ABSTRACT BACKGROUND. There have been few studies conducted in hospitalized patients in Viet nam on the epidemiology of surgical site infections (SSIs) and the impact of hand hygiene practices. This study aimed to assess the impact of a bedside hand sanitizer program on SSIs in orthopaedic and neurosurgical patients. DESIGN. A prospective quasi-experimental study was conducted with an untreated control group design in neurosurgical patients and before-after design in orthopaedic patients. A cost analysis based on data derived from the results of this study was also performed. SETTING. Cho Ray Hospital, a tertiary university hospital in Ho Chi Minh City, Viet nam. PATIENTS. All patients admitted for operation between 11 July and 15 August 2000 (Before), and 14 July and 18 August 2001 (After) were included, except those who had undergone another operation within one month prior to admission or were admitted because of SSIs. INTERVENTION. Bedside hand sanitizers were introduced into the Orthopaedic ward and one Neurosurgical ward (Ward A) from September 2000. Training on proper use was also provided to ward staff. Another Neurosurgical ward (Ward B) was used as a control group with no intervention conducted. RESULTS. A total of 1368 patients were recruited into the study. After intervention, in Ward A of the neurosurgical department, the SSI rate between the two periods was reduced by 54% (8.3% to 3.8%; p=0.09). Superficial SSIs were eliminated after the intervention (p=0.007). Comparison between Ward A (intervention) and Ward B (control) showed that, before the intervention, there was no difference in incidence of SSI between the two wards (Ward A: 8.3%, Ward B: 7.2%, p=0.7); however, after intervention, the incidence of SSI in Ward A was significantly lower than Ward B (3.8% and 9.2%, p=0.04). For orthopaedic patients, the SSI rate between the two periods was reduced by 34% (14.8% to 9.8%; p=0.07). SSI patients had a median post-operative length of stay of 19 days longer than patients without SSI (p&lt0.001). Costs were 2.5 times higher in patients with in-hospital SSI compared to uninfected patients (p&lt0.001). Mean SSI-attributable costs were conservatively estimated at US$368 in neurosurgical patients and US$207 in the orthopaedic patients in the before period. SSIs were responsible for at least 14 percent of the annual budget before intervention. The savings per SSI prevented were estimated at US$332 in neurosurgical patients and US$157 in orthopaedic patients. Annual cost savings arising from the intervention were estimated at US$11,112 in orthopaedic patients and US$19,320 in neurosurgical patients. CONCLUSIONS. The incidence of SSI in the hospital was high. The use of hand sanitizers reduced SSI rates, particularly impacting on the incidence of superficial SSIs. The hand sanitization program was found to be a dominant intervention being both more effective and cost saving as compared with no intervention in both study departments. The use of bedside hand sanitizers should be encouraged in the hospitals in Viet nam, where there often is a lack of other hand-washing facilities. / PhD Doctorate

Surgical site infections (SSIs) are an emerging cause of increased morbidity, mortality, and treatment cost, in veterinary medicine. Medical records were searched to evaluate for associations that could increase the risk of developing SSIs. Logistic regression was used to analyze the risk factors statistically, to determine their influence on SSI risk. An SSI incidence rate of 3.0% was found in this study for all small animal surgical procedures performed from September 2010 to July 2011, with implants, hypotension and surgical classification associated with increased likelihood of SSI. Active surveillance is crucial for the development of methods to prevent SSI’s. Biofilms contribute to the antimicrobial resistance properties commonly found in bacteria such as methicillin-resistant Staphylococcus pseudintermedius, which is found in canines. An enzyme known as DispersinB was studied to assess its effect on biofilm formation and degradation. DispersinB prevented the formation and eradicated biofilm in vitro. In vivo testing is required to further assess the effects of DispersinB. / Ontario Veterinary College Pet Trust, Canadian Institutes of Health Research, Kane Biotchech

