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Prevention and Treatment of Surgical Site Infections

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Infectious Diseases".

Deadline for manuscript submissions: closed (31 January 2022) | Viewed by 18822

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Special Issue Editor

Dr. Trisha Peel

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Guest Editor

Department of Infectious Diseases, Monash University, Melbourne, Australia
Interests: prevention of surgical site infections; clinical trials; antimicrobial stewardship; health services research

Special Issue Information

Dear Colleagues,

Worldwide, there are over 300 million surgeries annually and 1–5% of these procedures are complicated by surgical site infections (SSIs), and this number is higher for certain groups including colorectal surgeries. These infections are a leading cause of healthcare-associated infections and are most expensive, with healthcare budget estimates of $20,000 per SSI. SSIs represent a significant burden to patients, frequently necessitating prolonged hospitalizations, repeat operations, and broad-spectrum antimicrobial therapy. These infections are also an important driver for the emergence of drug-resistant infections, which The World Health Organization has described as one of the most critical public health issues of our time. Despite the global burden of SSIs, clear knowledge gaps exist for the prevention and management of SSIs. The present Special Issue will examine the evidence for the epidemiology, prevention, and management of surgical site infections including novel and non-antimicrobial approaches to prevention and management. The issue will also explore the role of the multi-disciplinary team management approaches and the potential role to engage and support patients in co-design and shared decision-making processes.

Dr. Trisha Peel
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Surgical site infection
Epidemiology
Patient-related outcomes
Drug-resistant infections
Infection prevention and control
Antimicrobial management
Surgical approaches for SSI treatment
Multidisciplinary team
Consumer co-design

Published Papers (5 papers)

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Research

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13 pages, 2143 KiB

Open AccessArticle

Establishing a Learning Model for Correct Hand Hygiene Technique in a NICU

by Irén A. Kopcsóné Németh, Csaba Nádor, László Szilágyi, Ákos Lehotsky and Tamás Haidegger

J. Clin. Med. 2022, 11(15), 4276; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11154276 - 22 Jul 2022

Cited by 3 | Viewed by 2014

Abstract

The ability of healthcare workers to learn proper hand hygiene has been an understudied area of research. Generally, hand hygiene skills are regarded as a key contributor to reduce critical infections and healthcare-associated infections. In a clinical setup, at a Neonatal Intensive Care Unit (NICU), the outcome of a multi-modal training initiative was recorded, where objective feedback was provided to the staff. It was hypothesized that staff at the NICU are more sensitive towards applying increased patient safety measures. Outcomes were recorded as the ability to cover all hand surfaces with Alcohol-Based Handrub (ABHR), modelled as a time-series of measurements. The learning ability to rub in with 1.5 mL and with 3 mL was also assessed. As a secondary outcome, handrub consumption and infection numbers were recorded. It has been observed that some staff members were able to quickly learn the proper hand hygiene, even with the limited 1.5 mL, while others were not capable of acquiring the technique even with 3 mL. When analyzing the 1.5 mL group, it was deemed an insufficient ABHR amount, while with 3 mL, the critical necessity of skill training to achieve complete coverage was documented. Identifying these individuals helps the infection control staff to better focus their training efforts. The training led to a 157% increase in handrub consumption. The setting of the study did not allow to show a measurable reduction in the number of hospital infections. It has been concluded that the training method chosen by the staff greatly affects the quality of the outcomes. Full article

(This article belongs to the Special Issue Prevention and Treatment of Surgical Site Infections)

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8 pages, 494 KiB

Open AccessArticle

The Prevention of Periprosthetic Joint Infection in Primary Total Hip Arthroplasty Using Pre-Operative Chlorhexidine Bathing

by Wen-Chi Su, Yu-Chin Lai, Cheng-Hung Lee, Cheng-Min Shih, Chao-Ping Chen, Li-Ling Hung and Shun-Ping Wang

J. Clin. Med. 2021, 10(3), 434; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10030434 - 23 Jan 2021

Cited by 4 | Viewed by 2750

Abstract

Periprosthetic joint infection (PJI) after total hip arthroplasty (THA) is a devastating complication. The aim of this study was to investigate whether preoperative bathing using chlorhexidine gluconate (CHG) before THA can effectively reduce the postoperative PJI rate. A total of 933 primary THA patients, with the majority being female (54.4%) were included in the study. Primary THA patients who performed preoperative chlorhexidine bathing were assigned to the CHG group (190 subjects), and those who did not have preoperative chlorhexidine bathing were in the control group (743 subjects). The effects of chlorhexidine bathing on the prevention of PJI incidence rates were investigated. Differences in age, sex, and the operated side between the two groups were not statistically significant. Postoperative PJI occurred in four subjects, indicating an infection rate of 0.43% (4/933). All four infected subjects belonged to the control group. Although the PJI cases were significantly more in the control group than in the CHG group, statistical analysis revealed no statistical significance in the risk of PJI occurrence between the two groups (p = 0.588). Preoperative skin preparation by bathing with a 2% chlorhexidine gluconate cleanser did not produce significant effects on the prevention of postoperative PJI in primary THA. Full article

(This article belongs to the Special Issue Prevention and Treatment of Surgical Site Infections)

