Heather Young

Local antibiotic therapy strategies in orthopaedic trauma: Practical tips and tricks and review of the literature

The use of local antibiotics for the prevention of infection in the setting of open fractures and as part of the treatment of osteomyelitis is well established. Antibiotics are most commonly incorporated into polymethylmethacrylate (PMMA) cement, which can then be formed into beads, moulded to fit a bone defect or used to coat a guide wire or IM nail. Newer delivery vehicles and techniques are being evaluated to improve upon these methods. Many factors influence how local antibiotics are applied. Treatment strategies are challenging to standardise due to the variability of clinical presentations. The presence of hardware, upper versus lower extremity, healed versus non-healed fracture and quality of soft tissues overlying the affected bone, as well as patients comorbidities all need to be considered. Despite the accepted use of local antibiotic therapy in orthopaedic trauma, high-quality evidence regarding the use of local antibiotics is lacking. Indications, techniques, dosages, types of antibiotics, elution properties and pharmacokinetics are poorly defined in the clinical setting. The purpose of our manuscript is to review current strategies and provide practical tips for local application of antibiotics in orthopaedic trauma. We focus on delivery vehicles, types of antibiotics, dosage recommendations when mixed with PMMA and indications.

Surgical Site Infection after Colon Surgery: National Healthcare Safety Network Risk Factors and Modeled Rates Compared with Published Risk Factors and Rates

p d The Inpatient Prospective Payment System stipulates that hospitals must report rates of colon surgical site infection (SSI) to the National Healthcare Safety Network (NHSN) beginning in 2012, and colon SSI rates will be linked to reimbursement beginning in 2014. For the last decade, the se of pay-for-performance has been promoted in the belief hat economic incentives and penalties can accelerate imrovements in the quality and outcomes of care. Without n appropriate risk-stratification model, surgeons and hositals would be penalized for performing operations on atients at higher risk for SSI developing, including those ith more severe surgical disease or comorbid conditions. herefore, pay-for-performance can result in unintended utcomes, such as the exclusion of severely ill patients from are. NHSN used logistic regression to develop procedurespecific risk-adjustment models; this replaces the older National Nosocomial Infection Surveillance risk index system. This new tool is based largely on nonmodifiable patient and procedure factors and predicts the expected rate of SSI after various surgical procedures. The procedures and variables included in the model-building process were voluntarily reported from 2006 to 2008 in emergent, urgent, and elective settings. Formal assessment of data accuracy was not performed. Eight risk factors were found

Evidence of nosocomial transmission of human rhinovirus in a neonatal intensive care unit

n n Nosocomial respiratory infections cause significant morbidity and mortality, especially among the extremely susceptible neonatal population. Human rhinovirus C is a common viral respiratory illness that causes significant complications in children <2 years old. We describe a nosocomial outbreak of human rhinovirus C in a level II-III neonatal intensive care unit in an urban public safety net hospital.n n

Statewide Collaboration to Evaluate the Effects of Blood Loss and Transfusion on Surgical Site Infection after Hysterectomy

We used mandatory public reporting as an impetus to perform a statewide study to define risk factors for surgical site infection. Among women who underwent abdominal hysterectomy, blood transfusion was a significant risk factor for surgical site infection in patients who experienced blood loss of less than 500 mL.

Time-Saving Impact of an Algorithm to Identify Potential Surgical Site Infections

OBJECTIVEnTo develop and validate a partially automated algorithm to identify surgical site infections (SSIs) using commonly available electronic data to reduce manual chart review.nnnDESIGNnRetrospective cohort study of patients undergoing specific surgical procedures over a 4-year period from 2007 through 2010 (algorithm development cohort) or over a 3-month period from January 2011 through March 2011 (algorithm validation cohort).nnnSETTINGnA single academic safety-net hospital in a major metropolitan area.nnnPATIENTSnPatients undergoing at least 1 included surgical procedure during the study period.nnnMETHODSnProcedures were identified in the National Healthcare Safety Network; SSIs were identified by manual chart review. Commonly available electronic data, including microbiologic, laboratory, and administrative data, were identified via a clinical data warehouse. Algorithms using combinations of these electronic variables were constructed and assessed for their ability to identify SSIs and reduce chart review.nnnRESULTSnThe most efficient algorithm identified in the development cohort combined microbiologic data with postoperative procedure and diagnosis codes. This algorithm resulted in 100% sensitivity and 85% specificity. Time savings from the algorithm was almost 600 person-hours of chart review. The algorithm demonstrated similar sensitivity on application to the validation cohort.nnnCONCLUSIONSnA partially automated algorithm to identify potential SSIs was highly sensitive and dramatically reduced the amount of manual chart review required of infection control personnel during SSI surveillance.

The Effect of Preoperative Skin Preparation Products on Surgical Site Infection

Skin preparation products contribute to surgical site infection (SSI) prevention. In a case-control study, diabetes was associated with increased SSI (adjusted odds ratio [OR], 5.74 [95% confidence interval (CI), 1.22-27.0]), while the use of chlorhexidine gluconate (CHG) plus isopropyl alcohol versus CHG alone was found to be protective (adjusted OR, 2.64 [95% CI, 1.12-6.20]).

Clinical Reasoning of Infectious Diseases Physicians Behind the Use or Nonuse of Transesophageal Echocardiography in Staphylococcus aureus Bacteremia

In this prospective cohort with Staphylococcus aureus bacteremia, transesophageal echocardiography (TEE) was performed in 24% of cases. Consulting Infectious Diseases physicians most frequently cited low suspicion for endocarditis due to rapid clearance of blood cultures and the presence of a secondary focus requiring an extended treatment duration as reasons for foregoing TEE.

Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship—Observational Studies

Observational studies compare outcomes among subjects with and without an exposure of interest, without intervention from study investigators. Observational studies can be designed as a prospective or retrospective cohort study or as a case-control study. In healthcare epidemiology, these observational studies often take advantage of existing healthcare databases, making them more cost-effective than clinical trials and allowing analyses of rare outcomes. This paper addresses the importance of selecting a well-defined study population, highlights key considerations for study design, and offers potential solutions including biostatistical tools that are applicable to observational study designs. Infect Control Hosp Epidemiol 2016;1-6.

An Evaluation of Surgical Site Infection Surveillance Methods for Colon Surgery and Hysterectomy in Colorado Hospitals

Surgical site infection (SSI) surveillance techniques for colon surgery and hysterectomy among Colorado infection preventionists were characterized through an online survey. Considerable variation was found in SSI surveillance practices, specifically varying use of triggers for SSI review, including laboratory values, healthcare personnel communication, and postoperative visits.

Cluster or coincidence? An unusual cause of surgical site infections in adult trauma patients

Mycoplasma hominis is a bacteria that colonizes and infects the genitourinary tract; extragenital infections are not common. Three surgical site infections because of M hominis in immunocompetent adult trauma patients were detected at our facility in a 6-month time period. We investigated this case series and hypothesize transmission based on common exposures.