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Results for “SURGICAL WOUND INFECTION”

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At least 19 recordsLinked to original sources
PubMed2003

[Bacteriological study of surgical infected wounds in elective surgery. Bacteriology of surgical wound infection].

OBJECTIVE: To identify the frequency and type of microorganisms isolated from infected surgical wounds at the Instituto Nacional de Perinatología, and identify the association among the microorganisms isolated and the outcome of the infected patients. METHODOLOGY: Observational, descriptive and cross-sectional study carried out between January 1999 and January 2001. Postoperative patients of an obstetric or gynecologic procedure, complicated with a surgical wound infection and with a culture and smear of the wound, were included. RESULTS: During the study period 41 surgical wound infections were identified. The general incidence of surgical infections was 3.9 infections per 1,000 surgical procedures. The incidence of infections after abdominal hysterectomy was 12.4 per 1,000, after vaginal hysterectomy 6.5 per 1,000, postcesarean section 5.3 per 1,000 and after episiotomy 1 per 1,000 procedures. The comparison among bacterial isolates in 1988 with 1999-2000 period showed a high frequency of gram negative bacteria isolation in the second period. CONCLUSIONS: In this study the incidence of surgical infections was less than the incidence reported in the medical literature, but the type of bacteria isolated was similar to other studies.

Adolescent↗
PubMedDate not supplied

Effective and creative surveillance and reporting of surgical wound infections.

Surgical wound infections offer a major challenge to hospital infection control programs. Surgical procedures and host factors are independent variables which markedly influence the risk of infection. Frequently used categories of surgical procedures (clean, contaminated, and infected) are inadequate to identify the special risks and problems of individual procedures. In 1976, in conjunction with the practicing surgeons of a large, referral hospital, the Infections Control Committee instituted surveillance of selected clean surgical procedures and deep-versus-superficial wound infections. Major problems associated with the cleaning of sternal saws and the timing of the administration of prophylactic antibiotics have been detected by these methods. Conventional surveillance undoubtedly would have overlooked these problems. Effective surveillance and control of surgical wound infections requires a willingness to modify surveillance activities to meet the local needs, and a determination to include the operating surgeons in the planning of surveillance activities.

Hospital Bed Capacity, 500 and over↗
PubMed2002

Evidence-based surgical wound care on surgical wound infection.

Surgical wound infection is an important outcome indicator in the postoperative period. A 3-year prospective cohort epidemiological study of 2202 surgical patients from seven surgical wards across two hospitals was carried out using gold standard surveillance methodology. This involved following patients up as inpatients and postdischarge surveillance to 30 days by an independent observer. The results led to the development of a mathematical model for risk of clean, elective surgical wound infection. Risk of surgical wound infection was increased by smoking, higher body mass index, presence of malignancy, haematoma formation, increasing numbers of people in theatre, adherent dressing usage, and higher times to suture removal (P<0.05). The results show that this type of surveillance is an effective way of collecting accurate data on wound infection rates. It was noted that patient care practices affected the surgical wound infection rate and the surveillance was used to facilitate the adoption of evidence-based practice, through recommendations for clean surgery, to reduce the risk from extrinsic risk factors for wound infection. As a result of the implementation of this evidence-based practice there was a significant reduction (P<0.05) in the clean wound infection rate.

Bandages↗
PubMedDate not supplied

Factors associated with risk of surgical wound infections.

Surgical wound infections are the most common hospital-acquired infections among patients who undergo inpatient surgery. Risk of infection is a function of both patient susceptibility and exposure. The authors studied all discharges in Pennsylvania from October 1, 2004, through September 30, 2005, in which a circulatory (n= 65 940), neurological (n= 6706), or orthopedic (n = 107 825) procedure was performed using data from the Pennsylvania Health Care Cost Containment Council. They estimated the impact of patient-specific factors on risk of infection and compared the ability of these factors to predict infections relative to hospital effects. Results suggested that for all 3 types of procedures, patient-specific factors were a significant determinant of risk of surgical wound infection. However, prediction of infection was improved by 23% to 33% when hospital fixed effects were included. Although patient-specific factors had a statistically significant association with risk of infections, much of the risk of surgical wound infections is determined by hospital factors.

Adult↗
PubMed2006

Non-pharmacologic prevention of surgical wound infection.

Surgical site infections are among the most common serious perioperative complications. Infections are established during a decisive period that lasts a few hours after contamination. Adequacy of host immune defenses is the primary factor that determines whether inevitably wound contamination progresses into a clinical infection. As it turns out, many determinants of infection risk are under the direct control of anesthesiologists; factors that are at least as important as prophylactic antibiotics. Major outcome studies demonstrate that the risk of surgical wound infection is reduced threefold simply by keeping patients normothermic. Infection risk is reduced by an additional factor of two by if supplemental oxygen is provided (80% versus 30%) during surgery and for the initial hours after surgery. The contribution, if any, of other factors including, tight glucose control, fluid management, and mild hypercapnia have yet to be suitably tested.

