I’ve written this post in preparation for tomorrow’s Journal Club, which will be about this paper on S. aureus colonisation and SSI (register here). Having not written or reviewed much on S. aureus for quite a while, I’m reading my second S. aureus paper in two weeks, following last week’s blog on a paper from the Healthcare Infection Society special on “MRSA: the enduring foe“!
Continue readingSurgical Site Infection
Real world observations to prevent SSIs
This week we welcome Dr Jude Robinson as a guest blogger to Reflections to discuss a paper on surgical site infection prevention.
I feel very honored to have been asked to be a guest speaker on the esteemed IPC partners journal club. I love critiquing papers, and I honestly don’t give myself enough time to do this on a regular basis, probably the same position as many of us with our busy clinical roles. I have really enjoyed preparing for this, so I hope you are able to join Register. I have used a recognised critical appraisal framework to support me with this journal review Qualitative Studies Checklist.
Continue readingBundles of success in SSI prevention?
Surgical site infection (SSI) frustrates me. When we undertake elective procedures, we have much more control over processes and patient flows than in most other aspects of hospital life. We have a range of evidence-based interventions, and we know that if we get them right, the risk of SSI is reduced hugely. And yet, preventable SSIs continue to occur because we don’t always get the bundle of interventions implemented. And so patients suffer harm, our theatres and precious beds have to do subsequent procedures related to SSI, costs ramp up, and we have to use more and more antibiotics. I gave a webinar last week providing an overview of the bundle of interventions at our disposal to reduce the risk of SSI.
Intra-operative vancomycin: to randomize or not
Today we discussed a recent paper published by our orthopedic surgeons on using powdered vancomycin in the wounds of spinal surgery to prevent surgical site infections (SSI). Two years ago I already had a post on the topic. The powder is spread deep in the wounds, on the bone and metal, before fascia and skin are closed. Yet, none of the 3 guidelines addressing prevention of surgical site infections that appeared recently recommends this intervention; WHO (2016) didn’t even include the intervention, CDC (2017) said “don’t do it”, and NICE (2019) acknowledged that the procedure is widely used without strong supporting evidence and recommended: stop doing it and do a trial. Continue reading
An empty gut before surgery?
We Dutch, we love gut decontamination. Not only in critically ill patients, but also in those undergoing elective colorectal surgery. A decontaminated gut is a safe gut, and that feeling was based on data from Dutch studies. A new study from Finland, published in Lancet, now questions whether our gut feeling was correct. Continue reading
What does good surgical wound closure look like?
I love and hate SSI prevention in equal measure. On the one hand, we have good evidence and strong guidelines around SSI prevention – but on the other hand, implementing these interventions to prevent SSI can be enormously tricky in practice. One key factor in preventing SSI is creating a well-closed wound in theatre. Surprisingly, there’s precious little data on how to measure what a well-closed surgical wound looks like. This qualitative study presents some potential indicators to measure good surgical wound closure in order to prevent SSI.
Preventing S. aureus SSI: Who does what? (part 2)
A month ago I blogged on the practices of pre-operative (or better peri-operative) treatment of nasal S. aureus carriage to prevent S. aureus surgical site infection (SSI) in orthopaedic or cardiothoracic surgery patients. The issue brought forward was that a “treat-all” (thus “screen none”) strategy is more feasible, more effective and cheaper than the “screen & treat” strategy. The latter strategy, is associated with less mupirocin exposure and thus less selective pressure for mupirocin-resistance genes. There was a poll with 2 questions. What is your current practice for patients undergoing orthopaedic or cardiothoracic surgery and what do you think the strategy should be, with 3 options for each question; “do nothing”, “screen & treat”, or “treat all”. Today the results. Continue reading
Preventing S. aureus SSI: Who does what?
Pre-operative (or better peri-operative) treatment of nasal S. aureus carriage is one of the most – if not the most – effective infection prevention measure. A large double-blind randomized controlled trial convincingly confirmed the meta-analysis results of previously performed smaller studies: 5 days of nasal mupirocin ointment together with chlorhexidine showering reduced the incidence of deep-seated S. aureus surgicial site infection (SSI) with 80% among S. aureus carriers undergoing orthopaedic or cardiothoracic surgery. Eight years after publication of these findings I (and others) still have the feeling that many hospitals have not implemented this measure. Continue reading
SSIs – time to de-invest in laminar flow?
Laminar flow is a very embedded technology for the prevention of SSI in some types of surgery (especially hip and knee arthroplasty). However, it seems from a recent Lancet ID review that this widely adopted practice is way ahead of the evidence supporting it: the bottom line finding of the review is we should stop wasting time and money on laminar flow theatres for some procedures, and focus on basic prevention initiatives (especially getting antibiotic prophylaxis right) in all surgical categories.
Agent Orange in spinal surgery
This week I learned from an orthopaedic surgeon that randomized trials were something that could be of use in “pharmaceutical sciences”, but that it is well-known that in the “surgical science” retrospective analyses are better for deriving evidence. We came to this when discussing the benefits of powdered vancomycin in the wounds of spinal surgery. Apparently this is something “all spinal orthopaedics do”, because it works so good. Continue reading
Reflections on Infection Prevention and Control 