Ongoing Strategies to Improve Antimicrobial Utilization in Hospitals across the Middle East and North Africa (MENA): Findings and Implications.

Antimicrobial resistance (AMR) is an increasing global concern, increasing costs, morbidity, and mortality. National action plans (NAPs) to minimize AMR are one of several global and national initiatives to slow down rising AMR rates. NAPs are also helping key stakeholders understand current antimicrobial utilization patterns and resistance rates. The Middle East is no exception, with high AMR rates. Antibiotic point prevalence surveys (PPS) provide a better understanding of existing antimicrobial consumption trends in hospitals and assist with the subsequent implementation of antimicrobial stewardship programs (ASPs). These are important NAP activities. We examined current hospital consumption trends across the Middle East along with documented ASPs. A narrative assessment of 24 PPS studies in the region found that, on average, more than 50% of in-patients received antibiotics, with Jordan having the highest rate of 98.1%. Published studies ranged in size from a single to 18 hospitals. The most prescribed antibiotics were ceftriaxone, metronidazole, and penicillin. In addition, significant postoperative antibiotic prescribing lasting up to five days or longer was common to avoid surgical site infections. These findings have resulted in a variety of suggested short-, medium-, and long-term actions among key stakeholders, including governments and healthcare workers, to improve and sustain future antibiotic prescribing in order to decrease AMR throughout the Middle East.

Is precision medicine the future of surgical site infection prevention?

James Price, Senior Lecturer and Honorary Consultant in Infection, Brighton and Sussex Medical School, University of Sussex, UK Broad infection prevention and control (IPC) measures are routinely employed to prevent surgical site infections (SSIs),1 including screening for (and subsequent suppression of) key pathogens and surgical antimicrobial prophylaxis. Prediction There is growing literature on the application of mathematical modelling to routinely collected healthcare data in order to accurately predict an individual's: (i) risk of carrying or acquiring key pathogens;(ii) future need for surgery;and (iii) likelihood of developing a healthcare associated infection. [...]with large proportions of the population yet to receive routine vaccinations, incorporation of assessment and vaccine delivery within secondary care pathways has the potential to support post-discharge outcomes and to optimise preparation of future hospital admissions and procedures.

Loop ileostomy closure as a 23-hour stay procedure: a randomized controlled trial

Background: Loop ileostomy closure is associated with low complication rates, consisting mostly of postoperative ileus, but is still leading to significant length of hospitalization. Hence, decreased length of stay could be achieved by decreasing ileus rates. The purpose of this study was to assess the safety and feasibility of ileostomy closure performed in a 23-hour hospitalization setting using a standardized enhanced recovery pathway. Methods: This randomized controlled trial included healthy adults undergoing elective ileostomy closure. All patients were enrolled in a standardized enhanced recovery pathway specific to ileostomy closure, including daily irrigation of the efferent limb with an enteral nutritional formula for 7 days preoperatively. Once surgery was completed, patients were randomized to either conventional hospitalization (CH) or to 23-hour stay (23HS). Primary outcome was total length of stay in days, and secondary outcomes were 30-day rates of readmission, postoperative ileus, surgical site infection, postoperative morbidity and mortality. Owing to COVID-19 limiting access to surgical beds, the study was terminated early. Results: A total of 47 patients were randomized;23 in the CH arm and 24 in the 23HS arm. Patients in the 23HS arm had a shorter median length of stay (1 d v. 2 d, p = 0.015) and similar readmission rates (4% v. 13%, p = 0.348), postoperative ileus (0% in both arms), surgical site infection (0% v. 4%, p = 0.489), postoperative morbidity rates (17% v. 22%, p = 0.724) and mortality rate (0% in both arms). Conclusion: This study suggests that loop ileostomy closure as a 23-hour stay procedure in a standardized enhanced recovery pathway is feasible and safe.

