Randomized clinical trial comparing two options for postoperative incisional care to prevent poststernotomy surgical site infections. Negative Pressure Wound Therapy for Surgical-site Infections: A Randomized Trial. Identification of risk factors by systematic review and development of risk-adjusted models for surgical site infection. Wound Infection After Elective Colorectal Resection Reducing colorectal surgical site infections: a novel, resident-driven, quality initiative. A survey on prevention of surgical infections in operating theaters. Surgical site infections in an abdominal surgical ward at Kosovo Teaching Hospital. Reduction of Surgical Site Infections after Implementation of a Bundle of Care Predictors of surgical site infections among patients undergoing major surgery at Bugando Medical Centre in Northwestern Tanzania Comparative effectiveness of skin antiseptic agents in reducing surgical site infections: a report from the Washington State Surgical Care and Outcomes Assessment Program. A colorectal "care bundle" to reduce surgical site infections in colorectal surgeries: a single-center experience.
Surgical site infection ( SSI ) remains an important complication of cardiac surgery . Prevention is important , as SSI is associated with high mortality and morbidity rates . Incisional care is an important daily issue for surgeons . However , there is still scant scientific evidence on which guidelines can be based . A r and omized clinical trial was performed to compare two options for postoperative incisional care . Patients undergoing sternotomy for cardiothoracic surgery were eligible . To protect an incision from exogenous contamination or direct inoculation by endogenous pathogens , the study group received an adhesive drape , impermeable to water and air . The control group was treated with a water- and air-permeable absorbent dressing . Primary outcome measure was SSI .  Between March 2003 and January 2005 , 1,185 patients were included . Both groups were comparable for base-line characteristics . No significant difference was found in the incidence of sternal SSI between groups ( 2.6 vs. 3.3 % ) . In our study , an incisional-care program using a sterile , impermeable adhesive drape did not perform better than an absorbent dressing in reducing SSI after cardiothoracic surgery . In our view , future studies in the field of prevention of SSI should concentrate on other areas of interest OBJECTIVE This study seeks to evaluate the efficacy of negative pressure wound therapy for surgical-site infection ( SSI ) after open pancreaticoduodenectomy . BACKGROUND Despite improvement in infection control , SSIs remain a common cause of morbidity after abdominal surgery . SSI has been associated with an increased risk of reoperation , prolonged hospitalization , readmission , and higher costs . Recent retrospective studies have suggested that the use of negative pressure wound therapy can potentially prevent this complication . METHODS We conducted a single-center r and omized , controlled trial evaluating surgical incision closure during pancreaticoduodenectomy using  negative pressure wound therapy in patients at high risk for SSI . We r and omly assigned patients to receive negative pressure wound therapy or a st and ard wound closure . The primary end point of the study was the occurrence of a postoperative SSI . We evaluated the economic impact of the intervention . RESULTS From January 2017 through February 2018 , we r and omized 123 patients at the time of closure of the surgical incision .  SSI occurred in 9.7 % ( 6/62 ) of patients in the negative pressure wound therapy group and in 31.1 % ( 19/61 ) of patients in the st and ard closure group ( relative risk = 0.31 ; 95 % confidence interval , 0.13 - 0.73 ; P = 0.003 ) . This corresponded to a relative risk reduction of 68.8 % . SSIs were found to independently increase the cost of hospitalization by 23.8 % . CONCLUSIONS The use of negative pressure wound therapy result ed in a significantly lower risk of SSIs . Incorporating this intervention in surgical practice can help reduce a complication that significantly increases patient harm and healthcare costs BACKGROUND  Surgical site infections ( SSIs ) are complications of surgery that cause significant postoperative morbidity . SSI has been proposed as a potential indicator of the quality of care in the context of clinical governance and monitoring of the performance of NHS organisations against targets . OBJECTIVES We aim ed to address a number of objectives . Firstly , identify risk factors for SSI , criteria for stratifying surgical procedures and evidence about the importance of postdischarge surveillance ( PDS ) . Secondly , test the importance of risk factors for SSI in surveillance data bases and investigate interactions between risk factors . Thirdly , investigate and vali date different definitions of SSI . Lastly , develop models for making risk-adjusted comparisons between hospitals . DATA SOURCES A single hospital surveillance data base was used to address objectives 2 and 3 and the UK Surgical Site Infection Surveillance Service data base to address objective 4 . STUDY DESIGN There were four elements to the research : ( 1 ) systematic review s of risk factors for SSI ( two review ers assessed titles and abstract s of studies identified by the search strategy and the quality of studies was assessed using the Newcastle Ottawa Scale ) ; ( 2 ) assessment of agreement between four SSI definitions ; ( 3 ) validation of definitions of SSI , quantifying their ability to predict clinical outcomes ; and ( 4 ) development of operation-specific risk models for SSI , with hospitals fitted as r and om effects . RESULTS Review s of SSI risk factors other than established SSI risk indices identified other risk ; some were operation specific , but others applied to multiple operations . The factor most commonly identified was duration of preoperative hospital stay . The review of PDS for SSI confirmed the need for PDS if SSIs are to be compared meaningfully over time within an institution . There was wide variation in SSI rate ( SSI% ) using different definitions . Over twice as many wounds were classified as infected by one definition only as were classified as infected by both . Different SSI definitions also classified different wounds as being infected . The two most established SSI definitions had broadly similar ability to predict the chosen clinical outcomes . This finding is paradoxical given the poor agreement between definitions . Elements of each definition not common to both may be important in predicting clinical outcomes or outcomes may depend on only a subset of elements which are common to both . Risk factors fitted in multivariable models and their effects , including age and gender , varied by surgical procedure . Operative duration was an important risk factor for all operations , except for hip replacement . Wound class was included least often because some wound classes were not applicable to all operations or were combined because of small numbers . The American Association of Anesthesiologists class was a consistent risk factor for most operations . CONCLUSIONS The research literature does not allow surgery-specific or generic risk factors to be defined . SSI definitions varied between surveillance programmes and potentially between hospitals . Different definitions do not have good agreement , but the definitions have similar ability to predict outcomes influenced by SSI . Associations between components of the National Nosocomial Infections Surveillance risk index and odds of SSI varied for different surgical procedures . There was no evidence for effect modification by hospital . Estimates of SSI% should be disseminated within institutions to inform infection control . Estimates of SSI% across institutions or countries should be interpreted cautiously and should not be assumed to reflect quality of medical care . Future research should focus on developing an SSI definition that has satisfactory psychometric properties , that can be applied in everyday clinical setting s , includes PDS and is formulated to detect SSIs that are important to patients or health services . FUNDING The National Institute for Health Research Technology Assessment programme Introduction : Surgical site infection ( SSI ) is a potentially morbid and costly complication following major colorectal resection . In recent years , there has been growing attention placed on the accurate identification and monitoring of such surgical complications and their costs , measured in terms of increased morbidity to patients and increased financial costs to society . We hypothesize that incisional SSIs following elective colorectal resection are more frequent than is generally reported in the literature , that they can be predicated by measurable perioperative factors , and that they carry substantial morbidity and cost . Methods : Over a 2-year period at a university hospital , data on all elective colorectal resections performed by a single surgeon were retrospectively collected . The outcome of interest was a diagnosis of incisional SSI as defined by the Center of Disease Control and Prevention . Variables associated with infection , as identified in the literature or by experts , were collected and analyzed for their association with incisional SSI development in this patient cohort . Multivariate analysis by stepwise logistic regression was then performed on those variables associated with incisional SSI by univariate analysis to determine their prognostic significance . The incidence of SSI in this study was compared with the rates of