Surgical site infections (SSIs) are a leading cause of morbidity and mortality in the United States. Researchers have demonstrated the impact that SSIs have on the healthcare system and the need to improve patient outcomes. The purpose of this project was to develop an educational program for the 8-member nursing staff of an outpatient vascular surgical office to help reduce the occurrence of SSI rates for patients seen pre and postoperatively after a noted increase in SSI rates at this clinical setting. Guided by the Fitzpatrick model, a group of 6 health care providers comprising 3 surgeons and 3 nurse practitioners served as content experts to conduct formative evaluation during development of the educational program. Members of the surgical office nursing staff completed a questionnaire; results were analyzed using descriptive analysis. Findings indicated that 100% of nursing staff had no on-site work training on basic signs and symptoms of infection and infection control; 100% of staff were not confident in assessment of the surgical site and addressing patient issues; and at least 50% reported that they lacked knowledge of proper wound care including bathing, dressing changes, and expected symptoms for healing and/or complications postoperatively. Educational materials were designed to address these gaps. This project might benefit the surgical center nursing staff by providing education to help reduce surgical site infection in vascular patients, and bring about positive social change by improving quality of life and patient outcomes for the vascular surgery patient through a reduction in the occurrence of SSIs.

In response to improving quality patient care, combined with the growing rates of surgical site infections (SSIs) in vascular patients, the need to explore current practice trends with current evidence has been identified. SSIs affect quality patient care and compromise patient safety. Empirical evidence has recommended the use of a chlorhexidine wash preoperatively to reduce SSIs. Despite this recommended practice, vascular patients were not receiving it in their routine plan of care within a hospital organization in southern Ontario. Guided by Lewin's theory of planned change, this project explored how the planning of a chlorhexidine preoperative surgical skin preparation protocol impacted progress toward improved care of vascular patients. The project was designed as a quality improvement project examining approximately 110 vascular surgical procedures over a 1-month period and staff surveys that were provided to staff in the preoperative (n = 88), same day surgery (n = 68), and inpatient (n = 47) units. These data were analyzed and demonstrated a reduction in vascular SSIs from 4.9% pre-implementation to 2.8% 1-month post-implementation. Major themes generated from the staff surveys demonstrated the nursing staff had a good understanding of the content that was presented in the in-service provided. These findings have implications for social change by highlighting the benefits of incorporating evidence in to practice and further informing the preoperative practice in other surgical specialties.

Few investigators have used robust analytic methods to assess risk factors and outcomes for surgical site infections (SSIs) after craniotomy and craniectomy (CRANI) procedures. We performed a retrospective study among patients undergoing CRANI procedures between 2006 and 2010 at the University of Iowa Hospitals and Clinics (UIHC) to assess the effect of an intervention (e.g., limiting Gliadel wafer use among patients with malignant brain tumors) on the trend of SSI rates, to identify independent risk factors for SSIs, and to evaluate one-year postoperative patient outcomes associated with these SSIs. We abstracted demographic data and clinical data from medical records or from the UIHC's Health information Management System. We identified 104 patients with SSIs and selected 312 controls. Of SSIs, 88% were deep incisional or organ space infections, 70% were identified after patients were discharged from their initial hospitalizations, 32% were caused by Staphylococcus aureus alone or in combination with other organisms, and 27% were caused by Gram-negative organisms alone or in combination with other organisms. Significant independent risk factors for SSIs were: previous chemotherapy (odds ratio [OR], 10.0; 95% confidence interval [CI] 1.1, 92.1), preoperative length of stay ≥ 1 day (OR, 2.1; 95% CI 1.3, 3.5), preoperative serum glucose ≥ 100 mg/dL (OR, 1.7; 95% CI, 1.0, 3.0), Gliadel® wafer use (OR, 8.6; 95% CI 3.2, 23.1), and postoperative cerebrospinal fluid leak (OR, 4.0; 95% CI, 1.6, 10.3). Gliadel® wafer use was the strongest risk factor; however, limiting Gliadel® wafer use did not decrease SSI rate significantly among patients with brain tumors. Perioperative ventricular drains or lumbar drains were not independently associated with an increased risk of SSIs, but drains may have clinical significance. An SSI risk index that included the significant preoperative patient-related risk factors had a better predictive power than the National Healthcare Safety Network (NHSN) risk index. After adjusting for preoperative length of stay, age, comorbidity score, severity of illness score, the reason for the procedure, and procedure month, patients with SSIs were hospitalized longer postoperatively than were controls during their readmissions (2.3 days; P < 0.0001). After controlling for the same covariates and treating SSI as a time-varying factor, patients with SSIs were more likely than controls to: die (hazard ratio [HR], 3.3; 95% CI, 1.8, 5.8), be readmitted (HR, 4.1; 95% CI, 2.9, 5.8), and have reoperations (HR, 56.6; 95% CI, 38.1, 84.0). In conclusion, surgeons could predict patients' risk of SSIs based on their preoperative risk factors and surgeons could modify some processes of care to lower the SSI risk. Preventing SSIs after CRANI procedures could improve patient outcomes and decrease healthcare utilization.