SG-APSIC1040: Implementing a quality-improvement approach to surgical-site infection prevention in the Philippines

Objectives: We aimed to reduce surgical site infections in Camarines Norte Provincial Hospital, Philippines, (1) by establishing SSI surveillance in the surgical departments, (2) by implementing quality improvement processes, and (3) by developing and implementing an SSI prevention care bundle. Methods: In partnership with Americares, SSI surveillance based on CDC criteria was instituted for all surgeries, excluding orthopedic surgeries. Staff were trained in applying quality-improvement methodology, infection prevention and control, and SSI prevention. A care bundle based on the WHO evidence-based interventions for SSI prevention was designed. Interventions included preoperative bathing, surgical hand preparation, intraoperative surgical-site preparation using 2% chlorhexidine isopropanol solution, and postoperative wound management. The model for improvement methodology was used to implement these changes for 12 months from May 2020 to May 2021. Results: In total, 718 surgeries were followed for SSI surveillance, with an average of 58 surgical patients per month in 2020, which increased to 90 patients per month in 2021. In 2020, the SSI incidence rate was 1.76%, and this rate increased 38.64% to 2.44% in 2021. A statistically significant increase in knowledge of 5.29 points (95% CI, 4.91–5.67) among 150 participants undergoing SSI training between pretest (+6.46) and posttest (+ 11.76) was achieved. SSI care-bundle checklists were used for 80% of eligible surgical patients by 2021. Compliance with the SSI care-bundle checklist increased from 0 to 87.69% (n = 718) by October 2021, subsequently decreasing by 2.75% by December 2021. Conclusions: A quality-improvement process embedded in routine surgical care can be a building block for reducing SSIs. However, we did not achieve an overall decrease in SSIs, likely due to increased reporting of SSIs through improved SSI surveillance. However, important gains were achieved in improved healthcare worker knowledge and practice through the implementation of an SSI care bundle. Fluctuations in checklist compliance reflected COVID-19 surges.

Ongoing Efforts to Improve Antimicrobial Utilization in Hospitals among African Countries and Implications for the Future.

There are serious concerns with rising antimicrobial resistance (AMR) across countries increasing morbidity, mortality and costs. These concerns have resulted in a plethora of initiatives globally and nationally including national action plans (NAPs) to reduce AMR. Africa is no exception, especially with the highest rates of AMR globally. Key activities in NAPs include gaining a greater understanding of current antimicrobial utilization patterns through point prevalence surveys (PPS) and subsequently instigating antimicrobial stewardship programs (ASPs). Consequently, there is a need to comprehensively document current utilization patterns among hospitals across Africa coupled with ASP studies. In total, 33 PPS studies ranging from single up to 18 hospitals were documented from a narrative review with typically over 50% of in-patients prescribed antimicrobials, up to 97.6% in Nigeria. The penicillins, ceftriaxone and metronidazole, were the most prescribed antibiotics. Appreciable extended prescribing of antibiotics up to 6 days or more post-operatively was seen across Africa to prevent surgical site infections. At least 19 ASPs have been instigated across Africa in recent years to improve future prescribing utilizing a range of prescribing indicators. The various findings resulted in a range of suggested activities that key stakeholders, including governments and healthcare professionals, should undertake in the short, medium and long term to improve future antimicrobial prescribing and reduce AMR across Africa.

Reduction of early surgical site and other care related infections in 3553 hip fracture patients: lessons learned from the 5-year Safe Hands project.

BACKGROUND: Surgical site infection (SSI) after acute hip fracture surgery is a devastating complication associated with increased suffering and mortality. The aim of the study was to investigate early SSI, sepsis, pneumonia and urinary tract infections over five years, before and after the implementation of the Safe Hands project. METHODS: This was a single-centre observational study with a 5-year longitudinal design, investigating the effects of an infection-prevention intervention targeting the clinical care pathway of individuals with acute hip fracture. Statistical analyses were based on routinely collected patient outcome data comprising 3553 patients. The study conforms to the criteria of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). RESULTS: The incidence of early SSIs decreased from 2.5% in years 1-2 to 1.1% in years 4-5. Similar results were observed for sepsis (2.7% to 1.3%) and urinary tract infections (14.2% to 4.2%). The multivariable regression results suggest that, for every observed year, the odds of early SSIs decreased. Male gender, procedure time, sepsis and preoperative skin damage increased the odds significantly. CONCLUSIONS: Our preventive bundle, based on partnership between researchers, managers and clinicians and a strong commitment to change from the involved professions, appear to be effective in reducing the frequency of potentially devastating SSIs and other hospital acquired infections after hip fracture surgery. The use of external and internal facilitators was crucial to enable individual and organisational learning and overcoming barriers to improvements. TRIAL REGISTRATION: Clinical Trials.gov ID: NCT02983136 Registered 6 December 2016-Retrospectively registered.