incisional SSI in this patient population reported in the literature , predicted by a nationally based system monitoring nosocomial infection , and described in a prospect ively acquired intradepartmental surgical infection data base at our institution . Results : One hundred seventy-six patients undergoing elective colorectal resection were identified for evaluation . The mean patient age was 62 ± 1.2 years , and 54 % were men . Preoperative diagnoses included colorectal cancer ( 57 % ) , inflammatory bowel disease ( 20 % ) , diverticulitis ( 10 % ) , and benign polyp disease ( 5 % ) . SSIs were identified in 45 patients ( 26 % ) . Twenty-two ( 49 % ) SSIs were detected in the outpatient setting following discharge . Of all preoperative and perioperative variables measured , increasing patient body mass index and intraoperative hypotension independently predicted incisional SSI . Although we could not measure statistically increased length of hospital stay associated with SSI , a representative population of patients with SSI accumulated a mean of $ 6200/patient of home health expenses related to wound care . Our rates of SSI were substantially higher than that reported generally in the literature , predicted by the National Nosocomial Infection System , or described by our own institutional surgical infection data base . Conclusions : The incidence of incisional SSI in patients undergoing elective colorectal resection in our cohort was substantially higher than generally reported in the literature , the NNIS or predicted by an institutional surgical infection complication registry . Although some of these differences may be attributable to patient population differences , we believe these discrepancies highlight the potential limitations of systematic outcomes measurement tools which are independent of the primary clinical care team . Accurate surgical complication documentation by the primary clinical team is critical to identify the true frequency and etiology of surgical complications such as incisional SSI , to rationally approach their reduction and decrease their associated costs to patients and the health care system BACKGROUND Surgical site infections ( SSIs ) cause significant patient morbidity and increase costs . This work prospect ively examines our institutional effort to reduce SSIs through a  resident-driven quality initiative . METHODS A general surgery resident-championed , evidence d-based care bundle for patients undergoing colorectal surgery at a single academic institution was developed using attending mentorship . National Surgical Quality Improvement Program definitions for SSIs were used . Data were collected prospect ively and bundle compliance was monitored using a checklist . The primary outcome compared SSIs before and after implementation . RESULTS In the 2 years preceding st and ardization , 489 colorectal surgery cases were performed .  SSIs occurred in 68 patients ( 13.9 % SSI rate ) . Following implementation of the bundle , 212 cases were performed with 10 SSIs ( 4.7 % SSI rate , P < .01 ) . Multivariate logistic regression analysis found a decrease in superficial and overall SSIs ( odds ratio .17 , 95 % confidence interval .05 to .59 ; odds ratio .31 , 95 % confidence interval .14 to .68 ) . CONCLUSIONS These data demonstrate that  resident-driven  initiatives to improve quality of care can be a swift and effective way to enact change . We observed significantly decreased SSIs with a renewed focus on evidence -based , st and ardized patient care BACKGROUND It is well known that surgical site infections ( SSIs ) contribute significantly to the cost of nosocomial infections . Although many guidelines and recommendations exist , research has demonstrated that practice s for preventing SSIs in operating theaters ( OT ) vary . AIM The purpose of this study was to describe the current infection control practice s for SSIs , formerly called surgical wound infections , in OTs , and compare these findings with evidence -based practice guidelines . METHODS In order to accomplish the purpose , a prospect i ve , cross-sectional descriptive survey was conducted . Data were collected by interviewing the charge nurses in 24 OTs of 11 hospitals in the city of Izmir , Turkey . The results were tabulated and compared with an evidence -based guideline . RESULTS Data showed that there is a lack of adherence to the guideline . The most compliant areas to the guideline were h and /forearm antisepsis and the use of surgical gowns and drapes . IMPLICATION S It is suggested that increased compliance to infection control guidelines for surgical infections in OTs would facilitate providing best practice and evidence -based care . There is a need for further research to determine why there is a difference between what is practice d and what guidelines indicate should