Blood Glucose↗
PubMedDate not supplied

Role of the environment of the operating suite in surgical wound infection.

Most surgical wound infections are acquired in the operating room from the patient's own microbial flora. The remainder are acquired mainly from the staff in the operating room during surgery. The inanimate environment (e.g., walls, floors, and surgical instruments) has little relevance to the spread of infection. Because the air is an important route of spread in joint prosthesis operations, the routine use of an ultraclean air system and exhaust-ventilated clothing is frequently recommended. The value of such a system in other types of clean surgery is doubtful, but other measures, such as the following, may provide similar results at less cost: reduction of the number of persons in the operating room; a policy of not opening doors during operations; the use of comfortable, washable, bacteria-impermeable clothing by the operating-room staff; and concentration of the airflow over the operation site rather than over the whole operating room.

Air Microbiology↗
PubMedDate not supplied

[Risk factors of surgical wound infection].

Surgical Site Infection (SSI) continues to be a major source of morbidity following operative procedures. The aging of the population means that not only will the number of operations likely increase, but the National Nosocomial Infections Surveillance (NNIS) Risk Index, which standardizes the risk of SSI for an aging population, will be greater. The NNIS report for 1986-1996 described an SSI rate of 2.6% for all operations at the reporting hospitals. It seems likely that overall SSI rates are likely to be greater than reported. All surgical wounds are contaminated by bacteria, but only a minority actually demonstrate clinical infection. The SSI are the biological summation of several factors: the inoculum of bacteria introduced into the wound during the procedure, the unique virulence of contaminants, the microenvironment of each wound, and the integrity of the patients host defense mechanisms. Risk factors were studied in single and multivariate analyses. Although an SSI rate of zero may not be achievable, continued progress in understanding the biology of infection at the surgical site and consistent applications of proven methods of prevention will allow us to further reduce the frequency, cost, and morbidity associated with SSI.

Age Factors↗
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↗
PubMed1976

The epidemiology of 2056 remote site infections and 1966 surgical wound infections occurring in 1865 patients: a four year study of 40,923 operations at Rush-Presbyterian-St. Luke's Hospital, Chicago.

Over a 4-year period 40,923 operations and 44,716 surgical admissions were monitored for both community and hospital onset infections. One thousand eight hundred sixty-five patients had 1966 surgical wound infections and 2056 remote infections including 1652 hospital onset and 404 community onset infections. One thousand one hudnred forty-four patients with multiple infections averaged 40 days in the hospital contrasted with 24 days for 721 patients with a single wound infection. The total excess cost of hospitalization for these patients was $951,150. A statistically significant reduction occurred for urinary tract infections, lower respiratory infections and clean and contaminated surgical wound infections. It is suggested that these are all inter-related and a significant reduction in surgical wound infections can be achieved through control of infections at remote sites, particularly those associated with medical devices. The coagulase positive staphylococcus is still the most important single bacterial species in the primary etiology of surgical wound infections. When the gastrointestinal tract is entered or "supra" infecting organisms appear, gram negative bacteria and mixed gram negative and gram positive infections are dominant. Reduction in remote site infections occurring in surgical patients is necessary to reduce the incidence of surgical wound infections, suggest preventive and control measures, and document the effectiveness of such measures.

Adolescent↗
PubMed1994

[Use of ciprofloxacin and metronidazole in prophylaxis of surgical wound infection in surgical treatment of laryngeal cancer].

The purpose of the work was determination of bacterial flora in laryngeal malignant tissue and postoperative scar in patients who were prophylactically given 2 x 200 mg ciprofloxacine intravenously and 1.5 mg metronidazole for five days starting on the day of the operation. Laryngeal cancer specimens from 55 patients and swabs from postoperative scar from 30 patients were investigated bacteriologically. In the cultures from the malignant tissue and scar numerous micro-organisms were obtained which could be the cause of surgical wound infection. In the cultures from the scar the frequency of isolation of enterococci and Streptococcus viridans was found to be decreased while the frequency of staphylococci and Streptococcus haemolyticys isolation was increased. Despite the presence of pathogens, in none case clinical manifestations of wound infection were observed.

Cicatrix↗
PubMed1992

A study of 245 infected surgical wounds in Singapore.