A systematic review of cost and well-being in hip and knee replacements surgical site infections.

This systematic review examined peer-reviewed literature published from 2010 to 2020 to investigate the health care system costs, hidden out-of-pocket expenses and quality of life impact of surgical site infections (SSIs) and to develop an overall summary of the burden they place on patients. SSI can significantly impact patients' treatment experience and quality of life. Understanding patients' SSI-related burden may assist in developing more effective strategies aimed at lessening the effects of SSI in financial and well-being consequences. Peer-reviewed articles on adult populations (over 18 years old) in orthopaedic elective hip and knee surgeries published from 2010 to 2020 were considered. Only publications in English and studies conducted in high-income countries were eligible for inclusion. A search strategy based on the MESH term and the CINAHL terms classification was developed. Five databases (Scopus, EMBASE, CINAHL, Medline, Web of Science) were searched for relevant sources. Reviewers categorised and uploaded identified citations to Covidence and EndNoteX9. Reviewers will assess article titles, abstracts and the full text for compliance with the inclusion criteria. Ongoing discussions between reviewers resolved disagreements at each selection process stage. The final scoping review reported the citation inclusion process and presented search results in a PRISMA flow diagram. Four main themes were extracted from a thematic analysis of included studies (N = 30): Hospital costing (n = 21); Societal perspective of health system costing (n = 2); Patients and societal well-being (n = 6) and Epidemiological database and surveillance (n = 22). This systematic review has synthesised a range of themes associated with the overall incidence and impact of SSI that can inform decision making for policymakers. Further analysis is required to understand the burden on SSI patients.

The Strike Team as an implementation strategy for surgical infection prevention

Background: Surgical site infections (SSIs) incur up to $10 billion annually due to their excessive morbidity. SSI prevention bundles have had variable success in colorectal surgery. For example, at the University of Wisconsin Hospital, a 505-bed regional referral center, SSI rates have remained high despite the introduction of a 14-element SSI prevention bundle in 2016. To aid in the implementation of this complex bundle, the hospital started Strike Teams in 2019. We have described the impact of Strike Teams on colorectal SSI rates in our tertiary-care hospital. Methods: A Strike Team with key stakeholders from colorectal surgery (ie, surgeon, OR director, nurses, surgical technicians), anesthesia, pharmacy, infection prevention, and infectious disease was formed, supported by the hospital's executive leadership. The Strike Team met monthly throughout 2019 to review each SSI case, discussed barriers to adherence for the SSI prevention bundle elements with implementation difficulties (Table 1), and proposed actionable feedback to increase adherence. The latter was disseminated to frontline clinicians by the teams' surgical leaders during everyday clinical practice. The Strike Team was paused in 2020 due to resource reallocation in response to the COVID-19 pandemic. Monthly and quarterly SSI surveillance was conducted according to CDC guidance. Results: Colorectal SSI rates before, after, and during Strike Team activity are shown in Fig. 1. Adherence rates to the bundle elements targeted by the Strike Team are shown in Fig. 2. Conclusions: Adherence to the preferred antibiotic prophylaxis increased, although adherence to other bundle elements of focus did not change significantly. SSI rates decreased below our expectation while the Strike Team was active in our hospital, although SSI reduction was not sustained. Further research should study the effectiveness of Strike Teams as a long-term implementation strategy for SSI prevention in colorectal surgery.Funding: NoneDisclosures: None