be practice BACKGROUND Abdominal surgical site infections ( SSI ) cause substantial morbidity and mortality for patients undergoing operative procedures . We determined the incidence of and risk factors for SSI after abdominal surgery in the Department of Abdominal Surgery at the University Clinical Centre of Kosovo ( UCCK ) . METHODOLOGY Prospect i ve surveillance of patients undergoing abdominal surgery was performed between December 2005 and June 2006 . CDC definitions were followed to detect SSI and study forms were based on Europe Link for Infection Control through Surveillance ( HELICS ) protocol . RESULTS A total of 253 surgical interventions in 225 patients were evaluated . The median age of patients was 42 years and 55.1 % of them were male . The overall incidence rate of SSI was 12 % . Follow-up was achieved for 84.1 % of the procedures . For patients with an SSI , the median duration of hospitalization was 9 days compared with 4 days for those without an SSI ( p2 , use of antibiotic prophylaxis and NNIS class of > 2 were all significant at p < .001 . The SSI rates for the NNIS System risk classes 0 , 1 and 2 - 3 were 4.2 % , 46.7 % and 100 % , respectively . CONCLUSIONS SSI caused considerable morbidity among surgical patients in UCCK . Appropriate active surveillance and infection control measures should be introduced during preoperative , intra-operative , and postoperative care to reduce infection rates Background Surgical Site Infections ( SSI ) are relatively frequent complications after colorectal surgery and are associated with substantial morbidity and mortality . Objective Implementing a bundle of care and measuring the effects on the SSI rate . Design Prospect i ve quasi experimental cohort study . Methods A prospect i ve surveillance for SSI after colorectal surgery was performed in the Amphia Hospital , Breda , from January 1 , 2008 until January 1 , 2012 . As part of a National patient safety initiative , a bundle of care consisting of 4 elements covering the surgical process was introduced in 2009 . The elements of the bundle were perioperative antibiotic prophylaxis , hair removal before surgery , perioperative normothermia and discipline in the operating room . Bundle compliance was measured every 3 months in a r and om sample of surgical procedures . Results Bundle compliance improved significantly from an average of 10 % in 2009 to 60 % in 2011 . 1537 colorectal procedures were performed during the study period and 300 SSI ( 19.5 % ) occurred . SSI were associated with a prolonged length of stay ( mean additional length of stay 18 days ) and a significantly higher 6 months mortality ( Adjusted OR : 2.71 , 95 % confidence interval 1.76–4.18 ) . Logistic regression showed a significant decrease of the SSI rate that paralleled the introduction of the bundle . The adjusted Odds ratio of the SSI rate was 36 % lower in 2011 compared to 2008 . Conclusion The implementation of the bundle was associated with improved compliance over time and a 36 % reduction of the SSI rate after adjustment for confounders . This makes the bundle an important tool to improve patient safety Background Surgical site infection ( SSI ) continues to be a major source of morbidity and mortality in developing countries despite recent advances in aseptic techniques . There is no baseline information regarding SSI in our setting therefore it was necessary to conduct this study to establish the prevalence , pattern and predictors of surgical site infection at Bug and o Medical Centre Mwanza ( BMC ) , Tanzania . Methods This was a cross-sectional prospect i ve study involving all patients who underwent major surgery in surgical wards between July 2009 and March 2010 . After informed written consent for the study and HIV testing , all patients who met inclusion criteria were consecutively enrolled into the study . Pre-operative , intra-operative and post operative data were collected using st and ardized data collection form . Wound specimens were collected and processed as per st and ard operative procedures ; and susceptibility testing was done using disc diffusion technique . Data were analyzed using SPSS software version 15 and STATA . Results Surgical site infection ( SSI ) was detected in 65 ( 26.0 % ) patients , of whom 56 ( 86.2 % ) and 9 ( 13.8 % ) had superficial and deep SSI respectively . Among 65 patients with clinical SSI  , 56(86.2 % ) had positive aerobic culture . Staphylococcus aureus was the predominant organism 16/56 ( 28.6 % ) ; of which 3/16 ( 18.8 % ) were MRSA . This was followed by Escherichia coli 14/56 ( 25 % ) and Klebsiella pneumoniae 10/56 ( 17.9 % ) . Among the Escherichia coli and Klebsiella pneumoniae isolates 9(64.3 % ) and 8(80 % ) were ESBL producers respectively . A total of 37/250 ( 14.8 % ) patients were HIV positive with a mean CD4 count of 