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At least 415 records · Page 23Linked to original sources
PubMed2005

Wise use of perioperative antibiotics.

NOSOCOMIAL SURGICAL SITE INFECTIONS (SSIs), especially those caused by antibiotic-resistant organisms, are a major concern for perioperative nurses. Administering the correct antibiotic at its effective dose within the optimal time frame can help prevent SSIs. THE SIGNIFICANT RELATIONSHIP between microbial resistance and overuse of antibiotics justifies an examination of practices and a move away from widespread antibiotic administration. NEW ANTIBIOTIC GUIDELINES and research support recommendations for antibiotic administration for specific cardiac, colorectal, gynecologic, ophthalmologic, orthopedic, and urinary surgical procedures. Perioperative nurses can help protect their patients from nosocomial SSIs by using this clinical evidence.

Anti-Bacterial Agents↗
PubMed2007

Improving compliance with prophylactic antibiotic administration guidelines.

To reduce the incidence of surgical site infections, preoperative prophylactic antibiotics should be administered within 60 minutes before the initial incision is made. A recent study and anecdotal observations, however, indicate that rates for compliance with these guidelines are low. A quality improvement project was undertaken at a Florida health care facility to determine if implementing changes in preoperative processes would increase compliance with prophylactic antibiotic administration guidelines. After the strategies were implemented, compliance rates with the national guidelines for administration of antibiotics within 60 minutes of surgical incision increased from 75% at baseline to 95% postimplementation.

Anti-Bacterial Agents↗
PubMed2001

Critical pathways intervention to reduce length of hospital stay.

PURPOSE: Despite their popularity, critical pathways have been evaluated in only a few controlled studies. We evaluated the effectiveness of critical pathways in reducing length of hospital stay. SUBJECTS AND METHODS: We compared postoperative lengths of stay of patients who underwent coronary artery bypass graft (CABG) surgery, total knee replacement, colectomy, thoracic surgery, or hysterectomy before and after pathway implementation at a university hospital. For three procedures, changes in lengths of stay at neighboring hospitals without pathway programs were assessed for comparison. RESULTS: A total of 6,796 patients underwent one of the procedures during the study. The percentage of eligible patients managed on a critical pathway ranged from 94% for hysterectomy to 26% for colectomy. For most procedures, the postoperative length of stay was decreasing during the baseline period. After pathway implementation, the length of stay decreased 21% for total knee replacement, 9% for CABG surgery, 7% for thoracic surgery, 5% for hysterectomy, and 3% for colectomy (all P < 0.01). However, similar decreases were seen in the neighboring hospitals that did not have critical pathways or other specific efficiency initiatives. CONCLUSIONS: Critical pathways were associated with a rapid reduction in postoperative length of stay after all five study procedures. Secular trends at nearby hospitals, however, produced comparable reductions for the three procedures available for comparison. These findings raise questions about the effectiveness of critical pathways in a competitive environment.

Adult↗
PubMed2001

Prophylactic antibiotics are not indicated in clean general surgery cases.

BACKGROUND: In assigning risk of infection, the traditional wound classification system has been replaced by the National Nosocomial Infection Surveillance (NNIS) system. NNIS classification is determined by procedure length, wound cleanliness, and ASA status. To date, no prophylactic antibiotic guidelines have been proposed for the NNIS system. METHODS: Clean general surgery cases were retrospectively reviewed in our hospital for infection and prophylactic antibiotic use. These cases were then stratified per the NNIS system. RESULTS: One thousand twenty-three clean general surgery cases had 16 (1%) surgical site infections. The infection rate in NNIS class 0, 1, and 2 cases not given prophylactic antibiotics was 1.21%, 3.03%, and 0%, respectively. The infection rate in NNIS class 0, 1, and 2 cases given prophylactic antibiotics was 0.94%, 2.44%, and 6.67%, respectively. CONCLUSIONS: No statistically significant decrease in infection rate was demonstrated by us using prophylactic antibiotics, regardless of the NNIS classification in clean general surgery cases.

Antibiotic Prophylaxis↗
PubMed2002

The use of the Kugel mesh in ventral hernia repairs.

BACKGROUND: The management of ventral hernias is a common problem. Goals of hernia repair include reduction of the contents, reperitonealization of the abdomen, repair of the fascial defect, and restoration of the normal abdominal wall contour. Repairs frequently require the use of mesh to reduce the incidence of recurrence. A variety of repair techniques have been described, often associated with significant pain, prolonged recovery, and complications. METHODS: We describe a technique using a partial component separation, reperitonealization of the abdominal cavity with the hernia sack, and insertion of the Kugel mesh for bridging the gap. RESULTS: We have used this technique on 65 ventral hernias. Fifty-two patients went home from the recovery room and 11 stayed less than 23 hours. One patient had a wound infection and 2 had seromas. There have been no recurrences to date. CONCLUSIONS: Repair of ventral hernias with the Kugel mesh using a partial component separation is safe, effective and durable.