Introdução: A profilaxia antimicrobiana cirúrgica tem se demonstrado como uma das mais importantes medidas para redução das infecções de sítio cirúrgico. O momento da administração dessa profilaxia é essencial para atingir concentrações terapêuticas nos tecidos durante o procedimento cirúrgico, condição freqüentemente não observada. O objetivo deste estudo foi caracterizar o lapso de tempo transcorrido entre a profilaxia antimicrobiana e o início da incisão cirúrgica. Métodos: Amostra de procedimentos cirúrgicos eletivos realizados em um hospital geral acompanhada mediante observação direta do momento de administração da antibioticoprofilaxia e da incisão. Resultados: Foram analisados 130 procedimentos. A maioria dos pacientes da amostra era do sexo feminino (64,6%). Em 60% dos procedimentos avaliados, os pacientes internaram no mesmo dia da cirurgia e o antimicrobiano mais utilizado foi cefazolina (91,5%). O antimicrobiano profilático foi administrado com uma mediana de 8 minutos antes da incisão, sendo que em 18 (13,8%) procedimentos foi aplicado num tempo maior que 30 min e em 37 (28,5%), foi administrado após a incisão. Em apenas 13,8% a profilaxia foi administrada conforme o protocolo da instituição. As especialidades cujos procedimentos cirúrgicos apresentaram menor freqüência de adequação do horário de administração foram cirurgias plástica (4,5%), urologia (6,7) e vascular (9,1%). Conclusão: Apesar de consagrada, a administração da profilaxia em tempo adequado ainda permanece longe do ideal no nosso meio. As instituições devem adotar medidas eficazes para minimizar a inadequação desta medida. / Introduction: Antimicrobial surgical prophylaxis has been demonstrated as one of the most important steps to reduce surgical site infections. The timing of administration of prophylaxis is essential to achieve therapeutic concentrations in tissues during the surgical procedure, which is frequently not observed. The aim of this study was to characterize the lapse of time between antimicrobial prophylaxis and beginning of surgical incision. Methods: A sample of elective surgeries performed in a general hospital accompanied by direct observation of the timing of administration of antibiotic prophylaxis and the incision. Results: We analyzed 130 procedures. Most of the patients were female (64.6%). In 60% of the procedures evaluated, patients hospitalized on the same day of surgery and antimicrobial more used was cefazolin (91.5%). The antibiotic prophylaxis was administered with a median of 8 minutes before incision, and in 18 (13.8%) procedures were applied to a time longer than 30 min and 37 (28.5%) was administered after the incision. In only 13.8% prophylaxis was administered according to institutional protocol. Whose specialty surgical procedures had lower rates of appropriateness of administration time were plastic surgery (4.5%), urology (6.7) and vascular (9.1%). Conclusion: Although established, the administration of prophylaxis in a timely manner remains far from ideal in our midst. Institutions should adopt effective measures to minimize the inadequacy of this measure.

