Surgical Site Infection (SSI)

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Albumin and surgical site infection risk in orthopaedics: a meta-analysis

Albumin and surgical site infection risk in orthopaedics: a meta-analysis

The most common complication an orthopaedics patient can confront is surgical site infection (SSI). SSI has been a challenge for surgeons for many years, and the trends currently prefer the development of post-operation man- agement to decrease the SSI rate. However, can SSI be predicted using less invasive or more tolerable tests? Recently, researchers have shown that malnutrition has links with serious complications in orthopaedics, but as many as 50 % of cases of pre-existing malnutrition are unrecognized in the hospital population [1, 2], with a reasonable explanation being that observable signs of
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The effect of triclosan coated sutures on rate of Surgical Site Infection after hip and knee replacement: a protocol for a double blind randomised controlled trial

The effect of triclosan coated sutures on rate of Surgical Site Infection after hip and knee replacement: a protocol for a double blind randomised controlled trial

The primary outcome is superficial SSI infection based upon Health Protection Agency (HPA) published defini- tions, which originate from the Centers for Disease Con- trol and Prevention (CDC) 1992 published definition. The HPA criteria are the nationally agreed definition used within the UK, and routinely collected by the ma- jority of UK Trusts [17]. Superficial incisional infection is defined by the HPA, as a surgical site infection that occurs within 30 days of surgery and involves only the skin or subcutaneous tissue of the incision, and meets at least one of the criteria in Table 1. To ensure accurate collection the 30-day HPA patient self reported ques- tionnaire was recorded in all patients collected by tele- phone, by a blinded research nurse.
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The effect of triclosan coated sutures on rate of Surgical Site Infection after hip and knee replacement : a protocol for a double blind randomised controlled trial

The effect of triclosan coated sutures on rate of Surgical Site Infection after hip and knee replacement : a protocol for a double blind randomised controlled trial

The primary outcome is superficial SSI infection based upon Health Protection Agency (HPA) published defini- tions, which originate from the Centers for Disease Con- trol and Prevention (CDC) 1992 published definition. The HPA criteria are the nationally agreed definition used within the UK, and routinely collected by the ma- jority of UK Trusts [17]. Superficial incisional infection is defined by the HPA, as a surgical site infection that occurs within 30 days of surgery and involves only the skin or subcutaneous tissue of the incision, and meets at least one of the criteria in Table 1. To ensure accurate collection the 30-day HPA patient self reported ques- tionnaire was recorded in all patients collected by tele- phone, by a blinded research nurse.
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Surgical Site Infection Following Caesarean Section in NRS Medical College, Kolkata

Surgical Site Infection Following Caesarean Section in NRS Medical College, Kolkata

Surgical site infection (SSI) used to complicate up to 8.9% of all cesarean sections (CSs).[1] Post-cesarean wound infection is one of the common causes of maternal morbidity ,sometimes mortality. In India, hemorrhage and infection are the leading causes of maternal death following CS.[2,3] The incidence of wound infection is associated with the duration of operation, indication of CS, prolonged rupture of membranes ,anemia , and multiple per vaginal examinations.[4,5] Staphylococcus aureus is the most commonly isolated bacteria in wound infections following CS.[7]However gram negative organisms like E. coli, Proteus mirabilis, Pseudomonas and Klebsiella etc. are also isolated in CS wound infections.[9] Present study reviewed 299 CS deliveries to calculate the prevalence of SSI, the risk factors, the common bacterial pathogens and their antibiotic sensitivity.
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Surgical site infection and its associated factors following cesarean section in Ethiopia: a cross sectional study

Surgical site infection and its associated factors following cesarean section in Ethiopia: a cross sectional study

In this study, the duration of cesarean section lasting longer than 60  min was an independent risk factor for surgical site infection. This is similar to the study finding which was done in India [19], Ethiopia [20], and Nigeria [9] showed that prolonged duration of the surgical pro- cedure (lasting longer than 30 min) are usually associated with higher rates of surgical site infections. The pos- sible reason might be due to as the length of operation increased, a tissue exposed to potential bacterial infec- tions is also increased. Hence, the contaminated wound during the procedure is high chance of getting infected after the procedure.
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Incisional Negative Pressure Wound Therapy in the Prevention of Surgical Site Infection after Vascular Surgery with Inguinal Incisions: Rationale and Design of a Randomized Controlled Trial (INVIPS Trial)

Incisional Negative Pressure Wound Therapy in the Prevention of Surgical Site Infection after Vascular Surgery with Inguinal Incisions: Rationale and Design of a Randomized Controlled Trial (INVIPS Trial)