2022 CONFERENCE POSTER COLLECTION: THE OFFICIAL VOICE OF PERIOPERATIVE NURSING

[...]new OR caregivers moved from an observation to an immersion in SPD, allowing them to truly gain an understanding of the importance of the processes and the SPD technician's role. Given this scenario, the implementation of guidelines throughout the perioperative period is of fundamental importance, as they are essential to assist decisions about the most appropriate health care in specific circumstances, guiding and qualifying the practice. The oldest guideline is the Protocol for the Surveillance of Surgical Site Infection, version 6, by Public Health England, which dates to 2013, and the most recent is the Surgical Site Infection Event (SSI), published in 2020 by the Centers for Disease Control and Prevention. Implementing an Ultraviolet Germicidal Irradiation (UVGI) System in Surgical Services, NMRTC, Camp Pendleton, During the COVID-19 Pandemic Annissa Cromer, Regina Leassear, Angela Spruill Within Surgical Services at Navy Medicine Readiness and Training Command, Camp Pendleton, an adjunct method to regular cleaning protocols was implemented to ensure complete disinfection of harmful pathogens.

Surgical site infections in patients undergoing breast oncological surgery during the lockdown: An unexpected lesson from the COVID-19 pandemic.

Background: The present study aims to evaluate how the measures to contain the SARS-CoV-2 spreading affected the surgical site infections (SSIs) rate in patients who underwent nondeferrable breast cancer surgery (BCS). Methods: This study is a retrospective analysis of prospectively collected data from a consecutive series of patients underwent nondeferrable BCS in a regional Italian Covid-free hub during two different period: March to April 2020 (pandemic cohort [PC]) and March till April 2019 (control cohort [CC]). SSIs were defined according to the criteria established by the Center for disease control and prevention (CDC) and additional treatment, serous discharge, erythema, purulent exudate, separation of deep tissues, isolation of bacteria, and stay (ASEPSIS) scoring systems. Results: One hundred ninety-nine patients were included in the present study: 100 and 99 patients who underwent nondeferrable BCS from March to April 2020 (PC) and from March to April 2019 (CC), respectively. The overall SSIs rate in this series was 9.1% according to CDC criteria and 6.5% according to ASEPSIS criteria. The SSIs incidence decreased during the pandemic period. Moreover, the SSIs rate according to ASEPSIS criteria was statistically lower in the PC than in the CC. We observed significant evidence of higher SSIs, both in terms of CDC and ASEPSIS score, in patients having undergone breast reconstruction compared with patients not undergoing immediate reconstruction. Conclusions: The restrictive measures issued during the lockdown period seemed to lower the SSIs rates in patients undergoing nondeferrable BCS.

Quarterly epidemiological data on Clostridioides difficile infection, Escherichia coli bacteraemia, Staphylococcus aureus bacteraemia and Surgical Site Infection in Scotland April to June 2021 (Q2) 2021

Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) Scotland provided a commentary on quarterly epidemiological data in Scotland for April to June (Q2) 2021 on the following: Clostridioides difficile infection, Escherichia coli bacteraemia, Staphylococcus aureus bacteraemia and surgical site Infection. Data are provided for the 14 NHS boards and one NHS Special Health board. Results showed that there were 277 CDI cases, of which 73.3% (203) were healthcare infections. In theprevious quarter there were 262 cases. There were 1103 ECB cases, of which 48.2% (532) were healthcare infections. In the previous quarter there were 961 cases. There were 408 SAB cases, of which 63.7% (260) were healthcare infections. In the previous quarter there were 388 SAB cases. Epidemiological data for SSI were not included for this quarter due to the pausing of surveillance to support the COVID-19 response. The data used for this report is part of the mandatory surveillance in Scotland. ARHAI Scotland supports NHS boards to analyse their data. Local monitoring in hospital and community settings isrequired to reduce these infections.

