), and others (6--each isolated once). These results indicate that antibiotics did not prevent postoperative infection in approximately 8% of patients undergoing m-c surgery. The frequency of isolation of Bacteroides sp. from these infections suggests that anaerobic bacteria may persist in healing pressure ulcers and perioperative antibiotics might include coverage for anaerobic bacteria.

Adolescent↗
PubMed1991

Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System.

To perform a valid comparison of rates among surgeons, among hospitals, or across time, surgical wound infection (SWI) rates must account for the variation in patients' underlying severity of illness and other important risk factors. From January 1987 through December 1990, 44 National Nosocomial Infections Surveillance System hospitals reported data collected under the detailed option of the surgical patient surveillance component protocol, which includes definitions of eligible patients, operations, and nosocomial infections. Pooled mean SWI rates (number of infections per 100 operations) within each of the categories of the traditional wound classification system were 2.1, 3.3, 6.4, and 7.1, respectively. A risk index was developed to predict a surgical patient's risk of acquiring an SWI. The risk index score, ranging from 0 to 3, is the number of risk factors present among the following: (1) a patient with an American Society of Anesthesiologists preoperative assessment score of 3, 4, or 5, (2) an operation classified as contaminated or dirty-infected, and (3) an operation lasting over T hours, where T depends upon the operative procedure being performed. The SWI rates for patients with scores of 0, 1, 2, and 3 were 1.5, 2.9, 6.8, and 13.0, respectively. The risk index is a significantly better predictor of SWI risk than the traditional wound classification system and performs well across a broad range of operative procedures.

Centers for Disease Control and Prevention, U.S.↗
PubMedDate not supplied

The effects of perioperative hypothermia and the duration of anesthesia on postoperative wound infection rate in clean wounds: a retrospective study.

OBJECTIVE: To determine the effects of hypothermia and duration of anesthesia on the infection rate in clean wounds in dogs and cats. STUDY DESIGN: Retrospective clinical study. SAMPLE POPULATION: Seven hundred seventy-seven dogs and cats undergoing clean surgical procedures. METHODS: Records of animals prospectively evaluated for postoperative wound infection were retrospectively evaluated for the prevalence of perioperative hypothermia. Body temperatures during the perioperative period and the duration of surgery and anesthesia were recorded. Data were analyzed to identify differences between animals with infected and uninfected wounds and multiple logistic regression modeling was used to evaluate the independent contribution of risk factors to the incidence of postoperative wound infection. RESULTS: No statistically significant differences were found in the analysis of temperature data between animals with infected and uninfected wounds. Duration of anesthesia was significantly greater in animals with wound infections (P = .01). Multiple logistic regression modeling identified duration of anesthesia as a risk factor for postoperative wound infection independent of the duration of surgery. CONCLUSIONS: In animals with clean surgical wounds, mild perioperative hypothermia is not a significant risk factor for postoperative wound infection. The duration of anesthesia, however, is a significant risk factor independent of the duration of surgery. CLINICAL RELEVANCE: To decrease the incidence of postoperative wound infection, the duration of anesthesia should be minimized. Surgical time, as well as the time required for ancillary diagnostic tests while under anesthesia should, therefore, be kept to a reasonable minimum.

Anesthesia↗
PubMed1986

[Bacterial evaluation of wound infections].

Collected wound samples were received by Hospital Microbiology Laboratory were examined for bacterial isolation, their antibiotic susceptibility and distribution in terms of clinical departments were determined. S. aureus was found to be the major causative agent with the ratio of % 38.92. Wound infections were frequently encountered in the Pediatric department (% 43.83) and the isolated strains were found to be highly resistant to the most of the antibiotics.

Anti-Bacterial Agents↗
PubMed2006

The role of hyperbaric oxygen therapy in the treatment of sternal wound infection.

Sternal wound dehiscence and infection are major problems for patients and health care providers. A range of risk factors, including diabetes, obesity and internal thoracic artery harvest, has been implicated. Several pathophysiological mechanisms, which may account for the development of infection, have been proposed. There is a growing body of evidence which suggests that sternal ischaemia may play a significant role in the initiation of wound infection, and that this may be exacerbated by harvest of the internal thoracic artery. Current treatments for infection include wound debridement, irrigation and tissue flap reconstruction. In addition, several novel therapies such as negative pressure dressings have been shown to be safe and useful. Hyperbaric oxygen therapy - the administration of 100% oxygen at pressures greater than atmospheric pressure - is widely used in the treatment of various chronic wounds. The mechanism whereby hyperbaric oxygen exerts its effects is being elucidated and there is a growing body of clinical evidence that supports its use. It has been suggested that there may be a role for hyperbaric oxygen therapy in the treatment of sternal infection. The theoretical mechanisms would seem plausible, but at present there is only limited evidence to support its use. This review addresses the theory and evidence supporting the role of hyperbaric oxygen therapy in the treatment of sternal wound infection.

Humans↗
PubMedDate not supplied

Epidemiologic evaluation of postoperative wound infection in clean-contaminated wounds: A retrospective study of 239 dogs and cats.

OBJECTIVE: To evaluate risk factors for development of postoperative wound infections in clean-contaminated wounds. STUDY DESIGN: Retrospective clinical study. SAMPLE POPULATION: Two hundred thirty-nine dogs and cats that had clean-contaminated surgical procedures. METHODS: Records of animals that had a clean-contaminated surgical procedure and were prospectively monitored for development of postoperative wound infection were reviewed. Prospective data included signalment, nutritional status, body weight, duration of surgery, surgical procedures, wound classification, surgical site clip time before surgery, hypotension during surgery, the presence of an active distant infection, endocrinopathy, administration of an immunosuppressive agent, administration of antibiotics, and the type of antibiotic used. Additional retrieved data included total anesthesia time, temperature variables, blood loss, and suture material used. RESULTS: Intact males (P =.008) and animals with concurrent endocrinopathy (P =.008) were at a higher risk of development of postoperative wound infection. Total surgery time (P =.02) and total anesthesia time (P =.04) were longer in animals that developed postoperative wound infection. No other factors were statistically significant. CONCLUSIONS: Intact males and animals with a concurrent endocrinopathy were at higher risk of postoperative wound infection after clean-contaminated surgical procedures. CLINICAL RELEVANCE: Time under anesthesia and duration of surgery should be minimized to reduce the risk of wound infection in clean-contaminated surgical procedures.

Anesthesia↗
PubMed2003

Assessing and controlling wound infection.

Quantitatively, wounds harboring bacteria that exceed 105 colony-forming units per gram are considered infected wounds. There are acute wounds and chronic wounds, and the approach to controlling the infection is similar. Although the granulating bed may be avascular, systemic anti-infectives are employed adjunctively to circumvent systemic infection. The main armamentarium of the attack is the use of topical anti-infectives, which invade the bacteria where they reside, and, consequently, reduce their numbers and promote wound healing.

Chronic Disease↗