Category Archives: Infection Control

Negative Pressure Wound Therapy Use to Decrease Surgical Nosocomial Events in Colorectal Resections

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“Surgical site infection (SSI) is one of the most common complications following open colon and rectal surgery. Significant morbidity—secondary to increased length of stay, delay in adjuvant treatments, and psychosocial effects—has been well established in the literature. Further, SSIs confer additional monetary costs to the healthcare system.6 Despite best practice recommendations including prophylactic antibiotics and aseptic technique, SSIs remain common in open colorectal surgery. Rates of SSI in the literature range between 15
and 30%. Increased use of laparoscopy in colorectal surgery has significantly impacted rates of SSI but the uptake of laparoscopy has not been complete as certain patients are not candidates and conversion to open is required in approximately 15% of cases.”

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Negative Pressure Wound Therapy for Surgical-site Infection

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“Despite improvement in infection control, SSIs remain a common cause of morbidity after abdominal surgery. SSI has been associated with an increased risk of reoperation, prolonged hospitalization, readmission, and higher costs. Recent retrospective studies have suggested that the use of negative pressure wound therapy can potentially prevent this complication.”

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Using negative pressure wound therapy devices to decrease the incidence of infrainguinal wound infections

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Surgical site infection (SSI) is a well-characterized morbidity after vascular surgical procedures, especially after infrainguinal and lower extremity bypass. Rates of SSI after these interventions range from 4.8% to 38.5%, which is higher than predicted for “clean” (type I/II) wounds (2%-6%). SSI rates are increased because of the proximity of wounds to the perineum and genitalia, use of prosthetic materials, and disruption of lymphatic vessels during groin incisions; most are attributable to inoculation by skin flora or direct bacterial
spread at the time of initial operation.

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Association between positive intra-operative bile cultures during Whipple procedures and subsequent organ space infections

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“The association between intraoperative bile cultures and infectious complications after
pancreatoduodenectomy remains unclear. Pancreatoduodenectomy remains a complex and technically demanding procedure with high rates of morbidity (25–52%) and mortality (1–3%). Infectious complications, such as surgical site infections (SSIs) and organ space infections (OSIs), are reported as the most common complications following pancreatoduodenectomy besides pancreatic fistula and delayed gastric emptying.”

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 Bacterial translocation as a cause of surgical sepsis

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‘The term ‘bacterial translocation’ is used to describe the passage of viable resident bacteria from the gastrointestinal tract to normally sterile tissues such as the mesenteric lymph nodes and other internal organs.7 The term also applies to the passage of inert particles and other macromolecules, such as lipopolysaccharide endotoxin, across the intestinal mucosal barrier.’

‘Bacterial translocation has been shown to occur in various patient populations.6 As already stated, it occurs in patients undergoing elective abdominal surgery, organ donors and those with intestinal obstruction, colorectal cancer, ischaemia–reperfusion injury shock and pancreatitis. Many authors suggest an increased prevalence in patients with obstructive jaundice, those receiving parenteral nutrition and the malnourished, but the evidence for this is limited. Interestingly, translocation, assessed by endotoxin or bacterial culture of portal or systemic blood, has only rarely been demonstrated after trauma’

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Role of bacterial translocation in post op infection after GI surgery.

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‘The incidence of postoperative sepsis has increased in the past decades, with the proportion of severe sepsis cases rising to unprecedented levels. Cases of sepsis are noted both after elective and emergency surgeries, but in the cases of elective surgeries, mortality is not respectively affected. Gastrointestinal perforation is the most common surgical condition requiring immediate surgical intervention. More specifically, colonic perforation may cause peritonitis through the spread of bacteria from the intestines, and, therefore, there is a high risk for further bacterial spread via blood flow.”

Figure 1 Mechanism of bacterial translocation after major gastrointestinal surgery.
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Presentation and management of perirectal sepsis

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“Perirectal sepsis is a potentially severe complication which may follow minor anorectal
intervention and be slow to be diagnosed and treated. Awareness of the possible
diagnosis, urgent investigation with cross-sectional imaging and immediate treatment with
broad-spectrum antibiotics is vital. However, radical surgical intervention may be necessary.”

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