Research progress on the application of antiseptics after mucosal exposure of SARS-CoV-2

The transmission routes of SARS-CoV-2 include droplet, air and contact transmission, but regardless of the transmission route, the virus must eventually be exposed through the oral, nasal and ocular mucous membranes to invade the human body. Guaranteeing the respiratory protection of front-line medical staff in the prevention and control of COVID-19 is one of the primary tasks of nosocomial infection management. According to "Technical Guidelines for Prevention and Control of COVID-19 in Healthcare Settings (3rd Edition)", oral/nasal cavity can be disinfected with hydrogen peroxide, iodophor, in the event of occupational respiratory exposure. But, at the moment, In the field of nosocomial management, compared with hand hygiene, "mucosal hygiene" is rarely mentioned, especially the treatment of respiratory mucosa after exposure to acute infectious respiratory pathogens, which is still blank in the domestic research. After a rapid literature review, it is found that some antiseptics have been widely used in clinical practices, such as gargling with bactericidal solution before the diagnosis and treatment procedure for dental patients under COVID-19 epidemic, nasal decolonization for patients undergoing elective surgery to prevent surgical site infection, and use of eye drops of antiseptics to prevent neonatal conjunctivitis. In view of the current lack of effective antiviral drugs for treatment of SARS-CoV-2, and the constantly emerging mutant strains can break through the immune barrier of human body, this paper recommends that medical personnel use antiseptics for emergency mucosal disinfection as an supporting measure for respiratory tract protection after accidental exposure to SARS-CoV-2 of oral, nasal and ocular mucosa.

Epidemiological characteristics of nosocomial infection among non-plan secondary surgery patients in a general hospital

OBJECTIVE: To retrospectively investigate the association between the non-plan secondary surgery and the nosocomial infection so as to provide objective basis for prevention and control of nosocomial infection in the non-plan secondary surgery patients. METHODS: The medical records of all the patients who received non-plan secondary surgery in a three-A tertiary hospital of Xi'an from Jan 2018 to Dec 2019 were retrospectively investigated. The baseline data, clinical features and status of infection of the non-plan secondary surgery patients were retrospectively reviewed and analyzed by full-time staff of disease prevention and control department. RESULTS A total of 111948 patients underwent surgeries in the whole hospital from Jan 2018 to Dec 2019, 194 of whom underwent the non-plan secondary surgery, accounting for 0.17%. Postoperative hemorrhage was the leading cause of the non-plan secondary surgery, followed by incision infection(57.22%), incision dehiscence(11.34%) and poor healing(8.76%). Among the 194 patients undergoing non-plan secondary surgery, 57 had nosocomial infection, respiratory system, surgical site and blood system were the infection sites, there was 1 case who had nosocomial infection for the first time before the surgery, 24 cases who had nosocomial infection for the first time after the surgery and 32 cases who had nosocomial infection after the secondary surgery. Among the 24 patients who had nosocomial infection for the first time after surgery, 70.83% were male patients, 75.00% had clean-contaminated incision, 66.67% were with the operation duration no less than 3 hours, 75.00% were treated with preoperative antibiotic prophylaxis, and 91.67% were tumor patients. Among the 32 patients who had nosocomial infection after the secondary surgery, 75.00% were male patients, 53.13% were no less than 60 years old, 78.13% were with the operation duration no less than 3 hours, and 68.75% were tumor patients. CONCLUSION: The non-plan secondary surgery and the nosocomial infection are mutually causal, the postoperative surgical site infection for the first time may lead to the secondary surgery, and the secondary surgery may result in the increase of incidence of nosocomial infection.

Efficacy of Temperature-Controlled Airflow in Maintaining Ultraclean Conditions throughout the Operating Room

Thirty years of evidence supports the efficacy of ultra-clean air in preventing surgical site infection (SSI). Ultraclean is defined as fewer than 10 Colony Forming Units (CFUs) per cubic meter or <10CFU/m3 (35ft3) However, achieving and maintaining ultraclean conditions in the contemporary operating room has proven challenging. For decades, Laminar Air Flow (LAF) systems were recommended for use in rooms where infection sensitive joint arthroplasty procedures are performed. But, a growing body of evidence has called the efficacy of LAF in prevention of these infections into question. As a result, CD C no longer recommends use of LAF for joint arthroplasty. The WHO has gone a step further issuing a conditional recommendation against its use in these procedures. At the same time, demand for total hip and knee arthroplasties are expected to grow exponentially over the next decade and for reasons that are unclear rates of prosthetic joint infection (PJI) are on the rise. Taken together, these factors suggest that the time has come to rethink management of airborne contamination and ventilation technology in the operating room. Temperature-controlled Air Flow (TcAF) is a novel ventilation technology that has been proven to maintain ultra-clean conditions throughout the entire operating room. TcAF uses continuous HEPA filtration and combines a robust central unidirectional down-flow driven by gravity from a temperature gradient together with mixing ventilation in the periphery of the room. While TcAF has been scientifically validated to maintain ultra-clean conditions of <10CFU/m3(35ft3) throughout the entire operating room, the impact of TcAF on prevention of surgical site infection was unknown. The aim of this study was to evaluate the efficacy of TcAF on prosthetic joint infection (PJI). A retrospective case control study was performed with 1,000 consecutive cases of primary total joint arthroplasty before and 1,000 consecutive cases after the installation of an ultra-clean TcAF system. TcAF was associated with a statistically significant reduction in surgical site infection. With reduction in surgical site infection proving to be ever more challenging and demand for infection sensitive procedures rising, more rigorous attention to airborne contamination may represent a new pathway to improvement. While not the focus of this paper, the advent of Covid-19 should bring into greater focus the risk of airborne transmission andfurther incentiviņe mitigation.

