Influence of Rescrubbing Before Laparotomy Closure on Abdominal Wound Infection After Colorectal Cancer Surgery

Ortiz, Héctor; Armendáriz, P.; Kreisler, Esther; García‐Granero, Eduardo; Espín‐Basany, Eloy; Roig, José V.; Martín, Adán; Parajó, Alberto; Valero-Navarro, Graciela; Martínez, Marta Comas; Biondo, Sebastiano

doi:10.1001/archsurg.2012.150

Cited by 19 publications

(9 citation statements)

References 32 publications

(32 reference statements)

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“…An analysis of more than 8,500 patients in the US and UK highlights that despite the use of core interventions such as antibiotic administration and glycemic control, SSI reduction bundles are highly variable between institutions [9]. Furthermore, studies on singular interventions frequently fail to demonstrate any significant decline in SSI rates [33–35]. …”

Section: Discussionmentioning

confidence: 99%

Surgical site infection reduction bundle in patients with gynecologic cancer undergoing colon surgery

Schiavone

Moukarzel

Leong

et al. 2017

Gynecologic Oncology

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Objective Surgical site infections (SSIs) can lead to substantial morbidity, prolonged hospitalization, increased costs, and death in patients undergoing colorectal procedures. We sought to investigate the effect of using an SSI reduction bundle on the rate of SSIs in gynecologic cancer patients undergoing colon surgery. Methods We identified all gynecologic cancer patients who underwent colon resection at our institution from 2014–2016, during which time a service-wide SSI reduction bundle was introduced. The intervention included preoperative oral antibiotics with optional mechanical bowel preparation, skin preparation with antibacterial solution, and the use of a separate surgical closing tray. SSI rates were assessed within 30 days post-surgery. Results Of 233 identified patients, 115 had undergone colon surgery prior to (PRE) and 118 after (POST) the implementation of the intervention. A low anterior resection was the most common colon surgery in both cohorts. The incidence of SSI within 30 days of surgery was 43/115 (37%) in the PRE and 14/118 (12%) in the POST cohorts (p≤0.001). Wound dehiscence was noted in 30/115 (26%) and 2/118 (2%) patients, respectively (p≤0.001). In patients whose operation took longer than 360 minutes, 30-day SSI rates were 37% (28/76) and 12% (8/67), respectively (p≤0.001). In patients with an estimated blood loss >500 cc, SSI rates were 44% (27/62) and 15% (10/67), respectively (p≤0.001). Conclusions The implementation of an SSI reduction bundle was associated with a significant reduction in 30-day SSIs in these patients. The intervention remained effective in patients undergoing longer operations and in those with increased blood loss.

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Section: Discussionmentioning

confidence: 99%

Surgical site infection reduction bundle in patients with gynecologic cancer undergoing colon surgery

Schiavone

Moukarzel

Leong

et al. 2017

Gynecologic Oncology

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“…In some hospitals it is routine to rescrub before closure, whereas other surgeons only renew gloves, or do not change at all before wound closure. One study investigated the difference between changing gloves, covering the used drapes with clean drapes and using a new set before closing the abdomen compared with completely rescrubbing, changing drapes and sets. The results suggested that taking more drastic measures is not always better: the rate of SSI was significantly higher when surgeons rescrubbed, new drapes were used and a new set was opened before wound closure.…”

Section: Perioperative Measuresmentioning

confidence: 99%

Alternatives to antibiotics for prevention of surgical infection

Ploegmakers

Damink

Breukink

2017

British Journal of Surgery

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Background: Surgical-site infection (SSI) is still the second most common healthcare-associated infection, after respiratory tract infection. SSIs are associated with higher morbidity and mortality rates, and result in enormous healthcare costs. In the past decade, several guidelines have been developed that aim to reduce the incidence of SSI. Unfortunately, there is no consensus amongst the guidelines, and some are already outdated. This review discusses the recent literature regarding alternatives to antibiotics for prevention of SSI.Methods: A literature search of PubMed/MEDLINE was performed to retrieve data on the prevention of SSI. The focus was on literature published in the past decade.

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“…We could not find any RCTs in digestive surgery concerning changing gloves during surgery. Although we found an observational study with low quality evidence for changing gloves, there were no significant effects (182) . Moreover, we could not find any RCTs or OBSs in digestive surgery concerning repeated hand washing for preventing SSI.…”

Section: Rationalementioning

confidence: 62%

The Japan Society for Surgical Infection: guidelines for the prevention, detection, and management of gastroenterological surgical site infection, 2018

Ohge

Mayumi

Haji³

et al. 2020

Surg Today

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Background The guidelines for the prevention, detection, and management of gastroenterological surgical site infections (SSIs) were published in Japanese by the Japan Society for Surgical Infection in 2018. This is a summary of these guidelines for medical professionals worldwide. Methods We conducted a systematic review and comprehensive evaluation of the evidence for diagnosis and treatment of gastroenterological SSIs, based on the concepts of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The strength of recommendations was graded and voted using the Delphi method and the nominal group technique. Modifications were made to the guidelines in response to feedback from the general public and relevant medical societies. Results There were 44 questions prepared in seven subject areas, for which 51 recommendations were made. The seven subject areas were: definition and etiology, diagnosis, preoperative management, prophylactic antibiotics, intraoperative management, perioperative management, and wound management. According to the GRADE system, we evaluated the body of evidence for each clinical question. Based on the results of the meta-analysis, recommendations were graded using the Delphi method to generate useful information. The final version of the recommendations was published in 2018, in Japanese. Conclusions The Japanese Guidelines for the prevention, detection, and management of gastroenterological SSI were published in 2018 to provide useful information for clinicians and improve the clinical outcome of patients.

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Influence of Rescrubbing Before Laparotomy Closure on Abdominal Wound Infection After Colorectal Cancer Surgery

Abstract: To test the hypothesis that strict asepsis in closing wounds following laparotomy reduces the risk for surgical wound infection in elective colorectal cancer surgery.

Cited by 19 publications

References 32 publications

Surgical site infection reduction bundle in patients with gynecologic cancer undergoing colon surgery

Surgical site infection reduction bundle in patients with gynecologic cancer undergoing colon surgery

Alternatives to antibiotics for prevention of surgical infection

The Japan Society for Surgical Infection: guidelines for the prevention, detection, and management of gastroenterological surgical site infection, 2018

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