Adult↗
PubMed2003

Comparison of repair techniques for major incisional hernias.

BACKGROUND: Multiple techniques exist for repair of incisional hernias. Laparoscopic ventral hernia repairs as well as sliding myofascial rectus flap ventral hernia repairs (the separation of parts technique) have received recent attention for low recurrence and low complication rates. These procedures are diametrically opposed solutions to the same clinical problem. METHODS: Two surgeons of different surgical specialties will jointly compare and contrast these two ends of the spectrum regarding repair of ventral hernias. RESULTS: An algorithm for patient selection is presented. CONCLUSIONS: No one technique is the "best" procedure for all patients. Knowledge of the wide variety of surgical options will be of benefit to all patients with incisional hernias.

Algorithms↗
PubMed1992

Which prophylactic regimen for which surgical procedure?

For optimal prevention of infection subsequent to a surgical intervention, it is necessary to follow a series of general principles, including the classification of the type of surgical intervention, the characteristics of the antibiotic used, and the route and the time of its administration. Moreover, with reference to the different types of surgery, other factors assume importance: the etiology of the infection and the ability of the antibiotic to achieve adequate levels in the tissues at the beginning of the infective process. In general abdominal, biliary, and obstetric-gynecologic surgery, which covers many clean-contaminated and contaminated interventions for which antibiotic prophylaxis has been shown to be the most effective, the etiology is often mixed (aerobic and anaerobic flora) with a predominance of gram-negative microorganisms. Thus, an appropriate prophylactic regimen must consider a third-generation cephalosporin, such as cefotaxime, that is effective against most gram-negative bacteria, in particular against Klebsiella pneumoniae. Acylureido penicillins can also be used because of their activity against enterococci, gram-positive microorganisms that are also causes of infection in this area of surgical intervention. Combining an antimicrobial such as clindamycin or metronidazole, which are particularly active against anaerobes, may be recommended as well. In urologic surgery, most infections are caused by Enterobacteriaceae; in addition to the antimicrobial spectrum, the ability of the antibiotic to concentrate adequately in the urine and renal tissue must also be considered. Beta-lactam antibiotics are the agents of choice, in particular, third-generation cephalosporins, aztreonam, and acylureido penicillins. In cardiac, orthopedic, and partially in neurologic surgery, where most infections are due to gram-positive bacteria (primarily methicillin-resistant staphylococci), antibiotic prophylaxis should include a glycopeptide agent (teicoplanin, vancomycin). In the field of surgical prophylaxis, more experience has been accumulated with cefotaxime, used as a short-course regimen or as a convenient single dose, than with any other newer cephalosporin. Cefotaxime's broad spectrum of action provides coverage against most potential pathogens and, when used as a single dose, is both convenient and cost-effective.

Anti-Bacterial Agents↗
PubMed1998

Overview of quinolones in the treatment and prevention of surgical infection.

Postoperative infection remains a complication of surgical procedures, resulting in increased morbidity, mortality, and cost. The frequent polymicrobial etiology and emerging patterns of resistance continue to compromise cure rates. Although quinolones have many attractive properties for the surgical setting, combination therapy is routinely indicated for appropriate coverage. Advanced-generation quinolones, such as trovafloxacin, offer an increased antimicrobial spectrum, including activity against important surgical pathogens, and longer elimination half-lives. These newer agents may be used intravenously or orally as once-daily single-agent therapy for surgical prophylaxis, and in place of combination therapy for complex intra-abdominal and pelvic infections.

Administration, Oral↗
PubMed2006

[Surgical site infection in general surgery: 5-year analysis and assessment of the National Nosocomial Infection Surveillance (NNIS) index].