An Evaluation of the Effect of the Use of N95 Respirators by Surgical Teams on Early Surgical Site Infections in Orthopedic Cases.

Background Surgical site infections (SSIs) are seen in the postoperative period in orthopedic and traumatology clinics. Just as in all surgical clinics, SSIs lead to patient dissatisfaction with the results, prolong the length of stay in the hospital, and increase treatment costs. SSIs are known to occur as a result of wound contamination through inoculation of microorganisms found mainly in the air or in the surgical area. Because of the coronavirus disease 2019 pandemic, N95 masks have been widely used in the operating rooms of our hospital by nurses, residents, and surgeons since March 2020. This study aims to evaluate the effect of N95 respirator use by the surgical team on SSIs determined in patients operated on in our clinic compared to surgical mask use. Methodology In this retrospective study, the use of N95 respirators by the surgical team was compared with the use of surgical masks to evaluate the effect on SSIs in patients operated on in our clinic. Two groups were formed of patients operated on by the surgical team wearing surgical masks between February 2019 and February 2020 and those operated on with the surgical team using N95 respirators between March 2020 and March 2021. Each patient was diagnosed with postoperative SSIs by two different surgeons in the same clinic and by an infection clinic specialist based on clinical and laboratory findings. Results A total of 1,486 patients were examined; 729 patients in February 2019-February 2020 period (Group 1) and 757 in March 2020-March 2021 period (Group 2). In total, 124 and 104 patients were excluded from the first and second groups, respectively, for various reasons, including revision surgery, open fractures, diabetes, smoking, peripheral vascular disease, or other comorbidities that could affect infection rates. SSIs were determined in 35 patients in Group 1 and 13 patients in Group 2. The SSI rates in the second period in both types of procedures (arthroplasty and trauma surgeries) were determined to be significantly lower. Conclusions Because of the use of intraoperative N95 respiratory masks by surgical teams in orthopedics and traumatology procedures, the number of SSIs decreased significantly compared to the use of surgical masks.

Comparing Infection Rates from Using Different Surgical Preparation Solutions and Techniques in Foot & Ankle Elective Surgery

