Surgical site infections are the common healthcare-associated infections. This article introduced the guidelines on the prevention and control of surgical site infection in using from background, making progress, and recommendations, to give directions for clinicians and infection prevention and control professionals choosing appropriately for decreasing surgical site infection risks.
Objective To study the influence factors of surgical site infection (SSI) after hepatobiliary and pancreatic surgery. Methods Fifty patients suffered from SSI after hepatobiliary and pancreatic surgery who treated in Feng,nan District Hospital of Tangshan City from April 2010 and April 2015 were retrospectively collected as observation group, and 102 patients who didn’t suffered from SSI after hepatobiliary and pancreatic surgery at the same time period were retrospectively collected as control group. Then logistic regression was performed to explore the influence factors of SSI. Results Results of univariate analysis showed that, the ratios of patients older than 60 years, combined with cardiovascular and cerebrovascular diseases, had abdominal surgery history, had smoking history, suffered from the increased level of preoperative blood glucose , suffered from preoperative infection, operative time was longer than 180 minutes, American Societyof Anesthesiologists (ASA) score were 3-5, indwelled drainage tube, without dressing changes within 48 hours after surgery, and new injury severity score (NISS) were 2-3 were higher in observation group (P＜0.05). Results of logistic regression analysis showed that, patients had history of abdominal surgery (OR=1.92), without dressing changes within 48 hours after surgery (OR=2.07), and NISS were 2-3 (OR=2.27) had higher incidence of SSI (P＜0.05). Conclusion We should pay more attention on the patient with abdominal surgery history and with NISS of 2-3, and give dressing changes within 48 hours after surgery, to reduce the incidence of SSI.
ObjectiveTo investigate the impact of comprehensive interventions on the prevention of the incidence of surgical site infection (SSI) after hip or knee arthroplasty.MethodsPatients who underwent total hip and knee arthroplasty for the first time in orthopedics department of Chengdu Fifth People’s Hospital from January 2016 to March 2018 were selected. The patients were observed after surgery for 1 year, and divided into the control group and the treatment group according to the odd or even hospitalization number. Basic precautions were taken in the control group, while further comprehensive preventive measures (preoperative chlorhexidine bath, intraoperative body temperature maintenance, using antibacterial film over surgery area without shearing, health and education after discharge from hospital) were taken in the treatment group. The incidence of SSI of the two groups was compared to evaluate the effects of comprehensive interventions.ResultsA total of 341 patients were included, including 174 in the control group and 167 in the treatment group. No one failed to be followed up. Among the 341 patients undergoing surgery, 13 had SSI, including 11 (6.3%) in the control group and 2 (1.2%) in the treatment group. The incidence of SSI in the treatment group was lower than that in the control group (χ2=6.102, P=0.014). Single factor analysis showed that sex (χ2=10.933, P=0.001), preoperative chlorhexidine sponge bath (χ2=8.837, P=0.003), intraoperative thermal insulation (χ2=13.917, P<0.001), health education (χ2=12.671, P<0.001), skin preparation methods (χ2=6.102, P=0.014), perioperative blood glucose control (χ2=17.512, P=0.003), and surgical type (χ2=8.360,factor P=0.004) were the effect factors of occurrence of SSI. Logistic regression analysis showed that surgical type [odds ratio (OR)=0.129, 95% confidence interval (CI)(0.026, 0.640), P=0.012] and strict blood glucose control [OR=9.868, 95%CI (2.158, 45.131), P=0.003] were the independent factors affecting the occurrence of SSI.ConclusionsComprehensive intervention measures can effectively reduce the occurrence of SSI after hip and knee arthroplasty. It is not confirmed that preoperative chlorhexidine bath can reduce the occurrence of SSI. But choosing selective operation and controlling the perioperative blood glucose below 200 mg/dL can reduce the risk of SSI.
ObjectiveTo explore the risk factors for and preventive measures of orthopedic perioperative surgical site infection. MethodsWe retrospectively analyzed the clinical data of 2 752 cases of orthopedic surgery performed from January 2010 to December 2012. The risk factors for such infection were analyzed and certain preventive measures were put forward. ResultsA total of 97 patients were infected with a surgical site infection rate of 3.52%. The surgical site infection was closely related to ages, basic diseases, surgical site, types of incision, preoperative hospital stay, operative time, urgent elective surgery, the use of antibiotics, medical staff hand hygiene and other factors, of which the rate of infection after amputation was the highest, reaching 23.81% (20/84). ConclusionMaking full preparations before operation, strengthening medical staff's hand disinfection, prophylactic antibiotics, good precautions and regulations in operation, and nursing meticulously after operation can be taken to prevent and reduce surgical site infection in orthopedic operation patients effectively.
Objective To probe the distribution and drug resistance of pathogens causing surgical site infection in patients after gynecologic operation, and provide reference for prevention and treatment. Methods Seventy patients with incision infection after gynecologic operation in West China Second University Hospital of Sichuan University from January 2010 to May 2015 were selected. Species of the pathogens from the submitted specimens and the results of the drug susceptibility testing were analyzed. Results Seventy-two strains of pathogens were isolated, including 36 strains (50.0%) of Gram-negative (G–) bacteria and 36 strains (50.0%) of Gram-positive (G+) bacteria. The main G– bacteria were Escherichia coli (36.1%) and Enterobacter cloacae (5.6%); the main G+ bacteria were Staphylococcus aureus (18.1%), Staphylococcus epidermidis (12.5%), and Enterococcus faecalis (8.3%). Escherichia coli showed low sensitivities to ampicillin, ceftriaxone, and gentamicin, with resistance rates of 76.9%, 61.5%, and 61.5%, respectively. Staphylococcus aureus showed low sensitivities to penicillin G, clindamycin, and erythromycin, with resistance rates of 92.3%, 69.2%, and 61.5%, respectively. Staphylococcus epidermidis showed low sensitivities to erythromycin, penicillin G, and ciprofloxacin, with resistance rates of 88.9%, 77.8%, and 77.8%, respectively. No carbapenem-resistant G– bacteria or vancomycin-resistant G+ bacteria were detected. Conclusion Postoperative surgical site infection is the most common nosocomial infection. The main bacteria related to postoperative incision infection in the gynecology department of the hospital are Escherichia coli, Staphylococcus aureus, Staphylococcus epidermidis, and Enterococcus faecalis, which become resistant to common antibiotics currently. Therefore more attention should be paid to bacterial isolation and drug susceptibility test results for rational use of antimicrobial drugs and effectiveness of the treatment to nosocomial infection.
