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PubMed1978

Prevention of surgical wound infection.

Operative wound infection is examined through classifications based on estimation of frequency, severity, and sources of infection. These classifications help in identifying preventive and corrective measures. All surgeons are concerned with postoperative infection because it can convert a superior technical result into a disaster. The analysis of postoperative infection is complicated by the complex and constantly changing relations among host, challenging microbe, and the existing antimicrobial measures. The effect of physical, pharmacologic, and biological variables is estimated with emphasis on measures that promise further control of infection in the surgical patient. Proposals are offered for further efforts in controlling this hazard.

Anti-Bacterial Agents↗
PubMed1999

Contrast media radiography in patients with retrosternal irrigation drainage for severe sternal wound infection.

Severe wound infection after open-heart surgery is a potentially life-threatening complication, which is mostly treated by re-operation with debridement, and insertion of closed irrigation drainage. Until now there is no consensus about the appropriate duration of irrigation therapy. Since the retrosternal irrigation cavity is likely to become continually smaller as the infection heals, this study was intended to answer the question, as to whether this process can be made visible by the use of contrast media radiography, and whether this information could be used to determine when an irrigation therapy can safely be discontinued. In 1997, 34 patients suffered from sternal wound healing disturbances which required re-operation at our institution (incidence = 0.97%). During the re-operation, a closed retrosternal irrigation drainage was inserted. Of the 34 patients contrast media radiography examinations were carried out on the first, 4th and 12th postoperative day (POD), which consisted of an antero-posterior x-ray of the chest after contrast media injection through each inlet tube. At POD 4 and 12 in the majority of cases, the retrosternal irrigation cavity became smaller when compared with the previous x-ray examination. Only in three of the non-survivors there was a huge irrigation cavity visible at the 12th POD, which sometimes even included the pleural cavity. We conclude that in patients with mediastinitis treated by insertion of a closed irrigation drainage, the retrosternally irrigated cavity seems to become smaller over the therapeutic course of treatment. This process can be visualized by contrast media radiography. Results from this examination should be included in decision making about the best time for discontinuation of the irrigation therapy.

Anti-Infective Agents, Local↗
PubMed1963

Studies on the local treatment of rabies-infected wounds.

Local treatment of wounds infected with rabies virus is a valuable adjunct to the use of antiserum, vaccine or both in preventing disease. In the absence of effective chemotherapeutic agents for systemic use, improved treatment awaits a better understanding of the fate of virus at the site of exposure and of the method of spread to the central nervous system.The studies on experimental animals reported in this paper serve further to evaluate methodology in treatment; to evaluate the effectiveness of various substances, including antirabies serum, soap and benzalkonium chloride; and to explore the possible role of blocking agents in preventing rabies. The results obtained provide further evidence of the importance of first-aid procedures. Certain oil-based local anaesthetics, almond oil, benzyl alcohol and benzalkonium chloride, interfere with motor function and exert a marked sparing effect when inoculated intramuscularly above the site of infection; aqueous or saline-based local anaesthetics and saline do not interfere and fail to protect. The role of blocking agents, if any, in preventing rabies in man is unknown.

Ammonium Compounds↗
PubMed1994

[Introduction of an infection registration program for surgical wound infection based on the WHOCARE software of WHO].

Surveillance of surgical wound-infection (SWI) is an important instrument in the internal and external quality control in surgery. In the past it has been shown that statistics on surgical wound infection are helpful for reduction of wound infection rates. With the engagement of nurses for clinical hygiene at our hospital we had the possibility to evaluate programs for surveillance of nosocomial infection. In a pilot study we began with the surveillance of SWI. The set of data registered was defined by WHOCARE, the software-package used in the study which is distributed by the WHO Europe. Criteria of the NNIS-Study for SWI were applied. Between March and December 1992 approximately 1.300 surgical interventions had been registered. Although the dataset in WHOCARE is limited with regard to an easy surveillance, it was possible to find out infection rates dependent on all major parameters. Additionally reports on individual infection rates and tables containing information of infected cases were sent to every surgeon. By analyzing some of the problems detected during the study, we developed an improved protocol for routine surveillance of SWI. In the future it will save time and will allow the best quality of collected data in narrow collaboration between the departments of microbiology, clinical hygiene and surgery. This protocol should be transferable to other hospitals and represents an anticipated precautious measure with regard to legal regulations on quality control in medicine.

Cross Infection↗
PubMed2002

Control of wound infections using a bilayer chitosan wound dressing with sustainable antibiotic delivery.