Background/Aims: Inguinal incisions are a common route of access in vascular surgery. Due to anatomical challenges and a diverse bacterial flora in this area, surgical site infections (SSI) re- present a common, debilitating and sometimes life-threatening complication. The INVIPS-Trial evaluates the role of Negative Pressure Wound Therapy (NPWT) on closed inguinal incisions in elective vascular surgery to prevent SSI and other wound complications. Methods: This rando- mized controlled trial (RCT) registered at ClinicalTrials.gov (Identifier: NCT01913132) compares the effects of a NPWT dressing (PICO, Smith & Nephew, UK) and the center’s standard wound dressing (Vitri Pad, ViTri Medical, Sweden) on postoperative wound complications, especially SSI. The study includes two distinct vascular procedures with different SSI risk profiles: endovascular aortic repair (EVAR) and open surgical approaches involving the common femoral artery (OPEN). Results: Four hundred ninety-five groin incisions in both treatment arms are anticipated to be in- cluded in the EVAR group and 147 inguinal incisions in both treatment arms in the OPEN group. Since a large percentage of inguinal vascular procedures in both groups but especially in the EVAR group are performed bilaterally, many patients can serve as their own control by randomly re- ceiving NPWT on one and the standard dressing on the contralateral inguinal incision. Conclusions: This ongoing RCT attempts to elucidate the potential benefit of NPWT on closed inguinal incisions after different vascular procedures. Outcome and conclusions of this trial could have implications on postoperative wound care of patients in both vascular surgery and other surgical specialties.
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Prophylactic use of antibiotics as per SIGN 104 guidelines versus routine antibiotic prophylaxis for prevention of surgical site infection in clean and clean contaminated ENT surgical procedures: a comparative study

Prophylactic use of antibiotics as per SIGN 104 guidelines versus routine antibiotic prophylaxis for prevention of surgical site infection in clean and clean contaminated ENT surgical procedures: a comparative study

aureus, Clostridium perfringens, Bacteroids, Haemophilus influenzae, Klebsiella, Pseudomons and Proteus. In nasal surgeries S. aureus, Klebsiella spp., and Escherichia coli are common pathogens for SSI; while procedures on ears may be complicated by infection with Haemophilus, Pseudomonas and Staphylococcus. The choice of antibiotic for preventing SSI will be influenced by its effectiveness against the likely pathogen. The chosen antimicrobial should be bactericidal, cause minimal side effects and have a minimal impact on the local colonizers of the patient and the hospital. 3 While the need of antibiotics is obvious in contaminated and dirty wounds, in clean and clean contaminated wounds their role is debatable.
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Role of topical application of gentamicin containing collagen implants in cardiac surgery

Role of topical application of gentamicin containing collagen implants in cardiac surgery

The criteria for definition and classification of Surgical Site Infections (SSI) in the literature vary. A majority of studies have used criteria laid down by Centers of Disease Control and prevention for surgical site infection [2,13,14]. It is focused on the depth, but not on the clinical severity, of the infection [13]. In UK NICE (National Institute of Clinical Excellence) has issued guidelines for recognition and management of SSI [15]. Deep SWI includes all SWI with sternal dehiscence or infections down to the sternum, even when the sternum remained stable [2,13]. Infections are usually classified as definite if both clinical signs of infection and prespecified bacterial cultures were positive [1,2,13]. A more comprehensive clinical wound scoring system, such as the ASEPSIS score will be more informative but more laborious to use [16,17].
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BACTERIAL ISOLATES AND ANTIBIOTIC SENSITIVITY PATTERN FROM LAPAROTOMY WOUNDS IN A NIGERIAN TERTIARY HOSPITAL

BACTERIAL ISOLATES AND ANTIBIOTIC SENSITIVITY PATTERN FROM LAPAROTOMY WOUNDS IN A NIGERIAN TERTIARY HOSPITAL

Background: The burden of managing surgical site infection (SSI) is enormous and coupled with the changing pattern that has been observed by other researchers with respect to causative agents of SSI, it therefore becomes imperative to study the bacteriology of the common aetiological agents responsible for post-operative wound infection in the study centre. Therefore the aim was to determine the bacterial isolates responsible for causing SSI as well as the antibiotic sensitivity pattern.

