Keywords
surgical site infection
surveillance
arthroplasty procedures.
Abstract
Abstract:
Background: The rate of surgical site infections (SSI) is strongly influenced by operating room quality, which is determined by the structural features of the facility and its systems and by the management and behaviour of healthcare workers.
The aim of the present study was to assess the microbial contamination in operating room during hip- and knee-replacement procedures, the behavior of operating room staff and the incidence of SSI through postdischarge surveillance.
Methods: Microbial contamination was evaluated by active and passive samplings at rest and in operating conditions. Organizational and behavioral characteristics were collected by observational assessment. The incidence of SSI was evaluated in 255 patients and the follow-up examinations were carried out at 30 and 365 days after the procedure.
Results: The mean value of the airborne and sedimenting microbial load was respectively 12.90 CFU/m3 and 0.02 CFU/cm2/h.
With regard to outcome, the infection rate proved to be 0.89%, associated with knee-replacement procedures. The microorganism responsible for this superficial infection was Staphylococcus aureus.
Conclusion: Clinical outcomes proved to be satisfactory explained by the microbial load (in both at-rest and operating conditions), the appropriate behavior of the staff, compliance with the guidelines on preoperative antibiotic prophylaxis, and efficient management of the ventilation system.
References
References
Humphreys H. Preventing surgical site infection. Where now? J Hosp Infect. 2009;73:316-22.
Cristina ML, Spagnolo AM, Sartini M, Panatto D, Gasparini R, Orlando P, Ottria G, Perdelli F. Can Particulate Air Sampling Predict Microbial Load in Operating Theatres for Arthroplasty? PLoS ONE. 2012;7:e52809.
Pittet D, Ducel G. Infectious risk factors related to operating rooms. Infect Control Hosp Epidemiol. 1994;15:456-62.
Ha’eri GB, Wiley A.M. Total hip replacement in a laminar flow environment with special reference to deep infections. Clin Orthop 1980;148:163-8.
Lidwell OM. Clean air at operation and subsequent sepsis in the joint. Clin Orthop. 1986;211:91-102.
Webb BG, Lichtman DM, Wagner RA. Risk factors in total joint arthroplasty: comparison of infection rates in patients with different socioeconomic backgrounds. Orthopedics. 2008;31:445.
Gastmeier P, Sohr D, Brandt C, Eckmanns T, Behnke M, Rüden H. Reduction of orthopaedic wound infections in 21 hospitals. Arch Orthop Trauma Surg. 2005;125:526-30.
Haenle M, Skripitz C, Mittelmeier W, Skripitz R. Economic impact of infected total knee arthroplasty. ScientificWorld Journal. 2012;doi:10.1100/2012/196515.
Lee J, Kang CI, Lee JH, Joung M, Moon S, Wi YM, Chung DR, Ha CW, Song JH, Peck KR. Risk factors for treatment failure in patients with prosthetic joint infections. J Hosp Infect. 2010;75:273-6.
Brandt CM, Sistrunk WW, Duffy MC, Hanssen AD, Steckelberg JM, Ilstrup DM, Osmon DR. Staphylococcus aureus prosthetic joint infection treated with debridement and prosthesis retention. Clin Infect Dis.1997;24:914-9.
Blom AW, Brown J, Taylor AH, Pattison G, Whitehouse S, Bannister GC. Infection after total knee arthroplasty. J Bone Joint Surg Br. 2004;86:688-91.
Ottria G, Dallera M, Aresu O, Manniello MA, Parodi B, Spagnolo AM, Cristina ML. Environmental monitoring programme in the cell therapy facility of a research centre: Preliminary investigation. J Prev Med Hyg. 2010;51:133-8.
Istituto Superiore per la Prevenzione e Sicurezza sul Lavoro (ISPESL) (2010) Linee guida sugli standard di sicurezza e di igiene del lavoro nel reparto operatorio.
Available at: http://www.ispesl.it/linee_guida/Comparto_o_Settore/ISPESL-LG-SaleOperatorie.pdf Accessed on 15/01/2016.
Le Guyader A, C.CLIN-Ouest Recommandations pour les contrôles d’environnement dans les établissements de santé Octobre 1999.
Available at: http://www.hpci.ch/files/documents/guidelines/hh_gl_rec-ctrl-environ.pdf. Accessed on 15/01/2016.
Sartini M, Ottria G, Dallera M, Spagnolo AM, Cristina ML. Nitrous oxide pollution on operating theatres in relation to the type of leakage and the number of efficacious air exchanges per hour. J Prev Med Hyg 2006;47:155-9.
Huenger F, Schmachtenberg A, Haefner H, Zolldann D, Nowicki K, Wirtz DC, Bläsius K, Lütticken R, Lemmen SW. Evaluation of postdischarge surveillance of surgical site infections after total hip and knee arthroplasty. Am J Infect Control. 2005;33:455-62.
Eisenring MC, Zanetti G, Sax H, Troillet N, SWISS NOSO Epidemiological surveillance of surgical site infections. SWISS NOSO Protocol. Version October 2011.
HELICS. Surveillance of Surgical Site Infections. Protocol Version 9.1. September 2004.
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Hospital Infection Control Practice Advisory Committee. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol. 1999;20:247-78.