Introdução: A profilaxia antimicrobiana cirúrgica tem se demonstrado como uma das mais importantes medidas para redução das infecções de sítio cirúrgico. O momento da administração dessa profilaxia é essencial para atingir concentrações terapêuticas nos tecidos durante o procedimento cirúrgico, condição freqüentemente não observada. O objetivo deste estudo foi caracterizar o lapso de tempo transcorrido entre a profilaxia antimicrobiana e o início da incisão cirúrgica. Métodos: Amostra de procedimentos cirúrgicos eletivos realizados em um hospital geral acompanhada mediante observação direta do momento de administração da antibioticoprofilaxia e da incisão. Resultados: Foram analisados 130 procedimentos. A maioria dos pacientes da amostra era do sexo feminino (64,6%). Em 60% dos procedimentos avaliados, os pacientes internaram no mesmo dia da cirurgia e o antimicrobiano mais utilizado foi cefazolina (91,5%). O antimicrobiano profilático foi administrado com uma mediana de 8 minutos antes da incisão, sendo que em 18 (13,8%) procedimentos foi aplicado num tempo maior que 30 min e em 37 (28,5%), foi administrado após a incisão. Em apenas 13,8% a profilaxia foi administrada conforme o protocolo da instituição. As especialidades cujos procedimentos cirúrgicos apresentaram menor freqüência de adequação do horário de administração foram cirurgias plástica (4,5%), urologia (6,7) e vascular (9,1%). Conclusão: Apesar de consagrada, a administração da profilaxia em tempo adequado ainda permanece longe do ideal no nosso meio. As instituições devem adotar medidas eficazes para minimizar a inadequação desta medida. / Introduction: Antimicrobial surgical prophylaxis has been demonstrated as one of the most important steps to reduce surgical site infections. The timing of administration of prophylaxis is essential to achieve therapeutic concentrations in tissues during the surgical procedure, which is frequently not observed. The aim of this study was to characterize the lapse of time between antimicrobial prophylaxis and beginning of surgical incision. Methods: A sample of elective surgeries performed in a general hospital accompanied by direct observation of the timing of administration of antibiotic prophylaxis and the incision. Results: We analyzed 130 procedures. Most of the patients were female (64.6%). In 60% of the procedures evaluated, patients hospitalized on the same day of surgery and antimicrobial more used was cefazolin (91.5%). The antibiotic prophylaxis was administered with a median of 8 minutes before incision, and in 18 (13.8%) procedures were applied to a time longer than 30 min and 37 (28.5%) was administered after the incision. In only 13.8% prophylaxis was administered according to institutional protocol. Whose specialty surgical procedures had lower rates of appropriateness of administration time were plastic surgery (4.5%), urology (6.7) and vascular (9.1%). Conclusion: Although established, the administration of prophylaxis in a timely manner remains far from ideal in our midst. Institutions should adopt effective measures to minimize the inadequacy of this measure.

Introdução: A profilaxia antimicrobiana cirúrgica tem se demonstrado como uma das mais importantes medidas para redução das infecções de sítio cirúrgico. O momento da administração dessa profilaxia é essencial para atingir concentrações terapêuticas nos tecidos durante o procedimento cirúrgico, condição freqüentemente não observada. O objetivo deste estudo foi caracterizar o lapso de tempo transcorrido entre a profilaxia antimicrobiana e o início da incisão cirúrgica. Métodos: Amostra de procedimentos cirúrgicos eletivos realizados em um hospital geral acompanhada mediante observação direta do momento de administração da antibioticoprofilaxia e da incisão. Resultados: Foram analisados 130 procedimentos. A maioria dos pacientes da amostra era do sexo feminino (64,6%). Em 60% dos procedimentos avaliados, os pacientes internaram no mesmo dia da cirurgia e o antimicrobiano mais utilizado foi cefazolina (91,5%). O antimicrobiano profilático foi administrado com uma mediana de 8 minutos antes da incisão, sendo que em 18 (13,8%) procedimentos foi aplicado num tempo maior que 30 min e em 37 (28,5%), foi administrado após a incisão. Em apenas 13,8% a profilaxia foi administrada conforme o protocolo da instituição. As especialidades cujos procedimentos cirúrgicos apresentaram menor freqüência de adequação do horário de administração foram cirurgias plástica (4,5%), urologia (6,7) e vascular (9,1%). Conclusão: Apesar de consagrada, a administração da profilaxia em tempo adequado ainda permanece longe do ideal no nosso meio. As instituições devem adotar medidas eficazes para minimizar a inadequação desta medida. / Introduction: Antimicrobial surgical prophylaxis has been demonstrated as one of the most important steps to reduce surgical site infections. The timing of administration of prophylaxis is essential to achieve therapeutic concentrations in tissues during the surgical procedure, which is frequently not observed. The aim of this study was to characterize the lapse of time between antimicrobial prophylaxis and beginning of surgical incision. Methods: A sample of elective surgeries performed in a general hospital accompanied by direct observation of the timing of administration of antibiotic prophylaxis and the incision. Results: We analyzed 130 procedures. Most of the patients were female (64.6%). In 60% of the procedures evaluated, patients hospitalized on the same day of surgery and antimicrobial more used was cefazolin (91.5%). The antibiotic prophylaxis was administered with a median of 8 minutes before incision, and in 18 (13.8%) procedures were applied to a time longer than 30 min and 37 (28.5%) was administered after the incision. In only 13.8% prophylaxis was administered according to institutional protocol. Whose specialty surgical procedures had lower rates of appropriateness of administration time were plastic surgery (4.5%), urology (6.7) and vascular (9.1%). Conclusion: Although established, the administration of prophylaxis in a timely manner remains far from ideal in our midst. Institutions should adopt effective measures to minimize the inadequacy of this measure.

