American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update
TL;DR: This data indicates that pre-emptive surgery is a viable option for the treatment of deep vein thrombosis in women with pre-operative indications and this work’s results support this view.
Abstract: Disclosures outside the scope of this work: Dr. Minei receiv grant support from Irrespet Corp. AtoxBio. Dr. Laronga rec sation for lectures from Genomic Health Inc. and royalties Date. Dr. Jensen is a consultant and paid speaker for Ethico ceives honoraria from CareFusion for their Speaker’s Progr from Irrimax Corp. for consulting and Research Funding honoraria from Surgical Inc. for consultation. Dr. Itani for a multi-institutional study for Sanofi-Pastuer and the Committee Chair. Dr. Dellinger is on the Advisory B Melinta, and Therevance and a grant recipient from Moti trial of iclaprim vs. vancomycin for treatment of skin and so tions. The remaining authors declare no conflicts. Presented at the Surgical Infection Society, Palm Beach, FL
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TL;DR: A 2018 retrospective analysis of Medicare beneficiaries identified that ∼8.2 million people had wounds with or without infections, with highest expenses were for surgical wounds followed by diabetic foot ulcers, with a higher trend toward costs associated with outpatient wound care compared with inpatient.
Abstract: Significance: A 2018 retrospective analysis of Medicare beneficiaries identified that ∼8.2 million people had wounds with or without infections. Medicare cost estimates for acute and chronic wound treatments ranged from $28.1 billion to $96.8 billion. Highest expenses were for surgical wounds followed by diabetic foot ulcers, with a higher trend toward costs associated with outpatient wound care compared with inpatient. Increasing costs of health care, an aging population, recognition of difficult-to-treat infection threats such as biofilms, and the continued threat of diabetes and obesity worldwide make chronic wounds a substantial clinical, social, and economic challenge. Recent Advances: Chronic wounds are not a problem in an otherwise healthy population. Underlying conditions ranging from malnutrition, to stress, to metabolic syndrome, predispose patients to chronic, nonhealing wounds. From an economic point of view, the annual wound care products market is expected to reach $15-22 billion by 2024. The National Institutes of Health's (NIH) Research Portfolio Online Reporting Tool (RePORT) now lists wounds as a category. Future Directions: A continued rise in the economic, clinical, and social impact of wounds warrants a more structured approach and proportionate investment in wound care, education, and related research.
544 citations
Cites background from "American College of Surgeons and Su..."
...5–$10 billion per year.(80,81) Despite all efforts, SSI contributes to mortality in 75% of cases....
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TL;DR: In this paper, the authors present consensus recommendations for the optimal perioperative management of patients undergoing cardiac surgery based on a review of meta-analyses, randomized clinical trials, large nonrandomized studies, and reviews.
Abstract: Enhanced Recovery After Surgery (ERAS) evidence-based protocols for perioperative care can lead to improvements in clinical outcomes and cost savings. This article aims to present consensus recommendations for the optimal perioperative management of patients undergoing cardiac surgery. A review of meta-analyses, randomized clinical trials, large nonrandomized studies, and reviews was conducted for each protocol element. The quality of the evidence was graded and used to form consensus recommendations for each topic. Development of these recommendations was endorsed by the Enhanced Recovery After Surgery Society.
513 citations
TL;DR: Bundles can effectively reduce the risk of SSIs after CRS, by fostering a cohesive environment, standardization, and reduction in operative variance, if implemented successfully and complied with.
98 citations
Cites methods from "American College of Surgeons and Su..."
...No study bundle included post-hospital interventions as described by the ACS and SIS SSI guidelines.(19) Effects of the SSI Bundles on Surgical Site Infections...
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...Several key elements identified by the ACS and SIS were, however, not utilized or were utilized by only a few studies.(19) These included smoking cessation which was implemented in J Gastrointest Surg...