Wójkowska-Mach J, Jaje E, Romaniszyn D, Kasparek M, Frańczuk B, Bulanda M, Heczko PB. Comparison of SSI rates in endoarthroplasty of hip and knee in a Cracow patient population and the importance of postdischarge surveillance. Infection 2008;36:36-40.
Spagnolo AM, Orlando P, Panatto D, Amicizia D, Perdelli F, Cristina ML. Staphylococcus aureus with reduced susceptibility to vancomycin in healthcare settings. J Prev Med Hyg. 2014;55:137-44.
Garvin KL, Konigsberg BS. Infection following total knee arthroplasty: prevention and management. Instr Course Lect. 2012;61:411-9.
Health Technical Memorandum 03-01: Specialised ventilation for healthcare premises. 2007.
Whyte W, Lidwell OM, Lowbury EJL, Blowers R. Suggested bacteriological standards for air in ultra-clean operating rooms. J Hosp Infect. 1983;4:133-9.
H+ Die Spitäler der Schweiz. Klassifizierung und technishe Anforderungen an Spitalräume. 2007.
Orlando P, Cristina ML, Dallera M, Ottria G, Vitale A, Badolati G. Surface disinfection: Evaluation of the efficacy of a nebulization system spraying hydrogen peroxide. J Prev Med Hyg. 2008;49:116-9.
Zwolinska M, Bodgan A. Thermal sensations of surgeons during work in surgical gowns. JOSE. 2013;19:443-53.
Sartini M, Spagnolo AM, Panatto D, Perdelli F, Cristina ML. Improving environmental quality in an operating room: Clinical outcomes and economic implications. J Prev Med Hyg. 2013;54:75-9.
Cristina ML, Spagnolo AM, Orlando P, Perdelli F. The role of the environment in the spread of emerging pathogens in at-risk hospital wards. Rev Med Microbiol. 2013;24:104-12.
Spagnolo AM, Ottria G, Amicizia D, Perdelli F, Cristina ML. Operating theatre quality and prevention of surgical site infections. J Prev Med Hyg. 2013;54:131-37.
Brandt C, Hott U, Sohr D, Daschner F, Gastmeier P, Rüden H. Operating room ventilation with laminar airflow shows no protective effect on the surgical site infection rate in orthopedic and abdominal surgery. Ann Surg. 2008;248:695-700.
Knobben BAS, Van Horn JR, Van der Mei HC, Bussche HJ. Evaluation of measures to decrease intra-operative bacterial contamination in orthopaedic implant surgery. J Hosp Infect. 2006;62:174-80.
Lynch RJ, Englesbe MJ, Sturm L, Bitar A, Budhiraj K, Kolla S, Polyachenko Y, Duck MG, Campbell DA Jr. Measurement of foot traffic in the operating room: implications for infection control. Am J Med Qual. 2009;24:45–52.
Jiranek WA, Hanssen AD, Greenwald AS. Antibiotic-loaded bone cement for infection prophylaxis in total joint replacement. J Bone Joint Surg Am. 2006;88:2487–500.
van Kasteren ME, Mannien J, Kullberg BJ, de Boer AS, Nagelkerke NJ, Ridderhof M, Wille JC, Gyssens IC. Quality improvement of surgical prophylaxis in Dutch hospitals: evaluation of a multi-site intervention by time series analysis. J Antimicrob Chemother. 2005;56:1094–102.
Prokuski L. Prophylactic antibiotics in orthopaedic surgery. J Am Acad Orthop Surg. 2008;16:283–93.
Bhattacharyya T, Hooper DC. Antibiotic dosing before primary hip and knee replacement as a pay-for-performance measure. J Bone Joint Surg Am. 2007;89:287-91.
AlBuhairan B, Hind D, Hutchinson A. Antibiotic prophylaxis for wound infections in total joint arthroplasty: a systematic review. J Bone Joint Surg Br. 2008;90:915-9.
SIOT Working Group GUIDELINES. Perioperative antibiotic prophylaxis in prosthetic surgery of the hip and knee. GIOT. 2011, 37, 4-17.
Gemmell CG, Edwards DI, Fraise AP, Gould FK, Ridgway GL, Warren RE. Joint Working Party of the British Society for Antimicrobial Chemotherapy, Hospital Infection Society and Infection Control Nurses Association. Guidelines for the prophylaxis and treatment of methicillin-resistant. Staphylococcus aureus (MRSA) infections in the UK. J Antimicrob Chemother. 2006;57:589-608.
American Academy of Orthopaedic Surgeons Advisory Statement: Recommendations for the use of intravenous antibiotic prophylaxis in primary total joint arthroplasty. Information Statement 1027. June 2004.
Barnes S, Salemi C, Fithian D, Akiyama L, Barron D, Eck E, Hoare K. An enhanced benchmark for prosthetic joint replacement infection rates. Am J Infect Control. 2006; 34:669-72.
Perdelli F, Dallera M, Cristina ML, Sartini M, Ottria G, Spagnolo AM, Orlando P. A new microbiological problem in intensive care units: Environmental contamination by MRSA with reduced susceptibility to glycopeptides. Int J Hyg Environm Health. 2008;211:213-18.