Category: Other Introduction/Purpose: Surgical site infection (SSI) after Foot & Ankle surgery ranges from 1.2% to 13.2%, higher than any other elective orthopaedic procedure. Infection is of concern for the patient and expensive for the healthcare system. SSI is multifactorial and can be divided into host-related and perioperative factors. Skin preparation is one of the key peri-operative factors in reducing SSI. The current literature supports a combined chlorhexidine and alcohol preparation technique, although there is some conflicting evidence. Most studies to date have used proxy outcomes such as growth from swabs shortly after skin preparation. There are no large scale studies which have looked at definitive clinical outcomes such as the rate of postoperative SSI. Methods: A retrospective review of data was undertaken for two longitudinal cohorts which were using two different skin preparation solutions and techniques due to a change in hospital protocol. Each cohort was continuous and derived from the same overall populationIn cohort 1, Povidine-Iodine (Betadinetm) followed by Alcoholic Chlorhexidine was used on swabs (Double prep group). In cohort 2, 2 Alcoholic Chlorhexidine was used in a prep stick applicator. Standard criteria for diagnosing surgical site infection were used. All open injuries, procedures for ongoing infection, amputations for osteomyelitis /diabetic foot and COVID- 19 positive cases were excluded. Results: After applying standard exclusion criteria, 919 elective F&A procedures in the Double prep group and 491 procedures were included for the Single prep groupAs these were continuous longitudinal cohorts of large scale from the same population, there is a justifiable presumption of group matchingIn cohort 1 there were 15 superficial infections (1.6%) and 3 deep (0.3%). In cohort 2 there were 18 superfical infections (3.6%) and 1 deep (0.3%). The total infections in cohort 1 were 18 (2%) and 19 in cohort 2 (3.9%)There was an increase in superficial, and therefore total infection rates, in the single prep group compared to the double prep group. These increases were statistically significant;p <0.05 with regards to superficial infection and total infection rates in the single prep group. Conclusion: Double skin preparation, with Povidone-Iodine followed by alcoholic Chlorhexadine, statistically significantly decreases foot and ankle surgical infection rates as compared to a single alcoholic chlorhexidine skin preparation

Lead the way or leave the way: Early experience of management of emergency pelvi-acetabular surgery during the COVID-19 pandemic at a tertiary care hospital in Pakistan

Objective: To report the early experience, the relationship of surgical site infection after pelvi-acetabular fracture fixation with certain possible risk factors, and organizational protocol for emergency pelvic surgery currently being used during the COVID-19 pandemic by an integrated team of orthopedic surgeons. Study Design: Prospective study. Setting: Department of Orthopedic and Spine Surgery, "Ghurki Trust Teaching Hospital Lahore, Pakistan. Period: March 2020, to August 2020. Material & Methods: A total of 25 patients diagnosed with acetabular fractures were included. Fracture patterns were classified according to judet and letournel and young burgess classification systems. Factors studied included patient's age, gender, body mass index, fracture pattern, type of surgery, comorbidities, smoking status, associated injuries, surgical site infections and mortality. Results: In a total of 25 patients, 21(84.0%) were male and 4(16.0%) female patients with overall mean age as 38.04±14.58 years. Overall, mean BMI was 23.20±2.60 kg/m2. There were 12(48.0%) patiens who had hypertension while 4 (16.0%) smokers. There were 21 (84.0%) patients who did not have any associated injuries while 3 (12.0%) had the associated extremities. The mean hospital stay of the patients was 5.08±0.76 days. The results revealed no significant association of Gender with these parameters (p > 0.001). Conclusion: There is no added risk of infection and mortality for the provision of emergency trauma services to pelvi-acetabular fractured patients even during panic and pandemic situations. [ FROM AUTHOR] Copyright of Professional Medical Journal is the property of Professional Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Hospital-acquired infections in a tertiary hospital in Iran before and during the COVID-19 pandemic.

Infection prevention protocols are the accepted standard to control nosocomial infections. These protective measures intensified after the coronavirus 2019 (COVID-19) pandemic to reduce the risk of viral transmission. It is the rationale that this practice reduces nosocomial infections. We evaluated the impact of these protective measures on nosocomial infections in our center with more than 20,000 records of annual patient admission. In a retrospective study, we evaluated the incidence of nosocomial infections in Sina hospital for 9 months (April-December 2020) during the COVID-19 period and compared it with the 8 months in the pre-COVID period (April-November 2019). Despite decreasing the number of admissions during the COVID era (hospitalizations showed a reduction of 43.79%), the total hospital nosocomial infections remained unchanged; 4.73% in the pre-COVID period versus 4.78% during the COVID period. During the COVID period the infection percentages increased in the cardiovascular care unit (p-value = 0.002) and intensive care units (p-value = 0.045), and declined in cardiology (p-value = 0.046) and neurology (p-value = 0.019) wards. This study showed that intensifying the infection prevention protocols is important in decreasing the nosocomial infections in some wards (cardiology and neurology). Still, we saw increased nosocomial infection in some wards, e.g., the intensive care unit (ICU) and coronary care unit (CCU). Thus, enhanced infection prevention protocols implemented in hospitals to prevent the spread of a pandemic infection may not always decrease rates of other hospital-acquired infections during a pandemic. Due to limited resources, transfer of staff, and staff shortage due to quarantine measures may prohibit improved prevention procedures from effectively controlling nosocomial infections.