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A systematic review and meta-analysis of randomised controlled trials of delayed primary wound closure in contaminated abdominal wounds

A systematic review and meta-analysis of randomised controlled trials of delayed primary wound closure in contaminated abdominal wounds

A systematic review and meta-analysis was conducted to compare surgical site infection (SSI) between delayed primary (DPC) and primary wound closure (PC) in complicated appendicitis and other contaminated abdominal wounds. Medline and Scopus were searched from their beginning to November 2013 to identify randomised controlled trials (RCTs) comparing SSI and length of stay between DPC and PC. Studies ’ selection, data extraction, and risk of bias assessment were done by two independent authors. The risk ratio and unstandardised mean difference were pooled for SSI and length of stay, respectively. Among 8 eligible studies, 5 studies were done in complicated appendicitis, 2 with mixed complicated appendicitis and other types of abdominal operation and 1 with ileostomy closure. Most studies (75%) had high risk of bias in sequence generation and allocation concealment. Among 6 RCTs of complicated appendicitis underwent open appendectomy, the SSI between PC and DPC were not significantly different with a risk ratio of 0.89 (95% CI: 0.46, 1.73). DPC had a significantly 1.6 days (95% CI: 1.41, 1.79) longer length of stay than PC. Our evidence suggested there might be no advantage of DPC over PC in reducing SSI in complicated appendicitis. However, this was based on a small number of studies with low quality. A large scale RCT is further required.
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Delayed appendectomy versus early appendectomy in the treatment of acute appendicitis: a retrospective study

Delayed appendectomy versus early appendectomy in the treatment of acute appendicitis: a retrospective study

Comparisons of postoperative outcomes between two groups are shown in Table 4. The mean WBC count at postoperative first day of group B were lower than that of group A (p = 0.0039). There were no significant differ- ences in time to soft diet, length of postoperative hospital stay, complication rate, and readmission rate between two groups. Although surgical site infection (SSI) rate includ- ing intra-abdominal abscess (IA) of group B was slightly higher than that of group A, there was also no significant statistical difference (Group A, 1.7% and Group B, 3.9%; p = 0.3143). Table 5 shows results of hospital costs be- tween two groups and there were no significant differ- ences in all comparative variables.
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Comparison of Purse String Versus Conventional Closure of Ileostomy Skin Wounds

Comparison of Purse String Versus Conventional Closure of Ileostomy Skin Wounds

Abstract- Background- Ileostomy closure is common surgical procedure done in most center across the globe. The aim of the study was to compare the purse string(PS) versus conventional linear closure(CLC) of ileostomy skin wounds in the incidence of Surgical Site Infection (SSI) following the stoma reversal. The secondary aim was to compare the cosmetic outcome following the two techniques, and also to identify other factors (such as duration of the operation and the postoperative stay, medication and complications) that might affect wound healing.
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Captive Nations: Measuring Economic Growth on Native American Reservations in California

Captive Nations: Measuring Economic Growth on Native American Reservations in California

A surgical site infection (SSI) is an infection that occurs after a surgery in the part of the body where it was performed (Centers for Disease Control and Prevention, 2018). The infection is superficial which involves only the skin initially but can spread to other parts of the body toward organs. In the hospital setting SSIs are the most common type of healthcare associated infections, which account for 31% of hospitalized patients (Center for Disease Control and Prevention, 2018). Throughout the U.S it is estimated that the incident of SSIs ranges from 160,000 to 300,000 a year and estimated costs include $3.5 to $10 billion annually (Science Daily, 2017). SSIs are associated with increased morbidity and mortality, increased length of stay and increased health care costs. Improvements have been made with infection control practices and sterile techniques but it is not enough to make a significant difference. SSI rates have increased because there are more operative procedures performed in the United States, which leads to more chances of SSI Incidences.
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N628 FMEA Prevention of Surgical Site Infections A Systematic Review in the Pre Surgical Phase Summary Brief

N628 FMEA Prevention of Surgical Site Infections A Systematic Review in the Pre Surgical Phase Summary Brief

SSIs can in fact, attribute costs as high as $25,546 for just one surgical site infection, based on a review of studies published from 2001 to 2004 (Horan, et al, 2013). For elderly patients, SSIs due to S. aureus led to, on average, 12 additional hospital days, with excess costs of more than $40,000 and for patients with a MRSA SSI, a reported mean hospital charge of $84,020 or higher than those recovering from surgery with no complications (U.S. National Library of Medicine, 2008). In short, uninfected patients have a decreased length of hospital stay following surgery, and therefore, have more remaining rehabilitation days with insurance
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Groin Hernia’s Presenting as Emergency: A Study Regarding Surgical Repair and Outcome in Rajiv Gandhi Institute of Medical Sciences & General Hospital, Kadapa

Groin Hernia’s Presenting as Emergency: A Study Regarding Surgical Repair and Outcome in Rajiv Gandhi Institute of Medical Sciences & General Hospital, Kadapa