The aims of the study were to correlate the laboratory detection rate of wound infections with the actual wound infection rate, and to analyse the bacteriology of these wounds to provide a rationale for antibiotic usage in prophylaxis and treatment of surgical wound infections. The wound infection rate in a general surgical unit was determined using the most comprehensive surveillance available to us and was correlated with the laboratory detection rate. A correlation coefficient of 0.8 was obtained, allowing a reasonable estimation of the actual wound infection rate from laboratory data. Review of the bacteriology of consecutive infected surgical wounds over a 4 year period in a university hospital, revealed that the commonest organisms cultured were Staphylococcus aureus, Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa, enterococci and beta-haemolytic streptococci. Methicillin-resistant S. aureus (MRSA) caused 50% of all staphylococcal wound infections. All MRSA isolates were sensitive to fusidic acid and vancomycin. All the non-MRSA isolates of S. aureus were sensitive to cephalexin. Some 89% of E. coli were sensitive to gentamicin, with 93% and 100% sensitive to cefuroxime and ceftriaxone respectively. Klebsiella isolates have shown an increased resistance to aminoglycosides, with a new strain from one patient, isolated in 1990, resistant to penicillins, aminoglycosides and third generation cephalosporins. Pseudomonas spp., enterococci and beta-haemolytic streptococci did not show a change in resistance patterns over the same time period.

Anti-Bacterial Agents↗
PubMed2001

An economic analysis of surgical wound infection.

Audit of surgical wound infection is not only an outcome indicator, but also an important aspect of infection control. The literature suggests an expensive 'gold standard' involving a full-time audit nurse collecting prospective data, including a 30-day follow-up into the community.Our study indicates that the cost of surgical wound infection is three-fold: cost to the hospital, the community services and the patient. Although the greatest costs were due to prolonged stay or re-admission to hospital (just under pound90 000), costs to the community and patient cannot be ignored. Hospital expenditure varied according to the type of operation. The study clearly demonstrated the potential cost savings to be highlighted by this type of audit.

Costs and Cost Analysis↗
PubMed2005

[Incidence of infected surgical wound and prophylaxis with cefotaxime in cesarean section].

BACKGROUND: Surgical wound infection after cesarean section varies from 2.5 to 16.1%, thus the utilization of antibiotic prophylaxis has increased routinely and irrationally. Despite this, we can still see cases of infections. OBJECTIVE: To determine if the antibiotic prophylaxis with cefotaxime is associated with the decreased incidence of wound infection in patients submitted to cesarean section without risk factors. PATIENTS AND METHODS: This study was carried out as a randomized clinical trial in patients submitted to cesarean section. Two groups were formed: in the first group we administered cefotaxime and the other one did not receive prophylaxis. The follow-up lasted 30 days to evaluate clinical data of infection. RESULTS: We performed 3,300 cesarean in the studied period; 1,000 patients had the inclusion criteria to participate in the study. A surgical wound infection was observed in 31 (0.96%) patients without risk factors. In 14 of these patients we administered cefotaxime, and in 17 patients we did not use prophylaxis. The highest frequency of infection was observed in the group of 24 to 30 years old, with 16 patients (51.6%). The clinical data of infection were: dehiscence in 29 patients (93.5%), pus secretion in 23 (74.2%), and fever in only 3 (9.7%) of them. The hospital stay after the infection was of five days in 75% of the cases. When the use of cefotaxime as prophylaxis was analyzed in both groups we had an odds ratio of 0.82, which was not significant. DISCUSSION: The use of cefotaxime in patients operated of cesarean does not have great transcendence since it does not reduce the infection incidence. The use of antibiotics in an irrational way implies a high cost, since the majority of the post-operation infections are not complicated, involving exclusively the skin and cellular subcutaneous tissue. Then, the cases with risk factors should be analyzed carefully for the cefotaxime administration.

Adult↗
PubMed2002

Post-discharge surveillance: can patients reliably diagnose surgical wound infections?

Post-discharge surgical wound infection surveillance is an important part of many infection control programs. It is frequently undertaken by patient self-assessment, prompted either by a telephone or postal questionnaire. To assess the reliability of this method, 290 patients were followed for six weeks postoperatively. Their wounds were photographed and also covertly assessed for signs of infection by two experienced infection control nurses (ICNs). Patients also responded to a postal questionnaire seeking evidence of infection at both week four and week six post-surgery. Correlation between the patient's assessment of their wound and the ICNs diagnosis was poor (r = 0.37) with a low positive predictive value (28.7%), although negative predictive value was high (98.2%). Assessment of photos for signs of infection by two experienced clinicians also correlated poorly with the ICNs diagnosis of infection (r = 0.54). The patient's recall of prescription of an antibiotic by their general practitioner (GP) for wound infection during the postoperative period correlated best with the ICNs diagnosis (r = 0.76). This latter measure, particularly when confirmed by the GP in those patients reporting an infection, appears to provide the most valid and resource efficient marker of post-discharge surgical wound infection.

Aftercare↗
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↗