Objective To systematically review the efficacy of chlorhexidine versus povidone iodine in the prevention of wound infections after surgeries by meta-analysis. Methods All randomized controlled trials comparing these two disinfectants were searched from databases of PubMed, The Cochrane Library (Issue 3, 2016), EMbase, WanFang Data, VIP and CNKI from inception to August 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. Results A total of 14 randomized controlled trials were included. The results of meta-analysis showed that the chlorhexidine group had significantly lower rates in any surgical site infection (RR=0.71, 95% CI 0.58 to 0.88,P=0.001) and superficial incisional infection (RR=0.66, 95% CI 0.48 to 0.91,P=0.01) when compared with povidone iodine group. However, there were no significant differences in deep incisional infection (RR=0.51, 95% CI 0.23 to 1.11,P=0.09) and organ-space infection (RR=0.97, 95% CI 0.53 to 1.76,P=0.92) between the two groups. Furthermore, subgroup analysis revealed differences in any surgical site infection and superficial incisional infection could only be found in surgeries possibly contaminated. Conclusion Chlorhexidine may be superior in decreasing the incidence of infection in probably contaminated surgery.
ObjectiveTo investigate the risk factors for surgical site infection (SSI) in patients after colorectal surgery, in order to provide a basis for regulation and implementation of preventive measures against SSI. MethodsFrom February to December 2012, a targeted surveillance on surgical site infection of "colon resection" and "rectum resection" surgery patients in the Department of Gastrointestinal Surgery was carried out. We analyzed the monitoring data, and explored the occurrence of postoperative SSI. At the same time, by case-control study, both single and multiple regression logistic analyses were performed on the 12 variables such as hypertension, diabetes mellitus duration during operation, America Society of Anesthesiologists score, grade of incision and so on to analyze the risk factors for SSI. ResultsAmong the 535 patients who underwent colorectal resections, 44 had SSI with an infection rate of 8.22%. Multiple logistic regression analysis showed that the length of hospital stay[OR=1.070,95%CI(1.033,1.109), P<0.001]and emergency surgery[OR=6.320,95%CI(1.932,20.669),P=0.002] were independent risk factors for SSI after colorectal resections. ConclusionThere are many risk factors for SSI after colorectal surgery. Through the implementation of targeted surveillance, we can find the main risk factors, which provides a basis for the regulation and implementation of intervention measures against SSI.
It has been certificated that hip and knee arthroplasty can improve quality of life and relieving pain and discomfort for ageing population and patients with muscloskeletal disorders. However, the outcomes of prosthetic joint infections (PJI) after arthroplasty usually are disastrous. The incidence of PJI is lower, but the number of this population is huge, which makes the strong impacts on quality of life for patients and healthcare economics. This review discusses the prevention strategies of PJI based on clinical epidemiology, diagnostic definition, pathogenesis, microbiology and risk factors, combined with some guidelines for prevention surgical site infections published recently.
ObjectiveTo analyze the current situation of antimicrobial agents using in day surgery patients to guide the rational use of antimicrobial agents in day surgery.MethodsThe day surgery performed in Day Surgery Center of Xiangya Hospital of Central South University from June 2016 to September 2017 was selected. We retrospectively collected and analyzed patients’ hospitalization data and return visit data, statistically analyzed their use of antimicrobial agents, explored whether there was an unreasonable phenomenon in the use of antimicrobial agents, and analyzed the reasons.ResultsThere were 4 054 surgeries included in this study, and 1 293 patients using antimicrobial agents, the use rate of antimicrobial agents in day surgery patients reached 31.89%. Aseptic, clean-contaminated, contaminated and dirty surgery accounted for 12.22%, 65.20%, 7.27%, and 15.31% separately. Whether the application of antimicrobial agents in aseptic surgery patients had no effect on the outcome of the incision (P=0.073). The most common type of antimicrobial agents used by patients are cephalosporins (57.50%), mainly used as single drugs (97.91%) and mostly oral used in patients’ home. Most of the sources of antimicrobial agents were purchased by patients after they were discharged from the hospital (65.43%). The antimicrobial agents more used by Stemmatological Department (23.98%), Ear/Nose/Throat Department (22.58%) and Obstetrics and Gynecology Department (22.51%). The average used time of antimicrobial agents was (5.37±1.86) days, and 7.42% of patients still had surgical site infections after the use of prophylactic antimicrobial agents, most of them from General Surgery Department.ConclusionsThe unreasonable phenomena in the use of antimicrobial agents in patients with day surgery include: a high proportion of preventive medications for clean-contamination surgery, a high level of initial medication, and most patients take oral medications at home and lack of guidance, and long medication time. There is an urgent need for scientific guidance on the use of antimicrobial agents for patients undergoing day surgery.