Impact of the implementation of an interdisciplinary infection control program to prevent surgical wound infection in pediatric heart surgery

Izquierdo-Blasco, Jaume; Campins-Martí, Magda; Soler‐Palacín, Pere; Balcells, Joan; Abella, Raúl; Gran, Ferrán; Castillo, Félix; Nuño, Rosario; Sanchez‐de‐Toledo, Joan

doi:10.1007/s00431-015-2493-9

Cited by 19 publications

(36 citation statements)

References 23 publications

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“…After a careful search for references, we identified an additional 8 of 48 papers relevant for the analysis. After the removal of duplicates, exclusion of reports other than original papers or reviews, and reports that did not fulfill the inclusion criteria, we identified 20 publications for the final analysis [1][2][3][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Detailed information included in these 20 papers is provided in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Antibiotic Prophylaxis in Pediatric Cardiac Surgery: Where Are We and Where Do We Go? A Systematic Review

Jaworski

Kansy

Dzierżanowska-Fangrat

et al. 2019

Surgical Infections

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Background: Prophylactic antibiotic therapy is given routinely in the peri-operative period to prevent surgical site infection. However, in pediatric cardiac surgery, an optimal schedule has not been defined. Pediatric recommendations follow the guidelines for adults, which might be improper because of the inherent challenges in pediatric research and the heterogeneity of the population. Implementation of an effective prophylaxis protocol is needed for children undergoing cardiac surgery, especially in view of worldwide antibiotic overuse and the development of drug resistance. In this review, we analyze the current knowledge supported by up-todate publications about antibiotic prophylaxis in pediatric cardiac surgery. Methods: The PubMed Ò database was searched for full-text journal articles describing peri-operative antibiotic prophylaxis in pediatric cardiac surgery published since 2000. Antibiotics used for standard prophylaxis with dosing schema, time of the first dose, additional dosage in extracorporeal circulation (ECC) priming, and prophylaxis duration were analyzed. Additionally, we looked for special clinical situations such as antibiotic prophylaxis in children with the sternum left open after surgery and patients with b-lactam allergy or preoperative methicillin-resistant Staphylococcus aureus (MRSA) colonization or those requiring extracorporeal membrane oxygenation (ECMO). Results: A total of 1,546 articles were evaluated, and we identified 20 for further analysis. On the basis of the current peri-operative antibiotic prophylaxis recommendations for cardiac surgery and the papers reviewed, we tried to propose a schedule for peri-operative antibiotic prophylaxis in pediatric cardiac surgery. Conclusions: There is a need for careful use and examination of the schedule proposed because the pharmacokinetics of antibiotics in pediatric patients with ECC is not fully understood. This should be evaluated further. Formulating uniform recommendations concerning peri-operative antibiotic prophylaxis is difficult.

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Section: Resultsmentioning

confidence: 99%

Antibiotic Prophylaxis in Pediatric Cardiac Surgery: Where Are We and Where Do We Go? A Systematic Review

Jaworski

Kansy

Dzierżanowska-Fangrat

et al. 2019

Surgical Infections

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“…In Europe, Izquierdo, et al conducted a quasi-experimental interventional study comparing a pre-intervention cohort and a post-intervention cohort to assess the effectiveness of a better intervention program designed to reduce the high incidence of hospital acquired infections observed at a university hospital in Barcelona, Spain. The authors concluded that implementation of a better intervention program was associated with an 82% reduction in HAIs incidence [25].…”

Section: Discussionmentioning

confidence: 99%

Effect of Infection Prevention and Control Measures on the Length of Hospital Stay of Patients at Lebanese Hospitals

