Optimisation of perioperative procedural factors to reduce the risk of surgical site infection in patients undergoing surgery: a systematic review.

Surgical site infections (SSI) are the leading cause of hospital readmission after surgical procedures with significant impact on post-operative morbidity and mortality. Modifiable risk factors for SSI include procedural aspects, which include the possibility of instrument contamination, the duration of the operation, the number of people present and the traffic in the room and the ventilation system of the operating theatre.The aim of this systematic review was to provide literature evidence on the relationship between features of surgical procedure sets and the frequency of SSI in patients undergoing surgical treatment, and to analyse how time frames of perioperative processes and operating theatre traffic vary in relation to the features of the procedure sets use, in order tooptimise infection control in OT. The results of the systematic review brought to light observational studies that can be divided into two categories: evidence of purely clinical significance and evidence of mainly organisational, managerial and financial significance. These two systems are largely interconnected, and reciprocally influence each other. The decision to use disposable devices and instruments has been accompanied by a lower incidence in surgical site infections and surgical revisions for remediation. A concomitant reduction in post-operative functional recovery time has also been observed. Also, the rationalisation of traditional surgical sets has also been observed in conjunction with outcomes of clinical significance.

Guidelines for improvement of the procedural aspects of devices and surgical instruments in the operating theatre.

Surgical site infections are a major complication for patients undergoing surgical treatment and a significant cause of mortality and morbidity. Many international guidelines suggest measures for the prevention of surgical site infections (SSI) in perioperative processes and the decontamination of surgical devices and instruments. This document proposes guidelines for improving the perioperative setting in view of the devices and instrumentation required for surgical procedures, aiming to reduce contamination rates and improve clinical performance and management for patients undergoing surgical treatment. This document is intended for doctors, nurses and other practitioners involved in operating theatre procedures, resource management and clinical risk assessment processes, and the procurement, organisation, sterilisation and reprocessing of surgical instruments.

[Valuation on prognostic factors about secondary acute peritonitis: review of 255 cases]. / Considerazioni sui fattori prognostici della peritonite acuta secondaria su di una revisione di 255 casi.

Despite advances in diagnosis, surgical treatment, antimicrobial therapy and intensive care support, severe secondary peritonitis remains a potentially fatal affliction. The purpose of this study is to present our experience of postoperative mortality in 255 patients with secondary acute peritonitis between 1998 to 2002. The Mannhein Peritonitis Index score (MPI) was calculated for each patient to predict the peritonitis related in-hospital death. Both literature reviews and our results show a strong correlation between some etiopathogenetic elements (age, origin of sepsis, organ failure, ...) and prognosis. Our patients were classified in three groups according to MPI, one with a score less than 21, another with a score between 21 and 29 and the third one with a score greater than 29. There was no mortality in the first group and there was significantly less mortality in the second group than the third one (P<0.001). While prognosis is influenced by many factors, the intervention time was the same, greater than 24 hours, for all the patients regardless of MPI score. This study suggests that intervention time may be considered the main determinant of mortality in patients with peritonitis. This observation is especially relevant since intervention time is a modifiable prognostic factor whilst many other factors are not.

[The treatment of intestinal intussusception in childhood]. / Il trattamento dell'invaginazione intestinale in età pediatrica.

Intussusception is one of the most frequent cause of mechanical bowel obstruction in children. On the basis of clinical features and diagnosis operations were conducted on 26 children. In 21, the treatment was manual disinvagination. In 5, pathomorphological changes of the walls of the invaginated portion suggested the intestinal resection. The results of treatment and prognosis are discussed.

[Afferent loop obstruction after total gastrectomy presenting as acute pancreatitis (clinical contribution to the etiopathogenesis)]. / L'ostruzione dell'ansa afferente nel gastrectomizzato totale quale rara causa di pancreatite acuta (contributo clinico all'etiopatogenesi).

Afferent loop obstruction presenting as acute pancreatitis is an uncommon pathology encountred after total gastrectomy or gastric resection. The authors refer about a case of afferent loop syndrom presenting as acute pancreatitis, and conclude that, since this disease is very rare, aggressive and variable, its diagnosis and therapy is still controversal.

[Solitary rectal ulcer (a case report)]. / L'ulcera solitaria del retto (contributo clinico).

The solitary rectal ulcer is a rare disease localized not only in the rectum but in other colonic tracts. It more frequently appears in female, the age preferred by the disease is the one between twenties and thirties. The 68% of ulcers is localized in the anterior wall of rectum and her length varies from 4 to 15 cm. The S.R.U. is a benign chronic disease that does not pass the muscularis mucosae, originated by an alteration of the mechanism of defecation with a prolapse of mucosa. Nowadays the therapy must by addressed to treat the prolapse and not the ulcer. The Authors report a case recently observed and after a review of the literature, analyze anatomo-clinic, etiopathogenetic and therapeutic aspects of the disease.

[Desmoid tumors of the abdominal wall (clinical cases)]. / I tumori desmoidi della parete addominale (contributo clinico).

The authors on the basis of three cases of desmoid tumors observed, examine the etiologic factors, clinical aspects and results of medical and surgical therapy. According with the date learnt from the latest literature authors propose a surgical therapy in first instance by a large excision with clear edges. This approach guarantees the most efficacious prophylaxis of recurrence.

[Indications for surgical treatment of ulcerative rectocolitis]. / Le indicazioni al trattamento chirurgico della retto-colite ulcerosa.

The indications to surgical treatment of the ulcerative colitis (RCU) are a discuss argument to date, for etiopathogenetic uncertain still being. The problems of treatment are expressed by A.G. Parks and J.H. Pemberton very well, who said that "... Its treatment, both medical or surgical, is empirical", and "... The patients with chronic ulcerative colitis heal with proctocolectomy". From 1980 to 1992 we observed 65 cases of URC. 21 (32%) of these were treated by surgery. The indications to surgical treatment were: unsuccessful of medical therapy (14 cases), toxic megacolon (3 cases), severe dysplasia (2 cases), perforation (2 cases). We have submitted 5 patients to colectomy with ileostomy, 13 patients to colectomy with ileorecto-anastomosis and 3 to proctocolectomy with definitive ileostomy. Morbidity was 14.2% (anastomotic linkage, bronchopneumonia sepsis, wound sepsis). Mortality was 4.7% for a case of large bowel multiple perforations. The treatment of the URC is a difficult choice for surgeon, because he must decide the surgery timing. To different of the Crohn's disease, that is not heal with surgery, today URC allows more surgical aggressive attitude.

[Heterologous lyophilized collagen in the secondary healing of pilonidal fistulae]. / Il collagene eterologo liofilizzato nella guarigione per seconda intenzione delle fistole pilonidali.

The authors evaluate heterologous lyophilized collagen efficacy and tolerability in second intention healing of pilonidal sinus fistulae. This therapeutical approach seems to be characterized by a lower relapse incidence. The use of heterologous lyophilized collagen relevantly reduces the prolonged healing time required by such method.