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...The ACS and Surgical Infection Society (SIS) therefore have released new SSI guidelines for 2017 identifying additional interventions to aid in decreasing SSI rates further.(19) These interventions consist of prehospital elements such as smoking cessation prior to surgery and mechanical bowel preparation with oral antibiotics for elective colectomies....
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...Standardized wound dressing removal time was utilized by 16 studies and showering with chlorohexidine or antimicrobial solutions, either before or after surgery, was implemented by 14 studies, but the ACS and SIS state insufficient evidence exists to support these interventions.(19) A meta-analysis demonstrated no significant change in SSI rates with inclusion of pre-operative chlorohexidine showers or cleansing wipes (p = 0....
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...The ACS and SIS have identified several elements that lack sufficient evidence to warrant inclusion in a bundle.(19) Standardized wound dressing removal time was utilized by 16 studies and showering with chlorohexidine or antimicrobial solutions, either before or after surgery, was implemented by 14 studies, but the ACS and SIS state insufficient evidence exists to support these interventions....
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01 Feb 2019
TL;DR: A 2018 retrospective analysis of Medicare beneficiaries identified that ∼8.2 million people had wounds with or without infections as discussed by the authors, and the highest expenses were for surgical wounds followed by diabetic foot ulcers, with a higher trend toward costs associated with outpatient wound care compared with inpatient.
Abstract: Significance: A 2018 retrospective analysis of Medicare beneficiaries identified that ∼8.2 million people had wounds with or without infections. Medicare cost estimates for acute and chronic wound treatments ranged from $28.1 billion to $96.8 billion. Highest expenses were for surgical wounds followed by diabetic foot ulcers, with a higher trend toward costs associated with outpatient wound care compared with inpatient. Increasing costs of health care, an aging population, recognition of difficult-to-treat infection threats such as biofilms, and the continued threat of diabetes and obesity worldwide make chronic wounds a substantial clinical, social, and economic challenge. Recent Advances: Chronic wounds are not a problem in an otherwise healthy population. Underlying conditions ranging from malnutrition, to stress, to metabolic syndrome, predispose patients to chronic, nonhealing wounds. From an economic point of view, the annual wound care products market is expected to reach $15-22 billion by 2024. The National Institutes of Health's (NIH) Research Portfolio Online Reporting Tool (RePORT) now lists wounds as a category. Future Directions: A continued rise in the economic, clinical, and social impact of wounds warrants a more structured approach and proportionate investment in wound care, education, and related research.
95 citations
TL;DR: There was evidence of effect of reducing the SSI risk in surgical patients under general anaesthesia with tracheal intubation, however, the evidence for this beneficial effect has become weaker and the strength of the recommendation needs to be reconsidered.
Abstract: Background In 2016, the World Health Organization (WHO) strongly recommended the use of a high fraction of inspired oxygen (FiO2) in adult patients undergoing general anaesthesia to reduce the risk of surgical site infection (SSI). Since then, further trials have been published, trials included previously have come under scrutiny, and one article was retracted. We updated the systematic review on which the recommendation was based. Methods We performed a systematic literature search from January 1990 to April 2018 for RCTs comparing the effect of high (80%) vs standard (30–35%) FiO2 on the incidence of SSI. Studies retracted or under investigation were excluded. A random effects model was used for meta-analyses; the sources of heterogeneity were explored using meta-regression. Results Of 21 RCTs included, six were newly identified since the publication of the WHO guideline review; 17 could be included in the final analyses. Overall, no evidence for a reduction of SSI after the use of high FiO2 was found [relative risk (RR): 0.89; 95% confidence interval (CI): 0.73–1.07]. There was evidence that high FiO2 was beneficial in intubated patients [RR: 0.80 (95% CI: 0.64–0.99)], but not in non-intubated patients [RR: 1.20 (95% CI: 0.91–1.58); test of interaction; P=0.048]. Conclusions The WHO updated analyses did not show definite beneficial effect of the use of high perioperative FiO2, overall, but there was evidence of effect of reducing the SSI risk in surgical patients under general anaesthesia with tracheal intubation. However, the evidence for this beneficial effect has become weaker and the strength of the recommendation needs to be reconsidered.
