Guideline for Prevention of Surgical Site Infection, 1999 ☆ ☆☆ ★ ★★

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.

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Guideline for Prevention of Surgical Site Infection, 1999

An estimated 2 million patients develop nosocomial infections in the United States annually. The increasing number of antimicrobial agent-resistant pathogens and high-risk patients in hospitals are challenges to progress in preventing and controlling these infections. While Escherichia coli and Staphylococcus aureus remain the most common pathogens isolated overall from nosocomial infections, coagulase-negative staphylococci (CoNS), organisms previously considered contaminants in most cultures, are now the predominant pathogens in bloodstream infections. The growing number of antimicrobial agent-resistant organisms is troublesome, particularly vancomycin-resistant CoNS and Enterococcus spp. and Pseudomonas aeruginosa resistant to imipenem. The active involvement and cooperation of the microbiology laboratory are important to the infection control program, particularly in surveillance and the use of laboratory services for epidemiologic purposes. Surveillance is used to identify possible infection problems, monitor infection trends, and assess the quality of care in the hospital. It requires high-quality laboratory data that are timely and easily accessible.

An overview of nosocomial infections, including the role of the microbiology laboratory.

Background and aims: Major liver resection incurs a risk of postoperative liver dysfunction and infection and there is a lack of objective evidence relating residual liver volume to these complications. Patients and methods: Liver volumetry was performed on computer models derived from computed tomography (CT) angioportograms of 104 patients with normal synthetic liver function scheduled for liver resection. Relative residual liver volume (%RLV) was calculated as the relation of residual to total functional liver volume and related to postoperative hepatic dysfunction and infection. Receiver operator characteristic curve analysis was undertaken to determine the critical %RLV predicting severe hepatic dysfunction and infection. Univariate analysis and multivariate logistic regression analysis were performed to delineate perioperative predictors of severe hepatic dysfunction and infection. Results: The incidence of severe hepatic dysfunction and infection following liver resection increased significantly with smaller %RLV. A critical %RLV of 26.6% was identified as associated with severe hepatic dysfunction (p Conclusions: The likelihood of severe hepatic dysfunction following liver resection can be predicted by a small %RLV and a high BMI whereas postoperative infection is more related to liver dysfunction than precise residual liver volume. Understanding the relationship between liver volume and synthetic and immune function is the key to improving the safety of major liver resection.

https://gut.bmj.com/content/gutjnl/54/2/289.full.pdf

The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resection

Surgical site infection (SSI) is among the leading nosocomial causes of complications and increased medical expense. 1–4 It is also a clinical outcome indicator of fundamental importance in elective surgery. 2,5–7 In 1992, the Centers for Disease Control and Prevention (CDC)’s National Nosocomial Infections Surveillance (NNIS) system modified the definition of surgical wound infection slightly and changed the name to surgical site infection. SSIs are divided into incisional SSI and organ/space SSI. 8 Elective colorectal resection is the most frequent procedure in colorectal surgery. Organ/space SSIs, including intraabdominal or pelvic abscess and anastomotic leakage, are dreaded complications that may occur after colorectal resection. The distinction between abdominal abscess with and without leakage is of clinical and pathogenetic importance, because their risk factors for SSI may be different. Anastomotic leakage depends, to a great deal, on surgical skills, 9 whereas weight loss of 10% body weight may be associated with abdominal abscess. 10 The risk factors for incisional and organ/space SSIs may also be different. Drainage of the surgical area and ostomy may predispose a patient to incisional SSI rather than organ/space SSI. 11,12

In 1991, the CDC’s NNIS system proposed a risk index consisting of scoring each operation by counting the number of risk factors present among the following: a patient with an American Society of Anesthesiologists (ASA) preoperative assessment score of 3, 4, or 5; an operation classified as contaminated or dirty-infected; and a prolonged length of operation. 13 The NNIS risk index may provide a valid comparison of SSI rates among surgeons or among hospitals. There are limitations in predicting SSI risk after elective colectomy, because most of the patients undergoing such a procedure have an ASA score of 1 or 2 and undergo a clean-contaminated procedure. Additional risk factors, including patient and surgical factors, need to be identified.

The primary goal of this prospective study was to identify the risk factors for SSI at each specific site in patients undergoing elective colorectal resection.

Risk Factors For Surgical Site Infection After Elective Resection of the Colon and Rectum: A Single-Center Prospective Study of 2,809 Consecutive Patients

https://www.amjmed.com/article/0002-9343(91)90362-2/pdf

Risk factors for postoperative infection

OBJECTIVE
The authors' objective was to determine whether preoperative administration of tamsulosin decreases postoperative urinary retention after spine surgery.


METHODS
In this randomized, double-blind, placebo-controlled clinical trial performed at a single institution between 2016 and 2019, eligible males aged 50 to 85 years were administered tamsulosin or placebo for 5 days prior to elective spine surgery. Patients were excluded if they were taking alpha adrenergic blocking drugs; were allergic to tamsulosin, lactose, or sulfa drugs; had a preexisting indwelling urinary catheter, orthostatic hypotension, history of urological surgery, or renal failure; or were scheduled for cataract surgery within 2 weeks. Screening identified 1051 eligible patients (140 declined participation, 150 did not meet the inclusion criteria, and 151 did not enroll for other reasons). A total of 610 patients were randomly assigned to receive 0.4 mg oral tamsulosin or an identical placebo capsule for 5 days preoperatively and 2 days postoperatively.


RESULTS
A total of 497 patients were included in the final statistical analysis. The overall rate of postoperative urinary retention was 9.7%, and tamsulosin had no observed effect on reducing the rate of postoperative urinary retention as compared with placebo (9.4% vs 9.9%, p = 0.96). There were no significant differences in the reported adverse events between groups. Multivariate logistic regression was performed to model the effects of patient, surgical, and anesthetic factors on postoperative urinary retention, and the study drug remained an insignificant factor.


CONCLUSIONS
This study did not detect an effect of perioperative tamsulosin on reducing the rate of postoperative urinary retention in male patients aged 50 to 85 years who underwent elective spine surgery. This study does not support the routine use of tamsulosin to reduce postoperative urinary retention in patients without a previous prescription. It is unknown if subpopulations exist for which prophylactic tamsulosin may reduce postoperative urinary retention.

Does tamsulosin decrease postoperative urinary retention in spine surgery? A double-blind, randomized controlled trial.

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Risk factors for postoperative infection

Does tamsulosin decrease postoperative urinary retention in spine surgery? A double-blind, randomized controlled trial.