Surgical site infection: incidence and impact on hospital utilization and treatment costs.

United BioSource Corporation, 7101 Wisconsin Avenue, Bethesda, MD 20814, USA.
American journal of infection control (Impact Factor: 3.01). 05/2009; 37(5):387-97. DOI: 10.1016/j.ajic.2008.12.010
Source: PubMed

ABSTRACT Surgical site infections (SSIs) are serious operative complications that occur in approximately 2% of surgical procedures and account for some 20% of health care-associated infections.
SSI was identified based on the presence of ICD-9-CM diagnosis code 998.59 in hospital discharge records for 7 categories of surgical procedures: neurological; cardiovascular; colorectal; skin, subcutaneous tissue, and breast; gastrointestinal; orthopedic; and obstetric and gynecologic. Source of data was the 2005 Healthcare Cost and Utilization Project National Inpatient Sample (HCUP NIS). Primary study outcomes were rate of SSI by surgical category and impact of SSI on length of stay and cost. Results were projected to the national level.
Among 723,490 surgical hospitalizations in the sample, 6891 cases of SSI were identified (1%). On average, SSI extended length of stay by 9.7 days while increasing cost by $20,842 per admission. From the national perspective, these cases of SSI were associated with an additional 406,730 hospital-days and hospital costs exceeding $900 million. An additional 91,613 readmissions for treatment of SSI accounted for a further 521,933 days of care at a cost of nearly $700 million.
SSI is associated with a significant economic burden in terms of extended length of stay and increased costs of treatment. Our analysis documented nearly 1 million additional inpatient-days and $1.6 billion in excess costs.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Microbial contamination of the operating theatre (OT) is a major cause of nosocomial infection (NI). The study assessed the level of microbial contamination and determines the antimicrobial resistance of the bacterial isolates. Settle plate's method was used for air sample collection while swab method was used to collect samples from surfaces and other articles in the major OT. Collected samples were transported and microbiologically processed using standard procedures. One hundred and twenty air, 36 article and 12 surface samples were taken for microbiological evaluation. The highest level of microbial contamination was detected in the OT air before proper cleaning-fumigation as compared to after the intervention. Moreover, microbial growth was found on surfaces and semi-critical articles. On the other hand, articles which were sterilized by autoclave showed no microbial growth. The five types of bacteria isolated were coagulase negative Staphyllococci (68; 53.4%), Staphyllococcus aureus (42; 33.1%), Pseudomonas aeruginosa (13; 10.2%), E. coli (2; 1.6%), and Bacillus spp. (2; 1.6%). Methicillin resistance S. aureus (MRSA) account for 7.7% of the S. aureus isolates. The highest resistance was found against penicillin G and ampicillin with a resistance rate of 52.7 and 44.5%, respectively. Multidrug resistance was observed among 23 (36.5%) of the bacterial isolates. In general, the results indicate proper cleaning-fumigation of OT significantly reduced the microbial contamination, and bacterial strains such as coagulase negative Staphylococci, and S. aureus have a greater propensity to cause contamination in OT. In conclusion, there was high level of microbial contamination in the OT, particularly in air and semi-critical articles. However, it has been dramatically reduced through proper cleaning-fumigation of the OT. Therefore, regular microbiological surveillance of the OT is mandatory in reducing microbial contamination. Furthermore, efforts should be made to ensure strict infection control practices in the OT.
    African journal of microbiology research 04/2015; 9(9):639-642. DOI:10.5897/AJMR2014.7276 · 0.54 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Inguinal hernia repair is a clean surgical procedure and surgical site infection (SSI) rate is generally below 2%. Antibiotic prophylaxis is not routinely recommended, but it may be a good choice for institutions with high rates of wound infection (>5%). Typical prophylaxis is the intravenous application of first or second-generation cephalosporins before the skin incision. However, SSI rate remains more than 2% in many centers in spite of intravenous antibiotic prophylaxis. Even a 1% SSI rate may be unacceptable for the surgeons who specifically deal with hernia surgery. A hernia center targets to be a center of excellence not only in respect of recurrence rate but also for other postoperative outcomes, therefore a further measure is required for an excellent result regarding infection control. Topical gentamycin application in combination with preoperative single-dose intravenous antibiotic may be a useful to obtain this perfect outcome. Data about this subject are not complete and high-grade evidence has not been cumulated yet. Prospective randomized controlled trials can make our knowledge more solid about this subject and help the surgeons who seek perfect outcome regarding infection control in inguinal hernia surgery.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Surgical site infection (SSI) remains to be one of the most frequent infectious complications following abdominal surgery. Prophylactic intra-operative wound irrigation (IOWI) before skin closure has been proposed to reduce bacterial wound contamination and the risk of SSI. However, current recommendations on its use are conflicting especially concerning antibiotic and antiseptic solutions because of their potential tissue toxicity and enhancement of bacterial drug resistances. To analyze the existing evidence for the effect of IOWI with topical antibiotics, povidone-iodine (PVP-I) solutions or saline on the incidence of SSI following open abdominal surgery, a systematic review and meta-analysis of randomized controlled trials (RCTs) was carried out according to the recommendations of the Cochrane Collaboration. Forty-one RCTs reporting primary data of over 9000 patients were analyzed. Meta-analysis on the effect of IOWI with any solution compared to no irrigation revealed a significant benefit in the reduction of SSI rates (OR = 0.54, 95 % confidence Interval (CI) [0.42; 0.69], p < 0.0001). Subgroup analyses showed that this effect was strongest in colorectal surgery and that IOWI with antibiotic solutions had a stronger effect than irrigation with PVP-I or saline. However, all of the included trials were at considerable risk of bias according to the quality assessment. These results suggest that IOWI before skin closure represents a pragmatic and economical approach to reduce postoperative SSI after abdominal surgery and that antibiotic solutions seem to be more effective than PVP-I solutions or simple saline, and it might be worth to re-evaluate their use for specific indications.