76 citations
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TL;DR: The guidelines for the prevention of surgical wound infections (SSI) were published by the Centers for Disease Control and Prevention (CDC) in 1999 as discussed by the authors, with the goal of reducing infectious complications associated with these procedures.
4,730 citations
TL;DR: The “Guideline for Prevention of Surgical Site Infection, 1999” presents the Centers for Disease Control and Prevention's recommendations for the prevention of surgical site infections (SSIs), formerly called surgical wound infections, and replaces previous guidelines.
Abstract: The “Guideline for Prevention of Surgical Site Infection, 1999” presents the Centers for Disease Control and Prevention (CDC)'s recommendations for the prevention of surgical site infections (SSIs), formerly called surgical wound infections. This two-part guideline updates and replaces previous guidelines.Part I, “Surgical Site Infection: An Overview,” describes the epidemiology, definitions, microbiology, pathogenesis, and surveillance of SSIs. Included is a detailed discussion of the pre-, intra-, and postoperative issues relevant to SSI genesis.
4,059 citations
TL;DR: Results of this multistate prevalence survey of health care-associated infections indicate that public health surveillance and prevention activities should continue to address C. difficile infections.
Abstract: Background Currently, no single U.S. surveillance system can provide estimates of the burden of all types of health care–associated infections across acute care patient populations. We conducted a prevalence survey in 10 geographically diverse states to determine the prevalence of health care–associated infections in acute care hospitals and generate updated estimates of the national burden of such infections. Methods We defined health care–associated infections with the use of National Healthcare Safety Network criteria. One-day surveys of randomly selected inpatients were performed in participating hospitals. Hospital personnel collected demographic and limited clinical data. Trained data collectors reviewed medical records retrospectively to identify health care–associated infections active at the time of the survey. Survey data and 2010 Nationwide Inpatient Sample data, stratified according to patient age and length of hospital stay, were used to estimate the total numbers of health care–associated in...
3,010 citations
TL;DR: Maintaining normothermia intraoperatively is likely to decrease the incidence of infectious complications in patients undergoing colorectal resection and to shorten their hospitalizations.
Abstract: Background Mild perioperative hypothermia, which is common during major surgery, may promote surgical-wound infection by triggering thermoregulatory vasoconstriction, which decreases subcutaneous oxygen tension. Reduced levels of oxygen in tissue impair oxidative killing by neutrophils and decrease the strength of the healing wound by reducing the deposition of collagen. Hypothermia also directly impairs immune function. We tested the hypothesis that hypothermia both increases susceptibility to surgical-wound infection and lengthens hospitalization. Methods Two hundred patients undergoing colorectal surgery were randomly assigned to routine intraoperative thermal care (the hypothermia group) or additional warming (the normothermia group). The patients' anesthetic care was standardized, and they were all given cefamandole and metronidazole. In a double-blind protocol, their wounds were evaluated daily until discharge from the hospital and in the clinic after two weeks; wounds containing culture-positive pu...
2,442 citations
University of Oklahoma1, University of Washington2, University of Nebraska Medical Center3, Johns Hopkins University4, Northwestern University5, University of Colorado Boulder6, University of Colorado Hospital7, University of Michigan8, University of Virginia9, West Virginia University10, Emory University11, Rush University Medical Center12
TL;DR: These guidelines were developed jointly by the American Society of Health-System Pharmacists (ASHP), the Infectious Diseases Society of America, the Surgical Infection Society (SIS), and the Society for Healthcare Epidemiology of America (SHEA).
Abstract: These guidelines were developed jointly by the American Society of Health-System Pharmacists (ASHP), the Infectious Diseases Society of America (IDSA), the Surgical Infection Society (SIS), and the Society for Healthcare Epidemiology of America (SHEA). This work represents an update to the
1,691 citations