Use of prophylactic closed-incision negative-pressure therapy (CINPT) is associated with reduced surgical-site infections in patients undergoing open abdominal surgeries during the Covid-19 pandemic

Background Surgical-site infections (SSIs) are found to occur after about 2-5% of all surgeries. SSIs have many drawbacks such as the need for readmission, revision operations, prolonged duration of hospital stay, increased financial burden on patients and increased risk of worsening outcome in cancer patients. Closed-incision negative-pressure therapy (CINPT) was studied as a method of preventing infections in wounds occurring after closed surgical incisions particularly during the covid-19 pandemic. There are many studies showed promising results of this procedure. Therefore, in this prospective clinical randomized study, we aimed to evaluate the benefit of performing prophylactic CINPT in controlling SS's in open colorectal surgeries, hepatobiliary surgeries and gynecological cancer surgeries involving laparotomies, in comparison with the standard dressings. Patients and method We included 120 patients of SS's with open colorectal surgeries, hepatobiliary surgeries and gynecological cancer surgeries involving laparotomies in the period between 2015 and 2020. We divided the patients randomly into two groups: the first group is the study group, which included 30 patients managed by CINPT, and the second group is the control group, which included 90 patients managed by standard non-CINPT management. We compared patients who underwent CINPT with the control group of high-risk patients undergoing routine management non- CINPT procedures. Results The median rate of occurrence of general adverse wound outcomes was 32.5% for all the included patients: 20% in the CINPT group and 36.7% in the control group (P =0.049). The median rate of occurrence of SS's was 17.5% for all the included patients: 7% in the CINPT group and 15% in the control group (P=0.001). Time to diagnose SS's in the CINPT group was longer than that in the control group (19 vs 13 days;P=0.03). The increased duration of operation and the presence of preoperative or postoperative stoma were associated with increased incidence of occurrence of SSI, while CINPT was associated with decreased incidence of occurrence of SS's (P<0.001). Conclusion We observed a marked reduction in the rates of SS's in closed laparotomy wounds in colorectal, hepato-pancreato-biliary and in gynecological oncology surgeries managed with prophylactic CINPT particularly during the Covid-19 pandemic.

Observational Study of Hand Hygiene Compliance at a Trauma Hospital in Iraqi Kurdistan

Healthcare-associated infections, commonly caused by poor hand hygiene, represent a significant source of disease and economic burden for healthcare systems, especially those in resource-limited settings. The few existing studies on hand hygiene compliance in resource-limited hospital settings suggest that compliance is insufficient. The difference in compliance rates between units in resource-limited trauma hospitals is largely unknown. We aimed to assess hand hygiene compliance rates among healthcare workers at a trauma hospital in Iraqi Kurdistan and compare the levels of compliance between the emergency room (ER), the intensive care unit (ICU), and the acute care ward (ACW). We carried out overt observations in 2018 using the validated World Health Organization ‘five moments for hand hygiene’ observational tool. We observed a total of 622 hand hygiene opportunities performed by 149 healthcare workers. Hand hygiene compliance was defined as handwashing with soap and water or the use of alcohol-based hand rub, in accordance with the ‘five moments for hand hygiene’ concept. Overall, the hand hygiene compliance rate was found to be 6.8% (95% confidence interval 5.0–9.1). Compliance was significantly lower in the ER (1.0%), compared with the ICU (8.1%) (p = 0.0012), and the ACW (11.1%) (p < 0.0001). In all three units, the availability of alcohol-based hand rub and handwashing sinks was insufficient in relation to the number of patient beds. We conclude that the overall level of hand hygiene compliance was low, with the lowest level of compliance in the ER. Our findings call for improved resource allocation and strengthened hand hygiene routines. These relatively simple measures could potentially lower the incidence of healthcare-associated infections and improve the mortality and morbidity of patients in already overburdened healthcare systems.