Incidence and time trend of surgical site infection in Ramathibodi Hospital during the years 2003-2005.

OBJECTIVE: To determine the incidence of surgical site infection (SSI) for high-risk surgical procedures and any changes in the incidence of SSI during the years 2003 to 2005. MATERIAL AND METHOD: SSI surveillance data were obtained from Ramathobodi's Infection Control Committee for analysis. RESULTS: The overall 30-day incidence of SSI for 492 hepato-biliary-pancreas and colon procedures was 7.7% (38 of 492). Of the 38 SSIs, only 35 were analyzed in detail. MosI patients had SSI types I and II, 89% of SSIs were detected within 20 days after operation, and most common organisms isolated were enterococcus species, E.coli, and P. aeruginosa. SSI rate for the year 2005 (11%) was significantly higher than that of the preceding years (4-5%). CONCLUSION: Overall, SSI rates for Ramathibodi Hospital were not significantly different from those of other studies. The increased SSI rate for the year 2005 needed an explanation, but the value of the present report lies in the potential usefulness of the presented results for future prevention of SSIs. years (4-5%). CONCLUSION: Overall, SSI rates for Ramathibodi Hospital were not significantly different from those of other studies. The increased SSI rate for the year 2005 needed an explanation, but the value of the present report lies in the potential usefulness of the presented results for future prevention of SSIs.

A randomized controlled trial of pubovaginal sling versus vaginal wall sling for stress urinary incontinence.

PURPOSE: To compare the results of Pubovaginal sling and Vaginal wall sling for the treatment of stress urinary incontinence in females. MATERIAL AND METHOD: Between February 2001 and December 2001, a randomized controlled trial was done to compare safety and efficacy of pubovaginal sling versus vaginal wall sling in the management of women with urinary incontinence. Fifteen women 42-68 years old (mean age 51.3 years) were treated with fascial sling (group A) and 11 women 45-60 years old (mean age 50.4 years) with vaginal wall sling (group B). Twenty-one patients had type II SUI and 5 patients had type III SUI (ISD); none had pre-operative detrusor instability. Measures of outcome included efficacy based on SEAPI-QMN, post-operative presence of stress or urge incontinence, frequency of complications, operative time, post-operative pain, length of hospitalization, length of clean intermittent catheterization (CIC) time and mean global evaluation. RESULTS: All patients were followed for at least 3 months after surgery (median 7 months). A total of 20 and 6 women received spinal and general anesthesia, respectively. SEAPI-QMN decreased from a median of 6.3 to 0.8 for group A and from 6.1 to 0.9 for group B. No patient in either group had persistent stress incontinence. Urge incontinence was present in 2 of group A patients and 1 of group B patients. No serious post-operative complications were encountered in both groups. Post-operative pain and operative times for group B patients were significantly lower than for group A patients. Length of hospitalization, length of CIC time and mean global evaluation were not significantly different between the two groups. CONCLUSION: In the short-term, both pubovaginal sling and vaginal wall slings were effective in the treatment of women with SUI. However, the use of vaginal wall sling resulted in significantly shorter operative times and lower post-operative pain compared with pubovaginal sling. Therefore, the vaginal wall sling should be the prefered treatment for SUI.