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Review

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8 pages, 495 KiB

Open AccessReview

Plasmin, Immunity, and Surgical Site Infection

by Stuart Hastings, Paul S. Myles and Robert L. Medcalf

J. Clin. Med. 2021, 10(10), 2070; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10102070 - 12 May 2021

Cited by 7 | Viewed by 2498

Abstract

SSI are a universal economic burden and increase individual patient morbidity and mortality. While antibiotic prophylaxis is the primary preventative intervention, these agents are not themselves benign and may be less effective in the context of emerging antibiotic resistant organisms. Exploration of novel therapies as an adjunct to antimicrobials is warranted. Plasmin and the plasminogen activating system has a complex role in immune function. The immunothrombotic role of plasmin is densely interwoven with the coagulation system and has a multitude of effects on the immune system constituents, which may not always be beneficial. Tranexamic acid is an antifibrinolytic agent which inhibits the conversion of plasminogen to plasmin. Clinical trials have demonstrated a reduction in surgical site infection in TXA exposed patients, however the mechanism and magnitude of this benefit is incompletely understood. This effect may be through the reduction of local wound haematoma, decreased allogenic blood transfusion or a direct immunomodulatory effect. Large scale randomised clinical trial are currently being undertaken to better explain this association. Importantly, TXA is a safe and widely available pharmacological agent which may have a role in the reduction of SSI. Full article

(This article belongs to the Special Issue Prevention and Treatment of Surgical Site Infections)

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21 pages, 2374 KiB

Open AccessReview

Randomised Controlled Trials of Alcohol-Based Surgical Site Skin Preparation for the Prevention of Surgical Site Infections: Systematic Review and Meta-Analysis

by Trisha N. Peel, Eliza Watson and Sue J. Lee

J. Clin. Med. 2021, 10(4), 663; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10040663 - 09 Feb 2021

Cited by 9 | Viewed by 3733

Abstract

(1) Background: Surgical site skin preparation is an important approach to prevent postoperative wound infections. International guidelines recommend that alcohol-based combinations be used, however, the optimal combination remains uncertain. This study compares the effectiveness of alcohol-based chlorhexidine and alcohol-based iodophor for surgical site skin preparation for prevention of surgical site infections (SSIs). (2) Methods: Randomised controlled trials comparing alcohol-based interventions for surgical site skin preparation were included. The proportion of SSIs was compared using risk ratios (RR) with 95% confidence intervals (95% CI). The meta-analysis was performed with a fixed effect model using Mantel-Haenszel methods. As an a priori subgroup analysis SSI risk was examined according to different surgical procedural groups. (3) Results: Thirteen studies were included (n = 6023 participants). The use of chlorhexidine-alcohol was associated with a reduction in risk of SSIs compared with iodophor-alcohol (RR 0.790; 95% CI 0.669, 0.932). On sub-group analysis, chlorhexidine-alcohol was associated with a reduction in SSIs in caesarean surgery (RR 0.614; 95% CI 0.453, 0.831) however, chlorhexidine-alcohol was associated with an increased risk of SSI in bone and joint surgery (RR 2.667; 95% CI 1.051, 6.765). When excluding studies at high risk of bias on sensitivity analysis, this difference in alcohol-based combinations for bone and joint surgery was no longer observed (RR 2.636; 95% CI 0.995, 6.983). (4) Conclusions: The use of chlorhexidine-alcohol skin preparations was associated with a reduced risk of SSI compared to iodophor-alcohol agents. However, the efficacy of alcohol-based preparation agents may differ according to the surgical procedure group. This difference must be interpreted with caution given the low number of studies and potential for bias, however, it warrants further investigation into the potential biological and clinical validity of these findings. Full article

(This article belongs to the Special Issue Prevention and Treatment of Surgical Site Infections)

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20 pages, 3340 KiB

Open AccessReview

Ventricular Assist Device-Specific Infections

by Yue Qu, Anton Y. Peleg and David McGiffin

J. Clin. Med. 2021, 10(3), 453; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10030453 - 25 Jan 2021

Cited by 13 | Viewed by 6857

Abstract

Ventricular assist device (VAD)-specific infections, in particular, driveline infections, are a concerning complication of VAD implantation that often results in significant morbidity and even mortality. The presence of a percutaneous driveline at the skin exit-site and in the subcutaneous tunnel allows biofilm formation and migration by many bacterial and fungal pathogens. Biofilm formation is an important microbial strategy, providing a shield against antimicrobial treatment and human immune responses; biofilm migration facilitates the extension of infection to deeper tissues such as the pump pocket and the bloodstream. Despite the introduction of multiple preventative strategies, driveline infections still occur with a high prevalence of ~10–20% per year and their treatment outcomes are frequently unsatisfactory. Clinical diagnosis, prevention and management of driveline infections are being targeted to specific microbial pathogens grown as biofilms at the driveline exit-site or in the driveline tunnel. The purpose of this review is to improve the understanding of VAD-specific infections, from basic “bench” knowledge to clinical “bedside” experience, with a specific focus on the role of biofilms in driveline infections. Full article

(This article belongs to the Special Issue Prevention and Treatment of Surgical Site Infections)

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