A novel bilayer chitosan membrane was prepared by a combined wet/dry phase inversion method and evaluated as a wound dressing. This new type of bilayer chitosan wound dressing, consisting of a dense upper layer (skin layer) and a sponge-like lower layer (sublayer), is very suitable for use as a topical delivery of silver sulfadiazine (AgSD) for the control of wound infections. Physical characterization of the bilayer wound dressing showed that it has excellent oxygen permeability, that it controls the water vapor transmission rate, and that it promotes water uptake capability. AgSD dissolved from bilayer chitosan dressings to release silver and sulfadiazine. The release of sulfadiazine from the bilayer chitosan dressing displayed a burst release on the first day and then tapered off to a much slower release. However, the release of silver from the bilayer chitosan dressing displayed a slow release profile with a sustained increase of silver concentration. The cultures of Pseudomonas aeruginosa and Staphylococcus aureus in agar plates showed effective antimicrobial activity for 1 week. In vivo antibacterial tests confirmed that this wound dressing is effective for long-term inhibition of the growth of Pseudomonas aeruginosa and Staphylococcus aureus at an infected wound site. The results in this study indicate that the AgSD-incorporated bilayer chitosan wound dressing may be a material with potential antibacterial capability for the treatment of infected wounds.

Administration, Topical↗
PubMed1998

Burn wound infections: current status.

The burn wound represents a susceptible site for opportunistic colonization by organisms of endogenous and exogenous origin. Patient factors such as age, extent of injury, and depth of burn in combination with microbial factors such as type and number of organisms, enzyme and toxin production, and motility determine the likelihood of invasive burn wound infection. Burn wound infections can be classified on the basis of the causative organism, the depth of invasion, and the tissue response. Diagnostic procedures and therapy must be based on an understanding of the pathophysiology of the burn wound and the pathogenesis of the various forms of burn wound infection. The time-related changes in the predominant flora of the burn wound from gram-positive to gram-negative recapitulate the history of burn wound infection. Proper clinical and culture surveillance of the burn wound permits early diagnosis of gram-positive cellulitis, and the stable susceptibility of beta-hemolytic streptococci to penicillin has eliminated the threat of this once common burn wound pathogen. Selection and dissemination of intrinsic and acquired resistance mechanisms increase the probability of burn wound colonization by resistant species such as Pseudomonas aeruginosa. Even so, effective topical antimicrobial chemotherapy and early burn wound excision have significantly reduced the overall occurrence of invasive burn wound infections. Individual patients, usually those with extensive burns in whom wound closure is difficult to achieve, may still develop a variety of bacterial and nonbacterial burn wound infections. Consequently, the entirety of the burn wound must be examined on a daily basis by the attending surgeon. Any change in wound appearance, with or without associated clinical changes, should be evaluated by biopsy. Quantitative cultures of the biopsy sample may identify predominant organisms but are not useful for making the diagnosis of invasive burn wound infection. Histologic examination of the biopsy specimen, which permits staging the invasive process, is the only reliable means of differentiating wound colonization from invasive infection. Identification of the histologic changes characteristic of bacterial, fungal, and viral infections facilitates the selection of appropriate therapy. A diagnosis of invasive burn wound infection necessitates change of both local and systemic therapy and, in the case of bacterial and fungal infections, prompt surgical removal of the infected tissue. Even after the wounds of extensively burned patients have healed or been grafted, burn wound impetigo, commonly caused by Staphylococcus aureus, may occur in the form of multifocal, small superficial abscesses that require surgical debridement. Current techniques of burn wound care have significantly reduced the incidence of invasive burn wound infection, altered the organisms causing the infections that do occur, increased the interval between injury and the onset of infection, reduced the mortality associated with infection, decreased the overall incidence of infection in burn patients, and increased burn patient survival.

Adolescent↗
PubMedDate not supplied

The association of propofol usage with postoperative wound infection rate in clean wounds: a retrospective study.

OBJECTIVE: To determine if the use of propofol influences the postoperative infection rate of clean surgical wounds in dogs and cats. STUDY DESIGN: Retrospective study. SAMPLE POPULATION: 863 dogs and cats undergoing clean surgical procedures. METHODS: Medical and anesthetic records of surgical cases used as part of a previously described epidemiologic study on postoperative wound infection rates were reviewed. The records of all animals with clean surgical wounds were reviewed to determine if propofol had been used for anesthetic induction or maintenance during the procedure. To determine the effect of propofol use on wound infection rate, data were analyzed using Fisher's exact test, followed by multiple logistic regression to adjust for various factors, including surgery time, time from clipping to surgery, antibiotic usage, coexisting distant infection, endocrine disease, and the use of immunosuppressive drugs in the perioperative period. RESULTS AND CONCLUSIONS: Of 863 dogs and cats with clean surgical wounds, 46 received propofol as part of the anesthetic protocol. A total of 6 of 46 animals (13%) receiving propofol developed postoperative wound infections, compared with 33 of 817 animals (4%) not receiving propofol (P = .014; % difference = 9%; 95% CI = 0.5% to 24%). Adjusting for all other factors evaluated, animals receiving propofol were 3.8 times more likely to develop postoperative wound infections compared to animals not given propofol (95% CI = 1.5-9.9). CLINICAL IMPLICATIONS: Propofol is a lipid-based emulsion capable of supporting microbial growth. Administration of a potentially contaminated solution may contribute to surgical wound infection or other patient morbidity or mortality. Strict aseptic technique in the preparation of the solution and prompt disposal of unused drug are imperative to curtail the potential for extrinsic contamination.