Most common age group developing complications following emergency hernioplasty in my study were of the age group 51 -60 followed by 70 years and above and Least complications was found in younger age group of 13 - 40. The most common post operative complication was found to be surgical site infection, and the incidence of SSI was found to be more in patients who underwent resection Mean hours of delay in hospitalization among those who underwent resection anastamosis was 34.07 hours compared to 7.55 hours of delay among those who did not undergo resection anastamosis.
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A Study of Surgical Wound Infection in Government Rajaji Hospital, Madurai

A Study of Surgical Wound Infection in Government Rajaji Hospital, Madurai

More than 70% of surgical procedures are now performed on an outpatient basis, which poses major problems for surveillance of SSI. Although many surgical site infections will develop in the 5-10 days after surgery, a SSI will develop as long as 30 days after surgery and be attributable directly to the operation, long after even most inpatients have been discharged from the hospital. Estimates of the incidence of surgical site infections are thus dependent upon voluntary self reporting by surgeons, which may not occur for any of several reasons. Therefore, estimates of the incidence of surgical site infection in National Nasocomal infection surveillance are almost assuredly underestimates, although the data are the best that are available.
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Mycotic Aneurysms: Clinical Aspects and Results of Surgery (About 12 Cases)

Mycotic Aneurysms: Clinical Aspects and Results of Surgery (About 12 Cases)

Flattening with excision of the infected tissues was performed in all cases. The restoration of vascular continuity was immediate in all cases using end-to-end direct anastomosis in 8 cases, 2 cases of extra-anatomical bypass using a dacron tube and two cases of anatomical bypass using the saphenous vein in situ. Cytobacteriological examination of the collection fluid isolated from Pseudomonas aeruginosa (1 case) and Salmonella (1 case). A post-operative probabilistic antibiotherapy was adapted in all cases secondarily to the antibiogram for an average duration of 71 days [42-120 days]. The average duration of hospitalization was 25 days [2-60 days]. Early complications were dominated by 2 cases of acute limb ischemia, 2 cases of superficial surgical site infection, 1 case of deep surgical site infection and 1 case of false aneurysm of a common femoral artery and 1 case of hematoma. Follow-up was performed in all patients with an average delay of 14 months [1-60]. During the follow-up, a patient presented an ischemic cerebrovascular accident on a site of mitral endocarditis with a good evolution under medical treatment with physiotherapy, a case of regressive occlusive syndrome after the installation of a nasogastric tube and a case of false aneurysm of the common femoral artery requiring extra- anatomical iliofemoral bypass using the contralateral saphenous vein. One amputation was performed for ischemic gangrene of the limb. There were 1 case of operative mortality, 2 cases of late mortality, one in a chronic renal failure with uremic shock and the 2nd case in a septic shock
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Incidence and risk factors of surgical site infections in elective abdominal surgeries

Incidence and risk factors of surgical site infections in elective abdominal surgeries

and it is mediated by production of a cascade of numerous proinflammatory mediators produced in response to the products of microbial invasion. These products can be a lipopolysaccharide(endotoxin) derived from gram-negative bacteria; or a peptidoglycanand teichoic acid from gram-positive bacteria; multiple fungal cell wall components such as mannan and numerous others. Patients have sepsis if they meet the following clinical criteria for SIRS and have an evident local or systemic infection.

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Antibacterial coating of implants in orthopaedics and trauma: a classification proposal in an evolving panorama

Antibacterial coating of implants in orthopaedics and trauma: a classification proposal in an evolving panorama

potential of bacteria which might not be directly adja- cent to the implant. To overcome these issues, combi- nations of antibiotics with other compounds have been proposed either alone or in association with a particu- lar mechanism of controlled release [84]. Antibiotics such as gentamicin, vancomycin, and others have been loaded into porous hydroxyapatite (HA) coatings on titanium implants. The antibiotic-HA coatings exhibit significant improvement in preventing infection com- pared with standard HA coatings in vivo, but there are still many unresolved issues regarding the methodology of antibiotic incorporation into the HA coating and the optimal release kinetics and possible detachment of the coating at the time of press-fit insertion.
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Bacteriological study of post-operative wound infections with special reference to MRSA and ESBL in a tertiary care hospital

Bacteriological study of post-operative wound infections with special reference to MRSA and ESBL in a tertiary care hospital

The emergence of high antimicrobial resistance among bacterial pathogens has made the management and treatment of post-operative wound infections difficult. Staphylococcus aureus was susceptible to Penicillin but due to misuse of antibiotics, it is resistant to most of the Penicillin group worldwide due to Methicillin resistance. Most Methicillin Resistant Staphylococcus aureus (MRSA) infections occur in health care settings and are called Hospital acquired MRSA. Such infections are generally associated with invasive procedures, I.V catheters, surgical wounds, etc. 4 The emergence of
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