Ahmad¹,

Iskandar²,

Matta³

et al. 2018

J Infect Dis Epidemiol

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Background: Infection Prevention and Control (IPC) measures are related to medical practices that prevent or minimize spreading of infectious diseases. The purpose of this study was to evaluate the effect of IPC measures on the length of hospital stay (LOS) of patients in infectious diseases service at Lebanese hospitals. Methods: This was a prospective cohort study in two Lebanese hospitals between January 2017 and July 2017. Hospital 1 was a governmental university hospital located in Beirut with a total number of 544 beds, with Composite Index of Activities for the Control of Nosocomial Infections-2 (CIACNI-2) and Composite Indicator of Control of Multi-Resistant Bacteria (CIC-MRB) scores of 76/100 and 69/100, respectively. Hospital 2 was a non-university private hospital located in Mount Lebanon with a total number of 110 beds, CIACNI-2 and CIC-MRB scores of 95/100 and 70/100, respectively. Adult patients of both genders aged over 18 years, admitted to the intensive care, internal medicine or surgical wards, with positive bacteria cultures and treated with antibiotics were eligible to be enrolled in the study. The primary outcome was to assess the effect of IPC measures of each hospital on the total LOS. Bivariate and multivariable analyses were used to identify the statistical associations. Results: A total of 369 patients were enrolled in the study. Private hospital had higher scores of IPC measures. Patients at the hospital with lower IPC measures had an additional LOS of 2 ± 2.73 days when compared to the hospital with higher IPC measures (p = 0.106). Multi linear regression showed that the hospital with higher IPC measures was associated with significant shorter LOS (p < 0.001). Conclusion: Applying high standards of IPC measures can decrease the total length of hospital stay in Lebanese hospitals.

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“…All studies were conducted in tertiary urban or teaching hospitals. Among studies conducted in highincome settings, 15 were in European countries, [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] 19 in the United States of America, [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] one in Australia, 36 three elsewhere in North America, [37][38][39] and three in Asia. [40][41][42] There were three nonrandomised interventional studies, 6,22,23 32 cohort studies, [2][3][4][5][7][8]...…”

Section: Epidemiology Of Perioperative Infections In High-income Counmentioning

confidence: 99%

“…Among those studies, the most common infection studied was surgical site infection with varied incidence of 1.2% (12/981) to 48% (22/46). 2,6,17,23,[25][26][27][31][32][33]35,37,38,42 Risk factors for surgical site infections were duration of surgery, 17,21 age <1 month, 17,27,32 blood transfusion, 21 parenteral nutrition, 32 perioperative medical device, 32 excessive bleeding within 24 hours after surgery, and incorrect timing of preoperative antibiotics. 27 Postoperative bacteraemia occurred in 1.5% (15/ 992) to 10.2% (13/127).…”

Section: Epidemiology Of Perioperative Infections In High-income Counmentioning

confidence: 99%

“…After implementing the intervention, the incidence of surgical site infection decreased significantly from 10.9% (95% confidence interval (CI) 4.7-18.8) to 1.92% (95% CI 0.4-5.52) in the preand post-intervention period, respectively. 6 Another before-and-after study implemented measures to reduce surgical site infection using chlorhexidine in the operative and postoperative periods, standardised intravenous antibiotic within 5-60 minutes of the initial surgical incision, with initiation of cardiopulmonary bypass, and every 3 hours in the intraoperative period, antibiotics for 48 hours, and dressing removal at 48 hours in the postoperative period. These measures were associated with a reduction of sternal wound infection rates from 3.8 to 2.1%.…”

Section: Postoperative Infectionmentioning

confidence: 99%

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Perioperative infections in congenital heart disease

et al. 2017

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Background: Perioperative infections have significant consequences for children with congenital heart disease (CHD), which can manifest as acute or chronic infection followed by poor growth and progressive cardiac failure. The consequences include delayed or higher-risk surgery, and increased postoperative morbidity and mortality. Methods: A systematic search for studies evaluating the burden and interventions to reduce perioperative infections in children with CHD was undertaken using PubMed. Results: Limited studies conducted in low-to middle-income countries demonstrated the large burden of perioperative infections among children with CHD. Most studies focussed on infections after surgery. Few studies evaluated strategies to prevent preoperative infection or the impact of infection on decision-making around the timing of surgery. Children with CHD have multiple risk factors for infections including delayed presentation, inadequate treatment of cardiac failure, and poor nutrition. Conclusions: The burden of perioperative infections is high among children with CHD, and studies evaluating the effectiveness of interventions to reduce these infections are lacking. As good nutrition, early corrective surgery, and measures to reduce nosocomial infection are likely to play a role, practical steps can be taken to make surgery safer.

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Impact of the implementation of an interdisciplinary infection control program to prevent surgical wound infection in pediatric heart surgery

Cited by 19 publications

References 23 publications

Antibiotic Prophylaxis in Pediatric Cardiac Surgery: Where Are We and Where Do We Go? A Systematic Review

Antibiotic Prophylaxis in Pediatric Cardiac Surgery: Where Are We and Where Do We Go? A Systematic Review

Effect of Infection Prevention and Control Measures on the Length of Hospital Stay of Patients at Lebanese Hospitals

Perioperative infections in congenital heart disease

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