INTRODUCTION: The aim of this study was to describe the rate of surgical site infections (SSI), classified according to the NNIS index and its components, as well as to evaluate this scale and assess the importance of several factors that influence the development of an SSI. PATIENTS AND METHOD: All episodes of SSI were prospectively registered over a 5-year period. All patients (infected or not) were given an NNIS index and an NNIS category. Postoperative hospital stay and bacteria cultured from the surgical site were also analyzed. Chi2 test, Student's t-test and multiple logistic regression were used. RESULTS: There were 6,218 patients and 513 SSI (8.25%). The infection rate was 2.27% for clean surgery, 9.17% for clean-contaminated surgery, 11.40% for contaminated surgery, and 19.14% for dirty surgery; 4% for ASA I, 8.23% for ASA II, 13.54% for ASA III, 19.55% for ASA IV, and 33.33% for ASA V; 6.97% for length of procedure = 75th percentile, and 23.01% for > 75th percentile; 3.95% for NNIS 0, 8.17% for NNIS 1, 22.08% for NNIS 2, and 37.23% for NNIS 3. Among the components of the NNIS index, the length of the surgical procedure had the greatest influence on the rate of SSI (OR = 3.43 versus OR = 2.60 for the grade of contamination and OR = 2.20 for ASA index). The infection rates according to the type of intervention were: 30.9% in hepatobiliopancreatic surgery, 24.3% in small bowel surgery, 16.1% in colorectal surgery, 15.4% in gastroduodenal surgery; 8.5% in other soft tissue interventions, 7.7% in exploratory laparotomies, 6.4% in appendicectomies for appendicitis, 5.0% in cholecystectomy, 5.0% in other interventions of the digestive tract, 3.3% in breast surgery, 1.5% in herniorrhaphies, and 0.7% in endocrine surgery. CONCLUSIONS: The NNIS index is a valid instrument for classifying surgical patients according to the risk of developing an SSI. Of the three components, the length of the intervention has the greatest influence on increasing the risk of infection. The NNIS categories also distinguish different levels of risk of infection.

Female↗
PubMed1997

Modified Boerema technique for the closure of congenital abdominal wall defects to prevent incisional herniation and infection.

Tension and infection often cause wound dehiscence or incisional herniation after the fascial closure of congenital abdominal wall defects in neonates. To overcome these problems, a modification of the Boerema technique (a method for repairing large incisional hernia in adults) was applied to repair abdominal wall defects in 14 neonates. The efficacy of this technique is discussed in this report.

Abdominal Muscles↗
PubMed2003

Lavage of contaminated surfaces: an in vitro evaluation of the effectiveness of different systems.

INTRODUCTION: Lavage is an effective, additive therapeutic procedure with a broad application in surgery. In addition to irrigation with the conventional syringe, the pulsed jet lavage system is used. The effectiveness of bacterial reduction depends on, among other things, the irrigation pressure. Complications of high-irrigation pressure in bone and joint surgery are intramedullary seeding of bacteria, visible damage of the bone, or delayed healing of the fracture by lavage of the fracture zone. The purpose of this in vitro study was to evaluate the effectiveness of mechanical irrigation on several surfaces using different systems of irrigation. MATERIALS AND METHODS: Four different test surfaces (nonbiological surfaces: sterilized bone cement and titanium osteosynthesis plates; biological surfaces: gamma-irradiated bovine muscle and cancellous bone) were contaminated with a defined suspension of different bacterial species (Staphylococcus aureus, Enterococcus faecalis, Pseudomonas aeruginosa). The samples were irrigated with three different systems (conventional 50-ml plastic syringe, manual pump irrigator, jet lavage) in a standardized, randomized experimental setup. After irrigation of the sample the amount of residual bacteria (colony-forming units) was determined. RESULTS: An effective bacterial reduction was achieved with the use of irrigation regardless of the system that was used and surface that was cleaned. On average P. aeruginosa was reduced around log 1.907, E. faecalis around log 1.666 and S. aureus around log 1.506. On biological surfaces, a reduction around log 0.801 for muscle and around log 1.738 for bone samples was achieved independent of the system that was used for irrigation. For the titanium surface a reduction of log 1.652 compared with log 2.580 for the bone cement surface was demonstrated. Statistical analysis showed that mechanical lavage resulted in a significant reduction of all tested bacterial species on the surfaces. The best bacterial reduction was achieved with the manual pump irrigator (P = 0.06). The results demonstrate that the manual pump irrigator achieved significantly better bacterial reduction (P = 0.039) on "biological surfaces" (bone and muscle) compared with nonbiological surfaces (titanium and cement). CONCLUSION: The results show that irrigation is an effective technique for bacterial reduction on contaminated surfaces. A remarkable finding was the limited bacterial reduction of Staphylococcus aureus from gamma-sterilized muscle. The use of a continuous manual pump irrigator showed a greater reduction of bacteria contamination compared with the other means of irrigation investigated. In conclusion, the manual continuous irrigation system proved to be practical, economical and effective in reducing the bacterial load on various surfaces.

Animals↗
PubMed2003

Acute wound healing: the biology of acute wound failure.

Acute wound healing failure is an important source of morbidity and mortality for surgical patients. Many incisional hernias, gastrointestinal anastomotic leaks, and vascular pseudoaneurysms occur despite patient optimization and standardized surgical technique. Modern surgical experience suggests that biologic and mechanical pathways overlap during "normal" acute wound healing. The cellular and molecular processes activated to repair tissue from the moment of injury are under the control of biologic and mechanical signals. Successful acute wound healing occurs when a dynamic balance is met between the loads placed across a provisional matrix and the feedback and feed-forward responses of repair cells.

Acute Disease↗