296 cells/ml . Using multivariate logistic regression analysis , presence of pre-morbid illness ( OR = 6.1 ) , use of drain ( OR = 15.3 ) , use of iodine alone in skin preparation ( OR = 17.6 ) , duration of operation ≥ 3 hours ( OR = 3.2 ) and cigarette smoking ( OR = 9.6 ) significantly predicted surgical site infection ( SSI ) ConclusionS SI is common among patients admitted in surgical wards at BMC and pre-morbid illness , use of drain , iodine alone in skin preparation , prolonged duration of the operation and cigarette smoking were found to predict SSI . Prevention strategies focusing on factors associated with SSI is necessary in order to reduce the rate of SSI in our setting BACKGROUND Surgical site infections ( SSI ) are an important source of morbidity and mortality . Chlorhexidine in isopropyl alcohol is effective in preventing central venous-catheter associated infections , but its effectiveness in reducing SSI in clean-contaminated procedures is uncertain . Surgical studies to date have had contradictory results . We aim ed to further evaluate the relationship of commonly used antiseptic agents and SSI , and to determine if isopropyl alcohol has a unique effect . STUDY DESIGN We performed a prospect i ve cohort analysis to evaluate the relationship of commonly used skin antiseptic agents and SSI for patients undergoing mostly clean-contaminated surgery from January 2011 through June 2012 .  Multivariate regression modeling predicted expected rates of SSI . Risk adjusted event rates ( RAERs ) of SSI were compared across groups using proportionality testing . RESULTS Among 7,669 patients , the rate of SSI was 4.6 % . The RAERs were 0.85 ( p = 0.28 ) for chlorhexidine ( CHG ) , 1.10 ( p = 0.06 ) for chlorhexidine in isopropyl alcohol ( CHG+IPA ) , 0.98 ( p = 0.96 ) for povidone-iodine ( PVI ) , and 0.93 ( p = 0.51 ) for iodine-povacrylex in isopropyl alcohol ( IPC+IPA ) . The RAERs were 0.91 ( p = 0.39 ) for the non-IPA group and 1.10 ( p = 0.07 ) for the IPA group . Among elective colorectal patients , the RAERs were 0.90 ( p = 0.48 ) for CHG , 1.04 ( p = 0.67 ) for CHG+IPA , 1.04 ( p = 0.85 ) for PVI , and 1.00 ( p = 0.99 ) for IPC+IPA . CONCLUSIONS For clean-contaminated surgical cases , this large-scale state cohort study did not demonstrate superiority of any commonly used skin antiseptic agent in reducing the risk of SSI , nor did it find any unique effect of isopropyl alcohol . These results do not support the use of more expensive skin preparation agents BACKGROUND Kaiser Sunnyside Medical Center has participated in the American College of Surgeons National Surgical Quality Improvement Program ( NSQIP ) since January 2006 . Data on general and colorectal surgical site infections ( SSIs ) demonstrated a need for improvement in SSI rates . OBJECTIVE To evaluate application of a " care bundle " for patients undergoing colorectal operations , with the goal of reducing overall SSI rates . METHODS We prospect ively implemented multiple interventions , with retrospective analysis of data using the NSQIP data base . The overall , superficial , deep , and organ/space SSI rates were compared before and after implementation of this colorectal care bundle . RESULTS Between January 2006 and December 2009 , there were 430 colorectal cases in our NSQIP report with 91 infections , an overall rate of 21.16 % . Between January 2010 , when the colorectal care bundle was implemented , and June 2011 , there were 195 cases and 13 infections , a 6.67 % overall rate . The absolute decrease of 14.49 % is significant ( p < 0.0001 ) . The rate of superficial SSI decreased from 15.12 % to 3.59 % ( p < 0.0001 ) . The rates for deep and organ/space SSI also showed a decrease ; however , this was not statistically significant . The NSQIP observed-to-expected ratio for colorectal SSI decreased from a range of 1.27 to 1.83 before implementation to 0.54 after implementation ( fiscal year 2010 ) . CONCLUSIONS Our institution was a NSQIP high outlier in general surgery SSIs and had a high proportion of these cases represented in colorectal cases . By instituting a care bundle composed of core and adjunct strategies , we significantly decreased our rate of colorectal SSIs
From the patient ’s perspective , an infection delays healing , can increase time away from work or family , and can cause additional pain and complications ( eg , sepsis , long-term disabilities , death ) .
urgical site infections ( SSIs ) continue to cause significant patient harm despite many advances in Sinfection prevention .
The negative effects of SSIs on morbidity , mortality , and the cost of care has kept SSI reduction a top priority for health care organizations worldwide .
A 2011 systematic review found that approximately 55 % of SSIs in the United States may be preventable by using evidence -based guidelines .