ABSTRACT
BACKGROUND: Surgical site infection (SSI) remains a major cause of morbidity and death. This study analyzed the results of surveillance to evaluate the incidence, risk factors, and characteristics of SSI in patients who underwent an operation in a typical Italian surgical ward. METHODS: A group of 1,281 patients operated on from August 2005 to December 2007 underwent prospective and direct observation of incisions by a surgeon according to the U.S. Centers for Disease Control and Prevention (CDC) National Nosocomial Infections Surveillance (NNIS) method. The minimum follow-up was 30 days. A locally-modified risk index score (LRI) based on the NNIS was calculated for each patient, using as a cut point the 75(th) percentile of the duration of surgery (in minutes) for that particular procedure. RESULTS: Seventy-six patients were affected by incision site infection, and the SSI rate was 5.9%. Thirty-four (2.6% of the series) were superficial incisional, 32 (2.5%) deep incisional, and 10 (0.8%) organ/space SSIs. An increasing value of the LRI was significantly (p < 0.05) related to an increasing risk of infection. The SSI rates were 0.6%, 3.7%, 7.3%, and 26.8% for LRI value of M = - 1, 0, 1, and >or=2, respectively. Obesity (body mass index >30 kg/m(2)), diabetes mellitus, and emergency surgery were associated with a higher risk of infection by multivariable analysis independent of the LRI. CONCLUSIONS: The NNIS method can be useful for SSI surveillance and monitoring in single surgical wards. Longer operations, diabetes mellitus, and obesity increase the risk of SSI, as does performance of surgery in an emergency situation.
Subject(s)
Cross Infection/epidemiology , Surgical Wound Infection/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Humans , Incidence , Italy/epidemiology , Male , Middle Aged , Prospective Studies , Risk Factors , Young AdultABSTRACT
We describe a very rare case of chronic peritonitis with secondary adhesive intestinal obstruction caused by Sphingomonas paucimobilis in a healthy 28-year-old Chinese man. This bacillus has not been described as a cause of spontaneous peritonitis in healthy people. It was an asymptomatic, generalized, and slow-growing peritonitis causing peritoneal adherens and at the end intestinal occlusion that needed surgical adhesiolysis.
ABSTRACT
The standard preoperative care of the surgical wards of 4 hospitals for patients undergoing abdominal (stomach and colon) and gynaecological (uterum) surgery has been described. Date collection included the comparative assessment of standard protocols and intervention, with nurses in charge of the preoperative care. Patients undergoing colon surgery may be prescribed an ash-free diet for 7-10 days or may eat normal meals till two days before the surgery. The same variability exists for the antimicrobial prophylaxis and its route of administration. Patients are not allowed to drink from the midnight before the surgery. Enemas administered the afternoon before the surgery may contain castor oil. A systematic review of preoperative care is warranted and guidelines for an evidence based practice should be provided in order to reduce the variability and improve the effectiveness of preoperative care.