Anesthetics, Intravenous↗
PubMed1993

Postoperative wound infection after total abdominal hysterectomy: a controlled study of the increased duration of hospital stay and trends in postoperative wound infection.

BACKGROUND: Total abdominal hysterectomy, a common operative procedure, is infrequently accompanied by incisional wound infection. No recent study has examined the excess hospital stay attributable to such infections. METHODS: This historical cohort study of cases and matched controls was performed in a tertiary care university hospital. RESULTS: During the 5-year study period (1985 to 1989), the infection rate was 10.5 per 100 procedures; patients with infection remained hospitalized 3.55 days longer than did matched control patients (p = 0.0025). CONCLUSION: In this era after the introduction of the diagnosis-related groups for reimbursement, incisional wound infection after total abdominal hysterectomy leads to a significant period of extra hospital stay.

Adult↗
PubMed1992

Microbiology of postoperative wound infection: a prospective study of 1770 wounds.

A prospective study of postoperative wound infection was carried out over a 12-month period. Intra-operative swabs from the patients' anterior nares, the opened viscus and parietes were cultured using standard bacteriological techniques. Of the 1770 wounds studied, 167 (9.4%) became infected. Wound infection rates, according to clinical wound types, were clean 5.9%, clean-contaminated 10.7%, contaminated 24.3% and dirty 52.9%. The figures according to microbiological wound types were clean 4.7%, and potentially, lightly and heavily contaminated 15.3%, 22.1% and 30.2% respectively. The commonest causative organisms were Staphylococcus aureus 23.7%, Escherichia coli 16.9%, Staphylococcus epidermidis 13.5% and Pseudomonas aeruginosa 13.0%. When isolated intra-operatively, Enterobacter spp., Proteus spp., Klebsiella spp. and P. aeruginosa appeared to have a high probability of causing postoperative wound infection, but the intra-operative isolation of Bacteroides sp. was a poor predictor of subsequent wound infection.

Adolescent↗
PubMed1996

Sternotomy infection with Mycoplasma hominis: a cause of "culture negative" wound infection.

Wound infections with Mycoplasma species are unusual; diagnosis may be delayed because of the growth characteristics of this organism. We report Mycoplasma hominis infection of sternotomy wounds in two patients. The first presented with fever and drainage from the incision 1 week after coronary artery bypass grafting. The other patient presented with drainage from the incision three weeks after double-lung transplantation. In both cases, initial cultures were negative, but the typical colonial morphology of M. hominis was subsequently detected. Successful treatment consisted of debridement and long courses of antibiotic therapy; omental flap grafting was eventually required for the second patient. Other published cases were reviewed and compared with the newly reported cases.

Aged↗
PubMed1985

Serious wound infections in burned patients.

Wound infections are a major problem in burned patients. To determine the rate of wound infection associated with initial wound size and the amount of open full-thickness wound, we prospectively studied all patients admitted within 1 week of burn injury during a 2-year period using weekly wound cultures. Wounds were treated with topical silver sulfadiazine and occlusive dressings. Burn wound excision and immediate grafting were initiated during the first postburn week. One thousand five hundred twenty-three patient weeks (483 patients) were evaluated. Serious burn wound infections developed during 55/185 patient weeks (42.3%) when the initial total burn (ITB) was greater than 40% body surface area (BSA). This decreased to 27/304 (8.9%) when the ITB was 21% to 40% and 60/1034 (5.8%) when the ITB was less than 20% BSA. Burn wound infections developed during 57/211 patient weeks (27.0%) when the initial full-thickness burn (IFB) was greater than 20% BSA. The rate of wound infection decreased to 73/776 (9.4%) when the IFB was 1% to 20% and to 12/536 (2.2%) when no IFB was present. We further analyzed the prevalence of serious wound infections in relation to the open wound size during the hospital course. Wound infections occurred during 47 of 96 patient weeks (49.0%) when the current full-thickness wound was greater than 10% BSA. The infection rate decreased to 76 of 594 (12.8%) and 17 of 833 patient weeks (2.0%) when the remaining full-thickness wound was reduced to 1% to 10% and less than 1% BSA, respectively (p less than 0.05). Early wound closure would appear to reduce the risk of serious wound infections, especially in patients with full-thickness burns.

Adolescent↗