Background: The aim of surgical antibiotic prophylaxis (SAP) is to prevent surgical site infection (SSI) by administering an appropriate antimicrobial agent perioperatively. However, SAP may be associated with adverse effects and incurs added costs. The primary objective of this prospective study is to establish whether clinicians are adhering to existing perioperative antibiotic prophylaxis guidelines in terms of indication, dosage and timing of SAP. Secondary objectives are to determine the proportion of patients receiving inappropriate antibiotics; and to evaluate correct practice concerning re-dosing and duration of SAP. Methods: A cross-sectional prospective audit of the anaesthetic records and prescription charts of surgical patients was conducted at Groote Schuur Hospital, a tertiary level teaching hospital in Cape Town, South Africa, over a period of one week. Data were collected by anaesthetists – blinded to the study objectives – and the investigators; then captured on Excel spread sheets and compared to existing SAP guidelines. Descriptive statistics and binary logistic regression were used for analysis. Results: Of the 192 patients consented, 180 questionnaires were completed for data analysis. The median age of participants was 44.5 years (IQR: 31.5-58), with a preponderance of females (58.7%). SAP was administered in 149 cases (82.8%) and withheld in 31 (17.2%). This was appropriate in 91.9% (137/149) and 77.4% (24/31) respectively. Twelve patients (6.7%) received inappropriate antibiotics and in seven (3.9%) it was inappropriately withheld. Of the 156 patients who should have received SAP, choice of drug was correct in 121 (77.6%), dosage in 110 (70.5%) and timing in 87 (55.8%). Absolute compliance was achieved in 44.4% (80/180). Errors were mostly related to timing, re-dosing and duration of SAP. Conclusion: Anaesthetists and surgeons at Groote Schuur Hospital demonstrate variable adherence to surgical antibiotic prophylaxis guidelines. Interventions aimed at improving compliance are warranted.

Background: Surgical site infections are the second most common healthcare-related infection and implies high costs for the healthcare. It causes suffering for the patient and places high demands on the nursing care. The nurse's preoperative preparation of the patient is an important part where the patient's possible risk factors should be identified. It is also important that the patient receives information that is suitable for the patient's needs of nursing care. The nurse carries the primary liability of nursing care and has a responsibility to prevent surgical site infections from occurring. Aim: The aim of this study was to investigate the nurse's prerequisites to prevent the occurrence of surgical site infections in hospital care. Method: The chosen method was a literature review based on ten articles of qualitative and quantitative methods published between 2013–2022. Results: The analysis resulted in the following themes and sub-themes:Necessary communication with the sub-themes Team collaboration and Information transfer.Availability of principles and resources with the sub-themes Access to evidence-based guidelines, Pre-, intra- and post-operative premises and knowledge, A safe environment andAccess to materials. Pedagogical ability with the sub-themes Meeting the patient individually and Adequate patient education. Conclusion: The results showed that there were both positive and negative aspects regarding the nurse's prerequisites for preventing surgical site infections, but the negative aspects were overrepresented. The nurses often had the required knowledge but did not use their abilities tothe same extent during work. This resulted in limited nursing care with insufficient complianceto the evidence-based guidelines.